text:
Q: How to Configure Spring Cloud StreamBridge to produce Avro? So I am trying to use StreamBridge to dynamically send messages to different topics. I am successful in doing so if my output is a Message< String>, but not Message< GenericRecord>
Code example:
@StreamListener(Sink.INPUT)
public void process(@Payload GenericRecord messageValue,
                    @Header(KafkaHeaders.RECEIVED_MESSAGE_KEY) GenericRecord messageKey,
                    @Header("Type") String type) {
    log.info("Processing Event --> " + messageValue);

    // Code...

    // convert to Message<GenericRecord>
    Message<GenericRecord> message = ...

    streamBridge.send(type, message);

    log.info("Processed Event --> " + messageValue);
}

The error I get is Caused by: org.springframework.messaging.converter.MessageConversionException: Could not write JSON: Not a map: which I am guessing is because streamBridge acceptedOutputTypes = application/json
2020-06-28 04:42:55.670  INFO 54347 --- [container-0-C-1] o.s.c.f.c.c.SimpleFunctionRegistry       : Looking up function 'streamBridge' with acceptedOutputTypes: [application/json]

I tried modify accepted output type to be avro by setting the following in my properties, which did not work.
spring.cloud.stream.function.definition=streamBridge
spring.kafka.producer.key-serializer=io.confluent.kafka.serializers.KafkaAvroSerializer
spring.kafka.producer.value-serializer=io.confluent.kafka.serializers.KafkaAvroSerializer
spring.cloud.stream.bindings.streamBridge-out-0.content-type=application/*+avro
spring.cloud.stream.bindings.streamBridge-out-0.producer.use-native-encoding=true

Any ideas on how to configure StreamBridge to be avro?
edit: I also tried streamBridge.send(type, message, MimeType.valueOf("application/*+avro")) but that also had a conversion error.

A: I could not get StreamBridge to work dynamically so I switched to using Function:
@Bean
public Function<Message<GenericRecord>, Message<GenericRecord>> process() {
    return message -> {

        // Code...

        String topic = message.getHeaders().get("type");

        // convert to Message<GenericRecord>
        Message<GenericRecord> message = MessageBuilder...
            .setHeader("spring.cloud.stream.sendto.destination", topic)
            .build();

        return outgoingMessage;
    };
}

Properties file is:
spring.cloud.function.definition=process
spring.cloud.stream.bindings.process-in-0.destination=${consumer_topic}
spring.cloud.stream.bindings.process-in-0.group=${spring.application.name}

spring.cloud.stream.bindings.process-out-0.content-type=application/*+avro
spring.cloud.stream.bindings.process-out-0.producer.use-native-encoding=true

Edit: Streambridge got fixed to support this: https://github.com/spring-cloud/spring-cloud-stream/issues/2007

A: You need to the the useNativeEncoding producer property to use a custom serializer.

redpajama_set_name: RedPajamaStackExchange


· To provide high quality professional development for senior leaders looking to take the next step.
· To provide practical tools to take away.
· To provide evidence-based examples of impact to develop confidence and provide a network of support.
3 twilight sessions: 3.45 refreshments for 4 pm start.
In addition, an opportunity to shadow a head teacher for a day, providing a close-up and honest opportunity for discussion and evaluation on the exciting opportunities headship enables.


text:
Human rights under Sisi
Egypt's open-air prison
Egyptian authorities have arrested thousands in a crackdown on dissent, even its most benign forms. And some former prisoners are finding that they are not really free despite having been released. Ruth Michaelson reports on the case of a female Egyptian activist from Cairo
Just before dawn on 11 May last year, Amal Fathy and her husband Mohammed Lotfy's lives changed forever. As Amal was trying to get their young son to sleep, Lotfy heard a knock at the door. On the other side, a plainclothes security officer stood alongside a group of masked and heavily armed special forces. Lotfy let them in and invited them to sit down.
"The plainclothes security official pulled up a chair at the dining table. He said to me, 'You must know why we are here,'" recalled Lotfy.
While Lotfy was working documenting human rights abuses with his organisation, the Egyptian Commission for Rights and Freedoms, it had been Amal that was in danger, despite her having done no more than upload a video to social media complaining about sexual harassment she'd suffered during a visit to the bank. The video had gone viral and smears about Amal, a former actress and activist, began to appear in the pro-government local media.
Still, said Lotfy, "I didn't expect her to be arrested." When the officers demanded that the couple come to the local police station, they found another dozen masked and armed special forces waiting outside their building, who looked as though they were prepared to arrest hardened criminals.
Capriciousness and draconian punishments
Amal was taken into pre-trial detention, where two charges were laid against her: the first of spreading false news, undermining national security and publishing "an indecent video using foul language", and the second, brought by Egypt's national security prosecution service, of belonging to a terrorist group, spreading false news and undermining national security.
Wegen Kritik an sexueller BelästArrested for criticising sexual harassment: according to Amnesty International, the detention of human rights activist Amal Fathy represents a new low point for freedom of expression in Egypt. Amal Fathy had reported via Facebook about the sexualised harassment she had experienced and criticised the government for not addressing the problemigung verhaftet: Nach Darstellung von Amnesty International stellt die Inhaftierung der Menschenrechtsverteidigerin Amal Fathy einen neuen Tiefpunkt für das Recht auf freie Meinungsäußerung in Ägypten dar. Amal Fathy hatte über Facebook über die von ihr erlebte sexualisierte Belästigung berichtet und die Regierung kritisiert, weil sie sich dieses Problems nicht annimmt.
"We don't know which terrorist group or group they're referring to and we don't know what the evidence against her is – we don't have access to the case file. We don't even know if it's about the video as well, or if it's actually about something else," said Lotfy.
Amal's detention punished both her and her family. "For almost three months, I wasn't myself," Lotfy recounted. "I couldn't stay seated even for an hour. I was hyperactive and nervous. I was constantly trying to distract myself from the idea that my wife was detained and there was little I could do. It even affected my relationship with our son, as I couldn't sit with him for more than an hour." When their son, now almost 4 years old, would ask where his mother was, Lotfy told him Amal was in hospital.
The 34-year-old was held in pre-trial detention until 30 December last year, when she was released on probation. She received confirmation of her first sentence just three days later. Both cases still loom large over the family's day-to-day existence, amid fears that Amal could be re-arrested at any time. Although she is now out of prison, confusion surrounding the terms of her probation means that she remains under house arrest.
Human rights in a stranglehold
Her case is, sadly, far from unique: She is now one of a growing number of high-profile prisoners released into what human rights groups have called an open-air prison. An estimated 60,000 people are currently imprisoned in Egypt on political or politically related charges, according to Human Rights Watch, although Egyptian President Abdul-Fattah al-Sisi and the Egyptian authorities have routinely denied that any political prisoners exist in the country.
All on one page
Egypt's presidential election: The defamation gameAbducted civilians in Egypt: The disappearedAfter the release of Egyptian blogger Alaa Abdel-Fattah: Freedom of expression at an all-time low
Abdul Fattah al-Sisi, Arab Spring, Arabellion, Democracy and civil society, Egypt Revolution 2011, Egypt's army, Freedom of the press, Human rights
Political analyst Taqadum al-Khatib argues that Egypt can, in co-ordination with its European partners, develop a common vision to solve the complex conflict in Libya. For this to ...More
Arab Spring 2.0
The Middle East's fearless protesters
The upheavals of the past year in the MENA region are arguably as momentous as those of the Arab Spring in 2011. Yet perhaps the biggest difference is that our interest seems to ...More
Book review: Tawfiq al-Hakim's "Return of the Spirit"
Awaiting the day of resurrection
In 2019, the long-running Penguin Classics series released its first novel translated from Arabic: Tawfiq al-Hakim's "Return of the Spirit", conveyed into English by William ...More
The Prophet and Sharia
Islamic family law reform – a question of interpretation
Equality in divorce, a ban on polygamy: reformers of Islamic family law have a clear agenda. They are exploiting the ambiguity of traditional jurisprudence. By Joseph CroitoruMore
Sisi's raids on the press
Egypt's Mada Masr – "We're not going to shut up"
Raids on Egypt's last independent news outlet, Mada Masr, have left its staff shaken but defiant. Reporters are working under "increasingly hostile" circumstances in Cairo, ...More
Interview with Lebanese writer Amin Maalouf
Petrodollars proved stronger in the Middle East than cultural tradition
Decades of oil exports have completely destabilised culture and politics in the Middle East. Speaking with Lena Bopp, the renowned writer Amin Maalouf says that the distorted ...More
Ruth Michaelson
https://en.qantara.de/node/35423

