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Administration Dept. - Jo'Han Chant'Ney
JO'HAN's CIRCLE
Harmony Health Balance
C.M.A. Services
Balance of Synergies
Documentary & Press
Interviews and Broadcasts
KJC's OFFICE
Ownership Office
Administration Dept.
- Service >
Graphic Arts and Design
Editorship & Publishing
- Assistance >
Copyright Office Intl.
Legal Doc. Certifications
Scenographies
- Cooperations >
Jo'Han Chant'Ney
Briefly of Jo'honaa'éí Hání
KJC's Eagle Creations Hitstory
Currently it is charged to the owner and efficently coordinated it in two work-stations:
Fiscal Registered Office [FRO] and Digital Mobile Station[DMS].
Segretery > The connection of these two work-stations creates an automatic satellite geolocation system controlled by the Authorities of the transit or stay States. Introduced as an International Secretariat Service, communications and operations are handled anywhere in the shortest possible time, since it is not a virtual structure and is therefore managed by human resources.
Bookkeping > Accounting and Employment Consultant is managed by authorized Private Professional Studio.
Archives > Archives are preserved as digital and paper into unmentioned places for security.
Clients Dept. > Customer service is a service of management and protection of information and privacy. Every natural or legal person is identified by a Code produced by the Security Office. The data and information held by KJC's aren't freely accessible from anyone. Private or military authorities need to request access to data with serious motivation. Government agencies have their own data access systems for which KJC's cannot guarantee in these cases.
KJC's EAGLE CREATIONS
"The Research of"
Before using a pencil and create a drawing, KJC conducts a detailed research to obtain as much information as possible suitable to be able to define which topic or theme needs to be analyzed for a project, subsequently.
The reasons are:
- to avoid the occurrence of a similarity with other existing manufactured products; the components of a new design mustn't contain common elements of figurative content so asn't to confuse them with a visual and advertising communication in the market of another existing design.
- to achieve the result by giving the right meaning to the project;
- to arouse "historical" and / or "ethnic" emotions through the drawn image (or simulation of the context).
The research also consists in finding new techniques through figurative art.
Study Techniques
To create an image that is advertising or simply identifying commercial brands, KJC uses the synchrony of essential elements that play the role of the "communicative preselection" (the one hidden behind the real communicative representation that affects the interest of those who is watching).
To name a few: subjectivity, environment, context, purpose, and so on. The study isn't based exclusively on the personal choice of KJC but above all on the timeshare of the real purpose that the image must have, therefore the impact on "Visual" Communication.
The purpose is never subject to degradation and to the pleasure of others; in order not to make the mistake of contributing to an unsolicited and non-objective communication (the one that the author intends to expose in the communication market).
Work Techniques
The KJC's planning work is the employ of every aspect of the creative matter, leaving preceding what have been defined as "guiding procedures" for each actual realization.
The technical support works to allow the complicity of all the instruments taken into consideration not attacked by the author's style or by the production; allowing the use of all the tools necessary for the realization suitable for prints, digital supports, etc.
It's the Result of the realization that identifies the working technique used by KJC.
For the graphic design, the KJC's system is discreet until complete. The project is made entirely by the own production.
For a multimedia or scenic project, KJC needs other complementary, professional structures that collaborate, both in the realization and in the management of the obtained resources, collected or made available from the author or Production in some cases. (Executive Office).
KJC has its own style for which it identifies with it.
In the methods of graphic and scenographic realization of the visual image, directed to some range of users, it does not transmit its own style but the one appropriate to the topic suggested by the Author, which satisfies both without altering the objective of the Communication itself, the choice of the Author.
The preferred style for graphic creations is composed of a set of information about sacred geometry, alchemical ties, numerology, metaphysics, sound and color vibrations, emotional frequencies.
Styles can be modified by KJC to emphasize the interest of the visual commercial request. KJC also adopts styles that can identify or imply belonging to certain societies, ethnicities, cultures, technologies, trends and life choices.
The Color choosing
In the phases of realization of the visual image, the KJC's technical intervention, puts the colors in relation and in conflict, so that they form a harmonious and pleasant color scheme, suitable for representing different scenic and psychological contexts.
Color frequencies are researched or created for special effects and stimulate the limbic system for a more conscious opening.
The Consultancy
The consultancy is addressed in graphic design environments and in all structures that need to communicate their business through the image.
Consultancy services are available on the request for customized graphic formats, targeted research elements, creative and managerial solutions.
- Copyright 2018 KJC's Eagle Creations -
Jo'Hán Chánt'Ney
Medicine Man of the Grand Canyon, Arizona Alien and Keeper of the Diné Spiritual Heritage


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Tag: Kleiner Perkins Caufield & Byers
Tag Archives: Kleiner Perkins Caufield & Byers
Ellen Pao resigning as CEO of Reddit
July 10, 2015 Internetacting chief executive, Alexis Ohanian, Business, Business/Finance, Businesspeople, co-founder, Digital media, Ellen, Ellen Pao, Hipmunk, Kleiner Perkins, Kleiner Perkins Caufield & Byers, News websites, Ohanian, Pao, Reddit, Sam Altman, San Francisco, Science and technology in the United States, Social bookmarking, Software, Steve Huffman, United States, Victoria Taylor, World Wide Websmbale
Ellen Pao resigning as acting chief executive of Reddit.
Jury clears top Silicon Valley firm of gender bias
April 1, 2015 LegalAjit Nazre, Amazon.com Inc, Businesspeople, California, Corporate directors, Ellen Pao, Financial economics, GOOGLE INC., Investment, John Doerr, Kleiner, KLEINER KONDITOREI-BAECKEREI, Kleiner Perkins, Kleiner Perkins Caufield & Byers, Pao, Pao v. Kleiner Perkins, Silicon Valley, Steve Sammut, TiE, Trae Vassallo, Twitter, TWITTER INC., Venture capital, Venture capitalists, Women corporate directors, Women in venture capitalsmbale
(BVO) – Silicon Valley powerhouse venture capital firm Kleiner, Perkins, Caufield and Byers was cleared on Friday of claims it short-circuited the career of a former partner because she is a woman, in a gender discrimination trial that shook the tech world.

