After being stalled in negotiations for months, mostly around disputes over SNAP, the farm bill the conference report has been released.
The agreement was reached after a proposal — backed by House Republicans and President Trump — to add stricter work requirements for those who receive food stamps was taken off the table.
The behemoth piece of legislation will cost $867 billion over 10 years, according to House committee staffers.
Of course, it's not law just yet.
The bill must still pass both the House and the Senate and be signed into law by the president, but that could come as early as this week.
While much of the farm bill compromise mirrors current law, there is a major change coming for farmers: Industrial hemp will be legalized. It's a boon for the increasingly popular cannabidiol, or CBD oil, industry, which is being used for medicinal purposes.
Forestry was another sticking point that emerged in the final weeks of negotiations, with the White House weighing in on the California wildfires. It didn't get exactly what it wanted, but specific thinning projects ranging from 3,000 acres to 4,500 acres of forest will be exempt from the public comment period.
As for conservation, the bill severely cuts funding for one of the three major programs that pays farmers to use environmentally friendly practices, like cover crops and field rotation. A different program will see more money, and there will be more land that farmers will be paid to fallow.
Changes to food stamps, or the Supplemental Nutrition Assistance Program, emerged as the biggest sticking point between the House and Senate bills and bogged down negotiations since the summer.
The House plan, which passed by the narrowest of margins and without single Democratic vote, called for those who receive the SNAP food subsidy to work more.
The Senate's version of the farm bill, which had no controversial changes to SNAP, passed 86-11. The final compromise bill is also expected to enjoy broad bipartisan support.
Lawmakers are hoping for swift passage this week so that it does not get swept into negotiations to keep the government funded beyond next Friday.
Keeping in spirit with the holiday season, Congress gifted itself a little breathing room by last week by punting on a fight over funding the government into late December. This came on the heels of tributes honoring former President George H.W. Bush at both the U.S. Capitol where he lay in state and at the memorial service at the Washington National Cathedral last week.
Bush died late last month at age 94.
Trump had repeatedly weighed in on negotiations saying he wanted stricter work rules in the final bill. Not having stricter work requirements is seen as a setback by conservatives who had made reducing federal safety net programs a top priority with Republicans controlling of both chambers of Congress and the White House.
The outcome of the midterm elections changed the negotiating leverage conservative holdouts had on the work requirement issue. If no deal was reached, the farm bill writing process would start anew under Democratic control of the House when the new Congress is seated in January.
According the Agriculture Department, more than 42 million Americans received SNAP benefits last year. The nutrition section of the farm bill, which includes SNAP, makes up about 80 percent of the farm bill's expenditures.
The Trump administration has hinted at plans to limit states' authority to temporarily suspend work requirements for some food stamp recipients. States can use the waivers citing areas of high unemployment or limited job availability.
Politico reported last week that Agriculture Secretary Sonny Perdue will introduce the proposed rule change after the farm bill passes.
After months of struggle, lawmakers in Washington have reached agreement on a new farm bill. The bill will cost nearly $900 billion over the next 10 years. Grant Gerlock of NET News in Nebraska reports on what's in the bill and what's not.
GRANT GERLOCK, BYLINE: One of the biggest fights over the huge farm bill had nothing at all to do with farmers. It was about the largest budget item in the bill - the food stamp program, also known as SNAP. House Republicans wanted to double the number of people required to work in order to stay in SNAP. Senate Democrats vowed to block that proposal. The standoff lasted for months. But when the midterms flipped the House, it forced the issue. This morning, House Speaker Paul Ryan endorsed the compromise.
PAUL RYAN: This bill strengthens work requirements and boosts work supports so that more people are spurred toward opportunities.
GERLOCK: That makes it sound like the House proposal is in the bill, but it's not. There is extra money for training programs, but the work requirements were dropped to clear the way for the bill to pass. And that's how it is with much of the farm bill. It makes incremental changes, not structural reforms. That goes for SNAP and Forestry, which leaves out most last-minute demands made by the White House to fast track forest-thinning projects. Some describe this as a status quo bill. It even costs about the same. But Juli Obudzinski of the National Sustainable Agriculture Coalition says there are significant changes. She points to what she calls tiny but mighty programs that the farm bill would make permanent, things like outreach to minority and veteran farmers and training for new farmers.
JULI OBUDZINSKI: We know that these issues, they're not temporary issues, especially the aging farm population and where the next generation of farmers are going to come from.
GERLOCK: The farm bill would more than double research funding for organic farming, and it legalizes hemp for industrial products and medicinal CBD oil, something many farmers hope will become a new, lucrative cash crop. Up to now, only a handful were able to grow it under tight regulations. John Currier farms in the Imperial Valley of Southern California where four generations of his family have grown winter vegetables, like cauliflower, lettuce and broccoli. He now wants to swap those veggies for hemp because he says he can't keep up with farm consolidation.
JOHN CURRIER: I mean, the writing's on the wall that unless you're a big corporate farmer that's year-round in the produce business, you pretty much got to get out of it.
GERLOCK: In the farm bill, states can allow hemp production as long as the crop contains less than 0.3 percent of THC, the compound in marijuana that causes the high. Aspiring hemp farmers like Currier would even be eligible for crop insurance.
CURRIER: I need something else to grow. I mean, this hemp deal's kind of fallen in our lap at the exact perfect time.
GERLOCK: But it's not a done deal until the farm bill reaches President Trump's desk.
MARK NELSON: And it always goes back to politics, and I hate politics; most farmers do.
GERLOCK: That's Mark Nelson, who raises corn, soybeans and cattle near Paola, Kan. Like a lot of farmers, Nelson has been working against a headwind. The trade fight with China has spoiled soybean prices. And on top of that, a drought crashed crop yields. He says crop insurance subsidies, which are mostly unchanged in the farm bill, help him avoid a critical financial blow.
NELSON: And that's what's important for most farmers is just get me to next year. We know we're going to have our ups and downs. We're going to have years where we don't produce and crop insurance helps us with our lenders and banks. And that's all tied to the farm bill.
GERLOCK: A bill that's years in the making and crucial for the people who grow the food we eat. For NPR News, I'm Grant Gerlock.
CORNISH: That story comes to us from Harvest Public Media, a reporting collaboration focusing on agriculture and rural issues.
(SOUNDBITE OF GRUP SES' "GSBCB WITH COCO BRYCE") Transcript provided by NPR, Copyright NPR.
If you peer into Americans' grocery carts, you're unlikely to see a mix of foods and beverages that make for an ideal diet. And this is true for many of the nearly 42 million people who receive food stamps, too.
Congress is considering provisions in the latest farm bill that would roll back eligibility and impose strict work requirements for people receiving help from the Supplemental Nutrition Assistance Program, or SNAP.
About 3.8 million Texans rely on SNAP, the largest program for feeding low-income Americans.


