text:
Optimal Use of Crisaborole in Atopic Dermatitis – An Expert Guidance Document
[Epub Ahead of Print] First published online: October 1, 2021
Charles W Lynde MD, FRCPC1, James Bergman MD, FRCPC2, Loretta Fiorillo MD3, Lyn Guenther MD, FRCPC4, Marissa Joseph MD, FRCPC, FAAD5, Jill Keddy-Grant MD6, Ian Landells MD, FRCPC7, Danielle Marcoux MD, FRCPC8, Catherine McCuaig MD, FRCPC9, Michele Ramien MD10, Wingfield Rehmus MD MPH FAAD11
1Associate Professor, Department of Medicine, University of Toronto, Toronto, ON, Canada
2Clinical Assistant Professor, Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
3Clinical Professor, Director of Pediatric Dermatology, University of Alberta, Edmonton, AB, Canada
4Professor, Western University, London, ON, Canada
5Assistant Professor, University of Toronto, Medical Director RKS Dermatology Centre Women's College Hospital, The Hospital for Sick Children, Toronto, ON, Canada
6Assistant Professor, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
7Clinical Associate Professor, Departments of Medicine and Pediatrics, Memorial University of Newfoundland, St. John's, NL, Canada
8Division of Dermatology, Sainte-Justine University Medical Center; Clinical Professor in Pediatrics, University of Montreal, Montreal, QC, Canada
10Clinical Associate Professor, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
11Division of Dermatology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
Disclosure Statements and Acknowledgment
Charles W Lynde has been a Consultant, Principal Investigator & Speaker for Celgene, Galderma, Genzyme, GSK, Johnson & Johnson, LeoPharma, Novartis, Pfizer, Sanofi Aventis, Bausch.
James Bergman has been a consultant for Aralez, Cipher, Dermtek, Galderma, GlaxoSmithKline, Janssen, Johnson & Johnson, La Roche Posay, Leo, Mead Johnson, Mustela, Nestle, Novartis, Pediapharm, Pierre Fabre, Pfizer, Bausch, and a speaker for Aralez, Cipher, Johnson & Johnson, Nestle, PediaPharm, Pierre Fabre, and Bausch.
Loretta Fiorillo has been a consultant for Amgen, Abbvie, Celgene, Galderma, Johnson & Johnson, Leo Pharma, Pfizer, and Bausch, an investigator for Celgene, Pfizer, Leo Pharma, and Galderma a speaker for Astellas, Celgene, Pedia Pharma, Novartis, and Pfizer.
Lyn Guenther has been a consultant for Celgene, Galderma, GSK, Johnson & Johnson, Leo Pharma, Pfizer, Sanofi Aventis and Bausch, an investigator for Celgene, GSK, Leo Pharma, Novartis, and Roche, a speaker for Astellas, Celgene, GSK, Leo Pharma, Novartis, Pfizer, Sanofi Aventis, and Bausch, and has given expert testimony for Leo Pharma.
Marissa Joseph has been a consultant and served on advisory boards for Abbvie, Amgen, Bausch, Celgene, Galderma, Janssen, Leo Pharma, Lilly, Novartis, Naos, Pierre Fabre, Pfizer, Pediapharm, Sanofi Genzyme.
Jill Keddy-Grant has been a clinical investigator for Abbvie, Amgen, Astellas, Celgene, Galderma, Pfizer, Regeneron, and Leo Pharma and on advisory boards for Abbvie, Actelion, Aralez, Bayer, Bausch, Celgene, Cipher, Janssen, Leo Pharma, Mustela, Pfizer and, Pierre Fabre.
Ian Landells has been an investigator for Abbvie, Janssen/J&J, Amgen/Pfizer, Merck, Bausch, BMS, Celegene, Galderma, Allergan, Leo, Basilea, Novartis, Astellas, a speaker for Abbvie, Janssen/J&J, Amgen/Pfizer, Merck, Bausch, Astellas, Pediapharm, Leo, Novartis, GSK, Lilly; and an advisor for Abbott, Janssen/J&J, Amgen/Pfizer,Celegene, Cipher, GSK, Novartis, Allergan, Lilly, Bausch.
Danielle Marcoux has been a consultant for Abbvie, Celgene, Galderma, GSK, Johnson & Johnson, Leo Pharma, Pfizer, Sanofi-Regeneron, Bausch; an investigator for Abbvie, Celgene, Galderma, Leo Pharma, Lilly, Novartis; a speaker for Fondation Dermatite Atopique, Pfizer, Sanofi, Leo Pharma, Johnson & Johnson, Bausch.
Catherine McCuaig has been a consultant for Abbvie, Celgene, Galderma, Pierre Fabre, GSK, Johnson & Johnson, Leo Pharma, Pfizer, Sanofi-Regeneron, Bausch; a speaker for Pfizer
Michele Ramien has been a consultant for Actelion, Amgen, Abbvie, Cipher, Johnson & Johnson, Leo Pharma, Novartis, Pierre Fabre, Pfizer, and Bausch.
Wingfield Rehmus has been a consultant for Abbvie, Cipher, Leo, Mustela, Pfizer, Pierre Fabre, Sanofi-Genzyme, and Bausch and a speaker for Abbvi, Bausch, and Pfizer.
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by an unrestricted educational grant from Pfizer Canada.
All authors contributed to the development of this work and its review and agreed with its content.
The authors acknowledge and thank Anneke Andriessen, PhD, for her invaluable assistance with preparing this manuscript.
Atopic dermatitis (AD) is a lifelong pruritic, inflammatory skin disease associated with altered immune function and epidermal barrier dysfunction.1-3 The chronic and recurring cyclic waxing and waning nature of AD leads the patient to treatment fatigue and imposes a significant burden on both the patients' and caregivers' quality of life (QoL).1 AD frequently appears early in childhood and affects over 20% of children and up to 3.5% of adults.2,3 Measurements of the prevalence of AD can differ, and this variability can be impacted by geographic location, population studied, and definition of AD used. A Canadian study showed that the adult prevalence of AD is up to 3.5% and that AD may be more prevalent among First Nations populations.2 This research further revealed that men were less affected than women and that AD decreases with age. Additionally, the study noted that the severity of AD varies per region.2 In many countries, the prevalence of AD is on the rise, especially in young children from developing lower-income countries in South East Asia and Latin America.4 Although the role of race and ethnicity in the pathophysiology of AD remains unclear, a higher incidence of AD was observed in Black American children (17.3%) compared to White children (10.4%).4
The pathophysiology includes skin barrier defects, inflammatory cytokines, and immune abnormalities. ADs' etiology is multifactorial and involves an incompletely understood interaction between genetic factors, immune system dysfunction, skin barrier disorders, genetic and environmental stressors.5,6 Most of the patients with AD have mild disease; however, 10% – 20% of children with AD are categorized as severe, and these rates are slightly higher in adults.2
There is a need for a variety of therapeutics targeted to different levels of severity.6,7 A treatment paradigm that recognizes that patients may oscillate between degrees of severity and integrates topical and systemic therapies may align more closely with clinical reality.8,9 AD treatment is often challenging due to the disease itself, treatment fatigue, and patient/caregiver concerns. Patients and caregivers frequently have concerns about medication safety and adverse events (AEs) as well as the long-term use of topical corticosteroids (TCS) or topical calcineurin inhibitors (TCI).9 Crisaborole ointment is an effective and safe alternative to TCS and TCI.9 Sharing best clinical practice standards, addressing challenges in treatment application, and methods to improve patient adherence to therapy may improve treatment results.9
This paper aims to review best clinical practices in treating AD patients, explore optimal use of crisaborole in mild to moderate disease, and provide expert guidance for the real-world use of crisaborole ointment to improve patient outcomes. This papers' target audience is general practitioners, pediatricians, pediatric dermatologists, and dermatologists who treat patients with AD.
The project used a modified Delphi communication technique for interactive decision-making for medical projects, adapted from face-to-face meetings to suit a virtual platform.10-12 The meeting was virtually convened on May 8, 2021, and the expert panel consisted of eleven dermatologists, including nine pediatric dermatologists from diverse geographical regions within Canada, who commonly treat patients with AD. In preparation for the meeting, a literature review surrounding crisaborole for the treatment of mild-moderate AD was conducted, and the panel members were surveyed regarding the use of crisaborole ointment for the treatment of AD.
The literature review and the pre-meeting survey results were presented at the virtual meeting. During the meeting, the experts were divided into three breakout groups to discuss and adopt draft recommendations for the real-world use of crisaborole ointment that were prepared from the literature searches by CWL and AA. The three groups presented their adapted versions of the recommendations to the larger group following the breakout session. The adapted recommendations were then collated and edited if necessary. The panel then voted and adopted the recommendations using evidence coupled with expert opinion based on the clinical experience of the advisors. The meeting summary and subsequent review of the manuscript were performed online (Figure 1).
Figure 1: The project process
Searches for English-language literature [2015– 2020] took place on April 14, 2021, on PubMed and Google Scholar as a secondary source. The data gathered by the literature review prioritized clinical studies published on the use of crisaborole, articles describing the current best practice in AD, and the most recent clinical guidelines, consensus papers and, algorithms. Excluded were duplications, articles of insufficient quality [small sample size, flawed methodology], and the most recent reviews were used in the case of review articles.
The searches yielded sixty-two papers deemed clinically relevant to current best practices of crisaborole use in AD. After removing duplicates and articles of insufficient quality, thirty publications remained: Four on epidemiology, ten reviews, three consensus papers and algorithms, four guidelines, five clinical studies, and four systematic reviews, meta-analyses, or posthoc analyses.
The literature review indicated that the guidelines, algorithms, and consensus papers for topical AD treatment had not changed significantly over the past decade apart from adding crisaborole ointment and removing the black box for topical calcineurin inhibitor (TCI) treatment.7-9, 13-21
A consensus paper and algorithm that explored the need for practical solutions to improve AD care was developed and published by the authors' panel.8 The consensus statements and algorithm for topical treatment and maintenance of AD were integrated into the panels' recommendations presented in this publication.
The DERMA (D: Diagnosis/Distribution; E: Education/Emollients; R: Red/Itchy; M: Medication/Maintenance; A: Assessment /Adherence) AD Algorithm targets a broad base of health care professionals treating patients with AD. The consensus statements and DERMA AD algorithm for topical treatment and maintenance of AD reflected current practice and were integrated into the panels' recommendations (Figure 2).
Figure 2: DERMA algorithm DERMA Atopic Dermatitis Algorithm. BID indicates twice daily; DERMA, Diagnosis/Distribution; E: Education/Emollients; R: Red/Itchy; M: Medication/Maintenance; A: Assessment/Adherence; PDE4, phosphodiesterase-4; TCIs, topical calcineurin inhibitors; TCS, topical corticosteroids.
*Approved in Canada for ages ≥ three months.
†At present, only tacrolimus has Canadian approval for maintenance therapy.
J Cutan Med Surg permitted reproduction of the DERMA AD Algorithm
Clinical Evidence of Crisaborole
Crisaborole is a small molecule, anti-inflammatory nonsteroidal PDE4-I inhibitor for the treatment of AD, which has demonstrated safety and efficacy in patients with mild-to-moderate AD.22-30 Two percent crisaborole ointment was first approved by the American Food and Drug Administration (FDA) in December 2016 and then in 2018 by Health Canada for mild-to-moderate AD patients aged 2 years and over and in March 2020 (USA) and May 2021 (Canada) for patients aged 3 months and over.25
The efficacy and safety studies on crisaborole used various clinical assessment scales such as Investigator Static Global Assessment (ISGA), Atopic Dermatitis Severity Index (ADSI), Eczema Area, and Severity Index (EASI) score, and Patient-Oriented Eczema Measure (POEM).
A randomized, double-blind, intra-patient controlled study (for the first 14 days) was continued as an open-label study applying crisaborole to all lesions. The study, including 40 patients of 18 years-old and older, demonstrated significant changes from baseline in crisaborole-treated lesions, ISGA, and pruritus NRS improvement from day fifteen assessment onwards.23 The study also showed normalization of the genomic skin profile (approximated normal skin), inhibition of inflammatory genes known to be induced through degradation of cAMP by PDE4, and reduction in epidermal hyperplasia and TEWL.23
The safety and efficacy of crisaborole treatment over 28 days were shown in two identical randomized, double-blind, vehicle-controlled studies including 1,522 patients with mild-to-moderate AD of 2 years and over.22 Significantly more patients treated with crisaborole than vehicle reached the primary endpoint (ISGA: clear, almost clear) than those treated with the vehicle at day 29 assessment.22 A long-term, open-label, single-arm 48 weeks safety study that included 517 patients of 2 years and over showed similar safety results as in a previous study that included adult AD patients.22,24 In the long-term open-label study, nine patients (1.7%) withdrew due to AEs such as a stinging sensation after applying the ointment.24 Another phase four open-label, single-arm study on 137 infants aged 3 months to less than 24 months of age demonstrated that crisaborole is safe and effective. ISGA of clear or almost clear was achieved at day 29 assessment by 30.2% of patients.25 The study further indicated that improvements exceeded the minimal clinically significant difference in total POEM score at day eight and day twenty-nine.25 The POEM subscale data further revealed improved sleep and pruritus, markedly improving patients' and their caregivers' quality of life.25 Crisaborole yielded a rapid and statistically significant reduction in pruritus within four days.26-28 Notably, in two vehicle-controlled studies, the vehicle effect on pruritus was considerable.26,28
A pooled analysis of four studies of mild-to-moderate AD patients demonstrated efficacy and local tolerability of crisaborole treatment. After crisaborole use, most patients had mild to no pruritus from the first assessment through the remainder of treatment.27
In a further study, treatment with crisaborole resulted in a marked improvement in QoL for patients and their parents, caregivers, and families.28
A post hoc analysis of 2 phase 3 studies showed the effectiveness of crisaborole compared to the vehicle in significantly alleviating mild-to-moderate AD severity (per ADSI), and percentage of body surface area (%BSA) affected.29
Finally, a systematic literature review and network meta-analysis comparing efficacy and safety profiles of crisaborole ointment, 2%, versus other topical treatments for mild-to-moderate AD showed crisaborole was superior to vehicle and pimecrolimus 1% cream, and comparable to tacrolimus, 0.1% or 0.03% ointments, concerning ISGA 0/1 at 28-42 days.30 Additionally, the systematic review showed that the AEs rates for application site burning/stinging were much higher for TCIs than for crisaborole.30 The studies included different patients, and endpoints varied, so comparative assessment of medications from this meta-analysis is difficult. Head to head comparative studies are needed to see objective scientifically-grounded efficacy comparison.
Crisaborole works better for mild than moderate disease, where it provides a faster reduction of pruritus and other AD symptoms relieve.9,25-30 Crisaborole is not typically used with TCI due to potential irritation, but the combination may be suitable for steroid-phobic patients and those at high risk of sequelae.9
It is advisable to avoid crisaborole application on significantly flared skin due to possible irritation. Crisaborole ointment can be beneficial for dermatitis of the hands and feet due to the potential for deeper penetration into inflamed, thicker lichenified skin as a result of the smaller molecular size of crisaborole. There appears to be less irritation of the hands and feet, and the good safety profile of crisaborole justifies application in infants and children.9,25-30
Statements and Recommendations
Statement 1: Atopic dermatitis (AD) is a lifelong inflammatory skin condition associated with epidermal barrier dysfunction and altered immune function. When AD is not controlled by behavioral measures such as skincare and avoidance of triggers, treatments such as TCS, TCI, and more recently, PDE4-I should be considered. It is important to use topical agents in conjunction with moisturizers and gentle cleansers.
The complex multifactorial pathogenesis of AD includes genetic and environmental factors.5 The skin barrier in AD is dysfunctional, and this defective skin barrier leads to water loss from the skin and the ingress of irritants, pathogens and allergens resulting in further inflammation.7 As the dysfunctional barrier at baseline is further disrupted, an inflammatory immune response is upregulated, which further disrupts the barrier leading to a feedback loop.6,31,5,6
AD presents clinically as recurrent scaly erythematous and pruritic papules and plaques of skin with varying severity. This morphology, in addition to pruritus and family history of atopy, are important diagnostic criteria.7,32 Specific signs of AD include oozing, scaling, crusting, erythema, edema, and lichenification, which, together with the body surface area involved and the impairment of daily activities, help determine AD severity (Figure 3-5).
Most patients with AD present with mild disease and can be adequately treated with frequent moisturization and topical therapy such as TCS, TCI, or crisaborole.3,5,7,8,12-21
Educating patients and caregivers about the condition, avoiding triggers, and daily skincare regime, including gentle cleansers and moisturizers, is a vital part of the approach.7-9, 13-21
Figure 3: Baby with mild facial AD
Figure 4: Child with moderate AD on the right arm
Figure 5: Child with severe AD on the left hand
AD is a chronic disease, and as a result, adherence to therapy is a major obstacle. Education and patient support and can improve adherence and, in turn, outcomes. It is important to remember that AD education is not a one-and-done phenomenon. Ongoing reinforcement of the treatment plan and goals is needed. Clinicians need to explain the condition, the rationale for treatment, optimal treatment use, and demonstrate the application process in their office.8,9 During the detailed conversation, solicit the patients' or caregivers' input and questions to enable their active role in the process.9 This will help manage expectations, adherence to treatment, and maintenance of the lifelong chronic disease.9 Actions to improve patient adherence with treatment include detailed but easy to follow information and options to revisit the information by reading materials or trusted websites (Box 1).8,9,15,19
Apply a patient age-appropriate regimen. Before starting crisaborole therapy, inform and educate the patient and caregiver about:
Why crisaborole treatment
AEs such as irritation, burning, or stinging
Measures that may prevent or quickly resolve reactions such as a gentle cleanser and a refrigerated moisturizer
Demonstrate the application of the ointment
Test patient tolerability in-office with a sample before a prescription to determine the degree of irritation, burning, or stinging
Avoid the crisaborole use on severely inflamed areas or open skin
Limitation of ointment used to areas less likely to sting/burn
Lynde CW, et al. Skin Ther Let. 2020 Jun- (suppl): 1S-12S. https://www.skintherapyletter.com/dermatology/topical-crisaborole-dermatitis-treatment/
Eczema Society of Canada/Société canadienne de l'eczéma. Atopic Dermatitis: A Practical Guide to Management. Keswick, Ontario: Eczema Society of Canada/Société Canadienne de l'eczéma; 2016.
AAD. How will I know what to do to control the eczema? 2018. https://www. aad.org/public/diseases/eczema/eczema-resource-center/controlling-eczema/eczema-action-plan