redpajama_set_name: RedPajamaCommonCrawl


It can be a crushing feeling knowing that you have more debts than you can pay with your current income. Before considering drastic actions such as credit consolidations or even bankruptcy, take a close look at your bills and how they can be prioritized. You may find the situation is more manageable than you thought.
The first step is to take a hard look at your continuing expenses. If you often spend more than you earn, it does not matter how well you prioritize your bill payments. Check your expenses and determine what are truly needs versus wants. Cable TV is nice, but it cannot come at the expense of food or medicine. (There are now great, low-cost internet TV options like Netflix available for $7.99 per month.) Formulate a budget with your new priorities, and stick to it.
Next, consider which of your debts are secured vs. unsecured. Secured debts mean that the creditor has some form of collateral that they can seize if you fail to pay your bills – such as your house and your car. Unsecured debts are debts without collateral, like your credit card bills.
Finally, consider any debt that may not be secured with collateral but that could cause loss of a need – for example, failing to pay child support or income taxes can have serious repercussions and even cost you jail time.
With that in mind, here is a proposed order of priority to help you dig out of your debt. You can juggle them a bit within categories, but the main rules are: necessities first, secured debts and other loss-related debts first, unsecured debts last.
Necessities – Food and healthcare needs cannot be ignored. Take care of these expenses first. A good budget can help you get the most out of your dollar.
Housing Costs – This includes not just mortgage payments but also property taxes, homeowner's insurance and utility costs. It does not do you any good to pay your mortgage if the house is unusable due to your utilities being disconnected.
Legally Supported Expenses – Things such as your income taxes, child support, and other court judgments must be dealt with next (and arguably even before housing costs, if you are in imminent danger). These expenses can cause loss of property through liens or seizures, or loss of freedom through incarceration.
Car Payments – If your car is necessary to maintain your job, it's next on the list — including not just loan or lease payments but also insurance. If you can use public transport or carpool, you may reduce this in priority – but do not just let your car be repossessed. Work with your creditor; they would rather help you with making your payments than take away your car.
Student Loans – Defaulting on student loans can have serious repercussion such as garnishing of tax refunds. While your diploma will not be taken away, you should probably consider this higher priority than unsecured debt.
Unsecured Debt – Start attacking this in the order of highest interest rate first, typically credit cards. If you have to, contact the creditors to seek alternate payment terms. They may be willing to work with you.
You probably did not get in this situation quickly and it will take even longer to get out of it – but if you stick with your plan and keep a firm line on needs vs. wants, you can eventually get out of the hole and experience the relief of not having more debt than you can manage. Remember that your eventual success is going to have more to do with controlling expenses than the order in which you pay your bills.
If you want to reduce your interest payments and lower your debt, join MoneyTips and try our free Debt Optimizer tool.


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Turkey goalkeeper is sent off by referee after saving two penalties; the defender that replaces him saves third penalty (video)
In Turkey, Goalkeeper Ersin Aydin surely had a day he'll never forget as he helped his club Usakspor beat Turkish third-tier rivals Ergene Velimese. Ersin, had a day most goalkeepers can only wish for, as he saved two penalties but was yellow carded twice for coming […]
by Jude on January 21st, 2020
The 10 Most Anticipated PC Games of 2020
Looking back before we move forward, 2019 was a good year for PC gaming. But in spite of how excellent many of those games are, they'll have some pretty stiff competition this year. With highly-anticipated titles like Mount & Blade: Bannerlord and Cyberpunk 2077 on […]
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Energy - Technology -
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Danish offshore drilling contractor Maersk Drilling has been awarded a two-well contract extension from Aker BP for the Maersk Integrator low-emission rig. Source link Related posts: FutureOn launches offshore oilfield digital twin platform Eni expands in Mozambique with three new offshore licenses Occidental closes $55 […]
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Motivation and Tips
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7-weeks after, family of murdered LUTH doctor cries out over police silence on the investigation
by Linda Ikeji Blog on May 25th, 2019
Family of Stephen Urueye, the resident doctor at the Lagos University Teaching Hospital, Idi Araba who was stabbed to death by hoodlums, has cried out over the alleged silence by the police on the case. The family lamented that about seven weeks after the 25-year-old doctor was cruelly killed, the police had not called to update them on investigation into the murder. Late Urueye, who was supposed to finish his housemanship at LUTH in December 2019, was attacked on Thursday, April 4, around 9pm while he was seeing off a female friend along the Canal area – a route near the College of Medicine campus said to be notorious for robbery attacks. The assailants reportedly stabbed him in the thigh while trying to dispossess him of his phone and ATM card. He died at the hospital in the early hours of Friday and the police in a statement had said two suspects, Gbadebo Jimoh and Malik Adeboye, were arrested in connection with the murder. However, an elder sister of the deceased, Mrs Amina Wahab, in an interview with City Round on Thursday, said that was the last they heard about the case. She said the police had kept the family in the dark about the investigation, adding that justice appeared to be elusive. Wahab stated, "We have not heard anything from the police. They have not contacted the family at all. We don't know what happened to the suspects they arrested. We don't know whether they have been released or not."It is almost two months now, no information from the police; no justice. At least, we deserve to know what is happening. The bandits stabbed him near his private parts which aroused suspicions. A robber will probably stab somebody in the chest or hand to injure him.The most annoying part of it is that my mother called a policeman, one Officer Nurudeen, at the State Criminal Investigation and Intelligence Department over the case on Wednesday and he was insulting her. Maybe they have concluded that we are weak and cannot do anything."Wahab stated further that attempts by the family to get first-hand information on the attack from the female friend Urueye was seeing off that evening had proved abortive. She said,"One of Stephen's (Urueye) friends gave us the phone number of the girl whom he was seeing when the attack happened. Her real name, according to Stephen's friends, is Deborah and not the name the police gave out. Whenever we call her and introduce ourselves as Stephen's relations, she would just end the call. All attempts to trace the girl have been abortive. Why is she running away if she has nothing to hide? "She is not his girlfriend and we don't know her. We all know his girlfriend. She (Deborah) is the only eyewitness to the incident yet she has not deemed it fit to contact the family to give us information about what actually happened. Somebody lost his life because he took the risk to see you off in a dangerous area; courtesy demands that you show up to tell the family exactly what happened." The Police Public Relations Officer in the state, DSP Bala Elkana, said the command had been relating with LUTH authorities on the case. He said, "We have been engaging the hospital authorities in our investigation and the chief security officer of the hospital has been coming for updates." But Wahab said the family had not received any information from LUTH as regards police investigation. The spokesperson for LUTH, Kelechi Otuneme, promised to reach out to the CSO to confirm the police claim.The post 7-weeks after, family of murdered LUTH doctor cries out over police silence on the investigation appeared first on Linda Ikeji Blog.