Olfactory (ol-fak'to-re) receptors, used to sense smells, are similar to those for taste in that they are chemore-ceptors sensitive to chemicals dissolved in liquids. These two chemical senses function closely together and aid in food selection, because we smell food at the same time we taste it. In fact, it is often difficult to tell what part of a food sensation is due to smell and what part is due to taste. For this reason, an onion tastes quite different when sampled with the nostrils closed, because much of the usual onion sensation is due to odor. Similarly, if excessive mucus secretions from an upper respiratory infection (such as a cold) cover the olfactory receptors, food may seem to lose its taste. About 75 to 80 percent of flavor actually derives from the sense of smell. Clinical Application 12.2 discusses an unusual type of sensory abnormality.


See publications for Susan Klein, CNM.
This provide was the worst provider I have ever seen. She was rude and condescending. She told me I needed to lose weight and would not take my questions seriously. I will never see her again.
I had a really good, first experience with the care Provider. She was very thorough, calm, and, interested in helping me with my needs.


This is the Juventus Away Kids Football Kit 2018 2019. Cheer the reigning Serie A champs, joined by new teammate Cristiano Ronaldo.
SoccerLord provides this Cheap Juventus Away Kids Football Kit also known as the Cheap Juventus Away Kids Soccer Kit Jersey with the option to customise your football kit with the name and number of your favourite player including Cristiano Ronaldo, Sami Khedira, Paulo Dybala, Cuadrado, Zaza, Mario Mandzukic an iconic player such as Del Piero, Pirlo or even your own name.
Please note if you are choosing any patch such as the Serie A, European Champions League patch or the Europa League Patch the patches will be stamped onto the shirt. If you don't want the patch stamping onto the shirt and want it simply putting in with the shirt please contact out help desk. The maximum length of a customised name is 10 characters, the maximum amount of numbers is 2, if you require specialized printing please contact our help desk. Please also note if you put the number beginning with "0" it will automatically be changed to just a single digit unless you contact the site and make special arrangements.


Your fiancé will be more than happy to help with this great trick.
The joy of planning a wedding is something that a girl dreams about as soon as they are big enough to make toilet paper veils. But I'd challenge any guy to raise their hand and admit they've been dreaming about their wedding day! I'm pretty sure a groom does not spend his days dreaming about the color of his tuxedo, or whether he'll wear a tie or bow tie.
Even when guys do finally take the plunge, offering up a ring to the one they love, they are rarely the one stressing about wedding details. Menu selection, venue, color schemes, decorations, music, a cake designer, a wedding planner, showers, or any of the other details that go into planning that "dream wedding – that's firmly in the hands of the bride to be.
This planning burden, coupled with "whatever you want dear" responses from the groom can add to a bride's stress level. Many brides get annoyed and frustrated trying to get their fiancé involved in the wedding plans, without feeling like they are pulling teeth.
But stress no more. We have come up with a great solution that will help you get your future husband involved with the wedding; Eventastic Weddings universal gift registry.
Typically when you go to register for wedding gifts you are stuck at those typical big box retailers such as The Bay and Home outfitters for the typical wedding gifts like kitchen appliances and bedding. Most grooms would rather have their back teeth removed than head off on a gift shopping excursion and meeting with a bridal registry consultant.
The Eventastic Weddings universal gift registry is something completely different. It allows you and your groom to register for any item, from any store anywhere, by using your smart phone to swipe a product's bar code. If shopping on line, you can use our handy tool bar button to add items to your registry list from various web sites. This allows you to add virtually any gift you can imagine to your registry.
So if your guy wants to add a new flat screen TV, accessories for his Harley, or a new snowblower, he can; simply with a click from his smartphone.
Another great feature that your future husband will love is Eventastic Weddings cash gift registry. They can allocate a dollar amount to specific goals and items that they are saving for, e.g new golf clubs, fishing trip, theatre room renovations, anything they truly want and collect the funds directly from your wedding website!
We're pretty sure we've come up with a sure fire way to finally get your future husband involved at last. What do you think?
It's free to sign up! Go to www.eventasticweddings.com and begin registering your gifts today.


