Singapore has a health system widely considered by many conservatives as vastly superior to that of America's. So what makes this healthcare system different than America's, and how did the government of Singapore get this system to work? These questions should become clear at the end of this post.
Singapore's healthcare system is vastly different from our own. The first major difference is that it is far more regulated than America's current system. To say that the government has some control over the market at all levels of healthcare is an understatement. The Ministry of Health has the ability to set provider service fees, cost control, service planning and a list of other regulatory machinations to control the quality of services rendered at hospitals and other institutions. The system focuses on utilizing a number of different stop gap measures to help the poor, sick and the elderly such as MediSave, MediShield and Medifund. While many similar systems exist in the American healthcare system, the fact that the government can also control costs and financing has little to no equal in the American healthcare system. U.S. Medicare and Medicaid do have measures that allow the federal government to set the maximum amount that they will spend on patients. This owes itself to some cost control as all hospitals have to take these patients. However, the existence of insurance companies throws off this rate control by giving more basic healthcare practices the ability to deny Medicaid and Medicare recipients and take patience with private insurance companies that pay more money. In Singapore, most hospitals in Singapore are connected to the government via heavy subsidizing and have not choice but to conform to the rules of the government.
The 1993 White Paper generated by the government of Singapore gave a set of criteria upon which the government would aim to give Singaporeans excellent healthcare. In it five major fundamentals were stated: promoting good health, personal responsibility over reliance on welfare or medical insurance, providing good and affordable basic medical services to all Singaporeans, reliance on free market competition to raise efficiency and finally intervention whenever necessary to keep healthcare costs down. That brings us to the second question - why do some conservatives think the system better than America's?
One thing that has become abundantly clear is that the free market economy, much like nature, does not care whether you live or die. That being the case, it is in everyone's best interest to ensure proper government regulation in the healthcare system. Singapore has pushed a system that has a large amount of government regulation in it. The tantalizing portions of this system, however, are that it pushes people to be more responsible, reduces third party interventions into an individual's healthcare, and yields overall more efficient healthcare. Personally, I feel that there are many aspects of Singapore's healthcare system that could be imported into America. There is a good case for changing the face of healthcare to be more similar to Singapore's model. The problem is that in changing America's healthcare model a voluminous bill would have to be created in order to work stop-gap measures keeping individual from dying during the interim.
So what is single payer health care? According to Merriam Webster's dictionary single payer healthcare is defined as "of, relating to, or being a system in which healthcare-providers are paid for their services by the government rather than by private insurers". Is this an accurate statement? I will now explain what a single-payer is, the strengths that it creates, and the limitations towards fixing healthcare that come from it.
To begin with, is the definition of single payer healthcare, as given by Merriam Webster's dictionary, correct? The answer is complex, but best summarized as, not exactly. Single-payer healthcare is generally simplified to having the government pay for everything. For this reason, single payer healthcare can be said to be a subset or even a step towards socialized medicine wherein the government owns healthcare facilities and pays the medical personnel. It is, however, possible to have a single-payer system that is run by the government. The reason why anyone talking about healthcare system models needs to know this is that, many healthcare systems espoused by the left as perfect examples of nationalized single-payer healthcare are more accurately stated as universal government-guided healthcare systems (UGGHS). The difference between these systems is that single payer healthcare has its strengths in reducing administrative costs and thus creating a more efficient system. Universal government-guided healthcare, on the other hand, is any system where the government works to set prices for medical expenditures in a nation. In this model, the government has far more control and thus can achieve more cost saving measures than simple administrative costs. It should be noted that while UGGHS and single-payer can go together, they do not have to.
As stated previously, the greatest strength of single-payer healthcare is savings on administrative costs. Right now, the U.S. healthcare system is a series of many different insurance companies that pay what they want and have their own set of paperwork associated with it. This leads to tremendous problems as currently doctors are spending around half of their time on paperwork. Considering that this time spent on paperwork excludes time spent examining patients, it is not too much of an exaggeration to say that paperwork is literally affecting patient's health. With this in mind, reducing administrative costs is a strength that single-payer healthcare can fix. More importantly, it could even lead to overall better healthcare by giving medical doctors more time for individual patients and more time to take patients overall. If such is the case, single-payer healthcare could revolutionize medicine for the better.
So then what are the limitations of this new system? Firstly, the most important benefit of changing to a single-payer system, better healthcare overall, is not a guarantee but a hypothesis. In reality, it is not uncommon for single-payer healthcare to begin leading to increased wait times in nations that have made their healthcare more socialistic in this manner. Second, the biggest benefits of single-payer healthcare tend to run more in line with the UGGHS model stated earlier. This means that even as healthcare costs would be changed, they would not be made cheaper since a single-payer healthcare system without an UGGHS will not necessarily control costs. In the long-run, the worst case scenario is that healthcare becomes more expensive, and less capable of ensuring health benefits to people who most need them.
Ultimately the American healthcare system is a complex web of priorities, incentives and duties that ultimately lead to an individual receiving treatment. Many different entities can play a part to helping an individual receive healthcare. My opinion is that some sort of nationalized government-guided healthcare system is necessary in some way shape or form for cost control purposes. This stems from the fact that countries like Germany and Finland use UGGHS, in addition to other factors, to help make healthcare simpler and more affordable. At the same time, one cannot deny that having the federal government intrude too much in areas of healthcare has the potential for more harm than good. So while I personally have been convinced that single-payer models have strengths that need to be examined more closely, I also think that the government's role in healthcare needs to be better established. Not for what it should do, but for what it should not.
The Trump administration began with the bold declaration to end the Affordable Care Act (ACA). As time has passed, this has proven more difficult than the president originally planned. The problem has become that the lack of clarity upon what will happen as health insurance is reworked. This uncertainty has led to insurance companies losing their desire to stay in the ACA market places. Already, the ACA has resulted in one insurance company, Humana, suffering from particularly difficult losses and quitting the market place. With even more questions about the future of healthcare laws, it stands to reason that more health insurance agencies will follow. For this reason, the Trump administration has decided to make interim rule changes to increase the solvency of the program until the new program has been created. In short, these changes are three-fold: first narrowing the enrollment window, second expanding the definition of silver-care plans and lastly giving more time for insurers to create plans for 2018. My goal in this post will be to assess how it will affect insurers, the public and add a bit more context to the problems associated with repeal that have occurred.
Moral hazard is when one party partakes in behavior that can negatively impact another party. For health insurers under the ACA, this is when individuals opt to join an insurance company only upon realization that they were sick. This behavior should theoretically have trade-offs. The fact that adverse selection for pre-existing conditions can no longer occur removes the major incentive against such actions. Thus, it is wiser to not sign up for healthcare until it is necessary. The problem that such waiting causes is that insurance is based on a sick-healthy ratio, and additions of sudden sickly individuals would decrease the profits that they had projected to earn. By narrowing the time frame associated with late-term insurance enrollment, the ability of insurers to ensure profits intrinsically rises. The fallout of this change, however, is that it may lower the amount of young people who can get insurance in the first place. The people most likely to enroll at the last minute are the young. These are individuals who are most needed for insurance companies to thrive. In this way, the new regulations are a double-edged sword. By eliminating the younger, more beneficial aspect of the ratio, Trump's Health and Human Services department (HHS), has made it such that the potential to end up with a more sickly pool of people for insurance companies is higher. If this were to occur, it would back-fire in its implementation yielding a more unstable market for insurance companies.
Under the ACA, the insurance market has various tiers for the health care plans. They are summarized in descending order of value as platinum, gold, silver and bronze. Under the current regulations, silver plans have an actuarial value (AV) of 70%. By this it is meant that if an individual from a standard population needed healthcare, 70% of their healthcare expenses could reasonably be expected to be covered. In implementation, a range variance exists allowing for +2 points of coverage meaning insurance companies actually pay between 68-72% of costs. The change the Trump administration hopes to put into effect would allow a lower minimum value. Under the new regulations, the variance range would become -4/+2. By increasing the variance, a silver plan could now have an AV of 66% instead of the current 68%. This would greatly increase the number of plans an insurance company could create. However, it would also lower the value of the plans in question. So while insurance companies would definitively benefit from this change, for the consumer, it is a mixed blessing. By increasing the burden on individuals, a stronger argument could easily be made for a health reform bill to replace the ACA. However, it would also go counter to the desires of the constituents who voted for President Trump. Interestingly enough, the change to AV values will have far broader implications than one might initially think. This owes to the way that tax credit costs are currently calculated. Since tax credit costs are based on Silver plan values, tax credits given by the government would be directly impacted by these changes. The tax credit value, known as the "benchmark", is based on the second lowest value silver plan in an individual's area. The amount of tax credit for an individual could be as low as 66% of the cost rather than present minimum of 68%. Since the tax credit would be lower, it can then be safely assumed that some individuals may not be able to afford the more expensive plans. Thus, insurance companies may see a decrease in enrollment.
