text:
Xeomin Drug Information /
incobotulinumtoxinA - Drug Summary
Muscle Relaxants, Other Neuromuscular Blockers
Children, distant spread of toxin effects, infants, neonates
Postmarketing data for incobotulinumtoxinA and other botulinum toxins suggest that botulinum toxin effects may, in some cases, be observed beyond the site of local injection. The symptoms are consistent with the mechanism of action of botulinum toxin. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life-threatening; deaths related to the distant spread of toxin effects have been reported. Advise patients and caregivers to seek immediate medical help if speech, swallowing, or respiratory disorders occur. The risk of symptoms is probably greatest in neonates, infants, and children treated for spasticity but symptoms can occur in adults treated for spasticity and other conditions, and particularly in those patients who have underlying conditions that would predispose them to these symptoms. Symptoms consistent with spread of toxin effect have been reported at doses comparable to or lower than doses used to treat cervical dystonia.
Parenteral acetylcholine release inhibitor and neuromuscular blocking agent
Used for treatment or improvement of patients with blepharospasm, cervical dystonia, upper limb spasticity, severe glabellar lines, or chronic sialorrhea
Spread of toxin effect beyond the site of local injection has been reported
Xeomin Intramuscular Inj Pwd F/Sol: 50U, 100U, 200U
For the treatment of upper limb spasticity.
Intramuscular dosage
Individualize dosage, frequency, and number of injection sites based on the size, number, and location of muscles involved, severity of spasticity, the presence of local muscle weakness, the patient's response to previous treatment, or adverse event history with incobotulinumtoxinA. In patients not previously treated with botulinum toxins, begin initial dosing at the low end of the recommended dosing range and titrate as necessary. Do not exceed 400 units/treatment session. Do not administer more frequently than every 12 weeks; most patients were retreated between 12 and 14 weeks in clinical trials. Dosing by muscle: clenched fist: flexor digitorum superficialis or flexor digitorum profundus, 25 to 100 units IM with 2 injection sites/muscle; flexed wrist: flexor carpi radialis, 25 to 100 units IM with 1 to 2 injection sites/muscle, or flexor carpi ulnaris, 20 to 100 units IM with 1 to 2 injection sites/muscle; flexed elbow: brachioradialis, 25 to 100 units IM with 1 to 3 injection sites/muscle, or biceps, 50 to 200 units IM with 1 to 4 injection sites/muscle, or brachialis, 25 to 100 units IM with 1 to 2 injection sites/muscle; pronated forearm: pronator quadratus, 10 to 50 units IM with 1 injection site/muscle, or pronator teres, 25 to 75 units IM with 1 to 2 injection sites/muscle; thumb-in-palm: flexor pollicis longus, 10 to 50 units IM with 1 injection site/muscle, or adductor pollicis or flexor pollicis brevis/opponens pollicis, 5 to 30 units IM with 1 injection site/muscle.[41461] In clinical trials, up to 400 units in divided doses IM were injected to affected muscle groups at a minimum dosing interval of 12 weeks for up to 6 doses.[58784] [59224]
Children and Adolescents 2 to 17 years
Individualize dosage, frequency, and number of injection sites based on the size, number, and location of muscles involved, severity of spasticity, and the presence of local muscle weakness. Max per limb: 8 units/kg IM divided among affected muscles up to 200 units. Do not administer more frequently than every 12 weeks; most patients were retreated between 12 and 16 weeks in clinical trials. Dosing by muscle: flexed elbow: brachioradialis or brachialis, 1 to 2 units/kg IM (Max: 50 units) in 1 to 2 sites or biceps, 2 to 3 units/kg IM (Max: 75 units) in 1 to 3 sites ; flexed wrist: flexor carpi radialis or flexor carpi ulnaris, 1 unit/kg IM (Max: 25 units) in 1 site; pronated forearm: pronator quadratus, 0.5 unit/kg IM (Max: 12.5 units) in 2 sites or pronator teres, 1 to 2 units/kg IM (Max: 50 units) in 1 site; clenched fist: flexor digitorum superficialis or flexor digitorum profundus, 1 unit/kg IM (Max: 25 units) in 1 site; thumb-in-palm: flexor pollicis longus, 1 unit/kg IM (Max: 25 units) in 1 site or adductor pollicis, flexor pollicis brevis/opponens pollicis, 0.5 unit/kg IM (Max: 12.5 units) in 1 site.[41461]
For the treatment of blepharospasm.
Use an initial dose of 50 units (25 units per eye) IM in treatment-naive patients. In patients with a previous treatment with a botulinumtoxin A, consider their past dose, response to treatment, duration of effect, and adverse event history when determining the dose. Determine subsequent dosing and timing for repeat administration based on clinical response, but generally no sooner than every 12 weeks. Do not exceed 100 units per treatment session or 50 units per eye.
For the treatment of cervical dystonia.
120 units IM divided into affected muscles (e.g., sternocleidomastoid, levator scapulae, splenius capitis, scalenus, trapezius). Individualize dose and number of injection sites in each treated muscle based on number and location of the muscle(s) to be treated, degree of spasticity/dystonia, muscle mass, body weight, and response to any previous botulinum toxin treatments. Determine timing for repeat administration based on clinical response, but generally no sooner than every 12 weeks.
For the treatment of moderate to severe glabellar lines (facial wrinkles).
4 units/injection IM with 2 injections in each corrugator muscle and 1 injection in the procerus muscle. Max total dose: 20 units. Do not administer more frequently than every 3 months.
For the treatment of chronic sialorrhea.
Intraglandular dosage
30 units intraglandular for each parotid gland and 20 units intraglandular for each submandibular gland. Determine timing for repeat administration based on clinical response, and no sooner than every 16 weeks.
Children and Adolescents 2 to 17 years weighing 30 kg or more
22.5 units intraglandular for each parotid gland and 15 units intraglandular for each submandibular gland. Determine timing for repeat administration based on clinical response, and no sooner than every 16 weeks.
Children and Adolescents 2 to 17 years weighing 27 kg to less than 30 kg
12 units intraglandular for each parotid gland and 8 units intraglandular for each submandibular gland. Determine timing for repeat administration based on clinical response, and no sooner than every 16 weeks.
9 units intraglandular for each parotid gland and 6 units intraglandular for each submandibular gland. Determine timing for repeat administration based on clinical response, and no sooner than every 16 weeks.
50 units/eye IM for blepharospasm; 120 units/treatment session IM for cervical dystonia; 20 units/treatment session IM for glabellar facial wrinkles; 400 units/treatment session IM for upper limb spasticity; 100 units/treatment session intraglandular for chronic sialorrhea.
Upper limb spasticity: 8 units/kg IM (Max: 200 units) per limb per treatment session.
Chronic sialorrhea:
Weighing 30 kg or more: 75 units/treatment session intraglandular.
Weighing 27 kg to less than 30 kg: 60 units/treatment session intraglandular.
Upper limb spasticity:
2 to 12 years: 8 units/kg IM (Max: 200 units) per limb per treatment session.
1 year: Safety and efficacy have not been established.
2 to 12 years weighing 30 kg or more: 75 units/treatment session intraglandular.
2 to 12 years weighing 27 kg to less than 30 kg: 60 units/treatment session intraglandular.
Neonates
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Use each vial of reconstituted incobotulinumtoxinA for 1 session and 1 patient only.
Practitioners should be familiar with musculature and any anatomical abnormalities (e.g., past surgical procedures) of affected areas.
Do not inject through pen markings; a permanent tattooing effect may result.[41461]
Reconstitution/Dilution
Reconstitute with sterile, preservative-free 0.9% Sodium Chloride Injection.
Using aseptic technique, withdraw the proper amount of diluent in the appropriate size syringe and slowly inject the diluent into the vial. Discard the incobotulinumtoxinA if a vacuum does not pull the diluent into the vial.
Gently mix by rotating the vial; the solution should be clear, colorless, and free of particulate matter.
Using a 50 unit vial, dilutions calculated for an injection volume of 0.1 mL are as follows:
0.25 mL of diluent = 20 units/0.1 mL
0.5 mL of diluent = 10 units/0.1 mL
1 mL of diluent = 5 units/0.1 mL
1.25 mL of diluent = 4 units/0.1 mL
2 mL of diluent = 2.5 units/0.1 mL
2.5 mL of diluent = 2 units/0.1 mL
4 mL of diluent = 1.25 units/0.1 mL
5 mL of diluent = 1 unit/0.1 mL
Using a 100 unit vial, dilutions calculated for an injection volume of 0.1 mL are as follows:
1 mL of diluent = 10 units/0.1 mL
When using 8 mL of diluent (preservative-free 0.9% Sodium Chloride), 1) reconstitute the vial with 4 mL of diluent, 2) withdraw 4 mL of diluent into a syringe sized for 8 mL, then 3) using the same syringe, draw up 4 mL of the incobotulinumtoxinA solution from the reconstituted vial and mix gently.
16 mL of diluent = 1.25 units/0.1 mL
When using 16 mL of diluent (preservative-free 0.9% Sodium Chloride), 1) reconstitute the vial with 4 mL of diluent, 2) withdraw 12 mL of diluent into a syringe sized for 16 mL, then 3) using the same syringe, draw up 4 mL of the incobotulinumtoxinA solution from the reconstituted vial and mix gently.
Storage: Store reconstituted solution under refrigeration (2 to 8 degrees C) until ready for use. Administer within 24 hours of reconstitution.[41461]
Intramuscular Administration
Use a sterile 26-gauge (0.45 mm diameter), 37 mm length needle for superficial muscles or a 22-gauge (0.7 mm diameter), 75 mm length needle for injections into deeper muscles.
Avoid injection into the medial lower eyelid area to prevent ectropion.
Ecchymosis occurs easily in the soft eyelid tissues and can be prevented by applying pressure at the injection site immediately after the injection.[41461]
Cervical dystonia
Localization of the involved muscles with electromyographic guidance or nerve stimulation techniques may be useful.
Inject carefully when the injection site is close to sensitive structures (e.g., carotid artery, lung apices, and esophagus).[41461]
Glabellar facial wrinkles
Use a sterile 30- to 33-gauge (0.2 to 0.3 mm diameter), 13 mm length needle.
Avoid injection near the levator palpebrae superioris to reduce the risk of ptosis, particularly in patients with larger brow depressor complexes.
Administer at least 1 cm above the bony supraorbital ridge.[41461]
Upper limb spasticity
Localization of the involved muscles with electromyographic guidance, nerve stimulation, or ultrasound techniques is recommended.
For superficial muscles in adults: Use a sterile 26-gauge (0.45 mm diameter), 37 mm length needle.
For deeper musculature in adults: Use a sterile 22-gauge (0.7 mm diameter), 75 mm length needle.
For superficial muscles in pediatric patients: Use a sterile 30-gauge (0.3 mm diameter), 25 mm length needle.
For deeper musculature in pediatric patients: Use a sterile 27-gauge (0.4 mm diameter), 37 mm length needle.[41461]
Other Injectable Administration
Intraglandular injection
The concentration after reconstitution used in clinical trials was 5 units/0.1 mL in adults and 2.5 units/0.1 mL in pediatric patients.
Use a sterile 27- to 30-gauge (0.3 to 0.4 mm diameter), 12.5 mm length needle.
Inject into the parotid and submandibular salivary glands on both sides.
For adult patients, the salivary glands can be located using ultrasound imaging or surface anatomical landmarks. For pediatric patients, ultrasound guidance is recommended for the localization of the involved salivary glands.[41461]
Xeomin:
- Discard unused portion. Do not store for later use.
- Store at or below 77 degrees F
- Store reconstituted product in accordance with package insert instructions
- Store reconstituted product in refrigerator (36 to 46 degrees F) and administer within 24 hours
- Store vials in the refrigerator at 2 to 8 degrees C (36 to 46 degrees F) in the original carton
Albumin hypersensitivity, sucrose hypersensitivity
IncobotulinumtoxinA is contraindicated in individuals with known hypersensitivity to any ingredient in the formulation; do not use this medication in patients with a history of hypersensitivity to botulinum neurotoxin type A, a sucrose hypersensitivity, or an albumin hypersensitivity.
IncobotulinumtoxinA is contraindicated in the presence of infection at the proposed injection site(s). Use in patients with an infection at the injection site could lead to severe local or disseminated infection.
Dysphagia, respiratory insufficiency
Treatment with incobotulinumtoxinA other botulinum toxins can result in swallowing or breathing difficulties. Patients with pre-existing dysphagia or respiratory insufficiency may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection. When distant effects occur, additional respiratory muscles may be involved. Treatment of cervical dystonia with botulinum toxins may weaken neck muscles that serve as accessory muscles of ventilation. This may result in critical loss of breathing capacity in patients with respiratory disorders who have become dependent upon these accessory muscles. Serious breathing difficulties, including respiratory failure, have been reported in patients with cervical dystonia treated with botulinum toxins. Patients with smaller neck muscle mass and patients who require bilateral injections into the sternocleidomastoid muscles have been reported to be at greater risk of dysphagia. Deaths as a complication of severe dysphagia have been reported. Aspiration may result from severe dysphagia and is a particular risk when treating patients in whom swallowing or respiratory function is already compromised. Dysphagia may persist for several months. Limit the dose injected into the sternocleidomastoid muscle to decrease the occurrence of dysphagia.
Amyotrophic lateral sclerosis (ALS), myasthenia gravis, neuromuscular disease
Patients with neuromuscular disease with peripheral motor neuropathic disorders, amyotrophic lateral sclerosis (ALS), or neuromuscular junctional disorders (e.g., myasthenia gravis or Lambert-Eaton syndrome), may be at increased risk for severe dysphagia and respiratory compromise from typical doses of incobotulinumtoxinA.
