text:
American author writing on Holocaust: past serves as a warning how things can go between nations
Hans H. Luik, Kadri Veermäe,
From Facebook to Donald Trump's impeachment. American author Timothy David Snyder who specializes in the history of Central and Eastern Europe and the Holocaust has his strong opinion on every topic. According to him, looking to the past we can predict what is waiting in the future.
© DELFI.ee
During his visit to Estonia, the famous author and professor of Yale University shared his views on the current global agenda in an interview with Hans H. Luik, Estonian media entrepreneur, the founder and major shareholder of the Ekspress Grupp, and Kadri Veermäe, the Estonian journalist and art critic.
Kadri Veermäe: Your book "Black Earth" highlights the way the Eastern Europeans collaborated with the Nazi regime. Can you say did you find out what motivated them?
Snyder: "Black Earth" is not a book about east Europeans or west Europeans. It is a book about people and it has a general thesis about collaboration, which is that how people react to an occupation depends upon what kind of occupation it is.
Head of Holocaust memorial would like info to be available in Lithuanian as well
EP calls for countering Russia's attempts to whitewash Soviet crimes
So the argument that I make is that collaboration in the Holocaust, which is the subject of the book, is much more likely when the state itself has been removed. That is an East European scenario because that's the geopolitics of the world: the Soviets destroyed some states, nazis destroyed some states and they destroyed Poland together.
Answering your question is very hard because I do not know what you mean by collaboration. But my main argument is that people do not respond differently because they're different ethnicities. That is very comfortable for us. We all like to think about ethnicity. We like to say: "Well we are good and Russians are bad or Russians like to say we're good and Estonians are bad" etc.
That is not what my research showed. My research showed that ethnicity does not matter at all. What matters is what the political setup was?
K.V: So it is like Milgram experience?
Snyder: I do not remember that Milgram was controlling for anything, but I think that is basically right that as a broad sociological generalization you know much more about how country A is going to behave if you know exactly what pressure the country A was under.
If you want to think of it as an experiment and it's 1939 and your job is to predict who's going to collaborate if the information you have is information about ethnicity that will be useless to you. But if the information you have is which states are going to be destroyed or what kinds of occupation regimes they're going to be - that information will help you to predict what's going to happen.
K.V: But should we say that directly that it was the young Estonian policemen who killed Jews in Estonia? We tend to say that the Nazi regime was the one that killed Jews in Estonia.
Snyder: We are now moving from sociology to ethics. So I think that it is an ethical mistake for Germans to say that East Europeans collaborated and therefore there would not be Holocaust. But it is also an ethical mistake for East Europeans to say it was all the Germans' fault. "If it had not been for those bad Germans, we would not have done bad things."
I think it is very important from an ethical point of view to take national responsibility. So if you believe you belong to a nation then you probably believe your nation did all kinds of good things as a rule. And so if you believe your nation did all kinds of good things you must understand it can't only have done good things. It must have also done some bad things.
So I think from the point of view of Estonian national ethics, you have to say: yes, those were Estonian policemen who actually carried out those orders. It's also very important to describe that history and not just let it go or let it be overwhelmed by what the Germans and Soviets say.
I mean, this is important for everyone, not just Estonians.
I understand that small nations don't want big nations to bully them and to tell them what to do, but this is not about that. It's about how you become your own nation. If you are suppressing or lying about things that you know not to be true then the next generation suffers from this.
K.V: There has been some discussion in Lithuania about Jonas Noreika: he collaborated with the Nazi regime during the times but right now it is really difficult to assess his role in history. Was he a real hero who was in anti-soviet resistance or was he a collaborator? And how can we assess the role of this kind of individuals? Should we consider them still as heroes?
Snyder: I think the whole discourse of Eastern Europe would benefit from not using the word "hero", which is a very Soviet word which East European nationalists have more or less inherited from the Soviet Union.
Kapitonas Jonas Noreika-Generolas Vėtra su būsima žmona Antanina Karpavičiūte. Apie 1936 m., Palanga, LGGRTC nuotr.
I mean, it's ironically the nationalists who are often the least critical about certain Soviet concepts and "hero" is one of them.
Once I say, you're a hero, it's like you're not fully human anymore. So you become a sort of a demi-god. I would submit that it's better not to say that people are heroes, at least give it 200 years or so before you decide if someone is a hero or not.
That whole concept just gets in the way. I mean, these are human beings that we are talking about and it's really not that unusual for people to lead complicated lives.
For me the important thing is to understand the German occupation, to actually understand the Soviet occupation and then to know everything possible about that life or about any other life and then to pass judgments. The problem is that once you start putting up monuments and plaques on buildings, you have committed yourself to things. I think it's better to wait with all of that for quite a long time. People have a hard time admitting they make mistakes and calling people heroes makes it even harder to admit that you've made mistakes.
Hans H. Luik (HHL): Professor, I am observing an interesting loop in a negative sense. Every time it seems that now the levee is going to break and the Russian democratic movement is going to bring down another Berlin Wall or whatever lies there and make their participation heard through the voting and everything. But it's 20 years Putin's been there and they don't ever seem to achieve the critical mass. So what is it? Is it the view of Eternity as you put in your "20 lessons from the 20th Century" or how long are we going to observe this? This is a very sad loop: some optimism and then Putin again.
Snyder: What I try to do is to learn from Russians because Russians have experienced an extreme form of things that are present in the West as well and very often you can get clues from Russia what might be happening.
I don't think things are going to get better anytime soon in Russia. But I will also know that things are getting worse in my own country. Following the right kinds of Russians can help you figure out where things are going to go.
© Sputnik / Scanpix
If the question is why are things going badly in Russia then I think it has a lot more to do with 21st-century problems than it does with ancient Russian problems. It is very hard to have a democracy when one person has 60 billion dollars. It is hard to have democracy in a poor country which is dominated by exports of raw materials. It's hard to have democracy if a single oligarchical clan gets control of those resources, which is true in Russia.
It's very hard then to have democracy because democracy depends upon the decentralization of wealth and of political potential.
As long as we have a world hydrocarbon economy, it is going to be hard for the Russian system to change.
HHL: I am smiling since as you know the US is the biggest exporter of petrol and gas.
Snyder: And it has not been very good for our democracy.
K.V: Are you worried if you see in which direction the US is going to Should you be worried? Maybe it is a natural process.
Snyder: Natural processes worry me a lot. Erosion is a natural process, so are meteor strikes.
"Worry" wouldn't be the right word. I think democracy is something that you work for and you lose. It's a big problem with Americans that they are exceptionalists and they think: "Well, you know, we just are democratic whatever happens means either nothing or it will be somehow automatically corrected."
I don't think so. I think that democracy is exceptional. I think it's unusual. I think you have to be able to take risks for it, at least small risks, or else it goes away.
If the question is: do I think the United States could cease being a democracy, then I'll say that the US is a very flawed democracy. I mean constitutionally our democracy is much worse than yours because we have this ancient Constitution which has a lot of flaws built into it and it didn't anticipate a lot of 21st-century possibilities. So we are very far from being a democracy now and things are generally getting worse and they've been getting worse for the whole century basically.
K.V: What do you think will happen with Donald Trump's impeachment?
Snyder: Oh, he will be impeached but Europeans need to know that impeachment is an accusation, it is not a conviction. So he will be impeached. I would be very surprised if he's not impeached but the real question is whether he would be convicted. I think it is unlikely but not impossible.
It will depend on Senate Republicans. If Senate Republicans decide for whatever reason they have had enough of him, they can just hold a secret ballot. If they hold a secret ballot, they probably would vote to convict them. They are all afraid though: Trump is very popular not in the country, but he is very popular among Republican core voters. Republicans are behaving in my view in a very cowardly and unpatriotic way, but they do have something to be afraid of: they're afraid of losing their seats.
If they vote secretly though, they might vote to convict him because there's no one in Washington who actually believes he's not guilty. Everyone knows he is guilty.
Donaldas Trumpas
© Sipa / Scanpix
HHL: To continue with topics connected to us, I would like to ask: Who was Edward Snowden? Is he rather a traitor or a whistleblower? I would like to explain in some words. What happened in Estonia after his revelations: our liberal politicians, as well as the security community, tended to tell the audience that this is all happening all the time, we knew it. After that I observer the leader of a Senate commission saying that we did not have a clue what was the scope of NSA's illegal activities: spying after Angele Merkel and Dilma Rousseff.
Then Edward Lucas who was our colleague here 25 years ago wrote a brochure on Snowden as a traitor being hired by Russians. Do you have any evidence of that? How do you see Edward Snowden? How are his activities going to be tackled after 200 years?
Snyder: I have no evidence that no one else has and I don't know anything about Snowden that I haven't read in the press. I will tell you my view: if he wanted to be considered a hero he had to stay in the United States and face consequences, right?
So if he wanted to be remembered in 200 years as a hero, then he should have published what he wanted in the US and then stayed and faced prosecution or whatever it was going to be. If you don't take any risks, nobody's going to remember you as a hero in 200 years.
What I don't like about Snowden is that he ran away. That's the main thing that I don't like, it makes me suspicious.
HHL: But Russia was not his country of choice.
Snyder: Who knows.
HHL: He was applying for visas elsewhere like Europe.
Snyder: Yes, well, who would not but we just do not know. Right?
It could be that he knew he would go to Russia, but then he preferred other places. Who would not? But I do not have any knowledge about that.
His impact would have been much greater if he had stayed and been tried for something in the US and then spoken during his trial.
Edwardas Snowdenas
© AFP / Scanpix
The other thing which I do not like is the notion that only the Americans did it [spying]. That's totally ridiculous. The Germans do this, the British do this as well. If the Estonian government could do it the Estonian government would also try to do it. The Russians certainly try to do it and the Chinese, of course, try to do this kind of thing. The Americans may have had greater capability, but the idea that only Americans spy on foreign leaders is absurd. That is completely absurd. They might have had the greater technical capability at a certain point in history. But the idea that only Americans have the idea to tap Angela Merkel's phone is ridiculous.
KV: You are going to discuss in Tallinn how to win nationalism back from populists but maybe they can just keep it. What do you think?
Snyder: Nationalism is one of those words like populism where no one really knows what it means. My idea about the nation is that the nation is a perfectly legitimate part of someone's way of being in the world.
I am from a place. I was educated in a state. I identify with a country. But I also have friends in other countries and I care about those places and to some degree, I care about the world. There are layers to my notion of myself.
The question for me with the nation is: does the nation help you to think bigger or does it make you think smaller? For me, there's a difference between patriotism and nationalism. A patriot manages to think about the whole country and thinking about the whole country helps you think about Europe and then about the world.
But if thinking about the country makes you think: "well, I am going to think about my enemies inside the country and I am going to crush them." Then the nation is making you think smaller. Then for me, you are a nationalist in the negative sense of the word.
Another way that I think about it is related to the future. If you really care about the nation, then you care about the nation's future. So do you have a policy for the future or are you just talking about how you were always innocent?
And so that is a sign that maybe you do not really care about the country that much if all you're doing is talking about the past. I understand there are good reasons to talk about the past sometimes but if that is all you do then maybe you do not care so much about the nation because the nation cannot live in the past. The nation can only live in the future. If the nation exists at all it only exists in the future.
KV: If you see in Germany, like Pegida shouting "Wir sind das Volk" and activities from Alternative für Deutschland, how do you perceive it? One can do it for sure but should one use this kind of concept from the past?
Snyder: I think it is important to have serious conversations about problems in the present because if you do not do it then you end up having those kinds of conversations.
So there are some issues like immigration, for example, that is a question. You have to have an open conversation about what kind of immigration you want and try to have a consensus because if you do not have an open conversation about it, then the issue gets hijacked.
One of the reasons, not the only reason, but one of the reasons why Trump can resort to this basically fascist "build the wall ", "we are us, they are them", "we are good, they are rapists."
One of the reasons he can do this is because we didn't manage to have a serious conversation about immigration and pass laws about it. That is not the only reason, that it's one of the reasons.
But no, I do not think Germans should be talking about how "Wir sind das Volk" and I don't think Americans should be talking about "America first" and making white supremacist symbols in public. Nor should Estonians.
I think that the past does not have to be a source of taboos, past serves as a warning on how things can go.
One of the things which were characteristic of the 21st century is that all these people on the far-right do these things and then they say oh, but we are just kidding. Like they do these things and then they say but we do not take any responsibility for doing them. "We are just joking, right? We are just trying to make you react to us."
It is even worse because, in addition to endorsing some of the worst things in the past, you are also failing to take responsibility for what you are doing.
HHL: Do you approve a point of view that Alternative für Deutschland having been provoked exactly by Angela Merkel's Willkommen-politics. And the other part of this question would be: you were talking that we have to address serious issues like immigration. What is your pick on Social Democrats Thilo Sarrazin's view, that there are immigrants from Korea, China, Baltics, Poland to Germany who adopt the culture? And there are immigrants who tend to come from Muslim countries who do not adopt the culture, schooling system and constitutional values of women and men being equal, of Allah not being higher than Buddhist gods and Jesus Christ, etc.
Snyder: This in a way goes back to your question about collaboration in the Holocaust.
I am very skeptical of generalizations about groups partly because you can generally find an exception. Muslims in the US are considerably better integrated than a number of European groups. They are spread all around the country and they are generally middle-class and much less likely shoot people than white Protestants are for example in my country.
So I am skeptical of that because over the long run this is probably not true and also partly because I think the real question on immigration is not what they are like. The real question of immigration is what we are like.
If you ask about Merkel, I think Merkel was virtuous in the sense that she was trying to undo a bad history in the past.
The question was not whether those Muslims could be integrated or whether they are good people. The question is what Germans are capable of doing: not what you are capable of saying, what you are capable of doing.
Germans are making fun of that Wir schaffen das. But when she said that it was meant morally and I understand where she was coming from. But I think you can overdo it in every country and she overdid it.
Does that mean that Estonia should have zero refugees or that Poland and the Czech Republic and Hungary? The refugees you have could fit in this hotel and then some of your politicians make a huge deal out of it.
So the fact that 1 million was too much for Germany does not mean that zero is the right number for the Baltics? No, I don't' think so.
I am not really that interested in hearing how Muslims can never assimilate because I am a historian and I know that for hundreds of years it was the Muslims who brought culture to this continent and not the other way around. I mean algebra is called algebra for a reason, algorithms are called algorithms for a reason - that is an Arabic word.
My basic answer is: we have to be realistic about us and the answer is not zero. The answer is not building a wall because when you build a wall all you are doing is you're saying we are right. They are wrong. And that is always going to poison your politics.
HHL: What should - if anything - be done with Facebook? We had a conference here in spring where Nassim Talib was presenting. He told that Facebook should be broken into several pieces while some say that then it would be impossible for Facebook to take the fight from Chinese giants like TikTok and the others. Zuckerberg has not shown the willingness to come along. So what about that?
Snyder: I would like to start in a slightly more general way.
I think there was a point where no one knew what the political consequences of Facebook would be but now we do know. The political consequences of Facebook are that it drives out actual journalism because journalism becomes too expensive. Plagiarism is free and the invention of fiction is almost free. Whereas journalism is expensive. You have to pay someone to go and report a story and that costs money.
And Facebook has had devastating effects on journalism in the US and then the other effect related is polarization because the algorithm to Facebook is designed to find your weaknesses: the things that you like or the things that you are afraid of. And then gives you like a pulse - pleasure, pleasure, pleasure, pleasure, fear, pleasure, pleasure, fear, pleasure, pleasure, pleasure, fear. It trains us into being different kinds of political beings than we were before.
This is what we know, it is all established. Since we know it we have to do something about it. You can do things about it on the platform itself. So if you run a newspaper rules are about what a newspaper is. A newspaper cannot be just a picture of a newspaper. It is not a newspaper if it is just a picture of someone wearing clothes or driving cars.
There are rules about what newspapers are just like there are rules about anything. There is no rule what a social platform is but there could be. There could be consumer regulation which says that if you run a social platform that features any news at all, you have to give people the option of whether they prefer to receive more news or prefer to receive more news that was reported by humans.
It might be this law which says people should always be given a choice because if people were given that choice they would choose.
That is part of the issue. I think another way to look at it is economics. If a factory pollutes the air that is a negative externality. You internalize the externality by making them pay a certain amount. Facebook pollutes people's brains – we are all stupider thanks to Facebook. And so that is a negative externality. You can try to correct that by taxing the advertising and using that to support journalism or public education.
Fundamentally, I think that Facebook is too big and I do not care about Tik-Tok. I do not care about China, just let them be doomed in its own Chinese way.
Facebook is too big. It should be broken up and while we are on the subject Google and Amazon should also be broken up.
These companies are just too big. They meet all the classic criteria from a century ago of why companies should be broken up. Friedrich Hayek who all the Libertarians like to quote said monopolies are just as bad as Central planning. If Amazon continues the way it is now is going to the only company in the world. That does mean that Jeff Bezos is s a bad person or Zuckerberg. It is not about people it is about entities taking up too much space in the economy so Facebook should obviously be broken up.
KV: What is your next book going to be about and what kind of fiction books to read right now?
Snyder: I no not read a lot of fiction books, I read mystery novels and French and German as a sort of escapism. But what I am reading now is a lot of math and science and I am reading a lot of natural history: the history of the earth, history of science because I find that that is a pleasant contrast to everyday life. Also, it helps me to think, to get away from these human overly discursive subjects. I find it is nice to think about math and science a little bit.
So that is what I have been reading it when I go to bed: math and science.
My next book is going to be about freedom. It is about how we could be free. So the last couple of books have been about how you defend what you have and how do you diagnose what the problem is.
I am now trying to write a book about what things would be like if they were much better than they are. Because things could be much better than they are right now. Technology and wealth that we have could be used in a different way.
We are in an odd situation where we have so much. We have a lot of knowledge and we have a lot of money but we are not actually using it according to any set of values.
I like to think that although the bad scenario and the very bad scenarios are possible, they are not inevitable. So what I have been trying to think about is how you sketch out a future that seems attractive enough to draw politics on its way.
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We will visit three cenotes, each one with impressive characteristics. The natural beauty of this creation of nature will astonish you.
You'll be able to bathe in their waters. We'll arrive on board a truck. This type of truck was used to transport the henequen. The first visit will be to cenote Cascabel, where the greatness of its natural formations will dazzle you. Next, you'll be able to enjoy cenote Chaksikin and its deep waters. Here, as in the previous cenote, you'll enjoy more of a free swim, as they're underground cenotes. We continue the journey on the cenote Pool Co- com, which is open and allows you to enjoy of the nature around you. The visit ends with a de- licious meal in a local restaurant.
Don't forget to bring your swimsuit and a towel.
Please bring with you an official ID and your printed voucher.


