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Geriatricizing the ICU
For today's GeriPal Podcast we talk with Drs. Nathan Brummel and Lauren Ferrante, both critical care physician-researchers, about integrating geriatrics principles in intensive care units.
This is a major issue. Just think about the older patients you've seen in the ICU recently: older, frail, sick. Now imagine the environment - beeping, monitors, lines (tethers), sedating medications, stress, open doors, lights everywhere, noisy air mattresses. The environment alone is crying out for geriatricization! (I think I just made up a word).
Nathan and Lauren wrote a terrific article about the topic, link below, and discuss the landscape of work to be done in this area on this podcast.
-Alex Smith, @AlexSmithMD
Integrating Geriatrics in ICUs: The Time is Now
Eric: And Alex, we have two guests with us. One's skyping in and one here in studio.
Alex: Let's start with the in-studio guest. We have Nathan Brummel who is a Pulmonary Critical Care Physician Researcher at Vanderbilt and is in town for the GeriPal podcast and also happens to be attending the American Delirium Society meeting which is in San Francisco.
Eric: Great. I was just there yesterday. Great meeting.
Nathan: It is. It is.
Alex: Welcome to GeriPal podcast Nathan.
Nathan: Thanks for having me.
Alex: We also have via Skype Lauren Ferrante who is a Pulmonary Critical Care Physician Researcher at Yale. Welcome to the GeriPal podcast Lauren.
Lauren: Thanks for having me.
Eric: Lauren, we ask all of our guests, do you have a song request for Alex?
Lauren: Yes. We wanted to sing a song about change and so we are requesting "Waiting on the World to Change" by John Mayer.
Alex: Alright.
Alex: We keep on waiting ... Wait, let's do that again. Eric, you've got to sing too.
Eric: I have to sing too?
Alex: Yeah. You've got to sing "waiting".
Eric: Alright.
Alex: Yeah. We need it. We need the backup. Let me start again. [Singing]
Alex: Alright!
Eric: I can't believe you made me sing, Alex.
Alex: It's great. That song is actually about how you're waiting for others to change. Is that what you're advocating here when you're thinking about geriatricizing ICU's? Should we be waiting for them to change themselves? Is that the point?
Lauren: No. The whole point of the article is that we are advocating that the time for change is now.
Eric: Wait. What article are we talking about, Alex, here?
Alex: We should say that the topic of today is geriatricizing the ICU which is like critical care medicine. The title of the article is "Integrating Geriatric Principles Into Critical Care Medicine: The Time Is Now". And this was in Annals of the American Thoracic Society recently May of this year. Nathan and Lauren were both authors on this. Eric, do you want to start us off with the discussion here?
Eric: Yeah, so we'll have a link to this article online on our GeriPal blog. We usually like to start off how did both of you get interested in this subject?
Nathan: Sure. It started about three years ago at the American Geriatric Society meeting. There's a medical sub specialty section and at that breakfast Lauren and I were sitting together, we're both pulmonary critical care and knew each other through that but were at the AGS meeting. All the other groups were getting up, the cardiology section, the oncology section and they were presenting all the great work they were doing. We both sort of looked at each other and said, "Why not us?" We need something like this in critical care.
From that rose a sort of discussion between Lauren and I. We then put together an application to become a working group in the American Thoracic Society, the largest international group of pulmonary critical care physicians. Over the last few years that's morphed into an interest group now so we have a larger group that's working to do these very things of integrate geriatrics and aging research into critical care medicine.
Alex: Lauren, anything to add to that about like why did you see this as necessary? It was certainly a need there. Anything from your clinical experience that sort of cries out for this area?
Lauren: Definitely. I think in the hospital and in the medical schools we all talk about integration but we still tend to function in silos even in the ICU where we have to manage every single organ system. Actually, the ICU is pretty good at interdisciplinary and multidisciplinary care but with the growing number of older adults in our country and this is something that's been talked about a lot including on this podcast. I think we really saw that it's time to integrate these principles and not just to be calling geriatrics consults all the time. That's one of the things we address in the article.
Although we're both researchers, really it was the clinical need for this and that kind of drove us to form this working group and to address all facets of integrating geriatrics into critical care research education and clinical practice.
Eric: When we talk about principles, what geriatric principles are we actually talking about here?
Lauren: We're talking about a number of things. One of the things that both Nate and I have worked on are vulnerability factors that are present to a greater extent among older adults than they are among younger patients. These include things like frailty, or multi-morbidity, or cognitive impairment, or disability. And, many older adults are coming into the ICU with these preexisting problems but when we're looking at the critically ill older adult patient, it's extremely rare for someone in the ICU to be thinking about that at the forefront of their mind. We tend to focus on things inherent to the critical illness itself so something like respiratory failure that's keeping them on the vent and we're not really thinking about what they're coming in with. That's just one example.
Where a geriatrician might be thinking first about the preexisting vulnerability factors that an older adult is coming into the hospital with and how those vulnerability factors might inform their outcomes or their acute illness. That's just one example of a principle or at least consideration that we think we need to integrate into our practice that really isn't being considered in real time in the ICU currently.
Nathan: Yeah and I think adding to that, the increased emphasis on outcomes after critical illness. We're seeing things that are classically considered geriatric syndromes like cognitive impairment, disability and frailty in even our younger survivors. There's an added component not only for the older adults but younger survivors who are suffering with classic geriatric syndromes.
Alex: Of the geriatric syndromes, what do you think is the most common in the ICU? The one that comes to mind for me, well, it was sort of primed for this, was delirium. Does that ring true to you or is there actually empirical evidence about what's most common?
Nathan: Yeah. We haven't studied specifically the types of geriatric syndromes but delirium being the most common affecting up to 80% of people that are on a mechanical ventilator.
Alex: Wow. Say that again.
Nathan: Up to 80% will have at least one day of delirium while they're in the ICU.
Alex: Wow. That's huge.
Nathan: That cuts across ages and comorbidities and all these other factors. The vulnerability factors plus the insult that critical illness is that brings those two together. I think the other one that's ubiquitous is immobility.
Lauren: Yes definitely.
Nathan: Every single patient in the ICU is even though we're trying to get better at that, it's still quite common.
Alex: What sort of ... What do you think is, there are a couple of historical factors we start to get into this here a little bit. The ICU has changed over time, right? It used to be younger folks with reversible conditions, right? One of my mentees, Brian Block who I think both of you have met is writing a piece where he talks about how that ICU has really changed from being a place where young people with polio were on ventilators and now it's just replete with older adults, dementia often, other geriatric conditions. The demographics and the illnesses and conditions that are seen in the ICU have really changed over time.
Nathan: Right. That's a combination of things. One is that the population is aging but two is this is the population that's most likely to develop common reasons for ICU admissions, thinks like sepsis and pneumonia and respiratory failure. All of those track with age as well. I think another factor as well is it's not as socially acceptable to deny older adults ICU admission like it once was.
Alex: Lauren, from your perspective, thinking about the level of expertise and awareness of the importance of this issue within the American Thoracic Society, within critical care physicians nationwide or even globally, where do you think we're at? Is this a frontier area or do they recognize it's important they have a need? Do they already have some training? Or is this pretty new stuff to them?
Lauren: I think that there is increasing awareness of the need and if you look back even I think it was Derek Angus back in 2000 had looked at the epidemiology and the prevalence of older adults in the ICU. We mentioned that in our article. At the time, he found that more than half of patients in the ICU were older adults.
If you look at, this is not an official publication research project that I did, but if you look generally at the number of citations and interest in this area, it has been increasing since that time. And, in fact, there's decent interest in mid career senior folks and also in early career investigators in these specific issues. And the group that Nate described that we created in the American Thoracic Society has only grown and we keep getting additional interests from other ATS members. I just think that this is a really growing area and it is a frontier as far as incorporating these areas into practice. I think that we have seen a lot of progress in research, but we need to see the same amount of progress in clinical care and to continue the progress that we've made in research.
Eric: I'm just going to drill this down to practical issues of what we should be doing. There was a recent tweet that came out saying we have lots of tools for monitoring delirium in all age groups so what's your excuse for not monitoring brain dysfunction?
Alex: Are you saying moderating?
Eric: Monitoring.
Alex: Oh monitoring.
Eric: Did I mispronounce that? Oops. There was an ICU doctor who had a rhetorical question. Is it important to monitor something for where there is no obvious intervention to make it better? The cam ICU suggest hypoactive delirium? What's next?
Alex: Right. What do we do? We can detect it. What do we do about it? Interesting. Response?
Nathan: Yeah. I think it's important that, I agree with that statement that we don't have a drug that we can give which is what we all want. We want something quick and easy that we can give a patient. The problem or the difficult part about delirium is that you have to step back and stop and think about what might be causing it. The average ICU patient has upwards of 11 risk factors for developing delirium. Some of that is related to their underlying critical illness. We recently published a paper that looked at risk factors for delirium and we called them delirium subtypes and we identified a bunch of different like sepsis and hypoxemia and sedation was one of the ones that we looked at. We looked at the duration of each of those subtypes, each of those types of delirium. We found that each of them were related to long term cognitive impairment so delirium that people have in the ICU is related to their thinking and memory a year later.
What we found in that study was of all the causes, right, sepsis and hypoxemia, those don't tend to be reversible but sedative associated delirium was associated with long term cognition. That's a totally modifiable risk factor for delirium. It's not necessarily giving something, it's taking it away that may be helpful to patients. When you think of that, it's important because it's associated with outcomes but it's also you can look for new problems that you can potentially intervene on.
Alex: Lauren it sounds like you wanted to add to that.
Lauren: Yeah. One of the things, one of the areas where we really can improve in the ICU and many units are working towards this, is the prevention of delirium. Some of the steps that we mentioned in our article include implementing interventions that are already pretty standard on ACE units or Acute Care for Elders units. These include things we mentioned additions and subtractions from the physical environment. Some additions to the physical environment might include portable amplifying devices for hearing impaired patients.
Alex: Yes.
Lauren: Those devices are not standard right now in Intensive Care Units. I usually find myself looking for one whenever I'm on service even though we have a pretty aging conscious unit here at Yale. Then other things would be subtractions from the existing environment. We all know that there's a lot of sensory overload in the ICU and a lot of sleep disruption. Those things also predispose patients to delirium. I think we have a lot of work to do also in preventing ICU delirium in addition to treating it.
Eric: You did a nice job on your paper to break it down to things that we should be doing be doing now, things we should be thinking about short term in the next three years, and long term. Maybe we can briefly talk about each one of those. What should we be doing now to geriatricize ICU's?
Nathan: I think the first thing is to start paying attention to these syndromes like delirium and immobility and sensory impairment that are prevalent. Those are modifiable right now. Eyeglasses, hearing aids, getting people up out of bed are interventions that are effective and by the way those at least mobility has been shown to reduce delirium in the ICU. That's the only thing that we have to reduce delirium, two separate randomized control trials have shown that. The larger term or the more short term, the three to five years and five to ten year goals are things about educating more of the nuances of caring for older adults and treating geriatric syndromes in the ICU. Developing an educational curriculum, research, or research agenda, what gaps in knowledge do we have about caring for older adults? We actually submitted a proposal to review the literature and one of the comments we got back was well we all know there's nothing there.
Alex: There is no literature.
Nathan: That's our point.
Alex: Right. That's the point. Lauren, do you want to add to that?
Lauren: Yeah. In addition to training pulmonary and critical care fellows to really consider these geriatrics principles especially as they become attendings, I also like to think a lot about what can we do with the current practitioners in the ICU. I saw a recent paper, I was just trying to find it, I think it was out at the UAB group where they talk about virtual ACE units and where they're basically going around to different units and training the existing practitioners. I wonder if that might be a more practical model for early implementation.
Although we outline a number, I think one of the things we mention, just in service trainings, things like that. I think we can't lose sight of the fact that we have to train our current practitioners so that they're thinking about these concepts in real time.
The other thing that we mentioned for the future is we, and this is something Nate and I have talked about a lot is creating a network of aging intensivists researchers because one of the areas that we outline in the paper is that many clinical trials and studies in critical care medicine often exclude the oldest old or don't have critical numbers of older adults. We're hoping that our group which has a lot of critical care researchers in it will one day as we go from the K to the R phase will be able to have an aging intensivist network so that we can answer some questions about how to best treat older adults in the ICU.
Eric: Is there a reason for that lack of inclusion of oldest old into ICU research?
Nathan: From a practical perspective, it's not that the study exclusion criteria, say if you're over 85 or 90 you can't be in this study, it's that they exclude people with multiple comorbidities or cognitive impairment from their studies. They sort of de facto exclude older adults.
Lauren: Right.
Alex: Do you want to follow up on that Eric?
Eric: No. Go ahead.
Alex: It does seem like this is the bait and switch that often happens with clinical trials that they test it in a very select group of sort of healthier individuals in order to show efficacy but then they roll it out for people who have multi morbidity, dementia, functional impairment, real world oldest old type of patients and we have no idea whether it works in them or not. I love this idea of setting up a trials network to actually study this effectiveness in real world settings.
Lauren: And some of the, you know the demographics of the existing trials and near future trials may change now that the NIA's mandating inclusion across the lifespan with that new policy which I think is going to be effective next year. But we still feel that there will be benefit to have this aging intensivist network. That's in the longer term plan.
Eric: Right. Is there, you've probably been to a lot of ICU's, is there a design element to ICU's to make it more age friendly?
Alex: Are you talking about architecture?
Eric: Yeah. Like the way ICU's are designed. I mean when we think about ACE units, it's not just mobile ACE units but physical ACE units. A lot of times we also think about the design of those ACE units. Is there room for family members to be there? Is there room to actually do things like get up out of bed, walk around. Is there light coming in from the outside? Are the bathrooms easily accessible? What are your thoughts about that?
Nathan: I don't know from a national perspective but at Vanderbilt about now gosh it's when I was a fellow so it's longer ago than I care to think about but when we opened a new critical care tower and that incorporated a lot of those things you just talked about. There's space for the family to stay with the patient there. There is a bathroom that's accessible. It's a very large open space compared with our old ICU which you had to be an acrobat to be able to maneuver around all the equipment and the bed and everything like that. There may have been a chair in the corner for family versus a pull out couch or something for them to sleep on. I think those are important things.
We know from the demographic data that the number of ICU beds, even though the number of hospital beds nationally is decreasing, the number of ICU beds is increasing. Whether that's conversion of existing hospital beds into ICU beds or construction of new ICU's but I think that's a very important point for hospital administrators and architects to keep in mind as they design these spaces to make them aging friendly.
Lauren: Yes. We also have a new unit at Yale so we also have, space is definitely not a problem, there are huge windows, lots of light. But there are some things inherent to the ICU that aren't contingent on space that I think we, probably every ICU in the country, could improve on. And that one big problem is noise and also sleep disruption. We have a group here at Yale that works on sleep in the ICU. They measure the noise of the ICU and especially in certain rooms, it's just because the monitors are outside in the hall it can be really, really disruptive to the patient and disorienting. You can see how that might predispose to delirium.
The other problem we still have in every ICU I think is a tethering problem. I often start talks that I give of a picture that I give of a patient in the ICU bed just so that the audience can really grasp what that looks like. There are telemetry wires, multiple lines, central lines, Foley catheters, sometimes CVVH and the tethering devices, despite our best attempts at early mobilization, they can still be problematic especially for older adult patients.
Alex: I think about our ICU, the monitors are in the room, there's always at least one monitor beeping and if it's not the monitor beeping, it's the IV beeping, the fluids are beeping. There's always a beep. There's at least one beep if not two beeps. The television is on. They've got the air bed. And the air beds these days, the best air beds are wonderful for your skin but the decibel level of the air bed is like off the charts. You can hardly, I feel like I'm on an airplane with all that background noise. You need noise canceling headphones. We tried to have a meeting with an ICU patient the other day. We could hardly hear anything and we don't have, we're not like 88 years old with hearing loss. I can imagine just such deliriogenic, just sort of setting for older adults.
Nathan: It's a harsh environment for sure, for sure.
Lauren: From a design issue, it should really not be that hard to have the alarms transmit outside or to the nurse somehow or on their mobile heart beat. All the practitioners in our units are now connected through iPhones. From a design standpoint, there's really no reason that that alarm should be going off next to the patient's head as opposed to on our personal device. Hopefully, we can break, maybe engineers need to start working on that.
Eric: Yeah. The medication pumps, those are the worst.
Lauren: Yes.
Eric: All around the hospital they just go off. They go off for about ten minutes before somebody can walk into the room and turn it off. I just know the little yellow silence button but that only lasts for like a minute.
Alex: Then you've got to push it again.
Eric: Is there anything else that you guys would like to talk about before we end?
Lauren: I have a question for both of you as geriatricians. You read our paper and you've seen that we think we need to integrate the principles of geriatrics into critical care medicine but we certainly want to keep our geriatric colleagues involved in the ICU. Do you think that this is a good idea integrating it? Do you think that it's problematic from a geriatrics consult standpoint or do you think we would work together on this type of initiative? How do you foresee it from your end?
Eric: I love your analogy or the idea of bringing in an ACE unit into the ICU because if you look at a lot of ACE units, they're not taking over care. They're often just focusing on key geriatric syndromes for those individuals making recommendations on that. They don't need to be heavily involved with every patient and sometimes it's just a quick touch point. I can imagine the same thing happening in the ICU. I think the challenge is how do you actually staff that in hospitals. But I think if we think about interprofessional teams and ACE units, it's a reasonable and attainable goal to actually get. You don't have to do full geriatric consults on every ICU patient but you just develop a system where you can have those, even those quick touchpoints.
Alex: I just add to that to say that I think Eric, you're in more touch with this data that I am. The number of fellows, geriatrics fellows, clinical geriatrics fellows has remained relatively flat.
Eric: It's been relatively flat.
Alex: For a period of time. And there are a lot of older geriatricians who are retiring or approaching retirement age. I guess my point is there's no way that there's enough of a workforce of geriatricians to meet the demand in the ICU's. And so the primary focus should be on primary geriatrics delivered by critical care physicians in the ICU and education of those physicians, changing the environment, education nurses and the whole interdisciplinary team.
Eric: Yeah. Part of me also thinks, I think we can harp a lot on that geriatric workforce issue and why things can't happen. In some ways, that's probably not where we want to start. We can make this change. The workforce is there. The workforce is there from a specialty geriatric standpoint. The workforce is there from a interprofessional geriatric standpoint. Again, if you're in most ACE units, it's not just the geriatrician. It is the nurse with geriatric expertise. It's the physical therapist. It's the pharmacist. It's a team of individuals. And it's also like you said making sure we are also educating great primary geriatric skills for ICU providers, again, not just physicians but the whole interprofessional teams. I do think the workforce is there. We can do this. It's just getting bright people eager people, like the people we have on this podcast to actually make that change, not waiting.
Alex: Right. Don't wait for the change.
Nathan: Be the change, be the change. I think you raise a very good point about that where Lauren and I and others around the country and around the world really are approaching this from a critical care perspective but I don't know that we've really engaged our geriatrics colleagues to say hey let's sit down and figure out what that primary geriatrics for the ICU really looks like and how do we train people in that. I think that's a very good point that you raise.
Alex: One of our listeners out there or many of our listeners out there, if listening right now and you're thinking to yourself "I want to get involved in this. I'm a geriatrician. I do a lot of consults in the ICU. I see the issues they're talking about. This all rings true." Contact Nathan, contact Lauren. Get involved. We need geriatricians to have input on this issue.
Eric: I think there's a lot of great analogies. For instance like geriatric ED's, emergency departments. Learning lessons from the places where this has been implemented both delivering specialty geriatric care and also in like geriatric ED's, it's a lot about primary geriatric care from physicians and nurses and everybody that's involved and also design. Thinking about how we design these units whether ED's, ICU's, or hospitals.
Lauren: Absolutely and just to anyone who's listening and is thinking I want to be involved, but I don't know when I'm ever going to see an intensivist and I'm not going to the ETF meeting, we do have a group in the American Geriatric Society called the Medical Subspecialties Section and these are exactly the issues that we work on. If you email me or look in the program at the next AGS meeting, you should contact us even though the section is called the Medical Subspecialty Section, we actually invite everyone to come. Surgical subspecialists, geriatricians and these are the issues that we want to be talking about and working on. Again, that's where this group started, the group that Nate and I formed was actually at that meeting.
Eric: Wonderful. Well I want to thank both of you for joining us at this GeriPal podcast.
Alex: Thank you Nathan. Thank you Lauren.
Nathan: Thank you Alex. Thank you Eric.
Lauren: Thank you.
Eric: And Alex, how about you end with a little bit more of that song.
Alex: [Singing]
Eric: No more waiting right, the change is now. I want to thank all of our listeners for joining us. We look forward to talking with you next week and thank you to our guests.
Lauren: Thanks for having us. This was fun.
Nathan: Thank you.
Alex: Thank you so much Lauren. Thanks Nathan. Appreciate it.
reginald surict said…
Interesting. After reading this post I think you would also be interested in this article. Have a nice day!