IncobotulinumtoxinA products contain albumin, a derivative of human blood. As with other products derived from or purified with human blood components, the remote possibility of contamination or infection with hepatitis, Creutzfeldt-Jakob disease (CJD), variant Crequtzfeldt-Jakob disease (vCJD), or other bacterial or viral infection exists in patients receiving incobotulinumtoxinA. Screening plasma donors for prior exposure to certain viruses, testing for the presence of viruses, and inactivating and/or reducing viruses has reduced the risk of transmission of infectious agents. The manufacturing processes are designed to reduce the risk of transmitting infection; however, none of the processes are completely effective. There is also the possibility that unknown infectious agents may be present in this product. No cases of transmission of viral disease, CJD, or vCJD have ever been reported for albumin.
Closed-angle glaucoma
Use incobotulinumtoxinA with caution, in patients with or at risk for closed-angle glaucoma, as the toxin has anticholinergic effects.
Use incobotulinumtoxinA during pregnancy only if the potential benefit justifies the potential risk to the fetus. There are no adequate data on the developmental risk associated with the use of incobotulinumtoxinA in pregnant women. IncobotulinumtoxinA was embryotoxic in rats and increased abortions in rabbits when given intramuscularly at doses higher than the maximum recommended human dose (MRHD) for cervical dystonia (120 units), on a body weight basis. The no-effect doses for embryotoxicity in rats and increased abortion in rabbits were 6 units/kg (3 times the MRHD for cervical dystonia on a body weight basis) and 2.5 units/kg (similar to the MRHD for cervical dystonia on a body weight basis), respectively.
There are no data on the presence of incobotulinumtoxinA in human milk, the effects on the breast-fed infant, or the effects on milk production. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for incobotulinumtoxinA and any potential adverse effects on the breast-fed infant from incobotulinumtoxinA or the underlying maternal condition. No adverse effects were observed when an 8-month old infant was breast-fed during a severe clinical botulism illness in the mother. Type A botulism toxin was present in the serum and stool of the mother upon hospital admission (day 3 of illness). No botulinum toxin was detected in the infant's blood or stool, and no botulism organisms were detected in the infant's stool at hospital admission. A breast milk sample obtained at 4 hours after administration of 2 vials of trivalent botulism antitoxin to the mother did not contain any detectable botulinum toxin or botulism organisms. The infant continued to breast-feed throughout the maternal illness without any adverse effects.
Requires an experienced clinician
Use of incobotulinumtoxinA requires an experienced clinician as safe and effective use of this medication depends upon proper product storage, dose selection, medication reconstitution, and administration technique, in addition to, knowledge of the treated condition. Units of biological activity of incobotulinumtoxinA cannot be compared or converted to other botulinum toxin products. Physicians must understand the relevant neuromuscular and/or orbital anatomy of the area involved and know of any alterations to the anatomy due to prior surgical procedures. Use of standard electromyographic guidance or nerve stimulation techniques may be useful.
As with other botulinum toxin products, administer incobotulinumtoxinA with caution to patients with a history of surgery in the treatment area as this may alter drug distribution within the injected muscles and thus alter the intended effect. Further, ask all patients if they have any planned surgical procedures upcoming. Advise patients to tell their other health care practitioners of this therapy prior to any surgeries.
Driving or operating machinery
Advise patients to avoid engaging in potentially hazardous activities including driving or operating machinery if a loss of strength, muscle weakness, blurred vision, or drooping eyelids develops during incobotulinumtoxinA therapy.
visual impairment / Early / 0-12.0
seizures / Delayed / 3.0-3.0
anaphylactoid reactions / Rapid / Incidence not known
serum sickness / Delayed / Incidence not known
corneal erosion / Delayed / Incidence not known
ectropion / Early / Incidence not known
distant spread of toxin effects / Early / Incidence not known
dysphagia / Delayed / 13.0-18.0
blurred vision / Early / 0-12.0
dyspnea / Early / 5.0-5.0
hypertension / Early / 4.0-4.0
dysphonia / Delayed / 3.0-3.0
photophobia / Early / 0-1.4
paresis / Delayed / 0-1.0
hematoma / Early / 0.6-1.0
antibody formation / Delayed / 0.2-0.4
blepharospasm / Early / 0-0.2
edema / Delayed / Incidence not known
dysarthria / Delayed / Incidence not known
infection / Delayed / 0-20.0
ptosis / Delayed / 0.2-19.0
xerophthalmia / Early / 3.0-16.0
xerostomia / Early / 2.0-16.0
weakness / Early / 7.0-11.0
injection site reaction / Rapid / 0-9.0
headache / Early / 1.0-7.1
musculoskeletal pain / Early / 4.0-7.0
pharyngitis / Delayed / 2.0-6.0
myalgia / Early / 2.0-2.0
blepharedema / Early / 0-1.0
vomiting / Early / 1.0-1.0
nausea / Early / 1.0-1.0
pruritus / Rapid / Incidence not known
urticaria / Rapid / Incidence not known
diplopia / Early / Incidence not known
ecchymosis / Delayed / Incidence not known
muscle cramps / Delayed / Incidence not known
Amikacin: (Moderate) The effects of botulinum toxin can be potentiated by systemic aminoglycosides or other drugs that interfere with neuromuscular transmission. Monitor aminoglycoside concentrations, and monitor for evidence of neurotoxicity including systemic neuromuscular blockade.
Anticholinergics: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Aspirin, ASA; Carisoprodol: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Atracurium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Atropine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Atropine; Difenoxin: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Atropine; Edrophonium: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Baclofen: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Belladonna; Opium: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Benztropine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Budesonide; Glycopyrrolate; Formoterol: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Capreomycin: (Moderate) The effects of Botulinum Toxins could be potentiated by drugs that interfere with neuromuscular transmission, such as capreomycin.
Capsaicin; Metaxalone: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Carisoprodol: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Chlordiazepoxide; Clidinium: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Chlorzoxazone: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Cisatracurium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Colistin: (Moderate) The effects of botulinum toxin type A or botulinum toxin type B can be potentiated by drugs that interfere with neuromuscular transmission, such as colistimethate sodium. If these drugs are used in combination, monitor patients for increased adverse effects. Neuromuscular blockade may be associated with colistimethate sodium, and is more likely to occur in patients with renal dysfunction.
Cyclobenzaprine: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Dantrolene: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Dicyclomine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Diphenoxylate; Atropine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Doxacurium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Flavoxate: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Gentamicin: (Moderate) The effects of botulinum toxin can be potentiated by systemic aminoglycosides or other drugs that interfere with neuromuscular transmission. Monitor aminoglycoside concentrations, and monitor for evidence of neurotoxicity including systemic neuromuscular blockade.
Glycopyrrolate: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Glycopyrrolate; Formoterol: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Homatropine; Hydrocodone: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Hyoscyamine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Indacaterol; Glycopyrrolate: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Kanamycin: (Moderate) The effects of botulinum toxin can be potentiated by systemic aminoglycosides or other drugs that interfere with neuromuscular transmission.
Metaxalone: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Methscopolamine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Mivacurium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Neomycin: (Minor) The effects of botulinum toxin can be potentiated by systemic aminoglycosides or other drugs that interfere with neuromuscular transmission. However, neomycin oral and topical products are not well absorbed systemically; interactions are not expected.
Neuromuscular blockers: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Orphenadrine: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Oxybutynin: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Pancuronium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Paromomycin: (Minor) The effects of botulinum toxin can be potentiated by systemic aminoglycosides or other drugs that interfere with neuromuscular transmission. However, paromomycin is not well absorbed following oral administration; interactions are not expected.
Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Propantheline: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Rapacuronium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Rocuronium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Scopolamine: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Skeletal Muscle Relaxants: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Solifenacin: (Moderate) Systemic anticholinergic effects (e.g., blurred vision) may be potentiated if antimuscarinics are administered after administration of botulinum toxins.
Streptomycin: (Moderate) The effects of botulinum toxin can be potentiated by systemic aminoglycosides or other drugs that interfere with neuromuscular transmission. Monitor aminoglycoside concentrations, and monitor for evidence of neurotoxicity including systemic neuromuscular blockade.
Succinylcholine: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Tobramycin: (Moderate) The effects of botulinum toxin can be potentiated by systemic aminoglycosides or other drugs that interfere with neuromuscular transmission. Monitor aminoglycoside concentrations, and monitor for evidence of neurotoxicity including systemic neuromuscular blockade.
Trihexyphenidyl: (Moderate) The use of systemic antimuscarinic/anticholinergic agents following the administration of botulinum toxins may result in a potentiation of systemic anticholinergic effects (e.g., blurred vision, dry mouth, constipation, or urinary retention).
Trospium: (Moderate) Systemic anticholinergic effects (e.g., blurred vision) may be potentiated if antimuscarinics are administered after administration of botulinum toxins.
Vecuronium: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
IncobotulinumtoxinA blocks cholinergic transmission at the neuromuscular and salivary neuroglandular junctions by inhibiting the release of acetylcholine from peripheral cholinergic nerve endings. The neurotoxin first binds to the cholinergic nerve terminals, enters the nerve terminals, then the light-chain portion of the neurotoxin molecule translocates into the cytosol of the nerve terminal where it cleaves the SNAP25 protein, which is integral to the successful docking and release of acetylcholine from vesicles within nerve endings. In both muscles and glands, impulse transmission is re-established when new nerve endings are formed.
IncobotulinumtoxinA is administered by intramuscular and intraglandular injection. Animal (rodent) studies have shown the degree and duration of muscle paralysis to be dose-dependent.[41461]
Intramuscular Route
The median first onset of effect occurs within 7 days after injection. Typical duration of each treatment is up to 12 to 16 weeks; however, this is highly individualized.[41461] In a comparator study of incobotulinumtoxinA and onabotulinumtoxinA, the paralytic effect was measured by changes in compound muscle action potential (CMAP) after the IM injection of 4 units of either drug into the extensor digitorum brevis muscle of the foot in 14 healthy male adults. Regardless of the agent used, a 30% reduction in CMAP occurred in more than 50% of subjects on day 1. By day 7, all subjects had a 30% CMAP reduction after incobotulinumtoxinA receipt. The maximal effect on CMAP occurred between 7 to 14 days after administration (median CMAP approximately 40% of baseline); the median CMAP with both treatment methods was approximately 60% of baseline at the trial end on day 90.[41544]
In a phase 3 clinical trial of incobotulinumtoxinA for the treatment of blepharospasm, the median time to onset of effect was 4 days, the median time to waning of effect was 11 weeks, and the median duration of treatment effect was 110 days as reported by study patients.[41534]
In a phase 3 clinical trial of incobotulinumtoxinA therapy for the treatment of cervical dystonia, the median time to onset of treatment effect was 7 days, the median time to waning of effect was 10 weeks, and the median duration of treatment effect was 110 days as reported by study patients.[41535]
From pooled data of 2 phase 3 studies of incobotulinumtoxinA for the treatment of glabellar lines, the median time to onset of treatment effect was 2 to 3 days. After day 30, there was a gradual decline in the improvement of frown line severity; however, mean improvement compared to baseline was still present at day 120.[63336]
In a phase 3 study of incobotulinumtoxinA in patients with poststroke upper limb spasticity, the median time to onset of treatment effect was 4 days, and the median time to waning of effect was 10 weeks as reported by study patients.[59224]
Other Route(s)
Intraglandular Route
The median first onset of effect occurs within 7 days after injection. Typical duration of each treatment is up to 12 to 16 weeks; however, this is highly individualized.[41461]


