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text:
The Global Spine Care Initiative:
A Summary of the Global Burden of Low Back and Neck Pain Studies
FROM: European Spine Journal 2018 (Sep); 27 (Suppl 6): 796–801 ~ FULL TEXT
Eric L. Hurwitz, Kristi RandhawaM Hainan Yu, Pierre Côté, Scott Haldeman
Office of Public Health Studies,
University of Hawaii,
M?noa, Honolulu, HI, USA.
ehurwitz@hawaii.edu
PURPOSE: This article summarizes relevant findings related to low back and neck pain from the Global Burden of Disease (GBD) reports for the purpose of informing the Global Spine Care Initiative.
METHODS: We reviewed and summarized back and neck pain burden data from two studies that were published in Lancet in 2016, namely: "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015" and "Global, regional, and national disability-adjusted life years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015."
RESULTS: In 2015, low back and neck pain were ranked the fourth leading cause of disability-adjusted life years (DALYs) globally just after ischemic heart disease, cerebrovascular disease, and lower respiratory infection {low back and neck pain DALYs [thousands]: 94 941.5 [95% uncertainty interval (UI) 67 745.5-128 118.6]}. In 2015, over half a billion people worldwide had low back pain and more than a third of a billion had neck pain of more than 3 months duration. Low back and neck pain are the leading causes of years lived with disability in most countries and age groups.
CONCLUSION: Low back and neck pain prevalence and disability have increased markedly over the past 25 years and will likely increase further with population aging. Spinal disorders should be prioritized for research funding given the huge and growing global burden. These slides can be retrieved under Electronic Supplementary Material.
There is more like this at our
Global Burden of Disease Page
KEYWORDS: Back pain; Global burden of disease; Neck pain; Spine
From the FULL TEXT Article:
People are living longer, on average, but the health-related quality of life has not kept pace with enhanced longevity, resulting in an expansion of morbidity. [1] Low back and neck pain are conditions affecting an increasing number of individuals in terms of prevalence and disability. [2, 3] The 2015 Global Burden of Disease Study of injuries and risk factors brought together over 1800 independent experts in more than 120 countries and territories. [4] This study highlighted areas where improvements can be made in healthcare delivery. The 2015 Global Burden of Disease Study analyzed 249 causes of death, 315 diseases and injuries, and 79 risk factors for 195 countries and territories between 1990 and 2015. Incidence and prevalence were estimated for 2619 sequelae of 310 causes for 591 geographical regions using 60,900 data sources for the years 1990, 1995, 2000, 2005, 2010, and 2015. Four main papers were published for the Global Burden of Disease Study. [3, 5–7] Our objective is to summarize the methods and findings of two of the four capstone papers that include outcomes relevant to neck and back pain. [3, 7] These papers reported global data from 1990 to 2015 on the prevalence, years lived with disability (YLD), and disability-adjusted life years (DALYs), the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability. [8]
The World Spine Care (WSC) vision is "a world in which everyone has access to the highest quality spine care possible." (www.world spine care.org) The WSC created the Global Spine Care Initiative (GSCI) to develop an evidence-based, practical, sustainable, and scalable spine health-care pathway and model of care that can be implemented to underserved communities. A better understanding of the global burden of spine pain is needed. Therefore, the objective of this paper is to summarize relevant findings and trends related to back and neck pain from the most upto- date 2015 GBD reports for the purpose of informing the GSCI, identifying critical global spine care and research gaps and needs, and offering potential explanations for differences between estimates of community and global burden.
We summarized the methods and findings of two of the four capstone papers that include outcomes relevant to neck and back pain. [3, 7] From these papers, we summarized data on the prevalence, years lived with disability (YLD), and disability-adjusted life years (DALYs). [8]
Global burden of disease survey
The global burden estimates for low back pain and neck pain were established through eight steps: (1) establishing a case definition; (2) establishing health states; (3) systematic reviews; (4) establishing disability weights; (5) adding national health surveys; (6) performing Bayesian metaregression; (7) performing severity distribution; and (8) finalizing YLD estimates. [2, 9] The GBD Neck Pain Expert Group and GBD Low Back Pain Expert Group performed steps 1–3, and the GBD Core Team performed the remaining steps. [2, 9] We have provided summaries of the case definitions, establishing health states, measures of burden, and establishing disability weights used in the GBD reports below.
Measures of burden
Disability-adjusted life years (DALYs) is an overall summary measure of population health that the GBD uses, which combines years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs). [10]
Established disability weights
For GBD 2010, a comprehensive re-estimation of disability weights was carried out through a large-scale empirical study. Household surveys were conducted in five countries that were diverse in languages, cultures, and socioeconomic status. The surveys used paired comparison questions, where respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they believed was healthier. An open access web survey was also used that asked additional questions about population health equivalence, which compared the overall health benefits of various life-saving or disease prevention programs. [11] An analysis of the paired comparison data was performed using probit regression analysis. Results from the population health equivalence responses were used to anchor results from the paired comparisons on the disability weight units between 0 (no loss of health) and 1 (loss equivalence to death). [11] In 2013, additional Webbased surveys were completed in four European countries and combined with data previously completed in the GBD 2010 disability weights measurement study. [12]
Socio?demographic index
The GBD investigators computed a summary measure for each geographic location in 2015 called the Socio-Demographic Index (SDI) that takes into account per capita income, years of education, and fertility rate. [6, 7] Expected disease-specific YLDs and DALYs based on the SDI for each location were computed and compared to observed YLDs and DALYs, yielding observed to expected ratio measures of disease burden that exceed, are consistent with, or lag behind expectation based on the SDI components. [6, 7]
Taking uncertainty into account
To account for uncertainty in estimation due to sampling, model estimation, and model specification (e.g., variable study sample sizes, adjustments from non-reference definitions, parameter and disability weight uncertainty), 95% uncertainty intervals (UIs) were derived from 1000 draws from the posterior distribution of each step in the estimation process (the UIs reflect the ordinal 25th and 975th draw). [7]
Definitions of low back pain and neck pain
The case definition for low back pain (LBP) was LBP (± pain referred into one or both lower limbs) that lasts for at least 1 day. [13] The 'low back' was defined as the area on the posterior aspect of the body from the lower margin of the 12th ribs to the lower gluteal fold. [2] The case definition for neck pain was: neck pain [± pain referred into the upper limb(s)] that lasts for at least 1 day. [2] The anatomical region of the neck was defined according to the recommendation by The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. [14] 'Neck or shoulder' pain was assumed to be a proxy for 'neck' pain.
Health states
The GBD low back and neck pain expert groups developed a series of sequelae to characterize the different levels of severity considering the variation in functional loss associated with acute and chronic neck pain with or without arm pain, and acute and chronic LBP with or without leg pain.
Table 1 reports the global prevalence numbers of low back and neck pain and YLDs caused by these conditions. The global point prevalence of low back pain and neck pain of greater than 3 months increased by 18.7% from 2005 to 2015. [3] Specifically, the global prevalence of low back pain of more than 3 months duration has increased by 17.3% [539,907,000 (95% UI 521,449,000–559,556,000)] and neck pain of more than 3 months duration has increased by 21.1% [358,007,000 (95% UI 313,408,000–409,411,000)] over the last 10 years [3]. Low back and neck pain YLD remain the top cause of global YLD since 1990. [3]
Age-specific global rankings of low back and neck pain YLDs and DALYs are reported in Online Resource Table 1. Globally, in 2015, low back and neck pain were the leading causes of YLD in persons 25–64 years old, second leading cause of YLD in those 20–24 or 65–79 year olds, third leading cause of YLD in those aged 80 +, and fourth leading cause of YLD in 15–19 year olds. [3] Furthermore, the global YLD caused by low back and neck pain has increased 18.6% (95% UI 17.6% to 19.6%) from 2005 to 2015. [3] Similarly, YLD caused by low back pain alone increased by 17.2% (95% UI 16.4–18.1%) and YLD caused by neck pain increased by 21.0% (95% UI 18.9–23.2%) over the last 10 years. [3]