GINGOOG City, Misamis Oriental – Davao City Mayor Sara Duterte opted not to comment on the supposed growing wealth of the Duterte family, and her Statement of Assets, Liabilities and Networth.
In an interview after the campaign sortie here, Mayor Sara said she will just wait for the other parts of the report of the Philippine Center for Investigative Journalism (PCIJ) before making a comment.
However, she assured the public that what she and her family declared in their SALNs are truthful.
"Well, karamihan naman doon, walong ano, baseless actually. Hindi namin sinasagot. Pero kung meron man kami makita na karapat dapat na sagutin, then I will answer," Mayor Duterte said.
The presidential daughter is currently campaigning for the senatorial candidates of the Hugpong ng Pagbabago, a regional party she formed together with some politicians from Mindanao.
The presidential daughter's wealth, according to the PCIJ report, grew more than six times. In 2017, Mayor Duterte's net worth registered a 28.45 percent increase and climbed to P44.83 million from the previous P34.89 million in 2016.
"I deemed to wait for the complete report… sabi nila three parts daw so antayin namin second, third parts then I will decide if there's anything there worthy of a comment na di nasagot ng SALN ko," she said.
Mayor Duterte, who is married to Atty. Manases Carpio, is seeking reelection as Davao City Mayor while her brother Paolo is running for the city's first district representative.
The President's son also experienced a second upsurge in his net worth in 2017, the PCIJ noted, rising to P27.74 million from P19.84 million in 2016.