How did your interest in salvaging pieces of old homes and buildings start?
My dad, Garlan Gudger, Sr. started this business in 1969, before I was even born, so this business is all I've ever known! As a young boy, I would roller skate through the store and dig through buckets of old door knobs. Having been raised around this business, I not only learned to love architectural relics but more importantly, I learned to appreciate them.
What's the oldest piece of salvage material you've found?
Why is it important to save these pieces of old structures?
Architectural antiques are part of our American history. Each time we lose a historic building, we lose part of our past. By saving architectural pieces – solid wood doors, mantels, lights, corbels, trim, wrought iron, salvaged wood and more – we can give these incredible pieces a chance at a second life. Not only does this help preserve a piece of our history, but it contributes to the sustainability of some of our natural resources. If not saved, many of these pieces would end up in a landfill. The craftsmanship seen in so many of the rescued pieces is a dying art and needs to be preserved for future generations.
Southern Accents has seen a tremendous amount of growth the last few years. We have our own wood shop where we produce quality restoration and custom work. Our salvaged wood business has grown and now encompasses two warehouses of 30,000 square feet. We've started taking on more commercial design and installation jobs and the past couple of years have expanded our business to include event staging. My goal for the next 10 years is to continue doing what I love: rescue, restore, protect and document architectural elements of historical significance.


