text:
Q: Post new record into AspNetUsers from another controller (Web api) I want to POST new user to AspNetUsers using webApi
Here is what I'm trying to do:
[HttpPost]
        public async Task<IHttpActionResult> POST([FromBody]ICollection<ApplicationUser> employees)
        {

        employees.First().PasswordHash = HashPassword(employees.First().PasswordHash);

        if (!ModelState.IsValid)
            {

                return BadRequest(ModelState);
            }

        foreach (var item in employees)
        {
            db.Users.Add(item);
        }
        try
        {
            await db.SaveChangesAsync();
        }
        catch (System.Data.Entity.Validation.DbEntityValidationException dbEx)
        {
            Exception raise = dbEx;
            foreach (var validationErrors in dbEx.EntityValidationErrors)
            {
                foreach (var validationError in validationErrors.ValidationErrors)
                {
                    string message = string.Format("{0}:{1}",
                        validationErrors.Entry.Entity.ToString(),
                        validationError.ErrorMessage);
                    // raise a new exception nesting
                    // the current instance as InnerException
                    raise = new InvalidOperationException(message, raise);
                }
            }
            throw raise;
        }
        var manager = new UserManager<ApplicationUser, int>
        (new CustomUserStore(new ApplicationDbContext()));

        var roleManager = new RoleManager<CustomRole, int>
            (new CustomRoleStore(new ApplicationDbContext()));
        manager.AddToRoles(employees.First().Id, "User");

        return CreatedAtRoute("DefaultApi", new { id = employees.First().Id  }, employees);
    }
    public static string HashPassword(string password)
    {
        if (password == null)
        {
            throw new ArgumentNullException("password");
        }

        byte[] salt;
        byte[] subkey;
        using (var deriveBytes = new Rfc2898DeriveBytes(password, SaltSize, PBKDF2IterCount))
        {
            salt = deriveBytes.Salt;
            subkey = deriveBytes.GetBytes(PBKDF2SubkeyLength);
        }

        var outputBytes = new byte[1 + SaltSize + PBKDF2SubkeyLength];
        Buffer.BlockCopy(salt, 0, outputBytes, 1, SaltSize);
        Buffer.BlockCopy(subkey, 0, outputBytes, 1 + SaltSize, PBKDF2SubkeyLength);
        return Convert.ToBase64String(outputBytes);
    }

I tried to test it using Postman and here is what I'm getting:
****[ArgumentNullException]: Value cannot be null.
Parameter name: value
   at System.Security.Claims.Claim..ctor(String type, String value, String valueType, String issuer, String originalIssuer, ClaimsIdentity subject, String propertyKey, String propertyValue)
   at System.Security.Claims.Claim..ctor(String type, String value)
   at Microsoft.AspNet.Identity.ClaimsIdentityFactory2.<CreateAsync>d__19.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter1.GetResult()
   at DataInGrid.Models.ApplicationUser.d__0.MoveNext() in C:\DataInGrid\DataInGrid\Models\IdentityModels.cs:line 18
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter1.GetResult()
   at DataInGrid.Providers.ApplicationOAuthProvider.<GrantResourceOwnerCredentials>d__2.MoveNext() in C:\DataInGrid\DataInGrid\Providers\ApplicationOAuthProvider.cs:line 42
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.Owin.Security.OAuth.OAuthAuthorizationServerHandler.<InvokeTokenEndpointResourceOwnerPasswordCredentialsGrantAsync>d__3f.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.ValidateEnd(Task task)
   at Microsoft.Owin.Security.OAuth.OAuthAuthorizationServerHandler.<InvokeTokenEndpointAsync>d__22.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.ValidateEnd(Task task)
   at Microsoft.Owin.Security.OAuth.OAuthAuthorizationServerHandler.<InvokeAsync>d__0.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.Owin.Security.Infrastructure.AuthenticationMiddleware1.d__0.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.Owin.Security.Infrastructure.AuthenticationMiddleware1.<Invoke>d__0.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.Owin.Security.Infrastructure.AuthenticationMiddleware1.d__0.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.AspNet.Identity.Owin.IdentityFactoryMiddleware2.<Invoke>d__5.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.AspNet.Identity.Owin.IdentityFactoryMiddleware2.d__5.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.Owin.Host.SystemWeb.IntegratedPipeline.IntegratedPipelineContextStage.d__5.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at System.Runtime.CompilerServices.TaskAwaiter.ThrowForNonSuccess(Task task)
   at System.Runtime.CompilerServices.TaskAwaiter.HandleNonSuccessAndDebuggerNotification(Task task)
   at Microsoft.Owin.Host.SystemWeb.IntegratedPipeline.IntegratedPipelineContext.d__2.MoveNext()
--- End of stack trace from previous location where exception was thrown ---
   at Microsoft.Owin.Host.SystemWeb.IntegratedPipeline.StageAsyncResult.End(IAsyncResult ar)
   at Microsoft.Owin.Host.SystemWeb.IntegratedPipeline.IntegratedPipelineContext.EndFinalWork(IAsyncResult ar)
   at System.Web.HttpApplication.AsyncEventExecutionStep.System.Web.HttpApplication.IExecutionStep.Execute()
   at System.Web.HttpApplication.ExecuteStepImpl(IExecutionStep step)
   at System.Web.HttpApplication.ExecuteStep(IExecutionStep step, Boolean& completedSynchronously)
-->****

A: Your code is a hot mess. I'm not sure what in the world you're doing. First, UserManager and RoleManager are services. You never new them up; instead, you inject them into your class:
[ApiController]
public UserApiController : ControllerBase
{
    private readonly UserManager<ApplicationUser> _userManager;

    public UserApiController(UserManager<ApplicationUser> userManager)
    {
        _userManager = userManager;
    }

    ...
}

Then, to create a new user, you should be using:
await _userManager.CreateAsync(user, password);

That will take care of hashing the password for you, as well as other necessary tasks such as normalizing the username, email address, etc.
Next, you should not be binding the post to ApplicationUser. That's your entity, and it's not appropriate for something like a create user request. Namely, it has no Password property to hold the user's desired password, pre-hashed. Instead, you should create a view model/DTO class with just the properties you want to be able to submit. That could be as little as just an email address and a password.
Then, you map the posted data onto an instance of your ApplicationUser entity:
var user = new ApplicationUser
{
    Email = model.Email
    // etc.
};

Then:
await _userManager.CreateAsync(user, model.Password);

Since you're posting a list of users to create, you'd simply iterate over that and do the same thing for each one.


All the vertical lines are slanting to the terrestrial Vanishing Point below me.
One line is almost vertical, the closest one to the center.
I line up on that one and mark the location of the second one.
The horizon line joins the two V.P.'s and each horizontal line on the building meets on a V.P..
Day 3, I can just see it in this image, the subtle change of white in the building.
Day 5, I never try to get a fast 100% coverage because I only saw the view in full sun once... on the first day. I know what I want and I'll get it at the first opportunity, In the mean time I'm working out the aerial perspective.
Day 3 also, I did another oil knife painting. Geez, that's three I had going, Jacaranda Keokea in the morning, the Keokea Church, and this 5.5x7.5.
Day 6, This is the 2:00 shadow on the church. I might want to change it to a smaller and higher contrast 3:30 shadow.
Day 7, I got the branches in and worked on the foreground.
Day 8, Shadows are are friends, they come and go so quickly. Here in the upcountry area it's never just sun or just clouds. And to time it so the shadows are where you want them when you want them is just out of you hands.
Today I did see see the church in full sun a little earlier and got to show a little more white. I want contrast. I whited out areas that I want to change tomorrow and darkened the area I want in shadow.
I haven't even started the windows and there are a lot of them, I waited to get the buildings shadows where I wanted them first. They are still not right on the tower and I may have made a mistake taking out the shadow area in the middle right hand side.
The three horned Jackson Chameleon to the right stopped by today, he is the real Master of Color. He's looking right at me. 13" long, the biggest I have ever seen.
Day 9, May 20, my birthday, I'm 62. It's nice to be able to compare work from one day to the next. The Liquitex Painting and Blending Medium is coming in very handy.
Day 10, I know what I want but the sun won't cooperate. I want high sunlight and shadow contrast, sunlit in the middle and shadows surrounding. It's been cloudy a lot.
Moving around the land shadows, glazing shadows with transparent cyan and/or turquoise depending on what I see with Liquitex Blending and Painting Medium. I may add some clouds. I added the leaves of the ti plants around the church, waited until I saw the actual colors, I don't like making colors up, I don't learn that way. That is what it's all about.. having fun and learning.
Day 14, I think I like the second post in Day 11 better. I have to get this painting finished tomorrow, there is an Upcountry paint out to submit to on May 28th.


