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Table of Contents
Millennial Shopping Habits and What They Mean For Retail Building Owners
What’s Next for Foreign Investment?
Private debt is the latest “soup du jour” for yield starved investors
Repurposing Old Real Estate
PErspective in Healthcare Real Estate
Millennial Shopping Habits and What They Mean For Retail Building Owners By Stuart Eisenberg, Assurance Partner
Millennials – those born roughly between 1980 and 2000 – are changing the face of retail.
They have a combined purchasing power of $2.45 trillion worldwide – $600 billion in the U.S. – and they account for almost a third of all retail sales.
Their influence is only going to grow – by 2025, they will comprise 75 percent of the workforce.
Millennials are now major consumers, but they differ from previous generations in the following ways:
Millennials know what they want.
Thrifty: Having come of age during the Great Recession, many are either underemployed or unemployed, and many have crippling student debts. They are keen bargain hunters and big users of discounts and coupons.
“NOwners”: Prizing experience over ownership, they love shopping, but see it as a form of entertainment and are often inclined to browse, but not buy. Smart retailers are turning this to their advantage and offering shoppers a fun experience. For example, H&M’s store in midtown Manhattan has a runway shoppers can walk down wearing their new clothes – they are filmed and the best videos are displayed on storefront screens.
Tech-savvy: Millennials are glued to their mobile devices and have a strong preference for brands that offer seamless integration between online and offline sales. Technology also enables retailers to engage shoppers with discounts and special offers.
Impatient: With all the world’s stores at their fingertips, millennials do not like to stand in line or wait for purchases to be delivered. This desire for instant gratification was behind an uptick in so-called click-and-collect purchases during the UK’s holiday shopping period – customers make purchases online and receive a discount when they pick up their purchase at a designated store. Some see retail stores eventually becoming more like distribution hubs, with qualified experts on hand to offer advice.
Multichannel shoppers: Millennials do more shopping online than other generations, but they also still like going to the mall. According to OpinionLab, 37 percent of millennials prefer mall shopping while only 27 percent would rather shop online. They use their phones to browse and compare prices online, but online purchases can take too long to deliver and they do still enjoy the instant gratification of purchasing in-store.
The OpinionLab survey is good news for brick-and-mortar retailers, provided they have a strong and easy-to-use website, and attractive store interiors.
In order to attract them as customers and tenants, retail building owners should consider the following options:
This article first appeared in
Interiors: Renovate and retrofit interiors to make them bright, attractive, aesthetically pleasing places to be. Install power points / charging stations in common areas, with comfortable seating and WiFi, so mall shoppers can recharge their mobile devices on the go. Rotate signage frequently to keep the center looking fresh, and include self-service kiosks to reduce line waiting times.
Tenant mix: Have a wide variety of tenants including fitness and entertainment providers so that shoppers can also work out, relax and socialize. Include value-oriented retailers such as dollar stores, thrift stores, and drug stores. Pet stores are also a draw for millennials, who have tended to put off marriage and children, but do have a fondness for pets and pet accessories.
Co-locate: Millennials like to live in dense, mixed use, walkable urban neighborhoods close to offices, shops and entertainment. Malls in downtown neighborhoods that offer a range of shopping and entertainment options will be a sure draw for the millennial customer.
PopUps. Once an oddity, PopUp stores are becoming more common. Short-term leases – often lasting just a couple of weeks – are a way to increase mall occupancy, provide new and online stores with a temporary storefront to increase their brand awareness, and provide shoppers with a new and different experience each time they visit. Real Estate Weekly.
Stuart Eisenberg is a Partner and National Real Estate Industry Practice Leader at BDO USA, LLP. He can be reached at 212-885-8431.
What’s Next for Foreign Investment? By Anthony La Malfa, Assurance Partner
As a whole, foreign investment in U.S. commercial real estate is on the rise, totaling $45 billion in 2014, according to research firm Real Capital Analytics
. This marks the highest level of investment in the industry since 2007. Even despite low oil prices and a strong U.S. dollar that has hurt exports in other industries, foreign investment in commercial real estate is only expected to grow throughout this year as international investors continue to be attracted by the stability real estate assets offer. According to the United Realty/Zogby Real Estate Confidence Index for the fourth quarter of 2014, about 60 percent of 113 institutional real-estate professionals surveyed said they anticipate a significant increase in foreign investment.
Who Are the Leaders of the Foreign Commercial Real Estate Investment Pack?
Investments from Canada, Norway and China have been most significant, reports
World Property Journal
. While we’ve seen investment from nations across the globe, including emerging markets like Singapore and some Middle Eastern nations, these three players are currently pumping the most capital into U.S. commercial real estate and REITs. Canada was the largest buyer of U.S. real estate in 2014 with 26 percent of direct foreign investment, followed by Norway and China, with 12 percent and 10 percent, respectively.
Their dollars are primarily being allocated towards “trophy assets,” as well as “gateway” markets. For example, the Government Pension Fund of Norway, one of the largest sovereign wealth funds in the world, recently closed on its purchase of a 45 percent stake in a 40-story skyscraper at 11 Times Square in Manhattan for $401.9 million, a deal that valued the 1.1 million square foot property at $1,273 a square foot, according to reports from
The Wall Street Journal
.
Strong Demand for “Safe” Investments
Despite a stronger dollar, foreign investors are not shying away from U.S. commercial real estate as they continue to have an appetite for these hard assets thanks to low interest rates and strengthening property fundamentals. Foreign investors are attracted to the safety U.S. properties afford, especially when they might be experiencing financial distress in their own countries coupled with a weakening of currency.
Especially appealing to foreign investors are traditional “gateway” markets, like New York, Washington, Southern California, and Southern Florida. “Trophy assets” in these markets often come with consistent rent rolls and predictable streams of net cash flow. They are also considered more secure because the market is large, relatively liquid, and consistent over time. From a liquidity perspective, assets in these markets are easier to sell, which is beneficial for the foreign investor who is typically interested in the long-term holding versus the immediate return.
Foreign investors are also demonstrating an interest in secondary U.S. markets, such as Atlanta, Seattle and San Diego. For example, Bahrain-based Investcorp acquired a portfolio of multi-family communities in the metropolitan areas of Washington, Orlando, San Diego and Baltimore for $300 million. While these markets may not always be considered as safe as gateway markets, they offer investors an alternative with potentially higher returns than the gateway markets in which availability is limited due to high demand.
Investment in Central Business Spaces Indicates Strength in Office Real Estate Market
Foreign capital acquired $17 billion in U.S. office space assets in 2014, making up 45 percent of all foreign investment in U.S. commercial real estate, and this trend could continue throughout 2015. Of these investments, most were in central business district (CBD) spaces. And New York and Boston are the leading markets for foreign office investment. Testament to this is that in January, the Canadian investment firm Ivanhoe Cambridge bought the office building 3 Bryant Park from Blackstone for $2.2 billion
.
As in 2014, the first quarter of 2015 experienced year-over-year increases in both net absorption and rental rates for CBD office space, although the increases were somewhat subdued. The slower increases were partially due to seasonality and, with respect to absorption, partially due to new available space. As companies try to cater to the growing numbers of millennials in the workforce, the lack of demand for suburban office space has contributed to the strong performance of CBD office space. Therefore, it is noteworthy that the end of 2014 saw an uptick in foreign investment in suburban office space as well, indicating interest in office properties across the board, despite the trend toward centralized business space.
Foreign Investors Getting in On Ground-Floor Of Major Development Projects
The development landscapes of primary markets in the U.S. have long been dominated by local players, such as private-equity funds or pension funds. Wealthy foreign investors, including sovereign funds looking to shift funds away from oil markets, are now outbidding these traditional players, according to
The Wall Street Journal
.
They’re drawn by the potential for higher investment returns compared to an existing property and are less risk-averse than traditional players. While established, fully leased commercial real estate properties are safe investments and appealing, many foreign investors are enticed by potential for higher returns. There has been an onslaught of major towers in large metropolitan markets like Boston, New York and Washington, D.C., funded by newcomer foreign backers.
Foreign Investment Helps Pave Way For Brighter Industry Outlook
As international capital flows into domestic real estate markets, there could be investment across the board in domestic markets large and small. According to CoStar, the cross-border flow of investment dollars into U.S. commercial real estate appears to be gaining strength this year as foreign investors cast a wider net to cover markets outside the core gateway cities. Couple the influx of foreign investment across markets with a strengthening economy, and the future for commercial real estate looks bright.
This article first appeared in
Commercial Property Executive.
Anthony La Malfa is a senior director in the Real Estate Industry practice in BDO's New York office. He can be reached at 212-885-8140.
Private debt is the latest “soup du jour” for yield starved investors By Reza Khan, Senior Manager
Strong Tailwinds Push a Significant Tide of Capital Through The U.S. Real Estate Industry
This influx has been put to work as one can see building cranes in most gateway cities. While this is creating buoyancy in the market, the challenge is to find financing. As banks have been rigorous with their underwriting process due to regulatory constraints, the volume of loans from conventional sources has diminished. Investment managers and other investors have recognized this gap and have entered into the financing foray in order to fill the void and capitalize on the next opportunistic play. Competition in the commercial real estate debt market is quickly rising to pre-crisis levels and it is like shooting fish in a barrel.
The use of debt is an essential element of any capital stack. It is highly favored by borrowers because:
Lenders have no claim to equity and therefore there is no dilution of equity.
Financing is less complicated than raising equity, primarily around regulatory and legal compliance.
The lender has no claim to profits.
It amplifies the return on investment.
Private debt has attracted significant investor capital in recent years. In 2014, a total of 26 global debt funds raised $20 billion, which is up from the 29 funds that raised $16 billion in 2013
1
. The catalyst for this movement can be attributed to: 1) Regulatory developments have restricted the flow of debt from traditional sources; and 2) Between 2015 and 2019, approximately $1.5 trillion
2
of commercial real estate debt is due. The loans maturing in this period amount to 2.5 times more than the 10-year balloons that matured between 2012 to 2014.
Debt investments operate much like fixed income product with returns that are very close to equity yields, making debt funds very attractive on a risk-adjusted basis. Through creative deal structuring, some funds are able to generate low double-digit returns by taking a loan and selling off pieces. Also, by re-organizing sub-performing or non-performing portfolios, managers are able to generate returns slightly above equity yields.
Returns depend on a multitude of factors such as risk, value, asset quality and the strength of the sponsor. As there are more entrants into the private debt arena, it is likely that yields will drop given the aggressiveness of competitors in finding deals to utilize capital.
The prospect of steady cash flow and the priority of the capital stack make the investment profile very attractive to investors, even with the potential drop in returns. According to a recent Preqin study gauging investor's perceptions of debt investments, 47 percent of respondents held positive views toward debt; 37 percent were of neutral opinion; and 16 percent viewed the asset class negatively.
Preqin also noted institutional investors are allocating more capital to the alternative asset class and some were establishing private debt as a new category in the alternative space. This positive outlook is fostering the growth of the asset class globally.
The buoyancy of the industry has attracted non-conventional entrants like PE funds, insurance companies, pension finds and some sovereign wealth funds (SWF). The capital provided by the new sources is hunting for yields in a low interest rate environment. Based on another Preqin survey of private debt investors, direct lending (62 percent) is the most attractive investment option, closely followed by special situation positions (50 percent), with distressed and mezzanine (approximately 30 percent lending) rounding out the major areas of focus by all participants.
PE funds are looking to capitalize on the latest “opportunistic” play, and debt funds present the latest avenue to achieve at least low double-digit returns. As banks have pulled back on lending activities, bankers have relocated to investment management firms to continue their activity.
An investment manager notes insurance companies have a significant amount of capital and are not hobbled by allocation constraints. Insurance companies do care about interest rate risk but are more focused on performance to maturity. AXA established a $1.8 billion debt fund in 2014. Met Life registered with the SEC to offer a debt fund. It is likely other major insurance companies will follow.
In the past, SWFs focused on trophy assets around the world. That sentiment has changed and SWFs are now searching for yields fueling investments with enormous sums of capital.
Government agencies have a limited amount of funds to lend – approximately $60 billion in 2015. That amount is being transacted at a very quick pace and the year is not over. Industry veterans indicate the non-conventional participants will seek to fill the void. With ensuing competition, it is essential lenders remain disciplined with their underwriting process in order to avoid a repeat of the last cycle.
Another area of the lending industry that has gotten a second wind is commercial mortgage backed securities (CMBS). After coming to a grinding halt in 2009, CMBS is making a slow and steady return. Banks that closed down these units are reviving them to get in on the action. In 2014, there were $94 billion of transactions compared to $86 billion in 2013. Year to date, there have been about $35 billion, compared to $21 billion in 2014 for the same period.
With delinquencies at an all-time low, many borrowers are using this market segment to obtain debt. A New York-based mortgage broker cites securitization as a way to address the “lumpiness” of real estate transactions. It is easier and more efficient to work with an investment banking team than to pull together a consortium of banks to fund large financings. This indicates that single asset owners also are venturing down the CMBS path as CMBS were typically associated with portfolio deals.
Evidence indicates there is vibrant lending market filled with conventional sources and new entrants. Some are a bit cautious that this boom in real estate debt will turn into a game of musical chairs that will undoubtedly leave some parties holding non-performing or underwater properties. However, many in the industry argue the market dynamics are different from the 2006 to 2009 period. In the last cycle, debt was replacing equity which was a toxic formula when values declined.
Competition in the lending market will continue to grow given the demand for financing, and lenders will become more aggressive in order to win the best deals. However, many feel the underwriting process will not be compromised as in the last cycle. Lesson learned? Or will the hunt for high double-digit returns overshadow discipline? Only time will tell.
1 Preqin
2 Trepp Analytics
Reza Khan is a Senior Manager at BDO USA, LLP. He can be reached at 212-885-8503 or rkhan@bdo.com.
Repurposing Old Real Estate
By John Tax, Assurance Director
Nowadays, everything is being repurposed or recycled – from ordinary household items such as paper, glass and metal, to real estate – without regard to whether it is commercial, residential, retail or industrial real estate. The concept of repurposing is not a new one, but rather one that has taken on a new life amid the rush to go green. Owners, developers and re-developers have taken this concept to heart by reusing everything from office buildings to hospitals to auto dealerships.
There are a number of considerations when a building owner or a developer decides to reuse an existing structure. Some of these considerations are:
Cost – Taking an existing structure and reconfiguring it for a new use is often less expensive than building a completely new asset, especially when you consider the costs of demolition and the cost of new construction.
Use – When an existing structure goes dark, a new use for the asset could be just the ticket to returning the asset to profitability. In recent years, dark spaces in shopping centers, big-box stores, office buildings and auto dealerships have been repurposed into artists’ spaces in Missouri, a YMCA in Texas, business school classrooms in Pennsylvania and a grocery store in Michigan, respectively.
Need – Commercial real estate can be repurposed to fill a need in a community. Building owners must have a good understanding of the market and be ready to convert the asset to a new use quickly to capitalize on these needs.
Location – The new use should be complementary to the existing area. For example, converting an existing big-box store to a gym or taking a commercial property and creating a school might be a great idea in an area with numerous multi-family residential properties.
Repurposing is definitely not without a downside and there are often difficulties faced by building owners when attempting to reuse a property. These risks could include:
Structure – Converting a building from one use to another requires an understanding of the physical requirements of the new concept. Technology is rapidly changing and an existing structure may not be suited for the new use. Technology-heavy tenants, including medical facilities, call centers and Internet companies require significant supporting infrastructure, cabling and cooling units. These items may not have been originally contemplated in the existing structure.
Use – Sometimes the new use for the property may seem like an easy conversion, but all factors must be considered or the unforeseen could occur. In a recent RealtorMag article, "Repurposing the Right Way," Meg White discusses one developer's project to convert an old mill house into a restaurant. The owner installed central air conditioning for the first time and shortly thereafter the property was infested with worms. It turned out that the humidity created by the air conditioning caused the worms to migrate out of the old beams.
Zoning – Changing the use of a structure will necessitate a change in zoning. This will require working with the local government and zoning commission to effect the necessary change. This can be a time-consuming process which could ultimately delay or even stop the project if the appropriate zoning approval cannot be attained.
Americans with Disabilities Act (ADA) Compliance – Older structures often are not ADA-compliant and upgrading an existing structure could be expensive. Reconfiguring entranceways, bathrooms and hallways for ADA compliance can be time-consuming and sometimes cost-prohibitive.
Parking and Traffic – Changing the need for parking and changes in traffic flow around the building could be problematic. If the building’s new use causes an increased need for parking, that must be taken into consideration. Other area residents could be against an increase in traffic and protest the new use.
Marketing – Changing the use of an existing building requires a keen marketing program to change the public’s perception of the building, especially when considering a new use for a historic building.
Repurposing a property requires commitment and creativity. Different stakeholders such as the owner, the developer, the local government and the community must work together toward a common goal. Any adaptive use requires vision, a detailed understanding of the local market and the marketing expertise to find a different category of tenant. The considerations and hazards listed above are just a few. There are numerous other considerations and difficulties that are market-specific which can arise. However, by working together, carefully weighing all necessary decisions and responding to issues as they arise, everyone can win in the end.
John Tax ia a Director in the Real Estate Department at BDO USA, LLP. He can be reached at 212-885-8027 or jtax@bdo.com.
PErspective in Healthcare Real Estate
While the number of senior housing real estate deals continues to rise, deal sizes seem to be on the wane
. In 2011, the 312 senior housing and care deals totaled $27.6 billion in transaction volume, according to data from the National Investment Center for Seniors Housing and Care (NIC). By comparison, from the second quarter of 2014 to the first quarter of 2015, there were 609 deals totaling $19.9 billion, according to NIC data
.
Healthcare property investors – real estate investment trusts (REITs) and private equity firms – are especially attracted to the senior housing sector because of its market fundamentals. Aging demographics mean growing demand, and since most facilities are private-pay, they are less susceptible to government funding decisions than other healthcare properties such as hospitals and skilled nursing facilities.
Some larger REITs have been concentrating their portfolios on the senior housing sector
to limit their exposure to government reimbursement issues. Healthcare REIT Ventas announced in April
it would spin off most of its skilled nursing facility portfolio into an independently traded REIT. Meanwhile, Health Care REIT raised $750 million
through a benchmark offering of senior unsecured notes to fund, among other things, investments in healthcare and senior housing products.
However, since large portfolio deals in the senior housing sector have been harder to come by recently, some large REITs are downsizing to move the needle with smaller portfolio and single-asset acquisitions – and some industry insiders predict more REIT spinoffs could be on the horizon. These spinoffs make attractive targets for PE firms. For example, a number of PE firms are currently bidding for an operating company spun out of a recent merger
between Ventas and hospital provider Ardent Health Services. The sale of the company could fetch upward of $500 million
.
Analysts have predicted that senior housing will go from a niche sector to a mainstream asset class during the next 15 years as the population ages. The sector is highly fragmented, meaning there are plenty of opportunities for consolidation as smaller providers look to achieve economies of scale.
Distressed deals present additional opportunities. Bankruptcies – as a result of market forces and healthcare reform – are on the rise in the senior housing sector. Mid-sized providers are looking to grow by acquisition
after a period where they were priced out of such deals. Although far from straightforward, a successful makeover of a distressed senior housing property can make it an attractive target for REITs
and PE firms further down the line.
Big portfolio deals may be down, but there are still plenty of investment opportunities in the senior housing sector as large players spin off businesses and small players look to consolidate.
For more information on BDO USA's service offerings to this industry, please contact one of the following practice leaders: | 26,113 | 10,683 | 0.000095 |
warc | 201704 | This guide walks you through every step in writing an awesome cover letter - from staring at the blinking cursor on a blank Word document to jumping out of your chair when you find out you got the interview!
All I ask is this one small favor: Don't read each step. Do each step.
In other words, don't think of this like your typical self-help article where you read through everything front to end, think to yourself, "Wow, what a good idea," and then click on the next link, never having accomplished anything.
Instead, after you look through a step, go out and do it. No single step will take more than 30 minutes. And then, when you get to the end, you'll have an amazing cover letter. Not just some vague idea of how to write one. Promise.
1) Do You Need a Cover Letter?
Before you write a single word though, find out whether you even need a cover letter at all.
Seriously.
While a great cover letter in the right situation can be the difference between getting an interview or not, the best cover letter in the wrong situation isn't worth the words you put on paper.
There are two times when you don't need a cover letter:
Cover letters aren't accepted. Cover letters won't actually be read. 1) Cover letters aren't accepted.
First of all, find out how you're expected to submit your application - email, web form, carrier pigeon, etc. If you need to submit your application online, check out what the submission form looks like ahead of time. If there's no space to submit a cover letter - great, you're done! The company is telling you cover letters aren't valued - so no need to write one.
Unfortunately, it's not always that clear…
2) Cover letters won't actually be read.
Many companies that don't value cover letters won't come out and tell you that. Often, if you're expected to email your application, the instructions may say something like: "Send your resume to recruiting@acme.com" - with no mention of cover letters one way or another.
While it's tempting, in these situations, just to submit a cover letter anyway, my philosophy is that the only cover letter worth submitting is a great one. And great cover letters take time. Thus, it's worth your while to find out beforehand whether companies actually want cover letters. That way, you don't waste time on an amazing cover letter that never gets read.
How do you find this out?
Believe it or not, the best way is to ask. If you know someone at the company, by all means have them ask for you. If not, don't hesitate to write to a recruiter or hiring manager directly. It's in their interest to get the best applications so, if you ask nicely, you're likely to get a response. Here's how to do it:
Dear Ms. Smith, I'm interested in applying for the Sales VP role at Acme Inc. Before I do, I'd like to be certain that I prepare the materials that will best help you make your hiring decision. As such, would you like me to furnish a cover letter along with my resume? Thank you for any information you can share! All the best,Jane Doe
If you don't hear back and you're truly passionate about the job, the best advice is to still submit a cover letter. That way, no matter the company's policy, you'll be covered.
But by doing a little research ahead of time, you can often save lots of time down the road!
2) Who's Your Audience?
OK, so you've discovered that you have to submit a cover letter. And you're raring to get started. But, like any great writer, you first have to know
whom you're writing for. So here are three important points about your audience: It could be a recruiter (i.e, someone whose job is finding great candidates but who wouldn't have much contact with you, once you're hired) or a hiring manager (i.e., someone whose main job isn't finding candidates but who would be your boss or teammate, once hired). In many companies, it will be both. But the nice thing about cover letters is that it doesn't really matter. Because each will be facing the same situation... Picture this scene: It's 6 PM on a Friday evening. The office is empty - except for one glowing cube. Here, the lonely recruiter or hiring manager sits, toiling away in search of the perfect candidate. In front of him or her is anywhere from 50-500 cover letters and resumes. Suddenly, the weekend seems very far away... As grim as this story sounds, it's the reality for many roles. And it's the reason why your cover letter has to be awesome: it simply needs to stand out! Now imagine this: It's two weeks later and interviews are starting for the job. In comes a candidate who doesn't seem qualified at all. How does the cover letter reader feel? Humiliated. And what do they do about? Next time, they only offer interviews to the candidates with the best, most obvious qualifications.
The key takeaway here is that
cover letter readers are both in a hurry but also cautious in picking candidates to interview. So start to put yourself in their shoes as you begin to write. Think, "How can I both catch their attention but also convince them I'm a safe bet?" Given that 90% of your competition will inevitably submit generic cover letters and/or fail to demonstrate substantial qualifications, recognizing this single insight will already put you in elite company. 3) Why Write a Cover Letter?
One last question to ponder before we start writing:
What's the point of the cover letter anyway?
Especially given all the applications recruiters and hiring managers have to get through, why would they ever ask for more material? After all, every cover letter they receive doubles the amount of reading they have to do per candidate (compared to just looking at resumes).
The answer actually has everything to do with that crippling workload. Because as painful as reading hundreds of cover letters is, doing hundreds of interviews is worse. And yet, without the cover letter, that's exactly what recruiters would have to do!
It all starts with the resume.
You see, resumes are a great idea in theory. They take really different, hard-to-compare candidates and they boil them down to one-page summaries that can be contrasted, side-by-side. This makes the recruiter's life easier initially. But the dark side of resumes is that, because they're so short and regimented, it's hard to really get a feel for each unique candidate. Plus, candidates can create one resume for 1,000 different jobs, so a recruiter has no idea how committed the candidate is to his/her particular company. As a result, resumes and candidates all begin to seem the same after a while - necessitating lots of interviews to sort candidates apart.
But what if there was a companion to the resume? A similarly short document but one that actually helped to distinguish good candidates from bad ones, committed job-seekers from those who couldn’t care less?
Enter the cover letter.
The cover letter has three important advantages over resumes:
It can give recruiters a better feel for the real candidate.Instead of hiding beyond bullet points, candidates can fully express themselves and show off their personalities. It can signal how passionate a candidate is about the job.Because good cover letters must be personalized to the company and role, it's impossible to put together good cover letters for thousands of jobs like you can with a single resume. It can separate the wheat from the chaff.Since each cover letter will be relatively unique, it's easier to choose between applicants than with resumes - where each applicant seems similar.
So now you know why many recruiters require cover letters. And instead of seeing the cover letter as yet another hassle that must be endured, you can start to see it as an opportunity. A chance to stand out, show off your personality and passion, and get ahead of candidates with similar resumes.
4) Choose a Format
At this point, you've laid all the groundwork for a successful cover letter:
You've determined that you actually need to write one. You understand whom you're writing for. You know why you're writing.
So let's get down to it, starting with selecting a format.
This can be one of the most fun steps in the cover letter development process - but don't overthink it! Unless you're applying for a design job (in which case the format represents your sense of style), your words still trump your design.
Open up Word (or your word processor of choice) and you'll likely be confronted with a variety of templates - including a handful of cover letters. Choose the template that best matches your desired company's style - Modern for a quirky startup, Traditional for a 100 year-old law firm.
If you don't have access to templates though, no worries! We'll walk through the entire process of designing your own in the following steps.
5) Enter Your Address
Believe it or not, many cover letters go awry at the very top. The reason for this is that cover letter-writers list an address that gets them disqualified right off the bat.
Specifically, they do one of two things:
They list an out-of-town address.For some companies, this is a deal-breaker. They just don't want to bother with flying candidates in from elsewhere. But if you're prepared to fly in yourself, then don't let them rule you out! If you're getting ready to move to a city, list your future address (even if it's just a friend's place where you plan to crash). And if you don't have a place but would be willing to move, then don't list any mailing address at all. Why give them an excuse to kick you out of the process if you're willing to do what it takes to stay in? They list an inappropriate email address.Have you been checking your messages at sexymama85@yahoo.com since high school? Then guess what? It's time for a new address! Either use an alumni address (e.g., jdoe@alum.ucla.edu) or a professional-sounding personal address (e.g., jane.doe@gmail.com) - and be sure to check it regularly. Stay away from work email since you don't want your current boss seeing your correspondence with your future boss!
In addition to avoiding these deadly cover letter sins, write your name and contact info in the upper right-hand corner of the page, just like this:
Note that centering this information and putting the mailing address and email/phone details on single lines will allow you to save a few lines. And remember, every line counts - your cover letter is being read to next to hundreds of others, so you can't afford to waste the reader's limited attention.
6) Select a Recipient
Do you prefer receiving junk mail sent to everyone or personal letters meant only for you? Well, people who review cover letters feel the same way - they're much happier to get a personalized cover letter that speaks to them specifically than a generic letter that could go to any company. And one of the ways you deliver personalization is by choosing a person to send it to!
I know this sounds crazy, but most cover letters aren't really directed to anyone in particular. Instead, they're designed to be as generic as possible. Have you ever thought to yourself, "I need to send a bunch of cover letters so I'll write a general one and then use Find/Replace to change the company's name?" If so, the result has likely started "Dear Sir or Madam..."
Unfortunately, nothing says you couldn’t care less than not listing an actual name. This is especially true when the job listing has a name attached to it. But it's even true when no name is listed. That's because someone always reads the letter - and finding their name's not that hard.
Here's how to do it:
Ask a friend.If you know someone who's working at the company, ask them to find the Recruiter or Hiring Manager for the role. Find it online.Do a Google search for the name of the company + the team + "manager." For instance, if you're applying for a job with the Global Accounting group at Granger, search Granger Global Accounting manager. Chances are you'll find a LinkedIn result or another similar page. Note, this is better than searching on LinkedIn directly, since you often won't be able to see the manager's name unless they're in your network. Ask the company.Send an email to the firm's general address (usually info@domain.com) or call the main line. Just tell them that you're looking to get in touch with someone on the team that's hiring and want to see who's in charge.
If you still can't find a name, you can always fall back on Dear Hiring Manager, which at least sounds more specific!
Also, unless you're applying to a very traditional firm, don't bother listing the company's address. It just wastes a lot of space on the page and you really don't want to go beyond a single page - again, out of the respect for the reader's time and limited attention. Chances are, any company that would ding you for not reminding them of their own address, is one that you wouldn't want to work for anyway!
Thus, including today's date, your cover letter should now look like the following:
Note that you should address the recipient formally, even at less traditional firms. It's just a professional courtesy and no one will ever judge you negatively for doing so. The only exception is if you know the recipient personally, in which case you can address as them you normally do.
7) Get Their Attention
There are three key goals of any cover letter:
Get the reader's attention.As we've noted before, it's possible that they're reading your letter after hundreds of other ones. So you need to work hard to stand out. Get them to like you.People first and foremost hire people they want to work with. Your colleagues are going to spend more time with you than their families! So it's no wonder that many managers would rather hire a good, likable candidate than a great, unlikable candidate. Convince them you can do the job.As critical as likability is to the hiring process, you've got to be able to get the job done. And if you're coming from a different industry or function, it's doubly important to nail this part.
OK, but before you get to that, you've got to get their attention in the first place. If you don't catch their eye right away, they'll never appreciate any of your other points.
So how to catch a busy reader's attention? Simply put, start with something
surprising.
Most cover letters start with: “I would like to apply for the X job at Y company. Blah, blah, blah...”
While this is straightforward, it's also a recipe for getting lost in a sea of identical cover letters.
So instead, try this format: Surprising Fact -> which leads to the reason you’d like to apply.
Here are three categories of Surprising Fact openers:
1)
Early adopter of the company - I still remember the first Google search I did in 1999. Even though no one had heard of it at my school, I knew right away that this would change everything. And so when I saw the Google Product Manager role listed online, I couldn't resist the opportunity to be a part of the next product that changes everything.
2)
Story about the company making a difference in your life - I'll never forget my bright red Nike Airs. Lining up on that cold, November morning with all the best X-country runners from around the county, I was so nervous. But looking down at that "Swoosh" on my shoe, I just knew I could win. And I'm just as confident today that I can help Nike win as it moves into the Latin American market.
3)
Why the company or job excites you - I've always been an engineer at heart. Whether it was tinkering with our broken toaster as a child or helping Target fix its supply chain issues system by system, I love making things work. So, it's with great passion, that I submit my application for the Data Engineering role at Fidelity.
Note that in each of these cases, the Surprising Fact includes lots of juicy human details that the reader can sink their teeth into. Whether it's painting a vivid scene ("cold, November morning") or calling out a specific experience ("tinkering with our broken toaster"), these little details make your story come alive and get the reader to pay attention.
However, as you can see, the Surprising Fact isn't just something unique about you (being one of Google's first users) but something unique that draws a natural connection to the company (being one of Google's first users makes you a natural to help them launch new products).
That's because as soon as you've grabbed their attention, you want to start making the case about your fit with the company...
But first, here's how our sample cover letter is looking:
8) Get Them to Like You
So you have their attention - now what?
Use it to get them to like you. Because, at the end of the day,
people want to hire people they like.
Now, as we've discussed, the secret power of the cover letter is that it can illustrate your personality as well as your qualifications. The only catch is that, in your rush to show off your sterling personality, you may come off as having a terrible personality! After all, who likes a candidate who just brags about himself?
Thus, while you want them to like to you - you need to earn their appreciation carefully. Here are three methods:
Humility- Start by admitting that you're not perfect or completely unique. For example: "As passionate as I am, I realize I'm just one of millions of Disney fans out there." Culture- Specify that you're not a great fit for every company, but for this one in particular. And, if possible, draw upon a reference at the company to help give you more credibility: "But the one thing I know is that I'd fit right in with Disney's collaborative culture. After talking with Joe Smith in marketing, I'm truly excited about the possibility of working in such a team-driven environment." Testimonial- If you're going to brag, let someone else do it for you. You could draw a quote from a LinkedIn recommendation or even an old performance evaluation: "As my former manager at Warner Bros. said, I 'excel in fast-paced team settings.' So I'm confident that Disney is the right place for me."
If you can blend these different elements together smoothly, you can create a compelling portrait of yourself. One that's both a good fit for the company and eminently likable.
See another example in our sample letter:
9) Show Them What You Can Do
Now that you've hooked the reader's attention and gotten them to start liking you, you've got to seal the deal. In other words, you've got to blast away any lingering doubts about your ability to do the job. Because no matter how much they like you, they don't want to be embarrassed by bringing in someone who's unqualified.
Here, the best tactic is to systematically take down any objection they may have. You do this by going back to the words the reader loves best - the ones they wrote! Specifically, take the requirements from the job description, put them in the first column of a two-column table, and start knocking them down one by one in the second column. Not only does this make it easy for you to structure your qualifications but the unique format will catch the reader's eye - as always, a critical feat when competing against hundreds of other similar-looking applications.
Here are some examples:
There are a couple of characteristics that define a good response here:
Unique stories- It's one thing to say you have Office experience. It's another to say you've trained teammates on it. By adding a quick story to each point, you gain significant credibility and keep the reader's attention. Quantification- Another way to demonstrate skill is to attach a number to your work. Again, anyone can write ad copy. But only someone with serious qualifications will have the chance to reach two million people! Clear impact- You're being hired to move the needle, not just do stuff. So wherever possible, try to show the impact of your work. Whether it's the revenue your app generated or the positive buzz your press release caused, see if you can illustrate the outcomes you created.
Now, since this approach is so unconventional, two questions inevitably arise:
1) Isn't this the same as the resume?
While it's true that some of the points you call out in your defense may also sit on your resume, it's also likely true that application reviewers missed them. This is because the standard way to review a resume is to glance at the titles (the companies you worked for and the schools you attended) and skim over the details. There's just not enough time to look at the specific points. However, cover letters need to be read more closely since their format is less easily digestible. And thus, your awesome accomplishments are more likely to get viewed on the cover letter.
This is especially important if you're trying to change functions or industries. In these situations, reviewers won't find any familiar headlines on your resume when they do their quick scan. For example, if they're hiring for an Accountant and all your titles say Project Manager, they're likely to toss you out (remember that reviewers tend to be risk averse!). But if you're able to catch their attention with a powerful cover letter, they may actually take the time to see all the transferrable skills you've built up in Project Management (organization, detail orientation) that could serve you well as an Accountant.
2) Do I have to list all of the requirements?
Nope! In fact, it's better to just list the five key requirements that are critical to the role. This keeps the cover letter on one page (remember the importance of speed for the reviewer) and leaves you more room to describe your most important qualifications.
How to determine the key requirements? Just think about what would be essential to performing the job. In the case of the Accounting job, bookkeeping experience and expertise with QuickBooks would probably count as key. Whereas the generic requirement of being a "hard worker" isn't always worth responding to.
See how it all comes together in our sample cover letter:
10) Set the Stage for Follow-up
If you put nothing in your cover letter from this book except for one sentence,
make it this one: "I will contact you next week to discuss the possibility of an interview."
This is because, as powerful as the cover letter is at getting your candidacy noticed, being noticed isn't always enough. Not when there are so many candidates vying for just one spot.
No, the only sure-fire way to get the job is to get interviewed. And getting interviewed often requires follow-up.
Thus, let the last line of your cover letter set the stage for you to follow-up soon. This way, if you don't hear back from the company, you've got a written pledge to follow-up. And who are you to break a promise?
Here's how it looks in our sample letter:
11) Follow-up!
So you sent out your amazing cover letter? Great. But there's still one final step to land an interview:
Put a reminder on your calendar to follow-up in one week. If you don't hear back from the company within a week, send a follow-up note. It doesn't matter when the deadline for applications is - companies can and do hire at any time. So don't sit around waiting to hear back while they're busy hiring someone else! Let them know that you're still very interested in the role and that, given your perfect fit, you'd be happy to answer any questions they might have.
Ideally, you've done your homework and know who's reviewing applications, so you can send a personal note like this:
Dear Ms. Smith, As promised in my cover letter from last week, I just wanted to follow-up on my candidacy for the Sales VP role. As a veteran sales leader with a deep passion for setting and achieving bold goals, I'm confident that I can help Acme take its sales development to the next level. Thus, please don't hesitate to reach out with any questions about my candidacy. I'm happy to share any additional information that would help with your search. Thanks so much, Jane
You can also reach out to contacts at the company to advocate for you and send an additional follow-up the next week. However, between your powerful cover letter and your follow-up, you've given yourself the best shot possible at getting an interview and, ultimately, a great job.
12) Share!
Thanks so much for reading! One final note for you:
This is the same advice that made my Amazon book on cover letters a best-seller for four years in a row. But I've decided to give it away for free because life is just too short for one more wasted application, one more dream job that got away.
All I ask in return is that you pay it forward!
PS: Need a little more support? Want to get some experienced eyes on your cover letter before clicking Submit?
I've reviewed thousands of cover letters as a hiring manager at LinkedIn and startups - as well as a career coach at the University of Michigan.
And now, for the first time, I'm offering that same service to the general public as part of a new online coaching program. | 25,006 | 10,468 | 0.000096 |
warc | 201704 | There are many benefits to changing a fuel filter in your small engine. A fuel filter is designed to properly strain the gas before it reaches the carburetor in your lawn mower, snow blower or equipment.
Fuel filter replacement is important because:
It prevents foreign particles from clogging your engine Dirty fuel filters can cause your engine to run too lean, leading to diminished performance and uneven operation Clean filters conserve the amount of gas you need | 472 | 295 | 0.003419 |
warc | 201704 | Media convergence , phenomenon involving the interconnection of information and communications technologies, computer networks, and media content. It brings together the “three C’s”—computing, communication, and content—and is a direct consequence of the digitization of media content and the popularization of the Internet. Media convergence transforms established industries, services, and work practices and enables entirely new forms of content to emerge. It erodes long-established media industry and content “silos” and increasingly uncouples content from particular devices, which in turn presents major challenges for public policy and regulation. The five major elements of media convergence—the technological, the industrial, the social, the textual, and the political—are ... (100 of 1,842 words) | 854 | 474 | 0.002233 |
warc | 201704 | Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.
Trends in Childhood Cancer Mortality --- United States, 1990--2004
Cancer is the fourth most common cause of death (after unintentional injury, homicide, and suicide) amongpersons aged 1--19 years in the United States(1,2). Because recent childhood cancer mortality has not been wellcharacterized in terms of temporal, demographic, and geographic trends(2,3), CDC analyzed cancer death rates amongchildren (defined as aged 0--14 years) and adolescents (defined as aged 15--19 years) for the period 1990--2004 by sex,age group, race, ethnicity, U.S. Census region, and primary cancer site/leading diagnosis, using the most recentdata available from the National Vital Statistics System (NVSS). This reportdescribes the results of that analysis, which indicated that, overall, age-adjusted childhood cancer death rates decreased significantly during 1990--2004among both sexes, both age groups, all races (exceptAmerican Indians/Alaska Natives [AI/ANs]), Hispanics, non-Hispanics,and all U.S. Census regions. However, decreases in death rates varied among U.S. Census regions and between Hispanicsand non-Hispanics. Eliminating racial/ethnic health disparities is one of the overarching goals ofHealthy People 2010 (4). Further research is needed to understand geographic and ethnic disparities in childhood cancer death rates.Moreover, cancer prevention and intervention measures should be designed to reach populations that are underserved and athigh risk.
NVSS collects death certificate data from vital statistics offices in the 50 states and the District ofColumbia.* All reported deaths among children and adolescents during 1990--2004 were included in this analysis.Population estimates used as denominators in death rate calculations were from the U.S. Bureau of the Census and weremodified by the Surveillance, Epidemiology, and End Results (SEER)program(1). Age-adjusted death rates and trendswere calculated for all primary cancer sites combined and for the two leading cancer diagnoses: leukemias and brain andother nervous system neoplasms.§ All rates were per1 million population and age adjusted to the 2000 U.S.standard population. For all primary cancer sites/leading diagnoses combined, death rates and trends were stratified furtherby sex, age, race, ethnicity, and U.S. Censusregion. Rates and overall annual percentage changes (APCs) from 1990to 2004 were calculated usingSEER-Stat.¶ Joinpoint regression was performed to determine statisticallysignificant changes in trends during 1990--2004(5). The overall statistical significance level wasa = 0.05, with a maximum of three joinpoints and four line segments allowed(5).
A total of 34,500 childhood cancer deaths were reported in the United States during 1990--2004. A total of2,223 cancer deaths occurred in 2004; among these, leukemias were the most common diagnoses (25.5%), followed bybrain and other nervous system neoplasms (25.0%) (Figure 1). From 1990 to 2004, death rates declined significantlyfor leukemias by 3.0% per year, for brain and other nervous system neoplasms by 1.0% per year, and for all othercancers combined by 1.3% per year (Table).
For all cancers combined during 1990--2004, boys (33.1 per million) had significantly higher death rates thangirls (26.1); adolescents (37.9) had significantly higher death rates than children (26.9); whites (30.1) and blacks (29.3)had significantly higher death rates than Asians/PacificIslanders (A/PIs) (26.4) and AI/ANs (20.0), respectively;and Hispanics (30.3) had significantly higher death rates than non-Hispanics (29.1) (Table). Death rates decreasedsimilarly by sex, age group, and race; decreases ranged from 1.5% to 2.0% per year during 1990--2004. However,APCs, reflecting a decline in death rates, differed by 60% between Hispanics and non-Hispanics: 1.0% per year forHispanics compared with 1.6% per year for non-Hispanics. Statistical analysis with joinpoint regression revealed that thedeath rate for whites remained stable during 1990--1992 (p = 0.77), declined significantly during 1992--1996 by 4.3%per year (p = 0.001), and then stabilized again during 1996--2004 (p = 0.07)(Figure 2). Death rates for blacks and A/PIs declined significantly, both by 1.6% per year (p<0.001 for blacks and p = 0.003 for A/PIs). Death rates forAI/ANs were stable during 1990--2004 (p = 0.18); this trend might be attributed to the small numbersavailable for analysis in this population. Regressionanalysis also revealed that the death rate for Hispanics remained stable during1990--1992 (p = 0.53), declined significantly during 1992--1998 by 4.3% per year (p = 0.01), and then stabilized during1998--2001 (p = 0.32) and during 2001--2004 (p = 0.57); the death rate for non-Hispanics declined significantlyduring 1990--1996 by 2.6% per year (p<0.001) and 1996--2004 by 0.9% per year (p = 0.009) (Figure 2).
Death rates did not decrease equally in allregions** during 1990--2004: 2.1% per year in the Midwest, 1.8%per year in the South and Northeast, and 1.4% per year in the West (Table). For all cancers combined, childrenandadolescents living in the West (31.1 per million) had significantly higher death rates than those living in theMidwest (29.1), the Northeast (28.4), and the South (29.8), respectively (Table).
Reported by:LA Pollack, MD, SL Stewart, PhD, TD Thompson, Div of Cancer Prevention and Control, National Center for ChronicDisease Prevention and Health Promotion; J Li, MD, EIS Officer, CDC.
Editorial Note:
The findings in this report indicate that, during 1990--2004, overall childhood cancer deathrates declined significantly among boys and girls, children and adolescents, Hispanics and non-Hispanics, most racialgroups, and all U.S. Census regions. Incidence rates for all childhood cancers increased by 0.6% per year during1975--2002 (6). The overall decreasing trend in childhood cancer mortality in the United States likely reflects advances incancer treatment in this population (3).
Acute lymphocytic leukemia accounts for approximately 73% of childhood leukemia cases(1). Likely because of advances in treatment, such as chemotherapy and bone marrow transplantation, substantial improvement hasoccurred in survival rates for children and adolescents with acute lymphocytic leukemia(7). In this analysis, death rates declinedsubstantially for childhood leukemias during 1990--2004, which is consistent with findings fromprevious trend analyses for the period 1975--1995(3). For brain and other nervous system neoplasms, death ratesdeclined significantly during 1990--2004. Five-year relative survival rates for brain and other nervous system neoplasms alsohave improved (1,7).
The results of this analysis indicate geographic disparities in childhood cancer death rates. During1990--2004, childhood cancer death rates in the West were the highest among all U.S. Census regions and were the slowestto decline. The causes of these disparities cannot be determined based on the data available and need to be exploredby further studies, including cancer survival studies. Moreover, variations by ethnicity were observed. Hispanics andnon-Hispanics had similar childhood cancer death rates in 1990, but these rates declined more rapidly fornon-Hispanics than for Hispanics during 1990--2004. Studies have documented that Hispanics lack sufficient access tohealth-care services because of inadequate heath-insurancecoverage, lack of health insurance, poor geographic access tohealth-care providers, lack of transportation to and from providers, and cultural and linguistic barriers(8), which might contribute to this disparity. However, differences in tumor aggressiveness, cancer stage at diagnosis, and response to treatmentalso should be considered.
The findings in this report are subject to at least five limitations. First, the reporting of race/ethnicity to theU.S. Bureau of the Census and on death certificates usually is reliable for blacks and whites; however, death rates forAmerican Indians, A/PIs, and Hispanics are underestimated by 21%, 11%, and 2%, respectively(9). Second, the ability to stratify death rates for each primary cancer site/leading diagnosis bydemographic and geographic variables and to assessthe geographic variation at the state or county level was limited because of low death counts. Third, causes of deathmight be misclassified on death certificates. Fourth, using the 2000 U.S. standard population for all study years mightnot reflect actual annual population. Finally, cancer deaths among boys and girls who had cancer diagnosed as childrenbut who died as adolescents are reflected in adolescent mortality rates. Thus, the mortality rates of adolescents mightreflect the improved survival of children withcancer.
The overall trend of declining childhood cancer mortality during 1990--2004 likely reflects better treatmentof childhood cancer. Surveillance of childhood cancer mortality should be well maintained to monitor the persistence ofthese declines. Possible causes for disparities in childhood cancer death rates (e.g., lack of health insurance, difficultyin accessing health care, late diagnosis, poor treatment quality, and unhealthy behaviors and lifestyles) need to bestudied further. By addressing these factors, geographic and ethnic disparities in childhood cancer death might be reduced,and children with cancer might live longer.
CDC maintains the National Program of Cancer Registries, which monitors cancer rates and trends. CDC alsois working in partnership with organizations (e.g., the Lance Armstrong Foundation) to educate childhoodcancer survivors, their families, and their health-care providers to recognize long-term effects associated with cancertreatment. These measures aim to enhance quality of life and increase survival.
References
Ries LA, Smith A, Gurney JG, et al. Cancer incidence and survival among children and adolescents: United States SEER Program1975--1995. Bethesda, MD: National Cancer Institute, SEER Program; 1999. NIH publication no. 99-4649.
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA CancerJ Clin 2006;56:106--30.
Linet MS, Ries LA, Smith MA, Tarone RE, Devesa SS. Cancer surveillance series: recent trends in childhood cancer incidence and mortality inthe United States. J Natl Cancer Inst 1999;91:1051--8.
US Department of Health and Human Services. Healthy people 2010 (conference ed, in 2 vols). Washington, DC: US Department of Healthand Human Services; 2000. Available athttp://www.health.gov/healthypeople.
Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335--51.
Ward EM, Thun MJ, Hannan LM, Jemal A. Interpreting cancer trends. Ann N Y Acad Sci 2006;1076:29--53.