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Popular Nigerian Actress, Eniola Badmus made the most of herself as she was recording a video for her teeming fans on social media. Badmus, who shot to limelight after starring in Funke Akindele's 'Jenifa's Diary', was walking down a staircase and showing off her voluptuous […]
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Stop Comparing Yourself to Others
One resolution we should all make for this new year is to stop comparing ourselves to others. Whether it is the social media account we follow or the advertisements in our inbox, sometimes our inner voices whisper that who we are or what we have […]
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If you love Abba music, and would enjoy singing along, join JVH members and guests at Pepe's Restaurant in Alcalali at 7.30pm, where Valley Voices will be singing all the old favourites. Tickets cost 15€, and can be obtained by ringing 625 349 599, or emailing jvhevents@hotmail.com A 3-course meal is included (with wine, bread and allioli) Click here for the menu. The sponsors for this event are Garcia Villas, and Jalon Valley Help would like to thank them for their support. All proceeds of the evening will go to the Charity.


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Navigation: Home > News > NEWS > Marriage Scandal: We're reviewing allegations against our MD, Nuru — FCMB
Marriage Scandal: We're reviewing allegations against our MD, Nuru — FCMB
First City Monument Bank (FCMB) has bowed to the public pressure and has launched an investigation into the alleged sexual misconduct involving its Managing Director, Adam Nuru who allegedly fathered two children with a staff.
The said staff, identified as Moyo Thomas, is said to be the wife of another banker, Tunde Thomas, who on learning, developed health problems after learning of the illicit affair, which eventually deteriorated and led to his death a few days ago.
A group, Justice for Tunde Thomas, which blew the case open, is currently collecting signatures with which to launch a protest to the Central Bank of Nigeria (CBN), with a demand that the bank boss be sacked from his job for what is seen as unacceptable in the industry.
The group claimed that the shocking news of the affair made the deceased develop stroke, after the wife eloped to the US with the two children, whom he had nurtured as his, from where she also informed him that he was not their father.
After the relocation of his wife to the US where she was said to have sought and obtained asylum status, over domestic violence, Tunde was said to have moved on with his life, by marrying another woman, who became pregnant for him, only for death to come knocking through heart attack, apparently induced by the thought of the previous incident, before he could seal the marriage in a traditional way.
Following the outcry by Nigerians, who at the last count had garnered about 400 signatures, with a demand by the CBN to act against the alleged illicit act, the bank said it had begun its own investigation to get to the root of the matter.
In a statement on Friday, FCMB Group Head, Corporate Affairs, Diran Olojo, said the bank was aware of the allegations making the rounds against its MD and was already taking action, adding that its board of directors had already commenced a review into the matter, adding that its findings would be disclosed in due course.
The statement, read: "We are aware of several stories circulating across several media platforms about our bank's Managing Director, Adam Nuru, a former employee Ms Moyo Thomas and her deceased ex-husband, Mr Tunde Thomas," the statement read.
"While this is a personal matter, the tragedy of the death of Mr Tunde Thomas and the allegations of unethical conduct, require the bank's board to conduct a review of what transpired, any violations of our code of ethics and the adequacy of these code of conduct ethics. This will be done immediately," the bank said.
"We enjoin all our stakeholders to bear with us as we conduct this review and to please respect the various families involved. Our Board of Directors are reviewing all aspects of this report and once they are done with their review, we will revert to you."
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Volume 55, Issue 23, June 2010 DOI: 10.1016/j.jacc.2009.12.063
Active Cascade Screening in Primary Inherited Arrhythmia Syndromes
Does It Lead to Prophylactic Treatment?
Nynke Hofman, Hanno L. Tan, Marielle Alders, Irene M. van Langen and Arthur A.M. Wilde
Received October 26, 2009
Revision received December 1, 2009
Accepted December 7, 2009
Published online June 8, 2010.
Nynke Hofman, MSc*,
Hanno L. Tan, MD, PhD†,
Marielle Alders, PhD*,
Irene M. van Langen, MD, PhD* and
Arthur A.M. Wilde, MD, PhD†,* (a.a.wilde{at}amc.nl)
↵*Reprint request and correspondence:
Dr. Arthur A. M. Wilde, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
Objectives The purpose of this study was to investigate the follow-up and treatment of the mutation-carrying relatives of a proband with an inherited arrhythmia syndrome.
Background The congenital long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome (BrS) are primary inherited arrhythmia syndromes that may cause syncope and sudden cardiac death in young individuals. After establishing the disease-causing deoxyribonucleic acid (DNA) mutation in probands, we actively conducted cascade screening to identify, most often asymptomatic, relatives who are also at risk of life-threatening arrhythmias.
Methods We retrospectively collected data from our cardiogenetics database and patient records and analyzed whether the identified carriers received prophylactic treatment.
