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package org.wildfly.elytron.web.undertow.server;

import static org.wildfly.common.Assert.checkNotNullParam;

import java.util.List;
import java.util.function.BiFunction;
import java.util.function.Function;
import java.util.function.Supplier;

import org.wildfly.security.auth.server.SecurityDomain;
import org.wildfly.security.cache.IdentityCache;
import org.wildfly.security.http.HttpExchangeSpi;
import org.wildfly.security.http.HttpServerAuthenticationMechanism;

import io.undertow.security.api.AuthenticationMode;
import io.undertow.security.api.SecurityContext;
import io.undertow.security.handlers.AbstractSecurityContextAssociationHandler;
import io.undertow.server.HttpHandler;
import io.undertow.server.HttpServerExchange;

/**
 *
 *
 * @author Darran Lofthouse
 */
public class ElytronContextAssociationHandler extends AbstractSecurityContextAssociationHandler {

    private final String programmaticMechanismName;
    private final SecurityDomain securityDomain;
    private final Supplier<List<HttpServerAuthenticationMechanism>> mechanismSupplier;
    private final Function<HttpServerExchange, ElytronHttpExchange> httpExchangeSupplier;
    private final BiFunction<HttpExchangeSpi, String, IdentityCache> identityCacheSupplier;
    private final AuthenticationMode authenticationMode;

    /**
     * @param next
     */
    protected ElytronContextAssociationHandler(Builder builder) {
        super(checkNotNullParam("next", builder.next));
        this.programmaticMechanismName = builder.programmaticMechanismName != null ? builder.programmaticMechanismName : "Programmatic";
        this.securityDomain = builder.securityDomain;
        this.mechanismSupplier = checkNotNullParam("mechanismSupplier", builder.mechanismSupplier);
        this.httpExchangeSupplier = checkNotNullParam("httpExchangeSupplier", builder.httpExchangeSupplier);
        this.identityCacheSupplier = builder.identityCacheSupplier;
        this.authenticationMode = builder.authenticationMode;
    }

    /**
     * Create a new Elytron backed {@link SecurityContext}.
     */
    @Override
    public SecurityContext createSecurityContext(HttpServerExchange exchange) {
        return populateSecurityContextBuilder(SecurityContextImpl.builder(), exchange)
                .build();
    }

    protected SecurityContextImpl.Builder populateSecurityContextBuilder(SecurityContextImpl.Builder builder, HttpServerExchange exchange) {
        final ElytronHttpExchange httpExchange = this.httpExchangeSupplier.apply(exchange);
        return builder.setExchange(exchange)
                .setProgrammaticMechanismName(programmaticMechanismName)
                .setSecurityDomain(securityDomain)
                .setMechanismSupplier(mechanismSupplier)
                .setAuthMode(authenticationMode)
                .setHttpExchange(httpExchange)
                .setIdentityCacheSupplier( identityCacheSupplier != null ?
                        () -> identityCacheSupplier.apply(httpExchange, programmaticMechanismName) : null);
    }

    public static Builder builder() {
        return new Builder();
    }

    public static class Builder {

        HttpHandler next;
        String programmaticMechanismName;
        SecurityDomain securityDomain;
        Supplier<List<HttpServerAuthenticationMechanism>> mechanismSupplier;
        Function<HttpServerExchange, ElytronHttpExchange> httpExchangeSupplier = ElytronHttpExchange::new;
        BiFunction<HttpExchangeSpi, String, IdentityCache> identityCacheSupplier;
        AuthenticationMode authenticationMode;

        protected Builder() {
        }

        public Builder setNext(HttpHandler next) {
            this.next = next;

            return this;
        }

        @Deprecated
        public Builder setProgramaticMechanismName(final String programmaticMechanismName) {
            return this.setProgrammaticMechanismName(programmaticMechanismName);
        }

        public Builder setProgrammaticMechanismName(final String programmaticMechanismName) {
            this.programmaticMechanismName = programmaticMechanismName;

            return this;
        }

        public Builder setSecurityDomain(final SecurityDomain securityDomain) {
            this.securityDomain = securityDomain;

            return this;
        }

        public Builder setMechanismSupplier(Supplier<List<HttpServerAuthenticationMechanism>> mechanismSupplier) {
            this.mechanismSupplier = mechanismSupplier;

            return this;
        }

        public Builder setHttpExchangeSupplier(Function<HttpServerExchange, ElytronHttpExchange> httpExchangeSupplier) {
            this.httpExchangeSupplier = httpExchangeSupplier;

            return this;
        }

        public Builder setAuthenticationMode(AuthenticationMode authMode) {
            this.authenticationMode = authMode;

            return this;
        }

        public Builder setIdentityCacheSupplier(BiFunction<HttpExchangeSpi, String, IdentityCache> identityCacheSupplier) {
            this.identityCacheSupplier = identityCacheSupplier;

            return this;
        }

        public HttpHandler build() {
            return new ElytronContextAssociationHandler(this);
        }
    }
}

redpajama_set_name: RedPajamaGithub


A doctor has asked that pregnant women should stop asking for Caesarean section if they have no strict reason for it.
A gynaecologist, Dr. Adebayo Bamisebi, on Tuesday advised pregnant women to only have Cesarean Section if there's genuine reason for it.
Bamisebi, of the Department of Obstetrics and Gynaecology, Ibeju-Lekki General Hospital, Akodo, Lagos, who gave the advice in an interview with the News Agency of Nigeria, noted that some women who deliver through C-Section do so on flimsy excuse or based on fashion.
"Earning a Caesarean section is for a special reason. It could be because of a problem with the baby or the mother or even both of them.
"It could also depend on quite a number of reasons, which may be strictly foetal, strictly maternal and strictly foetal-maternal.
"When a C-Section is being carried out, we must be sure that the woman actually merits it, not just through a cooked-up excuse to have it done,'' Bamisebi said.
The gynaecologist said that vaginal delivery that is not complicated is the ideal.
According to him, eight out of every 10 pregnant women should be able to deliver without much problem.
However, he said, 20 per cent, that is, two out of every 10 pregnant women, would likely experience some hitches which might result in other forms of delivery, one of which is a C-section.
The gynaecologist noted that most women who reject vaginal delivery are the young and educated ones who do so out of the fear they got from friends who have had child delivery.
Bamisebi, who said that vaginal delivery could be less discomforting and less painful when the appropriate analgesia is given, urged women not to opt for surgical delivery if there is no strict indication for it.
The medical practitioner said a pregnant woman who has a prolonged labour, or one whose baby is big, can be admitted for Caesarean section, adding that such women could also present improper position of the baby, causing unnecessary delay that could lead to obstruction of labour.
"That kind of delivery should be completed by a Caesarean-section, right in good time, in order to have a healthy baby and mother.
"So, for those who will earn it, it is as safe as anything, particularly when it is done in good time with all the modern safety tools," the physician noted.
He, however, urged fellow physicians not to deny pregnant women whose condition warrants Caesarean section in order to ensure the safety of the mother and the child.


Meaning and definitions of significant, translation in Bengali language for significant with similar and opposite words. Also find spoken pronunciation of significant in Bengali and in English language.
What significant means in Bengali, significant meaning in Bengali, significant definition, examples and pronunciation of significant in Bengali language.


Welcome to the Hope Hamilton Church website which should provide you with a flavour of what we are about and the sorts of things we do.
We are the Anglican Church for the people of Hamilton and we believe that a church is simply a community of people wanting to follow Jesus. This does not mean we are especially holy or 'sorted' yet but believe that the church is the place where, together, we find the depth and richness of life Jesus came to offer.
The bible describes church as a body made up of many different parts and that is certainly true at Hope Hamilton. We are of different ages and backgrounds, some are single and others married, some are parents and others are not, we come from a number of different nationalities and cultures, some have been followers of Jesus for many years, some just exploring faith and some simply seeking a community to belong to.
We believe that any church should be a blessing to its neighbourhood and we try to do this through acts of kindness such as cleaning up the litter and graffiti, providing events for neighbours to meet together and above all praying for Hamilton every day.
You are very welcome to come and be part of this community but if you want to find out a bit more first then give me a call and I would love to meet you.
Hope Hamilton Church is part of the Welcome Boxes project. We aim to help refugees and asylum seekers housed in Hamilton settle and begin to thrive. Trained church Welcome Box volunteers go in pairs to visit a new family or individual with a welcome box. We then link them in to places where they can find community and support, like Hope Cafe and City of Sanctuary.
If you would like to get involved or require more information please contact our Coordinators Richard and Debbie.
of Good Friday and Jesus dying on the cross.
(bring your own or make one at church on the day).
and crafts for the children.
Family service to celebrate Easter!
There will be some baptisms taking place during the service!
If you have a safeguarding concern, then please contact our local Safeguarding Co-ordinator, Tom Grant on 07941 381 340.
If you wish to speak to the Diocesan Safeguarding Team, or to someone outside the church, their contact details can be found here.
Click here for the Hope Hamilton Church Safeguarding Policy.