text:
Home Top News Maps in Jordan's children textbooks mark Israel, ignore Palestine
Maps in Jordan's children textbooks mark Israel, ignore Palestine
Maps placed in two textbooks provided to Jordanian school children and financed by the U.S. Agency for International Development (USAID) have stirred controversy in the kingdom because they illustrate Israel and fail to mention Jordan and Palestine.
The Jordanian education ministry distributed the textbooks for students in grades one through 12, which contained health-related contents.
The maps featured on some of the pages portrayed a crooked lesson in geography: while Israel, Syria, Lebanon, Saudi Arabia and Iraq were all marked, Jordan and Palestine was left out. However, Jordanian cities, including the capital Amman, Irbid and Zarqa were marked.
"In effect, the exclusion of these names annexes Palestine to Jordan," the West Bank Association said in a statement, according to Israel's Ynetnews website. "Anyone who recognizes the Zionist entity eliminates Jordan and Palestine."
According to the association, one of the textbooks that displayed the map cautioned students against smoking and also deals with topics like healthy eating habits. USAID financed the textbooks as part of a series.
"This step intentionally and offensively misleads children under the guise of imparting health awareness," the group said.
The Jordanian Association reflected the sentiments that such omissions were intentional. The group against Zionist stance argued that the map marked Golan Heights as an occupied territory, but did not specify other occupied regions- referring to Palestine-indicates the act was not unintentional.
The group called on all teachers to refuse to distribute the books, and "warn the students about the dangers that they contain."
The inclusion of the Israeli map in school textbooks infuriated other professional groups across the country; pointing "new terms" that Jordanians oppose were penetrating in school books.
The chairman of the Jordanian agronomists' association, Mahmoud Abu Ghanima, was quoted by Ynetnews as saying that the books should be pulled out, and those who helped distribute them should be indicted.
In an interview with the Ad-Dustour newspaper, the chairman of the teachers' association, Mustafa Rawashdeh, further called for the indictment of those responsible for the mishap.
The education ministry, in turn, told the newspaper it has established a committee to probe the allegations.
However, retired army colonel and Director General and Founder of the Horizon Center for Studies and Research in Amman, Dr. Rateb Amro said that he believed that there is no tension between Jordan and Israel and the relationship of the two is at good terms, Israeli Ynet.com online reported on Sep.14.
Source: Al Arabiya

redpajama_set_name: RedPajamaCommonCrawl


3nom will get the job done, and that you don't have to worry about it.
on your business not your IT.
We believe in great relationships. At 3nom, we believe that nothing is more important than the interaction between our customers and our team. We don't want to just get a sale, we want to build a relationship. It's you, the customer who keeps us in business. We know that, and it is our goal to do whatever we can to help you succeed.


text:
Malik returns empty-handed as Qadri firm on march
Dated: 07 January 2013
LAHORE: Federal Interior Minister Rehman Malik, who called on Tehrik-e-Minhajul Quran (TMQ) chief Dr Tahirul Qadri at his secretariat on Monday night, reportedly failed to convince him to give up his proposed march and sit-in at Islamabad on January14.
"The march will be held at all costs, and if anyone tried to sabotage it, then I cannot guarantee that it will remain peaceful. "In such a case, those interfering in our peaceful march will be responsible for any untoward outcome," warned Qadri while talking to reporters along with Rehman Malik after the meeting.
The TMQ chief clarified that Rehman Malik had not come for any negotiations. He said: "I will only hold negotiations with the prime minister and his cabinet if they come to me for the purpose," he said. "I clearly explained my charter for change and a package of demands to Interior Minister Rehman Malik and he agreed that all of my demands were in line with the Constitution and law of the land," he added.
Malik said he had asked Dr Qadri about his plans regarding the proposed march on Islamabad and the venue where hewould be stationed for the sit-in. He said he was satisfied that all the demands of Dr Qadri were according to the Constitution and that he was not trying to postpone elections or doing anything extra-constitutional.
He said he had asked Dr Qadri not to come to Islamabad but since his demands were in line with the Constitution, the government would not stop his march. The minister said he asked the Punjab home secretary and other officials concerned to provide security to Dr Qadri's march and escort them through the Punjab territories from where he intended to pass before reaching the federal territory of Islamabad.
He clarified that neither the Pakistan Muslim League-Q leadership nor the Muttahida Qaumi Movement chief Altaf Hussain were trying to do anything unconstitutional or were involved in any move to derail democracy. He quoted Altaf Hussain as saying that his party was not involved in any move against democracy or trying to delay elections. Malik said his government would not tolerate anything against the country's security, solidarity and sovereignty.
Qadri protested that certain elements had been trying to sabotage his march by creating hurdles in it. He mentioned that bus owners had been pressurised to cancel the booking for the Islamabad march and a number of bus owners and transporters had returned the advance money and cancelled bookings.
He said his march was aimed at turning the present democracy of loot and plunder into a democracy for the welfare of the common man. "I want that the law should create a capacity to implement the requirements of the Constitution so as to establish freedom for all to cast their vote and contest elections, maintain the rule of law, and make sure that no corrupt elements contest elections or reach the parliament," he added.
Qadri said any party which called itself democratic would have no objections to his demands and plans of his march on Islamabad.
Dr Hassan Mohi-ud-Din Qadri highlights the importance of social media tools for Dawah
Social media powerful tool for the articulation of the message of hope: Dr Hassan Mohi-ud-Din Qadri
Nations have no future without education: Dr Tahir-ul-Qadri
Allama Syed Jawad Naqvi visits the campus of Minhaj University Lahore
Gosha-e-Durood: Monthly Spiritual gathering for January 2021 held