text:
Q: Not able to get custom directive attribute value I've a custom directive called "mycomponent".
restrict: 'AE',
templateUrl: 'template.html',
scope:{
    sTransactionType: '=transactionType',
    sStorageVariable: '=storageVariable'
},
link: function(scope, element, attrs){
    console.log("attrs.transactionType:: "+attrs.transactionType);
    console.log("scope.sTransactionType:: "+scope.sTransactionType);

And markup as:
<my-component transaction-Type="FundTransfer" storage-Variable="FundTransferToday"></my-component>

Now, when I try to access the value of attributes transaction-Type and storage-Variable in link function of directive, it returns undefined.
Values can be accessed by attrs.transactionType but not able to get it with scope.sTransactionType.
I tried to change attribute name, scope varibale name.
How do I get custom directive attribute values in scope variables ?
Updated code:
var fundtransfer = angular.module("fundtransfer",['mydirectives']);
var controllers = {};
controllers.cntFundTransfer = function($scope, $rootScope){
}

var mydirectives = angular.module("mydirectives",['Constants']);
mydirectives.directive('myComponent', function($rootScope){
restrict: 'AE',
templateUrl: 'template.html',
scope:{
    sTransactionType: '=transactionType',
    sStorageVariable: '=storageVariable'
},
link: function(scope, element, attrs){
    console.log("scope.sTransactionType:: "+scope.sTransactionType);
}
}

<my-component transaction-type="FundTransfer" storage-variable="FundTransferToday"></my-component>

A: Your attribute naming is wrong.
all should be in lowercase
try like this
<my-component transaction-type="FundTransfer" storage-variable="FundTransferToday"></my-component>

JS
restrict: 'AE',
templateUrl: 'template.html',
scope:{
    sTransactionType: '=transactionType',
    sStorageVariable: '=storageVariable'
},
link: function(scope, element, attrs){
    console.log("scope.sTransactionType:: "+scope.sTransactionType);
}

redpajama_set_name: RedPajamaStackExchange


We're proud and grateful for having been elected Peace Profile of the Month by The Norwegian Peace Council!
The Fram Museum along with the Russian Geographical Society, are behind an exhibition of Norwegian-Russian polar photographs. The exhibition entitled "Norway & Russia - The Polar Connection", opened in St. Petersburg earlier in September and highlights a long history of cooperation between Norwegian and Russian explorers and scientist.
The exhibition represents a cultural cooperation that should be applauded given the increasingly strained political bonds between Russia and Norway.


text:
Menu CIO
New modems to fuel superfast broadband over copper
The first commercial g.Fast services are expected next year
Mikael Ricknäs (IDG News Service) 18 June, 2015 01:18
Alcatel-Lucent 7368 ISAM residential gateway works with both VDSL2 and g.Fast.
Alcatel-Lucent and chipmaker Sckipio Technologies are debuting modem technology that will help make speeds of hundreds of megabit per second over copper cables a reality.
The technology that makes it possible is called g.Fast. Step-by-step, chipmakers and equipment manufacturers are getting it ready for large-scale commercial services. They are expected to arrive next year.
After getting the network equipment to work, vendors are increasingly focusing on the modems.
Alcatel-Lucent has launched the 7368 ISAM residential gateway, which uses g.Fast and 802.11ac to offer speeds surpassing 750Mbps, it said. The product has four Gigabit Ethernet ports and two USB 3.0 ports. It can also be used to deliver broadband over VDSL2. The thinking is that operators can offer VDSL2 today and then upgrade to G.fast.
Sckipio, meanwhile, has announced a new line of G.fast reference designs to support G.fast modems inside an SFP (small form-factor pluggable) module. This approach lets modem manufacturers develop products that aren't tied to one access technology, and also makes upgrades easier. Sckipio has also developed a reference design for an affordable modem.
Neither company offered any details on pricing and shipping.
The speed increase offered by g.Fast is needed for applications such as streaming 4K video (and in the future, 8K video), IPTV, cloud-based storage, and HD video calls. At the International CES trade show in January, Sckipio demonstrated G.fast's ability to carry 4K TV.
Operators backing g.Fast include British Telecom, Telekom Austria and Swisscom.
Last month, Swisscom said it was testing G.fast data transmission under real conditions for the first time, offering speeds up to 500Mbps. The operator is planning to use G.fast for all its FTTS (fiber to the street) and FTTB (fiber to the home) connections from 2016. Because g.Fast performs at its best over short distances, the technology will be used in combination with fiber.
Telekom Austria also expects to launch commercial services next year. BT is a bit more cautious and has stated its first services will come next year or in 2017.
Are you optimising your office costs? Video could help
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Join the CIO Australia group on LinkedIn. The group is open to CIOs, IT Directors, COOs, CTOs and senior IT managers.
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CIO50 2020 #18 Michael Fagan, Kmart Group

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: How to ADD OBR to the HL7 message? I am trying to generate the HL7 message using the Python library hl7apy, but when HL7 message is generate it does not gives the OBR segment in the output, please try to solve this query.
The code is
from hl7apy import core
hl7 = core.Message("ORM_O01")
hl7.msh.msh_3 = "SendingApp"
hl7.msh.msh_4 = "SendingFac"
hl7.msh.msh_5 = "ReceivingApp"
hl7.msh.msh_6 = "ReceivingFac"
hl7.msh.msh_9 = "ORM^O01^ORM_O01"
hl7.msh.msh_10 = "168715"
hl7.msh.msh_11 = "P"

# PID
hl7.add_group("ORM_O01_PATIENT")
hl7.ORM_O01_PATIENT.pid.pid_2 = "1"
hl7.ORM_O01_PATIENT.pid.pid_3 = "A-10001"
hl7.ORM_O01_PATIENT.pid.pid_5 = "B-10001"
hl7.ORM_O01_PATIENT.pid.pid_6 = "DOE^JOHN"

# ORC
hl7.ORM_O01_ORDER.orc.orc_1 = "1"
hl7.ORM_O01_ORDER.ORC.orc_10 = "20150414120000"

# OBR
# We must explicitly add the OBR segment, then populate fields
hl7.ORM_O01_ORDER.ORM_O01_ORDER_DETAIL.ORM_O01_OBSERVATION.ORM_O01_ORDER_CHOICE.add_segment("OBR")
hl7.ORM_O01_ORDER.ORM_O01_ORDER_DETAIL.ORM_O01_OBSERVATION.ORM_O01_ORDER_CHOICE.OBR.obr_2 = "1"
hl7.ORM_O01_ORDER.ORM_O01_ORDER_DETAIL.ORM_O01_OBSERVATION.ORM_O01_ORDER_CHOICE.OBR.obr_3 = "2"
hl7.ORM_O01_ORDER.ORM_O01_ORDER_DETAIL.ORM_O01_OBSERVATION.ORM_O01_ORDER_CHOICE.OBR.obr_4 = "1100"

assert hl7.validate() is True

print "\n Validate HL7 Message: ", hl7.validate()

print "\n\n HL7 Message : \n\n", hl7.value
print "\n\n"
# Returns True

A: You should add a OrderDetailGroup before adding and populating the OBR segment.


