text:
FictionFiction
Non-fictionNon-fictoon
All my fiction
An Unsung Song
An Orphaned Existence
Diary of a Cynical Suicide
There is a body next to my bed
short writeups
Twin-story
Modern Adventures of Munchausen
MBTI related non-sense
The Unsaid
Sidharth Vardhan
Fiction, short stories, short writeups
…………………. Mrit feels a pain, he can't tell what from, in his left temple, a strange feeling of desperation as if he is getting late for something and an equally vague agony as he hears his mom from other room telling him that it is time for his bed. He really wants to see the cartoon serial, his favorite to the end and it will be only a few minutes longer and he decides to let her keep calling until he has seen the end of the episode and to later excuse himself by saying that he didn't hear her.
… but wait, he, the kid (of seven odd years ) that decides to let her mother shout is Mrit and not Mrit at the same time – for his body seems to be moving at its own will; he is the kid – it is Mrit's tv, Mrit's favorite cartoon, Mrit's mother's voice that is heard but he is someone else too, someone else living there inside the kid looking through kid's eyes and hearing through kid's ears. Plus, it is as if some other entity is controlling the kid. Like Mrit, this other entity feels the childish excitement and curiosity to see the end of episode like him, but, unlike him, (all this he somehow realized very quickly after first few moments of shock) doesn't feel the pain in temple (it occurs to Mrit, it can't be called pain in temple since he doesn't have a body of his own), agony or desperation and doesn't know what is to follow – that is the mother will come in and take him by force just when the episode is at climax. Oh no, he must wait in quiet desperation to confirm his ideas.
And yes that is what happens, the mother comes in and asks him to go to bed. While inside the body of that kid who now lies in his bed musing in innocent anger at the injustice of grown ups, the future somehow continues to reveal itself to Mrit who now foresees how for the next few nights, the kid will go back again and again to that episode and wonder about how his favorite superhero, Spiderman will defeat so powerful an enemy – imagine different ways in which it can be done and wonder what method did makers of series used. And yes, these things did happen and both he and the entity did go through the days of that childish insatiable curiosity together. ………………….
…………………. By now, Mrit has come to think of the boy, the entity and the body as same – only himself a separate ghost but not completely separate – for he still thinks he and the kid should not have been separated and he shouldn't be forced to live in his own body, like a ghost living silently in someone's else body. In some ways though, the separation is a good thing, for the pain and agony he is is feeling would be unbearable if he had a body – at least the other entity's childhood is safe from this pain.
The kid, who has now gained a foot in height and wears specs his eyesight affected because of seeing too many cartoons, must now go to his new school (father's promotion meant change of city), he is afraid to – his new classmates don't like him; but the fear won't stop him from trying to befriend them. And soon, the kid will enter the classroom but Mrit still there inside the kid wants to scream and tell him to stop and not enter the room because Mrit knows that boys in the classroom will play a prank on him; but Mrit can't scream, can't stop him, his efforts in that direction only bring him the discovery that he has no mouth of his own and there is no use of this foreknowledge – he can't stop the kid from entering the room and let those boys bully him.
And yes, he watches in desperation; while feeling the helplessness of an omniscient, kind and yet impotent God; as the boy weeps in humiliation – and Mrit, there inside the boy, feels the same level of self-pity as the boy does. But for Mrit, there is a comfort to be had in foreknowledge that all it will soon end as the teacher, Ms. V__, who will remain his favorite teacher all his life, is about to enter the room – she will punish the boys and take him away for a talk. He smiles in anticipation of the warmth both he and the boy will feel in the words of Ms. V___ . ………………….
…………………. The boy has now gained another couple of feet in height. There is no other entity, Mrit is sure by now – that no alien force has taken control of his body but somehow or other, he is forced to live his own life in third person, to be a mute spectator of it while being equipped with a useless foreknowledge of nearby future and at the same time feeling that inexplicable and that forever worsening pain. But what can he do after all? There is nothing for him but to live his life like an unattached part of his own soul.
And so, the kid is now well established in his school – a leader of the very group of troublesome boys that once bullied him. Wearing contact lens instead of specs, he flies away to school with his friends while his mom begs him to be careful with his bike and not drive too fast but his impatient hormones are unwilling to give the road its due time. It is good that mothers can be trusted never to lose their love for you but what about his teacher and his favorite teacher on top of that? And today, he is going to disappoint her. Mrit wants to stop him, but by now has got used to his inability to do anything. There is nothing but to wait while boy's attention-seeking disturbances in the class earn him at first, a warning from (who is now) Mrs. V__ and he wants to stop but his reputation among boys is at stake and there is pretty A___ sitting in front seat of class with her beautiful cat eyes and sometimes because of his pranks, she looks back and smiles! And so, he continued on with his prank, the teacher got angry and threw him out – Mrit looks forward to how both he and the boy will feel a quiet restlessness whenever he sees the teacher from now on, a feeling which he shall associate with guilt for the rest of his life. ………………….
…………………. The pain now seems to be somewhat lesser but that doesn't comfort him, instead he feels a sense of loss – it is as if he was holding something precious and heavy, it was stressing the muscles but the weight was worth carrying. The fact that his muscles are now relaxed only means that he has lost the precious object.
But whatever the object was, the vague feeling of its loss was nothing compared to ecstasy that he, being in boy's body is having for the boy is in love – love, not one of those crushes that he keeps on getting day after cupid-struck day but the one, actual, true, never again, happily ever after kind of love – that they are made for each other, just perfect – oh goodness! just perfect; – or so at least so he thinks, but Mrit in his foreknowledge knows better and want to stop him since he knows the girl, K___ is so sensitive and shall come to sorrow when things go bad as they will because the boy will start acting like a jerk. But there is no stopping this hormone-fueled boy and there is nothing for Mrit but to wait for tears that will spoil K__'s face when the couple would break up and, for days, the boy will feel the same quiet restlessness that he once felt in presence Mrs. V__ ………………….
…………………. It is strange, Mrit thinks, that having foreknowledge of what is about to happen doesn't help him from feeling less strongly than the boy when the things do happen, the foreknowledge doesn't reduce the shock. By now he has developed a sort of one-sided relationship with the boy. He doesn't judge the boy for he would have made the same mistakes if he didn't have foreknowledge. But he has acquired a wish to talk to the boy, maybe that is what he is getting late for. Because the feeling that he is getting late for something has only grown stronger over all this time. But he doesn't even know what he would have told the boy if such a communication was possible.
The boy, in his college now, has a teacher whom he respects and is determined not to disappoint. And so he becomes the class monk – he won't care for the girls; not even the bubbly T__ who has an obvious crush on him and he, himself, has that feeling once again – that this is the one, actual, true, never again, happily ever after kind of love – that they are made for each other, just perfect – oh goodness! just perfect; but he has been wrong before and so no matter what his gut-feeling says and what Mrit tries to tell him, he will continue to ignore her until she will get tired of trying. And yes like other things, no amount of wishful thinking on part of Mrit could stop it from happening. if Mrit had a face and a palm, he would have facepalmed throughout this whole episode and yes, another few days of quiet restlessness ………………….
…………………. For some time now, Mrit is getting the feeling that it might be some sort of remembrance he is having – that should explain the foreknowledge but there are major issues with that line of reasoning. When one remembers, one sees things as if from a distance, and not as clearly as he is doing now – moreover, the person remembering knows that he is remembering and also knows about his/her 'present time' as different from the past time remembered or seen on the memory screen. That is not so in his case. If this is a memory then he doesn't know about the world outside it and the memory itself feels so real. Even his foreknowledge of future is limited – maybe if he tries, tries real hard he could look much further into future than just immediate consequences of events he is living. But efforts in that direction have only given him some sort of heavy headaches ('some sort of' because though they feel like headaches, he doesn't really have a head and the body of his residence shows no sign of such pain).
And so there is nothing for him but to continue living (if it can be called living) inside the man, who has just got a job see his father leave for work – Mrit has foreseen that he is seeing the father last time, the later is to die of a heart attack while in his office. Despite knowing how futile such efforts are, Mrit tries hard to make the son see it, make him say some good word to his father. Nothing gained. He can't change the course of events ………………….
…………………. This must be what a life without free will feels like – you would know better, but that won't change a thing. Maybe he is dreaming? it could explain foreknowledge and perhaps helplessness too. And he is definately passing through time with a sort of dreamspeed, it seems like only minutes ago when his host was a little boy fanboying the spiderman. And so he tries to wake, tries, tries and tries. To no avail. He believes one can easily wake if one knows that one is dreaming, but if he is dreaming, that is not the case with him.
And for the moment he is not so eager. For today, is the day of his marriage. He doesn't love her the way he has loved the women in his past but he knows that she loves him and she had provided the emotional support when his father died, and he will do everything to make her happy. And so the marriage. Mrit is happy for the one good decision this man has taken all his life. ………………….
…………………. Ah! Now, he sees it. That is exactly what it is. That explains everything – the desperation, the agony, the pain. But the truth has only left Mrit more desperate and anxious, oh! far more anxious than ever, but he tries to forget it, and even if it is what it seems to be, it is worth all the pain and anguish to relive this movement because the man who was his resident is now sitting with his mother and his father-in-law, who helped establish his career, outside the operation room where his wife is to deliver.
Mrit smiles seeing him so anxious, but he himself is also too excited to live the happiest moment of his life again. Yes, he knows what is in store. The nurse comes out and hands over the baby. Looking at its little face, the touch of its fragile skin, the man wants to scream to the world that he has now known the meaning of the world. And despite knowing what lies in the storehouses of future, Mrit can't help rejoicing in most pleasurable moment of his life ………………….
………………….It is now the time. All the two years Mrit had, after realizing what was to happen to him, didn't make him any more prepared for this – he sees that man, himself, for now he has no doubt that not only there was no other entity, but there wasn't a separation, oh no! all that is too clear to him. He was reliving his life – and he knows it now, because it will all end today. There he is, his wife begging him not to drive fast when he goes to his office. And he smiles
And for the moment he is not so eager. For today, is the day of his marriage. He doesn't love her to her, Mrit wants to make himself tell her how she is the best thing that has happened to her and to make him put a hand on her cheek to say the part for which the words are inadequete – if only he could do that, she might have understood him, and to make him kiss the little child on whom the man takes only a passing look, not wanting to wake it up, not able to listen Mrit's protests that it was worth waking the child up. Also, Mrit wants to ask the man to call his mother and thank her for all she did. Same for his father-in-law and favorite college professor. And yes, he must apologise to Mrs V_, K__ and T__ but no, nothing can be done, there won't be any apologies or expressions of gratitude any longer, as he drives his bike at at eighty kmph on a busy road and hits a truck on his left while trying not to hit a car in front which slowed down unexpectedly. He had tried to scream but no voice left his mouth. He had felt unable to move, the blood all over his face due to injury in his left temple.
But doesn't death mean end of life? (what he really meant wwas shouldn't death be end of consciousness?) he had always thought so, until while reliving his life, he remembered about an episode he saw on tv about how one's brain stays alive for several minutes after death and how people who have had near-death-experiences often report seeing their had seen their life being played out. Is that what it is? He doesn't feel the control over his body, no senses to give him a clue where he or his body is – maybe the control over his body was, in fact, the precious thing lost. All that is left to him is his brain with its memories and only a few last moments, the tools he must now use to come to terms with his fate and hope his family will find happiness without him. A part of him reproaches him for a last time for not having heard is mother's and wife's pleas about driving too fast; but the reproach is allowed to stay there unheeded and unanswered while it continues to create the familiar quiet restlessness before it too fades away and there is nothing but to wait quietly for that greater darkness to engulf him and make peace with all the things that he is leaving behind unsaid.
Copyright – Sidharth Vardhan
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About Yours Truly