American artist Grear Patterson is based in the Bronx, New York. We first met at his solo exhibition True Romance at Marlborough Contemporary, which attracted a broad spectrum of creatives and collectors from Mayfair to Hackney. Grear's mixed-media works are known for recurring motifs and exploring pop-culture. Despite features in publications like GQ and Vogue, there is no further evidence of Grear's social media presence or website. Inevitably, my curiosity led me to his Bronx studio, which has since moved further out to Yonkers. Living off the beaten track, Grear has paved the way for artists more concerned by square footage than an enviable address.
Born to a Chilean mother and Canadian father, Grear grew up in a house filled with art in North Carolina before studying at Duke University and the School of Visual Arts in New York. With shows hosted by cutting-edge galleries such as Marlborough Contemporary, Rod Bianco in Oslo and Carl Kostyal in Stockholm, Grear is always on the move. Despite never buying return tickets for his journeys to exhibitions, Grear is also finding time to build a house in the Bahamas. Group shows have included Total Project Space in Athens, Galerie Olivier Robert in Paris and the 9th Shanghai Biennale. Alongside talented friends like artists Nick Fahri, James Franco and Chase Hall, they all seem to share an appreciation for the old school approach of relying on word of mouth for their ideas and work to cross-pollinate.
Grear's personal art collection includes artists such as Edward Weston, Edward Steichen and Dash Snow as well as Joe Bradley and Roe Ethridge. Visual references in Grear's work vary from the culture of the Bronx to 1980/90's films watched as a child, and the fabrics collected in his studio. From parachutes to boat sails, these fabrics could be seen to represent, "youthful possibility, odyssey and adventure" according to Marlborough Contemporary. As Grear drove me to the subway, I reflected upon the artist's playful character, positive energy and inexhaustible imagination. I felt optimistic about exploring the next generation of artists in New York.
I always made stuff and growing up around works my parents had. So being an artist was always on the radar.
I haven't made that work yet and being remembered at all is a luxury.
Even if you're sad, it makes you feel better.
I just like being outside and nature - the grandeur of simple things.
Can you offer some insight into the culture of the Bronx?
I have old family buried in the Bronx, but never lived here prior. I'd say respect is met with respect and family always comes first.
J. M. W. Turner or Caravaggio.
Do you interact with the digital world or technology in your work?
That they can do anything.
Gagosian, where I saw Richard Serra's exhibition as a kid with my dad.
Ed Ruscha, because I once took a picture of him kissing the model Lauren Hutton and he reminded me of a secret agent.
Everyday things and my own mind patterns.
I start working around 9am having woken up around 7am to prepare some stuff I want to make and take it from there. Start and clean really.
Work everyday, stay in touch with loved ones and friends.


Talent packed, loving, fun, and funny are just some of the words we would use to describe the Goodworth family! We had so much fun with this boy-filled family up Logan Canyon on a beautiful fall evening. We have to applaud Allison who so brilliantly pulled together 6 kids (7 if you count her husband, Warren) and made them look soooo good! Can you believe she has had 6 kids! She is just absolutely beautiful, inside and out.
Audrey, the youngest, and the ONLY girl was cute as a button and so sweet! We can't imagine what it would be like to be the only girl with 5 older brothers. We laughed whenever we would have the kids get closer together because they would move a centimeter! Ha! There is such a difference The Goodworths are one of those families we can definitely learn from capturing all girls versus all boys but these boys were so great, kind, and had fun together.
...ONE OF THOSE FAMILIES WE CAN DEFINITELY LEARN FROM.
As we were driving to the Jardine Juniper Trailhead up Logan Canyon for this session, we were talking about the Goodworth family since we knew them from our neighborhood. I said to Alex, "The Goodworths are one of those families we can definitely learn from. They have such great kids and are so fun to be around. They are super adventurous, musically inclined, and athletic, but also just so genuine." I meant every word.
Allison and Warren, thank you for blessing us with this opportunity to capture your family! We had so much fun with you and learning more about all of you! The love you two have for each other is evident in the way you look at and treat each. The two of you also have some mad parenting skills for raising such awesome kids! Goodworth kids, thank you for being so awesome during this session! You made it so easy-going and fun! We hope you cherish these images as much as we do!
Alex & Stacey are a husband and wife photography team based in Cache Valley, UT with a passion for changing lives, promoting healthy, loving marriages and families, and providing extraordinary experiences for their clients with divine images that last forever. Alex & Stacey serve bride and grooms all over Utah and Southern Idaho.


SM POLISH: Light weight, delivers a bright polish finish, excellent wear. Works well in all types of finishing equipment. COLOR: Pink; WEIGHT: 55-60 lbs.
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SY-1 FAST CUT: Light weight, fast cutting media that leaves excellent finish ready for anodizing or painting. This media is very comparable to our X plastic media; COLOR: Tan; WEIGHT: 55-60 lbs.
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23-01-2019 - In celebration of 35 years of pioneering the drum rack, Pearl's ICON Rack systems are being greatly expanded with a new selection of clamps and accessories.
Developed in 1983 with legendary Toto drummer Jeff Porcaro, Pearl's original DR-1 DrumRack was the first free-standing, frame-based drum support system available. Today, in celebration of 35years of pioneering the drum rack, Pearl's ICON (short for Independent CONtrol,) Rack systems are beinggreatly expanded with a new selection of clamps and accessories.All new pre-configured single and three-sided rack packages and individual ICON components have beenupgraded to include a rotating support foot.
In addition, eight new accessory clamps have been developed for the slip-free ICON square rack rail and round support pipe; dramatically increasing the level of set-up flexibility and function variety. To showcase the possibilities of these new additions to the ICON cannon, Pearl will launch an online player resource and idea center of ICON Rack Recipes; featuring step-by-step instructions on how to get the most from existing and available Pearl Rack parts.


In any of the living arrangements listed above, wm+a associates may work with the individual, their family or caregivers, educational staff, and other contributing professional staff in delivering existing individualized programs to help improve daily living skills, social planning, educational goals or other life skills goals. Some individuals will require training, guidance and support with self-care and self-help activities such as bathing, toileting, grooming, and dressing. During social planning activities, the associates support individuals to become active participants in all areas of community life, including social and recreational activities. This focus on planning and effective skill building is essential to building successful relationships and improving quality of life.


text:
Tag Archives: The Kings of Summer
'The Kings of Summer' Director Jordan Vogt-Roberts on Improv, Cinematic Comedy and Wanting to Make a 'Star Wars' Movie Before He Dies
Last weekend I posted a Short Starts column in celebration of the early work of Jordan Vogt-Roberts, a filmmaker who has done a lot of comedy sketches and short films in the past (including the popular award-winning Successful Alcoholics) and now has his debut feature, The Kings of Summer, opening in theaters. One of the pieces that I shared is a video consisting of well-known coming-of-age movie clips with the title "Toy's House Rip-O-Matic Tone Reel" (The Kings of Summer was formerly titled Toy's House), and I explained that I was pretty curious about its purpose in the development of the new film. Vogt-Roberts emailed me in response, and later we had a chat on the phone about that, his other works and a lot more. It was a long phone call. We discussed improv, which is something he's clearly passionate about (see the youth organization Detroit Creativity Project, which he mentions) and the desire for more movies, particularly comedies, to better utilize the visual medium — he's very passionate about this also. And he expressed his interest in directing a Star Wars movie. We also, of course, talked about The Kings of Summer and how it fits in with those topics. Well, maybe not with Star Wars. But I'll say this: he'd probably deliver a decent installment of the franchise, especially one with humor and kids and woodsy locations. Are they looking to redo The Battle for Endor? Just kidding. Seriously, he's one to really watch. And a lot of