text:
Interesting Market News
Random market news.
- OPEC and Russia extend production cuts to March 2018.
- But WTI fell below $50 again.
- ~1.7mm bbl/day production expected to go online in 2017, excluding US shale.
- Lumber and Nickel continue to decline, like other industrial commodities (despite relatively weaker USD).
- S&P Technology driving broader index (7.9% YTD, 4.6% ex-AAPL, FB, AMZN, MSFT, GOOGL).
- VIX remains below 10.
- Bitcoin at ~USD 2600.
- US Loan funds have 28th consecutive weeks of inflows. AUM now ~$150bn.
- US Trade Balance in Goods worse than expected (-US$67.6bn), which will likely lead to lower GDP growth figures.
- Large divergence b/w Trump budget deficit projections and CBO's (zero vs. ~$1.4tr in 10 years).
- US restaurant traffic (MillerPulse) has been negative since April 2016, but largest drop most recently (-5%).- Broader EM bank lending conditions improved materially this quarter.
- Brazil Total Loans continues decline from 2015 peak. Now ~BRL 3,100bn.
- US Total C&I loans flat since late 2016. ~USD 2.1tr a/o April 2017.
- India SENSEX hit record high again at ~30,750.
- USDCNY now down to ~6.87.
- Robust Q1 GDP growth across Eurozone.
- Corporate debt to GDP comparison.
- HF gross and net leverage estimates.
- "Insurers are introducing fixed-rate deferred annuities with income guarantees to circumvent BICE"
http://www.investmentnews.com/article/20170525/FREE/170529942/dol-fiduciary-rule-pushes-indexed-annuity-carriers-to-develop-new
- "Church of England's Investment Fund Eyes Music Royalties"
http://www.institutionalinvestor.com/article/3720293/investors-endowments-and-foundations/church-of-englands-investment-fund-eyes-music-royalties.html#.WSejYevyu0o
"Asset managers are willing to consider esoteric investments as they increasingly seek new ways to diversity their portfolios."
CoE returned 17.1% in 2016 and 9.6% average return over 30 years.
- "Investing In Private Equity: Concerns in a hot market"
https://www.ipe.com/investment/investing-in/private-equity/investing-in-private-equity-concerns-in-a-hot-market/10018677.article
- WSJ's series on (new) quants in finance this week.
"In our series "The Quants," The Wall Street Journal explores just how far this approach has changed the nature of investing—and where it will evolve next."
https://www.wsj.com/articles/the-quants-meet-the-new-kings-of-wall-street-1495389163
Random infra news.
- Progressive lawmakers lay out alternative infrastructure plan. http://thehill.com/policy/transportation/334654-progressive-lawmakers-lay-out-alternative-infrastructure-plan
"The proposal from Lieu would inject $2 trillion into a wide range of transportation projects over 10 years, including those that boost public transit systems, water and sewer systems, clean-energy jobs, high-speed internet access and veterans hospitals." Rhetorical bidding war is good.
- Germany bans road privatisations, limits PPPs. Following lengthy coalition battles, the government has agreed to set up a federal road infrastructure company free from private capital and imposed additional limits on PPPs.
- Cote d'Ivoire is planning to build a 25MW solar plant in the north of the country to alleviate demand pressure on the grid.
- Brookfield Asset Management has deployed 45% of Brookfield Infrastructure Fund III (BIF III) and expects to launch the next generation fund in 2018, CEO Bruce Flatt told shareholders.
- US-based manager BlackRock has reached final close on its Colombia Infrastructure Debt Fund.
- Clifford Capital is preparing the issuance of project finance loan securitisations, chief executive Clive Kerner told McKinsey's Global Infrastructure Initiative Summit in Singapore. The government-backed finance institution is aiming to come to the market by the end of 2017 or early 2018, Kerner said.
Driven by Basel 3 to reduce long-term loan exposure. Infra is hot now, but they must still have a lot that they can't sell to resort to something like this.
- Sri Lanka's cabinet has approved the development of a 1,040 hybrid solar and wind park in Pooneryn in the Northern Province on the country's north-western coast.
- The city of Rio de Janeiro has signed a contract with the International Finance Corporation (IFC) to help structure and implement a public-private partnership to build and maintain approximately 130 new schools, for pre-school and kindergarten education.
- TPG pays $2.4bn for west coast fibre-optic provider. The firm said it plans to merge Wave Broadband with a company it acquired last August to make the sixth largest cable operator in the US.
- Swiss Life backs Cellnex's landmark €430m telecoms deal. The transaction, also backed by Germany's Deutsche Telekom Capital Partners, ensures Cellnex becomes Switzerland's first independent operator of mobile telco infrastructure.
Tech stuff.
"Funding Vs. Exit Showdown: More Money Is Once Again Flowing Out Of Tech Than In"
https://www.cbinsights.com/blog/exits-vs-deals-tech-trends/
"Digital Health Funding Reaches Record Level"
https://www.cbinsights.com/blog/digital-health-funding-trends/
"SEA tech startups lag far behind China and India in attracting VC funding"
https://www.dealstreetasia.com/stories/sea-tech-startups-china-india-vc-funding-73389/
"SoftBank invests $100m in Brazilian ride-hailing app 99"
https://www.dealstreetasia.com/stories/softbank-brazil-ride-hailing-app99-73427/
Legal-tech system that summarizes documents.
https://www.agolo.com/splash
Fun with image identification.
amzn.to/takepicture
Fun with hacking.
http://map.norsecorp.com/#/
Events tmrw.
- Italy Bus & Cons Confidence, 4:00 AM ET (108.0 Mfg and 107.3 Cons consensus)
- US Durable Goods Orders, 8:30 AM ET (New orders -1.0% M/M, 0.2% M/M Core consensus)
- US GDP, 8:30 AM ET (0.8% Q/Q consensus)
- US Consumer Sentiment, 10:00 AM ET (97.6 consensus)
- US Baker-Hughes Rig Count, 1:00 PM ET
Wall Street Journal, Financial Times, Institutional Investor, AI-CIO/Chief Investment Officer, Investment & Pensions Europe, Pension & Investments, Infrastructure Journal, Infrastructure Investor, CBInsights, Deal Street Asia, Trading Economics, Bloomberg, MarketWatch, Standard and Poors, Moody's, Fitch Ratings, CME Group, Capital IQ, Quandl."


007, Clinton & Java. - You don't know me.
Pierce Brosnan began show business as a teen runaway, working with the circus as a fire eater. He later gained more conventional acting experience working in London theatres. His theatrical breakthrough came when American playwright Tennessee Williams hand-picked Brosnan to play McCabe in the British premiere of Red Devil Battery Sign. He got another big break when he landed the TV series "Remington Steel" (1982-1987). After the cancelation of his TV show, Brosnan moved to movies and appeared in numerous films, including, of course, several James Bond flicks in which he plays the womanizing British spy 007.
Aw, c'mon! Considering that Casino Royale has arguably the most boring plot of all the James Bond novels, I thought Craig really rocked the role. And I liked that he was able to bring some authentic physicality to the role, instead of relying solely on handguns and gadgets.
Happy Mothers day :) Hope you had a good one.
And yeah, I prefer Pierce.
Lets not forget his classic performance in Mrs. Doubtfire.
I don't recall him being in that. Whooops. Who did he play?


Glorious Golden Irish Sweet Potato Bread!!
I am proud to say this is my very own creation! It's fantastic; tastes like a sweet bread with the spices and you almost think you're eating a pumpkin bread, but there's NO sugar!! You'll love it just buttered as a snack.
Use half regular white flour and half white whole wheat flour.
Sift dry ingredients into a big bowl or just put in bowl and mix very well with a whisk to combine.
Mash with some of the water when done to look like canned pumpkin consistency, not too watery.
Measure out 1/2 c + 1/3 c and put into a glass measuring cup then add buttermilk up to 1c.
Cut butter into little chunks over the flour mixture, then cut in with a pastry blender a bit.
Then use your finger tips to squish the butter bits, keep working with fingers until it's all just crumbly.
Add egg and potato mixture into flour and mix.
Add raisins and stir dough vigorously.
You can knead the dough right in the mixing bowl, dust the dough with flour and use a rubber spatula or what I prefer a 'bowl scraper' to fold dough over and incorporate flour. Add more as needed until dough is not quite as sticky.
Grease cookie sheet and gently plop dough on it, make it into a neat, rounded ball.
Cut a cross into top with a sharp little knife.
Pat top with one beaten egg using fingers (I find this is just quicker and easier!) or a pastry brush, get it into the cross too.
* For regular potato bread you can use regular potato and leave out the spices.
* If you don't have store bought buttermilk you can make up your own, I almost always have to. 1c milk plus 1 Tablespoon of vinegar or lemon juice is the ratio, for this recipe just mix 1/3 c milk with 1 tsp vinegar or lemon juice, it should be enough, make more if needed.
*This bread tastes like a dessert bread or pumpkin bread but has no sugar and uses very healthy sweet potato which is especially good for women! Great taste!
This is a really nice recipe. I never would have been interested in making Irish bread before reasing this.. nice.
Thanks, I hope all the pictures help people when they make it, especially nice for beginning bakers. Let me know how it turns out for you!


The 1TB My Passport Wireless from WD is a portable, wireless USB 3.0 hard drive with a 1TB hard drive installed which allows you to wirelessly share data with any Wi-Fi enabled device, without needing an Internet connection. Designed for photographers, videographers, or anyone needing to share information wirelessly, it is compatible with iOS, Android OS, Windows, and Mac wireless devices. The My Passport Wireless is pre-formatted as ExFAT for Windows and must be reformatted for Mac. The drive allows up to eight users to simultaneously access files stored on the drive and up to 4 HD videos can be streamed simultaneously.
The My Passport Wireless has a USB 3.0 port that can be used to connect it to a computer using the included USB cable. It also has an SD card slot, which can be used to transfer and backup the contents of SD cards to the drive. If a camera has Wi-Fi built-in, then its files may be wirelessly transferred to the My Passport Wireless using FTP protocols. Once the file transfer is complete, the downloaded content may be wirelessly shared.
In terms of power, the My Passport Wireless features a rechargeable battery that supports up to six hours of continuous video streaming and up to 20 hours of standby time. The battery may be charged using the included USB power adapter.


