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Subsignal – La Muerta – Album Review
by manofmuchmetalPosted on May 29, 2018
Artist: Subsignal
Album Title: La Muerta
Date Of Release: 25 May 2018
When I heard the news that Sieges Even were to cease, I was hugely disappointed. Here was a band that not many years before, had released 'The Art of Navigating By The Stars', a record that, by all accounts, was a progressive metal masterpiece. I listened to it on repeat for weeks as I studied for some important exams and it remains a frequent visitor to my playlists well over a decade later.
However, the two main protagonists within Sieges Even, namely Markus Stefan and Arno Menses, realised with the release of 'Paramount', that they wanted to try something a little bit different. It's the hallmark of good musicians and truly creative types after all. Apparently inspired by the song 'Eyes Wide Open', they decided that they wanted to venture down a more melodic path, as well as being less blinkered and open to new influences. And so Sieges Even was laid to rest, with Subsignal rising from the ashes.
Under the new Subsignal guise, the Germans didn't abandon their progressive roots entirely, as was evidenced via their stunning debut, 'Beautiful and Monstrous' in 2008. The song writing was certainly more honed, more succinct in many ways and arguably more accessible, but there was still a level of intelligence and sophistication to the material overlaid by more pronounced melodic sensibilities that shined through from the outset. The debut, on balance, remains my favourite to date. It features the exquisite composition, 'The Sea', which is also my favourite ever song under the Subsignal moniker. Melancholic, dramatic and emotional, I'd go further and say it is one of my favourite songs by any band.
Since the debut, I have followed the band with interest and they have never disappointed. Although the debut remains their best in my opinion, it doesn't mean that subsequent releases have not been good. They are all superb albums actually, full of great music lovingly constructed and delivered with unerring accuracy and pin-sharp ability. They are all slightly different too, with a character all of their own. For many, the sophomore release, 'Touchstones', is their high water mark and it is honestly tough to argue with this assertion. But, for me, it doesn't feature 'The Sea' and that's essentially the difference.
And now, in 2018, Subsignal bring us their fifth studio recording, entitled 'La Muerta'. Naturally, I was intrigued to hear what the quintet of Steffen and Menses, alongside bassist Ralf Schwager, drummer Dirk Brand and keyboardist Markus Maichel would offer us next. With the increase of social media, we've been cleverly drip-fed information over the past few months to increase the anticipation, which has only served to heighten the interest further.
The answer is that 'La Muerta' is once again different from past Subsignal outings. It is at once very recognisable as Subsignal but also it embraces new influences, or at least there's a more pronounced use of other influences. There is certainly some truth in the statement that 'La Muerta' is the most mainstream-sounding record that Subsignal have ever recorded, with plenty of pop-like choruses and AOR embellishments. However, it is also satisfyingly ambitious, with plenty of variety within the eleven tracks and, as it turns out, a pleasing amount of progressive intent.
The perfect example of just about all of this is the track 'Passages', that's nestled in the latter stages of 'La Muerta'. It opens up with the kind of huge, bombastic, all-encompassing synth intro that's the preserve of the prog rock scene and which gets my attention every time, raising the hairs on the back of my neck without fail. From there, the track descends into full-on AOR territory, complete with acoustic guitar, swathes of bright and breezy synths and melodies that get lodged in your head after just a couple of spins. 'Passages' is also the longest track on the album, and it wrings every last second out of its seven-and-a-half minute length to delight us with extended instrumental sections, emotional solos and tempo changes. In short, it is a thoroughly tremendous composition.
The AOR influences again loom large over 'As Birds', one of the most upbeat songs on 'La Muerta' which, at times elsewhere, can be quite a raw and emotional listening experience. There's a cheeky exuberance about this song that I adore, with even the faintest hint of The Beach Boys in some of the layered vocals.
I must admit that it took quite a while for me to fully appreciate the excellence of 'La Muerta'. As ultimately accessible as this album is, it took some time for the melodies to make their full impact. And because there is so much subtlety within this collection of songs, your full attention is required at the outset to extract as much out of the music as possible. But the effort is not wasted and, as I sit here now, I'm wondering whether this might be my favourite Subsignal album of them all. It might be too early to say, but the fact that I'm considering this, it must mean that the album is pretty great, even by Subsignal's lofty standards.
The title track is another superb track, with a wonderful trademark opening lead guitar melody from Markus Steffen, enhanced by some excellent and varied drumming courtesy of Dirk Brand that is both understated and ever so slightly cocky at the same time – I love it, just as I love the expansive chorus that emerges from the highly structured and tightly-delivered verses.
'Bells' then delivers arguably one of the most powerful choruses on the record, hugely melodic and full of depth of emotion. This is juxtaposed with a contemplative intro and verses that are a quieter and much more introspective proposition.
The introduction to 'Approaches' that emerges after the gorgeous instrumental 'Teardrops', is very reminiscent of Shadow Gallery. However, this is short-lived as the unmistakeable character of Subsignal shines through the remainder of the song, one that allows bassist Ralf Schwager and keyboardist Markus Maichel to take their share of the limelight, to great effect.
The icing on the cake is the intro to the laid-back, almost wistful 'Trains' which, if I've heard it right, features a recording of a station tannoy announcing the departure of a train to Norwich. If that's the case, the train will almost certainly have travelled through the small market town in which I live. It's a small thing, but a nice touch for me at least.
Lastly, before 'La Muerta' comes to a close, we are treated to the sublime melancholy of 'Drowning', a piano-led piece full of raw human emotion and drama that sees Menses joined by the angelic voice of Iamthemorning's Marjana Semkina. It is a devastating way to conclude, one that leaves an indelible mark upon my soul and ensures that it isn't long before the album is spun again.
As we've come to expect from Subsignal, 'La Muerta' is a pin-sharp, smooth and hugely professional album, aided by a flawless production courtesy of RPWL/Blind Ego's Kalle Wallner and Yogi Lang . But more than that, it is an artful and thoroughly fulfilling collection of melodic progressive rock songs that have genuine depth, plenty of sophistication and, once under your skin, become essential musical companions to gladden your heart and lighten any mood. What a superb album.
Amorphis – Queen of Time
Posted in Album Review, AOR, Melodic Metal, Progressive RockTagged 2018, Album Review, AOR, Gentle art of music, La Muerta, Melodic Metal, metal, Progressive Rock, Soulfood, Subsignal
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Sundby est une station de la ligne 1 du métro de Copenhague située sur l'île d'Amager sur la commune de Copenhague.

Situation
La station de métro Sundby est située à Copenhague dans le quartier d'Ørestad sur Ørestads Boulevard.

Elle est située entre les stations DR Byen et Bella Center.

Histoire
La station de métro Sundby entre en service le .

Elle doit son nom au quartier de Sundby qu'elle dessert. La construction de cette station a permis le développement urbain du nouveau quartier d'Ørestad dont elle dessert un secteur qui n'a pas encore été développé (Amager Fælled Kvarter en danois).

Services au voyageurs

Accès
La station Sundby est aérienne. Elle est accessible par deux escaliers et un ascenseur menant directement au quai situé sur un viaduc. La station ne possède pas de niveau destiné à l'information des voyageurs et à la vente des titres de transport.

Quais
La station dispose d'un quai central couvert et à l'air libre desservant 2 voies sur lesquelles circulent les métros à conduite automatique. Les voies sont séparées du quai par des portes vitrées à ouverture automatique. Des écrans informent les voyageurs des directions et du temps d'attente pour les prochains métros.

Intermodalité
La station est en correspondance avec le réseau de bus de l'agglomération de Copenhague.