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Q: AWS Restrict access from cloudfront to load balancer I'm using Cloudfront with load balancing and ec2 instances.
In AWS, my load balancer accepts traffic from all http connections. It is possible to restrict that to accept only http connections from my Cloudfront distributions ? And how can I do that ?
Thanks.

A: There is now a solution for this. There is now a lambda that listens for IP updates from amazon and will update your security groups with the cloudfront IPs.
Lambda to update Security Groups with Cloudfront IPs

A: AFAIK, you can't do this at layer 3 as an ELB will allow access from anywhere (0.0.0.0/0).
If you're running Apache and can find a specific header that cloudfront uses/sets then you could do this at layer 7 using mod_headers.
According to http://docs.aws.amazon.com/AmazonCloudFront/latest/DeveloperGuide/RequestAndResponseBehaviorCustomOrigin.html cloudfront will set the Header Via to 1.1 alphanumeric-string.cloudfront.net, so you could match this in your virtualhost by doing something like:
SetEnvIf Via "^1\.1\ [a-z0-9]+\.cloudfront\.net$ VIA_CLOUDFRONT
<LocationMatch /origin/>
    Options -Indexes
    Order deny,allow
    Deny from all

    # allow from cloudfront only
    Allow from env=VIA_CLOUDFRONT
</LocationMatch>

redpajama_set_name: RedPajamaStackExchange


C&D Corporation initiated its business in conference and exhibition at the beginning of 2001. Through nearly ten years of development, Conference & Exhibition Group showed great growth in various business areas. A development pattern of self-owned area operating, commissioned area operating, and self-holding exhibitions coexisting with conference reception service, advertisement designing and booth building and transportation has been formed. It has become a large-scale comprehensive conference and exhibition enterprise that has ranked among top ten of domestic industry for its venue size. And it has repeatedly won honorary titles such as "Top 10 Conference and Exhibition Group in China", "Top 10 Brand Conference and Exhibition Venue in China" and "Top 10 Most Influential Conference and Exhibition Enterprises in China".
Today, Conference & Exhibition Group operates and manages three large-scale modern venues and one high-end concert hall, with a total area of over 950,000 square meters. In the past decade, Conference & Exhibition Group has successfully held more than 3,000 conferences and exhibitions of different kinds, including China International Fair for Investment and Trade, China Xiamen Machinery & Electronics Exhibition, China International Medical Equipment Fair, China International Pharmaceutical Machinery Exposition. Besides, it has many well-known brand exhibitions of its own: "China Xiamen International Stone Fair" has been the largest one of its kind around the world; "China Xiamen International Buddhist Items & Crafts Fair" has been the No.1 of its kind across the globe; Cross-Straits Building Material & Products Fair is the largest professional trade exhibition hosted in Taiwan by Mainland China.


Mahamaya Excellency Collage is approved by State Government and Affiliated to Guru Ghasidas Cetntral University Bilaspur, Chhattisgarh. Mahamaya Excellency Collage founded in 2000, is a self financed collage. The college is situated at Mangla Chauk, Narmada Nagar, Bilaspur(Chhattisgarh) in an eco-friendly environment blessed with sublime beauty of nature. The place is well connected by road rail from Raipur, the capital of Chhattisgarh.
Mahamaya Excellancy College, Bilaspur offers various graduate courses as well as Post Graduate courses.
Mahamaya Excellancy College, Bilaspur is affiliated to Guru Ghasidas University, Bilaspur.
List of facilities available at Mahamaya Excellancy College, Bilaspur for students.


Hanging out on the roof!
Top of the morning to ya! Luna Bug and Olive Oyl here reporting on the latest and the greatest at HVC.
The craziest thing happened this morning…. it was egg bar AND we had waffles! With whipped cream! And strawberry sauce! And blueberry sauce! So much to choose from, so little time, so I did what any normal person would do and got both waffles and eggs. PLUS the sun is out and the breeze is blowing and we can't complain because it sure beats the 90-degree humidity. Weather Guy is in good spirits at the moment and we have to agree this is a 10/10 day.
Towards the end of breakfast we watched a video on empathy and talked about our role and impact as camp counselors. PK shared an email from a camper's family and the impact that HVC has had on this child's growth and we talked about how special camp can be in one's life. This was a lovely segue into our morning meeting about camper counselor relationships. We then went off into our various priorities– llamas, pottery studio (headed by the awesome Gabe who just arrived), the animal barn, and of course, PK crossfit. This afternoon they'll be an emergency drill on the ropes course to get our staff prepared for anything that may come their way this summer.
I spoke too soon when I said the gang's all here! We've got another baby pig to keep Hamilton company who's on his way in the next few days. Jury's still out on names…Piggie Smalls? Notorious P.I.G.? So many good options to choose from! We can't wait to meet the little buddy.
Tonight's another special evening with Big Circle Night, a staple of staff training week, where counselors get the chance to open up about themselves and their time at camp. Speaking of evening programs, Booth Night last night was a big hit, where new staff got to learn all the ins and outs of the job. Be sure to check out lots of fun pics, plus some cool light painting shots from electives, as promised!
Sandia as a cow talking about food!
Some of our teen program folks!
Ace talking about the daily schedule!
Cassie and her famous interest groups puppet show!


I didn't like having a voice everyone recognized. I'd call girlfriends with toddlers who answered the phone, "Hel-wo," and I'd say, "Is your mommy home?" They'd drop the phone on the counter and yell, "MOMMMMMEEEEE, IT'S SUZANNE ON THE PHONE!" 4 words is all it took.
I started trying to figure out what makes southern speech different.
The fourth thing we do is pronounce our vowels all wrong. I's sound like ah. "Ah'm gonna go outside." Or we'll add an "r" to it, so that if I'm sleepy I might say, "I'm tarred." And our e's sound like a's. Me sounds like may. My kids used to love to say "me" like that. "Give that toy to may." "No, give it to may." They started out saying it like that to make fun of me, but now they keep saying it out of habit, and I think it's cute.
I have given my southern accent a lot of thought and decided that it's something that makes me stand out. I know I've used it to my advantage to get out of traffic tickets and so forth. I've decided that I'm proud of it. If you are interested in talking southern, I'll try to come up with some more lessons. Until then, just say, "Y'all." You'll have people eating of your hand.


This week has been a good one! I've heard from people whom I thought may be left within the past, have felt some of the stress I've been carying around lift off of my shoulders and my heart, and today was very productive! I had the day off of work, but I rarely get a week day off so I decided to put it to good use! I feel like I helped take a step towards the manifestation of future events- I got a new student ID card for university (I'm planning on starting classes in January, having not been in university for 6 years now), and I got passport photos taken so that I can finally renew my passport (I'd LOVE to travel in the new year). I'm starting to feel more excitment brewing within me over some of the things that I've been feeling nervous about, or feeling fear so much that I haven't bothered to even think about them very often. I was able to spend quility time with my sister as well, and caught up on sleep, and am now relaxing with a glass of wine in the warmth of my cozy apartment.
In this moment, all is well in the world. And, I give thanks.


These three-dimensional pencil illustrations by Chilean artisan Fredo are absolutely unbelievable! The 17-year-old marvel attracts inquiries that appear as though they're visiting jump off the web page! Really , by taking pictures of his specialized at merely the appropriate factor, it's hard to divide just what's authentic etc. Even with that there is probably Fredo has actually been awakened by experts that have actually preceded him, as an example, M.C. Escher, Fredo's specialized absolutely has a present turn. A few of his significantly core illustrations also component frightening monsters holding physical things like a lighter or attaching of the web page for a pop can.
So start looking for pencil drawings of things today.
Thanks for the interview, Fredo! We're truly amazed by your talent.


We worked closely with L2 Business Consulting to update their website to reflect their wide range of specialised services within technical consultancy advice to the nuclear, oil/gas and other high hazard industries. Updating their website to be mobile friendly and present their business as contemporary and forward thinking team of specialists.
As world leading website consultants to the scientific, energy and life science sectors we were well placed to deliver an efficient website refresh to our long standing clients. Feedback to date has been positive, and prospects for growth are looking confident.
Partnering with L2 Business Consultants to provide them with priority content updates to keep their website relevant and driving business.
Performance, security and back-ups are covered by our exclusive website care plans that deliver peace-of-mind to our clients that their website is performing to its optimum to drive business growth.


On April 26, 1972, President Richard M. Nixon, Henry A. Kissinger, H. R. ("Bob") Haldeman, unknown person(s), White House operator, Robert C. Byrd, unknown person(s), and Rose Mary Woods met in the President's office in the Old Executive Office Building from 3:43 pm to 4:31 pm. The Old Executive Office Building taping system captured this recording, which is known as Conversation 333-021 of the White House Tapes.
Subscribe to Byrd, Robert C.