§ Based on International Classification of Diseases, TenthRevision codes for leukemias (C91.0--C91.4, C91.7, C91.9, C92.0--C92.5, C92.7, C92.9,C93.0--C93.2, C93.7, C93.9, C94.0, C94.2, C94.4, C94.5, and C95.0) and brain and other nervous system neoplasms (C70--C72).
**Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin.South: Alabama, Arkansas, Delaware,District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, andWest Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department ofHealth and Human Services.References to non-CDC sites on the Internet areprovided as a service to MMWR readers and do not constitute or implyendorsement of these organizations or their programs by CDC or the U.S.Department of Health and Human Services. CDC is not responsible for the contentof pages found at these sites. URL addresses listed in MMWR were current as ofthe date of publication.
DisclaimerAll MMWR HTML versions of articles are electronic conversions from ASCII textinto HTML. This conversion may have resulted in character translation or format errors in the HTML version.Users should not rely on this HTML document, but are referred to the electronic PDF version and/orthe original MMWR paper copy for the official text, figures, and tables.An original paper copy of this issue can be obtained from the Superintendent of Documents,U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800.Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed tommwrq@cdc.gov. | 13,042 | 5,454 | 0.000184 |
warc | 201704 | Do You Have Celiac Disease and Have Questions Or Need Help?
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Celiac.com Sponsors: People with Untreated Celiac Disease Show Resistance to Hepatitis B Vaccine Jefferson Adams
Jefferson Adams is a freelance writer living in San Francisco. His poems, essays and photographs have appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate among others.
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Celiac.com 06/30/2008 - The results of a Hungarian study published recently in the June issue of Pediatrics suggest that people with untreated celiac disease show abnormal resistance to the hepatitis B (HBV) vaccine, while celiac patients on a gluten-free diet show a near normal response to the vaccine.
A team of doctors led by Dr. Eva Nemes, at the University of Debrecen, administered 2 to 3 doses of recombinant HBV vaccine to 128 patients with celiac disease and an age matched control group of 113 non-celiac patients within a 6-month period. Twenty-two of the celiac patients were following a gluten-free diet when they received the vaccine.
One month after the last HBV vaccination, the team took blood samples to look for anti-HBV antibodies. The group of 22 patients who received the vaccination while on a gluten-free diet had a sero-conversion rate of 95.5%, which means that more than 9 out of 10 patients developed the desired resistance to hepatitis B.
The other 106 patients with celiac disease, as well as the control group, were vaccinated at approximately 14 years of age, and their immune response was evaluated by measuring anti-HBV titers about two years later. Of the 106 subjects with celiac disease, seventy had been diagnosed and were maintaining a strict gluten-free diet when they were vaccinated, twenty-seven were undiagnosed and untreated, and nine were diagnosed, but not following a gluten-free diet.
The seventy subjects with celiac disease that was diagnosed and treated showed a sero-conversion rate of 61.4%. Given the size of the study samples, that’s not significantly different from the 75.2% sero-conversion rate for the control group.
The big difference arose in those subjects with undiagnosed celiac disease, who showed a response rate of just below 26%, which was substantially lower than the control group and the treated celiac patients. The nine patients with active celiac disease who were not faithfully following a gluten-free diet showed a response rate of 44.4%. The thirty-seven subjects with celiac disease who had failed to respond to the vaccine were placed on a gluten-free diet and given a follow-up vaccine. One month later 36 of them (over 97%) showed a positive response to the vaccine.
The team concluded that the positive response to the vaccine by celiac patients who were following a gluten-free diet, and the high resistance shown by subjects with undiagnosed celiac disease, and those not following a gluten-free diet, indicates that active celiac disease may play a major role in a failure to respond to the vaccine.
The team recommends that newly diagnosed patients be checked for resistance to the HBV vaccine, and that those showing resistance be placed on a gluten-free diet before receiving a follow-up dose. They did not go so far as to suggest that those showing resistance to the HBV vaccine be screened for celiac disease, but that would not seem unreasonable, given their results.
Pediatrics 2008; 121:e1570-e1576.
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warc | 201704 | Flux limiters From CFD-Wiki
Most of us might have seen the behaviour of numerical schemes in order to capture shocks and discontinuity that arises in hyperbolic equations. Physically, these equations model the convective fluid flow. It has been observed that low-order schemes are usually stable but quite dissipative in nature around the points of discontinuity/shocks. On the other hand higher-order numerical schemes are unstable in nature and show oscillations in the vicinity of discontinuity. One can have a batter understanding of this behaviour by analysing the modified equation of these schemes.
The problem is that one can not have high order accuracy without oscillations and without oscillations one has to compromise for accuracy. One needs to optimize these two extremes in order to have highly accurate and stable oscillation free methods. In order to do so, an idea of flux limiters came into the picture. According to the idea, one tunes the numerical flux in such a way that the resulting scheme gives a second order accuracy in the smooth region of flow and sticks with first order of accuracy in the vicinity of shocks/discontinuities. This kind of schemes are known as high resolution schemes and in 1984 Harten gave a paper on one such scheme in Math. Comp. The idea goes like this:
Define the numerical flux fuction of high resolution conservative scheme as
where are the numerical flux of conservative low order and high order schemes respectively. and is a function of smoothness parameter defined by
What remains next is to define the limiter fuction in such a way that it satisfies at least the following:
remains positive , satisfies passes through a perticular region known as TVD region associted with the underlying scheme in order to guarantee stability of the scheme.
There are other properties too which it should satisfy for better results.
In 70's Vanleer came up with his conservative schemes and published 5 papers in a row in Journal of Computational Phyics. Then in 1984 (in SINUM) P. K. Sweby gave a scheme. There are many other methods which use more or less the same idea i. e. the idea of adding antidiffusive term in low order scheme. This gave various schemes like Flux Corrected Transport (FCT) by Book and Borris, Piecewise Parabolic Method (PPM) by Colella and Woodward (JCP) etc.
References C. B. Laney, "Computational Gas Dynamics" E. F. Toro, "Reimann Solvers and Numerical Methods for Fluid Dynamics" R. J. Leveque, "Numerical Methods for Conservation Laws" | 2,528 | 1,222 | 0.000824 |
warc | 201704 | General Assembly
Senate, April 16, 2012
The Committee on Judiciary reported through SEN. COLEMAN of the 2nd Dist., Chairperson of the Committee on the part of the Senate, that the substitute bill ought to pass.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (
Effective July 1, 2012) (a) A person is guilty of public indecency in a correctional institution when such person is in the custody of the Commissioner of Correction and confined in a correctional institution and performs a lewd exposure of such person's intimate parts, or an act of masturbation, which lewd exposure or act may reasonably be expected to be viewed by a reasonably identifiable employee of the Department of Correction. For the purposes of this subsection, "intimate parts" has the meaning provided in section 53a-65 of the general statutes, and "masturbation" has the meaning provided in section 53a-193 of the general statutes.
(b) Public indecency in a correctional institution is a class D felony. If any person who is confined in a correctional institution of the Department of Correction is sentenced to a term of imprisonment for a violation of this section, such term shall run consecutively to the term for which such person was serving at the time of such violation.
Sec. 2. Subdivision (5) of section 54-250 of the general statutes is repealed and the following is substituted in lieu thereof (
Effective July 1, 2012):
(5)
[or ] (B) a violation of any of the offenses specified in subparagraph (A) of this subdivision for which a person is criminally liable under section 53a-8, 53a-48 or 53a-49 . , or (C) a violation of section 1 of this act
This act shall take effect as follows and shall amend the following sections:
Section 1
New section
Sec. 2
54-250(5)
Statement of Legislative Commissioners:
In Subsec. (a), "such person" was substituted for "a person" for accuracy, and in Subsec. (b), the final phrase was replaced by "such violation" for conciseness.
The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.
OFA Fiscal Note
Correction, Dept.
GF - Potential Cost
See Below
See Below
Judicial Dept.
GF - Potential Revenue Gain
See Below
See Below
Note: GF=General Fund
Explanation
The bill is anticipated to result in costs to the Department of Correction and revenue for the Judicial Department to the extent that acts of public indecency occur in prisons in the future. In 2011, there were a total of 390 violations of the Department of Correction's policies related to indecent exposure, committed by 94 inmates. The department anticipates that the harsher penalties and the requirement to register as a sex offender will significantly deter future occurrences of public indecency.
To the extent that the violations continue after passage of the bill, costs will be incurred by the Department of Correction if prison sentences for violation of the statute exceed the terms of the offender. The bill specifies a penalty of up to five years in prison for violation of the statute. Prison sentences for violation of the statute will occur concurrently with an inmate's existing sentence. On average, it costs the Department of Correction $44,165 to incarcerate an offender annually.
Additionally, the bill levies a fine of up to $5,000 per violation, which will potentially increase Judicial Department revenues to the extent that fines are assessed in future cases.
The Out Years OLR Bill Analysis
This bill creates a crime of public indecency in a correctional institution. A prisoner commits this crime if (1) he or she performs a lewd exposure of his or her intimate parts or masturbates and (2) the act can reasonably be expected to be viewed by a reasonably identifiable Department of Correction employee. Under the bill, this crime is a class D felony punishable by up to five years in prison, a fine of up to $5,000, or both.
The bill also makes this new crime a “nonviolent sexual offense” which requires registration as a sex offender for 10 years and for life for a subsequent offense.
EFFECTIVE DATE: July 1, 2012
BACKGROUND Public Indecency
A person commits public indecency if he or she, in a place where the conduct may reasonably be expected to be viewed by others, performs (1) an act of sexual intercourse, (2) a lewd exposure of the body with intent to arouse or satisfy his or her sexual desire, or (3) a lewd fondling or caress of another's body. This crime is a class B misdemeanor punishable by up to six months in prison, a fine of up to $1,000, or both (CGS § 53a-186).
COMMITTEE ACTION
Judiciary Committee
Joint Favorable
Yea
41
Nay
0
(03/28/2012) | 5,225 | 2,221 | 0.000457 |
warc | 201704 | To be responsible for their acts, agents must both perform those acts voluntarily and in some sense know what they are doing. Of these requirements, the voluntariness condition has been much discussed, but the epistemic condition has received far less attention. In Who Knew? George Sher seeksto rectify that imbalance. The book is divided in two halves, the first of which criticizes a popular but inadequate way of understanding the epistemic condition, while the second seeks to develop a more adequate alternative. It is often assumed that agents are responsible only for what they areaware of doing or bringing about - that their responsibility extends only as far as the searchlight of their consciousness. The book criticizes this "searchlight view" on two main grounds: first, that it is inconsistent with our attributions of responsibility to a broad range of agents who shouldbut do not realize that they are acting wrongly or foolishly, and, second, that the view is not independently defensible. The book's positive view construes the crucial relation between an agent and his failure to recognize the wrongness or foolishness of what he is doing in causal terms: the agentis responsible when, and because, his failure to respond to his reasons for believing that he is acting wrongly or foolishly has its origins in the same constitutive psychology that generally does render him reason-responsive. | 1,415 | 720 | 0.001393 |
warc | 201704 | What do Hall of Fame baseball managers like Connie Mack and John McGraw have in common with today's business leaders? Why are baseball managers like Joe Torre and Dusty Baker better role models for business, government, and non–profit management than respected corporate giants like Jack Welch and Bill Gates? And just what does Peter Drucker have to do with Oriole ex–manager Earl Weaver?
Management consultant, baseball writer, and columnist for InformationWeek, Computerworld, and InfoWorld, Jeff Angus shows how anyone can become a better manager by taking lessons from the leaders and nuances of the one game that is the truest test of managerial prowess. As proven by Angus' highly popular blog, Management by Baseball is a fun, story–filled guide that gives managers and anyone in business practical, actionable, understandable tools they can use to improve performance:
How do you start an organization from scratch? Take a page from baseball's 19th century origins.
How do you adapt to changing markets and social conditions? Learn from the man who invented Babe Ruth.
What are the simplest ways to turn around a weak department? Pick up Dick Williams' proven tactics.
How do you redesign corporate strategy in response to your competitors? Learn Joe Torre's secret advantage.
How do you develop emotional intelligence as a leader? Find out how Ichiro Suzuki made his transition from Japan to the Major Leagues a historic success
As a management consultant who has published articles not only on business but also on major league baseball, Angus had an epiphany: baseball is more than America's favorite pastime; it's a metaphor for management. The lessons Angus was helping corporate executives learn by day were the same ones he saw acted out at the ballpark by night. And he had better success helping his day-job clients solve problems when their situations were described in terms of their sporting counterparts. Angus's book takes a trot around the diamond as he shares winning and losing strategies from the dugout. We learn the best and worst of how baseball managers do everything from decision-making to hiring/firing, and managing change. While best appreciated by hard-core baseball fans, this is a worthwhile addition to public library business collections. Copyright 2006 Reed Business Information. | 2,345 | 1,244 | 0.000812 |
warc | 201704 | ClassDojo teamwork empathy self-reflection humility perseverance ProsConvenient combination of student feedback and parent communication features. ConsEffective (and ethical) use is largely dependent on how teachers utilize the program. Bottom LineWith thoughtful classroom implementation, it can help students, teachers, and parents support students' growth through goal-setting and celebration.
The dashboard provides easy access to reports, messaging, settings for customization, and the behavior-tracking interface. The app makes it easy to monitor behaviors from anywhere in the room.
Common Sense Reviewer
Classroom teacher
The interface makes tracking and reporting student behavior easy for teachers. The bright colors, avatars, fun graphics, and sounds appeal to the senses of elementary school-age kids. Long-term engagement will depend on effective use.
It's a powerful tool for monitoring students' growth and setting goals. However, some kids could interpret it as a system of extrinsic rewards and punishments. Teachers will need to set the right tone and use the platform responsibly.
Extensive documentation is available, including a FAQ page, suggested uses, and helpful videos.
Start out by using ClassDojo to track class-wide progress toward behavioral goals. Use it like a high-tech marble jar: Points can be added or taken away depending on how the class is behaving. Help your class set goals and work toward rewards based on how many points they've earned. However, be careful to ensure that individuals aren't publicly singled out in negative ways. You can also use the system to monitor students' individual progress and look for behavioral patterns. In this sense, you could use ClassDojo as more of a high-tech behavior chart, with frequent assessments for each student.
At the end of class, consider how you'll display the behavior point totals for the day -- either by class or by individual student. Be sure to utilize the built-in tools to communicate with parents, which can help bridge the gap between home and school. ClassDojo can also be incredibly effective as a teacher tool. Teachers who are concerned about privacy and don't want to make class behaviors public could privately use the app to track student behavior. The behavior reports would be very helpful for reporting!
Watch this video to see more ways you can use ClassDojo:Read more Read less
ClassDojo is an online classroom-management platform that helps teachers record and track their students' behaviors in real time while also giving students instant feedback. Much of this happens publicly through the use of a visual tracker, often displayed to the class on a screen or interactive whiteboard. Teachers can keep some information private depending on how they choose to set things up. The platform is designed to help individual students, as well as entire classes, identify areas for improved behavior and set related goals.
Teachers can set up various behaviors to track, whether specific to their classroom or based on school-wide expectations. Behaviors are categorized as "positive" or "needs work" and could be labeled in a variety of ways; anything from "on task" to "critical thinking" or "kindness" could be fair game. Each behavior is paired with an icon that students can easily identify; as points are awarded or taken away, the system also plays positive and negative sounds. Teams of teachers who share students throughout the day can set up shared behaviors to help offer consistent expectations. With the mobile app (iOS and Android), teachers can give points from anywhere in the room, potentially freeing them up to move about as they teach.
Students and parents can create accounts to see data on progress toward various goals; this includes detailed reports on the types of behaviors that were observed in each class. Families can also use the ClassDojo Messenger app to monitor their child's progress and communicate with teachers. Newer additions allow teachers to share classroom events and photos, giving families more of a connection to the classroom.Read more Read less
Many teachers see ClassDojo as a transformational tool in their efforts toward employing better classroom management. This type of real-time, class-wide communication can help make behavior expectations more clear and concrete for students. At the same time, it's important to note that the platform may not be for everyone. Teachers should be sure to emphasize positive reinforcement and utilize the tool's public features in ways that support students' privacy and dignity. Also, even in light of teachers' best efforts, some students might still interpret the system in more of an extrinsic way. The program's effectiveness depends largely on how you use it -- it's bound to work best with continual and consistent use.
ClassDojo excels the most as a communication tool, where it helps make a wider picture of students' daily experiences in class more transparent for teachers, parents, and kids. The program can give teachers a more specific look at students' behaviors and the social skills they're learning. The reports are also very useful for parents, although they don't automatically include detailed explanations about why students' points were awarded or deducted. While it might be more labor-intensive for teachers, an embedded commenting feature could help make this data more meaningful and actionable for parents and kids. Overall, the program can be a valuable way to keep instruction more whole-child-focused, as a complement to schools' attention toward students' academic skills and assessment.Read more Read less
See how teachers are using ClassDojo Teacher Reviews Class Dojo engages students in their own behavior.3Ryan C. Tri County Elementary School De Witt, NE4September 30, 2015 Easy to use and consistent behavior management program using positive and negative reinforcement.3Jessica G. Thayer Central Primary School Hebron, NE4September 30, 2015 Overall it is a great tool to manage student behavior and communicate it to parents.3Susan P. N R Burger Middle School Hattiesburg, MS4November 3, 2013 Track, share, and evaluate student participation and behavior with just a few clicks!2Cassy M. Rochester High School Rochester, IL3October 26, 2013 | 6,302 | 2,873 | 0.00035 |
warc | 201704 | The Rise and Rise of Net Lease Apr 16, 2014
Cap rates for the single tenant net leased retail market continued their downward trend to 6.7 percent in the first quarter of 2014, surpassing the previous quarter’s historically low rate of 6.8 percent. During the same time period, cap rates for the industrial sector compressed by 15 basis points. The main factor contributing to cap rate compression in the industrial sector can be attributed to competition amongst institutional investors for this product. The higher average price point for this asset class allows institutional investors to allocate larger pools of funds in single transactions rather than multiple smaller transactions.
Following a dynamic 2013 with more than $44 billion of net lease transactions, according to Real Capital Analytics, the net lease market experienced a significant amount of additional supply in the first quarter of 2014. The supply of net lease properties increased to more than 3,000 properties available in the first quarter, a 17 percent rise when compared to the previous quarter. Owners of lower quality assets, with shorter lease term or limited credit, have added supply to the market to take advantage of the low cap rate environment as the consensus of net lease participants believe that the market strongly favors sellers.
Despite the influx of supply, a lack of quality offerings remains in the single tenant market across all sectors. The main challenge facing investors is the limited pipeline of properties with long-term leases to investment grade tenants in primary markets. Even with lower quality retail assets more prevalent in the market, cap rates for the entire net lease retail market continued to decline to historically low levels. After vigorous fundraising years and accommodating capital markets, investors are struggling to acquire assets that fit acquisition criteria while meeting return thresholds.
Transaction volume for the single tenant net lease market for 2014 is expected to be on par with 2013 assuming the 10-year treasury remains stable. Regardless of the increase in supply of assets, current demand greatly exceeds today’s inventory levels. Demand should remain consistent as positive price and transaction momentum continues to attract investors. | 2,296 | 1,097 | 0.000918 |
warc | 201704 | As a trader, having a good trading system is very important. A system allows a trader to save time on a daily basis when trading. It also allows a trader to be only make decisions based on a platform that has been backtested using various parameters. Broadly, there are two main types of trading systems. One, there is a manual system where one uses excel analysis. Secondly, there is the automated or mechanical system. A simple Google search will produce thousands of trading systems which have been developed by traders. Some are good while some are not appropriate at all. In this article, I will write on how you can develop your own trading system.
When developing a mechanical trading system, your aim should never to make a billion dollars. The two most important goals you should aim to achieve are: to identify a trend as early as possible and to avoid whipsaws. On paper, these are simple strategies which you can come up with. In reality, it is more complicated than this because the strategies contradict one another.
Set the timeframe
Every trader has specific timeframes that they trade with. Some are perfect trading with hourly charts while others are perfect when trading 30 minutes charts. To select the timeframe, you need to assess yourself to understand the type of trader you are. If you are a day trader, I suggest you use hourly and 30 minutes charts. If you are a swing trader, you should use daily charts.
Select indicators
After setting the timeframe, the next step is to select the indicators to use. As a day trader, to accomplish the first goal mentioned above, I suggest that you use moving averages. You should use two moving averages, one fast and another one slow and wait until the fast one crosses the slow one. This is a concept known as moving average crossover.
Find indicators to confirm the trend
In this stage, you simply want to fulfil the second goal we mentioned above. You want to avoid being in a false trend, thus the need to confirm the trend. To achieve this goal, I suggest that you use MACD, Relative Strength Index, and Stochastic.
Risk assessment
No system is accurate. Therefore, it is important to define the risk that you intend to use. Some trades will go against the system. It is thus important to define the amount of risk you are willing to take on every trade you enter.
Entry and exit points
After following the above steps, the final step is to define the entry and exit points. There are many theories on how to make this happen. However, most people believe in entering the trades when all the indicators match up even before the candle closes. Other people prefer seeing all the traders match up and wait until the candle closes up. In my experience, I believe in waiting for the candle to close. This is because at times the indicators might match and change before the candle closes. Once you are in a trade, the next challenge is on when to exit. The best way to do this is to trail your stop. This means that if your trade turns positive by X, you move your stop by X. You can also set the stop loss by using the support and resistance levels.
An example of a trading system
In this part, we will create a simple trading system that you can reciprocate.
Entry positions
Place a buy position if: the 5 day moving average is above the 10 day simple moving average and when the stochastic lines are moving up. Finally, enter when the RSI is greater than 50.
Exit positions
Place a sell order when the 5 day simple moving average moves below the 10 day simple moving average. The stochastic lines should be moving down. This will prevent you from entering when the stochastic lines are in overbought sections. The relative strength index should be less than 50.
Rules of exits
The trade should exit when the 5 day simple moving average crosses the 10 day simple moving average in the opposite direction. Also, the RSI should cross back to zero. Finally, you should exit when the trade hits the stop loss of 100 pips.
The charts below shows some examples of this system in action.
A short trade
A long trade | 4,099 | 1,749 | 0.000575 |
warc | 201704 | Hi Vignesh, Labrador is such an active animal in this planet that even an hour of brisk walking seems just not enough for this breed. Also, humans are not as active as dogs. If you walk a dog for an hour, you yourself need to burn a lot of calories.
Walking is more structured way of exercising these animals. If you want your dog to get exercise enough to keep him tired all day then you have to make him run. If you have a big roof you can make him run on there. Or, if you have a park then you can take him at the time when there are no-one there. You just have to buy a cosco ball and throw it for your dog to run and chase it. Running is the best form of exercising for dog and 15 minutes of running will be equal to 45 minutes of your walking with the dog. Also, you yourself will preserve your own energy.
Labradors in general tend to get bored with walking on leash and as puppies they love to run and retrieve things. As they grow older, even if they run 20-25 minutes on per day basis that's all they need and you don't necessarily have to take them for long walks as running will meet all their exercising requirment.
Also, the more he runs the more he gets tired making him less destructive at home. More exercise will mean increase their appetite which will promote their over-all growth. | 1,306 | 672 | 0.001494 |
warc | 201704 | DaranidePronunciation Generic Name: dichlorphenamide (DYE klor FEN a mide) Brand Name: Daranide, Keveyis What is Daranide (dichlorphenamide)?
Dichlorphenamide is a carbonic anhydrase inhibitor. Carbonic anhydrase is a protein in your body. Dichlorphenamide reduces the activity of this protein.
The Daranide brand of dichlorphenamide is used to treat glaucoma.
The Keveyis brand of dichlorphenamide is used to treat occasional paralysis (loss of movement) caused by high or low levels of potassium in your blood.
Dichlorphenamide may also be used for purposes not listed in this medication guide.
What is the most important information I should know about Daranide (dichlorphenamide)?
Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.
What should I discuss with my healthcare provider before taking Daranide (dichlorphenamide)?
You should not use dichlorphenamide if you are allergic to it, or if you have:
severe breathing problems;
liver disease;
an allergy to sulfa drugs; or
if you also take aspirin in high doses.
In addition to the above, you should not use
Daranide if you have an electrolyte imbalance (such as acidosis or low levels of potassium or sodium in your blood).
To make sure dichlorphenamide is safe for you, tell your doctor if you have:
kidney disease.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether dichlorphenamide passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
How should I take Daranide (dichlorphenamide)?
Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.
Dichlorphenamide is usually taken twice per day. Follow your doctor's dosing instructions very carefully.
While using dichlorphenamide, you may need frequent blood tests. This will help your doctor determine how long to treat you with dichlorphenamide.
Call your doctor at once if you have accidental falls while taking
Keveyis. Your dose may need to be changed.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include dizziness, drowsiness, vomiting, loss of appetite, numbness, weakness, tremors, or ringing in your ears.
What should I avoid while taking Daranide (dichlorphenamide)?
This medicine may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.
Daranide (dichlorphenamide) side effects
Get emergency medical help if you have
signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
the first sign of any skin rash, no matter how mild;
accidental falls while taking Keveyis;
worsening of your paralysis symptoms while taking Keveyis;
confusion, thinking problems;
low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, extreme thirst, increased urination, numbness or tingling, muscle weakness or limp feeling; or
severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Accidental falls are more likely in older adults or in people who take high doses of Keveyis. Use caution to avoid falling or accidental injury while you are taking this medicine.
Common side effects may include:
nausea, vomiting, loss of appetite;
numbness or tingling; or
altered sense of taste.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail) What other drugs will affect Daranide (dichlorphenamide)?
Tell your doctor about all your current medicines and any you start or stop using, especially:
aspirin (including baby aspirin);
digoxin;
penicillin;
theophylline;
antifungal medicine;
a laxative; or
a diuretic or "water pill."
Other drugs may interact with dichlorphenamide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.
Where can I get more information? Your pharmacist can provide more information about dichlorphenamide. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2012 Cerner Multum, Inc. Version: 1.01. Revision Date: 2015-10-07, 2:36:44 PM. | 6,832 | 2,922 | 0.000345 |
warc | 201704 | We provide evidence for the causal pro-trade effect of migrants and in doing so establish an important link between migrant networks and long-run economic development. To this end, we exploit a unique event in human history, i.e. the exodus of the Vietnamese Boat People to the US. This episode represents an ideal natural experiment as the large immigration shock, the first wave of which comprised refugees exogenously allocated across the US, occurred over a twenty-year period during which time the US imposed a complete trade embargo on Vietnam. Following the lifting of trade restrictions in 1994, US exports to Vietnam grew most in US States with larger Vietnamese populations, themselves the result of larger refugee inflows 20 years earlier. | 752 | 461 | 0.002175 |
warc | 201704 | A greater firm-level transparency through enhanced disclosure provides more information regarding the risk situation of an insurer to its outside stakeholders such as stock investors and policyholders. The disclosure of the insurer's risktaking can result in negative influences on, for example, its stock performance and insurance demand when stock investors and policyholders are risk-averse. Insurers, which are concerned about the potential ex post adverse effects of risk-taking under greater transparency, are thus inclined to limit their risks ex ante. In other words, improved firm-level transparency can induce less risktaking incentive of insurers. This article investigates empirically the relationship between firm-level transparency and insurers' strategies on capitalization and risky investments. By exploring the disclosure levels and the risk behavior of 52 European stock insurance companies from 2005 to 2012, the results show that insurers tend to hold more equity capital under the anticipation of greater transparency, and this strategy on capital-holding is consistent for different types of insurance businesses. When considering the influence of improved transparency on the investment policy of insurers, the results are mixed for different types of insurers. | 1,287 | 622 | 0.00161 |
warc | 201704 | 1 Answer | Add Yours
The Sex Discrimination Act of 1986 reads:
An Act to amend the Sex Discrimination Act 1975 and sections 64 and 73 of the Employment Protection (Consolidation) Act 1978; to make provision with respect to requirements to discriminate in relation to employment which are contained in public entertainment licences; to provide for the removal of certain restrictions applying to the working hours and other working conditions of women; and to repeal the Baking Industry (Hours of Work) Act 1954.
Basically what this implies is that as recently as 1954, the UK women workforce was experiencing inequality in terms of work hours, pay, working conditions, working opportunities, retirement options, and benefit packages compared to men.
For this reason, the amendments made to the Act included not only changes to these conditions but, also changed the wording of the Act itself, as it changed the word "man" (which in itself was a qualifier) to "worker" as an inclusive collective.
Also, the Sex Discrimination Act stopped putting limits to the number of members a firm has to have as partners in order to include a female to be a partner as well. The limit used to be 5, and 6 would have made it illegal for a woman to become a partner in a firm. The SDA86 also put a stop to that and had that article removed.
There is also an amendment made for Equal Pay and retirement, both stating separately that being a woman should not be used against a worker to try and retire them early, fire them, or withhold retirement benefits. In other words, all the old practice in which women were considered second class citizens will now be officially over.
For a student with IT or any area this is a very clear message that the old roles of "boys and girls" have shifted. In a multicultural environment like is college, there may be some ethnic groups which will find it quite aggravating having to work with women, or will find it near-offensive that women try for the same opportunities as males. It does not happen as often in a learning environment, but it happens nonetheless. Therefore, any college student needs to learn to put their own views of women's rights to the side and concentrate in succeeding, even against "a girl" or anyone who has the same hunger for making it in a changing world.
We’ve answered 319,200 questions. We can answer yours, too.Ask a question | 2,403 | 1,235 | 0.000818 |
warc | 201704 | A methodology for indexing river environmental condition was developed and applied to 269 subsections of national rivers located in the Republic of Korea, based on a river management perspective. The resulting index has been called the River Environment Index (REI). To develop the methodology, a total of 32 factors related to a river's environment were initially investigated, from which 16 were chosen based on their measurability, predictability, measurement regularity and obtainability. Then, using the analytical hierarchy process (AHP) and based on a survey of 62 river management experts in Korea, the weighting coefficient for each of the 16 factors was determined. Finally, the REI values were estimated by linearly combining the 16 measured factors for the 269 river subsections and mapped using a geospatial information system platform. We expect that the REI will be used to increase the efficient allocation of national budgets for environmentally-friendly river restoration projects of the country's national rivers. Through this new index, prioritization of these rivers will be made using an holistic river management perspective. | 1,150 | 608 | 0.001648 |
warc | 201704 | Two urban street canyon models, STREET and OSPM, were investigated at Pearse Street, in the centre of Dublin City. Both STREET and OSPM is semi–empirical model that calculates series of hourly concentrations at different receptor locations within a street canyon. From the assessment carried out, for the STREET model, the value of the site specific constant parameter K with a value of 7 gave the best results for STREET modelling. For different consideration of background concentrations best results were obtained using OSPM with HEF with hourly backgrounds followed closely for backgrounds based on stability class for the entire duration of the study period.
Keywords: Air Quality Directives, emissions, empirical models, STREET, OSPM, Ireland, NOx concentration, nitrogen oxides, urban streets, street canyons, dispersion modelling, air pollution | 860 | 478 | 0.002112 |
warc | 201704 | "Send me over an RFP and I’ll hire some $1,500-a-day freelancers to work on it with me, ignore my important clients, and get back to you in a week!" Sound familiar? If so, we’re going to do a little social profiling and assume that you work in an agency and have been involved in the process of pitching for business.
For something so integral to the success of an agency (and a brand) the process of acquiring new business—the pitch process—is notoriously fraught. Long lead times, long pitch lists, layers of consensus needed to select a partner, layers of meaningless paperwork for RFPs, requests for spec work, lack of access to decision makers, cost pressure from procurement for the agency, search consultants who may or may not be motivated or equipped to arrange the best marriage, giving away IP… when it’s bad, it’s pretty terrible. Even the wording of recent guidelines from the normally restrained 4A’s (the American Association of Advertising Agencies) and ANA (the Association of National Advertisers), referring to "excessive, unfocused RFP demands and cattle calls," reveals the extent of the problem when it comes to the process of securing new business.
But rather than dwell on the negatives, and given that agencies are in the business of solving problems, we thought we’d get some insight into potential solutions to make the practice of developing new creative relationships more efficient, respectful, pleasant and, well, creative.
While we anticipated some resistance to an open conversation about reforming the pitch process, the question, "How would you suggest improving the pitch process" was answered with resounding enthusiasm. The tone was highly positive, with little finger-pointing—that could, of course, have to do with the delicate nature of the question, but there was also some acknowledgment that agencies have more of a say in the process than it might sometimes seem.
"Agencies suggesting ways to improve the pitch process is a bit like crying over spilled milk because in the end, if we don’t like the way a pitch is being run, we don’t have to participate," says Jeff Jones, Partner and President at McKinney, before sharing his single best idea: Ditch the pitch altogether in favor of hiring agencies like senior executives. "Even the best pitch process today does very little to assess fit from both perspectives," says Jones.
Similarly, Laurie Coots, Chief Marketing Officer of TBWA\Worldwide says that agencies have to set new standards, know what’s important to them, and to define the lines within which they will participate and stick to them.
"Agencies are victims of our own drama," she says. "We have taught the clients that we will give them free ideas, that we will invest extraordinarily for a chance to prove we are the right partner, we will give away our IP for a shot—and now we are crying foul."
So in the spirit of constructive conversation, Co.Create solicited feedback from agency presidents, CEOs, CMOs, Creative Directors, Managing Directors, and new business heads to get some clear thinking on the matter. The feedback was overwhelming and could have resulted in 50 ways to improve the pitch process. Instead, we parsed the valuable input into 10 recurring thematic ideas that agencies feel will make agency/client relationships just a little bit easier.
Be sure to tell us what you think. Is the process broken? Is it fixable? It’s a complex issue and we want to hear your point of view.
While business relationships are no doubt a different beast than personal relationships—more formal, thankfully less intimate—the human behavior behind forming these bonds is the same. As in love, chemistry—or fit—is the most important element to a fruitful partnership, and the rigid, often arms-length way in which new partners are engaged does little to help foster the necessary connection to make professional fireworks.
Rosemarie Ryan, Co-CEO of Co Collective suggests thinking of the process less like pitching and more like dating. "Chemistry is everything. Do they spend the entire time talking about themselves or are they genuinely interested in you? Do you want to keep talking after the meeting ends, does the time fly by? Are you looking forward to getting together again?," she says. "Find the people you would walk through a burning building with and then get down to the real work."
That said, Sam Wilson, Managing Director from Wolff Olins cautions that while dating is an apt metaphor, competitive dating is not the goal. "One at a time, please. There is nothing worse than those briefing calls (or worse, in-person meetings) where there are multiple agencies present. They can’t be themselves; you don’t get to know them. This is not
The Bachelor!"
For Krystle Loyland, head of new business at Mother New York, the importance of meeting prospective clients at the pitch phase is key to a quality outcome. "Pitches are often run by marketing folks who don’t necessarily have the authority or vision to make the final decisions. So by the time you present to the ones who do, you have developed creative ideas based on someone else’s strategy," she says. "This will always prove to be a waste of time and energy for both the client and the agency." Mother avoids this, says Loyland by meeting with all key decision-makers at the beginning of the pitch process. "This helps us not only better understand the core business problem, but also the client dynamic. It allows everyone involved to assess chemistry, compatibility, and shared values; and ultimately leads to better-fit work and long-term` partnerships, not short-term wins."
As in your personal life, where you meet someone matters as well, which is why AKQA CEO Tom Bedecarre insists that pitches should always take place at the agency. "If you are hiring an agency, then you are hiring the people, culture and work environment of that agency. It makes no sense to have pitch meetings at client offices or neutral locations because it shortchanges the opportunity to learn more about the people, culture and work environment of the agency you are about to hire."
Because as John Matejczyk, Executive Creative Director of MUH•TAY•ZIK HOF•FER says, "Understand what you’re really hiring is what’s the hardest to come by: taste." And the best way to get a sense of someone’s taste is certainly not in a cattle call.
If many agency leaders advocate for a more personal touch when searching for a creative mate, others go a step further, suggesting that clients engage prospective agencies in short term but real project to get a sense if they’re a perfect match.
"If you’re looking for a long term agency partner, beta test. Build and test a live partnership with the agency(ies) you’re considering; get involved, assess it, optimize it, roll it out more widely if it works," suggests Emma Cookson, Chairman, BBH New York. "Assign a controlled but real project, pay fairly but not excessively, and work with the agency honestly and in depth—it’s the only way to really know in advance what you’re buying." On the flip side, Cookson feels that for one-off jobs, the pitch should be limited to fast, intense, focused presentations. "Think TED talks. That would minimize time/effort on both sides, maximize pace and stay focused on what you really need to buy - a big central concept or idea that you can then later blow out together."
Similarly, Alasdair Lloyd-Jones, COO, Big Spaceship suggests reinventing the pitch process by building collaboration. "Bring on two agencies that excite you and pay for them to work with your team for a month or two on a particular challenge," he says "It’s full commitment on both sides. At the end of those two months, you decide which of the two makes the most sense to commit to based on thinking, cultural fit, ideas, achievement and commitment to the brand. You have to put in time and money but you end up with the best partner and that should lead to a longer-term engagement."
And it’s understanding the nuances work styles, personalities and culture that Andrew O’Dell, CEO at Pereira & O’Dell, sees as the key to more a more valuable pitch process. "The biggest issue with most reviews is it doesn’t simulate a real working relationship and that can be a big business hazard for clients in the long-run. Compensate the top two finalists for a 3-6 month period and engage them on a real assignment, not pitch. Both agency and client will benefit from the extra time spent building the relationship and developing work. At the very least, a more informed and confident decision can be made by both sides."
It’s easy for agencies, hungry for accounts or eager to work with a hot-shot client, to think they have little say in pitching matters. But not so, say these agency leaders.
Amalgamated CEO Brian Martin says that often companies enter the pitch process as if it is a beauty pageant looking to take home the crown. But that’s missing the point. "Winning the pitch is merely the beginning of a (hopefully) long relationship," says Martin. "That relationship is going to have significant ramifications on your firm’s future. So don’t approach the pitch prepared to jump through every hoop the client puts in front of you. Approach the meeting as if you’re looking to hire them. Be thoughtful and ask good questions. But most of all, be ready to walk away if the answers you receive in the process aren’t what you want to hear. A partnership is only good if expectations on both sides are in alignment."
"You are hiring each other," says Co’s Rosemarie Ryan. "It’s important that both parties are honest with each other about their hopes, dream, worst fears. More critically, it’s important that they are honest with themselves about whether that’s something they can live with."
Another way of looking at this same idea is to consider soliciting creative partners not within a pitching framework, but as if you’re hiring a key member of your team. "The best thing that could happen to the agency/client relationship is stopping the pitch process altogether," says Jeff Jones. "Clients should hire agencies following the same process they use to add a marketing executive to their team. Just like great marketing executive candidates, many agencies have the right credentials but very few are the right fit for the organization. Even the best pitch process today does very little to assess fit from both perspectives."
Tom Denari, President and Principal, Young & Laramore echoes the sentiment. "Recognize that agency relationships are just that—relationships. Instead of having the agencies spend ungodly hours developing a campaign that might never be used—or worse yet, might be very ineffective—have the actual working team commit to a two-day session of intense interviewing," he says. "Interview the agency principals individually. Find out what they believe in. What are they in the business for? Are they going to sell out? See if their stories match. Make sure you can work with a group that might present something you won’t like, not just something you do."
Transparency is a beloved buzzword, often devoid of any meaning. But when actually applied, it can foster a sense of common respect—no matter if the outcome works in an agency’s favor.
McKinney’s Jeff Jones asks that clients be clear about their intentions—whether they’re looking for a new partner or just simply fishing for ideas. "Both are OK. It’s only a problem when you are not transparent because it is obvious to agencies. We can tell based on the list of agencies you are talking to and the overall tone and structure of the process."
Peter McGuinness, CEO at DDB Chicago says, "Be honest with those who don’t have a shot so they can bow out early and with some dignity."
For AKQA’s Bedecarre, transparency meets a very pragmatic need: "Agencies must balance the costs of time and resources put into a given pitch against the potential benefits of winning the business. If the odds of winning are 1 out of 2, your expected value of the pitch is 50% of the assignment. If the odds are 1 out of 6, then the expected value drops to 16.7% of the assignment. Agencies should be willing to put 3 times the effort into a pitch against a single competitor compared to a 6-way shootout. So if clients narrow the list of finalists to 2 or 3 agencies, the results will be stronger."
And if the odds don’t stack up in an agency’s favor, Big Spaceship’s Lloyd-Jones simply asks for honest feedback. "Thorough feedback is the least a client can do to those agencies that didn’t make it. It respects the amount of effort put in and helps an agency improve for next time or at least understand why their pitch didn’t win."
Mother’s Loyland adds its incumbent upon all parties to ensure they’re painting an accurate portrait of their skills. "A pitch is really just a shorthand way to see if you have found the perfect collaborator. Sometimes this pure ambition becomes muddled because clients want to be someone they aren’t prepared to be, and agencies want to win new business by being someone they are not. This will always prove to be a waste of time and energy for both the client and the agency."
Unless you’re Bill Murray and Scarlett Johansson, getting lost in translation is the farthest thing from romantic. In the pitch scenario, when the agency is unable to ask direct questions of key clients, any communication is open for misinterpretation.
"When a company decides to change agencies, it is usually looking for a better way forward. Quite often, RFPs state that clients want to 're-invent’ the brand, or 'challenge the status quo’ of the category, or 're-capture’ market share, or appeal to a new or expanded target. These bold moves require change, but when it comes down to it, big moves may not be supported by the ultimate decision-makers," warns 180 Managing Partner/CEO Michael Allen. "Therefore, all stakeholders need to own the RFP, evaluation criteria must be clear, and it should be evident who has the final say. Everyone needs to make time for the process to work."
As John Matejczyk says: "Always have the person whose yes’ matters in the meeting. Unfortunately, everyone’s 'no’ matters; few clients’ 'yes’ matters. That’s who has to be in the meetings, making the decisions—not just about what agency to hire but what work to create. When I look back on the biggest hits of my career, without exception, we were dealing with the decision makers from the very first meeting. No escalation. No ‘go sell it through the business units’."
"Do clients really buy the pitch?" Dan LaCivita, President of digital agency Firstborn says no. For him, the pitch is created inside a bubble, with the focus on creating the perfect pitch as opposed to the perfect solution to the client’s problem. From there, the initial creative idea often ends up looking nothing like what was presented. "As we know, once the pitch is won, the idea(s) presented are often tweaked and altered, 'Frankenstein-ed’ together leaving the agency with only a shell of the once amazing concept that supposedly won them the business in the first place," he says. "I think there needs to be greater value put on not just selling an idea to the client, but on also selling the approach to an idea. Seeing how an agency thinks when developing creative solutions to real business problems is extremely valuable for a client looking for a long-term relationship."
Beth Waxman-Arteta, CMO of JWT North America agrees. "It’s fair enough to qualify an agency based on its previous work, but focusing on how it thinks about the direction of the client’s business will help both the agency and client determine if they are a good fit. Instead of discussing the past, agencies are better off highlighting their critical thinking skills and a future vision for the client."
She suggests a simpler RFI process, one that gets straight to the point: the client. "Wouldn’t a process that covers the basics and brings clients face-to-face with prospective agencies earlier on in the game be the most effective use of our time? I had the good fortune to participate in a review last summer that ran exactly this way, and it was a refreshing experience for everyone at the agency. The process moved straight from RFI to chemistry meetings, where the client stopped us short and said: "Forget your presentation. Obviously we know you can do all that—let’s just talk." They got to know us better much faster by asking direct questions about their challenges and how we’d solve them. Agency experience does matter, but it materializes much faster and in the most relevant ways when clients ask us direct questions about their business and how we envision the future.
McKinney’s Jeff Jones is blunt when it comes to the sticky topic of intellectual property. "Approach the topic of IP like a real partner. It’s an arms race for intellectual property in today’s business world, and it is no exception for agencies. Clients who take hard stands on IP ownership are fundamentally not respecting the agency business model and are setting up the relationship to ultimately fail. Agencies may say yes initially because they need to grow, but win/lose relationships on IP are an ultimate recipe for failure."
For whatever reason, talking about money is a delicate conversation that most people dance around. But in the pitch process, it’s crucial to talk about… right away.
"Knowing that you are in the right ballpark will save a lot of time and effort. Everything is always negotiable, but if there’s a serious gap between your budget and their rough price, better to know before you fall in love," offers Sam Wilson of Wolff Olins.
Jones is once again straightforward in his call for the straight goods on money. "Don’t make the budget a mystery. In today’s world, there is no way the budget is not known. Every marketing P&L has a line item for agency fees. It could save a lot of time and lead to a better decision if clients were clear about this.
John Matejczyk has an even more radical—but ultimately intriguing—idea when it comes to talking money during the pitch process. He suggests paying agencies to pitch. "It’s not just that a pitch is an enormous drain on an agency’s resources. It’s also that significantly compensating an agency for the pitch process will clarify your own thinking about who you really want to be working with. No one writes large checks to an agency who is there just to ‘round out the list.'"
If much of the input has centered around building productive relationships, some call for complete forthrightness when it comes to what’s exactly expected of the pitch process, like the duration of the pitch and the agencies competing, both of which DDB’s Peter McGuinness think should be limited.
"People spend hours working through financial and legal contracts and little if any time on a contract for the relationship," says Co’s Rosemarie Ryan. "Spend a day on what success looks like, for the business, the team, the individual. What are some things you should always do/never do?"
Donna Wiederkehr, CMO, Aegis Media North America says, "The best processes start with clients clearly defining their objectives, which must be well thought-out and actionable. It is important for agencies to have a clear understanding of why the business is going in for review, why the client is considering a change in agency, what the client wants to accomplish with this pitch process, etc. While these questions may seem intuitive and inherently basic, they are absolutely fundamental to the process."
For 180’s Michael Allen, even with a clearly defined, streamlined process, spec work should never be a part of the equation. "Spec creative work rarely wins pitches and is usually created in a vacuum (with little client involvement). Besides, it isn’t needed to evaluate an agency. Clients are savvy and know a lot about different agencies and the work they are capable of creating. If clients are unsure and need a test drive, start with a project.
Finally, having an eye to the future helps keep what can be a long, laborious process moving forward. Says Amalgamated’s Brian Martin: "Pitch meetings tend to start more broadly and progressively focus in on the core issue the client is looking to solve. So, give the client a sense of what you will deliver in the next meeting. The client will feel as if you understand their business better because you are going deeper than the others. And, by having that next meeting before you are actually asked to have the meeting, you will be better prepared with what to do with that next meeting."
Beth Waxman-Arteta of JWT adds that it’s important to "keep in mind where you want your business to be in the next several years—and get to that point right away. Asking your potential agency partners to explore and dream with you about the future is a step toward bettering the pitch process." | 21,578 | 9,115 | 0.000114 |
warc | 201704 | Prosthetics and orthotics is the clinical discipline related to the provision of prostheses (artificial limbs) to people with amputations, and orthoses (supportive devices), to people with musculoskeletal weakness or neurological disorders. You will acquire theoretical knowledge of anatomy, physiology, biomechanics, and prosthetic and orthotic prescription, design and fabrication, enhanced by strong practical skills in research methodology, clinical assessment, and the application of prosthetic and orthotic techniques.
In first year, you will develop skills in foot and ankle orthotics, upper-limb orthotics, transtibial prosthetics, upperlimb prosthetics and clinically applied research. This is followed by 12 months of clinical theory and practice, with a focus on trans-femoral prosthetics and above-knee orthotics, while primarily located in a clinical environment.
Clinical practice and theory may be held outside official University semester dates.
Professional recognition
After you graduate you will be eligible for membership to the Australian Orthotic and Prosthetic Association.