text:
Prime Minister's Schemes प्रधानमंत्री योजना
All about Pradhan Mantri yojana and other government schemes in India.
Schemes List
Awas Yojana
Model Application Form
FAQ on PM Awas Yojana
Helpline-Toll Free Number
Credit Linked Subsidy Scheme
List of PLI
प्रधानमंत्री आवास योजना
ग्रामीण आवास योजना
Gramin Awas Yojana
Other PM Yojana
PM Kisan
PMFBY
Gold Monetization Scheme
Req. Documents for Home Loan
PMAY Success Story
State Housing Scheme
Pradhan Mantri Urja Ganga Project
Admin @ DKR Wednesday, July 17, 2019 latest news, pib, scheme, yojana No comments
Posted On: 17 JUL 2019 by PIB Delhi
The Government has taken various policy initiatives to increase the domestic production of crude oil and natural gas which include: -
(i) Policy for Relaxations, Extensions and Clarifications under Production Sharing Contract (PSC) regime for early monetization of hydrocarbon discoveries;
(ii) New Domestic Natural Gas Pricing Guidelines-2014;
(iii) Marketing including pricing freedom on natural gas production under PSC regime from difficult areas such as High Pressure-High Temperature (HP-HT) reservoirs and deep water and ultra deep water areas;
(iv) Discovered Small Field Policy;
(v) Hydrocarbon Exploration and Licensing Policy;
(vi) Policy for Extension of Production Sharing Contracts;
(vii) Policy for early monetization of Coal Bed Methane;
(viii) Setting up of National Data Repository;
(ix) National Seismic Programme for appraisal of Unappraised areas in Sedimentary Basins;
(x) Re-assessment of Hydrocarbon Resources;
(xi) Policy framework to streamline the working of Production Sharing Contracts in Pre-NELP and NELP Blocks;
(xii) Policy to Promote and Incentivize Enhanced Recovery Methods for Oil and Gas;
(xiii) Policy framework for exploration and exploitation of Unconventional Hydrocarbons under existing Production Sharing Contracts, Coal Bed Methane contracts and Nomination fields.
Up to 10th CGD Bidding Round, PNGRB has authorized 228 GAs covering 406 districts spread over 27 States and UTs covering approximately 70 percent of India's population and 53 percent of its geographical area for development of CGD network.
9 Geographical Areas (GAs) in Odisha upto 10th CGD bidding round are Khordha district, Cuttack district, Angul & Dhekanal Districts; Sundargarh & Jharsuguda Districts; Balasore, Bhadrak & Mayurbhanj Districts; Bargarh, Debagarh & Sambalpur Districts; Ganjam, Nayagarh & Puri Districts; Jagatsinghpur & Kendrapara Districts; Jajpur & Kendujhar Districts, wherein authorization has been issued. CGD network in GAs of Khordha district and Cuttack district is operational.
GAIL is executing Jagdishpur-Haldia-Bokaro-Dhamra Pipeline (JHBDPL) of length 2,655 km and Barauni-Guwahati Pipeline of length 729 km under Pradhan Mantri Urja Ganga Project to connect Eastern India. Total length of pipeline under Pradhan Mantri Urja Ganga Project is approx. 3,384 km, out of which 766 km of pipeline is in Odisha state and the balance 2,618 km is in the states of Uttar Pradesh, Bihar, Jharkhand, West Bengal & Assam. At present the pipeline has been commissioned upto Barauni in Bihar.
This information was given by Union Minister of Petroleum & Natural Gas, Shri Dharmendra Pradhan in a written reply to the Rajya Sabha today.
Source: PIB
Subscribe for Latest Schemes of Government via e-mail Daily
Free ! Free ! Free!
प्रधानमंत्री योजना
प्रधानमंत्री आवास योजना Prime Minister Awas Yojana (PMAY)
सबके लिए आवास (शहरी) मिशन Housing For All (Urban) Mission
माननीय प्रधानमंत्री ने राष्ट्र की स्वतंत्रता के 75 वर्ष पूर्ण हो जाने पर वर्ष 2022 तक सभी के लिए आवास की परिकल्पना की है। इस उद्येश्य की प्राप्ति के लिए केन्द्र सरकार ने एंक व्यापक मिशन "2022 तक सबके लिए आवास" शुरू किया है। 25 जून 2015 को प्रधानमंत्री श्री नरेन्द्र मोदी ने इस बहुप्रतीक्षित योजना को प्रधानमंत्री आवास योजना के नाम से प्रारम्भ किया है।
Hon'ble Prime Minister envisioned housing for All by 2022 when the Nation completes 75 years of its Independence. In order to achieve this objective, Central Government has launched a comprehensive mission "Housing for All by 2022". This much awaited scheme has been launched by the Prime Minister of India, Sh. Narendra Modi on 25th June, 2015 as Pradhan Mantri Awas Yojana.
सरकारी योजनाओं / प्रधानमंत्री योजनाओं की सूची : List of Central Government of Schemes
List of Central Government Schemes of Government of India केन्‍द्र सरकार के सभी सरकारी योजनाओं की सूची Here is the complete list o...
Gramin Awas Yojana "Gramin" under PM Awas Yojana
2022 तक सबके लिए आवास हेतु प्रधानमंत्री आवास योजना की ग्रामीण आवास योजना- 'ग्रामीण' का क्रियान्वयन DDA Aawas Yojana 2017 के बा...
PM Awas Yojana प्रधानमंत्री आवास योजना
प्रधानमंत्री आवास योजना सबके लिए आवास (शहरी) मिशन Click here to know the scheme details in English Click Here to know about onli...
Prime Minister Awas Yojana (PMAY) Housing For All (Urban) Mission हिन्दी में जानने के लिए यहां क्लिक करें हिन्दी भाषा में FAQ पढ़न...
प्रधानमंत्री किसान मानधन योजना का लाभ कैसे लें - जानें ऑनलाईन रजिस्‍ट्रेशन की पूरी प्रक्रिया
प्रधानमंत्री किसान मानधन योजना का लाभ कैसे लें प्रधानमंत्री किसान मानधन योजना के लिए पंजीकरण की शुरूआत 9 अगस्त से हो चुकी है। इस योज...
Aayushman Bharat - Pradhan Mantri Jan Arogya Yojana(PM-JAY) : Complete Details
Aayushman Bharat Yojana Pradhan Mantri Jan Arogya Yojana (PM-JAY) Aayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana (PM-JA...
Pradhan Mantri Awas Yojana - Latest Progress Report
Pradhan Mantri Awas Yojana - Latest Progress Report (as on 23rd November, 2020) Pradhan Mantri Awas Yojana (Urban) - Housing For All (...
विस्‍तारित प्रधानमंत्री उज्ज्वला योजना-2 (E-PMUY 2) के तहत एलपीजी गैस के लिए कैसे आवेदन करें?
विस्‍तारित प्रधानमंत्री उज्ज्वला योजना-2 (E-PMUY 2) के तहत एलपीजी गैस के लिए कैसे आवेदन करें? इसके लिए योग्‍य लाभार्थी कौन हैं? जानें आवेद...
List of Selected Cities under PMAY - HFA (Urban)
List of Cities selected under Prime Minister Awas Yojana - Housing For All (Urban) Apply Online City Name Urban Population as per ...
Beneficiaries under PMAY-G
Beneficiaries under PMAY-G प्रधानमंत्री आवास योजना के लिए योग्‍य लाभार्थी कौन है? जानिए पूरी जानकारी बस एक क्लिक पर । (a) whether the...
Archive Notification
Archive Notification January (85) December (124) November (114) October (157) September (158) August (137) July (113) June (133) May (128) April (85) March (100) February (101) January (112) December (77) November (113) October (36) September (21) August (62) July (233) June (112) May (22) April (12) March (125) February (233) January (96) December (106) November (45) October (57) September (38) August (74) July (126) June (85) May (41) April (31) March (102) February (93) January (21) December (34) November (14) October (28) September (11) August (65) July (45) June (23) May (27) April (28) March (22) February (13) January (7) December (22) November (31) October (14) September (15) August (23) July (49) June (32) May (42) April (20) March (16) February (8) January (1) December (2) November (1) October (2) September (2)
We are not the official website and are not linked to any Government or Ministry. All the posts published here are for information purpose only. Please do not treat as official website and please don't disclose any personal information here.
Copyright © 2015 Prime Minister's Schemes प्रधानमंत्री योजना. All rights reserved.
PM Awas Yojana (85)
Prime Minister Scheme (142)
Rajyasabha (124)
Ujjwala (15)
Copyright © Prime Minister's Schemes प्रधानमंत्री योजना | Powered by Blogger Design by ronangelo | Blogger Theme by NewBloggerThemes.com