The new administrations is realizing that creating a new healthcare law is more difficult than originally believed. This owes to the fact that the ACA may have many problems, but has done a large amount of good for the nation as a whole. If nothing else, the number of uninsured Americans has dropped substantially thanks to the law. The general anger from Trump supporters about the healthcare law seems focused on its limitations and the lack of value from the law. This makes it far more problematic to create a new healthcare law when all current plans are similar to Rand Paul's replacement bill, see here or Tom Price's plan see here. The part of the ACA most often cited as problematic is the individual mandate. Some have criticized it as "un-American". This stems from the fact that it is the federal government forcing individuals to buy insurance. The problem is that removing the mandate would only serve to destabilize the insurance market. Insurance companies would constantly raise rates in an attempt to make-up for the losses. Eventually, insurance might become virtually unfeasible for the American population. At this point everyone loses health insurance. At the same time, the world is not stopping for the Republican Party to make a better law. So by expanding the time before insurance companies must give a decision about staying in the market place, the Trump administration hopes that it will be able to alleviate the short term problems while a much better long-term alternative takes shape.
Ultimately, the ACA is a bill that has proven a transformative bill for American healthcare. While certain specifics, like the individual mandate, are not well received, the bill has had success in getting more people health insurance. There is a good case to be made that the Trump administration's changes to the health law could help stabilize the market. The problem is that the basis for that argument is also the basis of the reverse effect happening, making the situation worse. Allowing for worse overall healthcare for some as a trade-off to stabilize the market can easily be made thanks to the steadily more plausible idea of a death spiral. At the same time, putting the burden on the most susceptible Americans will strike a nerve with many who fight for the voices of the poor.
My opinion is that, reluctantly, the changes could yield a net good for the nation. By this I do not mean that all the changes are for the best, just that there is enough well thought out logic to see why the Trump administration is making these particular changes. However, the ultimate problem is that so long as questions about a new healthcare system remain in the balance, these temporary patches will only serve as the equivalence of tying a tourniquet to a man bleeding to death; a temporary fix without much value if proper treatment is not issued as soon as possible.
21st Century Cures Act – Promises or Problematic?
Late last year a new healthcare act was passed. The 21st Century Cures Act has been lauded by many on both sides as a compromise that would help many sick individuals. The 21st Century Cures Act promised to bolster new cures and create faster regulatory processes that would help the nation get promising innovative cures to those who need them. The basis of these claims is that the nation's current set-up slows down innovation by asking for randomized control trials (RCTs) and spending too little on finding new cures. While these claims seem true on the surface, many criticize the new healthcare act for its incentives for pharmaceutical companies. Personally, I have a saying that goes "A good compromise will probably leave both sides unhappy." So when an act passes with as much praise and speed as the new act did, I cannot help but wonder if the disadvantages would outweigh the advantages. For this reason, I will analyze the act's contents to determine strengths and weaknesses of the act, then make an informed conclusion as to whether it is a net positive or negative.
The positives of the 21st Century Cures Act are numerous. The biggest benefit for society would have to be funding for the National Institute of Health (NIH). The NIH is an invaluable part of research funding in the nation. Since the NIH does a large portion of its research through grants, organizations can more efficiently allocate money given to them in ways that benefit their research. That established, the new act has secured over 4 billion dollars for the NIH over the next 10 years. The NIH is probably the single greatest driver of innovation owing to the intrinsic costs of pathophysiologic research. The fact is that pharmaceutical companies can make no guarantee that the research to discover the pathophysiology of a disease will yield them any wealth. It is actually a well-known fact that as much as $3 billion can be invested in new drug discovery research and no new drug may be approved by the Federal Drug Administration (FDA). This is because the complexities of biology prevent researchers from always knowing the effect of changes they make. In essence, intended benefits and side-effects generally do not yield actual benefits and side-effects. So, funding the NIH to do the burden of such research frees pharmaceutical companies to aim more money on specific treatments. This will make it cheaper to find cures for disease with few or no treatments and expand the treatments already in existence.
One of the major concessions of the act, from a safety stand point, is that the 21st Century Cures Act has eroded the FDA's strength to determine the value of new cures. The problem with the act comes in the degradation of the data that is being given to the FDA. It is no secret that RCTs are regarded as incredibly valuable data. This owes to the fact that personal experience is subject to many external factors including one's own biology. The bigger issue with the new law and the FDA is "real-world experience." From a scientific standpoint, RCTs are "ideal-world experience". RCT's do not give perfect data of all the flaws of a drug, they set a relatively high bar that allows the FDA to make reasonable assumptions about the safety of a drug. By moving over to "real world experiences", more side-effects could be missed. This is important because many drugs carry risks that are not discovered until years after they have been in the market. Considering that it takes 12 years to get a black box warning on a medication and 5 to get it removed, the negative implications of rapid approval start to become more worrying. Without expediting the process of getting black box warnings added or getting drugs removed from the market, it becomes worrying that many new drugs are being added to the market.
The 21st Century Cures Act's most worrying aspect is that it could lead to many dangerous drugs coming to market, without novel drugs that may help ever seeing the light of day. The FDA was created at a time when dangerous substances with little or no medical value were being peddled as cures. The act could end up creating more overall problems caused by an expansion of medications known as me-too drugs. To be fair, me-too drugs do come with benefits. In the statin class, many me-too drugs currently exist for the sole purpose of competing with other drugs in that class. Because the market, dyslipidemia, is so large even a small percentage can be worth billions over a decade. If one can make an improvement in this class then the benefits are net positive. Me-too drugs can also increase economic output via creating a need for advertising, production and other media. Another noteworthy advantage is that it could lead to drugs that are not as potent as a competitor getting priced more cheaply to undercut the competition. The problem is that, it could also jeopardize patient safety by adding many new drugs with too little information on them. The lack of information could lead to inappropriate use creating harm or death. For example, 81 mg aspirin is no longer sold under the therapeutic label of "baby aspirin". This is because it was noted that 81 mg aspirin could cause Reye's syndrome in children with viral infections. Adults are not subject to this same deadly adverse effect, and with the existence of other drugs such as ibuprofen or acetaminophen, it was decided that aspirin would no longer be used in children. Since even well-known drugs can have interactions that are not well known for years, adding more medications with less data could have effects that will not bode well in time for society. While adding new classes of drugs can hold many of the same negatives, it also gives a unique form of treatment. In the long run, new drug classes could potentially be used in conjunction with existing therapy. In this way, the funding for new drugs comes off as dubious.
In summation, while the 21st Century Cures Act was a well-intentioned idea, its overall likelihood for net negative healthcare is high. The positives are noteworthy. We will see more drugs enter the market. This will almost assuredly increase the number of jobs and boost the economy in general. New cures will help patients and lead to instances of better outcomes. At the same time a rational person can look at the situation and say that the possibility for negatives does exist. Adding 1 or two more high intensity statins could help the healthcare industry, but if a patient is statin intolerant then 20 new cure does not help. Also, those who are already doing well on a statin but might need an additional medication will not benefit from this new act. Adding more problems is the lack of data that is compounding this problem. In the healthcare industry, mistakes can be life altering or threatening. Adding more potential cures without sufficient data to assess them is not a good idea. In this respect, the 21st Century Cures Act is problematic legislation that will not help patient healthcare as much as it was promised to do.
USciences American Society of Consultant Pharmacists chapter volunteered at the Star Harbor Senior Center in March to introduce the Vial of Life program, which encourages individuals to have their complete medical information ready in their home in the event that first responders and emergency medical workers are called. The information would allow them to know about the person's medications, allergies, and illnesses.
The chapter has had a productive year, expanding opportunities on campus and off in the areas of leadership service, inter-professional education, working toward our mission for seniors' medication safety, and networking.
In April 2016, PCP ASCP members joined a regional planning team with student and pharmacist members of Pennsylvania and Maryland ASCP chapters to plan the student track for the Mid-Atlantic ASCP Annual Conference held in August 2016. In addition to planning, five PCP students attended this regional event in Alexandria, VA.
In the fall, the chapter raised funds for the Alzheimer's Association and participated in the Walk to End Alzheimer's at Citizens Bank Park.