text:
Validity and analysis of the Diabetes Injection Device Preference Questionnaire (DID-PQ)
Kristina S. Boye1,
Louis S. Matza ORCID: orcid.org/0000-0001-6374-59482,
Brooke M. Currie2 &
Karin S. Coyne2
Journal of Patient-Reported Outcomes volume 4, Article number: 104 (2020) Cite this article
The Diabetes Injection Device Preference Questionnaire (DID-PQ) was designed to assess patient preference between two non-insulin injection devices. In a recent crossover study, people with type 2 diabetes (T2D) completed the DID-PQ after performing mock injections with two non-insulin injection devices. The purpose of the current analysis was to use these data to assess construct validity of the DID-PQ and demonstrate one way to test whether there is a significant preference for one injection device over another.
Data were from an open-label, multicenter, randomized, crossover study assessing preference between the dulaglutide and semaglutide injection pens. In addition to the 10-item DID-PQ, people with T2D completed a global item assessing overall preference. DID-PQ responses were compared to the global preference item (percent agreement, Gwet's AC1, prevalence-adjusted and bias-adjusted Kappa [PABAK]). For each item of the DID-PQ, a two-sided binomial test assessed whether the difference in preference was statistically significant.
The sample included 310 participants (48.4% female; mean age = 60.0). The DID-PQ had minimal missing data. There was strong concordance (percent agreement > 78%) between the global preference item and all DID-PQ items except item 6, which assesses preference related to needle size (59.7%). The Gwet AC1 and PABAK statistics also indicated strong agreement between the global preference item and all DID-PQ items except item 6. There was a statistically significant difference (p < 0.0001) in preference on every DID-PQ item, with more participants preferring the dulaglutide device.
Patient preference has been recommended as a "major factor driving the choice of medication" in a consensus report by the American Diabetes Association and the European Association for the Study of Diabetes. Current findings suggest that the DID-PQ may be a useful tool for providing insight into preferences of people with T2D using non-insulin injectable medication.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are often recommended for treatment of type 2 diabetes (T2D) [1]. Medications in this class have demonstrated efficacy for glycemic control, along with a low risk of hypoglycemia and the potential benefit of weight loss [2,3,4,5]. The injectable GLP-1 RAs vary in terms of injection devices and treatment administration procedures, which could have an impact on patient preference.
Therefore, two patient-reported outcome (PRO) measures have been developed to assess patient perceptions of injection devices used to administer these non-insulin injectable medications: the Diabetes Injection Device Experience Questionnaire (DID-EQ) and the Diabetes Injection Device Preference Questionnaire (DID-PQ) [6]. The DID-EQ was designed to assess perceptions of a single injection device, and it has demonstrated reliability and validity in patients treated with GLP-1 RAs [7]. The DID-PQ was designed to assess preference between two non-insulin injection devices. This questionnaire has been used in two previous studies [7, 8]. In both studies, however, it was completed by a relatively small subset of patients who had used two non-insulin injection devices (n = 27 and n = 58). Therefore, it was not possible to draw conclusions about construct validity of the DID-PQ from these previous datasets.
In a recent crossover study with a larger sample, people with T2D performed mock injections with two non-insulin injection devices, and all participants completed the DID-PQ to report preferences between the devices [9]. Data from this study provide the first opportunity to examine performance of the DID-PQ in a larger sample. The purpose of the current analysis was to assess construct validity of the DID-PQ and demonstrate one way to test whether there is a significant preference for one injection device over another.
Data were from an open-label, multicenter, randomized, crossover study (ClinicalTrials.gov identifier: NCT03724981) [9, 10] assessing patient preference for the dulaglutide single-use pen [11] and the semaglutide single-patient-use pen among injection-naïve patients with T2D [12]. The devices used in the study were those commercially available in the United States. The study design is illustrated in Fig. 1. Study participants were recruited at 13 clinical sites across the US, including nine general practice clinics and four endocrinology clinics. After providing consent to participate in the study, participants were randomly assigned to one of the two device orders (i.e., either dulaglutide or semaglutide first, followed by the other device). After being trained to use each device based on device instructions for use (IFU), participants performed all steps of injection preparation and administered mock injections into an injection pad. Further details of the study design, inclusion/exclusion criteria, and methods have been published previously [9].
Crossover Study Design
After completing training and performing mock injections with both devices, participants completed the measures described below. Both questionnaires were administered on paper forms and used the brand names (Trulicity for dulaglutide; Ozempic for semaglutide). The questionnaires included color images of the injection devices at the top of the page to avoid any confusion regarding which device corresponded to each question and response option.
Global preference item
The global preference item evaluated patient preference between the devices. The item asked "Overall, which device do you prefer?" Response options were Ozempic, Trulicity, or No Preference. All participants completed the global preference item before completing the DID-PQ.
Diabetes Injection Device Preference Questionnaire (DID-PQ)
The DID-PQ was designed to assess patient preferences between two non-insulin injection devices [6, 7]. The 10 questionnaire items were developed based on qualitative research with patients. Items 1 to 7 focus on preference related to specific characteristics of injection delivery systems. Items 8 to 10 are global items assessing preference based on overall satisfaction, ease of use, and convenience of the injection devices. Each item is rated on a five-point scale allowing respondents to indicate whether they prefer or strongly prefer one of the devices over the other. For each item, participants could also select the "no preference" response. As the five response options are categorical, mean scores are not calculated.
Analyses were performed using data from participants who had (1) been randomized to a device order, (2) been exposed to both devices regardless of whether they successfully completed the mock injection, and (3) completed the global preference item. No imputations were performed for missing data. All statistical tests were two-sided with a significance level of 5%. Descriptive statistics (mean, standard deviation, range, and frequency) were used to summarize demographic and clinical characteristics, as well as responses to questionnaires.
The categorical response options of the DID-PQ cannot be treated as continuous scores. Therefore, correlations with a criterion measure that would typically be conducted to examine construct validity of PRO instruments cannot be used. Instead, the 10 DID-PQ items were compared to the global preference item using categorical analyses so that concordance between the two instruments could be assessed. For these analyses, the five DID-PQ response options were collapsed into three categories by combining the "prefer" and "strongly prefer" response options. Thus, the DID-PQ and global preference items had the same three levels of response: prefer dulaglutide device, prefer semaglutide device, and no preference between devices.