redpajama_set_name: RedPajamaCommonCrawl


In my last post, I explained that Christians typically try to convince non-Christians of the truth of the Bible by proving its reliability textually and historically. But non-Christians have another way of evaluating Christianity: they want to know if they can trust the Bible morally.
It doesn't occur to me to answer that question for one main reason. I have lived so long inside the Christian worldview that I forget how different our religion is. Most religions and philosophies aim to change behavior from bad to good in order to please God, be a good citizen, or feel good daily. Christianity, on the other hand, only tries to prove that something happened historically. Once you've proved that, you work backwards to prove the rest. My question is "Is Jesus God who rose from the dead?" Once I answer that question then I can assume that God knows how I ought to live.
Here's why this is great news. When a person simply evaluates from their own perspective whether or not a certain philosophy or religion will make them "good," "please God," or "feel good," they're doing the best they can. But they're basically just reflecting the current wisdom of their friends and family and media. They cannot rise above their culture because they're stuck in it; just like a fish couldn't imagine walking on land because his whole world involves water. When Christianity comes along with its way of "being good," "pleasing God," and "feeling good daily," the wisdom comes from another world. It's not up for debate or evaluation because we humbly realize that God is speaking (as opposed to humans, who should be critiqued).
Evaluating Christianity goes like this: Did Jesus die as a historical event? Did he rise from the dead? If so, then he must have been someone very important. What did he say about himself? Did God approve of his message? Jesus claimed to be God. And when God lets Jesus come back to life, that seems like a pretty significant endorsement of what Jesus said. Now, with that in mind, how did Jesus say we get on good terms with God? How did he command us to live? Our aim is to figure that out, respond accordingly, and assume that God knows best how to be good rather than bad, how to please God, and how to feel good today. History comes first, and all the practical stuff is the natural result.
A few weeks ago I preached a sermon called "You Can Trust the Bible." Like I've always done in talks like this I laid out a simple path: 1) You can trust the Bible textually. 2) You can trust the Bible historically. 3) You can trust the Bible personally.
With the first point I showed how the copies of various books of the Bible are so plentiful and precise that we can know with nearly perfect confidence that the words in our Bibles are the words originally written by the authors. With the second point I showed how the Bible stands up to repeated attacks on its historical value, proving itself more accurate over and over. This makes sense because the authors have such an incredible advantage over modern people in terms of knowing what actually happened (i.e. they saw it happen).
After making those two points, I pulled in for the clincher, "That's why you can trust the Bible and give your life to Jesus." Christians in the audience loved it. I got lots of pats on the back from those in our family.
Nearly every book I read in college and seminary about how to "prove" the Bible took my two steps. But modern people expect another step. They have a different standard for evaluating a religion. They want to know if they can trust it morally.
Modern people expect to know if they can trust every moral claim about a religion or philosophy before they jump into it. Think about this for a minute. Why do they have this expectation? I'll give two reasons, but I'll only focus on the second.
1) Religions and philosophies aren't chosen these days because they're true but because you agree with them. People chose a religion as an endorsement of the philosophy they already hold. It's like getting a historical, cultural stamp of approval that backs up what you already believe.
2) They want an answer to this question because this is how modern religions and philosophies are evaluated.
I'm finding that more and more of my non-Christian friends approach spirituality in a semi-Buddhist way, so I'll use that religion to make my point.
Not every person in the West thinks just like this. Not everyone connects their line of reasoning to Buddhism. But there are similarities among hard-working pragmatists, socially progressive secular humanists, well-meaning agnostics, generous atheists, and sweet and carefree New Agers. Ultimately they want to find a life-philosophy that helps them be good not bad, be good enough for 'god', or feel good today.
So, when I go on and on about historical arguments for the Bible and its factual nature, people yawn. Other people seem interested but unaffected on a spiritual level. The textual question doesn't matter to them, nor does the historical question. They want the moral, life philosophy, personal peace, 'be good' question answered.
It's an important question. And in the next post, I'll explain how Christianity actually answers it.
Huston Smith, World Religions, 98. Quotes from Woodward, Some Sayings, 283.
Can You Trust Your Bible, Part 1: Hasn't the Bible Been Changed Over Time?
The Bible is of the utmost importance to Christians. This is our foundation for life and godliness; the source for our beliefs about God, ourselves, and our world; and the place we go to hear the voice of God. Whether your Bible is dusty or well-worn, the Bible is essential to your life as a Christian.
But can we trust it? Most of us would say yes. Yet most Christians would be hard pressed to explain why they believe the Bible is trustworthy. When skeptics tell us that the Bible is unreliable, that it has been copied and recopied so many times that it can't be trusted, that the Bible has been changed by human beings, that it's old fashioned and irrelevant for today, and many other such accusations, we brush them aside. But deep down, many of us feel uneasy.
Part 1: Hasn't the Bible Been Changed Over Time?
Part 2: Doesn't the Bible Contain Errors?
Part 3: How Do We Know the Bible Is Scripture?
Part 4: Who Put the Bible Together?
Part 5: How Do We Know We Got the Right Books?
Part 6: What Gives the Bible Its Authority?
Two accusations against the Bible go hand in hand. One is that the Bible contains errors (we will deal with this tomorrow), and the other is that the Bible has been changed over time. Christians have historically believed that the Bible is inerrant (i.e., it contains no errors). So if the Bible does indeed contain errors—whether historical, scientific, self-contradictory, etc.—and if the Bible has indeed been changed, then we have a problem.
First of all, it is important to clarify that when we say the Bible is inerrant, we mean that it contains no errors in its original manuscripts. We don't have any of the original manuscripts for any of the books of the Bible (this seems like a good thing considering how easy it would be for these manuscripts to become idols). We have many (I mean that: many!) manuscripts that are very old, but none that are original. So if we find a minor mistake here and there (and we do find minor inconsistencies), we don't need to be unsettled—we're only claiming inerrancy for the original documents.
Now, I just mentioned two scary things: (1) we don't have any of the original manuscripts, and (2) our copies contain minor errors. Don't be afraid. In reality, the diversity of the manuscripts we have actually strengthens the reliability of Scripture. Early on, the books of the New Testament were copied, translated, and spread across the known world. So if someone was going to tamper with the words of Scripture, they had a narrow time frame in which to do it. The reality is that we have many manuscripts in a handful of languages. So there are "families" of Greek manuscripts that are very similar to one another. There are also "families" of Coptic manuscripts that are very similar to one another, etc.
Let's put this into perspective. We have somewhere north of 20,000 manuscripts of the New Testament in museums and collections around the world. That's a lot. And if that doesn't sound impressive to you, consider that many of other works we have from the ancient world are considered reliable even though they are based on no more than a few manuscripts.
And here's the impressive thing. These diverse manuscripts agree with each other more than 99% of the time. So the Bible spread around the world, was translated into a handful of languages, and was copied like crazy. And all of these copies agree with one another almost completely. That less than 1% disagreement is not scary in number or in content. It is significant that we know exactly where these discrepancies are located. You can see them as you're reading your Bible. Most English translations mark these with footnotes that indicate "Some manuscripts read "_____." Pay attention to these while you read, and you'll find that they are rare and that none of them are very significant.
We'll talk about the Old Testament a bit in Part 4, but it's worth pointing out the discovery of the Dead Sea Scrolls. These scrolls were discovered in 1948 in caves near the Dead Sea. They contained a lot of things, but significantly, archaeologists found several copies of the Old Testament. Prior to their discovery, the oldest manuscript of the Old Testament that we had was dated around 1000 AD. The Dead Sea Scrolls, however, were dated around 200 BC. This means that they were written, sealed up, and hiding in the darkness long before Jesus and his followers were born, just waiting to be discovered in the 20th century. In many cases, these Old Testament scrolls match our Bibles very closely. In some cases, the scrolls differ. What this means (and this was not news to scholars) is that a handful of textual traditions were in circulation even at that early date. In any case, this finding confirms that our Old Testament has not been reworked wholesale since the time of Christ. (For more on the reliability of the Old Testament, stick around for Part 4).
So we can be confident that the Bible we have matches the Bible that the inspired authors wrote. But does that matter? If the original manuscripts contain errors, then we can't trust our Bibles. I'll address that possibility tomorrow.


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text:
# Examples #

-------

### Basic pipeline ###
A basic pipeline process which stream each row to the next operation in order of dependencies

The output of the pipeline is as follows:

1. Operation 1 running with message 'First Row'
2. Operation 2 running with message 'First Row'
3. Operation 3 running with message 'First Row'
4. Operation 1 running with message 'Second Row'
5. Operation 2 running with message 'Second Row'
6. Operation 3 running with message 'Second Row'

### Process with custom context ###
A process with a custom context showing how data can be stuffed in the context and shared between all rows

### Mixed yielding pipeline ###
A process which mixes streaming operations (per row) which return using the yielding keyword with synchronous operations (per operation) which return all the data at the completion of their execution

The output of the pipeline is as follows:

1. Operation 1 running with message 'First Row'
2. Operation 2 running with message 'First Row'
3. Operation 1 running with message 'Second Row'
4. Operation 2 running with message 'Second Row'
5. Operation 3 running with message 'First Row'
6. Operation 3 running with message 'Second Row'

### Add and remove ###
Yet to be done

### Product import ###
A simple process showing how you would load data from a flat model into some sort of database

Process operations:

- Creates and stores product categories which are not in the database
- Finds the matching product category GUID for the product and then store the product in the database

