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Pharm questions 226-270
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226. A nurse is teaching a patient about a prescription for a monoamine oxidase (MAO) inhibitor for depression. What will the nurse teach the patient to avoid while taking this drug?
a. Alcoholic beverages
b. Aged cheeses
c. Brussels sprouts and cabbage
d. Grapefruit juice
Aged cheeses are rich in tyramine, which interacts with MAO inhibitors to raise blood pressure to life-threatening levels. Patients taking MAO inhibitors should be taught to avoid tyramine-rich foods. Chianti wine contains tyramine, but other alcoholic beverages do not. Brussels sprouts and cabbage are foods rich in vitamin K, which can interfere with the effects of warfarin. Grapefruit juice inhibits CYP3A4 and interferes with the metabolism of many medications.
227. The nurse is providing multiple medications to a patient whose spouse brings him grapefruit juice every morning. The nurse should be concerned about which classes of drugs? (Select all that apply.)
a. Calcium channel blockers
b. Selective serotonin reuptake inhibitors
c. Aminoglycosides
d. Beta blockers
e. Penicillins
Calcium channel blockers and selective serotonin reuptake inhibitors have been shown to reach increased and/or toxic levels when taken with grapefruit juice. Grapefruit juice is not contraindicated with aminoglycosides, beta blockers, or penicillins.
228. The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? (Select all that apply.)
a. Binding of one or both agents is reduced.
b. Plasma levels of free drug will rise.
c. Plasma levels of free drug will fall.
d. The increase in free drug can intensify effects.
e. The increase in bound drug can intensify effects.
When two drugs bind to the same site on plasma albumin, coadministration of those drugs produces competition for binding. As a result, binding of one or both agents is reduced, causing plasma levels of free drug to rise. The increase in free drug can intensify the effect, but it usually undergoes rapid elimination. The increase in plasma levels of free drug is rarely sustained.
229. A nurse is caring for a patient who is taking multiple medications. To help ensure that adverse drug reactions are prevented or minimized, the nurse will do which of the following? (Select all that apply.)
a. Ask the patient about over-the-counter medications used.
b. Contact the prescriber to request cytochrome P450 levels.
c. Limit the patient's calcium intake.
d. Obtain a thorough diet history.
e. Request orders for PRN medications to treat any anticipated symptoms of drug interactions.
Over-the-counter medications add to drug interactions, and a thorough history of all medications taken by the patient is essential to minimize adverse drug reactions. Cytochrome P450 levels yield important information about a patient's ability to metabolize drugs and can help predict whether drugs will reach toxic levels or be ineffective. A diet history allows providers to anticipate significant known food-drug interactions. Limiting calcium intake is necessary only if the patient is taking drugs known to interact with calcium, such as tetracycline. Asking for PRN medications to treat drug reactions may only compound the risk, because the risk of drug interactions increases with the number of medications taken.
230. The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurse provides patient education at discharge and instructs the patient to take the drug on an empty stomach. When should the patient take the drug? (Select all that apply.)
a. 1 hour or more before a meal
b. Only after an 8-hour fast
c. Only after the patient has missed a meal
d. At least 2 hours after a meal
e. Within 12 hours with liquids but not solids
The absorption of some drugs can be significantly reduced by food; these drugs should be taken on an empty stomach, which is 1 hour or more before a meal or at least 2 hours after a meal. An 8-hour fast is not necessary; the patient does not need to miss a meal to take the medication; and it is not reasonable to have the patient on thin liquids for 12 hours
231. A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 beats per minute and learns that the patient is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What will the nurse do?
a. Contact the prescriber to report the symptoms.
b. Delay the dose so the drug can clear from receptor sites.
c. Give the medication as ordered, because the dose is correct.
d. Request an antinausea medication from the prescriber.
The symptoms indicate toxicity, and even though the dose is safe and effective in most cases, an individual patient may have toxic effects with a standard dose. The nurse should contact the prescriber to discuss the next steps. Delaying a dose without a change in order is not within the scope of practice for a nurse. The nurse should not give a dose of a medication when toxicity is suspected, because additional drug will compound the symptoms. Antiemetics are useful for counteracting drug side effects, but they should not be used when the patient's symptoms indicate toxicity.
232. A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by:
a. antagonists produced by the body that compete with the drug for receptor sites.
b. decreased selectivity of receptor sites, resulting in a variety of effects.
c. desensitization of receptor sites by continual exposure to the drug.
d. synthesis of more receptor sites in response to the medication.
Continual exposure to an agonist would cause the cell to become less responsive or desensitized. The body does not produce antagonists as a response to a medication. Receptor site selectivity is determined by physiologic factors and not by the substances that bind to them. Medications do not cause more receptors to be produced.
233. A patient has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse suspects that the patient may be experiencing toxicity. What would be the nurse's priority action?
a. Call the prescriber and have the antibiotic changed.
b. Suspect an allergic reaction and administer a PRN antihistamine.
c. Ask the prescriber to order a plasma drug level test.
d. Set up oxygen and obtain an order for an antagonist.