I qualified from St Georges Medical School in 2007 and immediately went to work in private practice. This helped me to continue my training and give me access to equipment such as real time ultra sound, where my interest in working within women's health developed. Though already qualified in the matwork pilates series with APPI, I continued to develop my pilates interest by completing the Polestar equipment series. By combining a hands on approach with pilates, I found a great adjunct to treating a range of injuries.
After a number of years in private practice I returned to the NHS where a high patient case load, an experienced multidisciplinary team and access to consultants helped me further develop my skills. I trained to use acupuncture and worked extensively in the field of chronic pain also using CBT.
This year I made the decision to move back into private practice in order to give my patients the time I feel their treatment needs. I continue to treat a wide range of acute and chronic conditions using a variety of hands on techniques and a pilates based rehab approach.


Revolution Analytics (formerly Revolution Computing) was founded in 2007 to foster the R Community, as well as support the growing needs of commercial users. Our name derives from combining the letter "R" with the word "evolution." It speaks to the ongoing development of the R language from an open-source academic research tool into commercial applications for industrial use.
Through our Revolution R products, we aim to make the power of predictive analytics accessible to every type of user & budget. We provide free and premium software and services that bring high-performance, productivity and ease-of-use to R -- enabling statisticians and scientists to derive greater meaning from large sets of critical data in record time.
For customers such as Pfizer, Novartis, Yale Cancer Center, Bank of America, Motorola, Hess and others, our flagship Revolution R Enterprise product stands for faster drug development, reduced time of data analysis, and more powerful and efficient financial models.
Revolution Analytics' executive leadership represents some of the most respected and experienced names in statistical computing and open source business--with venture funding from Intel Capital and North Bridge Venture Partners.


text:
package ezvcard.io;

import java.util.List;

import ezvcard.VCardDataType;
import ezvcard.VCardVersion;
import ezvcard.io.scribe.VCardPropertyScribe;
import ezvcard.io.xml.XCardElement;
import ezvcard.parameter.VCardParameters;
import ezvcard.property.VCardProperty;

/**
 * An extended type class used for testing that contains XML marshalling
 * methods, but not a QName.
 * @author Michael Angstadt
 */
public class SalaryType extends VCardProperty {
	public int salary;

	public SalaryType(int salary) {
		this.salary = salary;
	}

	public static class SalaryScribe extends VCardPropertyScribe<SalaryType> {
		public SalaryScribe() {
			super(SalaryType.class, "X-SALARY");
		}

		@Override
		protected VCardDataType _defaultDataType(VCardVersion version) {
			return VCardDataType.INTEGER;
		}

		@Override
		protected String _writeText(SalaryType property, VCardVersion version) {
			return property.salary + "";
		}

		@Override
		protected SalaryType _parseText(String value, VCardDataType dataType, VCardVersion version, VCardParameters parameters, List<String> warnings) {
			return new SalaryType(Integer.parseInt(value));
		}

		@Override
		protected void _writeXml(SalaryType property, XCardElement parent) {
			parent.element().setTextContent(property.salary + "");
		}

		@Override
		protected SalaryType _parseXml(XCardElement element, VCardParameters parameters, List<String> warnings) {
			return new SalaryType(Integer.parseInt(element.first(VCardDataType.INTEGER)));
		}
	}

}

redpajama_set_name: RedPajamaGithub


They have maintained their own economic system, language, customs and culture, with distinctive dress, legends, music and dance and thus have avoided traditional tourism development. A good example of maintaining their culture is their arts and crafts. The Kuna woman are very famous for making mola`s – a square cloth with intricate designs depicting daily life and rituals.
Island accommodations consist of simple, yet comfortable native style cabins with roofs and walls of thatched palm trees- "all natural" lodgings that blend in perfectly with the tropical scenery. Although only a 30 minute plane ride away from Panama City, a trip to the San Blas islands will transport you 20 centuries into the past.


participants learn how to cook Monkey Knots in Dutch ovens.
"They don't get homesick at camp, they get campsick at home," describes Director Lisa Empfield of the Boy Scout experience at Camp Minsi. The Pocono Summit summer camp, nestled in the woods off Route 940 brings Scouts from as far away as Long Island and Maryland for a week long experience, earning merit badges in education-based programs geared to teach life skills.
Over 1,000 campers a season enjoy program areas such as Ecology-Conservation, ScoutCraft, and Communications, exposing 11 to 18 year olds to environmental sciences, outdoor cooking, and even public speaking.
Camper days begin with an optional 6:30 a.m. Frigid Froggy Swim followed by a 7:45 flag ceremony and breakfast. Scouts are responsible for ensuring they attend classes for badges so off they go for the day to sites featuring athletics, aquatics and shooting sports.
Ecology-Conservation Lodge at Camp Minsi July 10.
A crowd favorite, the Muck Hike, takes Scouts on a trek through the swamp. "A Scout is clean but not afraid to get dirty," read t-shirts recipients eagerly purchase upon completion.
Camp directors and volunteers spend their summer vacations bringing various career talents to the site. Teacher and program director Greg Larson says, "We're not just having fun in the woods," listing professions including plumbing and carpentry that are taught in the Ranger Crew. He adds, "When they leave the program they are ready for life."
Registered Scouts are welcomed with their troop or on their own. Social development flourishes as individual campers are invited into a troop for the week.
Building a bridge to adventure, adult-led Cub Scouts prepare to cross over into self-sufficient Boy Scouts during Minsi's final week of camp. The new Bridge to Adventure program invites the younger Scouts to experience what's in store as they evolve into Boy Scouts with activity badges including Forester, Geologist and Craftsman.
Empfield considers Minsi's $315 fee exceptional when compared to the other sport and summer camps, as it includes food and accommodations with goal driven activities to earn merit badges. She invites Scouts to visit the website at minsitrails.com/camping or call their council office and pick a week!


text:
Cristina Dogaru-Cucuian (born 28 December 1971) is a Romanian handball player. She competed in the women's tournament at the 2000 Summer Olympics.

References

1971 births
Living people
Romanian female handball players
Olympic handball players of Romania
Handball players at the 2000 Summer Olympics
Sportspeople from Râmnicu Vâlcea

redpajama_set_name: RedPajamaWikipedia


Quantity to buy of Toshiba Satellite Pro R50-C-179 Core i3-6006U 4GB 128GB SSD 15.6"
Quantity to buy of Toshiba Satellite Pro A50-E-1D5 i5 8Gb 256Gb SSD Win10pr 15.6"
The power of an enterprise-class laptop. The freedom and convenience of a tablet. The Toshiba Portégé Z20t Ultrabook offers innovative 2-in-1 versatility in a supremely crafted chassis, along with outstanding battery life and an exceptional handwriting experience.
The Portégé Z20t Ultrabook just happens to be ultraversatile, too. Unlike convertible PCs, it lets your workers detach the display for a true tablet experience, while giving them the traditional clamshell laptop they need to hammer out business emails, crunch numbers, craft proposals and stay productive on their feet - without buying two devices.
Camping beside power outlets can pose a serious disruption to mobile business, but with the Portégé Z20t Ultrabook those worries will be a thing of the past.
The powerful processor in the Portégé Z20t Ultrabook combines blazing-fast speed with exceptional energy efficiency, providing a super-thin laptop and ultra-fast tablet in one supremely mobile device.
Convertible and detachable PCs can be vulnerable to theft but Toshiba has you covered. Portégé Z20t Ultrabook is equipped with an innovative system allowing you to lock the tablet onto the keyboard dock with a special switch, making it immoveable. Then, when you lock the keyboard base to a desk with a Kensington lock, you can walk away with confidence.