### Send Orders ###
Yet to be done

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Teresa Evans, a veteran classroom teacher in Australia, designed this Everyday Games homeschool language arts course as a fun and interesting way to teach math and phonics. Her math games can help elementary homeschool students improve without realizing they are really "doing math." The reading games practice many skills, such as consonant blends, suffixes, prefixes, compound words, and much more. One of the best ways to encourage a student to learn is by helping them have fun, and Everyday Games do just that!
To view Reading Games by skill, go to the Literacy Center, and search "Everyday Games." To view Math Games by skill, go to the Focused Learning Center: Math and scroll to Everyday Games.
Go to Class Lessons and download the lesson plan and selected game. Record chosen games on the lesson plan and check them off when completed.
These Everyday Games homeschool language arts include printable board games that make early reading and math skills fun for young homeschool students.
Visit the Literacy Center and Math Center to find a list of games by skill.
Tic Toe Toe is a classic pencil and paper game that has been played for generations and generations. Wikipedia actually tells me that it was played by the Romans in the first century BC by a different name of course. So I think I can rightly say that this game has really stood the test of time.
One of the things I like most about using Tic Tac Toe with children is that it teaches strategic thinking. While chess may be too complex for some children, this simple game can be enjoyed by all and help them to develop thinking skills.
While the rules are simple and universal, did you know that with a few simple changes this classic game also makes a great math game. Best of all, you don't need any fancy materials, just some paper and a pencil! Here are a few different version that you might like to try!
Total 15 – One player is odd numbers – 1, 3, 5, 7, 9; the other player is even numbers and 0 – 0, 2, 4, 6, 8. Players take turns to add a number to the Tic Tac Toe grid. Odd numbers start. Use each number only once. The first person to complete a line that adds up to 15 is the winner. The line can have both odd and even numbers. This is much trickier than it looks and players can use lots of strategy as they carefully place their numbers.
Total 12 – Play as above but total to 12 instead of 15.
Total 18 – Play as for Total 15 but total to 18 instead.
After many years of using games in her classrooms, Teresa Evans, a veteran teacher in Australia, designed these language arts Everyday Games that are simple to prepare, easy to learn, fun, and engaging for the children. She promotes games as a wonderful tool for introducing a new concept and reviewing concepts and skills. Games allow children to have fun while they learn, and often they have so much fun that they don't even realize they are learning.
Mrs. Evans started sharing her homeschool language arts games online several years ago, and they are now used by teachers, homeschoolers, and parents in many different countries. Her games tend to focus on printable games for math, phonics, and reading skills. She really enjoys creating games that are colorful and visually appealing, while retaining a high educational value, and she loves to challenge children with games and make them really think! She also creates math puzzles and brain teasers that require children to apply their math skills and knowledge.
Mrs. Evans' educational motto is "Keep it Simple." She believes games should be simple to prepare and use but also provide maximum educational value. Her games make learning and reviewing skills fun, challenging, and engaging, and they can help children build their skills and confidence in the areas of math and phonics.
Currently, Mrs. Evans works from home creating games and resources for her online sites. You can see more of her games at Making Math More Fun, Kids Reading Games, and Games 4 Learning.
Would you like to tell others about this Everyday Games homeschool language arts course?


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text:
Plastic woke-washing: Is this fake leadership fooling anyone anymore?
By Sian Sutherland, Co-founder of A Plastic Planet
IN APRIL 1994, senior executives from the seven largest tobacco companies in the US appeared before a Congressional committee on health. One by one the men took it in turns to tell chair Democrat Henry Waxman from California that nicotine isn't addictive. [i] Speaking some three decades after the US Surgeon General's landmark report on smoking and lung cancer, [ii] the kingpins of big tobacco just about managed to keep a straight face throughout. Fast forward to 2019 and there's a stark comparison with the rhetoric happening around the plastic crisis.
Good business doing the right thing in the right way makes the world go around at a time when Nature needs all the help it can get. But so often corporations vested in maintaining a proven destructive status quo deploy breathtakingly bold but paper-thin diversionary tactics to delay desperately needed change.
"Will this be the tipping point for plastic?"
Industry leaders have known for decades exactly how damaging the plastic they've been selling us has been to the planet. In 1972, two seminal papers were published in the journal Science, revealing the presence of plastic in the North Atlantic Ocean. Researchers found around 3500 plastic particle pieces per square kilometre in the western Sargasso Sea. [iii] In 1979, a Hawaii state circuit court struck down a plastic bottle ban following covert lobbying from the Society of the Plastics Industry. [iv]
Some four decades later the world's biggest producers are seeking to shape the debate in a more overt way. Earlier this year, 30 chemical and plastics manufacturers from around the world clubbed together to launch the self-styled Alliance to End Plastic Waste. The firms have committed to investing some £778 billion over the next five years in infrastructure and innovation. Hidden amongst an almost implausibly vague set of campaign objectives is a vow to keep plastic waste "in the right place." [v] There is no measurable goal of reducing the actual production of the plastic that will almost always become valueless waste plaguing our oceans and landscapes for decades to come. Many of the members of this plastic waste-fighting Alliance are also the world's biggest plastic polluters. It's like arsonists lobbying for better fire extinguishers.
"Our industry leaders have Herculean tasks ahead."
The tipping point for the tobacco industry was, of course, the final acceptance that it is damaging to human health. Many scientists believe the omnipresence of plastic – now measurable in our air, our soil, our drinking water and even our own bodies – is also impacting our health. Will this be the tipping point for plastic? The final reckoning that EPR [Extended Produce' Responsibility] will actually extend beyond 'recycling' and mean culpability for the impact of the endocrine-disrupting chemicals our plastic is riddled with? Environmental lawyers Client Earth and CIEL reports state it could be only a matter of time.
Our industry leaders have Herculean tasks ahead. They need to lead us out of our addictive misuse of a miraculous but toxic material and must do so with absolute transparency. Plastic pacts, pledges and policies that include slippery words like 'recyclable' (by whom exactly?) are no longer sufficient for an increasingly savvy citizen. Nor is creating deflective quangos. Blaming plastic pollution on littering is yet another diversionary tactic; heaping the responsibility again on the public who don't yet have much plastic-free choice. People buy what they are sold. It is industry's job to sell them something different. It really is that simple.
Sian Sutherland is Co-Founder of A Plastic Planet (and a Founding Member of The Conduit). The global campaign group has a single goal – to ignite and inspire the world to turn off the plastic tap. To learn more about Sian and A Plastic Planet, listen to her interview on our podcast, Conduit Conversations.
Would you like to write for Conduit Insights? Get in touch to learn more.
[i] https://www.who.int/tobacco/media/en/TobaccoExplained.pdf
[ii] https://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/60
[iii] https://www.ncbi.nlm.nih.gov/pubmed/5061243
[iv] https://elr.info/sites/default/files/articles/9.10193.htm#op_1_fn_48
[v] https://endplasticwaste.org/answers/
Inside Cambridge Analytica's Plot to Break the World A chat with Conduit Connect member Sylvana Sinha


Buy stock companies that create the technology behind the coins or prefer to buy only the coins?
What is the most undervalued altcoin today?
Bittrex getting USD pairs? Will this help altcoins overcome the BTC bear market?
Why are cryptocurrency faucets going out of fashion?


text:
You are here Travel guides Culture Urban Squares, Streets & Urban Spaces Bremen Marketplace
Bremen Marketplace
Listed under Squares, Streets & Urban Spaces in Bremen, Germany.
Photo by flickr user treehouse1977
'The Town Hall and the statue of Roland on the marketplace of Bremen in north-west Germany are outstanding representations of civic autonomy and sovereignty, as these developed in the Holy Roman Empire in Europe. The old town hall was built in the Gothic style in the early 15th century, after Bremen joined the Hanseatic League. The building was renovated in the so-called Weser Renaissance style in the early 17th century. A new town hall was built next to the old one in the early 20th century as part of an ensemble that survived bombardment during the Second World War. The statue stands 5.5 m tall and dates back to 1404.'
Copyright © UNESCO/World Heritage Centre. All rights reserved.
UNESCO.
Written by press.
Gamla Stan and Stadsholmen Island
Gamla Stan 'The Old City' was where Stockholm started, and when the commercial and residential sections spread onto 13 surround…
Palaces and Parks of Potsdam and Berlin
Construction for the New Palace began in 1763 to celebrate Prussia's success in the Seven Years War, under the reign of Fredric…
Las Vegas Strip – The Strip
Bright flashing lights in weird and wonderful shapes, music and palpable wealth: really called Las Vegas Boulevard South, a fou…
Park Hotel Bremen
"Huge, country-styled hotel, primarily business, in a park in the middle of Bremen"
Munster Christmas Market
The real magic of the traditional German Christmas markets is in the air – or the atmosphere to be precise. The contrast of th…
"Fun and funky 60s-themed pad with an almost unbelievably cheap price tag"
Bremen travel guide
Lower Saxony travel guide
Germany travel guide
Germany travel specialists
The best Squares, Streets & Urban Spaces