The rankings of low back and neck pain YLDs and DALYs by geographic area are reported in Online Resource Table 2. Low back and neck pain were the leading cause of disability in all high-income countries, the leading cause of YLD for all but two countries in Latin America and the Caribbean (Haiti and Venezuela were the exceptions), and the leading cause of YLD for three out of five countries in South Asia (second leading cause of YLD in India and Pakistan). [3] Low back and neck pain were the leading cause of disability in every geographical region within central Europe, eastern Europe, and central Asia and the leading cause of YLD in 9/46 Sub-Saharan African countries. [3] Low back and neck pain YLDs and DALYs were greater than expected in North America and Europe, and generally consistent with or less than expectation based on the SDI in most other locations (see Online Resource Table 2).
Occupational ergonomic factors (e.g., heavy manual lifting, excessive bending and twisting, whole body vibration) and high body mass index (BMI) are estimated to be responsible for 30.9% [95% confidence interval (CI) 29.2, 32.5] and 5.5% (95% CI 3.4–7.6) of YLD due to low back pain. [7] The GBD investigators estimate that the highest occupational risks of LBP are in service industries and manual work such as agriculture, and although the proportion of the workforce engaged in agriculture may decline in the coming years, they estimate that almost 65% of the burden would remain. [7]
In 1990, low back and neck pain were ranked as the 12th leading cause of DALYs globally; in 2005, the 8th leading cause, moving up to 4th in 2015, after ischemic heart disease, cerebrovascular disease, and lower respiratory infection. [7] From 1990 to 2005, DALYs from low back and neck pain increased by 34.5%, and from 2005 to 2015 by 18.6% (from 1990 to 2015 low back and neck pain DALYs increased by 59.5%). In 2015, low back and neck pain was the leading cause of disability in most countries (second leading cause of DALYs in high-income countries after ischemic heart disease). [7] A reason for this increase may be aging populations around the world.
Both low back and neck pain have a higher prevalence in older age groups; therefore, as life expectancy increases and the number of older individuals increases compared to the number of younger individuals, we may see an increase in conditions prevalent in older age groups (i.e., expansion of morbidity). [3] Other risk factors that may influence an increase in spinal pain include overweight and obesity. [7] As the GBD report shows, painful musculoskeletal disorders are the leading cause of disability globally and great threats to health in general; because of their effects on mobility, the threats will likely only worsen as the population ages. Although disability estimates and rankings have increased over time, the true magnitude of increased burden of disease attributable to low back and neck pain is unknown due to uncaptured sources of uncertainty and to differences in case definitions over time. [10]
Gaps in the GBD reports informing future research
Although there is a large body of research in the area of spinal disorders, including neck and back pain, notable gaps remain in our understanding of the epidemiology of these conditions in both developed and emerging countries. The global burden of disease reports give us a standardized, comprehensive indication of the burden, yet the data are based on estimates with many underlying disability weighting, modeling, and other assumptions. GBD investigators acknowledge the challenge of quantifying the burden of disease accurately given the variety of data sources, variable data quality, the range of biases, and data gaps in many jurisdictions. With respect to spinal disorders, definitions of neck and back pain vary among studies, which affects who is included and excluded in the study populations. This may result in high variability in prevalence between studies and thus affect the GBD prevalence estimates.
In addition, as noted in the GBD reports, the largest data gaps regarding spinal disorders and other non-communicable diseases exist because data on these conditions and their sequelae are not routinely collected and reported in systematic fashion in many jurisdictions (e.g., low back and neck pain, as well as other high ranking YLD disorders had data representativeness indices under 50%). GBD investigators recommend that countries centralize and invest in population-level epidemiological data systems for conditions responsible for high YLD (such as low back and neck pain). They also recommend that journal editors require authors of epidemiological studies to include data on functional health status as well as severity, distribution, and duration of symptoms. These research gaps are well within our abilities to address. Greater efforts should be applied to gather data on spine disorders in communities that are most in need. World Spine Care and the Global Spine Care Initiative are helping to address these data gaps using participatory action research methods, collecting and analyzing qualitative, epidemiologic and outcomes data from low- and middle-income communities and designing and testing models of care and data collection systems with the goal of reducing disability due to spinal disorders worldwide. [15, 16]
Differences between global and community estimates
There are large variances between estimates of global versus community prevalence of spinal disorders. As we have reported elsewhere [17], methodological variability across studies may be due to differences in case definitions, recall periods, modes of data collection, and validation of the instruments used or the representativeness of the samples. These issues affect the estimates and our ability to make valid comparisons between communities and populations. In general, studies that specify a minimum episode duration (e.g., 1 day, 3 months) have lower prevalence estimates than ones with non-specified episode duration [18], but even so the range of estimates is variable.
Heterogeneity in case definitions (e.g., "back pain", "low back pain", "dorsolumbar") result in different prevalence estimates. Prevalence estimates are higher in surveys of self-reported pain than in health-care utilization surveys. Large variation within and between studies of different modes of data collection precludes accurate estimates and meaningful inferences regarding the true frequency and impact of spinal pain within and between communities at single points and over time. [19–21] For example, when using a checklist to indicate musculoskeletal symptoms, there is an expectation that prevalence will be higher than when using more open ended or generally worded descriptions of the musculoskeletal disease and symptoms. [20]
The 2015 Global Burden of Disease Study has highlighted the enormous global burden of spinal disorders. Lower back and neck pain was the leading cause of disability in 2015. [7] Globally, the prevalence of low back and neck pain has increased by 18.7% over the last 10 years and YLD caused by low back and neck pain has increased by 18.6% over the last 10 years. [7] Given the growing global burden of spinal disorders and the adverse personal and societal effects on quality of life and work ability, we agree with the GBD authors that low back and neck pain should be a priority for future research on prevention and therapy, especially critical as the worldwide population increases in size and average age. Large heterogeneity in observed to expected burden associated with back and neck pain indicates differences in how health systems are meeting population health needs. As noted by GBD, research funders are increasingly using DALYs for prioritizing decisions.
Therefore, conditions highly prevalent and disabling, but historically underfunded (such as low back and neck pain and other musculoskeletal conditions) in populations with relatively low health-care market power (e.g., low- and middle-income communities) should receive more attention, research, and resources. This is a position fully endorsed and being put into place in several low- and middle-income communities by the World Spine Care and the Global Spine Care Initiative. With increasing disability from back and neck pain, these research and health-care efforts on prevention and therapy must be implemented more widely if we hope to compress morbidity in both absolute (fewer years lost due to functional health loss) and relative (lower ratio of years of functional health lost to life expectancy) terms.
The Global Spine Care Initiative and this study were funded by grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.
EH declares he is a consultant for: RAND Corporation; EBSCO Information Services; Southern California University of Health Sciences; Western University of Health Sciences. Data and Safety Monitoring Committee Chair, Palmer Center for Chiropractic Research. Research Committee Co-chair, World Spine Care. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. HY declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. PC is funded by a Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology, and declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance. Financial Services Commission of Ontario. Ontario Trillium Foundation, ELIB Mitac. Fond de Recherche and Sante du Quebec. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Clinical Policy Advisory Board and stockholder, Palladian Health. Advisory Board, SpineHealth.com. Book Royalties, McGraw Hill. Travel expense reimbursement—CMCC Board.
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Since 11-21-2018