redpajama_set_name: RedPajamaCommonCrawl


Power bank:is compatible with major brand phone or pad like Apple, Huawei, Samsung and Xiaomi etc, it's light and portable, and very practical for business trip or travel. The application of smart phone becomes more and more extensive, which derives a lot of mobile phone peripheral gifts, such as mobile phone charger souvenir, advertising mobile phone rope, headphone promotional gifts, etc. It is the best gift for promoting and publicizing enterprises.
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By The Numbers: #HULI2018 Split
Home Featured Stories By The Numbers: #HULI2018 Split
Gilbert S.C. Keith-Agaran and Assistant Editor Alfredo G. Evangelista
The debates over the impact of the midterm election results began as soon as the winners were projected and as the results were finalized in the weeks following. Locally, Maui elected a new Mayor and provided six new members to the County Council (and in the Primary election, Mauians picked new State Representatives for South Maui and Wailuku).
Maui County Races
The County of Maui results perhaps surprised some people with mixed results for #Huli2018 candidates and establishment candidates.
Mayor Elect Michael Victorino
Maui Mayor
Voters elected former Council member and Board of Education member Mike Victorino, 27,057–22,078. Victorino led West Maui Councilwoman Elle Cochran from the first printout of the absentee mail and walk-in ballots, 13,381–8,660. The 2018 election further confirmed the split between voters in 2014 who supported County regulation of agricultural pesticides and those associated with more establishment, status quo concerns.
In some recent elections, establishment candidates have taken leads from the early printouts, reflecting mainly ballots cast by absentee mail or absentee walk-in and then watched as Election Day ballots eroded those leads. The same pattern followed this year. By the second print-out, counting votes from ten of the thirty-four Maui County precincts, Victorino had expanded his lead, 17,859–11,907. In the third report, Victorino's lead was still 26,227-20,956. Victorino would capture all eleven of the Central Maui precincts, five of the six Upcountry precincts and Lāna'i and Molokai. Victorino won twenty-two of the thirty-four precincts in beating Cochran. Cochran won four of the five West Maui precincts and three of the four South Maui precincts but could not close the gap built by Victorino from the early voting.
Victorino will be installed as Mayor on January 2, 2019. "I am grateful to the widespread support we received from the Filipino community," said Victorino, who promised to continue the tradition of raising the Philippine flag at the County building during the month of October celebrated statewide as Filipino-American History Month. "I look forward to working with Maui's Filipino community and meeting many of its members at the various upcoming events."
Incumbent Councilwoman Kelly King expected to be the next Council Chair
Maui County Council
Kaua'i and Maui remain the only Counties where all registered voters can vote for each member of the County Council. While all Kaua'i Council members serve at large, Maui's Charter requires each of the nine members to live in one of nine geographic communities, maintaining representation for smaller rural areas. In the past, many voters chose to not vote in the races for seats outside of their particular community. This year, a group of council candidates, along with Mayoral candidate Elle Cochran ran as a slate and urged voters to #VoteAllNine.
The Council races marked an electoral milestone as women candidates won six seats on the nine-member County Council: incumbent Kelly King (South Maui), incumbent Yuki Lei Sugimura (Upcountry), former Council member Alice Lee (Wailuku), Tamara Paltin (West Maui), Natasha Kama (Kahului) and Keani Rawlins-Fernandez (Molokai). Four of the women were also part of the #VoteAllNine Coalition which included Hāna winner Shane Sinenci.
For the first time in almost twenty years, the County Building will not have Alan Arakawa's presence. Voters rejected three-time Maui Mayor Arakawa's attempt to stay in office by re-taking his old Kahului Council seat in favor of Kama, a minister and Faith Action for Community Equity (F.A.C.E.) advocate. Kama previously did not prevail in races for the State House and Wailuku Council seat. Kama trounced Arakawa, 28,454–17,580, winning every precinct. Kama led from the start, 12,562–8,157, foretelling a disappointing night for Arakawa. In the second printout, her total increased 16,796–11,127, and then, in the third report, 27,191–17,013.
"The Maui County 2018 Election was one in which the voters of this County should be proud of," said Kama. "They collectively voted for their Mayor and nine council members believing that what we said we meant."
"It has been a pleasure to serve you all throughout the years," Mayor Arakawa said. "Maybe come say Hi to me if you see me and Ann having lunch at Tante's or anywhere else in the community."
Maui voters treated two other former Council members more kindly. Mike Molina will return to the Ha'ikū seat given up by Council Chair Mike White and Lee, former Council member and housing department head, took the Wailuku post held by Pino-Waiian Alika Atay, 23,656–21,225. While Atay held the Wailuku seat, voters in that district favored Lee 5,484–3,761. Similarly, Kahului voters provided Atay little Mabuhay, giving Lee a 4,017–2,228 margin. Atay captured South Maui, West Maui and parts of Ha'ikū-East Maui but could not overcome the margins built by Lee in winning twenty of the thirty-four precincts. Lee also won Upcountry 5,101–4,428 which she represented on the Council in the 1990s. Atay's sole term on the Council had been nagged by controversies involving one of his Council aides and campaign spending allegations. Lee led from the first printout, 12,012–8,338. She expanded the gap in the next report, 15,797–11,556. Lee kept her lead in the third report, 22,917–20,180, with thirty-three of the thirty-four precincts reporting.
"I feel very excited at the prospect of serving our residents once again as a Council Member," said Lee. "My goal is to bring back a sense of unity and collaboration to the County Council. Our problems are too large to be left unattended due to the distractions of divisiveness and personal agendas."
Molina followed a similar route as Lee, capturing the Central Maui precincts and getting enough votes in the rest of the County to beat back Furtado, 24,170–20,412. The amiable former teacher led after the initial report, 11,819–8,425 and held on his lead in the third report, 23,399–19,423.
"My family and I were very pleased with the election results," said Molina "and I would like to thank everyone for giving me the privilege of serving on the Maui County Council again. I believe by working together and respectfully with my Council colleagues, Mayor Elect Victorino and our citizens, we will do many things to keep our community strong both now and in the future."
Kamalu Carroll fell short in her bid to succeed her father Bob Carroll for the Hāna seat which Sinenci won in his second try for the post, 23,573–19,412. Sinenci showed strength throughout the County, dropping only twelve precincts to Carroll. Carroll did sweep the four Kahului precincts 3,274–2,575. Sinenci offered a version of the Henry Ford quote on success to reflect his feelings on the elections: "Coming together is a beginning, keeping together is progress and working together is success!"
Molina and Sinenci were the only men who prevailed against their women opponents. Paltin, former Mayoral candidate and County lifeguard, crushed Pinoy candidate Rick Nava for the West Maui seat, 38,368-14,534. Sugimura will remain as the Upcountry member by handily beating educator Hannibal Starbuck, 27,250–17,218.
"I am humbled and grateful and know the Filipino community vote was a big part of my success," Sugimura said. "My work continues. Please call me if I can help you."
Longest tenured member Riki Hokama kept his council seat, surviving a strong challenge from Lāna'i resident Gabe Johnson in a rematch of their 2016 election, 22,414–20,433. Hokama took the eleven Central Maui precincts 9,466–5,131. Johnson won South Maui 3,670–2,729, West Maui 2,883–2,354, Upcountry 4,574–4,474 but could not overcome the early margin built by Hokama from early voting and Wailuku and Kahului. Johnson also captured the East Maui-Molokai-Lāna'i communities, 4,150–3,447 including Lāna'i narrowly, 407–390.
"We appreciate the support received" said Hokama "and we will continue to serve Lāna'i and the county as best as can."
King easily won a second term as the Kīhei Council member, taking thirty-four of the thirty-four precincts. King led all council candidates in the number of votes received, smashing Zandra Crouse: 30,855–11,979.
"The election clearly showed voters want change and are expecting leaders to focus on shared goals and values," said King, who many expect to be the next Council Chair. "I am excited to get past the struggle for control that often permeates the current council and move forward in service to the community with an emphasis on transparency, collaboration and fairness."
The Molokai race may have settled the balance of power between expected old guard Council members and the #Huli2018 group as Rawlins-Fernandez won the rematch with Council member Crivello. While Crivello narrowly led after the early voting, 10,206–9,106, and the second report, Rawlins-Fernandez overtook her in the 9:38 p.m. printout, 20,988–19,931. With only one precinct left to report, Crivello could not make up the difference. Election Day ballots powered the challenger to a comfortable victory. In the second printout at 8:08 pm, Crivello's lead narrowed 13,567–12,500. Rawlins-Fernandez touted her law degree and MBA as important points, noting no other Council candidate held either credential. Crivello was Molokai's choice but the sixteen precincts throughout the County won by Rawlins-Fernandez—including South Maui 3,687–2,688, and Upcountry 4,871–4,117—provided Rawlins-Fernandez with a 22,049–20,583 victory. The Ha'ikū precinct alone provided a 2,287–1,015 gap.
The election again displayed the ideological gaps between the working class-union urban neighborhoods of Central Maui and on Lāna'i with the South Maui, West Maui and the more rural communities. The eleven precincts in House Districts 8 and 9, with a total turnout of 16,507 voters, generally favored the old guard candidates: Victorino, Lee, Crivello, Hokama, Molina and Sugimura. However, the Wailuku precincts favored Kama and Sinenci while three of the four Kahului precincts voted for Arakawa and Carroll. South Maui (District 11: turnout 8,108), East Maui (District 13: turnout 8,789) and West Maui (District 10: turnout 6,529) voted #Huli2018. Molokai and Lāna'i precincts generally supported establishment candidates, although Lāna'i narrowly favored Johnson, and both islands favored Kama. The Upcountry precincts (District 12: turnout 10,546) generally supported the slate of challengers but favored their former council member Lee, the likeable Molina and their current council member Sugimura. The large Ha'ikū precinct (13–02), with 2,053 of 7,203 registered voters casting ballots on the Election Day, provided heavy support for the #VoteAllNine slate: Cochran (1,444), Sinenci (1,356), Paltin (1,439), Atay (1,324), Kama (1,476), King (1,491), Furtado (1,394), Starbuck (1,245), Johnson (1,209) and Rawlins-Fernandez (1,292). In contrast, Lahaina Civic Center (10–05), with an Election Day turnout of 1,427 voters, provided less overwhelming support for the #Huli2018 slate: Cochran (802), Atay (608), Rawlins-Fernandez (573), Johnson (631), Sinenci (619), Furtado (644), Kama (792), Starbuck (508), Paltin (911) and King (833). All districts supported Sugimura, Paltin and King over their opponents.
"This election year we saw some changes in our community. Whether they are good or bad changes is something we will all find out in the future," Arakawa notes. "I hope that no matter who made it past the General Election and got into office, they realize one thing: serving the public is not the same as running for office."
Kama who will replace Arakawa in January explained "We said we would work with whoever gets elected to make Maui County a better place of all. We said that we wanted to make sure our people had shelter that their paychecks could afford. We said we were going to take care of our ecology, because it is our economy. We said give us a chance, and they did. Now, it is up to us to do it. That everything we now do is for our constituents and the newly elected Mayor and Council are now, We, and not Me."