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Shannon Chamber Skillnet
Skillnet Steering Group
Chambers Ireland Board
Shannon For Business
Shannon Free Zone
Made in Shannon
Why Shannon?
The Shannon Region
World-Class Visitor Attractions
Shannon for Investment
Other Certs of Origin
How to Complete a Certificate of Origin
Verify a Cert
Sources of Information for Importers and Exporters
Shannon Chamber Forums
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Our Members' Views
Purchase Order Finance a new mechanism to fund working capital for SMEs
Pictured at the Shannon Chamber and InvoiceFair seminar in the Oakwood Hotel in Shannon (from left): Aengus Burns, Grant Thornton; Helen Cahill and Peter Brady, InvoiceFair; William Cleary, management consultant; Sharon O'Dwyer, Greentech Plastics Ltd., and; Damian Gleeson, Grant Thornton and director, Shannon Chamber. Photo: Eamon Ward.
An obvious gap in the market for a mechanism to connect small and medium-sized companies (SMEs) with Capital Markets Funders to enable them access essential cash flow led to the formation of InvoiceFair, who have developed a market-based funding solution that is economically accessible to Irish SMEs looking for Purchase Order Finance.
The inspiration for InvoiceFair came from the co-founders', Helen Cahill, Peter Brady and Ivan Fox, combined involvement and understanding of working capital, financial services, investment markets, and the dynamics of running a business. Their vision was to address the on-going market failure facing SMEs around access to appropriate solutions to working capital finance.
The company was recently awarded Deloitte's 'Most Disruptive FinTech 2019' award for providing real choice and alternatives for ambitious SMEs seeking funding. Invoice Fair has traded receivables worth €400million since 2015.
The benefits that can be derived from access to the receivables trading platform were outlined at a recent Shannon Chamber seminar, held in association with InvoiceFair and Grant Thornton, at which a number of companies in the Mid-West outlined how it has helped them scale, expand into export markets, fund new projects and extend customer reach.
Speaking at the seminar, Ms Cahill CEO said: "While SMEs can fund certain elements of their businesses through traditional banks, their growth is often restricted by an inability to access the required working capital. That's where InvoiceFair make a real impact; the platform enables SMEs to release working capital by selling their current or future receivables to a pool of institutional funders. Unlike traditional facilities, the SME, by accessing a deep pool of funders, will not run up against concentration or geographic limits and will be able to leverage on blue chip purchase orders to release cash when they need it.
"There is a burgeoning appetite for trade receivables by institutional funds, which our platform has access to. The platform gives SMEs a gateway to capital market funders, an audience they could not otherwise access. This big market failure is access to Purchase Order Finance and we are addressing this gap," Ms Cahill added.
As Grant Thornton's advisory partner, Aengus Burns stated: "We are seeing a growing number of non-traditional funders in the market, smaller operators who are nimble and flexible in their approach. They are looking for a great story, a business with a future led by strong, credible people."
With a deep background in industry, InvoiceFair's co-founder Peter Brady understands intimately the importance of working capital: "Companies need to have enough funds to pay the bills. The biggest challenge for many is not winning the big purchase order but the ability to fund it. They can't get the materials in or they can't get the people to deliver it. Releasing a percentage of the sales order value to acquire finance in advance enables companies to pay suppliers up front; to fund their supply chains.
"The Capital Markets Funders understand receivables and future receivables as an investment class; they have the knowledge to be able to understand the risk and the strength of the business model. The InvoiceFair platform unlocks cash for companies within twenty-four hours; that's the real benefit to an SME. Speed and flexibility mean everything when working capital is under pressure," he added.
Sharon O'Dwyer, general manager, Greentech Plastics Ltd., Limerick, a user of Purchase Order finance from InvoiceFair, speaking at the seminar said: "Working capital is essential to the success of any company, particularly when you are in a position to win new business. The one thing you want to avoid with a finance provider is slow decision-making and this is where we have found InvoiceFair to be of exceptional benefit. We have access to working capital finance within twenty-four hours."
Commenting on the value of a seminar of this nature, Shannon Chamber chief executive, Helen Downes added: "It is important to put the spotlight on any aspect of finance that can deliver benefits to companies, particularly the small to medium sized company. They are the lifeblood of our economy and any new platform, like InvoiceFair, and that has been already regarded as a game changer for financing working capital, has to be highlighted. We were delighted to host the seminar and to hear from two users of the platform, Sharon O'Dwyer of Greentech Plastics and William Cleary, a management consultant, who is vastly experienced in working with SMEs across multiple sectors."
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Why One New Amsterdam Star Thought The Pregnancy Reveal Was A Joke, and 'Repercussions' On The Way
New Amsterdam ended the first half of Season 4 with a doozy of an episode that shook up just about every character and many relationships, and fans can count on some fallout when the show returns in 2022. One of the biggest shockers of the episode came at the end, when Lyn Malvo dropped a bombshell on Reynolds that will really put his statement that he's "up for complicated" to the test. She's pregnant, and the pregnancy will have some repercussions in the rest of Season 4… even though actor Jocko Sims originally thought it was a joke.
I spoke with Jocko Sims about the midseason finale of New Amsterdam and the pregnancy twist that few fans probably thought would actually happen. After all, the Reynolds/Malvo/Baptiste situation is complicated enough already! The actor shared his reaction to finding out about what's in store for these characters:
What I try to do is I try to catch things at the table read, which we have one today for Episode 12 or 13, and that is exciting for me. You know, to see it the first time written, but somebody on set, Andy Voegeli, our cinematographer, he ruined it for me. And it really ruined the surprise for many reasons. One, I thought he was joking with me. I'll tell you that, I'll give you that. That's a good answer. I thought it was a joke. But I think it's so damn good. I think it's so interesting. I think that we need this on the show, and I think the fans are gonna love it.
It may have seemed like a joke when the cinematographer of all people dropped the spoiler on Jocko Sims, but neither Malvo nor Reynolds were laughing about it when she dropped it on him in the midseason finale! Admittedly, the episode ended before there was time for Reynolds to do much more than look stunned, and it's hard to blame him.
When he said he was up for complicated, it seems pretty safe to say that this isn't what he had in mind! When I noted that an unplanned pregnancy is something that you don't really see coming with three surgeons – one of whom is an OB/GYN – involved, he shared his perspective:
Yeah. [laughs] Three intelligent adults here that have somehow found themselves in this situation. Love is a powerful thing.
Love has certainly been powerful enough between Reynolds, Malvo, and Baptiste that they've all tried to navigate this unconventional relationship, but will it be powerful enough now that there are two candidates as the father of her child? It's clearly early enough in the pregnancy that she's not showing yet, and an OB/GYN might be in tune with her own body enough to suspect and test herself pretty early, so a question now is how soon it would even be medically possible to test the paternity.
A lot may depend on whether or not there's a big time jump between the midseason finale and when New Amsterdam returns in the new year, but Jocko Sims confirmed that the question of the father is definitely going to come up. And there will be some "repercussions" for how they handle it, as he explained:
There will be a moment where Reynolds and Baptiste are very interested to know who the father is. And their desire to know this, it's gonna come with a little bit of repercussions. We tend to forget about Lyn and what she's going through in the pregnancy, as there might be some complications.
The actor didn't specify whether these "complications" will be emotional – which they should all just expect by this point in their three-person relationship – or physical for Malvo. She certainly has a high-stress job, and her life presumably won't be any less stressful now that she's dealing with an unplanned pregnancy and two men who are seemingly concerned more about the paternity than her well-being.
Still, only time will tell how the story unfolds. Fans have seen enough of Reynolds over four seasons so far to be confident that he wouldn't deliberately ignore what she's going through, so it should be interesting to see what happens and how all three of them will handle it. Although the future is uncertain for the polyamorous trio, Jocko Sims did weigh in on what kind of hypothetical father Reynolds would be:
I think that he'd be a great father. I think it'd be a great storyline for him to have kids, and have a family. If it's with Lyn, or anyone else maybe in the future. We're not sure where this relationship will end up. But I've always wanted Reynolds to have kids. I think that'd be great. I think he'd be a great father.
Will fans get to see Reynolds become a dad? Even if he is the father of Malvo's future child, she presumably wouldn't give birth before the end of the season, short of a big time jump. Then again, until we've seen what the complications are and what decisions these three doctors make about the pregnancy, we can only speculate about whether fatherhood is in his future soon, eventually, or at all.
New Amsterdam returns for the second half of Season 4 with the midseason premiere on Tuesday, January 4 at 10 p.m. ET on NBC, immediately following the premiere of the sixth and final season of This Is Us. There's a lot more on the way even beyond Reynolds, Malvo, and Baptiste, with Max and Helen actually leaving New York for London despite Dr. Fuentes seizing control of the hospital. According to showrunner David Schulner, there's going to be a sense of abandonment among those they left behind, and there is some additional relationship drama on the way due to Leyla finding out the truth about Bloom's bribe.