Fall was also the kickoff for the First Annual Geriatrics Day on University of the Sciences campus. This event took place during the National Week of Fall Prevention (coinciding with the start of Fall) and was an interactive, fun and educational event for the whole campus and local community. ASCP students prepared baskets of questions related to both fall prevention and geriatric cognitive impairment.
The chapter members also volunteered at the Stone Harbor Senior Center for Medication Education Day, sponsoring pharmacy bingo and providing additional activities related to medication safety, medication adherence, and immunization education.
The students distributed medication list wallet cards, pill boxes, posters, and encouraged patients to sign the pledge to take their meds. They also addressed health-related questions such as OTC recommendations, identified common side effects, counseled on device use such as inhalers, discussed risk vs benefit of adherence to patient's chronic conditions such as hypertension, high cholesterol, diabetes, and asthma.
In total, they were able to get 170 signed pledges, distributed more than 250 wallet cards, and reached about 500 patients. Even after the competition is over, the group will continue outreach efforts to fortify current relationships and build new ones. They will also measure patient impact in West Philadelphia through patient surveys and adherence assessments.
USciences' Community and Government Affairs, Philadelphia College of Pharmacy, Mayes College of Healthcare Business and Policy, and the Exercise and Wellness Management Program were all involved in The Healthier You Conference 2016 held in South Philadelphia on October 8. The event attracted hundreds of adults from the region for a day of fun activities to promote healthy living.
Event founder, Kristin Motley, PCP Field Supervisor and Compliance Coordinator, started the conference two years ago to encourage adults to make small changes in their lives now so they can avoid preventable health conditions like heart disease, diabetes, and certain types of cancer. Nidhi Bagga set the tone for the day by leading a Morning Meditation and Yoga class. Heidi Freeman facilitated an interactive mindfulness workshop, while PCP students, Lauren Farmer, Swara Kasbekar, and Amit Gupta hosted information tables on healthy eating, stress management, and smoking cessation. Elizabeth Greene and Andrew Mina from the USciences CPR Team was on hand to give live CPR demonstrations. Allen Choi, Shon Mathew, Christopher Geraci, and Anu Kurria, pharmaceutical and healthcare business majors, were conference interns and worked with the Executive Board to plan and promote the conference.
The 2nd annual American Society for Brewing Chemists (ASBC) LABS Workshop in Philadelphia was held on Friday, March 10th at the University of the Sciences. The USciences Brewing Science program opened their teaching laboratories for a hands-on lab in brewing microbiology. Participants practiced ASBC methods for microbiology by evaluating a yeast slurry for potential spoilers. Activities included microscopy, differential media, and bacteria ID methods. Volunteer Lab Leaders from breweries and USciences instructed the attendees.
Lia Vas, professor of mathematics, was invited to give presentations at several prestigious Australian universities during her sabbatical leave at Western Sydney University.
PCP received notice from Accreditation Council for Pharmacy Education (ACPE) Continuing Education (CE) Commission that the Continuing Pharmacy Education Program was granted accreditation until January 31, 2022.
The ASHP Foundation awarded the Philadelphia College of Pharmacy- University of the Sciences a $25,000 Pharmacy Residency Expansion Grant. This grant will support the PGY2 Critical Care Residency Program offered in conjunction with Cooper University Hospital. The goal of this grant program is to expand the number of ASHP-accredited residency positions.
Yardlee Kauffman PharmD, Assistant Professor of Pharmacy, was recently appointed to the PPA Editorial Board and acknowledged as an Adjunct Fellow with the Penn Center for Public Health. Kauffman also recently published an article about metabolic monitoring of second-generation antipsychotics.
Dan Hussar PharmD spoke on the topic, "New Drugs of 2016," at the Mid-Winter Conference of the Connecticut Pharmacists Association on February 2 in Southington, CT. He and P4 student William Tidwell coauthored a paper, "New Drugs: Elbasvir/grazoprevir, Velpatasvir/sofosbuvir, and Eteplirsen," that was published in the January/February issue of the Journal of the American Pharmacists Association.
Diana Solomon (Class of 2016) was recognized as the A.S.P.E.N. New Practitioner Award recipient for the Pharmacy Practice Section.
Chris Dorian, P2, reported: PCPediatrics & PCP-SSHP recently collaborated to put on a Pediatric Pharmacy Roundtable event which was a huge success! Almost 100 PCP students met with 13 pharmacists in health-system pediatrics and it was a huge success!
Eric Simpson PharmD'19, Operation Heart Patient Care Coordinator, worked with other Philadelphia College of Pharmacy student members to promote "Valentines for Heart Patients." This was designed to promote the American Heart Association campaign – February is Heart Month. The volunteers set up in the STC atrium and invited students and faculty to sign a valentine card and add their personal message.
The PCP students who volunteered are Monica Nguyen, ( NJPhA Coordinator); Anisha Benny, Telvin Mannat, Kevin Pak, Nina Vo, Bethina Escala.
Sixty cards were delivered to the Center for Advanced Heart Failure Care at Hahnemann University Hospital. Eric visited the center to hand deliver the valentines cards.
The members of the Center for Advanced Heart Failure Care dressed "red" to promote National Wear Red Day on February 3, 2017. Grace Earl, PharmD participated in the National Wear Red Day, an American Heart Association campaign, to promote women's health. Dr. Earl is a faculty member in the Department of Pharmacy Practice and Administration, PCP, and her practice site is at the Center for Advanced Heart Failure Care at Hahnemann University Hospital.
Philadelphia College of Pharmacy/USciences was well represented at the ASHP Midyear Clinical Meeting in Las Vegas from December 5 to 9, 2016. Ninety-one students were in attendance, mostly to interview for post-graduate pharmaceutical industry fellowship positions with most others pursing PGY1 residency positions including attendance at the residency showcases. There were 30 research posters presented by 45 students with many alums and preceptors visiting the posters. Students presenting posters received a travel stipend funded by alumni donations to the PCP Student Engagement Fund.
Dan Hussar and P4 student Melissa White are coauthors of an article, "New Drugs: Insulin degludec, Lixisenatide, and Patiromer sorbitex calcium," that has been published in the November/December issue of the Journal of the American Pharmacists Association. Dan spoke on the topic, "New Drug Update 2016," at the Annual Meeting of the American Society of Consultant Pharmacists in Dallas on November 6 and in a Grand Rounds presentation at Chambersburg Hospital on November 18. On November 20, he spoke with members of the Delaware County Pharmacists Association on the topic, "The Future of Our Profession."
Islam Ghazi recently published two articles. "Physical compatibility of tedizolid phosphate with selected i.v. drugs during simulated Y-site administration" was published in the American Journal of Health-System Pharmacy and "Treatment of multidrug-resistant Pseudomonas aeruginosa with ceftolozane/tazobactam in a critically ill patient receiving continuous venovenous haemodiafiltration" was published in the International Journal of Antimicrobial Agents.
Zein Al-Atrache PhD'17 gave a talk at the Society for Neuroscience meeting in San Diego on November 12th 2016 entitled "Expression of Amyloidogenic Secretases Implicated in Neurodegeneration is Altered in Astrocytes Following Infection with Chlamydia Pneumoniae." Al-Atrache also presented a poster at the Alzheimer's Association International Conference in July 24th of 2016.
Several USciences students contributed paper sessions for the Eastern Pennsylvania, Delaware, and New Jersey Section of the Mathematical Association of America on November 12, 2016.
Mia Vega, Alyse Parker and Oberon Wackwitz presented on Fibonacci Sequences.
Stephen Seach, Patrick Reagan and Ryan D'Elia presented on The Influence of Artificial Intelligence on Chess.
Aaron Hogan, Colleen Walsh and Rebecca Colandrea presented on The Rubik's Cube.
And Ashley Cai, Nhu Truong and Judy Fang presented about Fractals.
Doctor of Pharmacy students from University of the Sciences – Philadelphia College of Pharmacy (PCP) attended the 146th Annual Meeting & Convention of the New Jersey Pharmacists Association at Harrah's Resort in Atlantic City, New Jersey. A full-day of student events were planned for Saturday, October 29th, 2016. The PCP team came in second place in the Self-Care Competition.
Several USciences members were involved in the programming. Kim Bryant, Director of the USciences Career centered delivered the session on interviewing skills. A number of volunteers led round-table discussions, including Grace Earl, PharmD, Clinical Associate Professor of Pharmacy. Dr. Earl also served as a judge in the Self-Care Competition. Steve Zlotnic, PharmD, delivered a presentation on Biosimilars 2.0, and is an adjunct clinical professor at PCP.
Alumni from the University of the Sciences – Philadelphia College of Pharmacy were presented with awards at the convention awards ceremony. PCP alumnus, Lt. Col. Stephen A. Brickman, RPh, Class of 1963, received the "Bowl of Hygeia Award" for an outstanding record of community service. Stephen was also spotlighted in The New Jersey Journal of Pharmacy in the Community Pharmacist Spotlight (Fall 2015 available at http://njpharmacists.org/resources/journal). He has been involved in disaster management in the New Jersey as a member of the Disaster Medical Assistance team. Another alumnae member, Kristine N Cigna, PharmD, CCP, Class of 2010, received the "Pharmacist Mutual Distinguished Young Pharmacist Award." Kristine is employed by the VNA Health Group (Visiting Nurse Association) in New Jersey.
On Thursday, December 1st, students packed into the ARC Rec Gym to speak with several organizations recruiting work-study students at the Work-study Job Fair for off campus positions. Students who qualify for work-study have the opportunity to work at places such as the VA Medical Center and be compensated $11/hr for their time! Organizations in attendance included MANNA (Metropolitan Area Neighborhood Nutrition Alliance), The Food Trust, Mitchell Elementary School, and many more. Co-sponsors for the event, Alpha Delta Theta and Sigma Phi Zeta, provided stockings to be decorated, filled, and donated to the children of St. Christopher's Hospital!
If you are interested in work-study, but aren't sure if you qualify, contact financial aid to find out! If you would like to know more about work-study and the types of positions available, contact Melissa Satchell (m.satchell@usciences.edu).
Grace Earl passed the Board of Pharmacy Specialties examination and is now a Board Certified - Ambulatory Care Pharmacist.
Rachel Boardman and Bailey Colvin, P3 students, within the Longitudinal IPPE program with Cooper Rowan have had their oral presentation submission accepted from the Society of Student-Run Free Clinics Annual Conference in February held Anaheim, Ca. A total of six CMSRU students will also be attending and presenting at this conference a total of 3 oral presentation and 1 poster presentation (see details below).