De nombreux emplacements pour le stationnement des vélos sont disponibles sur les espaces publics alentour ainsi qu'en-dessous de la station située en viaduc.

À proximité
 Amager Fælled, réserve naturelle

Notes et références

Voir aussi

Articles connexes
 Métro de Copenhague
 Ligne 1 du métro de Copenhague

Lien externe
 Station Sundby sur le site officiel du métro de Copenhague

Station du métro de Copenhague
Station de métro mise en service en 2002
Ligne 1 du métro de Copenhague
Transport à Amager

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Numerical Simulation of Binary Black Hole and Neutron Star Mergers Gauss Centre for Supercomputing e.V.
Numerical Simulation of Binary Black Hole and Neutron Star Mergers
Luciano Rezzolla
Max Planck Institute for Gravitational Physics (Albert Einstein Institute), Potsdam-Golm (Germany)
pr32pi
SuperMUC of LRZ
Scientists from the Albert Einstein Institute in Potsdam/Germany used HPC system SuperMUC to study the dynamics of compact-object binaries, i.e. neutron stars and black holes, and improve our understanding of strong gravity.
One of the last predictions of general relativity that still awaits direct observational confirmation is the existence of gravitational waves. Those fluctuations of the geometry of space and time are expected to travel with the speed of light and are emitted by any accelerating mass. Only the most violent events in the universe, such as mergers of two black holes or neutron stars, produce gravitational waves strong enough to be measured with present detectors. These waves are extremely weak when arriving at Earth, and their detection is a formidable technological challenge for advanced detectors such as Virgo, and LIGO, which are expected to observe around 40 events per year.
To interpret the observational data, theoretical modelling of the sources is a necessity and requires numerical simulations of the equations of general relativity and relativistic hydrodynamics. Such computations can only be carried out on large-scale supercomputers, given that many scenarios need to be simulated, each of which typically occupies 500 CPU cores over 10 days.
The main goal of the research group at the Max Planck Institute for Gravitational Physics (Albert Einstein Institute) in Potsdam/Germany under leadership of Prof. Luciano Rezzolla is to predict the gravitational wave signal from the merger of two compact objects. Comparison with future observations will provide important insights into the fundamental forces of nature in regimes that are impossible to recreate in laboratory experiments. The waveforms from binary black-hole mergers will allow to test the correctness of general relativity in previously inaccessible regimes. The signal from binary neutron stars mergers will provide input for nuclear physics, because the signal depends strongly on the unknown properties of matter at the ultra high densities inside neutron stars, which cannot be observed in any other astrophysical scenario. Besides mergers, the team also improved the analytic models of close encounters, i.e. black-hole scattering, providing information on which approximations provide accurate estimates.
Figure 1: Early evolution of a differentially rotating and strongly magnetized neutron star as produced in a binary neutron star merger. A dense and magnetized outflow is powered at the expenses of rotational energy and generates electromagnetic emission that is compatible with the observed X-ray afterglows of short gamma-ray bursts. The panels show the color-coded magnetic field strength in Gauss (log scale) and indicate the initial magnetic field (red lines) as well as the neutron star (black lines).
Copyright: Max Planck Institute for Gravitational Physics (Albert Einstein Institute) in Potsdam-Golm
Figure 2: Snapshots of a binary neutron star merger, from inspiral (top left), touching (top right), merging (bottom left) to the formation of a metastable HMNS (bottom right). The colors represent the mass density in the orbital plane.
The results might be used to determine the distance to a source, by exploiting the fact that observed frequencies of distant sources are reduced due to the expansion of the universe. Independent distance measures are very valuable for cosmology, improving estimates of the current and past expansion rate of the universe and predictions of its future fate. Finally, the simulations also helped to shed some light on the mystery of so called short gamma ray bursts, intense and sudden bursts of gamma radiation that puzzled astronomers for (since) decades, and which are believed to be caused by neutron-star mergers. In particular, the researchers found that the strongly magnetized and rapidly rotating merger remnant could be used to explain the X-ray afterglows which often accompany those bursts.
Computations were executed on HPC system SuperMUC of LRZ Garching.
W. Kastaun, L. Rezzolla, D. Siegel, K. Takami
Max Planck Institute for Gravitational Physics (Albert Einstein Institute), Potsdam-Golm
Science Park Potsdam-Golm
Am Mühlenberg 1, D-14476 Potsdam-Golm/Germany
e-mail: luciano.rezzolla@aei.mpg.de
Tags: MPI Potsdam LRZ Astrophysics

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Q: where to put freeze_support() in a Python script? I am confused about using freeze_support() for multiprocessing and I get a Runtime Error without it. I am only running a script, not defining a function or a module. Can I still use it? Or should the packages I'm importing be using it?
Here is the documentation.
Note that the specific issue is about scikit-learn calling GridSearchCV which tries to spawn processes in parallel. I am not sure if my script needs to be frozen for this, or the some code that's called (from the Anaconda distro). If details are relevant to this question, please head over to the more specific question.

A: On Windows all of your multiprocessing-using code must be guarded by if __name__ == "__main__":
So to be safe, I would put all of your the code currently at the top-level of your script in a main() function, and then just do this at the top-level:
if __name__ == "__main__":
    main()

See the "Safe importing of main module" sub-section here for an explanation of why this is necessary. You probably don't need to call freeze_support at all, though it won't hurt anything to include it.
Note that it's a best practice to use the if __name__ == "__main__" guard for scripts anyway, so that code isn't unexpectedly executed if you find you need to import your script into another script at some point in the future.

redpajama_set_name: RedPajamaStackExchange


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Cruise Ships, Newbuilds, World News 10th July 2018
Cruise News – August 2018
by Andrew & Donna Cooke
On 14th May Silversea Cruises announced that it had awarded Fincantieri with an order for another ultra-luxury cruise ship, with delivery scheduled for the fourth quarter of 2021. The contract is valued at over €320 million. Named Silver Dawn, the new vessel will be a sistership of Silversea's flagship, the 40,791gt Silver Muse, which was launched from the Fincantieri shipyard at Sestri Ponente (Genoa) in April 2017. The order came just months after the cruise line signed a contract with Fincantieri for the construction of the Silver Moon, another sistership to the Silver Muse, which is due to be delivered in 2020.
Viking Advances
On 10th May 2018 Viking Cruises' sixth ship, the 47,842gt and 930 guest capacity Viking Jupiter, was floated out, marking a new chapter in the construction process. Scheduled for delivery in early 2019, the arrival of the Viking Jupiter will officially make Viking the largest small ship ocean cruise line in the industry, only four years after launching its ocean business. Just under a month later on 7th June the 47,842gt Viking Orion, the fifth cruise ship built by Fincantieri for Viking Ocean Cruises, was delivered at the shipyard in Ancona. Ten additional ships are also planned for delivery starting in 2021, which could bring Viking's ocean fleet to 16 ships by 2027.
P&O Flagship Gets Underway
On 21st May P&O Cruises announced that it had marked the first construction milestone for its newest ship with a steel cutting ceremony at the Meyer Werft Shipyard in Papenburg. The ship's name was announced that same week, on 24th May. This highly anticipated announcement came as a result of a competition that P&O Cruises ran last year when it invited members of the public to suggest a suitable name for the ship. Over 30,000 submissions were received with a panel of experts made the final decision. The chosen name was Iona, artist's impression above.
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News Round-up – August 2019
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News Round-up June 2019