redpajama_set_name: RedPajamaCommonCrawl


text:
Santa Cruz County Beaches
Matt Crawford
Santa Cruz's beaches are world-famous, but not all of the best beaches here are well-known outside of the local community. Surfing spots like Pleasure Point and Steamer Lane usually get the most attention, but Santa Cruz's most gorgeous—and sometimes tucked away—shores offer stunning sunsets, fascinating marine life, and endless family fun.
Bonny Doon Beach
This small and secluded clothing-optional beach is off the radar for most Santa Cruz visitors. Located along the base of a cliff about eight miles up Highway 1, it's well protected from gusts of wind, and for that reason it is perfect for a naked lunch—or even just a regular lunch. The only downside is the slightly difficult walk down the cliff. But once there you can actually hear the waves crashing on the shore and the birds calling to each other. Highway 1 at Bonny Doon Road. Drive north from Santa Cruz on Highway 1 about eight miles to the intersection of Bonny Doon; park in dirt lot on the left.
Cowell Beach/Main Beach
Beach St., Santa Cruz
Tourists and families tend to flock to this city-run beach in summer, and for good reason. Restaurants line the nearby Santa Cruz Municipal Wharf, and the games and rides at the adjacent Boardwalk go nicely with an afternoon dip in the Bay. This is also prime territory for learning to surf, playing volleyball or just relaxing in the rays.
Lighthouse Point/Its Beach
Lighthouse Point, Santa Cruz
The Santa Cruz Surfing Museum, perched on the cliff above Its Beach, tells all about how Hawaiians introduced the sport of surfing to Santa Cruz in the late 19th century, while just below at Steamer Lane, actual surfers demonstrate how far the sport has come in haoles' hands. On the other side of the museum is dog-friendly, and sometimes clothing-optional, Its Beach, which offers great sunset views in wintertime and a nice pooch play area at low tide. West Cliff Drive at Lighthouse Point, Santa Cruz.
Natural Bridges State Beach
West Cliff Drive, Santa Cruz
Named after an arched rock formation jutting offshore, this beach features stunning views of the coastline and its animal inhabitants. There's plenty of space to spread out, and marine critters crawl and cling in the tidepools on the West side of the beach. Take a break from the heat and picnic in the eucalyptus grove that looks over the sand. During the fall and winter, you can easily spot thousands of migratory Monarch butterflies, who call this beach their home for a few months every year. West Cliff Drive at Swift Street, Santa Cruz.
New Brighton State Beach
One of the most popular beaches in town, New Brighton anchors the northernmost end of a long stretch of beach that extends some 15 miles down the coast, forming a thin crescent limning the Monterey Bay. Visitors love the combination of seashore and forested bluffs, where Monterey Pines, cypress and eucalyptus shade picnic areas and campgrounds that are open year-round. From Santa Cruz, take Highway 1 south toward Capitola; exit at the New Brighton/Park Avenue ramp, turn right and then follow the signs.
Panther Beach
This long stretch of beach is perfect for romantic walks, sea life viewing and all types of beach sports. Located about 10 miles up Highway 1, it's accessible via a short hike across the railroad tracks and down a narrow trail. Once there, beachgoers are treated to stunning sandstone formations and a bit of privacy. Highway between mileposts 95 and 96.
Seacliff State Beach
This long strip of beach, which abuts New Brighton State Beach, has a few key attractions that make it irresistible to visitors. One is the beach itself, long and uninterrupted except for one intriguing feature: a pier and half-sunken cement ship, the USS Palo Alto. From Santa Cruz, take Highway 1 south toward Aptos and take the State Park exit. Follow the signs to Seacliff State Beach.
Sunset State Beach
South of Santa Cruz
The last Santa Cruz County beach in a long string of them lacing Monterey Bay, Sunset State Beach is a gorgeous, remote stretch of sand lying at the foot of bluffs and 200-foot-tall sand dunes that see toy airplane enthusiasts congregate every weekend. A wooded campground with hot water showers (that takes quarters) and picnic areas, Sunset is a popular gathering place for families and groups seeking a getaway that truly feels far from the madding crowd. From Santa Cruz, follow Highway 1 south toward Watsonville and take the San Andreas exit. Follow San Andreas Road several miles past Manresa State Beach and as it curves to parallel the sea and watch for signs.
Twin Lakes State Beach
East Cliff Drive at 7th Ave, Santa Cruz, CA
Twin Lakes Beach runs east along East Cliff Drive from the harbor jetty to the bluffs. Along with lots of sand and good waves for bodysurfing, this beloved local beach has fire rings and bathrooms. As a bonus, Schwann Lake, across the road from the beach, has a trail skirting a picturesque inland lagoon where birds congregate.
Seabright Beach
East Cliff Drive at Seabright, Santa Cruz
The most easily accessed stretch of sandy fun in town starts on the banks of the San Lorenzo River across from the Boardwalk and runs eastward to the harbor as Seabright Beach (the locals call it Castle Beach, after a kitschy turreted restaurant that used to jut out from the bluffs). A popular place for suntanning and picnics, Seabright is expansive and family-friendly, and is walking distance to the charming Seabright district and its restaurants and bars.
Rio Del Mar State Beach
Located by the sleepy fishing village-turned-vacation-neighborhood of the same name, Rio Del Mar is the southernmost end of a stretch of beach that includes Seacliff and New Brighton. From Santa Cruz follow Hwy 1 south to Aptos. Take Rio Del Mar exit toward the right and follow signs to Rio Del Mar.
Manresa and Manresa Uplands State Beach
South of Aptos
Just north of Sunset Beach is Manresa Beach, a true gem. Surfers often come here to escape the crowded sets a few miles north, and, unlike most state beaches, at Manresa your four-legged friends can join you (on leashes). From Santa Cruz, follow Highway 1 south to the San Andreas Road exit past Aptos. Turn right and go three miles for beach, four for the campground.
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Well this is sucksville – I was all excited about Amazon's new Shorts program of selling brief works for 49 cents. They'd opened the program up – but only if you are the sole author of a book already in their store. Not yet… but soon! I was hoping put some of my plays out there!
This entry was posted in General on August 29, 2005 by Sharon Sarmiento.
"It is a requirement that authors eligible for Amazon Shorts need to be the sole writer of at least one book sold on our site. Please look at the Amazon website in our "Books" section for more information on how to get your book sold on Amazon.com".


high efficiency energy saving spiral classifier for sale crusher/mining spring cone Jiaozuo City Xinhai Mine Machinery Equipment Plant . standard model images of workers operating a produce grinding mill in aw HP Series Hydraulic No.
for alumina production mainly through Bayer process, which requires the A/S ratio of bauxite ore in the world was built in Jiaozuo, Henan province, confirming the spiral classifier were used, while the Φ 2700×3600 overflow ball mill and Φ not recycled to maintain the high pulp concentration and the flotation efficiency.
Ministry of Communications, effective date: June 1, 2007); . Environmental Function Categories of Surface Water in Hubei Province (Department Standards for Classification and Gradation of Soil Erosion (SL190-2009); . of wastewater and sewage produced during project construction and Jiaozuo-Zhicheng.
Cement Manufacturing Process Flow ChartStone Crusher Machine. Builtin precision High Efficiency Stone Sand Screw Spiral Classifier series FL. Chat Online Jiaozuo City Xinhai Mine Machinery Equipment Plant. Add to Favorites.
Oct 6, 2018 Furthermore, they also provide the opportunity for efficient heat sources for chemical systems for the production of hydrogen for fuel cell applications. In the present study, a two-dimensional numerical model that A.C. Classification of behaviour in a steady plug-flow model of catalytic combustion.
Jun 29, 2014 3 Department of Biology, Jiaozuo Teachers College, Jiaozuo 454001, China leaves commonly exhibit a spiral phyllotaxy. made a significant contribution to the plant classification, plied with a wavelet function; the analyzing ability for the . evacuable pellet die to produce a 13mm diameter pellet.


text:
Q: Ho to declare in header is overload operator in struct? I have a structure in which the operator template type. Want to make the correct announcement of this structure in header. Write the following code
header file
struct add_positive {
    template<typename T>
    T operator()(T value, const T& now);
};

.cpp file
template<typename T>
add_positive add_positive::operator()(T value, const T& now) {
    if (now >= 0) {
        return value + now;
    }

    return value;
}

But when compiling get the following error:
error: prototype for 'add_positive add_positive::operator()(T, const T&)' does not match any in class 'add_positive'
 add_positive add_positive::operator()(T value, const T& now) {
error: candidate is: template<class T> T add_positive::operator()(T, const T&)
  T operator()(T value, const T& now);
Can't understand what I did wrong?

A: You can simply use an inline definition:
struct add_positive {
    template<typename T>
    T operator()(T value, const T& now) {
        if (now >= 0) {
           return value + now;
        }
        return value;
     }
};

Note that you usually have to provide a definition for your templated function in the header file.
In the header the following should equally work:
struct add_positive {
    template<typename T>
    T operator()(T value, const T& now);
};

template<typename T>
T add_positive::operator()(T value, const T& now) {
    if (now >= 0) {
       return value + now;
    }
    return value;
 }

redpajama_set_name: RedPajamaStackExchange


See the gallery for tag and special word "Treasure". You can to use those 8 images of quotes as a desktop wallpapers.
We all have common frailties but we need to treasure friends more.
May love's kindred treasure box fling your luminescent glove.
When I was 14 or 15, our teacher introduced us to Dickens' 'A Tale of Two Cities.' It was just for entertainment - we read it aloud - and all of a sudden it became a treasure.
Much more quotes of "Treasure" below the page.
Through the years I've found that I prefer live playing to recording. I still do lots of recording - but I treasure the live shows.
I think people are by-and-large happy with the providers that they have got now. They treasure that doctor-patient relationship.
If we treasure our own experience and regard it as real, we must also treasure other people's experience.


Restingwell has now been selling floating tanks for almost than thirteen years and have had as it's primary task to design a new user-friendly floatingtank that we started to sell in 2005.
Restingwell Spirit was made mostly for the Scandinavian market but also promoted over all the world.
Austria, Belgium, China, Croatia, Czeck Republic, Denmark, England U.K., Estonia, Norway, Finland, Germany, Japan, Lithuania, Netherlands, Poland, Russia, Serbia, Sweden, Switzerland and Ukraine.
The floatation tank must be robust and well built.
To use standard articles that is tough.
The floating tank must be easy to operate for everybody.
Easy to install. Now 1.5-2.0 hours set up time. That's fast!
Electric connections using max 10 Amp /230V. One phase.
Easy to make service by the owner without service personal must be called upon.
Spare parts is in stock for fast delivery if anything stops working.
To produce many tanks and therefore get lower production price.
Pricelevel must be among the best upon the European market.
To maintain updated information and to inform about floatation to people.