Entry Requirements
You must have a relevant Bachelors degree equivalent to an Australian Bachelors degree, completed in the past five years(or subsequent postgraduate study and/or relevant work experience) with a minimum grade average of 70 per cent.
Email Enquiry
Recipient: La Trobe University
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warc | 201704 | TOLEDO, Ohio, Jan. 4, 2017 -- FirstEnergy Corp. (NYSE: FE) has rebuilt a transmission line connecting substations in Bowling Green and Pemberville to help enhance service reliability for about 38,000 customers in Wood County in the Toledo Edison service area.
The $6.3-million project included replacing 220 poles in the existing transmission right-of-way and installing a second 69-kilovolt circuit. Overall, more than 16 miles of wire was installed along the route. In addition, remote control switching devices were installed on the new sections, which allows grid operators to assess operational conditions more quickly, reducing the length and frequency if service disruptions occur.
"Doubling the capacity of the transmission line will help provide increased reliability for customers in Wood County," said Rich Sweeney, regional president of Toledo Edison. "The rebuilt power line and remote-control equipment will help strengthen the grid and increase the flexibility and redundancy of our system."
The rebuilt line went into service in mid-December. As part of the project, work also was done to upgrade the Pemberville substation, with additional enhancements scheduled to be done at the Bowling Green substation next year.
The project is one of numerous distribution and transmission infrastructure projects totaling approximately $115 million that FirstEnergy completed in 2016 in Toledo Edison's service area.
FirstEnergy is dedicated to safety, reliability and operational excellence. Its 10 electric distribution companies form one of the nation's largest investor-owned electric systems, serving customers in Ohio, Pennsylvania, New Jersey, West Virginia, Maryland and New York. The company's transmission subsidiaries operate more than 24,000 miles of transmission lines that connect the Midwest and Mid-Atlantic regions. Follow FirstEnergy on Twitter @FirstEnergyCorp or online at www.firstenergycorp.com.
Editor's Note: Photos of work to rebuild a Toledo Edison transmission line in Wood County are available for download on Flickr. Forward-Looking Statements: This news release includes forward-looking statements based on information currently available to management. Such statements are subject to certain risks and uncertainties. These statements include declarations regarding management's intents, beliefs and current expectations. These statements typically contain, but are not limited to, the terms "anticipate," "potential," "expect," "forecast," "target," "will," "intend," "believe," "project," "estimate," "plan" and similar words. Forward-looking statements involve estimates, assumptions, known and unknown risks, uncertainties and other factors that may cause actual results, performance or achievements to be materially different from any future results, performance or achievements expressed or implied by such forward-looking statements, which may include the following: the speed and nature of increased competition in the electric utility industry, in general, and the retail sales market in particular; the ability to experience growth in the Regulated Distribution and Regulated Transmission segments; the accomplishment of our regulatory and operational goals in connection with our transmission investment plan, including, but not limited to, the proposed transmission asset transfer to Mid-Atlantic Interstate Transmission, LLC, and the effectiveness of our strategy to reflect a more regulated business profile; changes in assumptions regarding economic conditions within our territories, assessment of the reliability of our transmission system, or the availability of capital or other resources supporting identified transmission investment opportunities; the impact of the regulatory process and resulting outcomes on the matters at the federal level and in the various states in which we do business including, but not limited to, matters related to rates and the Electric Security Plan IV; the impact of the federal regulatory process on Federal Energy Regulatory Commission (FERC)-regulated entities and transactions, in particular FERC regulation of wholesale energy and capacity markets, including PJM Interconnection, L.L.C. (PJM) markets and FERC-jurisdictional wholesale transactions; FERC regulation of cost-of-service rates, including FERC Opinion No. 531's revised Return on Equity methodology for FERC-jurisdictional wholesale generation and transmission utility service; and FERC's compliance and enforcement activity, including compliance and enforcement activity related to North American Electric Reliability Corporation's mandatory reliability standards; the uncertainties of various cost recovery and cost allocation issues resulting from American Transmission Systems, Incorporated's realignment into PJM; economic or weather conditions affecting future sales and margins such as a polar vortex or other significant weather events, and all associated regulatory events or actions; changing energy, capacity and commodity market prices including, but not limited to, coal, natural gas and oil prices, and their availability and impact on margins and asset valuations, including without limitation impairments thereon; the risks and uncertainties at the Competitive Energy Services (CES) segment, including FirstEnergy Solutions Corp. and its subsidiaries and FirstEnergy Nuclear Operating Company, related to continued depressed wholesale energy and capacity markets, and the viability and/or success of strategic business alternatives, such as potential CES generating unit asset sales, the potential conversion of the remaining generation fleet from competitive operations to a regulated or regulated-like construct or the potential need to deactivate additional generating units; the risks and uncertainties associated with a lack of viable alternative strategies regarding the CES segment, thereby causing FES to seek protection under the bankruptcy laws and the losses, liabilities and claims arising from such bankruptcy proceeding; the continued ability of our regulated utilities to recover their costs; costs being higher than anticipated and the success of our policies to control costs and to mitigate low energy, capacity and market prices; other legislative and regulatory changes, and revised environmental requirements, including, but not limited to, the effects of the United States Environmental Protection Agency's Clean Power Plan, Coal Combustion Residuals regulations, Cross-State Air Pollution Rule and Mercury and Air Toxics Standards programs, including our estimated costs of compliance, Clean Water Act (CWA) waste water effluent limitations for power plants, and CWA 316(b) water intake regulation; the uncertainty of the timing and amounts of the capital expenditures that may arise in connection with any litigation, including New Source Review litigation, or potential regulatory initiatives or rulemakings (including that such initiatives or rulemakings could result in our decision to deactivate or idle certain generating units); the uncertainties associated with the deactivation of older regulated and competitive units, including the impact on vendor commitments, such as long-term fuel and transportation agreements, and as it relates to the reliability of the transmission grid, the timing thereof; the impact of other future changes to the operational status or availability of our generating units and any capacity performance charges associated with unit unavailability; adverse regulatory or legal decisions and outcomes with respect to our nuclear operations (including, but not limited to, the revocation or non-renewal of necessary licenses, approvals or operating permits by the Nuclear Regulatory Commission or as a result of the incident at Japan's Fukushima Daiichi Nuclear Plant); issues arising from the indications of cracking in the shield building at Davis-Besse; the risks and uncertainties associated with litigation, arbitration, mediation and like proceedings, including, but not limited to, any such proceedings related to vendor commitments, such as long-term fuel and transportation agreements; the impact of labor disruptions by our unionized workforce; replacement power costs being higher than anticipated or not fully hedged; the ability to comply with applicable state and federal reliability standards and energy efficiency and peak demand reduction mandates; changes in customers' demand for power, including, but not limited to, changes resulting from the implementation of state and federal energy efficiency and peak demand reduction mandates; the ability to accomplish or realize anticipated benefits from strategic and financial goals, including, but not limited to, the ability to continue to reduce costs and to successfully execute our financial plans designed to improve our credit metrics and strengthen our balance sheet through, among other actions, our cash flow improvement plan and other proposed capital raising initiatives; our ability to improve electric commodity margins and the impact of, among other factors, the increased cost of fuel and fuel transportation on such margins; changing market conditions that could affect the measurement of certain liabilities and the value of assets held in our Nuclear Decommissioning Trusts, pension trusts and other trust funds, and cause us and/or our subsidiaries to make additional contributions sooner, or in amounts that are larger than currently anticipated; the impact of changes to significant accounting policies; the ability to access the public securities and other capital and credit markets in accordance with our financial plans, the cost of such capital and overall condition of the capital and credit markets affecting us and our subsidiaries; further actions that may be taken by credit rating agencies that could negatively affect us and/or our subsidiaries' access to financing, increase the costs thereof, increase requirements to post additional collateral to support, or accelerate payments under outstanding commodity positions, letters of credit and other financial guarantees, and the impact of these events on the financial condition and liquidity of FirstEnergy and/or its subsidiaries, specifically the subsidiaries within the CES segment; the risks and uncertainties surrounding FirstEnergy's need to obtain waivers from its bank group under FirstEnergy's credit facilities caused by a debt to total capitalization ratio, as defined under each of such credit facilities, in excess of 65% resulting from impairment charges or other events at CES; changes in national and regional economic conditions affecting us, our subsidiaries and/or our major industrial and commercial customers, and other counterparties with which we do business, including fuel suppliers; the impact of any changes in tax laws or regulations or adverse tax audit results or rulings; issues concerning the stability of domestic and foreign financial institutions and counterparties with which we do business; the risks associated with cyber-attacks and other disruptions to our information technology system that may compromise our generation, transmission and/or distribution services and data security breaches of sensitive data, intellectual property and proprietary or personally identifiable information regarding our business, employees, shareholders, customers, suppliers, business partners and other individuals in our data centers and on our networks; and the risks and other factors discussed from time to time in our United States Securities and Exchange Commission (SEC) filings, and other similar factors. A security rating is not a recommendation to buy or hold securities and is subject to revision or withdrawal at any time by the assigning rating agency. Each rating should be evaluated independently of any other rating. The foregoing factors should not be construed as exhaustive and should be read in conjunction with the other cautionary statements and risks that are included in our filings with the SEC, including but not limited to the most recent Annual Report on Form 10-K, any subsequent Quarterly Reports on Form 10-Q and Current Reports on Form 8-K. New factors emerge from time to time, and it is not possible for management to predict all such factors, nor assess the impact of any such factor on our business or the extent to which any factor, or combination of factors, may cause results to differ materially from those contained in any forward-looking statements. FirstEnergy expressly disclaims any current intention to update, except as required by law, any forward-looking statements contained herein as a result of new information, future events or otherwise.
CONTACT: Chris Eck, (330) 384-7939 | 12,764 | 5,226 | 0.000192 |
warc | 201704 | Minister for Europe, David Lidington, today gave a speech about the potential impact of independence on Scotland.
Thank you for that kind introduction. It is great to be back in Edinburgh.
I have spent the day so far meeting members of the Scottish Parliament, and representatives of Edinburgh’s business and academic communities. And always, the discussion has been on what independence would mean for people and businesses in Scotland.
With less than 450 days to go until the referendum, it is right that the focus should shift from rhetoric to reality, and that people throughout Scotland should take a good hard look at what the options mean for them. Scotland is faced with a choice between staying within the UK, or leaving and going it alone.
As Minister for Europe, I from time to time meet people who remember the referendum campaigns of the 1970s, both on Scotland and on the European Union. And people ask why we have these issues have been opened up once more. But my own view is that there is no point in ignoring questions of such magnitude where they remain unresolved. People here in Scotland will make their decision on 18 September next year.
This is democracy in action, and I believe that it is right that people should have the opportunity to decide their own future. But I don’t agree that if the vote here for independence, then “everything will be much the same on Day One… only better”. This, to me, is a casual and complacent assertion that underestimates the size of the task involved and the associated costs.
So rather than making sweeping statements and counter-claims, I have six straightforward questions. And I would ask you to consider whether you think you have heard credible answers to these questions so far in this debate. The first is what happens with EU membership if Scotland becomes independent? There is no precedent for the break-up of an existing member of the European Union, so no one knows for certain. But Jose Manuel Barroso, the President of the European Commission, who is surely an authoritative voice on this issue, has said that an independent Scotland would be regarded as a new country seeking accession to the European Union for the first time.
Independent legal opinion sought and published by the UK Government says that the remaining nations of the United Kingdom would be seen as the continuing state, retaining the UK’s international rights and privileges and its EU membership. In the face of that evidence, the Scottish Government has now admitted that membership would not be automatic and that negotiation would be required. The task facing an independent Scottish Government would then be to win over 28 member states, each of which would have a veto. This includes those countries that are anxious about the unity of their own nations, cautious about setting precedents and with little motivation to make the journey smooth for Scotland.
The second question is what would happen to the pound? Under the terms of the EU treaties, all new EU member states are expected to make the legal and political commitment to adopt the Single Currency. The United Kingdom and Denmark have the right to keep its own currency, but Mr. Barroso said in November that no new member states would be allowed to opt out. The Scottish Government knows that the pound is popular, but recent experience has shown that being in a currency union without other kinds of integration is less than straightforward. There is no guarantee that the UK and Scotland would be able to come to an agreement on a currency union. The Chancellor of the Exchequer has said he thinks it’s unlikely that it could be made to work. And even if it could be agreed, it would require a newly independent Scottish state to accept significant limits on its economic sovereignty and to submit its budgetary plans to Westminster for approval.
The third question relates to Schengen, the agreement that abolished passport and immigration controls for almost all the EU member states. Would an independent Scotland join? As defined in the Treaties, all countries seeking accession to the EU are expected to join the Schengen area. There is no automatic right to opt-out, and no legal grounds to suggest that membership is anything other than obligatory. If an independent Scotland were to join Schengen, then control of its borders would be out-sourced to Europe’s periphery. The one border that Scotland would have to secure would be that with England, drawing a line between Scottish businesses and their main trading partners.
The option that is favoured by the Scottish Government – to remain in a Common Travel Area with the UK and Ireland – is not on offer to new member states. It would be a significant new opt-out demand that would expend considerable negotiating capital with no certainty of success and which would, again, require the unanimous agreement of each Member State.
The fourth question is what would happen to the payments being made to the EU budget if Scotland became independent? Now the Scottish Government itself has said that an independent Scotland would be a net contributor to the European Union. But suggestions that Scotland would retain its share of the UK’s rebate appear to stand on very shaky ground. At the EU budget negotiations in February, the UK was able to defend its rebate but this was a hard-fought fight against the entrenched interests of other member states.Legal opinion received by the UK Government is clear that an independent Scotland would not get a share of the UK rebate. Scotland would have to negotiate such arrangements from scratch and it would be very difficult to secure any similar deal.
So if a new independent Scottish state were let into the EU, the default expectation must be that Scottish taxpayers would see their payments to the EU rise significantly.
The fifth question is who will stand up for Scotland’s interests in Europe when it comes to negotiations on financial service or energy or fisheries or agriculture? The Scottish Government’s position is that this can only be done by those who care for Scotland alone. Their assumption is that an independent Scotland would negotiate as a small state, with its bargaining power amplified by a flood of goodwill.
Now it’s true that the UK Government now negotiates on behalf of the whole of the United Kingdom. And by doing so, it brings to the table its considerable weight within the EU and experience and its extensive diplomatic network.
We have a track record of using our position as one of Europe’s biggest economies; with the third largest population; membership of the UN Security Council, G7, G8 and G20; and 40 years of forging alliances to fight for all the UK’s interests in Europe. We also have one of the most inclusive arrangements anywhere in the EU when it comes to devolved administrations participating in the making of decisions. Scotland has benefited from the UK’s strong voice in Europe. UK ministers – not least the Prime Minister – have forgone sleep and hotel beds, negotiating hard through the early hours. And they have delivered on issue after issue.
On the EU budget, we secured the first ever cut in the long-term budget, which will benefit taxpayers in every part of the United Kingdom. On financial services, we have secured safeguards for British firms - in Edinburgh as much as London - on the Single Supervisory Mechanism and on the Markets in Financial Instruments Directive. On fisheries, we achieved a deal on discards that the Scottish Fishermen’s Federation welcomed as a “practical plan”. The Offshore Health and Safety Directive, agreed shortly before the 25th anniversary of Piper Alpha, the world’s worst offshore disaster, won praise from Oil & Gas UK. And on Tuesday morning in Luxemburg, I bumped into Environment Secretary Owen Paterson - who was somewhat bleary eyed – a third of the way through gruelling negotiations on reform to the Common Agricultural Policy (CAP).
The mandate that Owen Paterson helped to secure this week is a breakthrough that offers greater clarity and certainty to Scottish farmers, and a reassurance that the Scottish Government and Scottish Parliament will have the freedom to deliver a common agricultural policy here tailored to the needs and circumstances of people in Scotland. And last night – again in the early hours - the Financial Secretary to the Treasury Greg Clark secured a deal on resolving troubled banks that will protect taxpayers around Europe. When it comes to negotiations, in general what we find is that small nations with similar interests to our own look to the UK to take the lead.
And in the heat of a debate in which national interests are at stake, you don’t want to be relying on just goodwill in the corridors of Brussels. It’s a commodity particularly in the small hours of the morning are in very short supply.
My sixth question is about the UK’s security and its wider role in the world. As the Minister with responsibility for NATO, I am taking a close interest in how the defence and security elements of the debate are unfolding. You will have seen the latest reports from independent experts on the defence capability of an independent Scotland. Are you genuinely confident about the answers that the Scottish Government has given on NATO membership? NATO membership is not automatic. It is a matter for the North Atlantic Council to determine, as has been pointed out by NATO itself.
And even though the SNP has reluctantly changed its view on membership, the response from NATO is that an independent Scotland would still need to apply. Outside experts, such as the Scotland Institute, have said that the SNP position assumes automatic entry and imposes conditionality on NATO. And the Scottish Government has to accept that NATO membership is not a done deal. Every NATO member, whether it possesses nuclear weapons or not, needs to sign up to the Strategic Concept which states in terms that NATO will be a nuclear alliance for as long as these weapons exist.
And this is not something that can be fudged or brushed under the carpet.
Those are my questions. I don’t pretend to be dispassionate about the answers. I care a great deal about the choice that people in Scotland will make. I also don’t want to suggest that independence only cuts one way. I am quite clear that if Scotland were to leave the United Kingdom, it would be a loss for all sides.
Both Scotland and the UK would be diminished - in our global standing, in our future economic prospects and by erecting barriers that would cut across the long-standing ties of friendship and family between us.
So I want to use the remainder of this speech to set out the positive case for what we can achieve in Europe if we stay together. First let me knock down the suggestion that the only way Scotland can remain a member of the EU is if it votes for independence. That is just not true. In January, the Prime Minister set out clearly his vision for Europe – a Europe that is more competitive, more flexible, more open and more democratically accountable. His goal is to reform the EU into a body in which the British people will feel comfortable, and then to hold a vote in which we settle the question of Britain’s membership once and for all – a vote in which the Prime Minister made clear, he wants to campaign, heart and soul, to remain in the EU.
The background to the Prime Minister’s speech was five years of undeniably tough times in Europe. The speech has sparked a major debate about Europe’s future, and this is a debate that we are helping to shape. The Eurozone has been in an extended recession. One in four young people is unemployed. Countries across Europe have had to slash spending, and not just in southern Europe. Sweden is looking at cutting pensions and sickness benefits, as is Denmark. Finland is under pressure to raise the pension age.
In that European context, Britain has been holding its own. We have an economy that is starting to recover. We have remained attractive for investors. UN figures released this week showed that we have held onto our position as number one in Europe for foreign direct investment, which rose by 22% last year at a time when investment worldwide fell by 18%. And businesses created 1.3 million private sector jobs across the UK since 2010. Our employment rate is above the EU and Eurozone average, and higher even than the employment rate in the United States.
But we urgently need to tackle competitiveness in Europe because the EU is central to our future prosperity. It is forecast to be our main market for the next ten to fifteen years.Now the Scotch Whisky Association can tell you that the French drink more Scotch in a month than they do cognac in a year. But Europe matters for other Scottish exports too: seafood, agricultural products; wind and wave technology; machinery; equipment; oil and gas; and as a source of students for Scotland’s top universities.
And sometimes hidden amidst the gloom in the world’s biggest marketplace, the EU, are opportunities for Scottish firms. This year’s Global Connections Survey showed that Scottish exports to the EU rose by 14.7% in 2011. Take a firm like Jaggy Nettle from the Borders, which got a grant from the UK Government to go to Milan Fashion Week, and now sells its clothes in luxury boutiques alongside labels like Prada.Europe is also the source of about half the UK’s investment stock. Last year, Spain’s Gamesa chose the port of Leith for a new wind turbine manufacturing plant in an investment worth £125m, and France’s Chanel bought up the Barrie Knitwear cashmere mill in the Scottish borders.
But while Europe remains our biggest market place, we live in a world that is changing rapidly. In China, there are now over 160 cities with populations of more than one million people. They include Edinburgh’s twin city of Xi’an and Glasgow’s twin city of Dalian. There are twice as many people living in these two cities alone as there are in the whole of Scotland. UN figures released this month forecast that the global middle class will number over three billion by the end of the decade, over half of whom will be in Asia.
This is an opportunity for all of us as it’s the global middle class that wants the exports that UK firms produce. Working together, our EU membership is helping us to win better terms for trade across the world in the developed and emerging economies alike. We need to focus on this challenge. We cannot afford to stand still.
And we are winning support from other member states because they can see that the reforms we are seeking benefit all of Europe and not just the United Kingdom alone. To take a single example, at the G8 summit in Lough Erne this month, we helped to launch negotiations on the Transatlantic Trade and Investment Partnership, the world’s biggest ever trade deal. The benefit to the UK from this deal between the EU and the United States would be up to £10 billion a year, the equivalent of £380 per family in the UK.
For Europe, the figure is £100 billion and for the US £80 billion. Success with this trade and investment partnership will bring concrete benefits for businesses in Scotland, for which the US is the largest international export market – the destination for £3.5 billion of goods and services every year.
The Wall Street Journal said the deal was, and I quote, “a major political coup” for the UK, but recognised too the effort that had gone into these talks. It noted: “They didn’t come about by accident: they were the result of months of diplomatic effort by British officials”. I would add by British Ministers too, especially the Prime Minister who has worked hand in hand with Angela Merkel in pushing for the deal with other European countries.
In summary, I would like to ask each and every one of you to weigh up the options very carefully ahead of a referendum. We know that a vote for independence is a vote for uncertainty, with its attendant risks and costs. And we know that no one is forcing the Scottish people to go down this path. I can say in all sincerity that people throughout England, Wales and Northern Ireland want our centuries-old Union to continue. And when it comes down to it, the vote next September will have the greatest impact on Scotland’s young people, the majority of whom want to stay in the UK according to the most recent polls.
Independence would close off an avenue of opportunity for those who are self-confident enough to use the double identity they have as British and Scottish to make their way in the world – as countless Scots have done before them. Some will have ambitions that lie mainly or wholly in Scotland, but there will be others that want to test themselves against a wider field.
…Politicians who could measure their stature against Disraeli, Lloyd George or Keir Hardie, with the ability to inspire and lead 63 million British people. I am reminded here of Gordon Brown, an MP from a Scottish constituency, of others with a Scottish heritage such as Tony Blair and Harold Macmillan, who led the whole of the United Kingdom.
…Diplomats who want to make their careers in a diplomatic network with 267 posts in 154 countries and twelve territories worldwide.
…Soldiers, sailors and aviators who could command the world’s finest military in operational missions around the world.
…Scottish economists who want to tackle global poverty via the G8, the G20 or the world’s top economic bodies.
…Businessmen and women who may well be based in Edinburgh or Inverness, but who are equally at home in London or Cardiff, and who can call on UK Trade & Investment’s export support in more than 100 markets.
…And athletes who – after the Commonwealth Games in Glasgow next year will want to represent Team GB at the Rio 2016 Olympic Games.
By working together, we can provide that support and help the next generation to prosper.
My belief is that the people of Scotland should have the opportunity to have the best of both worlds. We should help each other out as family and friends do.
That is our common purpose within the UK, and that is what should be our joint endeavour over the coming years.
Thank you very much indeed. | 18,579 | 7,814 | 0.000131 |
warc | 201704 | Legal history: cases about clubs and associations
Please note that the following material is not a full summary of the case - it merely highlights the principle referred to in the appropriate section of this manual.
Blackmoor Golf Club VTD 2027
The club rented its golf course from an associated company, Blackmoor Links Ltd. Nearly all members had to make an interest-free loan to the company. The tribunal found that the loan to the company was part of the consideration for the supply of facilities by the club.
Exeter Golf and Country Club Ltd 1981 STC 211
The Exeter Golf and Country Club asked its members to make interest-free loans to it to raise additional funds. HMRC assessed on the basis that the loans were non-monetary consideration for membership supplies. This consideration had to be valued at open market value. HMRC determined that value by calculating the interest that would have been payable on an equivalent loan from a bank. The Court of Appeal upheld the assessment.
Institute of Leisure & Amenity Management 1988 STC 602
In this case the Judge said about the term civic nature, “In my judgement, the expression does not include organisations which aim to provide everyday and generally expected municipal services which in modern conditions include the provision of parks, leisure centres and similar facilities”.
It was also considered that ‘profession’ and ‘professional’ should be given a relatively narrow meaning. The meaning should be restricted to what is generally understood to be a profession.
Largs Golf Club 1985 STC 226
Members of the club had to buy a unit issued by the trustees of a separate Development Trust. The Court of Session found that the acquisition of a unit constituted consideration.
Nottingham Fire Service Messing Club VTD 348
The fire service provided a canteen, cooking equipment and cooks at a fire station. An operational fireman was paid £1 a week to act as mess manager. The mess manager signed off the accounts of the canteen, which was described as a club, although there was no constitution, committee, officers or rules. Prices were fixed to cover the cost of the food supplied. Anyone at the fire station could use the canteen.
The tribunal held that the canteen was not run by a club or organisation. It therefore did not have to register separately for VAT. The tribunal found that the canteen was run by the mess manager acting as an employee or agent for the fire service.
Tron Theatre Ltd 1994 STC 177
A company that promoted drama was registered as a charity. It requested sponsorship for seats in its theatre for £150. In return sponsors would get priority booking for two gala evenings, acknowledgment of their sponsorship on the seats and acknowledgment on a board in the theatre foyer.
The Court of Session agreed that the supply was taxable because the company would not have provided the goods and services for less than the £150 that the sponsors paid. Therefore the whole of the £150 was consideration in money under what is now section 19(2), VAT Act 1994. | 3,106 | 1,506 | 0.000679 |
warc | 201704 | Without any protective treatment, most bamboo species have an average natural durability of less than 2 years. Stored under cover, untreated bamboo may last 4-7 years. These variations in bamboo durability strongly depend on the species, the length of the culm, the thickness of the wall, but also, and equally important, the time of harvesting.
Untreated bamboo, just like almost any other wood, has a high chance of being attacked by insects. Bamboo insect infestation occurs due to the presence of starch and other carbohydrates. Insects obtain their food supply from the bamboo and degrade it, therefore bamboo should be chemically treated to avoid infestation.
The forming of bamboo mold, spores and mildew on the surface of bamboo canes is not uncommon, especially when bamboo is not 100% dry. Surface mold on bamboo products will only occur once, maybe twice until the moisture content inside the bamboo canes is completely evaporated.
Storing bamboo in water or "leaching bamboo" is a traditional bamboo preservation method, used by indigenous communities and farmers of several Asian and Latin American regions. In Latin America it has been the tradition to transport bamboo from the mountain and jungle areas towards the urban centers by means of bamboo rafts.
Chemical bamboo preservation (with or without the help of special equipment) ensures long term protection. Depending upon the method of bamboo treatment, chemical preservatives can impart short term or long term protection.
Drying bamboo poles requires more time than wood of similar density. This because bamboo possess hygroscopic materials (compound that easily absorbs moisture) that may contain 50-60% moisture content, depending on the felling season, area of growth and species. | 1,765 | 913 | 0.001101 |
warc | 201704 | Customer Logins
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Semiannual Eurasia Transportation Summits Spring meeting (Istanbul), fall meeting (Moscow or London), featuring member-selected topics and interactive discussions with industry peer and regional decision makers Briefing Books and Discussion Summaries IHS Energy research conducted for and available to Forum members only Informal Networking Events Private dinners/receptions with Eurasian country guests and IHS Energy experts Events Invitations to exclusive client-IHS expert gatherings; seats at IHS Energy spring and fall Executive meetings Roundtables; seats at IHS CERAWeek; invitations to the annual IHS Energy Executive Conference in Houston (additional fee). Analyst Privileges Timely responses from on-demand IHS Energy researchers
In addition to delegate membership deliverables, executive membership includes:
Eurasia Oil Export Forecasts (online delivery, Excel format) Historical data and outlooks to 2035, with semiannual updates; includes assumptions and highlights of key changes since last update Eurasia Gas Export Forecasts (online delivery, Excel format) Historical data from 1990 and outlooks to 2035 for natural gas production, consumption and exports with semiannual updates for major regional producers and all consumers; includes assumptions and highlights of key changes since last update Energy and the New Global Competition: Perspectives from IHS CERAWeek 2014 The articles in this IHS Energy Special Report, published in The Wall Street Journal during IHS CERAWeek 2014, examine how the competitive landscape in the energy industry is being reshaped by rapid change in markets, emerging new technologies, and shifts in geopolitics. The Energy View from 2030: Which scenario will it be? When developments occur that surprise us, it is often because assumptions about the present, as well as the future, have been overturned. The consequences can be very significant for companies, governments, and societies. The history of energy is filled with unexpected developments that go against what had been the general consensus. Although no course of action will provide true clairvoyance about the future, the process of developing scenarios forces us to question the present in order to understand the different ways the future could unfold and to prepare for them. This essay is based on the current IHS Energy Scenarios, which provide three distinct visions of how the future could unfold.
Executive-level members receive our proprietary Eurasian oil and gas forecasts to 2035, covering the following concepts:
At this global energy company, the Market Intelligence team – which supports procurement decisions totaling $13.5 billion annually – cut in half the number of source locations that analysts must access to gather information and reduced by 50% the time required to generate reports/charts for decision makers.Learn more about our client’s successes
With operations in Texas and California, this independent oil and gas company implemented a single, integrated system that enabled access to 30+ standard reports with the latest well and production info via the Web, avoiding manual processes and increasing data currency. Easily created/maintained “hands-free” data feeds saved months of development time.
To gain an advantage in highly competitive energy markets, this industry leader leverages rapid, accurate analysis of global oil and gas projects -- from exploration to concept selection and field plan development -- that save time and deliver insights by comparing cost scenarios and production profiles.Learn more about our client’s successes
One of the world’s largest energy companies – a Fortune 100 leader in global oil, gas and chemical markets – turned a potential business disruption into a new opportunity to drive efficiency and innovation by providing 9,000+ worldwide employees with easy access to a major catalog publication via a single online platform.Learn More About Our Customers Success | 4,217 | 2,007 | 0.000505 |
warc | 201704 | Alibaba’s Tmall Global now features goods from 14,500 overseas brands, 80% of them selling in China for the first time.
Apps like Foursquare are most popular among the young, Pew Research Center finds.
Location-based services is a hot topic in mobile commerce. And there’s a lot of hype around “geosocial” mobile apps such as Foursquare, Gowalla and Shopkick, which enable users with GPS-outfitted smartphones or wireless-equipped laptops to “check in” at locations, such as a retail store, share their location with friends, read comments about that location by other users, and find other users nearby. According to a new study by the Pew Research Center’s Internet & American Life Project, however, it’s still early days.
4% of online adults use a service such as Foursquare or Gowalla. On any given day, 1% of Internet users are using these services. This is the second survey by Pew to ask about location-based services. In a May 2010 survey, 5% of adult Internet users said they had used such an app or site.
Key findings in the current survey include:
7% of adults who go online with their mobile phone use a location-based service. 8% of online adults ages 18-29 use location-based services, significantly more than online adults in any other age group. 10% of online Hispanics use these services, significantly more than online whites (3%) or online blacks (5%). 6% of online men use a location-based service compared with 3% of online women.
Though location-based services typically require a phone with mobile web access and GPS functionality, 2% of non-wireless users (those who do not go online with either a mobile phone or a wireless-enabled laptop) also say they have used a location-based service. This number may include mobile phone users who use geosocial services that enable checking in via text message. These non-wireless respondents may also include individuals who use location-reporting services such as Google Latitude or Dopplr, which can be used on a PC.
The new Pew report is based on the findings of a daily tracking survey on Americans’ use of the Internet. The results in this report are based on data from land-line and mobile telephone interviews conducted by Princeton Survey Research Associates International between Aug. 9 and Sept. 13, 2010, among a sample of 3,001 adults, age 18 and older. | 2,385 | 1,154 | 0.000887 |
warc | 201704 | Better Communication In LCPS Goal: 100
For decades, K-12 educators have known that parental involvement is one of the most powerful drivers of student achievement and school performance. What has changed significantly in the world of K-12 education, however, is that new web-based technologies have made it possible for schools to increase parental involvement in ways that were simply impossible before -- using cost-effective technology solutions that have broad, sweeping impact across all subject areas, all grade levels, and at all performance levels --- truly transforming the learning community. The obstacles schools face in harnessing the power of parental involvement primarily revolve around the issues of information and communication. Older children often filter what information reaches their parents, and younger children can rarely articulate the kinds of details parents want. In addition, the sheer volume of information that changes daily in a school environment presents a major communication challenge. Although there are many different parenting styles, all parents of school-age children need current and relevant information to effectively apply the parenting styles that work for them. When parents have rich and timely information, they can use it to make a tremendous positive impact on the success of their children. In some cases, timely information to parents can be a matter of very high stakes: the difference between graduating or not … between making the honor roll or not … between being eligible for a sports team or not. Our mission is to get LCPS to provide the world leading technology solutions that help schools improve student performance by harnessing the power of parental involvement, supporting teachers, and engaging the learning community. Parents and Teachers Must Communicate - we hear that over and over again. Please visit the following website for a preview of an example of the software system we want LCPS to begin using: www.edline.com
Sponsor Links Signatures 7 years agoRobert United States7 years ago 7 years agoLisa McCurtain United States7 years ago 7 years agoLori Snyder United States7 years ago 7 years agoPaula Zottoli United States7 years ago 7 years agoSheila D. Jasper United States7 years ago 7 years agoGrace Vigil United States7 years ago 7 years agoDianne Davis United States7 years ago 7 years agoBeatrice Mines United States7 years ago | 2,423 | 1,091 | 0.000922 |
warc | 201704 | American Dryer: A Cost-Efficient Drying Alternative
American Dryer has been manufacturing hand dryers since 1952, enabling those who maintain public restrooms to do away with wasteful paper towels. Their eXtremeAir, Advantage, and Global lines are energy-efficient and durable, and span a wide range of features and prices to meet any operation's needs.
Reduce Operating Costs
Purchasing an American Dryer unit allows you to save money in several ways. To see how much your business can save per year and how quickly your hand dryer purchase will pay for itself, use the company's cost calculator. Here are a few of the ways an American Dryer hand dryer can cut your costs:
No longer have to purchase paper towels, saving on the purchase price and delivery costs. Use fewer trash bags and create less waste for pickup. Reduce labor and time spent on cleaning restrooms. Lower energy use and utility costs than standard hand dryers.
In addition to reducing operating costs, purchasing one can help your business gain LEED credits, which can, in some locations, translate into grants and tax credits
1. American Dryer Global
American Dryer manufactures five lines of hand dryers. Below is some information about each of them to help you find the model that will work best for your business.
The
Global® series is the company's economy offering. This model features a heavy-duty, one-piece cover available in:
The cover is vandal-resistant, with tamper-resistant screws and protected air intake vents. The 1/12 HP motor is maintenance-free and permanently lubricated, and the nichrome heating element includes a thermal protector. An automatic sensor turns the dryer on when the user puts his or her hands under the opening, and allows the dryer to run for a maximum of 60 seconds. This model's 63-decibel sound level is the quietest in its class.
American Dryer Advantage
The
Advantage™ is a powerful hand dryer in a compact package. The one-piece cover is available in five finishes: White ABS White epoxy-coated steel Brushed stainless steel Satin chrome finished stainless steel Black graphite epoxy-coated steel
The cover features tamper-resistant screws and shielded intake vents to deter vandals. The energy-efficient sensor activates the 1/8 HP motor, and will blow air for as long as 35 seconds. Average dry time is only 25 seconds, and the sound level is the quietest in its class at only 67 decibels. The nichrome heating element has a thermal protector to prevent overheating for maximum life.
American Dryer eXtremeAir GXT
The
eXtremeAir GXT is a high-speed, energy-efficient hand dryer. This model is available in five finishes: White ABS Satin Chrome-Plated Steel White Epoxy-Coated Steel Black Graphite-Coated Steel Stainless Steel
This model was American Dryer's first to feature adjustable sound and speed. The speed is adjustable, with the corresponding sound levels ranging from 69 to 83 decibels. This unit's dry time is as quick as 10 seconds. This model is also compatible with any voltage from 100 to 240 volts. The GXT series is GreenSpec® listed, Greener Product certified, and can contribute to a building's LEED credits.
American Dryer eXtremeAir EXT
American Dryer's
eXtremeAir EXT dryer is the most energy-efficient hand dryer currently available, with power consumption so low that three can be installed on one circuit. This model's exterior finishes include: White ABS Satin Chrome-Plated Steel White Epoxy-Coated Steel Black Graphite-Coated Steel Stainless Steel
With its cool-air design, the EXT model blows air at 85 degrees F to use as much as three times less power than other hand dryers that claim energy efficiency. This model is GreenSpec listed and can help businesses qualify for LEED credits.
American Dryer eXtremeAir CPC
The
eXtremeAir CPC line from American Dryer uses Cold Plasma Clean® technology to kill germs such as E. coli, salmonella, staph, MRSA, C. diff, and influenza A without the use of a HEPA filter that has to be changed. This model is available in:
Satin Chrome-Plated Steel White Epoxy-Coated Steel White ABS Stainless Steel Black Graphite-Coated Steel
This unit's sound and speed are adjustable so you can find the balance that works for your business. It is GreenSpec listed and can also help buildings qualify for LEED credits.
1.
Good to Know: Green Building Incentive Strategies U.S. Green Building Council. Accessed October 2015.
2.
Cost Calculator American Dryer. Accessed October 2015. | 4,508 | 1,952 | 0.000518 |
warc | 201704 | Home loans can be complicated. But choosing one that meets your needs can be much easier if you gather enough information before you make a decision. Here are 20 questions that might apply to your situation.
Rate, term and payment The most fundamental questions about any loan concern how long you’ll have to repay the amount you borrowed, how much interest you’ll be charged and whether the interest rate and payments are fixed for the entire term or subject to periodic adjustments as market interest rates fluctuate. Here are four questions to ask: 1. What is the term of this loan? 2. What is the initial interest rate? 3. Is that rate fixed or adjustable? 4. How much would my initial monthly payments be? Adjustment periods, caps and negative amortization If the interest rate on the loan is adjustable, your monthly payment likely will change in the future and could be much higher than your initial payment.
Here are some questions to ask on this topic:
5. When can the interest rate be adjusted?
6. How will the interest rate be calculated?
7. What is the maximum interest rate increase for each adjustment period?
8. What is the maximum interest rate increase over the lifetime of the loan?
9. How much would my payment be today if the interest rate were calculated as it will be at the first adjustment period?
10. How much would my payment be at the maximum interest rate?
11. Could the amount I owe increase over time?
Costs and fees
Along with the interest rate and payment, you’ll want to consider the upfront and ongoing fees and costs you’ll be charged in connection with the loan.
Here are some questions to ask regarding costs and fees:
12. Can I see a Good Faith Estimate (GFE) for this loan?
13. Which of the costs on the GFE might change and by how much?
14. Are there any other costs that aren’t on the GFE?
15. Does this loan have a prepayment penalty?
16. Would this loan require an escrow account for homeowner’s insurance and property taxes?
17. Would I need to pay for mortgage insurance on this loan?
Needs and qualifications Not all loan products are available to all borrowers, so you’ll want to explore your options before you decide which loan would be right for you. Here are three questions that may help: 18. What are the qualifications for this loan? 19. Why would you recommend this loan for my needs? 20. Which other loans might also meet my needs? These 20 questions can help determine if a loan is right for you. Don’t be afraid to ask your lender these and any other questions you may have. The more you know, the better equipped you’ll be to choose your loan. | 2,668 | 1,204 | 0.000852 |
warc | 201704 | Ito S.,Miyagi Cancer Center | Tase T.,Miyagi Cancer Center | Satoh K.,Miyagi Cancer Research Institute | Ueki M.,Miyagi Cancer Center | And 2 more authors.
Pathology International | Year: 2014
In this report, unique endocervical glandular lesions exhibiting gastric differentiation were examined in a patient with Peutz-Jeghers syndrome. The result of the human papillomavirus (HPV) in situ hybridization (ISH) for the hysterectomy specimens was negative, but they demonstrated a papillary mucinous adenocarcinoma at the proximal endocervix continuous to atypical lobular endocervical glandular hyperplasia. Both contained MUC6-positive neutral mucin in cytoplasm, and showed different immunoreactivity to p16, Ki-67, and p53. Moreover, they harbored the identical K-RAS gene mutation suggesting that there was a common origin. Somatic K-RAS mutation and defective function of p16 may have been involved in the tumorigenesis of these unusual mucinous neoplasms. © 2014 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd. Source
Tanaka K.,Saga University | Tsuji I.,Tohoku University | Tamakoshi A.,Aichi Medical University | Matsuo K.,Aichi Cancer Center Research Institute | And 13 more authors.
Japanese Journal of Clinical Oncology | Year: 2012
Objective: With increased interest in non-alcoholic steatohepatitis, its common co-morbid condition, obesity, has recently attracted much attention as a risk factor for liver cancer. Recent studies also suggest that obesity may play a role in the development of liver cancer in alcoholic cirrhosis or viral hepatitis and in the general population. Methods: We systematically reviewed epidemiologic studies on overweight/obesity and liver cancer among Japanese populations. Original data were obtained by searching the MEDLINE (PubMed) and Ichushi databases, complemented by manual searches. The evaluation was performed in terms of the magnitude of association in each study and the strength of evidence ('convincing', 'probable', 'possible' or 'insufficient'), together with biologic plausibility. Results: Among nine cohort studies identified, five (four on patients with chronic liver disease and one on local residents) reported a weak to strong positive association, while four (one on patients with hepatitis B and three on local residents) found no association [summary relative risk for one unit increase in body mass index (kg/m. 2) 1.07, 95% confidence interval 1.03-1.10]. All three case-control studies identified (two on cirrhotic patients and one on atomic bomb survivors) reported a strong positive association (summary relative risk 1.31, 95% confidence interval 1.12-1.53). Overall, the summary relative risk was estimated at 1.13 (95% confidence interval 1.07-1.20), and overweight/obese individuals had a relative risk of 1.74 (95% confidence interval 1.33-2.28) compared with those who had normal/low weight. Conclusions: We conclude that overweight or obesity 'probably' increases the risk of primary liver cancer, to a moderate degree, among the Japanese population. © The Author 2012. Published by Oxford University Press. Source
Kashino I.,Center for Clinical science | Mizoue T.,Center for Clinical science | Mizoue T.,National Center for Global Health and Medicine | Tanaka K.,Saga University | And 17 more authors.
Japanese Journal of Clinical Oncology | Year: 2015
Objective: The association between vegetable consumption and colorectal cancer risk remains unclear and may differ by region. We performed a systematic review and meta-analysis of epidemiologic studies on this issue among the Japanese population. Methods: A systematic review and meta-analysis was performed by searching MEDLINE through PubMed and the Ichushi database for cohort and case-control studies that were published by the end of December 2014. Associations were evaluated based on their magnitude and the strength of the evidence. Meta-analysis was performed by using the random effects model to estimate the summary relative risk with 95% confidence interval according to the study design. The final judgment was made based on a consensus of the research group members with consideration for both epidemiological evidence and biological plausibility. Results: We identified six cohort studies and 11 case-control studies on vegetable intake and colorectal cancer among the Japanese population. Of the cohort studies, one study showed a weak inverse association with colon cancer and another study showed a weak positive association with rectal cancer in men, but other studies found no associations between vegetable consumption and colon and rectal cancers. With regard to case-control studies, one study found a strong inverse association with colon cancer, and three studies showed a weak-to-strong inverse association with rectal cancer. In meta-analysis, the summary relative risk (95% confidence interval) for the highest vs. the lowest categories of vegetable consumption were 1.00 (0.92-1.10) and 0.75 (0.59-0.96) for cohort and case-control studies, respectively. Conclusions: There was insufficient evidence to support an association between intake of vegetables and the risk of colorectal cancer among the Japanese population. © The Author 2015. Source
Wakai K.,Nagoya University | Sugawara Y.,Tohoku University | Tsuji I.,Tohoku University | Tamakoshi A.,Hokkaido University | And 17 more authors.
Cancer Science | Year: 2015
International reviews have concluded that consumption of fruit and vegetables might decrease the risk of lung cancer. However, the relevant epidemiological evidence still remains insufficient in Japan. Therefore, we performed a pooled analysis of data from four population-based cohort studies in Japan with >200 000 participants and >1700 lung cancer cases. We computed study-specific hazard ratios by quintiles of vegetable and fruit consumption as assessed by food frequency questionnaires. Summary hazard ratios were estimated by pooling the study-specific hazard ratios with a fixed-effect model. In men, we found inverse associations between fruit consumption and the age-adjusted and area-adjusted risk of mortality or incidence of lung cancer. However, the associations were largely attenuated after adjustment for smoking and energy intake. The significant decrease in risk among men remained only for a moderate level of fruit consumption; the lowest summary hazard ratios were found in the third quintile of intake (mortality: 0.71, 95% confidence interval 0.60-0.84; incidence: 0.83, 95% confidence interval 0.70-0.98). This decrease in risk was mainly detected in ever smokers. Conversely, vegetable intake was positively correlated with the risk of incidence of lung cancer after adjustment for smoking and energy intake in men (trend P, 0.024); the summary hazard ratio for the highest quintile was 1.26 (95% confidence interval 1.05-1.50). However, a similar association was not detected for mortality from lung cancer. In conclusion, a moderate level of fruit consumption is associated with a decreased risk of lung cancer in men among the Japanese population. © 2015 The Authors. Source
Shimazu T.,Research Center for Cancer Prevention and Screening | Wakai K.,Nagoya University | Tamakoshi A.,Hokkaido University | Tsuji I.,Tohoku University | And 20 more authors.
Annals of Oncology | Year: 2014
Background: Prospective evidence is inconsistent regarding the association between vegetable/fruit intake and the risk of gastric cancer. Methods: In an analysis of original data from four population-based prospective cohort studies encompassing 191 232 participants, we used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of gastric cancer incidence according to vegetable and fruit intake and conducted a meta-analysis of HRs derived from each study. Results: During 2 094 428 person-years of follow-up, 2995 gastric cancer cases were identified. After adjustment for potential confounders, we found a marginally significant decrease in gastric cancer risk in relation to total vegetable intake but not total fruit intake: the multivariate-adjusted HR (95% CI; P for trend) for the highest versus the lowest quintile of total vegetable intake was 0.89 (0.77-1.03; P for trend = 0.13) among men and 0.83 (0.67-1.03; P for trend = 0.40) among women. For distal gastric cancer, the multivariate HR for the highest quintile of total vegetable intake was 0.78 (0.63-0.97; P for trend = 0.02) among men. Conclusion(s): This pooled analysis of data from large prospective studies in Japan suggests that vegetable intake reduces gastric cancer risk, especially the risk of distal gastric cancer among men. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source | 8,855 | 3,468 | 0.00029 |
warc | 201704 | M. D. Anderson Cancer Center
Cancer Newsline Audio Podcast Series Date: September 29, 2008 Duration: 0 / 17:48
Return to Cancer Newsline
Welcome to Cancer Newsline a weekly podcast series from The University of Texas M. D. Anderson Cancer Center in Houston TX. The aim of Cancer Newsline is to help you stay current with the news on cancer research, and the rapidly changing advances in cancer diagnosis, treatment and prevention and provide you with the latest information on reducing your family’s risk of being diagnosed with cancer. My name is Doctor Leonard Zwelling I am a professor of medicine and pharmacology here at M. D. Anderson.
Today we will be talking with Dr. E.J. Shpall professor of medicine in the Department of Stem Cell Transplantation and Cellular Therapy and Dr. Laurence Cooper associate professor of Pediatrics in the Children’s Cancer Hospital at M. D. Anderson and Chief of the Cell Therapy section in the, Division of Pediatrics. What we will be talking about today is stem cells, their use in bone marrow transplantation and the availability of stem cells through donated and banked umbilical cord blood.