Moving to or from Grand Rapids, MI? U-Haul cargo and enclosed trailers are intelligently designed to protect and secure your precious belongings, while our open utility trailers are perfect for hauling building supplies, landscaping materials or bulky items. U-Haul car trailers have EZ load ramps for effortless loading of vehicles while our motorcycle trailers are lightweight and easy to tow. Get FREE trailer rental rate quotes in Grand Rapids MI 49525 today.
Cargo trailers in Grand Rapids, MI are lightweight, aerodynamic, and engineered for better fuel economy which makes it easy to tow behind any vehicle. Millions of families use our enclosed cargo trailers to move every year. U-Haul has a large selection of enclosed trailers to rent in-town or one way, review our cargo trailer sizes and reserve a trailer rental online at North Park Auto Repair Inc!
Utility trailers are perfect for towing large or oversize cargo in Grand Rapids MI 49525. Many utility trailer rentals come equipped with a loading ramp for easy convenience. The utility trailer selection at North Park Auto Repair Inc provides an affordable solution for home improvement projects, furniture delivery and for towing recreational vehicles. Utility trailer rentals are also popular with businesses for deliveries and trade-show events. Utility trailers come in a wide range of sizes and styles so that any car can tow.
Moving cross-country with your vehicle on a car trailer is a smart way to save gas and eliminate miles of wear and tear on your vehicle. Our Tow Dolly is a low-cost option for towing front wheel drive vehicles, while auto transports are ideal for long distance moves. Both car haulers fit most sized vehicles in Grand Rapids, MI and are also an economical alternative to calling a tow truck in the case of a break-down. Whether towing behind a U-Haul moving van or your own personal vehicle, you can rent a car hauler for both in-town and one way moves.
Motorcycle trailers in are lightweight, easy to tow and have an easy-access loading ramp. Each motorcycle trailer also comes equipped with an integrated chock for the front wheel and with heavy-duty tie-down rings to support even the heaviest of motorcycles. Reserve your motorcycle trailer rental in Grand Rapids, MI online today!
The man that helped me was awesome.
The approval process took to long, over 15 minutes wait.
Same comments as the pick up location. One UHaul issue was the cabin leaked. When I opened the back to load, the upfront deck was wet and one packing blanket was soaked. We dried everything before loading. Overnight it rained. When we unpacked the vehicle our boxes on the shelf were wet, not terrible but wet and soggy. The mattress on the same side was damp. There is a leak somewhere.
I requested a pickup at a different location and the truck was not there. I was never notified that my pickup location was changed. I will not use another location that isn't dedicated U-HAUL store. Very disappointed with the lack of Assistance I got. Thankful my experience with U-HAUL equipment and standards didn't disappoint.
there was no indication that i had to use my phone to check out (the location was closed). after 20 minutes on hold, i finally got a person who clued me in as how to proceed. i got an error in the app during the checkout process and was unable to resume the check out. i had the keys by that point so i just used the truck. i also got an error during the check in process and was unable to resume. i was, however, able to restart the check in and got it to work. both errors occurred when i was attempting to upload photos.
Owner wasn't aware of my rental and as a result I had to wait 10 minutes for him to get there. He was extremely helpful once he arrived.


text:
Tacoma police chief's wife says he pointed a gun at her
Historic, $3.6 M Capitol Hill home neighbors Volunteer Park
These dead Seattle brands are worth remembering
David Brame denies allegations, says it was she who abused him
RUTH TEICHROEB, SEATTLE POST-INTELLIGENCER REPORTER
The wife of Tacoma police Chief David Brame has accused him in court documents of pointing his service revolver at her and trying to choke her during two separate incidents in the past six months.
[Note: The article originally stated that David Brame's wife, Crystal, obtained a temporary restraining order against him. However, the order in effect applied to the handling of marital assets, custody and dissolution issues. Crystal Brame also applied for a restraining order regarding her personal protection, but that request had not been adjudicated.]
Brame, a veteran officer who rose through the ranks to become chief in January 2002, denied those allegations in court papers filed in King County Superior Court last month.
He maintained he was the real victim of domestic violence during his 11-year marriage. His wife, Crystal, filed for divorce two months ago.
As evidence of his wife's volatility, Brame, 44, claimed his wife scratched, bruised and pushed him during two altercations in September 1996.
Brame said he reported the assaults to police -- first to his boss, then-interim Chief Ken Monner, and to an officer who photographed his bruises; then to police in Gig Harbor, where he was living at the time.
Both times Brame insisted that police not arrest his wife or even investigate his allegations -- even though a state law requires officers to arrest anyone accused of domestic violence if the complaint is credible.
He explained his unusual behavior in court documents by saying he wanted to "protect himself" in case his wife ever tried to malign him with false abuse allegations.
Brame refused to comment yesterday, as did his wife's attorney.
Tacoma City Manager Ray Corpuz, who hired Brame, cautioned that accusations made during a contested divorce must still be proven.
"He's doing a great job," Corpuz said. "I'm not interested in exploring David's personal life at this time."
Mayor Bill Baarsma, who sits on the City Council's public safety committee, was surprised at the allegations but said they were a "private matter."
"He's been an outstanding chief," Baarsma said. "Unless there's a complaint filed with the city manager as to his performance, I'm not prepared to comment."
There are discrepancies between Brame's version of events and what Gig Harbor Police Chief Mitch Barker said yesterday his officers recall and records indicate.
While Brame visited Gig Harbor police twice in September 1996, Barker said Brame was "vague" about his marital problems and did not report any physical assault by his wife.
"If someone comes in and says they've been assaulted by a domestic partner, we have an obligation to investigate," Barker said.
A Gig Harbor police report indicates that Brame told an officer on Sept. 15, 1996, that his wife had been "verbally hostile" but that he had "not used physical force of any kind" on her. He said he was worried she might make "false allegations" of abuse.
Thirteen days later, Brame appeared again at the Gig Harbor police station, this time telling an officer that he'd had an altercation with his wife but that "nothing happened," according to Barker.
Refusing to say more, Brame phoned a Tacoma detective who met privately with him at the Gig Harbor police station, Barker said.
In court papers, Crystal Brame, 35, portrayed her husband as controlling and jealous, refusing to let her use their credit card without permission and checking her car's odometer to monitor trips to the grocery store.
She also accused him of leaving his loaded service revolver on a bedroom shelf within reach of their two children.
Her fear increased last November when she alleged that Brame "choked me and threatened that he could snap my neck if he wanted to." It was the fourth time that year he'd tried to choke her, each time sending flowers later to apologize, she said.
And just before they separated in February, she alleged in court documents that Brame pointed his service revolver at her, "telling me 'accidents happen.' "
She did not report either incident to police.
Fearing Brame's reaction and wanting to protect his career, his wife said she filed for divorce in South King County, and did not ask for a restraining order even though her attorney urged her to do so.
She claims her husband's continued threats prompted her to seek a temporary restraining order on March 26.
"I do remain very afraid of my husband," she said in a court declaration.
A hearing on the restraining order scheduled for last week in Kent was canceled after a motion was filed to move the case to Pierce County Superior Court.
In court papers, Brame blamed his wife's "ferocious temper" and emotional instability for the abuse, noting his embarrassment at being victimized by someone who is just over 5 feet tall and weighs 105 pounds. Brame is 6-foot-1 and weighs 175 pounds.
"As hard as it is to believe and as ashamed as I am of this fact, Mrs. Brame has physically abused me for a number of years, often in the presence of the children," Brame said.
He recalled his frustration as a police officer when domestic violence victims refused to cooperate with police.
"Now, I see that I have become the very victim who frustrated me all those years," Brame said.
But he denied pointing his revolver at his wife or choking her, saying that he was "scrupulously careful" to defend himself in the least aggressive manner when she attacked him.
RUTH TEICHROEB