A drug with a narrow therapeutic index indicates that a drug is relatively unsafe and should be monitored closely. The nurse should have a blood level drawn to confirm suspicions of toxicity. The nurse would not have the antibiotic changed, because there is no cause at this time. The patient is unlikely to be experiencing an allergic reaction, because the antibiotic has been in the system for 10 days. The patient shows no signs of anaphylaxis, so oxygen and an antagonist are not indicated.
234. A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine?
a. It binds to different types of receptors in the body.
b. It can cause constipation in toxic doses.
c. It causes only one type of response, and the constipation is coincidental.
d. It is selective to receptors that regulate more than one body process.
Morphine is a medication that is selective to receptor type that regulates more than one process. Because it is selective to receptor type, it does not bind to different types of receptors. Constipation is a normal side effect and is not significant for toxicity.
235. A patient asks why albuterol causes a feeling of jitteriness when it is used to treat wheezing. The nurse knows that albuterol is a beta-adrenergic agonist that acts on beta2 receptor sites to cause smooth muscle dilation in the bronchioles of the lungs, but that it also can sometimes act on beta1 receptor sites in skeletal muscles to cause tremors. To explain this to the patient, the nurse will rely on knowledge of:
a. drug selectivity.
b. modified occupancy theory.
c. relative potency.
d. reversible effects.
The ability of a drug to be selective for receptor sites in a patient determines the types of effects it can have on the body. This drug can bind to two different types of receptors that cause different reactions. The modified occupancy theory addresses the strength of an attraction between a drug and a receptor and the drug's ability to activate the receptor. Relative potency describes the amount of drug needed to produce a specific effect. Most drugs remain bound to receptors permanently, causing the effects to be reversible.
236. Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.)
a. Affinity and intrinsic activity are dependent properties.
b. Affinity refers to the strength of the attraction between a drug and its receptor.
c. Drugs with high affinity are strongly attracted to their receptors.
d. Drugs with low affinity are strongly attracted to their receptors.
e. The affinity of a drug for its receptors is reflected in its potency.
Affinity refers to the strength of the attraction between a drug and its receptor. Drugs with high affinity are strongly attracted to their receptors, and the affinity of a drug and its receptors is reflected in its potency. Affinity and intrinsic activity are independent properties. Drugs with low affinity are weakly attracted to their receptors.
237. Which drugs will not be affected by interpatient variability? (Select all that apply.)
a. Antiseptics applied to the skin to slow bacterial growth
b. Antacids to help with the discomfort of heartburn
c. Broad-spectrum antibiotics that are effective against many organisms
d. Chelating agents that remove metal compounds from the body
e. Topical analgesics used to treat localized pain
Antiseptics, antacids, and chelating agents are all receptorless drugs that do not depend on the body's processes for effects; these agents react with other molecules. Broad-spectrum antibiotics and topical analgesics bind with receptors to produce desired effects, and these processes can be influenced by individual patient variables.
238. A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. What will the nurse ask the prescriber?
a. Whether a sublingual form of the medication can be given
b. Whether the medication can be given by a parenteral route instead
c. To order an enteric-coated form of the drug
d. Whether the patient can receive a sustained-release preparation of the drug
Enteric-coated drugs are preparations that have been coated with a material that dissolves in the intestines, not the stomach. This coating is used either to protect the drug from stomach acid and pepsin or to protect the stomach from a drug that can cause gastric upset. Sublingual forms often are used for drugs that undergo rapid inactivation during the first pass through the hepatic circulation so that the drug can be absorbed directly into the systemic circulation. Parenteral routes are more costly and less safe than oral administration and should not be used unless necessary. A sustained-release preparation is used to release the drug into the body over a specific period to reduce the number of daily doses required to sustain therapeutic drug levels.
239. A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely?
a. Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect.
b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical.
c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body.
d. The bioavailability of a drug is determined by the amount of the drug in each dose.
Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the drug. Two brands may be chemically equivalent and still differ in bioavailability, which is not determined by the amount of drug in the dose.
240. A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?
a. Administer the drug at intervals longer than the drug half-life.
b. Administer this medication intravenously.
c. Monitor plasma drug levels.
d. Teach the patient that maximum drug effects will occur within a short period.
A drug with a narrow therapeutic range is more difficult to administer safely, because the difference between the minimum effective concentration and the toxic concentration is small. Patients taking these medications must have their plasma drug levels monitored closely to ensure that they are getting an effective dose that is not toxic. Administering medications at longer intervals only increases the time required to reach effective plasma drug levels. Drugs that have a narrow therapeutic range may be given by any route and do not differ from other medications in the amount of time it takes to take effect, which is a function of a drug's half-life and dosing frequency.
241. A patient is given a prescription for azithromycin (Zithromax) and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct?
a. "A large initial dose helps to get the drug to optimal levels in the body faster."
b. "The first dose is larger to minimize the first pass effect of the liver."
c. "The four smaller doses help the body taper the amount of drug more gradually."
d. "Tubular reabsorption is faster with initial doses, so more is needed at first."