Aggravastu (Interior Decorators & Designers) is located at 86, SHAKTI NAGAR, GOPALPURA BYE PASS. Aggravastu phone number is 0141 - 2503853.
Currently there are no reviews submitted for Aggravastu (Interior Decorators & Designers).
Click here to submit your review on Aggravastu.


text:
Home » Media » Animal Behavior College Honors the 2014 Dog Trainer In-Classroom Program Graduates
Animal Behavior College Honors the 2014 Dog Trainer In-Classroom Program Graduates
ABC President Steven Appelbaum Challenges graduates to use their training to make a difference
Animal Behavior College celebrated its third graduation class during a commencement ceremony on June 13 honoring the many achievements of its Dog Trainer In-Classroom Program students. The late morning event took place on the grounds of the school's headquarters located at 25104 Rye Canyon Loop in Mann Biomedical Park, Santa Clarita, Calif.
Dressed in royal blue academic regalia, the enthusiastic graduates, some accompanied by their canine friends, sat composed during the ceremony. Many of the graduates are former military personnel who decided to use the discipline, drive and determination skills they acquired while in the armed services to train dogs professionally, ensuring dogs and their owners enjoy a harmonious and mutually respectful relationship.
"You are professional dog trainers who will continue to make a difference in many lives," said Steven Appelbaum, president and CEO of Animal Behavior College, to an audience of family, friends and employees of the college. "The road ahead is paved with many challenges. Challenges you are equipped and ready to handle. However, readiness is dependent on your willingness to keep an open mind by expanding beyond your comfort level and maintaining a passion for learning and aspiring to continue to grow professionally."
Debbie Kendrick, vice president of operations for ABC, also praised the graduates' accomplishments and joined Appelbaum in presenting award certificates giving special mention to students who graduated from the program with honors. Those students include, Brian Hastings, Irma "Toni" Medina Leitneberg, Breanna Rappleya and Angel Samano Jr.
"Five years ago we came to this school with different expectations," Angel said during his address. "We have spent the last five months since then learning what it takes to train dogs and their owners and have been given a myriad of tools to use as professionals."
Beth Harrison, the program's course instructor, congratulated Angel and his fellow graduates. She provided remarks encouraging them to use their newly acquired knowledge and skills to strive for excellence with the goal of "being the best dog trainer they could be." Amanda Yocom of Best Friends' Animal Society and Chris Gant, a former graduate of the college and professional dog trainer, thanked graduates for volunteering in the shelter and inspired them to stay compassionate about helping dogs and working with their owners to ensure a positive owner-to-dog relationship.
The students received certification for mastering various dog training tools and techniques using positive reinforcement for handling canine behaviors. The program covers everything from training basics and safety to effective problem solving and pet first aid. The hands-on portion of the program provides students with an opportunity to participate in an internship at shelters like Best Friends' Animal Society with a mentor, giving them invaluable practical experience in real life situations.
Angel Samano, with his dog, Bosco, shares how the Dog Obedience Program changed his life
"I have more knowledge and tools at my disposal to continue to serve people in a new way," Angel said. With his dog, Bosco, at his side, the former Marine lance corporal credits the program with helping him embark on a new and exciting career. "If you had asked me a year ago what I would do (after the military), being a dog trainer wouldn't have been on the list. ABC has not only helped to change my life, but has helped to change Bosco's life."
Pets today are living longer, eating healthier and receiving more services. In fact, the jobs forecast for dog trainers and other animal care and service workers in the U.S. appear promising. The U.S. Bureau of Labor Statistics predicts employment will grow 23 percent from 2010 to 2020, faster than the average for all occupations. With more people in the U.S. owning dogs (35.5 percent or 43,346,000), ABC certified dog trainers have the option of working for an established company or building their own successful dog training business.
To learn more about the program visit Dog Obedience Instructor Training Program or call 800-795-3294.
The Class of 2014!
Will G says
Wow! Congratulations to all the graduates! Animal Behavior College is a great school; you all have amazing opportunities ahead!


Viewing Saturday 4th May 11- 4 pm. Monday 6th May 12 noon to 6 pm.
Art works William Charles Piguenit( major large oil), William Buelow Gould( large oil still life), Sidney Nolan( Ned Kelly oil ), Aron Gerle, Edith Holmes( Sydney Harbour oil), Norman Lindsay, John De Burgh Perceval,( important large pottery bowl) Philip Davey, Mirka Mora, Benjamin Landara, Bill Leak( Don Bradman mixed media) William Ricketts, Harold Hughan, Colin Johnson, Kath Ballard, Piers Bateman, Pasquale Giardino( early important oil), Kenneth Jack, Ken Done etc.
Ceramics and pottery- from all over the world covering over two centuries includes antique, vintage and retro by quality makers retro Bernard Leach, Royal Worcester, Royal Vienna,Sitzendorf, Rosenthal, Royal Doulton, Chinese and Japanese ceramics, large selection of Carlton ware, Australian pottery by Hughan, Ricketts, Perceval, Royal Winton, etc.
Silver- Sterling silver includes English items includes Georgian, Victorian, Continental silver, etc.
Glass and crystal- Good selection of quality French glass includes fantastic selection early Lalique Murano, etc.
Decorative wares – Japanese Cloisonné, and Satsuma, bronze sculptures, vases, clocks, lamps, snuff bottles, perfume bottles, designer items etc.
Jewellery - High quality selection includes precious stone such as diamonds, Tanzanite, Kunzite, sapphires, black diamonds, silver and other vintage jewellery, wrist watches by Rolex, IWC,Tag Heuer, Chopard, rings, necklaces, bracelets, earrings, brooches, fob watches, etc.
Furniture- Victorian, Edwardian, Arts and Crafts, and Retro include: side tables, tables, sofas, and armchairs; include quality period, vintage and revival etc.
Other: Signed rare books (huge collection), ephemera, programmes, Powerball, Oz Lotto and Keno machines, ( as used on Television), Leadlight windows and carved timber panels from Marble Bar (Tattersall's Hotel) Sydney 1893,medallions and coins, football cards, signed early 1900 to circa 2000 photographs and posters, fountain pens, mantle clocks, candleholders, etc.
www.aaauctions.com.au a stunning offering at low estimates; this has never been a better time to buy.


text:
using System;
using System.Collections.Generic;
using System.Data;
using System.Data.SqlClient;
using System.Linq;
using System.Text;
using System.Threading.Tasks;
using Taskling.Blocks.Common;
using Taskling.Blocks.ListBlocks;
using Taskling.Exceptions;
using Taskling.InfrastructureContracts;
using Taskling.InfrastructureContracts.Blocks;
using Taskling.InfrastructureContracts.Blocks.CommonRequests;
using Taskling.InfrastructureContracts.Blocks.ListBlocks;
using Taskling.InfrastructureContracts.TaskExecution;
using Taskling.SqlServer.AncilliaryServices;
using Taskling.SqlServer.Blocks.QueryBuilders;
using Taskling.SqlServer.Blocks.Serialization;

namespace Taskling.SqlServer.Blocks
{
    public class ListBlockRepository : DbOperationsService, IListBlockRepository
    {
        private readonly ITaskRepository _taskRepository;

        public ListBlockRepository(ITaskRepository taskRepository)
        {
            _taskRepository = taskRepository;
        }

        public async Task ChangeStatusAsync(BlockExecutionChangeStatusRequest changeStatusRequest)
        {
            try
            {
                using (var connection = await CreateNewConnectionAsync(changeStatusRequest.TaskId).ConfigureAwait(false))
                {
                    var command = connection.CreateCommand();
                    command.CommandTimeout = ConnectionStore.Instance.GetConnection(changeStatusRequest.TaskId).QueryTimeoutSeconds;
                    command.CommandText = GetListUpdateQuery(changeStatusRequest.BlockExecutionStatus);
                    command.Parameters.Add("@BlockExecutionId", SqlDbType.BigInt).Value = long.Parse(changeStatusRequest.BlockExecutionId);
                    command.Parameters.Add("@BlockExecutionStatus", SqlDbType.TinyInt).Value = (byte)changeStatusRequest.BlockExecutionStatus;
                    await command.ExecuteNonQueryAsync().ConfigureAwait(false);
                }
            }
            catch (SqlException sqlEx)
            {
                if (TransientErrorDetector.IsTransient(sqlEx))
                    throw new TransientException("A transient exception has occurred", sqlEx);

                throw;
            }

        }

        public async Task<IList<ProtoListBlockItem>> GetListBlockItemsAsync(TaskId taskId, string listBlockId)
        {
            var results = new List<ProtoListBlockItem>();

            try
            {
                using (var connection = await CreateNewConnectionAsync(taskId).ConfigureAwait(false))
                {
                    var command = connection.CreateCommand();
                    command.CommandText = ListBlockQueryBuilder.GetListBlockItems;
                    command.CommandTimeout = ConnectionStore.Instance.GetConnection(taskId).QueryTimeoutSeconds;
                    command.Parameters.Add("@BlockId", SqlDbType.BigInt).Value = long.Parse(listBlockId);

                    using (var reader = await command.ExecuteReaderAsync().ConfigureAwait(false))
                    {
                        while (await reader.ReadAsync().ConfigureAwait(false))
                        {
                            var listBlock = new ProtoListBlockItem();
                            listBlock.ListBlockItemId = reader["ListBlockItemId"].ToString();
                            listBlock.Value = SerializedValueReader.ReadValueAsString(reader, "Value", "CompressedValue");
                            listBlock.Status = (ItemStatus)int.Parse(reader["Status"].ToString());