redpajama_set_name: RedPajamaCommonCrawl


As many gluesticks as you want!
Have 1 or more students form a tunnel by going into the plank position (or a push-up position), right beside each other.
At one end of these students, set up the gluesticks in some sort of bowling formation.
At the other end of the tunnel, have a thrower with the beanbag.
The object is for the thrower to knock over all of the pins as quickly as possible by sliding the beanbag through the tunnel to the other end.
The people making the tunnel MUST stay in that position until all of the gluesticks are knocked down.
If the thrower misses any gluesticks, he must run to the end of the tunnel, get the beanbag, run back to the start, and continue throwing until all the sticks are down.
Once he has done this, he becomes part of the tunnel and a new thrower steps up to try.


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Many people looking to eat better make changes to their diet with the goal of losing weight in order to look better and feel more confident about their appearance. But the reality is that this is just one reason to consume foods that are lower in fat and calories and higher in vitamins, minerals, and important nutrients.
You see, these kinds of changes to the standard diet can also be good for the heart, one of our most important organs. Eating foods, such as fruits and vegetables, that can be found on the following list could help you improve the strength of your cardiovascular system and give your body the tools it needs to fend off serious health problems, including heart disease and stroke.
Once a buzz term among nutritionists, today omega-3 fatty acids have entered the mainstream. Foods that contain a moderate amount of omega-3 fatty acids have been shown to help in brain functionality, and can assist in keeping heart disease at bay. This makes consuming these kinds of foods particularly important for individuals with a family history of heart health problems, though anybody of just about any age group can benefit from adding these foods to their diet.
So, what foods contain an ample amount of omega-3 fatty acids? Good news for those who are a fan of fish, because salmon, tuna, mackerel, herring, and rainbow trout all contain their fair share of omega-3s. Of course, if you're not much of a fan of seafood, you can find omega-3 fatty acids in some eggs, flaxseeds, and walnuts. You can also purchase omega-3 supplements and take them each day.


Summer time doesn't have to be all floral and flounce. As much as I lean into my inner girly girl this time of year (especially on the blog), I equally love minimal - what I call "city girl" summer style. Easy paired down pieces with interesting modern details in cool tones are my go to. Here are some of my favorites to shop now. Here's a mix of casual, work friendly and something the ever present summer event.


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George Town Festival
A festival for everyone
The George Town Festival (GTF) is an annual festival held in Penang, in honour of the city's designation as a UNESCO World Heritage Site in 2008. Once a humble celebration, the George Town Festival is now a global festival anticipated by many. International New York Times reviewed it as a 'festival growing into a major Asian arts event' while CNN Travel recognised it as 'Best of Penang rolled up in one big festival'. The Guardian, a British daily newspaper, cited the festival as 'one of southeast Asia's most exciting celebrations of culture, heritage and community'.
Under the theme 'A Festival for Everyone', the Festival celebrates our diverse arts and cultural heritage encompassing visual art, theatre, music, dance, film, photography and more. In addition to the classic mainstays like 'When Night Falls', 'Art in the City' and 'The Extravaganza', there will be pre-Festival pop-up performances, community engagement programmes, ticketed shows, exhibitions, installations, talks, sharing sessions and more. The annual GTF is a project by George Town World Heritage Incorporated (GTWHI), organised by TLM Event, endorsed by the Penang State Government and fully supported by the City Council of Penang Island (MBPP), and Penang Global Tourism (PGT) in celebration of local and international works of art.
No. 54-3-6, Wisma Sri Mata, Jalan Van Praagh, 11600 Penang, Malaysia.
Copyright © 2020 George Town Festival. All Rights Reserved.