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TRACYLIFESTYLE: YOUTUBER & MAKEUP ARTIST
This is TracyLifestyle.
TracyLifestyle, tell us more about how you got into makeup and astrology?
I've always had a natural thing for beauty, astrology and spirituality. In my high school years, I became more intrigued by it all and started doing my own research on.
Over time, many people that I have encountered complimented the way I style myself in hair and makeup. People also have always been fascinated by my insight in astrology and spirituality!
I was then encouraged to turn it into a career.
So in the passed year, I decided to purchase a camera and laptop to launch my YouTube channel. Through social media & specifically my YouTube channel, I was able to reach many different people.
Which was a big goal of mine and that helped me enlighten people in many different ways.
My ultimate goal was to help people enhance their own beauty with their own features rather than basing it off a specific person. I love to have personal talks with my followers where I can help enlighten them by providing my insight.
I do nails as a living and so I interact with different personalities on a daily basis.
What has been the most difficult thing about pursuing a career on YouTube?
The most difficult aspect of my craft is to be self motivated and consistent in uploading new content for my supporters.
Somedays, it gets discouraging to keep creating content especially when it involves coming up with new ideas daily.
It gets to the point where I want to give up but I'm an optimistic person so I work through it.
TracyLifestyle – What sets your artistry apart from everyone else?
What sets my content apart from others is the fact that it is very diverse. I create content for all age ranges.
I inspire others to want to understand more about life, astrology, spirituality & self esteem.
I keep it light and fun but I also have more serious content.
Find TracyLifestyle:
Instagram: https://www.instagram.com/tracylifestyle/?hl=en
YouTube: https://www.youtube.com/channel/UC7e9nsexVWbT8j8D2TTBtfw
Email: Tracylifestyle23@gmail.com
Artist On The Watch: Jake Beck
Artist On The Watch: Emma Quinones
Top Artist: Meet King Jordis

redpajama_set_name: RedPajamaCommonCrawl


Renovation work begins this week at Pingree Park, an 18-acre park in an East Side Detroit neighborhood spanning from East Warren Avenue to East Canfield Street.
Better walkways, updated landscaping for beauty and safety, renovated sports fields with improved grass surfaces, welcoming gathering spaces, much-needed pruning for the old trees that provide needed shade in the heat of the summer, will all be part of a community effort to improve the city's park.
The Pingree Park makeover aligns with the mayor's progressive initiative to renovate 40 smaller parks across the city this year hoping to reduce blight and restore community pride.
Magna International is a key partner in the project and previously donated $100,000 to help get the project off the ground. The company's employees will also participate in the volunteer effort.
Detroit's Pingree Park will be renovated through the efforts of Project EverGreen, Magna International and local green industry volunteers.
Improvements will provide residents with better use of the park, increased safety for kids playing on the grass sports fields and generate community pride. It will also create a central community hub for people to gather and connect with one another.
The second phase of the project will take place in the spring of 2018.


Am I right the Autobeat feature of the TRG-16 didn't make it into Slate? Not a major thing, but I actually used it in v1.
I might have missed something because I am just trying out things in this massive app. This will take some time! Love it so far.


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2022 / Churchill Downs Incorporated ("CDI") / Fair Grounds / Gary Palmisano Jr. / Wagering
Fair Grounds Lowers Pick 5 Takeout and Introduces New Pick 6 Pick 5 and Pick 6 takeout rate is set at 15%
NEW ORLEANS (Wednesday, October 26, 2022) – With the approval of the Louisiana State Racing Commission handed down Wednesday afternoon, Fair Grounds Race Course & Slots announces two horseplayer-friendly adjustments to the 2022-23 wagering menu. Takeout will be reduced on the Pick 5 from 25% to 15%. Also, a new Pick 6 at the same 15% rate will be added.
Takeout is the percentage of every wagering dollar removed before payoffs are calculated.
Racing officials at Churchill Downs Incorporated ("CDI") and Fair Grounds have been studying successes at other tracks and working to make this change at Fair Grounds.
"We are very excited about both of these new wagering opportunities for horseplayers," said Gary Palmisano Jr., the newly appointed Executive Director of Racing for CDI. "Fair Grounds has not had a Pick 6 in many years. After monitoring the success of this same wager at the New York Racing Association, we feel this is an interesting variation of the pool to implement and worth exploring."
Fair Grounds offers a traditional Pick 5 where the entire pool, after the 15% takeout, is paid out to winning bettors. If there are no perfect Pick Five tickets, the entire pool, minus the takeout, will carry over to the late Pick Five the next racing day. On most racing days there will be two Pick Five opportunities for horseplayers – an early and a late – and on cards of 11 races or more, a third may be added.
The new Pick 6 wager will have a $1 minimum wager. It will be "non-jackpot" and 75% of the after-takeout pool will be paid to all tickets with 6 winners. The other 25% will be paid to all those with 5 of 6 winners as a consolation. If no one has 6 winners, then 75% goes to the next day as a carryover and 25% is paid to all the consolation tickets.
"The obvious goal is that this wager will create numerous carryover opportunities and draw attention to racing in New Orleans," Palmisano Jr. added.
The 80-day, 2022-2023 Fair Grounds racing season opens on Friday, November 18 and runs through Sunday, March 26. Regular post time will be 1:05 p.m. CT, but opening day post time is 3:00 p.m. CT. Sixty-five stakes worth a combined $8.5 million, up more than $700,000 from last season, will be offered during the Thoroughbred meet.
Louisiana Officials Revoke Ownership License Of Former Co-Defendant In Zetas Money Laundering Case
Horseracing Integrity and Safety Authority Submits Prohibited Substances List to the Federal Trade Commission


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You are here: Home / News / Texas A&M University at the ASEE GSW Conference
Texas A&M University at the ASEE GSW Conference
April 21, 2021 | By Candice Meyers
The 2021 ASEE Gulf-Southwest Annual Conference was held virtually from March 24- March 26, 2021, and hosted by Baylor University. The yearly conference is an excellent opportunity for educators across Louisiana, Texas, and New Mexico to explore the different facets of engineering education.
In 2020 and 2021, the Engineering Education community rose to a challenge of the ever-changing constraints imposed by the COVID-19 pandemic. Educators around the globe taught in a completely virtual environment. The task at hand was to deliver course content in a new medium and keep the students engaged and meet course learning outcomes. We are still facing an uncertain future, where nobody knows what the new ''normal'' will be. The 2021 conference provided a venue to discuss the lessons learned while transitioning to online education. More importantly, open dialogue addressed where we go from here. The conference's theme was "Reimagining Engineering Education for a Changing World" and challenges facing engineering education as a result of the COVID-19 pandemic.
Texas A&M's growing efforts in the scholarship of teaching and learning in engineering education were evidenced at the conference. There were 12 papers from Texas A&M University faculty and students: 9 from College Station, 1 from Prairie View A&M, and 2 from West Texas A&M. These papers represented nearly 20% of the moderated papers at the conference. Moreover, out of the 24 authors from Texas A&M University, this was the first time that nine of the authors had ever published at ASEE GSW.
"The Development of a Texas A&M University Faculty of Engineering Education," a paper by Tracy Hammond, Karan Watson, Samantha Ray, Robert Lightfoot, Shawna Thomas, and Drew Casey, won third place in the Faculty/Staff/Professional Papers category. The paper presented Texas A&M University's development of an interdisciplinary faculty group to foster and support research and innovation in engineering, engineering technology, and computer science education. TAMU's Faculty of Engineering Education is composed of members all across the university, including faculty from the college of engineering, college of education, and the colleges of business, liberal arts, and geosciences. The group supports collaborations for education research, curricular and pedagogical innovations, professional development, and mentoring current and future scholars in these fields. In a little over a year and during a pandemic, TAMU's Faculty of Engineering Education went from being a disparate group of individuals into a strong, cohesive community of practice.
In addition to Texas A&M's scholarship, faculty actively served in the local conference. Dr. Tracy Hammond, Director of the IEEI, was a moderator for the undergraduate student session. The students were extremely skilled and she found that the session was an excellent place for recruiting diverse and brilliant graduate students.
Dr. Shawna Thomas, Instructional Assistant Professor, Computer Science & Engineering, Texas A&M University and Seth Polsley, Graduate Student, Texas A&M University helped review the best student papers. Dr. Charles Patrick, Professor of Practice, Biomedical Engineering also helped review the best faculty papers, along with several other TAMU faculty.
Dr. Randy Brooks, Associate Professor of Practice, Texas A&M Engineering Academy – Brenham, Texas A&M – College of Engineering was elected onto the GSW Executive Committee as Secretary (for a three-year term June 2021-June 2024) and Dr. Paula De Witte, Associate Professor of Practice & Adjunct Professor of Law, Computer Science and Engineering, Texas A&M University School of Law, Texas A&M Engineering Experiment Station was elected onto the executive committee as the Section Newsletter Editor for the same three-year term.
ASEE GSW 2022 will be held at Prairie View A&M University and ASEE GSW 2026 is anticipated to be held at Texas A&M University, College Station.


text:
package be.viaa.amqp;

import com.rabbitmq.client.Channel;

import java.io.IOException;
import java.util.concurrent.TimeoutException;

/**
 * Abstract AMQP service representation
 *
 * @author Hannes Lowette
 *
 */
public interface AmqpService {

	/**
	 *
	 * @throws Exception
	 */
	void createIfNotExists(String name) throws Exception;

	/**
	 *
	 * @param queue
	 * @param consumer
	 */
	void read(String queue, AmqpConsumer consumer) throws IOException, TimeoutException;

	/**
	 *
	 * @param queue
	 * @param data
	 */
	void write(String queue, byte[] data, Channel channel) throws IOException;

