LONDON (AFP) - Everton forward Wayne Rooney will be punished "internally" after being charged with drink-driving, manager Ronald Koeman said on Thursday (Sept 7).
Rooney, England's all-time record goalscorer and former captain, was pulled over by police near his home in Cheshire, north-west England, in the early hours of Friday morning last week.
He has been charged with "driving whilst over the prescribed (alcohol) limit" and is due to appear at Stockport Magistrates' Court on Sept 18.
Reading a prepared statement at his weekly press conference, Koeman told reporters at Everton's Finch Farm training ground: "I am very disappointed. In line with any disciplinary matter, this will be dealt with internally by the club at the appropriate time."
Despite Rooney's brush with the law, Koeman confirmed the former Manchester United striker would play for Everton against Tottenham Hotspur in the Premier League on Saturday.


Have you ever thought to yourself "I wonder what Nationals superstar Bryce Harper would look like if his head were placed on the body of a turkey?" Well, if you have, there's something deeply wrong with you. But the Potomac Nationals—the Class A affiliate of the Nats—has decided to reward you for your horrifying idea with a bobblehead that will haunt you to the end of your days.
What's your favorite part of the video, aside from the David Attenborough-esque narration? I'm a fan of this "gobblehead" (because of course that's what it's called) being described as "half turkey, half Nationals phenom," which is an incorrect description, given that the only part of this monstrosity that is Harper is his head.
The P-Nats, who clearly took all the wrong lessons from The Island of Dr. Moreau, will be giving away this limited-edition bobblehead on May 13 as part of "Pfitzgiving." Because what better way to give thanks than by contemplating the Cronenberg universe where such a creature could exist and being glad you don't live in it?


SUNSHINE DEZHONG AUTO PARTS Co.Ltd.
AUTO HRVATSKA PRODAJNO SERVISNI CENTRI D.O.O.
Latin America Members and N! Suppliers.
This forum will be a local gathering between the N! North America Members and N! Suppliers.


In my junior year of college—for reasons I sometimes question today—I transferred from a large public university in California to a pricey private one in New York. My tuition bill more than quadrupled, and while my parents anted up, I had to pick up the rest: housing, food, and books.
Multiple shifts waitressing enabled me to cover my dorm, materials, and meals—microwaved noodles, mostly.
In five short years, my daughter will start college. While I appreciate the life skills those years gave me, I want a less stressful experience for her. Yet the expected price for her degree? For the 2014-15 school year, students paid more than $42,000 in tuition, room, and board at a private institution and nearly $19,000 a year for an in-state public school, according to the College Board.
Sandra Hernandez understands this reality well. At the Fair Haven branch of the New Haven (CT) Free Public Library where she is branch manager, Hernandez encounters many high school students who are the first in their family to apply to college. For them, getting accepted is only half the battle.
To start, Hernandez directs students to online sites for scholarships, and offers to help them with their FAFSA (Free Application for Federal Student Aid) forms, which are required for anyone applying for financial aid. She also hires students as volunteers so they can earn community service hours needed for a local scholarship, the New Haven Promise. Some students also work at the library during the summer and after they enter college to bring in additional funds. Parents can also seek help from Hernandez and the staff—who are always ready to offer their services.
At Bound Brook (NJ) High School, about 80 percent of students are eligible for free and reduced-price lunch. So Katie Llera, Bound Brook's school librarian, talks with students early—when they're still sophomores—to get them thinking not just about the SAT, the ACT, and possible careers—but about their financial needs. She'll even discuss jobs they might consider to help stretch their resources while in college. Llera also counsels them about scholarships that require an application fee and otherwise seem dubious.
This is vital information for the majority of families. While students commonly turn to college counselors for help as they near the end of their high school careers, the involvement of a librarian is becoming more critical to help students wade through online resources and provide other needed services.
During my sophomore year of college, I landed a coveted spot at one of the undergraduate libraries on campus. I loved the dusty smell of the stacks—not to mention the decent hourly wage. When my daughter starts college, she'll work as well. Perhaps on campus, perhaps not—but she will help support her needs and literally buy into her own education. Her father and I are going to cover as much of the cost as we can ("Hello, student loans.") But, like most students, she'll need a job to help pay for her degree. And like most parents should, I'll encourage her to seek help from the library—both at high school and college—for direction and maybe a paycheck as well.
"I haven't heard of many other librarians getting involved [in college guidance]," says Llera.
Perhaps it's time to step up.
As the teacher librarian in a high school and a student who benefited from taking the College-Level Examination Program (CLEP) exams many years ago, my co-worker and I always guide our seniors to www.collegeboard.org/clep where students can successfully gain college credits for what they already know. Our CLEP link on the library website includes test information, the testing center of the local county college where they can take the tests, links to prep materials in our collection, and also practice sites on the public library website. Students just need to check with their admitting college to make sure CLEP credits are accepted, and they may realize some of the best savings/financial aid they will ever receive!


text:
Exhibition title wall by David Genco (Luxembourgian, born 1985); Photo: Matt Flynn ? Smithsonian Institution
See more objects with the tag sensory design.
0100, The Senses: Design Beyond Vision
Design activates our senses. Today, many designers are focusing attention on multisensory experiences, expanding beyond design's traditional emphasis on visible form. Offering dozens of opportunities to encounter design through touching, smelling, listening, and interacting as well as looking, The Senses: Design Beyond Vision celebrates our varied ways of exploring the world and experiencing joy and wonder.
Sensory design is physical. Design touches us, and we touch back. A chair supports the body. A tool fits in the hand. Tableware changes our experience of food. Every material—wool or wood, paper or plastic—has its own sound, surface, weight, and smell.
Sensory design enhances experience. Designers are experimenting with new materials and technologies to harness the power of the senses and heighten design's impact and reach. Smart materials respond to temperature and light. Digital interfaces communicate via sound and haptic feedback. Software translates sonic data into visual or tactile forms.
Sensory design is inclusive. By activating multiple senses, designers embrace users with different needs. Every person has unique sensory abilities, which change over the course of a lifetime. Tactile maps facilitate mobility and knowledge for blind and sighted users. Audio devices translate sound into vibrations felt on the skin. Tools for the kitchen and bathroom use color and form to guide people living with dementia or vision loss.
This exhibition explores extraordinary work by some of the world's most creative thinkers, presenting experimental prototypes and practical solutions that extend the sensory richness of our world. We hope you will leave with a heightened understanding of how your different senses work together to shape the meaning of products, spaces, and media.
#DesignBeyondVision
The Senses: Design Beyond Vision is made possible by the generous support of Delta Faucet Company. Additional support is provided by the Barbara and Morton Mandel Design Gallery Endowment Fund, the Ehrenkranz Fund, and Edward and Helen Hintz. Funding is also provided by Jesse Ormond Sanderson, Jr. and Robert Keith Black, Amita and Purnendu Chatterjee, New York State Council on the Arts with the support of Governor Andrew M. Cuomo and the New York State Legislature, and public funds from the New York City Department of Cultural Affairs in partnership with the City Council Exhibition design by Studio Joseph Exhibition graphics by David Genco Curated by Ellen Lupton, Senior Curator of Contemporary Design, and Andrea Lipps, Assistant Curator of Contemporary Design, Cooper Hewitt, Smithsonian Design Museum Exhibition voiced by Michele Spitz; Generously provided by Woman of Her Word In-kind support provided by Tretford Americas Accessible Exhibition Guide designed and produced by Sina Bahram and Joshua Lerner, Prime Access Consulting Project lead: Pamela Horn, Director of Cross-Platform Publishing and Strategic Partnerships, Cooper Hewitt, Smithsonian Design Museum Curatorial assistant: Julia Pastor, Cooper Hewitt, Smithsonian Design Museum Audio tour voiced by Michele Spitz, edited by Cliff Hahn; generously provided by Woman of Her Word
0101, Accessible Exhibition Design
Senses.0101
Listen to an audio recording of this text here.
This object was previously on display as a part of the exhibition	The Senses: Design Beyond Vision.
Short URL http://cprhw.tt/o/2Lr1w4/
Accession Number Senses.0100
Object ID 1159162135
<ref name=CH>{{cite web |url=https://www-4.collection.cooperhewitt.org/objects/1159162135/ |title=0100, The Senses: Design Beyond Vision |author=Cooper Hewitt, Smithsonian Design Museum |accessdate=21 January 2022 |publisher=Smithsonian Institution}}</ref>

redpajama_set_name: RedPajamaCommonCrawl


In today's industrialised world the demand for steel, particularly from the automotive industry, has become overwhelming. Although effective methods for the testing of raw steel materials exist, the call for more efficiency, more safety and higher quality never stops.
In order to improve on the current methods for non-destructive testing for steel billets, H. Rohloff (Pty) Limited has developed the Billet InspectIR, an automated, high-speed system for the in-line inspection of steel billets and tubes.
Our Billet InspectIR is capable of inspection speeds of up to 1.2m/s. Depending on your loading and off-loading capabilities, this means that a 6m-length billet will take approximately 4 ~ 6 seconds to inspect.