Resident of One Chicago, Bachelor Nation, and Cleveland. Has opinions about crossovers, Star Wars, and superheroes. Will not time travel.
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Home DUI & DWI Illinois Rosamond
Rosamond DUI & DWI Lawyers
Daniel C Jackson
Champaign, IL DUI & DWI Lawyer with 20 years of experience
(217) 383-0140	501 W. University Avenue
Champaign,	IL 61820
Free ConsultationDUI & DWI and Criminal Defense
Rachael E Moore Perry
Bloomington, IL DUI & DWI Attorney
Bloomington,	IL 61701
DUI & DWI, Criminal Defense, Family and Traffic Tickets
Southern Illinois University - Carbondale
Rachael enjoys representing clients with passion and fervor in family matters, criminal defense and bankruptcy. In her words, "The people are the very best part of this job – it's what made me choose this career. Obtaining the best result possible for someone during a difficult time in their life brings me personal and professional satisfaction."
Chris Gramm
Bloomington, IL DUI & DWI Lawyer with 20 years of experience
(309) 275-6677	820 E. Grove Street
DUI & DWI, Criminal Defense and Traffic Tickets
Chris Gramm was born and raised in McLean County. After graduating from University High School in Normal, he received his BA from Illinois State University(ISU) and MA from the University of Illinois (U of I) prior to attending law school at Northern Illinois University(NIU). Before opening a law practice in Bloomington, he was formerly a lawyer with the McLean County State's Attorney's Office where he prosecuted misdemeanors, DUI and traffic cases. Chris is a member of the McLean County and Illinois State Bar Association and the National Association of Criminal Defense Lawyers. Chris is now a partner with the law...
Robert Elovitz
Edwardsville, IL DUI & DWI Lawyer with 32 years of experience
(618) 692-4800	521 St Louis St
Edwardsville,	IL 62025
Free ConsultationDUI & DWI, Criminal Defense, Family and Traffic Tickets
27 years experience defending those accused of serious criminal offenses. Over 20 years experience representing people in contested family matters and high-asset divorces. Extensive jury trial experience in criminal and civil courts. 24 years experience in the defense of serious Federal Criminal cases.
Donald Knuckey Jr.
East Peoria, IL DUI & DWI Attorney with 11 years of experience
(309) 825-9485	4001 East Washington Street
East Peoria,	IL 61611
Free ConsultationDUI & DWI, Bankruptcy, Criminal Defense and Family
University of Detroit Mercy School of Law
Jim Grimaldi
Lincoln, IL DUI & DWI Lawyer
(217) 651-8089	303 S. Kickapoo St., Suite 3
Regions Bank Building, Second Floor
Lincoln,	IL 62656
DUI & DWI and Criminal Defense
Jim Grimaldli is a criminal defense attorney representing clients with cases involving DUI, Felony Charges, Misdemeanor Charges, Traffic Tickets, Criminal Expungements, and Driver's License Reinstatement. Mr. Grimaldi practices in Logan, Sangamon, McLean, and Dewitt Counties.
Dale Thomas
Pekin, IL DUI & DWI Attorney with 35 years of experience
(309) 346-5297	337 Court St.
Pekin,	IL 61554
DUI & DWI, Criminal Defense, Personal Injury and Traffic Tickets
Employment:
•	Former Felony Assistant State's Attorney, Peoria County
•	Former Special Assistant to the Director, Federal Bureau of Investigation, Washington, D.C.
•	Former Judicial Law Clerk, United States District Court, Western District of Texas, San Antonio Division
•	Former law clerk, United Food and Commercial Workers International Union Washington, DC
•	Former Vice President of United Food and Commercial Workers Union, Local 881, Oak Brook, Illinois.
•	Graduated 2nd out of 159 students at John Marshall Law School.
•	Author: Picket Line Misconduct; Is Forfeiture of Reinstatement Rights for Purely Verbal Threats Sound?
18. J. Mar. L Rev. 445, 1985.
•	Team Member, Wagner Labor Law...
Clark A. Walker
Free ConsultationDUI & DWI, Criminal Defense, Divorce and Personal Injury
Over twenty four years of practice representing clients in a honest, ethical and direct approach. I will never promise you results which are unobtainable and communicate with you in a direct, straightforward manner.
Sean M Britton
Charleston, IL DUI & DWI Attorney with 25 years of experience
(217) 345-4200	517 Seventh St.
Charleston,	IL 61920
Free ConsultationDUI & DWI, Criminal Defense, Medical Malpractice and Personal Injury
Attorney focusing on all types of criminal and civil litigation throughout East Central Illinois.
Jennie Simons
O'Fallon, IL DUI & DWI Lawyer with 8 years of experience
(618) 277-5500	1405 Green Mount Rd.
O'Fallon,	IL 62269
DUI & DWI, Asbestos, Criminal Defense and Personal Injury
Florida Coastal School of Law
Jaye Lindsay
O'Fallon, IL DUI & DWI Attorney with 10 years of experience
(618) 515-5555	621 W. US Hwy-50
DUI & DWI, Criminal Defense, Nursing Home and Personal Injury
Southern Illinois University - Carbondale and Southern Illinois University School of Law
Experienced trial lawyer with experience pursuing compensation in catastrophic injury claims and defending against serious criminal charges.
John Hensley
(217) 531-2180	One E. Main Street
DUI & DWI, Divorce, Estate Planning and Family
Joshua Phillip Rinker
Bloomington, IL DUI & DWI Lawyer
(309) 827-0388	111 W. Front St.
DUI & DWI, Criminal Defense, Divorce and Estate Planning
Sean Murley
Belleville, IL DUI & DWI Attorney
(618) 444-1618	7 Walnut Street
Belleville,	IL 62220
(309) 706-4311	820 East Grove Street
DUI & DWI, Civil Rights, Criminal Defense and Personal Injury
University of Missouri - Columbia
Thomas Jackstadt
Collinsville, IL DUI & DWI Lawyer with 46 years of experience
(618) 344-4875	2105 Vandalia St.
Collinsville,	IL 62234
DUI & DWI, Criminal Defense, Juvenile and Personal Injury
Letitia Wiggins
McLeansboro , IL DUI & DWI Attorney
(618) 643-4488	301 S. Jackson Street
McLeansboro ,	IL 62859
DUI & DWI, Divorce and Family
Jeremy Wang
Joliet, IL DUI & DWI Lawyer with 10 years of experience
(630) 712-9264	2660 S Cherry Hill Road
Joliet,	IL 60433
Free ConsultationDUI & DWI, Criminal Defense, Personal Injury and Traffic Tickets
Jeremy Wang of Oak Brook, Illinois, is a successful trial-tested litigation lawyer. 630-712-9264. Free 20 minute consultations. Du Page County, Cook County, Will County Attorneys is a division of the Wheaton law firm, J. Wang Law, LLC.
When he first started his legal career, Jeremy often heard complaints due to the lack of attention clients received from attorneys they hired in the past. These well established lawyers, although successful, may have been so busy - they did not have the time to give each client the attention they needed. As a young attorney, this is how Mr. Wang built his...
Dominick R Dolci
Oakbrook Terrace, IL DUI & DWI Lawyer with 31 years of experience
(630) 261-9098	17W662 Butterfield Rd
Free ConsultationDUI & DWI, Criminal Defense, Juvenile and White Collar Crime
Dominick Dolci is a family law and criminal defense attorney in DuPage County, IL. Dominick acts as the Managing Partner at the Law Offices of Dolci & Weiland, with offices in Oakbrook Terrace, IL and Chicago, IL.
Mr. Stephen A Brundage
Wheaton, IL DUI & DWI Attorney with 31 years of experience
(630) 260-9647	1749 S Naperville Rd
Wheaton,	IL 60189
My law enforcement background as an investigator, instructor, evidence technician and police officer provides a key advantage to clients of my criminal defense practice. I have practiced law in Illinois for 27 years, helping thousands of clients obtain the best possible outcome when facing criminal charges, from DUI and traffic offenses to serious felonies such as drug charges and sex crimes. Our law firm, serving DuPage, Kane, and Cook counties, also offers strong advocacy in divorce, custody and related issues, as well as and personal injury, real estate, and wills and trusts. For experienced, personalized representation in your legal...
Andrew Weisberg
Chicago, IL DUI & DWI Attorney with 25 years of experience
(773) 694-8129	20 N Clark Street, Suite 2200
Free ConsultationDUI & DWI, Criminal Defense, Domestic Violence and Juvenile
A+ Rated with the BBB and with well over 100 5-Star reviews online, Andrew M. Weisberg is a highly successful criminal defense attorney. Call Now for a Free and Immediate Consultation at (773) 694-8129. Mr. Weisberg returns most calls within 15 minutes! Don't trust your freedom and future to lawyers who practice in multiple areas of law. It is critical to hire an attorney solely dedicated to the practice of criminal defense. Mr. Weisberg commits 100% of his practice to defending those who have been accused of a crime in Chicagoland. His sole mission is to provide the best representation...
Alexander Ivakhnenko
Wheeling, IL DUI & DWI Lawyer with 15 years of experience
(773) 562-8602	370 West Dundee Road
Wheeling,	IL 60090
DUI & DWI, Criminal Defense, Immigration and Traffic Tickets
DePaul College of Law and Loyola University Chicago School of Law
Provided professional language support for the federal, criminal and immigration courts nationwide with Russian and Ukrainian languages. Studied asylum, U.S. immigration and refugee law courses in Moscow Russia, 2002, and Rome, Italy, 2004. Provide professional legal representation with federal and state criminal charges. You may reach us directly at 773-562-8602 and we will analyze your potential exposure to criminal charges timely, efficiently, and without delay. Specialize in U.S. immigration law practice adjusting status, naturalization, family-based LPR, representing clients with both affirmative and defensive asylum claims. Developed a keen expertise in evaluating, handling and completing asylum and removal cases in the U.S....
David J. Winer
Skokie, IL DUI & DWI Lawyer with 34 years of experience
(847) 336-9111	9933 Lawler Street
Skokie,	IL 60077
Free ConsultationDUI & DWI, Criminal Defense and Traffic Tickets
David Winer and the Law Office of Winer & Winer have been a presence in LAKE COUNTY for over 30 years specializing in DUI/Traffic & Criminal Ddefense and Secretary of State hearings. It is critical to hire a local lawyer with intimate knowledge of the legal environment. David Winer has been very active as a member of the Criminal/Traffic Law committee and Chairman of the Lake County Lawyer Referral Service and a past member the Editorial Board & Contributing Author of the Lake County Docket and Chairman of the Juvenile Law Committee. Several times DAvid has been chosen to lecture and...
Ronald L. Bell
Libertyville, IL DUI & DWI Lawyer with 42 years of experience
(847) 495-6000	1113 S. Milwaukee Ave. Suite 204
Libertyville,	IL 60048
DUI & DWI, Criminal Defense, Family and Personal Injury
Attorney Ronald L. Bell has extensive litigation and negotation experience and has held former positions such as the Assistant Illinois Attorney General and Chief Corporate Counsel to a $250 million dollar company. Ronald Bell has argued and/or presented cases before the United States Supreme Court, Illinois Supreme Court, 7th Circuit Court of Appeals and every Illinois appellate court. Attorney Bell has top academic credentials and he was the top student in his law school class at the age of 23, a former editor of the law review and graduated college at the age of 20.