Aerugite: Mineral information, data and localities.
Dark grass-green, blue-green, pale brown.
Named by Gilbert-Joseph Adam in 1869 from 'aerugo', which means 'copper rust', alluding to its appearance.
This page provides mineralogical data about Aerugite.
Fine-grained crystalline, massive, as crusts, to 2 mm thick.
Natural History Museum, London, England, 32590 and 1907,103.
Oxidised vein in a nickel arsenic deposit.
Xanthiosite 2 photos of Aerugite associated with Xanthiosite on mindat.org.
Paganoite 1 photo of Aerugite associated with Paganoite on mindat.org.
Petewilliamsite 1 photo of Aerugite associated with Petewilliamsite on mindat.org.
Bergemann C. (1858) Ueber einige Nickelerze.- Journal für praktische Chemie  75, 239-244.
Davis, R.J., Hey, M.H., Kingsbury, A.W.G. (1965) Xanthiosite and Aerugite. Mineralogical Magazine: 35: 72-83.
Fleet, M.E., Barbier, J. (1989) Structure of aerugite (Ni8.5As3O16) and interrelated arsenate and germanate structural series. Acta Crystallographica: B45: 201-205.


Simon Williams (Carrickmines) won the 2014 Golf Croquet Championship, played at Carrickmines, with the disappointingly low entry of 10 (with room for 32). Of the strongest players, Jack Clingan, Robert Barklie and former champions Fred Rogerson and Ronan Rogerson were missing. Those who attended enjoyed many competitive games in the bright sunshine.
In the final, Simon recovered from a first-game loss to beat Evan Newell (Carrickmines) at hoop 12 of the third game. He beat five-times champion Patsy Fitzgerald (Co. Meath Croquet Cracks) in the semifinal, while Evan beat Danny Johnston (Dublin University). Sandy Greig of Carrickmines made a great start in the event, with wins over Evan and Patsy, but Danny knocked him out in the end.


No other city provides and celebrates its living tapestry and history quite the way Derry~Londonderry does. From the ancient 17th Century Walls listed as a "You must see" destination by UNESCO to the renowned tours of the City which tell the story of the history of the Walled City.
Sporting three fantastic theatres, from the ultra modern Millennium Forum, the award-winning Playhouse to the newly refurbished Waterside Theatre, Derry~Londonderry is undeniably a hotbed for the thespian arts.
Some say that a picture paints a thousand words, and in Derry~Londonderry the work of local galleries VOID, McGilloway and Context are both nationally and internationally recognised, add to this the celebrated Nerve Centre, a vibrant and modern multimedia centre in the heart of the city and the Verbal Arts Centre, the only arts centres devoted to the verbal arts in Northern Ireland.