text:
Macchinetta, the first Bizzarrini's car creation
Everything in this world always has a beginning, so it is with works in the automotive world. Of course, as an automotive enthusiast you already know the famous Italian automotive designer named Giotto Bizzarrini.
Yes, it is undeniable that some of the creations he made while working in the world's automotive have became legendary car figures. And on this occasion, let's take a brief look at his first automotive work called Macchinetta which is made when he was a student.
1953 Macchinetta built by Giotto Bizzarrini based on the Fiat 500 Topolino, while he was a student of the University of Pisa. (Picture from: http://bit.ly/37sg6wo)
Well, before he managed to design the car that would bear his name, or the V-12 engine would fill the Lamborghini's engine room (in several forms) from 1963 to 2010, or the legendary Ferrari 250 GTO, young Giotto Bizzarrini was a student at the University of Pisa.
In there as part of his graduation project, he overhauled a Fiat 500 Topolino, by upgrading its four-cylinder engine and revising the chassis to make it better handled. Eventually, the project succeeded in earning him an engineering degree in 1953, and later brought him to work as a teacher. However, because of his love for the automotive world was too big, so made him later left the teaching profession and worked as a chassis engineer at the Alfa Romeo's factory.
1953 Macchinetta built by Giotto Bizzarrini based on the Fiat 500 Topolino, by upgrading its four-cylinder engine and revising the chassis to make it better handled. (Picture from: http://bit.ly/37sg6wo)
Shortly thereafter his career at Alfa Romeo rose to become a test driver. Until one day in 1957, he heard that the Ferrari prancing horse manufacturer was looking for a new test driver, then he drove his Macchinetta to Maranello. What happened next, not many people know thus giving rise to many stories about it.
In one version that Enzo Ferrari was impressed by the technique and design of the small car, so he offered Bizzarrini a job. In another version, Enzo accuses Bizzarrini of "being not too smart, but very brave" for driving the cutie car to Maranello for an interview.
A young Giotto Bizzarrini with his creation, the 1953 Macchinetta. (Picture from: http://bit.ly/37sg6wo)
In short, then he was accepted to work at the Maranello-based car manufacturer, where he would go on to design cars like the 250 Testa Rossa, the 250 GT SWB and the aforementioned 250 GTO, and it's likely that his Macchinetta creation played a role in his hiring.
If you look at the shape of Macchinetta at a glance, it is similar to the Ferrari Ouvo, the 1950s one-off car made by coachbuilder Carrozzeria Fontana which after completion was sent to Mexico, where the Marzotto brothers intended to participate in the Carrera Panamericana racing event in 1953.
1953 Macchinetta uses a 569cc SOHV four-cylinder engine with the Siata-owned cylinder head, and coupled with a pair of Dell'Orto carburetors. (Picture from: http://bit.ly/37sg6wo)
As previously mentioned that the cutie Macchinetta started life as a Fiat 500 B Topolino which uses a 569cc SOHV four-cylinder engine in standard conditions it only spewed power of 16.5 horsepower. Then Bizzarrini changing its cylinder head with the Siata-owned which allowed it to breathe more freely.
And those engine mated to a pair of Dell'Orto carburetors so that the power-bursted up to 30 horsepower. And to improve the car balance, the engine position is then placed in the backwards, from the top of the front wheels to near the center of the frame.
The most obvious change can be seen in the installation of the aerodynamic coupe body which replaces the original Fiat body. Then, under the aluminum shell, Bizzarrini fabricated a tubular steel frame similar to the construction used by the Ferrari cars of the day, with the application of a teardrop coachwork design that was a direct result of Bizzarrini's knowledge of airflow.
Even though its modest power output, Macchinetta proved capable of reaching a top speed of 95 mph, that's a speed number might proved daunting for passengers in such a small car. *** [EKA | FROM VARIOUS SOURCES | HEMMINGS ]
Related posts: Automotives , Classic , Technology , Unique
post by Hafiz Buddy on Wednesday, December 23, 2020
Label: Automotives , Classic , Technology , Unique
Hafiz Buddy
Automotives|Classic|Technology|Unique|


Food for thought: Americans will eat 1.35 Billion chicken wings on Super Bowl Weekend, enough to circle the Earth three times, and the favorite dipping sauce is ranch dressing. That's according to The National Chicken Council annual Chicken Wing Report, and includes wings eaten in restaurants and at home.
That figure is up 1.5%, or 20 million wings, from 2017.
In case you haven't heard, this year, the Philadelphia Eagles and New England Patriots battle for the Lombardi Trophy on Super Bowl Sunday.
Americans will eat 20 million more wings this year. If wings were dollars, that would only buy us two minutes of commercials during the big game. If you can't do the math – a 60 second commercial during the Super Bowl costs $10 million bucks.
This survey was conducted online within the United States among 2,086 U.S. adults ages 18 and older, among whom 1,381 eat chicken wings.
ecoXplorer has been told this online survey is "not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated".
Wing eaters if they prefer to eat traditional, bone-in wings or boneless wings, and bone-in wings are widening the gap against their boneless cousin.
According to the survey, 60% of wing eaters prefer traditional, bone-in wings while 40% chose boneless. In 2015, the spread was 54% vs. 46%, respectively. Boneless wings are typically white, boneless chicken breasts cut into strips, breaded or floured and tossed with Buffalo sauce.
This data parallels with recent research by The NPD Group, which found that 64 percent of chicken wings served in restaurants are bone-in.
Servings for the bone-in wings rose by 6 percent in 2017, while boneless wings declined at a similar rate.
Or, just take a peck at this infographic.


1. COLORADO ACTIVITY. I love to do anything outdoors, but I especially enjoy spending summers in Vail and cycling up Vail Pass. I also like to bike up Flagstaff Mountain in Boulder for the great workout and killer views.


text:
TweetDeck returns to work after a break in US and Europe
A recent report revealed that the TweetDeck Twitter dashboard has been disrupted for some time in Europe and United States before being recovered later.
TweetDeck suffered from a disruption of the platform after 11 am EDT and was returned at around 12.22 pm, while users from North America, Europe, Norway and New York reported the shutdown.
TweetDeck is a Twitter dashboard application for various account departments, originally a stand-alone application, but Twitter had earlier acquired it and merged it into the front of the microblogging site. "We realize that some people are having problems with Download TweetDeck, but our team is working to solve the problem, and we will share more updates on this topic! "
Read also: Update: Facebook, WhatsApp and Instagram suffers worldwide outage
So far, the reason for the interruption of the service is unclear because Twitter has not mentioned any specific cause of the problem. Details about the number of areas that have suffered from power outage are still unclear. Earlier in June, Google Calendar, Entagram, Google Apps and Snap Chat to a great break.
Read also: New features from Twitter are moving to TweetDeck soon
Tech Ammar Muzzaffar - January 14, 2021 0