Matt Fakhoury
(847) 920-4540	1136 S. Delano Court West
Free ConsultationDUI & DWI, Criminal Defense, Domestic Violence and Traffic Tickets
Saint Louis University School of Law
When you're facing tough charges, you need a tough lawyer. Matt Fakhoury is an aggressive criminal defense attorney who will put your needs and your rights first! As a former prosecutor, Mr. Fakhoury knows the legal system from an insider's perspective--and that helps you get the results you deserve. Mr. Fakhoury is also an Adjunct Professor at DePaul University, where he teaches law courses in the undergraduate sociology department. With years of experience as a lawyer and professor, Mr. Fakhoury has tried numerous bench and jury trials for his clients with outstanding results. If you were arrested and charged...
Stavri Vako
PALATINE, IL DUI & DWI Attorney with 9 years of experience
(847) 429-8811	4811 EMERSON AVE
PALATINE,	IL 60067
Free ConsultationDUI & DWI, Criminal Defense, Immigration and Traffic Tickets
After graduating with honors from DePaul University in 2009, Mr. Vako attended Southern Illinois University School of Law in Carbondale. There, his constant pursuit of excellence allowed him to succeed academically, as well as compete as a member of the Moot Court Board in various advocacy tournaments around the country. His moot court team won best brief two years in a row. These experiences helped Mr. Vako develop a casual yet effective style of courtroom advocacy and demeanor; one that has helped him throughout his career. His compassionate approach and willingness to work with opposing counsel, and against them when...
Ray Flavin
Woodstock, IL DUI & DWI Lawyer with 29 years of experience
(815) 334-9004	315 East South Street
DUI & DWI and Domestic Violence
Master's of Business Administration
Law Degree Southern Illinois University
25+ years Criminal Defense Attorney
United States Navy Veteran
James G. Dimeas
Schaumburg, IL DUI & DWI Attorney with 29 years of experience
(847) 807-7405	120 W Golf Road
Schaumburg,	IL 60195
Free ConsultationDUI & DWI, Criminal Defense, Domestic Violence and White Collar Crime
-Over 26 years of experience handling criminal cases in Cook County, DuPage County and Kane County, as well as federal courts as far away as Las Vegas.
-Rated "Superb", the highest classification possible by AVVO, the organization that rates every attorney in the nation.
-Recognized as one of the "Top 100 Criminal Defense Trial Lawyers" by The National Trial Lawyers. This designation is only reserved for the "best of the best" and only for a very few distinguished attorneys.
-Named a "Best DWI Attorney" by Best DWI Attorney in 2017.
-Recognized as...
David L. Freidberg
(630) 574-1000	140 Butterfield Rd
Welcome to the Chicago, Illinois, Law Offices of David L. Freidberg, P.C., a premier Chicago criminal law attorney who knows how the system works and when to negotiate or simply take the gloves off and fight it out in court.
We pride ourselves on providing our clients the most powerful and aggressive criminal defense available in the Chicagoland area. We handle all criminal cases, including drug offenses, rape, assault and murder.
Experienced, Compassionate, Aggressive Criminal Defense
If you have been charged with a crime, you want to know your attorney will take a sincere interest in your case and do...
Steven H Fagan
Park Ridge, IL DUI & DWI Lawyer with 23 years of experience
(847) 635-8200	2644 Dempster Street
Northwest Suburban Bar Association and Chicago-Kent College of Law, Illinois Institute of Technology
Steven Fagan is an experienced defense attorney who devotes his practice to the areas of DUI, criminal, and traffic law in the Chicago community as a member of the knowledgeable team of Fagan, Fagan & Davis. Attorney Fagan received his undergraduate degree from the University of Illinois – Urbana-Champaign in 1995 before earning his Juris Doctor from Chicago-Kent College of Law in 1998. He is admitted to practice law by the Illinois State Bar Association and is a member of the National College for DUI Defense, the National Association of Criminal Defense Lawyers, the Illinois Association of Criminal Defense Lawyers,...
Donald J Ramsell
Wheaton, IL DUI & DWI Lawyer with 37 years of experience
(800) 342-5384	128 S County Farm Rd
Donald J. Ramsell, author of several DUI articles and books, is the one of the few DUI defense attorneys to appear and argue on a DUI case before the United States Supreme Court in its entire 213 years of existence. In his 33 year career his firms have defended 15,000 clients.
Peter O'Connor
Frankfort, IL DUI & DWI Lawyer with 6 years of experience
(708) 705-9655	37 Old Frankfort Way Suite B
Frankfort,	IL 60423
Peter G. O'Connor knows how to defend people in court. Whether you are charged with a simple traffic ticket, a DUI, or a criminal offense, you can count on Peter to get you through it. The toughest part of the criminal process is not knowing the next step. There are many questions you may have. Am I going to go to jail? Will my employer find out? What will happen to my record? Will I lose my driving privileges? These are all completely normal questions for anyone facing a criminal charge. So Call me know to so we can discuss...
Brandon K. Davis
Chicago, IL DUI & DWI Lawyer with 12 years of experience
(312) 736-2052	420 W Huron St
Brandon K. Davis is a defense attorney at The Davis Law Group, P.C. where he primarily represents clients charged with DUI, criminal and traffic-related offenses. He has been recognized for his accomplishments by a variety of organizations including SuperLawyers in the fields of DUI and Criminal Defense. Brandon also regularly represents those facing the suspension, revocation or cancellation of their driving privileges. Brandon received his Bachelor of Arts Degree from the University of Wisconsin-Madison with a major in Political Science and a minor in Business. He received his J.D. from Chicago-Kent College of Law. Brandon is a member of the...
John S. Fotopoulos
Joliet, IL DUI & DWI Attorney with 21 years of experience
(815) 373-5100	58 N Chicago St
Free ConsultationDUI & DWI, Criminal Defense, Domestic Violence and Personal Injury
John Marshall Law School
John S. Fotopoulos, former Cook County judge serving at the Daley Center in Chicago, established his law firm on two simple firm principals: to have competitive rates allowing everyone to afford the advice they need and to have legal counsel that is always available for clients.
John takes immense pride in his work, fulfilling a great deal of credits in continuing education seminars to ensure compliance and competency. In addition, his countless hours of legal research ensures that he stays ahead of the competition and is fully educated to take care of clients' legal needs. John's practice ensures that you are...
Brandon C. Mayberry
Marion, IL DUI & DWI Attorney with 6 years of experience
(618) 579-5250	104 Calvert St.
Marion,	IL 62959
Brandon C. Mayberry grew up in Jonesboro, Illinois. After high school, Brandon attended Shawnee Community College where he earned an Associates of Arts degree. He then attended Southern Illinois University, where he earned a B.A. in Paralegal Studies with a specialization in Pre-Law graduating Cum Laude. From there, Brandon went on to attend Southern Illinois University School of Law. Brandon graduated from the SIU School of Law. While in law school, Brandon was a member and marshal of the Phi Alpha Delta law fraternity. While attending SIU School of Law Brandon began working as a law clerk for the Law...
Kathryn L Harry
Oak Brook, IL DUI & DWI Attorney with 30 years of experience
(630) 472-9700	1200 Harger Rd
Oak Brook,	IL 60523
Free ConsultationDUI & DWI, Criminal Defense and Domestic Violence
Lawyer since 1991.
Email: oakbrooklaw@oakbrooklaw.com
Website: www.oakbrooklaw.com
What am I good at?
*	Explaining how the law works in plain English
*	Analyzing your case & providing options
*	Transparency in fees & expectations
Have I worked on a case like yours?
Possibly...given that I have been doing this for almost 30 years. Call me to find out. (630) 472-9700
What do I charge?
Every case is different so I don't have "standard rates" on a chart from which I quote. Many cases are charged on a flat fee basis, like criminal and traffic. I promise to provide you with a clear and transparent pricing...
Daniel Walsh
(815) 409-7357	58 N. Chicago Street
I am a life long Will County Resident and former Will County Prosecutor. I was involved in some of the highest profile cases in Will County, including cases that were featured on national television.
Stephen Komie
(312) 263-2800	1 N. LaSalle St.
DUI & DWI, Criminal Defense, Divorce and Family
National College for DUI Defense at Harvard Law School and DePaul College of Law
Stephen M. Komie is the founder of Komie and Associates, and he has over 40 years of experience successfully representing clients in state, federal, and international trials and appeals. Mr. Komie is best known for high profile cases such as his defense of Sandra Fabiano for child abuse and John Carroccia for murder, which were widely reported in the Illinois media. He has helped numerous clients achieve victory in criminal and civil trials across Illinois and the United States.
Mr. Komie provides his clients with dedicated, tenacious defense against criminal charges, and he has won many landmark decisions, including the 1995...
Stacey A. McCullough
(630) 665-7300	1737 South Naperville, Rd.
DUI & DWI, Criminal Defense, Domestic Violence and Juvenile
Stacey A. McCullough's career has been focused on the successful defense of the criminally accused in DuPage County for over 20 years. She has firmly established her advocacy skills through hundreds of hearings and trials for offenses ranging from traffic violations to felonies. Stacey's experiences and involvement in the legal community have instilled in her the understanding that each case and client she takes on is unique and important. She reviews all circumstances thoroughly and provides clients with explanations of proceedings, potential challenges, and possible outcomes. Clients can be confident Stacey's representation is personal, honest, respectful and dedicated.
State of...
Dan Nold
Crystal Lake, IL DUI & DWI Lawyer with 9 years of experience
(815) 307-8803	7115 S Virginia Rd, Suite 107
(815) CALL-DAN I'm a criminal defense trial lawyer who has first chaired dozens of jury trials to verdict and hundreds of bench trials and contested hearings in the last 6 years. I am now a resident of Crystal Lake, Illinois and have made McHenry County my home. I am committed to advocating for my clients to protect their rights from the government throughout all stages of the criminal process. I am also an avid advocate for victims of domestic violece in order of protection proceedings for petitioners as well as respondents. If your case involves a...