U.S. Surgeon General Vivek Murthy has released a landmark public health report with a vision for transforming our behavioral health system so that we can adequately treat substance use disorders in America. Coming in the midst of an unprecedented opioid overdose epidemic, the document spells out why federal officials have shifted their approach on drug control policy to a public health approach.
Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health was released on Nov. 17, 2016 with fanfare, during a live-streamed broadcast from the Paramount Studios in California, featuring health agency officials, celebrity speakers, recovery community members, and a question and answer session with researchers (recording available on youtube).
A public health approach to the issue of addiction requires that we integrate substance use disorder services into the "mainstream" health system, a major change after decades of a segregated system of care.
The common belief "that alcohol and drug problems are the product of faulty character or willful rejection of social norms" is wrong, and results in damaging stigma that inhibits people from getting help.
Addiction is a medical disorder, a disease of the brain, that can be successfully treated with a comprehensive approach, just like many other chronic medical conditions.
Prejudice and discrimination have created many of the challenges currently plaguing the substance use disorder treatment field, and nothing short of a culture change will have to happen to transform the system.
1 in 7 people will misuse alcohol and other drugs, and more than 20 million people in the U.S. have a substance use disorder, yet only 1 in 10 are getting treatment.
78 people die every day in the U.S. from an opioid overdose, and those numbers have nearly quadrupled since 1999.
About 25 million people are in successful recovery. Research indicates that approximately 50 percent of adults who once met diagnostic criteria for a substance use disorder are now in stable remission (1 year or longer). Even so, remission from a substance use disorder can take several years and multiple episodes of treatment, along with recovery support services, and/or mutual aid (participation in 12 step-type groups).
Health policy experts, the media, and Dr Murthy himself are making comparisons between this report, and a previous milestone in public health, the 1964 Surgeon General's Report on Smoking and Health, released by Surgeon General Dr. Luther Terry. That groundbreaking effort was the first federal government report to connect smoking with lung cancer, heart disease, and other detrimental health effects, at a time when years of tobacco marketing had positioned smoking as a safe, socially attractive, and even healthful. It spearheaded 50 years of tobacco control efforts that have positively improved the public health.
Like hypertension or diabetes, substance disorders can and should be addressed before they reach the crisis stage. The widely held stereotype that people need to "hit bottom" before they can begin effective treatment is wrong and dangerous.
The Facing Addiction report is broken into sections that can be downloaded individually, including an executive summary, fact sheets and key findings, plus many supplemental materials. A printed copy of the full report can be ordered for free.
Adolescent misuse is a risk factor for developing a severe use disorder, underscoring the need for prevention efforts, as well as early treatment.
Changes in specific brain circuits impact decision making, self-control, and other aspects of brain function in ways that are persistent and long-lasting, after prolonged substance use.
The brain can also take a long time to return to health, one reason why relapses are expected in substance disorders. Research in alcohol and other drug use shows it will be 4-5 years before the risk of relapse drops below 15%.
The medical consequences of substance misuse include cardiovascular and cardiopulmonary diseases, liver and pancreatic diseases, stroke, and cancers of the larynx, liver, and colon.
Studies show that every dollar spent on substance use disorder treatment saves $4 in health care costs.
Most existing substance use disorder treatment programs lack the needed training, staffing and infrastructure to provide treatment for co-occurring physical and mental illnesses.
To accomplish this behavioral healthcare transformation, the report notes that the treatment, prevention, and research sectors need appropriate funding. The legislature did not take action last year to fully fund the Obama administration's requested $1 billion, but the "21st Century Cures Act" that just passed this week and is waiting for President Obama's signature, includes substantial new commitments towards the original funding goal.
Has our leadership been slow to address the widely held myths about addiction in America, the disparities in access to behavioral health care, and the need for systemic change? This new report is based on more than two decades of research which is "far more than we knew about the effects of smoking when the first Surgeon General's Report on Smoking and Health was released in 1964.
A decade ago, in 2005, an expert panel convened by the Institute of Medicine called our behavioral healthcare system a "quality chasm" and recommended many of the same policies found in Facing Addiction in America. Still the new Surgeon General's report is intended to be the most prominent, and public effort to date to combat stigma with science, and refute the misconceptions about addiction that are deeply embedded in our culture.
Public policy efforts to update our approach to substance disorder treatment include the 2000 passage of the Drug Addiction Treatment Act (DATA), which changed the Controlled Substances Act to allow physicians to treat opioid use disorder treatment with medications like buprenorphine in medical offices, rather than only in segregated clinics. However, this hasn't increased access to opioid use disorder as much as needed to meet the current demand.
The Facing Addiction in America recommendations align with federal efforts under the Office of National Drug Control's public health-focused 2010 strategy to increase access to medication treatments, behavioral therapies, and recovery supports for substance use disorders. The Affordable Care Act of 2010 and the Mental Health Education and Parity Act of 2008 were significant legislative efforts to reduce inequities in behavioral health care access, although they haven't yet been fully implemented.
Dr Murthy headlined this 2016 report release with the vivid statement that "how we respond to this crisis is a test for America." This report is one of several initiatives at the end of the Obama administration that close out a period of major change in healthcare policy, but lead into an uncertain future.
With an incoming administration that has pledged to repeal the Affordable Care Act, credited for expanding access to substance disorder treatment for 60 million Americans, the future of these new policy recommendations and whether we can address the public health epidemic we are in today will be a test for our new leadership.
Like many medical conditions, how we describe addictive disorders has changed over time. The last version of the behavioral health diagnostic manual (DSM V) changed the previous categories of substance "dependence" and "abuse" to a diagnosis of substance "use disorders" that exist on a continuum from mild to severe. Substances refers both to alcohol and other drugs. Addiction medicine no longer uses the terms "chemical dependency" or alcohol or drug "dependence".
Substance misuse is the use of any substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them.
A substance use disorder is when prolonged, repeated misuse of a substance leads to a medical illness that impairs health and function.
Addiction is the commonly used term for a severe and chronic substance use disorder.
Dorela Prifanji PharmD'17 was recognized with the Student Award from the Pennsylvania Society of Health System Pharmacists. The award is given to a student actively involved in initiatives related to advancing the practice of health system pharmacy.
Lia Vas PhD, professor of mathematics, has been granted sabbatical leave during which she has received approximately seven invitations to present at institutions in Australia, New Zealand, Denmark, and Norway while also collaborating on a research project with Dr. Roozbeh Hazrat of Wester Sydney University in Australia. Dr. Vas said she hopes to increase visibility of research at USciences and foster new projects and future collaborations.
Paula Kramer PhD, OTR/L, FAOTA, director of the post-professional doctor of occupational therapy program, gave the keynote address for the New York State Occupational Therapy Association conference on November 5.
Song Oh and Jun Baek won the SSHP Clinical Skills Competition and will represent the Philadelphia College of Pharmacy at the national competition. The semi-final round will occur on Saturday, December 3, 2016 at the ASHP Midyear Clinical Meeting in Las Vegas, NV.
Students from USciences' Society of Physics Students (SPS) traveled to San Francisco, Calif. in November 2016 for PhysCon, the quadrennial physics conference held by the National Society of Physics Students.
From Left to Right: Caitlyn McConnell, Oberon Wackwitz, Mia Vega, Katee O'Malley, Luke Conover toured San Francisco during PhysCon.
During the trip the group attended the conference, hearing from Dr. S. James Gates, a theoretical physicist known for his work in supersymmetry, who recently won the National Medal of Science for his outstanding contributions to the field of physics, and Nobel Laureate Dr. Eric Cornell. Additionally, the students participated in workshops and presented research.
"It was great to be surrounded by 1,000 physics majors who all have different ambitions within the field," said Katee O'Malley Phys'17.
In addition to O'Malley, Caitlyn McConnell BMS'18, Phys'18, Mia Vega Phys'19, Oberon Wackwitz Phys'17, and Luke Conover Phys'17 attended the conference representing USciences and said that the experience was eye opening and fun.
The students also visited the Stanford Linear Accelerator Center, a two-mile long national accelerator laboratory, which has been integral to many astounding discoveries in physics.
From Left to Right: Mia Vega, Caitlyn McConnell, Oberon Wackwitz, Katee O'Malley, and Luke Conover toured the SLAC laboratory.
Vega, who is unsure about what path she wants to take upon graduation, said the best part was a workshop about the career opportunities for individuals graduating with a bachelor's degree in physics. She said it helped her recognize different job opportunities in industry, higher education, and teaching. Vega presented at the conference on behalf of the group about the outreach that USciecnes' SPS has done to encourage young women to pursue STEM fields.
Before returning to Philadelphia, the group fit in some sightseeing as well, visiting Fisherman's Warf, Pier 39, and the Golden Gate Bridge.
Approximately 200 University of the Sciences students discussed the ramifications of drug and alcohol abuse, noise violations, underage drinking and the use of fake IDs at a meeting with an officer from the Philadelphia Police Department last month hosted by the Office of Student Engagement.
On Wednesday, October 26th, Lt. Derek Hawkins, commanding officer at University City District, spoke to USciences students involved in fraternities and sororities about hot topics that impact college students. Following Lt. Hawkins' presentation, a question and answer session was held giving students the opportunity to ask questions pertaining to the topics discussed.
Each semester, fraternity and sorority life hosts one educational event that is mandatory for 80% of each chapter to attend.