                            if (reader["LastUpdated"] == DBNull.Value)
                                listBlock.LastUpdated = DateTime.MinValue;
                            else
                                listBlock.LastUpdated = reader.GetDateTime(5);

                            if (reader["StatusReason"] == DBNull.Value)
                                listBlock.StatusReason = null;
                            else
                                listBlock.StatusReason = reader.GetString(6);

                            if (reader["Step"] == DBNull.Value)
                                listBlock.Step = null;
                            else
                                listBlock.Step = reader.GetByte(7);

                            results.Add(listBlock);
                        }
                    }
                }
            }
            catch (SqlException sqlEx)
            {
                if (TransientErrorDetector.IsTransient(sqlEx))
                    throw new TransientException("A transient exception has occurred", sqlEx);

                throw;
            }

            return results;
        }

        public async Task UpdateListBlockItemAsync(SingleUpdateRequest singeUpdateRequest)
        {
            try
            {
                using (var connection = await CreateNewConnectionAsync(singeUpdateRequest.TaskId).ConfigureAwait(false))
                {
                    var command = connection.CreateCommand();
                    command.CommandTimeout = ConnectionStore.Instance.GetConnection(singeUpdateRequest.TaskId).QueryTimeoutSeconds;
                    command.CommandText = ListBlockQueryBuilder.UpdateSingleBlockListItemStatus;
                    command.Parameters.Add("@BlockId", SqlDbType.BigInt).Value = long.Parse(singeUpdateRequest.ListBlockId);
                    command.Parameters.Add("@ListBlockItemId", SqlDbType.BigInt).Value = long.Parse(singeUpdateRequest.ListBlockItem.ListBlockItemId);
                    command.Parameters.Add("@Status", SqlDbType.TinyInt).Value = (byte)singeUpdateRequest.ListBlockItem.Status;

                    if (singeUpdateRequest.ListBlockItem.StatusReason == null)
                        command.Parameters.Add("@StatusReason", SqlDbType.NVarChar, -1).Value = DBNull.Value;
                    else
                        command.Parameters.Add("@StatusReason", SqlDbType.NVarChar, -1).Value = singeUpdateRequest.ListBlockItem.StatusReason;

                    if (!singeUpdateRequest.ListBlockItem.Step.HasValue)
                        command.Parameters.Add("@Step", SqlDbType.TinyInt).Value = DBNull.Value;
                    else
                        command.Parameters.Add("@Step", SqlDbType.TinyInt).Value = singeUpdateRequest.ListBlockItem.Step;

                    await command.ExecuteNonQueryAsync().ConfigureAwait(false);
                }
            }
            catch (SqlException sqlEx)
            {
                if (TransientErrorDetector.IsTransient(sqlEx))
                    throw new TransientException("A transient exception has occurred", sqlEx);

                throw;
            }
        }

        public async Task BatchUpdateListBlockItemsAsync(BatchUpdateRequest batchUpdateRequest)
        {
            using (var connection = await CreateNewConnectionAsync(batchUpdateRequest.TaskId).ConfigureAwait(false))
            {
                var command = connection.CreateCommand();
                var transaction = connection.BeginTransaction();
                command.Connection = connection;
                command.Transaction = transaction;
                command.CommandTimeout = ConnectionStore.Instance.GetConnection(batchUpdateRequest.TaskId).QueryTimeoutSeconds; ;

                try
                {
                    var tableName = await CreateTemporaryTableAsync(command).ConfigureAwait(false);
                    var dt = GenerateDataTable(batchUpdateRequest.ListBlockId, batchUpdateRequest.ListBlockItems);
                    await BulkLoadInTransactionOperationAsync(dt, tableName, connection, transaction).ConfigureAwait(false);
                    await PerformBulkUpdateAsync(command, tableName).ConfigureAwait(false);

                    transaction.Commit();
                }
                catch (SqlException sqlEx)
                {
                    TryRollBack(transaction, sqlEx);
                }
                catch (Exception ex)
                {
                    TryRollback(transaction, ex);
                }
            }
        }

        public async Task<ProtoListBlock> GetLastListBlockAsync(LastBlockRequest lastRangeBlockRequest)
        {
            var taskDefinition = await _taskRepository.EnsureTaskDefinitionAsync(lastRangeBlockRequest.TaskId).ConfigureAwait(false);

            try
            {
                using (var connection = await CreateNewConnectionAsync(lastRangeBlockRequest.TaskId).ConfigureAwait(false))
                {
                    var command = connection.CreateCommand();
                    command.CommandText = ListBlockQueryBuilder.GetLastListBlock;
                    command.CommandTimeout = ConnectionStore.Instance.GetConnection(lastRangeBlockRequest.TaskId).QueryTimeoutSeconds;
                    command.Parameters.Add("@TaskDefinitionId", SqlDbType.Int).Value = taskDefinition.TaskDefinitionId;
                    using (var reader = await command.ExecuteReaderAsync().ConfigureAwait(false))
                    {
                        while (await reader.ReadAsync().ConfigureAwait(false))
                        {
                            var listBlock = new ProtoListBlock();
                            listBlock.ListBlockId = reader["BlockId"].ToString();
                            listBlock.Items = await GetListBlockItemsAsync(lastRangeBlockRequest.TaskId, listBlock.ListBlockId).ConfigureAwait(false);
                            listBlock.Header = SerializedValueReader.ReadValueAsString(reader, "ObjectData", "CompressedObjectData");

                            return listBlock;
                        }
                    }
                }
            }
            catch (SqlException sqlEx)
            {
                if (TransientErrorDetector.IsTransient(sqlEx))
                    throw new TransientException("A transient exception has occurred", sqlEx);

                throw;
            }

            return null;
        }

        private string GetListUpdateQuery(BlockExecutionStatus executionStatus)
        {
            if (executionStatus == BlockExecutionStatus.Completed || executionStatus == BlockExecutionStatus.Failed)
                return BlockExecutionQueryBuilder.SetListBlockExecutionAsCompleted;

            return BlockExecutionQueryBuilder.SetBlockExecutionStatusToStarted;
        }

        private async Task<string> CreateTemporaryTableAsync(SqlCommand command)
        {
            var tableName = "#TempTable" + Guid.NewGuid().ToString().Replace('-', '0');
            command.Parameters.Clear();
            command.CommandText = ListBlockQueryBuilder.GetCreateTemporaryTableQuery(tableName);
            await command.ExecuteNonQueryAsync().ConfigureAwait(false);

            return tableName;
        }

        private DataTable GenerateDataTable(string listBlockId, IList<ProtoListBlockItem> items)
        {
            var dt = new DataTable();
            dt.Columns.Add("BlockId", typeof(long));
            dt.Columns.Add("ListBlockItemId", typeof(long));
            dt.Columns.Add("Status", typeof(byte));
            dt.Columns.Add("StatusReason", typeof(string));
            dt.Columns.Add("Step", typeof(byte));

            foreach (var item in items)
            {
                var dr = dt.NewRow();
                dr["BlockId"] = long.Parse(listBlockId);
                dr["ListBlockItemId"] = long.Parse(item.ListBlockItemId);
                dr["Status"] = (byte)item.Status;

                if (item.StatusReason == null)
                    dr["StatusReason"] = DBNull.Value;
                else
                    dr["StatusReason"] = item.StatusReason;

                if (item.Step.HasValue)
                    dr["Step"] = item.Step;
                else
                    dr["Step"] = DBNull.Value;

                dt.Rows.Add(dr);
            }

            return dt;
        }

        private async Task PerformBulkUpdateAsync(SqlCommand command, string tableName)
        {
            command.Parameters.Clear();
            command.CommandText = ListBlockQueryBuilder.GetBulkUpdateBlockListItemStatus(tableName);
            await command.ExecuteNonQueryAsync().ConfigureAwait(false);
        }
    }
}

redpajama_set_name: RedPajamaGithub


Dunhill Icon Cologne by Alfred Dunhill, Dunhill Icon by Alfred Dunhill is the perfect woody-aromatic cologne for the refined gentleman .
A well-rounded citrus bouquet of fresh bergamot and neroli absolute set the stage for this classic aroma fougere.
Spicy and aromatic black pepper crackle at the heart while lavender and cardamom smooth the experience into a rich memory. Smoky oud and leather base notes entice an aroma reminiscent of timeless luxury and grounded in the present through hints of fresh vetiver and oak moss.