But Arakawa suggests that the newly elected officials be forewarned about the challenging realities of governing: "When you're in office you have to tell people sometimes that they're wrong; they don't have all the facts; or that the law is not on their side. There's no magic wand you can wave as a mayor or council person to change that."
He observes further, "The trouble is, the people who elected you don't like to hear the word "no." They expect you to act on the complaint about their neighbor's house being out of code or built without the right permits but they don't want you to apply that same standard to their house or their friends."
"It doesn't work like that," Arakawa warns. "You can help your friends through the county process but you can't shortcut it or eliminate it for them without others getting upset about the unfair treatment. Guidance and education about county laws and codes are fine. Ignoring laws and codes is not."
"So be ready to say no and get ready to have some fair-weather supporters turn their backs on you," he concludes. "Such is the life of public service."
Lee, who had a sabbatical of twenty years from elective office, is raring to go: "I look forward to working with all nine members to find the best solutions possible for all of our residents. I will encourage each member to contribute in a spirit of cooperation and sincerity."
Hawai'i Governor and Lt. Governor
Governor David Ige with his running mate Josh Green easily won reelection statewide over their Republican challengers Andrea Tupola and Marisa Kerns, 244,814–131,604. The Democrat ticket of Ige-Green won every precinct in Maui County, 32,059 (64.5%)–14,625 (29.4%). The Green and Nonpartisan tickets garnered 6.1% of the Maui votes.
Unlike the U.S. Congress, where every State regardless of population is guaranteed two U.S. Senators (so small population States like Hawai'i, Alaska and Wyoming have as much clout as New York, Texas and California), Hawai'i allocates State Senate seats by population.
Locally, continued Democratic control of both chambers of the legislature was never in doubt, with most seats already decided in the August Democratic Party Primary. Only three legislative races continued to the General Election (West Maui House, West Maui/South Maui Senate and East Maui-Molokai-Lāna'i House). Roz Baker (South and West Maui) and J. Kalani English (Lāna'i-Molokai-East Maui) will return to the State Senate while Lynn DeCoite (East Maui-Molokai-Lāna'i) and Angus McKelvey (West Maui) won reelection to the House. Baker easily defeated Green Party candidate Melissah Shishido, 8,911–4,337. McKelvey, with 3,673 votes, defeated two opponents, Republican Chazen Marten (1,318) and Green Party Jen Mather (1,137). DeCoite won another term by turning back perennial Green Party standard-bearer Nick Nikhilananda, 5,787–2,296. The Maui House delegation will also include veterans Kyle Yamashita (Upcountry) and Justin Woodson (Kahului). Newcomers will be Troy Hashimoto (Wailuku), who was appointed to replace former House Speaker Joe Souki at the end of last session, and Tina Wildberger (South Maui). In short, Maui voters kept the all-Democrat delegation intact for the session that begins in January.
The State Senate did lose two Filipino legislators—Will Espero who resigned midterm for his unsuccessful run for Lt. Governor and Brickwood Galuteria who lost a reelection bid in the Democratic Primary. Returning Filipinos are Donna Mercado-Kim, Lorraine Inouye, Donovan Dela Cruz, and Gilbert Keith-Agaran. In the House, Rida Cabanilla successfully won her old seat and will join Filipinos Ty Cullen, Henry Aquino, Della Au-Belatti, Joy San Buenaventura and Romy Cachola, who all won reelection. The Republicans did reduce the Democratic Majority to twenty-four in the twenty-five member State Senate and maintained five seats in the fifty-one member House.
U.S. Congress and National Races
Ever since the 2016 Presidential election, the current President's panoply of critics has pointed to 2018 as an important milestone in national repentance. The polls, for the most part, foretold change in favor of the opposition party. But the voters (especially rural voters in Missouri, North Dakota and Indiana) spoke otherwise with regard to the U.S. Senate.
Re-taking the Senate was always a tall-order given the number of seats the Democrats were defending but Democrats were very optimistic about forging a majority in the House. Hawai'i's delegation remained Blue. Outspoken Mazie Hirono won another term in the U.S. Senate while nationally ambitious Tulsi Gabbard returns for another term. Hirono, who made a national mark as a member of the Judiciary Committee hearings on Judge Brett Kavanaugh's nomination to the U.S. Supreme Court, easily defeated Republican Ron Curtis, 276,133-111,977. Maui County favored Hirono, 37,628 (76.8%)–11,347 (23.2%). Gabbard easily bested GOP Brian Evans, 153,132–44,816, with Maui County totals of 39,775 (82.1%)–8,685 (17.9%). Former U.S. Rep. Ed Case moves to the Urban Honolulu seat that Colleen Hanabusa vacated, keeping the all-Democrat Hawai'i delegation intact. While Election Night results suggested a modest majority, as counting continued, Democrats ended up gaining more seats than any midterm since the post-Watergate election.
Nationally, Democrats also posted gains in Governorships and State legislative chambers. Democrats added seven governorships, recouping some of the losses sustained in 2010 and 2014 and picked up hundreds of state legislative seats.
Same Day Registration
This was the first election where same day registration was allowed at the polls and a surge did occur at certain polling places on Election Day which resulted in some delay in the process. Maui County Clerk Danny Mateo reported an additional 987 voters took advantage of the opportunity. "I'm a little surprised at the high number even though our office had gone out to register voters at many events and locations. It's exciting that people are coming out to register," said Mateo, who will retire at the end of December 2018 to pursue other opportunities. Mateo has served the County for twenty-two years, with ten and a half years on the Council and five years as County Clerk. "I am surely looking forward to Maui County being a County wide all-mail voting in the future. I believe it will help increase voter participation, making the voter process a lot easier by mailing the ballots to all registered voters in Maui County. It will also alleviate some of the Clerk's office in recruiting volunteers because we hire 500 workers to assist on election day."
For Maui County, 96,721 were registered to vote. The total voters were 48,461 or 50.1%. Of that amount, 22,638 voted at the polls (23.4%) while 25,823 voted via absentee (26.7%).
A comparison of four years ago (versus a comparison of two years ago which included a presidential race) shows an increase of 9,394 of total registered voters (from 87,327 to 96,721) or 10.75%. The total number of voters increased from 46,005 to 48,461 (2,456) or 5.3%. Those who voted at the polls (24,578 in 2014) decreased by 1,485 or 6% while those who voted via absentee (21,427 in 2014) increased by 5,955 or 27.79%.
Statewide, the total registration of voters was 756,751, with 52.7% or 398,657 voting. Of that amount, 23.1% or 175,120 voted at the polls versus 29.5% or 223,537 voting via absentee.
Four years ago, the total Statewide registration of voters was 706,890, with 52.3% or 369,642 voting. Of that amount, 25.5% or 180,535 voted at the polls versus 26.6% or 189,107 voting via absentee.
Blank Votes–Coulda? Woulda?
Voters continue to leave certain races and ballot questions blank. Blank votes may reflect "None of the above" or "Don't know enough" or, while all Maui County residents can vote in all Council contests, a choice to not weigh in on representatives for other communities. Regardless, in close races, blank votes play a role.
On Maui, the largest number of blank votes was for the Office of Hawaiian Affairs At-Large Trustees, with 73,535. Another 18,807 voters left the OHA O'ahu Trustee blank and 13,130 voters left the Maui Resident Trustee blank.
For the Maui Mayor race, 1,302 voters left that race blank while 1,177 voters left the Governor's race blank. There were 1,483 blank votes for the U.S. Senate race and 2,004 blank votes for the U.S. Congressional District II race.
In the state legislative races, 1,381 voters left the Baker-Shishido race for State Senate blank while only 397 voters left the McKelvey-Marten-Mather State House race blank and 698 voters left the DeCoite-Nikhilananda State House race blank.
But for the Maui County council races, thousands of voters did not vote.
Races where the blank votes were greater than the margin of victory:
– Rawlins-Fernandez over Crivello (Molokai) – 7,814 blank votes in a race decided by 1,466 votes;
– Hokama over Johnson (Lāna'i) – 7,589 blank votes in a race decided by 1,981 votes;
– Sinenci over Carroll (East Maui) – 7,459 blank votes in a race decided by 4,161 votes;
– Molina over Furtado (Makawao-Haiku-Paia) – 5,857 blank votes in a race decided by 3,758 votes; and
– Lee over Atay (Wailuku-Waihee-Waikapu) – 5,559 blank votes in a race decided by 2,431 votes.
Races where the margin of victory was greater than the number of blank votes:
– Paltin over Nava (West Maui) – 7,645 blank votes in a race decided by 13,734 votes;
– King over Crouse (South Maui) – 7,611 blank votes in a race decided by 18,876 votes;
– Sugimura over Starbuck (Upcountry) – 5,968 blank votes in a race decided by 10,032 votes; and
– Kama over Arakawa (Kahului) – 4,408 blank votes in a race decided by 10,874 votes.
The large number of blank votes in Council races persisted despite a campaign by both establishment candidate supporters and the #Huli2018 coalition to inform and urge people to vote all nine of the respective council slates. Voters, however, continued to leave certain races blank. Wailuku and Kahului voters, for example, tallied the largest number of blank votes in the Molokai, Lāna'i, West Maui and South Maui races while South Maui recorded over a thousand blank votes in each of eight council districts and 939 in their own region.
BLANK VOTES BY REGION:
Wailuku 9,672
Kahului 6,484
Lahaina 10,068
South maui 12,851
Upcountry 10,929
East maui/Molokai/Lāna'i 9,867
Hmmm. Coulda?? Woulda??
Ballot Questions
On the Ballot questions, money was certainly political speech. Given the advertising dollars against both the State Constitutional Convention and the Investment Property Tax Surcharge for Education Constitutional Amendment, the rejection of both proposals was not unexpected. Although the Hawai'i Supreme Court ruled against including the Education Con Am, the results were still tallied with Maui County rejecting the question.
Two of the three Maui Charter proposals passed—voters rejected having claims filed with the Corporation Counsel rather than the County Clerk, 21,880–19,559 but approved higher penalties for illegal rentals, 26,045–19,048, and expanded use of the Open Space Fund, 30,389–14,456.
Reflecting on the results for Maui's Filipino community, Mayor Arakawa observed, "I've always listened to our Filipino community and our newly elected officials should as well. As long as Filipinos continue to fight for what they want they will have the ears of our elected officials. For example, the Filipino community has wanted a new Kahului Community Center for a long time now, so let the new mayor and new council know that remains a priority for you."
With the midterm elections completed, people on the "losing" end of things might well be lamenting the lack of turnout of like-minded voters. As political scientist and analyst Larry J. Sabado from the University of Virginia observes, "Every election is determined by the people who show up." President Abraham Lincoln wryly noted, "Elections belong to the people. It's their decision. If they decide to turn their back on the fire and burn their behinds, then they will just have to sit on their blisters."
In short, not voting is effectively also voting to give those who do cast ballots more influence over the results.
Or if you prefer a more local approach: If you neva' vote, no can dat one!
Gilbert S.C. Keith-Agaran represents Central Maui in the Hawai'i State Senate. He is currently in the middle of his four-year term and did not appear on the ballot this year.
Alfredo G. Evangelista majored in Political Science at the University of Southern California (B.A. 1980) and received his Juris Doctor in 1983 from the UCLA School of Law. He is licensed to practice in all the state and federal courts in the State of Hawai'i (1983), the Supreme Court of the United States (1989), and the Ninth Circuit Court of Appeals (1990).