Piriform sinus fistulas occur due to developmental abnormalities of the third and fourth branchial arches, and almost always occur unilaterally. They generally present as recurrent abscesses in the anterior-inferior neck, with concurrent thyroiditis. They have conventionally been managed with complete removal of the sinus tract, and thyroidectomy if required; however, endoscopic approaches have been increasingly favored. Herein we describe a case of bilateral piriform sinus fistulas, and present a review of the literature concerning their endoscopic management.
Our patient was determined to have bilateral piriform sinus fistulas based on computer tomography, magnetic resonance imaging and microlaryngoscopy. We performed electrocauterization of the proximal fistula tracts, followed by injection of fibrin sealent. Our patient has not had a recurrence in the ten months since his procedure. There were no complications.
Twenty-three articles describing an endoscopic approach to these fistulas were identified through PubMed, and a search through the references of related articles was completed.
Of one hundred and ninety-five patient cases we reviewed, an endoscopic procedure success rate of 82% and complication rate of 5.6% was determined. Piriform sinus fistulas that occur bilaterally are a rare congenital abnormality of the neck. Endoscopic approaches are an acceptable alternative option to open procedures, with similar success and a lower rate of complications.
Third and fourth branchial apparatus anomalies, commonly referred to as piriform sinus fistulas (PSFs), are sinus tracts and fistulas that develop from the piriform sinus. They occur more commonly on the left side, and typically present in childhood with recurrent acute suppurative thyroiditis and neck abscess often following an upper respiratory tract infection [1–3]. Infants and neonates may have respiratory distress, stridor, dysphagia and feeding difficulties due to tracheal compression from the abscess [3, 4]. Thyroid function is usually normal .
PSFs are uncommon and can be difficult to diagnose, due in part to their non-specific presentations . Furthermore, bilateral PSFs are extremely rare, with a thorough literature search revealing only four other patients described with this condition [5–7]. Herein, we present a case of a patient with bilateral piriform sinus fistulas, and review their management.
Our patient initially presented at 10 months of age with rapid development of a mass in the left neck that was tender, firm and erythematous. It was associated with fever as well as dysphagia, and decreased oral intake. The patient had no significant past medical history, nor family history. A lateral neck x-ray suggested a retropharyngeal infectious process. After 48 h of antibiotic treatment, there was minimal clinical improvement; a computer tomography (CT) scan of the neck demonstrated a 5.4 × 3.5 × 4.2 cm left neck abscess extending to left parapharyngeal and retropharyngeal spaces (Fig. 1). Following imaging, the patient underwent incision and drainage. The wound culture grew Streptococcus viridans and Hemophilus parainfluenzae.
For 6 months after the surgery, the wound persisted to drain intermittently, culminating in a submandibular cellulitis. A CT neck and wound culture at that time were unremarkable, and the patient improved after 5 days of IV antibiotics.
At 8 years of age, the patient again presented with a 4 day history of sore throat, fever, drooling, and neck stiffness and swelling; IV antibiotic therapy was initiated. A CT neck confirmed a bilobed right-sided retropharyngeal abscess measuring 2.3 × 2.9 × 3.3 cm and 2.0 × 2.1 × 2.8 cm in the superior and anterior lobes, respectively. The thyroid gland was noted to be intimately involved with this inflammatory process (Fig. 2). The patient was brought to the operating room for incision and drainage of the abscess. The wound culture was positive for Streptococcus anginosis.
Shortly following the resolution of the infection, magnetic resonance imaging (MRI) was performed identifying bilateral communications between the piriform sinuses and thyroid lobes (Fig. 3). Direct laryngoscopy confirmed the diagnosis of bilateral piriform sinus fistula with the passage of 4 Fr ureteric catheters though tracts originating in the piriform sinuses, on both the left and right sides (Fig. 4).
After lengthy discussions and deliberation and review of the relevant literature, the family opted for endoscopic electrocauterization with fibrin sealant management (Fig. 5). We favoured this approach as the PSFs were bilateral, and therefore a total thyroidectomy may have been required for definitive surgical management.
Cauterization and obliteration of the bilateral PSFs was performed without complication. First, a flexible catheter was passed into the piriform sinus to confirm its location. With the location confirmed, a Bugbee catheter was inserted into the fistula and the edges were cauterized at a setting of 8 W. Once adequate cauterization was achieved, Tisseel was injected into the fistula tract. This procedure was performed in both the left and right PSFs. A follow-up 6 months with direct laryngoscopy confirmed closure of both tracts. There has been no recurrence 10 months following the procedure, at the time of writing of this manuscript.
A thorough literature search about the endoscopic management for piriform sinus fistulas was performed. To identify journal articles, a literature search using PubMed was conducted using the filters English language and years 1998-2017. The references in each article were also reviewed to find additional papers. Twenty-three articles were identified as relevant studies. Table 1 lists the year the study was published, number of patients enrolled, patient characteristics (age, gender), techniques used, success rate, amount of follow-up and complication rate. A procedure was considered a success if did not have to be repeated for either recurrence, or incomplete fistula tract closure. For research groups that had multiple publications using repeat patient cases, only their last publication was included.
A PubMed search was also used to find cases of bilateral piriform sinus fistulae. No filters were used. Four cases were found from three publications.
From one hundred and ninety-five cases of piriform sinus fistulas, based on 23 studies, we calculated an endoscopic success rate average of 82% and complication rate of 5.6%. Post-operative follow-up times ranged from 6 weeks to 18 years with an average of 35.5 months. Patient ages ranged from newborns to 31 years, and there was a gender distribution of 1.8 females to 1 male (56 females, 31 males). However, the gender and ages of the patients in the studies could not be identified for 55% of patient cases presented. All the studies were published from 2003 to 2016.
PSFs are notoriously difficult to diagnose. While neck abscesses are a common entity in pediatric otolaryngology patients, PSFs are rare. With a repeated history of anterior neck abscesses, or when imaging identifies thyroid gland involvement, this diagnosis should be considered. Confirmation is typically done with direct laryngoscopy, which has a positive predictive value (PPV) of 90%, or barium swallow (PPV 88%) [1, 2]. Management of a piriform sinus fistula involves antibiotics and incision and drainage for acute infections, and observation, followed by surgery or endoscopic techniques for long-term management.
In the acute setting, the choice of antibiotic should reflect typical oral flora as well as Staphylococcus aureus . Surgical drainage for source control is indicated where there is abscess formation .
Considering long-term management, observation may be considered, especially for asymptomatic PSFs; however, 89-94% of patients will continue to have recurrent infections [2, 3]. Therefore, further treatment is usually necessary.
Surgical removal of the sinus tract, and the thyroid gland if required, is typically curative, and has been the standard of care for many years [1, 9]. However, excising the entire fistula tract can be very technically challenging, especially if the patient has significant scarring from repeated infections and prior surgical drainages. Incomplete excision may lead to recurrence . In addition, the recurrent laryngeal nerve is at risk for injury leading to potential vocal cord paralysis. Salivary fistulas, hemorrhage, wound infection, cicatrises, Horner syndrome and injury to branches of the facial nerve are other possible complications. Reported success rates range from 85 to 100% [2–4, 6] with a complication rate of 5-6% [2, 3].
An alternative to surgery is endoscopic electrocautery or chemocauterization, followed by fibrin sealing or endoscopic suture ligation if necessary. This closes off the proximal portion of the tract, preventing leakage of pharyngeal contents into the sinus. Endoscopic techniques have recently been shown to be safe and effective [9, 10], and can be performed as an outpatient procedure, thereby reducing hospitalization and associated costs. The associated risks are lower compared to an external technique, also with the advantage of lacking a surgical incision and consequent scar [9, 11]. However, this is a newer procedure, and data regarding long-term results is scarce. Recent studies suggest the success rate is equivalent to, or slightly less than surgery, with success rate average of 82% (Table 1) [1–3, 8–29].
In summary, piriform sinus fistulas are uncommon developmental anomalies in children. The presentation of repeated anterior neck abscesses, particularly if the thyroid gland is involved should prompt the clinician to consider this entity, and trigger an appropriate work-up. As the fistulas may occur bilaterally, a careful inspection of both sides is required during laryngoscopy. Definitive management has classically been performed through an excision of the tract. Endoscopic electrocautery of the tract may be an acceptable alternative, with comparable success and a lower rate of complications.
JM and RC performed patient diagnosis, investigations and treatments. DL completed the literature review. All three analyzed and interpreted patient data, and were major contributors in writing the manuscript. JD aided in imaging selection for the manuscript. All authors read and approved the final manuscript.
Informed consent was obtained from the patient. The procedures were in accordance with the ethical standards of the Children's Hospital of Eastern Ontario.
The authors have no potential competing interest with respect to the research, authorship, and/or publication of this article.
Nicoucar K, Giger R, Jaecklin T, Pope HG, Dulguerov P. Management of congenital third branchial arch anomalies: a systematic review. Otolaryngol Head Neck Surg. 2010; https://doi.org/10.1016/j.otohns.2009.09.001. Accessed 16 May 2016.
Liberman M, Kay S, Emil S, Flageole H, Nguyen LT, Tewfik TL, et al. Ten years of experience with third and fourth branchial remnants. J Pediatr Surg. 2002; https://doi.org/10.1053/jpsu.2002.32253. Accessed 16 May 2016.
Xiao X, Zheng S, Zheng J, Zhu L, Dong K, Shen C, et al. Endoscopic-assisted surgery for pyriform sinus fistula in children: experience of 165 cases from a single institution. J Pediatr Surg. 2014; https://doi.org/10.1016/j.jpedsurg.2013.11.004. Accessed 16 May 2016.
Pereira KD, Smith SL. Endoscopic chemical cautery of piriform sinus tracts: a safe new technique. Int J Pediatr Otorhinolaryngol. 2008; https://doi.org/10.1016/j.ijporl.2007.10.007. Accessed 16 May 2016.
Bajaj Y, Ifeacho S, Tweedie CG, Jephson DM, Albert LA, Cochrane ME, et al. Branchial anomalies in children. Int J Pediatr Otorhinolaryngol. 2011; https://doi.org/10.1016/j.ijporl.2011.05.008. Accessed 16 May 2016.
Watson GJ, Nichani JR, Rothera MP, Bruce IA. Case series: endoscopic management of fourth branchial arch anomalies. Int J Pediatr Otorhinolaryngol. 2013; https://doi.org/10.1016/j.ijporl.2013.02.007. Accessed 16 May 2016.
Parida PK, Gopalakrishnan S, Saxena SK. Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin-our experience in 17 cases. Int J Pediatr Otorhinolaryngol. 2014; https://doi.org/10.1016/j.ijporl.2014.08.034. Accessed 16 May 2016.
Matsuzaki H, Makiyama K, Suzuki H, Ohshima T. Prevention of neck infection by endoscopic suture closure of pyriform sinus fistulae: a report of two cases. Braz J Otorhinolaryngol. 2016; https://doi.org/10.1016/j.bjorl.2015.11.012. Accessed 7 Jan 2017.
Miyauchi A, Inoue H, Tomoda C, Amino N. Evaluation of chemocauterization treatment for obliteration of pyriform sinus fistula as a route of infection causing acute suppurative thyroiditis. 2009; https://doi.org/10.1089/thy.2009.0015. Accessed 8 Jan 2017.


Budleigh were caught cold by the visiting side as Daniel Koita opened the scoring and was also on hand to double the lead in the 20th minute.
The first half ended with Elmore having been well on top and they richly deserved their half-time 2-0 lead. Both set of managers and coaches were busy at the interval giving out instructions, to which the first side to react was Elmore, making sure that the first action after the kick-off took place in their opponent's half as they put them under pressure.
The young Robins weathered the storm without conceding, and began putting some moves together themselves and were rewarded when Ryan Daffin netted on 56 minutes to reduce the arrears.
Both teams were making good use of the wings, and it was from wide play that Joseph Vincent struck to equalise for Budleigh.
Two minutes later, Man of the Match Daffin completed the turnaround with his second to seal a dramatic 3-2 success for the young Robins.
In the opinion of many present, a draw would have been a fairer result based on both teams' performances in the two halves, and they are probably right.


Tenite™ cellulosic plastics are noted for their excellent balance of properties - toughness, hardness, strength, surface gloss, clarity, and a warm feel. The mechanical properties of Tenite™ cellulosic plastics differ with plasticizer levels. Lower plasticizer content yields a harder surface, higher heat resistance, greater rigidity, higher tensile strength, and better dimensional stability. Higher plasticizer content increases impact strength. Color concentrates are available in let-down ratios from 10:1 to 40:1. Tenite™ Cellulose Acetate Butyrate 576-10 contains an odor mask and an ultra-violet inhibitor(UVI). It has a plasticizer level of 10%.


If your dream is to own your own property in paradise don't despair...purchasing Real Estate in Thailand as a foreigner is still possible, and we have listed the top 5 options for you!
The increasing popularity of the island as a top tourist destination has given rise to a greater number of foreigners looking to buy property in Koh Samui.
Before you buy or rent your next luxury villa, you'll want to make sure they have these features!
Looking for long-term rental options for your Koh Samui Property? Here we go through our top tips..
Best Place to Invest in Thailand?
We don't want to be biased, but we think Koh Samui is Thailand's most desirable location to invest. Read this blog to find out just why we think that..


