text:
Grade Inflation at UK Universities – Update
According to official figures released earlier this year, British universities have been awarding higher-class degrees at an unprecedented rate over the past decade, with at least one university issuing five times as many first-class degrees last year as it did a decade before. In other words, degrees are being "marked up", meaning students are leaving with a higher grade than a comparable student in previous years.
According to data from the Higher Education Statistics Agency, more than a quarter of graduates (26%) were awarded a first-class degree in 2017, which was up from 18% in 2012-13.
Examples of Grade Inflation:
At the University of Wolverhampton, in 2006-2007 academic year, 175 students (5% of the total) were awarded first-class degrees. In 2016-2017, 973 students (28% of the total) were awarded first-class degrees.
In contrast, Warwick University's proportion of first-class degrees rose from 22% in 2006-2007 to 27% a decade later and the proportion of second-class division 1s remained the same at 54%. But at Surrey University the number of first-class degrees rose to 41% of its graduates in 2017. At Oxford it rose to 33% and at Cambridge to 32% in 2017.
What may be the cause of this grade inflation?
Many within higher education point to public attitudes, including employers' perceptions that first and second-class division 1 degrees are viewed as "good" (or preferred) degrees. They also point at students who want value for the financial investment made in their education and expect a higher degree classification from their universities for the tuition fees paid. Another factor to consider is the competition between universities in attracting and retaining students that is seen as an incentive.
The government has announced that it will penalize universities found to have engaged in grade inflation.
The Teaching Excellent and Student Outcomes Framework (TEF) is the body that rates universities annually. TEC uses a number of criterion including student experience and teaching quality for its assessment of universities.
TEF, which is composed of academics, students and higher education experts who assess higher education providers for the government's university ratings system, will review the percentage of first-class and second-class division 1 degrees by each institution to determine any grade inflation. If assessments are judged excessive, the university could be downgraded. For example, a university with a gold rating, may be downgraded to silver rating.
The government has indicated that it has extended the TEF rating system to also include subject level. This means that individual subject will be rated gold, silver or bronze.
To start, 50 institutions will be measured in a series of pilots, before the plan is formally included to determine university ratings in the summer of 2020.
The Guardian https://www.theguardian.com/education/2018/oct/22/uk-universities-face-grade-inflation-crackdown
The Guardian https://www.theguardian.com/education/2018/nov/28/uk-universities-hold-inquiry-into-degree-awards-policies
The Independent https://www.independent.co.uk/news/education/university-grade-inflation-uk-first-class-degrees-second-thirds-government-a8594981.html
BBC https://www.bbc.com/news/uk-45935193
Filed under Credentials, Education
Tagged as college, education, united kingdom
7 Facts on the SQA and SQA Advanced Qualifications
In this week's blog, we would like to spotlight the Scottish Qualifications Authority (SQA) and their Advanced Qualifications. In partnership with SQA, ACEI has reviewed and evaluated the qualifications in Accounting, Business and Computing for U.S. educational equivalence comparability and credit equivalence.
1. Who is the SQA?
The Scottish Qualifications Authority (SQA) is an international leader in education and qualifications development. The SQA has over 100 years' experience in developing qualifications and qualifications systems, and over 20 years' experience of working internationally in partnership with schools, colleges, universities, employers, training organizations, industry professionals, professional bodies, and governments.
SQA helps individuals realize their potential and achieve their ambitions by providing a wide range of high-quality, internationally recognized qualifications, and associated services.
Based in Glasgow, SQA is a not-for-profit government-sponsored organization, accountable to the Scottish Government, and sits at the heart of Scotland's world- renowned education system.
2. What are SQA Advanced Qualifications?
SQA Advanced Qualifications are internationally recognized higher education qualifications at certificate and diploma level. They develop the theoretical knowledge and practical skills — such as information technology, communication, and problem solving — expected by a university or employer.
They have been developed to meet the skills needs of employers, and the requirements of education professionals, and also to enable advanced entry into many undergraduate degree programs in universities and higher education institutions.
3. Why study an SQA Advanced Qualification?
Achieving an SQA Advanced Certificate or SQA Advanced Diploma is one of the best ways to progress onto further studies or develop a career.
i. Valued by universities
An SQA Advanced Diploma is equivalent to the first two years of a degree, and is a recognized route into year 2 or 3 of a related degree program at home or overseas.
ii. Internationally recognized qualifications, designed by experts
Sitting at the heart of Scotland's world-renowned education system, SQA works in partnership to ensure qualifications are suitable, relevant, and up to date.
iii. Career-focused and trusted by employers
SQA qualifications enable our delivering centers to form industry and employer partnerships that provide opportunities to combine studying with on the job experience.
4. Who are SQA Advanced Qualifications for?
They are suitable for a wide range of learners, including: school leavers, adult returners to education, employees who wish to enhance their career prospects and people who wish to start their own business.
An SQA Advanced Qualification is ideal for students who would like to move on to a related undergraduate degree program at home or overseas, students who would like to study for a degree at an English-speaking university, or students who intend to enter into the workplace.
5. How do SQA Advanced Qualifications work?
i. Practical Learning
SQA Advanced Qualifications aim to develop the high-level transferable skills and academic knowledge required for degree study or work. They use practical approaches to learning, with study methods including project and assignment work, group work, presentations, and case studies.
ii. Assessment
Subjects are assessed in different ways. SQA Advanced Qualifications use a variety of assessment methods, such as an exam, essay, project, investigation and/or a practical assignment. Assessment is quality assured through internal verification (using an institution's own staff) and external verification (using SQA subject experts from the education sector).
iii. Certification
On successful completion of your SQA Advanced Qualification you will receive:
An SQA certificate stating the title of the qualification achieved
A listing of all the units passed and the Graded Units
iv. Progression
Once students have successfully achieved the SQA Advanced Qualification they have a number of options. They can progress on to a degree course in university at home or overseas through our Diploma to Degree program, do a qualification with a professional body, or go straight into employment.
6. Does the Diploma lead to a Degree?
The Diploma to Degree program is a well-established and successful route for students to complete an SQA Advanced Diploma and then progress directly on to the second or third year of a related undergraduate degree with one of our university partners.
SQA has partnered and set up progression pathway agreements with a number of highly regarded international institutions in countries around the world, covering various progression models, including online delivery. These institutions recognize the SQA Advanced Diploma as evidence of a student's capability, given the quality learning experience it provides, and as a result offer advanced entry.
Many students study for an SQA Advanced Diploma in their home country before progressing on to a related undergraduate degree either within their own country or abroad. This can be a cost-effective route for those looking to gain international experience while achieving a degree.
Successful graduates can study at universities around the world, including in the UK, USA, Canada, Ireland, Australia, and New Zealand.
Please note that individual universities may ask for additional entry requirements.
www.sqa.org.uk/studyoptions
7. What about Professional Body Exemptions?
Many professional bodies in the UK and internationally recognize the quality and value of an SQA Advanced Qualification, and in some cases may offer exemptions to criteria for membership. For example, individuals may not have to do an exam as their SQA Advanced Qualification may also satisfy an entry requirement for membership.
www.sqa.org.uk/advancedqualifications
For more information on available courses and centers in your area delivering SQA Advanced Qualifications: www.sqa.org.uk/advancedqualifications email: articulation@sqa.org.uk
For more information on the evaluation of SQA Advanced Qualifications and their U.S. educational comparability, please contact ACEI at acei@acei-global.org
Filed under Credentials, Education, Uncategorized
Tagged as credentials, education
November 9, 2018 · 7:00 am
AN EVALUATOR'S JOURNEY
When I accepted my mother's invitation to accompany her to a cocktail party, I did so reluctantly. It was July 1982 and as a freshly minted college grad with a BA in Political Science the last thing I wanted to do was attend a party with my mother. It turned out to be the best thing I could have done as I left the party with not one but three job offers. I decided to forgo the offer of working at a law office (even though I was toying with the idea of going to Law School), or a real estate office (numbers were not my forte) and chose instead to accept the hostess's invitation to work at her private not-for-profit Foundation that specialized in international education research and evaluation. The rest, as they say is history. Over a course of thirteen years, I worked my way up the proverbial ladder from file clerk, to junior then senior evaluator, assistant to associate director and finally as Executive Director. Bitten by the entrepreneur spirit and an MBA in hand, I bid goodbye to my mentor and founded the Academic Credentials Evaluation Institute (ACEI) in 1994.
You can say I was born into the field of International education. Beginning from an early age by insisting on "working" at the education firm my mother headed in Tehran, Iran, to attending an international boarding school in England, and continuing my higher education in the U.S. The same is true for my brother and business partner, Alan Saidi, who joined me at ACEI in 1996 as Senior VP and COO. Together, we have infused into ACEI our personal life experiences of having lived in three different continents and benefiting from three different education systems (Iran, UK, and USA). Our mission has always been to make ACEI a company that truly cares for and values its international candidates who are considering to further their education, or qualify for employment, immigration or professional licensing or maybe they are displaced because of war and conflict and seeking refuge in the U.S.
Our own experiences, as international students morphed into immigrants, have enriched our understanding of the dreams of international students, immigrants and the plight of refugees. We have also garnered a deep appreciation of world cultures and the varied nuances of education systems around the world. Together with a team of expert evaluators we pride ourselves in ACEI's history of over 22 years of dedicated service in international credential evaluation and helping our colleagues at U.S. schools and colleges with the admission of students from around the globe. We continue to share our experience through our e-learning training programs, our blog AcademicExchange, our monthly newsletter The Report, and by contributing to publications on world education systems, and speaking at various international education conferences.
As an Endorsed Member of the Association of International Credential Evaluators, we at ACEI are committed in preparing evaluations by recommending U.S. educational equivalencies that are consistent and in compliance with the Association's Standards and Best Practices.
If you are exploring opportunities of outsourcing your international student credential evaluations, we hope you will consider ACEI as your number one source. You and your international students will receive the personal care and attention we know you deserve. It is our mission to be of service and we want to be your trusted source for international credential evaluations.
Jasmin Saidi-Kuehnert
Jasmin Saidi-Kuehnert is the President and CEO of the Academic Credentials Evaluation Institute (ACEI).
Tagged as Credential Evaluations, credentials, education
Value Of Scottish Qualifications Authority Advanced Certificates And Diplomas Recognised By The Academic Credentials Evaluation Institute
The Academic Credentials Evaluation Institute (ACEI) and the Scottish Qualifications Authority (SQA) today announce the publication of the ACEI's Advisory Services 'Program/Curriculum Review' Report, which provides detailed analysis of four of SQA's Advanced Qualifications.
The report, based on ACEI's key principles in international credential/program evaluation, gives higher education institutions in the United States a better understanding of the value of SQA qualifications, the calibre of those who have achieved them, and how they compare with programs of study offered in universities and colleges across the United States.
The ACEI has found that SQA's Advanced Certificate in Business equates to 26 semester units of credit, just under one year of undergraduate study at a college or university in the United States. The SQA Advanced Diploma in Business and the SQA Advanced Diploma in Computing: Software Development each equate to 60 semester units – 2 years of undergraduate study, while the SQA Advanced Diploma in Accounting equates to 62 semester units.
The report, which is available to colleges and universities, also provides sample credential evaluations and sample certificates for each of the four SQA qualifications along with the equivalent US level for these qualifications.
SQA Advanced Qualifications are internationally recognised Higher Education qualifications at certificate and diploma level. They provide students with the theoretical knowledge and practical skills in a given subject that universities and employers expect. The qualifications have been designed in partnership with colleges, universities, employers and industry experts, and enable advanced entry into many undergraduate degree programs in universities and higher education institutions.
SQA's Diploma to Degree program is a well-established and respected route for SQA Advanced Diploma graduates to progress directly onto the second or third year of a related undergraduate degree.
Many students study in their own country before moving abroad to complete a related degree, entering directly into second or third year. This is a cost effective route for students to gain international experience and achieve a degree.
SQA has partnered with many highly regarded international institutions, who recognise the SQA Advanced Diploma for advanced entry into their degree programs, enabling them to attract a diverse student population.
President and Chief Executive of ACEI, Jasmin Saidi-Kuehnert, said: "At ACEI, we believe in the global mobility and integration of people in the academic and professional community and foster this vision by availing our expertise in international credential evaluation. We are honoured by our partnership with SQA given our shared belief in expanding education opportunities across borders."
Ms. Saidi-Kuehnert continued: "ACEI's Advisory Services conducted a detailed analysis and evaluation of SQA's Advanced Certificate and Advanced Diploma program offerings to facilitate acceptance of these qualifications by higher education institutions and employers."
SQA Chief Executive, Dr Janet Brown, said: "At SQA, we believe that partnership is essential in the education and training sectors and we are committed to working with our partners for the benefit of students by providing them with high quality, internationally recognised qualifications, which will enhance their futures."