How Do You Design A Free Farrowing System?
Any system designer should ask the questions who are the main users and what are the main functions? The users are effectively the clients and in the case of livestock systems the clients interacting with the system 100% of the time are the animals, the next largest users are the stockworkers.
So a farrowing system should satisfy the "Triangle of Needs" between the sow, her piglets and the stockworkers.
By returning to first principles and asking what the biological needs of the animals are we can determine which design criteria might meet those needs whilst in the framework of a sustainable farming enterprise.
What are the Biological Needs of the Sow?
Sow needs are likely to change throughout the different phases of farrowing namely; Nest-Building, Farrowing, Early Lactation and Late Lactation.
The importance of nest-building is discussed in our Why Free Farrowing pages and our Nest-Building Research pages.
As part of a successful life history strategy the sow also needs her piglets to survive.
What are the Biological Needs of the Piglets?
Essentially what do they need to survive? Much of their fate will be reliant on good maternal behaviour, therefore design criteria that satisfy the sow's biological needs are also linked to the piglets.
What are the Needs of the Stockworker?
Our Specific Pen Features pages have recommendations on design criteria that can help achieve these objectives.
For recommendations on how best to manage sows in free farrowing systems and optimise piglet survival please visit Free Farrowing Husbandry.
We have written an extensive review on design criteria that meet the biological needs of the sows and piglets in alternative farrowing and lactation systems. This paper brings together over 30 years of research in this area by many different research groups. Please visit Baxter et al. or get in touch.