Do you suffer from anxiety, depression, nightmares? You might be one of the infected!
In The Cured we find a world ravaged for years by the MAZE virus. A horrible disease that turns those infected into zombie-like cannibals. When a cure is at last found, the almost impossible process of reintegrating those cured of the virus, back into society, begins. Among the formerly afflicted is Senan, (Sam Keeley) a young man haunted by the horrific acts he committed while infected. Welcomed back into the family of his widowed sister-in-law, (Ellen Page) Senan attempts to restart his life-but is society ready to forgive him and those like him? Will fear and prejudice once again tear the world apart? Filled with numerous parallels to our troubled times, The Cured is a smart, scary, sensitive and hauntingly human tale of guilt and redemption. Not just a horror movie, but something much more thought-provoking.
The Cured was such an amazing movie. I love this take on the zombie genre. What happens if after the apocalypse, the undead return to life? Moving back into your neighborhoods, living next door? The Cured is truly different and that made it a fantastic and heart-breaking watch for me! It is a compelling tale, especially under our current world political state.
I was so excited to talk to one of the stars of the film, (my favorite) Sam Keeley, who plays Senan, one of the cured zombies trying to live some semblance of a normal life again. Sam was in Iceland buying a house but took the time to talk about The Cured with me. Our reception was terrible, but what a great guy to talk to! Just so you know, if you haven't seen the film – there are possible spoilers ahead.
Los Angeles Zombie Girl: Hi Sam! Thanks so much for talking to me! I just watched The Cured, it was amazing, I loved it!
LAZG: Since I live in the U.S. I, unfortunately, haven't gotten to watch any of your work, so can you share a little bit about your journey becoming an actor in Ireland?
SK: "Sure! I was in my final year of high school and I failed all my exams, which isn't very conducive for going to college. I hated school, so I'm afraid I'm not a very good role model. I was a singer/songwriter and was working on a demo album, so I was spending more time playing music than I was in school. My school guidance counselor, Teresa, a very special lady, got hold of me and she was like 'heh if you're gonna do this you need some sort of back up plan.' I sat down in her office and we went through various classes that I could do, and I didn't want to do any of them.
LAZG: Sound's like it was meant to be! Do you have any actors that have inspired you?
LAZG: I agree! Me too. Well, that brings us to The Cured. I feel like it's truly a fresh take on the overdone zombie genre. It doesn't feel like a traditional zombie film. How would you categorize it?
LAZG: The character of Conor (Tom Vaughan-Lawlor) who was also one of the cured alongside yourself, was the leader of an extremist underground political movement. I understand this was obvious retaliation to the people who wanted them exterminated, but his tactics seemed very terrorist. Was that a political statement in any way referring to the state of Ireland's troubled history?
LAZG: Who were really the bad guys? Right? Had the population that didn't get infected, who lived through the apocalypse, become the evil ones now?
LAZG: Your character, Senan, has a hard time living with the guilt of what he did while he was infected. He's a very sensitive guy and wasn't moving forward well. What did you do to prepare for such an emotional role?
LAZG: Why did Senan seem to have more guilt and worse nightmares than most of the other cured? Many of them did not seem to have any remorse. Is that just who they were before?
LAZG: What was it like working with Ellen Page?
LAZG: Do you have a behind-the-scenes story you can share?
LAZG: The ending of the film left me crazy! I know you can't know the future, to see if there is a sequel. But could Senan keep the boy safe and try to find him a cure?


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Нижнесапашево () — деревня в Кугарчинском районе Республики Башкортостан Российской Федерации. Входит в состав Ялчинского сельсовета.

География

Географическое положение
Расстояние до:
 районного центра (Мраково): 54 км,
 центра сельсовета (Ялчино): 2 км,
 ближайшей ж/д станции (Мелеуз): 32 км.

Население

Примечания

Ссылки
 Совет муниципальных образований Республики Башкортостан.

Населённые пункты Кугарчинского района

redpajama_set_name: RedPajamaWikipedia


text:
Yak On Debut Album And New Single 'Victorious (National Anthem)' | Music News
10 Feb 2016 — Filed Under: Music, Music News
Yak have recently confirmed some details about their first album, Alas Salvation and the upcoming UK tour. The debut record will be released on May 13 via Octopus Electrical and it is preceded by the single "Victorious (National Anthem)", to which you can listen below. The band has also revealed the dates for their UK headline tour, which will start after their February tour as a support act of King Gizzard & The Lizard Wizard.
Check all the upcoming dates below:
Manchester, Gorilla (February 15)
Nottingham, Rescue Rooms (February 16)
Bristol, Thekla, Bristol (February 17)
London, Electric Ballroom (February 18)
Brighton, The Haunt (February 19)
Birmingham, The Rainbow (May 11)
Sheffield, Bungalows & Bears (May 12)
Glasgow, Stereo (May 13)
Manchester, Deaf Institute (May 15)
Leeds, Brudenell Social Club (May 16)
Bristol, The Exchange (May 18)
Southampton, Joiners Arms (May 20)
Oxford, The Bullingdon (May 21)
London, Dingwalls (May 24)
#Peace.Love.Yak
Gaia Pennisi
Italian singer-songwriter, aspiring journalist, amateur photographer and wannabe cartoonist, Gaia has just too many ideas and too little time. She tries to combine all her passions together while living in London and dreaming of travelling the world.
Latest posts by Gaia Pennisi (see all)
Radiohead Might Have Just Shared Their New Album's Artwork | Music News - March 15, 2016
Garbage To Release New LP 'Strange Little Birds' | Music News - March 11, 2016
Iggy Pop And Josh Homme Perform Secret Gig Ahead Of Album Release | Music News - March 11, 2016

redpajama_set_name: RedPajamaCommonCrawl


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Democracy in America | The fog of war
The fog of war
A tragic video, but are we seeing a war crime?
By R.M. | NEW YORK
IN THIS week's paper we examine attempts to build ethical understanding into pilotless war planes, which would allow these machines to contribute to the decision to fire on a designated target. The idea is to input them with information so that they can quickly evaluate the likely damage to be caused from an attack and who (civilians, insurgents, friendly forces) will be most affected. "Software conscience" is the term used to describe it, and it's a nice thought, considering the numerous stories of civilian casualties resulting from air attacks and even conventional raids (see the post below).
Any effort to cut through the fog of war is welcome, but let us not forget how thick that fog is. Today Andrew Sullivan (via wikileaks) flags one of the most tragic, disturbing and riveting videos I have seen out of Iraq. And while Mr Sullivan quickly concludes that what we're seeing is a war crime, I think that is an over-simplified reaction to a complicated event. Here is the video:
I've watched this video a couple of times now, first with outrage similar to Mr Sullivan's, then with an eye towards seeing what the pilots saw. I don't mean to turn this tragedy into a psychological experiment, but I'm reminded of this selective attention test. By way of the text and markers in the video we are prodded to see one side of the event. (The helicopter pilots do not help matters with their casual approach to killing and intermittent laughter.) But ask yourselves, would you have been able to distinguish between the journalists' cameras and the guns some of the other men were carrying? More importantly, did you see the man with the RPG? Did you see him poke around the corner and seem to aim it at the helicopter?
Perhaps that is still not justification enough for the slaughter that ensued. I will let the Pentagon try to defend the act of firing on those helping the wounded. But I think the scene is more ambiguous than it first appears, and I think the pilots could make a case that they thought they were being engaged by armed insurgents. (We do not know why the helicopter was in the area.) I'm sure many of you will disagree, but my broader point is that no matter how precise our weaponry gets, no matter how much information we feed into our targeting systems, the decision to fire will always be based on incomplete information and come down to fallible human judgment. So while it is normal to react to these tragedies with varying degrees of moral repugnance, let us not be shocked. This is the nature of war and there is only one truly effective way to avoid such incidents.
More from Democracy in America
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Thinning out the field of Democrats could focus minds on the way to Iowa's caucuses
The election for Kentucky's governor will be a referendum on Donald Trump
Matt Bevin, the unpopular incumbent, hopes to survive a formidable challenge by aligning himself with the president
A state court blocks North Carolina's Republican-friendly map
The gerrymandering fix could help Democrats keep the House in 2020


Many lawmakers know Brittany Maynard's story by now, and many more will know soon as Brittany's husband, Dan Diaz, speaks out and urges supporters to action. But in order to be moved to act, they need to hear how important access to death with dignity is to you. Stand with Dan and tell them in a letter.
Writing letters is a powerful way to impact lawmakers' views. It is simple and highly effective. And the more letters lawmakers receive about the demand for end-of-life choice, the more significant the issue will become to them – and the more likely they will be to introduce or support a death-with-dignity law in your state.
We've included a letter that will go directly to your local legislator. Please consider personalizing it with your own reasoning or connection to the issue to make it even more compelling.


Awards for all, North & South Lanarkshire Councils, charitable donations and funds raised by our dedicated fundraisers are all greatly appreciated and absolutely essential.
Funds raised by our fundraisers are from a wide range of fundraising events.
The operational funding we receive plus the funds raised at fundraising Events allow the group to provide our comprehensive range of Support Services.
We are constantly pursuing alternative avenues of funding to ensure the future development of the organisation to all areas of Scotland.