These three-level responses were compared to responses on the global preference item in three ways: (1) percent agreement, (2) Gwet's AC1 statistic [13, 14], and (3) the prevalence-adjusted and bias-adjusted Kappa (PABAK) statistic [15]. The Gwet's AC1 and PABAK statistics were used to assess concordance instead of the traditional Kappa statistic because Kappa is sensitive to uneven data distributions [16]. For example, when there is high agreement in situations with an uneven distribution of responses across the possible response options (e.g., high prevalence observed for one response option), Kappa may not accurately represent concordance [16]. Gwet's AC1 is similar to Kappa, but it uses a different definition of chance agreement with a more realistic assumption that only a portion of the observed ratings will potentially lead to agreement by chance [13]. Thus, it is more robust to an uneven distribution of data. The PABAK statistic defines and incorporates both a bias index and prevalence index into its calculation of the estimate of chance agreement, therefore mitigating potential effects of rater bias and overall prevalence [15]. The Gwet AC1 and PABAK statistics were interpreted using benchmarks commonly used to interpret agreement statistics. For example, values over 0.80 are thought to indicate "almost perfect" agreement or "very good" agreement [17, 18].
To determine whether significantly more participants preferred one device over the other with regard to each item of the DID-PQ, comparisons between devices were performed according to the following steps: (1) participants who provided a neutral response for an item were dropped from analysis of that item; (2) for each item, responses were grouped into two categories (prefer dulaglutide device or prefer semaglutide device); and (3) a two-sided binomial test was performed to determine whether the difference in preference between the devices was statistically significant. This test assessed whether the proportion indicating preference for one of the two devices differed from 0.5. For each DID-PQ item, the null hypothesis was that the probability of preferring one of the devices was 0.5, which would indicate that an equal number of respondents preferred each device. If the binomial test yielded a significant p-value, then the null hypothesis could be rejected, which would mean that significantly more participants preferred one device over the other.
Sample characteristics
A total of 310 participants were included in the sample, with half (n = 155) randomized to each group (i.e., either dulaglutide or semaglutide device first). Detailed demographic and clinical information has been previously published for this sample [9], and a selection of participant characteristics are presented Table 1.
Table 1 Demographic and Clinical Characteristicsa
Validity of the DID-PQ
There were minimal missing data on the DID-PQ, as shown in Table 2. There was strong concordance (percent agreement > 78%) between the global preference item and nine of the 10 DID-PQ items (Table 2). Percent agreement was particularly high (> 91%) for the three DID-PQ global items assessing preference related to overall satisfaction, ease of use, and convenience (items 8, 9, and 10). The only DID-PQ item that did not have strong concordance with the global preference item was item 6, which asks about preference related to needle size (percent agreement = 59.7%). The Gwet AC1 and PABAK statistics were consistent with percent agreement, with results indicating strong agreement between the global preference item and all DID-PQ items except item 6 (Table 2).
Table 2 Agreement Between DID-PQ Items and the Global Preference Item Assessing Preferences between Two GLP-1 Receptor Agonist Injection Devices (N = 310)
Significance testing of preferences between devices
For each item of the DID-PQ, a two-sided binomial test was performed to determine whether significantly more participants preferred one device over the other (Table 3). There was a statistically significant difference (p < 0.0001) in preference on every item of the DID-PQ with significantly more participants reporting a preference for the dulaglutide injection device.
Table 3 Significance Testing for Difference in Preference between Devices on Each Item of the DID-PQ (N = 310)
Patient preference has been recommended as a "major factor driving the choice of medication" in a consensus report by the American Diabetes Association and the European Association for the Study of Diabetes [1]. To collect and interpret patient preference data, well-designed and valid measurement tools are needed. Current findings suggest that the DID-PQ may be a useful tool for providing insight into preferences of people with T2D using GLP-1 receptor agonists. While a single global item can be used to assess injection device preference, the DID-PQ can provide a more detailed assessment of factors contributing to this preference, including ease of use, convenience, overall satisfaction, and details of the injection experience.
Concordance with the global preference item supports the construct validity of the DID-PQ. Item 6 of the DID-PQ, which assesses preference related to needle size, had the lowest concordance (59.7% agreement). Although needle size is an important factor for some patients [6], this item may not have yielded consistent data because participants were injecting into an injection pad rather than injecting themselves. Therefore, they did not personally experience the feeling of injecting with either needle, and the factors that participants considered when responding to this question are unclear and may have varied widely. Future research involving actual injections rather than mock injections may be necessary to assess validity of DID-PQ item 6.
In addition to examining validity, the study provides a parsimonious and easily interpretable method for examining whether preference for one device over another is statistically significant (Table 3). This analysis approach excludes neutral (i.e., no preference) responses. For situations when it may be important to consider the number of neutral responses (which were relatively rare in the current study; Table 3), the Prescott test can be used to determine whether there was a statistically significant difference in preference while accounting for the frequency of respondents with no preference [19, 20]. The Prescott test was used in the original analysis of data from the current study, with similar statistically significant results favoring the dulaglutide device on all 10 items of the DID-PQ [9].
The structure of the DID-PQ does not allow for typical psychometric analyses, and the resulting limitations need to be considered. Unlike a PRO measure of symptoms or health-related quality of life, the items of the DID-PQ do not have ordinal response options ranging from lowest to highest on a particular construct, and item scores cannot be aggregated into subscales for analysis of continuous data. Instead, DID-PQ items yield categorical data representing preference. Therefore, it is not possible to assess internal consistency reliability with Cronbach's alpha, test-retest reliability with intra-class correlations, or convergent validity with Spearman correlations. Furthermore, there are not generic instruments or validated gold standard criterion measures that may be used for assessment of construct validity. While the current categorical analyses support construct validity of the DID-PQ via comparisons to a single item assessing global preference, it is not possible to thoroughly investigate reliability or validity of the instrument using common psychometric methods. Future research with the DID-PQ may provide further confidence in its validity.