text:
package com.bbva.kltt.apirest.core.parsed_info.paths;

import java.util.ArrayList;
import java.util.HashMap;
import java.util.List;
import java.util.Map;
import java.util.Set;

import com.bbva.kltt.apirest.core.parsed_info.Definitions;
import com.bbva.kltt.apirest.core.parsed_info.Responses;
import com.bbva.kltt.apirest.core.parsed_info.RootValues;
import com.bbva.kltt.apirest.core.parsed_info.Scheme;
import com.bbva.kltt.apirest.core.parsed_info.common.Item;
import com.bbva.kltt.apirest.core.parsed_info.parameters.Parameter;
import com.bbva.kltt.apirest.core.parsed_info.parameters.ParameterBody;
import com.bbva.kltt.apirest.core.parsed_info.parameters.ParametersGlobal;
import com.bbva.kltt.apirest.core.parsed_info.responses.Response;
import com.bbva.kltt.apirest.core.util.mapper.JacksonViews.GeneratorView;
import com.fasterxml.jackson.annotation.JsonIgnore;
import com.fasterxml.jackson.annotation.JsonView;

/**
 * ------------------------------------------------
 * @author Francisco Manuel Benitez Chico
 * ------------------------------------------------
 */
public class Paths
{
	/** Attribute - root values */
	@JsonIgnore
	private final RootValues rootValues ;

	/** Attribute - global definitions */
	@JsonIgnore
	private final Definitions globalDefinitions ;

	/** Attribute - Parameters global */
	@JsonIgnore
	private final ParametersGlobal parametersGlobal ;

	/** Attribute - global responses */
	@JsonIgnore
	private final Responses globalResponses ;

	/** Paths Map */
	@JsonView(GeneratorView.class)
	private final Map<String, Path> pathsMap ;

	/**
	 * Public constructor
	 * @param rootValues		with the rootValues
     * @param globalDefinitions with the global definitions
	 * @param parametersGlobal  with the global parameters
	 * @param globalResponses   with the global responses
	 */
	public Paths(final RootValues rootValues, final Definitions globalDefinitions, final ParametersGlobal parametersGlobal, final Responses globalResponses)
	{
		this.rootValues		   = rootValues ;
		this.globalDefinitions = globalDefinitions ;
		this.parametersGlobal  = parametersGlobal ;
		this.globalResponses   = globalResponses ;

		this.pathsMap 	 	   = new HashMap<String, Path>() ;
	}

	/**
	 * @return the rootValues
	 */
	public RootValues getRootValues()
	{
		return this.rootValues ;
	}

	/**
	 * @return the global definitions
	 */
	public Definitions getGlobalDefinitions()
	{
		return this.globalDefinitions ;
	}

	/**
	 * @return the global parameters
	 */
	public ParametersGlobal getParametersGlobal()
	{
		return this.parametersGlobal ;
	}

	/**
	 * @return the global responses
	 */
	public Responses getGlobalResponses()
	{
		return this.globalResponses ;
	}

	/**
	 * @return the pathsMap
	 */
	public Map<String, Path> getPathsMap()
	{
		return this.pathsMap ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if there is any scheme in the operation
	 */
	public boolean hasAnyScheme(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyScheme(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue     with the path value
	 * @param pathOperation with the path operation
	 * @return the schemes
	 */
	public Set<Scheme> getSchemes(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).getSchemes(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if there is any body parameter in the operation
	 */
	public boolean hasAnyParameterBody(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyParameterBody(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue        with the path value
	 * @param pathOperation    with the path operation
	 * @return a new body parameter
	 */
	public ParameterBody generateParameterBody(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).generateParameterBody(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if there is any formData parameter in the operation
	 */
	public boolean hasAnyParameterFormData(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyParameterFormData(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return a new map with the form data parameters
	 */
	public Map<String, Parameter> generateParametersFormDataMap(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).generateParametersFormDataMap(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if there is any header parameter in the operation
	 */
	public boolean hasAnyParameterHeader(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyParameterHeader(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return a new map with the form data parameters
	 */
	public Map<String, Parameter> generateParametersHeaderMap(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).generateParametersHeaderMap(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if there is any path parameter in the operation
	 */
	public boolean hasAnyParameterPath(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyParameterPath(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return a new map with the path parameters
	 */
	public Map<String, Parameter> generateParametersPathMap(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).generateParametersPathMap(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if there is any query parameter in the operation
	 */
	public boolean hasAnyParameterQuery(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyParameterQuery(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return a new map with the query parameters
	 */
	public Map<String, Parameter> generateParametersQueryMap(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).generateParametersQueryMap(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if there is operation identifier for this path operation
	 */
	public boolean hasAnyOperationId(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyOperationId(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @return all the operation identifiers
	 */
	public List<String> getAllOperationIds()
	{
		final List<String> outcome = new ArrayList<String>() ;

		for (final Path path : this.pathsMap.values())
		{
			outcome.addAll(path.getAllOperationIds()) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return the operation identifier
	 */
	public String getOperationId(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).getOperationId(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return the return item type
	 */
	public Item getOutboundServerItemType(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).getOutboundServerItemType(pathOperation) ;
	}

	/**
	 * @param outcome with the outcome map
	 */
	public void getOutboundServerExceptionsMap(final Map<String, List<Response>> outcome)
	{
		for (final Path path : this.pathsMap.values())
		{
			path.getOutboundServerExceptionsMap(outcome) ;
		}
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return a list with all the custom response exceptions for the path and operation
	 */
	public List<Response> getOutboundServerExceptionsList(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).getOutboundServerExceptionsList(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return a new set with the consumes for this pathValue-pathOperation
	 */
	public Set<String> getConsumes(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).getConsumes(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if exists any consumes for the pathValue-pathOperation
	 */
	public boolean hasAnyOperationConsumes(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyOperationConsumes(pathOperation) ;
		}

		return outcome ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return a new set with the produces for this pathValue-pathOperation
	 */
	public Set<String> getProduces(final String pathValue, final String pathOperation)
	{
		return this.pathsMap.get(pathValue).getProduces(pathOperation) ;
	}

	/**
	 * @param pathValue 	with the path value
	 * @param pathOperation with the path operation
	 * @return true if exists any produces for the pathValue-pathOperation
	 */
	public boolean hasAnyOperationProduces(final String pathValue, final String pathOperation)
	{
		boolean outcome = false ;

		final Path path = this.pathsMap.get(pathValue) ;
		if (path != null)
		{
			outcome = path.hasAnyOperationProduces(pathOperation) ;
		}

		return outcome ;
	}
}

redpajama_set_name: RedPajamaGithub


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A 25kg dog should be fed 2 1/2 - 3 1/2 cups per day.
Lamb meat (30.0%), ground rice (26.0%), rice bran, chicken fat, flaxseed meal, yeast extract, hydrolysed liver, dried kelp, dried carob, herbs (0.06%) (dried fennel, dried fenugreek, dried rosemary), dried ginger, dried turmeric, rosemary extract, yucca schidigera extract.
Lamb meal, ground rice, rice bran, chicken fat (preserved with mixed tocopherols and citric acid), flaxseed meal, yeast culture, liver digest, lecithin, salt, potassium chloride, calcium propionate (preservative), yeast extract, dried kelp, dried ginger, dried carob, dried fennel, dried fenugreek, dried rosemary, dried turmeric, dried cayenne, rosemary extract, yucca schidigera extract, ascorbic acid (vitamin C), iron proteinate, ferrous sulfate, zinc methionine complex, zinc oxide, sodium selenite, vitamin E supplement, vitamin B12 supplement, copper proteinate, copper sulfate, manganese proteinate, manganous oxide, folic acid, niacin, calcium pantothenate, vitamin A acetate, riboflavin, pyridoxine hydrochloride, thiamine mononitrate, biotin, menadione sodium bisulfite complex (source of vitamin K activity), calcium iodate, vitamin D3 supplement.
Cons: Insufficient meat products, use of fillers.
The first ingredient is a named meat product, and the second is a decent quality grain. We note the use of rice bran (filler) as the third ingredient however. If the two rice products were not split (see main page for explanation of "splitting") it is probable that the rice products would outweigh the meat. There are no further quality meat products in the food.
It is a concern to see chicken fat as the fourth (likely third) ingredient. Research at Purdue University has identified a fat in the top four ingredients of a dry dog food as a factor that increases the risk of bloat in large breed dogs. Smaller breeds are untested.
Liver digest is dried material resulting from chemical and/or enzymatic hydrolysis of clean and undecomposed animal tissue. We do not consider this to be a high quality ingredient.