Box 1: Patient and caregivers information and education about crisaborole
Statement 2: Crisaborole, 1% ointment, is a nonsteroidal anti-inflammatory PDE4-I with demonstrated efficacy in patients aged three months and older with mild to moderate AD. It is a well-tolerated alternative to TCS or TCI and can be used on any body site. It may be especially beneficial for:
Sensitive areas prone to thinning from TCS such as the face, intertriginous areas, and genitals
Hand, feet, palms, and soles, where the small molecular size may allow potential deeper penetration
A previous publication by the panel reviewed various cases that reflect real-world clinical use of crisaborole aimed to clarify its optimal use as monotherapy, combination therapy, sequential therapy, and maintenance therapy.9 Crisaborole can provide a good and safe alternative to TCS and TCI, such as in cases of steroid or TCI avoidance, and can be used in mild-to-moderate AD patients from 3 months of age upwards.25
The case studies discussed in the article suggested that crisaborole treatment was effective and well-tolerated for pediatric AD of the face, hands, and feet of infants, toddlers, young children, and adults where therapy with TCS or TCI had failed.9 One of the cases was a 5-year-old boy with moderate-to-severe AD of his hands that was painful and severely impacting daily activities, such as playing and interacting with other children. After eight weeks of crisaborole use, his hand palms and wrists involvement had almost entirely cleared.9
The advisors recommend that the smaller molecular size of crisaborole may allow better penetration into the skin to the site of inflammation.9 The advisors also indicated that there might be a cumulative effect of adding crisaborole for hands and feet that can benefit from its optimal penetration as part of a combination regimen with TCS and TCI in moderate-to-severe AD cases.9
Statement 3: Crisaborole may be used as a first-line topical agent and is also a good choice when previous treatment has yielded suboptimal results when TCS side effects constitute a significant concern, and in the case of TCS/TCI phobia.
TCS and TCI hesitancy exists among all cultures and likely contribute to AD treatment failure.33 Widely available biased unreliable, and inaccurate sources of information about eczema and topical therapies such as TCS and TCI are not helpful for AD patients and hinder physicians ability to educate and treat appropriately.33 Clinicians must inquire about and if present must thoroughly discuss the patients and caregivers' concerns about TCS and TCI and emphasize that these treatments are vital and, if used appropriately, safe and effective.5,7,8,9,12-21 Providing the patient with trusted websites can give balanced information, thus addressing the issues that are adding to patients concerns, especially in those with TCS and TCI phobia.15,19
If patients or caregivers continue to have safety concerns surrounding TCS/TCI treatment, then crisaborole can offer a safe alternative even in infants as young as three months of age.25 In this situation, offering a safe and effective alternative to TCS or TCI may improve treatment adherence and patient outcomes.9
Statement 4: When starting topical therapies such as crisaborole, consider the following:
Test the patients' tolerability with a sample before a prescription to determine the degree of stinging
Avoid its initial use on severely inflamed or open areas of skin
Limit its use to areas less likely to sting/burn
Use the product in combination with a refrigerated moisturizer
The recommendations are supported by the advisors' clinical experience9, a post hoc analysis of 2 phase 3 studies29, and a systematic literature review comparing efficacy and safety profiles of crisaborole and other topical treatments in mild-to-moderate AD.30 Crisaborole is used in mild-to-moderate AD, but it is best to avoid application on severely inflamed and open areas if possible to minimize stinging.29,30
Testing the patients' tolerability in-office before prescribing crisaborole provides an opportunity to teach the patient about the appropriate application of the medication and identifies the uncommon patient who has more prominent stinging and thus may not tolerate the medication. The application also helps to identify the patient who has mild discomfort. Proper education and guidance can minimize the symptoms and allow then to get past the short-term symptom. Application in the office and identifying these subgroups will instill greater confidence in the medication and make it more likely that the prescription will be filled and utilized rather than abandoned after one application.
Improved knowledge about the central roles a defective skin barrier and dry skin may play in AD increasingly recognizes the benefits of daily and ongoing use of mild cleansers and moisturizers.34 The use of a gentle cleanser that employs advanced vehicles with a near-physiologic pH (4.0–6.0) may help maintain skin barrier function by optimizing skin surface pH levels.34 Utilizing moisturizers to optimize the barrier decreases water loss, decreases inflammation, and improves the skin's barrier and natural moisturizing factors. Moisturizers that contain skin lipids such as ceramides have shown benefits over standard emollients when used for AD patients.35
In an algorithm for South and East Asian AD patients, moisturizers were included as a standard measure when using topical treatments for AD, such as pimecrolimus.36 A refrigerated moisturizer used in combination with crisaborole ointment may prevent irritation, burning, or stinging.9
Statement 5: TCS, TCIs, and PDE4-I may induce application site pain such as burning and stinging. Information and education on measures to prevent or treat these side-effects, such as testing/limiting application sites and concomitant use of a refrigerated moisturizer, can help optimize results and decrease skin irritation.
Few AEs such as irritation, burning, and stinging were reported in clinical studies using crisaborole but seem to be occurring more frequently in clinical practice.16,9
Clinical trials report stinging or burning occurring in up to 8%, but the symptoms are usually transient, and 1.7% of patients withdrew due to these symptoms. In practice, clinicians have anecdotally noted that the rate of stinging seems to be greater than that reported in clinical trials, but generally, the stinging is mild and transient.16,9 Topical medications can sting due to the stabilizers and preservatives in the vehicle cream or due to the medication itself. TCIs can sting, and this stinging is often correlated to the degree of inflammation in the area. Clinicians often apply TCS initially to calm down the AD, after which the TCI is better tolerated. Whether this technique applies to crisaborole is not clear but should be answered by future reports/ studies.8,9
Before starting crisaborole therapy, inform and educate the patient and caregiver on measures that may prevent or quickly resolve irritation, burning, or stinging if it occurs.9 Best practice tips of the panel include the use of crisaborole with daily skincare, such as a gentle cleanser and a refrigerated moisturizer.9 Apply a patient age-appropriate regimen and patient education.9 Identifying patients prone to skin irritation may benefit from an in-office trial with a sample before prescribing the ointment.
A pre-meeting survey was conducted among the panel to share best practice standards and clinical pearls they use in prescribing crisaborole to mild-to-moderate AD patients. All eleven advisors completed the survey. Demographics, number of visits of AD patients, the severity of AD, and treatment are shown in Table 1. When asked: If Crisaborole is not your first choice, indicate why not? stinging (63% [7]), burning (40% [4]) and costs (91% [10]) were frequently mentioned. Six physicians also answered crisaborole was not used for other reasons, which included: Lack of payer coverage, Need to be off-flare to initiate the treatment to get a good response, It is not as effective and does not work as quickly as TCS or TCI, Other medications are effective and more readily available and with which there is more clinical experience. The advisors noted to specifically use crisaborole for various body locations such as the face (72% [8]), hands (91% [10]), eyelids (55% [6]), intertriginous areas (63% [7]), genitals (63% [7]), and feet (81% [9]). According to the advisors, they hypothesize that the small molecular size of crisaborole appears to allow better penetration on areas with thicker skin.
Question Frequency (%)
No. of years experience in dermatology
30+ 5 (45)
20 – 25 4 (37)
10-15 1 (9)
5-10 1 (9)
What is the estimated average number of patients with moderate-to-severe AD visiting your practice weekly? Number of patients
50+ 1 (9)
How many of these moderate-to-severe AD patients are children (<12y)?
10 – 20 1 (9)
What are your choices of treatment for children (<12y) with mild to moderate AD?
TCS low potency 11 (100)
TCS mild potency 11 (100)
TCS high potency 4 (37)
Pimecrolimus 11 (100)
Tacrolimus 10 (91)
Crisaborole 11 (100)
What are your choices of treatment for 12-18 years of age with mild to moderate AD?
TCS low potency 9 (81)
Pimecrolimus 9 (81)
Tacrolimus 11 (100)
What are your choices of treatment for adults (≥18 years) with mild to moderate AD?
Table 1: Pre-meeting survey results
Topical corticosteroid (TCS), atopic dermatitis (AD)
When asked the main reasons to prescribe crisaborole, all (100% [11]) answered that there is a need for a nonsteroidal alternative. Other answers included TCS phobia (91% [10]) and TCI phobia (63% [7]) and suboptimal results with previous therapy (63% [7]).
When stinging or burning occurred with crisaborole use, the advisors discontinued the treatment more frequently in children than adults. For preventing and managing AEs, the advisors provided education before starting crisaborole treatment. Some tested patients' tolerability to the treatment in the office prior to a prescription to determine the degree of stinging. Further, they recommended measures to reduce stinging, such as concomitant use of a gentle cleanser and refrigerated moisturizer, cooling the ointment in the fridge, and concomitant TCS or TCI use (Figure 6). Finally, the advisors agreed to avoid the application of crisaborole on severely flaring skin.
When asked about the patients' response to crisaborole treatment within four weeks, forty percent of responders noted that on average, 20-50% of patients had improved, and 50% of the panel noted an improvement in over 50% of their patients (Figure 7 and 8).
Figure 6: Managing stinging/burning in children (<12 years) and adults reported from crisaborole use includes the following measures:
N = 11 (100%) answers are given for children and adults seperately
*Other: I test patient tolerability with a sample prior to a prescription to determine the degree of stinging; Avoidance of use on severely inflamed areas or open areas of skin; Limitation of use to areas less likely to sting/burn, Refrigerated moisturizer
Figure 7: Average skin condition improvement noted by the responders. N = 11
Figure 8: How quickly does the benefit of Crisaborole in the pruritus of your AD patients manifest itself? N = 11
Measures to reduce burning and stinging that may occur when using crisaborole were developed using the authors' expert opinion and clinical experience, and further studies are needed to support the possible benefits of these measures.
The review explored best clinical practices of crisaborole for mild to moderate AD patients and provided expert guidance for the real-world use of crisaborole ointment.
Atopic dermatitis is a common chronic inflammatory disorder in which patients experience a waxing and waning disease state that is punctuated by episodes of flares. If their disease is quiescent, then the patient continues good skincare by utilizing moisturizers and avoiding irritants. Patients will escalate and add topical medications at the first sign of a flare. Since every patient has a distinct disease course, some patients may never be fully clear while others clear between episodes. Recognition that patients with AD have a disease that often varies in severity and location on their body allows physicians to choose the appropriate treatments based on their clinical experience. The physician needs to educate their patient to escalate therapy accordingly at the first sign of disease in order to prevent severe flares. An eczema treatment plan is a necessity to ensure a smooth transition of therapy from baseline to flare. For mild to moderate AD patients, three topical options can be prescribed to control inflammation. Traditionally these medications have been divided into first and second-line therapy. However, the expert panel believes that the choice of a specific agent should be decided by the clinician based on factors such as disease severity, location, physician experience with the product, cost, and patient preference.
Crisaborole is a nonsteroidal PDE4-I with demonstrated safety and efficacy in patients aged three months and older with mild to moderate AD. It is a well-tolerated alternative to TCS or TCI and can be used on any cutaneous non-mucosal body site. It may be especially beneficial for areas with thicker skin, such as hands and feet, possibly due to improved penetration to the site of inflammation as a result of its small molecular size. There are no concerning serious safety signals associated with crisaborole. Crisaborole does cause a burning sensation in 8% of patients, but this is usually transient and may be minimized by the concomitant application of cool moisturizers. Consideration of in-clinic test site application of crisaborole to high-risk individuals may help identify those at risk and allow patient education, which may decrease the side effect and in turn improve adherence and outcome.
Garg N, Silverberg JI. Epidemiology of childhood atopic dermatitis. Clin Dermatol. May-Jun 2015;33(3):281-8.
Flohr C, Mann J. New insights into the epidemiology of childhood atopic dermatitis. Allergy. 2013; Nov;69(1):3-16.
Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16.
Kaufman BP, Guttman‐Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups–variations in epidemiology, genetics, clinical presentation, and treatment. Exp Dermatol. 2018 Apr;27(4):340-357.
Leung DYM, Guttman-Yassky E. Deciphering the complexities of atopic dermatitis: Shifting paradigms in treatment approaches. J Allergy Clin Immunol. 2014 Oct;134(4):769-79.
Gittler JK, Shemer A, Suárez-Fariñas M, et al. Progressive activation of TH2/TH22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis. J Allergy Clin Immunol. 2012 Dec;130(6):1344-54.
Mayba JN, Gooderham MJ. Review of atopic dermatitis and topical therapies. J Cutan Med Surg. May/Jun 2017;21(3):227-236.
Lynde CW, Bergman J, Fiorillo L, et al. Clinical insights about topical treatment of mild-to-moderate pediatric and adult atopic dermatitis. J Cutan Med Surg. May/Jun 2019;23(3_suppl):3S-13S.
Mayba JN, Gooderham MJ. Review of atopic dermatitis and topical therapies. J Cutan Med Surg. May/Jun 2017;21(3):227-236
Lynde CW, Bergman J, Fiorillo L, et al. Use of topical crisaborole for treating dermatitis in a variety of dermatology settings. Skin Therapy Lett. 2020 Jun (suppl): 1S-12S.
McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016 Jun;38(3):655-62.
Brouwers M, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010 Dec 14;182(18):E839-42.
Trevelyan EG, Robinson N. (2015). Delphi methodology in health research: how to do it? European Journal of Integrative Medicine. 2015 Aug;7(4):423-428.
Eichenfield LF, Boguniewicz M, Simpson EL, et al. Translating atopic dermatitis management guidelines into practice for primary care providers. Pediatrics. 2015 Sep;136(3):554-65.
Saeki H, Nakahara T, Tanaka A, et al. Clinical practice guidelines for the management of atopic dermatitis 2016. J Dermatol. 2016 Oct;43(10):1117-45.
Guenther LC, Andriessen A, Lynde CW, et al. Development of a clinical pathway for atopic dermatitis patients: a case-based approach. J Drugs Dermatol. 2016 Dec 1;15(12):1485-1494.
Wollenberg A, Oranje A, Deleuran M, et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol. 2016 May;30(5):729-47.
LeBovidge J, Borok J, Udkoff J, et al. Atopic dermatitis: therapeutic care delivery: therapeutic education, shared decision-making, and access to care. Semin Cutan Med Surg. 2017 Sep;36(3):131-136.
American Academy of Dermatology Association. How will I know what to do to control the eczema? 2018. https://www.aad.org/public/diseases/eczema/eczema-resource-center/controlling-eczema/eczema-action-plan. Accessed April 10 2021.
Centre hospitalier de l'Université de Montreal. Topical corticosteroids to reduce skin inflammation. Québec: Centre hospitalier de l'Université de Montreal; November 2016.
Leung TN, Hon KL. Eczema therapeutics in children: what do the clinical trials say? Hong Kong Med J. 2015 Jun;21(3):251-60. doi: 10.12809/hkmj144474.
Paller AS, Tom WL, Lebwohl MG, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep;75(3):494-503.e6
Bissonnette R, Pavel AB, Diaz A, et al. Crisaborole and atopic dermatitis skin biomarkers: an intrapatient randomized trial. J Allergy Clin Immunol. 2019 Nov;144(5):1274-1289.
Eichenfield LF, Call RS, Forsha DW, et al. Long-term safety of crisaborole ointment 2% in children and adults with mild to moderate atopic dermatitis. J Am Acad Dermatol. 2017;77(4):641-649.e645.
Schlessinger J, Shepard JS, Gower R, et al. Safety, Effectiveness, and Pharmacokinetics of Crisaborole in Infants Aged 3 to < 24 Months with Mild-to-Moderate Atopic Dermatitis: A Phase IV Open-Label Study (CrisADe CARE 1). Am J Clin Dermatol. 2020 Apr;21(2):275-284. doi: 10.1007/s40257-020-00510-6.
Yosipovitch G, Simpson EL, Tan H, et al. Effect of crisaborole topical ointment, 2%, on atopic dermatitis–associated pruritus: an extended analysis of 2 phase 3 clinical trials. Itch. 2018;3:e12. Erratum for: Itch. 2019;4(1)p e12.
Draelos ZD, Stein Gold LF, Murrell DF, et al. Post Hoc Analyses of the Effect of Crisaborole Topical Ointment, 2% on Atopic Dermatitis: Associated Pruritus from Phase 1 and 2 Clinical Studies. J Drugs Dermatol. 2016 Feb;15(2):172-6.
Simpson EL, Paller AS, Zane LT et al. Crisaborole ointment improves quality of life of patients with mild-to-moderate atopic dermatitis and their families. Dermatol Ther (Heidelb). 2018 Dec;8(4):605-619.
Silverberg JI, Tallmann AM, Ports WC, et al. Evaluating the efficacy of crisaborole using the atopic dermatitis severity index and percentage of affected body surface area. Acta Derm Venereol. 2020 Jun 11;100(13):adv00170.
Fahrbach K, Tarpey J, Washington EB, et al. Crisaborole ointment, 2%, for treatment of patients with mild-to-moderate atopic dermatitis: Systematic literature review and network meta-analysis. Dermatol Ther (Heidelb). 2020 Dec;10(6):1441-1444.
Kubo A, Nagao K, Amagai M. Epidermal barrier dysfunction and cutaneous sensitization in atopic diseases. J Clinical Invest. 2012 Feb;122(2):440-7.
Lansang P, Lara-Corrales I, Bergman JN. Approach to the assessment and management of pediatric patients with atopic dermatitis: A consensus document. J Cutan Med Surg. 2019;23(5S):32S-39S.
Li AW, Yin ES, Antaya RJ. Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review. JAMA Dermatol. 2017 Oct 1;153(10):1036-1042.
Lynde CW, Tan J, Skotnicki S, et al. Clinical insights about the role of pH in atopic dermatitis. J Drugs Dermatol. 2019 Dec 1;18(12):221.
Lynde CW, Andriessen A. A cohort study on a ceramide-containing cleanser and moisturizer used for atopic dermatitis. Cutis. 2014 Apr;93(4):207-13.
Luk D, Hon KLE, Dizon MVC, et al. Practical recommendations for topical treatment of atopic dermatitis in South and East Asia. Dermatol Ther (Heidelb). 2021 Feb;11(1):275-291.
Catherine McCuaig
Charles W. Lynde
Crisaborole
Danielle Marcoux
Ian Landells
J. N. Bergman
Jill Keddy-Grant
Loretta Fiorillo
Lyn C. Guenther
Marissa Joseph
Michele Ramien
PDE-4
topical treatment
Wingfield Rehmus
Higher Incidence of HPV-Driven Cancers in Males Calls for an Update to Current HPV Vaccination Guidelines and Implementation
Tazarotene Lotion 0.045% for the Treatment of Acne (FP)