Bringing the best of contemporary Italian filmmaking to the Santa Monica.
Westsiders know that Santa Monica is a great place to dine on Italian food, shop for fine Italian fashion and spot some impressive Italian sports cars. What many may not know, however, is every year Santa Monica becomes the premier location in the country to experience the joys of Italian cinema.
Cinema Italian Style '17 opening night Gala premiere of "A Ciambra," featuring: Gisela Marengo, Ron Perlman, Marta Milans (left to right). Photo: Courtesy.
The event kicks off on November 13th at the Egyptian Theatre with a screening of Italy's submission to the 2019 Academy Awards' Best Foreign Language Film category, Matteo Garrone's "Dogman". The event then heads to Santa Monica November 15-18 at the Aero Theater on Montana Avenue. The Santa Monica screenings will showcase the very best of Italian cinema and with an eclectic range of genres, there is something here for everybody.
"Boys Cry" (2018), directed by twin brothers Damiano and Fabio D'Innocenzo, tells the story of two best friends living on the outskirts of Rome who accidentally run someone over, only to find out the man was a mafia informer. The friends, played by Matteo Olivetti and Andrea Carpenzano, decide to use the incident to impress the local mafia and end up getting more than they bargained for. This film will be screened as the second part of a November 16 double feature beginning at 7:30 p.m.
Another thrilling film, "Naples in Veils" (2018) screened at 7:30 p.m. on November 17th, follows Arianna, a medical examiner who falls for a man at a party only to discover his corpse at the mortuary a few days later. Adriana, played by Giovanna Mezzogiorno, spots the man (Alessandro Borghi) on the subway and a psychological thriller ensues.
The family-centered comedy/drama "There's No Place Like Home" (2018), from Gabriele Muccino, director of "The Pursuit of Happyness", will surely be a crowd pleaser. In this film, which will be screened November 15 at 7:30 p.m., an extended family celebrates the 50th anniversary of grandparents on an island off the Italian coast. A storm, however, traps the three generations for two days and long-simmering family issues begin to surface, and dramedy ensues.
These films, and just a few of the dozens that will be showcased at the Aero, are all examples of a rich and vibrant film industry that exists in Italy. Laurent Boyé, a spokesperson for the Cinema Italian Style, says that while people are aware of classic Italian filmmakers like Federico Fellini and Sergio Leone, many people are not aware of contemporary Italian filmmakers, which is a shame because of the quality their movies.
"When people think about Italian movies they think about Fellini and all the great filmmakers of the neorealist period. They are all great films but they are dated and speak more to a post-World War II Italy, then the Italy of today. Unfortunately, people don't realize there are a lot of Italian contemporary movies out there that many people may only see on a flight to Italy," Boyé said.
For a full list of screenings and to purchase tickets visit www.cinemaitalianstyle.com.


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Q: Variation of scalar field action I am reading Polchinski's  review on AdS/CFT .
I have a very simple question, and please help me out. Thanks in advanced.
The question is about formula (3.19).
The scalar effective bulk action is given by
$$ S_{0,\rm cl}=-\frac{1}{2L^{D-1}}\int dzd^Dx  \phi_{\rm cl}(\Box-m^2) \phi_{\rm cl}+\frac{\eta}{2}\epsilon^{1-D}\int d^Dx \phi_{\rm cl} \partial_\epsilon \phi_{\rm cl}, \tag{3.17}$$
where a typo $d\to D$ has been corrected. The boundary action is
$$S_{\rm b}=\frac{\eta \Delta_-}{2}\epsilon^{-D} \int d^D x \phi^2(\epsilon, x). \tag{3.18} $$
The variation of the whole action is given by
$$ \delta \big( S_{0,\rm cl}+S_{\rm b}\big)={\eta}\epsilon^{-D}\int d^Dx \delta \phi_{\rm cl} \big( \epsilon\partial_\epsilon-\Delta_-\big) \phi_{\rm cl} . \tag{3.19} $$
My question is why there is no such term $\int d^Dx  \phi_{\rm cl}  \epsilon\partial_\epsilon \delta\phi_{\rm cl} $ in the variation of the action?

A: I think I understand the situation.
The term is there, and in principle you are right.
In the integral you wrote you have something that goes like $\sim \partial_{\epsilon} \delta \phi_{cl}$ which is the derivative of the variation on the boundary or to put it in a better way the variation of the derivative on the boundary and, most of the times in physics, you can set it to zero for consistency reasons.
Polchinski mentioned it actually above eq.(3.18)
"The boundary term must be such that
the boundary terms in the variation of the action vanish for variations that respect the
boundary conditions; this is in order to have a good variational principle."
Just ask yourself, what is the point -physically- to vary the derivative of the field on the boundary. (this is taken from a professor of mine teaching QFT)
If that was not sufficient, try to do power-counting.
The variation of the scalar effective bulk action plus the boundary term contains powers of variation and derivatives of the following form, i.e $\sim \delta \phi \partial \phi$, and the piece you wrote and said that it is not there goes like $\sim \partial_{\epsilon} \delta \phi_{cl}$.
Starting from a quadratic action you want to get linear solutions to the equations of motion and study them analytically. This is linearization.
Cheers!!!


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Contain:- 1 Faucet Tap Adapter & 1 Connector For 1/2 Inch Hose Pipe.


The Swim 101 Swim Team is a multi-level, team concept coaching program. The skills of each team member will be properly reinforced in order to lay the necessary building blocks needed for future success. We believe in fun, positive encouragement that is paired with an emphasis on technique- quality is the key to success! Our dedicated coaches also believe in nurturing the whole child competitively and emotionally, as well as in a team concept.
The Swim 101 Swim Team is modeled after our lesson program.
Multiple levels are important in order to ensure each child receives the needed attention for their progressing skill set. Since our nurturing coaches place an emphasis on whole-child development in a fun and encouraging environment, parents can be confident confident their children will progress at a steady pace. If a family has chosen to enroll their child in the Swim 101 Swim Team, the award system established in regular lesson programming is still available.
The Swim 101 Rec Team is an option for those families that want a longer lesson (45 minutes) in a swim team setting. While the children are improving upon their learned skills, they will be progressing steadily towards the requirements for the Swim 101 Rec Team.
The Swim 101 Bronze Team begins to ease the child into a competitive environment where technique is emphasized and time standards are introduced in a fun and encouraging way.
The Swim 101 Silver Team builds upon the Bronze expectations and introduces these children to more advanced training, techniques and competitive swimming requirements.
The Swim 101 Gold Team continues to emphasize techniques, consistencies of the techniques and the foundation of racing (reinforcing, reevaluating, racing).
Upon successful class completion, swimmers have two options, highlighted below. They may opt to move to the next designated class, or be placed at the appropriate level on our Swim 101 Swim Team. For example, if your child has successfully completed Barracudas, they have the option to progress to Dolphins or join the Swim 101 Rec Team, and so on. If a family has chosen to enroll their child in the Swim 101 Swim Team, the award system established in regular lesson programming is still available.


Pink Porta Johns are so rad and so girly! One look at it and I was sold. I gotta have a picture of it. I did. I was Ms. Unstoppable. I was literally dodging laser eyes and dagger stares. Well, who in the world would be happy having someone taking a picture of you while on your way inside the potty? Not me. But I've gotta have it. And because it was in an event surrounded by boobies, chichis and tatas, I renamed it Porta Janes. Sounds about right, doesn't it?
Effects used on Picmonkey: Applied Tranquil first, followed by Film Grain where I brushed off part of it to highlight the pink doors, then finished it off with Focal Soften and Focal Zoom! Love! Do ya?
Can't wait to see them again in 2014!