Dr. Shpall lets start with the obvious question. What is a stem cell?
Well, a stem cell is a very primitive cell that comes from the bone marrow originally and it is a cell that can stay very primitive or divide and make things that are more mature that we need to live. So a marrow stem cell ultimately divides and makes platelets to keep us from bleeding it makes red cells to carry oxygen it makes white cells to fight infection and to produce immune cells that keeps the immune systems healthy.
Now why umbilical cord blood? This is something a little bit newer then the traditional bone marrow transplantation. Why it is such a useful source of stem cells?
So many years ago, decades ago we started doing stem cell transplantation with bone marrow and bone marrow works well and preferred blood works well and if you can find a donor for a patient with bone marrow, it’s a standard of care transplant in this day and age. The problem is our first choice is that transplanters always to find a donor in the family and there is normally one in four patients that will have a member in the family because of the gene pool and how the genes combine you need to match the HLA markers the unique marker on your blood in order to have a safe transplant. And so one in four in the family will match. We therefore increasingly over the past decade and a half have been going outside the family there is a national marrow donor registry. Where 7 million donors have registered to donate their cells and they do it everyday. You can often find a donor in the registry for your patient which is also very good source of hematopoic support. The problem is if your white, Caucasian we find the donors 80% of the time, but if your any type of ethnic minority African American, Hispanic, Asian, interestingly Jewish. We do not find donors readily in the registry. It’s multi factorial, the reason that we don’t reason number one minorities don’t seem to donate readily and number two for certain of the ethic groups particularly African Americans they have a more complicated gene pool that makes it more difficult to match. So that you need more donors available to find matches then for other races.
So is that where the umbilical cord blood comes in?
Umbilical cord blood came on the scene in 1988 the first transplant was done. When Dr. Gluckman… Eliane Gluckman from France realized when you take a quart of blood from the umbilical cord and transplant to patient because it’s very rich in the stem cells that are in the marrow and when that worked several things became clear. Number one you can start banking cords all over the world that had ethnic minorities so that cord banks go into hospitals where African Americans or Hispanics are born and they are increasing the inventory of those units rapidly. So there are more out there for minority patients and the most critical thing is that cord blood is more naïve it has fewer cells and fewer T-cells so it appears when you use cord you don’t have to have a specific HLA match as you do for marrow so where routinely in the marrows we have to have six out of six of the major antigens match. Were using four out of six with equal efficacies.
So it got more wiggle room, more common.
More common and you can go into an Asian hospital and have Asian cords. So at M. D. Anderson with the first three thousand transplants we did with marrow only 25% of our patients were minority. When you look at the couple hundred cord bloods we done, 59% are minorities. So we are clearly with this source of hematopoic support supporting a unmet need that we desperately had no options for in the past.
Dr. Cooper we heard a lot about embryonic stem cells back in 2001 when President Bush made his ruling with regard to their availability and for federal funds. What’s the difference between the stems cells were talking about here and those stem cells.
That’s a common source of confusion and the key difference is that the stem cells that Dr. Shpall described are harvested from essentially the babies blood. Right after birth, so the mom delivers, the cord is clamp and then cut. Then the blood is drained from the placenta after the baby is born safely wrapped and bundled it’s those cells that essentially in that placenta or in that blood pool that are then collected and stored ,frozen in the banks like M. D. Anderson. That is a source of hematopoic stem cells. Hematopoic being the word physicians use to describe the genesis of blood and blood components. Just like E.J. said, to make platelets to make white blood cells or type of immune cells and red blood cells. The embryonic stem cells are a completely different type of cell, it’s much more primitive. In fact they belong way back in the genesis of the child, in the embryo in the mommy’s womb. Way back in the beginning and it’s those stem cells that are much more complicated in terms of there ethical use, translation into medicine.
You want to make it clear that the ethics are quite different then ethics described.
Exactly! There is no risk to the baby or to the mom to collect umbilical cord blood.
Umbilical cord blood is an adult stem cell. It is one of the adult stem cells that’s cord marrow, peripheral blood.
So it has already started its pathway toward being blood.
It is definitely adult to distinguish it from the more primitive. What diseases are you using stem cell transplants for?
In pediatrics where a lot of the initial enthusiasm from cord blood transplant got going, we have two main types of patients that come to our service. Children with cancer with malignancies and children with non-malignancies with inherited diseases. So in cord blood actually been successful for both of these both as a way to deliver a new immune system to patients with cancer and importantly also to deliver a new source of hematopoic blood deriving stem cells for patients who had a inborn error either in there actual blood component. Some babies are born with a marrow that poorly functions can’t make platelets, can’t make red blood cells and we can resuscitate those children by infusing in this cord blood stem cells. Also very interesting blood stem cells when there put in have the ability to help correct some metabolic diseases, some enzyme diseases in children and that work has been started at Duke in many ways and now really has farmed out across the United States and across the world and as a standard of care. So if you have a number of malignant disease as well as non-malignant disease you will be eligible and would receive umbilical cord blood transplantation for cure.
Dr. Shpall, in the adult population, same source of diseases or different?
The adult population is primarily malignant diseases, hematologic malignant diseases high risk so acute leukemia, lymphoma, chronic lymphocytic leukemia, even CML -chronic myelogenous leukemia have fail hematinic type standards. Those are the main Non-Hodgkin’s and Hodgkin’s Disease are all very commonly treated with cord blood.
Is this looked upon as last ditch treatment or do you do it earlier then you use to?
So it’s moving up in the priority. It use to be a last ditch effort and now as our data is getting better, there are more cords available and the cords are getting better. Right now in our center if we can find a perfect ten out of ten donor in the registry. That’s still our first choice but absent that we will now take cord blood over a nine out of ten mismatched. Donor or other strategies we are often considering that to be acceptable. It has got more acceptable our data has got better and the results have got better.
Since this can be banked cause we talked about banking it. So you collect it and freeze it for later use. Should all families at the time where there children are born, bank the cord blood for later use?
That’s another really good question, so the Pediatrics Society actually have a position statement on this and the recommendation is yes family should bank cord blood but it should not be patient specific. So in other words if a mom comes into the hospital we would encourage that mom to donate for instance to Dr. Shpall’s bank and that’s an anonymous donation, that family would no longer have record about where that cord blood will be used but would have essentially given the gift of life because that bank can be drawn by Dr. Shpall or myself when we have a child or in my case an adult whose in need for an umbilical cord blood we will pull that cord that has been donated to the bank and infuse it into the patient.
Is there any cost to the patient for doing that?
No cost at all to a public bank. That is to make a distinction from the public bank and all the private banks which are aggressively trying to get business to have mothers pay to keep there units banked for themselves and that does cost anywhere from 1200 to 1800 dollars and a yearly fee. It’s very unlikely for the most part that these will ever be used. These are people whose families don’t necessarily have these cancer types.
Just to follow up, I think it’s important to point out that the quality of the cells that are stored in the private bank is not subject to the inspection and the level of rigor we apply to our own public banks. So using during transplant we are actually very nervous by using private banked cells. I think historically those cells have not performed as well as those families that have invested and put up money would have wanted.
Lot of them are very small, they don’t have the expertise.
One of the things that came up when I was reading about these things is the idea of manipulating these cells after there collected. Dr. Cooper you do this in your laboratory. Could we talk about the kinds of manipulation you can do can you expand the populations and why does that make it better?
This is where E.J. and I have an overlap, both in the scientific world and also moving this type of technology to the clinic. As E.J. pointed out, cord blood transplantation is really achieved as a platform technology now are secure in our ability to deliver cord blood cells to adults and kids. So the question is, can you do better? My world is one of essentially augmenting the immune response delivered from that cord blood inoculum. As E.J. pointed out, most parents know when a baby is born, the pediatrician says if that kid has an infection in the first couple of months in life, you've got to get that kid right to the doctors office, and the reason is the kid has a very immature immune system. So of course the cord blood that was collected at birth also has a very immature immune system. That has benefits, as we pointed out, in terms of being able to do transplants across HLA barriers, bring minorities into essential to receive this type of therapy but it also poses challenges for us immunologists because what we have to do is make sure those cord blood cell now put into the recipient grow up in a way that will keep that recipient safe. Grow up an immune system that will fight off infections but importantly fight off the underlying cancer. So that’s where my lab has really taken a strong position and we have used the power of gene therapy . Modifying the actual DNA content of the cord blood T-cells to endow the T-cell, a type of immune cell with a new property that essentially renders into a efficient cancer fighting cell.
So it’s now more then constituting marrow that have been destroyed by chemotherapy to treat the patient it itself become part of the therapy.
Exactly, and I think E.J. can comment on her technology and together, I think you will see the power of combining all of this.
Our strategy, a real problem with the cord blood is that when you transplant these patients they take very to recover, longer then marrow and the have a immune deficit for few month to a years after the transplant. So our lab been focusing on expanding the cord ex vivo to improve the neutrophil and the platelet engraftment. We have developed a number of different technologies and are now close to a promising technology were getting very rapid engraftment of neutrophil that we haven’t seen before. This is coupled with Laurence’s very promising technology, we know that lapse is a big problem in patients and we also know that brio infection in our patients is a big problem. Laurence actually is taking is receptor technology ultimately linking it with viral technology we going to be ultimately transplanting these cords that can go in and produce immune reconstitution but also target the b cell malignancies and the viruses. So it’s really an exciting strategy.
So the last question, let's talk about where this all fits in to the big picture of cancer therapy. Historically it’s been surgery, radiotherapy , and chemotherapy. This is all new, now you actually treating the cancer with the transplant. How does it all fit in?
Well I think there are a number of ways to answer that question. The simplest way is to say, as transplanters, we develop off the self therapies for patients. We want to have essentially a one stop shop. When patients malignancy they are seen at M. D. Anderson and then we for a cord from our pre-bank supply. Infuse that cord blood into patients after chemotherapy. Put that patient essentially into remission and then use that as a platform to graft in other cells. Whether it be expanded blood from E.J. or whether it be T-cells from me or other types of immune cells. So essentially this concept where we have essentially agents, biological agents cells as drugs that can be delivered on demand.
We hope within the next five years that will be a poly-pharmacy strategy. We'll have patients that are on out-units getting multiple different cellular subsets of the cord blood that are doing different things, but altogether improving the survival.
The obvious question is will this supplant the more traditional form of therapy at some point?
Cord blood is already surpassing the other types of transplantation that E.J. talked about. Cells being garnered from bone marrow or from peripheral blood so you can see that there is a lot of momentum. So it is likely this type of technology will continue to accelerate and enter into other types of therapy yet to be determined.
I don’t know that we would ever supplant… I mean we still give a preparative regiment to suppress the immune system to eradicate the tumor before we give the cord. So I don’t see the cord therapy itself replacing what we are doing but I think it’s adding improved benefit to what we are doing, and probably in tandem with what we’re doing.
Terrific! Listeners if you have questions about anything that you heard today on Cancer Newsline, please contact askMDAnderson at 1877-MDA-6789 or online at www.mdanderson.org/ask/. Thank you Dr. Shpall, thank you Dr. Cooper and for listening this episode of Cancer Newsline. Again this is a weekly series please tune in again next week for our next episode of this series. Thank You.
Return to Cancer Newsline
© 2007 The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd, Houston, TX 77030 1-800-392-1611 (USA) / 1-713-792-6161 | 16,513 | 6,645 | 0.000153 |
warc | 201704 | This is a brief narrated animation on how the neurotransmitter from the pre-synaptic neuron is released into the synaptic cleft and how its subsequent binding to receptors in the postsynaptic neuron brings about the transmission and propagation of the nerve impulse.
Type of Material:
Narrated animation
Recommended Uses:
• In-class lecture supplement• homework
Technical Requirements:
Flash.
Identify Major Learning Goals:
• Users will initially view electron micrograph of pre- and post-synaptic neurons and the synapse between them.• User will see and hear narration of how the neurotransmitter in the pre-synaptic neuron is released into the synaptic cleft, and how its binding with the receptors in the post-synaptic neuron brings about the propagation of action potential• User will learn what happens to the neurotransmitter after the action potential is generated
Target Student Population:
Middle School, High School, College General Ed, College Lower Division
Prerequisite Knowledge or Skills:
Knowledge of some biological terms associated with the nervous system
Evaluation and Observation
Content Quality
Rating:
Strengths:
• Material is accurate.• Micrograph clearly depicts the object being described, in this case the pre- and post-synaptic neurons and the synaptic clefts.• Narration is clear and concise.• Illustrates how neurotransmitters carry signal across synaptic cleft. • Illustrates role of calcium in neurotransmitter release.
Concerns:
• Movement of ions across membrane driving nervous impulse is not well illustrated.
Potential Effectiveness as a Teaching Tool
Rating:
Strengths:
• Narration helps students understand the relatedness of the topics as depicted in the animation.• Narration helps user focus on key concept, in this case the events that take place in the synapse.• Graphics and animation provide a visual and auditory enhancement for visual and auditory learners.• Illustrates a complex concept clearly. Easy to follow with good narration.• Could produce assignments based on the animation.
Concerns:
• No assignments or test questions are provided.• A little simplistic with regards to ion transport across the membrane driving nervous impulses, which is key to this concept.
Ease of Use for Both Students and Faculty
Rating:
Strengths:
• Narrations and animations played simultaneously without problems.• Information is easy to understand. | 2,514 | 1,109 | 0.000951 |
warc | 201704 | The TPB's CLRP Aspirations Scenario Study integrated far-reaching land-use and transportation alternatives into one synergistic system. The study looked at the effect of implementing a 1,650-mile regional network of toll lanes (including new lanes and conversion of existing lanes, a region-wide 500-mile system of high-quality bus service, and changes in land-use policies to promote denser, transit–oriented development. The scenario has the acronym “CLRP” in the title because it was designed to provide potential inputs for the TPB’s Constrained Long-Range Plan. The land-use and transportation components of the study were largely based on findings from previous scenario analyses – the Regional Mobility and Accessibility Study (2006) and the Regional Value Pricing Study (2008).
Key Documents and Presentations
April 2013
Preliminary analysis of an update to the CLRP Aspirations Scenario Study will be presented to the TPB. This update includes new baseline planning assumptions (2012 CLRP, Round 8.1 Cooperative Forecast, Horizon Year 2040), modeling tools (TPB Version 2.3 Travel Forecasting Model, EPA's MOVES emissions model), and changes to the variably priced lane network to account for the recently enacted MAP-21 legislation.
January 2013
The findings of the CLRP Aspirations Scenario Study were presented at the 92nd Annual Meeting of the Transportation Research Board in Washington, D.C. In addition to presenting the results, the paper compares the CLRP Aspirations Scenario Study to the recommendations outlined in the MAP-21 legislation for scenario development and analysis to evaluate how well the current TPB scenario planning process aligns with the new legislation and how the process can be improved in the future.
October 2011
Analysis from an additional sensitivity test, the "Streamlined VPL Sensitivity Test" was presented to the TPB. This additional sensitivity test was conducted to response to concerns about the high cost of the VPL Network in the original CLRP Aspirations Scenario.
September 2010
The "final" report on the CLRP Aspirations Scenario Study was presented to the TPB. This report contained analysis of the CLRP Aspirations Scenario as well as a sensitivity test which examined the impact of the land use changes alone. | 2,309 | 1,122 | 0.000907 |
warc | 201704 | Abstract
Background Patient Internet portals have created new opportunities for assessment and management of chronic conditions. Objective To conduct an online screening survey for a study recruitment using a secure patient Internet portal to identify primary care patients with untreated depression, chronic pain, or mobility difficulty before nonurgent office visits. Design Internet-based screening survey for a randomized trial. Participants Patients who were registered portal users who had scheduled primary care appointments. Approach Electronic study invitations via the portal were sent to 4,047 patients with scheduled visits to 34 primary care physicians participating in the study. After clicking on a link in the study invitation, patients were consecutively shown the study description, consent form, and lastly, the screening survey to determine final eligibility for study participation. Results Of the 2,113 (52%) patients who opened the study invitation, 1,001 consented online to join the study and 981 (98%) of these completed the screening survey. Of the respondents, 319 (33%) screened positive for 1 or more of the 3 conditions. Conclusions The online screening survey conducted through the patient portal was effective in identifying patients with chronic conditions in advance of scheduled primary care visits for participation in an intervention study. | 1,381 | 687 | 0.001459 |
warc | 201704 | Abstract
Abstract Familial visceral myopathy is a form of chronic intestinal pseudoobstruction in which fibrosis of the smooth muscle of the alimentary tract causes protean symptoms of disordered visceral motility. Based on our 8 year observation of six members of one family with familial visceral myopathy and review of the few well-documented case reports of this disease, we have confirmed a role for surgeons in tissue diagnosis, case identification, and palliation of incapacitating symptoms of familial visceral myopathy after obtaining dynamic radiographic assessment of the entire alimentary canal. Because the duodenum and colon are the usual sources of major dysmotility symptoms, patients incapacitated by duodenal or colonic pseudoobstruction may benefit from bypass or resective operations. | 807 | 439 | 0.002286 |
warc | 201704 | BACKGROUND:
States and national organizations spend millions annually on antismoking campaigns aimed at youth. Much of the evidence for their effectiveness is based on cross-sectional studies. This study was designed to evaluate the effectiveness of a prominent national youth smoking-prevention campaign in the U.S. known as truth that was launched in February 2000.
METHODS:
A nationally representative cohort of 8904 adolescents aged 12-17 years who were interviewed annually from 1997 to 2004 was analyzed in 2008. A quasi-experimental design was used to relate changes in smoking initiation to variable levels of exposure to antismoking messages over time and across 210 media markets in the U.S. A discrete-time hazard model was used to quantify the influence of media market delivery of TV commercials on smoking initiation, controlling for confounding influences. Based on the results of the hazard model, the number of youth nationally who were prevented from smoking from 2000 through 2004 was estimated.
RESULTS:
Exposure to the truth campaign is associated with a decreased risk of smoking initiation (relative risk=0.80, p=0.001). Through 2004, approximately 450,000 adolescents were prevented from trying smoking nationwide. Factors negatively associated with initiation include African-American race (relative risk=0.44, p<0.001), Hispanic ethnicity (relative risk=0.74, p<0.001), completing high school (relative risk=0.69, p<0.001), and living with both parents at baseline (OR=0.79, p<0.001).
CONCLUSIONS:
The current study strengthens the available evidence for antismoking campaigns as a viable strategy for preventing youth smoking. | 1,662 | 871 | 0.001154 |
warc | 201704 | << Back to Chemical Sampling Information
Synonyms: JP8; JP-8; AVTUR; MIL-DTL-83133; NATO F-34 OSHA IMIS Code Number: J108 Chemical Description and Physical Properties:
a mixture of aliphatic, aromatic and substituted naphthalene hydrocarbon compounds
Potential Symptoms: Skin irritation (itching, burning, redness, rash); dermatitis; headache, fatigue, anorexia; dizziness, difficulty concentrating; poor coordination. INGES ACUTE: Vomiting, diarrhea, cramps; drowsiness, restlessness, irritability, loss of consciousness; death; pneumonitis (from aspiration) Health Effects: Irritation-Skin---Mild (HE16); CNS effects (HE7); Flammable (HE18) Affected Organs: CNS, skin, respiratory system Notes: JP8 is a kerosene-based fuel used in military jets (USAF, NATO, Japanese Self-Defense Forces), tanks and other fighting vehicles, and portable heaters. It contains benzene, toluene, xylenes and naphthalene, as well as additives (e.g., diethylene glycol monomethyl ether or ethylene glycol monomethyl ether).
Literature Basis: Risher, J., Bittner, P.M. and Rhodes, S.: Toxicological Profile for Jet Fuels (JP-5 and JP-8). Atlanta, GA: Agency for Toxic Substances and Disease Registry, Centers for Disease Control, 1998, 167 pp. Ritchie, G.D., Still, K.R., Rossi, J. III, Bekkedal, M. Y.-V., Bobb A.J. and Arfsten, D.P.: Biological and health effects of exposure to kerosene-based jet fuels and performance additives. J. Toxicol. Environ. Health B Crit. Rev. 6(4): 357-451, 2003. (air monitoring) Carlton, G.N. and Smith, L.B.: Exposures to jet fuel and benzene during aircraft fuel tank repair in the U.S. Air Force. App. Occup. Environ. Hyg. 15(6): 485-491, 2000. (naphthalene as marker of exposure) Rhodes, A. G., LeMasters G.K., Lockey, J.E., Smith, J.W., Yiin, J.H., Egeghy, P. and Gibson, R.: The effects of jet fuel on immune cells of fuel system maintenance workers. JOEM 45(1): 79-86, 2003.
Date Last Revised: 11/18/2003
Primary Laboratory Sampling/Analytical Method (SLC1): sampling media: Charcoal Tube (100/50 mg sections, 20/40 mesh) analytical solvent: Carbon Disulfide alternate analytical solvent: (99:1) Carbon Disulfide/Dimethylformamide maximum volume: 3 Liters maximum flow rate: 0.2 L/min current analytical method: Gas Chromatography; GC/FID method reference: OSHA Salt Lake Technical Center In-House File method classification: Not Validated
** All Trademarks are the property of their respective owners. | 2,431 | 1,461 | 0.000687 |
warc | 201704 | Perek 55 draws on a comparison between water and Torah. Let us expand and explain this connection.
The Midrash in Shir Hashirim compares Torah to water, saying that “Just as water only has a sweet taste if one is thirsty, so too Torah only has a sweet taste if one has a thirst for it.” There are two important points to glean from this Midrash. First, we see that Torah is supposed to be sweet, and second, this sweetness is directly related to our desire for Torah.
Even though on a basic level the Torah is sweet to anyone who merits understanding a little of its truth, on a deeper level, the sweetness of Torah is the extent to which the Torah affects us personally. Just as sweetness of taste occurs when the water enters our body, so too, the sweetness of Torah corresponds to how much one internalizes it. The true sweetness is in allowing Torah to seep into our very fibre to uplift us and make us better people, more connected to a Higher Source. This is why we ask that the Torah should be sweet for us, for learning Torah has the greatest power to perfect our character and connect us to Hashem. Unlike other mitzvos, the point of learning Torah can be completely missed – one who sees Torah as mere intellectual stimulation will not taste the true sweetness of Torah. The word “
vehaarev” shares a root with the word ‘to mix’, for the sweetness of Torah is how much it has become mixed in to who we are. Thirst is a prerequisite for this sweetness, for the more one values something, the more one will ‘let that thing in’ to affect him. For example, one values and appreciates one’s parents much more than the mailman, and therefore one places trust in and generally allows one’s parents to shape one’s life more than the mailman. The same goes for Torah. The more we desire and value Torah, the more we allow ourselves to be exposed to and influenced by Torah. | 1,939 | 943 | 0.001097 |
warc | 201704 | Culture and Recreation Literature
Aristocrat Alexis de Tocqueville (1805–1859) was only 26 years old when he traveled to New York with his colleague and friend, Gustave de Beaumont (1802–1866), to study and observe American democracy.
Though Tocqueville set out with the pretext of studying the American penal system on behalf of the French government (both he and Beaumont were magistrates at the time), he had the deliberate and personal goal of conducting an onsite investigation of the world’s first and then only completely democratic society: the United States. Tocqueville and Beaumont traveled for nine months through New England, eastern Canada, and numerous American cities, including New York; Philadelphia, Pennsylvania; Baltimore, Maryland; Washington, D.C.; Cincinnati, Ohio; and New Orleans, Louisiana.
The pair returned to France in 1832 and the following year published their study,
On the Penitentiary System in the United States and Its Application in France. Once this official obligation was behind him, Tocqueville left his post as magistrate and moved into a modest Paris apartment. There he devoted two years to writing Democracy in America (1835, 1840). The work was soon proclaimed the classic treatment of its subject throughout the Western world and secured Tocqueville’s fame as political observer, philosopher, and, later, sociologist.
Tocqueville proclaimed that during his travels, “Nothing struck me more forcibly than the general equality of conditions …. All classes meet continually and no haughtiness at all results from the differences in social position. Everyone shakes hands….” But he also foresaw the possibility that the principles of economic equality could be undermined by the American passion for equality, which not only “tends to elevate the humble to the rank of the great,” but also “impels the weak to attempt to lower the powerful to their own level.” While he warned against the possible “tyranny of the majority” as a hazard of democracy, he also added that law, religion, and the press provide safeguards against democratic despotism. | 2,167 | 1,177 | 0.000881 |
warc | 201704 | ALL dog article Guides tagged with Pancreatitis 6 dog article Guides Using Viokase-V Powder for Dogs, Viokase Powder By Team PetCareRx, May 22, 2013 Viokase-V(Pancrelipase)Powder for dogs and cats aids in the digestion process for pancreatic insufficiency sufferers by essentially providing the pancreatic enzymes that have been lost. Viokase-V Powder allows the proteins, starches, and fats present in the diet to be broken down and digested properly. READ full story My Dog Has Pancreatitis: What Should I Do? By Team PetCareRx, July 28, 2011 Dog pancreatitis can occur when a dog does not eat the proper foods. Learn how to adjust your dog's diet to prevent pancreatitis. READ full story Healthy Diet of Miniature Schnauzers By Team PetCareRx, July 20, 2012 A healthy Miniature Schnauzer should eat a balanced nutritious diet. Learn how to feed your Miniature Schnauzer here. READ full story Building Your Dog’s Diet with Strong Nutrients By Rebecca Kelley, July 17, 2012 There are many dog food options to choose from on the market today. Let us help you build your dog a proper diet they'll benefit from. READ full story Miniature Schnauzer Information: Health By Lauren Leonardi , July 03, 2012 The Miniature Schnauzer is a very lively and spunky dog, but they can inherit or develop serious health problems. Learn more about this breed's health needs. READ full story Causes of Diabetes in Your Cat or Dog By Madeleine Burry, August 19, 2012 From genetics, to weight, to preexisting diseases, lots of factors can cause diabetes in your pet. Learn about the causes of diabetes here. READ full story Page: 1 of 1 Page: 1 View All Prev Next | 1,651 | 828 | 0.001213 |
warc | 201704 | Get out of here, quick! Problems with transparent labels on glass doors. Boldt A., Stürmer B., Gaschler R., Schacht A., Sommer W.
We studied the case of transparent word labels (e.g., "push") placed on glass doors, when viewed from the other side as mirror-reversed script, hence requiring an action opposite to word meaning. As compared with a regular view, labels seen "from the other side" in the glass door situation caused strong delays of actions and a tripling of error rates. This problem is unrelated to mirror reading but is at least partially due to the need to act opposite to word meaning. The glass door effect was not related to practice and age and showed no adaptation effect after incompatible trials. Distribution analyses showed an increased correct reaction time (RT) effect for slower responses, whereas accuracy effects were specific for fast responses. In the literature, problems with such mixed mappings have often been interpreted in the sense of competing action tendencies. Experiments 1 to 4, however, demonstrated that this might merely be a task difficulty effect due to the necessity for a mental transformation in case of mirror-reversed labels. Moreover, our results strongly advocate against using transparent labels because they may pose a considerable risk. | 1,307 | 701 | 0.00144 |
warc | 201704 | I have lower face/chin sagging primarily when I bend forward or look down. I would like to have a minimal procedure. Would the Lifestyle Lift or mini face lift be recommended? Aren't they the same thing? My skin is still fairly elastic. I don't wish to have the full facelift procedure or Thermage, etc.
Lifestyle Lift or Mini Lift for Lower Face Sagging? Doctor Answers 6 Mini lift
The important thing for you would be to see a specialist in facelifting techniques. All these named procedures are marketing tools only. Some of them do not even work well.
A Mini-Facelift is an ideal procedure for minimal lower facial aging
If your main problem is lower facial aging, a mini facelift procedure can be an ideal procedure. Note, however, that not all facelifts are made alike. A "lifestye lift" a commercialized variant of a minifacelift. While it is appropriate for some patients, it is notable that the "lifestyle" company was recently fined for false advertising. For this reason, make sure your surgeon shows you many pictures of patients he/she personally took care of. This is also true of the Thermage procedure.
Lifestyle lift or minilift
Without a question in my mind a minilift by a board certified surgeon will give you a better longer lasting result. You didnt buy th "perfect pancake maker" you saw on late night television why buy a face operation. see my video
You might also like... Will a Lifestyle Lift help me?
I think the first thing to address is the fact that everybody has some sagging in the neck and chin when they bend forward or look down. The most important thing to consider is how you neck looks when you are in the neutral position. The Lifestyle Lift is a trademark. It is actually a lower third facelift that addresses jowling neck sagging. I would visit a qualifited and experienced facial plastic surgeon who can do a thorough evaluation for you. A minimally invasive procedure is nice in theory but patients are usually happiest when the choose a procedure that effectively addresses the issue that bother them the most, even if it requires a little more work.
Minilift should be enough for minimal jowling and neck sagging
Lifestyle lift is not a procedure. It is simply a trademarked marketing name to promote the Lifestyle Lift corp business. Every lifestyle lift center has surgeons that do their own version of a facelift. So there is no lifestyle lift procedure persay.
Anyway for minimal jowling and neck sagging, a minilift should be adequate.
Best,
Dr. S.
Mini Lift great option for lower face sagging
Goldiestar,
A minimal lift for the lower face and neck is a great option with the least downtime for facial rejuvenation. There are many minimally invasive facelift options for the neck and face, which go by several names: s lift, mini lift, short scar lift, macs lift, lunchtime lift, etc. These face lift surgery names are confusing. Technically, all these face lift procedures differ a little, but cosmetic results are the same.
Best cosmetic results for face lift surgery combine the facelift with another procedure, such as fat grafting, skin care, resurfacing, Botox cosmetic, etc.
More important than the specific technique is the rapport and relationship you build with your plastic surgeon. He/She will be able to fully explain in-person the appropriate surgical option which is right for you, without a sales pitch or pressure.
The name brand choices for face lift surgery may not offer complete care or counseling before/after surgery. In addition, they cannot provide supplemental plastic surgery services that you may want or require for the best results.
Consultation with a face lift surgeon will provide you with a personalized face lift. Speak with more than one plastic surgeon regarding face lift surgery.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship. | 4,069 | 1,875 | 0.000537 |
warc | 201704 | According to The Hand Center of Western Massachusetts, an arm or wrist cast may be worn while playing football at the discretion of an individual, his parents, his coach, and most importantly, his doctor. However, playing football, a high contact and forceful sport, runs a high risk of re-injury.Continue Reading
If a player chooses to participate in a contact sport with a cast, protection for his cast and for other players exists. For example, a product called The Cast Protector is a pad that surrounds the cast and is held with Velcro strips. Though it does not wholly prevent injury, it is approved for use in high school football, according to the product website.Learn more about Breaks & Sprains | 708 | 424 | 0.002369 |
warc | 201704 | Continue Reading
There are no specific drug therapies to treat instances of reverse sneezing. However, these episodes may be caused by another underlying condition that can predispose a dog to such episodes, states PetMD.
As outlined by PetMD, reverse sneezing is characterized by backwards motion of the head as the dog brings in air with lips sucking in. The purpose of this action is to remove irritants that may be lying behind the pet's nose and nasal passages. Reverse sneezing is typically the side effect of another condition, so treatment of the episodes of reverse sneezing lie in addressing the underlying condition. For puppies, a malformed palate may be a root cause. For adult dogs, the movement of the cilia lining the larynx may set off a reverse sneeze. The cilia function to remove irritants, but this function alone may not be sufficient. For instance, antihistamines can eliminate reactivity to allergens and thereby reduce reverse sneezing.Learn more about Veterinary Health | 999 | 531 | 0.001891 |
warc | 201704 | Back in Don Draper’s day agencies were primarily full service. They made a lot of revenue carrying out media planning and buying activities, and in some cases they even threw the creative in as added value. Remember, this was the day of the macho Marlboro man on horseback – simple creative that made its way to billboards and press to build brands.
The key to an agency’s success back then was their ability to effectively plan and buy media for clients using their relationships to get great deals – and get a great commission from the media owner in the process.
Fast forward a little while and the media landscape became more complex, with new channels and formats such as TV, that in turn demanded greater creative talent and resource; it takes many more people with different skills to film the Marlboro Man galloping through Monument Valley than it does to simply draw a picture of him there. These demands, coupled with agency chiefs recognising the value of monetising disparate disciplines led to the decoupling of planning/buying and creative teams, and in turn the fragmentation of full service media agencies.
At this junction agencies were effectively double-dipping; there was money to be made on both sides.
Over time, though, this played out badly for the media planning and buying agencies. Their original differentiator was eroded and their service became something clients could commoditise. Their world soon became about how cheaply they could buy the media and service the client – resulting in a vast reduction in margin – in the area that was the original cash cow. (Side note – this was the tinder for the eventual opaque trading practices that are now coming to light across agency trading desks – but that’s an entirely separate post).
The good creative agencies, on the other hand, prospered financially. Let’s face it – how do you put a price on an idea such as a drumming gorilla or surfing horses? You can’t commoditise a spark of brilliance.
This same story is now playing out in digital marketing, and it’ll be our creative marketing ability that will define our success from here on. Pure-play digital marketing agencies were able to form and exist because other agencies didn’t have our technical ability – that gave us a head start. But this technical advantage is eroding, and it’s not the current battle ground.
We’ve done a great job with technology and data, enabling us to take advertisers toward a place where they can talk in a personalised fashion to small audiences. However, this technical excellence is not being matched by engaging messaging and creative. We’ve been conditioned to think about algorithms, quality scores and metrics that can be measured neatly by numbers. We start by aiming to satisfying search algorithms rather than considering the emotional impact at the moment a human engages with our campaign.
It will be our ability to think like the marketers of old, and embed great creativity in our work, that will define our collective success over the next few years. So far we’ve failed miserably in this regard, and in 2017 mobile will be the platform that indicates if we are capable of stepping up.
Over 70% of all digital ad spend in the US will be on mobile next year. Mobile ad budgets globally are soaring. However, it’s on this platform where PageFair report 419 million people are blocking ads, nearly double the amount blocking ads on desktops. Some of this is down to consumers not feeling comfortable with the intrusive nature of the adverts and the use of their data, however it’s absolutely clear that the quality of our creative within digital is not matching our ability to target audiences.
Agencies, advertisers and publishers are not providing a valuable emotional experience to our audiences, maybe this is where we can all draw inspiration from Don Draper himself. | 3,965 | 1,902 | 0.000542 |
warc | 201704 | No breakthrough in fighting Somali pirates
The captain and chief engineer from the ship North Spirit were kidnapped in a port in Cameroon by gunmen.
The vessel's owner says they are now being held in Nigeria. The kidnapping happened about a week after a Russian navy ship freed another vessel, which had been seized by pirates in the Gulf of Aden.
On May 5, the Russian oil tanker Moscow University was captured by pirates off the coast of Somalia. As the crew barricaded themselves in, the Russian warship Marshal Shaposhnikov came to the rescue. Navy commandos engaged the pirates in a gunfight and boarded the ship, defeating the pirates without loss of hostages or navy personnel.
But despite this success, there have been no celebrations aboard the Marshal Shaposhnikov. This Russian warship is one of dozens patrolling the Gulf of Aden.
Over the past two years the firepower, resources and media attention dedicated to fighting piracy in the region has been stepped up. But in individual operations are a drop in the ocean, and on the whole the pirates have not been scared off.
Last year there were fifty hijackings, with the same number predicted for 2010. In order to avoid putting the hostages at risk, governments and companies end up paying multi million-dollar ransoms.
Nearly lawless, Somalia remains one of the poorest countries in the world. The success of the pirates is attracting more people into seafaring gangs.
Russian commandos say their enemies have become better trained and equipped.
“The pirates are drugged up and unpredictable. We have found out from them that they used to be offered $50 for each successful expedition. Now they are being offered $300,” says special team commander Lt. Colonel Andrey Ezhov.
Another problem is what to do with the pirates once they are captured. Since there is no chance they can be tried in Somalia, some captors have flown them to their own countries, or sent them to neighboring states.
Marshal Shaposhnikov's captain chose a different solution – he released the captives at sea with a supply of water, but no weapons or navigation equipment.
Commanders say that communication between international naval forces has improved greatly. But the pirates have responded.
“The transport corridor is chock-full of warships. But the pirates have simply moved further to the East, where we cannot monitor them,” said Captain Ildar Akhmerov, a Russian Naval Task Force Commander.
With 25,000 ships coming through the area each year, piracy will remain lucrative and hard to avoid. And in order to safeguard a key economic route, more extensive measures may be required from the world's powers. | 2,690 | 1,368 | 0.000742 |
warc | 201704 | September 22, 1998
Jonathan G. Katz
Secretary
U.S. Securities and Exchange Commission
(Mail Stop 6-9)
450 Fifth Street, N.W.
Washington, D.C. 20549
Re:
Release No. 34-40260; File No. 4-208
Dear Mr. Katz:
OptiMark Technologies, Inc. ("OTI") appreciates the opportunity to provide the Securities and Exchange Commission ("Commission" or "SEC") with comments on the proposed amendments to the Intermarket Trading System ("ITS") Plan relating to, among other things, the ITS/Computer Assisted Execution System ("CAES") linkage.
1 We are a computer technology firm based in Durango, Colorado that has developed a new approach for the processing of trading interest known as "OptiMark TM." Over the last few years, we have been playing an instrumental role in developing a new trading system based on our technology on behalf the Pacific Exchange, Inc. ("PCX"), known as the PCX Application of the OptiMark System ("PCX Application"). The PCX will make available the PCX Application to its members and their customers as an exchange facility later this year. 2 OTI is currently in the process of developing a similar application based on its technology for another market. 3
The Release raises a number of important issues about the current operation of ITS and reflects continued evolution in the Commission's assessment of existing market practices, which began with the Market 2000 study
4 and led to the adoption of the Order Handling Rules. 5 Central to the Commission's ongoing regulatory agenda has been the concerted effort to modernize the regulatory framework and promote greater market integration and competition. Consistent with such policy objectives, we believe that the Commission, as discussed below, should take active steps to enhance the role of ITS in the national market system ("NMS").
1.
ITS/CAES Linkage. OTI supports the Commission's proposal to expand the scope of the ITS/CAES linkage to include all listed securities, including non-Rule 19c-3 securities. We believe that establishing efficient linkages between the exchange and over-the-counter ("OTC") markets is essential to obtaining the best execution of customer orders. In this regard, we agree with the Commission that there is no fundamental regulatory or functional basis for discriminating between Rule 19c-3 securities and non-Rule 19c-3 securities with respect to their respective NMS status. 6 The investing public is entitled to have ITS access to the bids or offers displayed in the Consolidated Quotation System ("CQS"), irrespective of whether the subject security was listed before or after April 26, 1979. Due to the existing limitations imposed on the ITS/CAES linkage, the ability of the users of the PCX Application to interact fully with all of the publicly displayed interest is artificially constrained. 7 Because eliminating such limitations would result in increased liquidity and competitiveness for the public at large, the Commission should act promptly to expand the scope of the linkage while it continues to encourage improvements in third market trading rules and procedures.
2.
Voting Requirement. OTI also supports the Commission's efforts to modernize the internal governance structure for ITS. In particular, we agree that the ITS Plan's unanimous vote requirement should be replaced. The fact that the Plan requires a unanimous vote means that it can be used to easily deny access to ITS, impose a chill on innovation, and/or otherwise cause delays in an anti-competitive manner. 8 In this regard, it is important to recognize that the voting requirement -- whether unanimous or super-majority -- serves, in effect, as a procedural device allocating the burden of proof before the Commission ultimately makes decisions. Under the existing rules, a party seeking to amend the ITS Plan must pursue a protracted process, with no meaningful procedural safeguards or time limits on decision making. As a result, this process places all of the burdens on the proponent of change and leaves the opponent with all of the advantages (such as delays and debates). If the party in favor of change somehow can bring this process to a vote but fails due to the unanimity requirement, it must carry the burden of proof further until the Commission decides to review the failure to act.
By contrast, in the case of the two-thirds voting requirement proposed in the Release, the proponent of change, if it could muster requisite support, could obtain an affirmative vote, thereby placing the opponent in the position of having to justify its position before the Commission. The New York Stock Exchange ("NYSE") recognizes this important distinction in its comment letter.
9 It takes the position that a "super-majority voting requirement, coupled with a right to appeal to the Commission, would not provide the Participants with adequate protection." 10 Specifically, the NYSE claims that because the Commission "must approve a Plan amendment the Participants submit that meets the requirements of the Exchange Act and the Plan Rule," the Commissions "limited legal authority to review Plan amendments does not provide (NYSE) with protection sufficiently similar to the protection . . . under the Commission approved unanimous voting requirement." 11
In making such a claim, the NYSE is, in effect (indeed, quite explicitly), claiming the right to deny or otherwise control access to an NMS facility through the continued operation of the unanimity requirement for reasons that may
not pass muster under the Exchange Act. Of course, no exchange has any such right under the Exchange Act: Section 6(b)(5) expressly precludes an exchange from "regulat(ing) by virtue of any authority conferred by this title matters not related to the purposes of this title or the administration of the exchange." Presumably, the statuary limitations on an exchanges actions and authority are the apparent reasons for characterizing ITS as a private "contract" among the participants. 12 As the Commission is well aware, however, ITS is a creature of both the Congress and the Commission's own efforts, intended to ensure the best execution of customer orders and further the operation of the NMS. ITS would not exist but for the mandates of Congress in combination with the Commission's own efforts. Its juridical status is essentially a function of the Commissions orders and rules. It is a "contract" only in the sense that a "consent decree" can be viewed as a negotiated document.
As a result, the proponent of change should be allowed to drive forward a decision that ultimately the Commission will review. On review by the Commission, we hope that any opponent to change will come forward with reasons that can withstand the "disinfectant of sunlight" and the rigor of Exchange Act review. If not, it should identify now those reasons for the opposition that would not meet the Commissions public interest and protection of investors standard. Apart from anti-competitive reasons, we believe that there should be none.
13 Ultimately, whether or not the unanimous vote requirement is replaced, we urge that the Commission play a more active role in policing ITS, by means of either procedural changes or direct intervention. We believe that through a heightened scrutiny of ITS, a more integrated NMS structure that better protects investors will emerge.
3.
System Performance and Capacity. Finally, we believe that as a part of the ITS participants' ongoing operational responsibilities, they should be required to substantially improve system performance and capacity of ITS. As pointed by other commenters, much of the technology still in use today dates back to the 1970s, and there is an inefficient mesh of manual and automated sub-systems within ITS. 14 We are concerned that the resulting system inefficiency creates serious capacity limitations that lead to poor or untimely executions of ITS commitments and delays in obtaining access to ITS. 15
Ultimately, we are concerned that the current operating environment for ITS may frustrate the efforts by the PCX and other competing market centers to introduce technological innovations that are necessary to meet the evolving needs of the investor community. We urge that the Commission require a comprehensive review of system effectiveness, as previously recommended by the U.S. General Accounting Office ("GAO"),
16 and mandate a detailed plan of action by the ITS participants to improve system performance and capacity in the near future. As the Commission stated in its Temporary Order Extending the Operation of ITS, 17
The development of a national market system continues to be an evolutionary process, and if the types of systems represented by the ITS
are to become permanent features of that system as it evolves, they must continue to make improvements, changes and adaptations to meet the needs of persons trading in the various market centers and to accommodate Commission regulatory requirements designed to improve order interaction and price protection between and among markets.
We believe that such efforts to build the proper technological infrastructure will further the NMS objectives by allowing the nation's markets to be more integrated and, as a result, better positioned to serve the public in the new millennium.
**************
We thank the Commission for the opportunity to comment on these important public policy considerations. If you have any questions on our comments, please contact the undersigned.
Sincerely,
John C. Katovich
Senior Vice President and General Counsel
CC: Chairman Levitt
Commissioner Johnson
Commissioner Hunt
Commissioner Carey
Commissioner Unger
Richard R. Lindsey, Director, Division of Market Regulation
Robert L.D. Colby, Deputy Director, Division of Market Regulation
Belinda Blaine, Associate Director, Division of Market Regulation
-[1]- See Securities Exchange Act Rel. No. 40260 (July 24, 1998), 63 Fed. Reg. 40748 (July 30, 1998) ("Release").
-[2]- The Commission previously approved the PCXís proposal to operate the PCX Application under Section 19(b) of the Securities Exchange Act of 1934 ("Exchange Act"). See Exchange Act Rel. No. 39086 (Sep. 17, 1997), 62 Fed. Reg. 50036 (Sep. 24, 1997) ("Approval Order"). Our wholly-owned subsidiary, OptiMark Services, Inc. ("OSI"), will be responsible for operating portions of the PCX Application for the PCX and delivering the trading service in OSIís role as a facility manager for computer operations.
-[3]- See National Association of Securities Dealers, Press Release, dated September 9, 1998.
-[4]- See Division of Market Regulation, Market 2000: An Examination of Current Equity Market Developments (1994).
-[5]- See Exchange Act Rel. No. 37619A (Sep. 6, 1996), 61 Fed. Reg. 48290 (Sep. 12, 1996) (requiring public display of, and public access to, certain orders entered into electronic communications networks ("ECNs")).
-[6]- As the Commission is well aware, since the adoption of the Order Handling Rules, OTC markets makers for both Rule 19c-3 securities and non-Rule 19c-3 securities have been subject to the firm quote rule, Rule 11Ac1-1, under the so-called "1% Test."
-[7]- As described more fully in the Approval Order, the PCX Application is designed to carry out the PCX's responsibilities as an NMS participant by integrating the published bids and offers of away markets in its matching cycle as the "CQS Profiles." Unless the ITS/CAES linkage is expanded, the "CQS Profiles" would not include the bids and offers of OTC market makers in non-Rule 19c-3 securities.
-[8]- Indeed, the history of ITS is a dreary history of established markets using the existence of ITS, including the unanimous vote requirement, to delay or oppose change, including competitive alternatives. ITS itself came into existence only in response to Commission pressure in the 1970s to develop an NMS facility. The ITS/CAES linkage was established only as a result of a Commission order. The Cincinnati Stock Exchange automated systems were integrated into ITS only after protracted delay coupled with elaborate conditions. The expansion of the ITS/CASE linkage to include non-Rule 19c-3 securities has been delayed, and continues to be delayed, despite the Commissionís extensive review of the OTC market, an inquiry more searching than that of any other market in the Commissionís history.
-[9]- See Letter from James E. Buck, Senior Vice President and Secretary, NYSE, to Jonathan G. Katz, Secretary, SEC, dated August 31, 1998 ("NYSE Letter").
-[10]- See id . at 5.
-[11]- See id .
-[12]- See id . at 4.
-[13]- The November 7, 1997 letter from various ITS participants asserts that the Commission would be required to approve a Plan amendment submitted by two-thirds of the Participants even though it may not be the "best" alternative, thereby depriving the minority of important protections. In effect, the letter is claiming that a minority of self-regulatory organizations should have the power to reject a Plan amendment -- admittedly in the public interest and for the protection of investors -- given the possibility that they may not be able to convince the Commission that the proposed amendment would impose undue costs or otherwise be inferior to their own alternative. This position is based on reading the Commissionís authority in an unduly limiting manner. We believe that the history of the SEC consistently demonstrates a willingness to be creative in addressing practical implementation questions. If confronted with a choice between good enough and better, we believe that the Commission would find an appropriate way to address the issue.
-[14]- See, e.g. , Letter from Adam W. Gurwitz, Vice President Legal and Secretary, Cincinnati Stock Exchange, to Jonathan G. Katz, Secretary, SEC, dated August 27, 1998.