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Home Urology Overactive Bladder in Children
Overactive Bladder in Children
Rhaiana Gondim Oliveira,1 *Ubirajara Barroso, Jr2
1. University Hospital Professor Edgard Santos, Salvador, Brazil
2. Unit of Uro Nephrology and Discipline of Urology, Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
*Correspondence to [email protected]
The authors have declared no conflicts of interest.
EMJ. 2018;3[2]:70-77.
Children, constipation, incontinence, lower urinary tract dysfunction, overactive bladder (OAB)
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
Overactive bladder (OAB) is clinically defined as the presence of urinary urgency and may be associated with diurnal urinary incontinence, frequency, and enuresis, and/or constipation. In children aged 5–10 years, the prevalence is 5–12%. Association with emotional disorders is widely described in the literature. Constipation is associated with voiding symptoms because of crosstalk between the gastrointestinal tract and the urinary tract. OAB is believed to be multifactorial. Correct functioning between the pontine micturition centre, the periaqueductal grey matter, anterior cingulate gyrus, and prefrontal cortex is important for correct voiding development and the process of maturation. Patients with OAB have greater anterior cingulate gyrus activity and deactivation of the pontine micturition centre urinary inhibition process, leading to a greater frequency of bladder repletion sensation. Urotherapy is the first treatment to be initiated and aims to change behavioural patterns inthese patients. Other treatment options are anticholinergics, with oxybutynin being the most widely studied, but also described is the use of tolterodine, darifenacin, and mirabegron. Alternative treatments, such as nerve stimulation in the parasacral or the posterior tibial area, have shown improvement of symptoms in comparative studies with conventional drug treatment, and, in refractory cases, botulinum toxin A is an option. In this article, we review the pathophysiology, associated conditions, and aspects related to diagnosis and treatment of OAB.
Overactive bladder (OAB) is a common lower urinary tract dysfunction in children, defined as the presence of "urinary urgency, usually accompanied by frequency and nocturia, with or without urinary incontinence, in the absence of urinary tract infection or other obvious pathology."1 Clinically, urgency is commonly associated with daytime urinary incontinence and frequency; however, it may be due to voiding postponement and bladder overdistension.2,3
OAB is not associated with neurological and anatomical alterations of the lower urinary tract. The overall prevalence ranges from 1.5–36.4%; it is known that the peak incidence occurs between 5 and 7 years of age, with a higher prevalence in males.4,5 The quality of life of these patients may be associated with emotional and behavioural changes, such as symptoms of depression and anxiety. Patients may have problems such as attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder.6-8
Although OAB can resolve itself spontaneously, urinary symptoms can persist into adulthood.9,10 The correlation between the voiding and bowel symptoms is already very established. Children with OAB have three times more symptoms of constipation than children without urgency.11-13 The possible explanations are that the intestinal and bladder functions are controlled by the supraspinal region,14-17 and there seems to be crosstalk between the lower urinary tract and the rectum (Figure 1).18 Moreover, it has been suggested that contractions of the external urethral sphincter to prevent urinary loss and simultaneous contraction of the anal sphincter may, by negative feedback, reduce the rectal transit.14,18 Also, the hard mass of stool in the rectum could compress the bladder and modify its function.19-21 Obese children have a higher incidence of OAB when compared to eutrophic children. Studies suggest that there may be a frontal lobe disinhibition, justifying this phenomenon.14,15,22 Children with sickle cell and institutionalised children also have a higher prevalence of OAB.22 This article will review the pathophysiology, associated conditions, and aspects related to diagnosis and treatment of OAB.
Figure 1: Multifactorial pathophysiology of bladder, bowel, and brain dysfunction.
LUT: lower urinary tract.
The pathophysiology of OAB is not completely understood and is believed to be multifactorial. One theory is that the urgency and related symptoms stem from a cortical immaturity of the centres responsible for controlling urination.14 Supporting this hypothesis, voluntary and co-ordinated urination is developed over time. In the first 2 months of life, the child voids once per hour with an intermittent flow. In this phase, the voiding is mainly controlled by the brainstem.19,23 From the first to the third year of life, cortical inhibitory pathways and the pontine micturition centre along with periaqueductal grey matter, anterior cingulate gyrus (ACG), and the autonomic, somatic, and sensorial autonomic nervous systems are being developed, and urination becomes voluntary.19,23 With the child's development, the prefrontal cortex would typically start to have top-down control over more primitive afferent pathways of the brain, such as the limbic and paralimbic system.
The child may also experience voiding urgency by deciding not to urinate as part of a behavioural dysfunction. Similarly to lack of attention, voiding postponement may be the result of a behavioural dysfunction or neurophysiological immaturity. Children with oppositional defiant disorder who have difficulty following commands often refuse to go to the toilet to void or defecate, and may be affected by functional faecal incontinence.24,25 Unfortunately, little is to be found in the literature on the neurofunctional assessment of these patients, but there seems to be hypoactivation of the prefrontal cortex.26-28 In situations of voiding postponement, the child engages in techniques such as tightening the penis, which stimulates the dorsal nerve of the penis and thus causes the external urethral sphincter to contract and the bladder to relax.
Patients with OAB seem to have a greater ACG activity and a deactivation of the pontine micturition centre urinary inhibitory process, leading to a higher frequency of bladder repletion sensation.3 Therefore, a hyperactive ACG may lead to a greater responsiveness to bladder filling and, consequently, to urgency.
CLINICAL HISTORY AND DIAGNOSIS
The clinical history should include family history, neuropsychomotor development, voiding and bowel training, urinary tract infection (UTI) history, school performance, and the child's behaviour and psychosocial development.23 It was recently demonstrated that there is an association between mothers and daughters with OAB.10,29 The intestinal constipation should be investigated and evaluated through the Bristol Stool Diary and the Roma III or IV score.11
OAB occurs during the bladder storage stage. However, it may be accompanied by changes in the voiding phase, such as dysfunctional voiding. In a study, the authors demonstrated that some urinary symptoms have a low correlation with more objective data.30 Therefore, additional exams should be requested, such as urine tests, ultrasound (US) of the urinary tract, uroflowmetry, a bladder diary, and a bowel diary. The US should measure the post-void residual (PVR) and the bladder wall thickness and evaluate the rectal distension (≥3 cm suggests faecal impaction).11 The PVR is different according to age. The PVR is considered high in children 4–6 years old if it is ≥30 mL or >21% of bladder capacity, and in children 7–12 years old if it is ≥20 mL or >15% bladder capacity.2
A patient with OAB has a bell-shaped or tower-shaped uroflowmetry curve, which suggests urinary urgency (Figure 2).1 A urodynamic study should be reserved for those cases where there is failure after treatment or for patients who have signs of non-neurogenic bladder or even myogenic failure.23,31
Figure 2: Uroflowmetry curves. A) Bell-shaped curve; B) tower-shaped curve.
The bladder diary consists of the record of frequency and urine volume and of daytime urinary incontinence for a period of 48 hours. The expected bladder capacity is calculated by [Age (years) + 1] x 30 mL. The International Children's Continence Society (ICCS) defined as increased daytime urinary frequency as ≥8 times per day and decreased daytime urinary frequency ≤3 times per day.2 The bowel diary is made using the Bristol Stool Scale, also for a period of 7 days. Tools suchas the Dysfunctional Voiding Symptom Score (DVSS), the Vancouver Symptom Score for Dysfunctional Elimination Syndrome (VSSDES) questionnaires, and ROME III and IV should be used. The VSSDES can indicate diagnostic validity. The cut-off point is 11 with a threshold diagnostic sensitivity and specificity of 80% and 91%, respectively.32 In the DVSS questionnaire, levels above six for girls and nine for boys are considered suggestive of lower urinary tract dysfunction.33
Standard Urotherapy
Urotherapy is a very important measure in the treatment of OAB and is considered the first line of treatment. It consists of dietary hygiene changes regarding fluid intake, an adequate interval between urinations, adequate positioning to void, and defecation where the feet are supported on a flat surface with attention to the perineal musculature so that there is co-ordination between pelvic floor relaxation and bladder contraction.11 Caffeine, chocolate, and citrus foods can be avoided because they may stimulate the urgency symptom, although there is a low level of scientific evidence for these measures.3,5,11,23,34 The approach to constipation should be aggressive through hydration and fibre intake. We treat all constipated children with polyethylene glycol (PEG 3350). Initially, we treat faecal impaction at a dose of 1.0–1.5 g/kg/day (maximum dose of 100 g/day) for at least 2 months. The child should be encouraged to stay in the bathroom for 15–20 minutes at regular times.11
Anticholinergics are the first line of medical treatment for children who maintain OAB after urotherapy.3 All anticholinergics may have side effects, such as dry mouth, constipation, blurred vision, urinary retention, plethora, dizziness, and delirium, especially at high doses. Oxybutynin is the most common drug and can be given as either immediate release (IR) or extended release (ER) with a recommended dose of 0.3–0.6 mg/kg.5 van Arendonk et al.35 retrospectively analysed 27 patients with daytime urinary incontinence who used IR oxybutynin and switched to slow ER oxybutynin. A total or partial improvement of symptoms was observed in 13 of the 27 patients with an increased voided volume (33% versus 53%; p<0.01) and an improved bladder capacity (55% versus 70%; p=0.03).35 Intravesical administration is an alternative that allows for higher doses, with fewer adverse effects. However, this method is of little use because the children do not undergo intermittent catheterisation.34 Tolterodine is also available in two formulas, and some studies suggest a good efficacy and good tolerability in children.36,37 Bolduc et al.36 demonstrated that 77% of the children using tolterodine because of non-tolerability of oxybutynin proceeded without significant side effects. Tolterodine IR is available in doses of 1 mg or 2 mg, while ER is 2 mg or 4 mg. Studies comparing the results of oxybutynin and tolterodine in children with OAB are limited; however, they suggest that tolterodine is at least as effective as oxybutynin.38,39 Fesoterodine is the most recent long-acting antimuscarinic and is available in 4 mg or 8 mg. It is recommended for children weighing >25 kg and it is well-tolerated by children and adolescents.40 Solifenacin is a slow-acting antimuscarinic available in a dose of 5 mg or 10 mg. Hoebeke et al.41 demonstrated a total response rate of 85% and presence of adverse effects in 6.5% of patients with the use of solifenacin. Darifenacin is an antimuscarinic with a more selective action with less adverse effects on the central nervous system.5 A combined therapy of two antimuscarinics (such as oxybutynin and tolterodine) is also an option; a previous study showed that the combined drugs showed an improvement in urinary continence, and 63% of patients had moderate adverse effects, but not enough to stop the medication.41
Mirabegron is the β3 agonist approved for treatment of OAB in adults and has few studies of its use in children.5 It increases bladder capacity without changing the bladder pressure and PVR and works by promoting smooth muscle relaxation through the increase of cyclic adenosine monophosphate.3 The adverse effects commonly found in antimuscarinics have not been demonstrated in mirabegron.5 Blais et al.42 conducted a study in 58 children with refractory OAB and treated them with mirabegron for 11.5 months. They demonstrated a statistically significant improvement in bladder capacity and continence in these patients, with moderate adverse effects in 13% of the cases. This medication may be used as an adjuvant medication to another anticholinergic if necessary.11
There is a hypothesis that electrical neural stimulation (ENS) stimulates the nerves of the bladder, spinal cord, and central nervous system. The mechanism of action is still uncertain. There may be a local effect with activation of the bladder C fibres, or a spinal effect with sympathetic activation and/or parasympathetic inhibition.43 Dasgupta et al.44 conducted positron emission tomography/computed tomography (PET/CT) in eight patients with Fowler's syndrome and eight healthy controls to map the brain function of these patients during full bladder and the modulation during sacral nerve stimulation. In healthy controls, there was an increase in midbrain function and chromogranin A during full bladder. The Fowler's syndrome patients had no increase in brainstem activity, despite the increase in chromogranin A function in the absence of neuromodulation. The hypothesis is that neuromodulation assists in the re-establishment of voiding desire and the voiding capacity of patients.44
The main types of ENS are a) parasacral transcutaneous electrical nerve stimulation (TENS);3,5,43,45 b) posterior tibial nerve stimulation (PTNS);3,4,43,46 and c) stimulation by sacral implantation.3,43 In the TENS, two surface electrodes are placed on S3 level, whereas in the PTNS a 34-gauge needle is placed two fingers above the medial malleolus. Quintiliano et al.47 carried out a review study in which patients undergoing ENS showed complete resolution of OAB symptoms, urgency, and daytime incontinence in 31–78%, 25–84%, and 13–84% of patients, respectively. Randomised studies have shown TENS to be an effective method in the resolution of OAB symptoms in children and adolescents.47,48 The rate of complete resolution of symptoms with TENS is around 60%, with a recurrence rate of 10%.43,46
Borch et al.49 randomised 51 patients to three treatment groups. Group 1 received TENS plus active oxybutynin administration, Group 2 received TENS plus placebo oxybutynin administration, and Group 3 received placebo TENS plus active oxybutynin administration. All three groups experienced a positive effect in terms of decreasing urinary incontinence, incontinence severity, and urinary frequency, and improving maximum and mean bladder capacity, but in Group 3 one-third of the patients had urinary retention, which did not happen in Group 1; this signalled the importance of TENS in bladder emptying. Group 1 had a more significant improvement for daytime urinary incontinence (p<0.01), severity of urinary incontinence (p<0.05), and urinary frequency (p<0.001) when compared to the other groups.49
More recent studies have compared established treatments for OAB and TENS. Quintiliano et al.47 analysed two methods for the treatment of OAB in children: a) oxybutynin plus sham scapular electrical therapy, and b) TENS plus placebo. They demonstrated that TENS is as effective as oxybutynin for the treatment of OAB. In the oxybutynin group, there was a decrease in voiding frequency, but the TENS group showed an improvement in constipation. Adverse effects were only present in the oxybutynin group and resulted in treatment discontinuation in 13.3% of the patients.47