Dr Brown continued, "Our certificates and diplomas have been the foundation upon which generations of successful careers have been built, providing students with the skills and experience they need to excel for over 90 years. Increasingly our SQA Advanced Qualifications allow graduates to progress onto top-up degrees at a host of prestigious universities around the world."
"We are delighted to be working with the Academic Credentials Evaluation Institute, to help increase the opportunities available to SQA students who wish to progress onto second or third year study of an undergraduate degree, in the United States."
The Scottish Qualifications Authority is an international leader in education and qualifications development.
The Scottish Qualifications Authority is the national awarding body in Scotland – a not for profit government sponsored organisation accountable to the Scottish Government – sitting at the heart of Scotland's world-renowned education system.
The Scottish Qualifications Authority helps people to realise their potential and to achieve their ambitions by providing a wide range of high quality, internationally recognised qualifications and associated services. We currently offer Advanced Certificates and Diplomas, jointly certificated customised and vocational qualifications in more than 20 countries worldwide.
We have over 100 years of experience in developing qualifications and qualification systems and over 20 years of experience of working internationally in partnership with governments, colleges, universities, schools, employers, training organisations, professional bodies and industry. We have a growing number of international centres, in countries such as America, Bangladesh, China, India, Myanmar, Oman, Sri Lanka and United Arab Emirates.
www.sqa.org.uk/diplomatodegree
The Academic Credentials Evaluation Institute, Inc. (ACEI), founded in 1994 and based in Los Angeles, California, USA, is dedicated to promoting the advancement of international academic exchange and understanding through research on world education systems and the evaluation of international academic credentials.
ACEI is a Charter Member of the Association of International Credential Evaluators (AICE), a professional organization recognized by the U.S. Department of Education and U.S. Department of State, committed to establishing standards and best practices for credential evaluation services in the U.S.
ACEI's leadership team and analysts bring more than 50 years of solid experience in international education and hands on expertise in evaluation of academic credentials from around the world.
ACEI keeps abreast of international education trends and developments through its on-going research, site visits, partnerships and maintains working relations with institutions, ministries of education, and other education organizations worldwide.
Find out more: www.acei-global.org
Academic Credentials Evaluation Institute, Inc.
9461 Charleville Boulevard, Box 188
website: www.acei-global.org
email: acei@acei-global.org
Tagged as Credential Evaluations, education
The Welcome Project ©
A Partner Program 2018
The Welcome Project© is a joint endeavor by the Academic Credentials Evaluation Institute, Inc. (ACEI) and iTEP International, offering individuals classified as refugees assistance with the evaluation of their academic credentials for U.S. educational equivalence and determine their English language proficiency through an approved language assessment test.
According to the UN Refugee Agency, as of 2017, there are more than 68 million people who have been displaced because of war, violence and persecution. As stipulated in Section VII of the Lisbon recognition convention, we recognize it as our social responsibility to assist displaced persons with their reintegration into the community. We realize that through the recognition of their former education, these individuals can accelerate their integration and assimilation into society.
The Academic Credentials Evaluation Institute, Inc. (ACEI), founded in 1994 and based in Los Angeles, CA, is dedicated to providing credential evaluations and advocating for the recognition of international education qualifications.
iTEP International, founded in 2002 and based in Los Angeles, CA, offers a widely recognized English language proficiency test that meets the acceptance requirements for international education and immigrant community nationwide.
At ACEI and iTEP International, we see it as our responsibility and moral imperative to do our part to support the he integration of refugees, where possible, by offering our expertise in international credential evaluation and English language proficiency testing.
The Welcome Project combines both the international credential evaluation and English language proficiency testing at the onset of their resettlement in the U.S. These individuals will be able to receive recognition of their educational achievements and language competency. Such recognition will enable them to integrate into their new adopted community much faster as they set out to pursue employment opportunities and further their education.
The fundamental mission of The Welcome Project is aligned with U.S. higher education's institutional internationalization, diversity and inclusion strategies.
Join ACEI and iTEP International in adopting The Welcome Project and support displaced persons and refugees in achieving their educational and professional goals.
Together, we can make a difference.
jasmin@acei-global.org
http://www.acei-global.org
Perry Akins
Chairman & Cofounder iTEP International, LLC
perry@perryakins.com
http://www.itepexam.com
Tagged as education, international students
ACEI and iTEP International launch initiative to help refugees get education, jobs
The Welcome Project© is a joint endeavor by the Academic Credentials Evaluation Institute, Inc. (ACEI) and iTEP International, offering individuals classified as refugees assistance with the verification and evaluation of their international academic credentials for U.S. educational equivalence and determining their language proficiency through an approved language assessment test.
According to the UN Refugee Agency, as of 2017, there are more than 68 million people who have been displaced because of war, violence and persecution. In an effort to serve this displaced population already in the U.S., The Welcome Project© combines ACEI's international credential verification and evaluation with iTEP's English language proficiency test.
"As an international credential evaluation service provider, we see it as our responsibility and moral imperative to do our part to support the integration of refugees, where possible, by offering our expertise in this field, at the onset of their resettlement in the U.S.," says Jasmin Saidi-Kuehnert, President & CEO of ACEI. "By partnering with iTEP International through The Welcome Project©, we are able to combine our evaluation and English language proficiency test capabilities at specially reduced fees to make it affordable and amenable to institutional and organizational clients."
"We feel that through our combined expertise, individuals displaced by war and persecution will be able to receive recognition of their education achievements and language competency," says Dan Lesho, Executive Vice-President of iTEP International. "This recognition will enable them to integrate into their new adopted community much faster as they set out to further their studies or qualify for jobs."
The Welcome Project© is made available to U.S. schools, colleges and universities, and employers who wish to provide these vulnerable and displaced individuals access to education and employment by ensuring they meet academic and English language proficiency requirements.
About ACEI
ACEI is dedicated to the advancement of international academic exchange and understanding through the dissemination of information on world educational systems and evaluation of international educational documents.
ACEI works closely with U.S. colleges and universities, Professional State Licensing Boards, the U.S. Department of Homeland Security (Immigration Division) and the Human Resource Departments of several U.S. corporations with the evaluation and verification of international educational credentials. Our organization is actively involved in the training and professional development of admissions officers at U.S. institutions and examiners at U.S. State Boards, as well as officials at U.S. government agencies on matters concerning world educational systems, credential evaluation, diploma mills, and detecting document fraud. acei-global.org
About iTEP
The International Test of English Proficiency was introduced in 2008 to modernize English assessment with on-demand scheduling, fast scoring, and rich, accurate data. iTEP offers a variety of assessment tools for university and secondary school admissions and placement, hiring and employee assessment (including tests for specific industries) and iTEP Conversation, which assesses conversation skills in 30 minutes and is graded by certified and trained native English speakers (as are all iTEP exams). More than 750 colleges, universities, high schools, and boarding schools accept iTEP results for admissions. Applicants can take iTEP at more than 700 test centers in 51 countries. iTEP International is headquartered in Los Angeles, California. itepexam.com
33 Facts on Chile and its Education System
General Country Facts:
1. Located in Southern South America, bordering the South Pacific Ocean, between Argentina and Peru
2. slightly smaller than twice the size of Montana
3. It has a population of 17,789,267 (July 2017 est.)
4. It's capital is Santiago while Valparaiso is the seat of the national legislature
5. It commits 4.9% of GDP to education (2015), 90th in world ranking
6. 97.5% literacy amongst the ages of 15 and above
7. The government is a Presidential Republic
Overview of the Education System:
8. 12-year guaranteed free mandatory education (based on May 2003 reform to the Chilean Constitution)
9. The following undergraduate degree programs are offered: Técnico (Technician); Títulos Profesionales (Professional Titles) ; Bacherillato/Bachiller (Bachelor); and Licenciatura/Licenciado (Licentiate).
10. The Ministry of Education (Ministerio de Educación) regulates all levels of education and its Consejo Nacional de Educación approves and monitors institutions of higher education.
11. The Consejo Nacional de Educación monitors a new institution and its programs for a period of six years. If the institution's performance is satisfactory it is granted autonomy (institución autónoma). If not, the institution may be placed on a five-year probationary period or be forced to close.
12. Under the umbrella of the Consejo Nacional de Educación, there are two national accreditation commissions: the Comisión Nacional de Acreditación (CNA) which accredits institutions and programs at the undergraduate level and the Comisión Nacional de Acreditación de la Calidad de Programas de Postgrado (CONAP) which accredits institutions and their programs at the graduate level.
13. Institutional accreditation began in 2003 and is voluntary.
14. The Ministry of Education oversees and monitors vocational education.
15. Spanish is the official language of instruction.
Elementary and Secondary Education:
16. Elementary Cycle (Educación Básica) – 8-year elementary cycle (aged 6-13) leads to Licencia de Educación Básica, and consists of 2 phases:
i) primer ciclo básico (initial phase) [grades 1-4], 4 years in duration for ages 6-9;
ii) Segundo ciclo básico [grades 5-8], 4 years in duration for ages 10-13.
17. Secondary Cycle (Educación Média) – 4 years and divided into two 2-year cycles:
i) first 2 years consist of a common core curriculum
ii) last 2 years depend on the track selected (enseñanza média humanistico- cientifica/general secondary education, enseñanza média técnico-profesional/ technical vocational education, enseñanza artistica/art education).
18. Secondary education (educación secundaria or educación/enseñanza média) is offered at either a liceo, colegio or institution. Completion of secondary cycle lead to a Licencia de Educación Media or Licencia de Enseñanza Media which provide access to university education.
Higher Education (Educación Superior):
19. Admission to first year of university studies requires the Licencia de Educación Media or Licencia de Enseñanza Media (secondary school diploma).
20. Since late 2003, a new entrance examination known as Prueba de Selección Universitaria (PSU) has been instated and applied by all universities affiliated with the Consejo de Recotres de las Universidades Chilenas (CRUCH)
21. There are 3 types of institutions at the higher education level: Universidades (universities); Institutos Profesionales (professional institutes); Centros de Formación Técnica (technical training centers)
22. Universities have the right to award academic degrees such as Licenciado (Licentiate/ Undergraduate degree), Magister (Master/Graduate Degree), and Doctor (Doctorate) as well as the right to award qualifications intended for professional licenses.
23. Centros de Formación Técnica (technical training centers) and Institutos Profesionales (professional institutes) provide 2-3-year vocational education programs known as carerras técnicas de nivel superior, leading to the Técnico de Nivel Superior (Advanced Level Technician) certificate or Titulo Profesional, respectively.
24. Undergraduate University Education (Pregrado) – requires the secondary school diploma and entrance examinations for admission, offering programs of 4-5 years in length leading to the Licenciado degree in a field of specialization, or a Titulo Profesional (professional qualification), such as Ingeniero (Engineer) or Enfermero (Nurse). Some universities may offer a two-year program leading to the Bachiller which is an intermediate certificate and gives access to the Licenciado degree once an additional two year have been completed.
25. Graduate (Posgrado) – Requires the Licenciado or Titulo Profesional for admission. Direct entry to Doctorado program from Licenciado is possible, but the duration of studies will be longer.
26. Posgrado programs are as follow:
i) Postitulo (Post Degree), 1 year minimum in duration, focused on further specialization in a specific field/discipline but may not require a thesis;
ii) Magister, 1-2 years, and may require either a thesis (tesis de grado)or graduation assignment (trabajo final);
iii) Doctorado (Doctorate), highest academic qualification and requires a Licenciado or Magister degree for admission, and awarded after 3-5 years of study that includes research and successful defense of the doctoral thesis.
More facts:
27. Over last 20 years Chilean higher education has changed drastically, experiencing a boom in enrollments. In 2011, seven out of ten students were the first generation from their family accessing university. From 1990 to 2011 the gross higher education enrollment ratio increased from 14 percent to over 50 percent. Total enrollments have increased from about 660,000 in 2005 to almost 1.2 million today. (Click here for source)
28. There are 43 accredited universities, 19 accredited professional institutes, and 18 accredited technical institutions (by December 2015, according to the information from www.cnachile.cl), all of which contribute to a total of approximately 1,160,000 students in the Chilean educational system (44% in universities). (Source: EducationUSA)
29. The major institution is the University of Chile (originally founded in 1738), with campuses in Santiago, Arica, Talca, and Temuco.
30. The University of Santiago of Chile and the Federico Santa María Technical University, in Valparaíso, are technical universities patterned after the German model.
31. Private universities are the Catholic University of Chile in Santiago, the Catholic University of Valparaíso, the University of the North in Antofagasta, the University of Concepción, and the Southern University of Chile in Valdivia.
Bonus Fun facts:
32. Literature, poetry in particular, is the most significant of the creative arts in Chile. Two Chilean poets, Gabriela Mistral and Pablo Neruda, won the Nobel Prize for Literature (1945 and 1971, respectively), and the poetry of Vicente Huidobro and Nicanor Parra, also of the 20th century, is recognized in the world of Hispanic literature. In the late 20th century the novels of Isabel Allende became highly acclaimed not only in Latin America but also, in translation, in Europe and North America. (Source: Britannica)
33. Chile is one of the few countries on earth that has a government-supported UFO research organization. (Source: International Business Times)
Chilean Ministry of Education
EducationUSA
Fulbright Commission Chile
National Accreditation Commission Chile
National Council on Education
https://www.cia.gov/library/publications/resources/the-world-factbook/
https://wws.princeton.edu/sites/default/files/content/Chile%20Workshop%20Report_HigherEd%203.15.pdf
https://www.britannica.com/place/Chile/Education
https://www.educationusa.cl/educational-system-in-chile/
https://www.factretriever.com/chile-facts
Tagged as Chile, education, international education