It all puts me in mind of a grisly murder a couple of years back where the dismembered body parts of the victim were found scattered across two counties!
Imagine my horror when it emerged the killer had lived barely a dozen streets from where I live in Borehamwood!
So the eBay listings for firstly chunks of the mask of a Silurian from Warriors Of The Deep, then later its arm and then a LEG made me think of that terrible crime.
Any props from the original series of Dr Who are rare, those from actual creatures are even rarer.
This is a piece from the 1984 story starring Peter Davison - Warriors of the Deep. These fantastic creatures are iconic and this is fondly remembered as the only time they returned in the original run of the series, 14 years after their first appearance.
This is an original piece from the costume of the Silurian leader from the famous episode which saw the return of these creatures, first seen in 1970.
This is from the costume of their leader. This costume was purchased in a Bonham's auction in 1991. The body was made from scales attached to a boiler suite, however the original costume has deteriorated greatly due to this crude design.
This highly detailed piece was from the left leg and was worn on the skin directly and as such was made with much more detail and has survived in perfect condition.
This piece is presented in a massive 14 x 10 inch 3D display frame and come with a certifcate of authenticity from the doctor who prop experts from whom I bought the costume, who got them from the Bonhams BBC auction.
This highly detailed piece was from the leg and was worn on the skin directly and as such was made with much more detail and has survived in perfect condition.
You are bidding on part of a original Silurian costume ie the "Right leg".This was part of the Silurian body suit worn on-screen by Norman Comer playing the lead role of Ichtar in the 1984 Doctor Who story Warriors Of The Deep.
Leg measures approx 40 inches long.
This is an amazing piece and is in its original condition,the arm has lost some reptilian latex skin.
You are bidding on part of a original Silurian costume ie the front part of the left Arm and Chest,but not the back part of the costume.This was part of the Silurian body suit worn on-screen by Norman Comer playing the lead role of Ichtar in the 1984 Doctor Who story Warriors Of The Deep.
This Silurian left arm and chest is part of the Silurian body suit sold in Bonhams Doctor Who sale in 1991. The costume had the name of the actor "Norman Comer" written in which is the name of the leader ichta.


Accounts receivable (AR) and accounts payable (AP) practitioners from large companies know firsthand that many of their smaller trading partners have difficulties sending and receiving electronic payments and related information.
Now, the Federal Reserve's Business Payments Coalition has convened a workgroup of subject matter experts to address these problems.
The Simple Remittance Requirements paper, published in May 2018, defines a minimal, viable set of remittance data that small and medium businesses (SMBs) need for cash application and reconciliation. This resource will help businesses address the remittance data needs of SMBs. AP and AR practitioners can leverage Simple Remittance Requirements when they onboard smaller trading partners. It is also intended to be a useful reference for payment service providers and accounting software companies. Ideally, all accounting packages will support the remittance data categories defined in the paper. The workgroup also noted inconsistencies in terminology and defined major terms to promote clarity.
In general, accounting software geared toward small businesses is less complex and houses less data than major enterprise resource planning (ERP) systems. Additionally, there is a great deal of variability in the capabilities of accounting software used by small businesses. Payments sent by small business accounting software often are accompanied by very limited remittance data— information on the purpose of the payment.
On the receiving side, small businesses, like their larger trading partners, require specific information to apply and reconcile incoming payments to invoices. But currently many small businesses simply are not getting (or are unable to access) the needed remittance information with electronic payments. As a result, they struggle to apply and reconcile payments they receive.
Data elements described in Simple Remittance Requirements are needed regardless of the payment type used. Three levels of data elements are defined, graduated from simple to more complex.
The first level defines the four minimum data elements that would be needed in most cases to apply a payment. The basic data is simply the invoice number, invoice date, account number and amount paid.
Make sure to send at least these elements with a payment.
Recognize that this data may be all that is available for a small business to send with a payment, and request that it be sent.
The second level adds additional information, including discounts, adjustments and additional reference information.
The addition of discounts, adjustments and other reference information is valuable and should be sent when available.
Request that discounts, adjustments and other reference information, if available, be sent along with the basic information.
The third level is the more comprehensive EPN STP 820 transaction set, a simplified Electronic Data Interchange (EDI) standard developed by the Electronic Payments Network. NACHA's standard Corporate Trade Exchange (CTX) file format for Automated Clearinghouse (ACH) transactions accommodates STP 820. The STP 820 data would generally be the most extensive EDI-type data readily available to SMBs.
If you use EDI, follow the STP 820 transaction set. The resource explains how to map the data elements.
If you receive EDI data in remittances, accommodate the STP 820 specification.
In conclusion, addressing payment remittance details is an important step in helping SMBs implement electronic payments on both the sending and receiving sides. Enabling SMBs to move away from checks and adopt electronic payments is beneficial for everybody in the supply chain.
Download a free copy of Simple Remittance Requirements for more information and additional details on the data elements outlined above.
The Business Payments Coalition will use this foundational work product in its ongoing efforts to promote adoption of electronic payments and remittance exchanges. Participation in the Coalition is free and open to any individual or organization interested in its goal of making B2B payments more efficient across the end-to-end process. Visit the Coalition's website to learn more and to join.
Patti Ritter, CTP, is Senior Payments Consultant for the Payments, Standards and Outreach Group of the Federal Reserve Bank of Minneapolis.


When CarLeisha Garner decided to pursue a career in fashion, she never envisioned stepping into footwear. Armed with a degree in apparel design from Kent State University, in 2012, she landed a job at the former Jones Apparel Group, eventually moving into its shoe division.
Today, Garner, 35, is senior designer for fashion-comfort brand Aerosoles, a role she took on last May. 'When I first started, I wanted to work for a high-fashion brand, but as I [continued] in the industry, I enjoyed doing commercial product," said Garner of helping everyday women look fashionable.
Garner's footwear expertise is preparing her for a future endeavor — launching her own apparel line. "I now think what [apparel] someone would wear with the [shoes] I'm designing and how to accessorize," said the designer.
Here, Garner talks about her passion for fashion and never giving up on her goals.


Due to scheduling issues, we're not presenting any classes in Europe in 2017 or early 2018, so your last chance to come to one of our classes in Europe is in Dublin next month.
The class will be October 3-7, and is €2,795. You can get all the details on the class page here.


The church is the hope of the world. As church leaders, we have the responsibility of communicating the greatest message known to mankind; the only message capable of changing a person's entire eternity.
The weight of that responsibility is both profound and incredible. It moves us to action, and demands we communicate it well.
In the United States alone, we have 350,000 churches; each started by people with the desire to communicate the Gospel message. Yet oftentimes, churches have a difficult time communicating this message because they don't understand the basics of communication.
Think about it … Is your church clear on who they are and where they are going? Does your church use social media to nurture and grow relationships? Has your church spent unhurried time developing a brand that resonates with people in your church and community? Are you proud of your website and does it accurately communicate the uniqueness of your church? Have you evaluated and observed what guests experience on a Sunday morning? Do you want to create more awareness of your church in local communities?
At Sayge, we researched and identified the 12 Essentials to Church Marketing and Communications and developed a resource that equips Church Communications leaders.
And we did it for one reason; because eternity is at stake. We developed this important resource to help you reach more people with the Gospel.
When it comes to Church Communications, it's critical to remember you want to produce an excellent product not for excellence's sake, but because eternity is at stake.
Lose that perspective, and you lose everything.
Vision clarity is about staying focused on the mission and vision of your church. To reach clarity, you must know who you are as a church and where you are going.
Brand Standards are the compilation of documents where you articulate the mission, values, strategy and vision of the church. They protect the treatment of everything from your logo and tagline, to fonts and color choice and even email signatures and phone messages.
Brand Standards are critical but often overlooked.
Your communication strategy involves understanding your audience and then identifying the best way of communicating who you are to that audience. It helps you determine what, when and how you will communicate.
The systems you set in place allow the day-to-day operations to run smoothly.