Parrish Family Vineyard has a story that goes back 90 years and 4 generations starting with their grandfather's vision and continuing with innovative David Parrish. He has invented new methods of trellising and genius advancements that improve the quality of grapes, and hence the wines.
The state-of-the art, cool-chic tasting room and winery is stunningly set in their Adelaida Vineyard. There is outdoor and indoor seating (loungy, comfortable seating) all with sweeping views of the vineyards and countryside.
Wine Club members have a special indoor room with a fireplace and outdoor seating on the large veranda.
Cheese pairings, chocolate pairings and charcuterie board is available.
Parrish Family Vineyards is dog-friendly and child-friendly. You are welcome to bring a picnic and enjoy the putting green.


Razor wire barbed tape is a zinc-coated tape, As below picture, thickness 0.55 mm, having a double-edged profile, symmetrical spikes with cutting edges, compression around the galvanized steel wire rope with a diameter of 2.5 mm. Step teeth 36 mm. is used for manufacture of barbed wire concertina, flat safety barrier, mobile barrier and by itself, in the form of thread, as an alternative to the usual barbed wire.
BTO-22 is most commonly used type for domestic (other model can also be customized).
Barbed Tape Concertina (CBT); Barbed Tape Obstacle (BTO) .
Note: standard products styles are shown in the tables above, special specifications are available on request.


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NonProfitFacts.com » California » Hollywood Church Of The Nazarene
Hollywood Church Of The Nazarene in Hollywood, California (CA)
Support Schedule for Organizations Described in Section 509(a)(2)
Organization representatives - add corrected or new information about Hollywood Church Of The Nazarene »
Non-representatives - add comments about Hollywood Church Of The Nazarene»
Hollywood Church Of The Nazarene
Name of Organization Hollywood Church Of The Nazarene
Address PO BOX 906, Hollywood, CA 90078-0906
Activities Church, synagogue, etc
Subsection Religious Organization
Deductibility Contributions are deductible
Foundation Church
Assets $1 to $9,999
Filing Requirement 990 - Not required to file (church)
Asset Amount $3,296
Total revenue $90,131 $56,537 $63,217 $78,524 $68,946 $59,442
Contributions, gifts, grants, and similar amounts received $84,631 $50,437 $55,825 $71,579 $61,079 $51,642
Program service revenue including government fees and contracts $0 $0 $0 $0 $0 $0
Membership dues and assessments $0 $0 $0 $0 $0 $0
Investment income $0 $0 $0 $0 $0 $0
Gain/Loss from sale of assets other than inventory $0 $0 $0 $0 $0 $0
Net income/loss from gaming and fundraising events $0 $0 $0 $0 $0 $0
Gross profit/loss from sales of inventory $0 $0 $0 $0 $0 $0
Other revenue $5,500 $6,100 $7,392 $6,895 $7,867 $7,800
Total expenses $87,008 $60,998 $57,175 $96,950 $63,682 $67,600
Total net assets $4,098 $375 $4,636 $3,479 $14,165 $3,296
Excess/Deficit for the year $3,123 $-4,461 $6,042 $-18,426 $5,264 $-8,158
Net assets or fund balances at beginning of year $19,630 $4,098 $375 $4,636 $6,190 $11,454
Other changes in net assets or fund balances $-18,655 $738 $-1,781 $17,269 $2,711 $0
Net assets or fund balances at end of year $4,098 $375 $4,636 $3,479 $11,454 $3,296
Total assets $22,753 $4,836 $6,417 $21,905 $14,165 $3,296
Total liabilities $18,655 $4,461 $1,781 $18,426 $0 $0
Net assets or fund balances $4,098 $375 $4,636 $3,479 $14,165 $3,296
Did the organization engage in any significant activity not previously reported to the IRS? No No No No No No
Were any significant changes made to the organizing or governing documents? No No No No No No
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities No No No No No No
Has the organization filed a Form 990-T for the year? No No No No No No
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? No No No No No No
Amount of political expenditures, direct or indirect $0 $0 $0 $0 $0 $0
Did the organization file Form 1120-POL for this year? No No No No No No
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? No No No No No No
Total amount involved $0 $0 $0 $0 $0 $0
Initiation fees and capital contributions $0 $0 $0 $0 $0 $0
Gross receipts for public use of club facilities $0 $0 $0 $0 $0 $0
Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? No No No No No No
At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? No No No No No No
The organization is not a private foundation because it is: An organization that normally receives: (1) more than 33 1/3 % of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3 % of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975
Support Schedule for Organizations Described in Section 509(a)(2) (for 2009 - 2013)
2009 - 2013 Total
Public support $264,269
Subtotal $290,562
Gifts, grants, contributions, and membership fees received $290,562
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose $0
Gross receipts from activities that are not an unrelated trade or business under section 513 $0
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf $0
The value of services or facilities furnished by a governmental unit to the organization without charge $0
Less $62,397
Amounts received from disqualified persons $62,397
Amounts received from other than disqualified persons that exceed the greater of $5,000 or 1% of the total support $0
Total support $326,666
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources $0
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 $0
Net income from unrelated business activities, whether or not the business is regularly carried on $0
Other income $36,104
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1 Hollyrod Foundation 2934 1/2 N Beverly Glen Cir, Los Angeles, CA 90077-1724 CA 1999-02 $836,465
2 Hollys Garden 9912 Blossom Valley Rd, El Cajon, CA 92021-2203 CA 2009-04 $59,036
3 Hollywood Actors Theatre Institute Inc 158 Saint Joseph Ave, Long Beach, CA 90803-3165 CA 1977-07 $6
4 Hollywood Arts 5939 Hollywood Boulevard 3rd Floor, Hollywood, CA 90028-5409 CA 2006-05 $58,823
5 Hollywood Arts Council PO BOX 931056, Los Angeles, CA 90093-1056 CA 1978-07 $194,741
6 Hollywood Beautification Team 1741 N Cherokee Ave, Hollywood, CA 90028-4806 CA 1993-05 $1,660,868
7 Hollywood Canteen Foundation P-9036 PO BOX 45174, San Francisco, CA 94145-0174 CA 1948-04 $223,335
8 Hollywood Chamber Of Commerce 7018 Hollywood Blvd, Hollywood, CA 90028-6000 CA 1942-03 $2,502,462
9 Hollywood Chamber Of Commerce Community Foundation 7018 Hollywood Blvd, Hollywood, CA 90028-6000 CA 1996-05 $99,294
10 Hollywood Charity Horse Show 8383 Wilshire Blvd Ste 500, Beverly Hills, CA 90211-2408 CA 1995-01 $503,312
11 Hollywood Church Of The Nazarene PO BOX 906, Hollywood, CA 90078-0906 CA 1963-07 $59,442
12 Hollywood Cinema Production Resources 9700 S Sepulveda Blvd, Los Angeles, CA 90045-5206 CA 1998-07 $209,080
13 Hollywood Comedy Club 53 Dunn St, Laguna Niguel, CA 92677-5704 CA 1996-09 $1
14 Hollywood Community Housing Corporation 5020 Santa Monica Blvd, Los Angeles, CA 90029-2412 CA 1994-10 $2,436,810
15 Hollywood Community Tennis Association, Hcta C/O Mgga 1880 Century Park East 950, Los Angeles, CA 90067 CA 2004-02 $1
16 Hollywood Dolls Horse Club Inc 3102 Durand Dr, Los Angeles, CA 90068-1614 CA 2003-09 $1,199
17 Hollywood Dreamz, Hollywood Dreamz Charitable Corporation PO BOX 313, Hollywood, CA 90078 CA 2007-06 $34,650
18 Hollywood Education & Literacy Project 6336 Hollywood Blvd, Los Angeles, CA 90028-6303 CA 2000-01 $72,987
19 Hollywood Entertainment Alliance 466 Foothill Blvd 358, La Canada, CA 91011-3518 CA 1999-12 $97,564
20 Hollywood Entertainment Museum 1140 N Citrus Ave, Los Angeles, CA 90038-1102 CA 1987-02 $376,496
Subordinate Mount Vernon Nazarene University 800 Martinsburg Rd, Mount Vernon, OH 43050-9509 OH 1963-07 $72,621,953
Subordinate Point Loma Nazarene University Foundation 3900 Lomaland Dr, San Diego, CA 92106-2810 CA 1963-07 $4,037,104
Central The Church Of The Nazarene Inc 17001 Prairie Star Pkwy, Lenexa, KS 66220-7900 KS 1963-07 $0
Subordinate Harvest Food Center Inc PO BOX 690191, Vero Beach, FL 32969-0191 FL 1963-07 $821,120
Subordinate Vacaville Sonrise Community Flshp 630 Orange Dr Ste R, Vacaville, CA 95687-3110 CA 1963-07 $322,560
Subordinate Queens Central Korean Church Of The Nazarene 6111 220th St, Bayside, NY 11364-2244 NY 1963-07 $248,442
Subordinate Restore Hope Orlando Inc PO BOX 568606, Orlando, FL 32856-8606 FL 1993-01 $146,059
Subordinate Delta Gunnison Valley Church Of The Nazarene 1721 H Rd, Delta, CO 81416-2801 CO 1963-07 $98,624
Subordinate Canby PO BOX 880, Canby, OR 97013-0880 OR 1963-07 $86,789
Subordinate Los Angeles North Spanish Church Of The Nazarene 3571 Eagle Rock Blvd, Los Angeles, CA 90065-2848 CA 1963-07 $59,865
Subordinate Hollywood Church Of The Nazarene PO BOX 906, Hollywood, CA 90078-0906 CA 1963-07 $59,442
Subordinate Sparta 6287 State Highway 16, Sparta, WI 54656-3450 WI 1963-07 $42,446
Subordinate Pq Outreach Coalition 10060 Carmel Mountain Rd, San Diego, CA 92129-3228 CA 1963-07 $5,034
Subordinate Norristown Faith And Hope, Norristown 115 W Freedley St, Norristown, PA 19401-3333 PA 1963-07 $0
Subordinate Coastal Community Church Of Nazareth 12497 Tamiami Trl S, North Port, FL 34287-1447 FL 1963-07 $0
Subordinate Orlando The Way To Calvary Church Of The Nazarene 306 W Lancaster Rd, Orlando, FL 32809-4915 FL 1963-07 $0
Subordinate Valley Stream Korean Church Of The Nazarene 206-60 45 Drive 1st Fl, Bayside, NY 11361-3117 NY 1963-07 $0
Subordinate Alaska District Church Of The Nazarene 1140 N Tina Ln, Palmer, AK 99645-8955 AK 1963-07 $0
Subordinate Al South District Church Of The Nazarene PO BOX 680898, Prattville, AL 36068-0898 AL 1963-07 $0
Subordinate Alabama North District Church Of The Nazarene PO BOX 574, Boaz, AL 35957-0574 AL 1963-07 $0
South Dakota 10
NonProfitFacts.com is not associated with, endorsed by, or sponsored by Hollywood Church Of The Nazarene and has no official or unofficial affiliation with Hollywood Church Of The Nazarene