}

redpajama_set_name: RedPajamaGithub


text:
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Allergies and immunologyChild healthNutrition
Managing cows' milk protein allergy in infants
Dietary avoidance of cows' milk is the only management strategy for infants with cows' milk protein allergy (CMPA). If continued breastfeeding is not possible, infants with CMPA should be transitioned to a non-cows' milk infant formula. From 1 July, 2020, Special Authority criteria for accessing amino acid infant formula as a funded milk substitute will change, so primary care will need to begin planning for patients who may be affected.
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Cows' milk protein allergy (CMPA) in infants
Establishing a diagnosis of CMPA
Managing CMPA in infants following diagnosis
July, 2020 changes to Special Authority restrictions on AAF
How do the Special Authority criteria changes affect the management of patients with CMPA?
Published: 29 November 2019 | Updated: 7 September 2021
7 September 2021 General article revision, including updated funding criteria (July, 2020)
If you would like to know what changes were made when the article was updated please contact us
Key practice points:
Recognising cows' milk protein allergy (CMPA) in primary care is sometimes challenging as infants can present with a diverse range of non-specific symptoms; making the correct diagnosis is important so that infants are not unnecessarily subjected to dietary exclusions
For infants who are breastfed, consider any underlying breastfeeding problems and if there is a need for input, e.g. from a lactation consultant
The only effective treatment for CMPA is dietary avoidance of cows' milk, which may also include avoidance of products containing milk and restriction of cows' milk consumption by the mother if the infant is breastfed
If continued breastfeeding is not possible for infants aged under 12 months, a non-cows' milk formula should be trialled; options include soy formula (not funded), extensively hydrolysed formula (eHF) or in some cases amino acid formula (AAF)
Both eHF and AAF are funded with separate Special Authority approval criteria:
eHF is generally well-tolerated and should be the first-choice funded formula for most infants with CMPA
AAF is used for infants with severe or complicated conditions related to CMPA; it is currently overprescribed
The Special Authority criteria for accessing funded AAF changed on 1 July, 2020:
eHF must have been trialled first unless the infant has a history of anaphylaxis to cows' milk protein or eosinophilic oesophagitis
Applications for infants aged under 12 months can be made by any relevant practitioner, including nurse practitioners and prescribers
Applications for children aged over 12 months can only be made by a paediatrician, paediatric gastroenterologist or paediatric immunologist, or by a dietitian on the recommendation of one of these specialists
CMPA often resolves in early childhood; children with CMPA should be regularly re-evaluated as to whether cows' milk can be re-introduced into their diet
Children aged over 12 months may no longer require any infant formula as there is reduced requirement for milk as a primary nutrition source after this age
CMPA is an adverse immune response that occurs in approximately 2 – 3% of children before the age of three years.1 Sensitivity can occur to more than one type of milk protein, and cross-reactivity with other animal milk proteins such as goats milk is very common.2
Infants usually present with CMPA during the first few months of life, and in many cases, management can remain solely within primary care.1 CMPA is reported to resolve in approximately half of children before the age of 12 months, and in up to 90% by the age of five years.3 However, more recent evidence suggests that time to resolution is dependent on the type of CMPA (see: "CMPA is a spectrum of syndromes").4
CMPA is a spectrum of syndromes
Immune responses associated with CMPA can be IgE-mediated (immediate) or non-IgE-mediated (delayed), and there is a wide spectrum of possible reactions, ranging from mild gastrointestinal manifestations through to anaphylaxis.* (Table 1):1, 5–7
IgE-mediated CMPA – the onset of symptoms typically occurs within minutes of ingestion but may occur up to two hours later. IgE mediated CMPA often co-exists with allergies to other foods, such as eggs and peanuts.
Reactions may involve:
Skin – with redness, pruritis, urticaria or angioedema
Gastrointestinal tract – vomiting, diarrhoea or abdominal pain
Respiratory – coryza, stridor, cough or wheeze
Cardiovascular – infants may present pale and floppy
Non-IgE-mediated CMPA – symptoms typically occur more than two hours or even days following ingestion. Reactions usually involve the gastrointestinal tract, e.g. vomiting, diarrhoea, blood in the stools, and more rarely may also include the skin and respiratory tract.
*Note: anaphylaxis refers to any IgE-mediated reaction with respiratory or cardiovascular features.
CMPA is generally self-limiting, however, resolution of non-IgE-mediated CMPA is generally more rapid than for the IgE-mediated form.4 In a 2015 European study of children with confirmed CMPA diagnosed before the age of two years, 69% tolerated cows' milk when re-challenged after one year.8 However, when evaluated based on the type of CMPA diagnosed, 100% of the children with non-IgE-mediated CMPA had recovered, compared with only 57% of those with the IgE-mediated form.8
Making a clear diagnosis of CMPA can be difficult, particularly as many symptoms are non-specific, e.g. reflux, diarrhoea, vomiting, and many overlap with other conditions infants commonly present with in primary care (Table 1).7 In some cases, irritability and colic are the only symptoms that are present.6 As a result, CMPA is often over-diagnosed or other conditions are mislabelled as CMPA (see: "Lactose intolerance can be differentiated from non-IgE-mediated CMPA with an elimination trial"). A prospective cohort study demonstrated that 64% of infants exhibiting a possible adverse reaction to cows' milk were incorrectly suspected of having CMPA before testing was performed that excluded it as a diagnosis.12 Conversely, delaying or under-diagnosing CMPA can result in unnecessary morbidity, adverse nutritional or behavioural outcomes and parental anxiety.13 Regularly monitoring the infant's weight can help to determine whether an infant is thriving or not.
Remember that spilling is a normal infant behaviour. While vomiting is associated with several CMPA syndromes, it should be recognised that "spilling" is a distinct behaviour that is common before age 12 months. Infant spilling can be defined as regurgitation two or more times per day for three or more weeks in otherwise healthy infants aged three weeks to 12 months.14 The pattern and volume of spilling varies widely between infants, however, it is typically only a portion of the milk feed. Infant spilling is not associated with retching, haematemesis, aspiration, apnoea, failure to thrive, feeding or swallowing difficulties, abnormal posturing or accompanying tissue damage.14 In contrast, these features may be present with vomiting, which is a central nervous system reflex, involving forceful expulsion through the mouth due to co-ordinated movements involving the small bowel, stomach, oesophagus, and diaphragm. Vomiting as a symptom of CMPA is likely to involve the expulsion of large volumes of milk feed, and invariably be distressing for the infant, and is more likely to be accompanied by other clinical features (rather than occurring in isolation).
Consider any breastfeeding problems. Issues with breastfeeding can mimic, or co-exist with, CMPA. Infant "fussing" is common and multifactorial, and breastfeeding problems should always be considered as a potential cause or contributing factor – there are usually breastfeeding solutions for breastfeeding problems. Common issues can include under- or oversupply of milk, problems with positioning of the baby or with latching, functional lactose overload (fore- and hindmilk imbalance) and insufficient emptying of the breast. Provide support if you suspect breastfeeding issues are causing or contributing to feeding problems, or consider arranging for the mother to have an assessment, e.g. with a lactation consultant.
Lactose intolerance can be differentiated from non-IgE-mediated CMPA with an elimination trial
Non-IgE-mediated CMPA is often confused with lactose intolerance; although they can co-exist.7 This is problematic as mislabelling lactose intolerance as CMPA may result in unnecessary dietary restriction when a low-lactose diet would suffice. The key distinction between the two conditions is that CMPA is an immune-mediated reaction, while lactose intolerance involves a reduced capacity to digest lactose (a disaccharide). Lactose intolerance only causes symptoms in the bowel, e.g. diarrhoea, abdominal pain, bloating, and is not generally associated with rectal bleeding. Conversely, non-IgE mediated CMPA symptoms can be gastrointestinal, skin or rarely respiratory (as seen in Heiner's syndrome), and reactions such as proctocolitis can cause rectal bleeding.7
Both conditions can be investigated by trialling dietary exclusion of cows' milk. Symptoms are likely to improve within 48 hours of exclusion for infants with lactose intolerance, while non-IgE mediated CMPA symptoms often take at least two weeks to improve (sometimes longer).5, 7
Review the infant's allergic clinical history
If an infant is suspected of having CMPA, the first step is to take an allergy-focused clinical history. This process will also inform further investigations (Table 1).
In general, clinicians should aim to identify:1
Presenting symptoms and signs that may indicate possible CMPA, including age of onset, timing of onset following ingestion, reaction duration, severity and frequency
The infant's feeding history, including identifying sources of cows' milk protein in the infant's and mother's diet (if breastfed), the frequency of feeding (if breastfed), the quantity consumed (if bottle-fed), and any concerns regarding difficulty feeding or growth
Details of any previous management, including medicines and the response to any treatment or dietary change
Any history of atopic conditions in the infant or a first degree relative, i.e. parents or siblings
Interpreting the findings. The allergy-based clinical history should provide a clear distinction between IgE- and non-IgE mediated reactions, particularly in terms of the timing, nature of symptoms and family history:1
A history of immediate allergic symptoms in response to cows' milk ingestion strongly supports a diagnosis of IgE-mediated CMPA
Diagnosing non-IgE mediated CMPA is generally more difficult, particularly as the symptoms have a slower onset in relation to ingestion, they can vary significantly and may be localised to the gastrointestinal tract
CMPA is less prevalent in infants who are exclusively breastfed (0.5%) compared with the overall population (2 – 3%) as their only exposure to cows' milk protein comes through the maternal diet, which is associated with a low risk of clinical allergy.13 Therefore, it is important to not over-interpret minor symptoms in exclusively breastfed children. Any family history of atopic conditions, however, makes a diagnosis of CMPA more likely.1
For suspected non-IgE-mediated CMPA reactions:
A trial elimination of cows' milk in the infants diet for two to four weeks is suitable in most infants with mild-to-moderate non IgE-mediated CMPA symptoms and signs.1, 13 This should encompass all possible sources of cows' milk, including dairy products such as yoghurt and cheese. Breastfeeding should continue to be actively supported, with maternal avoidance of cows' milk.13 If infants cannot continue exclusive breastfeeding, or they are already formula feeding, they will require a non-cows' milk formula during this time (see: "Management of CMPA in infants following diagnosis"). For infants with suspected severe non-IgE reactions, consumption of cows' milk should stop, and they should be urgently referred to secondary care.
If the infant's symptoms clearly improve during an elimination trial of two to four weeks: re-introduce cows' milk to observe whether symptoms return, thereby confirming CMPA; this can be done at home.1 However, if there is still uncertainty, then more specific testing may be required (Table 1). Allergy testing (e.g. skin prick) is generally not necessary.
If the infant's condition does not improve following an elimination trial of two to four weeks: consider other possible sources of cows' milk, e.g. baked goods. However, tolerance to milk in processed products does not exclude CMPA as production methods such as heating and fermentation can diminish the amount of allergen present. In addition, alternative diagnoses should be investigated, and the infant may need to be referred to a paediatrician or allergy specialist.
For suspected IgE-mediated CMPA reactions:
For infants suspected of having an IgE-mediated CMPA reaction based on their allergic history, e.g. immediate urticaria following cows' milk consumption, a challenge with cows' milk is not generally not recommended in primary care.6 Cows' milk should be immediately excluded from the infant's diet and they should undergo allergy testing, e.g. serum allergen-specific IgE or skin prick testing, and referral to a paediatrician or allergy specialist should be considered.13 This history alongside a positive allergy test is sufficient to confirm a diagnosis of IgE-mediated CMPA. In all cases of anaphylaxis, the infant should be urgently referred to secondary care for management without the need for initial allergy testing.