Raise awareness on hunger and need for education or mobilise resources or write blogs or simply pick up an activity close to your heart to support us. Volunteer with us.
Sometimes even though we feel for a cause and want to be a part of the solution, our day to day work holds us back. At the end of the day we convince ourselves saying 'I would have done my bit if I had time'.
Forward the mailers to your friends and help us spread the word across.
Promote Akshaya Patra in your social networking profile and ask your friends to follow us.
Introduce Akshaya Patra to all your online communities/ fan clubs etc.
Download and use our screensavers, buttons, posters, wallpapers, banners etc.
If you are a blogger, write about Akshaya Patra in your blog and let people know that you support the cause. You can also write what you feel about Akshaya Patra and the cause we work for and send it to us. We will publish it in our blog.
Akshaya Patra feeds 1.76 million children every day across 12 states and 43 kitchens. We also plan to expand our operations to more and more locations. People across the globe are helping us raise this fund in their own small ways.
Register yourself as an online fund raising volunteer. Fund raised will go to providing mid-day meal to the school children. Dedicated fundraisers are acknowledged for their efforts on select collaterals of Akshaya Patra.
You can become a social media volunteer for Akshaya Patra depending on which Social Media site you are more active.
Become our fan on Facebook and regularly like our post and share with your friends.
You can be active in all or in any of these activities. Your effort will be acknowledged by us on our Face book page.
Besides the above-given options, if you feel you can support Akshaya Patra in some other way being in line with the objective of the organisation, we would like to hear from you.


text:
Home Magazine 2019 Spring Strength Union
Strength in Union
Local 728 Republic Services Members Show Solidarity
Republic Services workers at the company's Atlanta South facility were facing a tough time on the job last year. But they had a plan.
These members of Local 728 didn't just decide all willy-nilly to go out on strike. Instead, the local worked closely with the Teamsters Waste Division as well as the union's Strategic Research and Campaigns Department ahead of time to develop a strategic bargaining plan. The plan involved market research, internal organizing, community outreach and media engagement.
They then executed it with help from the Waste Division and Strategic Research and Campaigns staff.
Because of that planning and coordination, the unit's 120 drivers, helpers, mechanics and dispatchers were a united and militant workforce as they entered negotiations. They had gotten their message out to area churches, local news media and even nonunion workers at other Republic yards. And they were rewarded with a five-year contract that protects their future with the company.
The deal for the Teamster members, which included historic raises and increased job protections, could serve as a model for how the union attempts to organize other waste workers in the Atlanta metropolitan area, said Ben Speight, Local 728's Organizing Director and business agent. But it couldn't have happened without a united Teamster workforce.
Inspired by the 50th anniversary of Martin Luther King Jr. joining Memphis sanitation workers on the strike line, members said they were standing up for dignity on the job.
Atlanta members were also aided by a coordinated campaign headed up by Chuck Stiles, Assistant Director for the Teamsters' Waste Division, that brought in Teamster Republic Services members from across the nation.
But the company initially wouldn't budge in contract talks. So just after midnight on August 10, these Republic workers went on strike to protest the company's alleged violations of federal labor law. Members noted Republic broke the law when it took work away from full-time mechanics and outsourced it to subcontractors.
A little more than 15 hours later, they ended their walkout.
"Our job is to protect the public health and keep our communities clean," said Dave Thomas, a commercial driver at Republic in Atlanta. "When Republic broke the law and wouldn't listen to us, we felt we had no choice but to go on strike as a wake-up call. We want to protect the public, which is why this was a short strike."
Contract Gains
A little more than a week later, the company and members hammered out a new contract, one that won pay for all time worked, including breakdowns and any required down time.
Additionally, Local 728 members won premium pay for extra work like self-contained compactors, carts with casters and back-door residential services. And the agreement included strong annual wage increases.
The deal also strengthens union and members' rights on the job. The Teamsters negotiated out language that previously allowed Republic Services to veto or ban the appointed union business agent.
The union will now have access to new hire orientations for membership sign up. It also expanded safety bonuses to more workers, and won non-discrimination protections for sexual orientation.
Organizing Leads
Since the ratification of the most recent Republic Services Atlanta South collective bargaining agreement, Local 728 has received more organizing leads from Republic's competitors in the solid waste industry than it has in years. It has led to Local 728 filing for an election at Republic's Cummings, Ga. yard.
"The union is responding to these organizing leads by utilizing the leadership of the existing union group to help nonunion solid waste workers gain their rights under a Teamster contract," Speight said. "The goal of the local is to have a campaign that maximizes potential union density in the Atlanta metro market over the next few years."
Thomas said other waste workers could learn a lot from how Republic workers at the Atlanta South facility unified and stood strong to reach a good agreement for workers.
"If you want respect, you have to show them you want respect, and that you will do it en masse," he said. "You have to come together, and when you come together, everyone is stronger."
Congress, Stand for Workers
A Message from General President Jim Hoffa
Teamsters Have Five for Fighting in Pennsylvania
The Year of Women and Women Who Are on the Rise
A Silver Lining Amidst Every Dark Cloud
Teamsters Disaster Relief Fund Offers Help
Fighting for Safety and Unity on the Rails
BLET and BMWED Hold Conventions
A Mom-umental Win for Workers
At Local 955, Organizing is a Family Affair
Teamster News
Pension Reform Bill Re-Introduced in Congress
LGBT Caucus Plans for Future
Teamsters to the Rescue
Real Men Wear Pink
Red Cross Members Ratify New National Contract
Park District Teamsters Secure Contract
Victories at Local 703
Organizing RoundUp
This program consists of several different benefits for Teamster retirees. These Teamster benefits can help you and your family cut the rising cost of health care.


Excellent newly remodeled Winnipesaukee waterfront home in Alton Bay perfect for boating or just relaxing by the lake. Property 520 is a three level home with plenty of space for a larger group. It includes a gourmet kitchen with granite counter tops, living room with flat screen TV and wood stove, dining area, and sun porch all on the main level. There is also one bedroom with a queen bed and and a separate renovated 3/4 bathroom on this level. Walk out to a large newly reconstructed and expanded wrap-around deck with gorgeous expansive lake views.
The second level has a den with a flat screen TV and a new 26' x 16' screened in porch. There is a master bedroom with a king bed, wall AC unit, and attached remodeled full bathroom. There are also two additional bedrooms on this level; one with a queen bed and one with a twin bed with twin trundle. A renovated full bathroom is off the hallway. On the third level there is a bunk room with two sets of bunk beds and one twin bed.
There is also a walk-out unfinished basement with a ping pong table. Enjoy 100 ft of shore front with a dock that can accommodate up to a 24 ft boat and a swim dock with stairs into the water for easy lake access. This lake home is sure to be a vacation favorite with fun for the whole group.