A large initial dose is often used as a loading dose to help get serum drug levels to plateau levels more quickly. Larger doses do not prevent first pass effects in drugs susceptible to this type of metabolism. Tapering of doses sometimes is used to prevent rebound or withdrawal effects and is done by stepping down the amount of drug with each dose. Tubular reabsorption is a process that allows drugs to be reabsorbed from the urine into the blood.
242. A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply?
a. "This route allows more rapid absorption of the drug."
b. "This route is safer, less expensive, and more convenient."
c. "This route is the best way to control serum drug levels."
d. "This route prevents inactivation of the drug by digestive enzymes."
Parenteral routes include the intravenous, intramuscular, and subcutaneous routes. Enteral routes include oral administration, including pills and liquid suspensions. Enteral routes are safer, cheaper, and easier to use. Parenteral routes are used when rapid absorption, precise control of plasma drug levels, and prevention of digestive inactivation are important.
243. The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply?
a. "This drug causes severe gastric upset if given orally."
b. "This drug has a narrow therapeutic range, and the dose must be tightly controlled."
c. "This drug is absorbed much too quickly in an oral form."
d. "This drug would be inactivated by enzymes in the stomach."
Penicillin G is inactivated by digestive enzymes in the stomach and cannot be given orally. It does not have a narrow therapeutic range.
244. A prescriber has written an order for a medication: drug X 100 mg PO every 6 hours. The half-life for the drug is approximately 6 hours. The nurse is preparing to administer the first dose at 8:00 AM on Tuesday. On Wednesday, when will the serum drug level reach plateau?
a. 2:00 AM
b. 8:00 AM
c. 2:00 PM
d. 8:00 PM
It takes four half-lives for a drug to reach plateau. Total body stores reach their peak at the beginning of the fifth dose of a drug if all doses are equal in amount; in this case, this will be at 8:00 AM the following day.
245. An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient?
a. 60 mg morphine sulfate PO
b. 75 mg meperidine (Demerol) intramuscularly
c. 6 mg morphine sulfate intravenously
d. Fentanyl (Duragesic) patch 50 mcg transdermally
The intravenous route is the fastest route of absorption and the one most appropriate for a patient in extreme pain. With the oral route, the medication would take at least 45 minutes to be effective, too long for a patient in extreme pain. With the intramuscular route, the medication would take at least 15 minutes to be effective; although faster than the oral route, this is not as fast as the intravenous route. A Duragesic patch would be the most inappropriate route because of the long drug half-life. This is a more appropriate route for long-term use.
246. A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be:
a. excreted in hydrolyzed form in the feces to reduce drug toxicity.
b. reabsorbed from the urine into the renal circulation to minimize drug loss.
c. recycled via the enterohepatic recirculation to remain in the body longer.
d. transported across the renal tubules to be excreted in the urine.
Glucuronidation of some drugs in the liver allows drugs to enter the bile, pass into the duodenum, and then be hydrolyzed to release the free drug. This is a repeating cycle of enterohepatic recirculation, which allows drugs to remain in the body longer. Glucuronidated drugs that are more resistant to hydrolysis are excreted in the feces. Glucuronidation occurs in the enterohepatic circulation and not in the renal circulation.
247. A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result?
a. A loading dose was not given.
b. The drug was not completely dissolved in the IV solution.
c. The patient is taking another medication that binds to serum albumin.
d. The medication is being given at a frequency that is longer than its half-life.
Gentamicin binds to albumin, but only weakly and, in the presence of another drug that binds to albumin, can rise to toxic levels in blood serum. A loading dose increases the initial amount of a drug and is used to bring drug levels to the desired plateau more quickly. A drug that is not completely dissolved carries a risk of causing embolism. A drug given at a frequency longer than the drug half-life will likely be at subtherapeutic levels and not at toxic levels
248. When administering medications to infants, it is important to remember which of the following? (Select all that apply.)
a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble drugs.
b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently.
c. Infants have immature livers, which slows drug metabolism.
d. Infants are more sensitive to medications that act on the central nervous system (CNS).
e. Oral medications are contraindicated in infants, because PO administration requires a cooperative patient.
Immature renal function causes infants to excrete drugs more slowly, and infants are at risk for toxicity until renal function is well developed. Infants' livers are not completely developed, and they are less able to metabolize drugs efficiently. Because the blood-brain barrier is not well developed in infants, caution must be used when administering CNS drugs. Lipid-soluble drugs may be excreted in breast milk if the mother is taking them, but breast-feeding does not affect medications given directly to the infant. Oral medications may be given safely to infants as long as they are awake and can swallow the drug.
249. A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, "Which drug name is a generic drug name?" Which is the correct response?
a. Acetaminophen
b. Tylenol
c. Cipro
d. Motrin
Acetaminophen is the generic name. Tylenol, Cipro, and Motrin are all trade names.