Results From 1996 to 2008, 130 probands with a disease-causing mutation in one of the involved genes were identified, and 509 relatives tested positive for the disease-causing familial mutation. These subjects subsequently underwent cardiologic investigation (electrocardiography, exercise testing, Holter monitoring, ajmaline testing, echocardiography, where appropriate). After a mean follow-up of 69 ± 31 months (LQTS), 60 ± 19 months (CPVT), and 56 ± 21 months (BrS), treatment was initiated and ongoing in 65% (199 of 308), 71% (85 of 120), and 6% (5 of 81) of the relatives in the LQTS, CPVT, and BrS families, respectively. Eight carriers were lost to follow-up. Treatment included drug treatment (n = 249) or implantation of pacemakers (n = 26) or cardioverter-defibrillators (n = 14). All mutation carriers received lifestyle instructions and a list of drugs to be avoided.
Conclusions Cascade screening in families with LQTS, BrS, or CPVT, which was based on DNA mutation carrying and subsequent cardiologic investigation, resulted in immediate prophylactic treatment in a substantial proportion of carriers, although these proportions varied significantly between the different diseases.
cardiogenetics
inherited arrhythmias
prophylactic treatment
Congenital long QT syndrome (LQTS), Brugada syndrome (BrS), and catecholaminergic polymorphic ventricular tachycardia (CPVT) are primary inherited arrhythmia syndromes that may cause syncope and sudden cardiac death in young individuals. These arrhythmias are almost exclusively inherited as an autosomal dominant trait (1). In the past decade, the genetic basis of these arrhythmia syndromes has been unraveled more and more. Predictive testing using cascade screening in families with inherited arrhythmias is becoming more and more available as a result of this increasing yield of molecular genetic analysis. Predictive deoxyribonucleic acid (DNA) testing is warranted in these families because first-degree relatives have a 50% risk of carriership with a certain, although ill-defined, risk of lethal events and because most inherited arrhythmias can be treated successfully. Therefore, we believe that it is very important to inform affected families about the possibility of preventive treatment and risk stratification after predictive testing with the aim of preventing serious arrhythmias and sudden cardiac death. Due to the greatly varied expression and incomplete penetrance of these diseases, the decision to start treatment or not is not straightforward, particularly in asymptomatic patients. In our cardiogenetics department, we have >10 years of experience with these cases and, therefore, a long follow-up period. We studied what percentage of patients (carriers) are actually treated, the follow-up of all patients (treated or not), and the reasons why treatment was started or not. When a causative mutation is identified in the proband, cascade screening of the family is feasible, allowing pre-symptomatic treatment and appropriate lifestyle adjustments (2). Predictive genetic testing of relatives of a proband distinguishes carriers from noncarriers of the disease-causing mutation. For carriers, treatment and/or careful follow-up may be required. Noncarriers can be reassured that they are not predisposed to life-threatening arrhythmias and there is no risk of their offspring carrying the mutation.
LQTS and CPVT are heterogeneous. The major LQT types are caused by mutations in KCNQ1(LQT1), KCNH2(LQT2), and SCN5A(LQT3). Mutations in RYR2are responsible for the dominant form of CPVT, whereas CASQ2mutations cause the recessive form. Whether pre-symptomatic treatment is necessary depends on the disease. For both LQTS and CPVT, β-adrenoceptor blockers are the first choice of therapy (3). In LQTS patients, distinct genotype-phenotype correlations have been reported (4–6). Age at onset, symptom-related triggers, the ST-T segment morphology of the electrocardiogram, and the response to drugs are genotype specific. Timely treatment reduces the risk of cardiac events significantly, by 62% to 95% and by 74% in LQT1 and LQT2, respectively (7,8). In particular, in LQT1 β-blocker efficacy is very high, with failures almost exclusively due to noncompliance and/or the use of QT-prolonging drugs (7). The choice of treatment in carriers of LQT3 is more debated (β-blockers, prophylactic implantable cardioverter-defibrillator [ICD], left cardiac sympathetic denervation, or combinations thereof) (9,10). In BrS, pre-symptomatic testing is debated as well (11). In any case, all mutation carriers with LQTS or BrS should receive a list with drugs that must be avoided because they may precipitate lethal arrhythmias. Furthermore, all carriers should receive disease-related lifestyle modification instructions.
Taken together, treating physicians must contend with difficult therapeutic decisions, balancing the risks and benefits of the various treatment modalities.
The aim of this retrospective study was to evaluate whether pre-symptomatic genetic testing in the primary arrhythmia syndromes resulted in prophylactic treatment in mutation carriers. In addition, we evaluated which factors determine whether to initiate treatment.
In our multidisciplinary cardiogenetics outpatient clinic, genetic counseling and cascade screening for cardiogenetic diseases starts with the affected patient, the proband. Counseling sessions in probands and relatives combine the consultation of a cardiologist and a clinical geneticist or genetic counselor. Support from a psychosocial worker is routinely involved in predictive testing of minors. After the detection of a pathogenic mutation in the proband, the relatives are informed by letters written by the involved clinical geneticist or genetic counselor and distributed by the proband. When a relative expresses interest, he or she receives an appointment for genetic counseling. Once he or she decides to undergo direct predictive genetic testing, he or she gives written informed consent for DNA testing and related research for follow-up. Before the counseling session for predictive DNA testing, an electrocardiogram is obtained. The electrocardiographic findings can be discussed during the counseling session if the patient agrees, after discussing the advantages and disadvantages of predictive testing. The results of predictive DNA testing take about 4 weeks after counseling. In the meantime, treatment can be recommended if the results of the electrocardiogram (in LQTS) are obviously abnormal, combined with typical symptoms such as syncope.
The results of the DNA testing are given personally at the cardiogenetics outpatient clinic or by telephone, depending on the preference of the relative. Carriers of the familial mutation are referred for subsequent cardiological evaluation and regular follow-up, aiming to reduce sudden cardiac death. In addition to starting treatment with β-blockers or devices (pacemakers/ICDs), we counsel carriers, as a preventive measure, about lifestyle changes and the avoidance of particular drugs.