There may also be limitations associated with the mock injection procedures. Participants were trained on each device prior to injecting each pen into an injection pad. Participants did not inject themselves with medication. Some aspects of the injection experience, such as comfort related to needle size or liquid volume, were not apparent during these procedures. It is possible that some DID-PQ responses could have been different if participants had injected themselves instead of the injection pad. Still, participants were thoroughly trained on both injection devices, and they performed all parts of the injection process. Therefore, their DID-PQ responses were likely based on a good understanding of both devices.
Despite these limitations, the DID-PQ represents a step forward for assessment of patient preference between injection devices. For preference to inform clinical decisions, measurement tools focusing on comparisons between treatments will be necessary. Since the DID-PQ has been useful in several studies, perhaps it could be a model for development of questionnaires designed to assess preference among other treatments across a range of medical conditions.
The study presented in this manuscript has been posted to ClinicalTrials.gov (NCT03724981), and data are available upon request.
DID-EQ:
Diabetes Injection Device Experience Questionnaire
DID-PQ:
Diabetes Injection Device Preference Questionnaire
GLP-1:
Glucagon-like peptide-1
IFU:
PABAK:
Prevalence-adjusted and bias-adjusted Kappa
Patient-reported outcome
RA:
Receptor agonist
T2D:
Davies, M. J., D'Alessio, D. A., Fradkin, J., et al. (2018). Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 61(12), 2461–2498.
Aroda, V. R., Henry, R. R., Han, J., et al. (2012). Efficacy of GLP-1 receptor agonists and DPP-4 inhibitors: Meta-analysis and systematic review. Clinical Therapeutics, 34(6), 1247–1258 e1222.
Htike, Z. Z., Zaccardi, F., Papamargaritis, D., Webb, D. R., Khunti, K., & Davies, M. J. (2017). Efficacy and safety of glucagon-like peptide-1 receptor agonists in type 2 diabetes: A systematic review and mixed-treatment comparison analysis. Diabetes, Obesity and Metabolism, 19(4), 524–536.
Tofe, S., Arguelles, I., Mena, E., et al. (2019). Real-world GLP-1 RA therapy in type 2 diabetes: A long-term effectiveness observational study. Endocrinology, Diabetes & Metabolism, 2(1), e00051.
Trujillo, J. M., Nuffer, W., & Ellis, S. L. (2015). GLP-1 receptor agonists: A review of head-to-head clinical studies. Therapeutic Advances in Endocrinology and Metabolism, 6(1), 19–28.
Matza, L. S., Boye, K. S., Stewart, K. D., Paczkowski, R., Jordan, J., & Murray, L. T. (2018b). Development of the Diabetes Injection Device Experience Questionnaire (DID-EQ) and Diabetes Injection Device Preference Questionnaire (DID-PQ). Journal of Patient-Reported Outcomes, 2, 43.
Matza, L. S., Stewart, K. D., Paczkowski, R., Coyne, K. S., Currie, B., & Boye, K. S. (2018c). Psychometric evaluation of the Diabetes Injection Device Experience Questionnaire (DID-EQ) and Diabetes Injection Device Preference Questionnaire (DID-PQ). Journal of Patient-Reported Outcomes, 2, 44.
Matza, L. S., Boye, K. S., Currie, B. M., et al. (2018a). Patient perceptions of injection devices used with dulaglutide and liraglutide for treatment of type 2 diabetes. Current Medical Research and Opinion, 34(8), 1457–1464.
Matza, L. S., Boye, K. S., Stewart, K. D., et al. (2020). Assessing patient PREFERence between the dulaglutide pen and the semaglutide pen: A crossover study (PREFER). Diabetes, obesity & metabolism, 22(3):355–364.
ClinicalTrials.gov, Eli Lilly and Company. A Study Comparing the Dulaglutide Pen and the Semaglutide Pen (NCT03724981). 2019; https://clinicaltrials.gov/ct2/show/NCT03724981. Accessed 19 Dec 2019.
Eli Lilly and Company. Instructions for Use: TRULICITY® (Trū-li-si-tee) (dulaglutide) injection, for subcutaneous use – 0.75 mg/0.5 mL Single-Dose Pen once weekly. 2017; http://pi.lilly.com/us/trulicity-lowdose-ai-ifu.pdf.
Novo Nordisk. Instructions for Use: OZEMPIC® (semaglutide) injection, for subcutaneous use – 0.5 mg/1 mg. 2017; https://www.novo-pi.com/ozempic.pdf.
Gwet, K. L. (2008). Computing inter-rater reliability and its variance in the presence of high agreement. The British Journal of Mathematical and Statistical Psychology, 61(Pt 1), 29–48.
Gwet, K. L. (2014). Handbook of inter-rater reliability: The definitive guide to measuring the extent of agreement among Raters, (4th ed., ). Gaithersburg: Advanced Analytics, LLC.
Byrt, T., Bishop, J., & Carlin, J. B. (1993). Bias, prevalence and kappa. Journal of Clinical Epidemiology, 46(5), 423–429.
Feinstein, A. R., & Cicchetti, D. V. (1990). High agreement but low kappa: I. the problems of two paradoxes. Journal of Clinical Epidemiology, 43(6), 543–549.
Altman, D. G. (1991). Practical statistics for medical research. London: Chapman & Hall/CRC.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.
Pictor, A. (2003). Analysing Binary Outcome Data from a Crossover Design Study using the SAS® System, (vol. 2019) (8 July). https://www.lexjansen.com/views/2003/statpharm/st02.pdf.
Prescott, R. (1981). The comparison of success rates in cross-over trials in the presence of an order effect. Journal of the Royal Statistical Society: Series C: Applied Statistics, 30(1), 9–15.
The authors thank Adebimpe Atanda, Gordon Parola, Haylee Andrews, Jessica Jordan, Katelyn Cutts, Katie Stewart, Melissa Garcia, Natalie Taylor, Peter Chongpinitchai, and Timothy Howell for assistance with data collection; K. Jack Ishak for statistical consultation; Karen Malley for statistical programming; Sandra Macker for data management; and Amara Tiebout for editorial assistance.
Funding for this study was provided by Eli Lilly and Company. The authors had independence in the study design, data collection approach, analysis, interpretation of data, and writing the manuscript.
Eli Lilly and Company, Indianapolis, IN, USA
Kristina S. Boye
Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
Louis S. Matza, Brooke M. Currie & Karin S. Coyne
Louis S. Matza
Brooke M. Currie
Karin S. Coyne
All four authors collaborated on the study design, analysis plan, interpretation of data, and outline of the manuscript. LM and BC drafted the manuscript text, and KB and KC provided input and approval. The author(s) read and approved the final manuscript.
Correspondence to Louis S. Matza.
Participants were required to provide written informed consent before completing study procedures, and all procedures and materials were approved by an independent institutional review board (Ethical & Independent Review Services; Study Number 18128–01). This study was conducted in accordance with the Declaration of Helsinki.
Louis Matza, Karin Coyne, and Brooke Currie are employees of Evidera, a company that received funding from Eli Lilly for time spent conducting this research. Kristina Boye is an employee of and owns stock in Eli Lilly and Company.
Boye, K.S., Matza, L.S., Currie, B.M. et al. Validity and analysis of the Diabetes Injection Device Preference Questionnaire (DID-PQ). J Patient Rep Outcomes 4, 104 (2020). https://doi.org/10.1186/s41687-020-00266-x
Patient-reported outcome measures
Dulaglutide
Semaglutide
Crossover study