Waterford Building Supply is the New London County division of Finetco and was established in 1988. The Finetco group of companies which includes; Coventry Lumber, West Haven Lumber, Welco and Waterford Building Supply, provides quality building products to builders, contractors and retail customers throughout New England and New York.
The more some things change, the more some stay the same, this is true for Waterford Building Supply. Purchased by Finetco in 2016, customers can still count on the relationships that have been built over the years with the Waterford family and the dedication to "provide our customers with quality products and professional service". Finetco brings an expanded product line to include windows, doors, kitchens and baths, engineered lumber and more. Waterford Building Supply is expected to grow in size and become a true "full service" lumberyard with an increased service area.


text:
=head1 LICENSE

Copyright [1999-2014] Wellcome Trust Sanger Institute and the EMBL-European Bioinformatics Institute

Licensed under the Apache License, Version 2.0 (the "License");
you may not use this file except in compliance with the License.
You may obtain a copy of the License at

     http://www.apache.org/licenses/LICENSE-2.0

Unless required by applicable law or agreed to in writing, software
distributed under the License is distributed on an "AS IS" BASIS,
WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
See the License for the specific language governing permissions and
limitations under the License.

=cut

package XrefParser::ncRNAParser;

use strict;
use warnings;
use Carp;
use POSIX qw(strftime);
use File::Basename;

use base qw( XrefParser::BaseParser );

sub run {

  my ($self, $ref_arg) = @_;
  my $source_id    = $ref_arg->{source_id};
  my $species_id   = $ref_arg->{species_id};
  my $files        = $ref_arg->{files};
  my $verbose      = $ref_arg->{verbose};

  if((!defined $source_id) or (!defined $species_id) or (!defined $files) ){
    croak "Need to pass source_id, species_id and files as pairs";
  }
  $verbose |=0;

  my $file = @{$files}[0];

  print "source_id = $source_id, species= $species_id, file = $file\n";

  my %name_2_source_id=();
  my $added=0;

  my $file_io = $self->get_filehandle($file);

  if ( !defined $file_io ) {
    print STDERR "ERROR: Could not open file $file\n";
    return 1;
  }

  while ( my $line = $file_io->getline() ) {
    chomp $line;
    my ($gene_id,$transcript_id,$source_name,$acc,$display_label,$full_description, $status)
      = split("\t",$line);

    #trim the description.
    my ($description,$junk) = split("[[]Source:",$full_description);
    if($source_name eq "miRNA_Registry"){
      if($status eq "KNOWN"){
	$source_name = "miRBase";
      }
      else{
	$source_name = "miRBase_predicted";
      }
    }
    if(!defined($name_2_source_id{$source_name})){
      my $tmp = $self->get_source_id_for_source_name($source_name);
      if(!$tmp){
	die("Could not get source_id for $source_name\n");
      }
      $name_2_source_id{$source_name} = $tmp;
    }
    my $xref_id = $self->get_xref($acc,$name_2_source_id{$source_name}, $species_id);
    if(!defined($xref_id)){
      $xref_id = $self->add_xref({ acc        => $acc,
				   label      => $display_label,
				   desc       => $description,
				   source_id  => $name_2_source_id{$source_name},
				   species_id => $species_id,
				   info_type  => "DIRECT"} );
      $added++;
    }
    $self->add_direct_xref($xref_id, $transcript_id, "Transcript", "") if (defined($transcript_id));

    #just add to the transcript ONLY as the check at the end will move all
    #the those mapped to the transcript to the genes anyway due to the
    #biomart check
    #    $self->add_direct_xref($xref_id, $gene_id, "Gene", "")             if (defined($gene_id));
  }

  $file_io->close();

  print "Added $added Xrefs for ncRNAs\n" if($verbose);
  return 0;
}

1;