ترکیب شن و ماسه با خاک رس - محطم ومجموع النباتکاشی نیما - لعاب ها لعاب ها. مصریان به این ترکیب شن و ماسه ، خاک رس هم اضافه کردند و دیدند که این مخلوط روی یک سطح عمودی که روی آتش قرار دارد می ایستد به این . >> نرى الأسعار.شن و ماسه PCL,تولید کنندگان از دستگاه های سنگ شکن شن و ماسه - محطم ومجموع النباتخط تولید شن و ماسه شن و ماسه خشک. چین شن و ماسه سنگ شکن و شستشو و تجهیزات -سنگ شکن تجهیزات برای تولید شن و ماسه خشک بندی شن و ماسه. تجهیزات کونمینگ بهترین سنگ . >> نرى الأسعار.
State of research in automatic as-built modelling - ScienceDirect. bypassing the filtering step in order to avoid the potential loss of information [8,6]. To conclude this section, it is worth noting that point cloud preprocessing is a very active research field, and more importantly from a practical point of view, numerous tools are available from open-source libraries and software, e.g. PCL ,.شن و ماسه PCL,Converted from /dev/PCL - Dennis Paper & Food Service8846 PAPETTI'S EGG PATTY ROUND 3.5" 1OZ CN 144/1CT. 9497 PAPETTI'S EGG OMELET PLAIN SINGLE . 1750 Luigi SHERBET RASPBERRY CUP CN. 96/4OZ. 89390 Luigi ICE ITALIAN CHERRY .. 19139 PINELAND FARMS POTATO DELUXE WHITE MASH 4/5LB. 1957 PINELAND FARMS POTATO DICED.
Abstract. The bilateral filter is a non-linear technique that can blur an image while respecting strong edges. Its ability to decompose an image into different scales without causing haloes after modification has made it ubiquitous in computational photography applications such as tone mapping, style transfer, relighting, and.
May 29, 2017 . Abstract 3D urban maps with semantic labels and metric information are not only essential for the next generation robots such autonomous vehicles and city drones, but also help to visualize and augment local environment in mobile user applications. The machine vision challenge is to gen- erate accurate.
Measuring Exposure in Hurricane Katrina: A Meta-Analysis and an .
Apr 8, 2014 . In terms of instrument for measuring PTS, two studies used the PTSD checklist – specific version (PCL-S) , one used the civilian version of the PCL .. and a Bollinger Memorial Research Grant awarded to Christian Chan by the Graduate Student Assembly at the University of Massachusetts Boston.
Mar 4, 2016 . Correspondence: tianjing_ortho163 (J.T.); jouyangsmu.edu or jouyang126 (J.O.);. Tel. . We fabricate a gelatin/PCL electrospun fiber mat with natural bone powder; the scaffold, not only possesses the ... first washed in cold PBS and then mechanically cut into mash. Later, 0.075%.
Thai Beverage, better known as ThaiBev (Thai: ไทยเบฟ) (SGX: Y92), is Thailand's largest and one of Southeast Asia's largest beverage companies, with distilleries in Thailand, Scotland, and China. Listed on the Singapore Stock Exchange, Thai Beverage Plc has a market capitalization in excess of US$4 billion. In January.
Additive manufacturing of scaffolds with sub-micron filaments via .
Jun 12, 2015 . With its relatively broad molecular distribution (PDI = 2.4) and moderate molecular weight (Mw = 83 × 103 g mol−1) the PCL used in this study was readily melt electrospun. As would be expected of a molten linear polymer, the loss modulus G'' = 1.1 × 104 Pa dominated the storage modulus G'' = 9.6 × 102.
Dec 20, 2017 . On May 21, 2011, Paulo Jorge Bártolo (and others) published the chapter: Biofabrication Strategies for Tissue Engineering in the book: Advances on Modeling in Tissue Engineering.
5354 Mach 64 VT. 1002 5654 Mach 64 reference. 5446 Rage 128 PRO Ultra AGP 4x. 1002 0004 Rage Fury Pro. 1002 0008 Rage Fury Pro/Xpert 2000 Pro. 1002 0018 Rage Fury . 148c 2073 CN-AG92E. 174b 7c13 Radeon 9200 .. 10b5 3068 Alpermann+Velte PCL PCI HD (3V/5V): Timecode Reader Board. 10b5 3463.
d 10025354 Mach 64 VT 0. s 1002535410025654 Mach 64 reference 0. d 10025446 Rage 128 . s 10025964148c2073 CN-AG92E 0. s 10025964174b7c13 Sapphire Radeon 9200 SE .. s 10b5903010b53068 Alpermann+Velte PCL PCI HD (3V/5V): Timecode Reader Board 0. s 10b5903012fe0111 CPCI-ASIO4 1 ESD.
Biomimetic Domain-Active Electrospun Scaffolds Facilitating Bone .
Nov 27, 2017 . Fax: +86-25-86516414., *(N.G.) E-mail: guningseu.edu. . The novel three-layer membranes were structured with serial layers of electrospun chlorhexidine-doped-PLGA/PCL (PPC), PLGA/PCL (PP), and β-tricalcium . Lu, Wang, Wilson, McManus, Jumai'an, Padakanti, Alavi, Mach, and Prud'homme.
Risk for suicidal behaviors associated with PTSD, depression, and .
Mar 25, 2014 . Ramsawh, Holly J.; Fullerton, Carol S.; Herberman Mash, Holly B.; Ng, Tsz Hin H.; Kessler, Ronald C.; Stein, Murray B.; and Ursano,. Robert J., "Risk for suicidal . (PCL) and the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Past-year suicidality was.
clinical or biological relevance (Justice et al. 2009; Chan et al. 2013) compared to culture in a Petri dish or flask. Moreover, in bio-microsystems, 3D microfluidic environ- ment enables an efficient observation and analysis of the microorganism dynamics and functions, an imperative task in studying biological cells (Hanada et.
If interested in the PCL Program you must complete and return the Primary Care Loan Interest form . Please visit .. His surgical team operated much like a MASH unit . Dr . Bryant was ... Clements, M .D ., they launched a campaign to increase their scholarship endowment in order to have a positive and lasting impact on.
Efficient Computation of k-Nearest Neighbour Graphs for Large High .
Sep 23, 2013 . This paper presents an implementation of the brute-force exact k-Nearest Neighbor Graph (k-NNG) construction for ultra-large high-dimensional data cloud. The proposed method uses Graphics Processing Units (GPUs) and is scalable with multi-levels of parallelism (between nodes of a cluster, between.
PCl,+,PCl,- do not cleave the chlorine atom when heated .. The fermented mash is continuously distilled to yield acetone and .. CN in presence of a quaternary N base at 50-loo", then halogenating if desired or reducing and esterifying (by treating with Fe and ClS0,H in presence of a t-base) to gave a leuco sulphuric acid.
Robert K. Naviaux; Brooke Curtis; Kefeng Li; Jane C. Naviaux; A. Taylor Bright; Gail E. Reiner; Marissa Westerfield; Suzanne Goh; William A. Alaynick; Lin Wang; Edmund V. Capparelli; Cynthia Adams; Ji Sun; Sonia Jain; Feng He; Deyna A. Arellano; Lisa E. Mash; Leanne Chukoskie; Alan Lincoln; Jeanne Townsend.
Corrosion and biocompatibility improvement of magnesium-based .
Mar 29, 2017 . Abstract. Magnesium (Mg) or its alloys are widely tested as potential orthopedic implants, particularly as biodegradable alloys for fracture fixation due to th.


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Q: How to detect why a process terminated programatically in Linux Processes are terminated for one of three reasons: they've reached end of execution (nominal case), they contain an uncaught exception (synchronous crash), or they've received some signal that they are not handling (asynchronous crash). Within the design of a program, we can instrument ways of at least detecting each of these (e.g., catch statements, signal handlers, etc.).
Suppose I wanted to design a program that can monitor another program's execution in Linux. I can easily tell if the program terminated by noticing its PID disappearing from /proc, but I won't know why. Is there a way to observe the target program to determine the cause of termination?

A: The main limitation is the amount of details you need. At the operating system level, you can basically only count for exit code or signal that killed the process.
Depending on your restrictions, there are multiple options:

*

*wait - allows for quick notification (blocking call or signal), but only works for immediate children.

*ptrace, directly (rather tricky) or via the strace command; it has limitations, e.g. a single process can only be ptraced by one process at a time, but it allows to specify a list of syscalls to monitor, so it does not need to be as slow as default invocation of strace.