text:
Self-reported dietary adherence, disease-specific symptoms, and quality of life are associated with healthcare provider follow-up in celiac disease
Jacob J. Hughey ORCID: orcid.org/0000-0002-1558-60891,
Bonnie K. Ray2,
Anne R. Lee3,
Kristin N. Voorhees4,
Ciaran P. Kelly5 &
Detlef Schuppan5,6
BMC Gastroenterology volume 17, Article number: 156 (2017) Cite this article
The only treatment for celiac disease (CeD) is a lifelong gluten-free diet (GFD). The restrictive nature of the GFD makes adherence a challenge. As an integral part of CeD management, multiple professional organizations recommend regular follow-up with a healthcare provider (HCP). Many CeD patients also participate in patient advocacy groups (PAGs) for education and support. Previous work found that follow-up of CeD patients is highly variable. Here we investigated the self-reported factors associated with HCP follow-up among individuals diagnosed with CeD who participate in a PAG.
We conducted a survey of members of Beyond Celiac (a PAG), collecting responses from 1832 U.S. adults ages 19–65 who reported having CeD. The survey queried HCP follow-up related to CeD and included validated instruments for dietary adherence (CDAT), disease-specific symptoms (CSI), and quality of life (CD-QOL).
Overall, 27% of respondents diagnosed with CeD at least five years ago reported that they had not visited an HCP about CeD in the last five years. The most frequent reason for not visiting an HCP was "doing fine on my own" (47.6%). Using multiple logistic regression, we identified significant associations between whether a respondent reported visiting an HCP about CeD in the last five years and the scores for all three validated instruments. In particular, as disease-specific symptoms and quality of life worsened, the probability of having visited an HCP increased. Conversely, as dietary adherence worsened, the probability decreased.
Our results suggest that many individuals with CeD manage their disease without ongoing support from an HCP. Our results thus emphasize the need for greater access to high quality CeD care, and highlight an opportunity for PAGs to bring together patients and HCPs to improve management of CeD.
Celiac disease (CeD) is a chronic condition with autoimmune features driven by dietary consumption of gluten (a group of proteins present in wheat, barley, and rye) in genetically susceptible individuals [1]. The prevalence of CeD is estimated to be approximately 1% in most Western countries, although many individuals with CeD remain undiagnosed [2, 3]. Currently, the only treatment for CeD is a strict, lifelong gluten-free diet (GFD). Although the prognosis for most CeD patients on the GFD is good, the ubiquity of gluten in the Western diet and the need to avoid even minor contamination of otherwise gluten-free foods make adherence to the GFD a severe challenge [4,5,6]. Adherence to the GFD is highly variable and many CeD patients report a treatment burden that is comparable to patients with end-stage renal disease on dialysis [7, 8].
As an integral part of CeD management, guidelines from the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) and a consensus statement from the U.S. National Institutes of Health recommend regular follow-up with a healthcare provider (HCP) [9,10,11]. Such follow-up with a doctor and/or dietitian is essential for providing accurate information about the GFD, improving adherence to the GFD, verifying normalization of serology and other abnormalities found during diagnosis, monitoring symptoms, and checking for complications. The NIH consensus statement also recommends participation in a patient advocacy group (PAG) as a means to improve dietary adherence and to obtain emotional and social support. Unfortunately, a previous study found that HCP follow-up for many CeD patients is inadequate by multiple measures [12]. Overall, only 35% of patients followed for more than four years after diagnosis received care consistent with AGA recommendations.
Although improved HCP follow-up could enable improved CeD management, the factors that influence variation in HCP follow-up in CeD remain unknown. Importantly, several improved questionnaires have now been developed and validated to assess various aspects of life with CeD [13,14,15]. To our knowledge, however, these questionnaires have not yet been applied to understand how HCP follow-up is related to factors such as an individual's CeD-related symptoms and quality of life. The aim of this study was to identify the patient-specific factors associated with HCP follow-up among adults diagnosed with CeD who participate in the online network of a national PAG.
Survey design and distribution
The survey was designed by a committee of CeD physicians and researchers, as well as patient representatives from Beyond Celiac. The committee identified validated instruments to include and developed new questions to capture information regarding patients' healthcare utilization as well as personal and family medical history. The survey was reviewed by individuals with CeD for readability, clarity, and comprehensiveness before being sent to participants.
The survey was divided into five categories: Demographics, Emotional Well-Being, Celiac Disease-Specific Health, Gluten-Free Diet, Natural Course of Celiac Disease and Celiac Disease Diagnosis and Management. The survey comprised a total of 51 questions, with 15 including multiple sub-questions. The total number of questions a participant was asked to answer was dependent on the participant's age (12 years old and under, 13–18 years old, and 19 years old and above).
The study population consisted of individuals active in the online community of Beyond Celiac, a national PAG in the United States. Beyond Celiac disseminated announcements about the survey to over 49,000 people using email and shared the survey among a network of more than 114,000 Facebook followers from March 19 to March 31, 2015. The announcements included a description of the survey and a link to complete the survey.
For this paper, we analyzed data from respondents who were 19–65 years old, living in the United States, and personally diagnosed with CeD. Analysis of the survey data was approved as non-human subjects research by the Vanderbilt University IRB (#161349).
Validated instruments
The survey included validated instruments for dietary adherence (CDAT), CeD-specific symptoms (CSI), and quality of life (CD-QOL) [13,14,15]. Higher CDAT and CSI scores correspond to worse dietary adherence and CeD-specific symptoms, respectively, whereas a higher CD-QOL score corresponds to better quality of life. Two questions are common to both the CDAT and CSI ("Have you been bothered by headaches during the past 4 weeks?" and "Have you been bothered by low energy levels during the past 4 weeks?"). These two questions were each asked only once in the survey and unless noted otherwise, were used to calculate the score for both instruments. One question in the CSI ("How much physical pain have you had during the past 4 weeks?") and one element in the CD-QOL ("I have trouble socializing because of my disease.") were inadvertently omitted from the survey.
All elements of the CD-QOL have negative valence, with one exception ("I feel the diet is sufficient treatment for my disease"). For consistency with previous work, we calculated the CD-QOL score as the sum of scores from the individual elements after first reversing the scores of elements with negative valence. For example, since the score for each element could go from 1 to 5, a score of 4 ("quite a bit") for the element "I feel frightened by having this disease" was converted to a 2.
Analysis and visualization
Analysis was performed in R 3.4.0 [16]. Venn diagrams were generated using the VennDiagram package [17]. For multiple logistic regression, we first divided the score of each instrument by the number of elements in the instrument, resulting in a scaled score that could range between 1 and 5. This has no effect on statistical significance and makes the coefficients easier to compare to each other. In addition, age group was converted to an integer value. Coefficients for the multiple logistic regression based on all three instruments (Fig. 1) were visualized using the visreg package [18]. For multiple logistic regression based on individual elements in each instrument, p-values were converted to q-values (controlling the false discovery rate) using the method of Benjamini and Hochberg [19].
Visualization of multiple logistic regression model from Table 4. In each plot, the blue line shows the estimated fraction of respondents who visited an HCP in the last 5 y as a function of the score for the respective instrument (with the scores of the other two instruments and age held constant at their respective medians). Gray areas indicate 95% Wald confidence intervals
The survey was made available to members of Beyond Celiac and responses were collected from 1832 U.S. adults ages 19–65 who reported having CeD. The survey was designed to query multiple aspects of life with CeD. We first examined the respondents' demographics (Table 1). Overall, 89% of respondents were female, which is somewhat higher than previous studies [12,13,14,15]. The vast majority of respondents (95%) reported their race as "White or Caucasian," which is similar to a previous study based on individuals from an academic medical center and celiac support groups [15] and which could be a result of the higher frequency of CeD in non-Hispanic whites than in Hispanics or non-Hispanic blacks [20]. Respondents came from every age group and region of the U.S.
Table 1 Demographics of survey respondents (n = 1832)
We next examined how and by whom the respondents reported being diagnosed with CeD (Table 2). Overall, 83% of respondents were diagnosed by a pediatrician, primary care provider, or gastroenterologist (80% of respondents also considered one of these their main provider for CeD; Additional file 1: Figure S1). In addition, similar to previous work [15], 95% were diagnosed based on a blood test (83%), small intestinal biopsy (79%), or both (67%; Additional file 1: Figure S2). Although these distributions were similar in each age group, we did observe higher frequencies of blood test and gluten challenge in younger age groups and a lower frequency of small intestinal biopsy in the youngest age group (19–25 y.o.; Additional file 1: Figure S3). Respondents reported an array of other autoimmune or CeD-related conditions (Additional file 1: Figure S4), although the prevalence of type 1 diabetes was less than expected [21]. Taken together, these results suggest that the respondents are reasonably representative of U.S. adults diagnosed with CeD.
Table 2 Self-reported information on how and by whom respondents were diagnosed with CeD
We then analyzed the respondents' reported HCP follow-up. Of 1493 respondents diagnosed at least five years ago, 27% reported that they had not visited an HCP about CeD in the last five years (Table 3). Although we do not have additional data (e.g., medical records) to evaluate the follow-up care received by those individuals who did report visiting an HCP, these results suggest that many U.S. adults diagnosed with CeD are managing their disease without ongoing support from an HCP. We next quantified the reasons that respondents gave for not visiting an HCP. The most frequent reason was "doing fine on my own" (47.6%), followed by "haven't needed to," "provider was not knowledgeable," and "previous visits were not helpful" (Table 3, Additional file 1: Figure S5). Financial reasons ("co-pay is too high" and "uninsured") and general distrust of HCPs were less common.
Table 3 Self-reported information on HCP follow-up among respondents diagnosed at least 5 y ago
To better understand the factors related to HCP follow-up, we used the survey responses from the validated instruments for dietary adherence (CDAT), disease-specific symptoms (CSI), and quality of life (CD-QOL) (Additional file 1: Figure S6) [13,14,15]. Scores from all three instruments were significantly better in respondents diagnosed at least five years ago than in respondents diagnosed more recently (Additional file 1: Figure S7). For those respondents diagnosed at least five years ago, we then used their age group and CDAT, CSI, and CD-QOL scores in multiple logistic regression to predict whether an individual reported visiting an HCP about CeD in the last five years (Table 4). Scores from all three instruments, but not age group, were significantly associated with having visited an HCP. In particular, as celiac-specific symptoms and quality of life worsened (indicated by higher CSI and lower CD-QOL scores, respectively), the probability of having visited an HCP increased (Fig. 1). Conversely, as dietary adherence worsened (indicated by a higher CDAT score), the probability decreased. These results suggest that although scores from the three instruments are moderately correlated with each other (Additional file 1: Table S1), each instrument captures a unique aspect of life with CeD.