250. The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drug safety?
a. Allowing pharmaceutical companies to identify off-label uses of medications approved for other uses
b. Evaluating drug safety information that emerges after a drug has been approved and is in use
c. Expediting the approval process of the U.S. Food and Drug Administration (FDA) so that needed drugs can get to market more quickly
d. Requiring manufacturers to notify patients before removing a drug from the market
The FDAAA was passed to enable the Food and Drug Administration to continue oversight of a drug after granting it approval so that changes in labeling could be made as necessary and postmarketing risks could be tracked and identified. A provision of the FDA Modernization Act (FDAMA), passed in 1997, allows drug companies to promote their products for off-label uses as long as they promise to conduct studies to support their claims. Regulations to permit accelerated approval of drugs for life-threatening diseases were adopted in 1992 by the FDA. The requirement that drug companies notify patients 6 months before removing a drug from the market is a provision of the FDAMA.
251. A nursing student asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that randomization is used to:
a. ensure that differences in outcomes are the result of treatment and not differences in subjects.
b. compare the outcome caused by the treatment to the outcome caused by no treatment.
c. make sure that researchers are unaware of which subjects are in which group.
d. prevent subjects from knowing which group they are in and prevent preconception bias.
Randomization helps prevent allocation bias, which can occur when researchers place subjects with desired characteristics in the study group and other subjects in the control group so that differences in outcome are actually the result of differences in subjects and not treatment. Comparing treatment outcome to no treatment outcome is the definition of a controlled study. The last two options describe the use of blinding in studies; blinding ensures that researchers or subjects (or both) are unaware of which subjects are in which group so that preconceptions about benefits and risks cannot bias the results.
252. Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend's illness. Which statement by the nurse is correct?
a. "A drug at this stage of development can be used only in patients with serious disease."
b. "At this stage of drug development, the safety and usefulness of the medication is unknown."
c. "Clinical trials must be completed to make sure the drug is safe to use in humans."
d. "Until postmarketing surveillance data are available, the drug cannot be used."
Preclinical testing must be completed before drugs can be tested in humans. In this stage, drugs are evaluated for toxicities, pharmacokinetic properties, and potentially useful effects. Some drugs can be used in patients before completion of Phase III studies, but this is after preclinical testing is complete. Clinical trials proceed in stages, and each stage has guidelines defining how a new drug may be used and which patients may receive it. Postmarketing surveillance takes place after a drug is in general use.
253. A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. The nurse tell the patient that:
a. testing for all side effects of a medication would be prohibitively expensive.
b. patients in drug trials often are biased by their preconceptions of a drug's benefits.
c. researchers tend to conduct studies that will prove the benefits of their new drugs.
d. subjects in drug trials do not always represent the full spectrum of possible patients.
All drug trials are limited by a relatively small group of subjects who may not have all the characteristics of people who will be using the drug; therefore, some side effects go undetected until the drug is in use. Although drug trials are very expensive, this is only an indirect reason they do not detect all side effects before approval. In theory, well-designed drug trials, using blinded studies, minimize or eliminate subject bias. Designing studies to prove desired results is unethical.
254. A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names?
a. They are approved by the FDA and are easy to remember.
b. They are assigned by the U.S. Adopted Names Council.
c. They clearly identify the drug's pharmacological classification.
d. They imply the efficacy of the drug and are less complex.
Nonproprietary, or generic, names are assigned by the U.S. Adopted Names Council, which ensures that each drug has only one name. Trade names, or brand names, are approved by the FDA and are easier to remember. Some nonproprietary names contain syllables that identify the classification, although not all do. Drug names are not supposed to identify the use for the drug, although some brand names do so.
255. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer "2 puffs every 4 hours as needed for coughing or wheezing." The patient reports feeling jittery sometimes when taking the medication, and she doesn't feel that the medication is always effective. Which is not an appropriate nursing intervention for this patient?
a. Asking the patient to demonstrate use of the inhaler
b. Assessing the patient's exposure to tobacco smoke
c. Auscultating lung sounds and obtaining vital signs
d. Suggesting that the patient use one puff to reduce side effects
It is not within the nurse's scope of practice to change the dose of a medication without an order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to evaluate the patient's ability to administer the medication properly and is part of the nurse's evaluation. Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such a smoke avoidance, can be used as an adjunct to drug therapy. Performing a physical assessment helps the nurse evaluate the patient's response to the medication.
256. A postoperative patient is being discharged home with acetaminophen/hydrocodone (Lortab) for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct?
a. "It is not safe to take over-the-counter drugs with prescription medications."
b. "Taking the two medications together poses a risk of drug toxicity."
c. "There are no known drug interactions, so this will be safe."
d. "Tylenol and Lortab are different drugs, so there is no risk of overdose."
Tylenol is the trade name and acetaminophen is the generic name for the same medication. It is important to teach patients to be aware of the different names for the same drug to minimize the risk of overdose. Over-the-counter (OTC) medications and prescription medications may be taken together unless significant harmful drug interactions are possible. Even though no drug interactions are at play in this case, both drugs contain acetaminophen, which could lead to toxicity.