redpajama_set_name: RedPajamaCommonCrawl


text:
The IEA's Progress in International Reading Literacy Study (PIRLS) is an international study of reading (comprehension) achievement in fourth graders. It has been conducted every five years since 2001 by the International Association for the Evaluation of Educational Achievement (IEA). It is designed to measure children's reading literacy achievement, to provide a baseline for future studies of trends in achievement, and to gather information about children's home and school experiences in learning to read.

Over 60 countries and sub-national, benchmarking entities participated in PIRLS 2016.

History
PIRLS provides internationally comparative data on how well children read by assessing students' reading achievement. PIRLS collects considerable background information on how education systems provide educational opportunities to their students as well as the factors that influence how students use these opportunities. These background data include information about the following: national curriculum policies in reading; how the education system is organized to facilitate learning; students' home environment for learning; school climate and resources; and how instruction actually occurs in classrooms. Studies of reading literacy had been conducted prior to the PIRLS study of 2001, and PIRLS is the successor to IEA studies, such as the Reading Literacy Study, that started in 1970 and continued until 1991.  The PIRLS study of 2001 started the trend for cyclical testing; PIRLS has a frequency of five years.  By administering the test every five years, education systems are able to monitor their children's literacy achievement over time.  The current cycle, PIRLS 2016, is the fourth cycle of the IEA PIRLS. Like the previous PIRLS cycles (conducted in 2001, 2006, and 2011), the study will also collect extensive information about home supports for literacy, curriculum and curriculum implementation, instructional practices, and school resources in each participating country.

Cycles

PIRLS 2021
PIRLS 2021 will be the fifth cycle in the PIRLS framework. IEA's PIRLS will continue to collect considerable background information from the assessed students, their parents, teachers and school principals on how education systems provide educational opportunities to their students, as well as the factors that influence how students use these opportunities. Trend results across assessments permit countries to monitor the effectiveness of their educational systems in a global context, and PIRLS 2021 marks 20 years of trends.

PIRLS 2021 evolves further from PIRLS 2016 in allowing countries to administer the full PIRLS reading assessment, including both PIRLS Informational and Literary (the previous standard PIRLS assessment), and the ePIRLS Online Informational (the previous ePIRLS), as one seamless digitally based endeavour. Countries may also select from two levels of the PIRLS assessment; providing students with an assessment experience better suited to their reading abilities increases student motivation and provides more accurate assessment data. All results will be reported on the same PIRLS achievement scale.

PIRLS 2021 thus offers three flexible options, enabling participants to select the administration path best suited to assessing their education system:(1) A new fully digital ePIRLS assessment, which integrates all aspects of PIRLS Informational, PIRLS Literary, and the ePIRLS Online Informational assessments; 2) The paper-only version of the PIRLS assessment, which is equivalent to the original pen-and-paper PIRLS standard assessment; and (3) The paper-only version of the PIRLS assessment, taken together with the ePIRLS Online Informational assessment.

PIRLS 2016
PIRLS 2016 was released on December 5, 2017. It also collects extensive information about home supports for literacy, curriculum and curriculum implementation, instructional practices, and school resources in each participating country. In this cycle there were two additional initiatives:
(1) the PIRLS Literacy assessment (earlier known as prePIRLS) is equivalent to PIRLS in scope and reflects the same conception of reading as PIRLS. Its purpose is to extend the effective measurement of reading literacy at the lower end of the achievement scale. Countries whose fourth-grade students are still developing fundamental reading skills can participate in the PIRLS Literacy assessment and still have their results reported on the PIRLS achievement scale. The reading passages and questions in common between the PIRLS Literacy and the PIRLS assessments will enable the two assessments to be linked, and their results to be compared.
(2) Initiated in 2016, ePIRLS is a computer-based reading assessment of students' ability to acquire and use information when reading online. The assessment encompasses an engaging, simulated internet environment with authentic school-like assignments about science and social studies topics. The ePIRLS online reading achievement scale enables countries to examine their fourth-graders' online reading performance relative to their performance on the PIRLS reading achievement scales.

In terms of trends, the PIRLS results for student achievement by country states that 18 countries had higher average achievement, 13 countries had the same average achievement, and 10 countries had lower average achievement; and girls had higher reading achievement than boys in 48 of the 50 countries.

The 2016 PIRLS Encyclopedia has the Education Policy and Curriculum in Reading by country. It describes the structure of each education system, the reading curricula in the primary grades, and overall policies related to reading instruction.

The ten countries with the highest average reading achievement were: Russian Federation, Singapore, Hong Kong SAR, Ireland, Finland, Poland, Northern Ireland, Norway, Taiwan, and England.