text:
Lopinavir (LPV/r) ist ein Arzneistoff, der als Proteaseinhibitor zur Behandlung einer HIV-Infektion zum Einsatz kommt. Dieser HIV-Proteaseinhibitor wird in Kombination mit Ritonavir vom Hersteller Abbott-AbbVie unter dem Handelsnamen Kaletra vertrieben. Die Zulassung durch die EU-Kommission erfolgte im März 2001. Für den Markt in Drittweltstaaten wurde nach anfänglicher Weigerung der Hersteller die gleiche Wirkstoffkombination mit dem Namen Aluvia registriert. (Siehe Abbott – Kritik am Unternehmen)

Indikation
Die Wirkstoffkombination von Kaletra ist sowohl bei Erwachsenen als auch bei Kindern über zwei Jahren zugelassen. Klinische Prüfungen ergaben eine höhere Wirksamkeit gegenüber den Vergleichssubstanzen Nelfinavir bzw. Indinavir.

Pharmakologie
Der HIV-Protease-Inhibitor Lopinavir hemmt die Weiterverarbeitung der durch das HI-Virus neu gebildeten viralen Vorläuferproteine zu funktionstüchtigen Strukturproteinen und Enzymen und somit die Vermehrung des Virus.

Kombination mit Ritonavir
Lopinavir wird im menschlichen Organismus durch das Cytochrom-P450-System sehr rasch metabolisiert. Die alleinige Gabe dieser Substanz hätte aufgrund der zu geringen erreichbaren Konzentration im Blutplasma keinen therapeutischen Effekt. Daher wird der Wirkstoff nur in fixer Kombination mit Ritonavir, einem Arzneistoff derselben Gruppe, verabreicht. Die Aufgabe dieses zweiten Protease-Inhibitors ist es, den Abbaumechanismus für Lopinavir, also die Cytochrom P450 Monooxygenasen zu blockieren. Damit steht im Organismus ausreichende Konzentration von Lopinavir zur Verfügung, um eine effektive Hemmung der HIV-Proteasen zu bewirken. Der Nutzen dieser Strategie besteht in einer deutlichen Reduzierung der Dosis und somit der Tablettenanzahl für den Patienten.

Unerwünschte Wirkungen
Entsprechend den Erfahrungen mit den anderen Vertretern der Protease-Inhibitoren treten auch bei der Therapie mit Lopinavir häufig gastrointestinale Störungen auf, wie Durchfall, Bauchschmerzen, abnormer Stuhl. Selten beobachtet man ZNS- oder Hautreaktionen sowie Pankreatitis und Rhabdomyolyse. Unter Umständen kann es zu erhöhten Laborwerten (Cholesterin und Triglyzeride) kommen.

Patienten mit einer strukturellen Herzerkrankung, Herz-Rhythmus-Störungen, einem minder durchblutetem Herz (Ischämie) oder Kardiomyopathies sollten Kaletra mit Vorsicht verwenden.

Wechselwirkungen
Bedingt durch den Wirkungsmechanismus und die dahinterliegende Strategie der Wirkstoffkombination von Kaletra kommt es zu vielen Beeinträchtigungen des Organismus und Interaktionen mit anderen Arzneistoffen. Die Hemmung der Enzyme des Cytochrom-P450-Systems in der Leber führt nicht nur zu einer Erhöhung der Konzentration der Protease-Inhibitoren im Organismus, sondern zwangsläufig auch zu einer größeren Bioverfügbarkeit und damit stärkerer Wirkung anderer Arzneistoffe, die über den gleichen Mechanismus eliminiert werden (z. B. Benzodiazepine, Antiarrhythmika, Mutterkornalkaloide). Außerdem kann dieses Enzymsystem durch verschiedenste Einflüsse in seiner Wirkung gehemmt oder gefördert werden, ist auch nicht bei jedem Menschen in gleichem Maße aktiv sowie höchstwahrscheinlich geschlechts- und ethnospezifisch. Diese Tatsache macht nicht nur die Kombination Kaletra, sondern die gesamte Gruppe der Protease-Inhibitoren zu Medikamenten, die einer besonders sorgfältigen Therapieüberwachung durch erfahrene Mediziner unterliegen. Eine Nutzen-Risiko-Abwägung ist in Hinsicht auf Mehrfachmedikation höchst angebracht.

Diverses
Am 25. Juni 2005 drohte Brasilien damit, das Patent für das Anti-Aids-Medikament Kaletra zu ignorieren und Generika zuzulassen, wenn der Hersteller nicht binnen 10 Tagen die Preise senken würde. Bekannt ist, dass 600.000 Brasilianer mit HIV infiziert sind.

Thailand beschloss im März 2007, das Patent für Kaletra auszusetzen, nachdem Verhandlungen mit dem Hersteller Abbott Laboratories gescheitert waren. Abbott hatte angeboten, den Preis von 1.850 Euro auf 1.700 Euro (Jahresdosis) zu senken. Ein Generikum kann bereits für ca. 760 Euro angeboten werden. Die Aussetzung des Patentes wird von Seiten der Regierung mit einer Notfall-Regelung aus einem Abkommen der Welthandelsorganisation begründet. In Thailand sind 500.000 Menschen an AIDS erkrankt. 20.000 erhalten Kaletra.

Eine Kombination von Lopinavir und Ritonavir wird in klinischen Studien gegen COVID-19 erprobt. Sie sind Teil der im März 2020 begonnenen "Solidarity"-Studie der Weltgesundheitsorganisation, in deren Rahmen sie teils in Beta-Interferon getestet werden. Sie sind ebenfalls Teil der Ende März 2020 begonnen "Discovery"-Großstudie, in deren Rahmen auch Remdesivir und Hydroxychloroquin mit der bisherigen Behandlung an mehr als 3000 Covid-19-Patienten in acht europäischen Ländern verglichen werden sollen. Kaletra gehört zu einer Reihe von Medikamenten, von denen das deutsche Bundesgesundheitsministerium ab April 2020 Millionen von Packungen beschafft, um hilfsweise bei schweren Verläufen gegen Covid-19 eingesetzt zu werden.

Laut vorläufigen Zwischenergebnissen der Solidarity-Studie, die im Oktober 2020 vorgelegt wurden, konnte mit bis dahin 2062 Patienten (zzgl. Kontrollgruppe) kein nennenswerter Nutzen von Lopinavir sowie der Kombination von Lopinavir und Interferon festgestellt werden. Sie wurden im Juni 2020 aus der andauernden Studie genommen, in deren Rahmen verschiedene Medikationen auf ihre Wirksamkeit untersucht werden.

Weblinks
 Darstellungen von Lopinavir und seiner Wirkungsweise

Einzelnachweise

Arzneistoff
Virostatikum
AIDS
Phenolether
Xylol
Ethansäureamid
Alkansäureamid
Beta-Aminoalkohol
Hexahydropyrimidin
Harnstoff
Phenylethylamin

redpajama_set_name: RedPajamaWikipedia


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Maestro D'Arte 2016
Doppia Firma
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MAM – Maestro d'Arte e Mestiere, promoted by the Cologni Foundation for the Métiers d'Art in partnership with ALMA, the International School of Italian Cuisine, awards outstanding skills in the fields of artistic craftsmanship: from pottery to jewellery, from wood to furniture, from metalworking to mechanics and mosaics, from leather goods to restoration and fashion… up to food and beverage.
During the awards ceremony held at the Triennale Museum in Milan on 6 June 2016, Giordano Viganò was awarded along with other 75 artisans (62 representatives of Italian craftsmanship and 13 representatives from the fine food and wine sectors). The award pays tribute to the inimitable talent and savoir faire of these great artisans.
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Please contact the Center prior to surgery for pre-admission instructions and financial arrangements. You, your surgeon and/or your insurance company may request, in advance, an estimate or pre-authorization for your surgery. Our staff will help you finalize your financial arrangements before your surgery.
The fee for the use of the Center includes routine equipment and supplies, pre-operative services, routine drugs administered while in the Center, procedure room time and recovery room services. The fee DOES NOT include the cost for the professional services of your surgeon, radiologist, a pathologist, physician consultants, extraordinary supplies or anesthesiologist.
Most outpatient surgical procedures are covered by standard medical insurance. Patients will be asked for a partial payment upon admission to the Center, subject to the amount of insurance coverage. Full payment is required at the time of admittance for non-covered procedures and for patients who do not have medical insurance. However, the Center recognizes its obligation to remain flexible in financial matters. We require all payment arrangements be made prior to surgery.