The legend continues almost 90 years after Chick Chamberlain opened a drive-in restaurant on Marine Drive. The original counter stools remain in this current location, alongside the collection of Native artifacts Chick collected over the years. His son and grandson keep the hearty tradition alive with all-day breakfasts of Yukon-style bacon and free-range eggs, the towering Skookum Chief organic beef burger, and fresh berry pies. Everything is made from scratch and carefully sourced with pride.


text:
subrange: Carson Range Cascade Range Cathedral Range Northern Sierra Nevada Sierra Nevada Tehachapi Mountains White Mountains (California) All other
mountain: ChooseBanner Peak Carson Peak Cathedral Peak (California) Chinese Peak Clouds Rest Clyde Minaret Cockscomb Fairview Dome Grizzly Peak (Yosemite) Half Dome Inyo Craters Laurel Mountain Lembert Dome Liberty Cap (California) Little Baldy Long Valley Mammoth Mountain Matterhorn Peak Merced Peak Minarets (California) Mono Craters Mount Abbot Mount Ansel Adams Mount Clark (California) Mount Conness Mount Dade Mount Dana Mount Davis (California) Mount Hoffmann Mount Hopkins (California) Mount Lyell Mount Maclure Mount Mills (California) Mount Morgan (Inyo County, California) Mount Morgan (Mono County, California) Mount Morgan South Mount Morrison (California) Mount Ritter Mount Starr King (California) Mt Gibbs North Dome North Peak Panum Crater Parsons Peak Red Cones Red Slate Mountain Ruby Peak (California) Sentinel Dome Sharktooth Peak Tioga Peak Triple Divide Peak (Madera County, California)
Cathedral Range
Grizzly Peak (Yosemite)
Grizzly Peak (Yosemite) – Climbing, Hiking & Mountaineering
Grizzly Peak (Yosemite) Climbing Notes
Please submit any useful information about climbing Grizzly Peak (Yosemite) that may be useful to other climbers. Consider things such as access and accommodation at the base of Grizzly Peak (Yosemite), as well as the logistics of climbing to the summit.
Select Grizzly Peak (Yosemite) Location Map Detail:
Use this relief map to navigate to mountain peaks in the area of Grizzly Peak (Yosemite).
10 other mountain peaks closest to Grizzly Peak (Yosemite):
1. Liberty Cap (California) (2076 m) 1.7 km
2. Half Dome (2695 m) 2.5 km
3. Sentinel Dome (2476 m) 2.9 km
4. North Dome (2299 m) 3.1 km
5. Sentinel Rock (2145 m) 3.8 km
6. Mount Starr King (California) (2771 m) 4.2 km
7. Lost Arrow Spire (2112 m) 4.7 km
8. Three Brothers (Yosemite) (1881 m) 5.8 km
9. Eagle Peak (Mariposa County, California) (2372 m) 5.9 km
10. Clouds Rest (3025 m) 7.2 km