text:
Wenlock, Baron (UK, 1839 - 1932)
Creation: 13 May 1839
Extinct: 14 Jun 1932
Family name: Thompson later Lawley-Thompson later Lawley
Argent a Cross Formy throughout checky Sable and Or
A Wolf statant Sable
On either side a Wolf Sable gorged with a Plain Collar Or pendent therefrom an Escutcheon Argent charged with a Chevron of the first between three Moors' Heads affront�e proper
Je Veux De Bonne Guerre
Paul Beilby [Thompson later Lawley-Thompson], 1st Baron Wenlock
4th son of Sir Robert Lawley, 5th Bt., of Spoonhill, co. Shropshire, and of Canwell, co. Stafford, by his wife Jane Thompson, only dau. and hrss. in her issue of Beilby Thompson, of Escrick Park, co. York
10 May 1817 Hon Caroline Griffin (b. 6 Oct 1792; d. 2 May 1868; bur. at Escrick, co. York), 3rd dau. of Richard [Aldworth later Neville later Griffin], 2nd Baron Braybrooke, by his wife Catherine Grenville, sister of George [Grenville later Nugent-Temple-Grenville], 1st Marquess of Buckingham, and 4th dau. of Rt Hon George Grenville MP, First Lord of the Treasury (Prime Minister) and Chancellor of the Exchequer 1763-65 (by his wife Elizabeth Wyndham, sister of Charles [Wyndham], 2nd Earl of Egremont, and 2nd dau. of Rt Hon Sir William Wyndham, 3rd Bt. MP, of Orchard Wyndham, co. Somerset, by his first wife Lady Katherine Seymour, 2nd dau. by his first wife of Charles [Seymour], 6th Duke of Somerset), 2nd son of Richard Grenville MP, of Wooton under Barnwood, co. Buckingham, by his wife Hester Temple later Grenville, suo jure Countess Temple
1. Hon Beilby Richard Thompson later Lawley, later 2nd Baron Wenlock
2. Capt Hon Robert Neville Lawley (b. 30 Aug 1819; dsp. 16 Nov 1891), mar. 10 Nov 1852 Georgiana Emily Somerest (dsp. 21 Nov 1910), 5th dau. of General Lord Robert Edward Henry Somerset GCB KTS (by his wife Hon Louisa Augusta Courtenay, 11th dau. of William [Courtenay], 2nd Viscount Courtenay and de jure 8th Earl of Devon, 4th son of Henry [Somerset], 5th Duke of Beaufort
3. Rev Hon Stephen Willoughby Lawley, of Spurfield, Exminster, co. Devon (b. 4 Apr 1823; d. 23 Oct 1905)
4. Hon Francis Charles Lawley MP (b. 24 May 1825; dsp. 18 Sep 1901), mar. 18 Dec 1869 Henrietta Louisa Amelia Zaiser, 2nd dau. of Rev Frederick Augustus Zaiser, Chaplain to the King of Saxony
1. Hon Jane Lawley (d. 4 Feb 1900), mar. 6 May 1846 Rt Hon James Archibald Stuart-Wortley QC MP, Recorder of London (b. 3 Jul 1805; d. 22 Aug 1881), 3rd son of James Archibald [Stuart-Wortley-Mackenzie], 1st Baron Wharncliffe, by his wife Lady Elizabeth Caroline Mary Crichton, only dau. by his second wife of John [Crichton], 1st Earl Erne, and had issue
9 May 1852 (bur. at Escrick, co. York)
13 May 1839 Baron Wenlock, of Wenlock in the County of Shropshire
Fellow of All Souls' College 1806-17; took the name of Thompson in lieu of that of Lawley by Royal Warrant 1820; Member of Parliament (Whig) for Wenlock 1826-32 and for East Yorkshire 1832-37; resumed his patronymic of Lawley before that of Thompson by Royal Warrant 1839, his children being authorised to take the name of Lawley only; Lord Lieutenant of the East Riding of Yorkshire 1840-47; suc. his elder brother as 8th Baronet 30 Jan 1851
Beilby Richard [Thompson later Lawley], 2nd Baron Wenlock
28 Nov 1846 Lady Elizabeth Grosvenor (b. 9 Jul 1824; d. 16 Dec 1899; bur. at Escrick, co. York), 3rd dau. of Richard [Grosvenor], 2nd Marquess of Westminster, by his wife Lady Elizabeth Mary Leveson-Gower, 2nd dau. of George Granville [Leveson-Gower], 1st Duke of Sutherland
1. Hon Beilby Lawley, later 3rd Baron Wenlock
2. Hon Richard Thompson Lawley, later 4th Baron Wenlock
3. Rev Hon Algernon George Lawley, later 5th Baron Wenlock
4. Hon Sir Arthur Lawley GCSI GSIE KCMG, later 6th Baron Wenlock
5. Hon Robert Lawley (b. 5 Jul 1863; dsp. 18 Sep 1924), mar. 2 Jul 1924 Agnes Balsillie, dau. of Rev David Balsillie
1. Hon Caroline Elizabeth Lawley MBE (d. 15 Jul 1934), mar. 21 Apr 1870 Lt Col Hon Caryl Craven Molyneux (b. 4 Oct 1836; d. 7 Mar 1912), 2nd son of Charles William [Molyneux], 3rd Earl of Sefton, by his wife Mary Augusta Gregge-Hopwood, only dau. of Robert Gregge-Hopwood, of Hopwood Hall, co. Lancaster, and had issue
2. Hon Alethea Jane Lawley, mar. 12 Apr 1890 Cav Professore Taddeo Wiel, of Venice, Italy (d. 17 Feb 1920)
3. Hon Constance Mary Lawley (d. 4 May 1951), mar. (1) 19 Jun 1877 Capt Hon Eustace Vesey (b. 19 Jun 1877; d. 18 Nov 1886), 2nd son of Thomas [Vesey], 3rd Viscount de Vesci, by his wife Lady Emma Herbert, 5th dau. by his second wife of George Augustus [Herbert], 11th Earl of Pembroke, and (2) 7 Jul 1892 Maj Hon Edward William Berkeley Portman (b. 30 Jul 1856; dsp. 27 Apr 1911), 1st son and heir ap. by his first wife of William Henry Berkeley [Portman], 2nd Viscount Portman, and had issue by her first husband
4. Hon Katharine Lawley, mar. 28 Apr 1885 Walter Francis Forbes, of 16 Palace Gardens Terrace, London W8
6 Nov 1880 (bur. at Escrick, co. York)
Member of Parliament (Liberal) for Pontefract 1851-52; Lt Col, West Riding of Yorkshire Yeomanry 1859-70 (later Hon Col); Lord Lieutenant of East Yorkshire 1864-80
Beilby [Lawley], 3rd Baron Wenlock, GCSI GCIE KCB VD PC
14 May 1872 Lady Constance Mary Lascelles CI (b. 27 May 1852; dspm. 23 Aug 1932; bur. at Escrick, co. York), 1st dau. of Henry Thynne [Lascelles], 4th Earl of Harewood, by his first wife Lady Elizabeth Joan de Burgh, 1st dau. of Ulick John [de Burgh], 1st Marquess of Clanricarde, by his wife Hon Harriet Canning, sister and sole hrss. of Charles John [Canning], 1st Earl Canning, and only dau. of Rt Hon George Canning MP, First Lord of the Treasury (Prime Minister) and Chancellor of the Exchequer 1827
1. Hon Irene Constance Lawley, of Escrick Park, co. York (b. 7 May 1889), mar. 3 Dec 1920 Colin Gurdon Forbes Adam CSI ICS (b. 18 Dec 1889), 3rd son of Sir Frank Forbes Adam, 1st Bt. CB CIE JP DL, by his wife Rose Frances Kemball, dau. of Charles Gurdon Kemball, Judge of the High Court of Bombay, and had issue
s.p.m. 15 Jan 1912 (bur. at Escrick, co. York)
admitted to the Inner Temple 1870; sometime Maj, Yorkshire Hussars; raised and commanded the East Riding of Yorkshire Yeomanry (Hon Col); VD; Member of Parliament (Liberal) for Chester 1880; an original member and sometime Chairman of the East Riding County Council; Governor of Madras 1891-96; GCIE 1891; GCSI 1896; Privy Councillor 1901; a Lord in Waiting to the Prince of Wales 1901-10; KCB 1901; High Steward of Kingston-upon-Hull 1909-12; Vice-Chamberlain to Queen Mary 1910-12; President and Chairman of the East Riding T F Association; Chairman of the Yorkshire Insurance Company; a Director of the North Eastern Railway Company and of Barclays Bank
Richard Thompson [Lawley], 4th Baron Wenlock, CB
31 Jul 1909 Rhoda Edith Knox-Little (d. 12 May 1952), 2nd dau. of Rev Canon William John Knox-Little
s.p. 25 Jul 1918
Sub-Lieut, 7th (Queen's Own) Hussars 1875; Lieut 1876; served in the Nile Expedition 1884-85; Capt 1885; Military Secretary to his brother when Governor of Madras 1891-96; Major 1893; Lt Col 1899; served in the South African War 1901-02; CB 1902; Brevet Col 1903
Algernon George [Lawley], 5th Baron Wenlock
16 Jul 1896 May Ethel Donaldson (d. 12 Sep 1934), dau. of Sir Stuart Alexander Donaldson, First Premier of New South Wales
s.p. 14 Jun 1931
ordained Deacon 1881 and Priest 1884; Eton Missioner, Hackney Wick 1881-86; Chaplain, St Andrew's Bethnal Green 1886-96; Rector of St John-at-Hackney 1897-1911; Rural Dean of Hackney and Stoke Newington 1903-11; Prebendary of St Paul's Cathedral 1907-23; Missionary Chaplain at Brisbane, Australia 1912; Chaplain to the King 1912-26; Vicar of St Peter's, Eaton Square 1913-16; Curate of Stoke St Milburgh, co. Shropshire 1917-18
Arthur [Lawley], 6th Baron Wenlock, GCSI GCIE KCMG
15 Oct 1885 Dame Annie Allen Cunard GBE DGStJ (d. 29 Apr 1944), 3rd dau. of Sir Edward Cunard, 2nd Bt., by his wife Mary McEvers, dau. of Bache McEvers, of New York, New York, USA, merchant
s.p.m.s. 14 Jun 1932
1. Richard Edward Lawley (b. 9 May 1887; killed vp. in a hunting accident in India 4 Sep 1909)
1. Hon Ursual Mary Lawley, Maid of Honour to Queen Mary 1912-27 (b. 8 Jun 1888; d. 1979), mar. 21 Jul 1927 as his second wife George Abraham [Gibbs], 1st Baron Wraxall, and had issue
2. Hon Margaret Cecilia Lawley (b. 15 Jun 1889), mar. 14 Jun 1919 Geoffrey Dawson, of Langcliffe Hall, Settle, co. York, and 23 Sussex Place, Regent's Park, London, editor of "The Times", 1st son of George Robinson, of Skipton-in-Craven, co. York, and had issue
2nd Lieut, 10th Hussars 1882; served in the operations in Suakin 1884; Capt 1889; retired 1892; Private Secretary to his uncle, the 1st Duke of Westminster 1892-96; Secretary to the Administration of Southern Rhodesia 1896; Deputy Administrator of Matabeleland 1896; Administrator of Matabeleland 1898-1901 and Acting Administrator of Mashonaland 1899-1901; Governor of Western Australia 1901-02; KCMG 1901; Lieutenant-Governor of the Transvaal 1902-05; Governor of Madras 1906-11; GCIE 1906; GCSI 1911; served in World War I 1914-18 as Commissioner, British Red Cross in France; Chairman of the Child Emigration Society and of the Forestal Company; KJStJ
On the death of the 6th Baron Wenlock the Barony of Wenlock became extinct.
First written 11 Mar 2014