redpajama_set_name: RedPajamaGithub


text:
Design & Politics: The 2018 Midterm Elections
"Design is intrinsic to politics," argue faculty Jennifer Rittner, Marc Dones, and Andrew Schlessinger. "In fact, the entire Democratic experiment is a product of design."
In the Products of Design program, an opportunity to investigate the direct relationship between design and politics occurs biennially with the U.S. elections. This year, it was all about the Midterm Elections—when politicians compete for seats in the U.S. Legislative branch (Congress), as well as in State and Local political races.
The opportunity space for the 3-day workshop was Messaging. In a tense political climate, mixed groups of first- and second-year PoD teams investigated how design can mitigate the negative impacts of political messaging, and develop design strategies that fully enfranchise citizens in the democratic process. They then took their work out into the streets of New York City.
Students investigated how design can mitigate the negative impacts of political messaging, and develop design strategies that fully enfranchise citizens in the democratic process.
Assessing tone, visual language, verbal language and sound design, they revealed the ways in which political messaging incites emotional responses (provocation "LEMON-AID"); communicates our collective values (provocation "I SEE A LEADER"); and serves to increase or depress voter turnout (provocation "ACTION OR APATHY").
They investigated the degree to which political messaging is aligned with or divorced from policy, action, and governance (provocation "I BELIEVE"); and developed response mechanisms for addressing tactical concerns like voter identification (provocation "I DO ID"); and non-citizen participation in political engagement (provocation "VOICE").
"The next opportunity on the horizon is to turn these insightful investigations into design solutions for the 2020 elections," offers the team. "The countdown begins; partnerships are welcomed!"
Provocation: "I DO ID"
Initiating Question: "What aspect of your identity motivate you to the political action?"
Team: Qixuan Wang, Victoria Ayo, Pantea Parsa, Zihan Cheng, Andre Orta, Stephanie Gamble
Location: Grand Central Station
Provocation "I DO ID" investigates how far citizens would be willing to go to establish their identity as voters. Participants were invited to consider and vote on options from among four categories: Social Trust, Personal Data, Policy and Physical Alteration. From familiar forms of printed ID cards to more radical options such as fingerprint, DNA sample or microchip, participants were asked consider what privacy and identity mean to them in the context of voter suppression, voter fraud and citizen rights.
"I DO ID" emerged from an initial examination of the complex faucets of identity in the political sphere. How does identity affect voting behavior? What part of one's identity motivates one to vote? How is identity classified by political systems? While identity is complicated, nuanced and encompasses, identification itself is tactical.
A simply-designed poster provided the bridge for entering into conversations with participants without imposing the group's personal biases. On a rainy Election Day, people in Grand Central Station paused, considered, interacted and offered their insights. A surprising finding: a majority of participants would be willing to give up their privacy—just short of inserting a microchip—in order to prove their identity.
As one participant stood in front of the board for several minutes with a conflicted look on her face, PoD student Stephanie Gamble prompted her, "Would you share what you are thinking about right now?" She replied "I'm just thinking about how I would have answered this differently years ago, when I was younger. Things these days have me thinking twice."
"I DO ID" had provoked her to grapple with the question of identity. The next opportunity for designers is to develop a set of affirmative design artifacts n time for the 2020 elections.
Provocation: "I SEE A LEADER"
Initiating Question: "How might we reveal how people internalize ideas about gender and leadership?"
Team: Ben Bartlett, Yuko Kanai, Shin Young Park, Ted Scoufis, Hannah Rudin, Antya Weagemann
Location: Chelsea Market
How do the mental models we construct based on media representations of leaders inform the choices we make about voting? Team "I See a Leader" explored this question, focusing initially on gender.
Chelsea Market, which attracts tourists from many parts of the world, offered an ideal setting for the team to hear a broad range of ideas. They set up sketch artist stands there, each with an illustrator and an interviewer who would work with participants to visualize their ideal leader. The interviewer asked each participant to describe their ideal leader's physical attributes, prompting them as needed for more details, while taking care not to prime their responses to conform to an expectation.
This co-authoring, co-creation pop-up revealed radical ideas about the attributes of leadership and set the stage for some provocative, nuanced conversations about the representation of leadership in popular media. The sketching exercise allowed participants to externalize these ideas, sharing them not only with the research team but also we spectators in the public space who could respond or reflect on this provocative images.
While participants did not show a strong preference for common physiological attributes, they did indicate their desire for someone who represents their identities through design – principally fashion or the design of their appearance. How, then, do we square these responses with the choices people make in the voting booth?
Provocation "I See A Leader" raises more questions about the incongruence between our fantasy leader sand the decisions we make at the ballot. How might our media landscape offer more radical representations of leadership? How can design influence the messages we receive about what constitutes the look of a leader?
If Provocation "I See A Leader" is any indication, we need more representation by leaders who aren't afraid to dress down, sport multi-colored hair or wear prosthetics in the shape of tree branches.
PROVOCATION "LEMON-AID"
Initiating Question: "Where is the line for freedom of speech? How might this differ for different people and across cultures? How might we bridge this difference?"
Team: Evie Chung, Wei Runshi, Gustav Gyrhauge, Hui Zheng, Sherry Wu, Bart Haney
Location: Washington Square Park
Therapists in the U.S. have coined a new term for the collective, politically-induced anxiety that seems to accompany our current political and media culture: "Trump Anxiety Disorder." How might we create a space for people to unpack politically-induced anxiety and transform it into something constructive?
Introducing Provocation "Lemonaid," a lemonade stand that leverages the nostalgia of childhood to induce positive thinking.
There is power in delight as a function. To that end, "Lemonaid" features a bright color palette of yellows and blues; iconography designed to be reminiscent of cartoons; and stickers to keep the engagement fun. In fact, the roughly-produced prototype offered a whimsical, low-barrier entry point for people to open up and talk about issues. By externalizing anxieties in a visually-playful, co-authored, interactive form, participants are invited to release them and consider, "how now can I turn these lemons into lemonade?"
On a rainy Friday afternoon just a few days after the mid-term elections, Team "Lemonaid" set up their stand in Washington Square Park. With a clear and concise script – using playful language associated with the making of lemonade – team members asked parkgoers to share: 1) a political anxiety on a lemon sticker and 2) an example of aid in the form of a sugar cube sticker. They were then invited to affix their stickers to the Lemonaid stand, where it could be off of their mind and shared, anonymously, with the world.
The intervention was intended to be entirely non-partisan and non-debate-centric. Lemonaid intended to discover the means by which we can relieve political anxiety, without seeking to change people's politics. A further iteration might reveal additional steps for hearing, sharing and healing anxiety that may lead to positive steps in the real world, giving participants opportunities to engage with one another's lemons and sugar cubes through collective action. By gathering more thoughts and opinions, perhaps there would be an opportunity to reduce anxiety and encourage more thoughtful, less polarized political conversation.
Provocation: "VOICE"
Initiating Question: "When people cannot vote, how do they exercise their political freedom? Political impact through non-voting actions." Team: Carly Simmons, John Boran Jr., Yangying Ye, Felix Ho, Helen Chen, Yufei Wang
Location: Chinatown / Lower East Side
Given that 17% of New York City residents are not citizens, centering political conversations solely around voting is inherently exclusionary. Team "Voice" sought to reflect and empower non-citizen immigrants who voice their political opinions despite not being able to formally participate with a vote. Mirroring the NYC Votes branding, "I Voice" creates inclusion by offering wearable stickers that affirm, "I Voiced" in one of six languages: Traditional Chinese, Simplified Chinese, Korean, Hindi, Spanish, and English.
Traveling through the Lower East Side, Team "Voice" met with fourteen people from seven different countries: China, Mexico, Puerto Rico, Korea, USA, India, and Iran.
The two-day design intervention revealed widespread concern about anti-immigration policies and sentiments in the United States among voting and non-voting immigrants. Non-voters reported finding solace in their ability to organize around these issues within their communities; and many actively encourage friends and family who can vote to participate in the process and influence change.
Participants in the design provocation who "Voiced" but did not vote, received a sticker as a way to honor their actions; which many said made them feel included and empowered in a system that otherwise excludes them politically.
The artifact is the message, indicating that despite being dis-enfranchised from the political system they are still engaged in the collective endeavor of our democracy. The object serves as a form of recognition for the citizen while also reminding citizens around them, including politicians and the politically-minded, that non-citizen immigrants participate in the U.S. political system, even without the right to vote.
To Voice is to be heard; to wear the "I Voiced" sticker is to be seen. This artifact, more broadly adopted, offers an opportunity for non-voters to be more visible in a way that initiates positive policy changes.
Provocation: "I BELIEVE"
Initiating Question: "What are people's personal values and do they think any governmental bodies taking action on those values?"
Team: Phuong Anh Nguyen, Anna Chau, Seona Joung, Micah Lynn, Eugenia Ramos
Location: Penn Station
A staggering 41.9% of eligible Americans did not vote in the 2016 presidential election. Team "I Believe" wondered to what extent this inaction was induced by a gap between individuals' personal values and the political actions taken by elected leaders.
"I Believe" is a survey that flips the script. On a simply designed form, participants are asked to write their three "top" values. When completed, a member of Team "I Believe" folds and flips the paper to show how their three values align with a "representation matrix." Led by the question, "Who is taking action on your values?" participants choose from among the existing options: Republican, Democrat, Both, Neither, Other, Not Sure. Asking participants to identify which values are addressed by which political party - if at all – gave participants an opportunity to talk about how their values align with their vote.
The responses were fervent. Most indicated a clear distrust in the system, writing down "LIARS" in all capital letters to express their frustration on political leaders' lack of action. Even those who align themselves politically with one party did not believe that their top three values were fulfilled by their party. A few revealed their values are better served by individuals rather than the parties. Only one out of twelve participants responded that one party aligned with all three values; but shared that it was because the party had a specific policy that helped the respondent keep their money.
Provocation "I Believe" validated the increasing vexation Americans have when they can only choose from polar opposites; and it asks what more can design do to forge spaces to co-create new systems, new opportunities and new courses of action. "I Believe" hopes to offer new options to the many who remain apathetic, disengaged and disaffected by the misalignment between their beliefs and those elected to represent them.
Provocation: "TRIGGER WORDS: ACTION OR APATHY"
Initiating Question: How does political messaging depress voter turnout or ignite positive action?
Team: Sophie Carrillo, Rhea Bhandari, Tzu-Ching Lin, Yue Leng, Wes Rivell, Elvis Yang
Provocation "Action or Apathy" sought to discover how trigger words engendered different emotional responses that either lead people to vote or sit the election out.
The design provocation took the form of a visual spectrum representing a range of emotions. Alongside the spectrum were potentially triggering words and phrases commonly heard in news coverage, debates and political advertising during the 2018 midterm elections, among them "immigrant caravan," "alien," "food stamps," "healthcare," "Facebook" and "Amazon."
Participants were invited to choose words that trigger them and place them on the spectrum to indicate which words incited them to action and which led to feelings of powerlessness. They were then asked to talk about the emotions each word made them feel: enraged, traumatized, concerned, overwhelmed, discouraged, sad, neutral, excited, empowered, hopeful. The emotional responses were left open-ended so that participants could choose their own descriptive language and engage in a non-partisan conversation about their feelings, fears and hopes.
The critical element of the provocation was the spectrum, as it attempted to visualize the complexity of emotions and actions rather than identifying political feelings or actions as living only in a binary state: good or bad; us or them; liberal or conservative.
People were eager to express their feelings on these current topics, most of them were looking for outlets to talk about their rage, anger or just generally how excited they were about other not so controversial issues. As most of them were words, people had different backgrounds and stories, for some people this triggered other events they would then add and place on the spectrum, others had discussions as they saw other participants spectrums and compare each other.
A further investigation might seek to discover the degree to which these reported responses led to actual action or apathy in the ensuing days, months or years. Do emotional triggers lead to long-lasting emotional or behavioral shifts; and how does political messaging leverage the distinction between emotions and action? Understanding these relationships could help create opportunities not only for discussion but to increase participation.
tagged with PE34, Class of 2019, Class of 2020


An aesthetic doubly terminated gemmy titanite crystal from shigar .
1. In case of any reason(s), the buyer may opt to send back item(s) , within a week, after receiving it.!!
We strive hard your item(s) reach you safe and well-packaged.!!


text:
Association between kidney function and mortality among incident metformin users: a retrospective cohort study
M Schorr1,
L Bresee2,
A Soo2,3 &
B Hemmelgarn2
Metformin is first-line therapy for people with type 2 diabetes. Due to potential lactic acidosis it is contraindicated in patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2, although little is known about its use among patients with chronic kidney disease (CKD). The objective of this study was to determine the association between kidney function and mortality among incident metformin users.
Databases of the Alberta Kidney Disease Network (http://www.akdn.info; Alberta, Canada) were used to identify a cohort aged 66 and older with diabetes who were incident metformin users from November 1, 2002 until March 31, 2008. The cohort was stratified on frequency of creatinine measurements prior to initiating metformin: none; a pre measurement only (6 months prior to metformin initiation); a post measurement only (within 1 year after); and both pre and post measurements. Patients were categorized by stage of CKD: 1 & 2 ( ≥ 60 mL/min/1.73m2; reference); 3a (45 - 59 mL/min/1.73m2); 3b (30 -44 mL/min/1.73m2); 4 & 5 (< 30 mL/min/1.73m2); and no measurements. A Cox proportional hazards model was used to determine the association between kidney function and mortality, controlling for demographics, Charlson morbidity scores, hypertension, and visits to general practitioners.
Of the 22,051 new users of metformin, 1,766 (8.0%) did not have a creatinine measurement before or after metformin initiation. Baseline characteristics were similar across groups stratified by frequency of creatinine measurements. A larger proportion of patients who had no creatinine measurements were rural-residing (31.3%) compared to those with pre (17.5%), post (21.1%) and both (15.8%) measurements. Of the subset with a measured eGFR, 25% of incident metformin users had eGFR <60ml/min. There was a small significant increase in the risk of mortality in incident metformin users with CKD stage 3b only (HR: 1.15 ; 95% CI: 1.04-1.28) compared to people with an eGFR of ≥60 mL/min/1.73m2.
Metformin was commonly prescribed to patients with decreased kidney function, and did not appear to be associated with an increased risk of death.
Department of Medicine, Royal College of Surgeons in Ireland, Ireland
M Schorr
Department of Community Health Sciences, University of Calgary, Canada
L Bresee, A Soo & B Hemmelgarn
Department of Medicine, University of Calgary, Canada
A Soo
L Bresee
B Hemmelgarn
Correspondence to M Schorr.
Schorr, M., Bresee, L., Soo, A. et al. Association between kidney function and mortality among incident metformin users: a retrospective cohort study. BMC Proc 6, O46 (2012). https://doi.org/10.1186/1753-6561-6-S4-O46
Glomerular Filtration
Kidney Function


Meridian ProductsUncommon solutions to common IT problems.
At Meridian, we take a consultative approach to identifying and solving the unique business challenges of our clients. But through our years of experience, we have identified a number of key pain points that are experienced by many organizations in wide-ranging industries. The Meridian Data Solutions and profitlens products are our unique solutions to these problems.