-[15]- As demonstrated during the 1987 market break, a record volume in a declining market may easily overwhelm ITS. Although system capacity was increased in response to the crisis, the substantial rise in volume since then -- particularly in view of recent volatility in the market -- raises serious concerns about capacity in the current environment
-[16]- See GAO, Securities Trading: SEC Action Needed to Address National Market System Issues (March 1990).
-[17]- 44 Fed.Reg. 56069 (1979) | 14,425 | 6,120 | 0.000165 |
warc | 201704 | BOARD SERVICES CORPORATION 901 Marquette Avenue South Suite 2810 Minneapolis, MN 55402-3268 Telephone (612) 330-9283 Email IDSMFG@AOL.COM
November 22, 2002
Jonathan G. Katz, Secretary
U.S. Securities and Exchange Commission 450 Fifth Street, NW Washington, D.C. 20549-0609
RE: S7-40-02
Dear Mr. Katz:
The purpose of this letter is to address three proposals sent out for comment by the Securities and Exchange Commission (SEC) in its release 33-8138. The proposals are: (1) to require disclosure of the name of persons who have been determined to be "financial experts" serving on the audit committee of an investment company (a fund); (2) to mandate that the fund adopt a code of ethics for its principal executive and financial officers; and (3) to modify recently adopted rules pertaining to how often the management of the fund would have to conduct an evaluation of its disclosure controls and procedures. The comments below reflect the structure of the American Express (AXP) funds and are based on my experience working with the independent directors of these funds.
Financial Experts
In its release, the SEC states, "without some level of financial competence, members of an audit committee may be unable to adequately perform their vital corporate duties." The question presented is what financial competency best serves the interest of shareholders of a fund that, unlike the operating companies, must close its books daily. The release observes that the Sarbanes-Oxley Act directs the SEC to adopt rules defining the term "financial expert" and specifies several attributes that the SEC must consider in crafting the definition. However, these attributes are not the significant attributes needed by members of the audit committee of a fund nor does a term like "financial expert" explain to shareholders what is being monitored by their board. The provisions of the Sarbanes-Oxley Act were not designed to address any failures on the part of audit committees of funds and rules adopted under its provisions should reflect the differences between an operating company and a fund.
All members of the AXP funds' joint audit committee are independent from the investment manager and the independent public accounting firm selected by the independent directors is a firm different from the firm used by the investment manager to conduct its audit. Since the accounting model for investment companies is straight forward, the range of issues that have given rise to problems in operating companies, such as capitalization of expenses and off-balance sheet financing do not exist. What is significant to the independent directors of the funds is valuing assets and knowing whether the investment manager has processes in place needed to operate the funds, including those to monitor risk, safeguard assets, and comply with regulatory requirements. Problems that occur within financial presentations of a fund have much less to do with generally accepted accounting principles and much more to do with breakdowns in operational tasks. Accordingly, what a fund needs on its audit committee are members who understand operations and legal requirements. No one member carries the load and the collective wisdom of all the members of the committee is what is required. The names of the directors who serve on the joint audit committee and provide this collective wisdom already are disclosed in the registration statements and to single out the name of one or a few members misrepresents the importance of the combined judgment.
The release states that the "mere designation of the financial expert should not impose a higher degree of individual responsibility or obligation on a member of the audit committee. Nor do we (SEC) intend for the financial expert designation to decrease the duties and obligations of other audit committee members...." While "mere" (whatever that means) designation may not be intended to single out one or a few of the members of the audit committee, it certainly will do so.
Since this is a disclosure rule and not a rule that requires the designation of a financial expert, the best course of action for a fund seems to be to not designate a financial expert. Sarbanes-Oxley Act does not require such a person or persons be named but does require that if such person or persons are not named, the disclosure documents explain why not. Such an explanation for a fund might read something like the following:
"The fund has not designated a "financial expert" because the tasks performed by an audit committee for a fund are significantly different from those performed by an audit committee for an operating company. These tasks undertaken by the fund's audit committee require persons who are knowledgeable about a range of operating issues based on valuing all assets and closing the books on a daily bases. Operating companies close their books quarterly and their audit committees deal with technical accounting concepts such as estimates, accruals and reserves. Further, the fund's independent public accountant is not the auditor of the investment manager and does not provide any other services to it unless approved by the audit committee in advance."
Another reason a fund's board might decide not to include a "financial expert" among its members is that as presently drafted the only persons who can be "financial experts" are persons who have been public accountants and audited a fund or who have been financial officers of a fund. While these individuals are undoubtedly capable people, there are only a limited number of them. In addition, there are many qualities that go into being a good director besides specific knowledge of accounting practices and experience with internal accounting controls.
Nevertheless, a fund would have to seek out a person meeting the technical requirements of a "financial expert" if the SEC would not accept the concise type of disclosure described above. Other circumstances, such as comments by regulators or the media that could be interpreted to impinge the ability of an audit committee of a fund that did not have a financial expert, might compel a fund to seek out a person who meets the technical requirements of such expert.
Code of Ethics
According to the release, a "code of ethics" means a codification of standards that is reasonably designed to deter wrongdoing and to promote: honest and ethical conduct; avoidance of conflicts of interest; full, fair, accurate, timely and understandable disclosure in reports; compliance with applicable laws; prompt internal reports to appropriate persons; and accountability for adherence to the code. Under the proposal a fund, its investment manager, and its principal underwriter would have to have codes of ethics that apply to the principal executive, financial, and accounting officers. Reports would be required describing any amendments to and waivers granted from the code. The dilemma here for the AXP funds' boards results from the fact that the persons who serve in these capacities for the fund are employees of the investment manager and/or the underwriter. What role is the fund's board expected to perform? Further these employees of the investment manager and/or underwriter already are covered by a code of ethics imposed by their employer, American Express Financial Corporation (AEFC) and by a code of ethics required by AEFC's parent, American Express Company.
It is understood that many different organizational and operational structures exist among the companies that are subject to the provisions of the Investment Company Act. For those with a board of directors and no employees there are three primary questions: (1) can the same code of ethics be used for the fund, (2) the investment manager and the underwriter; if changes are made or waivers granted must the fund's board take action concurrent to the action taken by the other two; and (3) are the procedures designed to ensure compliance with the code more relevant than the code, therefore, more likely to be the focus of future SEC inspections?
The more detailed the code is, the more need to grant waivers and file reports. If procedures designed to ensure compliance with the codification of the standards as set out as the code are made part of the code, the administration of the code becomes more complicated. Again unlike an operating company where there appears to be no requirement to involve the board, a fund's board cannot avoid being part of the administrative process. Guidance by the SEC would be helpful but, absence that guidance, it might be useful to ponder responses to the three questions stated in the paragraph above.
Seemingly, an officer can sign one code of ethics that covers all of his or her duties, regardless of the entity to which the duties are owed. The entity providing the administration of the code should be the officer's primary employer, which for the American Express funds would be AEFC. In a manner consistent with that currently employed for administering the code of conduct with respect to trading securities, once the fund adopts the investment manager's code as the funds' code, the investment manager would make the funds' boards aware of changes to the code and, on an annual basis, list the waivers granted and actions taken for violations. Of course, if the rule is adopted as proposed in the release, it will require that within two days of changes being made in the code or waivers being granted, a report must be filed with the SEC, and the funds' boards would receive copies of the filings. The boards should not be the entity granting waivers but the officer's employer should be prepared to justify the waivers at the next meetings of the boards.
All this seems straight forward, but unlike an operating company, a fund is a regulated entity and is inspected periodically by the SEC. The release states the SEC "believes that ethics codes do, and should, vary from company to company and that decisions as to the specific provisions of the code, compliance procedures and disciplinary measures for ethical breaches are best left to the company." This is all well and good for companies that are not regulated but experience would indicate the SEC might take a different course over time for funds through the disclosure and inspections processes. As a result, directors of funds can be subsumed into operational tasks and legal exposure for the conduct of the tasks. While the AXP funds' boards appreciate the complexity of writing rules dealing with many different organizational structures, it is important for the SEC to be sensitive to unintended consequences of trying to write a rule that fits all such structures.
For a fund that hires outside management, the best approach would be for its board to consider a service provider's code of ethics and the reports it has filed pertaining to that code during the course of approving or renewing the contract with that service provider. If the service provider's code would not cover those persons who are the principal executive and financial officers of the fund under the proposed rule because they are lower level employees, then the rule as it pertains to the investment manager and principal underwriter should be modified to require that all of their employees who serve as a principal executive or financial officer of a fund be subject to the code.
Management's Internal Controls and Procedures for Financial Reporting
Most of the proposed rules in this section of the release do not apply to funds, however, a rule has been proposed that relates to how often a fund's management must evaluate the effectiveness of its disclosure controls and procedures in connection with certifying semi-annual filings. As currently required the certifying officers will certify that they designed disclosure controls and procedures to ensure that material information related to the fund is communicated to them and included in reports filed with the SEC and that they have conducted an evaluation of the effectiveness of the design and operation of the disclosure controls and procedures within 90 days of the date the report is filed. This is an evaluation that is required by Section 303 of the Sarbanes-Oxley Act. Since one or more of the AXP funds have a fiscal year ending each month, American Express Financial Corporation must conduct four such examinations a year. As proposed, the revised rule will require monthly examinations since the examination for a fund would have to be as of the end of the period covered by the semi-annual report.
By way of a comparison, both internal auditors and independent public accountants focus on tasks that are required to operate the funds in evaluating internal controls. These tasks apply across the operations of all funds so the test work on a selected task is done at one time during the year for all funds. Tasks do not change month-to-month and a complex of funds would not benefit by having the internal auditors or independent public accountants do the test work necessary to evaluate internal controls on a fund-by-fund basis. If they were required to do so, it would add significantly to the expenses of each fund. The problem the SEC faces is trying to shoe horn a complex with over 100 funds into a provision of a legislative act applicable to single entities. Since one fund's filing does not relate to the filing of another fund, the question is how to report work done that relates to a service provider's operations.
The primary question should be what is to be gained with monthly evaluations of disclosure controls. The answer is nothing. In fact, it may produce negative results since excessive repetitions can cause the lack of proper attention being given to the work, not to mention the added costs, time and effort that will be incurred. Based on the usual practices of reviewing operations, the quality of the evaluation of disclosure controls and procedures would be greatly enhanced and receive appropriate attention if done annually. The fact that the funds close their books daily provides a constant test of internal controls and reporting procedures. While it would be sufficient to report the date of the annual review once each year, so long as the funds continue to file semi-annual reports, then each filing could state the date of this annual review.
We greatly appreciate the opportunity to comment on the proposals.
Very truly yours,
Leslie L. Ogg
President | 14,520 | 5,818 | 0.000173 |
warc | 201704 | Filter Results: Publication Year
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Axons and their synapses distal to an injury undergo rapid Wallerian degeneration, but axons in the C57BL/WldS mouse are protected. The degenerative and protective mechanisms are unknown. We identified the protective gene, which encodes an N-terminal fragment of ubiquitination factor E4B (Ube4b) fused to nicotinamide mononucleotide adenylyltransferase… (More)
Axons in Wld(S) mutant mice are protected from Wallerian degeneration by overexpression of a chimeric Ube4b/Nmnat (Wld) gene. Expression of Wld protein was independent of age in these mice. However we identified two distinct neuromuscular synaptic responses to axotomy. In young adult Wld(s) mice, axotomy induced progressive, asynchronous synapse withdrawal… (More)
We used live imaging by fiber-optic confocal microendoscopy (CME) of yellow fluorescent protein (YFP) expression in motor neurons to observe and monitor axonal and neuromuscular synaptic phenotypes in mutant mice. First, we visualized slow degeneration of axons and motor nerve terminals at neuromuscular junctions following sciatic nerve injury in Wld(S)… (More)
Huntington's disease (HD) is a neurodegenerative disorder with complex symptoms dominated by progressive motor dysfunction. Skeletal muscle atrophy is common in HD patients. Because the HD mutation is expressed in skeletal muscle as well as brain, we wondered whether the muscle changes arise from primary pathology. We used R6/2 transgenic mice for our… (More)
Axon and synapse degeneration are common components of many neurodegenerative diseases, and their rescue is essential for effective neuroprotection. The chimeric Wallerian degeneration slow protein (Wld(S)) protects axons dose dependently, but its mechanism is still elusive. We recently showed that Wld(S) acts at a non-nuclear location and is present in… (More)
How the brain's antioxidant defenses adapt to changing demand is incompletely understood. Here we show that synaptic activity is coupled, via the NMDA receptor (NMDAR), to control of the glutathione antioxidant system. This tunes antioxidant capacity to reflect the elevated needs of an active neuron, guards against future increased demand and maintains… (More)
Mutations in RAB18 have been shown to cause the heterogeneous autosomal recessive disorder Warburg Micro syndrome (WARBM). Individuals with WARBM present with a range of clinical symptoms, including ocular and neurological abnormalities. However, the underlying cellular and molecular pathogenesis of the disorder remains unclear, largely owing to the lack of… (More)
Alpha-latrotoxin (LTX) causes massive release of neurotransmitters via a complex mechanism involving (i) activation of receptor(s) and (ii) toxin insertion into the plasma membrane with (iii) subsequent pore formation. Using cryo-electron microscopy, electrophysiological and biochemical methods, we demonstrate here that the recently described toxin mutant… (More)
Proximal spinal muscular atrophy (SMA) is a common autosomal recessive childhood form of motor neuron disease. Previous studies have highlighted nerve- and muscle-specific events in SMA, including atrophy of muscle fibres and post-synaptic motor endplates, loss of lower motor neuron cell bodies and denervation of neuromuscular junctions caused by loss of… (More)
The slow Wallerian degeneration phenotype, Wld(S), which delays Wallerian degeneration and axon pathology for several weeks, has so far been studied only in mice. A rat model would have several advantages. First, rats model some human disorders better than mice. Second, the larger body size of rats facilitates more complex surgical manipulations. Third,… (More) | 3,859 | 1,877 | 0.000542 |
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Does paying to freeze eggs suggest motherhood and career are incompatible?
With the decision by Apple and Facebook to offer company insurance coverage to women who want to freeze their eggs come questions about the message this may send to women who pursue careers at prominent tech companies. For instance: Is an employer paying to freeze a woman’s eggs a way to suggest motherhood and a demanding job are incompatible?Or: Might the existence of an egg-freezing benefit pressure women to delay having children in favor of their careers? “It’s complicated,” said Ellen Galinsky, president of the Families and Work Institute. “Egg freezing is very expensive, so this is a nice benefit. You want this option for people, but you don’t want to send the message that ‘we don’t expect you to be able to manage’ ” both parenting and a career.Apple and Facebook are among the first companies to offer the option to freeze eggs as part of their benefits. Those who support the practice say it gives women more control over their work and personal lives, allowing them to delay motherhood until it's the right time for them or their careers. “My sense is that the companies are sincere about trying to provide women more control over when they choose to start families,” said David G. Allen, distinguished professor of management at the University of Memphis’ Fogelman College of Business and Economics. “However, I would be hesitant to frame it in terms of a tool for leveling compensation and career progression for women. That could send the signal that the company believes women need to be strategic about managing when they have children or it will hurt their career, but men should feel free to have children whenever they want without worrying about it. It might make sense to offer the benefit to women and spouses to send the message that the goal is to help all employees manage their family planning, not just encouraging women to put off having children.”
Menlo Park, Calif.-based Facebook started providing the benefit, which applies to employees and their spouses or domestic partners, in January 2014. The social network offers as much as $20,000 in expenses for egg freezing and related procedures, such as surrogacy.
Apple, based in Cupertino, Calif., said it will offer similar coverage in 2015. In a statement, an Apple spokeswoman said that the company wants to “empower women … to do the best work of their lives as they care for loved ones and raise their families.”
Recruiting and retaining women has been a challenge for technology companies. A startling number of women working in science, engineering and technology (SET)—the same industries that grade schools are urging girls to pursue—are considering leaving those fields because of gender bias, according to a February 2014 report by the Center for Talent Innovation, a global think tank. The think tank discovered that, despite high ambition and passion for their work, women in SET fields in the U.S., Brazil, China and India are “languishing in the middle rungs of their organizations and, as a result, are much more likely than men to report that they plan to leave the industry within the year.”In fact, 32 percent of female SET employees in the U.S., 22 percent in Brazil, 30 percent in China and 20 percent in India were considering leaving their fields within a year, according to the report. Among SET senior leaders, 31 percent of women in the U.S., 22 percent in Brazil, 51 percent in China and 57 percent in India reported that a woman would never get a top position at their company, no matter how capable or high-performing. “I think it’s great that the companies are offering [egg-freezing benefits], because clearly some women want it,” said Joan C. Williams, chairwoman and director of the UC Hastings Foundation’s Center for WorkLife Law. “The best case scenario is that the company sends a message that if you want to use this benefit, that’s great, and if you don’t, there’s a place for you at the company as a mother. There is at this point massively documented discrimination against [working] mothers. The solution is not to eliminate this benefit, but to eliminate discrimination.” The Society for Human Resource Management’s 2014 Employee Benefits survey reveals that 26 percent of U.S. organizations offer in vitro fertilization coverage to their employees and 29 percent of U.S. organizations offer employees infertility treatment coverage other than in vitro. However, the number of companies offering medical coverage for egg freezing has not been studied. Williams said she doesn’t expect many companies to follow Facebook’s and Apple’s leads. “It’s extraordinarily expensive,” she said. “This is part of Silicon Valley creating organizational cultures that provide huge numbers of very expensive benefits—many of them designed to keep people at work longer,” she said. “This is definitely part of the picture of free dinners and dry-cleaning at the office.”Facebook’s and Apple’s media offices didn’t respond to requests for comment about criticism aired on social media sites that the benefit could be viewed as a substitute for creating a workplace where motherhood is compatible with a demanding career. However, Facebook spokeswoman Genevieve Grdina told Bloomberg News that the company offers other benefits to help workers transition to parenthood when they’re ready, including nursing rooms, subsidized day care, four months of paid parental leave and $4,000 in “baby cash.” Allen said it’s important that a company’s benefits demonstrate as much support for working parents as for those who want to delay having families. “This is a matter of communication and organizational culture,” he said. “If an organization already has a culture that is supportive of employees and supportive of family-friendly benefits, employees would be more likely to view it as positive and as just one more way the company is trying to be supportive. On the other hand, if employees tend to view the company as prioritizing the bottom line over employee well-being, especially if women view the company as not very supportive of work/family balance issues, then I think the message could be received more negatively.” Dana Wilkie is an online editor/manager for SHRM.
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warc | 201704 | <p>Has the <a href="https://www.thebalance.com/tips-for-managing-millennials-1918678" data-component="link" data-source="inlineLink" data-type="internalLink" data-ordinal="1">Generation Y</a> group of young adults now joining the workforce been parented, scheduled, pampered, overseen, and coddled into a tough transition to the workplace?</p><p>Depending on the Gen Y employee, some have a difficult time adjusting to employment. Others bring skills that all should emulate. Not all Gen Y employees are the same and it is a mistake to paint them all with the same brush.</p><p>I've written about <a href="https://www.thebalance.com/tips-for-managing-millennials-1918678" data-component="link" data-source="inlineLink" data-type="internalLink" data-ordinal="2">managing Gen Y employees</a> in the past. Here are some of the challenges you face when Gen Y employees enter your workforce. On the downside, many arrive with expectations that they are:</p><ul><li> <strong>Always, the smartest and the best.</strong> (Mommy said so and every academic grade said <strong>pass</strong>) They achieved a GPA of 3.0+ in their less than rigorous degree programs.</li><li> <strong>Good at everything and everything should come easily.</strong> This belief created children who weren’t prepared for a rigorous college program. Since the background and ability to pursue a substantial degree can be sabotaged and left behind by third grade, many students arrive unprepared with the appropriate background for degree programs that employers need.<br/><br/>This has created masses of young adults now graduating with urban planning, gender and ethnic studies, humanities, arts and sciences, and psychology degrees while computer science, sciences, health care, and math go begging for smart students.<br/><br/>Too hard, too much work, unprepared with prerequisites, said the students with whom I've spoken. Plus, a rigorous degree might interfere with weekend fun and parties. Must everything come easily?</li><li> <strong>Deserving of lots of money, quick <a href="https://www.thebalance.com/a-promotion-rewards-an-employee-for-work-contributions-1918231" data-component="link" data-source="inlineLink" data-type="internalLink" data-ordinal="3">promotions</a>, and only positive reinforcement.</strong> How many applications from graduating, potential workers have you seen who actually had real jobs?<br/><br/>Sure, many have jobs or <a href="https://www.thebalance.com/what-are-interns-and-internships-1918155" data-component="link" data-source="inlineLink" data-type="internalLink" data-ordinal="4">internships</a> listed, but what happened to all of those semesters with nothing going on, with potential internships not pursued, and even voluntary campus and civic responsibilities unlisted. I know, they say to me, college is my last real chance to have fun before I am an adult and weighed down with responsibilities.</li><li> <strong>Tethered to their parents by cell phones, text messages, and constant oversight</strong> Is this the first generation of children who were not set loose by their parents in the morning and told to come home when the streetlights came on? (Yes, I realize that we live in a more dangerous world.)<br/><br/>Decisions were made by those children early, how to spend the day and what to do, while this generation has play dates and structured activities 20 hours a week when not in school. And school? Fewer hours, more vacation, less challenging curriculum, teachers working on the wrong goals. Is it any wonder that managers are expected to give daily feedback and praise within a workplace structure that enables success for these young workers?</li></ul><h3>Gen Y Workplace Stories</h3><p>I could go on, but I'll stop here because this generation and their parents have created some funny (pathetic) workplace stories that I hear about from time to time. I hear stories about the mom who called the hiring Human Resources director to find out why her perfect daughter didn't get the job.</p><p>I’ve encountered parents who drop their children's resumes off at employers, because Johnny doesn't have a car. Then, they wonder why their child, who is prepared to do nothing, didn't get called for an interview.</p><p>Or, how about the parent who accompanied her child to a professional interview and sat in the lobby until the interview was over. In my own world, I called a reference and started our conversation with the standard, "how do you know the candidate I am calling you about?"</p><p>Oh, I'm his wife, she responded, so I really know him well. (He had asked his wife who to use as a <a href="https://www.thebalance.com/what-are-references-really-1918249" data-component="link" data-source="inlineLink" data-type="internalLink" data-ordinal="5">reference</a> and she had responded that he needed to list people who knew him well and liked him.)</p><p>I'm sure you have your stories, too. And, for every one of these scenarios, there are also many prepared, degreed, highly employable young people, so, don't take my words personally if these comments don't fit you. It's just that I hear about so much of this from my readers that the stories are not anomalies.</p><p>In this frame of mind, after spending the holidays with some young people I love, I encountered, <a href="http://www.fistfuloftalent.com/2010/07/would-you-hire-your-own-kid-.html" data-component="link" data-source="inlineLink" data-type="externalLink" data-ordinal="6" rel="nofollow">"Would You Hire Your Own Kid?"</a> from the <em>Fistful of Talent</em> blog (recommended blog, by the way). Tim Sackett says, "Just give me someone who can read, write, calculate and actually <em>want</em> to work and I'm pretty sure I can turn them into a productive contributor."</p><h3>Crucial Skills for Gen Y Employees</h3><p>But should we have to? Sackett cites the work of Susan Stewart at the <em>Conference Board</em>. In "Will You Want to Hire Your Own Kid? (Will Anybody Else?)", she identifies these skills as crucial for the young people joining our workplaces.</p><ul><li>Critical thinking and problem solving</li><li>Collaboration across networks and leading by influence</li><li>Agility and adaptability</li><li>Initiative and entrepreneurialism</li><li>Effective oral and written communication</li><li>Accessing and analyzing information</li><li>Curiosity and imagination</li></ul><p>Too many are arriving unprepared. <strong>Old news, I know, but I'd love to hear your stories.</strong> Fun news? Read Sackett's article. His examples of worker unpreparedness in these seven critical skills are hilarious - and downright scary.</p><p>Are you a parent? You have the power to fix this. I'm an employer. I just deal with the consequences. Instead of making profits, I spend time developing employees with whom I have a lot less <a href="https://www.thebalance.com/compensation-definition-and-inclusions-1918085" data-component="link" data-source="inlineLink" data-type="internalLink" data-ordinal="7">compensation</a> to share. They spend time learning the above skills when they could be setting the world on fire.</p><p>And, the secret to a happy life may not be just a successful career. However, achievement, pride, lots of money, self-respect, and the knowledge that you are using your talents and skills in pursuit of worthy outcomes, go a long way toward creating that happiness. Not getting the message? Maybe your kids will. Wisdom does seem to skip generations.</p><p>Your thoughts are welcome.</p> | 7,692 | 3,416 | 0.000296 |
warc | 201704 | Hi, your search found this article for you on Trip: ACA on Trial: Severability
MedPageToday, 2012WASHINGTON -- Next week the will hear oral arguments on the constitutionality of the healthcare reform law, just days after the two-year anniversary of the Affordable Care Act (ACA).
In a three-part series, MedPage Today takes a closer look at the main arguments for and against the law.
In this second article in the series, we discuss the arguments on whether the mandate can be removed from the law.
On Friday, we'll provide analysis of the constitutional issues involved in the ACA's expansion of Medicaid.
The individual mandate -- easily the most controversial piece of the landmark law -- requires everyone to have health insurance starting in 2014 and levies a tax penalty on those who don't.
It is considered by many to be the linchpin of the entire law and is expected to bring millions more into the insurance market.
Whether the mandate is constitutional is the main issue driving the debate (and one the court will hear oral argument on on Tuesday).
On Wednesday, the Court will devote 90 minutes of oral arguments to the issue of whether the rest of the ACA can still stand if the mandate is struck down.
The states who are suing the government over the ACA have asked the Supreme Court to strike down the entire law if it finds the individual mandate to be unconstitutional.
The Obama administration argues just the opposite: That if the mandate is found to be unconstitutional, , with the exception of two provisions -- the guaranteed-issue provision, which bans insurers from refusing to offer coverage due to a preexisting medical condition, and the community rating provision, which bars insurers from charging higher premiums based on a person's medical history.
"Other provisions can operate independently and would still advance Congress' core goals of expanding coverage, improving public health, and controlling costs even if the minimum coverage provision were held unconstitutional," Justice Department lawyers wrote in their brief filed with the Supreme Court on the separability issue. | 2,125 | 1,062 | 0.000948 |
warc | 201704 | Sustainable farming has emerged as a new, hip career path. In a down economy, why not? It’s a job that promises righteousness — eating local will save Americans from their sinister dependence on fossil fuels! — and deliciousness: How ’bout them heirloom tomatoes?
To capitalize on the trend — and to counter a projected 8 percent drop by 2018 in the nation’s 2 million farmers — the U.S. Department of Agriculture has set an ambitious target of adding 100,000 new farmers and ranchers this year alone. But is sustainable farming really sustainable for farmers? Most small farmers I have met in nearly a decade of reporting on agriculture simply don’t know. They sow, weed, water, harvest, and, at the end of the season, they cross their fingers and hope they have made a little money.
This, unfortunately, is all too common. “We see a lot of folks get started in farming because they want to grow things,” says Erica Frenay, who works with beginning farmers at the Cornell Small Farms Program. “But it’s really rare that we find someone who is incredibly enthusiastic about the invisible side of farming: the management and organization and record keeping. And the difference between success and failure is good management.”
AgSquared, an innovative new software program, aims to make these essential tasks easy. Through the program’s sleek, Web-based interface, farmers can plan which crops to plant, map where they are in the fields and assign and check off tasks. Over time, the data give small farmers an overview of whether their operations are efficient and profitable.
The program is the brainchild of plant biologist Giulia Stellari, 31, and plant breeder Jeffrey Gordon, 32. The pair met and began talking about the idea in 2007 while in grad school at Cornell. They were initially interested in networking data from small farmers that would help illuminate big trends, such as a pattern of pests or the effect of unseasonably hot weather on a new variety of peas. (The name, AgSquared, is an abbreviation for Aggregating Agriculture.) But after talking to farmers, Stellari and Gordon realized that kind of information didn’t exist in electronic form. “Most farmers used paper notebooks, or maybe an Excel spreadsheet,” says Stellari. “There was nothing out there that took the information and made it useful.”
One reason: Software designed to manage small, diversified farms didn’t really exist. The technology was geared for either backyard gardeners or commodity growers who manage hundreds of acres of two or three crops from the comfort of their air-conditioned tractors. Because many stewards of small farms sell through community-supported agriculture programs or at farmers markets that thrive on variety, they grow a head-wrecking number of different crops: anywhere from 30 to 75 in a season.
AgSquared is designed to coax order from the chaos. It helps farmers create a plan, calculating how many seeds and how much space the farm needs and when workers will need to harvest. It creates task lists and schedules that are intuitively related. For example, if a farmer enters that he planted tomatoes on June 1, the software creates a task reminding him to weed two weeks later. Perhaps most important, it can transform a farmer’s daily schedule — what was done, how much time it took and which problems arose — into detailed, searchable records.
Since AgSquared’s soft launch in December 2011, about 2,800 farms in the United States and Canada have signed up. The software is in beta testing and available free of charge as the company continues to tweak the program to meet farmers’ needs. Subscription pricing will start later in 2012, with a basic package listed at $60 annually, discounted to $36 for the first year.
The software already has proved invaluable to small farmers such as Jamie Baker. A former IT director, Baker and her husband, David, bought Primrose Valley Farm, an 83-acre property outside Madison, Wis., in 2008 and began growing fruits and vegetables. That first year, Baker set up elaborate spreadsheets to keep track of which crops they planted, what was harvested and who did what. “But I kept thinking: This needs a database,” she says. “With my background, I knew what could be accomplished with the right technology.”
One of the key ways the Bakers use AgSquared is to keep up with their organic certification. Its mapping feature helps them make sure their 75 kinds of crops are appropriately rotated. They can print out detailed records for their certifier that trace crops from seed to harvest. The Bakers also use AgSquared’s checklists to make sure nothing falls through the cracks. “On any given day, five things come up to distract you,” she says. “If you don’t have the ability to check something off, you end up in a situation where you say, ‘Did anyone ever do that?’ ”
Jerry Cornett is using AgSquared to launch his next career. After more than two decades in the U.S. Navy, the 46-year-old retired commander returned to his home state of Nebraska, where he and his wife plan to open a farm-to-table restaurant with a menu ambitious enough to draw customers from nearby Lincoln. “My wife gave me a list of 50 kinds of fruits and vegetables she wants me to grow through the seasons: fennel, beets, kohlrabi, ground cherries, tomatillos,” he says. “I’m looking at this from 21 years in the military. How do I measure progress? How do I measure profitability? I love doing this. But if it nets me $10,000 a year, it’s not worth it.”
Cornett uses AgSquared’s calendar and mapping features. But labor is his biggest cost. So he also uses the software to track how long it takes to finish specific tasks, such as transplanting seedlings from the greenhouse to the fields. By analyzing the data, he has discovered how to shave five or 10 minutes off mundane chores, seemingly negligible bits of time that add up over the course of the year. Eventually, he will be able to judge which of those 50 crops are worth growing himself and which don’t make financial sense.
“People like to complain about what’s going on with Big Ag and corporations,” Cornett says. “But if you want small farms to succeed, you have to figure out what makes a five- or 10-acre farm profitable. Because then others will come and do it.”
Black, a former Food section staffer based in Brooklyn, writes Smarter Food monthly. Follow her on Twitter: @jane_black. | 6,649 | 3,267 | 0.000319 |
warc | 201704 | This piece is part of this week’s On Leadership roundtable exploring Tim Cook’s succession of Steve Jobs as CEO of Apple, and how to follow in the footsteps of an icon.
It’s tough as a new CEO to fix a troubled company suffering under a legacy of misleadership, as Meg Whitman is about to learn at Hewlett-Packard. But it’s even tougher to follow in the footsteps of an icon—a leader who didn’t just win big with the company, but changed the industry’s game.
Just ask James Parker, who took over Southwest Airlines after larger-than-life Herb Kelleher and stepped down after three underwhelming years. Or ask Jeffrey Immelt, who has spent a decade as CEO of General Electric but still can’t escape the shadow of Jack Welch, Fortune’s “Manager of the Century” for the 20th century.
So it’s fair to say that Tim Cook, Steve Jobs’s successor at Apple, is stepping into the toughest job imaginable—taking over for everyone’s choice as “Manager of the Century” for the 21st century. How should Cook lead in the footsteps of such a legend?
First, stay fiercely loyal to the strategic ideas around which Steve Jobs has built Apple and its unprecedented track record of success. When most of us think of Apple, we think of its alluring gadgets and graceful retail spaces. But as Silicon Valley futurist Paul Saffo puts it, “Apple has beautiful products, but what Jobs has been building is a company whose legacy is ideas.” Those ideas involve the power of elegant design, the interplay between hardware and software, and the vital role of technology “ecosystems” in reshaping the logic of how entire industries work. Simply put, there is no room for compromise or second-guessing on the point of view that has separated Apple’s business plan and product roadmap from every other company.
Second, stay true to yourself. Don’t try to channel Steve Jobs’s individual performance at public events and product unveilings (his so-called “reality distortion field”) or his borderline tyrannical persona inside the company. Sure, Apple’s 50,000 employees are fanatical in their devotion to the greatest American innovator since Thomas Edison. But with Jobs’s perfectionist style came a certain mental exhaustion, physical fatigue and even fear within the ranks that “Tim being Tim” (as opposed to “Tim trying to be Steve”) could go a long way to relieve.
Finally, use this moment of leadership succession to recalibrate how Apple (and all of us who play such close attention to Apple) think about the idea of leadership itself. There’s no doubt that Steve Jobs will go down as one of the most creative, visionary, high-impact leaders of his generation—or any generation. But his genius has been of a uniquely personal kind: the “smartest-guy-in-the-room” syndrome that is deserved in his case, but is decidedly underserved among so many CEOs who overrate the power of their intellect or the acuity of their vision. The reason so few leaders at other companies come close to Steve Jobs’s record is that they share many of the most demanding and controlling features of his personal style, but little of his insights and creativity.
Tim Cook has a chance to show the world that you don’t need to be as smart and visionary as Steve Jobs—who is?—to lead the company that Jobs built. Indeed, the best leaders I know don’t want the job of thinking for everyone else. They understand that if they can tap the hidden genius inside the organization, and the collective genius outside the organization, they will create ideas much more powerful than what even the smartest individual leader could come up with on his or her own. In other words, nobody alone is as smart as everybody together.
The folks at IBM, who just celebrated the company’s 100th anniversary, call this new leadership mindset “humbition”—the subtle blend of ambition and humility that drives the most successful leaders at their company.
Humility was never a big part of the Steve Jobs leadership repertoire—and that worked out fine for him, his company and his customers. Yet what Tim Cook has the opportunity to demonstrate, to audiences inside and outside of Apple, is that he can be as committed as his predecessor to beautiful products, elegant designs and transformational strategies, without pretending that he can wield the lone genius of his predecessor.
In that sense, the great leadership opportunity facing Tim Cook is to extend the legacy of Steve Jobs, by showing that you don’t have to be Steve Jobs to maintain his record of innovation and imagination. Here’s wishing him luck.
Related Articles:
Nancy Koehn: Putting Steve Jobs in perspective
William C. Taylor: Tim Cook, here’s how to lead Apple
Carol Kinsey Goman: Should Tim Cook wear a black turtleneck? | 4,979 | 2,393 | 0.000441 |
warc | 201704 | Definitions from Wiktionary, Creative Commons Attribution/Share-Alike License adj. Within a blood vessel Etymologies from Wiktionary, Creative Commons Attribution/Share-Alike License endo-+ vascular Examples
This less-invasive procedure, called
endovascularstent grafting, leads to a much shorter hospitalization and a quicker recovery time.
In such "
endovascular" procedures within the arteries, the device is slid up through a small incision into an artery in the leg and then into place in the aorta.
Traditionally, doctors have advocated preventative interventions, such as
endovascularprocedures, surgical resection, or radiation therapy and sometimes a combination of these procedures, on the assumption that unruptured AVMs pose similar risk to AVMs that have bled.
Others who have severe heart disease can now be treated using
endovasculartechniques, where stents are placed into the coronary arteries through a catheter instead of with open heart surgery.
"Increase of 1-year mortality after perioperative beta-blocker withdrawal in
endovascularand vascular surgery patients."
Ev3's devices are used in
endovascularsurgeries, or operations in which surgeons make small incisions and maneuver devices in the body using major blood vessels.
For larger veins, doctors may recommend
endovascularprocedures, which range in price from $2,500 to $3,000.
Boston Scientific Corp. and Medtronic Inc. settled two patent lawsuits in Texas and agreed not to pursue three others, ending all litigation between the companies related to interventional cardiology and
endovascularrepair.
Newer research is focused on
endovascularcooling, using small catheters that can apply cooling directly to the blood vessels leading to the brain.
Cora receives
endovasculartreatment, while Roxie's surgery includes a technique of bypassing the brain's blood vessels with a graft from her radial artery. | 1,909 | 963 | 0.001053 |
warc | 201704 | WWF’s Monica Echeverria has escorted scientists and television crews to the monarch butterflies’ wintering grounds twice. She spoke with WWF Travel about her remarkable experiences.
WWF Travel: Our tour takes place in February. Can you describe what our travelers will see at that time?Monica Echeverria: The first time I went to see the monarchs was at the end of January. At this time, the butterflies are often sleeping, but some of them wake up when the sun hits them and warms their wings. Then they fly to ponds or puddles to go take a drink of water and return to the trees.
The second time was at the beginning of March, just when they started to awake and fly all over the place. One of the most impressive scenes was when, we were driving on a highway and all of a sudden we noticed a colony of butterflies flying down the mountain. It was like a huge column of black and orange, all following each other. You think they are going to crash into you, but they don’t. All the cars stopped, and we watched for an hour.
WWF: What are the conditions like? ME: The butterflies are found in high-altitude areas. Often you will have to hike 1 or 1 ½ hours through oak, oyamel and pine forests to get the sanctuaries. WWF: Do the branches on the trees in the forests really bend from the weight of all the butterflies? ME: They do! It’s like tree branches in the winter, hanging from the weight of all the snow. Each weighs less than half an ounce. There are thousands on each branch. You don’t even see the trunk or branches of the trees—not one single spot is left. It’s all black and orange. WWF: Why do the butterflies come here? ME: As with some other species, the monarchs migrate to avoid the strong winters in Canada and the United States, finding the right temperature to hibernate in these forests. What we don’t know is how each year one generation for every four or five generations comes back to the same mountains. We don’t know how they find their way back to the same area. It’s a big mystery. WWF: How does a small butterfly have the energy to make such a long trip? ME: The generation that migrates is physically different from the other generations. For example, during their larval phase they don’t develop sexually, but instead they accumulate fatty deposits, gaining calories to prepare for the trip. They use those lipids for energy to fly all the way to Mexico. When they arrive, they sleep to gain weight and take in sun exposure. During this time they also become sexually mature. When they finally wake up, they go like crazy! You see them mating everywhere. WWF: What should travelers do to prepare for this trip? ME: Expect a lot of walking. Because of the high altitude and hills, you should be in good shape. Make sure to wear good hiking boots, and bring lots of water. It can get cold, so bring gloves and a hat and a warm jacket. | 2,929 | 1,436 | 0.000712 |
warc | 201704 | Related Information Additional Resources
Volume 13, Number 8—August 2007
Research Risk Factors for Colonization with Extended-Spectrum β-Lactamase–producing Bacteria and Intensive Care Unit Admission
Highlight and copy the desired format.
EID Harris AD, McGregor JC, Johnson JA, Strauss SM, Moore AC, Standiford HC, et al. Risk Factors for Colonization with Extended-Spectrum β-Lactamase–producing Bacteria and Intensive Care Unit Admission. Emerg Infect Dis. 2007;13(8):1144. https://dx.doi.org/10.3201/eid1308.070071 AMA Harris AD, McGregor JC, Johnson JA, et al. Risk Factors for Colonization with Extended-Spectrum β-Lactamase–producing Bacteria and Intensive Care Unit Admission.
Emerging Infectious Diseases. 2007;13(8):1144. doi:10.3201/eid1308.070071. APA Harris, A. D., McGregor, J. C., Johnson, J. A., Strauss, S. M., Moore, A. C., Standiford, H. C....Morris, J. (2007). Risk Factors for Colonization with Extended-Spectrum β-Lactamase–producing Bacteria and Intensive Care Unit Admission.
Emerging Infectious Diseases, 13(8), 1144. https://dx.doi.org/10.3201/eid1308.070071. Abstract
Extended-spectrum β-lactamase (ESBL)–producing bacteria are emerging pathogens. To analyze risk factors for colonization with ESBL-producing bacteria at intensive care unit (ICU) admission, we conducted a prospective study of a 3.5-year cohort of patients admitted to medical and surgical ICUs at the University of Maryland Medical Center. Over the study period, admission cultures were obtained from 5,209 patients. Of these, 117 were colonized with ESBL-producing
Escherichia coli and Klebsiella spp., and 29 (25%) had a subsequent ESBL-positive clinical culture. Multivariable analysis showed the following to be statistically associated with ESBL colonization at admission: piperacillin-tazobactam (odds ratio [OR] 2.05, 95% confidence interval [CI] 1.36–3.10), vancomycin (OR 2.11, 95% CI 1.34–3.31), age >60 years (OR 1.79, 95% CI 1.24–2.60), and chronic disease score (OR 1.15; 95% CI 1.04–1.27). Coexisting conditions and previous antimicrobial drug exposure are thus predictive of colonization, and a large percentage of these patients have subsequent positive clinical cultures for ESBL-producing bacteria.
Extended-spectrum β-lactamase (ESBL)–producing gram-negative bacteria are emerging pathogens. Clinicians, microbiologists, infection control practitioners, and hospital epidemiologists are concerned about ESBL-producing bacteria because of the increasing incidence of such infections, the limitations of effective antimicrobial drug therapy, and adverse patient outcomes (
1 – 5).
Research conducted to date has focused on identifying risk factors for colonization with multidrug-resistant, gram-positive bacteria. In contrast, little research has been conducted to identify the risk factors for colonization with gram-negative multidrug-resistant bacteria in nonoutbreak settings. To our knowledge, no study of the magnitude of our study has been conducted, nor have any studies based in the United States sought to identify risk factors for colonization with ESBL-producing bacteria on admission to an intensive care unit (ICU).
The primary objective of our study was to identify factors predictive of colonization with ESBL-producing bacteria at admission to an intensive care unit (ICU). In addition, we identified the percentage of patients colonized with ESBL-producing bacteria who had a subsequent positive clinical culture for the same species of ESBL-producing bacteria. Understanding risk factors for colonization is important for several reasons. First, understanding the potential causal mechanisms of colonization can lead to successful infection control, involving antimicrobial stewardship and public health interventions aimed at controlling the emergence of ESBL-producing bacteria. Second, such knowledge can help identify which patients should be receiving empiric ESBL-targeted antimicrobial therapy. Some hospitals have used active surveillance culturing for antimicrobial drug–resistant, gram-negative bacteria to help guide empiric therapy (
6). Study Population and Sample Collection
We conducted a prospective cohort study of patients admitted to either the surgical or medical ICU at the University of Maryland Medical Center from September 1, 2001, through June 1, 2005. Descriptions of the hospital and the ICUs are reported in other publications (
7 , 8). During the study period, on average, 8.6 clinical cultures per month were positive for ESBL-producing bacteria. No outbreaks of ESBL-producing bacteria were found among clinical cultures based on control process charting. No additional infection control precautions were used for patients with ESBL-producing bacteria on clinical culture. ESBL surveillance culture results were not given to physicians or nurses. Contact isolation precautions were applied for patients with vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus infections.
During the study period, nurses obtained perianal specimens for culture from all ICU patients within 48 hours of ICU admission. All patients who had admission culture results were included in this study. Patients with multiple admissions to either of the ICUs during the study period were allowed to enter the cohort of at-risk patients multiple times, as long as they were not positive for ESBL-producing bacteria on any prior admissions (because patients remain at risk for ESBL-producing bacteria on each subsequent admission). This study was approved by the Institutional Review Board of the University of Maryland, Baltimore. Informed consent was not required by the Institutional Review Board because perianal specimens were cultured as part of infection control quality improvement involving active surveillance culturing for vancomycin-resistant enterococci.
Microbiologic Methods
The perianal cultures were processed for ESBL-producing bacteria in real time as the specimens were collected. The perianal cultures were first screened for potential ESBL-producing bacteria by plating onto MacConkey agar (Remel, Lenexa, KS, USA) with 2 μg/mL of ceftazidime added to the cooled agar before the plates were poured (
9). Plates were incubated at 37°C for 24 to 48 hours. Lactose-fermenting colonies growing on the ceftazidime-containing plates were identified as Escherichia coli or Klebsiella species by using API 20E identification strips (bioMérieux Vitek, Inc., Hazelwood, MO, USA). All E. coli and Klebsiella isolates underwent ESBL confirmatory testing by disk diffusion for ceftazidime and cefotaxime with and without clavulanic acid as recommended by the Clinical Laboratory Standards Institute’s guidelines ( 10). Data Collection and Variables
For all patients included in the study, we collected data regarding the patient’s previous hospital antimicrobial drug exposures, length of hospitalization before ICU admission, coexisting conditions, previous positive cultures, and other hospitalization-related and demographic information. Antimicrobial drug exposures were assessed in the period between hospital admission and ICU admission. Antimicrobial drugs were analyzed as binary variables; if an antimicrobial drug was received during the period defined above, it was classified as having been received independent of the number of doses received. Duration of antimicrobial drug exposure was not analyzed. Coexisting conditions were assessed by the Charlson Comorbidity Index, the Chronic Disease Score (CDS), and the infectious disease–specific CDS (CDS-ID) (
11 – 13).
Initial bivariable statistical comparisons were conducted by using the χ
2 test for categorical data and the Student t test or Wilcoxon test for continuous data. Continuous variables that were not normally distributed were categorized for the purpose of multivariable analyses. To identify patient characteristics associated with colonization by an ESBL-producing bacterium on ICU admission, we used multivariable logistic regression. Because patients were allowed to enter into the study multiple times, we also assessed the need to control for the correlated error structure of the data. All variables that were associated with ESBL colonization in the bivariable analysis at the p<0.1 level were included in the model-building stages of the multivariable analysis. A stepwise model building method was used. Variables were retained in the final model if they were significant at a p<0.05 level or if they were observed to have a confounding effect on the association between another predictor and ESBL colonization status. A confounding effect was defined as a change in the model coefficient by >10%. An additional bivariable statistical analysis was performed to identify risk factors for subsequent clinical culture positivity with the same species of ESBL-producing bacteria among the cohort of patients colonized with an ESBL-producing bacteria. We calculated the C statistic of the final model. The C statistic reports values from 0.5 (indicating no predictive power) to 1.0 (indicating perfect prediction). In addition, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for patients with or without all dichotomous variables in the final model. Statistical analysis was performed with SAS Version 9.1 (SAS Institute, Cary, NC, USA).
During the study period, 5,209 (84%) admitted patients had results of admission perianal cultures and were included in this study, 4,398 patients had 1 ICU admission, and 618 patients had repeat admissions. Ninety-one percent of the surveillance cultures were obtained within the first 12 hours of ICU admission. The cross-sectional patient cohort consisted of 2,096 (40%) admissions to the medical ICU and 3,113 (60%) admissions to the surgical ICU. The mean age of the patients was 55 years. The mean comorbidity score as measured by the CDS–ID was 2.73 and 2.42 as measured by the Charlson Comorbidity Index. Based upon International Classification of Diseases, 9th revision (ICD-9) codes, 1,285 (25%) had diabetes, 1,344 (26%) had cancer, and 193 (4%) were HIV positive; 1,594 (31%) of patients had been transferred from another healthcare facility, and 1,693 (33%) had been previously admitted to the same hospital within the past year.