My midwife, Shari Romero, has been the perfect person to walk with me on this journey. Not only did we attend dozens of births together during my pregnancy, but she also always guided me back to visualizations of my own birth story.
I've been day dreaming about the flow of your birthing…all smooth and bluish and floating with golden light and easy breath.
Each day, I've been working on clearing my mind and envisioning exactly how I want this little being to emerge into our world. I am prone to anxiety, and there have definitely been days where I feel overwhelmed with all the "what-ifs," but I find that if I meet each scary possibility with a positive affirmation or a peaceful visualization…everything settles.
We're having our baby at the Denver Center for Birth - a place that has become like a second home for me. A safe and comforting space where I can go and birth our baby. We don't know if the girls will join us at the center. We don't know how early or late I want to arrive. We're trusting that it will all become clear in the moment.
Baby is low, low, low…and I'm having way more contractions than I did with the girls. I feel like this baby is going to meet us quickly, and yet also believe that we'll have the right amount of time to feel calm and peaceful. I just started doing some labor prep massages and acupuncture with Fertile Grounds. It's been a wonderful way to slow down and honor the space I'm in. I'm definitely not eager to have a baby right now. I feel so full, alive, and content in these last few days (or weeks) of waiting.
It's amazing how many random people will comment on how uncomfortable I must feel…or how big my belly look. The reality is that I feel wonderful and my baby is just the right size.
And then I'll hopefully spend this week making a few nourishing soups/stews that we can freeze for after baby arrives. I am SO excited to have this baby in winter. There is something that feels so perfect about the long nights and cold days. Hot teas and soups never sounded great in the summer, but will be the absolute best this December/January.
Rebecca Walsh, Jennifer Mason, and Lindsey Bartell will hopefully all be at the birth. These women have worked with me and loved me for the past several years, and I couldn't ask for a better team to capture this baby's arrival. Lindsey came over and took all of these beautiful images (and put together this short film, which has made me cry at least 10 times already).
It's so hard to believe that the next blog post I write about this journey will be my birth story. Thank you to everyone who has been holding space for us. Your love and good thoughts infuse my days.


Whilst during the occasion you've got an exceedingly endeavor and function within of the compact enterprise location of labor also as an out in the region possible you've got bought witnessed how lazy males and females use their socialization talents to amass outdoors of functionality. Why is mankind commonly looking budi arie setiadi for to obtain faraway from hold the profession executed? Why can or not it might be that human beings should get essentially the most and do the the really minimum?
How occur human beings use their brainpower to build up from carry out in lieu of make the most of it to construct up noticeably supplemental outside the house your house of regardless of the things they might be accomplishing? Various people ideal now would phase out that these that may give you the option as a result of some type of manipulation or psychological techniques to obtain other people to operate are smarter compared in to the ease. Maybe they're and perhaps they are not? But an extra challenge is clearly they are able to be lazy.
Yet another element I have located in firm is usually that lazy women and adult males in the event the probable gets hard typically slide on their own very own butts just because they failed to steer by living proof, but relatively guidebook by pressure, trickery, untrue assures, condescending evaluations coupled together with the dangled carrots of marketing. Many folks who're lazy increase to normally be the heads of associations, unions, enterprises or absolutely be a phase of your ranks in the course of the politicians.
Likely they may be desired to rally help for getting people to work. Even so, the straightforward truth is other individuals these days who run tough over the foundation see these persons not finishing up the purpose hard and endeavor to emulate them and mimic their fears to hold out. Then he and lastly these lazy those people men and women together with the foundation transfer regarding the important.
I would choose to segment out in all of this is imitation isn't intelligence and laziness within just of the particular human being is pertaining for the worst innate households of mankind that exist. Are all you lazy men and women joyful of yourselves? I hope so, given that I'm certainly not astonished. It certainly is astounding this a number of the progressed species would render by by itself so worthless. You can expect to desire to unquestionably settle on into account this in 2006.


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Topic: Tristan Sartor
Grace Among the Leavings Debuts at the Roxy Regional Theatre
Clarksville, TN – Local author Beverly Fisher was present in theotherspace at the Roxy Regional Theater on Monday, June 20th, as her novella "Grace Among the Leavings" turned dramatic presentation debuted in Clarksville.
Based on Fisher's family research and Civil War gleanings, "Grace Among The Leavings" tells the story of eleven-year-old Grace Meadows and her family's hard times in the wake of war.
It features Ava DoVanne, a rising seventh grader, in the starring role. As Grace, DoVanne showed her command of the script and the stage in her performance.
"Grace Among the Leavings" at the Roxy Regional Theatre.
Sections: Arts and Leisure | No Comments
Beverly Fisher's "Grace Among The Leavings" makes it's way to the Roxy Regional Theatre's theotherspace, June 20th – 28th
Clarksville, TN – The journey from the page to the stage does not always follow an established route: sometimes a new path must be forged.
Following months of adapting, rewriting and workshopping, Beverly Fisher's Civil War novella "Grace Among The Leavings" completes its journey to the stage of the Roxy Regional Theatre's theotherspace with four staged readings, June 20th – June 28th.
Originally adapted to the stage by Dennis Darling and Kari Catton and produced by Theatre in the Park in Lincoln's New Salem State Historic Site in Illinois, "Grace Among The Leavings" underwent further adaptation this past year by Roxy Regional Theatre co-founder and artistic director John McDonald.
"Grace Among The Leavings" stars Ava DoVanne as Grace.
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"SHREK The Musical JR." at the Roxy Regional Theatre, May 20th – June 11th
Clarksville, TN – Once upon a time in a faraway swamp, there lived a green ogre who one day found his home overrun by a group of banished fairytale misfits. Thus begins the tale of an unlikely hero who finds himself on a life-changing journey alongside a wisecracking donkey to rescue a feisty princess.
The Roxy Regional School of the Arts presents an irreverently fun adventure for the entire family with "SHREK the Musical JR." at the Roxy Regional Theatre, May 20th through June 11th.
Based on the Oscar-winning DreamWorks Animation film and the book by William Steig, "SHREK The Musical JR." is directed and choreographed by Tom Thayer, with additional choreography by Emily Rourke and music direction by Lacey Connell.
(L to R): Truman Jepson as Lord Farquaad, Allison Ferebee as Princess Fiona, Patrick Long as Shrek and Riley Jenkins as Donkey.
Clarksville's Roxy Regional Theatre brings Disney's "The Aristocats Kids" to the stage, May 29th – June 13th
The Purr-fect Family Musical
Clarksville, TN – Everybody wants to be a cat! Twenty-eight students from the Roxy Regional School of the Arts are getting the chance to do just that in Disney's "The Aristocats Kids" at the Roxy Regional Theatre, May 29th – June 13th.
In this feline adventure based on the Disney animated film, Madame's jealous butler Edgar cat-naps Duchess and her Aristokittens and abandons them in the Parisian countryside. Luckily, Thomas O'Malley and his rag-tag bunch of alley cats come to their rescue!
The Roxy Regional Theatre takes you under the sea with Disney's "The Little Mermaid Jr." May 17th-June 1st
Clarksville, TN – Go "under the sea" this summer with the Roxy Regional School of the Arts in Disney's "The Little Mermaid Jr.", opening Friday, May 17th, at 6:00pm.
Based on the Hans Christian Andersen story and the Disney film, "The Little Mermaid Jr." tells the story of the beautiful young mermaid Ariel (Ashley Knowles), who longs to leave her ocean home to live in the world above.
But first, she'll have to defy her father King Triton (Tristan Sartor), make a deal with the evil sea witch Ursula (Sidney McCarty), and convince Prince Eric (Truman Jepson) that she's the girl with the enchanting voice.
"The Little Mermaid Jr." at the Roxy Regional Theatre starting May 17th.
"Spoon River Anthology" at the Roxy Regional Theatre, January 12th and 19th
Clarksville, TN – In two newly-added performances, young people from the Roxy Regional Theatre's School of the Arts will present their fresh take on Edgar Lee Masters' classic "Spoon River Anthology" on Saturday, January 12th, and Saturday, January 19th, at noon.
Staged by John McDonald with dance choreography by Jessica Davidson and choral work by Erin Keas, Edgar Lee Masters' collection of short free-form poems visit the inhabitants of a sleepy New England town. «Read the rest of this article»
Beauty and the Beast Jr. at the Roxy brings back fond memories
By Bill Larson | May 21, 2010 |
They say your first musical will always be your favorite, and that is the case for me with Disney's Beauty and the Beast, it was the show that was playing when I first ventured into the Roxy Regional Theatre. Their professional production of this Disney classic sparked a continuing love of Musical Theatre in me.
So, when I heard that the Roxy was planning on staging Disney's Beauty and the Beast Jr. as part of their 2010 season I was excited as I saw it as as chance to revisit my first musical. And I wasn't disappointed. Watching those young actors and actresses performing their hearts out, renewed that feeling of wonder that I experienced when I sat in the seats watching my very first show at the Roxy.
A video used to be embedded here but the service that it was hosted on has shut down. «Read the rest of this article»
Disney's BEAUTY AND THE BEAST Jr. is sure to Enchant at the Roxy Theatre
A tale as old as time….The beautiful Belle yearns to escape provincial life and her brute of a suitor, Gaston. However, Belle finds more adventure than she wanted when she becomes a captive in the Beast's enchanted castle! Dancing flatware, menacing wolves, and singing furniture will fill the Roxy's stage with thrills in this beloved fairy tale about very different people finding strength in one another and learning how to love. Disney's BEAUTY AND THE BEAST Jr., opens at the Roxy Regional Theatre Friday, May 21st, at 6:00 pm.