Looking for a new home in Black Mountain Vistas Parcel A? It is a great time to buy real estate in Black Mountain Vistas Parcel A and our site is a great place to begin your search. You can check out Black Mountain Vistas Parcel A schools, market statistics, the latest listings and more. Whether you are a first-time home buyer or you are already familiar with the home buying process, you can be assured that you have the best tools and the perfect agent available to help with your Black Mountain Vistas Parcel A home search.
There are currently 11 Homes for sale in Black Mountain Vistas Parcel A. The average price for Black Mountain Vistas Parcel A properties is $274,955which is 6% lower than all Homes within a 20 mile radius. The highest priced property in Black Mountain Vistas Parcel A is $380,400 while the lowest priced Home is listed at $190,000. Most of the properties available in Black Mountain Vistas Parcel A are Homes . Compared to last month, the average price of real estate in the area has gone up 100%.


text:
Denise's Story
Mission & Programs
Training Guidelines For 911 Telecommunicators FinalizedPress Release
INDIANAPOLIS, Ind. (June 09, 2016)—A group of 911 organizations jointly announced today during the annual National Emergency Number Association (NENA) trade show and conference that it finalized recommended minimum training guidelines for the nation's 911 call-takers and dispatchers, culminating a three-year effort. The topics to be included in the recommended guidelines were identified by members of the following organizations, as well as other key stakeholders representing the 911 community, including:
Association of Public-Safety Communications Officials (APCO)
Connecticut Department of Emergency Services & Public Protection
Denise Amber Lee Foundation
Fairfax County (Virginia) Department of Public Safety
Greater Harris County (Texas) 911 Network
Hamilton County (Indiana) Public Safety Communications
International Academies of Emergency Dispatch (IAED)
National Association of State 911 Administrators (NASNA)
National Fire Protection Association (NFPA)
North Central Texas Council of Governments (NCTCOG)
PowerPhone
RedSky Technologies
Rochester/Monroe County (New York) Emergency Communications Department
Vail (Colorado) Public Safety Communications Center
Weakley County (Tennessee) Emergency 911
"The effort was driven by the belief that it is vitally important Americans receive a consistent level of 911 service no matter where they live or travel," said Nathan Lee, president of the Denise Amber Lee Foundation. "Consequently, there must be agreed-upon common elements that ensure the person who answers a 911 call has met baseline core competencies," Lee said. "We believe that the result of this effort will be that the public ultimately will receive a more consistent, effective and professional level of service from telecommunicators across the United States."
While the National 911 Program has facilitated the Project by providing a forum for discussion and development, the Guidelines are not federally owned or mandated—rather, they are the joint product of members of the Working Group listed above. (The Program is a joint effort of the U.S. Department of Transportation/National Highway Traffic and Safety Administration [NHTSA] Office of Emergency Medical Services, and the U.S. Department of Commerce/National Telecommunications and Information Administration [NTIA]).
The recommended minimum training guidelines cover the following topics:
Telecommunicator roles and responsibilities
911 call processing
Emergency communications technology
Legal concepts
Interpersonal communications
On-the-job training guidelines
In addition, numerous subtopics were identified for each topic listed above. It should be noted that the topics identified in the Guidelines provide minimum-level understanding. In order to field and manage emergency calls in a live environment, telecommunicators must receive supplemental training that will enable them to process the discipline-specific emergency calls that are fielded by their respective PSAP/911 Center or Emergency Services Provider.
The Guidelines were vetted by the 911 community at large, via the NENA Workspace platform, before they were finalized. All comments received were adjudicated by a subcommittee formed specifically for this purpose; the subcommittee was comprised of Working Group members who had volunteered for the task.
"The comments received were positive and supportive of the effort, and the result," said Laurie Flaherty, program manager for the National 911 Program. "This is a watershed moment for the 911 community, and many people put their heart and soul into making this momentous event happen."
A parallel goal of the Project was to develop Model Legislation for any state that does not currently have legislation concerning minimum training for telecommunicators. For those that do, the Model Legislation is intended as a baseline to ensure that the recommended minimum training topics are being covered.
911 Guidelines At a Glance
How to Use This Document
Model Legislation
Recommended Minimum Training Guidelines for the 9-1-1 Telecommunicator
Wed January 22
A Victim's Plea; Meeting Expectations
Tue February 4
Wed February 5
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Recreational fishing is no doubt a healthy form of outdoor recreation.
that could be enjoyed throughout life.
towards a healthy diet for all individuals.
For a full version of the FRDC report download here.


The link between alcohol and dementia - what we all need to know!
According to the Alzheimer's Society, UK, Alcohol-related brain damage is a brain disorder caused by regularly drinking too much alcohol over several years. The term ARBD covers several different conditions including Wernicke-Korsakoff syndrome and alcoholic dementia. None of these is actually dementia, but they may share similar symptoms.
ARBD is defined as long-term decline in memory or thinking caused by excessive alcohol use and a lack of vitamin B1 (thiamine). Thiamine is needed to provide energy to the body. It is especially important for brain and nerve cells because they use so much energy.
Alcohol misuse causes ARBD in a range of ways. Regular heavy drinking over time damages nerve cells because alcohol is a toxin. It also causes chemical changes in the brain and the shrinkage of brain tissue.
The second way that alcohol misuse leads to ARBD is by causing thiamine deficiency. This is partly because heavy drinkers tend to not look after themselves and have a poor diet. Alcohol also irritates the stomach lining, leading to vomiting and poor absorption of nutrients. Thiamine deficiency also happens because alcohol interferes with the way the body stores and handles the vitamin.
Alcohol can also cause ARBD through repeated head injuries. People who misuse alcohol are more prone to falls and getting into fights.
Finally, heavy drinking damages blood vessels and is linked to high blood pressure, raised cholesterol levels and an increased risk of heart attacks and strokes. All of these conditions can damage the brain.
According to a study, published recently in the journal Alcoholism: Clinical and Experimental Research found that regular consumption among older populations is on the rise.
"Given the larger number of Americans we are going to have (as the population ages), that's going to increase the need for more public health programming," said study author Rosalind Breslow, an epidemiologist at the US National Institute on Alcohol Abuse and Alcoholism.
People who have a form of dementia, whether caused by alcohol use disorder or not, are likely to suffer more serious memory loss if they consume alcohol. In part, this is caused by reactions between dementia medications, other medications for other ailments, and alcohol. It can also be caused by alcohol itself, especially in the later stages of dementia. Older adults who binge drank twice per month were 147 percent were more likely to experience cognitive decline and 146 percent more likely to have more memory problems compared to those who did not drink.
Families need to look for signs of alcohol misuse and seek help immediately. Besides the harm that older adults are causing to their own bodies, they should not be driving or causing any potential harm to other people because of their use of alcohol. Seeking treatment is essential and should not be taken lightly.


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Knife attack victim left illiterate and missing part of his skull
2 December 2020, 11:52 am ·3-min read
Ran Covell was left with life-changing injuries and had to have part of his skull removed. (Northumbria Police)
A 25-year-old man has been jailed for a brutal knife attack that left his victim missing part of his skull and unable to talk, read or write.
Dean Stewart's assault on 22-year-old Ryan Covell left the latter with such severe injuries, the victim's mother said her son's life has "significantly changed for the worse" and he was unable to tell his account to a court.
Northumbria Police said the two got into an altercation in the latter's flat at the Tyneside Foyer homelessness support accommodation in Newcastle.
Read more: Recycling firms face charges over deaths of five workers
Stewart used a knife to repeatedly attack Covell and inflicted life-threatening injuries to his neck and torso, with paramedics managing to keep him alive before emergency surgery at hospital.
He was put into an induced coma and had part of his skull extracted save his life, but it has left him with "life-changing" injures and unable to communicate, Northumbria Police said.
Dean Stewart has been jailed for seven years. (Northumbria Police)
A victim impact statement from Covell's mother, who was not named by police, said: "Ryan is not able to provide an account.
"He isn't able to defend himself or give his version of events and tell the court how he ended up being brutally stabbed.
"He cannot tell how he was left to die in the street, fighting for his life. The only person who can give an account or rationale for his actions is Dean Stewart."
Stewart, who lived at the Tyneside Foyer, admitted wounding with intent to commit grievous bodily harm and was jailed for seven years and eight months at Newcastle Crown Court on Monday.
Read more: Dangerous driver jailed for two years after live-streaming himself speeding
Covell's mother said in the statement: "Ryan still cannot talk, read or write and it's highly likely that he will never be able to do these things again.
"His life has significantly changed for the worse.
"He will never have a relationship, have children, be in employment or even go to the pub with his mates, simple everyday things we take for granted but are of the utmost importance."
"Stewart still has his whole life in front of him but he has robbed Ryan of this and I will never forgive him for that. He has denied Ryan the chance to live a fulfilling life and that makes me physically sick."
Northumbria Police's Detective Sergeant Brendan Paisley said: "This was a brutal and sustained attack that has changed Ryan Covell's life forever and we welcome the custodial sentence handed to Dean Stewart.
"If it wasn't for the life-saving intervention of the paramedics and doctors then I have no doubt that Stewart would have been convicted of murder.
"In many ways, Ryan's life has been taken from him and I know that the sentence will provide little comfort to him or his family.
"Their lives have been changed forever and I hope that, at the very least, they can now begin to put this case behind them and move on with their lives."
A man and woman were also arrested in connection with the attack and Northumbria Police continue to investigate.
Watch: How the new tiers system will work