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We at the Chatham Arts Council are delighted to provide the only online calendar exclusively dedicated to Chatham County arts events–performing, literary, and visual arts. Get out there and get inspired!
Louis Bayard presents Courting Mr. Lincoln
« Michael Parker presents Prairie Fever
Juliet Grames presents The Seven or Eight Deaths of Stella Fortuna »
From the prizewinning author of Mr. Timothy and The Pale Blue Eye comes Courting Mr. Lincoln, the page-turning and surprising story of a young Abraham Lincoln and the two people who loved him best: a sparky, marriageable Mary Todd and Lincoln's best friend, Joshua Speed. Told in the alternating voices of Mary Todd and Joshua Speed, and rich with historical detail, Courting Mr. Lincoln creates a sympathetic and complex portrait of Mary unlike any that has come before; a moving portrayal of the deep and very real connection between the two men; and most of all, an evocation of the unformed man who would grow into one of the nation's most beloved presidents.
Louis Bayard is a New York Times Notable Book author and has been shortlisted for both the Edgar and Dagger awards for his historical thrillers, which include The Pale Blue Eye and Mr. Timothy. His most recent novel was the critically acclaimed young-adult title Lucky Strikes. He lives in Washington, DC, and teaches at George Washington University.
Louis Bayard will be joined by Michael Parker at McIntyre's.
author, Author reading, authors, books, McIntyre's Books
https://fearrington.com/event/michael-parker-louis-bayard/
McIntyre's Books
books@fearrington.com
http://www.fearrington.com/mcintyres-books/
Is this event accessible?
Is this event kid-friendly?
Please confirm that this event takes place in Chatham County
2000 Fearrington Village Center
Pittsboro, 27312 United States + Google Map
Teen Writing Workshop with John Claude Bemis
Mark Greaney & Lt. Col. Hunter Rawlings present Red Metal


Argan Oil as a Serum Before Moisturizer.
Lots of anecdotal tradition in my family for using vitamin E for scars and skin repair. Oils have some occlusive properties, but primarily act as emollients. Therefore, I started using argan oil as a Serum before moisturizer and it helped my skin texture immensely. Since it's a dry oil AFAIK, it doesn't linger on the skin. It's moisturizing and doesn't cause pimples. I put them around my eyes. The only oil that doesn't break me out.
Also I found that pure Argan oil can help people with mild acne as the oleic acid found in the oil helps promote healthy levels of sebum production.
Wouldn't just pure argan oil from like Amazon be better? The 100ml bottles go a loooong way! And without colour and fragrance (those would be enough to break me out anyway).
So If you want to give argan oil a try, but you feel overwhelmed by sheer number of products out there. How can you make sure the oil you're buying is good quality?
My sister and I did our research and painstakingly negotiated with dozens of Moroccan exporters to be able to supply our pure argan oil (aka Argania Spinosa) at an affordable price without gouging our customers (think Josie Maran prices! $96.00 for the exact same product!). Ultimately end up with Sheer Argan's pure argan oil as our regular argan oil importer.


Your antibiotic may slow down how quickly your liver processes quinidine or quinine.
The amount of quinidine or quinine in your blood may increase and cause serious side effects, such as an irregular heartbeat.
Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Let your doctor know right away if you notice an irregular heartbeat or have any dizziness or fainting episodes.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Qualaquin (quinine sulfate) US prescribing information. AR Scientific, Inc. April, 2013.
2.Zhao XJ, Ishizaki T. A further interaction study of quinine with clinically important drugs by human liver microsomes: determinations of inhibition constant (Ki) and type of inhibition. Eur J Drug Metab Pharmacokinet 1999 Jul-Sep;24(3):272-8.
3.Zithromax (azithromycin oral) US prescribing information. Pifzer Labs May, 2016.
4.E.E.S. (erythromycin ethylsuccinate) US prescribing information. Arbor Pharmaceuticals, Inc. April, 2018.
5.Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, Philippides GJ, Roden DM, Zareba W. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2010 Mar 2;55(9):934-47.
6.Damkier P, Hansen LL, Brosen K. Effect of diclofenac, disulfiram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine. Br J Clin Pharmacol 1999 Dec;48(6):829-38.
7.Lin JC, Quasny HA. QT prolongation and development of torsades de pointes with the concomitant administration of oral erythromycin base and quinidine. Pharmacotherapy 1997 May-Jun;17(3):626-30.
8.Spinler SA, Cheng JW, Kindwall KE, Charland SL. Possible inhibition of hepatic metabolism of quinidine by erythromycin. Clin Pharmacol Ther 1995 Jan;57(1):89-94.
9.Phansalkar S, Desai AA, Bell D, Yoshida E, Doole J, Czochanski M, Middleton B, Bates DW. High-priority drug-drug interactions for use in electronic health records. J Am Med Inform Assoc 2012 Sep-Oct; 19(5):735-43.


A NetZero Village, for which Green Hammer provided energy consultation, recently received two awards at the ACI New York Home Performance Conference. The innovative net-zero energy apartment building located in upstate New York received the "Trailblazing Project" and "Lowest HERS Index" awards. Bruns Realty Group was the developer of the $20 million project.
The apartments ranging in size from 790 to 1,093 square feet are expected to generate more energy than they produce. Green Hammer's Dylan Lamar, working in partnership with former Green Hammer employee Jesse Schwartzberg of Black Mountain Design Build, provided energy modeling and cost-optimization studies to help the project team achieve its energy goal on budget.
Go here to learn more about the project's energy-saving measures.


Presidential Candidate for the Allied Congress Party of Nigeria (ACPN), Oby Ezekwesili, has accused President Muhammadu of rewarding security chiefs, who she said are incompetent, hence the growing insecurity in the country.
Where did Ezekwesili make this assertion?
Ezekwesili, who spoke with journalists in Calabar on Friday, said the security infrastructure of the country is broken and that it needs to be urgently fixed.
"So he looks at those who fail and what he does is extend their stay in an office in which they have failed. We have seen it with the military; we have now seen it with the police. How can the president even be thinking of retaining the IG of police after the expiration of his term in office? Is it for stellar performance? This is the IG of Police that the president told the entire country did not go to where he had assigned him to go in Benue State. What the president is essentially telling us is that Nigerian life does not matter that much to him otherwise, he should be very aghast at the level of killings that happen.
"My greatest shock and one of the triggers for my deciding to run for election, not being politician as you all know, is that the debasement of the Nigerian life is the final straw that can turn us into a society of anarchy; for it to be that children should grow up in this society and just come to the understanding that killing a person is a normal thing, that you can just do it, there is no consequence. My goodness, what kind of impunity is that? So for me, I want to be the president of this country and be an effective Commander in Chief of our Armed Forces on the basis of competence, capacity and character.
"There are Nigerians who are comfortable with the suffering in the country. Comfortable with the mediocrity we have seen in governance. Those kinds of Nigerians would be interested in APC and PDP, but if you are a Nigerian and you believe that this is not our lot, that we cannot afford to be a country that is persistently failing. We cannot be a country that locks in 87 million of our people in poverty and think that it is okay for the number of the poor to continue to grow. If you are in that class then you would be the people who would be joining my campaign and saying that we need a new set of mindset to solve our problem," Ezekwesili said.
She said she was in Calabar to participate in a Carnival and to use the season of the celebration to interact with citizens on a one of one kind of campaign.


Under waterlogged conditions, the non-grafted tomato plants had significantly lower survival rate (53%), compared to the 100% survival rating of grafted plants. Both grafted and non-grafted plants while under waterlogged conditions had high leaf stomatal resistance, low transpiration rate and high stress rating, compared to the non-waterlogged plants. However, one week after resumption of aerobic soil conditions, both stomatal resistance and transpiration as well as stress rating returned to normal in grafted plants unlike in the non-grafted plants which continued to show high stomatal resistance, low transpiration rates and high stress rating. The morphological changes associated with stress in the plant regardless of treatments were cupping, drooping and eventual wilting of leaves. Due to severe stress under waterlogged conditions, the non-grafted plants had significantly lower yield which was just about 41% that in grafted plants. The grafted, non-waterlogged plants had comparable yield with the non-grafted, non-waterlogged plants.
Application of benzyladenine was not effective in alleviating waterlogging stress effects on both grafted and non-grafted tomato.
The study was conducted in a logged-over forest of Tampakan Highlands that has an elevation of about 1,350 m. It was aimed to assess the timber stocking rate and level of floristic diversity of the forests that may be influenced by future mining operation in the area. Data collection and data presentation were undertaken following the BraunBlanquet methodology.
Results indicate that Tampakan forests are highly productive, with relatively large trees and highly diverse species despite past logging. Forty-nine (49) timber species and timber stocking rate of 69cu m/ha were recorded in the forests. A total of 312 plant species had been listed in the 73 plots or in a combined area of 1.93 ha. The forest still contained most species of the original old-growth forest. The pioneer vegetation dominated by Piper aduncum was very low in species richness. This indicated the importance of natural forest in preserving native flora.
It was recommended that zoning plan be prepared to demarcate areas that need to be reserved as permanent forest and more effective forest protection schemes be devised. Enrichment planting in pioneer areas should also be undertaken, with active participation of the B'laan tribe.
Guide to the fresh water fishes in Tubod River, Lake Danao and its outlet, Inawasan River in Leyte, Philippines.
Description and key for the identification of 21 fresh water fish species occur Tubod River (18 species), Lake Danao (4 species); and its outlet; Inawasan River (1species) in Leyte Main Island in Philippines are presented together with notes and ecology of the species.


No really, I think I am.
Most recently discovered oddity is how I will at random times have an entire plot line from a Nancy Drew novel jump into my brain. This evening it was the one where Nancy gets a message from the farmer about some pictures on some paper he found maybe? And someone gets kidnapped. Okay, maybe not entire plot lines, but the general idea for sure.
Don't get me started on Boxcar Children, or the Mandie series (the one with the mine, loved it), or the ultimate book Choose Your Own Adventure.
Thinking of these books make me really miss the little mini library in the Bethel housing out in Virginia. I loved that place.
This entry was posted in Uncategorized and tagged Bethel housing, Boxcar Children, Choose Your Own Adventure, I would always choose to follow-didn't matter who I was following, Langley AFB, Mandie book series, Nancy Drew, something about a parchment I think. Bookmark the permalink.
1 Response to I think I'm losing my mind.
I ADORED the Choose Your Own Adventure series when I was a child. Those were some good times. Talk about the ultimate escape through a book. I was also a big Nancy Drew reader and don't even get me started on Sweet Valley High.