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Syncope is often discussed by cardiologists or epilepsy specialists. These groups tend to look at syncope from their special perspective. This page is written from a more general perspective -- that of a "dizzy doctor". As a preview of the "take home" messages, the very definition of "syncope" and variants is poorly thought through, the syncope literature is wildly variable, there is an overemphasis on heart conditions, and "sorting" is the huge problem with syncope.
Incidence of syncope per 1000 person years by age from Sotieriades et al (2002).
Syncope (faint) is often considered as a subset of the symptom of transient loss of consciousness (or in other words, passing out). Using this definition syncope is the most common -- accounting for about 80% -- of the 3 conditions that cause transient loss of consciousness. The other two, accounting for another 10%, include epilepsy and pseudoseizure. Obviously then, epilepsy/pseudoseizure are minor contributors.
The most common definition of syncope is a sudden fall of blood pressure resulting in loss of consciousness. There are three syncope subvariants that differ mainly in their prognosis and need for follow-up. As this is not generally known when the syncope occurs, ths categorization process doesn't have much pragmatic use, at least urgently.
"vasovagal" syncope, also known as "simple faint", or "neural" syncope, is a loss of consciousness, associated with lower blood pressure, triggered by an emotional event.
"vasodepressor syncope" is syncope mediated by vasodilation.
"cardioinhibitory syncope" is syncope mediated by slowing of the heart, or reduced contraction of the heart.
A narrower definition of syncope is that of Jones and Gibbons (2014) who stated that syncope is a "transient loss of consciousness, associated with cerebral hypoperfusion, no lasting neurologic deficits and complete recovery". This definition does not require a fall in systemic blood pressure -- one might envision instead syncope due to choking and pressure on both carotids. It might also allow for "syncope" due to occlusion of a single carotid, which we think is highly improbable. It excludes entities like stroke. Practically, this definition is more difficult to use "in the field", as rarely does one know how well the brain is perfused. We think it is better to stick with broader definitions.
We and some others (Sotieriades et al, 2002) think that syncope is better defined as simply a transient loss of consciousness. This does not greatly change the statistics, as most transient loss of consciousness (80%) is due to lowered blood pressure, but it avoids the confounding of the very large "unknown" category between individuals thought to have lowered blood pressure or not. In the following, we will qualify our statistics according to the definition.
Presyncope consists of unsteadiness, dizziness, weakness, or cognitive symptoms without loss of consciousness. Dizziness is frequently reported during presyncope, such as from a racing heart (Walfridsson and Walfridsson, 2005) Presyncope is often a symptom of orthostatic hypotension. We think that "presyncope" is a unfortunate term in its usual usage where the "syncope" is missing. How can one say something is "pre", when the event never occurs ? This sloppy use of language leads to problems with sorting patients into diagnostic categories.
Pseudosyncope is an apparent loss of consciousness unaccompanied by circulatory changes such as reduced blood pressure. According to Blad et al (2015), tilt-induced vasovagal syncope overlaps with psychogenic pseudosyncope, and the two may be combined as well. They suggest that indicaters of pseudosyncope are high attack frequency, delayed recovery of consciousness, apparent loss of consciousness > 1 minute, ictal eye closure, atypical triggers, and absence of prodromes. The term pseudosyncope is also an unfortunate one, as it is common to also use the prefix "pseudo" in front of another potential cause of loss of consciousness, such as a seizure, that is not "pseudo" at all. Thus a seizure (to a neurologist) would meet the definition of "pseudosyncope" to an internist.
Falls -- i.e someone who trips over a dog is not "syncope".
Functional (pseudosyncope or pseudoseizures) -- see commentary above about the unfortunate use of these terms.
Some authors also choose to excludefrom syncope loss of consciousness due to hypoxia or hypoglycemia (e.g. Moya et al, 2009) . We think this is inappropriate splitting.
The incidence of syncope is estimated to be about 18.1-39.7 events/1000 patient years (Ganzeboom et al, 2006). In other words, 2-4% of the population every year. Somewhere between 3%-35% (presumably the larger #) of the population experience syncope at some point in life (Savage, 1985; Ganzeboom et al, 2006).
Of these 2-4% of the population, only about 1% end up seeing their general practitioner, and only about 0.1% end up in the emergency department (Moya, 2009). It seems reasonable to assume that syncope in the ED has more of the "dangerous" faints -- who would go to the ER if they fainted at the sight of their own blood after all ? Thus the statistics about syncope from the ED, likely overestimate the danger of syncope in general.
That being said, syncope also accounts for roughly 1-3% of all emergency room visits (Kapoor, 1990; Soteriades et al, 2002; Moya et al, 2009) and 6% of all hospital visits. Between 71 and 125 children and adolescents/100,000 population experience syncope each year. The number of visits to Emergency Departments for syncope rises steadily with age (Sotieriades et al, 2002).
Hospitalization accounts for more than 75% of the health care costs of syncope (Moya et al, 2009). In the US, the mean cost was $5400/hospitalization for syncope in 2009.
Risk stratification is used for persons with syncope of unknown origin. Most risk stratification algorithms depend largely on an abnormal ECG as an effort is made to detect lethal arrhythmias or individuals with structural heart disease.
Baron-Esquivias et al (2010) reported the proportion of patients with various types of syncope in Emergency Departments in Spain. They defined syncope as as loss of consciousness with lowered blood pressure. This is shown in the figure on the right. There were 1217 patients with syncope as defined, as well as another 202 patients with "Non Syncope Transient-LOC". Putting this together, about 80% of patients with transient LOC were categorized as "Syncope", and about 20% as just "transient LOC". As both groups included very large "unknown" categories, we ourselves think it would have been better to simply consider them as together as others have done. (Sotieriades et al, 2002). Nevertheless, Baron-Esquivias did provide enough details that one can analyze them either way.
The biggest single cause of syncope in the ED as reported by Baron-Esquivez et al (2010) is "neural syncope. Other studies suggest that about 35-48% of syncope in the ED is "neural" (Moya, 2009).
Again, remember that in the study providing this data, other neurological disorders such as stroke or brain cancer (for example) were excluded from the "neural" group, so this group are actually "vasovagal" type faints. "Neural" is an unfortunate term as "neural" might also be interpreted as the loss of consciousness due to a brain illness (which were excluded). Also known as "faint", or "vasovagal syncope", the "neural" category is defined as a loss of consciousness due to an emotional event -- for example -- seeing one's own blood. About 44% of all syncope from this large study was "neural". Other studies have similar findings.
In syncope units (dedicated syncope clinics), even more "neural" or "reflex" type syncope are diagnosed -- 56-73% (Moya, 2009).
Closely related to the "neural" or vasovagal faints, are "situational" syncope, again syncope triggered by a bodily event.
carotid sinus hypersensitivity -- syncope after pressure on the carotid sinus in the neck.
"Unknown" is the second biggest category - -accounting for 28% of all syncope in the ED ( Baron-Esquivias et al, 2010). In the general population, "unknown" is even bigger accounting for 37% (Sotierdes et al, 2002).
In the other 202 patients categorized in the ED study of Baron-Esquivias et al (2010) as "NST-LOC" -- non syncope transient loss of consciousness, "unknown" made up even more -- 43%. One might think -- how does an unknown in the "syncope" group differ from an "unknown" in the NST-LOC group ? Isn't there quite a bit of ambiguity here ? If we moved some of the "unknowns" in the "syncope" box into the "NST-LOC" box, wouldn't the proportions be very different. Why not just put them all together ... Another consideration is that what is "unknown" in the emergency department, could certainly move into some other category after more evaluation. Like arrhythmia for example. Well, anyway.
Orthostasis -- drop in blood pressure on standing is the next biggest category -- about 9.4% of all syncope (defined as transient LOC). We have another web page that discusses orthostatic hypotension here. It is surprising that there were only 9.4% given that such a large proportion of the population has orthostatic hypotension. Presumably this means that few people actually lose consciousness -- presumably they "feel it coming on" and sit down.
AV block (normal pacemaker fails and heart is driven by other sites).
According to Walfridsson and Walfridsson, "dizziness" was reported in 47% of patients with SVT (supraventricular tachycardia). There are numerous drugs that can cause bradycardia, especially in persons affected by the "long-QT" syndrome.
Basically all the rest of heart disease.
There are a few miscellaneous entities not included above.
Raynauds Disease (Guiloff et al, 2012) -- this is difficult to comprehend.
There are also many drugs that prolong the QT interval and that may precipitate heart block and syncope.
(Cherin et al, 1997). These associations seem very odd to us and we are dubious that they should be used to make any decisions about medications.
Syncope is associated with dangerous diseases.
Syncope, defined as transient loss of consciousness, is dangerous. There appears to be a tendency in the literature to overestimate the risk however. As an overview, it seems to be just a little more dangerous than getting older.
Solbiati et al (2015), in a meta-analysis including 25 studies and 11158 patients in total reported that the one year mortality of syncope was 8.4%. Of course, syncope mainly occurs in older people and this statistic might be less dramatic if one subtracted the expected mortality -- i.e computed "excess mortality". From the figure on the right, taken from the Framingham study (Soteriades et al, 2002), it does not appear to us that there is an 8% mortality at 1 year -- rather the "worst case" mortality is in the 10% of syncope that are cardiac which may indeed be about 10%. For the other 90% mortality appears to be somewhere between 1 % (which is about normal), and 3% which is significant but hardly 8.4%. So there are some major differences in studies attempting to quantify expectation of death after syncope. We think the Framingham data is more reasonable and think the meta-analysis of Solbiati et al is overly gloomy.
According to Dipaola et al, the 48 hours following syncope are the highest risk times for a major adverse event. (Dipaola et al, 2014). In reality, these studies are reporting mortality in persons who have had syncope, and the underlying cause of syncope is generally the cause of death (Moya, 2009).
Soteriades et al (2002, figure to right) reported survival after syncope (defined as transient loss of consciousness), broken out by cause. This was a very large "population" type study done in Framingham, Conn.
Importantly, there was no effect on survival for individuals with "vasovagal" syncope (also called "neural syncope above"). However, all other major categories - -including "unknown", neurological causes (such as stroke), and individuals with cardiac causes of syncope did not survive as long as persons without syncope.
About 30% of people with one syncopal episode have recurrence in 3 years (Moya, 2009). Logically, one would expect that recurrent syncope would be far more dangerous than a "one time" syncope.
Entem et al (2009) reported that arrhythmia was found in 33 of 140 patients with syncope of unknown origin, using an implantable loop recorder, during a mean followup period of roughly a year. Given that one would be unlikely to convince most people to have a device implanted unless they had some very good reason, we think this statistic is far too high because of sampling bias.
According to an extensive meta-analysis by Linzer and associates (1997) for the American College of Physicians, "a careful history, physical examination combined with an ECG will yield a diagnosis in 50% of cases". Or looking at the doughnut hole, a careful history, physical exam and ECG yields a diagnosis in only 50%. As only about 10-20% of syncope is "cardiac", we presume that Linzer is saying that 20% of the diagnoses are made by the ECG, and the rest are through the general physical examination and history. This seems very reasonable. Especially the history, as talking to the patient is often the most important part of an evaluation.
History should establish the context of the syncope -- i.e. were they getting a flu shot ? (i.e. vasovagal) The warning signs and rapidity, what happened after the loss of consciousness (i.e. perhaps a convulsion ?), any available data about blood pressure -- were they pale ? No pulse ? How long did it take for them to recover ?
Reuber et al (2016) used a factor analysis to find questions that were best at discriminating between seizures, pseudoseizures and syncope -- obviously here their definition of syncope was not transient loss of consciousness as recomended above. Recall that only a small proportion of transient loss of consciousness in the ER are from seizures or "pseudo"-LOC. Questions reflecting a "catastrophic experience" -- i.e. a dramatic experience -- were endorsed to a greater extent by pseudoseizure patients, and were least endorsed by seizure patients. Questions reflecting "Mind/body/world disconnection" had a similar pattern. So in essence, dramatic answers to questions about what happened are more common in pseudoseizure patients. No big surprise, as pseudoseizures are often just mini-dramas intended to accomplish some purpose.