He came to Simon Peter, who said to him, "Lord, do you wash my feet?" Jesus answered him, "What I am doing you do not understand now, but afterward you will understand." Peter said to him, "You shall never wash my feet." Jesus answered him, "If I do not wash you, you have no share with me." Simon Peter said to him, "Lord, not my feet only but also my hands and my head!" Jesus said to him, "The one who has bathed does not need to wash, except for his feet, but is completely clean. And you are clean, but not every one of you." For he knew who was to betray him; that was why he said, "Not all of you are clean." When he had washed their feet and put on his outer garments and resumed his place, he said to them, "Do you understand what I have done to you? You call me Teacher and Lord, and you are right, for so I am. If I then, your Lord and Teacher, have washed your feet, you also ought to wash one another's feet. For I have given you an example, that you also should do just as I have done to you. Truly, truly, I say to you, a servant is not greater than his master, nor is a messenger greater than the one who sent him. If you know these things, blessed are you if you do them.


LaserWeld is a large scale, vertically integrated, turnkey manufacturer.
Specializing in Laser processing all materials & delivering a turn-key product on time!
LaserWeld is a family owned and operated business since 1998 that specializes in manufacturing solutions. It is a vertically integrated company offering a complete range of services to our customers. LaserWeld procures raw material, saws, cuts, machines, welds, assembles, powder coats and delivers its products Just In Time.Specializing in the use of laser cut parts, LaserWeld incorporates the advantages of both human and robotic welding. Using aggressive manufacturing and pricing approach, LaserWeld has been awarded products previously manufactured in Europe, Asia and Mexico. Our approach has been to arrive at price value through speed and efficiency, to arrive at speed through superior quality. We always start with and focus on quality.LaserWeld is a strategic supplier of the forklift industry, as well as construction, oil exploration and production.
Being vertically integrated we have the capability to design and manufacture not only our parts but the fixturing and processes involved in making the product and maintaining high quality standards in a timely and effective way.