Sauerkraut is beyond easy to make, extremely valuable for healing your gut and it's cheap to make! More strains of probiotic than the $50.00 per month probiotic you are getting from the health food store.
Fermenting. How does it work? The process is called lacto-fermentation. On the surface of the cabbage there is beneficial bacteria present. Lactobacillus is one of the many bacteria's found, it's also present in yogurt as well as many other fermented food products. For the food safety questions: When the cabbage is submerged in brine the bacteria begins to convert the sugars to lactic acid, a natural preservative inhibiting the growth of harmful bacteria.
small bowl that the Mason jar will sit into.
Make sure your Mason jar and lid are washed and rinsed of all soap residue. Make sure your hands are really really clean. You'll be using your hands to massage the salt into the cabbage.
Discard any limp outer leaves of the cabbage. Keep the first two good leafs by pealing it off and placing it aside. Trim out the core and cut into quarters. Slice each quarter down its length, making 8 wedges. Slice each wedge crosswise into thin ribbons.
Transfer the cut cabbage to a big mixing bowl and sprinkle the salt, ginger, garlic and hot peppers over top. Begin working the salt into the cabbage by massaging and squeezing the cabbage with your hands. At first, it may not seem like enough salt, but gradually; the cabbage will become watery and limp. This will take 10 minutes. Let your cabbage sit for an hour covered. Then massage again. Repeat if you don't see juice at the bottom of the bowel.
Put your Mason jar next to the bowl with the cabbage in it. Put handfuls of the cabbage into the Mason jar and pack it down tight. If you have a canning funnel, this will make the job easier. Pour in any liquid released by the cabbage while you were massaging it into the jar. The cabbage needs be covered with liquid.
Get the outer leaf that you put aside and fold it till it fits into the mouth of the jar. Place over the surface of the sliced cabbage. This will help keep the cabbage submerged in its liquid.
Cover the mouth of the mason jar with Mason jar lid. Keep a little loose as the fermentation process may kick some of the liquid out of the jar.
If after 24 hours, the liquid has not risen above the cabbage, dissolve 1 teaspoon of salt in 1 cup of water and add enough to submerge the cabbage.
Now that you have made your first jar of sparkling vegetables, start planning to go crazy by adding carrots, other vegetables, sea vegetables. The sky is the limit, have fun.
Because this is a small batch of sauerkraut, it will ferment more quickly than larger batches. Start tasting it after 3 days — when the sauerkraut tastes good to you. Throw away the folded up cabbage leaves and screw on the lid and refrigerate. There's no hard and fast rule for when the sauerkraut is "done" — go by how it tastes.
Let me know how you do with this wonderful health giving treat!


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National Gallery £3.6m painting went on display in women's prison
Artemisia Gentileschi Self-Portrait as Saint Catherine of Alexandria
Izzy Lyons
29 May 2019 • 3:28pm
A £3.6 million painting has been exhibited in a women's prison as part of a nationwide tour.
A rare self portrait by the celebrated artist of Italian Baroque, Artemisia Gentileschi, went on display at HMP Send, a female prison in Surrey, from Monday 20 May to Wednesday 22 May.
The 17th-century painting, titled Self Portrait as Saint Catherine of Alexandria, was recently acquired by the National Gallery and is the first painting from a national collection to go on display in a prison.
HMP Send is the painting's latest venue in a nationwide tour that has seen it visit a Yorkshire GP surgery, a Newcastle high school and Glasgow Women's Library.
In December last year, the National Gallery announced that the painting would be taken to "unusual and unexpected venues" around the country as a "Christmas present for the nation".
The painting on display in HMP Send Credit: The National Gallery
Artemisia's final visit will be a stop on the E17 Art Trail as part of its Waltham Forest London Borough of Culture 2019 celebrations.
Whilst on display in HMP Send, the National Gallery delivered three workshops for up to thirty women prisoners - including learning about the painting and the artist.
Director of the National Gallery, Dr Gabriele Finaldi said: "It is unprecedented for the National Gallery to take a great painting into a prison but this tour is turning out to be exceptional in many ways."
The artwork was previously exhibited at a Pocklington GPs surgery Credit: Charlotte Graham
The National Gallery has also donated several books on art subjects, including the Baroque and self portraiture, to help develop the art reference collection of HMP Send Library.
Justice Minister Edward Argar said: "We are committed to reducing reoffending and supporting rehabilitation. The arts can play a huge role in achieving these goals.
"I fully support this initiative by the National Gallery to deliver workshops and bring important artwork inside the prison gates for all to see."
The painting was bought by the National Gallery in 2018 and was its first acquisition of a work by a female artist in nearly 30 years.
Hannah Rothschild, who in 2015 became the first woman to chair the National Gallery Board of Trustees, said at the time that it was part of the Gallery's "long-held dream" to increase its collection of paintings by important women artists.


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Redwood Lumber vs Douglas Fir Lumber
By Avantica David
Gabriel Connor Salter
Redwood lumber and Douglas fir lumber are extremely popular choices when it comes to home improvement and woodworking projects. Both of these commonly grow in various parts of the world, with significant production. In the northwestern forests of America, redwood trees are prevalent. They are lumbered in excess and are shipped to different parts of the country from the forests. Douglas fir, on the other hand, makes up a significantly smaller portion of American forests.
Redwood Lumber vs. Douglas Fir Lumber
Redwood and Douglas fir lumber are not the same, and each has its own advantages over the other.
The basic difference between the two woods, as far as appearance is concerned, is that Douglas firs are very light brown in color, whereas Redwoods, as their name suggests, are reddish brown to brown in color. Redwoods always have a red colored tinge in them.
2. Uses
Douglas fir and Redwood are commonly used in the manufacturing of furniture and other hardwood items. In addition, both Redwood and Douglas fir are ideal for indoor use. That said, the functions of both these kinds of wood are slightly different. While Douglas fir is more suited for making strong frames in the house, Redwood lumber is most ideal for setting hardwood flooring or for a redwood deck. Since both types of lumber are extremely durable, they can both be used outdoors as well. They can withstand the most weather variations and the damage caused by rain and sun.
3. Composition
Both Redwood lumber and Douglas fir lumber are straight grained and, therefore, very sturdy. They are highly resistant to decay and are extremely stable. They can sustain heavy weights when used as beams and framing structures. Redwood lumber has an added advantage of being an insect repellent. However, Douglas fir lumber scores over Redwood lumber because of its great strength to weight ratio. Structurally Douglas fir lumber is stronger than Redwood lumber, and perhaps that is why it is used more frequently for preparing frames of building structures. Regardless, both these types of wood are known for their strength.
Although Redwood lumber is more prominently found, Douglas fir lumber is extremely economical in comparison to Redwood lumber. Generally, Douglas fir is about 50% cheaper than Redwood, which is considered to be one of the most expensive types of lumber. This has perhaps to do with the fact that Douglas fir trees spring out very fast after they have been cut down, planted or burnt. Redwood trees are old growth trees and are considered very rich due to their fine grained appearance, rich color and slow growth. That said, although Douglas fir is known by this name, it is not a fir species at all, and the old growth trees of Douglas fir are free of sap and have a very high strength. As a result, Douglas fir lumber can also be expensive at times; still, it is never as expensive as Redwood lumber.
Due to its high strength and low cost, Douglas fir is more popularly used in structural work where large quantities of lumber are required. On the other hand, the furniture made from Redwood is considered more exquisite because of the rich appearance.
redwood deck: What is Inside a D Battery?
Softwood Lumber: Uses for 5 Softwoods
By Evaline Tiondi
Understanding Basic Types of Lumber
A Redwood Deck Lasts Longer
What are the Advantages to Using Redwood...
What are the Advantages to Using Redwood for Your Log Furniture?
Choosing the Right Wood for Bed Slats
By Jackie Carmichael