257. The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process?
a. Asking the prescriber for an order to monitor serum drug levels
b. Monitoring the patient for drug interactions after giving the medication
c. Questioning the patient about over-the-counter medications
d. Taking the patient's blood pressure throughout the course of treatment
The assessment part of the nursing process involves gathering information before beginning treatment, and this includes asking about other medications the patient may be taking. Monitoring serum drug levels, watching for drug interactions, and checking vital signs after giving the medication are all part of the evaluation phase.
258. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen (Tylenol) 650 mg PO every 6 hours PRN pain. What will the nurse do?
a. Ask the patient what medications have helped with pain in the past.
b. Contact the provider to request a different analgesic medication.
c. Give the pain medication and reposition the patient to promote comfort.
d. Request an order to administer the medication every 4 hours.
The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to moderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication. Asking the patient to tell the nurse what has helped in the past is a part of an initial assessment and should be done preoperatively and not when the patient is having severe pain. Because the patient is having severe pain, acetaminophen combined with nondrug therapies will not be sufficient. Increasing the frequency of the dose of a medication for mild pain will not be effective.
259. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching this patient about home management should begin by doing what?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
c. Giving information about how diet and exercise affect insulin requirements
d. Teaching the patient about the long-term consequences of poor diabetes control
Because insulin must be given correctly to control symptoms and because an overdose can be fatal, it is most important for the patient to know how to administer it. Asking for a demonstration of technique is the best way to determine whether the patient has understood the teaching. When a patient is receiving a lot of new information, the information presented first is the most likely to be remembered. The other teaching points are important as well, but they are not as critical and can be taught later.
260. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration?
a. Assessing the patient's pain level 15 to 30 minutes after giving the medication
b. Checking the medication administration record to see when the last dose was administered
c. Consulting a drug manual to determine whether the amount the prescriber ordered is appropriate
d. Documenting the reason the medication was given in the patient's electronic medical record
Assessing the patient's pain after administering the medication is an important part of the nursing process when giving medications, but it is not part of the six rights of drug administration. Checking to see when the last dose was given helps ensure that the medication is given at the right time. Consulting a drug manual helps ensure that the medication is given in the right dose. Documenting the reason for a pain medication is an important part of the right documentation—the sixth right.
261. A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not working. What will the nurse do?
a. Ask the patient about the number and frequency of tablets taken.
b. Assess the patient's headache pain on a scale from 1 to 10.
c. Report the patient's complaint to the prescriber.
d. Suggest biofeedback as an adjunct to drug therapy.
When evaluating the effectiveness of a drug, it is important to determine whether the patient is using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and how often helps the nurse determine compliance. Assessing current pain does not yield information about how well the medication is working unless the patient is currently taking it. The nurse should gather as much information about compliance, symptoms, and drug effectiveness as possible before contacting the prescriber. Biofeedback may be an effective adjunct to treatment, but it should not be recommended without complete information about drug effectiveness.
262. A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?
a. A 30-year-old man with kidney disease
b. A 75-year-old woman with cystitis
c. A 50-year-old man with an upper respiratory tract infection
d. A 9-year-old boy with an ear infection
The individual with impaired kidney function would be at risk of having the drug accumulate to a toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder and not usually the cause of excretion problems that might lead to an adverse reaction from a medication. A respiratory tract infection would not predispose a patient to an adverse reaction, because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would not have the greatest predisposition to an adverse reaction simply because he is a child; nor does an ear infection put him at greater risk.
263. A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual states that elderly patients are at increased risk for hepatic side effects. Which action by the nurse is correct?
a. Contact the provider to discuss an order for pretreatment laboratory work.
b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk of adverse effects.
c. Notify the provider that this drug is contraindicated for this patient.
d. Request an order to give the medication intravenously so that the drug does not pass through the liver.
The drug manual indicates that this drug should be given with caution to elderly patients. Getting information about liver function before giving the drug establishes baseline data that can be compared with post-treatment data to determine whether the drug is affecting the liver. Giving the correct dose at the correct interval helps to minimize risk, but without baseline information, the effects cannot be determined. The drug is not contraindicated.
264. A patient has been receiving intravenous penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5° C (101° F). Which is the correct action by the nurse?
a. Administer the next dose and continue to evaluate the patient's symptoms.
b. Ask the prescriber if an antihistamine can be given to relieve the itching.
c. Contact the prescriber to request an order for a chest radiograph.
d. Hold the next dose and notify the prescriber of the symptoms.
Pruritus and wheezing are signs of a possible allergic reaction, which can be fatal; therefore, the medication should not be given and the prescriber should be notified. When patients are having a potentially serious reaction to a medication, the nurse should not continue giving the medication. Antihistamines may help the symptoms of an allergic reaction, but the first priority is to stop the medication. Obtaining a chest radiograph is not helpful.
265. A nurse is reviewing a patient's medical record before administering a medication. Which factor(s) can alter the patient's physiologic response to the drug? (Select all that apply.)
a. Ability to swallow pills
b. Age
c. Genetic factors
d. Gender
Age, genetic factors, and gender all influence an individual patient's ability to absorb, metabolize, and excrete drugs; therefore, these factors must be assessed before a medication is administered. A patient's ability to swallow pills, although it may determine the way a drug is administered, does not affect the physiologic response. Height does not affect response; weight and the distribution of adipose tissue can affect the distribution of drugs.