Table 1. Clinical presentations and differential diagnosis of IgE-mediated and non-IgE-mediated CMPA.4, 8–11
Immune type
Time to reaction following ingestion
Occurrence in exclusively breastfed infants
Potentially useful investigations
(some of which are performed in secondary care)
IgE Acute allergic reaction (non-anaphylactic) Immediate, up to two hours Perioral or orbital angioedema/erythema, generalised urticaria, vomiting, diarrhoea No recurrence if cows' milk is completely avoided. Incidence approximately 2% in infants. Possible Idiopathic/viral induced urticaria Skin prick test, IgE antibodies.† An oral inpatient challenge may be considered but is not required for a diagnosis if there is a clear correlation between consumption of milk and the onset of symptoms.
Anaphylaxis Immediate, up to two hours Respiratory +/- cardiovascular involvement often associated with above features As above. IM adrenaline preferably in the midpoint of the anterolateral thigh is the treatment of choice. Rare manifestation of CMPA. Extremely rare Sepsis, acute cardiovascular or respiratory compromise, seizures Skin prick test, IgE antibodies.† An inpatient challenge is not indicated.
(IgE and non-IgE) Atopic dermatitis (eczema)* Highly variable: min/hours/days Pruritic rash Infants: cheeks, trunk, extensor surfaces
Older children: flexure surfaces, face, eyelids.
Approximately 70% of cases occur in infants aged 3–6 months, however, the incidence due to CMPA unknown. A wide variety including seborrhoeic dermatitis, psoriasis, acrodermatitis enteropathica Cows' milk elimination and re-challenge
Non-IgE Eosinophilic oesophagitis** Days Vomiting, irritability, feed refusal, failure to thrive, oesophageal dysmotility Histological diagnosis, unresponsive to proton pump inhibitors. Extremely rare with variable age of onset (less likely in older children). A family history is common. Extremely rare
(case reports) GORD, mucosal candidiasis, Crohn's disease Endoscopy, eosinophil count
Food protein-induced enterocolitis syndrome (FPIES) Vomiting 2 – 4 hours
Diarrhoea 5 – 10 hours Profuse vomiting +/- diarrhoea, sudden onset of pallor and floppiness. Around 20% present as hypovolaemic shock (with associated metabolic acidosis and methaemoglobinaemia) Responds to fluid resuscitation, adrenaline not required. Half of affected children outgrow the condition by three years of age. Extremely rare
(case reports) Sepsis, gastroenteritis, malrotation, intussusception, metabolic disorder Clinical diagnosis with a focus on history, no laboratory markers available (a raised white blood cell count often adds to clinical confusion)
Cows' milk protein-induced GORD Hours/days Frequent regurgitation, poor feeding, feed aversion, failure to thrive, symptoms indicative of tissue damage e.g. haematemesis Partially responsive to proton pump inhibitors when underlying mechanism related to CMPA. Up to 40% of infants with GORD have CMPA. Idiopathic GORD, eosinophilic oesophagitis, malrotation Clinical diagnosis. Requires endoscopy if haematemesis or significant failure to thrive.
Enteropathy Hours/days Vomiting, diarrhoea, severe irritability, failure to thrive, iron deficiency anaemia, protein losing enteropathy Receiving cows' milk in diet. Unknown incidence due to CMPA. Lactose intolerance, coeliac disease giardiasis, immune deficiencies, autoimmune enteropathy Small bowel biopsy for histology, duodenal disaccharidases and microscopy of duodenal aspirate for giardia
Proctocolitis Hours/days Low-grade rectal bleeding and mucus in stool in an otherwise well infant usually within the first three months of life Normal perianal inspection, thriving. CMPA is the most common cause. Necrotising enterocolitis, constipation with anal fissure, infantile inflammatory bowel disease, chronic granulomatous disease, juvenile polyp Rectal biopsy only if atypical features or non-responsive to treatment (eosinophils predominate). If symptoms are prolonged monitor haemoglobin and ferritin levels.
Heiner's Syndrome (milk-induced pulmonary disease/ haemosiderosis) Hours/days Cough, wheezing, recurrent fever, nasal congestion, recurrent otitis media, failure to thrive, haemoptysis, dyspnoea, colic, anorexia, vomiting and diarrhoea, blood in stool Extremely rare. Patients may have IgG antibodies to cows' milk protein (and in some cases IgE antibodies will be present). Peripheral eosinophilia is often seen. Responds to dietary elimination. Unknown Idiopathic pulmonary haemosiderosis, chronic bronchopneumonia, aspiration pneumonia Chest X-ray (looking for pulmonary infiltrates), cows' milk elimination and re-challenge
Potentially Non-IgE
unlikely to be isolated or a sole manifestation Colic Hours/days Paroxysms of unexplained, inconsolable crying (more than 3 hours a day, more than 3 days per week for at least 3 weeks) Responds to dietary elimination, more likely if it presents soon after the introduction of cows' milk protein in the diet Idiopathic colic, developmental disorders, urinary tract infection Cows' milk elimination and re-challenge
Constipation Hours/days Passage of infrequent and/or hard stools Responds to dietary elimination, more likely if it presents soon after the introduction of cows' milk protein in the diet Hirschsprung's disease, slow transit constipation Cows' milk elimination and re-challenge in conjunction with laxative treatment. Consider rectal biopsy in infants with early-onset severe constipation.
* Atopic dermatitis as a sole manifestation of CMPA is debated in the literature, and it is important to establish whether other stimuli are potential triggers, such as laundry powder or soap
**	There is a lack of expert consensus as to whether eosinophilic oesophagitis is a primary non-IgE-mediated reaction, or a mixed immune reaction. However, most guidelines define it as non-IgE-mediated.
† Higher IgE levels are predictive of a longer duration of CMPA. CMPA, cows' milk protein allergy; GORD, Gastro-oesophageal reflux disease; IM, intramuscular.
Recommendations for referral to secondary care
Infants with severe or resistant symptoms and signs of CMPA should be referred to secondary or emergency care with the urgency of referral depending on their specific clinical scenario. This includes:1, 9, 13
Severe failure to thrive
Any severe, persisting or treatment-resistant gastrointestinal or skin symptoms, e.g. persistent rectal bleeding and/or vomiting, severe atopic dermatitis
Hypoproteinaemia/protein losing enteropathy (clinical features include vomiting, diarrhoea, severe irritability, failure to thrive, iron deficiency anaemia)
Food protein induced proctocolitis (low grade rectal bleeding in otherwise healthy infants)
Dispelling dietary myths: cows' milk does not increase the risk of type 1 diabetes
It has historically been thought that avoiding cows' milk protein in favour of elemental infant formulas (such as eHF or AAF) reduces the infant's risk of developing type 1 diabetes, as previous research suggested this may potentially be the case. However, recent studies suggest there is no increase in pancreatic islet autoimmunity through the avoidance of cows' milk.15, 16 In fact, there may even be an increased risk of type 1 diabetes in children receiving eHF compared with non-hydrolysed cows' milk formulas as a first choice.15, 16 Clinicians should therefore emphasise that the decision to avoid cows' milk protein should be made based on medical indication of CMPA rather than parental preference.
1. Exclude cows' milk
Avoidance of cows' milk is the only treatment for CMPA.5 Regardless of the underlying cause and clinical type of CMPA, any dietary consumption of cows' milk should be eliminated following diagnosis; this includes both direct sources in the infant's diet (e.g. cows' milk, cows' milk formula or solid foods containing cows' milk) and potentially maternal cows' milk consumption if the infant is breastfed (see: "The role of breastfeeding in the management of CMPA"). For infants with mild-to-moderate CMPA symptoms, solid foods containing milk may potentially still be able to be consumed because in some cases the production process significantly diminishes the amount of allergen present.
A nutritional assessment should ideally be performed in primary care following any decision to remove cows' milk protein from an infant's diet (or the mother's) to ensure the amounts of protein, calories and micronutrients (e.g. calcium and vitamin D) are adequate. However, calcium supplementation is usually not required for the infant.5 Other dietary sources of calcium should be encouraged provided they are age appropriate and the infant does not have a proven allergy to them, e.g. some breakfast cereals, tofu, dark leafy vegetables. Maternal calcium supplementation may be needed in some cases, which can be achieved with 800 mL per day of a calcium fortified non-cows' milk alternative, e.g. rice or oat milk, or with oral calcium supplements.5
2. The role of breastfeeding in the management of CMPA
Exclusive breastfeeding is recommended in infants until age six months, at which point it is not sufficient alone for growth and development.17 Infants generally should continue to be breastfed until they are aged at least 12 months, however, solids should be progressively introduced from around the age of six months (not before four months).17
Infants with CMPA should continue breastfeeding if possible:1, 13
Exclusively breastfed infants – eliminate cows' milk protein from the maternal diet to avoid transmission via breastmilk
Mixed feeding infants – eliminate cows' milk protein from the infant's diet first; the mother may be able to continue consumption of milk in some cases of delayed reactions; if there are residual symptoms, or if the infant has an immediate CMPA reaction, maternal cows' milk protein exclusion is recommended
If maternal exclusion of cows' milk does not resolve symptoms, or if breastfeeding is problematic or not solely adequate, or if the mother wishes to wean the infant before they are aged 12 months, infant formula will be required and the mother supported in this decision. However, prior to switching to formula, ensure that other reasons for the infant's symptoms have been considered and if the mother wishes to continue breastfeeding that she has received additional support to do so.
3. Selecting an appropriate infant formula
Only three types of formula are recommended for infants with CMPA: (1) soy formula (not funded), (2) extensively hydrolysed formula (eHF) and (3) amino acid formula (AAF).18 Both eHF and AAF are fully funded with Special Authority approval (separate application criteria). Other formulas such as goats'-milk based, lactose-free and partially hydrolysed formula are not suitable for infants with CMPA due to the potential for cross-reactivity against proteins with a similar structure, or direct immune responses against conserved proteins. Alternative "milk beverages", such as rice, oat or almond milk, are nutritionally inadequate and therefore not recommended as a substitute for breast or cows' milk in infants.5 N.B. They are also not recommended as the primary milk option for children aged under five years.
Extensively hydrolysed formula (eHF) is the first-line choice formula for most infants with CMPA
The age of the infant and the clinical characteristics of the CMPA should determine the type of formula most appropriate as an initial option. However, in the majority of cases, eHF is recommended as the first-line choice of infant formula for CMPA (Table 2).1, 13 Hydrolysis of cows' milk breaks down potentially allergenic proteins into less-reactive peptides, making an immune response less likely. As a result, CMPA symptoms resolve in approximately 90% of infants that transition to eHF.5
Soy can be discussed as an alternative to eHF in infants aged over six months
Soy-based formula is not funded in New Zealand but is comparable in price to standard cows' milk formula. In some cases, infants may find soy formula more tolerable than eHF and therefore its use can be discussed as a possible alternative, e.g. non-anaphylactic CMPA associated with gastrointestinal symptoms (Table 2).6 However, soy formula is not considered to be suitable for children aged under six months as rates of concurrent soy allergy are higher in this group.19
Amino acid formula (AAF) should be reserved for complicated or severe conditions
AAF is considered to be the closest formula option to being "non-allergenic" as it consists of individual amino acids.20
Despite being highly tolerable, its current use as a funded formula is controversial as it is approximately three times more expensive to produce than eHF, and eHF will be sufficiently hypoallergenic in most infants.21, 22 Therefore, access to funded AAF should not be based on a preference; there needs to be a medical requirement for it (Table 2).
The indications for AAF in infants with CMPA include:20
Severe intolerance, allergy or malabsorption on eHF
Growth faltering, particularly with multisystem involvement and multiple food exclusions
Currently, many infants are inappropriately prescribed AAF. In children aged 12 months or older, the expected prescribing ratio for eHF to AAF should be approximately 3:1, however, under the current funding criteria it is estimated to be an almost 1:1 ratio.22 Most children have a reduced requirement for milk once they are aged over 12 months and should be able to progress to solids as their primary source of nutrition, meaning that dependence on AAF can be avoided or reduced. However, the timing of this dietary transition will differ between children, and there are no clear recommendations for weaning off formula. It may be appropriate to consult with a paediatrician or dietitian with expertise in the management of CMPA for further advice.
4. Long-term re-introduction of cows' milk