text:
Rumors are already creating a buzz around Apple's 2019 offerings
Apple's famed analyst Ming-Chi Kuo revealed that the company's 2019 iPhone offerings will come with an improved Face ID technology.
According to Kuo, Apple is reportedly working on an upgraded Face ID camera system with a new and more powerful flood illuminator. The added feature will improve Apple's facial recognition technology by "lowering the impacts from visible lights of environment," says Kuo.
Apple's new smartphones, starting from iPhone X, uses a recognition system called Face ID to unlock the device and authorize payments. Face ID uses a combination of light projectors and sensors to take several images of your facial features – and flood illuminator produces infrared light to illuminate your face. "Infrared illumination helps in enabling the face recognition to work in non-favorable conditions," says Professor Anil Jain, who studies pattern recognition and computer vision at Michigan State University.
Apple also appears to be developing a 3D Time-of-Flight (ToF) camera for its upcoming iPads, suggests Kuo, though the camera would not appear on next year iPhones. The camera system will allow the iPad to capture 3D models while measuring the distance of the subject using light or lasers. iPhones releasing next year will also include the removal of the 3D touch feature, the integration of three camera lenses, and the possibility of the notch being ditched.
Also, a recent report claimed that Apple has chosen Intel to supply the modems for its first 5G mobile phones, which will be launched in 2020.
Xiaomi reproduces Apple's Memoji
Apple's designer Jony Ive leaves to start his own firm
Drive.ai comes under Apple's umbrella
Here's everything you need to know about Apple's iOS 13
TYAN to showcase its technology at Computex 2019

redpajama_set_name: RedPajamaCommonCrawl


Treatment can be completed quickly and conservatively, meaning you have perfectly beautiful teeth with no sound of the drill. Please view our commendations page to see patients' own recommendations.
We offer a free suitability test to see if you could benefit from this modern aesthetic form of braces and if so all aspects of the treatment will then be explained. Please contact our receptionist Sophie for further advice on Clearstep, the alternative to Invisalign.