266. The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of:
a. clinical pharmacology.
b. drug efficacy.
c. pharmacokinetics.
d. pharmacotherapeutics.
Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions. Clinical pharmacology is concerned with all aspects of drug-human interactions. Drug efficacy measures the extent to which a given drug causes an intended effect. Pharmacokinetics is the study of the impact of the body on a drug.
267. What does it mean when a drug is described as easy to administer?
a. It can be stored indefinitely without need for refrigeration.
b. It does not interact significantly with other medications.
c. It enhances patient adherence to the drug regimen.
d. It is usually relatively inexpensive to produce.
A major benefit of drugs that are easy to administer is that patients taking them are more likely to comply with the drug regimen. Drugs that are easy to give may have the other attributes listed, but those properties are independent of ease of administration.
268. A patient tells the nurse that he was told by the prescriber that the analgesic he is taking is very effective. Which statement by the patient demonstrates an understanding of the drug's effectiveness?
a. "I don't have to worry about toxicity, since it takes a large amount of this drug to cause an overdose."
b. "It has no side effects and doesn't interact with other drugs."
c. "I only have to take it every 12 hours."
d. "It might make me sleepy, and it lessens pain for several hours at a time."
A drug is effective if it produces the intended effects, even if it also produces side effects. Because no drug is completely safe, the level of toxicity does not determine effectiveness. All drugs have side effects and many react with other substances; these do not affect the drug's effectiveness. Ease of administration is independent of a drug's effectiveness.
269. What are the properties of an ideal drug? (Select all that apply.)
a. Irreversible action
b. Predictability
c. Ease of administration
d. Chemical stability
e. A simple trade name
In addition to predictability, ease of administration, and chemical stability, other properties include a reversible action so that any harm the drug may cause can be undone and a simple generic name, because generic names are usually complex and difficult to remember and pronounce.
270. Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's response to the medication? (Select all that apply.)
a. Chemical stability of the medication
b. Ease of administration
c. Family medical history
d. Patient's age
e. Patient's diagnosis
The family medical history can indicate genetic factors that may affect a patient's response to a medication. Patients of different ages can respond differently to medications. The patient's illness can affect how drugs are metabolized. The chemical stability of the medication and the ease of administration are properties of drugs.
What are examples of Dosage Forms?
What is the removal of drug from the body?
What are Beta2 Receptor Agonists used for?
What is the most common side effect of NSAIDs?
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Our condo is warm and inviting with neutral colors to welcome you as you walk in the door. We are close to many restaurants that are sure to become your favorite place to eat. You will want to spend most of your days being a beach bum or watching the dolphins play because our condo is just steps away from the beach and Boca Cieaga Intercoastal Waterway!
All new bamboo flooring recently installed throughout . All new updated lighting fixtures, unit looks awesome !!


It is Pam here today on the Craftwell Blog sharing with you my upcycled project!!
I decided to give my cat "Gracie" an upcycled treat jar.
Gracie is a "boy", lol!!!
He has a story to tell about his name!!!
Run strips of pattern paper through the Xyron Creative Station or use your favorite adhesive.
Wrap pattern paper that has adhesive applied to it along with borders around jar.
Stamp a Crazy Cat image on to water color paper.
Sandwich prepared colored image along with die and label dies between two "A" plates, "B" plate, metal shim and platform using the Craftwell Cut N' Boss.
Add labels and prepared crazy cat to front of jar.
Die cut borders and rosettes using two "A" plates and platform using Craftwell Cut N' Boss.
Form rosettes; add large one to top of jar lid along with a metal knob.
Add smaller ones to front of snack jar.
Adhere small circles and brads to centers.
Wrap twine around jar lid ring with twine.
Die cut label using watercolor paper using Craftwell Cut N' Boss, two "A"plates, "B"plate, metal shim and platform.
Water color paper with distress markers, dry completely.
Do stitch line work and pets name with the word "snack" with black pen.
I hope you have enjoyed my snack cat treat jar and try making a fun treat jar for your pet.
Remember this is a month of Upcycle Projects here on the Craftwell Blog so if you missed anything make sure to go back to the beginning of the month to get lots of inspiration from the Craftwell Cut N' Boss Design Team.


text:
Michael Brown: It's 40 years since Thatcher's victory and my Commons entrance. I remember it all so clearly.
By Michael Brown
White hot heat of the technological Cummings?
Our Survey. Johnson – doing very well. But way to go before he levels with…you know who
The limits of support for One Nation. Our Survey.
Michael Brown was a Conservative MP from 1979 until 1997
All of us remember that sense of elation the day we got the right A level grades to go to university or the magical day when we passed our driving test. But for me nothing has compared with the moment, 40 years ago, when I was declared "duly elected to serve as Member of Parliament for Brigg and Scunthorpe". It took three recounts before the result was finally announced by the returning officer at 1.27pm on Friday 4th May 1979. Against expectations, I had gained a safe Labour seat for the Tories.