We examined patient characteristics, coexisting conditions, and previous antimicrobial drug exposures to identify factors potentially associated with colonization by an ESBL-producing bacterium on ICU admission (Table 1, bivariable analysis). Of 5,209 patient admissions, 117 (2%) patients were colonized by an ESBL-producing
E. coli or Klebsiella species bacterium on ICU admission. Specifically, 76 (65%) patients were colonized by an ESBL-producing E. coli, 55 (47%) were colonized by an ESBL-producing Klebsiella species, and 14 (12%) patients were colonized by both. Stratified bivariable analyses by organism are as follows: for E. coli, zosyn (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.17–3.18), vancomycin (OR 1.66, 95% CI, 0.91–3.03), age (OR 2.51, 95% CI 1.57–4.00), and coexisting conditions (OR 1.19, 95% CI 1.05–1.35); for Klebsiella spp., zosyn (OR 2.30, 95% CI 1.31–4.06), vancomycin (OR 3.91, 95% CI 2.21–6.91), age (OR 1.29, 95% CI 0.76–2.20), and coexisting conditions, as measured by CDS-ID (OR 1.12, 95% CI 0.96–1.31). Stratified analysis results for those patients who were in the hospital at least 24 hours before ICU admission are as follows: zosyn (OR 2.34, 95% CI, 1.11–4.94), vancomycin (OR 3.25, 95% CI 1.57–6.75), age (OR 1.39, 95% CI 0.68–2.86), and coexisting conditions as measured by CDS-ID (OR 95% CI 1.01–1.44).
The results of the final multivariable logistic regression analysis are shown in Table 2. Age >60 years (OR 1.79, 95% CI 1.24–2.60), coexisting conditions as measured by the CDS-ID (OR 1.15, 95% CI 1.04–1.27), in-hospital use of piperacillin-tazobactam (OR 2.05, 95% CI 1.36–3.10), and in-hospital use of vancomycin (OR 2.11, 95% CI 1.34–3.31) were all found to be independently associated with colonization by an ESBL-producing bacterium on admission to an ICU. No other antimicrobial drug was found to have a significant (p<0.05) effect in the final multivariable model. Note that we did not adjust for the correlated error structure of the data in the final analysis; because the correlation was low, this adjustment had little effect on our estimates (data not shown). The C statistic of the final model was 0.69. Patients categorized on the basis of the presence of all of the following dichotomous predictors of the final model (zosyn, vancomycin and age >60) yielded a sensitivity of 9.4%, specificity of 97.3%, positive predictive value of 7.3%, and negative predictive value of 97.9%.
For the 117 patients identified as colonized with ESBL-producing bacteria, we assessed their history of culture positivity with ESBL-producing bacteria as well as other antimicrobial drug–resistant bacteria (Table 3). Of the ESBL-colonized patients, 6 (5%) had positive clinical cultures for ESBL-producing bacteria during the same hospital admission but before ICU admission, and 29 (25%) had a subsequent ESBL-positive clinical culture from the time an ICU admission surveillance specimen was obtained for culture to the date of hospital discharge. The only risk factor that predicted subsequent positive ESBL clinical culture was the amount of time in the hospital between positive surveillance culture and hospital discharge (OR 1.03 per additional day, 95% CI 1.01–1.06). These 29 patients had 56 clinical cultures with ESBL-producing bacteria. The sources of the 56 clinical cultures positive for ESBL-producing bacteria were the following: 9 blood cultures, 17 sputum or bronchoscopy specimens, 10 urine cultures, 12 wound cultures, and 8 miscellaneous sources. Of 117 ESBL-colonized patients, 41 (35%) were known to have been previously infected or colonized with either methicillin-resistant
S. aureus (MRSA) or vancomycin-resistant enterococci (VRE). Among the 5,092 patients not colonized with ESBL-producing bacteria, 33 (0.6%) had a subsequent positive ESBL clinical culture with the same bacterial species between the time of ICU admission surveillance culture to the date of hospital discharge.
In this study, we identified risk factors for colonization with ESBL-producing
E. coli and Klebsiella spp. at ICU admission. We identified age >60 years, comorbidity as measured by the CDS-ID, previous in-hospital piperacillin-tazobactam use (current admission), and previous present admission in-hospital vancomycin use (current admission) as independent risk factors. We also quantified the ESBL colonization/clinical culture positivity rate among these patients and addressed the question of whether patients colonized with ESBL had a history of colonization with MRSA and VRE.
The risk factors identified are potentially important because they can help determine which patients may need empiric antimicrobial drug therapy targeted to the ESBL-producing bacteria. Carbapenem antimicrobial agents may be preferred as empiric choice for patients at risk for ESBL-producing bacteria (
2). We are not recommending that all patients with these risk factors receive empiric antimicrobial drug therapy targeted to ESBL-producing bacteria. However, among particular patients with the identified risk factors and levels of severity of infection that require empiric therapy, a choice of empiric therapy that includes coverage of ESBL-producing bacteria may be warranted. Thus, we recommend that for patients in ICUs with similar characteristics to the units in this study, physicians consider using antimicrobial agents targeted against ESBL-producing bacteria. These ESBL-targeted drugs should be considered when the physician chooses to prescribe an antimicrobial drug for situations such as fever of unknown origin, suspected pneumonia, or suspected bacteremia. In addition, these risk factors identified may be of use to hospital antimicrobial drug stewardship programs and pharmacy and therapeutics committees.
We hope that our risk factor study and other risk factor studies in the area of antimicrobial drug resistance will be used in future antimicrobial agent stewardship intervention studies and future infection control intervention studies. Previous risk factor studies have led to antimicrobial agent stewardship intervention studies aimed at controlling ESBL-producing bacteria (
14 , 15). In the areas of pneumonia and neutropenia patients with fever, risk factors studies have successfully led to intervention studies that have affected national guidelines ( 16 – 18). Well-designed intervention studies, based on risk factor studies of antimicrobial drug resistance, can lead to more appropriate antimicrobial drug use, which will improve patient outcomes and decrease the emergence of antimicrobial drug resistance ( 19 , 20).
The risk factors identified may be causally related to the outcome of ESBL-colonization or may only be statistically associated. Age >60 years and the presence of coexisting conditions have validity and biologic plausibility for a causal association with colonization status (
1 , 9 , 21). The identification of piperacillin-tazobactam and vancomycin as risk factors is more intriguing. Vancomycin and piperacillin-tazobactam are widely used at our tertiary-care hospital, the University of Maryland Medical Center, and thus may just be markers of ICU patients who require broad-spectrum antimicrobial coverage. However, understanding intestinal ecology and antimicrobial drug resistance is still in nascent stages. Vancomycin and piperacillin-tazobactam may be true causal risk factors for colonization with ESBL-producing bacteria. Piperacillin-tazobactam is believed to be effective against ESBL-producing bacteria only when the inoculum is low ( 22). Thus, with regard to the intestinal flora, piperacillin-tazobactam may not be effective at eradicating ESBL-producing bacteria due to inoculum effects and low intestinal concentration of piperacillin-tazobactam. Additionally, we were surprised by the identification of piperacillin-tazobactam as a risk factor as some hospitals have adopted antimicrobial drug stewardship policies that have limited the prescribing of cephalosporins and increased the use of antimicrobial drugs, including piperacillin-tazobactam, in an effort to control ESBL-producing bacteria ( 15 , 23). Vancomycin may be a risk factor through relative decolonization of the normal flora through vancomycin exposure and then subsequent colonization with ESBL strains through horizontal transmission before ICU admission ( 24, 25).
We found a ratio of colonization to clinical culture positivity that was the same order of magnitude as for VRE and MRSA (
26– 29). In addition, only 35% of patients with ESBL-colonization were previously known to be VRE or MRSA positive. These numbers and the local prevalence rate of ESBL-producing bacteria are important parameters in assessing the cost-effectiveness of active surveillance for ESBL-producing bacteria. Further work, including cost-effectiveness studies, needs to address whether active surveillance is beneficial for ESBL-producing bacteria.
Several studies. performed worldwide, have analyzed risk factors for colonization with multidrug resistant
Enterobacteriaceae. Many studies have not analyzed the specific antimicrobial drug resistance mechanism and thus are not directly comparable to our study. A study from Canada determined that several antimicrobial drugs were risk factors for multidrug resistant Enterobacteriaceae ( 30). In contrast to our study, most of their isolates had AmpC as a resistance mechanism, and thus their study did not determine risk factors for ESBL-producing bacteria. A 4-year cohort study done in France determined the ESBL-producing bacteria colonization rate in 2 ICUs to be 0.97% and thus concluded that, in their setting, active surveillance was unlikely to be cost-effective ( 31). A study in Israel identified 26 (10.8%) of 241 patients tested by active surveillance as colonized with ESBL-producing bacteria. Risk factors identified in multivariable analysis were poor functional status, current antimicrobial drug use, chronic renal insufficiency, liver disease, and the use of histamine 2 receptor antagonists ( 32).
A limitation of our study is that we did not have access to records of the antimicrobial drugs that patients may have received as outpatients before their hospital admission. However, relevant to the question of empiric therapy, most intensive care clinicians do not have access to records of outpatient antimicrobial drug use when they are empirically choosing antimicrobial agents. Another limitation of the study is that we did not have access to the subsequent ESBL-positive clinical isolates and thus were unable to compare them by molecular epidemiologic methods, such as pulsed-field gel electrophoresis, to see whether they were identical to the ESBL-colonizing isolates identified previously. We did not perform chart review; thus, the subsequent clinical cultures with ESBL-producing bacteria could have represented either clinical infection or colonization, based on definitions from the Centers for Disease Control and Prevention (
33). The use of ceftazidime in the screening agar may have caused the CTX-M family of β-lactamases to be missed. However, no CTX-M enzymes were detected in a sample of clinical isolates from the University of Maryland Medical School and the adjacent Veterans Affairs Medical Center from 2001 to 2002 ( 34).
In this study, we identified risk factors for ESBL-producing bacterial colonization among ICU patients. These data may be useful for identifying which patients may warrant empiric ESBL-targeted antimicrobial drug therapy. We also demonstrate that subsequent infections with ESBL-producing bacteria develop in a large percentage of ICU patients colonized with ESBL-producing bacteria.
Dr Harris is an associate professor in the Department of Epidemiology and Preventive Medicine at the School of Medicine of the University of Maryland. His research interests include emerging pathogens, antimicrobial drug–resistant bacteria, infection control interventions, medical informatics, and epidemiologic methods in infectious diseases.
Acknowledgments
We thank Colleen Reilly and Jingkun Zhu for database maintenance and abstraction.
This research was supported by National Institutes of Health grants K23 AI01752-01A1 and R01 AI60859-01A1.
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Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer.Clin Infect Dis. 2002;34:730–51. Carratala J, Fernandez-Sabe N, Ortega L, Castellsague X, Roson B, Dorca J, Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients.Ann Intern Med. 2005;142:165–72. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin.JAMA. 2000;283:749–55. Safdar N, Maki DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida.Ann Intern Med. 2002;136:834–44. Thomson KS, Moland ES. Cefepime, piperacillin-tazobactam, and the inoculum effect in tests with extended-spectrum beta-lactamase–producing Enterobacteriaceae.Antimicrob Agents Chemother. 2001;45:3548–54. Saurina G, Quale JM, Manikal VM, Oydna E, Landman D. Antimicrobial resistance in Enterobacteriaceaein Brooklyn, NY: epidemiology and relation to antibiotic usage patterns.J Antimicrob Chemother. 2000;45:895–8. Donskey CJ, Chowdhry TK, Hecker MT, Hoyen CK, Hanrahan JA, Hujer AM, Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients.N Engl J Med. 2000;343:1925–32. Donskey CJ, Hanrahan JA, Hutton RA, Rice LB. Effect of parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faeciumin the mouse gastrointestinal tract.J Infect Dis. 1999;180:384–90. Montecalvo MA, de Lencastre H, Carraher M, Gedris C, Chung M, VanHorn K, Natural history of colonization with vancomycin-resistant Enterococcus faecium.Infect Control Hosp Epidemiol. 1995;16:680–5. Ostrowsky BE, Venkataraman L, D'Agata EM, Gold HS, DeGirolami PC, Samore MH. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period.Arch Intern Med. 1999;159:1467–72. Chang FY, Singh N, Gayowski T, Wagener MM, Marino IR. Staphylococcus aureusnasal colonization in patients with cirrhosis: prospective assessment of association with infection.Infect Control Hosp Epidemiol. 1998;19:328–32. Coello R, Glynn JR, Gaspar C, Picazo JJ, Fereres J. Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus(MRSA) amongst hospital patients initially only colonized with MRSA.J Hosp Infect. 1997;37:39–46. Gardam MA, Burrows LL, Kus JV, Brunton J, Low DE, Conly JM, Is surveillance for multidrug-resistant Enterobacteriaceaean effective infection control strategy in the absence of an outbreak?J Infect Dis. 2002;186:1754–60. Thouverez M, Talon D, Bertrand X. Control of Enterobacteriaceaeproducing extended-spectrum beta-lactamase in intensive care units: rectal screening may not be needed in non-epidemic situations.Infect Control Hosp Epidemiol. 2004;25:838–41. Ben-Ami R, Schwaber MJ, Navon-Venezia S, Schwartz D, Giladi M, Chmelnitsky I, Influx of extended-spectrum beta-lactamase-producing Enterobacteriaceaeinto the hospital.Clin Infect Dis. 2006;42:925–34. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988.Am J Infect Control. 1988;16:128–40. Moland ES, Hanson ND, Black JA, Hossain A, Song W, Thomson KS. Prevalence of newer beta-lactamases in gram-negative clinical isolates collected in the United States from 2001 to 2002.J Clin Microbiol. 2006;44:3318–24. Tables Table 1. Potential predictors of colonization by an ESBL-producing bacterium on ICU admission Table 2. Independent predictors of ESBL-producing bacteria colonization in multivariable logistic regression model Table 3. History of culture positivity with antimicrobial drug–resistant bacteria among 117 patients colonized with ESBL-producing bacteria at ICU admission
DOI: 10.3201/eid1308.070071
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Page created: June 30, 2010 Page last updated: June 30, 2010 Page last reviewed: June 30, 2010 Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Office of the Director (OD) | 31,794 | 11,498 | 0.000088 |
warc | 201704 | The concept of “vocation” or “calling” is an application of the doctrine of providence: God not only preserves the cosmos and superintends the history of nations but is subtly at work in the most minute circumstances of each individual life.
The doctrine’s biblical lineage is clear: Since God feeds the birds of the air and clothes the lilies in splendor (Matthew 6:26-29), and since a sparrow cannot fall from the sky apart from the will of the Father (Matthew 10:29), then surely God provides and cares even more for His children. If God has a plan to prosper us (Jeremiah 29:11), and works all things to good for those who love Him and are called according to His purpose (Romans 8:28), then surely each believer is called to a role in the salvation of the world and the redemption of all things.Continue Reading on www.worldmag.com | 864 | 513 | 0.002015 |
warc | 201704 | Piotr Faliszewski, Edith Hemaspaandra, Lane Hemaspaandra, Joerg Rothe
Control of elections refers to attempts by an agent to, via such actions as addition/deletion/partition of candidates or voters, ensure that a given candidate wins (Bartholdi, Tovey, and Trick 1992). An election system in which such an agent's computational task is NP-hard is said to be resistant to the given type of control. Aside from election systems with an NP-hard winner problem, the only systems known to be resistant to all the standard control types are highly artificial election systems created by hybridization (Hemaspaandra, Hemaspaandra, and Rothe 2007). In this paper, we prove that an election system developed by the 13th century mystic Ramon Llull and the well-studied Copeland election system are both resistant to all the standard types of (constructive) electoral control other than one variant of addition of candidates. This is the most comprehensive resistance to control yet achieved by any natural election system whose winner problem is in P. In addition, we show that Llull and Copeland voting are very broadly resistant to bribery attacks, and we integrate the potential irrationality of voter preferences into many of our results.
Subjects: 7.1 Multi-Agent Systems;9.2 Computational Complexity Submitted: Apr 23, 2007
This page is copyrighted by AAAI. All rights reserved. Your use of this site constitutes acceptance of all of AAAI's terms and conditions and privacy policy. | 1,482 | 784 | 0.00128 |
warc | 201704 | Historians have long blamed rats for spreading the plague in Europe nicknamed the "Black Death" in the 14th century, but new research points the finger at a different furry culprit: gerbils.
Known for decimating the European population in the middle ages, the Black Death was caused by the bacterium
yersinia pestis, which somehow made its way from Asia to Europe in 1347, according to the study published today in the journal PNAS.
Study co-author Nils Stenseth, a biologist at the University of Oslo, said that 12 to 15 years before the plague hit Europe, Asia experienced a warm spring and wet summer, which is good for the gerbils and fleas that carried the plague. Then, a drought decimated the gerbil population, forcing the plague toward domestic animal and human hosts, he said. It then made its way to Europe, though the vessel is unclear, Stenseth said.
Stenseth and his team determined the climate hundreds of years ago by examining tree growth rings, according to the study. The authors wrote that a better approach would be to study the DNA gleaned from the remains of plague victims.
Epidemiologist Dr. Bill Schaffner, chair of preventive medicine at Vanderbilt University Medical Center, said he found the study "intriguing" because he'd never before heard of an animal other than the rat being blamed for the Black Death. But he said the authors are doing a lot of inferring to come to their conclusions.
"My bottom line is that this is a fascinating new thesis," said Schaffner, who was not involved in the study. "And I think that it likely will result in a lot of controversy among people who are disease historians."
But your pet gerbil won't give you the plague, Stenseth. The animals that spread the plague in Asia was actually a separate, wild species known as a great gerbil, Stenseth said. | 1,831 | 964 | 0.001047 |
warc | 201704 | Head insulation and heat loss in the newborn. Abstract
The thermal balance of 13 term infants was measured in a closed-circuit metabolism chamber. Each was studied naked, then with a gamgee-lined hat, and finally with a 'cummerbund' made of a similar material and of similar dimensions. At 27 degrees C the oxygen consumption of the 'hatted' babies was only 85% and the total heat loss 75% of the values measured with the infants naked. The cummerbund offered no detectable benefit. An additional 10 infants were studied while wearing a tubegauze hat at environmental temperatures of 28.5 (+/- 0.5) degrees C. This type of hat gave no measurable thermal protection. It is concluded that a substantial reduction of thermal stress in adverse environments can be achieved simply and clearly by adequately covering the vault of the skull. | 837 | 500 | 0.002007 |
warc | 201704 | andconsistent positions on the matter are pretty rare on both sides. No, I don't include hard-core "states' rights" neo-secessionists as "well-considered" any more than I do the "abolish the states/federalize everything" busybodies. Personally, I think the commerce clause is pretty thin basis for our current level of federalization, but that it's irrational to consider onlycommerce as a matter where national consistency is worth overriding local particularism.
So, in the "amazing but not surprising" category comes two new Republican initiatives (they're in power, so their hypocrisy is most obvious) to obliterate states' rights with regard to safety issues. The National Right-to-Carry Reciprocity Bill would require the same treatment of concealed carry gun permits as of drivers' licenses: "full faith and credit" overriding local laws about whether and to whom concealed carry permits should be issued.
In states that issue concealed firearm permits, a state`s laws governing where concealed firearms may be carried would apply within its own borders. In states that do not issue carry permits, a federal "bright-line" standard would permit carrying in places other than police stations; courthouses; public polling places; meetings of state, county, or municipal governing bodies; schools; passenger areas of airports; and certain other locations.There's lots of pseudo-social science in the justifications section. I note, though, that Vermont has nolicensing requirement: would full faith and credit require that all current and former Vermonters be allowed unlicensed national permission to carry handguns?
And the US House is also considering a bill that would obliterate state food labeling requirements which were in any way more stringent or complete than federal requirements.
Attorneys general from 37 states wrote lawmakers Wednesday in opposition to the measure.Frankly, the national trend has usually been "California first, then everyone," so this is definitely swimming against the tide. Call it the "National Food Lobby Efficiency Act" because it would mean there was only one legislature and one set of agencies to pressure.... and who cares about those pesky The obvious target, they wrote, is California's Proposition 65, a law passed by voters requiring companies to warn the public of potentially dangerous toxins in food. The law has prompted California to file lawsuits seeking an array of warnings, including the mercury content in canned tuna and the presence of lead in Mexican candy.
Of course, the full hypocrisy of this is only realized when you consider the effect of "Marriage Protection" legislation that flies in the face of "full faith and credit." I can't believe the Supreme Court has let this stand....
Update: Oh, medical insurance coverage is now a federal issue, because states are requiring insurance companies to actually cover things.... | 2,918 | 1,483 | 0.000681 |
warc | 201704 | CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT.
Blackmun, J., delivered the opinion of the Court, in which Burger, C. J., and White, Powell, Rehnquist, and O'connor, JJ., joined. Marshall, J., filed a dissenting opinion, in which Brennan, J., joined, and in Part I of which Stevens, J., joined, post, p. 251.
JUSTICE BLACKMUN delivered the opinion of the Court.
The issue in this case is whether the transfer of a prisoner from a state prison in Hawaii to one in California implicates a liberty interest within the meaning of the Due Process Clause of the Fourteenth Amendment.
Respondent Delbert Kaahanui Wakinekona is serving a sentence of life imprisonment without the possibility of parole as a result of his murder conviction in a Hawaii state court. He also is serving sentences for various other crimes, including rape, robbery, and escape. At the Hawaii State Prison outside Honolulu, respondent was classified as a maximum security risk and placed in the maximum control unit.
Petitioner Antone Olim is the Administrator of the Hawaii State Prison. The other petitioners constituted a prison "Program Committee." On August 2, 1976, the Committee held hearings to determine the reasons for a breakdown in discipline and the failure of certain programs within the prison's maximum control unit. Inmates of the unit appeared at these hearings. The Committee singled out respondent and another inmate as troublemakers. On August 5, respondent received notice that the Committee, at a hearing to be held on August 10, would review his correctional program to determine whether his classification within the system should be changed and whether he should be transferred to another Hawaii facility or to a mainland institution.
The August 10 hearing was conducted by the same persons who had presided over the hearings on August 2. Respondent retained counsel to represent him. The Committee recommended that respondent's classification as a maximum security risk be continued and that he be transferred to a prison on the mainland. He received the following explanation from the Committee:
"The Program Committee, having reviewed your entire file, your testimony and arguments by your counsel, concluded that your control classification remains at Maximum. You are still considered a security risk in view of your escapes and subsequent convictions for serious felonies. The Committee noted the progress you made in vocational training and your expressed desire to continue in this endeavor. However your relationship with staff, who reported that you threaten and intimidate them, raises grave concerns regarding your potential for further disruptive and violent behavior. Since there is no other Maximum security prison in Hawaii which can offer you the correctional programs you require and you cannot remain at [the maximum control unit] because of impending construction of a new facility, the Program Committee recommends your transfer to an institution on the mainland." App. 7-8.
Petitioner Olim, as Administrator, accepted the Committee's recommendation, and a few days later respondent was transferred to Folsom State Prison in California.
Rule IV of the Supplementary Rules and Regulations of the Corrections Division, Department of Social Services and Housing, State of Hawaii, approved in June 1976, recites that the inmate classification process is not concerned with punishment. Rather, it is intended to promote the best interests
of the inmate, the State, and the prison community.
*fn1 Paragraph 3 of Rule IV requires a hearing prior to a prison transfer involving "a grievous loss to the inmate," which the Rule defines "generally" as "a serious loss to a reasonable man." App. 21. *fn2 The Administrator, under para. 2 of the Rule, is required to establish "an impartial Program Committee" to conduct such a hearing, the Committee to be "composed of at least three members who were not actively involved in the process by which the inmate . . . was brought before the Committee." App. 20. Under para. 3, the Committee must give the inmate written notice of the hearing, permit him, with certain stated exceptions, to confront and cross-examine witnesses, afford him an opportunity to be heard, and apprise him of the Committee's findings. App. 21-24. *fn3
The Committee is directed to make a recommendation to the Administrator, who then decides what action to take:
"[The Administrator] may, as the final decisionmaker:
"(a) Affirm or reverse, in whole or in part, the recommendation; or
"(b) hold in abeyance any action he believes jeopardizes the safety, security, or welfare of the staff, inmate
. . . , other inmates . . . , institution, or community and refer the matter back to the Program Committee for further study and recommendation." Rule IV, para. 3d(3), App. 24.
The regulations contain no standards governing the Administrator's exercise of his discretion. See Lono v. Ariyoshi, 63 Haw. 138, 144-145, 621 P. 2d 976, 980-981 (1981).
Respondent filed suit under 42 U. S. C. § 1983 against petitioners as the state officials who caused his transfer. He alleged that he had been denied procedural due process because the Committee that recommended his transfer consisted of the same persons who had initiated the hearing, this being in specific violation of Rule IV, para. 2, and because the Committee was biased against him. The United States District Court for the District of Hawaii dismissed the complaint, holding that the Hawaii regulations governing prison transfers do not create a substantive liberty interest protected by the Due Process Clause. 459 F.Supp. 473 (1978).
*fn4
The United States Court of Appeals for the Ninth Circuit, by a divided vote, reversed. 664 F.2d 708 (1981). It held that Hawaii had created a constitutionally protected liberty interest by promulgating Rule IV. In so doing, the court declined to follow cases from other Courts of Appeals holding that certain procedures mandated by prison transfer regulations do not create a liberty interest. See, e. g., Cofone v. Manson, 594 F.2d 934 (CA2 1979); Lombardo v. Meachum, 548 F.2d 13 (CA1 1977). The court reasoned that Rule IV gives Hawaii prisoners a justifiable expectation that they will not be transferred to the mainland absent a hearing, before an impartial committee, concerning the facts alleged in the
prehearing notice.
*fn5 Because the Court of Appeals' decision created a conflict among the Circuits, and because the case presents the further question whether the Due Process Clause in and of itself protects against ... | 6,621 | 3,039 | 0.000331 |
warc | 201704 | “But what, what, should I wear to the wedding?”
Is someone you know getting married? Your brother or your husband’s college roommate? Your cousin, colleague, acquaintance, nanny? Always, people ask, what should they wear? Weddings are the Forest Of Fog And Terrors in the Land Of What To Wear. Like Candyland, if you will.
What are the High WASP feelings about wedding dress? Do we care most about, for example, what time white tie kicks in? No. That’s 6pm. And all other matters of formal tradition are answered here. But few resources will tell you you the most important rule. Here goes.
You should wear whatever your social ecosystem says to wear.
Otherwise known, heretoforth, as your “micro-culture.” Anyone with a better term I welcome you to the front of the room. Please write it on our white board. Thank you.
How so? What do we mean?
1. Determine what the bride, groom, and families want and comply to the best of your ability. What matters more than supporting the families taking this big step, after all? Voicing a contrary opinion, adhering to rules outside their personal system, is bad manners. No matter the ‘official’ code. – Example: I’ve received two queries from readers puzzled by invitations requesting long dresses be worn at an afternoon wedding. It is an odd concept, but not scandalous, after all. The vision may be bourgeois, even declassé, but so are many long, happy marriages. – Example: I attended a wedding where the groom wore a black suit, his bride a white smoking, and we all cabin-camped in fog so thick it dripped. The dress code was noted as something like Anarchic. These visions may be outré, but so are many long, happy marriages. – Example: Groom in navy suit with lavender tie, groom in navy suit with green tie, dress code strictly Emily Post for 4pm at the yacht club. Divergent from last century’s traditions, but so are many long, happy, well, you say it. Contrary to popular belief, High WASPs believe more in respect for families, any families, than in a particular codification of behavior. 2. If the microculture doesn’t provide clear direction, i.e. bride is a tatooed printmaker living in Raleigh, Durham, her family are Southern Baptists, the groom’s family New York eclectic, choose the low-offense alternative. That may mean dressing to the standard code. It may not. So ask for guidance. This is not a time for renegade fashion unless your invitation source requests. Above all, support whoever invites you, or be prepared to deal with a long reparation process.
– Example: If you are friend of the tatooed bride – does she want you to reinforce her rebellious rockabilly aesthetic? Or bow your head to tradition and put on some pearls?
If you have any doubt, just ask. If you come from an indirect culture, have the indirect conversation. 3. This What To Wear burden ought not to be borne by guests alone. If you are the bride or the groom, do what you can to give people the right clues. Weddings are about two people, and probably two families, merging cultures and traditions, in the context of a whole coterie of social and economic and aesthetic considerations. You cannot assume that everyone knows what Black Tie, Elegant Hoedown, or Stick It To The Man dress codes mean.In this context, setting an aesthetic that’s consistent across your Save the Dates (if you do them), your invitations (if you do them), and your wedding style itself, is actually a favor to the attendees.
I do not need to say, but I will, that we assume you won’t press your advantage. That those of us who are not Beyonce ought most likely to stop short of insisting all our guests wear white, and allow for personal expression. But establishing a predictable environment is not a bad idea.
– Example: My wedding was black tie. But I wrote in the invitation to one friend, “Dress For Fun!” As it turned out, he was the one man who wore a suit and came up to me in some distress and asked me why I had sent that signal. He was right. I should have been more explicit. Do I remember anyone’s polyester peach taffeta from that night? Outfits that at other times, in other places, might have raised my eyebrow? No. I remember only that those who loved me wanted to belong to and support whatever I was creating. The same will be true in your community, of your loved ones. Help them out.
These High WASP rules aren’t as straightforward to follow as a 12-point matrix of colors, materials, timing, lengths, and venues would be.
This is not binary code, rather, an unspoken navigation of the mix and match that families, and society, ask of us. As is marriage. Which doesn’t come with a simple how-to either.
Most of all, do not use ‘etiquette’ as a way to make people feel uncomfortable. Not you, the guest, not you, the bride, not you, the groom, and not you, you over there, the bride’s mother. Why would one ever use a wedding, one of the most joyous events in the human canon, to make other people feel badly? | 5,113 | 2,507 | 0.000412 |
warc | 201704 | Jhanjhar Bhaidia, the veteran leader of the Adivasi Morcha Sangathan then got up and asked them why they had now come to the conclusion that electoral politics was the key to people's emancipation. He said that even if it was the policy of the Adivasi Morcha Sangathan to be indifferent to all elections from the lowest Panchayat to the highest Lok Sabha it allowed its members to fight elections or support political parties on their own. Consequently members of the AMS have fought at the Panchayat and Assembly election levels and supported some party or other at the Lok Sabha level. During the assembly elections of 2008 Versingh Davar of the AMS had contested and a big contingent of the Sangathan had taken part in the rallies organised by the NBA in Khandwa. However, when Versingh and Jhanjhar had asked the NBA to support Versingh in the elections then the NBA had taken the stand that they do not take part in elections and neither do they support any party considering the whole electoral process to be corrupt. Jhanjhar asked Alok as to why had the NBA now changed its stand when it had refused to support Versingh earlier.
Alok had no answer to this apart from repeating that by becoming part of the AAP phenomenon it had now become possible to win elections. In the same breath he said that since the NBA was a people's movement it did not have the resources of political parties and thus it required the support of the AMS. Then, I intervened and said that organising people's movements and electoral politics are two different ball games altogether. The AAP had performed well in the Delhi elections by mobilising huge resources from all over India and abroad both in terms of finances and voluntary human power. On an average Rupees 25 lakhs had been spent per assembly constituency and hundreds of volunteers had given their time and skills to the electoral campaign. This had created a mass upsurge in its favour through a publicity blitz involving door to door campaigning, hoardings, radio advertisements and the like. Thus, if Alok wanted to win the elections he would have to mobilise similar resources which in the case of a large Lok Sabha constituency like Khandwa meant Rs 2 crores at least. Given the fact the AAP's centralised resource mobilisation had mustered only about Rs 10 crores so far, there was little possibility of any support coming from the central kitty for Alok's campaign and so he would have to mobilise resources on his own. Therefore, in addition to appealing for support from the AMS, he would have to more importantly mobilise resources for a publicity blitz to cover the whole of Bagli assembly constituency because even at its best the AMS could mobilise only about 10000 votes which is not sufficient.
Later on we had a long discussion about electoral politics. People said that electoral politics had become extremely vitiated with money power and it was unlikely that it could be cleansed on the strength of idealism. Unlike many of our Adivasi activists in Alirajpur, the veterans here did not appear to be impressed at all by the AAP's Delhi performance!!! Deepsingh, another veteran of the organisation said that the farther we stayed away from elections the better it was and he broached the subject of the annual Gatha celebration to commemorate the martyrs on April 2nd instead.
Alok is not the only activist but there are many others of the people's movements, notably people like Medha Patkar, who have now jumped into the electoral fray enthused by the AAP's performance in Delhi. However, none of these activists seem to have given a thought to the crucial resource mobilisation aspect which was the main factor behind AAP's electoral success. Both door to door campaigning to cover each and every household in a constituency and a publicity blitz through hoardings, posters and vehicle rallies will cost a huge packet and without this it won't be possible for a candidate to convey to the electorate that she is a winning proposition.
And here lies the most important problem. People who have money, not only the upper class but even the middle class, do not go along with the views about development that people like Alok and Medha espouse. Arvind Kejriwal was clever enough to target only corruption and promise freebies but he took care to not fundamentally challenge the present development pattern and that is how he has managed to raise resources. In fact faced with the daunting prospect of raising resources at a much greater level for the Lok Sabha elections he even went and held forth to the Conference of Indian Industry that he was in favour of capitalism and only against cronyism. Nevertheless the daily contributions to the AAP rarely cross Rupees 10 lakhs these days and that is woefully short of the huge requirements of fighting a nationwide election. Thus, if Medha, Alok and many other activists have to garner funds then they have to give up some of the central tenets of their development philosophy. There is no way in which Adivasi Self Rule or decentralised sustainable agriculture can be accommodated in the resource extractive development paradigm that holds sway at present. Even if Alok and Medha do declare like Arvind that they are for capitalism they are unlikely to be believed by those who hold the purse strings.
Even if we grant for the sake of argument that the activists of people's movements will be able to garner the necessary financial resources, the fight for a more decentralised system is unlikely to be won through winning elections with such huge expenditures. Winning the elections in this manner will require a jettisoning of the ideals for which the people's movements have been fighting. A lot more thought should be expended on how to take forward people's movements in an era of near complete capitalist domination instead of getting carried away by the AAP's victory in Delhi. Personally as an anarchist I find this rush of stalwarts of the people's movements across the country to join the electoral bandwagon of the AAP a little disconcerting!! Anyway the forthcoming elections will provide a reality check to all and sundry!! | 6,157 | 2,736 | 0.000366 |
warc | 201704 | Dear APW,
Last week, I was down in San Diego, tagging along on David’s business trip, and hanging out with friends that I don’t get to see enough. The baby and I had margaritas with Jamie, a friend I made through wedding planning on the internet, and her family (well, I had margaritas and he ate his toy). And I got time by the pool with one of my ladies who I’ve been friends with for the last twenty (!) years. We’ve been through three weddings together (hers, mine, hers but way better), and three pregnancies (hers, mine, hers again). This made me think (margarita in hand) about the way friendships helped me make it through my wedding planning, and how friendships are one of my patented marriage secrets.
Let’s be for real. If you’re female, and you tell me that you have an uncomplicated relationship with friendship, I’ll think you’re lying. Friendship stretches its tangled roots back as long as we can remember. There was the friend I made because we had the same bus stop. The friend I made by inviting her to my Halloween party in kindergarten. Matching BFF first day of school outfits from JCPenney’s the first day of 4th grade (but not knowing if my friend was as into them as I was). Friendship bracelets and pen pals at Girl Scout camp. Friends you passed fancy folded notes with. Friends who broke up with you by letter. Friends you thought you’d be close to forever that you lost touch with. Friends you never thought you’d talk to again, who have been there for every life marker.
This shit is complicated, ladies.
Wedding blogs present a blissful image of friendship—lifetime friends in artfully mismatched hip dresses, grinning at the camera. Once we get past the fact that it’s insanely hard to find artfully mismatched dresses without employing a design professional, who the hell has a wedding party made up of only lifelong best friends these days? Most of us are mashing together our high school friends, with college friends, a sibling or two, and newer friends that we’re not sure how to honor. We’re hoping that our high school friends don’t say something to offend our college friends, and that our college friends won’t be too insulted by the antics we get up to with our hometown crowd. We’re wondering if so-and-so will be insulted if we don’t include them, and if so-and-so will be weirded out if we DO include them. We’re trying to make our wedding fun for our friends, not impose, and ask for help, all at the same time.
This shit is complicated, ladies.
For me, the rubber meets the road when it comes to friendship and marriage. We’ve talked a lot on APW about the validity (or not) of the phrase, “Marrying my best friend.” Personally, I did marry my former platonic best friend, and as such, I no longer consider him my best friend. He’s my husband. It’s a totally different role. For me, this is a reminder that the role of friend has to be filled by others. All of my relationships can’t be handily balled into one person.
And it turns out, friendships matter. I mean, scientifically speaking, not just friendship-bracelet speaking. They matter to our health, they matter to our marriages, and sadly, we’re getting worse and worse at friendship. We may be friending more people on Facebook, but we’re losing real life in-depth relationships. This year, according to
The State Of Friendship In America Report (yes, that’s a thing), 75% of Americans said they were unsatisfied with their friendships and 63% said they were not confident in their friendships (amazing info-graphics here). Perhaps unsurprisingly, there was no relationship between number of Facebook friends and satisfaction with actual friendships. Plus, we now have fewer close friends. Studies show that in 2004 people had an average of only two people to confide in (down from three people in 1985), and 25% had no one to confide in at all. More pressingly, according to USA Today, “The percentage of people who confide only in family increased from 57% to 80%, and the number who depend totally on a spouse is up from 5% to 9%.” Why does this matter? Well, besides the fact that it’s dangerous to make one person your entire safety net, The New York Times reports that, “Friendship has a bigger impact on our psychological well-being than family relationships,” according to Rebecca Adams, a professor of sociology at the University of North Carolina, Greensboro. Tara Parker-Pope’s article further explains, “Exactly why friendship has such a big effect isn’t entirely clear. While friends can run errands and pick up medicine for a sick person, the benefits go well beyond physical assistance; indeed, proximity does not seem to be a factor.” And according to For Better, also by Tara Parker-Pope, involvement in a wider community strengthens marriage too.
It turns out, at least for me, the science is right. My marriage is strong when my outside relationships are strong. Luckily for me, this particular scientific solution means more margaritas, not vitamins, so everyone wins. It does, however, mean I have to do the hard work of maintaining those friendships, because I deeply need them. I need my pack of girlfriends to listen to me bitch about family and relationship issues, and to give me advice after I lay it all on the line. I need my local friends to come over to barbecue, to house-sit when I’m out of town, and to gossip with me. I need to go out to dinner with the friends I made online through wedding planning, and giggle over the kids interacting, and talk about motherhood and tequila. I need to get excited about new babies with my lifelong friend, and laugh at inside jokes we’ve had for twenty years. Each of those relationships strengthens a different part of my personality. They allow me to come to my partnership with stories to tell and perspective gained. They give me a chance to be my true self in a very different way than I am in partnership.
Getting married made all those years of broken-heart friendship necklaces worth it. They gave me a primary relationship to come home to, which in turn made my friendships so much more important.
And by the way. I’m pretty sure friendship bracelets are back. Luckily, I still mostly remember how to make them. I’m gonna get on that this month. Happy July, kids. Happy Friendship Month.
xo
P.S. We still have a few slots open for Friendship Month, so if you have a story to tell, please send it in! We particularly want to hear your stories about friendship and weddings—because we all know that can be painful… and blissful… sometimes all at once.
Photo: Amber Marlow Photography (APW Vendor) | 6,822 | 3,156 | 0.000328 |
warc | 201704 | READERS offered some old, new, usual and not so usual suggestions to our recent request for ways to eliminate fleas on dogs and cats.
Carole and John Micklos of Essex own a 100-pound female Doberman pinscher named Mandy, who is flea-free. The couple uses a combination of different sprays to eliminate fleas in the house, outside and on the dog. To save on the cost of an exterminator, John suggests buying a large sprayer ''for about $7'' and attacking the outside and inside with a good commercial flea spray. ''We've had great success on Mandy with Hartz Blockade,'' he says.
Pets on Wheels coordinator Elaine Farrant has two black cats and resists using toxic remedies. She writes, ''I vacuum the house at least twice a week and I diligently comb my cats daily beginning around the eyes, ears and neck and working down the back to the hind quarters. I drop the critters which my flea comb removes into a jar of soapy water to drown,'' she says.
Brent Rickman from Lutherville vacuums daily and sets up a flea trap at night.
''Fleas are attracted to lights and our trap is a dish of soapy water with a gooseneck lamp turned on a few inches over the water," he says. "Last night we caught 15 to 20 fleas.''
Garlic powder in her pet's food has worked for Mrs. Edward Armanas of Ellicott City. ''I endangered my pets with all kinds of chemicals, sprays and bombs designed to kill fleas," she says, "until I began sprinkling garlic powder over his food.''
Alma Homrighausen from Baltimore had several helpful hints. She, too, has flea traps -- lights over an adhesive surface which the fleas stick to. An advocate of natural products, Homrighausen uses cedar mulch and plants marigolds outside. Both are natural insect repellents.
Inside, she uses a product she discovered at a vendor's table at a Chesapeake Cat Show. Called Orange Magic, ''it is a citrus solution which is a testimonial for safe flea control. I dilute just one ounce to a gallon of water and scrub the floors and appliances and woodwork with it. I spray it lightly on everything, my curtains, furniture and carpets,'' she says. The product is not put on the cats but Homrighausen keeps a bowl of it near her flea combs to kill the fleas she combs off.
Orange Magic is available from Jerry Fox, who says it is an all-natural citrus extract solvent and degreaser. He says it's strong enough for industrial use but has no hazardous ingredients. For details call Fox at 788-7990 or (800) 543-4379.
Hilda and Ray Foreman of Dundalk eliminated the flea problem on their long-haired terrier with a product called Petcor, from Tanners' Exterminating Service in Dundalk. Bud Tanner at the company says Petcor ''has been a good and popular flea spray which is safe for kittens and puppies as well.''
The Sussex spaniel Bandit, who belongs to S.J. Mickens, is kept free of fleas with daily vacuuming and a good flea soap.
Velma Bosley of Randallstown uses garlic powder, about a teaspoon in the food.
Hazel Ayus cleans the cat box every day and lightly sprays her pets' sleeping area with a disinfectant. ''We haven't had fleas in 15 years,'' she wrote.
Veterinarian Ed Jendrek, who owns the Carney Animal Hospital on Harford Road, suggests vacuuming and flea sprays for the house and pet. ''Garlic powder and brewers yeast in the pet's food works in 50 percent of cases," he says.
''Bathe the animal once each week, say every weekend, during flea season and then in the middle of the week, use a good flea spray on it," he advises. "This is a routine which generally works. If the flea infestation gets out of hand inside, an exterminator is necessary,'' he says.
Something that has worked for this pet writer is two teaspoons of Avon's Skin So Soft with two teaspoons of Listerine in about three cups of water, either sprayed on the pet or wiped on daily.
Whatever weapons you chose to fight fleas, be sure to check your products, read your labels and talk to your veterinarian. | 3,962 | 2,050 | 0.000491 |
warc | 201704 | Many crucial powers and basic rights of the U.S. Constitution are couched in general terms, leaving much room for judicial interpretation. For this reason, a change of membership in the Supreme Court, and particularly the appointment of a new chief justice, is always a significant, and sometimes a momentous, event. The naming of William H. Rehnquist to succeed Warren E. Burger as chief justice prompts reflection on the possible future direction of the court.
When Richard Nixon gained the opportunity to name four justices to the court, various constitutional Cassandras confidently predicted the apocalypse. Nothing of the sort came to pass, as an overview of the Burger Court`s work suggests.
The court did not noticeably alter the major restraintist chord in constitutional adjudication since 1937: abstention in cases involving government regulation of business and the economy. Two cases reviving the apparently moribund Contract Clause were indeed surprising, but have proved a piffle. In civil rights, the Warren Court`s central achievement of racial equality before the law has been extended in manifold directions.
With respect to voting rights, a centerpiece of the Warren Court`s
``constitutional revolution,`` reapportionment at all levels of government, even of entire states, is today commonly ordered by federal district courts. Even the Warren Court avoided the sticky question of
``gerrymandering`` that the Burger Court has just decided is amenable to judicial oversight.
As for defendants` rights, the Burger Court merely chipped away at the periphery of what the Warren Court had staked out. Nor was the heart of liberal precedent disturbed in 1st Amendment cases, as the court struck down judicial ``gag orders`` in almost all circumstances and, despite
inconsistencies, left the wall of separation between church and state intact. Barring additional appointments by President Reagan, the balance of the court is not likely to shift much. Judge Antonin Scalia, if confirmed as associate justice, will in effect replace Chief Justice Warren Burger, in many respects his philosophic kinsman. Even the opportunity for additional appointments by Reagan would not necessarily portend dramatic constitutional change, as the Burger Court, a majority of whose members were appointed by Republican presidents, has demonstrated.
Should challenges to existing doctrine by a reconstituted court occur, they would most likely affect (1) the right of privacy, especially a woman`s right to an abortion (the recent decision not to extend this judicially created privacy right to homosexuals terminates, or at least interrupts, its 20-year period of continual expansion), (2) affirmative action, (3) the exclusionary rule and (4) certain aspects of ``positive`` judicial review, where courts exercise quasi-legislative and quasi-administrative functions.
In general, federalism may become more of a restraint on federal power, including judicial, than it has been for decades. But here, any modifications in present doctrine are bound to be marginal: Our country has become too much of a nation to abide any serious erosion of federal constitutional authority. Ideally, the court should strive to strike a happy medium between extremes of indifference to injustice and an overzealous social conscience. To succeed it must convince the people that the values it seeks to protect are those to which the nation itself is, or should be, committed. History and text are important, but not enough. The court ultimately must draw sustenance--and legitimacy for its decisions--from the broad currents of public sentiment.
Yet these currents often flow in channels shaped by the constitutional vision and argumentative power of great justices. The chief architect of the Warren Court`s ``constitutional revolution`` was clearly Justice Hugo L. Black. The core of our inheritance from that period--nationaliza tion of the Bill of Rights, voting equality and racial equality before the law--was pressed incessantly by Black. Yet he was also the pre-eminent exponent of judicial subservience to the intent of the framers.
This approach is generally subscribed to, though with quite different results, by Justice Rehnquist. Conceivably, we could be witness to an enormous historical irony: Any assault on Warren Court precedents is likely to be grounded in Justice Black`s constitutional philosophy. | 4,408 | 2,197 | 0.000457 |
warc | 201704 | Business leaders gathered Tuesday to urge legislators to overturn Gov. Pat Quinn's veto of smart-grid legislation backed by Commonwealth Edison Co.
"The governor's veto was a great disappointment to the business community and consumers alike," said Jerry Roper, president and CEO of the Chicagoland Chamber of Commerce. "Opportunities for this kind of investment don't come around every day, and when one does, our elected officials should seize it."
The clock is ticking for ComEd to either pull together enough votes to override the veto, agree to concessions in order to gather more votes or give up and start over.
The ComEd bill calls for a plan to invest in smart-grid technology, which would allow its customers to see in real time how much power they are using to better manage electricity usage. The technology also would allow ComEd to pinpoint outages and make repairs more quickly. Eventually, homeowners could reduce their home energy use with a smartphone application, and those with solar panels could sell excess electricity back to the grid.
Opponents say the bill would have a profound effect on how electricity rates are determined, lessening the oversight of the Illinois Commerce Commission and paving the way for the utility to boost its bottom line.