Woah-- way behind on my fall weddings on here! They've been up on Facebook for a while, but in case you missed it... GAVIN AND NAOMI GOT MARRIED! Wooohoo! They had plans for outdoor ceremony (the first I would've photographed at my church), but torrential rains before the ceremony caused them to relocate inside. Thankfully lots of friends and Gavin himself got everything looking awesome inside!


I've been getting into major side dish ruts lately, have you? No? So it's just me? I usually focus too much attention on the main course and the sides get totally neglected. Poor things!
Tomato, Corn, and Avocado Salad: Combine halved cherry tomatoes, corn (fresh or canned), diced avocado, the juice of a lime, a swirl of extra virgin olive oil, salt, and freshly cracked pepper. Toss it all together and you have yourself one delicious little concoction.
Fingerling Potatoes and Cherry Tomatoes: Saute halved or quartered fingerling potatoes in a tablespoon of extra virgin olive oil on medium-high heat. Season with salt and pepper. Stir every so often until the potatoes are cooked through and the cut side is nicely browned. Add halved cherry tomatoes and allow them to cook for 2-3 mins. Sprinkle in dried basil and thyme (or use fresh if you have it). Add in a tablespoon of balsamic vinegar and a tablespoon of white wine vinegar. Let it cook for a few more minutes and you're set! The result is super savory with a little punch from the vinegars.
omg jan those look bomb. i so want to make both of them!!!
I'm a huge fan of both of these dishes! So perfect for a summer barbeque.
They look so yummy in your cute little bowls!
Both dishes look really good, I think that even I will be able to make these. You are adorable Janelle!
Both look yummy, I think that even I will be able to make these dishes. You are adorable Janelle.


Interested in joining our list of amazing Clients?
Have a general question? We'll get back to you as soon as humanly possible.
Curious about working at Emery? If you're courageous, empathetic and committed to doing great work, you'd fit right in.
Booking a speaker or workshop? Someone from our leadership team may be just the right match for your event!


Anyone who knows me will know that I was a Tracktion fanboy. It was probably the first audio host that I grew a deep appreciation for, and it allowed me to enjoy making music in ways that hadn't happened before. And this was in the very early days of the software.
I held faithfully to the Tracktion bandwagon, watching it receive almost daily updates, changing the landscape of the host world by refusing to succumb to the traditional interface standards and complicated windows and menu systems that so many other hosts were plagued with. The direct-ness of the software, complete with those silly arrows(if you've used Tracktion, you know what I'm talking about!), was unheard of. There was no traditional mixer, no complex interfaces…….it just stayed out of the way.
I then watched, and participated directly, as Mackie took over my beloved Tracktion. Things were going well, and as a beta tester, I was excited. Then it just dropped. Radio silence. Nothing. People were left to wonder exactly what was going on. Even those "in the know", really didn't know anything.
Years passed, and it became apparent that Mackie decided it was not worth putting resources into any more. As far as myself or anyone could see, Tracktion was dead. And as a result, the world passed it by. New technologies and operating systems were released, and Tracktion no longer was a staple in my audio production workflow.
Then came Tracktion 4. Out of nowhere, it was announced that the original developer, Julian Storer, along with select members of the former Mackie team and others, were raising Tracktion from the dead, making it more "modern" and moving the vision forward. And I, after all these years, am beaming.
Tracktion 4, which you can find out more about here, is not much of a feature update. Really, it's designed merely to bring Tracktion into the modern world with 64-bit support, WASAPI support(a VERY underrated technology, equivalent to the OSX Core Audio system), and more. New features are said to be coming once they can get Tracktion to where it needs to be engine-wise.
I'll be watching, and it's very likely that I'll be finding ways to re-introduce Tracktion into my workflow. It's always great to see an old friend return.


Seven years after the crash of her first marriage to fellow silver spoon kid, Abiodun Kuku, one of the sons of the late Ogbeni Oja of Ijebu land, Chief Bayo Kuku, Funke Fowler, took a step towards moving on by tying the knot on Saturday April 13th, with her fiancé, Aigbovbioise Aig-Imoukhuede at the Oriental Hotel, Lagos.
At first because there wasn't so much frenzy about the wedding in the media, many assumed I would be a very low key, private ceremony especially because of how quickly Funke's first marriage ended shortly after two lavish ceremonies were held to celebrate the union. In 2011 when she got married the first time, Lagos was practically shut down for her engagement/traditional wedding.
The party which held at Tafawa Balewa Square, Lagos was considered one of the most hyped wedding ceremony in Lagos at that time due to the sheer opulence and extravagance that was on display. Her white wedding ceremony which took place in November of 2011 in Dubai was nothing short of wealth on display as well. Unfortunately, with all trappings of wealth on display at both ceremonies, the centre couldn't hold between Funke and her ex-husband.
Alas! That wasn't to be as the couple went all out in traditional Lagos style, sparing no expense for the traditional wedding. Despite that, her close friends believe that the love that exists between Funke and Aigbovbiose who is having his first adventure in marriage, would be enduring.
Expectedly, the wedding had in attendance several big wigs including the richest man in Africa, Aliko Dangote.
While Funke, the daughter of Tunde Fowler, the chairman of Federal Inland Revenue Service, FIRS, runs a fashion outfit, Heritage with Love, alongside her clothing boutique, Aigbovbioise who is a younger sibling to Aigboje Aig-Imoukhuede, a former MD of Access Bank now chairman of Coronation Capital Markets, is head of Coronation Capital Markets at Coronation Merchant Bank Ltd.