TENS can also be used in the treatment of constipation. Veiga et al.50 demonstrated that TENS resolved 60% of cases of constipation in patients with OAB, although it was unrelated to any improvement in OAB. Two other randomised studies have already been completed. In one study, the participants who received 20-minute TENS sessions demonstrated increased colonic transit time compared with a control group.51 The second study was a double-blind, controlled study that evaluated the acute effects of TENS on rectal motility and it showed that after TENS the bowel contractions improved.52
The PTNS approach is well tolerated in children, and studies have shown that it is an effective method in the treatment of OAB.53 Initial studies have demonstrated an improvement in complete resolution of OAB symptoms by 56–100%.5,54 The rate of complete resolution of symptoms was significantly higher in the TENS group compared to the PTNS group (70% versus 9%).55 Boudaoud et al.56 analysed PTNS versus sham treatment and concluded that, despite the improvement of urodynamic parameters in the PTNS group, there was no difference in clinical results between the two groups. Peters et al.57 conducted a randomised, multicentre study comparing PTNS and tolterodine ER and found a similar reduction in urinary frequency, severity of urgency, and increased voiding volume.
We recommend ENS in cases of standard urotherapy failure because there are no direct side effects and a higher effectiveness against the OAB and constipation. The sacral implant is performed through percutaneous transforaminal access to stimulate the S3 nerve.3,43 Roth et al.58 demonstrated complete or >50% improvement in 88% of children. Of these, 63% had nocturnal enuresis, 89% improved daytime urinary frequency, and 59% had constipation.2 However, because of the high rate of reoperations, this method is limited to patients who are refractory to the other methods.
Botulinum Toxin A
Botulinum toxin A acts in the neuromuscular junction preventing the action of acetylcholine and adenosine 5-triphosphate on the parasympathetic presynaptic terminations, promoting chemically reversible desensitisation and flaccid paralysis of the muscle.45 The effect begins 5–7 days after injection and can last for about 6 months. The botulinum toxin A injection is a viable option for patients with refractory OAB, but few studies have been performed for non-neurogenic patients. Hoebeke et al.59 reported a study with 21 children with non-neurogenic OAB in which 100 U of botulinum toxin were given at 15 injection sites in the bladder wall. Few adverse effects were reported, with a complete success rate of 42% in the first application, a 61% increase in bladder capacity (p<0.001), and 11% recurrence within 1 year.59 It should be used in children ≥3 years of age at the dose of 5–10 U/kg. It is contraindicated in patients with peripheral motor neuropathy, neuromuscular junction disorders, UTI, uncorrected coagulopathy, and in pregnant women. The adverse effects are pain, UTI, haematuria, and autonomic dysreflexia. Around 2–9% of patients may present postprocedure transient acute urinary retention requiring clean intermittent catheterisation at this stage.5
OAB is a common clinical entity in children and knowledge of the neurophysiology factors of voiding provides information that helps to manage it. The diagnosis is clinical and should be complemented with a bladder diary, US of urinary tract with PVR evaluation, and uroflowmetry. Treatment should start with urotherapy, and in refractory cases TENS, PTNS, and medications can be included. If the symptoms persist, botulinum toxin A and sacral neuromodulator implants may be alternatives.
Haylen et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourol Urodyn. 2010;29:4-20. Austin PF et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the Standardization Committee of the International Children's Continence Society. Neurourol Urodyn. 2016;35(4):471-81 Franco I. Overactive bladder in children. Nat Rev Urol. 2016;13(9):520-32. de Wall LL, Heesakkers JP. Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome. Res Rep Urol. 2017;9:145-57. Ramsay S, Bolduc S. Review overactive bladder in children. Can Urol Assoc J. 2017;11(1-2 Suppl 1):S74-9. Chiaffarino F et al. Impact of urinary incontinence and overactive bladder on quality of life. Eur Urol. 2003;43(5):535-8. Milsom I et al. Global prevalence and economic burden of urgency urinary incontinence: A systematic review. Eur Urol. 2014;65(1):79-95. Zorn BH et al. Urinary incontinence and depression. J Urol. 1999;162(1):82-4. Fitzgerald MP et al. Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol. 2006;175(3 Pt 1):989-93. Sampaio AS et al. Are lower urinary tract symptoms in children associated with urinary symptoms in their mothers? J Pediatr Urol. 2017;13(3):269.e1-e6. Santos DJ et al. Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J. 2017;11(1-2 Suppl1):S64-72. Veiga ML et al. Constipation in children with isolated overactive bladders. J Pediatr Urol. 2013;9(6 Pt A):945-9. Wolfe-Christensen C et al. Bladder and bowel dysfunction: Evidence for multidisciplinary care. J Urol. 2013;190(5):1864-8. Franco I. Pediatric overactive bladder syndrome: Pathophysiology and management. Paediat Drugs. 2007;9(6):379-90. Grape HH et al. Retest reliability of surface electromyography on the pelvic floor muscles. Neurourol Urodyn. 2009;28(5):395-9. Liao KK et al. Effect of sacral neuromodulation on the spinal nociceptive reflex of patients with idiopathic overactive bladder. Neuromodulation. 2008;11(1):50-5. Miyazato M et al. Rectal distention inhibits bladder activity via glycinergic and GABAergic mechanisms in rats. J Urol. 2004;171(3):1353-6. Leue C et al. Functional urological disorders: A sensitized defence response in the bladder-gut-brain axis. Nat Rev Urol. 2017;14(3):153-63. Bauer S et al., "Voiding dysfunction in children: Neurogenic and non-neurogenic," Walsh PC et al. (eds.), Campbell's Urology (2002) 8th edition, Philadelphia: W.B. Saunders Co., pp.2231-3. Koff SA et al. Association of urinary tract infection and reflux with uninhibited bladder contractions and voluntary sphincteric obstruction. J Urol. 1979;122(3);373-6. Koff SA et al. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urology. 1998;160(3 Pt 2):1019-22. Fraga LGA et al. Obesity and lower urinary tract dysfunction in children and adolescents: Further research into new relationships. J Pediatr Urol. 2017;13(4):387.e1-6. Feldman AS, Bauer SB. Diagnosis and management of dysfunctional voiding. Curr Opin Pediatr. 2006;18(2);139-47. Duel BP et al. A survey of voiding dysfunction in children with attention deficit-hyperactivity disorder. J Urol. 2003;170(4 Pt 2):1521-4. Logan BA et al. Voiding dysfunction related to adverse childhood experiences and neuropsychiatric disorders. J Pediatr Urol. 2014;10(4):634-8. Griffiths D et al. Brain control of normal and overactive bladder. J Urol. 2005;174(5):1862-7. Griffiths D, Tadic SD. Bladder control, urgency and urge incontinence: Evidence from functional brain imaging. Neurourol Urodyn. 2008;27(6):466-74. Kavia RB et al. Functional imaging and the central control of the bladder. J Comp Neurol. 2005;493(1):27-32. Sousa AS et al. Enuresis and overactive bladder in children: What is the relationship between these two conditions? Int Braz J Urol. 2016;42(4):798-802. Barroso U Jr et al. Comparative analysis of the symptomatology of children with lower urinary tract dysfunction in relation to objective data. Int Braz J Urol. 2006;32(1):70-6. Bael A et al. The relevance of urodynamic studies for urge syndrome and dysfunctional voiding: A multicenter controlled trial in children. J Urol. 2008;180(4):1486-95. Afshar K et al. Development of a symptom score for dysfunctional elimination syndrome. J Urol. 2009;182 (4 Suppl):1939-43. Bartkowski DP, Doubrava RG. Ability of a normal dysfunctional voiding symptom score to predict uroflowmetry and external urinary sphincter electromyography patterns in children. J Urol. 2004;172(5 Pt 1):1980-5. Kakizaki H et al. Pathophysiological and therapeutic considerations for non-neurogenic lower urinary tract dysfunction in children. Low Urin Tract Symptoms. 2016;8(2):75-85. van Arendonk KJ et al. Improved efficacy of extended release oxybutynin in children with persistent daytime urinary incontinence converted from regular oxybutynin. Urology. 2006;68(4):862-5. Bolduc S et al. The use of tolterodine in children after oxybutynin failure. BJU Int. 2003;91(4):398-401. Podnar S, Vodušek DB. Lower urinary tract dysfunction in patients with peripheral nervous system lesions. Handb Clin Neurol. 2015;130:203-24. Kelleher C et al. Comparative efficacy and tolerability of solifenacin 5mg versus oral antimuscarinic agents in overactive bladder (OAB): A systematic literature review (SLR) and mixed treatment comparison (MTC). Value Health. 2014;17(7):A466. Nijman RJ. Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children. Urology. 2004;63(3 Suppl 1):45-50. Malhotra B et al. Dose-escalating study of the pharmacokinetics and tolerability of fesoterodine in children with overactive bladder. J Pediatr Urol. 2012;8(4):336-42. Hoebeke P et al. Solifenacin for therapy resistant overactive bladder. J Urol. 2009;182(4 Suppl):2040-4. Blais AS et al. Prospective pilot study of mirabegron in pediatric patients with overactive bladder. Eur Urol. 2016;70(1):9-13. Barroso U Jr, Lordělo P. Electrical nerve stimulation for overactive bladder in children. Nat Rev Urol. 2011;8(7):402-7. Dasgupta R et al. Changes in brain activity following sacral neuromodulation for urinary retention. J Urol. 2005;174(6):2268-72. Dmochowski RR, Gomelsky A. Update on the treatment of overactive bladder. Curr Opin Urol. 2011;21(4):286-90. Lordêlo P et al. Prospective study of transcutaneous parasacral electrical stimulation for overactive bladder in children: Long-term results. J Urol. 2009;182(6):2900-4. Quintiliano F et al. Transcutaneous parasacral electrical stimulation vs oxybutynin for the treatment of overactive bladder in children: A randomized clinical trial. J Urol. 2015;193(5 Suppl):1749-53. Yang S et al. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: A position statement from the International Children's Continence Society. Pediatr Nephrol. 2017. [Epub ahead of print]. Borch L et al. Transcutaneous electrical nerve stimulation combined with oxybutynin is superior to monotherapy in children with urge incontinence: A randomized, placebo controlled study. J Urol. 2017;198(2):430-5. Veiga ML et al. Parasacral transcutaneous electrical nerve stimulation for overactive bladder in constipated children: The role of constipation. J Pediatr Urol. 2016;12(6):396.e1-6. Clarke MC et al. Decreased colonic transit time after transcutaneous interferential electrical stimulation in children with slow transit constipation. J Pediatr Surg. 2009;44(2):408-12. Moeller Joensson I et al. Transcutaneous electrical nerve stimulation increases rectal activity in children. J Pediatr Gastroenterol Nutr. 2015;61(1):80-4. Hoebeke P et al. Percutaneous electrical nerve stimulation in children with therapy resistant nonneuropathic bladder sphincter dysfunction: A pilot study. J Urol. 2002;168(6):2605-8. Hoebeke P et al. Transcutaneous neuromodulation for the urge syndrome in children: A pilot study. J Urol. 2001;166(6):2416-9. Barroso Jr U et al. Posterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children. J Urol. 2013;190(2):673-7. Boudaoud N et al. Management of refractory overactive bladder in children by transcutaneous posterior tibial nerve stimulation: A controlled study. J Pediatr Urol. 2015;11(3):138.e1-10. Peters KM et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: Results from the overactive bladder innovative therapy trial. J Urol. 2009;182(3):1055-61. Roth TJ et al. Sacral neuromodulation for the dysfunctional elimination syndrome: A single center experience with 20 children. J Urol. 2008;180(1):306-11. Hoebeke P et al. The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor. J Urol. 2006;176(1):328-31.
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SAN DIEGO—BT and Accelrys Inc. have announced they will be working together to combine their respective data solutions in order to mine helpful insight from massive public health repositories.
Combining BT's Cloud Compute platform with the Accelrys Enterprise Platform and Pipeline Pilot has resulted in a technology pairing that has proven to be up to the challenge of identifying useful information in vast quantities of data. Accelrys and BT continue to work toward additional solutions for the management and analysis of big data with the goal of eliminating concerns regarding information management so that customers can focus on their research.
"The generation of ever-increasing amounts of health data is both a blessing and a curse, as they are data-rich, but often information-poor," Leif Pedersen, senior vice president of marketing, product management and corporate development at Accelrys, said in a press release. "Working with BT, we've shown that we can deliver meaningful and valuable insights from these huge datasets."
BT has amassed publicly available health system and social care information in a research repository for use by the life-science industry, healthcare industry and academia. The repository is initially hosted in the United States and the United Kingdom, but it is also available for international access. The issue with such datasets is the sheer size as well as the fact that they may lack proper structure.
In addition to BT's research repositories, David Brown, chief technology officer of BT Life Sciences, BT Global Services, says the United Kingdom and British government "have a program as part of their life-science strategy to open up as much as possible the National Health Service and medical research."
Between this and the output generated from genomic sequencing—Brown notes that "one 10x human genome is around 1.2 terabytes of data"—there is an overwhelming amount of data to examine and process. Cloud computing, for which Brown says the best days "are still to come," allows researchers to store and analyze these massive amounts of data externally to manage costs and limit the need for extensive in-house infrastructure.
Andy Leuthe, senior director of Product Marketing for Accelrys, says big data management is one of the leading issues facing the industry today.
"Big Data is a challenge faced by a variety of different industries. Generally speaking, regardless of the industry, today's use of technology generates a tremendous amount of data. Mining and analyzing that data has the potential to unlock a tremendous amount of value for organizations," Leuthe notes.
"Specifically for biotechs and pharmaceutical organizations, the amount of data generated is significant and probably as an industry may be near the top as far as data generated and data consumed. The Big-Data challenge for the companies Accelrys serves is trying to find that next big discovery in the tidal wave of data."
The two companies announced a formal partnership in April of last year to provide pharmaceutical and biotech organizations with solutions from Accelrys made available on and delivered by BT's cloud services. Accelrys' solutions continue to be integrated into the BT for Life Science R&D Workbench, which is built on the BT Cloud Compute IAAS platform. In addition, Accelrys recently made its HEOS collaboration suite available on BT Cloud Compute platform, and is a foundational member of the BT for Life Sciences ecosystem.
"Building on the launch of BT for Life Sciences last year, we are excited that our continued collaboration with Accelrys is bringing new innovations to the life-science industry," Bas Burger, president of Global Pharmaceutical & Chemical for BT Global Services, commented in a statement. "By making it easier for scientists to gain valuable medical insights from anonymous data buried in large datasets, we can help provide the interpretation of health outcomes. Working together, BT and Accelrys are making such patient outcomes analysis available to those companies developing drugs, enabling real-world outcomes that can be linked to the drug development pipeline."