redpajama_set_name: RedPajamaCommonCrawl


We are often quick to judge or create stories or scenarios about the lives of others. We share our voice and opinions and surely blast our own agendas on the inter-webs, we participate in screened comment threads hammering others into battle of right vs wrong. Sometimes this little place can make people feel quite big and justified hiding behind their handheld devices. Some find comfort in faceless dialogue and thrill seek to point out the wrong of how many live their lives - on a square. Again, on a square, a screen, a place of fingered technologies.
What is it worth to spread hate or shame to people whom you've not met or embraced or felt their heart in their words or their actions. To call someone shameful over photo post on the damn Internet says more about you than it does the people you accuse.
Live less pro-right and live from a place being pro-love. Move from peace and react from love.


text:
COVID symptoms often don't end when people test negative, which usually happens after about 10 days. Symptoms, including, changes to smell and taste, fever, trouble breathing, coughing, throat and chest pain, hair loss, fatigue, exhaustion, and headaches, can last for weeks, months, or more.
Photograph by Jackie Molloy
How do you know if you have long COVID?
There is no single diagnostic test for it, and no medical consensus about what symptoms it encompasses. Experts weigh in on what you can do if you still feel sick.
ByEmily Sohn
A few days after Michele Hart tested negative following a COVID infection in June 2022, she started participating in virtual meetings for her job. But after each call, she crawled back into bed to rest. When she returned home from a three-day work trip, more than a week after her negative test, she spent the entire weekend in bed recovering. An avid runner and hiker, she had stopped doing both because she was tired and, she thought, possibly depressed. She wondered if she would ever feel well again.
"One of the things I found myself doing after that initial 10 days was, at least once a day, Googling something like, 'When will I be better?'" says Hart, 45, a product specialist for a school curriculum company. The answers were frustrating: "Hang in there. Some people have it like this. Some people have it like that."
A long COVID patient began her day waiting in the exam room for the first of four doctor appointments. An active athlete, since having long COVID she gets fatigued more easily. She had to reteach herself how to dribble a basketball.
COVID symptoms often don't end when people test negative, which usually happens after about 10 days. Symptoms can last for weeks, months, or more. In one of the latest studies on lingering symptoms, researchers in Scotland surveyed more than 31,000 people who'd had symptomatic infections and found that 42 percent reported they had not fully recovered between six and 18 months after their infection began.
But when do ongoing COVID symptoms officially become long COVID, and how can someone know if they have a chronic condition or symptoms that will go away eventually?
Those are tricky questions without satisfying answers, says Michael VanElzakker, a neuroscientist at Harvard Medical School and Massachusetts General Hospital. Long COVID, while an active area of research, is not a clearly defined condition with specific medical criteria. There is no single diagnostic test to confirm it and no easy way to explain what is causing symptoms. Many studies are ongoing, but answers are still a work in progress.
"A core question still remains," VanElzakker says. "Why do some people seem to fully recover, and some don't?"
There is still no medical consensus about what the condition should be called, which symptoms it encompasses, how long a person must be sick before being diagnosed with it, or exactly how many people experience it.
Symptoms need to persist for at least three months after a probable or confirmed COVID infection to meet the World Health Organization's definition of a post-COVID condition. The U.S. Centers for Disease Control and Prevention considers four weeks long enough to suspect long COVID, which is also called post-acute sequelae of SARS CoV-2 infection (PASC), long-haul COVID, chronic COVID, and other names.
After multiple large studies it still isn't clear how many people are suffering from long-term symptoms, which are wide ranging. A study conducted in Germany identified 96 potential symptoms and found many of them in people who'd had prior infections. For young people, the most common symptoms included fatigue, cough, throat and chest pain, headache, fever, abdominal pain, anxiety, and depression. For adults, frequent ongoing symptoms included changes to smell and taste, fever, trouble breathing, coughing, throat and chest pain, hair loss, fatigue, exhaustion, and headache.
The Scottish study considered 26 persistent symptoms, including headaches, loss of taste and smell, tiredness, heart palpitations, constipation, breathlessness, joint pain, dizziness, and depression. But complicating the issue of diagnosis was that people who hadn't tested positive for COVID also experienced many of those same symptoms.
While 42 percent of people in the Scottish study had some lingering symptoms, an additional 6 percent said they hadn't recovered at all. German researchers found that adults, kids, and adolescents with a prior COVID infection were about 30 percent more likely than people without a positive COVID test to report a new condition more than three months after their infection. About 14 percent of more than 41,000 of people who responded to a CDC survey in October reported having persistent symptoms at least three months after a COVID infection.
Across studies, it looks like somewhere between one in five and one in 20 people end up with long COVID symptoms, says David Putrino, a neuroscientist at Mount Sinai Health System in New York. To him, the exact number is less important than the reality of the implications. "If any of those are true, it's an enormous number," he says. "My clinic already has a six-month waitlist crammed out the door. None of us are sleeping. We're all just treating 24/7."
Will I get better?
Also unclear is the prognosis for people with lingering symptoms. Most patients who visit Mount Sinai's Center for Post-COVID Care show some improvement within the first three months of rehab even if they experience setbacks or don't feel fully recovered, Putrino says. But about 10 percent don't improve.
Some might ultimately meet the criteria for myalgic encephalomyelitis or chronic fatigue syndrome, known shorthand as ME/CFS, a chronic condition that can be caused by viral infections. About 10 percent of people with severe cases of Epstein-Barr go on to develop ME/CFS, VanElzakker says. He suspects this will happen to a subset of long COVID patients.
On the flip side are people with lingering issues that ultimately go away, says VanElzakker, who lost patches of hair from his beard for several months after his own bouts with the virus. "Simply because someone doesn't feel better after three weeks," he says, "doesn't mean they're never going to get better."
What is causing it?
For people with ongoing symptoms, there are many potential causes, experts say, and understanding them can help guide treatment. One active area of research suggests that SARS-CoV-2, the virus that causes COVID-19, might stick around in some people's bodies, driving inflammation and symptoms long after rapid COVID tests come up negative. In a study of 44 people who died from or with COVID in 2020 and 2021, researchers found evidence of the SARS-CoV-2 spike protein in organs including the brain, heart, and intestines that had persisted for as long as seven months, even in people who were asymptomatic. The virus replicated within tissues for up to three months in some people, the study found.
Viral reservoirs are hard to detect in living patients because they don't show up in blood tests, VanElzakker says. He has co-founded a nonprofit called Polybio to investigate infection-associated chronic conditions like long COVID. The organization is funding research to collect gut samples from long COVID patients, and another that will collect lung tissue. He suspects that identifying where the virus ends up settling could explain the wide range of long COVID symptoms. If reservoirs get established in the gut, they could cause ongoing diarrhea, for example. In the lungs, they could cause coughing and shortness of breath.
As researchers compile evidence for viral reservoirs and other possible causes of long-term symptoms, the work is starting to guide treatment that recognizes the importance of individualized care, Putrino says. A patient with lingering symptoms from severe pneumonia and intubation, for instance, might benefit from pulmonary rehabilitation that pushes them to exert themselves. But the same kind of rehab can be disastrous for someone with post-exertional malaise who meets the criteria for ME/CFS. Antivirals might end up helping people with persistent reservoirs of COVID, but it doesn't make sense to give these drugs to everyone with long COVID.
"Our job now is to understand who's who in this big broad diagnostic catchall," Putrino says, "so that we can start to engage in precision medicine."
What should I do if I still feel sick?
If symptoms persist beyond four weeks, it's probably time to talk with your doctor about checking your heart and lungs and running other basic tests, Putrino says. If you get to 12 weeks, he recommends a more aggressive approach with a physician or high-quality clinic that is familiar with long COVID.
Because the pandemic has been such a difficult time in so many ways, a careful check of both physical and mental health can start to distinguish between the mix of problems people might be experiencing right now, says Lucinda Bateman, medical director of the Bateman Horn Center, a nonprofit focused on research into ME/CFS, fibromyalgia, and related conditions.
Some health issues that started after a COVID infection may be related to the severe stress of living through a pandemic or to missed medical appointments due to lockdowns, clinic closures, and overbooked doctors.
For people who have been to general practitioners and specialists and still don't have an answer, clinicians knowledgeable about ME/CFS could be helpful. They might look for signs of mast cell activation, a type of hyper-inflammation, Bateman says. Or they might consider dysautonomia, which is dysfunction of the autonomic nervous system that can be detected by looking for a drop in blood pressure or spike in heart rate when standing up. These conditions are tricky to diagnose because they can affect multiple systems and produce symptoms throughout the body, but distinctions can make a difference in medical guidance.
People don't usually get diagnosed with ME/CFS until they have been sick for between two and five years presumably, Bateman says, because doctors have not been taught about the illness. One hope is that, with an emerging cohort of long COVID patients, clinicians might be able to catch cases earlier and prevent them from progressing—by, for example, limiting physical and even cognitive activity during recovery for some people. "We're a culture of high-achieving and of pushing through pain, and that's the wrong advice for some conditions," she says, "particularly for post-viral conditions that relapse with activity."
As for Hart, her turning point came on the Fourth of July, after about a month of being sick, when she went to a concert and found that she was able to dance. There were ups and down for a couple of weeks after that, but now, six months later, she is back to full speed. "I couldn't do anything for like six weeks," she says. "But then I was fine."