Stansted is set to be the fourth busiest airport in the UK this Christmas with 156,673 people scheduled to land and 156,713 due to depart over a five-day window.
December 23 is the busiest day with 238 flights scheduled to arrive compared to 173 on Christmas Eve.
The figures come courtesy of Buyagift which commissioned a study using worldwide aviation data. Heathrow, Gatwick and Manchester are the three airports above Stansted.
Buyagift says that between December 21 and 25 a total of 69,330,024 people around the world will be taking to the skies, heading home to families for Christmas Day.
Among them are nurses, soldiers, and business people – some flying thousands of miles for family festivities. Of those, 1.8 million will be heading to the UK – making it the eighth busiest country for Christmas air travel.
Most flights into Stansted are from Spain, followed by the United States and then Germany.
The top 20 busiest airports globally at Christmas will be Beijing Capital International, followed by Dubai International, Atlanta Hartsfield-Jackson Intl, Tokyo Int (Haneda) and Los Angeles International. The figures place Heathrow 11th in the top 20.
The US is named as the busiest nation for in-country flights. During the five days before Christmas 118,844 flights will be arriving across America – more than 10 times the UK figure. The UK is eighth in the top 10 for in-country flights.
A record breaking 1.98 million passengers passed through London Stansted in November, up 8.7 per cent on 2017.
Stansted chief executive Ken O'Toole, said: "The first full month of the winter flight schedules and high airline load factors produced another strong performance in terms of passenger growth at London Stansted, and the busiest November for the airport on record.
"The growth trend will continue over the coming weeks as we prepare for our busiest ever festive getaway when we expect to welcome nearly 1.2 million passengers to the airport between 21 December and 6 January.


While living on the Island of Aphrodite, and traveling extensively throughout the Mediterranean region (Italy, Greece, France, Turkey, Spain), I noticed many overarching themes about the peoples of this region. Yes, they had different languages, culture, religion. But one of the things they had in common: a general distrust about store-bought foods. Specifically, they were concerned about the level of "hormones" (what we in the West call genetically-modified or GM foods) in the fruits and vegetables. The debate is still ongoing whether GM foods are detrimental to one's health. The reason many food manufacturers and farmers use them is simple: the world population is growing, and there's more demand than supply. So, they need to up the supply. At the same time, they lower their cost of production, so they can increase their profits. It's an unnecessary evil of the times in which we live.
As our world becomes more tech savvy, and we spend more time in high rises rather than green pastures, what is a goddess to do to? We want to eat healthy, exercise, look good, raise our children, make money, have a career, give back to society, and keep a good home. Whew. Too much to the list. Can I add one more to our growing list of responsibilities?
I suggest we grow our own gardens. I know, I know. I have the worst green thumb. I actually think it's black with a tinge of fungus. But I have started growing a small herbal garden: mint, oregano, rosemary and such. Anyone can do this with a few seeds, a couple of pots and some sunshine through their kitchen window. Once you gain a bit of confidence, we can begin digging outdoors.
What if I live in an apartment? Or in a large city?
This is probably the largest concern I have, as well. Many of my friends in the Mediterranean had their own homes. If they lived in the city or in an apartment, their parents often times lived in a home with a yard and were gardening. They would spend weekends (or at least Sundays) as family day. At the end of the day, parents would pile a bag of washed fruits/vegetables from their harvest and hand it to her on her way to the apartment. This would be her vegetable supply for the week.
Assuming that your parents aren't nearby, and if they were, they don't garden (although wouldn't that be a fabulous solution? Encouraging your mom/dad to start a fruit and vegetable garden – you could work on it together on weekends! Great mother/daughter bonding time, and you could enjoy the produce afterwards).
My suggestion is to find a nearby Food CO-OP. Co-ops are short for "cooperatives," which basically means a group of people came together to benefit from economies of scale (producing or advertising more cheaply in a group, rather than doing it on one's own). In terms of a food co-op, families come together to buy directly from local farmers. This is a great concept. It helps the entire community: your family (eating healthfully and consciously); the local farmers (they sell their goods); the local economy (keeps money flowing locally, instead of sending your money to a corporate headquarters hundreds of miles away); environment (less need for trucks to drop off crates and crates of fruits and vegetables that were probably picked way too early in the middle of Mexico and sitting in a truck or a warehouse or a shelf for days/weeks). The list continues of all the good that comes out of enjoying locally produce.
What if I live in a cold climate that doesn't grow many fruits and vegetables, especially in the winter?
I write this as the Northeast is covered in a blanket of snow. I last saw 33 inches fell in eastern Massachusetts. I feel for your guys. Truthfully, I haven't lived in that situation, as I split my time between Virginia (rather temperate, but enjoys four full seasons annually) and Cyprus. My only suggestion is to consider investing in a small greenhouse. Many people do this in the Mediterranean, as well. Albeit they are usually not covered in snow, the climate is still cold and rainy for most of November through February/early March. The greenhouses enable area farmers and locals to farm throughout the year, whether or not their is frost.
One last comment about growing your own garden. If you haven't had the pleasure of feeling the earth in your hands and watching the tiny sprouting of a little broccoli plant, then you need to. It is nearly magical that something from a dry, tiny seed would grow into a juicy, green plant that nourishes you and your entire family. Do you know how some people claim they go to the gym to work off steam and release tension? Well, that was never me. I exercise because if I don't, I can easily turn rotund like the rest of the women in my family. However, when I garden, I truly forget my problems. I have had friends tell me that they have warded off seeing therapists in exchange for some soul time in their tomato patch.
Finally, if all the public documents about GM foods being bad for your health doesn't motivate you into getting your manicured nails dirty, consider this: hitting the gym in many a Mediterranean countries is a relatively new concept. Most women walk to the store, to work, to the beach, and beyond, if they live in a city or village. In addition to walking, women and men garden. They spend an hour or so in the morning and/or evening weeding, watering and tilling by hand so that tomatoes, eggplant, peppers, spinach and more grows. It is a WONDERFUL pastime to spend with your children. I still smile when remembering my children running through the long field, and finding a perfectly shaped, crunchy cucumber. They would get so excited – it was like finding Easter eggs in the summer. The children learned to love the taste of the vegetables raw and still warm from the sun. You must taste a freshly-picked cucumber, crackling in your teeth. The ones we purchase in the grocery store, squishy and the color of old grass doesn't even come close to a real vegetable comparably.
To your health, my lovely goddesses! Please send pictures of your budding gardens or let me know what's your biggest hurdle with beginning one. Time? Space? Don't know where to start? We can figure it out together.


text:
package me.yeojoy.microdustwarning;

import android.app.Activity;
import android.content.Intent;
import android.graphics.Color;
import android.net.Uri;
import android.os.Bundle;
import android.view.View;
import android.widget.TextView;

import com.google.android.gms.analytics.HitBuilders;
import com.google.android.gms.analytics.Tracker;

import me.yeojoy.microdustwarning.util.DustUtils;

public class AboutActivity extends Activity implements DustConstants, View.OnClickListener {

    private static final String TAG = AboutActivity.class.getSimpleName();
    private static final String VIEW_NAME = "about activity";

    private TextView mTvAppVersion;

    @Override
    protected void onCreate(Bundle savedInstanceState) {
        super.onCreate(savedInstanceState);
        setContentView(R.layout.activity_about);

        mTvAppVersion = (TextView) findViewById(R.id.tv_app_version);
        mTvAppVersion.setText("v" + BuildConfig.VERSION_NAME);

        if (BuildConfig.DEBUG) mTvAppVersion.setTextColor(Color.RED);

        findViewById(R.id.tv_infomation).setOnClickListener(this);
        findViewById(R.id.tv_thanks_to).setOnClickListener(this);
        findViewById(R.id.tv_send_feedback).setOnClickListener(this);
    }

    @Override
    protected void onResume() {
        super.onResume();
        // Get tracker.
        Tracker t = ((DustApplication) getApplication())
                .getTracker(DustApplication.TrackerName.APP_TRACKER);

        // Set screen name.
        t.setScreenName(VIEW_NAME);

        // Send a screen view.
        t.send(new HitBuilders.AppViewBuilder().build());
    }

    @Override
    public void onClick(View v) {
        Intent intent;
        switch (v.getId()) {
            case R.id.tv_infomation:
                intent = new Intent(this, InfoActivity.class);
                intent.putExtra("title", INFORMATION_TITLE);
                startActivity(intent);
                break;

            case R.id.tv_thanks_to:
                intent = new Intent(this, InfoActivity.class);
                intent.putExtra("title", THANKS_TO_TITLE);
                startActivity(intent);

                break;

            case R.id.tv_send_feedback:
//                Intent emailIntent = new Intent(Intent.ACTION_SEND);
//                emailIntent.setType(HTTP.PLAIN_TEXT_TYPE);
//                emailIntent.putExtra(Intent.EXTRA_EMAIL, new String[] { EMAIL_ADDR });
//                emailIntent.putExtra(Intent.EXTRA_SUBJECT, EMAIL_SUBJECT);
//                emailIntent.putExtra(Intent.EXTRA_STREAM, Uri.parse("content://path/to/email/attachment"));
//
//                startActivity(emailIntent);

                intent = new Intent(Intent.ACTION_SENDTO, Uri.fromParts("mailto", EMAIL_ADDR, null));
                intent.putExtra(Intent.EXTRA_SUBJECT, EMAIL_SUBJECT);

                startActivity(Intent.createChooser(intent, "Send Email"));
                break;
        }
    }
}

redpajama_set_name: RedPajamaGithub


Eyeko's Skinny Brush Mascara is an award-winning mascara designed with a slim brush and dispersed bristles to easily grab, separate, and extend even the shortest lashes to deliver full and lengthening results. This water-resistant formula boasts an innovative Korean technology that locks in color for over 12 hours without smudging, clumping, or flaking. Enriched with conditioning pro-vitamin B to prevent breakage and promote healthy growth for instantly longer lashes with long-term care.