*BSD Process Accounting. Typically requires root privileges to access, and definitely requires them to turn it on (it's global). Once it's running, you can effectively watch a file which grows an entry for every finishing process, including exit code / signal, either programmatically (the ac_exitcode field in the acct struct) or via the lastcomm command (c.f. http://man7.org/linux/man-pages/man1/lastcomm.1.html).

A:
Processes are terminated for one of three reasons: (a) they've reached end of execution (nominal case), (b) they contain an uncaught exception (synchronous crash), or (c) they've received some signal that they are not handling (asynchronous crash).

I'm not sure what (a) should mean -- even if a program returns from its main() function, it's still terminating by explicitly calling the _exit(2) (or exit_group(2)) system call (from the C runtime code that called main() in the first place). If it doesn't call _exit(), it will crash.
Also, I don't see what difference is between (b) and (c): they would receive a signal in both cases -- which they could either catch, block or ignore (except for SIGKILL -- or SIGSTOP, but the latter won't terminate the process).

Suppose I wanted to design a program that can monitor another program's execution in Linux.

Then, you should imitate what strace(1) or gdb(1) are doing: use ptrace(PTRACE_ATTACH), etc. For instance, this will only monitor the exit of a process, not all its system calls:
strace -e trace=none -p PID
strace -e trace=exit,exit_group -p PID

The PTRACE_O_TRACEEXIT option of ptrace(2) is interesting:

The tracee is stopped early  during  process  exit,  when registers are still available, allowing the tracer to see where the exit occurred, whereas the normal exit  notification  is  done  after  the process is finished exiting.

Linux also has the proc connector netlink interface, which allows you to monitor processes without stopping or affecting them in any way. It only works as root, though. A sample program using the proc connector interface is forkstat(1):
forkstat -e exit   # will show all exiting processes
stdbuf -oL forkstat -e exit | grep -m1 PID  # will only show when PID exits

redpajama_set_name: RedPajamaStackExchange


Various media reports can be used to inform food fraud vulnerability assessments.
A recently published paper advocates the inclusion of media reports as a source of information for assessing food fraud vulnerability.1 Those of us who maintain the Food Fraud Database could not agree more. We have been monitoring media reports for years and they are an important source of information in the database (accounting for 45% of all primary source references).
As I mentioned in last month's post, there are challenges with using media reports to inform food fraud vulnerability. Many media reports are general discussions of the issue of food fraud and are not necessarily reporting new information. It may be difficult to filter out these types of reports without manual review. There may also be concerns about the validity of media reports on food fraud. This is the reason we implemented a classification for "weight of evidence" for incident records in the database. Overall, approximately 30% of the incident records in our database are classified as a "low" weight of evidence due to unverifiable data or a lack of corroborating reports. Some of our users choose to filter these out of their searches.
We have received requests for information about how the data in the Food Fraud Database compares with numbers reported in the paper. Table 11 in the paper described the top product categories, countries and type of fraud as reported in four food safety tracking systems.1 We have adapted that table below to data from the Food Fraud Database.
As shown in Table 11 in the paper, the top four products by number of articles in the media monitoring system (in 2014-2015) were meat, seafood, milk and alcohol. As shown above, when looking at data in the Food Fraud Database from 2014 and 2015, the top ingredient categories are very similar: Meat/Poultry, Seafood, Dairy Products, and Alcoholic Beverages. However, there was little agreement in the country of origin of the reported cases among any of the systems. For the Food Fraud Database (shown above), the top countries of origin in 2014–2015 were India, China, the United States and Colombia. According to the paper, the top countries of origin reported by the food fraud media monitoring system were Egypt, the United States, the U.K. and Saudi Arabia. The top country of origin reported by RASFF was China and by HorizonScan was the Czech Republic.
Table 4 reported the "types" of food fraud (which correspond to what we call "reasons for adulteration") and the corresponding number of articles collected, which we have also adapted to the data in the Food Fraud Database below.
It is not possible to make meaningful comparisons among the reported fraud "types" without harmonized definitions and standardization of data collection processes, as noted in the paper. A glance at Table 1 from the paper illustrates the variety of food fraud categorizations in use among the various systems.1 Generally, it is a challenge to directly compare any of the information coming from various sources such as RASFF, HorizonScan, the Food Fraud Database and others, due to the differences in the way data is collected, standardized and reported.
In contrast with foodborne illnesses, which are generally required to be reported to public health agencies, food fraud typically does not result in acute illness and is difficult to track. The nature of food fraud combined with differences in data tracking systems make it almost impossible to reconcile the data among the various systems. Regardless of which system is reporting, the reports are likely just a fraction of the true occurrence of food fraud; however, each can provide valuable perspective on risks to food safety (including those from food fraud). A holistic assessment of food fraud vulnerability should take into account a wide variety of information sources, including media reports.
The latest food fraud incidents highlight the range of food products prone to fraud: Wine, liquor, extra virgin olive oil, produce, milk, eggs, meat and octopus.
Some of the most fraudulent labels include organic, free range, wild caught and halal.
Karen Everstine, Ph.D. is senior manager, scientific affairs with Decernis, which delivers technology-enabled global risk management solutions for product development, compliance, safety, regulatory and market access. She has 15 years of food protection experience, most recently focused on supporting the food industry in their efforts to ensure food authenticity and compliance with the EMA-provisions of FSMA. She is the technical lead for the Food Fraud Database, which is a resource that collects and standardizes relevant food fraud data to support vulnerability assessments. She has previously held both research-based and applied roles in academia, government, and non-profit organizations, and has collaborated with members of the food industry and regulatory agencies on many projects. She received her Ph.D. and MPH from the School of Public Health at the University of Minnesota and began her food safety career on "Team D" at the Minnesota Department of Health. She has a strong knowledge of the food regulatory landscape, is highly collaborative, and committed to the development of resources to support food safety and authenticity. She has authored many peer-reviewed journal articles, trade journal pieces, and regularly responds to media requests.