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May 15, 2005 Issue
Evaluation of Poststreptococcal Illness
A more recent article on poststreptococcal illness is available.
RICARDO G. HAHN, M.D., LYNDA M. KNOX, PH.D., and TODD A. FORMAN, M.D., M.S.ED., University of Southern California, Los Angeles, California
Am Fam Physician. 2005 May 15;71(10):1949-1954.
Prevention and Recurrence
Poststreptococcal Reactive Arthritis
Poststreptococcal Glomerulonephritis
Laboratory Evaluation
Group A beta-hemolytic streptococcal pharyngitis, scarlet fever, and rarely asymptomatic carrier states are associated with a number of poststreptococcal suppurative and nonsuppurative complications. As in streptococcal pharyngitis, acute rheumatic fever, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and poststreptococcal glomerulonephritis most often occur in children. The hallmarks of rheumatic fever include arthritis, carditis, cutaneous disease, chorea, and subsequent acquired valvular disease. Pediatric autoimmune neuropsychiatric disorders encompass a subgroup of illnesses involving the basal ganglia in children with obsessive-compulsive disorders, tic disorders, dystonia, chorea encephalitis, and dystonic choreoathetosis. Poststreptococcal glomerulonephritis is most frequently encountered in children between two and six years of age with a recent history of pharyngitis and a rash in the setting of poor personal hygiene during the winter months. The clinical examination of a patient with possible poststreptococcal complications should begin with an evaluation for signs of inflammation (i.e., complete blood count, erythrocyte sedimentation rate, C-reactive protein) and evidence of a preceding streptococcal infection. Antistreptolysin O titers should be obtained to confirm a recent invasive streptococcal infection. Other important antibody markers include antihyaluronidase, antideoxyribonuclease B, and antistreptokinase antibodies.
Lancefield group A streptococci consist of a single species, Streptococcus pyogenes, that is associated with a variety of suppurative infections. Group A streptococci also have the capacity to trigger postinfectious syndromes of acute rheumatic fever and poststreptococ cal glomerulonephritis. Both entities are uniquely associated with these organisms. In addition, a variety of other nonsuppurative conditions are associated with infection with group A streptococci.1 Table 1 lists the suppurative and nonsuppurative complications of group A beta-hemolytic streptococcal illness.2–4 This article evaluates the most important complications.
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Strength of Recommendations
Key clinical recommendation
To achieve clinical and bacteriologic cures, physicians should treat streptococcal pharyngitis with 10 days of oral penicillin, oral cephalosporins (other than cefaclor [Ceclor] or loracarbef [Lorabid]), or oral erythromycin in patients allergic to penicillin.
Initial laboratory testing for patients with suspected poststreptococcal disease should include a complete blood count, erythrocyte sedimentation rate or C-reactive protein, and an antistreptolysin O titer.
Antihyaluronidase, antideoxyribonuclease B, and antistreptokinase antibodies should be ordered if the diagnosis of a possible recent streptococcal infection remains in question.
Patients with suspected carditis should undergo echocardiography because electrocardiography can have false-negative results.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series. See page 1865 for more information.
Complications of Group A Beta-Hemolytic Streptococcal Illness
Nonsuppurative
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection
Poststreptococcal autoimmune dystonia secondary to striatal necrosis
Sydenham's chorea and other autoimmune movement disorders
Suppurative
Cervical lymphadenitis
Fasciitis/myositis syndrome
Perianal dermatitis in children
Peritonsillar or retropharyngeal abscess
Toxic shock
Information from references 2 through 4.
Jump to section +
Group A streptococci elaborate a number of cell surface components and extracellular products that are important in the pathogenesis of infection and in the immune response of the human host. Although the pathophysiology of poststreptococcal syndromes is not fully understood, antigenic mimicry may be the triggering factor leading to autoimmunity. In untreated persons with streptococcal pharyngitis, streptococcal breakdown products are thought to have molecular similarity to human tissues (e.g., heart valve tissue) and initiate the harmful immune response. The major surface protein of group A streptococci is M protein extending from the cell wall, which allows the bacteria to resist phagocytosis. The body is able to overcome this resistance with M protein–specific antibodies. This process also confers protection against subsequent infections with an organism of the same M type. However, the development of a vaccine that confers such immunity has been difficult because there are more than 80 antigenically distinct types of M protein.
In addition, group A streptococci produce extracellular products that may be important in local and systemic toxicity and in the spread of infection through tissues. These include streptolysins and toxins that damage cell membranes and account for the beta hemolysis produced by these organisms. The pyrogenic exotoxins, also known as erythrogenic toxins, are responsible for the rash of scarlet fever. Pyrogenic exotoxins also have been linked to unusually severe invasive infections including necrotizing fasciitis and streptococcal toxic shock syndrome.
As in streptococcal pharyngitis, acute rheumatic fever and poststreptococcal glomerulonephritis most often occur in children. The peak incidence is between five and 15 years of age. Most initial attacks in adults take place in the late teens or early 20s. Rarely, initial attacks occur as late as the sixth decade. A recent epidemiologic survey5 of the Italian registry for renal biopsy, however, has suggested that poststreptococcal glomerulonephritis may be significantly underreported in patients 70 years and older.
The complications of streptococcal infection arise predominantly from pharyngitis and scarlet fever, and rarely from asymptomatic carriers. Although antibiotics have been shown to reduce the severity of acute symptoms and shorten the duration of the illness by about one day, more than 90 percent of treated and untreated patients with acute pharyngitis are symptom-free by day 7.6 Therefore, the primary reason for treating uncomplicated streptococcal pharyngitis is to markedly reduce the incidence of subsequent rheumatic fever or its recurrence.7 It is unclear whether appropriate antibiotic treatment of group A streptococci infection reduces the risk of post-streptococcal glomerulonephritis, but one recent review8 did note a trend showing some protection.
Although oral or intramuscular penicillin and oral erythromycin are recommended for initial treatment of group A streptococcal pharyngitis, a recent meta-analysis9 found improved microbiologic and clinical outcomes among patients treated with most cephalosporins. The review identified 35 clinical trials comparing a cephalosporin with penicillin, and found significantly improved rates of clinical cure with cephalosporins (93.6 versus 85.8 percent). This was true even when the analysis was limited to the highest quality studies, although it did not apply to cefaclor (Ceclor) and loracarbef (Lorabid).
Although there has been a dramatic decline in severity and mortality of acute rheumatic fever since the 1940s, outbreaks still occur in the United States,10,11 closely following epidemics of streptococcal pharyngitis or scarlet fever. The disease continues to be an illness of the poor and underprivileged. Developing countries have an estimated 10 to 20 million new cases per year.12 Documentation of pharyngitis in older children and adults approaches 70 percent, whereas in younger children the rate is about 20 percent.13 Having hindsight suspicion of rheumatic fever in children presenting with signs of arthritis or carditis in the absence of a documented pharyngitis is important. Of note, outbreaks of impetigo never result in rheumatic fever.11,14,15
Rheumatic fever is a late inflammatory complication of acute group A streptococcal pharyngitis that manifests as an acute systemic febrile illness; it can include migratory arthritis involving the large joints, signs and symptoms of carditis and valvulitis, the erythema marginatum rash, subcutaneous nodules (Figure 1), and choreoathetotic movements of Sydenham's chorea. These problems can appear in different degrees of severity and in various combinations. The clinical episodes may be time limited, but damage to the heart valves may be chronic and progressive, resulting in significant cardiac dysfunction. Although the Modified Jones Criteria provide a guide for clinical diagnosis,16 no specific symptoms, clinical signs, or laboratory tests are pathognomonic for rheumatic fever, nor do all patients with rheumatic fever fulfill the Modified Jones Criteria.11,16
View/Print Figure
Subcutaneous nodule.
The criteria list major manifestations that include carditis, erythema marginatum, polyarthritis, subcutaneous nodules, and Sydenham's chorea. Minor manifestations include clinical (e.g., arthralgia, fever) and laboratory (i.e., elevated C-reactive protein and erythrocyte sedimentation rate, prolonged PR interval on electrocardiograph) parameters. A diagnosis of rheumatic fever is supported by evidence of preceding group A streptococcal infection (i.e., positive throat culture or rapid streptoccocal antigen test, elevated or rising antistreptolysin titer), and the presence of two major manifestations or of one major and two minor manifestations.16
Arthritis is the most frequent and least specific manifestation of rheumatic fever. It usually affects the large joints and may be the first sign of illness. The lower extremities generally are affected first, followed by the upper extremities—hence the term migratory arthritis. Joint involvement occurs early in the illness and is more common and severe in adolescents and young adults. The polyarthritis may be painful, but it is transient; the inflammation lasts about two to three days in each joint and two to three weeks total. Radiographic examination can identify slight effusions but usually the results are normal. The arthritis is self-limited, resolves without sequelae, and responds well to salicylates and nonsteroidal anti-inflammatory drugs (NSAIDs).17
Carditis