Moya (2009) suggested (paraphrased here) that one should ask about circumstances (position, activity, predisposing factors), Onset of attack (especially palpitations), eyewitness inquiry (fall, color, duration, breathing, convulsions, tongue biting), End of attack (e.g. confusion, chest pain, palpitations, incontinence), and background (cardiac, neurological, diabetes, medication, previous spells).
Bare minimum physical examination should include.
Of course, a general physical and neurological examination is important as well.
In the emergency setting, blood tests including D-dimer may be useful for identifying pulmonary embolism or aortic dissection, and Troponin may be useful when a cardiac ischemic event is suspect. BNP (brain natriuretic peptide) > 300 pg/ml is a major adverse probability predictor, increasing odds as much as 7.3 fold (Reed et al, 2007). BNP is a peptide that suggests acute heart failure.
Interestingly, the orthostatic blood pressure measurement is often left out in emergency department evaluations. As about 10% of syncope in the ED is from orthostasis (Baron-Esquivias et al. 2006), this is a place where improvement is possible.
If the syncope can be triggered by a particular maneuver, such as stretching or straining, it may be helpful to have the individual attempt to trigger the syncope in a controlled setting, such as the medical office. Stretch syncope is a benign cause of fainting in young persons. (Mazzuca et al, 2007; Pelekanos et al, 1990).
Carotid sinus testing during the physical examination may also be helpful in very rare instances.
Not everyone agrees as to what should be the routine laboratory testing for syncope. This is usually left up to the discretion of whatever physician, nurse practitioner or physician's assistant that ends up caring for the patient after they are discharged from the emergency department. It is interesting to observe that many women use their OB-Gyne physician as the primary care physician. We have encountered patients who consider chiropractors to be their primary care provider. Recall that syncope has some excess mortality at 1 year (see above).
A full ECG is advised by nearly all. This is very sensible as it detects important conditions such as a heart attack or an irregular heart rhythm. A full ECG would seem unneeded in someone with a clear vasovagal faint however.
In a second meta-analysis by the Linzer (1997), the value of diagnostic testing for syncope was considered, with recommendations for the following studies in the other 50% of patients who are undiagnosed after history and physical -- i.e. "unknown" patients" is to get 1) electrophysiologic studies in patients with organic heart disease, 2) Holter monitoring or telemetry in patients known to have or suspected of having heart disease, 3) loop monitoring in patients with frequent events and normal hearts, 4) psychiatric evaluation in patients with frequent events and no injury, and 5) tilt-table testing in patients who have infrequent events or in whom vasovagal syncope is suspected. " These appear to be safe suggestions, that seem heavily weighted towards cardiac care.
Electrocardiograms and related testing for syncope.
As most syncope is not caused by electrical problems in the heart, but rather is from "vasovagal syncope", or from orthostatic hypotension, it should be apparent that electrocardiograms as well as related tests in all syncope patients will frequently be normal. One would expect from the prevalence of arrhythmia and other cardiac problems in the ED, the positive rate should be roughly 20%. Presumably the prevalence is higher in groups selected to be of higher risk -- i.e. those with recurrent syncope of unknown origin.
That being said, cardiac causes of syncope can be lethal and nearly everyone agrees that a routine ECG is often helpful in identifying abnormalities of rhythm, conduction or morphology of the heart electrical activity that give a clue as to the underlying etiology of the syncope. Here the cost of the test (Medicare pays about $60 for an EKG) is low, and the potential benefit of detection of a potentially lethal condition is high.
Recording a subset of the ECG during the spell can be achieved by using 24 hour ambulatory recording (also known as Holter monitoring), or an event recorder, or a memory loop recorder (called "loop" monitoring). These devices are constantly recording the ECG, allowing one to "go back in time" once an event is triggered. There are also some new "home devices" for personal use - -see below. The diagnostic yield of ambulatory event monitoring in syncope is 25-35% (Linzer et al, 1997). This seems a bit high to us, again perhaps due to selection bias. As event monitoring is meant to detect arrhythmia, and large studies suggest that only about 10% of syncope (defined as transient LOC) in the emergency department is diagnosed as arrhythmia (Sotiades et al, 2002) , the logical inference that many arrhythmia's are missed in the ED. This might be because the arrhythmias are intermittent, or perhaps because vasovagal patients are excluded from ambulatory event monitoring.
Twenty-four hour heart monitoring, often called "Holter monitoring", is potentially useful in persons who have frequent enough spells that can be expected to have an event during the 24 hours that they are monitored. Such individuals need to have a non-life threatening spell to make this modality safe. The yield of Holter monitoring is low, about 1-2%, and it is thus expensive in terms of cost per diagnosis (Moya et al, 2009).
The event recorder and loop memory recorder are useful in persons whose events occur less frequently than every 24 or 48 hours. These devices require the patient or an accompanying person to activate the monitor at the time of symptoms. (Hammill, 1997).
Recently implantable cardiac monitors have been made available for persons who need chronic monitoring of heart function (i.e. Reveal device, made by Medtronics). According to Burkowitz et al (2016), these devices are 4 times more productive of arrhythmia's than external event monitors. Of course, they are very invasive and very expensive.
Additionally, there are now smartphone devices (e.g. Kardia, AliveCor), that can be used to monitor the EKG on demand, using a smartphone app These devices are far less expensive (and time consuming) than undergoing ambulatory event monitoring. They do require one to be awake, or be in the company of someone who can operate the monitor, and they do not go "back in time" as do the Holter or similar devices, but their low cost (about $100) makes them very accessible. One wonders why a similar device could not be used to stream to an "app" on one's cellphone. I.e. why couldn't one make a $100 ambulatory event monitor ?
Moya et al (2009) stated that external event recorders have "no role in the evaluation of syncope". We are a little dubious about this, as we think that external event recorders as the device shown above could potentially be used in a far greater population of individuals than devices supplied by cardiology labs.
Autonomic testing, including tilt-table testing, for orthostatic hypotension. It is not needed for all syncope patients -- more discussion is below.
Carotid Doppler (very low yield). It is almost never needed.
EEG (low yield due to combination of relative infrequency of seizures and insensitivity of EEG).
Psychiatric evaluation (for pseudo-LOC). Rarely done.
The tilt table test procedure uses equipment to record blood pressure and pulse after a 70 degree tilt using a motorized table. It is looking for the 10% of patients who have syncope associated with orthostatic hypotension.
The "yield" on TTT varies according to author. According to Kapoor (2003), about 65% of patients with syncope but without structural heart disease have positive results on tilt-testing. As the huge majority of syncope patients are otherwise normal persons who have experienced an emotional disturbance (e.g. vasovagal), this figure seems very high (Baron-Esquivias, G., et al. 2010). We would rather expect about 10%, the prevalence of orthostatic hypotension. Grossi et al (1987) reported positive TTT in 26.69% -- again, seeming a bit high. Perhaps there is a selection bias here.
"Neurally mediated response", characterized by the sudden onset of hypotension, bradycardia, or both when the patient is kept in the upright position. This is the most common response. The low blood pressure is also called "orthostatic hypotension".
Dysautonomia -- a gradual decrease in blood pressure with little or no change in heart rate during the procedure.
The TTT can be anxiety provoking by itself, as it involves being strapped onto a contraption, potentially with intravenous medication. Given that many people feel faint even with simply having their blood drawn or a flu shot, the "test" itself may be provoking syncope.
The sensitivity of TTT depends on the methodology. It is about 90% when used with a low-dose isoproterenol protocol or nitroglycerin, but lower when used with a high-dose isoproterenol protocol.
We ourselves do not think that TTT using IV medication is sensible in syncope as we are concerned about the risk of provoking a cardiac event, and are unconvinced that the greater sensitivity warrants the risk. That being said, Moya et al (2009) stated that there was essentially no risk of the TTT. We are doubtful.
The operators of tilt tables (usually cardiologists) are usually unsophisticated about positional vertigo due to inner ear conditions, and can easily miss the single most common cause of positional vertigo -- BPPV. We have encountered patients who pass out after their BPPV is provoked.
Syncope -- defined as transient loss of consciousness, is a major diagnosis problem, but once the diagnosis is established, treatment is generally managed by the specialties that treat the diagnosis. Somewhat unique to syncope is that there are an immense number of "unknown" patients, some of which have lethal underlying disorders.
Vacek (1991) suggested that "The initial evaluation and management of most patients with syncope can be performed by the primary care physician ... Consultation with a cardiologist is necessary only when the results of the initial evaluation are unrevealing or if findings suggest the need for a more intensive secondary evaluation. "
The following is our opinion about who should treat transient loss of consciousness.
Vasovagal No treatment or evaluation is needed, unless the patient is actually "unknown"
Unknown Followup with a medicine physician. It should be a specialty of physician familiar with cardiac disorders.
Non-blood pressure LOC Neurology -- for example, seizures might be the cause.
Orthostatic (including "reflex") Medicine or Cardiology, possibly followed by Neurology if syncope is not due to a heart condition, medication, metabolic or dehydration as a cause.
More information about treatment of syncope associated with low blood pressure on standing up, can be found on the orthostatic hypotension page.
There a reasonably large literature concerning syncope, driving and working. This is discussed separately.
An 80 year old, largely healthy man with a history of rheumatic fever, presented to the clinic. He had a history of " recurrent falls, mainly associated with bending over, such as to pick something up. His exam is not suggestive of positional vertigo, although this is the most common cause of dizziness at his age. His testing also documented normal inner ear function."
Ambulatory event monitoring detected an intermittent 3:1 AV Block. In other words, his heart rate was dropping from about 80/min to about 25/min. A pacemaker was placed, and his falls abruptly stopped.
Baron-Esquivias, G., et al. (2010). "Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study." Europace 12(6): 869-876.
Blad, H., et al. (2015). "Tilt-induced vasovagal syncope and psychogenic pseudosyncope: Overlapping clinical entities." Neurology 85(23): 2006-2010.
Brignole, M., et al. (2004). "Guidelines on management (diagnosis and treatment) of syncope--update 2004." Europace 6(6): 467-537.
Burkowitz, J., et al. (2016). "Insertable cardiac monitors in the diagnosis of syncope and the detection of atrial fibrillation: A systematic review and meta-analysis." Eur J Prev Cardiol 23(12): 1261-1272.
Dipaola, F., et al. (2014). "Syncope risk stratification in the ED." Auton Neurosci 184: 17-23.
Entem, F. R., et al. (2009). "Utility of implantable loop recorders for diagnosing unexplained syncope in clinical practice." Clin Cardiol 32(1): 28-31.
Grossi, D., et al. (1987). "Head-up tilt for triggering and diagnosing syncope." Funct Neurol 2(4): 457-464.
Josephson, C. B., et al. (2007). "Neurocardiogenic syncope: frequency and consequences of its misdiagnosis as epilepsy." Can J Neurol Sci 34(2): 221-224.
Jones, P. K. and C. H. Gibbons (2014). "The role of autonomic testing in syncope." Auton Neurosci 184: 40-45.
Linzer, M., et al. (1997). "Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians." Ann Intern Med 126(12): 989-996.
Linzer, M., et al. (1997). "Diagnosing syncope. Part 2: Unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians." Ann Intern Med 127(1): 76-86.
Mazzuca, M. and P. Thomas (2007). "Self-induced stretch syncope of adolescence: a video-EEG documentation." Epileptic Disord 9(4): 413-417.
Miles, W. M. (1997). "Driving issues related to arrhythmic syncope." Cardiol Clin 15(2): 327-339.
Pelekanos, J. T., et al. (1990). "Stretch syncope in adolescence." Neurology 40(4): 705-707.
Reed, M. J., et al. (2007). "Role of brain natriuretic peptide (BNP) in risk stratification of adult syncope." Emerg Med J 24(11): 769-773.
Reuber, M., M. Chen, J. Jamnadas-Khoda, M. Broadhurst, M. Wall, R. A. Grunewald, S. J. Howell, M. Koepp, S. Parry, S. Sisodiya, M. Walker and D. Hesdorffer (2016). "Value of patient-reported symptoms in the diagnosis of transient loss of consciousness." Neurology 87(6): 625-633.
Solbiati, M., et al. (2015). "Syncope recurrence and mortality: a systematic review." Europace 17(2): 300-308.
Walfridsson, U. and H. Walfridsson (2005). "The impact of supraventricular tachycardias on driving ability in patients referred for radiofrequency catheter ablation." Pacing Clin Electrophysiol 28(3): 191-195.