From 1996 until the end of 2007, 349 consecutive families were counseled because of LQTS, CPVT, or BrS. A pathogenic mutation was identified in 130 probands and active family screening (cascade screening) followed. Our study population consists of 509 consecutive relatives of 100 probands who tested positive for the familial mutation. Of the remaining 30 probands, the family members were not available, not tested, or tested negative.
Clinical data and follow-up
We retrospectively collected clinical data from our study cohort. These data included symptoms, the detailed family history of sudden cardiac death and syncope, and the use of drugs/devices. During the first visit, standard 12-lead electrocardiography in the supine position was performed. After the relatives were informed of the results of genetic testing, the carriers were referred for an additional clinical workup, treatment if necessary, and follow-up. Information about treatment and follow-up was collected from patient records or by contacting the treating physician. We determined the numbers of patients in whom treatment (drugs, usually a β-blocker, pacemaker, or ICD) was initiated, and compliance (defined as the patient reporting that therapy was continued as prescribed) with this treatment. We advise seeing all the (treated) patients at least once yearly and check the follow-up and compliance with treatment of all patients by the involved cardiologist. The start of follow-up (months) in treated patients was defined as the start of treatment; this was usually shortly after genetic testing. The start of follow-up in carriers without treatment was the moment when the results of pre-symptomatic testing were known. The follow-up period was completed at the end of 2008 or earlier in case the patient died.
Electrocardiographic measurements
In the LQTS relatives, the R-R and QT intervals were manually measured in lead V5, if possible, and the QT intervals were corrected using Bazett's formula.
Quantitative variables are presented as mean ± SD and categorical variables as percentages. Comparisons were performed using chi-square tests. The presented p values are 2 sided and considered significant when <0.05. Calculations were performed with SPSS version 15 software (SPSS, Inc., Chicago, Illinois).
Active cascade screening yielded 509 relatives who tested positive for the familial disease-causing mutation in KCNQ1, KCNH2, SCN5A, RYR2, or CASQ2. The mean age of the relatives was younger in relatives of LQTS and CPVT families (34 ± 22 years and 31 ± 22 years, respectively) than those of BrS families (48 ± 20 years) (Table 1).This difference reflects our advice to test children of LQTS and CPVT families at a younger age than those of BrS families because of an expected earlier onset, in general.
Sociodemographic Characteristics
LQTS
In LQTS, 199 of 308 mutation carriers were treated (65%), and their mean follow-up period was 69 months (range 6 to 150 months) (Table 2).The mean follow-up of the untreated mutation carriers was 54 months (range 18 to 121 months). The decision to initiate therapy was mainly based on whether symptoms were present (Table 3),QTc duration, and family history. There was a significant difference in QTc duration between treated and nontreated carriers (p < 0.0001) (Fig. 1).Still, in 59% (n = 108) of the LQT carriers with a QTc <460 ms, treatment was initiated. All subjects, including those with normal QTc, received a list of QT-prolonging drugs to avoid. Furthermore, we gave instructions about circumstances that may reduce serum potassium levels (diarrhea, vomiting) and may therefore increase the risk of arrhythmias.
Number of Treated Patients Based on QTc
The corrected QT interval (QTc) of all long QT syndrome carriers was measured on the baseline electrocardiogram before treatment was initiated. In this graph, the baseline QTc durations of 193 of 194 treated carriers and 93 of 102 untreated carriers are included. QTc durations of the deceased patients and those lost to follow-up (n = 6 in both groups) are not included. There was a significant difference in QTc duration between treated and nontreated carriers (p < 0.0001).
Duration of Follow-Up
Initiation of Therapy in Subtypes of LQTS*
In 163 subjects, β-blockers alone were started, 26 mutation carriers received a pacemaker, and 10 received an ICD (6 patients taking a β-blocker and 4 patients not taking a β-blocker). All pacemakers were implanted in members of 2 large (and probably related) families with LQT3, caused by the 1795insD mutation in SCN5A. This aberrant gene causes both an LQTS and a BrS phenotype, and pacemaker therapy has proven to be effective (12). Ten patients received an ICD because they had a severe phenotype. In 3 patients, this was caused by compound heterozygous mutations; 2 mutation carriers were symptomatic despite β-blocker treatment and 5 had a first-degree relative with sudden cardiac death. The latter 5 all carried an SCN5Amutation, 4 of whom carried p.Ile1768Val (a mutation that we consider particularly malignant). In LQTS type 1 mutation carriers older than 20 years of age who are asymptomatic and have QTc values <500 ms, treatment is not routinely initiated, based on results of risk stratification studies in large LQT1 cohorts (4,8,13). In our series, 47 of 77 LQT1 mutation carriers are treated. Of the remaining 30 subjects, 17 adult patients (older than 20 years of age) were not treated because they were asymptomatic and had a QTc <500 ms, whereas 2 declined treatment, and 10 were not treated because their phenotype was completely normal. Among these 10 subjects, 4 carried just 1 mutation and had a normal QTc duration, whereas the proband in this family had 2 mutations (compound heterozygous), and the other 6 were not treated because both probands had a completely normal phenotype and QTc prolongation was discovered coincidentally. One LQT1 carrier was lost to follow-up (Table 4).
Number of Subjects With Follow-Up
Of 163 LQT2 patients, 121 were treated. Five patients died (see the following text). Forty-one carriers were not treated because of the following reasons: treatment declined (n = 3), not yet treated (n = 5), asymptomatic and normal QTc (n = 20), carrier of only 1 mutation, whereas the proband had 2 mutations (n = 4), age older than 60 years and asymptomatic (n = 9). One patient was lost to follow-up.