A week later at a No 10 reception for new Tory MPs the new Prime Minister, Margaret Thatcher, asked me how I had done. "I got over 31,000 votes and a 486 majority" I told her proudly. "No, Michael, I got the 31,000 votes; you got the 486".
Although I was still two months short of my 28th birthday I was not quite the youngest MP (that honour went to Stephen Dorrell). But the following week, after I swore the oath, Speaker George Thomas told me "Ooh my boy, you don't look old enough to be here".
I was brimming with confidence and arrived ready to change the world. Margaret Thatcher had a similar outlook but an old hand told me that both she and I would soon get all of that optimism and idealism out of our system. I replied, "But as she's the Iron Lady and I represent 20,000 steelworkers, steel has also entered my soul".
Walking into the building as a newly elected member was not particularly intimidating as I had spent the previous four years working for the great Nicholas Winterton as a research assistant. I knew the policemen, parliamentary staff in the Table Office, Vote Office and Library and had already had access to some of the watering holes. Therein, however, lay many of my initial problems. I was reprimanded on day one by a policeman at Carriage gates. I was no longer required to show a pass. "Oi you, who do you think you are? You're only a researcher, you know the rules", he barked. "I'm the new MP for Scunthorpe – who do you think you are?" I showed him my election address as he checked his "new boys" list before we both enjoyed the irony of the moment. "I'm so sorry, congratulations sir". Sir!!! I'd never been called that by anyone before.
But after a few raised eyebrows, it did not take long before word spread that one of those tiresome research assistants had been transmogrified. Clerks, policemen, doorkeepers and catering staff all eagerly helped to make my new routine easier. My own knowledge of the physical geography meant I knew where to "desk squat" while my office arrangements were being sorted out. Inside knowledge and a bit of string pulling quickly got me a share of an office in Norman Shaw North.
The early days were mostly spent dealing with mountains of post. But I had NO SECRETARY. Those were the days of paper and a constituency with nearly 100,000 electors. Mobile phones, the e-mail, Twitter, Facebook,and the internet were unheard of. One letter was from Michael Forsyth's wife (he was not yet an MP) mentioning, in passing, that she was looking for a part-time secretarial job. She was engaged within an instant.
There were simply not enough hours in the day. I wanted to be in the Chamber for the formal abracadabra which happens at the beginning of every new Parliament:- The re-election of the Speaker, taking the Oath, the State Opening, staking my claim to a regular area of the Chamber and witnessing the extraordinary sight of Margaret Thatcher running the new show. But there were also drinks receptions, lunch and dinner invites – far more than I could accept. Many were from senior Tory knights from the shires wanting my vote for various backbench committees chairmanships. There were no formal induction classes, as now, for newbies. We knew, however, to make our number with the Fees Office to discuss our pay arrangements (£6,897pa – the equivalent of £27,000 at today's prices!).
My most cherished memory of those early days was my first encounter with the MP for Huyton, Sir Harold Wilson. I was hovering nervously outside the fabled Members' Smoking Room pretending to read the Press Association ticker machine. "What's Yorkshire's cricket score, laddie?" growled the famous gravelly voice. Detecting my nerves he asked for my name and constituency and took me inside for a drink. He then proceeded to give me advice about the Parliamentary Labour Party before I had to admit to being a Tory gain. "Tories won Scunthorpe! Well done – have another drink lad." Eight months later I was to face a three-month steelworkers strike in Scunthorpe – the honeymoon of those early days was over. But my marriage to the constituency (with the help of a boundary change) was to last a further 18 years before the voters divorced me.
This article appears in this months edition of the Association of Former Members of Parliament magazine "Order Order!"
1979 General Election British Steel Harold Wilson Margaret Thatcher Michael Forsyth Scunthorpe Stephen Dorrell MP
Eddie Hughes: Our values must drive CCHQ. That means moving it to a town or small city – not a big one.
Rebecca Ryan: Help us to get Big Ben bonging for Brexit
Festus Akinbusoye: The scandal of rising assaults on police officers. And what must be done to help reduce them.
Robert Alden: CCHQ should be relocated to Birmingham
Tom Tugendhat: Huawei's human rights record needs scrutiny before 5G contracts are signed
Nicholas Boys Smith: The housing mission that Scruton and I pursued is inspired by a quest for beauty
Julian Brazier: Volunteers can help protect us from terror
24 comments for: Michael Brown: It's 40 years since Thatcher's victory and my Commons entrance. I remember it all so clearly.

redpajama_set_name: RedPajamaCommonCrawl


Charbrew's Organic Japanese Matcha is a combination of all of the health benefits of regular green tea amplified!
With Matcha you ingest the whole tea leaf, as opposed to the brewed water, which means it delivers everything that green tea delivers - but with much higher potency.
137 times more antioxidants than regular tea.
More antioxidants than blueberries, wolfberries, pomegranates, orange juice and spinach.