Helpful pages

PIRLS 2011
Combining newly developed reading assessment passages and questions for 2011 with a selection of secure assessment passages and questions from 2001 and 2006, the study offered a state-of-the-art assessment of reading comprehension that allowed for measurement of changes since 2001. The international population for PIRLS 2011 consisted of students in the grade that represents four years of schooling, provided that the mean age at the time of testing was at least 9.5 years. In the 2011 cycle, prePIRLS (now known as PIRLS Literacy) was offered to assess basic reading skills as a bridge to PIRLS, for countries where most children are still developing fundamental reading skills at the end of the primary school cycle.

PIRLS 2006
PIRLS 2006 assessed a range of reading comprehension strategies for two major reading purposes: literary and informational. The student test of reading comprehension addressed four processes:

 retrieval of explicitly stated information
 making straightforward inferences
 interpreting and integrating ideas and information
 examination and evaluation of content, language, and textual elements.
PIRLS 2006 assessed students enrolled in the fourth grade.

PIRLS 2001
The IEA Progress in International Reading Literacy Study (PIRLS) 2001 was the first cycle of assessments to measure trends in children's reading literacy achievement, and policy and practices related to literacy. The study examined three aspects of reading literacy: processes of comprehension, purposes for reading, and reading literacy behavior and attitudes. 35 countries took part in the first cycle where students enrolled in the fourth grade were assessed.

United States results by race and ethnicity

PIRLS assessment
The PIRLS study consists of a main survey that consists of a written reading comprehension test and a background questionnaire.  The PIRLS Reading Development Group (RDG) and National Research Coordinators (NRCs) from the participating countries collaborate to develop the reading assessments.  The assessment focuses on three main areas of literacy: process of comprehension, purposes for reading, and reading behaviors and attitudes.  The background questionnaire is used to determine the reading behaviors and attitudes.  The written test is designed to address the process of comprehension and the purposes for reading.  There are two purposes for reading that are examined in this study: reading for literary experience and reading to acquire and use information. Each student receives 80 minutes to complete two passages and then time to complete the survey.  There are a total of 8 passage.  Four passages are for each purpose of reading.  "With eight reading passages in total, but just two to be given to any
one student, passages and their accompanying items were assigned to student test booklets according to a matrix sampling plan. The eight passages were distributed across 10 booklets, two per booklet, so that passages were paired together in a booklet in as many different ways as possible." The PIRLS target population is the grade that represents four years of schooling, counting from the first year of ISCED Level 1, which corresponds to the fourth grade in most countries. To better match the assessment to the achievement level of students, countries have the option of administering PIRLS or PIRLS Literacy at the fifth or sixth grade.

Background questionnaire
Given to:

 Home/parents—This questionnaire includes questions about "students' early reading experiences, child-parent literacy interactions, parents' reading habits and attitudes, home-school connections, and demographic and socioeconomic indicators."
 Students—This questionnaire includes questions about "instructional experiences, self-perception and attitudes towards reading, out-of-school reading habits, computer use, home literacy resources, and basic demographic information."
 Teachers—This questionnaire includes questions about "characteristics of the class tested, instructional activities for teaching reading, classroom resources, assessment practices, and about their education, training, and opportunities for professional development."
 Schools—This questionnaire includes questions about "enrollment and school characteristics, school organization for reading instruction, school staffing and resources, home-school connections, and the school environment."

Participating organizations
 International Association for the Evaluation of Educational Achievement] with offices in Amsterdam and Hamburg
 International Study Center at Boston College
 Statistics Canada
 Educational Testing Services in Princeton, NJ
 National Foundation for Educational Research in England and Wales (NFER) in the United Kingdom
 Reading Development Group (RDG)

Participating countries

See also

 International Association for the Evaluation of Educational Achievement
 Programme for International Student Assessment (PISA), an educational ranking among OECD nations
 Trends in International Mathematics and Science Study (TIMSS)

References

External links
 , official website

Reading (process)
Literacy

redpajama_set_name: RedPajamaWikipedia


text:
The Long Path Back to the Basics
Afoot and light-hearted, I take to the open road,
Healthy, free, the world before me,
The long brown path before me, leading wherever I choose.
~Walt Whitman, "Song of the Open Road"
Start: Mink Hollow Lean-To
End: South Mountain
Today was a very long day. It rained last night. I stayed dry in my tent, but the rain convinced me to sleep in an extra hour, since I didn't want to go outside. I didn't have any trouble sleeping last night. Apparently (the troop leaders told me this morning) the scouts were up talking and laughing and singing into the wee hours of the morning. But I fell asleep before the troop leaders left the boys at the lean-to and went to sleep in their tent.
In the morning, I had to tackle more of the Devil's Path. I climbed Sugarloaf, Twin, and Indian Head Mountains. Like yesterday, the descents and climbs between peaks were very steep, and it took me a long time to maneuver the rock ledges. But there were some nice views. I also saw about 15 people doing day-hikes. They used some side trails allow loops on the Devil's Path.
I stopped for lunch at Devil's Kitchen Lean-To, at the eastern end of the Devil's Path. There was an assistant forest ranger there, and we spoke for a while. He was out on his patrols. He was also in college, and he had been doing this as a summer job for two years.
Just when he left, a group of four guys came (they looked college-aged as well). They were just there for the night, but their packs probably weighed more than mine. They had a new stove that they were trying to figure out how to light. Finally, after fifteen minutes, they lit it. But they had spilled so much fuel that the entire stove went up in flames. They almost burned the lean-to down! It was amusing to watch, and I left soon after.
Around 6:30, I got to Palenville. It seems like a very small town, but I didn't walk to the main part of it. I stopped at a gas station that had a grocery and deli. I've been so hungry lately that I've eaten more than I planned for. I got a deli sandwich for dinner, which I ate there. I also bought some Clif bars and peanut butter. They only had Jif creamy in small containers, but I'll deal with it (I'm a Skippy superchunk guy).
I still had a few more miles of hiking from Palenville, and I wasn't sure of an exact place to camp tonight, since there's no lean-to nearby (the closest one is another ten miles from here). I had to hike with my headlamp for a little while until I found a spot to camp.
The area where I'm camped is the former site of the Hotel Kaaterskill. In the nineteenth century, the Catskills were the major vacation spot for the rich and famous from New York. The Hotel Kaaterskill, and the nearby Catskill Mountain House, were two of the most prestigous. Now they're both destroyed. Nearby, there's a large state campground now (North/South Lake).
Apparently the Hotel Kaaterskill was built by a guy who got in a fight with the Montain House because they didn't accommodate the dietary needs of his daughter. So he bought some land a mile away and built a rival luxury hotel.
I'm really tired now. In one week I'll finish the Long Path, and be sleeping at the Altamont Inn (the only lodging option in Altamont).
Julie Saturday, July 04, 2009 10:27:00 PM
Superchunk is definitely the way to go with peanut butter. By the way, are you getting all this historical information from your guidebook? It's really cool. Who publishes hiking guidebooks?
Anonymous Tuesday, January 26, 2010 10:10:00 PM
www.nynjtc.org/product/guide-long-path
About the Dale Award
I am truly honored to have won a Martin A. Dale Sophomore Summer Award to support this trip. The award is given to a few Princeton sophomores each year to fund transformative, non-academic, non-working summer projects that provide opportunities for personal growth. I am very grateful to the generosity and vision of the late Martin A. Dale (Princeton Class of 1953) and his family.
About the Long Path
The Long Path is a 400-mile hiking trail in New York and New Jersey, going from the George Washington Bridge in Fort Lee, NJ, to Altamont, NY, near Albany.
The idea of the Long Path goes back to 1931, when Vincent Schaefer first envisioned a route stretching from New York City to Whiteface Mountain in the Adirondacks. Rather than being a formal trail, though, Schaefer proposed that the Long Path be an unmarked walking route connecting a series of interesting landmarks throughout New York. Schaefer wanted hikers to use a map, a compass, and their outdoor skills to reach these points. Schaefer's plan lost momentum after World War II, until the New York-New Jersey Trail Conference took a renewed interest in the Long Path in the 1960s. They have since worked to turn it into a blazed trail stretching from New York City to the Adirondacks.
Today, the Long Path remains a work in progress, ending some 30 miles short of the Blue Line (the boundary of Adirondack State Park).
About the Northville-Placid Trail
When I finish the Long Path, I will link up with the Northville-Placid Trail to reach Whiteface Mountain. The 130-mile Northville-Placid Trail, completed in 1924, is one of the oldest hiking trails in the country. It runs through Adirondack State Park, from Northville to Lake Placid.
About the 46 High Peaks
There are 46 mountains in the Adirondacks that were at one time believed to be above 4000 feet. More recent, accurate surveys have shown that some of those 46 peaks are slightly lower than 4000 feet, but the original designation of 46 high peaks remains. Robert and George Marshall and Herb Clark were the first "46ers" (people who climb all 46 high peaks); they climbed the 46 peaks between 1918 and 1925.


I'm on the radio speaking about the Boycott Bill, NGO Inquiry Committees and the Housing Crisis. The interview will be a little after midnight Israeli time on Galei Israel 102.5FM in Jerusalem, 106.5 in Tel Aviv and 89.3FM in the South.
I have my Tuesday post ready, but I'm waiting for my Monday post to be finished before I post both of them.