redpajama_set_name: RedPajamaCommonCrawl


This bright northeast corner apartment located on the edge of Victoria Park has 2 bedrooms and 1.5 bathrooms including a large master with 2 piece en-suite bathroom. Enjoy mountain views and the morning sun from the large wrap around balcony. The suite is freshly painted, has a spacious layout with large principal rooms and in-suite laundry. Move-in as is or bring your renovating ideas to make this unit truly special. This building is one of Central Lonsdale's best. "Keith 100" is known for its sense of community and residential neighbourhood yet is only a few minutes' walk to Lonsdale's urban scene. Open Sat June 11 2-4 pm.


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Village 21
Creating a Village to Support Young People
As part of the funding announcement by the Andrews Labor Government at the start of the year, Kids Under Cover was included in the plan to break the cycle of homelessness.
Funded by a one-off grant from the Victorian State Government to specifically support at-risk young people aged 18-21, village 21 is essentially a scaled up, co-located version of our existing Studio Program.
A first of its kind, Village 21 is an accommodation and support program based on a village concept, assisting at-risk young people aged 18 – 21 years who are leaving Out-of-home care (OOHC).
Anglicare's 'Home Stretch' campaign to increase the leaving care age from 18 to 21 years heightened the real need for further support.
Until the provision of care i s extended we must do more for this group of vulnerable young people.
Currently in Victoria (and many other states) once a young person turns 18 funding to their carer ceases and they are exited from OOHC.
It has been reported that 35% of young people leaving care once they hit 18 end up homeless in the first year1. Many are ill-equipped with skills to live independently and within one year, 50% of state care leavers will be unemployed, in jail, homeless or had become a new parent2.
Delivered in partnership with Anglicare Victoria, Village 21 is designed to interrupt the spiral of young people leaving care often find themselves on. By providing six relocatable studios in western metropolitan Melbourne for young people to live in, with support, for two to three years young people will be given the opportunity to live independently.
This village environment will assist in creating strong connections back to the community and teach skills in self-sufficiency.
Six young people and a professional mentor will reside on site with regular visits by Anglicare staff with expertise in employment and study pathways. The Village is designed to support communal activities such as cooking, maintaining shared gardens and learning life skills.
1 CREATE foundation on care leavers (Department of Families, Housing, Community Services and Indigenous Affairs, 2010)
2 www.homestretch.org.au
Return to Undercover News Autumn edition homepage


The school provides a well equipped and child friendly rumpus room and play pen for the pupils of primary and junior school.
The school provides a voice lab equipped with the latest musical instruments to nurture the musical skills of the pupils.The school also has another well-equipped music room for the use of junior and primary students.
The school also has an excellent art room and dance & movement room for the use of the pupils.


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WI Small Business Development Center at UW-Madison
975 University Ave., Suite 1290
UW-Madison Small Business Development Center (SBDC)
Monday-Friday; 8:30 am - 4:30 pm
The UW-Madison SBDC provides practical classes for starting, growing and managing your business. Our classes are attended by both entrepreneurs and employees of larger organizations. The SBDC also… read more
The UW-Madison SBDC provides practical classes for starting, growing and managing your business. Our classes are attended by both entrepreneurs and employees of larger organizations. The SBDC also provides no-cost consulting to help clients create operational efficiencies, understand financial management, marketing concepts, business planning and more.
Business & Leadership Classes for you and your employees
No-Cost Business Consulting
SHRM CP/SCP Certification Course for HR Professionals
First Steps to Starting a Business FREE online class
SHRM Learning System Certification Course
Wednesday Feb 15, 2023
Tuesday Feb 21, 2023
Launch into Leadership
Wednesday Mar 1, 2023
Entrepreneurial Training Program (ETP)
Tuesday Mar 7, 2023
Fearless Performance Management
We are located in Grainger Hall on the UW-Madison Campus at the corner of Park Street and University Avenue (975 University Ave) in Room 3260. Parking is located under the building off of Brooks St.