A 1-mile, privately owned meadow reach on Lassen Creek (tributary to Goose Lake) was affected by severe channel erosion and entrenchment, causing problems for red-band trout habitat, loss of floodplain function during high flows, and progressive drying and vegetation change on the adjacent meadow (grass to sagebrush). The problems started from 1960s channelization work and continued to evolve from years of summer-long, intensive grazing in the meadow. Under the direction of the Goose Lake RCD and their consultant (StreamWise), the project was designed and implemented using a geomorphic approach known as pond and plug. This approach, which has been used extensively to treat entrenched channel problems in the Upper Feather River Watershed, uses earth fill to plug and eliminate the existing gullied stream channel and redirects the flow to remnant stream channels on the surface of the meadow. Soil for filling the gully is acquired by excavating a number of on-site ponds. The end result is a streambed and channel with a much reduced cross-section area (compared to the treated gullied channel) that annually spreads winter and spring high flows onto the floodplain and recharges meadow hydrology that supports more robust forage growth and augments dry season baseflow in the stream. Grazing management was made part of the project that included fencing and off-site water to control livestock access. Construction work was completed in fall 2005 and subsequent inspection in spring 2006 found there was need for some follow-up maintenance and modification. With funding assistance from DFG, this work was completed in 2006 and stream conditions have continued on an improving trend since that time.


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Should we try Femara first?
For years clomiphene has been the main medication that fertility doctors and obgyns use to help women with polycystic ovarian syndrome and irregular cycles to get pregnant
That may be starting to change. In fertility practices such as ours, we have switched to a different drug, letrozole, also known by the brand name, Femara.
What is Letrozole?
Letrozole is a medication that blocks an enzyme in the body that converts testosterone into estrogen. It causes the estrogen levels to drop which lead to the pituitary gland to produce more of a hormone called FSH. FSH (follicle stimulating hormone) is the hormone the causes the eggs to start growing. By doing this, letrozole stimulates ovulation The most common use for letrozole is to help women with breast cancer reduce their risk of recurrence.
Why would you want to use letrozole instead of clomid?
Stimulation with letrozole results in fewer eggs than clomiphene, resulting in fewer multiple births. It is also less likely to cause the side effects of hot flashes and mood swings that are common with clomid.
So, what do the experts say about Femara?
The American College of Obstetrics and Gynecologists has endorsed letrozole as first line treatment for women with PCOS and infertility.
Tagged: PCOS, letrozole, femara, Clomid, clomiphene, ovulation, anovulation, fertility, infertility, female infertility
Delaying the diagnosis of PCOS
PCOS may take years to diagnose: Princeton IVF blog
How long to does it take to be diagnosed polycystic ovarian syndrome?
Apparently a lot longer than you might expect...
A recent study from University of Pennsylvania suggests that women with Polycystic Ovarian Syndrome may not receive the proper diagnosis for years.
Women across the US and Europe were surveyed and this is what the researchers found:
in 1/3 of women, it took at least 2 years to make the diagnosis
almost of half of women had visited at least 3 health care providers before the diagnosis was made
84 % of women did not believe they received enough information about PCOS at the time of their diagnosis
As a Reproductive Endocrinologist, this is both surprising and not expected.
In our practice, as in most fertility and gynecology practices, PCOS is one of the most common disorders that we see. It is the most common hormonal disorder in women of reproductive age and the ovulation problems associated with PCOS are the most common cause for infertility in women. So, as specialists, we are attuned to look for polycystic ovary, and are more likely to find it in its more subtle forms. We are also committed to educate our patients about their condition, what causes it, how it is treated and what other health implications it might have.
It is also very common for us to see women who were never told by their doctor that they might have PCOS, and only came to see us because they cannot conceive. Still others, looked up their symptoms online, realized they had PCOS and referred themselves.
Sometimes seeing a specialist can help.
Most of the time your OBGYN, midwife or even primary care physician can manage the symptoms of PCOS. If your symptoms are under control and have a good understanding of your condition, there is no reason to seek out help. If your symptoms not controlled, you are having trouble getting pregnant or you don't feel you have an adequate understanding of PCOS, seeing a sub specialist in Reproductive Medicine may be a good idea.
Tagged: delayed, delay, diagnosis, hirsutism, alopecia, acne, Infertility, female infertility, ovulation, anovulation, amenorrhea, PCOS, Penn, University of Pennsylvania
The inventor of clomid and his legacy
The legacy of the inventor of clomiphene, Frank Palopali
The story behind the first fertility drug, Clomid.
As the year draws to a close, the newspapers, TV stations and other media outlets will share stories about individuals whom we lost in the past year. We will hear stories about great artists, musicians, athletes, politicians and others, about how they lived their lives and how their life's work impacted our own lives. It is likely these accolades will miss out on someone whose impact on world of reproductive medicine and generations of couples suffering from infertility. That man was Frank Palopoli.
Who was Frank Palopali?
Frank Palopali was a research chemist at the Merrell Dow Company. He was the leader of the team that developed clomiphene (Clomid) one of the most commonly used fertility drugs in the world. His work in the laboratory started back in the 1950's and first clinical trials of clomiphene were published in 1961. In 1967, Clomid was approved by the Food and Drug Administration and it became available to the public.
So, why was Clomid such a big deal?
In this age of high tech, highly effective fertility treatments, IVF with genetic testing and the like, it is somewhat difficult to understand why an inexpensive pill you pick up at Walmart for less than $10 might be such a big thing, but it was a huge breakthrough. If you look back to the world of women's reproductive health care 50 years ago, most fertility treatments were relatively ineffective and more often than not involved major surgery. For instance, the treatment of polycystic ovarian syndrome (PCOS) at the time involved in operation called the ovarian wedge resection. The gynecologic surgeon would make it open incision in the abdomen (similar to a cesarean section) and remove a wedge-shaped portion of the ovary, and then stitch the remaining ovary back together before closing the abdominal incision. Like other major surgeries, recovery from this operation could take weeks or months, but the benefit, if any, was very short term, just a few months afterwards. Additionally, eggs were inevitably lost in the process and scar tissue could develop on the surface of the ovaries, both of which could harm a woman's future fertility.
With the invention of clomiphene it was now possible to treat PCOS with just a pill. It completely revolutionized the treatment of infertility caused by problems of ovulation, and ovulation problems such as irregular cycles are among the most common causes of infertility in women. No longer would costly and invasive procedures be required, at least for most women with PCOS. While future inventions such as injectable fertility drugs, alternative methods of ovulation induction and IVF would bring success to many more people, it all started with the development of Clomid.
Over past nearly half a century since this time, millions upon millions of women all over the world have been able to have children and grow their families because of this invention. The number of couples helped by clomiphene actually dwarfs the number of those helped by IVF.
How does Clomiphene work?
Clomiphene is an anti-estrogen. It is part of a class of drugs called SERMs (selective estrogen receptor modulators) which include tamoxifen (Nolvadex) and reloxifene (Evista), drugs which are used to breast cancer and menopausal symptoms. Clomid works by blocking estrogen, the main female hormone. By blocking estrogen from working at the brain and pituitary gland (the master gland at the base of the brain), it tricks the body into sensing that there is no at there is no estrogen around. As a result, the hormones (FSH and LH) that stimulate the ovary, start to rise. This rise in hormones then kickstarts the process of the egg starting to grow and begins the path towards ovulation.
What are clomiphene's side effects?
It is easier to understand the side effects of clomiphene when you understand how it works. Because Clomid is anti-estrogen, it can cause hot flashes, headaches, breast discomfort and other symptoms that we normally associate with menopause. Because it stimulates the follicles (the cysts which contain the eggs) to grow, it can cause discomfort in the abdomen and increases the risk of multiple births. There are also concerns about whether clomiphene increases the risk of ovarian cancer, though most of the studies suggest it safe that when use for a brief period time. This is another reason to seek out the care of a fertility specialist early in the course of your treatment.
What is clomiphene used for?
The original and most common use for clomiphene is to help women who don't ovulate regularly, to produce and release eggs, become pregnant or hold on to a pregnancy. Clomiphene is also that used to help women produce multiple eggs to help improve the chances for success with insemination (IUI) and IVF. Clomiphene has also been used in men to assist in their fertility. This medication is intended to be used under the guidance of us physician experienced in their use.
How much is the price of clomiphene?
Like any other medication, the cost of clomiphene varies from pharmacy to pharmacy. Generic clomiphene in the typical starting dosing (50 mg) frequently sells for less than $10 at large retailers such as Walmart or Target. In the US, this medication always requires a prescription.
How many days after Clomid do you ovulate?
This a common question without a straight forward answer. Most women will ovulate around day 14 of the cycle, give or take a few days. Since clomiphene is usually taken day 3-7 or days 5-9, that means about 5-7 days after the last pill. However, some women will ovulate earlier, some later or not at all. At our center, we like to monitor everyone on clomiphene to make sure we get the timing right, and not delay pregnancy any longer than necessary.
Clomid success rate- how well does it work?
When used for to help infertile women with irregular or absent menstrual cycles, clomid enables about 80% of women to ovulate when used over a period of time. About half of these women will go on to conceive. This is actually quite good when you realize that natural conception in normal fertile women is only about 20-25%. The success rates when using clomiphene for other causes of infertility (unexplained, male infertility, endometriosis, etc.) is lower.
Can clomiphene be used in men?
Clomid is sometimes used to treat male infertility, though it is considered an "off-label" use. Since its use and its effectiveness in men is somewhat more controversial than its use in women, it is best prescribed and managed by a urologist with special expertise in male fertility.
Tagged: Clomid, clomiphene, estrogen, fertility, infertility, PCOS, ovulation


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