Follicular non-Hodgkin's lymphoma is the most common indolent B cell lymphoproliferative disorder.
Follicular lymphoma (FL) is characterized by diffuse lymphadenopathy, bone marrow involvement, splenomegaly, and less commonly, other extranodal sites of disease, besides the bone marrow. Cytopenias can occur but B symptoms (fever, nightsweats, and weight loss) are uncommon.
The median survival at 10 years ranges from 36 to 71%, depending on risk stratification by the Follicular Lymphoma International Prognostic Index (FLIPI). Not all patients require immediate treatment; many can be observed closely, sometimes for many years. Presently the inclusion of anti-CD20 monoclonal antibody therapy (rituximab) along with chemotherapy, as well as in maintenance, has significantly improved the outcome for patients with FL. Patients with FL are at risk of transformation to a more aggressive, usually diffuse large B cell lymphoma, with the risk of 3% per year.
Are you sure your patient has follicular lymphoma? What should you expect to find?
FL patients present with diffuse painless lymphadenopathy often present for years and often waxing and waning. Bone marrow involvement is present in over 70% of patients and splenomegaly in about 30%. Computed tomography (CT) scans will confirm the adenopathy and if present, splenomegaly. Less than 15% of patients have B symptoms (fever, nightsweats, or weight loss). The most common cytopenia is anemia, and elevated LDH is present in less than 20% of patients.
The diagnosis is optimally made from a lymph node biopsy, specifically a surgical biopsy. Less optimal is a core needle biopsy. A fine needle aspirate is usually inadequate to make a diagnosis. The characteristic histology with malignant follicles is seen histologically, and immunohistochemistry studies show CD20, CD10 monoclonal surface immunoglobulin staining, with overexpression of the bcl-2 protein. Molecular cytogenetics shows the t(14;18) translocation in greater than 85% of cases.
The differential diagnosis of diffuse lymphadenopathy includes a large number of benign and malignant conditions. Reactive lymphadenopathy due to bacterial or viral infection, inflammatory or connective tissue disorders do not contain monoclonal B cells, do not have overexpression of bcl-2 protein, and lack the t(14;18) IgH/bcl-2 (the translocation involving the immunoglobulin heavy chain gene and the bcl-2 gene) translocation.
A variety of other lymphomas might be considered. These include nodal marginal zone lymphoma which is not CD10+ and lacks t(14;18), mantle cell lymphoma which is CD5+, CD10-, CD23- and expresses the t(11;14) translocation, and T cell rich large B cell lymphoma which contains large transformed neoplastic B cells in a background of normal T cells.
Follicular lymphoma is the second most common lymphoma in the USA and Western Europe and the most common indolent NHL. Approximately 24,000 new cases are diagnosed annually in the USA.
A number of environmental exposures have been associated with follicular lymphoma including herbicides and pesticides, and increased risk has been seen in farmers in the Midwestern USA.
Approximately 9% of individuals with follicular lymphoma have a first degree relative also with a lymphoproliferative disorder, although the precise genetic risk factors are yet to be determined.
Once a histologic diagnosis of FL is made, based on an adequate tissue biopsy, patients should have baseline laboratory studies including complete blood count (CBC) and differential, liver, and renal function tests. The most common hematologic disorder in patients with lymphoma is anemia, followed by thrombocytopenia and leukopenia. Although liver function tests (LFTs) are usually normal, an abnormal result might indicate occult liver involvement, and since ureteral obstruction can occur in lymphoma, the measurement of the serum creatinine is important.
These baseline studies are also necessary for planning therapy in terms of drug choices and possible dose modifications. The calcium and uric acid can be checked, but unless there is histologic transformation, one would expect normal results. Serum LDH can be elevated as a marker of the disease in about 10% of patients.
In contrast, the serum beta-2 microglobulin can be a more useful marker of indolent B cell non-Hodgkin lymphomas (NHLs) than LDH. We also check serum immunoglobulin levels, for baseline and on the small possibility of making a diagnosis of an immunodeficiency disorder such as previously undiagnosed combined variable immunodeficiency. HIV testing should be done since indolent lymphomas can occur in HIV+ individuals. Finally, prior to any therapy, we check hepatitis B and C serologies, since anti-B cell monoclonal antibody based therapy can lead to reactivation of hepatitis B infection.
What imaging studies (if any) will be helpful in making or excluding the diagnosis of follicular lymphoma?
CT scans of the chest, abdomen, and pelvis are helpful in staging the disease, determining sites of adenopathy, evaluating spleen size, and detecting the uncommon involvement of other extranodal sites. Neck CT scanning in general does not add significantly to the evaluation. Functional imaging with positron emission tomography-computed tomography (PET-CT) scans is controversial in the evaluation and management of patients with FL. However, if areas of intense uptake are seen this raises the possibility of histologic transformation to a more aggressive NHL.
If you decide the patient has follicular lymphoma, what therapies should you initiate immediately?
Although nearly 90% of patients have advanced stage disease, most do not require immediate treatment. Many patients will have waxing and waning disease and 20% may have a spontaneous remission at some time. There is no evidence from randomized trials of immediate chemotherapy versus observation or even rituximab versus observation, that there is a survival advantage to early treatment in asymptomatic patients. If patients have cytopenias, B symptoms, compromised end organ function, symptomatic extranodal disease, effusions, bulky symptomatic nodal disease, or splenomegaly, then treatment is indicated. The median time for needing treatment is at least 3 years.
When patients need their initial treatment, multiple randomized trials have shown improved response rates, duration of remission, and overall survival with the addition rituximab (R) to conventional chemotherapy. The most commonly used chemotherapy regimens were cyclophosphamide, vincristine, prednisone (CVP), and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). However, bendamustine plus R has been shown to be superior to CHOP-R, in terms of progression-free survival, and with less toxicity, but no difference in overall survival, but now is a very commonly used upfront regimen. For patients who have non-bulky disease another option is R alone, which has a 70% response rate, with a median time to progression of 2 to 3 years. The use of R plus lenalidomide has a high response rate and durable responses at 5 years. This regimen is being compared in a randomized trial to conventional therapy for treatment naive patients.
What other therapies are helpful for reducing relapse?
Approaches to prolonging remission have included some form of maintenance or consolidation therapy. These include maintenance R and autologous stem cell transplantation. Maintenance R has been given following induction therapy with R alone, as well as after chemotherapy. A recent update of a randomized trial of the initial treatment with R alone for 4 weekly doses followed by four maintenance doses (or observation) has reported that the maintenance R improved remission duration by more than two fold, and 45% of previously untreated patients are in remission at 8 years who receive the maintenance R. The event free survival was not improved when maintenance was extended to 5 years.
Maintenance R has also been shown to benefit patients who receive chemotherapy (CVP or CHOP but not bendamustine) and R for their initial treatment. A recent randomized trial using 2 years of maintenance R or observation, found significant improvement in progression free survival following chemoimmunotherapy, but to date there is no improvement in overall survival.
High dose therapy and autologous stem cell transplantation (ASCT) has been examined in several large randomized trials for consolidating first remission following conventional chemotherapy for FL. Although most studies demonstrate a significant improvement in PFS, there has been no impact on overall survival with first remission ASCT.
The prognosis of patients with FL is dependent on stage and other clinical/laboratory prognostic factors. Less than 10% of patient with FL present with early stage I or II disease. For these patients, involved field radiation therapy (largely for stage I) leads to a median survival of 19 years.
The overwhelming majority of patients with advanced stage FL will relapse following conventional therapy. At relapse, the first question is whether the patient can be observed again. When the patient needs treatment, however there are a vast number of options. These range from low dose local radiation for solitary sites of disease, to combination chemotherapy, usually with single agent rituximab (R), clinical trials with novel agents, as well as stem cell transplantation (autologous and allogeneic) for patients with multiple relapses or refractory disease. Low dose radiation 200cGy has response rates of 90% with excellent durable control for localized progressive symptomatic sites of disease. Although single agent R has been reported to be quite effective for relapsed FL, with response rates of 50 to 65%, these studies were largely done in patients who were R naive.
In the current paradigm of chemoimmunotherapy for FL, it remains uncertain how effective single agent R is in relapsed patients. However, single agent R should still be considered for relapsed patients who had at least 6 months of benefit from an R-containing regimen, with low volume disease. If the patient responds to weekly doses (for 4 weeks) of R, we generally recommend the Swiss Group for Clinical Cancer Research (SAKK) regimen of one dose q 2 months for four additional doses of maintenance.
The addition of R to conventional chemotherapy followed by maintenance R for 2 years has enhanced the efficacy of treatment of relapsed FL by 24 months in a large international randomized study of CHOP or CHOP-R for relapsed patients. Unfortunately the relevance of this study to the current paradigm of treatment is not clear, since these were rituximab and CHOP naive patients. Other regimens that are effective include bendamustine and rituximab.
Again however, the treatment paradigm has shifted to bendamustine plus rituximab as upfront therapy, making the utility of this regimen for salvage much less clear. CVP-R or CHOP-R may turn out to be used more for second or greater lines of conventional therapy. Unfortunately, the duration of subsequent remissions for patients with relapsed FL become progressively shorter.
Of the number of new agents being evaluated in follicular NHL, an oral kinase inhibitor, idelalisb, was recently FDA approved. Idelalisib has a 57% response rate with a median duration of 12 months. This agent targets the PI3 kinase delta isoform. Other new monoclonal antibodies, antibody-drug conjugates, and small molecules are being investigated in follicular NHL.
Both autologous and allogeneic stem cell transplantation have been used in patients with relapsed FL. The only randomized trial of autologous transplant (ASCT) versus chemotherapy predated the use of rituximab. In the CUP trial, the only randomized trial of ASCT, there was a significant improvement in PFS and OS for patients undergoing ASCT as compared to the control arm of no transplant. Although the treatment related mortality is low, at least 50% of patients relapse following ASCT. Concerns of late toxicities of ASCT include second malignancies such as myelodysplasia, secondary acute myeloblastic leukemia, as well as other solid tumors.
Myeloablative and reduced intensity non myeloablative allogeneic stem cell transplants have also been performed in patients with relapsed FL. The relapse rates are generally less than 20%, however higher treatment related mortality, ranging from 15 to 40%, has made the widespread applicability of this approach controversial in patients with relapsed FL.
Part of the natural history of indolent lymphomas is transformation to a higher grade histology, usually diffuse large B cell lymphoma (DLBCL). The risk over time is about 3% per year for patients with FL. Generally these patients are treated with CHOP-R or other regimens for DLBCL, and consideration is given to consolidating the remission with ASCT following remission induction. Although historically the prognosis for patients with histologic transformation has been poor, patients who are previously untreated for FL may have a similar prognosis as patients with de novo DLBCL.
FLs are neoplastic transformations of normal germinal center B cells that reside in secondary lymphoid follicles. The pathobiology of this disease is not completely understood.
The overwhelming majority of cases express the t(14;18) translocation. This translocation involves the immunoglobulin heavy chain (IgH) on chromosome 14 and the Bcl-2 gene on chromosome 18. The Bcl-2 gene comes under the control of the IgH promoter, which leads to the overexpression of Bcl-2 mRNA and protein. This protein which is a mitochondrial membrane protein, prevents programmed cell death or apoptosis, leading to prolonged cell survival. However, additional genetic lesions are necessary for the development of FL since t(14;18) is seen in a subset of diffuse large B cell lymphomas, and small numbers of normal B cells bearing t(14;18) have been detected in the peripheral blood and lymphoid tissues of normal individuals.
Further evidence for the need for additional genetic lesions is that mice engineered to overexpression the IgH- Bcl-2 translocation, develop follicular hyperplasia and not follicular lymphoma. Additional genetic lesions in these mice are needed before seeing lymphomas develop.
In addition to the genetic aberrancies of the neoplastic cells, more recent evidence suggests that the normal cells in the malignant microenvironment contribute to the behavior of FL. Specifically, using gene expression profiling, the presence of a T cell infiltrate may confer a more favorable prognosis, whereas an infiltrate rich in macrophages/monocytes may confer a disease with a more aggressive course and less favorable prognosis.
What other clinical manifestations may help me to diagnose follicular lymphoma?
Infrequently the pathologic diagnosis for FL cannot be made by conventional histology and immunohistochemistry, so fluorescent in situ hybridization (FISH) for t(14;18) may be helpful.
Taverna, C, Martinelli, G, Hitz, F. "Rituximab Maintenance for a Maximum of 5 Years After Single-Agent Rituximab Induction in Follicular Lymphoma: Results of the Randomized Controlled Phase III Trial SAKK 35/03". J Clin Oncol.. vol. 34. 2016 Feb. pp. 495-500. (5 years of maintenance rituximab did not lead to improved event free survival when compared to 8 months).