In most cases, CMPA is a self-limiting condition; resolving between the ages of one to three years in many children.4 Therefore, in the long-term it is important to regularly review and consider a cows' milk challenge to avoid unnecessary dietary restriction.1, 13 This is required for AAF Special Authority funded renewals. Reassessment for tolerance should be on a case-by-case basis, but in general a review every six months is reasonable.1, 13 However, for some infants with more severe IgE-mediated CMPA this recommendation will not be suitable, and it is best to discuss a tailored re-introduction strategy with their paediatrician.
Table 2: Appropriate choice of formula feed in infants with CMPA syndromes in primary care.1, 6
(if first not tolerated)
Acute allergic reaction
(non-anaphylactic) eHF or soy* (if aged > 6 months) eHF (if soy was trialled first) or AAF†
Anaphylaxis AAF
(with urgent referral) –
Mixed immune response (IgE- and non-IgE)
Atopic dermatitis (eczema) eHF or soy* (if aged > 6 months) eHF (if soy was trialled first) or AAF†
Non-IgE
Eosinophilic oesophagitis AAF –
Food protein-induced enterocolitis syndrome eHF AAF
Food protein-induced proctocolitis eHF AAF
Gastrointestinal syndromes, GORD, allergic eosinophilic gastroenteritis, food protein-induced enteropathy, constipation, severe irritability (colic) eHF or soy* (if aged > 6 months) eHF (if soy was trialled first) or AAF†
* Soy formula is not funded but may be used as an alternative to eHF for some infants with mild CMPA symptoms
† eHF must first be trialled first for 2–4 weeks and found to be inappropriate due to severe intolerance, allergy or malabsorption. AAF, amino acid formula; eHF, extensively hydrolysed formula; GORD, gastro-oesophageal reflux disease.
Under the previous Special Authority criteria an initial application for AAF could be made by any dietitian, relevant specialist or vocationally registered general practitioner if the patient met one of the following prerequisites:21
eHF was reasonably trialled (two to four weeks) and found to be inappropriate due to documented severe intolerance or allergy or malabsorption; or
History of anaphylaxis to cows' milk protein formula or dairy products; or
Eosinophilic oesophagitis
Approvals were valid for six months, at which point an assessment of whether the infant could be transitioned to cows' milk, soy or eHF took place.21 If the outcome was that AAF continued to be required, then an application could be made for renewal by any of the listed healthcare professionals above, or by any general practitioner on their recommendation.21
What changes happened in July, 2020?
From 1 July, 2020, the previous Special Authority approval was replaced with a new form that includes two different sets of funding criteria based on the patients age (Figure 1):21
Infants up to 12 months of age – applications can be made by any relevant practitioner (including dietitians, paediatricians, paediatric gastroenterologists, paediatric immunologists, general practitioners, nurse practitioners or nurse prescribers)
Children 12 months of age and older – applications need to be made by a paediatrician, paediatric gastroenterologist or paediatric immunologist, or by a dietitian on the recommendation of one of these specialists
In addition, new criteria were applied to both age groups (Figure 1):21
Access criteria now includes children with ultra-short gut and severe immune deficiency
Access criteria requires the following information:
Whether the child's cows' milk protein allergy/intolerance is IgE-mediated or non-IgE-mediated;
That AAF is required for a nutritional deficiency;
That there has been a period of three months since the previous application for AAF; and
In cases where eHF has previously been trialled:
A valid Special Authority number for eHF; or
The trial has occurred in an inpatient setting
(Approvals valid for six months)
Renewal for infants aged <12 months
Renewal for children aged ≥12 months
Figure 1. Special Authority criteria effective from 1 July, 2020 for funded amino acid formula (AAF) in children with CMPA who require formula.21
* This criteria likely applies to children with non-anaphylactic IgE mediated CMPA, where a single inpatient trial of 20 mL of eHF is suitable to establish the need for AAF.
† Including eosinophilic oesophagitis, ultra-short gut and severe immune deficiency.
** Dietitians must have consulted with a paediatrician, paediatric gastroenterologist or paediatric immunologist within the last 12 months. AAF, amino acid formula; CMPA, cows' milk protein allergy; eHF, extensively hydrolysed formula.
These changes allow any relevant prescriber, to make AAF funding applications in primary care for infants aged under 12 months. However, the criteria, in place since 1 July, 2020, also mean that general practitioners and other primary care prescribers are no longer able to apply for a child's AAF funding renewal once they are aged 12 months or older. Children likely to still be using AAF when they reach age 12 months will need to be referred to a dietitian, paediatrician, paediatric gastroenterologist or paediatric immunologist for a new Special Authority application to be completed.
Patient information is available from the Australasian Society of Clinical Immunology and Allergy:
CMPA: www.allergy.org.au/patients/food-allergy/ascia-dietary-avoidance-for-food-allergy/cows-milk-dairy
Food protein-induced allergic proctocolitis (FPIAP): www.allergy.org.au/patients/food-other-adverse-reactions/proctocolitis-fpiap
Food allergy: www.allergy.org.au/patients/food-allergy
Thank you to Dr Jan Sinclair, Paediatric Allergy and Immunology Specialist, Auckland DHB for expert review of this article.
N.B. Expert reviewers do not write the articles and are not responsible for the final content. bpacnz retains editorial oversight of all content.
Venter C, Brown T, Meyer R, et al. Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP—an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy 2017;7:26. http://dx.doi.org/10.1186/s13601-017-0162-y
Restani, Gaiaschi, Plebani, et al. Cross-reactivity between milk proteins from different animal species. Clin Exp Allergy 1999;29:997–1004. http://dx.doi.org/10.1046/j.1365-2222.1999.00563.x
Caffarelli C, Baldi F, Bendandi B, et al. Cow's milk protein allergy in children: a practical guide. Ital J Pediatr 2010;36:5. http://dx.doi.org/10.1186/1824-7288-36-5
Flom JD, Sicherer SH. Epidemiology of cow's milk allergy. Nutrients 2019;11:1051. http://dx.doi.org/10.3390/nu11051051
Lifschitz C, Szajewska H. Cow's milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr 2015;174:141–50. http://dx.doi.org/10.1007/s00431-014-2422-3
Vandenplas Y. Prevention and management of cow's milk allergy in non-exclusively breastfed infants. Nutrients 2017;9:731. http://dx.doi.org/10.3390/nu9070731
Walsh J, Meyer R, Shah N, et al. Differentiating milk allergy (IgE and non-IgE mediated) from lactose intolerance: understanding the underlying mechanisms and presentations. Br J Gen Pract 2016;66:e609–11. http://dx.doi.org/10.3399/bjgp16X686521
Schoemaker AA, Sprikkelman AB, Grimshaw KE, et al. Incidence and natural history of challenge-proven cow's milk allergy in European children - EuroPrevall birth cohort. Allergy 2015;70:963–72. http://dx.doi.org/10.1111/all.12630
Allen KJ, Davidson GP, Day AS, et al. Management of cow's milk protein allergy in infants and young children: An expert panel perspective. Journal of Paediatrics and Child Health 2009;45:481–6. http://dx.doi.org/10.1111/j.1440-1754.2009.01546.x
Moissidis I, Chaidaroon D, Vichyanond P, et al. Milk-induced pulmonary disease in infants (Heiner syndrome). Pediatr Allergy Immunol 2005;16:545–52. http://dx.doi.org/10.1111/j.1399-3038.2005.00291.x
Preece K, Blincoe A, Grangaard E, et al. Paediatric non-IgE mediated food allergy: guide for practitioners. N Z Med J 2016;129:78–88.
Elizur A, Cohen M, Goldberg MR, et al. Mislabelled cow's milk allergy in infants: a prospective cohort study. Archives of Disease in Childhood 2013;98:408–12. http://dx.doi.org/10.1136/archdischild-2012-302721
Fox A, Brown T, Walsh J, et al. An update to the Milk Allergy in Primary Care guideline. Clin Transl Allergy 2019;9:40. http://dx.doi.org/10.1186/s13601-019-0281-8
Benninga MA, Nurko S, Faure C, et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2016;150:1443-1455.e2. http://dx.doi.org/10.1053/j.gastro.2016.02.016
Hummel S, Beyerlein A, Tamura R, et al. First infant formula type and risk of islet autoimmunity in The Environmental Determinants of Diabetes in the Young (TEDDY) Study. Dia Care 2017;40:398–404. http://dx.doi.org/10.2337/dc16-1624
Writing Group for the TRIGR Study Group, Knip M, Åkerblom HK, et al. Effect of hydrolyzed infant formula vs conventional formula on risk of type 1 diabetes: The TRIGR randomized clinical trial. JAMA 2018;319:38. http://dx.doi.org/10.1001/jama.2017.19826
Ministry of Health. Feeding your baby. 2018. Available from: https://www.health.govt.nz/your-health/pregnancy-and-kids/first-year/6-12-months/feeding-your-baby (Accessed Nov, 2019).
New Zealand Formulary (NZF). NZF v89. 2019. Available from: http://www.nzf.org.nz (Accessed Nov, 2019).
Vandenplas Y, Brueton M, Dupont C, et al. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Archives of Disease in Childhood 2007;92:902–8. http://dx.doi.org/10.1136/adc.2006.110999
Meyer R, Groetch M, Venter C. When should infants with cow's milk protein allergy use an amino acid formula? A practical guide. The Journal of Allergy and Clinical Immunology: In Practice 2018;6:383–99. http://dx.doi.org/10.1016/j.jaip.2017.09.003
PHARMAC. Proposal to change access to amino acid infant formula. Available from: https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/proposal-to-change-access-to-amino-acid-infant-formula (Accessed Nov, 2019).
Special Foods Sub committee of the Pharmacology and Therapeutics Advisory Committee (PTAC). Minutes of the meeting held 22 July 2015. Available from: https://pharmac.govt.nz/assets/ptac-special-foods-subcommittee-minutes-2015-07.pdf (Accessed Nov, 2019).
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Fiona McLean 29 Nov 2019 19:35
Why does this article state that infants are exclusively breastfed until 6 months. Ascia guidelines recommend introduction of solids from age 4 to 6 months. I thought we were meant to follow the Ascia guidelines.
The Editor 3 Dec 2019 10:07
Hi Fiona, thank you for your comment. The Ministry of Health advice is to exclusively breastfeed infants until age six months, at which point solids can be progressively introduced. ASCIA advice is that breastfeeding is recommended for at least six months and solid foods can be introduced (while still continuing breastfeeding) around six months but not before four months. Essentially both sets of guidance agree that an ideal age to introduce solids is around six months, but ASCIA notes a lower limit for this range, but this would be an individual decision depending on the infant. Signs that an infant may be ready for solid food include being able to sit upright with minimal assistance and displaying an interest in food when offered. We have updated the article to say that solids may be introduced around six months but not before four months.
Bushra Wahid 6 Sep 2021 21:59
I think adding 'Milk ladder' to management is imperative here, talking to parents about transitioning/trialling cow's milk should begin before they turn one, at which point good quality written information should be provided to parents about 'Milk ladder'. The NHS trust has very good patient (and doctor) resource on this.
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It seems the term "Reformer" has become toxic. But the money backing "reform" is so huge that it just keeps stumbling forward, certain about what other people should do, loaded with money and power, but without any examples of success.
She's right about the toxicity of the term "reformer"… in addition to being inaccurate it is toxic in the minds of those who work in school. I would suggest the term "reformer" be replaced with the term "plutocratic profiteer".
Reform "think tanks", especially those underwritten by hedge funders, tend to promote ideas based on the premise that the marketplace is pure and anything that interferes with the marketplace is a problem. The market rewards those who can deliver a product cheaply and efficiently… and government regulations stand in the way of that ethos and democracy slows everything down. The algorithm of hedge funders is to strip away any regulations, disempower employees, find a way to tear up "costly" agreements that are in place, and view any adverse community impact as inconsequential collateral damage.
One of the initial problem business-minded reformers faced was measuring the output of education. That problem was solved when NCLB passed and standardized test scores became the metric of choice for politicians, taxpayers, voters, and the media. By setting cut scores based on norm-referenced tests it was no surprise that 50% of the schools were labelled as "failing", thereby opening the door for the "takeovers"… the language of hedge funders!
Look at the way vulture capitalists work and look at "school reform" models espoused by the GOP and neo-liberals… and tell me if you see a difference. The public's imagination has been captured by the idea that the business takeover of schools and government will result in the elimination of "waste, fraud and abuse" and an increase in productivity, which in the case of public education means higher test scores…. And if the latter doesn't happen, it's OK because taxes are not going through the roof. Welcome to the plutocracy where the system never changes and the results remain the same: the .01% get richer and the rest of us pay rent.