Of 68 LQT3 carriers, 31 were treated, 1 died, 4 were lost to follow-up, and 32 were untreated. Among them, 1 declined pacemaker implantation and 31 patients were untreated, based on an asymptomatic status, age, and a relatively normal electrocardiogram. Six subjects died during follow-up (Table 5).All but 1 were taking β-blockers. An autopsy was performed in none of them. One man died due of cancer at the age of 74 years. Another man died after an acute myocardial infarction complicated by ventricular fibrillation at the age of 59 years. Two others died within 2 years after they were identified as carriers. A woman died suddenly at the age of 52 years. She was treated with a β-blocker alone, although she had experienced cardiac arrest 8 years before, because she had significant cerebral impairment. A 65-year-old woman (LQT3) died at rest shortly after pacemaker implantation while taking β-blockers. Compliance with therapy was verified after the patients' death by interviewing close relatives.
Deceased LQTS Patients During Follow-Up
CPVT
Of 10 families, 120 relatives tested positive (64 from 1 family). The mean follow-up of treated CPVT carriers was 60 months (range 18 to 114 months). Eighty-five of them were treated with a β-blocker (71%), 1 received an ICD as well, and 1 carrier underwent a left cardiac sympathetic denervation (just like her sister, the proband) (14).
In general, treatment with a β-blocker was recommended for all carriers until an advanced age (about 70 years old). Eleven carriers were not treated because they carried a heterozygous CASQ2mutation, whereas the proband was homozygous. One other patient was considered too young to start treatment.
Four mutation carriers from a single family exhibited no ventricular ectopic beats during exercise testing. Whether the involved RYR2mutation in this particular family (c.14757-6C>T; c.14757-7T>A in intron 103) is disease causing is still being debated. Not all CPVT carriers followed the advice to take β-blockers; thus, 17 were untreated, including 5 persons aged older than 70 years. The mean follow-up of untreated CPVT carriers was 44 months (range 18 to 66 months). Two patients were lost to follow-up; no one died during follow-up.
Among 81 BrS carriers, 5 were treated (6.2%). Four of them received an ICD, but had no ICD shocks during follow-up. One mutation carrier had already received a pacemaker before he tested positive for the familial mutation because of conduction abnormalities. The mean follow-up duration was 56 months (range 30 to 78 months) in treated carriers, and 40 months (range 18 to 102 months) in untreated carriers. No one died during follow-up.
In our consecutive series, we found that immediate prophylactic treatment was started in a substantial proportion of carriers of a mutation causal to one of main arrhythmia syndromes (289 of 509, 57%). Initiation of therapy strongly depends of the type of disease. In LQTS and CPVT, 65% and 71%, respectively, of the mutation carriers were treated after a mean follow-up of almost 6 years; in BrS, only 6% were treated. Because the risks of and treatment options for arrhythmias in the different diseases are not completely comparable, the results are discussed separately.
Among our 308 LQTS patients (LQT1, n = 77; LQT2, n = 63, and LQT3, n = 68), 65% were treated after a mean follow-up of 69 months. Seven patients (2%) declined therapy, or discontinued taking a β-blocker daily. Compliance with therapy and follow-up in this patient group, therefore, is close to 100%.
Once treatment is started and evaluated, patients attend the outpatient clinic of the cardiologist once or twice yearly. In LQT1 patients, symptoms usually develop during physical activity (4,15), especially swimming (4,16). Because the LQT1 phenotype manifests at a young age, children are often treated well before they are 5 years old. The risk of events is strongly dependent on QTc duration (4,5,17). Other recently investigated predictors of events are the location of the mutation in the LQT1-associated gene (KCNQ1) and the biophysical effects of the mutation: patients with transmembrane mutations have longer QTc durations than patients with mutations in the C-terminus location, whereas dominant-negative mutations are associated with more events compared with those that cause haploinsufficiency (8). It is important to note that some specific mutations seem to have a significant malignant outcome (18).
In LQT2, there is more evidence of a first event at a later age than LQT1 (i.e., from puberty onward) (4,5). In addition to treatment with a β-blocker and the avoidance of QT-prolonging drugs, we advise LQT2 carriers actively change some lifestyle elements, such as the avoidance of sudden loud noises (e.g., ringtones and alarm clocks), because sudden auditory sensations often trigger arrhythmias in LQT2 (16). Female LQT2 carriers who desire to become pregnant receive extra monitoring after delivery because they have an increased risk of extra QTc prolongation shortly after delivery, possibly because of the combined effects of hormonal imbalance, stress, and fatigue (19–21).
LQT3 carriers show a large variation in phenotype. However, almost 50% of studied subjects (n = 30) in our series carry the 1795insD mutation in SCN5A. They exhibit a high incidence of nocturnal sudden death, bradycardia-dependent QT prolongation, intrinsic sinus node dysfunction, and generalized conduction abnormalities. Pacemaker implantation, in this large family with the 1795insD mutation, was shown to be effective in preventing sudden death (12).
In general, the management of LQT3 patients is complex. Although treatment with β-blockers lowers the heart rate, it has been observed that QTc duration in LQT3 patients increases even more at low heart rates (e.g., during the night), suggesting a higher risk of life-threatening arrhythmias. However, there is no clear evidence that β-blockers are contraindicated in LQT3 patients, and, unless patients had become symptomatic in the first year of life, they seem to be beneficial (10). Thorough examination (Holter monitoring) is recommended before starting β-blocker therapy and should be repeated during therapy.
Six LQTS patients died during follow-up (Table 5). Four of them died suddenly and unexpectedly without explanation. There was no autopsy performed of these patients, so we cannot exclude that cardiovascular heart diseases or other causes contributed to their death. Still, it is of concern that 2 LQT2 patients died shortly after treatment was started (8 months, and 4 months before death, respectively) and 1 LQT3 patient died within 10 days despite β-blocker and AAI pacemaker therapy. Although difficult to accept, and realizing these numbers are too small for conclusions, one has to consider the possibility that β-blocker therapy contributed to their death. Repeated monitoring (electrocardiographic, Holter) shortly after initiation of treatment thus seems mandatory.
Our results show an important clinical implication of positive genetic testing in families with LQTS: of all patients with a QTc <460 ms, 59% (n = 108) were treated after cardiologic investigation. These patients probably would have been missed if just electrocardiography was performed without genetic testing. In addition to that, as mentioned before, all LQT carriers receive lifestyle instructions and a list of QT-prolonging drugs to be avoided (7).