Monarchal despotism runs Bahrain. Democracy is verboten. None whatever exists. Neither human nor civil rights. Anyone criticizing Al Khalifa rule risks arrest, imprisonment, torture, even death. Repression persists. New "Protecting Society from Terrorism Act" legislation the latest example.
Americans for Democracy for Human Rights in Bahrain (ADHRB), the Bahrain Center for Human Rights (BCHR), and the Bahrain Institute for Rights and Democracy (BIRD) expressed deep concerns.
The new measure updates a 2006 law. Clarifying Bahrain's definition of terrorism. Including provisions further undermining fundamental rights. The law was revised earlier in August 2013. Used ruthlessly against pro-democracy activists. Banning dissent. Imprisoning hundreds in 2013 alone. Including children young as 15. Many receiving lengthy sentences. For wanting rights everyone deserves.
The updated law includes a separate prosecution office. For whatever authorities call terrorism-related crimes. "Effectively creating an entirely new process of criminal procedure for persons (unjustly) accused of terrorism," according to BCHR.
"Anyone arrested or detained on a criminal charge shall be brought promptly before a judge or other officer authorized by law to exercise judicial power and shall be entitled to trial within a reasonable time or to release."
Not in Bahrain. Or America. Or Israel. Or likeminded states. Brutality defines their agendas. Torture is longstanding US and Israeli policy. Bahrain's ruling authorities routinely detain victims for prolonged periods. Denying them all rights. New legislation authorizes prolonged pre-trial detentions. In brazen violation of international law. Authorities can detain suspects up to 28 days without charges or investigation. Three additional days for interrogations and charges to be drawn.
Most detainees "report that they are subjected to torture and ill-treatment during the pre-trial period. Such was the case of photographer Hussain Hubail, human rights defender Naji Fateel, and children Jehad Sadeq and Ebrahim Al-Muqdad."
Police now have greater than ever authority. Permitted to search anyone anytime without court authorization. Allowed to stop and search public and private vehicles. Ban free movement indefinitely. Interdict private communications. Up to 24 hours. Without court authorization. By order of the special prosecutor for terrorism-related crimes.
Anyone suspected of terrorism can be banned from certain areas up to 15 days. New legislation "provide(s) legal justification for many already utilized police practices that violate basic human rights," said BCHR. Shaheen Al-Buainain serves as senior prosecutor for alleged terrorism-related crimes. In 2013, he was accused of involvement in torture. A complaint was filed against him with Bahrain's Interior Ministry's Special Investigations Unit.
New legislation shows its government intends silencing dissent. Peaceful protesters can be accused of terrorism. Arrested. Tortured. Sentenced to long prison terms. For exercising their rights to free expression, assembly and association. Police states operate this way. Bahrain is one of the worst.
On December 29, Al-Wefaq Political Society secretary-general Shaikh Ali Salman was lawlessly arrested. BCHR and other human rights groups condemned his detention. For peaceful political activities. As leader of Bahrain's largest opposition political party.
"The silence of the international community contributed to the arrest of Shaikh Ali Salman, as it also contributes to the deteriorating human rights situation in Bahrain. With this high-profile arrest, however, the Government of Bahrain has gone too far in targeting its peaceful critics."
Al-Wefaq boycotted earlier 2014 parliamentary elections. So did other opposition parties. Refusing to participate in a sham process. Al-Wefaq members have been targeted for years. For their political and human rights activism. Former party members Matar Matar and Jawad Fairooz were arrested, tortured and detained for month.
"Earlier this month, Britain announced that it will be building a naval base in Bahrain, which the Government of Bahrain is bankrolling. The UK's support for the Government of Bahrain, despite the human rights situation and harassment of Al-Wefaq Society, has given the Bahraini authorities the green light to further attack political societies."
"The international community and the United States must condemn the detention of Shaikh Ali Salman, for it is a clear sign of the Bahraini authorities disregard for the human and political rights of the Bahraini people."
State terror defines official Bahraini policy. Anyone can be targeted for expressing political views freely. Championing human rights. Supporting democratic change. Daily crackdowns continue. Challenging repressive rule is considered terrorism. Beatings. Arrests. Disappearances. Torture. Imprisonments. Cold-blooded murder are standard practice.Women and children are brutalized like men. So are students, doctors, nurses, other medical personnel, journalists, human rights activists and foreign observers.
Elections when held are farcical. Business as usual persists. Ordinary Bahrainis have no say whatever. Police states operate this way. Bahrain is one of the region's worst.