text:
Nobu at Paris Las Vegas Is Now Open
April 10, 2022 By VegasPublicity
Chef Nobu Matsuhisa's second restaurant with Caesars Entertainment Las Vegas Resorts features his signature dishes in a lighter, more intimate atmosphere In partnership with Nobu Restaurants, Caesars Entertainment has opened its second Nobu restaurant location on the Las Vegas Strip at Paris Las Vegas. The restaurant features world-renowned Chef Nobu Matsuhisa's … [Read more...] about Nobu at Paris Las Vegas Is Now Open
A Special Oscar's Dinner Series on Wednesday, April 7
March 20, 2021 By VegasPublicity
Eat like the stars ate, a tribute to the making of the movie "Casino" In tribute to the blockbuster movie "Casino," former Las Vegas Mayor and mob attorney, Oscar B. Goodman will hold a special edition of the Oscar's Dinner Series at Oscar's Steakhouse at the Plaza Hotel & Casinoinside the restaurant's iconic glass dome on Wednesday, April 7. Attendees … [Read more...] about A Special Oscar's Dinner Series on Wednesday, April 7


text:
Palm Beach Smash and Grab Robbery Nets $1 Million in Merchandise
By Staff on January 2, 2022 10 Comments
Almost $1 million in handbags were stolen in a smash and grab robbery of the luxury bag store Only Authentics located in Palm Beach, Florida on Christmas Eve. The robbery took place a little more than two weeks after thieves initially stole close to $500,000 worth of bags.
No arrests have been reported.
The two robberies come after Florida Attorney General Ashley Moody announced the state's plan on December 2nd to help prevent such crimes through the creation of a statewide task force and database known as the Florida Organized Retail Crime Exchange, or FORCE.
According to Moody's announcement, the FORCE is a "talented team of investigators, state attorneys, law enforcement" that will utilize a new database that will help law enforcement track retail thefts and identify criminal organizations that are behind them.
"As organized crime has increased, as organized theft rings have become more complex and sophisticated, so will we. … Make no mistake, this does not harm just retailers … This holiday season, I want Floridians to feel safe and secure when they go out to our shopping centers," Moody stated.
However, as the two robberies of Only Authentics shows, the creation of the FORCE does not necessarily prevent such crimes from happening, rather just investing in technology that increases the chances of the criminals who committed such crimes to be caught and brought to justice.
In an interview with CBS 12 in Palm Beach, describing the two burglaries, the store's owner, Virgil Rogers, stated:
"It's almost like we're in the wild, wild west here. … We as citizens living on Palm Beach Island especially, we almost live in a bubble, we do, it's very sad and now it's come to the homefront and your own home, what's going on elsewhere."
Rogers is referencing the rise in smash and grab robberies luxury retailers are experiencing that are taking place across the country, from California to New York. Concerned over being hit again because of how light the sentencing can be for these criminals, Rogers stated,
"I think there should be stiffer penalties for these types of crimes. I don't think people should be allowed to be out on bail as quickly as they are because I am certainly not a millionaire, that's for sure, and I really can't take another hit like this. It will put me completely out of business."
That being said, as the FORCE looks to identify and prosecute individuals involved in organizing the retail thefts, Moody suggested that it will also try to crack down on whom the crime leaders recruit to actually execute the crime – like the ones mentioned by Rogers.
"We know that juveniles are often recruited to commit crimes for these large criminal organizations because they think juveniles will never be held accountable. And if we allow that to keep happening without working these cases up, and putting these organized crime leaders behind bars for a significant period of time, Florida may see what's going on in other states," Moody stated.
Casey Owens is a contributing writer for The Florida Capital Star. Follow him on Twitter at @cowensreports. Email tips to caseyowensreports@gmail.com.
Photo "Only Authentics" by Only Authentics.
Republished with permission from The Florida Capital Star
Palm Beach Smash and Grab Robbery Nets $1 Million in Merchandise added by Staff on January 2, 2022
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10 Responses to "Palm Beach Smash and Grab Robbery Nets $1 Million in Merchandise"
@ Edward
PLUS, Said Stores should be allowed to SUE the Families for Damages. After all, if the Parents can Sue because their 35 Year Old Criminal Son was Legally Shot by Police then the Store Owners should be allowed to Sue the Parents of the Looters.
Business should be permitted to post a sign that states "Looters Shot on Sight", and legally permitted to follow through with that action. Furthermore, any looter shot (and/or his or her family) are not permitted to profit in anyway as a result of said action… no race card, no Ben Crump, no ghetto lotto.
… problem solved
I SAY, allow the Stores to Hire "Active Armed Security" to be positioned inside the Stores and SHOOT any and ALL involved in the Smash-N-Grabs. They get a Bonus for each Kill.
It's not really like the "wild, wild west". as owner Virgil Rogers said. In the wild, wild west the owner of store selling high dollar merchandise would hire a couple of armed guards to provide immediate justice should bad guys try and steal his stuff. I don't think it would take too many immediate interventions by store owners before the smash and grab problem went away.
Deflecting blame of the lawless situation in our Nation for the "Mostly Peaceful" Smash and Grab along with other out of control crime to nefarious and shadowy "Crime Leaders" does nothing but provide cover to the white leftists who sponsored the Antifa riots under the guise of BLM along with providing cover to the Biden administration and the leftist media who cheered on the crimes. Also dont forget all the Soros installed and other leftist prosecutors who will not punish criminals.
We need to fund local LEO's to set up task forces to apprehend these criminals and prosecutors who will hand out maximum sentencing to stop the crime.
Funding a task force to chase down imaginary "large criminal organisations" does nothing but prolong the situation and provide cover for the leftists and Biden Administration who are responsable for our out of control crime.
I would have called it a "FART" for Fast Action Response Team". As long as there is not a consequence, crime will continue.
A Skeptic says:
Kids aren't sophisticated enough to steal a million dollars in expensive merchandise (handbags, jewelry, clothing, etc.) and sell them for any kind of significant return. (Try putting a $20,000 handbag on eBay at any price and see what kind of attention you get.) The merchandise has to be funneled through the same kinds of hands/organizations as if it was money being laundered, and sold privately. That takes a kind of sophistication and a network that the kids don't have. They make a LOT more money as the acquisition arm of organized crime than they ever could peddling them in their neighborhoods.
Good on Moody and FORCE. I wish them well.
Stop with the "Smash and Grab" terminology already. Everyone knows that the proper Progressive PC term is, "Undocumented Shopping Spree".
(sarcasm off)
I do agree with Mike these smash and grab are likely small time local gang or social media arranged. The idea that secret big time villains are in control seems kind of ludicrous. Ashley has been watching way too much Marvel, DC, or maybe too much old Bond movies on Netflix. Uhh Ash its local…very local and the local LEO's need to do their jobs.
Psst… Don't look now Ashley, Florida is seeing what's going on in other states right now. There is nothing complex or sophisticated about a smash and grab robbery.