Seventy-three percent of the carriers of the familial CPVT mutation are treated (successfully). CPVT is characterized by exercise-induced or acute adrenergic stress–induced polymorphic ventricular arrhythmias, often causing syncope; a normal baseline electrocardiogram; the absence of structural cardiac abnormalities; and a high mortality rate (22–24). Genetic testing is important because the disease penetrance is not 100%, which suggests that a normal exercise test does not exclude carriership automatically. Symptoms usually develop during childhood or adolescence. In a substantial portion of cases, cardiac arrest is the first manifestation of the disease (23). Because the onset of the disease already manifests at a young age, we advise our families to test their children at an early age. As a principle, all carriers are treated with a β-blocker. Although β-blockers do not seem to abolish exercise-induced ventricular ectopy completely, they do protect against serious arrhythmias in most patients. In 1 patient (a sister of the proband), significant arrhythmias continued despite β-blocker therapy; she successfully underwent left cardiac sympathetic denervation (13). One patient received an ICD because of psychosocial distress caused by mutation carriership.
New treatments for CPVT are being considered. Because preliminary evidence suggests that flecainide might be successful (25), we are starting a study in a larger group of patients. In general, we advise all carriers to avoid intensive sports and exercise.
Of our 81 BrS mutation carriers, 5 were treated with an ICD or pacemaker. Four patients received an ICD because they had syncope (n = 2) or expressed an explicit preference for an ICD after extensive counseling (n = 2). All 4 had a first-degree relative who had had a sudden unexplained death. All patients who are tested positive for BrS receive a list of drugs to avoid (26). Moreover, they are advised to use antipyretic drugs during fever because a substantial proportion of BrS patients exhibit more severe electrocardiographic abnormalities and an increased risk of symptoms during fever (27). Accordingly, we advise all patients to visit the hospital during at least 1 fever episode to establish whether their electrocardiographic abnormalities worsen with fever. The age at which symptoms first occur is consistently during approximately the fourth decade of life in all studies, with no definite explanation for this observation. All carriers see a cardiologist once yearly for evaluation. Although symptomatic children were described rarely, recently more and more evidence is appearing about abnormal electrocardiograms in children with or without symptoms (28). In general, asymptomatic carriers with a normal baseline electrocardiogram seem to have a low risk of arrhythmias, although this is debated. In addition to treatment with an ICD, quinidine therapy is used in some patients. A registry assessing the effectiveness of quinidine has recently been suggested (29).
Taken together, the results of this study show quite a high number of disease carriers of LQTS and CPVT in which treatment is initiated shortly after confirmation of mutation carriership. Although it is impossible to quantify the benefit of this approach, it is safe to state that life-threatening arrhythmias are probably averted. In BrS, this assumption is less obvious because none of the BrS patients had serious arrhythmias during follow-up and none of the 4 with ICDs has had an appropriate shock.
Indeed, the follow-up of BrS carriers is possibly the most difficult part of the study population because the treatment options are limited and extreme ("wait and see" policy versus implanting an ICD). The large differences between the phenotypes of the Brugada probands and relatives are still unexplained, mainly due to the still-limited knowledge of the genetic causes of BrS.
Active cascade screening for disease carriership of relatives of LQTS, CPVT, or BrS probands leads to immediate prophylactic treatment in a substantial proportion of disease carriers. In LQTS and CPVT, 65% and 71%, respectively, of the carriers are treated. In BrS, only 6% of the mutation carriers are treated. These differences reflect differences in treatment options and variations in disease expression and penetrance. A large number of carriers are treated pre-symptomatically; these patients would have been missed without genetic testing. These and other data point to the need to identify all affected family members, independently of their QTc or symptoms, to prevent deaths. All LQTS and BrS carriers should receive a list of drugs to be avoided. All LQT1, LQT2, BrS, and CPVT carriers should receive lifestyle modification instructions.
Dr. Tan was supported by the Netherlands Organization for Scientific Research(NWO, ZonMW-Vici 918.86.616). Dr. Wilde's research program is supported by ICIN project 27 and a Leducq programgrant CVD05"Alliance Against Sudden Cardiac Death."
implantable cardioverter-defibrillator
Revision received December 1, 2009.
Accepted December 7, 2009.
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You are going to email the following Active Cascade Screening in Primary Inherited Arrhythmia Syndromes
Nynke Hofman, Hanno L. Tan, Marielle Alders, Irene M. van Langen, Arthur A.M. Wilde
J Am Coll Cardiol. 2010 Jun, 55 (23) 2570-2576.


I started a class at jessicasprague.com called Oh Shoot this week. Our first lesson deals with shutter speed. We were instructed to take photo of the same object and change the shutter speed. The slower the shutter speed the more blur you will have. I took these photos at the hotel at Avila Beach just before we left yesterday afternoon. Click to enlarge the photo so you can see the differences better.
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Janan's practice focuses on corporate and securities law, with an emphasis on international transactions. He has extensive experience representing public and private issuers in a wide variety of financing, business combination and M&A transactions, including both private and publicly traded issuers. Janan also advises on securities compliance matters, commercial transactions, and corporate finance, procedures and governance.
Janan was a member of the judging panel for The Oil Council's 2012 Lifetime Achievement Award.
Janan was a former Executive member of CBA Securities South section.


A new lip balm brand jointly produced by Maxam and White Rabbit was sold out within 2 minutes after officially going on sale online at 10 am on September 20, 2018, reports Chinanews.com on Thursday.
The customer service on Maxam's Tmall online store said that for the time being the lip balm is off shelf since being sold out within two minutes. It's unclear whether there will be a future sale date for the product after it was snatched off the shelf so quickly.
Two lip balms sold for 78 yuan (about USD 11.4).