text:
Health care education, delivery, and quality| Volume 120, ISSUE 1, P131-136, July 01, 2007
PDF [354 KB]PDF [354 KB]
Figure Viewer
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Regional differences in EpiPen prescriptions in the United States: The potential role of vitamin D
Carlos A. Camargo Jr., MD, DrPH
Carlos A. Camargo Jr.
Reprint requests: Carlos A. Camargo, Jr, MD, DrPH, EMNet Coordinating Center, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114.
From the Center for D-receptor Activation Research
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
Sunday Clark, MPH, ScD
Sunday Clark
Michael S. Kaplan, MD
Michael S. Kaplan
Department of Allergy, Kaiser Permanente, Los Angeles
Philip Lieberman, MD
Philip Lieberman
University of Tennessee College of Medicine, Memphis
Robert A. Wood, MD
Robert A. Wood
Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins Medical Center, Baltimore
Published:June 13, 2007DOI:https://doi.org/10.1016/j.jaci.2007.03.049
Previous ArticleAnaphylaxis and vitamin D: A role for the sunshine hormone?
Next ArticleAssociation between IgE levels and asthma severity among African American, Mexican, and Puerto Rican patients with asthma
The epidemiology of anaphylaxis is uncertain, especially its geographic distribution.
To address this deficit, we examined regional rates of EpiPen prescriptions in the United States.
EpiPen prescriptions in 2004 were obtained for all 50 states and Washington, DC, from NDCHealth, Pharmaceutical Audit Suite (Alpharetta, Ga). Data included the number of total filled prescriptions, including refills, and the actual number of EpiPens prescribed. Several data sets were used to obtain state-specific populations, as well as multiple demographic, health, and weather characteristics. State population was used to calculate the average number of prescriptions written per person.
Overall, there were 1,511,534 EpiPen prescriptions filled during 2004. These prescriptions accounted for 2,495,188 EpiPens. On average, there were 5.71 EpiPens prescribed per 1000 persons. Massachusetts had the highest number of prescriptions per 1000 persons (11.8), whereas Hawaii had the lowest (2.7). In addition to state-to-state variation, there was an obvious regional difference: New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine) had the highest values, with 8 to 12 EpiPen prescriptions per 1000 persons, whereas the southern states (between and including California and Mississippi) had only 3 prescriptions per 1000 persons. The New England finding persisted even when controlling for all available factors (eg, population demographic characteristics, number of health care providers, prescriptions for other medications).
A strong north-south gradient was observed for the prescription of EpiPens in the United States, with the highest rates found in New England.
The regional differences in EpiPen prescribing may provide important etiologic clues (vitamin D status) and merit further investigation.
The epidemiology of anaphylaxis in the general population is uncertain. A review article by Neugut et al
Neugut A.I.
Ghatak A.T.
Miller R.L.
Anaphylaxis in the United States: an investigation into its epidemiology.
Arch Intern Med. 2001; 161: 15-21
estimated the US prevalence of anaphylaxis to be anywhere between 1% and 15%. By contrast, a population-based study in Olmsted County, Minn, concluded that the prevalence of anaphylaxis was less than 1%.
Yocum M.W.
Butterfield J.H.
Klein J.S.
Volcheck G.W.
Schroeder D.R.
Silverstein M.D.
Epidemiology of anaphylaxis in Olmsted County: a population-based study.
More recent studies from the United States, Canada, and the United Kingdom yield prevalence estimates ranging from 0.3% to 0.95%.
Bohlke K.
Davis R.L.
DeStefano F.
Marcy S.M.
Braun M.M.
Thompson R.S.
Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization.
Simons F.E.
Peterson S.
Black C.D.
Epinephrine dispensing patterns for an out-of-hospital population: a novel approach to studying the epidemiology of anaphylaxis.
Peng M.M.
Jick H.
A population-based study of the incidence, cause, and severity of anaphylaxis in the United Kingdom.
Arch Int Med. 2004; 164: 317-319
Gupta R.
Sheikh A.
Strachan D.P.
Anderson H.R.
Burden of allergic disease in the UK: secondary analyses of national databases.
The study yielding the highest prevalence estimate (0.95%) was by Simons et al
and used a novel approach to estimating the burden of anaphylaxis: evaluating medication-dispensing data for epinephrine for out-of-hospital treatment during a 5-year period in Manitoba, Canada. A recent expert roundtable concluded that this approach may provide one of the best insights into the actual frequency of anaphylaxis.
Lieberman P.
Camargo Jr., C.A.
Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology (ACAAI) Epidemiology of Anaphylaxis Working Group.
Ann Allergy Asthma Immunol. 2006; 97: 596-602
This approach also permits investigation of the geographic distribution of anaphylaxis, which is unknown. Our objective was to describe the geographic distribution of anaphylaxis in the United States and to explore potential mediators of any observed geographic differences. To do this, we examined state-specific EpiPen (Dey, Napa, Calif) prescriptions in 2004. Although our analysis was largely exploratory, we hypothesized—on the basis of the vitamin D–asthma hypothesis
Rifas-Shiman S.L.
Litonjua A.A.
Rich-Edwards J.W.
Weiss S.T.
Gold D.R.
Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age.
Am J Clin Nutr. 2007; 85: 788-795
—that northern states with less year-round sunlight (eg, New England) would have higher EpiPen prescriptions than southern states.
US regions and divisions were defined based on the US Census Bureau classifications.
US Census Bureau web site. Available at: http://www.census.gov/population/www/index.html. Accessed August 1, 2006.
The 9 divisions of the United States were New England (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island), Middle Atlantic (New York, Pennsylvania, New Jersey), South Atlantic (Delaware, Washington, DC, Maryland, West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida), East North Central (Michigan, Wisconsin, Illinois, Indiana, Ohio), East South Central (Kentucky, Tennessee, Alabama, Mississippi), West North Central (North Dakota, Minnesota, South Dakota, Nebraska, Iowa, Kansas, Missouri), West South Central (Oklahoma, Arkansas, Texas, Louisiana), Mountain (Montana, Idaho, Wyoming, Nevada, Utah, Colorado, Arizona, New Mexico), and Pacific (Washington, Oregon, California, Alaska, Hawaii). The 4 US regions were Northeast (New England and Middle Atlantic), Midwest (East North Central and West North Central), South (South Atlantic, East South Central, and West South Central), and West (Mountain and Pacific). Finally, region was divided into 2 groups—New England versus other US regions—to evaluate further the most clear-cut geographic difference in EpiPen prescribing.
EpiPen prescriptions and other medication prescriptions during 2004, for all 50 US states and District of Columbia, were obtained from NDCHealth, Pharmaceutical Audit Suite (Alpharetta, Ga). In 2004, there were no competitive self-injectable epinephrine products in the US marketplace. Data were obtained on the number of total filled prescriptions (including refills) and the actual number of EpiPens dispensed for EpiPen 0.3 mg, EpiPen Jr, and total EpiPens (0.3 mg and Jr combined). Additional data obtained from NDCHealth were the number of allergist, pediatrician, adult primary care (ie, adult generalist, family physician), and emergency physician prescription writers per state, and filled prescriptions for a few other medications (eg, inhaled corticosteroids, atorvastatin). Data on demographic factors (eg, age, race/ethnicity, income) and state population were downloaded from the US Census.
Data on other health characteristics were obtained from state-specific estimates provided by the 2004 Behavioral Risk Factor Surveillance System website.
Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS) web site. Available at: http://www.cdc.gov/asthma/brfss/default.htm. Accessed June 1, 2006.
Health characteristics data included health insurance status, history of asthma, history of diabetes, self-reported general health status, smoking history, alcohol consumption, and flu and pneumonia vaccinations for individuals age 65 years and older. State-level data on average annual temperature, average annual precipitation, average January normal temperature, and average July normal temperature were obtained from the National Oceanic and Atmospheric Administration for 1971 to 2000.
National Oceanic and Atmospheric Adminstration (NOAA) web site. Available at: http://www.noaa.gov/. Accessed June 1, 2006.
Estimated 2004 melanoma incidence, an admittedly crude surrogate for sun exposure,
Ivry G.B.
Ogle C.A.
Shim E.K.
Role of sun exposure in melanoma.
Dermatol Surg. 2006; 32: 481-492
Oliveria S.A.
Saraiya M.
Geller A.C.
Heneghan M.K.
Jorgensen C.
Sun exposure and risk of melanoma.
Arch Dis Child. 2006; 91: 131-138
was obtained from the American Cancer Society.
Jemal A.
Tiwari R.C.
Murray T.
Ghafoor A.
Samuels A.
Ward E.
Cancer statistics, 2004.
CA Cancer J Clin. 2004; 54: 8-29
All analyses were performed using STATA 9.0 (StataCorp, College Station, Tex). State population was used to calculate the number of prescriptions filled per person. All rates are presented per 1000 state population. Means are presented with SDs and medians with interquartile ranges. The association between factors of interest and region (ie, New England vs other US regions) was evaluated using the Student t test and Kruskal-Wallis test, as appropriate. Multivariate linear regression was used to evaluate the association between state factors and EpiPen prescriptions. All β coefficients are presented with 95% CIs.
In 2004, including refills, there were a total of 1,511,534 EpiPen 0.3 mg and EpiPen Jr prescriptions filled, with EpiPen 0.3 mg accounting for 78% (1,178,229) of prescriptions and EpiPen Jr 22% (333,305). These 1.5 million EpiPen prescriptions led to dispensing of 2,495,188 EpiPens or an average of 1.6 EpiPens per prescription. There were an average of 1.6 EpiPen 0.3 mg devices per prescription and an average of 1.9 EpiPen Jr devices per prescription.
We found considerable state-to-state variation when looking at the absolute number of EpiPens prescribed, from a high of 125,540 in New York to a low of 2369 in Wyoming. When adjusting for population differences, by looking at the prescription rates per 1000 state population, there were an average of 5.71 EpiPens prescribed per 1000 persons. As shown in Fig 1, state-to-state variation persisted, with the highest rates seen in Massachusetts (11.8) and the lowest rates seen in Hawaii (2.7).
Fig 1Number of EpiPen prescriptions per 1000 persons by state, ranging from 2.7 (Hawaii) to 11.8 (Massachusetts).
Download (PPT)
In addition to state-to-state variation, we observed a striking regional difference (Fig 2). The Northeast had the most EpiPen prescriptions, with 8 to 12 prescriptions per 1000 persons, and the Southern states had ¼ the prescriptions at 2 to 3 prescriptions per 1000 persons. When separating EpiPen 0.3 mg and EpiPen Jr, we found that these regional trends were similar with both sizes of EpiPen (data not shown). In an unadjusted linear regression model, all other US regions had significantly fewer EpiPen prescriptions than New England (reference group): Mid Atlantic (β, –3.64; 95% CI, –5.46 to –1.84), East North Central (β, –4.96; 95% CI, –6.50 to –3.41), West North Central (β, –5.84; 95% CI, –7.27 to –4.42), South Atlantic (β, –4.29; 95% CI, –5.64 to –2.94), East South Central (β, –5.60; 95% CI, –7.25 to –3.95), West South Central (β, –6.82; 95% CI, –8.47 to –5.17), Mountain (β, –6.35; 95% CI, –7.73 to –4.97), and Pacific (β, –5.40; 95% CI, –6.95 to –3.85).
Fig 2Regional differences in EpiPen prescriptions per 1000 persons.
Table I shows population demographic and health characteristics in the New England region compared with those in all other US regions combined. The state populations in the New England region had a higher median age, median household income, and percentage of people reporting health insurance. The number of allergists and emergency physicians was similar, but New England also had more pediatricians and adult primary care providers (per 1000 population). New England also prescribed more inhaled corticosteroids and atorvastatin per 1000 population; other studied medications did not significantly differ.
Table IState characteristics in New England region versus other US regions
Data presented as means ± SDs, or medians with interquartile ranges.
New England region
Other US regions
Median age in state (y) 39 ± 1 36 ± 2 .002
Percent female in state 51 ± 0.4 51 ± 0.8 .07
Percent white in state 92 ± 5 80 ± 14 .05
Median household income (US $) 62,696 ± 8576 52,500 ± 7688 .004
Percent high school graduates 84 ± 3 82 ± 4 .14
Percent any type of health insurance coverage 89 ± 2 84 ± 4 .01
No. of healthcare providers (per 1000 population)
Allergists 0.01 (0.01-0.02) 0.01 (0.01-0.02) .95
Pediatricians 0.32 (0.26-0.36) 0.22 (0.17-0.26) .006
Adult primary care providers 1.31 (1.14-1.47) 1.02 (0.90-1.12) .002
Emergency physicians 0.17 (0.14-0.22) 0.14 (0.13-0.17) .08
No. of allergy/asthma medications (per 1000 population)
Albuterol 31.2 (23.9-34.6) 36.2 (28.3-40.8) .13
Inhaled corticosteroids 62.3 (56.5-62.4) 37.1 (30.7-41.5) <.001
Montelukast 70.3 (62.1-83.2) 79.3 (62.3-86.5) .77
Pimecrolimus cream 11.2 (8.2-15.7) 12.4 (10.0-16.4) .38
No. of other medications (per 1000 population)
Atorvastatin 349.4 (303.9-453.8) 226.5 (185.0-262.6) .001
Oral hypoglycemic agents
Includes sulfonylureas, meglitinides, amino acid derivatives, biguanides, insulin sensitizers, α-glucosidase inhibitors, noninsulin combinations, and noninsulin others.
319.7 (307.2-358.3) 337.3 (280.0-391.1) .60
Includes Universal System of Classification codes 41000 (Diuretics, Ethical) and 31000 (Vascular Agents).
1957.4 (1905.7-2072.9) 1978.5 (1577.0-2346.6) .88
Average temperature (°F) 46 (43-49) 53 (48-59) .06
Average precipitation (in) 46 (43-48) 39 (23-46) .10
Melanoma incidence 280 (280-700) 910 (420-1390) .14
∗ Data presented as means ± SDs, or medians with interquartile ranges.
† Includes sulfonylureas, meglitinides, amino acid derivatives, biguanides, insulin sensitizers, α-glucosidase inhibitors, noninsulin combinations, and noninsulin others.
‡ Includes Universal System of Classification codes 41000 (Diuretics, Ethical) and 31000 (Vascular Agents).