At a news conference held at S&C Electric Co. in Chicago, which makes smart-grid technology, John Estey, the company's president and CEO, demonstrated how "self-healing" electrical lines promised by a smart grid would work in the case of an outage.
Today, he said, the power goes out, residents call ComEd and the company rushes trucks out to find, isolate and fix the problem, a process than can take hours or days.
With a smart grid, he said, the problem can be resolved in seconds. The system automatically isolates the outages and figures out a way to run power from substations that are still working to homes with outages, while ComEd runs trucks to fix the problem. The result, he said, is that outages don't become widespread.
"It's not bleeding-edge technology," he said. "This stuff really works."
Business leaders at the news conference said the technology would be crucial for a build-out of renewable energy sources as well as a coming onslaught of electric vehicles.
Jay Marhoefer, CEO and executive manager of Chicago-based Intelligent Generation, said the technology will keep Illinois competitive.
"Michigan is wooing us, and companies like us to move 60 miles east," he said.
jwernau@tribune.com | 2,512 | 1,282 | 0.000788 |
warc | 201704 | A sign at the mile marker 41 boat dock on the Alligator Alley as seen Thursday,… (Joe Cavaretta, Sun Sentinel )
With at least a month of rainy season yet to go, South Florida's overburdened drainage system is facing new challenges as heavy rains pound inland areas still soggy from Tropical Storm Isaac.
One month after the huge system had engineers scrambling to move record amounts of water away from our houses and off the streets, canals are brimming, water continues to spill south into the Everglades, and levels in Lake Okeechobee — now above 15 feet — continue to rise.
"Any additional rain could make a tolerable situation worse," said Tommy Strowd, operations director for the South Florida Water Management District.
Radar tracking maps at the National Weather Service show that in the last 30 days heavy rains have pounded western suburbs, according to forecaster Barry Baxter.
"The ground is saturated, so it doesn't take much," he said.
In the Everglades, water is lapping at the tree islands, concentrating deer, raccoons, bobcats and other mammals in ark-like communities dotted through the sawgrass prairie.
"This is where the animals seek refuge," said developer Ron Bergeron, a commissioner with the Florida Fish and Wildlife Conservation Commission, as he gunned his airboat Thursday and then coasted into a hardwood hammock about five miles south of I-75 in far western Broward County.
"They can take high water like this for about 60 to 90 days, but after that they could be in trouble."
In response, the wildlife agency issued an order banning airboats, ATVs and other vehicles from portions of the Everglades and Francis S. Taylor Wildlife Management Area in Broward, Palm Beach and Miami-Dade counties.
The emergency measures also prohibit hunting deer and other game animals.
Seasons of wet and dry are natural in South Florida, and water in the Everglades is not at record levels. Bergeron said he remembers that in 1994 he found dozens of dead deer after his wetlands camp was completely submerged for days.
But Isaac left a soggy legacy, and hurricane season has two months to run. In some areas of western Palm Beach County, "Isaac was unprecedented in the sheer volume of water we had to move," said Strowd.
High-speed pumps operating at maximum capacity drained more than 100 billion gallons of water left behind, roaring through one control gate in Palm Beach County at the highest rate ever recorded—10,300 cubic feet per second.
"When we get up to 12 inches of rain in 24 hours, flat land and the infrastructure we have is not designed to deal with that," Strowd said.
Operating the complex plumbing system that makes South Florida livable calls for a delicate dance involving several local, state and federal agencies trying to balance oft-competing interests of homeowners, farmers, sportsman and the ecosystem.
"What this event tells us that we are likely to get more intense rainfall because the atmosphere is warming up and holds more moisture," said Leonard Berry, a Florida Atlantic University climatologist who heads the Center for Environmental Studies. "We really need to rethink the way we manage water in flooding and in drought, and rethink the drainage systems."
Berry recommends adding more small pumping stations through the region.
For now, the Army Corps of Engineers and Water Management District officials say the system is working.
But Thomas Van Lent, a senior scientist at the Everglades Foundation, said times of too much water underscore the need for more storage capacity.
"After big rains like this, you end up just throwing it away," said Van Lent. "We need to change the infrastructure so we have more options to store that water for when we need it."
Dawn Shirreffs, of the National Park Conservation Association, agrees.
"You can never prevent an act of God, but storms like Isaac point up our inability to move water through the system," she said.
mwclary@tribune.com or 954-356-4465 | 4,017 | 2,065 | 0.000492 |
warc | 201704 | Big companies must keep up with the economic crisis. One nice strategy is that the company limits its projects to achieve effectiveness and efficiency so that the company should not waste the time and energy of the employees.
I agree that simplicity in business is important. Most companies are busy with the details that they forget the outside world has changed each and everyday. When they are ready with all of their details, they then realized that what they have prepared can’t be applied and sold to the customers outside for its out of date style and technology. By doing the jobs in simple way, the companies have more times to sit back and read the market's demands and they can review it for their next business strategy. | 740 | 432 | 0.00234 |
warc | 201704 | The Large Hadron Collider is almost back in commission after its accident last year. It is the biggest atom smasher in the world and it is not American. It has been designed to discover the Higgs Boson, the current fundamentalest particle of all. For the super-conducting magnets which contain the stream of particles to work properly, it has to be very cold, and it has just been announced that it is now colder than deep space.
The quantum world does not obey the usual rules, and Niels Bohr, one of the pioneers of quantum physics, said that if you are not shocked by the laws of the quantum world, then you haven’t understood them. In this world, for example, certain events can only be explained by time going backwards. I haven’t got too much of a problem with that, because if you look at neuro-pathology, you start to realise that the 3-D ‘external’ world, together with time, are created by the brain to create order out of our sensory input. As a model, it works pretty well, but that doesn’t make the external world real in a hard and fast way. Astrology also works, a lot of the time, at any rate. But it’s just another model, which is why it doesn’t always work. Just like our senses aren’t always reliable. And even if they are reliable, if you ask 2 people to describe the same event, you’ll probably get different accounts. Anyway, the Large Hadron Collider. It was just starting to get up and running last year, amid a lot of publicity, when it had an accident. There was a liquid helium leak and it’s taken over a year to sort. And 2 physicists have seriously suggested that the damage may have been caused by Higgs Bosons (which of course have yet to be discovered) travelling backwards in time from a future experiment. I doubt it is the true explanation, but I liked the idea that real physicists were suggesting it. Of course, the LHC doesn’t ‘know’ that it is going to be used to discover Higgs Bosons. Otherwise it could just as well send back some other particle. Which means that human intention must also be playing a part in creating this future that has not yet happened and from which Higgs Bosons could be travelling back in time to upset our plans. I don’t know if the scientists are thinking that way. But it makes complete sense to me. Because so much of what we call reality is the product of people’s imaginings, if not all of reality. There is a deep way in which the world is a product of consciousness. Our culture, for example, gradually developed the idea that reality is material and follows empirical, rational laws and sure enough, reality obliged and we find ourselves in such a universe. Some ancient cultures developed the idea that there is a relationship between the movements of the stars and human affairs and sure enough, reality obliged and we find ourselves in an astrological universe. I don’t mean all this in a superficial way, like reality is simply what you think it is. It’s to do with the imagination. The imagination seems to connect what is ‘in here’ with what is ‘out there’. So that when an idea about how the universe works stirs our imagination, it is because it is in some way real, and it’s probably hard to say which came first, reality or our idea about it. The fact that quantum physics is, properly understood, shocking, says a lot in its favour. If it is shocking, then it touches us, and that gives it reality. | 3,498 | 1,628 | 0.000635 |
warc | 201704 | Views: 189
As usual, I'm late to this party. Nevertheless . . .
I suggest the best solution to the lifeboat problem is for the person who has the power or authority to decide the order of boarding ( "the Captain" )to make a selection based on the passengers value, as he is able to determine that. If he has a young Einstein or Ghandi, they get on the lifeboat first because they are the most valuable in his opinion. If a young Lizzie Bordon, although perhaps she she seems an attractive breeder, she would be among the last.
The Captain, like all of us is biased and has incomplete knowledge and insufficient wisdom to select by value accurately, and he is wise enough to recognize these limitations. He does have the power to enforce his selections, therefor not to do so would be, for him, immoral. It's absurd to select by any criterion other than anticipated future value. Value is, of course, subjective.
I'd just tell him, "Screw the lifeboats, it's all about sea turtles, mate!"
If you can't beat em*, confuse em...
*make no mistake, you can't beat em when the question is a loaded hypothetical with infinite possibilities for moving goal posts. i.e. you suggest women and children, they reply young Hitler is on board, etc. etc. ad infinitum et nauseum.
"The most moral of the people" by making this distinction you are negating the statement,
"all humans have the same value." This is clearly an untrue statement, but it makes you feel warm inside doesn't it? Also who would decide who is the most 'moral' and what would the criteria be... volunteer hours? Now I would like to add a #4 to that list - those most likely to survive, with the greatest strength (in every sort of way) and most useful skills, especially teamwork.
I would then be stuck between choice 1 and 4... but I think #1 is the one, why? If a boat is sinking I don't think you would have time to fuss over who is most deserving of a place on a lifeboat. | 1,951 | 1,081 | 0.000934 |
warc | 201704 | My Thoughts on Aerobic Training & Hockey As It Relates To Preparation
Much of the banter and discussion regarding sportsperformance on the internet, conferences etc seem to focus on speed, power, andstrength. These topics are obviouslyvery critical in the development of high performance athletes. The one area that I always dedicate much thoughtand program development to is cardiovascular conditioning. Like the afore- mentioned physical qualities,this is one that also creates much controversy and debate. The following are my opinions on the topicbased on 30 plus years in the field, and the literature that has beenpublished, we do use this at www.accottawa.com . Although I am going toreference the sport of hockey often, the concepts can be applied to manysports.
Ice hockey is typically defined as an anaerobic sport. Here are the facts as we know it:
•The gameis 60 minutes in length
•Shiftsare made up of 30-60 second intense efforts
•Averageplay/player - 20 minutes or less
•Energysystem usage - all
•Atp-pc -limiting factor in 5-10 second bursts
•Lacticacid - 9-11 mmol/l observed during games
•Aerobic- the higher the players vo2 max, the higher the aerobic contribution and thelower the anaerobic one.
When devising a planto enhance the cardiovascular component of hockey, I believe it’s important tolook at the energy systems that support each other (ATP-PC Lactic Acidanaerobic & aerobic), and by enhancing this with a specific focus, I canthereby enhance the whole system.
The particular issuethat I see as a common problem in the training field is that many take theconcept of sport specificity too far.For example, since shifts are generally made up of 30-60 seconds of 5-10second repeated bursts, training should be entirely focused on intervals inthis range, and more specificity can be achieved by manipulating the restperiods to achieve the energy system goal.I.e.. 10 sec max effort with 50 second rest could be defined as a focuson the ATP-PC system, while 10 sec hard effort with 10 seconds recoveryrepeated 20 times would be aerobic. Sameinterval different focus.
The above examplecould be considered very sport specific to hockey as it matches up the shortbursts we typically see on the ice. I amnot convinced, being so sport specific in this particular instance is theoptimal method to train. Here are my reasons why:
The game itself is asstated earlier anaerobic in nature. Soif we take an NHL pro for example, his season would begin in September withtraining camp, and could last until mid June if he reaches the Stanley Cupfinal. This would be almost 10 months ofanaerobic focused work. This can beextremely fatiguing in addition to the stress of performing at such a highlevel. If you add to this volume ofyearly work (yes playing and practicing is work & volume to the body) highintensity sprint interval training, then you are asking your body to adapt toanaerobic work year round. There is apotential negative cost to the body with this kind of continual stress placedon it. Ie. Overtraining, injury etc.
If you take intoaccount that all of the strength and plyometric training that a hockey playerwill endure, this adds to the volume of total yearly anaerobic work. In a study by, Parra et al. he showedthat only 2 weeks of daily sprint interval training increased citrate synthasemaximal activity but did not change “anaerobic” work capacity, possibly becauseof chronic fatigue induced by daily training (Acta Physiol.Scand 169: 157–165, 2000).There is a possibility of this kind of chronic fatigue setting in for ahockey player also. Realizing that thestudy was only 2 weeks long and work was every day, I am extrapolating whatmight happen with a hockey player’s volume of work.
Theother fact from a reference point of view that I would like to make has to dowith the concept of training impacting either a peripheral or centraladaptation. In a great review article byDave DochertyAProposed Model for Examining the Interference Phenomenon between ConcurrentAerobic and Strength Training (Sports Medicine 2000 Dec 30 (6) he discusses whether exercise stimulus canaffect the body peripherally or via a central adaptation. It has been proposed that peripheral adaptations are stimulatedthrough the state of hypoxia experienced by the muscle during high intensity,aerobic interval training or high intensity strength training with reps at 10rm’s or over. Other adaptations includeincreases in muscle capillarisation, mitochondrial enzyme activity andmyoglobin content. Central adaptationare those associated with lower intensity training that is associated withchanges in the cardiopulmonary mechanisms.As training intensity increases the location of adaptation appears toshift to the peripheral components with changes in muscle capillarisation,oxidative enzyme activity, mitochondrial volume and density, and myoglobin.
The illustration below details this process.
While this article looked at the interference models forconcurrent strength and aerobic work, it certainly alludes to this zone ofinterference that I believe can cause problems for hockey players and otherathletes who focus too much high intensity interval training year round. There is clearly, important adaptations that appearto occur with low-intensity continuous training that are not observed withmixed or high-intensity training. In his review Docherty states “While theimmediate effect of low-intensity high- volume training on intense exerciseperformance can be difficult to assess, it would appear that the insertion ofthese low-intensity training sessions has a positive impact on performance,despite being performed at an intensity that is markedly less than that whichis specifically performed at during intense exercise competition. It is oftenpurported that these periods of relatively low-intensity, high training volumesmay provide the aerobic platform needed to facilitate the specific adaptationsthat occur in response to the high-intensity or specific workouts.”
In another good review by Olivier Girardtitled Repeat Spring Ability (RSA) Factors Contributing to Fatigue Part1 & 2, he states that research has shown that subjects with a greater VO2max have a superior ability to resist fatigue during RSA (not unlike hockey),especially during the latter stages of a repeated-sprint test when subjects mayreach their max VO2. This suggests thatimproving VO2 may allow for a greater aerobic contribution to repeated sprints,potentially improving RSA.
With all of this information I want to be clear that I amnot advocating that you train hockey players like marathoners or a Tour DeFrance cyclist. They do not need to berunning or cycling for 2-3 hours at a time, this would be not advantageous forstrength and power development. But Ibelieve there is enough evidence to advocate the use of aerobic training in arange of 30-45 minutes, working at heart rate intensity of 75-85% for a periodof time before the more specific energy system work is to be done.
Typically I like to use aerobic work very early in theoff-season training cycle twice per week.In addition to the reasons I have stated above, I believe that thisfundamental fitness characteristic provides safe base level training,especially for young athletes, in addition to re-introducing cardiovasculartraining to the more experienced player after time off from the competitiveseason. I believe that 3-4 weeks of thiskind of cardiovascular conditioning, placed on the appropriate days 2-3 timesper week and depending on the athlete will only enhance his base fitnesslevels. This in the end will provide abetter foundation for the intense work and recover that is necessary for highperformance sport.
The following is an example of general guidelines I use forplanning the conditioning element of our off ice training program. More specific changes to this will be donebased on the individual athlete.
I hope you found this article interesting and thoughtprovoking. It may not be the perfectmodel, but it is a concept that I have used for many years with relativesuccess. The world of sports performanceresearch is evolving constantly, with that I have not doubt, I could re-writethis article based on the exclusive use of high intensity intervals. The papers are there to support bothviews. As a coach you have to make achoice as to what might bring about results in an efficient and safemethod. This is what has worked forme. Feel free to debate this or askquestions on twitter @lornegoldenberg look forward to comments and questions. | 8,614 | 3,903 | 0.000259 |
warc | 201704 | I should say chimpsh*t, technically. We all know better than to mix our monkeys, chimps and bonobos, right? Artist Alison Ruttan has a longstanding interest in primate social interactions, and in her work she has often looked at chimp and bonobo behavior alongside that of their human counterparts.
In series such as Bred in the Bone, Ruttan (who was interviewed on Episode 28 of the podcast) looks at a range of chimpanzee and bonobo behaviors–from the aggressive to the intimate to the routine–in order to ask what, if anything, really separates human beings from our primate ancestors. Ruttan describes the project thusly:
It is possible to speculate that our shared social responses go all the way back to a common ancestor that humans, bonobos and chimpanzees all evolved from. We are all relatively newer species that evolved from this common ancestor somewhat close in time to each other, perhaps some 3-6 million years ago. Frans de Waal states in his book
Tree of OriginthatNot only are chimpanzees and bonobos our closest relatives, the reverse is also true; that is chimpanzees and bonobos are closer to us than to, say gorillas.Does that mean our behavior is biological in origin or that we have passed on these similar responses through culture memory? I have found that in actively comparing the nuances of our shared behavior it is hard not to see these comparisons everywhere you look. It has changed the way I see our own actions, sometimes it seems that we assume we are reacting to situations in a rational manner, we seem unaware at times of the way biology guides our actions and surprised when we don’t like the results.
Last weekend I was able to get a firsthand glimpse of Ruttan at work on the latest iteration of this project, a storyboard narrative recreating some of primatologist Jane Goodall’s photographs of wild chimpanzee families. Ruttan asked a group of friends and neighbors to re-stage some of these scenes in a heavily wooded (and mosquito-ed, natch) area on the Desplaines riverbed in River Forest, Illinois.
People of all ages showed up to gamely pose according to Ruttan’s instructions. No one was asked to behave in an overtly chimplike manner–indeed, part of what Ruttan’s work gets at is that there’s precious little that actually separates us from our chimp forbears. Instead, Ruttan sought to recreate key moments where primate and human behaviors cross-reference one another. So some of us groomed each other, or our children. The older kids triumphantly wielded big sticks and fallen tree branches while the younger ones enviously chased after them. Children gleefully took part in a project that allowed them to leap onto the backs of adults or chew bananas with their mouths open, to get muddy and scratch themselves in rude places and, best of all, to receive an inordinate amount of positive attention for doing so.
What fascinated me about the shoot itself was how familial it all felt, so much so that it was hard to tell who belonged with who in the group–who were the parents, who were the grandparents, who had kids, who didn’t. Despite the inherent diversity in the group there was an almost intimate, family-picnic feel to the endeavor that was surprising, given that most of us had never met before.
As one might expect, the kids seemed to have the best time of everyone, although when it was over one tiny miscreant could be heard bitching about the fact that she had not been allowed to fling excrement at people “the way real monkeys do.”
You can find more information about Ruttan’s work along with video clips from her Bred in the Bone project here, and additional images and information about the artist on the Monique Meloche Gallery website. | 3,784 | 1,880 | 0.000543 |
warc | 201704 | Complications of obesity Karen Miller | 10/10/2013, 6 a.m.
Obesity is not merely a cosmetic issue. Excess weight increases the risk of many diseases: Type 2 diabetes High blood pressure and cholesterol Heart disease Stroke Kidney disease Several cancers such as breast, uterine and kidney Sleep apnea a disorder in which breathing repeatedly stops and starts Gallbladder disease Erectile dysfunction Osteoarthritis Nonalcoholic liver diseases Gynecologic problems such as infertility and irregular periods | 508 | 337 | 0.002985 |
warc | 201704 | Contributing to this Bella Caledonia series only reminds me how far behind England is relative to the rest of the UK and the Republic of Ireland. Scotland decides on independence in less than a year, Wales is debating devolving police and criminal justice powers, while the Republic of Ireland has just voted in support of retaining the Senead, the upper house of their parliament. Then look at England – or rather, at the Westminster political class and London cultural elite. Here, ‘constitutional matters’ are not considered fundamental to the workings of the nation or Union, to be decided by the will of the people. Instead they are routinely dismissed as dull and a distraction from ‘real politics’.
The exception is Europe. Euroscepticism in England is tangled in a curious and in many ways paradoxical relationship with the rise of English identity in recent years and the emergence of Englishness as a political community. As this report from centre left think-tank IPPR shows, the disaffection among people in England with the constitutional status quo is growing. There is a strong link between anti-European sentiment and the desire for a renegotiation of England’s position in the Union or indeed outright independence.
UKIP is the only major party in England that is speaking to this growing constituency, which goes a long way to explain its recent surge of support. When asked which party “best stands up for English interests”, the majority root for Farage. Labour lags significantly behind, the Conservatives come a bad third, and the Lib Dems are hardly worth the count. Of course there are the English Democrats. With their roots in the ‘English National Party’ that formed in 1998 in response to the devolution settlement, EDP continues today to be a fringe party with little prospects. Today they have just one elected representative, the councillor David Owens, formerly of the British National Party – hardly an advertisement for the party.
It’s no wonder that constitutional issues in England are so often dismissed and avoided. The traditional mainstream parties of Westminster – I say ‘traditional’ as the Lib Dems now consistently poll below UKIP – are running scared. While they have their heads in the sand, the populist right and far right in England have ceded this rich and volatile ground.
In electoral terms, Labour has immediately the most to lose from further devolution. The Tories have some 100 more English seats at Westminster than Labour. England faces the nightmare of a ‘Forever Tory’ nation if Scotland breaks away from the Union. I personally believe that this could lead to a healthy re-engagement of Labour with left-leaning voters across the nation and even prompt a much-needed reincarnation of the party. But Labour politicians are understandably terrified to confront this challenge. It’s of no surprise that the Labour for Independence group in Scotland has faced slur campaigns from party HQ. Even if Scotland votes against independence, further devolution should still keep Miliband up at nights.If the Tory’s proposal of English votes on English laws is introduced, Ed faces the surreal scenario of winning power but remaining impotent to legislate on ‘England-only’ matters. Imagine PM Ed Miliband battling English Minister Boris Johnson – or even Nigel Farage. I for one would move to Scotland.
Meanwhile, Cameron is desperate to keep the rising discontent in England with the two Unions – Britain and Europe – at bay. He has tried to appease unruly backbenchers and win back defectors to UKIP with his promise of an in-out referendum on EU membership in 2017, but this doesn’t address the English question. In fact, the often explosive, irrational nature of the debate in England on Europe can be seen in part as a symptom of the repression of the English question. What exactly would the Prime Minister “win back for Britain” in his proposed pre-referendum negotiation of powers? The freedom to make doctors work longer hours? Is that really why he’s putting his neck on the line? Just remember the farce of the 2011 veto, ignored by Brussels as the childish tantrum that it was, and ridiculously trumpeted by Eurosceptics as a victory of which “Britain” could be “proud”. Why is this political arena so emotive and ridiculous? I think it’s useful to read ‘Britain’ here as ‘Greater England’. While Putin’s spokesperson riled Cameron by calling the UK “just a small island that no-one pays attention to”, the PM’s wounded reaction should be read in the context of a man who fears he will preside over the end of the Union and the reduction of his cherished Britain that ‘ruled the waves’ to an impoverished Little England no longer calling the shots.
I think Phil Mac Giolla Bhain was spot-on in his contribution to this series in identifying a markedly different “value base” within the political elites of Westminster and Holyrood. Take the health service: the NHS in Scotland and Wales have been sheltered from the restructuring and privatization visited by the Coalition on the English NHS. This is a key to a larger picture of drift between the ruling ideologies of the nations, with Scotland and Wales retaining the spirit of the post-war settlement, while Westminster is free to use austerity in England to attempt a radical shrinking of the state and the sell-off of our welfare services, public institutions and national treasures such as the English forests. While the rest of the UK can be seen to be pulling away from this essentially neo-liberal project driven through by London, people in England and particularly those outside of the dominant South East are justified to fear abandonment to this fate.
Finally, to answer the question
‘what does the constitutional process look like from England?’ I’m afraid my conclusion is far from palatable. The Westminster class has avoided what they term ‘constitutional matters’ for far too long, in the apparent hope that refusing to acknowledge the fast-changing nature and attitudes towards the Union and its place in the world would some-how disappear the issue. This refusal has fed into an often deranged debate on Europe. It is a mentality born of the peculiar history of the Anglo-British state, the post-imperial legacy and our unique lack of a written constitution. England cannot continue to ‘muddle through’. We are like a toddler stumbling over our first words while Wales, Scotland, Northern Ireland and the Republic have been fluent in the language for generations. We cannot continue to be silent about our own nation. The world will not wait for us to catch up. | 6,868 | 3,282 | 0.000317 |
warc | 201704 | Alec Esquivel is suing because, according to his attorney, Dru Levasseur of Lambda Legal, the law of the State of Oregon prohibits private insurers from excluding transgender people from health benefits, but the State itself excluded Mr. Esquivel, a state employee, from health benefits because of his gender identity.
Why would the State of Oregon do that, given the irrationality of the position it is in here, where it prohibits others from doing exactly what it is doing?
Let me answer that question with another question: what is
prejudice?
According to Merriam Webster's Dictionary, the definition includes an "irrational attitude of hostility." I'm not saying the State of Oregon is hostile to all trans health benefits, because it clearly is not, given its leadership position with private insurers on trans health benefits. But some administrator in the State of Oregon hierarchy clearly didn't get the memo. Otherwise, a lawsuit wouldn't be necessary.
"Irrational" defines the State's position here. Unfortunately, exclusion of trans people from access to health care is so widespread, so entrenched, and so unquestioned that most people just shrug their shoulders. I could tell you some interesting stories of my own, from the gynecologist who refused to treat me because she thought I would get cancer from my ultra-low dose of hormones, to the urologist that my HMO sent me to who couldn't figure out where anything was (that was painful), and the non-profit NYC health clinic, so widely revered now, that wouldn't give me my medical records so I could change my drivers license sex designation (late 90s -- I hear they're better now).
According to a press release from Lambda Legal,
"Alec Esquivel was denied coverage for a medically necessary procedure specifically because he is transgender. This type of discrimination is unlawful and risks the health of hardworking, productive citizens of Oregon," said Dru Levasseur, Transgender Rights Attorney at Lambda Legal. "By not covering this procedure, the state is refusing to provide him with the same health care coverage as his co-workers."
"Alec Esquivel is a 41-year-old law school graduate who is clerking for the Oregon Court of Appeals. Assigned female sex at birth, he was diagnosed with Gender Identity Disorder (GID) in 2001 and began to take steps to have his body match his male gender identity. In 2010, as part of his transition-related health plan, Esquivel's doctor recommended that he undergo a hysterectomy as part of his GID treatment and because he was at heightened risk for uterine and ovarian cancer."
The American Medical Association, the American Psychological Association, the American Academy of Family Physicians, and the National Association of Social Workers have all called for an end to trans health exclusions.
As reported this morning by the Oregon Statesman-Journal, "Esquivel's lawsuit contends the state covers hysterectomies and oophorectomies for a host of other reasons, but unfairly excludes coverage of the procedure for transgender people." Interestingly, the story includes the fact that PEBB has covered testosterone treatments for Esquivel during his time working for the state, according to his attorneys.
Why did they draw the line here? I suppose that it's because "surgery" creates an public relations problem.
"Lambda Legal attorney M. Dru Levasseur argued during a press conference Tuesday that by not covering physician-recommended treatment, the state is "effectively paying transgender employees less than non-transgender employees. Health care coverage is part of compensation. 'He's only asking for what other state employees receive,' Levasseur said."
Here is Lambda Legal's timeline
Here is the complaint
This type of thing goes on all the time, and kudos to Mr. Esquivel and Lambda Legal for saying "enough." I think we will begin to see a more litigation-orientation approach to the issue of trans health benefits, in addition to the corporate policy-level approach that has proved effective (up to a point) through the efforts of HRC and its Corporate Equality Index. While the corporate approach has produced benefits far beyond my expectations, insurers are giving serious push-back. As a former insurance coverage attorney, I know that insurance people are extremely conservative and they're not going to give up on this one without a fight. But, as with everything, a multi-pronged approach of carrots and sticks will move this along best.
imgsrc | 4,513 | 2,148 | 0.000469 |
warc | 201704 | Gaps are a popular trading opportunity for binary options. Many traders struggle, however, to determine the right gap type and draw the right conclusion from a gap. As a result, they lose money. Don’t make the same mistake. The easiest and the most profitable way to trade gaps is by using boundary options.
A gap is a price jump in the market. Between periods, something has made the market jump from one price level to another without covering the prices in between. This jump is always due to a significant surplus in demand (upwards gap) or supply (downwards gap).
The trouble with gaps is that this surplus can have fundamentally different reasons, which leads to fundamentally different implications for future price movements.
To know which direction the market will move in after a gap, you should at least know these gap types:
If that seems too complicated to you, however,
there is an easier approach to trading gaps: Instead of using high / low options or touch options to trade a gap, you can simply use a boundary option, which does not require you to predict the direction the market will move in.
Boundary options relieve you from having to make the difficult prediction which gap type you are dealing with and which direction the market will move in as a result. Yet, they generate a higher payout than high / low options and a higher winning percentage than touch options. Both facts are good reasons to trade gaps with boundary options.
A boundary option works much like a touch option with two target prices: There is one target price to the upper side of the current market price and one target price to the lower side of the current market price. If the market triggers each target price, you will win your boundary option.
Usually, both target prices are equally far from the current market price. This creates a symmetrical canal around the current market price. To win your binary option, the market has to leave that canal. When trading gaps, this canal is a great tool to win a boundary option.
When you recognize a gap in the market, you know that it will create a strong movement. In one direction, you also know how far this movement will last at least: If the gap closes, the movement has to be at least the size of the gap. If the gap does not close, it will create at least an equally large movement into the other direction. This knowledge equips you perfectly to invest in a boundary option. Try to find a boundary option with both target prices closer to the current market price than the size of the gap.
Now, you only have to find out whether the market will reach either target price before your boundary option expires. Luckily, there is a technical indicator that is perfect for that: The average true range (ATR). The average true range calculates the market’s average range of movement for one period over the last periods. Since a gap creates a stronger movement, the ATR provides you with a minimum value.
All you have to do to know whether the market has a realistic chance of reaching either target price of your boundary option, is to divide the distance from the current market price to the boundary option’s target price by the value of the ATR. The result will indicate how many periods it will take the market to reach the target price.
Of course, this result requires all periods to point in the same direction. After a gap, however, this is a reasonable expectation.
Make sure to find a suitable boundary option with a short expiration time (no more than 3 periods; the shorter, the better) and a target price shorter than the size of your gap. Than you will have a good chance of winning that option. Remember: Boundary options generate a payout of about 300 percent. If you win 50 percent of your trades with a strategy like this, you will make a fortune. | 3,841 | 1,612 | 0.000625 |
warc | 201704 | Abstract. We introduce a sensitive method that allows one to distinguish positive and negative agglutination reactions used for blood typing and determination of Rh affinity with a high precision. The method is based on the unique properties of photonic crystal waveguides, i.e., microstructured waveguides (MSWs). The transmission spectrum of an MSW smart cuvette filled by a specific or nonspecific agglutinating serum depends on the scattering, refractive, and absorptive properties of the blood probe. This concept was proven in the course of a laboratory clinical study. The obtained ratio of the spectral-based discrimination parameter for positive and negative reactions () was found to be 16 for standard analysis and around 2 for used sera with a weak activity. | 772 | 446 | 0.002248 |
warc | 201704 | Title Abstract
Consumer demand for intensely coloured wines necessitates the systematic testing of pigment extraction in Sangiovese, a cultivar poor in easily extractable anthocyanins. Pre-fermentation (absent, cold soak pre-fermentation at 5 °C, cryomaceration by liquid N
2 addition), temperature (20 or 30 °C), and saignée were compared during vinification (800 kg). Concentrations of anthocyanins, non-anthocyanic flavonoids and SO 2-resistant pigments were recorded daily. A semiparametric Bayesian model permitted the kinetic description and the comparison of sigmoidal- and exponential-like curves. In total anthocyanins, saignée at 30 °C yielded a significant gain, later lost at drawing off; cryomaceration had little effect and cold soak no effect at drawing off. Non-anthocyanic flavonoids increased steadily with saignée and at 30 °C. SO 2-resistant pigments were higher, particularly for the higher temperature/saignée combination. Using daily recordings, the model indicates turning points for concentration rise or fall, thus allowing a precise and detailed comparison of the vinification methods. Disciplines
Biostatistics | Viticulture and Oenology
Suggested Citation
Pantani, Ottorino L.; Stefanini, Federico M.; Lozzi, Irene; Calamai, Luca; Biondi Bartolini, Alessandra; and Di Blasi, Stefano, "Pre-maceration, Saignée and Temperature affect Daily Evolution of Pigment Extraction During Vinification" (April 2014).
COBRA Preprint Series. Working Paper 107. http://biostats.bepress.com/cobra/art107 | 1,571 | 855 | 0.001212 |
warc | 201704 | For the IT industry, the job outlook in the month of April brought quite a bit of optimism. The U.S. Bureau of Labor Statistics announced 223,000 new jobs were added last month and, of those, the IT industry contributed close to 21,000 new jobs. March’s numbers were revised down to 85,000 jobs from 126,000 which means April saw 97,000 more jobs added than the month prior.
The unemployment rate is also heading in the right direction. It now sits at 5.4%, which is the lowest jobless rate since May 2008. Over the year, the unemployment rate experienced a 0.8 percentage decrease.
But the big news this month is the significant job gains in the IT industry. Experts are predicting 49% of employers in the IT industry will add full-time headcount in Q2.
IT Industry Unemployment Rate Experiences Significant Decrease
The Professional and Business Services sector, which includes IT related professions, added 62,000 jobs in April. Within the industry, computer systems design/related services added 9,000 jobs, business support services added 7,000 jobs and management/technical consulting services adding 6,000 jobs.
This industry’s sub-sector, Professional and Technical Services, currently has an unemployment rate of 3.0%, which is a 0.3 percentage point decrease from March. In this specific sub-sector, there are 8.6 million employed with 20,7000 jobs added over the last month.
Tweet This:April Jobs Report: #IT industry has 3.0% unemployment rate and added 21,000 #jobs. Read our full analysis here mod.is/2aW6PS April Fast Facts Hourly Earnings Continue to Rise
The April jobs report has yet another piece of good news for the American workforce. Hourly wages are going up! Over the past year, average earnings have risen 2.2%. The current rate for all employees is $24.87, which is a 3-cent increase from the month prior.
The IT industry has experienced consistent growth each month which means the competition for top talent will continue to increase. Modis is here to make sure your business is moving forward and to help you keep pace with the ever changing world of technology. Check out our Salary Guide to ensure your workforce is evolving along with the industry or contact us today! | 2,221 | 1,106 | 0.000912 |
warc | 201704 | There are a variety of situations where you may need emergency power and other resources. Being stuck in a situation like this is not something most want to think about, however, it is important to be prepared for anything - for your family's safety. Power is something we all rely on and rarely go without... but in this precarious world, losing power is a very real possibility.
There are a large variety of different solar powered devices and chargers that will help you get through in the event of an emergency. From being stuck in your car, to weather emergencies, blackouts, to unforeseen catastrophes and more... having an alternate source of energy is vital.
This is why emergency solar powered gear has become more and more popular. It can be an important backup in the event of many emergencies and it is better to be prepared ahead of time than to deal with the aftermath.
Small-scale Emergency Solar Power Most of us have heard of basic survival gear like hand cranked flashlights and other devices, but these days, we have also many different devices that provide a higher level of power if required. There are now solar powered radios, which can help you keep in contact with the outside world in the event of isolation during an emergency. Solar powered lanterns and other lights can be charged during the day to provide vital light come nightfall. These light sources are important for basic living, as well as for protection.
Solar gadget chargers are also vitally important as they can charge your cell phone or many other devices which keep you connected to the outside world. There are so many different small emergency solar power options that one can even find a solar powered beverage heater that will keep one's drinks nice and hot, even in an emergency.
Rechargeable Batteries and Solar Chargers So many of today's survival gear relies on batteries for their power. Rechargeable battery technology has really improved in recent years, as has the ability of solar chargers to handle more serious charging needs like mobile devices. It is imperative to have a good supply of rechargeable batteries around and a solar battery charger (link). This will allow you to keep your battery-powered devices operational, regardless of what is going on with the electrical grid. Batteries powers so many of today's items that this might be, perhaps, the most important emergency solar power gear (link) that you can get. Without batteries, most of one's devices will not work. Larger-scale Kits
For those who want to have more extensive preparedness, there are kits available to include all that one needs for basic emergency solar power. These kits often include larger solar powered power sources, backups and those little extras that many of us do not think about when trying to put together an emergency preparedness kit. There are various kits that have more or less extensive lines of products, as well as providing or less power depending on the needs of the household. Many like these kits as they are all-inclusive and provide everything that a basic solar emergency preparedness kit needs. These emergency solar power kits are a simple way to ensure that you have emergency solar in the event of a power outage or other emergency situation.
Regardless of the situation, there are times when one might need the tools for emergency solar resources. Today, there are tons of high quality, efficient gadgets and chargers on the market that can help you and your family to prepare in the event of an emergency. It is better to be prepared before something happens and with these tools in your emergency preparedness arsenal, your family will be better prepared for anything that might happen. | 3,718 | 1,617 | 0.00062 |
warc | 201704 | by Chad Love
I’m going to the dogs this weekend, which means I’m off to the National Pheasant Fest and Quail Classic in Kansas City, which, unlike SHOT, remains mostly a zombie-free zone. There are, however, tons of upland hunting, gundog and conservation-related vendors and speakers at the trade show. So if there are any training questions you’d like me ask, products you’d like me to keep an eye out for or gundog breeds (there are dozens of breed clubs at the show) you’d be interested in learning more about, be sure to tell me in the comments section.
In the meantime, here’s an interesting story that dovetails nicely with my last blog post on GPS technology. South Carolina lawmakers are considering a bill that would make it a crime for anyone other than a dog’s owner to remove its GPS tracking collar.
From this story in the
Augusta Chronicle: The sometimes malicious dispute about hunting dogs running loose edged closer to a resolution Wednesday, when lawmakers agreed to advance a tougher law against vandals. At issue before a South Carolina Senate panel was how to punish people who remove or destroy the electronic collar or device a hunter has placed on a hunting dog. The Senate Agriculture and Natural Resources Subcommittee approved the bill, H. 3372, to make it a misdemeanor amid questions about the problem it targets. Rep. Bill Hixon, R-North Augusta, the bill’s sponsor, said he was told by a colleague about a Myrtle Beach man who prides himself on removing hunting dogs’ electronic collars, placing the devices in plastic bags and floating them down a river. The dog owners chase the signal, thinking they are drawing closer to their missing dogs. Hixon also pointed to an open case in the Upstate, in which a man killed another man’s dog, chopped up its electronic collar and buried the pieces in a tree stump. Authorities charged the man with killing the dog but had no recourse against his destruction of the animal’s collar. Under Hixon’s bill, the penalty for a first-time offender would be a $500 fine or up to 10 days in jail. On Wednesday, the Senate subcommittee sent the bill – and an amendment that would require hunters to put contact information on their dogs’ collars – to the full committee to vote on each piece.
Thoughts? At some $200 a pop for a replacement collar, I would think that intentionally removing a dog’s GPS collar is a pretty clear-cut case of theft/vandalism, and would be illegal, anyway. And if said action ultimately led to the death of a dog there might well be other charges, too. What do you think? Good idea? Bad? What about from the landowner’s perspective? If you find a dog running on your property what legal rights do you think you should have? | 2,809 | 1,451 | 0.000713 |
warc | 201704 | If you live on the west coast, kiss your favorite salmon goodbye. You probably won't be eating it this year. And nobody knows what'll happen next year.
Salmon doom and gloom strikes California and Oregon, and threatens Washington. And don't get too giddy, Alaska, because you could be next. It's happened before in Alaska, and it can happen again. For the first time, we're facing a total closure of salmon fishing off California and Oregon. Washington may escape the ax for now, but that doesn't mean everything is fine here. Does this matter? Are salmon important? Yes, salmon are a symbol of what many of us like best about the northwest. They're a common cultural icon (see photo at left), and an economic power in the northwest. The health of slamon is also a good measure of the health of our natural ecosystems, since salmon need healthy rivers, creeks, watersheds, and oceans. What comes next? Angst and pain, and maybe a renewed commitment to right the wrongs caused by a century of salmon abuse. One can always hope.Tweet | 1,034 | 590 | 0.0017 |
warc | 201704 | The next big break through in surgery might not be a sophisticated new tool or imaging device; instead, it may be a simple checklist that the surgical team has to run through before making the first incision. In a pilot study, researchers found that using the checklist cut the death rate following surgery by 47 percent, while the complication rate decreased by 36 percent. The procedure is simple: Surgeons and nurses run through a series of basic safety checks before each operation, similar to those made by pilots before take-off. The checks include asking: Is this the right patient? Is this the right limb? Has the patient had the right drugs? [
The Independent]
The checklist is composed of 19 fairly obvious items, but lead researcher Atul Gawande says that even a small change, like having surgical team members take a moment to say who they are and what they do before scalpel touches skin, can have important consequences later on should one of them develop a concern during the operation. Earlier studies have shown that communication problems are fairly common in operating rooms, with junior members of the team sometimes hesitant to speak up. “Giving them a chance to say their names allows them to speak up later,” Dr. Gawande said [
The New York Times].
The pilot study was an initiative of the World Health Organization. The research team tested their simple idea with often dubious and unhappy surgical teams operating on more than 7,500 surgical patients in eight hospitals in Toronto, Seattle, London, New Delhi, Amman, Auckland, Manila and Ifakara in Tanzania [Reuters]. Interestingly, the hospitals in both developed and developing world countries saw about the same reduction in post-surgical complications. Based on the checklist’s unambiguous benefits, which were reported in the
New England Journal of Medicine, Britain’s health agency announced that all surgeons in England and Wales must start using the checklist by February 2010.
Some surgeons may resist integrating the checklist into their routine, says Peter Walsh, of the medical watchdog group Action against Medical Accidents. “Some surgeons say that checklists de-professionalise them, turning them into automatons who don’t think” [
The Independent], he says. Other surgeons argue that they already ask all the questions listed on the checklist, and don’t need a piece of paper to remind them how to do their jobs. But the research team maintains that the checklist ensures consistency in surgical procedures, and also promotes teamwork and communication. Those simple factors can save a lot of lives and prevent a lot of pain, says Donald Berwick, the president of the US Institute for Healthcare Improvement. “I cannot recall a clinical care innovation in the past 30 years that has shown results of the magnitude demonstrated by the surgical checklist” [ The Independent], he says.
Related Content:
80beats: California Hospitals Confess Their Errors 80beats: When Surgery Is Over, Anesthetics Actually Increase Pain Image: iStockphoto | 3,088 | 1,574 | 0.000648 |
warc | 201704 | The eminent domain brush fire By Matthew Goldstein
It didn’t take long for the powerful voices on Wall Street to rise up in protest over an intriguing and controversial idea to condemn distressed mortgages through local government’s power of eminent domain.
Two weeks after Jenn Ablan and I first reported that officials in San Bernardino County, Calif. were giving serious consideration to the novel idea being pushed by financier-backed Mortgage Resolution Partners, 18 financial trade groups are voicing strong objections. The groups, led by the Securities Industry and Financial Markets Association, are concerned that if local governments can seize underwater mortgages it might discourage bank lending. Why? The argument is that if it can happen now, who knows when local governments might move to condemn mortgages again–crisis or not.
The unified opposition may make it difficult for Mortgage Resolution Partners, which says it is talking to public officials in Nevada, Florida and on Capitol Hill, to get much traction for its plan outside of San Bernardino. And if San Bernardino County goes forward with using private money to buy-up underwater mortgages held by banks and in mortgage-backed securities, a U.S. Supreme Court lawsuit challenging the legality of the measure seems more than likely.
And litigation, of course, takes time and it means it could be two years before any legal challenge to using eminent domain for mortgages get resolved. In other words, the goal of using eminent domain to keep struggling homeowners in their residences by reworking their mortgages in the eminent domain process could be years off.
The trouble is we don’t have two, or three years to wait for a resolution of the worst by-product of the financial crisis, which is that average Americans still sit saddled with too much debt — most of it housing debt. Last October, Jenn and I wrote how some economists were beginning to say “a great haircut” was needed to address all the debt hanging over the heads of ordinary Americans in order to jump-start the economy. And the calls for debt relief have only grown–it’s one reason Yale economist and housing guru Robert Shiller came out in favor of the eminent domain concept in a recent op-ed in The New York Times.
Is eminent domain the answer? It’s too soon to say and it’s not clear if it is constitutional, even though some legal scholars say it is. But if this idea sparks debate that’s not a bad thing.
Two years ago, I asked in a story whether we needed a Camp David style summit that would bring all the parties together (banks, bond investors, housing officials and consumer advocates) to has out a Marshall Plan for housing. As the saga of the housing crisis is now well into its fifth year, it’s a question that’s worth asking again. | 2,869 | 1,442 | 0.000713 |
warc | 201704 | Alamy Professors Gate at George Washington University By AnnaMaria Andriotis
With a few weeks left until the new school year begins, families with college-bound children are preparing to pay hefty tuition bills. As we point out in the Weekend Investor cover story, “You Paid For College
How?,” some families are turning to alternative methods to cover these costs.
Interest rates on federal loans run up to 7.9% and rates on private student loans as high as 16%, making them costlier than most consumer loans. In some cases, rather than turning to a bank, families are setting up their own loans with grandparents or parents becoming the lender.
Here’s a rundown of how so-called intrafamily loans work.
Intrafamily Loans Rate: 0.25% to 2.23%
Dan Weedin and his wife Barb faced roughly $30,000 in out-of-pocket college costs for their two children last year. To help fill in the gap, Mr. Weedin, an insurance consultant, says they turned to his parents who lent them $15,000. The Weedins repaid them in full earlier this year. “It was similar to having a line of credit but with a much friendlier lender,” he says. | 1,147 | 679 | 0.001516 |
warc | 201704 | The VITAH Trial Vitamin D supplementation and cardiac autonomic tone in hemodialysis: a blinded, randomized controlled trial 15:129 DOI: 10.1186/1471-2369-15-129
© Mann et al.; licensee BioMed Central Ltd. 2014
Received: 19 November 2013 Accepted: 28 July 2014 Published: 6 August 2014 Abstract Background
Patients with end-stage kidney disease (ESKD) have a high rate of mortality and specifically an increased risk of sudden cardiac death (SCD). Impaired cardiac autonomic tone is associated with elevated risk of SCD. Moreover, patients with ESKD are often vitamin D deficient, which we have shown may be linked to autonomic dysfunction in humans. To date, it is not known whether vitamin D supplementation normalizes cardiac autonomic function in the high-risk ESKD population. The VITamin D supplementation and cardiac Autonomic tone in Hemodialysis (VITAH) randomized trial will determine whether intensive vitamin D supplementation therapies improve cardiac autonomic tone to a greater extent than conventional vitamin D supplementation regimens in ESKD patients requiring chronic hemodialysis.
Methods /Design
A total of 60 subjects with ESKD requiring thrice weekly chronic hemodialysis will be enrolled in this 2x2 crossover, blinded, randomized controlled trial. Following a 4-week washout period from any prior vitamin D therapy, subjects are randomized 1:1 to intensive versus standard vitamin D therapy for 6 weeks, followed by a 12-week washout period, and finally the remaining treatment arm for 6 weeks. Intensive vitamin D treatment includes alfacalcidiol (activated vitamin D) 0.25mcg orally with each dialysis session combined with ergocalciferol (nutritional vitamin D) 50 000 IU orally once per week and placebo the remaining two dialysis days for 6 weeks. The standard vitamin D treatment includes alfacalcidiol 0.25mcg orally combined with placebo each dialysis session per week for 6 weeks. Cardiac autonomic tone is measured via 24 h Holter monitor assessments on the first dialysis day of the week every 6 weeks throughout the study period. The primary outcome is change in the low frequency: high frequency heart rate variability (HRV) ratio during the first 12 h of the Holter recording at 6 weeks versus baseline. Secondary outcomes include additional measures of HRV. The safety of intensive versus conventional vitamin D supplementation is also assessed.