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A reclusive video arcade repairman (Chase Williamson) experiences bizarre biomechanical mutations and Cronenbergian hallucinations when a mysterious new arcade machine appears in his shop. Reality itself threatens to fracture as the young man works to solve its mystery - and overcome the new chaos that has entered his life.
Sequence Break is written and directed by Graham Skipper, known for his acting work in such celebrated genre films as The Mind's Eye, Almost Human, and Beyond the Gates - as well as headlining Stuart Gordon's acclaimed stage spectacle, Re-Animator: The Musical.
Sequence Break stars Chase Williamson (The Guest), Fabianne Therese (Southbound), Lyle Kanouse (HBO's Big Love), and Audrey Wasilewski (AMC's Mad Men). You can read our review here.
We had the opportunity to speak with Graham Skipper about the film.
GS: I was a theatre kid growing up, and went to school for acting at Fordham University in NYC. But I've always been obsessed with movies - especially genre movies - and certainly always dreamt of getting to act in as well as create films of my own.
TMS: What's up with Sequence Break? Where can people see it? And what do you want them to know about the movie?
GS: Sequence Break is live on Shudder as of Thursday, May 24! The movie is a psychedelic, Cronenbergian trip down the rabbit hole as a reclusive video arcade technician is faced with impending love and a sentient video arcade machine. Biomechanical hallucinations and bizarre mutations abound!
GS: Years ago I read online about an urban legend of an arcade game called Polybius, wherein the game mysteriously appeared in an arcade and caused players to suffer hallucinations, seizures, and even death. I couldn't crack the code on how to successfully tell that story, until a few years ago Oz's story of being caught between two competing passions popped into my head, and I knew it needed to be told through a body horror lens, and then all of these components sort of magically slammed together in my head.
GS: When I wrote it, I was struggling in my own life with trying to balance my passion for acting and filmmaking, and my desire to be home and have a dedicated family life. It was those struggles that informed Oz's journey of feeling caught between two impossible choices, and needing to find a third option in order to survive and live a fulfilled life.
GS: As I recall, I wrote the first draft pretty quickly, like in a few weeks.
GS: The characters definitely got more developed with each draft, and the relationship between Oz and Tess became more alive and grounded. Also the logic of the final act became more solid and consistent.
GS: With a story that plays with form and storytelling structure like this, it was mainly a matter of making sure everything was as clear as possible, and that amidst all the bizarrity that happens within the film, that the characters remained grounded and believable.
GS: The works of Cronenberg were definitely influences - particularly VIDEODROME. Also David Lynch, and recent films like BEYOND THE BLACK RAINBOW, SPRING, TETSUO THE IRON MAN, and A FIELD IN ENGLAND.
TMS: Is everything that we see onscreen essentially what was in the final draft or did it change during shooting?
GS: Most of it was there in the script! There were some changes during shooting and even more changes during the edit, for clarity and pacing, but overall most of what was shot was there in the script.
GS: It was a quick shoot, around 14 days.
GS: Well, on this, Lynch and Cronenberg, certainly. I also looked at a lot of Japanese directors, specifically at how unafraid they are to really go for it in terms of visuals or making bold choices. Also having worked directly with Stuart Gordon, his style was a big influence on how I approached creating the film.
TMS: You worked with Chase on Beyond the Gates. Did his involvement come about from working with him in the past?
GS: I've been a fan of Chase's work for years, and then getting to work with him and become good friends really sealed the deal. I saw how natural he was in front of the camera, and how instantly he was able to drop in very real emotions into unbelievable situations, and I knew he had to play Oz.
GS: Well, Lyle - who plays Jerry - and Audrey - who plays the bartender - both produced the film with me and are both veteran stage and screen actors with credits a mile long, so it was a no-brainer to have them in the film! I was blessed with not only having the two of them make the film happen, but then to also both be excellent actors to boot was really a gift. Fabi of course had worked with Chase on JOHN DIES AT THE END, and I was a fan of hers from having seen several of her other films over the years, so when Chase suggested her for Tess we were excited for her to come in and read. She came in and read some scenes with Chase and totally nailed it! She was perfect. Then finally Johnny Dinan had worked with Lyle on another project and we had him come in and do some scenes and a monologue from the film for us. I'll never forget how intense and emotional that audition was. He was fantastic, absolutely blew us away.
TMS: Can you talk a little bit about the score. How closely did you work with the composer on the score?
GS: Van Hughes was my roommate in college and has always been one of the most talented composers I know, so I was thrilled when he agreed to come on board and score the film. I basically gave him a temp score that we used in the edit and then told him to use that as a guide, and he did just that! He absolutely slayed it - I think we had like 4 notes on the whole score when he first sent it in. He's brilliant and he and I have a real shorthand that made it super easy to make adjustments and get everything perfect.
TMS: There is some wild body horror and special effects sequences. Can you tell us a little bit about how those ideas originated and how they were ultimately put together by the effects team.
GS: Yes! Josh and Sierra Russell designed and executed the effects, and they really are a part of the soul of this film. I knew that a crucial aspect of telling this story was going to be the "lustful" encounters that Oz has with the game, and selling that. I wanted it both gross but also oddly sensual, all about slime and fluids and malleability. Josh and Sierra read the script and we sat down to meet a few times, and their instincts were totally in line with mine. We were all thrilled with how the effects turned out.
TMS: Is there anything you learned from working on Sequence Break?
GS: Really, so much of what I learned was in the difference between being an actor on a film and then being behind the camera. So much work goes into the creation of a film, from inception to post to film festivals to selling it to getting distribution...as an actor you're there for 4-6 weeks and then you're done, and the movie just kind of magically appears. I have a whole new appreciation for just how difficult it is to make a movie and get it in front of people, and feel that much more proud of how much literal blood, sweat, and tears went into this one to make something really special. I am also so indebted to the army that helped make this movie possible. My production team, the crew, the cast...everyone was so wonderful and supportive and really waded through the trenches with me to make this film happen, and I couldn't be more grateful to them.
GS: Good question! VIDEODROME is probably the most obvious answer, but I'll go a little more left field and say...THE LAST STARFIGHTER. I always like double bills that are thematically similar but differ in tone, so I think the intense psychedelic mind meld that comes with Sequence Break, followed by something like The Last Starfighter would be really fun. And then go play in an arcade afterward!
GS: I'm a huge fan of EVENT HORIZON, and I've always thought that movie could be updated in a cool way. So maybe that one!
GS: I'm in a few films that are on the film festival circuit right now that folks should keep an eye out for: ALL THE CREATURES WERE STIRRING and DEMENTIA PART 2. Also newly on Shudder I was lucky enough to play small role in Ryuhei Kitamura's fantastic DOWNRANGE. And of course check out SEQUENCE BREAK on Shudder today!


In this series we have covered the solution your business plan puts forward to solve the customers problem. This idea must now be tested to see whether there are any customers for it and to see how large the available market might be.
To the investor, the solution in itself has no value unless it can be realized in the market place. Ultimately, it will be the industry market size that decides the value of your business to an investor and, as a rule of thumb, the bigger the available market, the better.
Before calculating market size we need to look at a couple of definitions. For a business plan, the available market is defined by two terms, total available market (TAM) and served available market (SAM).
TAM (Total Available Market) is the total market size (people, revenues, units etc.) who have the problem you are seeking to solve today.
SAM (Served Available Market) is the part of the TAM who are able to use your solution to the problem. This is your target market.
As an example of how to determine market size (using made up data), suppose you are in the lawn care business. You have just started and have one operation but have plans to expand throughout the region into a chain of lawn care centers.
This means that if your business operated throughout the entire region with no competition its revenues would be 27 million per year. TAM defines the maximum size for the market the business operates in.
If there was no competition within the town and you had the resources to provide the service, then the revenue from the business would be 4.5 million per year. The SAM represents 16.7% of the TAM.
The business plan market size section can be presented in a number of formats, but a simple column format setting out the TAM and SAM now and in five years time, will allow the investor to quickly ascertain how big the market for the product could be and it prospects for growth over the duration of the business plan.
Market sizing is an important part of the business plan process. But this is planning not accounting. The market size section is an educated guess at how big the available market for the product is and aims to show that a successful launch and continued growth for the product is possible. It is based on available statistics and trade association data.
Start from verifiable and accurate base data. In the above example, the starting point was a government statistic based on the number of properties with gardens.
Double check any information with an alternative source if possible.
Check the results make sense.
Check the results using a bottom up calculation. For example, if you know a lawn care business in the region has revenue of 500,000 and estimated 2% of the market, then the TAM should be in the order of 500,000 / 2% = 25 million compared to the 27 million calculated above.
Keep the industry definition narrow, in this case lawn care treatments.
Be specific, don't try and say for example, there are millions of properties in the world with gardens and if we can take a very small percentage of that our plan will work.
The analysis will differ depending on whether you are dealing with an existing market or a completely new market. For an existing product there will be market and industry data available, for a new product you may need to carry out market size research with potential customers and work upwards from there.
This is part of the financial projections and Contents of a Business Plan Guide, a series of posts on what each section of a simple business plan should include. The next post in this series is about the analysis of the target market for the business plan product.


Congratulations to Myles Dwyer (The Old Mill) and Hanna Carr (Clonkeen) who were baptised recently.
Please pray for Fintan Purcell (Glascarn Lane) and Eilish Everard (Bradystown) who died during the week. May they rest in peace.
Standing Orders for June €4,277.59 Many thanks for your continued support and generosity.
St Benedict's Priory: Retreat House Cobh, Co Cork, is available for private individual or group retreats, private day retreats. Retreatants are welcome to share in our liturgical life - Holy Mass, Liturgy, and Hours of Adoration of the Blessed Sacrament. The retreat house is situated in quite peaceful surroundings and has a lovely Bible Garden. Also magnificent views of Cobh harbour and Cobh Cathedral. Suggested offerings €40.00 per day this includes breakfast, midday and evening meal. Tel (021) 4811 354 for more information.
"There is a need of only one thing" The responsorial psalm tells us what it is: living in the presence of the Lord. Abraham coaxes this presence: " Sir, please do not go on past your servant." Jesus enters a village and goes into the home of Martha and Mary. Yet, the "anxious and worried " Martha prefers her trivial distractions to the winning attraction of Christ. "The surest sigh that something is off in Martha's soul is that she even tells God what to do."( Father R. Barron). Saint Paul attests that God's stewardship is given to him " to bring to completion for you the word of God." Christian stewardship demands stillness, silence, and attentiveness before the Presence. To those who choose the better part, God chooses "to make known the riches of the glory of this mystery".
Lord Jesus, fill me with a desire to remain in your presence through everything that happens today. May I find you in the people I encounter and the events that take place. When I have a quiet moment, may I turn to you in prayer. May I trust in your love and care whether I am aware of it or not. I know you hold all things in your hands, and I pray to be firm in that confidence at every moment. Amen.
Lord, in the beauty and freshness of this new morning, I put my life in your hands once again. Renew in me the decision to follow you and to accept joyfully the responsibilities and duties of this day. Help me to receive gratefully the simple pleasures of food and drink, warmth and clothing and kindness from the people I meet. May I willingly take up the crosses and the burdens of everyday life as you took up your Cross for me. Amen.
Lord Jesus Christ, may this day bring justice to the oppressed, health to the sick and relief to those lands aflame with war and hatred. Help me to be an instrument of your peace. Amen.
Feasts days for the coming week.


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Jerry Ruben Lucena  (* 11. August 1980 in Esbjerg) ist ein dänischer ehemaliger Fußballspieler mit einem philippinischen Vater und einer dänischen Mutter.

Er spielt als Verteidiger oder auch im defensiven Mittelfeld.

Von 1999 bis 2007 spielte er für seinen Jugendverein Esbjerg. Im Jahre 2007 wechselte er dann nach Aarhus. Seit 2011 spielt er international für die Philippinische Fußballnationalmannschaft. Zuvor hatte er schon einige Einsätze in der U21-Auswahl Dänemarks.

Erfolge
Philippinen
 AFC Challenge Cup: 2014 (2. Platz)

Weblinks
 Statistiken bei danskfodbold.com

Fußballspieler (Aarhus GF)
Fußballspieler (Esbjerg fB)
Fußballnationalspieler (Philippinen)
Philippiner
Geboren 1980
Mann

redpajama_set_name: RedPajamaWikipedia