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Logistics & Logistics operators
Team and talent
Inheritance and Family Law
GLOBAL PROBLEMS - GLOBAL SOLUTIONS
Creating value in transport and logistics. Advice and contingency management as an element of success.
The client at the core of what we do
Holistic approach to address clients' needs in other areas entails that sometimes these also need to be addressed here through the creation of family agreements or protocols.
I.- FAMILY LAW.
Family Law is one of the most particular and sensitive areas of Civil Law, not only because of the delicate nature of its content but also because it usually involves minors and their future.
Extensive experience in advising on Family Law with a highly specialised team that is used to dealing with all kinds of situations, some of them very complex related to gender-based violence or domestic abuse. Our team of lawyers handles these complex issues with sensitivity, empathy and compassion.
Our advice always includes a preliminary orientation consultation to clarify the legal route to take and, on many occasions, to offer reassurance to the client.
The firm provides assistance in the following areas:
A.- MATRIMONIAL MATTERS.
1.- Matrimonial matters deriving from the celebration of the marriage and prior to the same. Our firm advises on the granting of marriage contracts where the future spouses stipulate the matrimonial property regime to govern their property relationships, as well as prenuptial agreements or protocols. We also provide advice in the case of international marriages, providing legal assistance on their effects and processing the necessary paperwork.
2.- Matters arising from the breakdown of the marriage bond.
(i) Annulments through civil proceedings.
(ii) Divorces, both consensual and contentious.
(iii) Application for and adoption of provisional and/or definitive measures.
(iv) Negotiation, in or out of court, of alimony and maintenance allowances.
(v) Negotiation, in or out of court, of guardianship and custody of minor children.
(vi) Negotiation, in or out of court, of visiting arrangements.
(vii) Negotiation of the awarding of the family home.
(viii) Negotiation, in or out of court, of the modification of provisional or definitive measures.
(ix) Liquidation, in or out of court, of the matrimonial property regime, whether it be community of acquisitions or participation in acquisitions, or readjustments between assets in the case of separation of property.
Specifically, advises on international divorces with conflicts between the legislations of different countries that determine the law regulating the validity of the marriage and its form as well as the personal and property effects of the marriage.
As a separate service, advice to women who are victims of gender-based violence or domestic abuse, with immediate assistance at hearings and applications for restraining orders or non molestation orders. This is a matter especially linked to Criminal Law, and both Departments of the Firm are fully coordinated with each other, albeit our lawyers specialising in matrimonial matters have a very specific criminal training that enables them to assess each specific case extremely well.
3.- Advice on arrangements for minors.
On many occasions the break-up of a marriage has consequences with respect to minors, children of the marriage. As already mentioned, Martínez-Echevarría advises on obtaining custody of the children by one of the parents or shared custody, in or out of court. We can also assist with negotiations regarding visiting regimes and alimony, and provide civil and criminal advice in the event of non-payment of maintenance allowances, non-compliance with visiting arrangements or legal kidnapping.
B.- PARENTAGE ACTIONS.
All issues that may arise in relation to declarations of parentage and challenges to the same.
C.- ADOPTIONS AND FOSTERING.
All types of adoption and foster care procedures as well as on all the legal proceedings and actions that usually form part of these situations.
D.- INCAPACITATION.
Throughout the year, our firm advises many clients who are indirectly or directly involved in incapacitation proceedings or others, such as the declaration of prodigality, which does not require the incapacitation of the affected person.
(i) Court proceedings for declarations of incapacity.
(ii) Court proceedings for de facto guardianship.
(iii) Court proceedings for declarations of prodigality.
(iv) Advice on the appointment of guardians, both of property and of persons.
(v) Advice on the appointment of de facto guardians.
(vi) Advice on the appointment of custodians / guardians ad litem.
(vii) Advice to guardians.
(viii) Advice to guardians on the rendering of accounts.
(ix) Advice on the removal of guardians.
DECLARATIONS OF ABSENCE AND DEATH.
Upon the disappearance of a person, the Law establishes a series of legal situations on the basis of which, and after certain time periods have elapsed, the disappearance acquires legal status which unfolds a series of legal effects related to the administration of their assets, the opening of their succession and the change of marital status of their spouse. Martínez-Echevarría advises on all these procedures and their implications in other branches of law.
II.- INHERITANCE LAW
Comprehensive legal services in Private Law and, specifically, in Inheritance Law, a speciality of Civil Law closely linked to Family Law. We have a team of professionals with extensive experience, in complete coordination with Departments as important in this area of Law as Tax Law.
As is well known, the notary public is an expert in this branch of law, providing effective advice and controlling the legality of the most important legal transactions in inheritance practice: wills and partition. However, sometimes this advice may not be sufficient in the case of agreed or amicable succession, and even less so in the case of inheritances through Court proceedings, which are completely outside the notary's area of competence. This is where the advice of a good legal team is of great importance. And it can make a difference at all levels.
In general, our Inheritance Law team advises our clients from the very beginning, that is to say, from when the death occurs.
First of all, through a system of initial orientative consultations,
By handling all preliminary administrative aspects,
Advising on the preparation of the notarial declaration of intestate heirs in the absence of a will if necessary.
Drafting the corresponding partition document as well as processing the paperwork before the Land, Company and Patent and Trademark Registries.
Our comprehensive advice includes all tax implications: preparation and settlement of Inheritance Tax and Tax on the Increase of Value of Urban Land (plusvalía).
1.- Prior advice. Substantive and tax planning
An inheritance (succession causa mortis) involves the liquidation of an estate and, as with any liquidation, for example that of a matrimonial property regime of community of acquisitions or that of a legal person (company, association, etc.), it often requires prior planning which may require advice from a professional. This advice begins with the foresighted preparation of a suitable will which, while respecting the law, meets the personal and financial interests of the testator/testatrix and his/her family.
Advice on inheritance matters at this level is part of the comprehensive advice in the field of private law provided by our Family Offices. Advice families or family groups on the administration and distribution or, where appropriate, liquidation of family estates organised as communities of acquisitions or through a corporate structure. In addition to the prior configuration of the estate structure, our lawyers in this Department are able to ensure that this structure and the administration system chosen by the client will be passed on to the next generation through instruments such as wills, succession agreements, modification of articles of association, para-social agreements, donations and trusts.
The configuration of the estate will in many cases determine the type of advice to be provided (business, industrial, agricultural, real estate, artistic or stock market), and also to be taken into account are the number of persons called to the inheritance, its characteristics and the international or non-international nature of the succession.
This advice, moreover, must not only respond to the needs of each family or business group or each client, but must also ensure the most scrupulous respect for the law and for the obligatory rights of forced heirs which always diminish a productive estate or subject its administration to collegiate discretion that can, in the end, be very detrimental.
Furthermore, the planning of any succession requires looking into the applicable taxation, given that, in many cases, it is taxation that will determine the scope of action of the specialist in Inheritance Law when trying to obtain the most fiscally favourable legal treatment for the client. The Inheritance Law team at Martínez-Echevarría works hand in hand with the Tax Law Department so that from the outset we can provide advice in a comprehensive and coordinated manner.
2.- Inheritance partition.
An inheritance necessarily results in the restructuring of an estate. Sometimes in its liquidation and in the creation of new ones. Even when there is a sole heir with no distribution of assets, the inheritance has to face a tax liquidation procedure which, if not controlled, may even entail the liquidation of companies or production units.
Inheritance Law team advises and assists in all matters relating to the appointment and/or execution of powers of the estate partitioner to avoid obstacles and vetoes in the partition by any of the co-heirs. The intervention here of a professional – usually a lawyer trusted by the deceased – is highly advisable. When the estate partitioner is a lay person, in practice, his/her performance always relies on that of a professional lawyer in all phases: inventory, appraisal and adjudication of the inheritance. Martínez-Echevarría and its lawyers have been executors and estate partitioners in some of the most important inheritances in Spain, in Madrid and other Autonomous Regions and abroad. Our firm's client portfolio is partly formed by important families of the high society and entrepreneurs and our lawyers are frequently assisting them in different matters.
The services provided by the firm's Inheritance Law Practice include advice on the sale of jewellery, paintings, decorative arts and goods of artistic value in national and international auction houses; obtaining certificates of antiquity and CITES, licences and export permits for antiques and works of art and contractual and real estate advice.
Unlike other countries in which the notary is the real executor and liquidator of the inheritance (France) or in which there are intermediaries who assume the administration and hand over of the assets (Anglo-Saxon Trusts), in our system, immediate succession takes place and the heir assumes rights, obligations and the capacity to manoeuvre. Here, too, the advice of a team of specialist lawyers is often necessary to defend the interests of the various parties involved (heirs, forced heirs, usufructuary widowers and legatees) and against creditors or contractual counterparties. Martínez-Echevarría is a renowned firm in this sector, participating throughout the year in dozens of inheritance and probate proceedings, advising all those involved, regardless of their position.
In all these cases, either as an estate partitioner or as a party lawyer, a professional must necessarily master all branches of law linked to an estate succession that includes, to a greater or lesser extent, a liquidation: Rights in rem, specifically in real estate; obligations and contracts and administrative law. Everything will depend on the structure of the estate and the obligations associated with the succession. The members of the Inheritance Law team have also worked in other Practices and are familiar with all areas of Civil Law.
Once again, this shows the tremendous importance of being in complete coordination with the Tax Law Practice, which has specialists in Inheritance and Donations Law, being able to provide services in any part of the country, regardless of the tax system.
3.- The procedural side of Inheritance Law. Court proceedings.
An inheritance upon death has, on the other hand, an enormous procedural aspect as many successions are heard before the Courts of Justice.
This is where the lawyer's work is essential. Court proceedings for the division of assets, including inheritance proceedings, are complex in all their phases and require the direct control of a good legal management team that not only masters the substantive and adjective law but also, in practice, can optimise expert evidence or make the most of all the resources available in the case.
Extensive experience in litigation, and inheritance is no exception. The firm has advised hundreds of clients on, among other matters, the following:
Challenges to wills and donations upon death;
Probate and notarisation of holographic wills;
Disinheritance and preterition of heirs.
Reduction of inofficious donations;
Claiming of legacies, forced heirships, supplementary parts of forced heirships and inheritance rights;
Formation, contestation and rescission of partitions.
4.- Inheritances and International Private Law.
From the point of view of both domestic and international law systems, we should bear in mind that the connecting point can lead to the application of Regional or Special Law within Spain, or foreign law. At present, Community regulations, and with good criteria, impose the domicile or residence of the deceased as the connecting point in the inheritance upon death (and not the nationality as in our Civil Code), which, in practice, is the most functional. However, on many occasions, the different inheritance systems of each legislation coexist – for example, by the application of the lex rei sitae for each real property included in the inheritance – which requires the lawyer to be flexible – by directing or being directed by – their international colleagues. It is not unusual for an Anglo-Saxon inheritance governed by a trust to have to be coupled with the inheritance of a real property located in Spain (on the coast, for example), in compliance with the legal requirements of both countries. The advice of an international professional is essential here.
Legal team of English and French-speaking professionals who have participated in the processing of inheritances with international links, especially in Europe and America, both in the US and Canada as well as Mexico and other Latin American countries. The Firm has a network of alliances with other firms in practically all European and American countries and the members of the Inheritance Law Department form part of the STEP network, specialists in trusts, estate partitioners and experts in Inheritance Law.
5.- Inheritances and Tax Law.