Table 4 Multiple logistic regression to predict whether respondent has visited an HCP about CeD in last 5 years (assuming he or she was diagnosed at least 5 years ago)
Finally, we determined which individual questions or statements in each instrument were the most strongly associated with having visited an HCP. For each instrument, we performed multiple logistic regression using age group, scores from the other two instruments, and the response to one question of the selected instrument (Fig. 2). The three instruments varied in the fraction of questions or statements that were significantly associated with visiting an HCP. In each instrument, we observed the strongest associations with questions or statements that referred to more general aspects of life with CeD. In the CDAT, the strongest association was with the statement "Before I do something I carefully consider the consequences" (stronger agreement indicated higher probability of having visited an HCP). In the CSI, the strongest association was with the question "Related to celiac disease, how is your health?" (worse health indicated higher probability of having visited an HCP). In the CD-QOL, the strongest association was with the statement "I feel frightened by having this disease" (stronger agreement indicated higher probability of having visited an HCP).
Coefficients and estimated FDR for association (in multiple logistic regression) between whether respondent has visited HCP in last 5 y and the response to individual questions in each instrument. P-values were converted to q-values to control for false discovery rate. Coefficients for questions in the CD-QOL were estimated after adjusting for valence, which means the scores of all individual questions except for one ("I feel the diet is sufficient treatment for my disease") were reversed
Celiac disease is a complex condition with autoimmune characteristics for which the only current treatment is a strict, lifelong, gluten-free diet. Although recommendations for managing CeD include regular follow-up with an HCP, follow-up is often inadequate [12]. Here we studied the factors associated with patient-reported follow-up related to CeD in a large group of U.S. adults. Over a quarter of our survey respondents who were diagnosed at least five years ago reported not having visited an HCP about CeD in the last 5 years. In addition, individuals who have visited an HCP about CeD generally have better dietary adherence, worse symptoms, and worse quality of life than those who have not.
The survey question about HCP follow-up was designed to be broad and straightforward to answer. The limitation is that our metric for HCP follow-up is necessarily coarse and does not account for all the variation in the quantity, and more importantly the quality, of care. Thus, even for the 66% of respondents who reported having visited in HCP about CeD in the last five years, it is likely that the level of follow-up often does not meet AGA recommendations [12].
Individuals with CeD face high rates of underdiagnosis and misdiagnosis and often endure 5–10 years of symptoms before being correctly diagnosed [22,23,24]. Such a long and frustrating "diagnostic odyssey" could negatively influence patients' opinions of the healthcare system and reduce the likelihood that they continue to interact with it after diagnosis. Notably, 37.8% of respondents to our survey reported not visiting an HCP in the last five years because their provider was not knowledgeable and/or previous visits were not helpful. If this is the case, then increasing the speed of an accurate diagnosis could contribute to improved CeD management after diagnosis.
To our knowledge, this is the first study to collect responses from the same individuals for three validated, CeD-related, instruments. Although the inadvertent omission of one element each from two of the instruments prevents strict comparison with previous studies, we reproduced the correlation between dietary adherence and symptoms [14] and between dietary adherence and quality of life [25]. Furthermore, our analysis allowed us to disentangle the effects of the three instruments on CeD-related follow-up. For example, even though better dietary adherence is positively correlated with better symptoms, a higher probability of visiting an HCP is associated with better adherence and worse symptoms. In addition, by analyzing the responses to individual elements of each instrument, we discovered that the correlates of having visited an HCP follow a hierarchy, at the top of which are more general concerns related to CeD, such as one's overall perception of health related to CeD and feeling frightened by CeD.
We observed multiple trends in the frequency of diagnosis methods between age groups. Individuals aged 19–25 reported the lowest frequency of small intestinal biopsy, which may reflect the growing willingness of HCPs to diagnose CeD without a biopsy [26, 27]. For example, the most recent European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines omit the need for a small intestinal biopsy, as long as IgA anti-transglutaminase (TG2) antibody titers are >10× the upper limit of normal and other clinical criteria are met [28]. We also found that younger age groups reported higher frequencies of gluten challenge. For example, 25% of respondents aged 19–25 reported that a gluten challenge was part of their diagnostic workup. Although our survey was not designed to address this issue, we speculate that this result may be related to the increasing prevalence of the GFD among people not diagnosed with CeD, especially among younger people [29]. Because the blood tests and small intestinal biopsy currently used for diagnosis are markers of active disease, a person who has been following a GFD will typically have to resume gluten consumption for 2–6 weeks (the gluten challenge) in order to be definitively diagnosed [11]. The gluten challenge is often accompanied by the return of symptoms, making this method of diagnosis burdensome and making patients reluctant to obtain a definitive diagnosis [30]. Notably, the need for a gluten challenge is obviated by a negative genetic test for HLA-DQ2 or -DQ8 [11], which excludes CeD, and we speculate that for most survey participants who underwent both genetic testing and a gluten challenge, the former was used to rule in (but not necessarily confirm) CeD. Our findings thus highlight the need for diagnostic tools that do not depend on ongoing gluten consumption.
Our study has several limitations. First, although our sample size is large, it is non-random and could suffer from self-selection bias based on who received notification of the survey (those who had previously interacted with the online community of Beyond Celiac) and who chose to respond. For example, involvement in support groups has been associated with less severe CeD-related symptoms [14] and involvement in face-to-face social support networks has been associated with higher CeD-related quality of life [31]. However, we observed considerable variation in the scores for all three instruments, which indicates that our respondents cover a wide range of lifestyles with respect to managing CeD. Second, our study is based only on self-reported data, and we do not have the respondents' medical records to confirm their diagnosis or their follow-up with an HCP. However, the frequency of various diagnostic methods in our data is consistent with previous studies, which suggests that the self-reported data from our respondents is accurate. Moreover, the high level of self-management required of CeD patients (often before and after diagnosis) means that they are typically well informed about their disease and diagnostic workup.
A third limitation is that our study is cross-sectional and observational, so it is not possible to determine causality in the associations we observe. That said, we find it unlikely that visiting an HCP about CeD causes worse symptoms and quality of life. We believe the more likely scenario is that symptoms and quality of life influence how a person manages CeD, in particular, whether a person seeks support from an HCP. Individuals who are satisfied with or who can tolerate their symptoms and quality of life may be less likely to visit an HCP, possibly because they feel that the lack of non-dietary treatment options means that HCPs have little to offer. The association between dietary adherence and having visited an HCP also has multiple interpretations. One is that visiting an HCP causes improved adherence, perhaps because HCPs provide patients with a better understanding of how to implement the diet or a better appreciation of the diet's importance. Another interpretation is that both dietary adherence and visits to an HCP are indirect measures for how conscientiously a patient manages his or her disease. These interpretations are not mutually exclusive, and it is likely that both are valid to varying extents among CeD patients.
Our results suggest that many adults with CeD manage their disease without ongoing follow-up care from an HCP. This study also demonstrates the ability of PAGs to rapidly engage CeD patients for research, which is encouraging for future efforts using patient input to drive clinical research directed at a better understanding of cofactors that trigger CeD, improved disease management, and non-dietary therapies [32]. Finally, our results emphasize the need for greater access to high quality CeD care, and highlight an opportunity for HCPs and PAGs to work collaboratively to achieve improved disease management by raising levels of awareness and education.
ACG:
AGA:
CDAT:
celiac dietary adherence test
CD-QOL:
celiac disease-related quality of life
CeD:
CSI:
celiac symptom index
FDR:
false discovery rate
HCP:
PAG:
patient advocacy group
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The authors thank the celiac disease patient community for sharing their experiences in pursuit of advancing research.
The study was funded by Beyond Celiac.
The survey questions and responses, along with the code to reproduce this study, are available at https://doi.org/10.6084/m9.figshare.4975229.
Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
Jacob J. Hughey
Talkspace, New York, NY, USA
Bonnie K. Ray
Celiac Disease Center, Columbia University Medical Center, New York, NY, USA
Anne R. Lee
Beyond Celiac, Ambler, PA, USA
Kristin N. Voorhees
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Ciaran P. Kelly
& Detlef Schuppan
Institute of Translational Immunology, University Medical Center, Mainz, Germany
Detlef Schuppan
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Conceived and designed the study: JJH, BKR, KNV, DS. Performed analysis: JJH. Interpreted results: JJH, BKR, ARL, KNV, CPK, DS. Wrote the paper: JJH. Reviewed drafts of the paper: JJH, BKR, ARL, KNV, CPK, DS. All authors read and approved the final manuscript.
Correspondence to Jacob J. Hughey.
The online survey was designed, advertised on social media, and conducted by Beyond Celiac, and as such, no consent was collected. Analysis of the survey data was approved as non-human subjects research by the Vanderbilt University IRB (#161349), as the survey collected no identifiable private information and analysis of the data involved no intervention or interaction between the investigators and the participants.
At the time of the study, KNV was an employee of Beyond Celiac and contributed to the study as described in the Authors' Contributions section. All the other authors declare that they have no competing interests.
Additional file 1: Supplemental Figures and Table.
Figure S1. Self-reported information on who the respondent considers his/her main provider for CeD. Figure S2. Venn diagram of self-reported diagnosis methods across all respondents. Figure S3. Self-reported information on methods of diagnosis for respondents in each age group. Figure S4. Self-reported prevalence of other autoimmune or related conditions among all respondents. Figure S5. Venn diagram of self-reported reasons for not visiting an HCP about CeD. Figure S6. Histograms of normalized scores for each instrument. Figure S7. Boxplots of normalized scores for each instrument vs. age and time since diagnosis. Table S1. Spearman correlation between scores of instruments. (PDF 693 kb)
Hughey, J.J., Ray, B.K., Lee, A.R. et al. Self-reported dietary adherence, disease-specific symptoms, and quality of life are associated with healthcare provider follow-up in celiac disease. BMC Gastroenterol 17, 156 (2017) doi:10.1186/s12876-017-0713-7
Received: 14 May 2017
Patient-reported factors