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Results of a Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of a Botulinum Toxin Type A Topical Gel for the Treatment of Moderate-to-Severe Lateral Canthal Lines
January 2012 | Volume 11 | Issue 1 | Original Article | 38 | Copyright © January 2012
Richard Glogau MD,a,b Andrew Blitzer MD DDS,c Fredric Brandt MD,d Michael Kane MD,e Gary D. Monheit MD,f Jacob M. Waugh MDG
aUniversity of California San Francisco, CA bPrivate Practice, San Francisco, CA cHead & Neck Surgical Group, New York, NY dDermatology Research Institute, LLC, Coral Gables, FL eManhattan Eye, Ear & Throat Institute, New York, New York fTotal Skin & Beauty Dermatology Center, Birmingham, AL gRevance Therapeutics, Inc., Newark, CA
Background: Injections of botulinum toxin type A are commonly used to treat facial wrinkles; however, undesirable effects are associated with injections (e.g., pain, bruising, ptosis, immunogenicity, and needle aversion). To address these issues, RT001 Botulinum Toxin Type A Topical Gel is being developed for the treatment of lateral canthal lines.
Objectives: To assess the safety and efficacy of RT001 for the treatment of lateral canthal lines in a randomized, double-blind, placebo-controlled study.
Materials & Methods: Adult subjects were enrolled to receive a single treatment of RT001 (n=45) or placebo (n=45) applied topically in the lateral canthal area. The primary endpoint was the composite of the Investigator Global Assessment of Lateral Canthal Line Severity (IGA-LCL) and the Patient Severity Assessment of lateral canthal line severity (PSA) defined as a 2-point or greater improvement on both scales.
Results: At four weeks, 44.4 percent of subjects treated with RT001 achieved a 2-point or greater improvement on a rigorous composite of both the IGA-LCL and PSA scales compared to 0.0% for the placebo subjects (P<0.0001). At four weeks, 88.9 percent of subjects achieved clinically relevant improvement by investigator assessment. Adverse events were mild in severity and unrelated to study treatment.
Conclusions: RT001 appears to be a safe and well-tolerated treatment for improvement of lateral canthal lines.
J Drugs Dermatol. 2012;11(1):38-45.
substantial body of literature supports the safe and effective use of botulinum toxin type A (BoNTA) injections for temporary improvement of facial wrinkles. Although an off-label use, BoNTA treatment of lateral canthal lines (LCL), also known as periorbital rhytids or crow's feet, has become a common clinical practice. Clinical practice has evolved substantially since the initial use of BoNTA for treatment of LCL. Current treatment recommendations focus on preserving a natural voluntary smile while softening the wrinkles in a neutral facial position ("at rest").1-2 This goal has been accomplished through progressive declines in the amount of BoNTA injected as well as broad use of intradermal injections.1-6 LCL at rest have been shown to be the major factor in perception of facial age and a 20 percent improvement in these LCL has been shown to be both readily detected and clinically significant.7 Elimination of the LCL which are normally present during a smile has come to be recognized as aesthetically unappealing. Lack of LCL at smile is perceived as a posed photo-smile, or a fake smile; these smiles are cortical in origin, voluntary, and do not reflect genuine emotion.1,4-6,8-9 The appearance of a photo smile is perceived to be an insincere smile which does not communicate genuine happiness, and a BoNTA-induced insincere smile has been shown to actually decrease subjects' ability to experience certain positive emotions.4-6,8-9 Even when


text:
Fluid Dynamics and Disease: Interfacial Flows and Plant Epidemiology
Unsteady sheet fragmentation: from compliance, wetting, non-isolated drop impacts, to secondary drops and contamination
Understanding what shapes the drop size distributions produced from fluid fragmentation is important for a range of industrial, natural and health processes. Fluid fragmentation plays an important role in pathogen transmission in particular. A particular example is from impacts on contaminated surfaces already, some dry, and others already wet, supporting sessile drops. These are ubiquitous in the field, where plant pathogens are attached to leaves via sticky mucilage requiring dissolution (e.g., spores of rust). The Crescent-moon fragmentation is one of the most efficient... more
Plant diseases represent a growing threat to the global food supply. The factors contributing to pathogen transmission from plant to plant remain poorly understood. Statistical correlations between rainfalls and plant disease outbreaks were reported; however, the detailed mechanisms linking the two were relegated to a black box. In this combined experimental and theoretical study, we focus on the impact dynamics of raindrops on infected leaves, one drop at a time. We find that the deposition range of most of the pathogen-bearing droplets is constrained by a hydrodynamical condition and we... more
Rain-induced foliar pathogen ejection
Plant diseases are a major cause of losses of crops worldwide. Although rainfalls and foliar disease outbreaks are correlated, the detailed mechanism explaining their link remains poorly understood. The common assumption from phytopathology for such link is that a splash is generated upon impact of raindrops on contaminated liquid films coating sick leaves. We examine this assumption using direct high-speed visualizations of the interactions of raindrops and leaves over a range of plants. We show that films are seldom found on the surface of common leaves. We quantify the leaf- surface's... more
Surface-tension phenomena in organismal biology: plants
Flows driven by surface tension are both ubiquitous and diverse, involving the drinking of birds and bees, the flow of xylem in plants, the impact of raindrops on animals, respiration in humans, and the transmission of diseases in plants and animals, including humans. The fundamental physical principles underlying such flows provide a unifying framework to interpret the adaptations of the microorganisms, animals, and plants that rely upon them. The symposium on ''Surface-Tension Phenomena in Organismal Biology'' assembled an interdisciplinary group of researchers to address a large... more


My family had a couple of Vic's/GMarq's over the decades. My brother had 2 different mid-90's Merc'.
I remember when they came out in '92. They were both very well done and certainly great value for the money.
With all the Panthers still out there, I wonder if one of the secondary market players could take the chassis and make some EV out of it?
I am not a Ford guy, but I actually really like the Panther cars. GMQ is a decent product, I think.


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As a modular system, choose the full kit (starting deck, drop section and launch ramp), or "sink" only the drop section into a pre-existing starting hill. Crescent comes equipped with the hyper-reliable Pro Gate ram, brain box, and starter controls; and we offer a deep list of "original equipment" accessories and options.
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Add 10.1in and 11.6in form factors to Packard Bell's repertoire.
Following – if a little late – in the footsteps of just about every other netbook maker, Packard Bell is launching two larger models to accompany its 8.9in Dot netbook – the 10.1in Dot S and 11.6in Dot M.
Unsurprisingly the Dot netbooks share some similarities with those from Packard Bell's parent company, Acer. The chassis appear nearly identical – what changes there are seem purely aesthetic – and share features such as a multi-touch touchpad and a choice of three-cell or six-cell batteries. Moreover the Dot S and Dot M come in the same sizes as the Aspire One D250 and the 11.6in Aspire One respectively.
The Dot M sports a 1,366 x 768 pixel screen, as per the 11.6in Aspire One, as well as WiFi, Bluetooth and optional 3G connectivity. Also similarly the Dot M has a 160GB hard drive, 1GB of RAM and is powered by an Intel Atom CPU.
Intel's 1.33GHz Z520 will be powering the Dot S, which is based around the older 945GSe chipset. Again a 160GB hard drive and 1GB of RAM are present alongside WiFi and Ethernet connectivity.
The Dot M and Dot S have €299 (~£267) and €399 (~£356) MSRPs respectively. I'd expect a direct Euro to Sterling conversion -so £299 and £399 – in the UK.


Guardian angel, be with me always. Read more..
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Build A Banner Simply Created Kit #133507 $19.95 Includes 18 5" x 7" blank canvas paper pennants, 6 ea. of 3 designs; 9' of jute twine; alphabet and image stencils; Stampin' Spritzer.