Carditis associated with rheumatic fever manifests as pericarditis, myocarditis, and most commonly, endocarditis.11 Pericarditis can present with chest discomfort, pleuritic chest pain, pericardial friction rubs, and distant heart sounds. Myocarditis is rare in isolation and can present with signs and symptoms of heart failure. Endocarditis may be asymptomatic or present with a new heart murmur. Note that heart murmurs do not necessarily indicate valvular involvement, and they may be transient. If valvular disease occurs, it is most likely in the mitral, aortic, tricuspid, or pulmonary valve, in that order.18 Electrocardiograph and radiograph abnormalities may be present in as few as 30 percent of patients with carditis.19 In symptomatic and asymptomatic patients with a high clinical suspicion of rheumatic fever, echocardiography is recommended.
Rheumatic heart disease is an important long-term consequence of rheumatic fever and is the major cause of acquired valvular disease in the world.20 It usually occurs 10 to 20 years after the original rheumatic fever attack and is likely to occur in almost one half of patients with evidence of carditis at the initial diagnosis. Mitral stenosis caused by calcification is a classic finding and frequently needs to be treated surgically.
Sydenham's Chorea
Sydenham's chorea is characterized by abrupt, purposeless, nonrhythmic, involuntary movements; muscular weakness; and emotional disturbances. It usually is more marked on one side of the body than the other and may be completely unilateral. Outbursts of atypical behavior such as crying and restlessness are observed and, in rare cases, manifestations of a transient psychosis may be noted. There is no sensory loss or involvement of the pyramidal tracts. Sydenham's chorea usually has a longer latency period and is a late isolated manifestation of the disease, thus acute-phase reactants and laboratory identification of streptococcal infection are absent. Sydenham's chorea is self-limited, occurs in no more than 5 percent of patients, and typically lasts two to three months.17
Erythema marginatum is a rash consisting of erythematous rings found largely on the trunk that may appear, disappear, and reappear over several weeks or months. They typically are not pruritic and spare the face. Subcutaneous nodules are small, painless nodules on the extensor surfaces. Although subcutaneous nodules were thought to indicate carditis, this has been challenged, and on careful examination nodules are found in more than 10 percent of patients.21
Poststreptococcal reactive arthritis is a distinct clinical entity and is different from the typical arthritis associated with rheumatic fever. There is at least one to two weeks between the acute streptococcal infection and the onset of poststreptococcal reactive arthritis. In addition, the response to aspirin and other NSAIDs is poor. The modified Jones criteria usually are not met, and there appears to be no evidence of carditis. The duration is prolonged or recurrent and of high severity, and can be accompanied by tenosynovitis and renal abnormalities.22–24 There are no clear definitions or treatment guidelines to increase consistency in treatment.25,26
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are indicative of a subgroup of children with obsessive-compulsive disorder or tic disorders occurring in association with streptococcal infections.27 Autoantibodies are proposed as the basis of this basal ganglia autoimmune illness, similar to the mechanism suggested for rheumatic fever and poststreptococcal glomerulonephritis.28 Included in this general category is Sydenham's chorea, but it does not lead to carditis. There are five clinical criteria proposed for diagnosing PANDAS: the presence of obsessive-compulsive disorder or a tic disorder; prepubertal symptom onset; an episodic course characterized by acute, severe onset and dramatic symptom exacerbation; the presence of neurologic abnormalities such as choreiform movements during symptom exacerbations; and a temporal relationship between group A beta-hemolytic streptococcal infections and symptom exacerbation.29
Poststreptococcal glomerulonephritis is the leading cause of acute nephritic syndrome. Most cases are sporadic, although the disease has been known to occur in epidemic form. The illness is most frequently encountered in children between two and six years of age with a recent history of pharyngitis in a winter setting or a rash in a warmer climate. The incidence of poststreptococcal glomerulonephritis appears to be decreasing.30 It develops about 10 days after pharyngitis or two weeks after a skin infection with a nephritogenic strain of group A hemolytic streptococcus. Immunity is type-specific and long lasting; repeat infections are rare.30 It is unclear whether antibiotic treatment of the primary skin infection affords protection from the development of poststreptococcal glomerulonephritis. Studies31 addressing this question have been too small to answer this question definitely.
The classic presentation of poststreptococcal glomerulonephritis is a full-blown nephritic syndrome with oliguric acute renal failure. Most patients have milder disease, and subclinical cases are common. Patients with overt disease demonstrate gross hematuria characterized by red or smoky urine, headache, and generalized symptoms such as anorexia, nausea, vomiting, and malaise.32 Swelling of the renal capsule can cause flank or back pain. Physical examination may reveal hypervolemia, edema, or hypertension. Coexisting rheumatic fever is highly unsual.33 Acute poststreptococcal glomerulonephritis usually is diagnosed on clinical and serologic grounds without the need for biopsy, especially in children with a typical history.
The overall prognosis in classic poststreptococcal acute proliferative glomerulonephritis is good. More than 95 percent of patients recover spontaneously and return to baseline renal function within three to four weeks with no long-term sequelae.34 When there is delayed resolution, severe renal failure at onset, progressive renal failure, or systemic features such as skin rashes, joint pain, hepatosplenomegaly, and persistent fever, then biopsy is indicated to ensure that there is not a more serious cause for the illness.35 Isolated cases of hypertensive encephalopathy have been caused by asymptomatic poststreptococcal glomerulonephritis, attesting to the wide spectrum of poststreptococcal illnesses.36
In patients with suspected poststreptococcal illness, laboratory evidence of inflammation and a preceding streptococcal infection should be documented. However, throat cultures often are negative by the time rheumatic fever, PANDAS, or poststreptococcal glomerulonephritis appears.37 Acute-phase reactants such as erythrocyte sedimentation rate and C-reactive protein levels are elevated early in the process and are effective in monitoring the disease. If either level returns to normal after discontinuation of antirheumatic therapy, the attack usually is over. A complete blood count should be ordered. Leukocytosis with neutrophilia and a mild normochromic normocytic anemia also may be present. Although synovial fluid analysis may reveal aseptic leukocytosis, it is not recommended routinely unless the patient has neurologic symptoms.
Several specific antibody responses are useful for the detection of preceding streptococcal infection because they reach a peak titer at about the time of onset of poststreptococcal disease and they indicate true infection rather than transient carriage. Initially, antistreptolysin O (ASO) titers should be obtained. If the test result is positive, it confirms a recent invasive streptococcal infection. The antibody response usually peaks at about four to five weeks and is first noted during the second or third week of an acute episode. However, ASO titers may be negative in up to 20 percent of patients who develop acute rheumatic fever.17
Elevated ASO titers may support but not definitely diagnose a poststreptococcal complication. The more specific and expensive antibody tests may be warranted, including antihyaluronidase, antideoxyribonuclease B, and antistreptokinase antibodies. Physicians should be aware that antibiotic therapy may prevent the development of an antibody response. If initial serologies are negative, but the clinical picture persists, it may be useful to repeat serial serum specimens two weeks later for comparison.17
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RICARDO G. HAHN, M.D., is professor and chair of the Department of Family Medicine at the University of Southern California (USC) School of Medicine, Los Angeles. Dr. Hahn earned an undergraduate degree and a master's degree in preventive medicine at the University of Washington, Seattle. He completed a family medicine residency at the Medical University of South Carolina in Charleston and an emergency medicine fellowship at the University of California in San Francisco....
LYNDA M. KNOX, PH.D., is assistant professor of family medicine at USC School of Medicine. She is co-director of the Southern California Center of Academic Excellence for Youth Violence Prevention funded by the Centers for Disease Control and Prevention. Dr. Knox received her psychology doctorate from the University of Texas, Austin.
TODD A. FORMAN, M.D., M.S.ED., is assistant professor of clinical medicine at the Keck School of Medicine at the USC School of Medicine and director of the Family Medicine Clerkship and the Eric Cohen Student Health Center. He completed his medical degree and a family medicine residency at the University of California Los Angeles School of Medicine.
Address correspondence to Ricardo G. Hahn, M.D., 1420 San Pablo St., PMB-B205, Los Angeles, CA 90033 (e-mail: rghahn@usc.edu). Reprints are not available from the authors.
The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.
Figure 1 was provided by the Public Health Image Library at the Centers for Disease Control and Prevention.
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18. Hilario MO, Andrade JL, Gasparian AB, Carvalho AC, Andrade CT, Len CA. The value of echocardiography in the diagnosis and followup of rheumatic carditis in children and adolescents: a 2 year prospective study. J Rheumatol. 2000;27:1082–6.
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33. Sieck JO, Awad M, Saour J, Ali H, Qunibi W, Mercer E. Concurrent post-streptococcal carditis and glomerulonephritis: serial echocardiographic diagnosis and follow-up. Eur Heart J. 1992;13:1720–3.
34. Couser WG. Glomerulonephritis. Lancet. 1999;353:1509–15.
35. Vijayakumar M. Acute and crescentic glomerulonephritis. Indian J Pediatr. 2002;69:1071–5.
36. Batson BN, Baliga R. Post-streptococcal hypertensive encephalopathy with normal urinalysis. Pediatr Nephrol. 2003;18:73.
37. Stollerman GH. Rheumatic fever. Lancet. 1997;349:935–42.
This article is one in a series on problem-oriented diagnoses coordinated by the Department of Family Medicine at the University of Southern California, Los Angeles, Calif. Coordinator of the series is Ricardo G. Hahn, M.D.
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