Meyrelle Fernandez is an ICU trainee from Newcastle who passed the primary exam last year. She is heading off for the challenge of melioidosis, scrub typhus, and leptospirosis in Darwin next year, but not before providing some sharp well structured answers to past SAQs. The first to be published are missing answers from 2009 first and second papers and there will be more to come. Stay posted!


K-Pop idol Sulli recently talked about something that she disliked about herself. But she's pretty, talented, and perfect, right? What on earth could she not like about herself you might ask.
A short preview of the upcoming TV show 'Jinri Store' showed her talking about how she used to hate the name stage name Sulli. Of course, the important thing is that she "used to", as she pointed out that the editing of the preview was pretty much along the lines of 'devil's editing'.
The former f(x) member's reality TV series is scheduled to air on October 23rd.


text:
Fake license plates lead to arrest of two sovereign citizens
Amanda Loviza Times Herald-Record
Mar 4, 2016 at 10:07 AM Mar 4, 2016 at 8:03 PM
WOODRIDGE — Two men driving vehicles with homemade license plates told police who stopped them they were exempt from New York and U.S. laws, taxation and motor vehicle rules.
Lewis Kearney, 25, of Glen Wild, and Chester Hallock, 30, of South Fallsburg, also initially refused to show police any identification, driver license, proof of insurance or vehicle documents, a press release said.
The two men were both driving separate vehicles down Old Falls Road inside the village on the afternoon of Feb. 28. A Woodridge police officer stopped the two drivers after observing the homemade license plates, which declared the vehicles not subject to taxation or motor vehicle rules.
The two men refused to provide police with identification, motor vehicle or insurance documents, police said in a press release. They told officers they were not subject to state or federal laws. Woodridge police called the Fallsburg Police Department for assistance.
When police tried to arrest Kearney and Hallock, Woodridge police chief John Calvello said the two men locked their cars and would not exit the vehicles for about 15 minutes. When they finally did get out, police charged them with resisting arrest and obstruction of governmental administration, both misdemeanors.
Kearney was also charged with aggravated unlicensed operation in the second degree, a misdemeanor, and driving an unregistered motor vehicle, uninspected motor vehicle, uninsured motor vehicle and not having plates displayed, all traffic infractions. Hallock was also charged with driving an unregistered motor vehicle and uninsured motor vehicle, not having plates displayed, and being an unlicensed operator, all traffic infractions.
It was the first time the Woodridge police have dealt with so-called sovereign citizens, Calvello said, but their claims do not exempt them from the law.
Kearney and Hallock were arraigned before Village Justice Heriberto Eddie Hernandez and remanded to Sullivan County Jail. Hallock made his $500 bail and was released the same day, pending a March 9 court appearance. Kearney was still being held at the jail Friday afternoon on a $5,000 bail, also awaiting the March 9 court date.
alovizavickery@th-record.com