Reid, who is 79, does not have long to live. I hate to be so abrupt about this, but Reid probably would not mind. In May, he went in for a colonoscopy, the results of which caused concern among his doctors. This led to an M.R.I. that turned up a lesion on Reid's pancreas: cancer. Reid's subdued and slightly cold manner, and aggressive anticharisma, have always made him an admirably blunt assessor of situations, including, now, his own: "As soon as you discover you have something on your pancreas, you're dead." I had planned to visit Reid, who had not granted an interview since his cancer diagnosis, in November, but he put me off, saying he felt too weak. People close to him were saying that he had months left, if not weeks.
Reid himself always seemed more predisposed to believing that the arc of the universe bent toward an ornery brawl. Reid once called the Federal Reserve chairman Alan Greenspan a "political hack," Justice Clarence Thomas "an embarrassment" and President George W. Bush a "loser" (for which he later apologized) and a "liar" (for which he did not). In 2016, he dismissed Trump as "a big fat guy" who "didn't win many fights." Reid himself was more than ready to fight, and fight dirty: "I was always willing to do things that others were not willing to do," he told me. During the 2012 presidential campaign, he claimed, with no proof, that Mitt Romney had not paid any taxes over the past decade. Romney released tax returns showing that he did. After the election, Reid told CNN by way of self-justification, "Romney didn't win, did he?" Reid took rightful criticism over this.
So that's a total of 3900 Senate hours, which means 163 days of Senate meeting 24/7, so they could clear the backlog IF THEY WORK. They can be done by mid-May (though new judicial vacancies will arrive and keep Senate longer.) Or they can use #TheReidaRule. But they have to act!
I fully supported McConnell applying the 'Reid Rule' to the Gorsuch SCOTUS nomination, and applauded further hardball maneuvers when Democrats tripled down on obstructionism. Whether additional steps are justified may depend on the minority's conduct in the coming months. Because these fights have become exceptionally high-stakes, zero-sum battles, and because the GOP is unlikely to notch many conservative legislative accomplishments with Nancy Pelosi as House Speaker, the elevation of qualified originalist jurists is the single most important task Republican Senators are faced with over the next two years. Advantages are notoriously transitory in politics, so this moment in time must be exploited to the maximum extent possible. Thankfully, Harry Reid's Republican successor seems to understand this quite well.


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Employee Spotlight: Roby Rada
Being the winner of AmpedHQ's first annual Spirit of Amped Award, Roby Rada is one dedicated employee. The award was created to celebrate those who embody the culture and values of our company.
"He's very deserving," said Josh Carder, one of the co-founders of Amped HQ. "Roby is very committed to his work and always goes above and beyond his role." Roby has exhibited an unyielding commitment to our employees and clients during a profoundly difficult year impacted by the COVID-19 pandemic. Amped HQ is very honored to recognize his contributions to the company.
Roby oversees the overall operations at Amped HQ whose commitment to going above and beyond is reflected while wearing multiple hats leading HR and recruitment processes, as well as client and stakeholder management. His contributions have allowed the company to grow at a rate of 400% in the last year.
Together with the founders of Amped HQ, Roby has helped build an unbeatable foundation for our growing company to stand on.


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GamestormEDU
Gamestormers at Protospiel Madison
Jon Spike
One of the best parts about the game creation journey has been the people I meet along the way, as well as embracing new adventures in the field. On a whim, I signed up for what is referred to as a "protospiel," or an event where game designers, playtesters, and publishers gather to try out game prototypes and give feedback to creators. Thankfully, Madison, WI, had a protospiel this past week I could attend in a short drive, allowing me to playtest and try others' games for a full day without needing to pay for a hotel, expensive travel, etc.
Although I am an extrovert, I was absolutely terrified about the prospect of trying to not only convince strangers to try my game, but also hop into strangers' games to give them feedback. Within minutes of arriving at the Protospiel, my fears were gone. Everyone was excited to talk games, peek at what I had brought, and share what they had created in a safe and non-threatening atmosphere.
I had the chance to playtest Gamestormers, my creative card game about designing a game, with a few different groups. I got some really powerful feedback and ideas, but honestly my favorite part was trying others' games. I thought I'd share a bit about the games I tried and what I learned from a design standpoint from each.
1. Rotundra
A shot of Rotundra in action.
The first big takeaway from sitting down to Rotundra in the beginning of Protospiel Madison was the importance of table presence. I saw Rotundra's unique, shifting circular platforms from across the room and knew I wanted to learn more. Having a really unique visual mechanic to your game is a great way to spark interest.
Once I sat down at the table, I met my opponent (it's a 2 player game) and learned the rules from one of the designers. In Rotundra, you must either build two research stations at the top or sides of the mountain, or you must eliminate one of the workers for the opposing player. I really liked how there were multiple victory paths and the ability to pivot if your original strategy did not work.
Another lesson learned from the Rotundra playthrough was good playtesting etiquette. The creator paused to let us know that we had been learning and playing for about an hour and wanted to see if we wanted to finish out the game or find a natural stopping point in case we wanted to move on. We mutually agreed to stop after the next research station that was built, and I thoroughly appreciated the opportunity to swing back to my Gamestormers stations to facilitate a playtest.
2. What's Ours is Mine: A Divorce Game
The next game I stumbled upon was a great fit for my style of game – a humorous, thematic game that is easy to learn but hard to master. I met the designer and artist for What's Ours is Mine: A Divorce Game and immediately was drawn to the narrative. Essentially, you and your opponent are a couple going through a divorce arbitration, and you must bid on items from your estate in order to "win" them. With a great sense of humor (who gets the Framed, Singing Salmon?!) and two rounds with distinct mechanics, it was a fun playtest.
My big takeaway from What's Ours is Mine: A Divorce Game was the importance of committing to your theme and making sure your game capitalizes on it. By embracing the absurdity of arguing over trinkets, the game walks the fine line of satirizing a very traumatic and taboo topic with some lightheartedness. It's definitely a game that will land perfectly with some players and completely repel others, and that is okay! You cannot expect every player to be drawn to your game, but if your fun take on an under-explored theme works really well, embrace it.
3. Spellslingers: Wizard Tournament
The game board for Spellslingers: Wizard Tournament
My last playtest of the day was a great mash-up of a board-based combat game and Magic: The Gathering called Spellslingers: Wizard Tournament. Not only was it enjoyable to meet the creator, but I also had the opportunity to play with two sisters who offer a playtesting business and critique instructions for The Gamecrafter. The game had interesting mechanics, such as using dice as both the player figurines and hit point counters, as well as being an indicator for determining the damage your characters could do. Spellslingers: Wizard Tournament also had nice asymmetry by having us select our character, complete with unique powers we could use on our turn.
My big takeaway from the game was that injecting new life into an existing game or genre could lead to a really interesting game. Spellslingers: Wizard Tournament took the established system of mana, spellcasting, and dueling, and turned it into a battle royale with movement, dice, and more. It made me step back and ask if I was reinventing a genre or simply copying what was already out there. In addition, it gave me some great ideas for how to approach the brainstorming process for future games.
Overall, I cannot recommend the experience of an event like Protospiel Madison. The people were incredibly supportive, the community believed in making everyone's game better, and the games were fantastic. I am so thankful for the designers and playtesters I met at the event.
Using Early Feedback to Enhance a Game
In "Homepage"
Crawling Before You Walk with Live Playtests and Babies
Sloane is Rolling and so is Gamestormers Playtesting!
Categories: Homepage