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In univariate analyses, several state-level factors were associated with the number of EpiPen prescriptions per state (Table II). Number of EpiPen prescriptions was positively associated with percentage of the state population that was female but did not differ by other sociodemographic factors. Strong associations were seen for number of healthcare providers (especially allergists), and with medication prescriptions of all types. Average temperature and average precipitation were not significantly associated with number of EpiPen prescriptions. Melanoma incidence had a significant inverse association with EpiPen prescriptions.
Table IIUnivariate predictors of number of EpiPen prescriptions per state
95% CI
Median age (per ↑1 y) −95 −3826, 3637 .96
Percent female in state (per ↑1%) 1.26 0.48, 2.05 .002
Percent white in state (per ↑1%) −106 −699, 486 .72
Median household income (per ↑$10,000) 9005 −407, 18418 .06
Percent high school graduates (per ↑1%) −1314 −3152, 523 .16
Percent any type of health insurance coverage 191 −1865, 2249 .85
Healthcare providers (per ↑1 provider)
Allergists 233 202, 265 <.001
Pediatricians 15 13, 17 <.001
Adult primary care providers 4.0 3.7, 4.6 <.001
Emergency physicians 30 25, 35 <.001
Allergy/asthma medications (per ↑1 prescription)
Albuterol 0.10 0.09, 0.12 <.001
Inhaled corticosteroids 0.12 0.10, 0.13 <.001
Montelukast 0.06 0.05, 0.07 <.001
Pimecrolimus cream 0.29 0.24, 0.33 <.001
Other medications (per ↑1 prescription)
Atorvastatin 0.019 0.017, 0.021 <.001
0.012 0.011, 0.014 <.001
Includes USC codes 41000 (Diuretics, Ethical) and 31000 (Vascular Agents).
Average temperature (per ↑1°F) 472 −468, 1412 .32
Average precipitation (per ↑1 inch) 371 −186, 928 .19
Melanoma incidence 24 20, 27 <.001
∗ Includes sulfonylureas, meglitinides, amino acid derivatives, biguanides, insulin sensitizers, α-glucosidase inhibitors, noninsulin combinations, and noninsulin others.
† Includes USC codes 41000 (Diuretics, Ethical) and 31000 (Vascular Agents).
Other factors describing the general health of the state population also were evaluated, including history of asthma, history of diabetes, self-reported general health status, cigarette smoking, alcohol consumption, and flu and pneumonia vaccinations for individuals age 65 years and older. We also examined confidential data on Dey marketing efforts in the different states. However, none of these factors were significantly associated with the number of EpiPen prescriptions filled (data not shown).
To identify population characteristics that might mediate the marked regional differences, we evaluated the rate of EpiPen prescriptions in the New England (highest prescription rates) compared with all other regions while controlling for all available factors (Table III). Controlling for these factors attenuated the higher rate of EpiPen prescriptions in the New England region, but the finding remained statistically significant (P < .001).
Table IIIMultivariate model of regional EpiPen prescriptions (per 1000 state population), comparing New England region vs other US regions
Unadjusted 5.39 4.11-6.67 <.001
Model 1 controls for 6 factors: median age, percent female, percent white, median household income, percent high school graduates, and percent with health insurance.
4.07 2.77-5.36 <.001
Model 2 controls for above, plus 4 factors: number of allergists, pediatricians, adult primary care providers, and emergency physicians.
Model 3 controls for above, plus 7 factors: number of prescriptions for albuterol, inhaled corticosteroids, montelukast, pimecrolimus cream, atorvastatin, oral hypoglycemic agents, and hypertension medications.
Model 4 controls for above, plus melanoma incidence.
∗ Model 1 controls for 6 factors: median age, percent female, percent white, median household income, percent high school graduates, and percent with health insurance.
† Model 2 controls for above, plus 4 factors: number of allergists, pediatricians, adult primary care providers, and emergency physicians.
‡ Model 3 controls for above, plus 7 factors: number of prescriptions for albuterol, inhaled corticosteroids, montelukast, pimecrolimus cream, atorvastatin, oral hypoglycemic agents, and hypertension medications.
§ Model 4 controls for above, plus melanoma incidence.
To address uncertainty about the geographic distribution of anaphylaxis and overcome sparse and often problematic data on healthcare utilization for this condition,
we examined EpiPen prescription rates across the United States. We found a strong north-south gradient, with the highest rates of EpiPen prescriptions in New England. Population-adjusted rates (ie, number of EpiPen prescriptions filled per 1000 people) were positively associated with several different factors, including percentage of the population that was female, the number of healthcare providers (especially allergists) per 1000 people, and the frequency of medication prescribing in general. Nevertheless, a multivariate analysis controlling for all of these factors suggested that these factors did not mediate the observed north-south gradient.
Ecologic studies are, by their very nature, exploratory, but they can yield important etiologic clues about disease. For example, it has been known for decades that the incidence of multiple sclerosis varies by latitude.
Hernan M.A.
Olek M.J.
Ascherio A.
Geographic variation of MS incidence in two prospective studies of US women.
Neurology. 1999; 53: 1711-1718
This geographic pattern may be explained by differences in vitamin D status, with higher incidence of multiple sclerosis at higher latitudes where vitamin D insufficiency is more common.
Brown S.J.
The role of vitamin D in multiple sclerosis.
Ann Pharmacother. 2006; 40: 1158-1161
Vitamin D3 (cholecalciferol) is a vital nutrient available from dietary sources (eg, fortified milk, nutritional supplements), but most is made in the skin after direct exposure to sunlight.
Feldman D.
Pike J.W.
Glorieux F.H.
Vitamin D.
2nd ed. Elsevier Academic Press, Amsterdam2005
It has become clear, especially in the northeastern United States,
Webb A.R.
Kline L.
Holick M.F.
Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin.
J Clin Endocrinol Metab. 1988; 67: 373-378
Thomas M.K.
Lloyd-Jones D.M.
Thadhani R.I.
Shaw A.C.
Deraska D.J.
Kitch B.T.
Hypovitaminosis D in medical inpatients.
N Engl J Med. 1998; 338: 777-783
that a large proportion of Americans have inadequate vitamin D intake, as reflected by serum 25(OH)D levels.
Hollis B.W.
Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D.
J Nutr. 2005; 135: 317-322
On the basis of these data, and emerging evidence of an inverse association between vitamin D status and risk of childhood wheezing,
we hypothesized a priori that we would find a north-south gradient in anaphylaxis, as reflected by regional differences in filled EpiPen prescriptions. Indeed, residence in the northeastern United States was the strongest independent predictor of EpiPen prescriptions per 1000 persons.
Although measurement of serum 25(OH)D levels is the best available approach to determine vitamin D status,
average state-specific or region-specific values are not available. Indeed, the measurement of sun exposure itself has proven quite challenging. Epidemiologists who study the relation of sun exposure with skin cancer continue to debate the advantages and disadvantages of self-reported information on regular versus intermittent sun exposure, frequency of sun burns, regularity of sunscreen use, and more.
For lack of any better available alternative, we used melanoma incidence rates as an admittedly crude surrogate measure of sun exposure and the resulting vitamin D levels. Sun exposure generally has a positive association with melanoma risk, but there is some evidence that chronic (regular) sun exposure may actually reduce risk of melanoma.
Thus, we recognize the probable limitations of our exploratory analysis. Regardless, we found that melanoma incidence rates had a significant inverse association with EpiPen prescriptions, but that adjustment for melanoma incidence did not eliminate the observed north-south gradient. Other meteorology variables, such as average temperature and precipitation, were not associated with the number of EpiPen prescriptions, but these variables are even more indirect measures of sunlight exposure, let alone vitamin D status.
Laboratory research suggests several potential mechanisms for how vitamin D could affect risk of allergic reactions and anaphylaxis. For example, vitamin D modulates antigen-presenting cells such as macrophages,
Griffin M.D.
Xing N.
Kumar R.
Vitamin D and its analogs as regulators of immune activation and antigen presentation.
Annu Rev Nutr. 2003; 23: 117-145
Lin R.
White J.H.
The pleiotropic actions of vitamin D.
Bioessays. 2004; 26: 21-28
as well as the generation of regulatory T cells
Gregori S.
Giarratana N.
Smiroldo S.
Uskokovic M.
Adorini L.
A 1alpha,25-dihydroxyvitamin D(3) analog enhances regulatory T-cells and arrests autoimmune diabetes in NOD mice.
Diabetes. 2002; 51: 1367-1374
Meehan M.A.
Kerman R.H.
Lemire J.M.
1,25-Dihydroxyvitamin D3 enhances the generation of nonspecific suppressor cells while inhibiting the induction of cytotoxic cells in a human MLR.
Cell Immunol. 1992; 140: 400-409
that express potentially inhibitory cytokines (IL-10 and TGF-β), and the ability to inhibit antigen-specific T-cell activation potently.
Schwartz R.H.
Natural regulatory T cells and self-tolerance.
Nat Immunol. 2005; 6: 327-330
Although many laboratory studies suggest that vitamin D induces a shift in the balance between TH1 and TH2-type cytokines toward TH2 dominance,
Cantorna M.T.
Zhu Y.
Froicu M.
Wittke A.
Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system.
Am J Clin Nutr. 2004; 80: 1717S-1720S
Pichler et al
Pichler J.
Gerstmayr M.
Szepfalusi Z.
Urbanek R.
Peterlik M.
Willheim M.
1 Alpha,25(OH)2D3 inhibits not only Th1 but also Th2 differentiation in human cord blood T cells.
Pediatr Res. 2002; 52: 12-18
found that in CD4+ as well as CD8+ human cord blood cells, vitamin D not only inhibits IL-12–generated IFN-γ production but also suppresses IL-4 and IL-4–induced expression of IL-13. Thus, the differences between the studies on the TH1-TH2 dominance may lie in the timing of exposure of the cells to vitamin D (ie, prenatal versus postnatal); the response of naive T cells to vitamin D exposure may differ from that of mature cells when exposed to vitamin D.
Annesi-Maesano I.
Perinatal events, vitamin D, and the development of allergy.
Pediatr Res. 2002; 52: 3-5
Another possibility is that the association differs by dose. In other words, nonpharmacologic doses of vitamin D (eg, as obtained from sunlight exposure) may have different consequences than high-dose oral supplementation, where an excess of vitamin D may indeed have opposite effects. These hypotheses merit further investigation.
Our exploratory study has several potential limitations. First, we assume that EpiPen prescriptions accurately reflect the underlying prevalence of anaphylaxis (ie, that geographic locations with higher EpiPen prescriptions have more anaphylaxis). Although the exact nature of the association between EpiPen prescriptions and actual anaphylaxis prevalence is not clear, this approach may be preferable to other more problematic sources of anaphylaxis data.
Accordingly, research on EpiPen prescriptions has been promoted by leading authorities in anaphylaxis epidemiology.
Second, we recognize that there are apparent inconsistencies in the north-south gradient (eg, Why doesn't Alaska have the highest rate?) and there is a suggestion of an east-west gradient across the United States. These inconsistencies are not surprising in an ecologic analysis of US states and, in this case, may reflect differences in dispensing of epinephrine ampules and/or epinephrine-containing inhalers, practice variation without medical explanation, or myriad other factors. Future studies will need to explore these possibilities in more detail. Third, our study may suffer from the ecologic fallacy, in which individual exposures are not linked with individual outcomes and, therefore, one cannot be certain of the actual associations in individual patients. In our study, we can be confident about the observed regional differences in EpiPen prescriptions but are less confident that the multivariate analysis adequately controlled for the potential confounding factors (eg, socioeconomic factors). For this reason, we encourage additional research to confirm the observed north-south gradient and to uncover the factors that best explain it.
We observed a surprisingly strong north-south gradient for the prescription of EpiPens in the United States. The southwestern United States (and Hawaii), with its warmer climate and more year-round sunlight, had the least EpiPen prescriptions per 1000 persons, whereas those in the northern United States (especially New England) had the highest rates. The regional differences may result from several different associations, but we were not able to eliminate the finding by adjusting for regional differences in many sociodemographic and healthcare delivery factors. We suggest that these data provide additional support for the hypothesized link between low vitamin D levels and respiratory/allergic disorders.
Given the paucity of data on anaphylaxis risk factors
and ongoing concerns about magnitude of this allergic problem,
Anaphylaxis, killer allergy: long-term management in the community.
we believe this novel hypothesis merits further study.
Published online: June 13, 2007
Accepted: March 26, 2007
Received in revised form: March 26, 2007
Received: September 5, 2006
Boston, Mass, Los Angeles, Calif, Memphis, Tenn, and Baltimore, Md
The NDCHealth prescription data were purchased by Dey (Napa, Calif).
Disclosure of potential conflict of interest: C. A. Camargo, Jr, has consulting arrangements with Dey and has received grant support from Dey and Verus. M. S. Kaplan has consulting arrangements with Dey and the EpiPen Advisory Committee and has received grant support from Genentech and the Childhood Asthma Research and Education Network. P. Lieberman has consulting arrangements with Dey and Verus; is on the speakers' bureau for Dey, Verus, Sanofi-Aventis, Genentech, Medpointe, and GlaxoSmithKline; and has served as an expert witness for Medpointe. R. A. Wood has consulting arrangements with Dey and has received grant support from Merck and Genentech. The rest of the authors have declared that they have no conflict of interest.