In ecology, edge effects refer to the changes in population or community structures that occur at the boundary of two habitats. Areas with small habitat fragments exhibit especially pronounced edge effects that may extend throughout the range. As the edge effects increase, the boundary habitat allows for greater biodiversity.
Edges arise where two habitat types come into contact as here in Pennsylvania, United States.
Inherent – Natural features stabilize the border location.
Induced – Transient natural disturbances (e.g., fire or flood) or human related activities, subject borders to successional changes over time.
Wide (ecotone) – A large distance separates the borders of two clearly and purely definable habitats based upon their physical conditions and vegetation, and in between there exists a large transition region.
Convoluted – The border is non-linear.
Perforated – The border has gaps that host other habitats.
Height can create borders between patches as well.
Environmental conditions enable certain species of plants and animals to colonize habitat borders. Plants that colonize tend to be shade-intolerant and tolerant of dry conditions, such as shrubs and vines. Animals that colonize tend to be those that require two or more habitats, such as white-tailed and mule deer, elk, cottontail rabbits, blue jays, and robins. Some animals travel between habitats, while edge species are restricted to edges. Larger patches include more individuals and therefore have increased biodiversity. The width of the patch also influences diversity: a patch must be deeper than its border in order to develop interior conditions.
Animals traveling between communities can create travel lanes along borders, which in turn increases light reaching plants along the lanes and promotes primary production. As more light reaches the plants, greater numbers and sizes can thrive. Increased primary production can increase numbers of herbivorous insects, followed by nesting birds and so on up the trophic levels.
When edges divide any natural ecosystem and the area outside the boundary is a disturbed or unnatural system, the natural ecosystem can be seriously affected for some distance in from the edge. In 1971, Odum wrote, 'The tendency for increased variety and diversity at community junctions is known as the edge effect... It is common knowledge that the density of songbirds is greater on estates, campuses and similar settings...as compared with tracts of uniform forest.'. In a forest where the adjacent land has been cut, creating an open/forest boundary, sunlight and wind penetrate to a much greater extent, drying out the interior of the forest close to the edge and encouraging growth of opportunistic species there. Air temperature, vapor pressure deficit, soil moisture, light intensity and levels of photosynthetically active radiation (PAR) all change at edges.
One study estimated that the amount of Amazon Basin area modified by edge effects exceeded the area that had been cleared. "In studies of Amazon forest fragments, micro-climate effects were evident up to 100m (330ft.) into the forest interior." The smaller the fragment, the more susceptible it is to fires spreading from nearby cultivated fields. Forest fires are more common close to edges due to increased light availability that leads to increased desiccation and increased understory growth. Increased understory biomass provides fuel that allows pasture fires to spread into the forests. Increased fire frequency since the 1990s is among the edge effects that are slowly transforming Amazonian forests. The changes in temperature, humidity and light levels promote invasion of non-forest species, including invasive species. The overall effect of these fragment processes is that all forest fragments tend to lose native biodiversity depending on fragment size and shape, isolation from other forest areas, and the forest matrix.
The amount of forest edge is orders of magnitude greater now in the United States than when the Europeans first began settling North America. Some species have benefited from this fact, for example, the brown-headed cowbird, which is a brood parasite that lays its eggs in the nests of songbirds nesting in forest near the forest boundary. Another example of a species benefiting from the proliferation of forest edge is poison ivy.
Conversely, Dragonflies eat mosquitoes, but have more trouble than mosquitoes surviving around the edges of human habitation. Thus, trails and hiking areas near human settlements often have more mosquitoes than do deep forest habitats. Grasses, huckleberries, flowering currants and shade-intolerant trees such as the Douglas-fir all thrive in edge habitats.
In the case of developed lands juxtaposed to wild lands, problems with invasive exotics often result. Species such as kudzu, Japanese honeysuckle and multiflora rose have damaged natural ecosystems. Beneficially, the open spots and edges provide places for species that thrive where there is more light and vegetation that is close to the ground. Deer and elk benefit particularly as their principal diet is that of grass and shrubs which are found only on the edges of forested areas.
Edge effects also apply to succession, when vegetation spreads rather than losing to competitors. Different species are suited either to the edges or to central sections of the habitat, resulting in a varied distribution. Edges also vary with orientation: edges on the north or south receive less or more sun than the opposite side (depending on hemisphere), producing varying vegetation patterns.
The phenomenon of increased variety of plants as well as animals at the community junction (ecotone) is also called the edge effect and is essentially due to a locally broader range of suitable environmental conditions or ecological niches.
Edge effects in biological assays refer to artifacts in data that are caused by the position of the wells on a screening plate rather than a biological effect.
The edge effect in scanning electron microscopy is the phenomenon in which the number of secondary and/or backscattered electrons that escape the sample and reach the detector is higher at an edge than at a surface. The interaction volume spreads far below the surface, but secondary electrons can only escape when close to the surface (generally about 10 nm, although this depends on the material). However, when the electron beam impacts an area close to the edge, electrons that are generated below an impact point that is close to an edge but that is far below the surface may be able to escape through the vertical surface instead.
↑ Levin, Simon A. (2009). The Princeton Guide to Ecology. Princeton University Press. p. 780.
↑ Smith, T.M.; Smith, R.L. (2009). "Elements of Ecology": 391–411.
↑ Murcia, C. (1995). "Edge effects in fragmented forests:implications for conservation" (PDF). Tree. 10 (2): 58–62. doi:10.1016/S0169-5347(00)88977-6. PMID 21236953.
↑ Skole, D. L.; C. Tucker (1994). "Tropical deforestation and habitat loss fragmentation in the Amazon: satellite data from 1978-1988". Science. 260 (5116): 1905–1910. doi:10.1126/science.260.5116.1905. PMID 17836720.
1 2 Corlett, Richard, T; Richard B. Primack (2011). Tropical Rain Forests an Ecological and Biogeographical Comparison (Second ed.). John Wiley & Sons Ltd, The atrium, Southern Fate, Chichester, West Sussex, PO19 8SQ: Wiley-Blackwell. pp. 266–267. ISBN 978-1-4443-3254-4.


PICCs (Peripherally inserted central catheters) provide access to the venous system, to allow for the delivery of medication or fluids. Typically, PICCs are used for patients who require therapy that will extend over a period of time. PICCs are usually inserted into a vein in the upper arm. Navilyst Medical's Vaxcel® PICC with PASV® Valve Technology is designed to automatically close and remain closed when not in use and automatically open for infusion or sampling. Its innovative design offers the versatility and capability to provide enhanced PICC placement and care.
Strict aseptic technique must be used during insertion procedure.
Typically, PICCs are used for patients who require therapies that will extend over a period of time. A PICC provides for patient comfort and convenience, and eases the management of home care. Further, peripheral entry for central access helps avoid complications that accompany subclavian or jugular catheter placement, such as pneumothorax.
Generally, the right upper arm is the preferred access site for PICC placement. Upper extremity access veins for PICC placement include those of the superficial venous system (the basilic vein or cephalic vein), and of the deep system (the brachial vein).
PASV® Valve Technology is designed for ease of placement, excellent performance, exceptional patient care, and to automatically resist backflow.
Inserted Vaxcel® PICC with PASV® Valve Technology.
Position of a Vaxcel® PICC with PASV® Valve Technology, inserted in the upper arm with the catheter tip resting near the heart.