Arsenal manager Arsene Wenger wants his side to apply pressure on their Premier League title rivals by reclaiming top spot with victory over Crystal Palace on Sunday.
The Gunners lost their place at the summit of the table to Manchester City following their mid-week 2-2 draw at Southampton.
While Arsenal dropped points at St Mary's last Tuesday, City were rampant in a 5-1 mauling of Tottenham Hotspur 24 hours later.
But Wenger hopes his men can get back to winning ways immediately at the Emirates Stadium against Tony Pulis's resurgent outfit.
That will restore a two-point advantage for the Gunners over nearest rivals City, who host third-place Chelsea on Monday.
"That's our target," Wenger said. "Can you win the next game if you give absolutely everything? Yes, so let's do it.
"It is a great opportunity for us to win our game and respond to our draw at Southampton.
"At the moment they (City) are on fire. But I believe we have just to focus on our own run because if you look at the schedule, if we are consistent we have a good chance to do it.
"You cannot speculate on any weakness in Man City in the coming months. So let's focus on us, and our strengths, in the coming months.
"It is the way we can do, if we keep the consistency and manage to win the big games - one of them will be Man City at home (on March 29).
"Of course that will be very important. Of course they had an impressive win, and a great quality game as well at Tottenham.
"But if you analyse it well, this game could have turned as well. All the turning points went in their favour. If they had not gone ahead, you are not sure they would have won the game."
Arsenal have suffered a major injury blow, with Aaron Ramsey ruled out for up to six weeks with a recurrence of a thigh problem.
The Wales midfielder has been one of the stand-out performers for the Gunners this season, scoring 13 goals for the north Londoners in all competitions.
He will miss crunch league fixtures in February against Liverpool and Manchester United, the FA Cup fifth-round clash with Brendan Rodgers's men, and the mouth-watering Champions League last 16 first-leg tie against Bayern Munich.
"He finished training normally, came in and had pain. We checked in on the scan and is was a recurrence of his muscle problem," Wenger said.
"Why did it happen? Have we not been cautious enough? We have respected the procedures. Maybe we should have been a bit more cautious, but it was not obvious."
Wenger reacted to Ramsey's injury by bringing in Sweden international midfielder Kim Kallstrom from Spartak Moscow on a short-term loan deal.
Improving Palace have lost only twice in their last six matches under new manager Pulis, who has seen his side climb to 14th place in the table.
The south London club brought a raft of new players to the club before the January transfer window closed on Friday.
Goalkeeper Wayne Hennessey, centre-back Scott Dann and midfielders Joe Ledley and Tom Ince all arrived at Selhurst Park, while Jason Puncheon's loan move from Southampton was turned into a permanent transfer.
"Obviously it was good business done by the football club and we just hope it gels as quick as necessary to get us the points to keep us in the Premiership (Premier League)," Pulis told Sky Sports.
"The important thing was getting competition, and also getting cover. There's almost a third of the season to go, and we needed that.
"What we've got to do now is get them into the groove as quickly as we can."


text:
Dave Colangelo wins the SCMS 2021 Anne Friedberg Innovative Scholarship Award!
Dave Colangelo, author of The Building as Screen: A History, Theory, and Practice of Massive Media (Amsterdam University Press, 2019), is the winner of this year's SCMS 2021 Anne Friedberg Innovative Scholarship Award.
"Illuminated Voices" by Sabina Haque & Victoria Wells, curated & facilitated by Mobile Projection Unit at APANO in Portland, OR.
The SCMS 2021 Anne Friedberg Innovative Scholarship Award Committee and the Board of Directors have selected The Building as Screen: A History, Theory, and Practice of Massive Media (Amsterdam University Press, 2019), as the winner of this year's award.
This year's committee members were Mark Gallagher (Chair), Erica Stein, Kara Andersen. In their report, the committee noted,
"the winning title was a consensus choice that all on the committee ranked highly and were pleased to champion."
A representative from the committee will make the formal announcement of the award during the awards ceremony, presented during the SCMS virtual conference this year, March 17-21, 2021.
Amsterdam University Press congratulate Dave on this fantastic achievement!
The Building as Screen
Dave Colangelo's The Building as Screen: A History, Theory, and Practice of Massive Media describes, historicizes, theorizes, and creatively deploys massive media – a set of techno-social assemblages and practices that include large outdoor projections, programmable architectural façades, and urban screens – in order to better understand their critical and creative potential. Massive media is named as such not only because of the size and subsequent visibility of this phenomenon but also for its characteristic networks and interactive screen and cinema-like qualities. Examples include the programmable lighting of the Empire State Building and the interactive projections of Montreal's Quartier des spectacles.
Dave Colangelo is an artist, educator, and researcher based in Toronto, Canada. He is a founding member of Public Visualization Studio. He is Assistant Professor of Digital Creation and Communication in the School of Professional Communication (FCAD) at Ryerson University, and Director, North America, of the Media Architecture Institute.
Friday, January 22nd, 2021


text:
Fortinet ties up with 19 varsities to groom professionals in cybersecurity
L N Revathy Coimbatore | Updated on September 23, 2020 Published on September 23, 2020
The demand for skilled manpower in cyber security solutions space has always been high, but seems to have risen exponentially in recent months.
According to the 2019 ISC2 Cyber Security Workforce Study, around 2.8 million professionals currently work in cyber security around the globe, but an additional four million trained workers would be needed to close the skills gap and properly defend organisations.
A Forbes Insights survey commissioned by Fortinet revealed that Chief Information Security Officers (CISOs) look for more talent and better training for employees.
To address this industry-wide skills gap, integrated and automated cybersecurity solutions provider - Fortinet has tied up with 19 universities such as Annasaheb Dange College of Engineering & Technology, Bennett University, Institute of Advance Management & Research, Shri Venkateshwara University, Sri SaiRam Engineering College, SASTRA Deemed University, Seacom Skills University, St. Xavier& Catholic College of Engineering and Sri SaiRam Institute of Technology for introduction of its Security Academy Programme (FSAP).
Rajesh Maurya, Regional Vice President, India & SAARC at Fortinet said the company is committed to closing the cybersecurity skills gap through the Network Security Expert (NSE) Training Institute programmes.
The FSAP allows academic institutions to equip participants with the skills necessary for a career in cybersecurity. "We're arming the next generation of security leaders with the skillset and knowledge the industry so desperately needs," Maurya said
FSAP is available in more than 80 different countries and is comprised of over 300 Authorized Security Academies.
With the addition of new institutions from India to the programme, Maurya said that Fortinet would help build, augment and develop the next generation of security professionals, address skills shortage and continue to help close the skills gap.


text:
Maryland court to webcast trials
Annapolis (MD) – Maryland's Court of Appeals, the highest court in the state, is putting into place plans to Webcast live sessions of the court, throwing its hat into the ring of a handful of other states that have a similar online outreach.
The Maryland court is pushing things quickly in order to be able to Webcast a high-profile same-sex marriage case, which begins on December 4. The current plan is to have the Webcasts go live starting this Thursday.
"It's all part of this outreach thing. Other courts have done it. I don't see why we shouldn't do it," said Maryland Chief Judge Robert M. Bell in an interview with the Baltimore Sun newspaper.
Most of the structured proceedings aren't exactly like Law & Order or even Judge Judy, but nevertheless there is a level of interest such that nearly half of the states have some sort of public viewing access to the courts. New Jersey, New Hampshire, and Ohio are among the states that broadcast live sessions of their state Supreme Court online.
Cases that get the most attention will be those that are high-profile, and having an always-on Webcast will certainly help to ensure uninterrupted viewing during these cases – which could draw millions of out-of-state and out-of-country viewers. According to the Associated Press, 50 million people tuned in to sources to watch at least parts of the 2000 Florida election court case.
Mark Raby
15 Top Notch Business Ideas for Ladies with Low Investment in India
Naomi Webb
Make The Most Of Independence Day Offers by Shopping from the Bajaj Finserv Emi Network
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[[File:IL-Fayette.jpg|300px|thumb|right|''Fayette County, Illinois
[[File:IL-Fayette.jpg|300px|thumb|right|''Fayette County, Illinois U.S. Census TIGER/Line map'']]
The Fayette County, [[Illinois (USA)|Illinois]], [[Old Order Amish|Old Order Amish]] community, now extinct, was located near Brownstown and Vandalia in 1894-1906. The community at its largest consisted of about 25 families. John A. Miller was the first minister, and he was joined by Mose Yoder of [[Howard-Miami County Amish Settlement (Kokomo, Indiana, USA)|Howard County]], [[Indiana (USA)|Indiana]]. Sam Bender was ordained minister and bishop of the church. Joe Bontrager, who lived in the community for about two years, also assisted in preaching.
U.S. Census TIGER/Line
'']] The Fayette County, [[Illinois (USA)|Illinois]], [[Old Order Amish|Old Order Amish]] community, now extinct, was located near Brownstown and Vandalia in 1894-1906. The community at its largest consisted of about 25 families. John A. Miller was the first minister, and he was joined by Mose Yoder of [[Howard-Miami County Amish Settlement (Kokomo, Indiana, USA)|Howard County]], [[Indiana (USA)|Indiana]]. Sam Bender was ordained minister and bishop of the church. Joe Bontrager, who lived in the community for about two years, also assisted in preaching.
Probably because of internal difficulties the Amish began to scatter, and by 1906 the settlement was completely gone. Many returned to [[Iowa (USA)|Iowa]], others went to Douglas County, and to [[Oklahoma (USA)|Oklahoma]] and [[Mississippi (USA)|Mississippi]]. A small cemetery of 14 graves remained five miles northwest of Brownstown.
{{GAMEO_footer|hp=Vol. 2, p. 318|date=1956|a1_last=Hostetler|a1_first=John A|a2_last=|a2_first=}}
[[Category:Old Order Amish Settlements]]
[[Category:Illinois Old Order Amish Settlements]]
[[Category:United States Old Order Amish Settlements]]
[[Category:Extinct Old Order Amish Settlements]]
Fayette County, Illinois U.S. Census TIGER/Line map
The Fayette County, Illinois, Old Order Amish community, now extinct, was located near Brownstown and Vandalia in 1894-1906. The community at its largest consisted of about 25 families. John A. Miller was the first minister, and he was joined by Mose Yoder of Howard County, Indiana. Sam Bender was ordained minister and bishop of the church. Joe Bontrager, who lived in the community for about two years, also assisted in preaching.
Probably because of internal difficulties the Amish began to scatter, and by 1906 the settlement was completely gone. Many returned to Iowa, others went to Douglas County, and to Oklahoma and Mississippi. A small cemetery of 14 graves remained five miles northwest of Brownstown.
John A Hostetler
Hostetler, John A. "Fayette County Old Order Amish Settlement (Fayette County, Illinois, USA)." Global Anabaptist Mennonite Encyclopedia Online. 1956. Web. 18 Jan 2021. https://gameo.org/index.php?title=Fayette_County_Old_Order_Amish_Settlement_(Fayette_County,_Illinois,_USA)&oldid=149186.
Hostetler, John A. (1956). Fayette County Old Order Amish Settlement (Fayette County, Illinois, USA). Global Anabaptist Mennonite Encyclopedia Online. Retrieved 18 January 2021, from https://gameo.org/index.php?title=Fayette_County_Old_Order_Amish_Settlement_(Fayette_County,_Illinois,_USA)&oldid=149186.
Adapted by permission of Herald Press, Harrisonburg, Virginia, from Mennonite Encyclopedia, Vol. 2, p. 318. All rights reserved.
©1996-2021 by the Global Anabaptist Mennonite Encyclopedia Online. All rights reserved.
Retrieved from "https://gameo.org/index.php?title=Fayette_County_Old_Order_Amish_Settlement_(Fayette_County,_Illinois,_USA)&oldid=149186"
Old Order Amish Settlements
Illinois Old Order Amish Settlements
United States Old Order Amish Settlements
Extinct Old Order Amish Settlements