text:
Successful Test Demonstrates Aerojet Rocketdyne Arkansas Site Ready to Produce Large Solid Rocket Motors
CAMDEN, Ark., Sept. 22, 2021 (GLOBE NEWSWIRE) -- Aerojet Rocketdyne recently conducted a solid rocket motor test firing that demonstrated the successful transition of large solid rocket motor mix, cast and test operations from Sacramento, California, to its Camden, Arkansas, site.
"Aerojet Rocketdyne continues to advance its decades of work delivering large solid rocket motors, leveraging new facilities and innovative technology and materials," said Eileen P. Drake, Aerojet Rocketdyne CEO and president. "Our Camden site is now proven ready to support the nation's defense requirements for large solid rocket motors."
The motor was cast at Camden's Engineering, Manufacturing and Development facility, which was officially opened last October. Aerojet Rocketdyne has been steadily building its capabilities and team at its Camden site, growing its workforce by more than 70% over the past five years.
Measuring 52 inches in diameter and weighing roughly 7,800 pounds, the eSR-73 is designed as an upper stage that can function as a second or third stage for a variety of large solid rocket motor applications. Aerojet Rocketdyne has produced large solid rocket motors for critical defense and space programs for decades.
The test firing of the eSR-73 demonstration motor builds upon work performed by Aerojet Rocketdyne for the U.S. Air Force Research Laboratory on the Missile Components Advanced Technologies Demonstration Motor (MCAT Demo) program. The MCAT Demo motor was successfully test-fired last year at the Utah Test and Training Range.
Both tests demonstrated state-of-the-art graphite composite cases, affordable advanced nozzles and high-energy, long-life solid propellant. The eSR-73 is a step closer to production readiness and served as a pathfinder for producing and handling large solid rocket motors at Aerojet Rocketdyne's Camden site.
View a video of the test at rocket.com/esr73.
About Aerojet Rocketdyne:
Aerojet Rocketdyne, a subsidiary of Aerojet Rocketdyne Holdings, Inc. (NYSE:AJRD), is a world-recognized aerospace and defense leader that provides propulsion systems and energetics to the space, missile defense and strategic systems, and tactical systems areas, in support of domestic and international customers. For more information, visit www.Rocket.com and www.AerojetRocketdyne.com. Follow Aerojet Rocketdyne and CEO Eileen Drake on Twitter at @AerojetRdyne and @DrakeEileen.
Aerojet Rocketdyne's successful test of the eSR-73 advanced large solid rocket motor