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text:
Why Teachers Have To Give Until They Can't Give Anymore
Written by Marcus Medford
Joel Ien is a life-long educator who has worked as a teacher, principal and professor at the Ontario Institute for Studies in Education. If the surname "Ien" sounds familiar, it's probably because you've seen Joel's daughter, Marci, on TV. Marci is a co-host on CTV's Canada AM and occasionally an anchor for CTV National News.
She says part of what makes her father such a great dad and great educator is his big heart. "He goes above and beyond for people, and they remember him for that," she says. Marci remembers her dad bringing lunches and bus fares for his students who couldn't afford it. But she says Joel was a tough teacher who demanded a lot from his students, but had a heart of gold.
Joel came to Canada from Trinidad 47 years ago to study at the University of Toronto after his parents sold a portion of their land in order to pay for his tuition. Joel graduated from U of T and won a scholarship which allowed him to study at Harvard University in Boston. Joel says that the time he spent at Harvard completely changed his perspective on education and evaluation.
Joel's teaching philosophy revolves around the belief that one must engage a student as a whole person and be invested in their success and well-being. Joel was truly dedicated to his students and says, "My time is the kid's time. Teaching cannot be a 9-3 job. You have to be willing to give and give and give until you can't give anymore."
What was your experience at Harvard like?
Fabulous. The experience was fabulous. That really changed the way I thought about evaluation. At U of T they mark you with a numerical or letter grade, at Harvard they mark you pass or fail. That was a very interesting concept. Pass or fail. Satisfactory or unsatisfactory. And we all studied together in groups, no one competed like at U of T, where we would get books and hide them. That competitive behavior was absent at Harvard because everybody studied together and everybody shared. And that affected how I taught later and how I evaluated kids. And I taught all the teachers at OISE the same thing, I said: "You are all going to be successful, or at least you all assume you're going to be successful. Now let's work together as a group and as a community and you'll all be very successful."
Right from the beginning I kept saying that, and I didn't evaluate the normal way. I'll give you an example: I asked students a question every week and each question was an interview question that they would write an answer to. I would just give check marks. I did that for three weeks; no marks. On the fourth week I put marks. And then there was a buzz in the class, "that's not what we're used to." Then I asked teachers, "what did we learn?" When we as teachers evaluate our students with a red mark, the anxiety level of the class rises. And we debriefed and discussed what putting a mark down can do, and how its effect on students can be negative rather than positive. Some teachers mark in red, and they throw it in front of the class and say, "You got a zero. A big fat zero." That destroys a student.
I know that part of your teaching method involves telling a story to your students on the first day of class, do you mind sharing that story?
I put on the board a name and two numbers, say 1905 dash 1942. And I ask the kids "where do you usually see this?" and they say "on a tombstone." Then I ask "what do you think that dash means?" The dash is the lifetime. All the years that come between the two dates are compressed in a dash. And that has to count, it has to mean something. You have to leave some mark in life. Then the kids analyze the dash in terms of what it can mean: what profession they follow, their dreams.
Why is that an important story to you?
It's significant to me because such a little dash can have such significance. It holds a lifetime; 70, 80 years. And what we have to consider is that we're here for a purpose. You have to find that purpose and don't let people deter us and stop us from where we are trying to get. You have to push forward and you have to progress and that's all part of the dash. One little dash. Leaving a mark, teaching kids, helping kids. That's very important to me. That story had a significant impact on his daughter Marci Ien as well. She named her second child "Dash" in honor of her father and his inspirational parable.
Of all the roles you had (teacher, professor, principal) in which would you say you were able to help kids the most?
As a teacher I could focus directly on the kids because I was working with them. As a principal and vice principal I focused on helping the kids by hiring the best teachers, teachers who care about kids. And you can tell. At first it was hard for me to be a principal because I love teaching kids. So as a principal I always taught. All the staff knew I would cover their classes if they ever had something important or personal to do. That was a good thing because I got to see whether my kids are learning. And because teachers knew I would cover their class and see what was going on they would make sure they're doing good things. So there was a method to my madness.
But for Marci and her siblings, Joel the teacher, was Joel the dad. And she recalls him being dedicated to his kids and their passions. "I did a show called Circle Square, I grew up on the show, I did it from when I was 10 until I was 16. We taped it every Saturday and the call time was 5:30 in the morning. Every Saturday morning for 6 years my dad drove me to the studio, in downtown Toronto and we lived in Scarborough. And there he was a teacher, working five days a week and he got up even earlier on the weekend to take me down there, and he never complained. He brought me to every taping for six years and it was crazy but it was fun. Going on the highway, sometimes we'd have hot chocolate and just the long drives and the conversations on early Saturday mornings were great. My dad has a really big heart and I think that's what made him such a great educator because he cared. He certainly taught me that, and it's carried on with me. I care for people, especially young people. And his generosity has stayed with me. He also gave us a love of art. And most definitely a love of sports. We've been going to Raptors games for 13 years and it's a date I do not break," says Marci.
After you were a teacher and principal you went on to be a professor at OISE, what made you decide to pursue a different career course?
Well I always wanted to go to OSIE. But every time I was ready to go, I got promoted. I thought I was never going to get to teach teachers; I always had a passion for doing that. I wanted to do it so badly I would hook up with OSIE and help them with interviews and help coach the kids with their resumes and interview skills. Because I used to go down to OSIE to volunteer and help, when I retired I got a call from the dean of OSIE: "Joel, we have a job down here at OSIE. We're starting a new course called 'teacher education seminar' it's a broad overall perspective of teacher education. So we'd like you to come down and talk to us." After our conversation he said "you're taking the full-time job."
During your time at OSIE you were the project coordinator of the "at risk to relief program: for at-risk teachers." Why do you think it's important to have training for teachers about at-risk youth?
Unless you have people trained who know what at-risk looks like then they won't be able to teach to correct it. The teachers have to be able to recognize at-risk behaviour, and how to make that child successful. And we never like to say a kid is at-risk themselves. When we say that a kid is at-risk we really put a stigma on that kid. Every kid can learn, it's just that they don't learn at the same rate every day. They can all learn and they all will learn if the teacher wants them to learn.
One of the interesting points of the program is that it focused on "a holistic approach to those at-risk" would you be able to explain what that approach is?
We focus on the whole kid. We make sure that student ate because that's basic and if kids are hungry they don't want to hear anything about math. So we take care of that. Then we look at home; does that student have a place to study? Then we talk to the parents; we ask them to set aside a spot where their child can sit and do homework and we ask them to encourage their child. Not everyone has parents who help them succeed so we try and fill in and be good teachers. That's why we don't just work 9-3. Then we look at the academics. I told them "I'm here to help you succeed and we're all going to succeed, but here's the deal" then I lay out what they have to do, like spend half an hour studying at home every night. "And when you go home I want you to teach your parents what you learned at the dinner table." And every night the parents had to be involved; you have to involve the parents in the child's education.
Another thing that was implemented into the teachers' at-risk program was professional seminars where teachers could create and discuss teaching methods with each other. How important do think those seminars are to have in any job setting?
Oh it's very important, to have that collegiality and an environment where everyone is willing to share, like I described at Harvard. Teachers sharing expertise, kids telling teachers "this is what you can do better for me." It's very important that teachers do that and also that they do that with their students. We have to be able to look at ourselves and we have to not be afraid to do something about what we see. Self-awareness and making adjustments, not just looking at ourselves and saying "I'm pretty good."
Some teachers say there's a difference between wisdom and knowledge, what do you think those differences are?
With knowledge you can pick up a book and read it, then you have knowledge of that book. I think wisdom goes deeper than knowledge. Anyone can get knowledge. When you become wise you are able to evaluate, appraise, assess and learn from your knowledge. When you become wise you seek knowledge.
Is there anything you think you can do as a teacher to instill wisdom into students?
Yes, by helping them when they get knowledge, encouraging them not to stop there. Tell them "I want you to go home and think about this and think about how you can apply this to your life. In what you do, how you treat others. Then tomorrow in class we'll discuss it." From that you will gain wisdom. Wisdom is one step further than knowledge.
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text:
Old Crow Medicine Show – Big Iron World
If there were a textbook on traditional, working-class, bluegrass songs, Big Iron World would be cited as a modern reference.
Derek Spahr
The cover of Old Crow Medicine Show's Big Iron World shows the five-member band standing on an empty street, seeming not to notice the camera taking their picture. When the record is opened, there is another picture of five men, but this picture is not of the band, it's of five railroad workers, presumably circa 1930. The point of the layout of these two pictures is obvious: OCMS and the railroad workers are the same people. If there were a textbook on traditional, working-class, bluegrass songs, Big Iron World would be cited as a modern reference. It's got all the requirements of the genre: a song referencing the union ("Union Maid"), a raucous song about sex (New Virginia Creeper), a song about shooting your female companion and leaving her in the ground ("My Good Gal"), and at least two songs ending with the word "blues" ("Minglewood Blues", "James River Blues.") Because of its close binding with traditional bluegrass songs, Big Iron World makes for a great listen.
"Down Home Girl" starts of the record, and sums up the perspective OCMS is coming from. It's a three-and a half minute song commenting on a woman who disguises her "down home" characteristics (ex. her breath tastes like pork and beans / she walks like she's walked through cotton fields) with "uptown" fashions (ex. perfume, high heels). OCMS let their perspective show throughout Big Iron World. Particularly on the wonderfully soulful "God's Got It," a standout, regardless of personal beliefs of the role of organized religion in the issues of the "poor man."
It would be inaccurate to assume from their "down home" outlook, that this record is some sort of red state v. blue state release. OCMS cite Karl Rove as a reference for those who are unsure if cocaine is for them ("Cocaine Habit.") This isn't to say that OCMS takes the blue side either: OCMS looks at issues in a humanist way. In "I Hear Them All," Keith Secor, one of the bands four singers, sings about listening to the struggles of people from all walks of life while the powerful sit there and "whistle Dixie with their money and their power."
Big Iron World feels like opening a door to a back room in a bar where people don't come to be seen. As you open the door wide enough to figure out you shouldn't be in there, you can't bring yourself to shut it quickly and scurry away. You are captured by five guys in the room, five guys playing songs that aren't anything new or groundbreaking, but playing them with passion and having the time of their life doing it. It's impossible to look away.
Related Topics:bluesindie