text:
U.K. Showbiz
Sam Mendes' World War I drama 1917 releases explosive final trailer... as motion picture continues to generate award season buzz
Final preview of the film 1917 is released before its Christmas Day theatrical opening in limited theaters
Film features Dean-Charles Chapman, George MacKay, Benedict Cumberbatch and Colin Firth
Story follows a pair of young soldiers entrusted on crucial mission to alert allies to attack
By Adam S. Levy For Dailymail.com
A new trailer for writer-director Sam Mendes' World War I drama 1917 was released Wednesday, giving moviegoers a final preview of the film before its Christmas Day arrival in limited theaters.
The film features an ensemble cast including Dean-Charles Chapman, George MacKay, Benedict Cumberbatch, Colin Firth, Andrew Scott, Richard Madden and Mark Strong.
It tells the story of a pair of English soldiers, Lance Corporals Blake and Schofield (played by Chapman and MacKay, respectively).
The latest: A new trailer for writer-director Sam Mendes' World War I drama 1917 was released Wednesday, giving moviegoers a final preview of the film before its Christmas Day arrival in theaters. It tells the story of a pair of English soldiers, Lance Corporals Blake and Schofield played by Dean-Charles Chapman (L) and George MacKay, respectively
The young men are tasked with a crucial mission of making their way through dangerous areas of battle to inform a company of 1,600 soldiers - including Blake's brother - that a deadly trap awaits at the hands of the German military.
'Your orders are to deliver a message calling off tomorrow morning's attack - if you fail, it will be a massacre,' Firth's character General Erinmore tells the men upon assigning the crucial mission.
Sarah Jessica Parker stuns as she joins 1917 writer-director... PICTURED: Sam Mendes' grandfather who inspired his new movie... 'Extraordinary' World War One epic 1917 storms into the... How stars of Sam Mendes' brilliant new First World War film...
Blake and Schofield are seen making their way through enemy areas, sometimes being fired on, as the violence of the first World War is boldly captured by Mendes.
'If we're not clever about this, no one will get to your brother,' Schofield tells Blake, who responds, 'I will.'
Grim: Colin Firth's character General Erinmore tells the men upon assigning the crucial mission, 'Your orders are to deliver a message calling off tomorrow morning's attack - if you fail, it will be a massacre'
Grueling: Blake and Schofield are seen making their way through enemy areas, sometimes being fired on, as the violence of the first World War is boldly captured by Mendes
Focused: The men must achieve their task of 1,600 fellow soldiers will die
At one point amid the chaos, Schofield asks Blake: 'Why in God's name did you have to choose me?'
The motion picture looks to be an early award season favorite, having been nominated for three Golden Globes earlier this month: Best Motion Picture - Drama, Best Director for Mendes, and Best Original Score for Thomas Newman.
The film is also up for eight Critics' Choice Awards, and has been well-received by the critic community so far, with a stellar Rotten Tomatoes rating of 94.
Visual: The trailer captures a vivid vision of the horrors of World War I
Acclaimed: The vivid motion picture looks to be an early award season favorite
Overwhelming: Actor John Hollingworth plays Sergeant Guthrie in the feted film
Mendes, speaking with CBS This Morning last week, said that the film was inspired by stories his veteran grandfather used to tell him about being a message carrier on the battlefront.
'That was one of the things he was asked to do, because he was very small, 5-and-a-half feet. And the mist hung at six feet in no-man's land in the winter, [so] they sent him with messages so he couldn't be seen above the top of the mist by the enemy,' the filmmaker said. 'He never talked about his experiences in the war, even to his own children.
'He never spoke about it until his 70s. He happened to speak about it with his grandchildren.'
Personal: Director-writer Sam Mendes said that the film was inspired by stories his veteran grandfather used to tell him about being a message carrier on the battlefront.
Out and about: Mendes was at a Q&A for the film in NYC Sunday
Vision: Mendes addressed a crowd about his upcoming war drama at the screening
Asked what his late grandfather would think of his latest film, Mendes noted that 'he was a storyteller by trade' and 'was a novelist.
'I think he would be proud a member of his family ended up telling stories, too,' Mendes said. 'But I also think he might have struggled to watch it. As a man who couldn't talk about it for 60 years, there would have been - we have a name for it now, PTSD. But I think putting him back in the middle of it, he might have struggled with it.'
1917 opens in limited theaters December 25, with a widespread release due January 10.
Plaza Suite Stars Matthew Broderick and Sarah Jessica Parker, Brian Stokes Mitchell, More, Will Be Honored at The Actors Fund Gala | Playbill
"1917": Director Sam Mendes on the World War I epic inspired by his grandfather's wartime experiences - CBS News
1917 (2019) - Rotten Tomatoes
Sam Mendes' World War I drama 1917 releases explosive final trailer amid award season buzz
Just like mom! Barron Trump joins his parents as they land in Mar-a-Lago for the weekend after a quick...
Supreme Court is set to rule on whether state electoral college voters have to support the popular vote...
Plane slides off taxiway at Kansas City airport in icy weather as massive winter storm hits the Midwest on...
Hank Azaria will no longer voice Apu on The Simpsons after 30 years... but will continue to voice various...
Friends of kidnapped girl, 14, use Snapchat to track her location to a motel where cops rescued her from...
FBI finds the Saudi government 'almost certainly' helps its citizens escape prosecution in the US for...
New York City landlord and two contractors are sentenced to up to 12 years in prison for running illegal gas...
My brother framed me for murder - and my parents gave him a fake alibi: Man who spent 15 years in prison for...
Instagram CEO and Zuckerberg's trusted lieutenant Adam Mosseri reveals an episode of Black Mirror inspired...
Fury as groom who offered underage waitress $100 for sex and then exposed himself to her in bathroom at his...
Elegant Dasha Zhukova marries billionaire shipping tycoon Stavros Niarchos in surprise $6.5M wedding 24...
Snow chic! Gayle King bundles up in a fur coat as she arrives in Switzerland to attend close friend Dasha...
Just in time! Karlie Kloss, Princess Beatrice, Gayle King, and Derek Blasberg lead a host of famous faces...
Harry and Meghan's hideaway, the Kremlin-linked tech tycoon and a web of intrigue: Tantalising questions...
Beaming Meghan Markle drives herself to Canadian airport to pick up a friend as speculation mounts among...
'It was all Meghan's idea': Samantha Markle blames her sister for the Sussexes' decision to quit royal life...
The team who will make Meghan Markle millions: Lawyers, web experts and a ruthless Hollywood PR machine who...
The bank of Dad is draining Charles: RICHARD KAY on how the Prince of Wales has had to dip into his own...
EXCLUSIVE: Meghan Markle never actually stepped foot into Canada women's center but she met with staffers at...
Queen's aides hit a 'deadlock' as they try to finalise details of Megxit deal and the future of Prince Harry...
Fyre Festival breakout star Andy King cashes in on his infamous offer of oral sex in exchange for water as...
Judge admonishes Harvey Weinstein's lawyers by telling them 'nothing you said makes logical sense' as jury...
Another serious offender set FREE: Bronx man, 20, viciously assaults girlfriend and pulls a knife - but is...
Man seeking love on the upcoming series of 90 Day Fiance appears in court accused of attacking his former...
A Chinese engineer reveals how he grew the FIRST EVER plant on the MOON using a mini-biosphere, which kept...
Fox News' Bill Hemmer signs off from the morning show he co-anchored for 12 years to take over Trump critic...
Prosecutors drop manslaughter charge against 'drunk driver' who smashed into elderly man's car because...
EXCLUSIVE: Looking great at 98! Beloved 'Golden Girl' Betty White is all smiles as she steps out in a bright turquoise ensemble to celebrate the nonagenarian's birthday
Horrifying moment Yellow Wiggle Greg Page, 48, collapses and goes into cardiac arrest on stage at a bushfire relief concert - before paramedics desperately battle to save him with CPR
What did I do last night? Hilarious moment a confused cat wakes up being snuggled by a huge golden retriever
EXCLUSIVE: Meghan Markle never actually stepped foot into Canada women's center but she met with staffers at the organization's office to give her 'support' instead
Teacher of the Year who skipped her White House award ceremony in 2019 kneels during anthem at NCAA game attended by Trump in support of Colin Kaepernick
Happy birthday Michelle Obama, I've canceled your school lunches! Donald Trump's administration lets schools cut back on fruit and veg and sell MORE pizza and burgers - and serve fries every day
Meghan's body coach arrives in Canada: How LA-based Pilates guru pal Heather Dorak is key part of Duchess's inner circle that is rallying round her as she begins her life after Megxit
'Take off that legal note... I'm not interested!' Megan McCain explodes at producer on The View for displaying a correction after the host said Michael Avenatti 'is going to jail' when he's actually being held on remand
'Are you kidding me?' Monica Lewinsky's shock after it's revealed Jeffrey Epstein and OJ attorney Alan Dershowitz and Bill Clinton's nemesis Ken Starr will both defend Trump at impeachment trial
Tim Tebow, 32, admits he says 'Yes, babe' to all wedding planning ideas from his Miss Universe fiancée, 24, as the pair prepares to tie the knot - and reveals their very long gift registry
'I wouldn't go to war with you people. You're dopes and babies!' How Donald Trump insulted the military's most senior officers as 'losers' prompting Rex Tillerson to call him a 'f***ing moron' is revealed in new book
Fury as groom who offered underage waitress $100 for sex and then exposed himself to her in bathroom at his own wedding only gets probation - as his wife stands by him
He must be on a FAT-wa: Obese ISIS religious leader is arrested in Iraq and is so heavy he has to be loaded onto back of truck
Twitter goes into frenzy as Gymshark celebrity influencers' exclusive fitness plans and entire recipe books by Chrissy Teigen and Gordon Ramsay are published online for FREE
Deaf man sues Pornhub for disability discrimination claiming its videos don't have subtitles - even after he purchased a premium subscription
We will acquit him in a WEEK - and we will get Democrats to join us. Lindsey Graham predicts outcome of Donald Trump's impeachment trial hours after being sworn in to deliver 'impartial' justice
EXCLUSIVE: Heartbreaking album pictures of the 'happy' and 'put together' Disney town family murdered by their heavily indebted father - as neighbors insist 'there were no red flags'
Harry and Meghan's hideaway, the Kremlin-linked tech tycoon and a web of intrigue: Tantalising questions about billionaire Yuri Milner who met the prince at elite 'Google Camp' last summer
'Having the best day of my life drinking all these leftist tears': Actor Laurence Fox taunts trolls after he was branded a 'white privileged male' during Meghan Markle racism row on Question Time
The nightmare parking clamp coming to a lot near you: The 'Barnacle' suctions on to car windshield and blocks a driver's view until fines up to $900 are paid
Furious passengers demand to know WHY they were left stranded for hours after RAF caused chaos by ordering air traffic control to shutdown Heathrow airspace
Troubled past of physical therapist who killed his wife, three kids and family dog in Disney town: His father hired hitman to shoot his mother who ended up with bullet lodged in her skull for 40 years


text:
Upstate doctors seeing increase in child COVID patients
by: Alessandra Young
GREENVILLE, S.C. (WSPA) – Doctors in the Upstate are saying they're seeing an increase in children with COVID.
Dr. Christian Montagano with EmergencyMD said in the past two weeks, they've seen a 60-70% positivity rate on COVID tests for both adults and children.
"We've had a lot of COVID positive children that have come in there. The only thing that I can say is a benefit, I think we've had minimal that we've had to send to the hospital for admission. Even though our numbers are way up," said Dr. Montagano.
He says a lot more children are coming through their doors, especially, at their Boiling Springs location.
Biden sending millions more COVID tests to schools to keep them open
"I don't think it's just limited to schools, and children in schools, I think it's across the board. I think this variant is just a super contagious variant," he said.
Dr. Montagano said the good news is the symptoms aren't as bad with Omicron as they were with the Delta variant.
"Anything from a runny nose, a cough, to a fever and sore throat to an occasional headache and some abdominal discomfort. It's kinda been all ranges, but for the most part, it's been on the milder side of symptoms," said Dr. Montagano.
If your child is experiencing symptoms, he said it's best to keep them away from others.
"It would be wise to take them out and get them tested and keep them at home until you get a positive or negative test result. Rather than send them to school and subject everyone there to possible COVID infection," he said.
It's not just the doctor's offices that are feeling the impacts of increasing children COVID cases.
"It is incredibly stressful, especially as a working parent, as a single parent," said Yuvia Florez, parent.
Yuvia Florez kept her daughter home from school when the 6-year-old was running a fever.
"With her and her asthma and her symptoms I'm just like we're not going to send her to school and make it worse," said Florez.
She agrees that sick kids should stay at home.
"I would hate if someone did that to my child, so I don't do that with mine," she said.
Dr. Montagano said that if you, or your child, tests positive, he recommends staying at home for 5-7 days since the symptoms started. He also recommends anyone who is old enough should get their vaccine.
If you are looking for a testing location, click here.
13-year-old injured in Savannah shooting
Vehicle crashes into Bay Street building
Winter Weather Advisory issued for the Lowcountry & Coastal Empire