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Artist Profile: Renee Zeffiro
"Peace" – drawing by Renee Zeffiro
BY ANDREA BUSTAMANTE
"Peace" – Renee Zeffiro wants to encourage happiness.
What type of energy did you put into this work?
The energy that put into this was more positive than anything. It's more of statement saying how peace can be reached in the world. So many things are going on in the world and and people think peace isn't achievable, but this is like a hope that it can be. It's a literal image of peace in my mind.
How does this express a part of your identity?
I'm a very positive person and I want to encourage happiness. I like to express that through my art.
Did you struggle making this, if you did, where?
I struggled a little bit because it was difficult for me to show exactly what I wanted it to mean. When you think of the world you think of people fighting, but I wanted to show the positive aspect of the world like nature. A lighter side to that perspectives.
What's your advice to a beginning artist?
Just try your hardest, but don't lose who you are. Don't make your work for someone else, or for their liking. Make it because you want to; anybody else should be irrelevant.
Are you looking to find a career in art?
Yes, want to but I'm not sure where to start. I think that [art] can help me express correctly things that I can't really express through conversation.
How did this work itself impact you, how did it make you feel when you finished it?
This piece made me feel proud because I truly felt my voice was clear and it amplified what the voice I wanted to convey. I had found my voice though pencil and paper.
What makes you create?
For the most part other people. I try to make things from my perspectives that accentuate why others should enjoy life, somewhat an advice to others.


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Posted on August 27, 2015 by Fairborn Daily Herald
Rams rebuilding after successful year
By Zach Gregory - zgregory@civitasmedia.com
Coach Neal Kasner
Zach Gregory | Greene County News
JAMESTOWN — Rebounding off a year where they met a lot of success, the Greeneview Rams will have to work hard to get near where the team was last season. But according to coach Neal Kasner, this team isn't one to back down from a challenge.
"We're young and inexperienced in a lot of spots. We've got some growing pains going on, but I think we're a talented team," he said. "I think we've got some good players who are working hard and have a great attitude. We have a chance to get a lot better."
One thing Kasners wants to focus on with this young group is finding an identity. He says that it's still a work in progress.
"You don't really know exactly what you have. With experienced teams, you kind of know what your strengths are. With a young team, you have to find out who your players are and what they do best. You have to put them in position to succeed," he said.
"You need to make sure you're in tune with the locker room. You have to take a little bit more of a leadership role. Last year we let the seniors fill that role."
One thing is for sure, even young Greeneview teams always look forward to taking on the Indians.
"Cedarville is always a battle. It's in week 10, probably where it should be. That's always a big game here in Jamestown," said Kasner.
Junior quarterback Collin Matt will take the lead behind center this season. He places Chance Frye, who led the Rams in rushing and passing last season. Kasner said that Matt has room to grow but possesses the ability to be a solid quarterback.
Junior Ethan Bradds will provide a big target for Matt. The tight end has put on some weight in the offseason and will give the Rams more options on the offensive end.
Senior Logan Test and junior Austin Roberts will get the majority of the carries this season. Greeneview relied heavily on the running game last year and Kasner said that will continue.
Roberts and Isaiah Harding will lead the hardhitting Greeneview defense this season. Kasner said he will rely on their leadership to help the younger players understand their roles.
The Rams are thinnest in their secondary, but Kasner said that he has some promising pieces. Tyler Robinette and Harrison Gallagher will be playing corner while Logan Test and David Vanhorn will be at the safety position.
Test has a live leg and will provide help on special teams. Kasner said that it is still early and they are still trying to work out who will be doing what on special teams. One hurdle the team needs to overcome is snapping. Frye punted for the team last year.
http://aimmedianetwork.com/wp-content/uploads/sites/50/2015/08/web1_DSC06601.jpgBarb Slone | Greene County News
http://aimmedianetwork.com/wp-content/uploads/sites/50/2015/08/web1_DSC_00032.jpgZach Gregory | Greene County News
http://aimmedianetwork.com/wp-content/uploads/sites/50/2015/08/web1_DSC_0089-1.jpgCoach Neal Kasner Zach Gregory | Greene County News
By Zach Gregory
zgregory@civitasmedia.com
Reach Zach Gregory at (937) 372-4444, Ext. 2124.
Fairborn OH, 45385
Follow @fairbornherald
Hi! A visitor to our site felt the following article might be of interest to you: Rams rebuilding after successful year. Here is a link to that story: https://www.fairborndailyherald.com/sports/2530/rams-rebuilding-after-successful-year


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Australian swimmer Maddie Groves alleges she was molested as a teenager
Olympic silver medallist Maddie Groves has claimed that she was molested by a swimming official who still works in the sport.
December 9, 2021 - 8:48AM
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Australian swimmer Maddie Groves has claimed she was molested by a person who still works in the sport.
Earlier this year, Groves announced she would not be competing at Olympic trials in June, citing "misogynistic perverts in sport" in a social media post explaining her decision.
"You can no longer exploit young women and girls, body shame or medically gaslight them and then expect them to represent you so you can earn your annual bonus. Time's UP," she wrote.
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Groves, who won silver in the 200m butterfly at the Rio Olympics, said she has received a lot of support since boycotting the Tokyo trials.
She has met with Swimming Australia, and the governing body announced it will set up an all-female panel to investigate the treatment of athletes.
But in a fresh revelation, the 26-year-old has claimed in an interview with ABC's 7.30she was sexually abused by a swimming official as a teenager.
Australian swimmer Maddie Groves. Picture: Instagram/mad_groves
Groves said she decided to speak publicly on the allegations after learning of an unrelated investigation into former elite swimming coach John Wright, who was accused of sexually abusing a number of teenage boys he trained at Queensland pools in the 1980s and 1990s.
"When I was underage, on multiple occasions I was actually molested by an adult male," she said.
"At the time I didn't feel like there was anyone I could tell about that. And there's no-one in swimming that I would trust disclosing that to now, either."
Groves chose not to identify the alleged perpetrator.
Groves won silver in the 200m butterfly at the Rio Olympics. Picture: Instagram/mad_groves
She declined to compete in the Olympic trials in June. Picture: Instagram/mad_groves
"I haven't made a complaint about this individual," she said.
"I guess my experience from trying to make complaints about other people in sport was so discouraging, it really didn't leave me feeling that making a complaint about this person would be any different to the others.
"I don't think I really want to report it to police. It's obviously a huge process emotionally and it takes such a long time … and then it doesn't necessarily end up working out that well.
"I've had a couple of other friends and people that I know in swimming that have been sexually abused and assaulted and they've been through that process.
"It ends up being really disappointing … and things don't really seem to change. It's sort of swept under the rug.
"And I think if I made a complaint, I don't really think anything would be any different to that.
"It's an uncomfortable thing to have to talk about and deal with, but it's not my fault, and I just hope that by speaking about this stuff that it is taken seriously and that there are protections put in place."
Swimming Australia statement in response to 7.30 report
Swimming Australia takes all complaints in relation to conduct very seriously and took all steps to address the complaints raised by Ms Groves. Ms Groves requested and was granted a meeting with President Kieren Perkins and former CEO Alex Baumann and was offered every opportunity to raise her complaints and concerns. At this meeting Ms Groves raised concerns in relation to a coach within our system. These allegations were the subject of a three-month independent investigation conducted by Q Workplace Solutions.
Ms Groves was afforded several opportunities to discuss the complaints, including participating in an interview with an independent investigator. Ms Groves was asked to provide further information to assist the investigation process, but she declined to do so.
The investigator ultimately determined that the complaint against Swimming Australia was unsubstantiated.
During her interview with the 7.30 program, Ms Groves also made allegations against another coach, which Swimming Australia was not aware of. At no time had complaints about this coach been made to Swimming Australia, and we are now cooperating with Sport Integrity Australia to ensure an appropriate, independent process is put in place for these new allegations.
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Finally, the allegations of sexual assault by an unidentified individual made by Ms Groves during the report was the first Swimming Australia had been made aware of this matter. These allegations have been referred directly to the Queensland Police in accordance with Queensland's legislative requirements.
Swimming Australia remains resolute in its commitment to continually improve our sport to ensure it is a safe and thriving environment for all participants from the grassroots through to the elite level.
Four-time Olympian Emily Seebohm has revealed she wouldn't want her kids to follow in her footsteps but just can't give up her dream.
Emily Seebohm is a four-time Olympian and seven-time medallist but the backstroke superstar has revealed just how little these stars get paid.
Four-time Olympian and seven-time medallist Emily Seebohm has revealed why she now believes crying is a sign of weakness.


Justin Homer is a partner in The Difference at PwC Australia.
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