Discussion
VITAH will determine whether an intensive vitamin D supplementation regimen will improve cardiac autonomic tone compared to conventional vitamin D supplementation and will assess the safety of these two supplementation regimens in ESKD patients receiving chronic hemodialysis.
Trial registration
ClinicalTrials.gov, NCT01774812
KeywordsChronic kidney disease Vitamin D Ergocalciferol Alfacalcidiol Autonomic nervous system Cardiovascular risk Clinical trial Background
More than 40,000 Canadians live with end-stage kidney disease (ESKD)—roughly 1 out of every 1,000 people, a number that has tripled over 20 years – and require life-sustaining dialysis or transplantation [1]. Patients with ESKD have a 20% annual mortality rate and an age-specific cardiovascular death rate that is 10-100x higher than the general population [2]. Sudden cardiac death (SCD) accounts for more than a quarter of deaths in the hemodialysis population, making it the leading cause of death [2]. However, as is repeatedly reflected by negative trials evaluating the effects of treatment of traditional cardiovascular disease risk factors in patients with ESKD [3–6], these deaths are not associated with typical coronary artery disease, suggesting alternative mechanisms for SCD in ESKD. As such, the pathophysiology of SCD in the ESKD population is complex and believed to require the interaction between a transient event (i.e. intermittent hemodialysis) and underlying substrate. This process induces electrical instability and ventricular arrhythmias followed by hemodynamic collapse. Two factors specific to ESKD patients that have emerged as potential contributors to this SCD-susceptible state are altered mineral metabolism, including vitamin D deficiency, and impaired cardiac autonomic tone [7–10].
Cardiac autonomic tone
Cardiac autonomic tone is derived from beat to beat measurements of the time intervals between successive QRS intervals, specifically RR intervals. Measurement of HRV provides direct insight into abnormalities of the autonomic nervous system, which consists of the sympathetic nervous system (SNS) and the parasympathetic (vagal) nervous system (PNS) limbs [7, 11, 12]. HRV assesses the dynamic interaction and balance between the SNS and PNS at the level of the heart, overall providing a measure of cardiac autonomic competence [11, 12]. The
a priori main outcomes of interest are measures of the frequency domain as these parameters are direct measures of cardiac autonomic tone [11] and are most commonly described in the ESKD study population [10, 13–15]. No one parameter of HRV has been established as superior in regards to their predictive ability as surrogate markers for adverse cardiovascular events [7, 16–19].
Decreased HRV is associated with an increased risk of arrhythmias and cardiac death in both the general population [7] and patients with ESKD on dialysis [8, 9, 12–15]. Further, alterations in HRV occur more frequently in dialysis patients and corresponds with an increased risk of SCD and cardiovascular mortality [9, 13]. In a study of 30 ESKD patients, 53% had autonomic dysfunction, in which 40% was isolated to the vagal (PNS) limb and 13% had combined sympathetic and vagal dysfunction [20]. Similarly, HRV findings in a study of 239 hemodialysis patients demonstrated drastic sympathetic over-activity and vagal withdrawal [15]. Another study of 383 patients with ESKD on hemodialysis found that impaired cardiac autonomic tone was independently associated with an increased risk of all-cause and cardiovascular death after adjustment for traditional cardiovascular risk factors [8]. Although HRV is a surrogate measurement, it has been established as an important and validated, non-invasive measure of cardiovascular-related mortality risk in the ESKD population [12, 13, 20, 21]. Consequently, interventions enhancing measures of HRV, and therefore influencing cardiac autonomic control, could potentially have considerable survival benefits in the high-risk ESKD patient population.
Vitamin D
There are multiple pharmacological analogues and formulations of vitamin D available for clinical use [22, 23]. To be effective in disorders resulting from vitamin D deficiency, nutritional sources of vitamin D (cholecalciferol, vitamin D
3; and ergocalciferol, vitamin D 2) must undergo two enzymatic hydroxylations: 1) in the liver to 25-hydroxyvitamin D (25OHD); 2) in the kidney, 1α-hydroxylase converts 25OHD to the biologically active form of vitamin D, 1,25-dihydroxycholecalciferol (calcitriol) or 1,25- dihydroxyergocalciferol [22, 23]. The liver hydroxylation is largely substrate driven, but the kidney’s 1α-hydroxylase is very tightly regulated by hormones (e.g. parathyroid hormone) and concentrations of calcium and phosphate ions [22, 23]. In the VITAH trial, we use the following terminology for the specific vitamin D analogues; nutritional vitamin D therapy is provided in the form of ergocalciferol, and alfacalcidiol, is provided as the active (activated) vitamin D derivative.
In ESKD, progressive loss of functional kidney activity reduces the availability of 1α-hydroxylase within the renal tissue, which in turn reduces 1,25-dihydroxyvitamin D
3 production [24]. ESKD patients are also commonly deficient in 25OHD due to decreased nutritional intake from intensive dietary restrictions, lack of sun exposure due to decreased mobility, and dysregulated mineral metabolism [24].
In general, vitamin D deficiency is common and associated with worse cardiovascular outcomes in both the healthy [25] and ESKD [26] populations. Furthermore, low vitamin D levels are associated with increased risk of SCD in both non-ESKD [27] and ESKD patients [28, 29]. In relation to cardiovascular pathophysiology, vitamin D has been shown to influence cardiac contractility and myocardial calcium homeostasis in humans [30–33]. Furthermore, a small study of hemodialysis patients showed that treatment with activated vitamin D reduced the QT interval on electrocardiography [34]. Recently, we have not only shown that low vitamin D levels are associated with vascular physiology that increases cardiovascular risk [35], but also that poor vitamin D status is associated with an impaired ability to maintain cardiac autonomic tone in response to endogenous angiotensin II in healthy humans [36], a hormone that is chronically upregulated in the ESKD population. Furthermore, we have also demonstrated that vitamin D supplementation is associated with
normalization of autonomic tone in response to an acute angiotensin II stressor in healthy subjects [37]. As vagal activity is markedly reduced in hemodialysis patients [15], it is possible that vitamin D supplementation could improve the cardiac autonomic response to stressors such as hemodialysis. Regardless, the impact of vitamin D therapy in the ESKD population, and on other surrogate clinical measures of cardiovascular risk has not been assessed. In an observational study, serum 25OHD predicted total and cardiovascular mortality in incident ESKD patients, but this association was abolished in patients provided therapy with calcitriol or its active analogues [26]. This novel observation suggests that intensive vitamin D therapy inclusive of 1,25-dihydroxyvitamin D 3 analogues as well as other vitamin D derivatives may provide a more significant therapeutic and survival benefit within the severely deficient ESKD population, and thus provides the basis for assessing the therapeutic role of intensive and conventional vitamin D supplementation regimens in altering cardiac autonomic tone, as in the VITAH trial.
Evidence to date supports the safety profile of vitamin D therapy. Vitamin D deficiency is the norm in hemodialysis patients and as such, vitamin D supplementation should result in significant increase vitamin D levels. Secondly, given there is significant controversy regarding the target 25-hydroxyvitamin D level in both the general and chronic kidney disease population [38, 39], we aimed to determine the effect of delivered dose of vitamin D, rather than level of vitamin D, on cardiac autonomic tone. Lastly, though there is significant practice variation, the activated and nutritional vitamin D doses chosen for the study reflect those recommended in and typically prescribed to the end-stage kidney disease population on hemodialysis [38].
Despite the high prevalence of vitamin D deficiency in ESKD, current guidelines regarding correction of vitamin D status are widely acknowledged to be opinion-based and derived from biochemical endpoints [38]. The nutritional vitamin D product (ergocalciferol) and dose proposed within this protocol is identical to that suggested by guidelines for treatment in the ESKD population [38, 40]. Furthermore, treatment with other nutritional forms of vitamin D
3 at a dose of 15,000 IU/day × 1 month [41] and 40,000 IU/day over 28 weeks, followed by 10,000 IU/day × 12 weeks [42] has been shown to be safe. A main clinical concern with activated vitamin D supplementation in the ESKD population is hypercalcemia, hyperphosphatemia and reduction in parathyroid hormone levels. This protocol employs the lowest possible dose of activated vitamin D (alfacalcidiol) available to minimize significant fluctuations in these biochemical values, though the relative importance of these changes remains unquantified within the literature [43].
In summary, the evidence to guide treatment that may minimize SCD and cardiovascular risk in ESKD is extremely limited. The VITamin D supplementation and cardiac Autonomic tone in Hemodialysis (VITAH) study is the first clinical trial to assess whether various vitamin D therapies, specifically ingestion of the combination of activated and nutritional vitamin D compared to activated vitamin D alone, influence cardiac autonomic tone and therefore cardiovascular risk in ESKD patients requiring hemodialysis.
Methods Study aims
The primary aim of the VITAH trial is to determine whether 6 weeks of intensive vitamin D supplementation, consisting of alfacalcidiol 0.25mcg orally at every dialysis session combined with ergocalciferol 50,000 IU orally once per week and placebo the remaining 2 weekly dialysis sessions, will influence HRV assessment of cardiac autonomic tone, compared to 6 weeks of conventional therapy with alfacalcidiol 0.25mcg and placebo orally at every dialysis session. The secondary aim is to determine whether this intensive vitamin D supplementation influences or modulates independent activity of the sympathetic and vagal limbs of the cardiac autonomic nervous system compared to the conventional alfacalcidiol regimen.
We hypothesize that vitamin D supplementation will increase
all cardiac autonomic parameters, but that the vitamin D treatment will specifically have the greatest impact on vagal tone. We hypothesize that cardiosympathovagal balance will decrease after vitamin D therapy due to the fact that any increase in cardiosympathetic tone will be offset by a larger increase in cardiovagal tone. Study design and setting Ethical considerations
Ethical approval has been obtained from the Conjoint Health Research Ethics Board (Project ID: E-24846) at the University of Calgary as well as Health Canada (UC-NEPH-2012001) for all study sites involved in the trial. Two external bodies, a Data Safety Monitoring Board and a Trial Steering Committee, will monitor study progress.
Study interventions
The intervention is the vitamin D therapy sequence, including 6 weeks of intensive therapy and 6 week of conventional vitamin D therapy, or vice versa (Figure 1). Given that the current clinical standard of care is use of activated vitamin D (one of the top drug classes prescribed as recently outlined in the United States Renal Data System [44]) in the ESKD population, a placebo arm is not included. Upon recruitment, participants who are prescribed any form of vitamin D (either nutritional or active) at that time will cease to take the medication for 4 weeks, a valid washout period employed by the PRIMO trial, a randomized controlled trial examining the effects of activated vitamin D on cardiac structure in subjects with non-dialysis dependent kidney disease [45]. Participants who are not on any form of vitamin D at the time of enrolment will be randomized to one of the two treatment sequences immediately. All participants will be randomized to Treatment Sequence 1 or Treatment Sequence 2, such that each participant will ingest both vitamin D therapy regimens in a randomized, blinded, placebo-controlled crossover design and thus act as his/her own control. A 12 week washout period was chosen between each 6 week vitamin D treatment block to ensure that there are no carryover effects from either study period as the t
1/2 for alfacalcidiol is approximately 4 hours, and the t 1/2 for ergocalciferol is 19–48 hours [22, 23, 46]. Identification of eligible subjects VITAH trial inclusion and exclusion criteria
Inclusion criteria
Exclusion criteria
• Age ≥ 18 years
• Any major cardiovascular event within the last 6 months prior to enrolment (this includes, but is not limited to, new onset arrhythmia, hospitalization for a cardiovascular complication)
• Thrice weekly hemodialysis outpatient within the Southern Alberta Renal Program
• Physician consent to participate
• Refusal to cease vitamin D therapy for four (4) weeks prior to initiation of the study
• Ability and agreement to cease any prior vitamin D medication for four (4) weeks prior to initiation of the study
• Palliative status or metastatic malignancy
• Ability to comprehend study protocol and provide oral and written consent in English (native language or translated)
• Known or anticipated upcoming change in dialysis modality including transfer to peritoneal dialysis, kidney transplant, or change in current hemodialysis schedule/duration
Randomization and blinding
Subject identification codes and corresponding treatment schedules, consisting of two treatment sequences randomized in small random block sizes, were developed by an independent biostatistician at the University of Calgary prior to initiation of the trial. Following informed consent, patients will be given the next available subject identification code and are then randomized to one of the two treatment sequences. The University of Calgary Research Pharmacy is the sole entity that holds the randomization list, and will prepare and dispense blister packs of the appropriate vitamin D supplementation for distribution to each subject accordingly upon email notification of recruitment. The study subjects, investigators, health care providers, study coordinators, and data analysts will be blinded to both the randomization schedule and subsequent treatment allocation.
On treatment days the hemodialysis nurses at each study site will administer the study drug to the subjects at the beginning of each dialysis session throughout the 24-week trial. Compliance with the vitamin D supplementation will be recorded on study drug administration schedules and checklists for each subject enrolled in the trial. To ensure blinding, all vitamin D combinations will be prepared in blister- packages by Research Pharmacy marked only with the participant’s study identification code. Each study capsule is packaged identically in1g soft gel capsules to ensure blinding. Specifically, each study capsule holds one 0.25mcg alfacalcidiol pill as well as a placebo or 50,000 IU ergocalciferol pill. Ergocalciferol has no distinct odour or taste. The Research Pharmacy has manufactured the VITAH placebo pills within each capsule to resemble the ergocalciferol pills in colour, shape, odour, taste and consistency to allow for a blinded controlled trial even if the study capsules are disassembled for the subjects to facilitate ingestion. To ensure compliance with the treatment, all blister-packs will be kept at the respective hemodialysis unit and study medications will be administered and recorded by the dialysis nurse (directly-observed therapy). Ergocalciferol (vitamin D
2), in contrast to the other commercially available nutritional vitamin D, cholecalciferol (vitamin D 3), is only available by prescription through a medical vendor and has been labeled with a federal Drug Identification Number through which product can effectively be tracked. This method allows the investigators to determine whether contamination is occurring during the study so it can be reduced and to determine its extent during the analysis phase. Subsequent statistical analyses will also be done blinded to the above treatment allocation. Data collection lnms [2]) and converted to normalized units (nu). Overall cardiosympathovagal balance (LF:HF) is derived from these measures. Time domain HRV measurements are also calculated (Table 2) [7, 8, 17–19]. Description of heart rate variability data to be analyzed from 24- hour Holter recording
Heart rate variability parameter (Acronym)
Description/Physiological representation
Represents contribution of baroreflex activity in overall cardiovascular control
Represents contribution of cardiac parasympathetic/vagal nervous activity
Represents the interplay between sympathetic and parasympathetic limbs of the autonomic nervous system
Variation (in units of standard deviation) between each successive R-wave in the ECG recording
Average of the variation (in units of standard deviation) between each successive R-wave when comparing multiple 5-minute sections of the ECG recording
Percentage of normal R-waves that differ from the wave directly before it by ≥50 milliseconds
Baseline and ongoing data collection
• Age, sex, target weight, duration on dialysis, cause of end-stage kidney disease, vascular access type
• Serum calcium, phosphate, parathyroid hormone, Kt/V, 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D
• Medication use
• GODIN leisure-time activity questionnaire
• DASI aerobic capacity questionnaire
• Serum calcium, phosphate, parathyroid hormone, Kt/V, 25OHD level, 1,25-dihydroxy vitamin D level, catecholamines
• Renin, aldosterone, angiotensin II
• Delivered dose of dialysis (Kt/V)
• Power spectral analysis (LF, HF, LF:HF) and time domain (SDNN, SDANN, pNN50%) HRV parameters
• Serum calcium, serum phosphate, parathyroid hormone, 25OHD, 1,25-dihydroxy-vitamin D, catecholamines
• Renin, aldosterone, angiotensin II
• Delivered dose of dialysis (Kt/V)
• Power spectral analysis (LF, HF, LF:HF) and time domain (SDNN, SDANN, pNN50%) HRV parameters
Primary outcome
The primary outcome of the study is sympathovagal balance (LF:HF), interpreted as the overall balance on stimulatory and inhibitory cardiac autonomic control, from baseline to the final study day within each 6 week treatment block (0 and 6 weeks, 18 and 24 weeks). Comparison of measured sympathovagal balance throughout each of the vitamin D supplementation treatment blocks as well as the 12-week washout period will allow for statistical interpretation of whether presence or absence of oral vitamin D therapy alters cardiac autonomic function within this population. An improvement in sympathovagal balance can be interpreted by a downward shift in LF:HF, in which a smaller value indicates greater contribution of cardioprotective vagal activity (Table 2).
Secondary outcomes
The secondary outcomes include additional measures of cardiac autonomic tone, including LF, HF, as well as time domain parameters of HRV including the standard deviation of the normal R-R interval (SDNN), standard deviation of the average normal R-R interval (SDANN), percentage of normal R waves occurring ≥ 50 ms after the R waves immediately before (pNN50%), as well as blood draw measurements related to vitamin D metabolism at the beginning and termination of each 6 week treatment block (Table 2).
Subject follow-up procedures
Subjects will be followed from trial entry until study completion (24 weeks study period). The study coordinator will review each subjects’ collected data at 6 week intervals to record primary and secondary endpoints, as well as to assess the safety and efficacy of the vitamin D administration in relation to study blood work. Study medication may be discontinued for reasons associated with concern for subject safety, or as requested by the subject or primary nephrologist.
Study withdrawal
Given that the primary and secondary outcomes require the measurement of cardiac autonomic tone with a Holter monitor, follow up for these outcomes can only occur if the subject is alive and accessible for monitoring. Therefore, subjects will be censored and withdrawn from follow-up under the following circumstances; subject or primary nephrologist request, transfer to peritoneal dialysis, kidney transplantation, transfer of subject to a non-study hemodialysis unit, hospitalization, or death. Upon withdrawal from the study, any data collected up to that time will be utilized in a last observation carried forward (LOCF) approach.
Statistical analysis
The primary analysis will test associations between intensive and conventional vitamin D therapies and observed fluctuations in LF:HF from baseline to 6 weeks later within each treatment block utilizing a non-parametric paired t-test. To further determine the relationships between cardiac autonomic tone and specific vitamin D therapy regimens, we will use a repeated measurements analysis of variance model to account for the cross-over design of the study utilizing Greenhouse-Geisser correction values to account for multiple comparisons. Treatment, treatment period, and treatment sequence will be analyzed as fixed effects within the model, as well as additional effect modifiers (gender, vitamin D, calcium, phosphate, parathyroid hormone). Additional analyses will include a subgroup analysis for those subjects with diabetes mellitus as diabetes has been shown to alter parameters of cardiac autonomic tone and vitamin D metabolism [9, 21].
Sample size calculation
While we are not aware of any studies examining the use of vitamin D on the primary outcome of this study, previous work by Kontopoulous et al. [47] has demonstrated that post-myocardial infarction (MI) patients (n = 25) randomized to receive 5–10 mg of quinapril (angiotensin converting enzyme inhibitor) per day for 35 days immediately following an MI displayed a 46% reduction in LF:HF from baseline to 6 weeks (mean ± SE: 10 ± 0.7; 5 ± 0.5), while those randomized (n = 25) to receive 50–100 mg of metoprolol per day for 35 days following an MI displayed a similar 36% reduction in LF:HF from baseline to 6 weeks (mean ± SE: 9 ± 0.6; 6 ± 0.4). As such, given that 1) vitamin D deficiency is the norm in hemodialysis patients, 2) vitamin D downregulates the renin-angiotensin system [24, 25, 35], and 3) increased RAS activity is associated with alterations in cardiac autonomic tone [35–37], we feel there is sufficient justification for the sample size calculation herein
. Based on these observations, we estimate the standard deviation of the pooled difference in LF:HF from both treatment sequences as 4.53. Using a 2 × 2 crossover design (2 sequences or treatment orderings and 2 time periods or occasions) and anticipating a 20% or larger reduction in LF:HF observed after 6 weeks of treatment with combined vitamin D vs. the reduction observed after 6 weeks of treatment with alfacalcidiol alone, we estimate that 54 subjects will be required (α = 0.05, β = 0.9). In anticipation of a 10% dropout rate, approximately 60 subjects in total will be recruited. Discussion
In summary, the VITAH trial will determine whether an intensive vitamin D supplementation regimen will improve cardiac autonomic tone compared to conventional vitamin D supplementation in patients receiving chronic hemodialysis. As the trial will remain relatively small in nature, it is possible that potential sources of bias may influence the results obtained. For example, subjects recruited must be stable dialysis patients which may represent a different area of the patient spectrum in terms of the benefit that may be derived from vitamin D supplementation therapy. Furthermore, our study is limited to the Calgary, Alberta area in Canada which may play a role in the vitamin D levels of our subject population based solely on geographical location and seasonal sunlight exposure although current evidence would suggest that a majority of dialysis patients are vitamin D deficient regardless of geographical location [24, 26–28]. The evidence surrounding the relationship between various vitamin D therapies and cardiovascular risk derived from clinical trials is extremely scarce. The OPERA study by Wang and colleagues [48] has recently demonstrated that in subjects with non-dialysis dependent chronic kidney disease, 52 weeks of daily paricalcitol supplementation did not alter left ventricular mass, volume, or ejection fraction. Critically, the study showed that cardiovascular-related hospitalization rates were significantly reduced in the vitamin D treatment group compared to placebo, suggesting that vitamin D may affect cardiovascular risk and underscoring the need for other cardiac parameters, such as cardiac autonomic tone, to be evaluated in relation to vitamin D supplementation. The VITAH trial will lend much needed data to the literature pool, and moreover conclusions drawn from this trial will provide quality evidence towards the current equipoise which exists within the discussion of the clinical efficacy of vitamin D in reducing cardiovascular-specific risk in this growing vulnerable chronic patient population.
Abbreviations 25OHD:
25-hydroxyvitamin D
ESKD:
End-stage kidney disease
HRV:
Heart rate variability
HF:
High-frequency
LOCF:
Last observation carried forward
LF:
Low-frequency
LF:
HF: Low-frequency: High-frequency
MI:
Myocardial infarction
PNS:
Parasympathetic nervous system
SDNN:
Standard deviation of the normal R-R interval
SDANN:
Standard deviation of the average normal R-R interval
SCD:
Sudden cardiac death
SNS:
Sympathetic nervous system
TP:
Total power
VLF:
Very-low frequency.
Declarations Acknowledgements
The authors would like to acknowledge the support of the nursing staff and Calgary Lab Services laboratory technicians at each study site involved with the trial for their ongoing cooperation and support. We would also like to thank the input from the Data Safety and Monitoring Board members of Drs. Stelfox (chair), McLaughlin and Tibbles.
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J Clin Endocrinol Metab. 2008, 93 (10): 3927-3935. 10.1210/jc.2008-0784.View ArticlePubMedGoogle Scholar Drechsler C, Verduijn M, Pilz S, Dekker FW, Krediet RT, Ritz E, Wanner C, Boeschoten EW, Brandenburg V, NECOSAD Study Group: Vitamin D status and clinical outcomes in incident dialysis patients: results from the NECOSAD study. Nephrol Dial Transplant. 2011, 26 (3): 1024-1032. 10.1093/ndt/gfq606.View ArticlePubMedGoogle Scholar Drechsler C, Pilz S, Obermayer-Pietsch B, Verduijn M, Tomaschitz A, Krane V, Espe K, Dekker F, Brandenburg V, März W, Ritz E, Wanner C: Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients. Eur Heart J. 2010, 31 (18): 2253-2261. 10.1093/eurheartj/ehq246.View ArticlePubMedPubMed CentralGoogle Scholar Selles J, Boland R: Rapid stimulation of calcium uptake and protein phosphorylation in isolated cardiac muscle by 1,25-dihydroxyvitamin D3. 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N Engl J Med. 2007, 357: 266-81. 10.1056/NEJMra070553.View ArticlePubMedGoogle Scholar Kontonopoulous AG, Athyros VG, Didangelos TP, Papagerogiou AA, Avramidis MJ, Mayroudi MC, Karamitsos DT: Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic nephropathy. Diabetes Care. 1997, 20 (3): 255-61.Google Scholar Wang AY, Fang F, Chan J, Wen YY, Qing S, Chan IH, Lo G, Lai KN, Lo WK, Lam CW, Yu CM: Effect of paricalcitol on left vantricular mass and function in CKD - the OPERA trial. J Am Soc Nephrol. 2014, 25 (1): 175-86. 10.1681/ASN.2013010103.View ArticlePubMedGoogle Scholar The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2369/15/129/prepub Pre-publication history Copyright
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. | 42,882 | 16,599 | 0.000061 |
warc | 201704 | Back in August, a robot landed on Mars.
Admittedly, we’ve landed robots there before, but none quite so big or impressive as
Curiosity. After decades of declining interest in the space program culminated with the retirement of the Space Shuttles, interest in space is experiencing a revival.
Walking on Mars could happen in our life time; after all, it was less than decade after the first man was launched into space that another man walked on the Moon. Only time will tell who the first person on Mars will be, Abby Harrison perhaps? Fifteen-year-old Abby is already plotting how to get herself to the red planet and her bio tells me she has a good chance of achieving her goal!
Mars is awesome; people have been dreaming about going there long before Abby was born. Werner Von Braun was analyzing the possibilities of manned missions to the Red Planet as early as 1948 – two decades before his Saturn V rockets would put us on the moon!
Here are some books* – fiction and non-fiction – to help you get your Martian fix until Abby gets us there and writes a memoir to be added to this list.
The Mars Trilogy by Kim Stanley Robinson Workers at the Jet Propulsion Lab (JPL) have had to drastically alter their schedules in order to be on Mars time; a solar day is approximately 40 minutes longer** than a day here on Earth. The Nebula and Hugo Award-winning trilogy, set in the near future of 2026, lands 100 scientists and engineers on the Martian surface. In order to adjust for the slight time difference, they keep a Terran clock with a vague “timeslip” to make up the difference in their new schedules. The books are multi-generational focusing on the difficulties in making the planet habitable and the conflicting view point of preserving it before progressing into the societal changes that occur when technology advances and multiple solar bodies are inhabited.
Postcards from Mars by Jim Bell Before Curiosity, there were Spirit and Opportunity. Together, the two little rovers have taken over 100,000 pictures. Photography lead on the missions, Dr. Jim Bell, has compiled 150 photos (and fold-out spreads) to show off the stunning alien landscape and the book includes a forward by Bill Nye. Rather than just show you Mars, the book talks about the adventures of these little Rovers-That-Could and discusses the obstacles they ran into and the discoveries they made. Both rovers were expected to work for 90 days which they exceeded; after 6 years, Spirit is now out of commission while Opportunity plugs away 8 years after its expiration date. In the Mars Trilogy, much is made of the aesthetic difference between Earth and Mars. Until a manned mission occurs, we’ll have to settle for the view in the stunning Postcards from Mars.
The Case for Mars: The Plan to Settle the Red Planet and Why We Must by Robert Zubrin With terrifying reports of out-of-control forest fires and melting ice caps, it’s hard not to wonder if we shouldn’t be focusing on space exploration and making other planets habitable. Due to its proximity, similar solar day, and not to terrible different gravity, Mars is a prime possibility. Recent photos from Curiosity show signs that liquid water once flowed on the planet as proof of dried riverbeds has been beamed back to us. If only it weren’t for that un-breathable atmosphere. Plans and arguments have come and gone since Von Braun’s The Exploration of Mars was published in 1956, but at some point we may need to stop dreaming about Mars and actually go there.
*
Before you get mad at me, yes, I left Mary Roach’s Packing for Mars off the list. While a great book, it isn’t specifically about Mars and so has not been included.
**
Prior to Curiosity, Mars rovers relied on solar panels forcing Earth-bound crews to adjust their schedule to that of Mars. Curiosity uses more reliable nuclear power but did two months of work during the planet’s day. Only recently have mission control workers returned to a normal Terran schedule. | 4,056 | 2,072 | 0.000493 |
warc | 201704 | How young should (or could) kids be to begin taking karate lessons? This is probably the most common question I’m asked from friends at social events. A question such as this has two answers: easy and hard. The easy answer is: at whatever age your local karate school will accept them. For
our school, it’s age 5. For my instructor’s school, age 3 or 4. Easy answer, done.
The hard answer is why do the parents want their child to study in the martial arts. Don’t misunderstand the intent of the question;
teachers love students and want kids to study karate (with their dojo especially). But the answer helps set expectations for the parents, the child, and the instructor. With expectations properly gauged and in place, the age of the child has less meaning in readiness for karate class and the overall experience will be better.
Here are some common answers parents give for why they want their kid in karate:
Fun – A parent took martial arts classes as a child themselves and remembered having a blast. Maybe it was recommendations from friends showing how fun it can be. Or it could be any other reason pertaining to having a good time. And it’s true. All the karate schools I know have fun in class. Sure there’s hard work, but work hard play hard is a common mantra. Kids learn better when they enjoy what they’re doing. Discipline – This one is a little tricky. Yes, there will be discipline in class. “Yes sir”, “No sir”, listening, staying in line, following instructions, obey on the first request, no rolling the eyes, no talking back, etc are all part of the discipline process. But, and it’s a huge “but”, karate instructors can’t instill discipline in a vacuum. Discipline has to be practiced at home as well. Karate instructors (any instructor really) can teach many things, including discipline, but without reinforcement at home the chances of the behavior taking root are very slim. Self-Confidence – It’s never too early to begin building self-confidence in children. Some kids lack belief in themselves, perhaps due to internal doubts or external put downs; especially as kids begin school. Martial Arts can be a great vessel to improve anyone’s perception of themselves. They learn how and when to defend themselves while also seeing progress in their abilities. The mental and physical fortitude developed can help kids to withstand quite a few obstacles in life. Exercise – Some parents just want their child to get some exercise. Could be a break from gaming systems or as an addition to other sports. Karate is good exercise all the way around. Learning the habit of regular exercise, even at a kids age, can continue to be beneficial later in life. My dad started me in martial arts at a young age (Age 6 – I think), and my kids started young too. (Ages 7 and 10) So, I am unapologetically biased about what young children can accomplish by practicing martial arts. Starting kids in karate in their early youth can be a huge advantage for them. Even more so when the expectations of the parents are properly in place, and the parents have the opportunity to be involved with them as the child grows in their martial arts journey. Sam Bowley McKinney, TX | 3,299 | 1,609 | 0.000644 |
warc | 201704 | "Any sufficiently advanced technology is indistinguishable from magic."
- Jose Ramon Pais Curto
"It is not enough to assess if processes are documented, controlled and audited. Companies also need to assess if processes are understood and used by the people that execute them."
- Søren Pommer
"It’s ironic, really, that the same vendors that only a few years ago differentiated themselves on the basis that they didn’t focus on the structured, process-centred business of project-based work...are now feeling the need to add a little more support for structured work to their products."
- Angela Ashenden
"The market researcher projects that the business process as a service (BPaaS) and cloud BPM markets will grow in value from $1 billion in 2013 to $7.12 billion by 2018."
- Lance Harris From the BPM Forum
"ACM is just BPM"
- Scott Francis
"If BPM means everything, then it means nothing."
- Keith Swenson
If you believe that we've missed a great quote from the past week, please add it in the comments below. If you come across one we should consider for next week, please use the hashtag #bpmqow on Twitter.
Have a great week! | 1,174 | 685 | 0.001514 |
warc | 201704 | Direct democracyis a concept that a growing number of citizens and states around the world are exploring and embracing. There are 190 million people in Switzerland, Italy, Liechtenstein and 24 States in the USA who now embrace the referendum system. 70% of the US population now live in a state that gives them the right to vote on initiatives and referendums.
To many people, direct democracy can mean different things. Some picture the classical/pre-modern (Athens) style of direct democracy where citizens meet in the town square and decide on important issues. Others see it as an opportunity to rid the world of devious self-serving politicians, where we can all sit at home and make all necessary political decisions via our laptops. Whatever it means to you, direct democracy has certainly become a much discussed topic over the last twenty or so years even though it has had numerous critics.
Direct democracy would appear to offer citizens more control over controversial and polarizing issues that directly affect their lives. That is not to say that direct democracy is a replacement for representative democracy, only that it can be an adjunct to it. One definition has direct democracy as, “A form of state in which the sovereign power is held by the People, i.e., national sovereignty belongs directly to the People. The People also exercise their sovereignty directly, for example by means of popular legislation.”
.My own definition would be: the right of citizens to initiate referendums on any issue, to veto legislation, and for these decisions to be binding on parliament.
There are a number of parts to direct democracy: general elections, citizens' initiatives, referendums, recalls, and plebiscites. A lot of misunderstanding and confusion could be avoided if these issues were all clearly distinguished from one another, along with their procedures. Of course, there are also many forms of election systems but these will not be discussed here.
The
Citizens’ Initiatedreferendum allows for one or more citizens to put their own proposal on the political agenda once the required number of signatures have been collected to trigger the citizens’ initiative. It is interesting to note here that only about 10% of citizens' initiatives actually pass in Switzerland, the birthplace of direct democracy. The signature requirement range is from as low as 2% and sometimes as high as 15%.
An O
bligatory referendumis triggered automatically by law, usually by a constitution which requires that certain issues must be put before the voters for approval or rejection.
A Veto
referendum(Facultative or optional referendum in Switzerland) is when new laws, or changes to laws which have been passed by parliament, can be subject to a referendum if the required number of citizens demand it. The new law becomes effective if the majority of the votes were in favour of it. It is worth noting that of the more than 2,200 laws passed by the Swiss parliament since 1874, only 7% have been subjected to a Veto referendum.
A R
ecall referendumcan be launched to remove corrupt elected officials, or to remove elected representatives whose policies and performance are found wanting. A high profile example of this was when Governor Grey of California was replaced in a recall by actor Arnold Schwarzenegger. The recall operates in a similar fashion to the citizens' initiative where citizens collect the required amount of signatures, and once this has been achieved, a referendum is held to decide if a certain elected official will retain their position. The recall has two components, a 'yes' or 'no' vote for recall and the names of the replacement candidates. The recall measure is successful if it passes by a simple majority. In that case, the replacement candidate with the largest vote wins the office. If the recall measure fails, the replacement candidate votes are ignored.
Referendums are often referred to as
Plebiscites.However, Plebiscites really are quite different to referendums and are controlled by authorities; they are not referendums or initiatives and therefore arguably are not part of direct democracy. A plebiscite is a public consultation controlled from above by those in power (e.g., President, Prime Minister, and Parliament) who decide when and on what subject the people will be asked to vote or give their opinion. They are a way for those in power to manipulate citizens and have power over them. They are used to give some form of legitimacy for decisions that those in power have already taken. In Switzerland, for example, it is quite different from Nazi Germany during 1933-1945, where there were three manipulated plebiscites.
In Switzerland, direct democracy means that a referendum process takes place either because a group of voters demands it, or because it is stipulated in the constitution, but the government cannot call the referendum, so therefore Switzerland does not have plebiscites and direct democracy in Switzerland cannot be controlled by the government.
With citizens protesting around the world about corporate greed, a lack of government direction, poor fiscal management and party political agendas, along with the lack of trust citizens appear to have in their political representatives, one might expect the discussion about direct democracy to snowball even further. It might be expected that citizens around the world will eventually demand this political tool to reign in their political masters. New Zealand has toyed with direct democracy since 1993, but to date, governments here have mostly ignored the will of the people in the referendums that have been held. | 5,678 | 2,496 | 0.000403 |
warc | 201704 | The health care provider manufacturersability have a activity to publicise notify on indiscretionaryability or undiscriminating use of drugs; and their-longability and extra-medicalability use must be demoralized as by a long chalk as they are promoted for the authorization use.
"I brainwave pigeonholed medicationsability similar to Viagra genuinely valuable to have them for orderly use; I go for generic material from the purported retail outlets or certificated online pharmacies," says Abdul, an Indonesian who has to yield to Sildenafil to alimentation his physiological property boisterousness of upright disfunction.
An Asian nation interpretation of the worldwide illustrious preparation containingability Tadafilability is responsive the high-ticket tag with what is named as Kamagraability. Beside the preamble of Anit-impotence drug formulationsability same Kamagraability and yet different one called Cavertaability have tried to payoff a trivial bite of the incalculable marketplace the common denounce physiological property mess up medicationsability enjoin.Post ads:
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Medications have a few or the opposite side-effectsability. Their tolerability is connected to their anyone sans long side-effectsability or short-term grave side-effectsability.Post ads:
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Besides nearby is an silent and verbalized word of warning - they essential be interrupted since time-consuming. How long? That depends upon the comprehension of your medical practitioner who is treating you and the earnestness of the clause that you have.
The bottom stripe is that maximum of the drugs are professed to be temporal interventionsability and so is Virility drug and cannot be incomparable substitutesability for a swell vigour. Besides the health professional manufacturersability have a sphere of activity to publicise tip off on indiscretionaryability or indiscriminating use of drugs and their-longability and extra-medicalability use must be saddened as considerably as they are promoted for the authorization use. | 4,414 | 2,326 | 0.000431 |
warc | 201704 | Teck Resources Ltd. has followed the lead of numerous competitors by announcing plans to cut costs and defer capital spending. But in Teck’s case, most of it is not voluntary.
Vancouver-based Teck said Wednesday that $1.5-billion of planned spending in 2012 and 2013 is being pushed out to the future. The move allows the miner to preserve its strong balance sheet, which could come in handy if the global economy deteriorates and commodity prices fall further. In 2008, Teck was caught with too much debt on its balance sheet when the financial crisis struck, and it nearly ruined the company.
However, these deferrals are largely due to regulatory problems that Teck is encountering, rather than any internal strategy. The company is facing permitting delays at its Quebrada Blanca and Quintette projects. Its Relincho copper project is being held up by port and power supply issues that lie outside the company. And its Fort Hills oil sands project in Alberta was delayed by joint venture partner Suncor Energy Inc., which is working on a cost-efficient project schedule.
The one key project that Teck voluntarily deferred is a new furnace at its zinc smelter in Trail, B.C.
With all that said, chief executive Don Lindsay views the deferrals as a sensible action in this environment.
“If the regulatory delays weren’t there, perhaps we would have made the [deferral] choices anyway,” he said on a conference call.
Teck also noted that it is considering delays of “a number” of other projects.
Teck’s hefty cash position of $4.2-billion could continue to grow over the next year, now that capital spending has been sharply reduced. While some investors would like to see an enhanced dividend or share buyback, Mr. Lindsay noted the project spending will be made eventually, and Teck is happy to “stay the course” with more moderate dividend increases and buybacks.
“We will still need the capital at some point in the future. Hopefully the not-too-distant future,” he said.
Mr. Lindsay also dismissed speculation that Teck is eager to get into the iron ore business. Teck has been studying iron ore for years, but Mr. Lindsay said that entry costs are too high and the company has “no particular interest” right now.
In the third quarter, Teck delivered an adjusted profit of $349-million, or 60¢ a share, way down from the $1.26 a share it earned in the same period a year ago. The difference is due to weaker commodity prices and sales volumes, a result of the global economic uncertainty. The numbers were slightly below analyst expectations, but investors were happy to see Teck’s strong balance sheet and new cost reduction plans. The company hopes to shave at least $200-million from its annual operating costs.
Teck also maintained its production guidance for this year, which was a big positive for investors. Many other mining companies have slashed production guidance in recent months, in addition to capital spending. | 3,020 | 1,531 | 0.000673 |
warc | 201704 | Posted on July 26th, 2016 by
In a recent study, the targeted agent cabozantinib did not demonstrate an improvement in outcomes compared to prednisone, among men with advanced prostate cancer. These results were recently published in the
Journal of Clinical Oncology.
Prostate cancer is the second leading cause of cancer-related deaths among men in the United States. Metastatic prostate cancer refers to cancer that has spread to several and/or distant sites in the body.
There are several treatment options for prostate cancer, depending upon several variables of the cancer and patient characteristics. However, since prostate cancer is stimulated to grow from exposure to the male hormone, testosterone, a common therapeutic approach is to reduce the formation of testosterone in the body. This can be done through surgery or medications.
Researchers continue to evaluate novel ways in which to improve survival while maintaining quality of life among men with metastatic prostate cancer, particularly among those whose cancer progresses despite prior therapy to reduce testosterone levels.
Cabozantinib is an agent referred to as a kinase inhibitor. It was developed to target certain cellular pathways that stimulate the growth and spread of cancer cells. Cabozantinib targets the MET and VEGF receptors to reduce cancer progression. Previous trials evaluating cabozantinib have demonstrated anti-cancer activity among men with metastatic prostate cancer that has progressed despite prior therapy to reduce testosterone levels.
Due to prior study results, researchers continued to evaluate cabozantinib among patients with advanced prostate cancer. The recent phase III clinical trial, referred to as the COMET-1 trial, included 1,028 men with metastatic prostate cancer that had progressed following prior therapies, including therapy to reduce testosterone levels. Patients in the trial were treated with either cabozantinib, or prednisone (a steroid).
The researchers concluded that among men with metastatic prostate cancer that progressed despite prior therapy, treatment with cabozantinib did not improve survival compared with prednisone.
Reference: Smith M, De Bono J, Sternberg C, et al. Phase III Study of Cabozantinib in Previously Treated Metastatic Castration-Resistant Prostate Cancer: COMET-1 . J Clin Oncol. Published online before print July 11, 2016, doi: 10.1200/JCO.2015.65.5597.
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warc | 201704 | I was on a call a few months ago with a friend I track with regularly.
On the call he said
“I need to have a vision big enough to make high capacity leaders afraid.”
That stopped me dead in my tracks.
I loved it.
Think about it.
Is there a higher or more urgent calling than accomplishing the mission of the church?
And yet so many churches limp along
satisfied with incremental progress and minimal commitment. Starbucks sometimes seems to have a more urgent mission than many churches do. That just shouldn’t be true.
Here’s what I think is true:
High capacity
visions attract high capacity people.
High commitment
environments attract highly committed people.
The
lower your bar is, the lower your chance is to accomplish anything significant. Big leaders are not stirred by small dreams.
Here are five things you can do that can help engage high capacity leaders:
1. Become passionate about an inexhaustible vision. One of the things I love about leading a church is that the mission is never ‘done’. Sure, it’s important to celebrate milestones along the way. But as long as there are unchurched people (we have about 200,000 within a 30 minute radius of our church) and as long as people need to grow in their faith (that’s never ‘done’ either), then we have work to do. High capacity leaders love visions that are much bigger than themselves. Reaching 200,000 people will keep almost any leader energized. 2. Ask big. If you are recruiting small group leaders, asking a leader to serve every week pulls in a more committed leader than asking someone to serve 1 in 5 weekends. Asking someone to join an inner circle and engage intellectually, spiritually and even financially calls out a different kind of leader than the call to simply handout programs and smile on a Sunday. High capacity people are drawn to high levels of challenge.
3.
Be innovative. As the church moves into the future, I think experimentation and innovation are going to be hallmarks for churches that are effective in reaching the next generation. Being willing to do things in different ways will attract the best minds, hearts and intellects to the mission. If you launch ventures like, say, online campuses or multisite, you will engage people who would never come to the table under more traditional forms of ministry.
4.
Continually point toward why you’re doing what you’re doing. High capacity leaders want to accomplish something bigger than themselves. There is no mission bigger than the mission of the church. Remind them regularly of giving their lives to a higher cause.
5.
Value input. Leaders love to be heard. You do. I do. High capacity leaders don’t always need to be right, and they don’t even need to always get their way. But knowing that their input is valued is huge. Listen as you lead. If you’re having trouble engaging high capacity leaders, your problem might not be that you’re asking too much. It might be that you’re asking too little.
What are you learning about attracting high capacity leaders?
Do you have a vision big enough to scare people? | 3,168 | 1,463 | 0.000709 |
warc | 201704 | When you’re my age, your mom is probably at that age when, nine chances out of ten, her doctor has told her to stay on a low-fat diet. When Mother’s Day comes around and you want to treat her to a good meal, it’s not easy because most of us think of special meals in terms of elaborateness which, very often, translates to a lot of fat. The trick, of course, is to re-wire our brains and re-think what “special” means. Special can mean a special favorite. This steamed whole fish dish, for instance, is a favorite with my mother-in-law. She often requested me to prepare this when we had parties here at the house. It is low-fat and it is special to her. Originally published on November 10, 2007, I am reposting the recipe for you cooks out there who choose to go the low-fat route for Mother’s Day.
Can any dish be simpler to cook than steamed whole fish? The only real work involved is the preparation. After that, just place the fish in the steamer and leave it to cook for 30 to 45 minutes depending on the size of the fish. No stirring, no nothing. Very few utensils to wash. And, unlike fried whole fish, no oil splatters to clean up afterwards.
I love steamed whole fish. But not all kinds of fish are good for steaming. My top preferences are tilapia and pompano and both are available all-year round in wet markets. Tilapia can either be saltwater or freshwater; pompano is either dark gray or silver. The dark dray pompano is the common variety. The silver pompano, or mestiza, is something I don’t see too often. In fact, it wasn’t until a few months ago that I became aware that there is pompano other than the dark gray variety.
Why is pompano great for steaming? Because the flesh contains enough oil to make it moist and soft.
Many of my friends who cook think that commercial broth cubes are an essential ingredient of steamed whole fish. I beg to disagree. Using broth cubes takes the control out of the cook because you’re stuck with the flavors in the broth cubes. Worse, the MSG content of broth cubes kills the natural flavors of the fish and who the heck wants that? Might as well eat canned fish.
What’s new here is the use of bottled ginger sauce from Shuin. The ginger sauce was recommended for siomai. When mixed with soy sauce and sesame seed oil, you have a wonderful dipping sauce that makes you feel like you’re eating in an authentic Chinese restaurant even when you’re enjoying the siomai at home.
If you have fresh ginger available, I recommend that you use grated ginger instead of bottled ginger sauce. I used sliced or julienned ginger in the past but after this experiment with the bottled ginger sauce, I am convinced that grating fresh ginger and mixing it with soy sauce and sesame seed oil will yield a more flavorful steamed fish than one that has sliced ginger in it. Grating squeezes out the juices from the ginger and the ginger juice will permeate the fish flesh better.
2 whole pompano, about 800 grams in weight before cleaning 4 tbsps. of ginger sauce or 4 tbsps. of freshly grated ginger with the juice ¼ cup of light soy sauce 1 tsp. of sesame seed oil toasted garlic chopped cilantro Clean the fish by gutting and removing the gills. Pompano has very small fine scales and you can remove them easily by scraping the fish’s skin with a small knife. Some cooks don’t find it necessary to do this; you decide if you wish to. Cut off the fins and tail. Make a diagonal incision along the entire length of the fish, from half an inch below the head to half an inch above the tail about one-fourth inch deep. Place the fish in heat proof plates. Mix together the ginger sauce or grated ginger, soy sauce and sesame seed oil. Pour over the fish, reserving about two tablespoonfuls for later use. Steam the fish over briskly boiling water for about 30 minutes. When the fish is done, remove the plate from the steamer and pour the reserved sauce over the fish. Sprinkle with toasted garlic and chopped cilantro (coriander leaves, locally known as wansuy). If you’re thinking of asking whether the toasted garlic and chopped cilantro are necessary, I will answer before you ask. Yes. YES. They may just be garnish but there is ornamental garnish and garnish that elevates the experience of enjoying your food. The crisp garlic adds color and texture; the cilantro adds contrast and depth. I don’t know how to describe it but if you decide to cook this steamed pompano with ginger sauce, remember to include a few bits of garlic and cilantro with every mouthful so you’ll understand what I can’t describe exactly with words. | 4,671 | 2,172 | 0.000471 |
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