Is there a better way to care for patients? On Tuesday at Fortune's fourth Brainstorm Health conference in San Diego, Kaiser Permanente CEO Bernard Tyson argued that there is—and urged his peers to move away from "episodic" treatment and toward a more holistic approach.
It is inarguable that behaviors beyond direct care impact a person's health—where you live, how you sleep, whether your environment supports healthy lifestyles and behaviors. Yet most quality measurement in the care industry "has been based on process measurements," said Tyson, whose company counts 12.4 million customers and annual operating revenue of more than $70 billion.
A change in mindset quickly leads to new approaches, Tyson said—such as setting up a virtual visit with a physician (say, with a dermatologist to evaluate a skin issue, based on a photo) rather than a physical one.
A change in metrics could even help one of the biggest issues in health: cost. A rethinking of the cost structure of the industry to better serve patients could very well "arrest the escalation" of cost of care each year, Tyson said.
But there will be bumps along the way. Kaiser Permanente, for example, is investing a lot in technology to create new access points, Tyson said. But more convenience has created more usage. "We're still working through that," he said. And then there's the transition from lifetime cost versus episodic cost to consider.


The seventh annual Sacramento Stand-Up Competition will be held July 26-27, 2019, at Sacramento Comedy Spot. The Sacramento Stand-Up Competition features 24 of the best comedians in the United States competing for a $1,000 Grand Prize, $500 Second Place Prize, and $250 Third Place Prize.
Congratulations to the 2018 performers!