Maxam is the brand of Shanghai Jahwa Corporation, and this is the first time that the cosmetics company co-produces a brand with a food company, the White Rabbit, which is also a famous brand in Shanghai.


text:
About JRS
Facts & Financials
Funding Inquiries
2020 Call for Proposals
The Bats of Kenya
Grantee Organization: Field Museum of Natural History
Grant Amount: $90,095
Contact: Bruce Patterson bpatterson 'atsign' fieldmuseum.org
Funding Dates: 6/15/12 - 4/15/16
Project Links:
Bats of Kenya Project
Bats of Kenya on ResearchGate
Video: Bat Calls from Kenya
Video: Into the Bat Caves of Kenya
Video: Studying the diversity of the bats of Kenya
Public perceptions of biodiversity are dominated by charismatic megafauna, shielding an appreciation of less conspicuous fauna that may have equal or greater overall importance. Bats are highly diverse, comprising more than a quarter of Kenya's >400 mammals. Bats perform vital ecological services, including many with consequences for agriculture, forestry, and public health. Fruit bats are crucial to the maintenance and re-establishment of natural vegetation. Their roles in seed dispersal and pollination are particularly important in tropical rainforest succession and community composition. Other bats are voracious predators of insects, saving farmers and foresters millions of dollars annually in avoided pesticide and insecticide costs. However, little is known concerning their distribution, abundance, roosting and food habits.
Key Objectives and Activities
With the Kenya Wildlife Service (KWS), the project team set out to document the distribution and status of more than 100 bat species. In the process, they planned to assemble a library of bat vocalizations that would permit remote, passive monitoring of bat populations and activities; they also proposed gather specimens and samples samples to study bat taxonomy, diet, parasites, and pathogens.
Planned Outputs and Outcomes
Goals of the project included distributional notes and systematic revisions in the technical literature, well-curated scientific collections feeding into public databases (like VertNet and GBIF), and an extensive call library of bat vocalizations that would permit remote monitoring and expanded studies of bat abundance, behavior, and ecology.
Morse, SF; KJ Olival: M Kosoy; S Billeter; BD Patterson; CW Dick; K Dittmar (2012) Global distribution and genetic diversity of Bartonella in bat flies (Hippoboscoidea, Streblidae, Nycteribiidae). Infection, Genetics and Evolution. 12(8): 1717-1723. (link)
Patterson, BD; PW Webala (2012) Keys to the bats (Mammalia: Chiroptera) of East Africa. Fieldiana: Life and Earth Sciences. 6: 1 – 160. (link)
Primary Software Platforms
Collection and research databases: KE EMu, Access
DNA sequencing: Geneious, Mega 5.0
Phylogenetics: RAXML, Mr Bayes
Morphometrics: Statistica
Bat Call Analysis: AnalookW, BatSound
Results to Date
The core contribution of the project was the complete information from nearly 4,000 field-observed bats, collected from 83 sites: physical measurements, genetics, identification of parasites, echolocation calls, and roosting information. More than 64 specimens were collected, representing 9 out of the 10 families of bats known to live in Kenya. In addition, ectoparasite samples were obtained from three quarters of all species captured. The call library now has vouchered echolocation calls for 57 species of bat (representing samples from more than 2,400 individuals). This compressive ecological, genetic, and morphological dataset will provide the basis for an improved understanding of the diversity and distribution of bats in Kenya, which, the team discovered, were not as well described as they anticipated at the outset of the project.
More than a dozen students and young scientists from Kenya and the United States participated in the project, assisting in the field and museums, learning specimen preparation and addressing questions about the relationships among species.
Seeing the Team in Action
We have the good fortune of fantastic video of the project – "Into the Bat Caves of Kenya, Parts 1 & 2" – in action through the Field Museum's fantastic science education series The Brain Scoop with Emily Graslie, the Museum's Chief Curiousity Officer.
The group discovered that much of the basic species-delimitation work was not sufficient to enable them to identify and curate the museum specimens they had hoped. Indeed, prior publication of a 'Keys to the Bats of Kenya' suggested that it would simply be a mechanical step to validate identification of 15,000 museum-held bat records. In attempting to curate the records, therefore, the group was unprepared for the discovery that the keys would fail for several key genera, making substantial curatorial progress a longer term goal. However, the comprehensive field surveys were a critical component to improving and updating the Keys, meaning that the curation will continue, if as part of a future project.
Project Director Biographies
Dr. Paul Webala is a Kenyan ecologist who has held positions at National Museums of Kenya (NMK), Kenya Wildlife Service (KWS), and now Moi University. His research focuses on the population and community ecology of bats, especially as revealed by echolocation calls. Dr. Bruce Patterson is curator at Chicago's Field Museum and focuses on the systematics and biogeography of Neotropical and Afro-tropical mammals. Dr. Dave Waldien is VP of International Programs for Bat Conservation International and leads their collaborative projects in Asia, Latin America and Africa.
Notes from JRS
JRS is proud to support this comprehensive survey of the bats of Kenya and the role this information could play in the conservation and appreciation of this important mammal. We aim to learn about the value of comprehensive data sets for a species or a geography to scientific research, policy and conservation the long-term evaluation of this project's outputs promises to be interesting. JRS has a strategic interest in eastern Africa and hope that this information will be incorporated into regional biodiversity information systems and can be expanded by neighboring countries. This project features an exemplary partnership between the Drs. Patterson and Webala as well as the training of Kenya scientific and field staff. In the course of the project, the Ebola outbreak in West Africa pointed to the importance of understanding bat biodiversity, behavior, and role in human diet and culture. An impressive amount of data has been collected as well as identification work in global museums. At the time of this project's close, much of the data is still unpublished, illustrating the challenge for JRS of how to monitor and ensure data publication even after our funding end. We are pleased that our 2014 grant to Rodrigo Medellin's team at the National Autonomous University of Mexico for ultrasound monitoring of bats in Mexico includes training of African bat specialists. We hope these grants contribute to African bat conservation, biodiversity informatics, international networks of researchers, and understanding these amazing flying mammals.
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