text:
Q: Type inference for lazy variable I have a lazy variable declared as follows:
private lazy var cachedTonesByChord: [Note: [Note]] = self.tonesByChord()

... where self.tonesByChord() has following signature:
() -> [Note: [Note]]

Now, when I remove the type:
private lazy var cachedTonesByChord = self.tonesByChord()

... compiler complains:

Use of unresolved identifier 'self'

Why can't the compiler infer the type automatically?

A: From The Swift Programming Language:

If a stored property's default value requires some customization or setup, you can use a closure or global function to provide a customized default value for that property. Whenever a new instance of the type that the property belongs to is initialized, the closure or function is called, and its return value is assigned as the property's default value.

Instead of a global function you want to use an instance method to set the value of the property but this isn't possible, because

If you use a closure to initialize a property, remember that the rest of the instance has not yet been initialized at the point that the closure is executed. This means that you cannot access any other property values from within your closure, even if those properties have default values. You also cannot use the implicit self property, or call any of the instance's methods.

So, the problem here is that you are calling a method on self.
Update
On a second thought this seems strange, because you have declared a lazy property, which will be created when your instance already exists.

A: Because your subclass may implement tonesByChord() with different return type.
For example:
class Chord {
    private lazy var cachedTonesByChord = self.tonesByChord()

    func tonesByChord() -> [Note:[Note]] {
        return [Note("C") : [Note("C"), Note("E")]]
    }
}
class ChordSub:Chord {
    func tonesByChord() -> [Note] {
        return [Note("A"), Note("B")]
    }
}

If the class is ChordSub, the Compiler cannot determine which tonesByChord() should be called without explicit type requirement.

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There's an old saying in real estate that there are really only three things that matter when it comes to a property: location, location, location.
Well, at the very least, it's fairly important. Whether it be a fine-dining experience, a local pub, or a school, finding comfort where you are matters. Atmosphere is crucial.
The Wolcott, Connecticut, native played just a single game for the Pensacola Ice Flyers of the Southern Professional Hockey League and was kept off the scoresheet before being released. Maybe it was for the best; after signing, DiNicola joked that it would take some adjusting to playing in Florida, since he's not a huge fan of warm weather.
It didn't take long for DiNicola to find a new team a little further north, with the SPHL's Knoxville Ice Bears picking him up last week.
And it hasn't taken long for the player who was 17th all-time in points (134) at Fitchburg State to start making contributions. In a pair of games for Knoxville over the weekend, DiNicola has already notched a goal and an assist.
Both points came in a 4-1 victory over the Hunstville Havoc, with DiNicola providing the assist on a first-period goal before potting his first pro goal in the second period, with a little help from an old friend. Former FSU teammate Ricky Kramer -- playing in his seventh game with Knoxville -- fed DiNicola on the marker.
Here's a quick update on Cushing Academy alumnus Wabissa Bede and the Virginia Tech basketball team: The Hokies are headed to the Sweet 16.
Virginia Tech notched wins over St. Louis and Liberty in the East Regional and will now face ACC foe Duke -- the region's top seed -- Friday night in Washington, D.C.


text:
Meet the locals starring in film about summer in Weston-super-Mare
It's not just the tourists that enjoy spending time in North Somerset
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People living in Weston-super-Mare have become the stars of the screen in a new film showcasing summer fun across the town.
Once Upon a Summer has been shot by local film maker Sally Low and follows a group of individuals enjoying a range of activities across the town from roller skating on Weston-super-Mare prom to open water swimming from the town's beach.
It also features people enjoying yoga in Weston's parks as well as pet owners taking their hounds for a walk on the beach.
Other locals appear cycling and long boarding along the seafront.
A casting call went out earlier this year asking for local people to appear in the film, with more than 80 people coming forward.
The film has been produced as part of the council's summer marketing campaign as the district enjoys a rise in people enjoying staycations as a result of the pandemic.
An open water swimmer appears in the new Weston Super Summer film (Image: North Somerset Council)
The film builds on the success of the 'SuperWeston' spring marketing campaign about the re-opening of Weston High Street following the coronavirus pandemic.
The film focused on 19 different businesses in the town centre as they prepared to emerge from lockdown and welcome back customers.
The SuperWeston campaign is part of North Somerset Council's place-making strategy, which has produced a blueprint on how the town will develop and evolve over the next decade.
A series of improvements are planned including enhancements to the seafront and the creation of new walking and cycling routes.
The new film will run across the SuperWeston social media and digital platforms, and will promote activities in the town to support physical and mental well-being.
A youngster cartwheels along Weston-super-Mare prom (Image: North Somerset Council)
North Somerset Council executive member for placemaking and economy Councillor Mark Canniford said: "A great deal of work has gone in to making this film and the result is breathtaking.
"This is part of a series of films that are to be produced as part of Weston's Placemaking strategy, used to promote the town to investors, residents, and businesses.
"Thank you to everyone that volunteered to be part of the campaign and played their part in making such a stunning film."
Sewer leaks onto Weston-super-Mare beach
Where you can get a covid 19 jab in Weston-super-Mare this week


text:
Измерительный пункт 1 (также ИП-1, НИП-1, 44-я отдельная испытательная станция измерительных средств, в/ч 13951) — измерительный пункт в рамках космодрома Байконур, основанный в 1956 году.

История

Строительство ИП-1 завершилось в ноябре 1956 года. Пункт представлял из себя три отдельные площадки, которые располагались по гребню господствующей над местностью высоты Килиншек в перпендикулярную трасе полета линию.

Первой от монтажно-испытательного корпуса площадкой была подвижная фазометрическая радиоугломерная станция «Иртыш», второй — площадка радиопередающих и оптических внешнетраекторных средств, а также системы единого времени и связи. На третьей телеметрической площадке располагался двухквартирный сборно-щитовой финский домик, рядом располагалась грунтовая линейка для шести-восьми подвижных станций «Трал» (с таким же количеством вспомогательных машин сзади линейки) и для 4-6 подвижных станций РТС-5 с двумя-тремя вспомогательными машинами. В пятидесяти метрах сзади от них располагалась грунтовая линейка для бензоэлектрических агрегатов 8Н01 на двухколесных прицепах (по числу машин).

1 декабря 1956 года ИП был готов к работе. В полной готовности находилась аппаратура СЕВ «Бамбук», фазометрическая радиоугломерная станция «Иртыш», два радиодальномера «Бинокль», кинотеодолитная система КТh-41, кинотелескоп КТ-50, 8 радиотелеметрических станций измерения медленноменяющихся параметров «Трал», 6 радиотелеметрических станций быстроменяющихся параметров РТС-5.

В августе 1957 г. на территории ИП-1 был развернут НИП-1 (в/ч 13961) КИК, но после работ по ИСЗ-3 (1958 год) он был расформирован, а его функции, часть техники и персонала передали ИП-1, который в структуре КИК стал именоваться НИП-1 (Тюра-Там). ИП-1 состоял из управления части, двух команд и группы транспортных средств.

4 октября 1957 года — обеспечение запуска первого искусственного спутника Земли (Спутник-1).

5 декабря 1957 года был проведен первый самолетный облет с бортовыми устройствами измерительных средств, проверка работы станции и расчетов ИП-1.

12 апреля 1961 года успешно обеспечен полет Юрия Гагарина в космос.
Аппаратурный состав ИП-1 свидетельствует о том, что он являлся центральным и многофункциональным ИПом измерительного комплекса космодрома Байконур НИИП-5.

ИП-1 — самый многочисленный в составе ПИК. К 1973 г. в его штате насчитывалось 130 офицеров.

Обеспечивал совместные полеты Союз-Аполлон, запуск Бурана и Протона.
1 сентября 2006 года — в соответствии с Приказом Министра Обороны РФ и главы Росавиакосмоса о передаче объектов космодрома Байконур в ведение предприятий Росавиакосмоса закончена передача объектов измерительного пункта гражданским специалистам.

Руководители
 Колеганов Г. М. (1955—1962);
 Ступаков И. И. (1962—1964);
 Сергеев А. С. (1964—1976);
 Гришко И. Н. (1976—1978);
 Евстигнеев И. А. (1978—1985);
 Дмитриенко Г. Д. (1985—1989);
 Агренин И. М. (1989—1990);
 Липкан Е. П. (1990—1992);
 Антропов О. В. (1992—1995);
 Воблый В. А. (1995—1999);
 Кудряшов В. В. (1999—2007).

См. также
 Научно-измерительный пункт

Примечания

Космонавтика СССР
История космонавтики
Байконур

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