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text:
CEPHA Network
IICAQM 2021
Clean Environment and Planetary Health in Asia
About CEPHA Network
The Clean Environment and Planetary Health in Asia (CEPHA) network aims to enhance inter-sectoral interdisciplinary engagement to co-create lasting partnerships that will help instigate a clean environment transformation in Asia (India, China, Thailand, Malaysia, and neighbouring countries) through low-carbon development, focusing on innovative solutions that can provide multiple health, environmental and socioeconomic benefits.
The CEPHA network engages with researchers, citizens, policymakers, the health sector, industry, and other stakeholders through systems-based participatory methods to develop lasting partnerships to tackle environmental pollution & NCDs. Another objective of CEPHA network to identify "what works", knowledge gaps, key challenges, and barriers/enablers in developing/prioritizing innovative solutions that can provide multiple benefits. The CEPHA network strengthens international co-operation and knowledge exchange on environmental pollution control and planetary health across Asia. The CEPHA network builds capacity and capability and widens participation across sectors and socioeconomic groups. The activities of CEPHA network focus on generating resources and research income through joint research grant applications.
The UK Research and Innovation (UKRI) through the Global Challenges Research Fund is our core source of fund, providing the bedrock of our work worldwide.
UK Research and Innovation work in partnership with universities, research organizations, businesses, charities, and government to create the best possible environment for research and innovation to flourish. They aim to maximize the contribution of each of their parts, working individually and collectively. They work with many partners to benefit everyone through knowledge, talent and ideas.
About IIT Madras
Indian Institute of Technology Madras (IITM) is one of the foremost institutes of national importance in India for higher technological education, basic and applied research. IIT Madras has been the top-ranked engineering institute in India for four consecutive years as well as the 'Best Educational Institution' in Overall Category in the NIRF Rankings of 2019 put out by the Ministry of Human Resource Development. More recently, IIT Madras has been given the title of Institute of Eminence. The Institute has sixteen academic departments and advanced research centres in various disciplines of engineering and pure sciences. IIT Madras is a residential institute with nearly 550 faculty, 8000 students, and 1250 administrative & supporting staff and is a self-contained campus located in a beautiful wooded land of about 250 hectares.
IIT(M) has a strong research, teaching and consultancy program in the area of environmental sciences and engineering. There is a dedicated Environmental and Water Resources Engineering (EWRE) Division under the Civil Engineering department. IIT Madras is also home to the recently incubated International Center for Clean Water (ICCW), an initiative for sustainable clean water and the Indo-German Center for Sustainability. The research areas pursued at IIT(M) are: Water quality management /wastewater treatment and technologies for clean water, Air quality management and technologies for clean air, Atmospheric physics and chemistry and Climate modelling, Solid waste management including waste to wealth technologies, Fate and transport of contaminants in the environment – multimedia and interphase transport including emissions to air, Soil remediation and transport in porous media, Bioremediation Engineering, Emission control technologies from combustion processes, Sensors for environmental monitoring, Ecological modelling, Environmental Sustainability and Impact on Society. The EWRE laboratory has set up a Continuous Ambient Air Quality Monitoring Station in collaboration with the Central Pollution Control Board (CPCB), New Delhi.
IITM Website (https://www.iitm.ac.in).
IIT Madras Air Quality Research Group
Prof. S.M. Shiva Nagendra leads air quality Research Group at the department of Civil Engineering.
The air quality research group focuses on
Urban Hotspot Air Quality Monitoring, Modelling and Control
Sensors for Air Pollution Monitoring
Personal Exposure and Health Impact
Real World Exhaust Emission Monitoring and Modelling
Ambient and Source Emission Control Technologies
Indoor Air Quality Monitoring, Modelling and Control
Emission Inventory and Source Apportionment
Machine Learning Techniques for Air Quality Classification and Prediction
Clean Environment and Planetary Health in Asia (CEPHA) network
Environmental and Water Resource Engineering Division
Indian Institute of Technology Madras
Chennai, India – 600 036
Telephone : 91-44-22574290
S.M. Shiva Nagendra, Ph.D.
CEPHA Network Co-Ordinator
Telephone : 91-44-22574290 (O)
Email: snagendra@iitm.ac.in
cepharesearch@iitm.ac.in
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