The other day we were watching a stunning concept iOS 7 to quickly control settings , added some widgets to multitasking comfortable to control WiFi, Bluetooth, 3G, etc.. jailbreak hopefully someday bring us something, because it seems that Apple never will. Meanwhile we will continue to review the daily news Cydia, today I show you something simple and very useful.
DismissMyKeyboard is a modification that allows us to hide the keyboard of the iPhone in the applications that use it, in some applications you can slide the screen to the keyboard is hidden, other simply touch the screen, and other directly is impossible to hide. Sometimes we see something that's on the screen, or read without swiping the screen repeatedly, and the keyboard that hinders us a bit. With DismissMyKeyboard only have to slide your finger across the space bar at the bottom of the keyboard so that your keyboard is hidden completely. A quick and simple gesture that will make comfortable reading on the iPhone, WhatsApp write, etc..
Article DismissMyKeyboard: easily hide the keyboard (Cydia) was originally published in News iPhone .


text:
package org.mockito.internal.junit;

import static org.assertj.core.api.Assertions.assertThat;
import static org.junit.Assert.assertEquals;
import static org.mockito.internal.stubbing.answers.DoesNothing.doesNothing;

import java.util.Arrays;
import java.util.Collections;

import org.junit.Test;
import org.mockito.internal.invocation.InvocationBuilder;
import org.mockito.internal.stubbing.StubbedInvocationMatcher;
import org.mockito.internal.util.SimpleMockitoLogger;
import org.mockito.stubbing.Stubbing;
import org.mockitoutil.TestBase;

public class UnusedStubbingsTest extends TestBase {

    private SimpleMockitoLogger logger = new SimpleMockitoLogger();

    @Test
    public void no_unused_stubbings() throws Exception {
        // given
        UnusedStubbings stubbings = new UnusedStubbings(Collections.<Stubbing>emptyList());

        // when
        stubbings.format("MyTest.myTestMethod", logger);

        // then
        assertEquals("", logger.getLoggedInfo());
    }

    @Test
    public void unused_stubbings() throws Exception {
        // given
        UnusedStubbings stubbings =
                new UnusedStubbings(
                        Arrays.asList(
                                new StubbedInvocationMatcher(
                                        doesNothing(),
                                        new InvocationBuilder().toInvocationMatcher(),
                                        null),
                                new StubbedInvocationMatcher(
                                        doesNothing(),
                                        new InvocationBuilder().toInvocationMatcher(),
                                        null)));

        // when
        stubbings.format("MyTest.myTestMethod", logger);

        // then
        assertThat(filterLineNo(logger.getLoggedInfo()))
                .isIn(
                        "[MockitoHint] MyTest.myTestMethod (see javadoc for MockitoHint):\n"
                                + // Java <9
                                "[MockitoHint] 1. Unused -> at sun.reflect.NativeMethodAccessorImpl.invoke0(Native Method)\n"
                                + "[MockitoHint] 2. Unused -> at sun.reflect.NativeMethodAccessorImpl.invoke0(Native Method)\n",
                        "[MockitoHint] MyTest.myTestMethod (see javadoc for MockitoHint):\n"
                                + // Java 9
                                "[MockitoHint] 1. Unused -> at java.base/jdk.internal.reflect.NativeMethodAccessorImpl.invoke0(Native Method)\n"
                                + "[MockitoHint] 2. Unused -> at java.base/jdk.internal.reflect.NativeMethodAccessorImpl.invoke0(Native Method)\n");
    }
}

redpajama_set_name: RedPajamaGithub


How to Avoid Three Mistakes When Filing An Auto Accident Claim - Do You Qualify for Social Security Disability?
An automobile accident is never an easy thing to deal with, especially if there are injuries or damage to property. Throw in complex legal proceedings in the mix, and it can be an incredibly stressful time. Since filing an auto accident claim is something most people never deal with, it can be a confusing process. Fortunately though, plenty of people have been down this road before you, and you can learn from their mistakes. Here's a look at some of the biggest mistakes people make when filing an auto accident claim, and how you can avoid them.
Once your claim is submitted, the insurance company will look over what you've sent, and make an offer. Here's the thing, though - that's almost always an initial offer. Typically, this first offer is lower that what you'd expect. Many people though, just assume that that's "how these companies are," and agree to that compensation. But you can almost always get more. If the first offer is too low, draft a letter explaining why that amount isn't agreeable. Remind the company of your documentation, and submit a counter offer. The insurance company will make a second offer, and you can negotiate until you're satisfied.
In any sort of legal proceedings, paperwork is important. An automobile accident case is no different. To increase your chances of a successful claim, make sure you have all of your documentation in one place. This includes police reports, written accounts of your story (along with any witnesses that saw what happened), photos of the scene, and any medical records or bills. Not having your evidence together can doom your case more quickly than anything else, leaving you with a small settlement or even none at all.
Mistake #3: Not Being Aware of the Compensation You Can Seek An auto accident claim isn't just limited to your health or your vehicle. You can also seek compensation for personal property that was in your car, like a laptop or cell phone or property that was attached to your car, like luggage on top or a bike on a rack. If you have any out of pocket expenses, like a taxi to get home after the accident, or a rental car to last until you get a new one, you can seek compensation for those as well.
But even if you avoid these three mistakes, the process of filing a claim can still be confusing. Oftentimes, it's best to just trust the professionals. They've likely dealt with hundreds of cases similar to yours, and they know how to come to a quick resolution. When you can take the stress off of yourself, and increase your chances of a successful settlement in the process, there's no reason not to let an auto accident attorney handle your case.


text:
'Piggy Back Ride' Polar Bear with Cub
This adorable polar bear cub clings to his mother's back for the ride of his life. Expertly detailed and hand-painted. A beautiful depicti...
Battle of Britain Silver Collection
We've had the good fortune to discover a small hoard of genuine 50% silver coin issues minted the same year as the great triumph in our sk...
Billy Goats Gruff by Charlie Bears
Charlie Morris loves fairy tales, and one of her favourites is the story of the Three Billy Goats Gruff. So much so, in fact, that she was...
Lucky Four Leaf Clover Pendant
Gorgeous green enamelling and rich, sparkling marcasite stones have been used to re-create a renowned symbol of good luck. This superbly cra...
Tom Kitten by Steiff
Naughty little Tom Kitten! His mother dressed him in his best clothes to impress the 'fine' company she was ex...
Home / Coins / Victoria 200 / The Gold Sovereigns of Queen Victoria
The Gold Sovereigns of Queen Victoria
Code: QVS
A complete set of all four sovereigns from Queen Victoria's reign, presented in a wooden display!
£475.00 per coin
(Plus free postage & handling per coin).
One coin will be sent to you every two months, payable in two monthly instalments of £237.50.
Queen Victoria ruled over the most powerful Empire the world has ever seen. During her reign Britain was the world's foremost global power and trading nation. As Britain's influence and prosperity grew, so did the need for the gold sovereign. Its use spread to almost every country in the globe and soon became known as 'The Chief Coin of the World'.
This collection comprises four historic gold sovereigns minted in the Victorian era and includes the three different portraits of the Queen:
the Young Head that was used for the first 50 years of the Queen's reign,
the Jubilee Head portrait that was issued to commemorate the Golden Jubilee in 1887,
the Veiled Head portrait that would be the final portrait of Her Majesty.
The collection also includes both designs that appeared on the sovereign's reverse:
the crowned shield and laurel wreath that was struck on the early coins,
the now-famous portrayal of St. George and the Dragon by Italian sculptor, Benedetto Pistrucci.
The 22-carat gold sovereigns are remarkably well preserved and are presented in fine circulated condition or better. They are protectively encased in durable, crystal-clear cases for easy viewing of both front and back.
The custom-crafted wooden Display Chest with gleaming golden hardware, and a lock and key will be sent early in your collection – at no additional charge!
Each coin is 22.05mm in diameter. Display measures 7¾" x 5½" x 1¾".
The Definitive Edward VII Collection
Queen Victoria Gold Half-Sovereigns
The Queen's Beasts Silver Bullion Collectio...
The Relief of Mafeking
The Georgian Silver Shillings


Whether you're looking for Granny Flats as a housing option for an older relative, as a way to give your teenagers some space, or simply as a get-away retreat or studio for yourself, All Granny Flats has the ideal Granny Flat for you.
All Granny Flats can supply you with a Granny Flat Kit if you wish to owner-build. Or you may choose to invest in a Granny Flat Package and have everything taken care of for you.
Please feel free to browse our range of Granny Flats or chat with one of our friendly team members today on 0408 652 261.


Everything was crystal clear. Driver was doing as we told him. Excellent customer service Congratulations on your efficiency.
I booked this company online not knowing what to expect. Their service really impressed me. Driver were on time and car was cleaned. We had a last minute itinerary change and they were able to pick us up with less than 20 hours notice. I am impressed and will highly recommend this company.
As always a great service, have used before and asked for Bill a super nice driver who made me feel safe and secure. Car is in excellent condition and Lakes supplied me with his mobile number for that added security measure.