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Less than a week ago, freshly returned from a spell of blissful newslessness in France, I suggested we might all be happier for not following the news. Since then, semi-consciously, I have been almost following my own suggestion. Apart from a quick, dispiriting skim of a single Sunday paper, I have ignored the newspapers altogether - a risky course in my line of business perhaps, but what the hey? I can report that I feel a great deal less miserable about things, a good deal less mentally cluttered, confused and ground down - and I have done more of the things that are worth doing (reading books, listening to music, staring slack-jawed into the middle distance) with the time saved by not ploughing through the depressing, banal, ill-written, self-important, vastly oversized publications that make up our much prized 'national press'.
(On the subject of size, it's always a shock to come across a national newspaper from even 30 years ago - they were tiny! The stranglehold of the printers' unions was in all kinds of ways deplorable - but at least it meant small, easily digestible newspapers - and more time for the population to get on with their lives, doing things more worthwhile than reading the papers.)
Posted by Nige at 11:02
malty 29 June 2008 at 14:07
Nige, do you think a persons newspaper reading history may say something about them ? mine would be, in chronological order, Daily Mirror, Telegraph, Evening chronicle, Evening News, Times, The Scotsman. I've now stopped taking daily newspapers, mostly hogwash, and were having ongoing, meaningful discussions regarding the Sundays, fed up with Jenkins and Gill, as for Clarkson, an empty headed turd, living off the backs of all of the hard working people in the motor industry. Need Liddle to cheer me up, Martin Ivens is pretty much on the ball, thoroughly enjoy Januszczak, can read BA on the blog, the rest is becoming a blur. The other Sunday may well go, The Scotsman on Sunday, is becoming alarmingly tribal, today hurling accusations at the fiendish English Tories for suggesting altering their daylight saving times, most of the press up here have a pathological distrust of anything Tory, The hatred for Thatcher is surreal. she's less popular than Myra Hindley.
Nige 29 June 2008 at 15:28
I don't know, Malty, mine began with childhood Telegraph, then youthful Guardian, then all over the place, from everything to nothing. I'm only happy my newspaper-reading days seem to be drawing peacefully to a close. Living in Scotland must be very wearing - cut 'em adrift I say, see how they like it...
Malty, I love The Scotsman! When my husband and I were in Scotland a couple of summers ago, the paper was having a rip-roaring time covering some politician named Tommy who'd been accused of getting it on with a prostitute. His wife came to court to defend him and said Tommy had such a hairy back the prostitute would have been sure to mention it and she didn't, hence, it was a frame job. Tommy offered to take off his shirt to show the court.
Love it! Is Tommy still a politician? Still hairy?
BTW, we *loved* Scotland, from Edinburgh to the Highlands, and would love to go back and live there, at least in the summer. Have you climbed Nevis?
Susan, Tommy Sheriden is indeed a character, three or four in a bed romps in hotel bedrooms with hookers, sleaze par excellence, now he and his wife are due back in court on perjury charges, wonderfull stuff, restores your faith in human nature. Now sadly no longer a politician, upset the women socialists and they sacked him. The Scotsman has gone to the dogs since The nationalists came to power, circulation plummeting. Ben Nevis, yes climbed it many times, latest was between Xmas and New Year, been seeing a physio ever since (inability to recognize the ravages of Anno Domini) conditions can be Alpine. If you ever visit again there's a good easy route to summit, Someone took a model T Ford up in pieces in the 1930s.
Nice to see Barack and Hillary doing a Light of the Silvery Moon number.
Jennifer George 30 June 2008 at 20:22
Staring slack-jawed into the middle distance is one of my favorite things.
Jonathan 14 July 2008 at 14:40
A very erudite, intelligent friend of mine hasn't read the newspapers in 15 years. Nor does he watch TV or listen to the radio. He hears reports from the 'Matrix' from friends, and knows enough about what's going on it in from them.
Its a question to ask whether he is more or less in touch with reality, being in touch with an unMEDIAted reality.
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Public Yarts
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Torturers For A McCain Victory
Don't You Know There's A Crusade On?
International Law in Action
Concluding Dieppe Postscript
Disturbing Images, and a Victory for Football
Dieppe Again
Back in Blighty
Au Revoir, Mes Amis...
Replacing Humph? Harumph!
New Meaning
The Euro Ratchet
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Medikal "brandishes" new GHS 200,113 Ford Mustang convertible after recently acquiring $200,000 mansion! – Ghana Music
Music/VideosNews
By Emmanuel Ghansah, Ghana Music On Nov 16, 2021
Medikal "brandishes" new GHS 200,113 Ford Mustang convertible after recently acquiring $200,000 mansion!
" data-medium-file="https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?fit=300%2C169&ssl=1″ data-large-file="https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?fit=708%2C398&ssl=1″ data-lazy-srcset="https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?w=1200&ssl=1 1200w, https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?resize=300%2C169&ssl=1 300w, https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?resize=1024%2C576&ssl=1 1024w, https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?resize=768%2C432&ssl=1 768w, https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?resize=390%2C220&ssl=1 390w" data-lazy-sizes="(max-width: 1200px) 100vw, 1200px" data-lazy-src="https://i2.wp.com/www.ghanamusic.com/wp-content/uploads/2021/11/0933193fd1929193.jpg?fit=1200%2C675&ssl=1&is-pending-load=1″ srcset="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7″/>
They were the talk of town after brandishing a brand new $200,000 plush mansion a few days ago but AMG Medikal has given fans another topic to discuss after acquiring a brand new Mustang.
This comes a few weeks after the rapper was caught up with the law after displaying a weapon in a viral video sighted on social media.
He was remanded into police custody for five days after which he was granted a GHc100,000 bail with one surety.
While he awaits his next appearance in the court on December 7th, Medikal seems to be enjoying life even better than he was doing before as he gets himself a new mansion complimented with a brand new 'Monster' vehicle.
A video sighted on social media captured his new Mustang being displayed in front of his new mansion, but we are yet to find out its cost.
THANK YOU for constantly reading our stories. Kindly like, comment and SHARE stories on all social media platforms for more entertaining updates!
Emmanuel Ghansah, Ghana Music 266 posts 0 comments
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Krasnolicowate (Alstroemeriaceae) – rodzina roślin jednoliściennych z rzędu liliowców (Liliales). Zasięg ich obejmuje głównie Amerykę Południową, sięgają na północ po Meksyk, poza tym rosną w Australii i na Nowej Zelandii. W węższym ujęciu systematycznym rodzina obejmuje tylko trzy rodzaje południowoamerykańskie (plemię Alstroemerieae), w szerszym zalicza się tu także dwa dalsze rodzaje (plemię Luzuriageae) spotykane po obu stronach Pacyfiku (takie ujęcie przyjmuje system APG III i APG IV).

Liczne odmiany ozdobne wyhodowano w obrębie rodzaju alstremeria Alstroemeria, uprawiane jako rośliny ogrodowe i na kwiaty cięte. Z korzeni Alstroemeria ligtu wyrabia się mąkę. Jadalne bulwy ma także kilka gatunków z rodzaju Bomarea. Z pędów Luzuriaga radicans pozyskuje się włókna stosowane do wyrobu sznurów.

Morfologia

 Pokrój Poza pojedynczymi gatunkami jednorocznymi pozostałe tworzą podziemne organy spichrzowe – kłącza i bulwy korzeniowe. Podziemne kłącza rozgałęziają się sympodialnie. Pędy nadziemne są wieloletnie lub krótkotrwałe, prosto wzniesione lub pnące.
 Liście Siedzące, u części przedstawicieli skupione w szczytowej części pędu. U nasady liście są skręcone. Użyłkowanie liści równoległe (łukowate).
 Kwiaty Wyrastają pojedynczo lub skupione w kwiatostany – jednoramienne wierzchotki na szczytach pędów lub w kątach liści. Liście przykwiatowe podobne do liści właściwych lub zredukowane do łusek. Kwiaty są promieniste lub grzbieciste. Okwiat tworzony jest przez 6 (8 u Drymophila) listków, w dwóch okółkach, niezróżnicowanych lub odmiennych (czasem z rozmaitymi wzorami, z miodnikami u nasady, listki wewnętrznego okółka z paznokciem). Pręcików jest 6, wolnych. Zalążnia powstaje z trzech owocolistków, jest jedno- lub trójkomorowa.
 Owoce Suche torebki i mięsiste jagody.