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text:
India to Buy 8,000 of These Anti-Tank Missiles From Israel
HomeIndia to Buy 8,000 of These Anti-Tank Missiles From Israel
This Article is From Oct 27, 2014
Reported by Sudhi Ranjan Sen (with inputs from Agencies)Updated: October 27, 2014 1:16 pm IST
New Delhi: India has opted to buy Israel's Spike anti-tank guided missile, rejecting a rival US offer of Javelin missiles that Washington had lobbied hard to win.
India will buy at least 8,000 Spike missiles and more than 300 launchers in a deal worth Rs 3200 crores ($525 million), it was decided at a meeting of the Defence Acquisition Council over the weekend. Twelve Dornier aircraft will also be bought for the navy and 362 infantry combat vehicles; the council also agreed to go ahead with locally building six submarines, in collaboration with a foreign partner, in a project worth $8.2 billion or Rs 52,000 crores.
Prime Minister Narendra Modi's five-month-old government wants to clear a backlog of defence orders and boost India's firepower, amid recent border tensions with China and heavy exchanges of fire with Pakistan across the Kashmir border.
"National security is the paramount concern of the government," an unnamed source told Reuters, quoting Defence Minister Arun Jaitley, who also holds the finance portfolio, as telling the procurement panel.
Spike is a man-portable 'fire and forget' anti-tank missile that locks on to targets before shooting. It is produced by Israel's Rafael Advanced Defence Systems, which declined to comment.
It beat out the rival US Javelin weapons system, built by Lockheed Martin Corp and Raytheon Co, that Defense Secretary Chuck Hagel had pitched during PM Modi's visit to Washington at the end of September.
US Javelin weapons system didn't compete initially. At much later date when field trials, technology transfer and cost had been worked with Israel, US offered to co-develop and co-produce the missiles.
Sources told NDTV that South Block decided against the US offer for three reasons: One, the extent of Technology Transfer to the Indian counterpart Bharat Dynamic wasn't clear; two, the cost of the Israeli missiles was cheaper than the US missile and finally canceling the Israeli deal at the last moment would have sent wrong signals to the international community.
Analysts estimate that India, the world's largest arms buyer, will invest as much as $250 billion in upgrading its Soviet-era military hardware and close the gap on strategic rival China, which spends three times as much a year on defence.
The government has raised the foreign investment cap on India's defence industries to speed up the military's modernisation.
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This Friday, students and teachers will be marking the passage of time and celebrating the autumn season together between 9:30 and 10:30.
Students will celebrate with their older/younger buddies, collecting and painting fall leaves, voting for their favorite pumpkin decorations, taking buddy costume pictures, and gathering as a whole school to listen to a story about the passage of time.
Parents, please encourage your children to wear costumes (and bring street clothes to change into), bring their carved and decorated pumpkins to school, and keep a look out for countless cute pictures to follow!


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