Systematyka
Drymophila i Luzuriaga były w przeszłości bardzo różnie klasyfikowane – do amarylkowatych Amaryllidaceae, w szeroko ujmowanych liliowatych Liliaceae, w Philesiaceae, we własnej rodzinie Luzuriagaceae. Ostatecznie od systemu APG III z 2009 dołączone zostały do krasnolicowatych, z którymi pokrewieństwo potwierdzone zostało badaniami molekularnymi, i z którymi współdzielą tak charakterystyczne cechy jak skręcone nasady liści oraz obecność specyficznych glikozydów i kolchicyny. W systemie Takhtajana z 2009 rodziny Alstroemeriaceae i Luzuriagaceae łączone są w rzędzie Alstroemeriales.

 Pozycja systematyczna i relacje filogenetyczne w obrębie liliowców według Angiosperm Phylogeny Website i system APG IV z 2016)
Grupa siostrzana dla zimowitowatych w obrębie liliowców w kladzie jednoliściennych. We wcześniejszych systemach APG (I i II) rodzaje z plemienia Luzuriageae były wyodrębniane w randze rodziny Luzuriagaceae.

 Podział systematyczny
 plemię: Alstroemerieae Bernhardi (liście skrętoległe, kwiaty w wierzchotkach)
 Alstroemeria L. – alstremeria
 Bomarea Mirb.
 plemię: Luzuriageae Bentham & Hooker (rośliny wspinające się, zwykle o pędach rozgałęzionych, z liśćmi w dwóch rzędach, czasem ogonkowych, kwiaty pojedyncze)
 Drymophila R. Br.
 Luzuriaga Ruiz & Pav. – czepin

Przypisy

redpajama_set_name: RedPajamaWikipedia


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You are here: Home › Our Blog › Brendan Brazier – Providing Plant-Based Nutrition for the Toughest Athletes
Brendan Brazier – Providing Plant-Based Nutrition for the Toughest Athletes
By Theresa Groskopp, CN on February 3, 2015 in Natural Health Heroes
He's a former professional Iron Man competitor and author who has enlightened many people with his eye-opening philosophies on better nutrition.
Brendan Brazier also founded and helped formulate the Vega line of sports & nutrition products as well as Thrive Foods Direct, which delivers whole food, plant-based meals directly to customers' doors.
He's got the body of a Greek god, the mind of a scientist and the heart of a champion. And he has some very valuable advice for athletes as well as just about anyone who wants to start eating right.
Brendan Brazier's journey to becoming a Natural Health Hero started when he was participating in high school track.
In a 2012 presentation at Tedx Fremont (see the full video below), Brazier recalls how, as a teenager, he loved running so much that he made the decision to try and compete at a professional level.
So he set out to discover what he needed to do to become a better athlete.
As he examined the training programs of top athletes, he realized their routines weren't much different from how he trained, or anyone else for that matter. The difference seemed to be in the time between workouts – the recovery time.
Brazier noticed that the sooner he could get his muscles to recover from intense exercise, the sooner he could get back to more training. And if you're training even more, you're getting even better.
The next conclusion young Brendan came to was that good nutrition was the most important key to speeding recovery.
"There's massage, there's light training, there's stretching, there's yoga. There's all these things that are great. But nutrition…I found that good nutrition was the thing that really made the huge difference in recovery."
As a high school athlete, Brendan started making changes to his diet, changes that even his coach was skeptical about. He experimented with lots of different methods: high carb and low carb, high protein and low protein. But today – he's one of the most outspoken vegans in America.
So what did he discover?
At just 15 years-old, Brendan switched to a plant-based diet. Over the next 15 years of his life, he developed a system for using a plant-based diet that is good enough to support pro athletes and everyday people alike.
The 3 Basic Thrive Nutrition Principles
These Thrive principles suggest that focusing on a plant-based diet helps your body create energy more efficiently. The following points are the foundation of Brendan Brazier's nutrition philosophy.
1. High Net Gain Nutrition
Maybe you've heard that it's all about calories in versus calories burned. Brazier says that's oversimplifying things because not all calories are created equal.
High net gain nutrition means choosing to eat foods that take less energy for your body to digest and use, while also giving you more nutrition.
One mistake Brazier made early on was assuming that because calories are a measure of energy from food then the more calories he ate the more energy he'd have. But most of us have felt that sluggish feeling after eating an unhealthy, high-calorie meal of fast food. So that way of thinking doesn't make sense.
We feel tired after eating junk because our bodies are working overtime to digest the food. On top of that, while there are plenty of calories, there may not be many nutrients in those calories. Frazier says what we eat is more important than we realize.
"It's not calories. It's not food volume. It's not mass. It's nutrients: vitamins, minerals, phytochemicals, antioxidants – all these things that we need… So I made the switch from eating lots of starchy refined foods that have very few nutrients and are hard to digest…to foods that are high net gain."
For plant-based energy, Brazier suggests fruits, which provide carbohydrates that are easier for your body to use and packed with different micronutrients, as well as so-called pseudo-grains like quinoa.
2. Sustainable Energy – Not Stimulation
If you're like me, you wake up every morning craving a cup of coffee. Brazier says that's a sign something could be wrong with your nutrition and your stress levels.
Too many Americans have become dependent on stimulants – like caffeine, sugar and nicotine. Those things can do the job, but the effects don't last long, we can become dependent and it's just not healthy.
Brazier says another important step is reducing "nutritional stress." In his Tedx Talk, Brazier explains that all types of stress have the same effect on our body. When we are stressed (by work, by family, because of poor nutrition or from over-exertion) the stress hormone cortisol is released. Then we often fail to sleep deeply enough to get the rest our bodies need.
So we feel tired all the time. Then we start using those stimulants to help us get through the day. It becomes a vicious cycle. But it seems hard to reduce stress because we can't quit our jobs and leave our families. However – we can change our diets.
Brazier claims that 40% of Americans' stress can be attributed to poor nutrition!
During training, Brendan found that he was gaining weight even though he was eating fewer calories and working out more. An expert told him this was likely "hormonal injury." The physical stress he was putting his body through was causing elevated cortisol levels, which made him gain weight.
Brazier says you need to look at yourself as a whole person with emotional and mental concerns, because you're not just as a machine processing calories…
"You may need to take a step back, stop exercising for a bit, really clean up your diet – plant-based, nutrient dense, whole food diet. Bring down your stress. Reintroduce the exercise and you'll tone muscle very quickly when that hormonal injury goes away."
3. Alkaline-Forming Foods
Brazier says a lot of the food Americans eat is acid-forming. That includes, soda and fast food, synthetic vitamins and drugs, meat and dairy.
Our bodies pull calcium from our bones to offset that acidity. Over time, this can cause your bones to become weak. Greens as well as many other vegetables and fruits are alkaline-forming foods that can offset that problem. But it's not the only thing healthy food can do for you…
What is just as important is the idea that alkalizing foods can reduce inflammation in your body. When muscles are inflamed or swollen from intense workouts – it makes it harder to move and harder to exercise. But reducing inflammation makes muscle contractions easier. Less inflammation means less energy is needed to make your body move.
"Eating this way doesn't necessarily make you stronger. But it allows you to lift heavier weight because you're not inflamed. And lifting heavier weight is what makes you stronger. So it paves the way."
Brazier works with strength athletes as well as endurance athletes (and even NASCAR drivers). He helps them with nutrition – not their workout routines. But he says the physical trainers for these individuals are often amazed that the athletes start being able to do more and more after they change their diets.
The Rest of Brendan Brazier's Story
Thankfully – for athletes and health-conscious people everywhere – Brendan Brazier didn't keep his methods to himself. Quite the opposite, actually.
Brendan recognized a need for not only the kind of eating habits he'd developed, but also for products that everyone could use with ease. People needed a different kind of "fast food."
After spending years perfecting his own plant-based diet, he teamed up with Charles Chang of Sequel Naturals to create a product based on the drink Brendan Brazier had been using since the early 1990s.
That first product has grown into an entire line of Vega offerings – including the Vega One line and Vega Sport.
More than just the face of Vega, Brazier is directly involved with the formulations. He remains loyal not only to his nutritional ideals, but also to seeking out environmentally-friendly ways of formulating and manufacturing Vega products. As he says…
"In fact, formulating Vega Products is when I began to realize how tightly personal and environmental health was intertwined."
Brazier has authored three books: The Thrive Diet (2007), Thrive Fitness (2009), and a recipe book called Thrive Foods (2011). Find out more about the Thrive books on his website.
You can find many of the top Vega products available at Natural Healthy Concepts. Plus, you'll enjoy free shipping to any address in the U.S.
Watch Brendan Brazier's Tedx Talk on Plant-Based Nutrition
Shop for these Vega Products and More at NHC Right NOW!
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Athletes, Brendan Brazier, diet, endurance training, Muscle Repair, phytonutrients, Recovery, Strength training, Vega, Vega Sport, vegan
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The Burlington Irish Heritage Festival is proud to announce our 2019 schedule of events! We hope you will join us for a rich offering of Irish and Irish-American culture from March 2 through March 25.
We were very excited and gratified to see the Burlington Irish Heritage Festival topped "The 8 Best Places to Celebrate St. Patrick's Day in Vermont!" according to Best Things Vermont!
On March 6 we were honored to host Fionnuala Quinlan, Consul General of Ireland for New England, at the 2019 Burlington Irish Heritage Festival. Consul General Quinlan spoke on the history and context of the Good Friday Agreement and the current issue of Brexit and how it impacts Ireland. We're delighted to make a video of her visit available to you here.
Please consider making a tax deductible donation to the Burlington Irish Heritage Festival.


This class is part of The Barefoot Dragonfly's 300-Hour Reflexology Certificate Course and can be taken following Introduction to Reflexology.
This is a 4-hour live class taught online using video and audio, on Wednesday, February 20th, 2019 9am-1pm CDT. Student will need access to a computer with speakers, microphone, and functioning webcam to participate in this live class. Textbook is Paula S. Stone's Therapeutic Reflexology: A Step-by-Step Guide to Professional Competence, Pearson 2011.
To students/graduates of other Reflexology programs: not enrolled in the 300-Hour Reflexology Certificate Course but would like to improve your session documentations? Please have at least 20 hours of Reflexology training prior to enrolling in this class.