text:
Why you should be working out while pregnant
Women who become pregnant and are already active in exercise look to continue working out while they're expecting and there's plenty of benefits for those who do explains a Jersey Shore physician.
Dr. Angela Jones a board certified physician at Hackensack Meridian Health Medical Group Healthy Woman OB/GYN says pregnancy can be very exhausting and exercise helps to give you more energy and helps you feel better.
She says it can really help a woman prepare for labor.
"Labor is work. Labor is hard and your body needs to be in shape in order to better accommodate and be able to get thru that," Jones said. "If you've got a body that's more physically fit, you're going to make labor easier and it might be shorter, you'll also decrease your risk of potentially ending up having a c-section and a fit body is much more prone to bouncing back faster than an unfit body post-partum or recovery post-delivery."
There's a couple key areas to focus on that will help better prepare you physically for giving birth.
"I think that any activity is good activity because the aerobic exercise that you get will prove to be very beneficial but I think that anything that works on core strengthening as well as flexibility will prove to be very advantageous especially during the delivery process," Jones said.
However, that's only to a point.
"Usually after the 16th week of pregnancy we don't recommend any exercises where you would be laying directly on your back only because of the weight of the uterus compressing some of the major blood supply," Jones said.
Jones says working out and exercising also helps with limiting excessive weight gain and lowering the risk of child obesity.
"Moms that are diabetic during pregnancy not only have an increased risk of having babies that are macrosomic or exceedingly large, but those children are also at an increased risk of childhood obesity as well as diabetes late on in life," Jones said. "A fit mom helps to pass on some of those benefits (of being in shape) to babies and decreasing the risk for further issues for them."
She explains that it also helps with the depression that comes with a pregnancy.
"In shape moms and moms that exercise are less likely to experience things like post-partum depression," Jones said.
It also gives you a boost and serves as a benefit for you and the baby during an exhausting pregnancy period.
"Pregnancy is a really amazing state of being, I mean you're growing another human being inside of your body," Jones said. "It can be very taxing for moms so the working out is a benefit to both mom and baby."
Are there any limits to what you should be doing?
Jones says it's best to stay away from lifts or exercises that put you at an increased risk of falling or playing sports like ice hockey or basketball.
"Anything that's going to increase your risk for falling or having direct compact to a growing uterus, you will certainly want to avoid," Jones said.
If you work out regularly and enjoy actively doing compound lifts like the dead-lift, squat or bench press, can you continue those workouts while pregnant?
Jones says as long as your don't overdo it, adjust the weight and have a spotter, it should be okay.
"As long as you're being safe and taking safety precautions and listening to the limits of your body, which is different for everyone, you should be fine," Jones said.
If you're feeling dizzy, lightheaded and short of breath while doing a workout, it's time to take a break because you're likely overdoing it.
It's equally as important to drink plenty of water and stay hydrated.
Exercising is something Jones encourages you to do after giving birth as well.
Before you start any kind of a workout program, Jones advises you to check-in with your OB/GYN doctor.
Filed Under: babies, Baby, cravings, exercise, gym, Jersey Shore University Medical Center, Pregnant, Women, Working Out
Categories: Monmouth/Ocean News, New Jersey News, News


text:
Q: Analysing simulation result of event sequences with branch So I have a problem where a sequence of
A1 > B1 > C1 > D1
or
A1 > B1 > C2 > D2
or
A1 > B1 > C2 > D3
or
A2 > B2 > C3 > D4
Note there's more than 1 root starting point too. Each stage also has some other properties to it. So I'd want to ask

*

*find all stage (regardless of ABCD) where property 1 = some value and has some where up the parent chain property 2 = some value.

*I need to work out the probability of getting to each stage if given all "sequence branch" are of equal probability. So probability of getting to D3 is 1/2(A) * 1/2(C) where as D1 or D2 stage is 1/2(A) * 1/2(C) * 1/2(D)

*Conditional probability. Given B1 has happened, what's the chance of D3.

What's the best way / technique to store and analyse / query / interrogate data like this? What sort of keywords should I google / field / technology to read and learn?
Note I'm thinking to generate in the neighbourhood of 100s of k up to millions sample of sequence events.
I've had some look at RDBMS recursive CTE. That solves problem 1, but 2 and 3 in combination seem a bit more difficult. Was wondering if a graph database like neo4j can solve the problem better?

redpajama_set_name: RedPajamaStackExchange


EXCLUSIVE: How hard has Hollywood fallen for the idea of a Robin Hood film? Warner Bros quietly has put one into development, scripted by Gangster Squad and Aquaman scribe Will Beall, and produced by The Lego Movie's Dan Lin, and John Zaozirny. They're keeping the take on this one secret (it's not Lego, which seems to work for everything), but this makes four major movie projects on the same subject. Sony, Disney and Lionsgate have the others.
This latest deal follows Lionsgate's recent buy of Robin Hood: Origins. That is a script by Joby Harold, the scribe behind the King Arthur films that Guy Ritchie is making with Charlie Hunnam, and it's described as an origins story with a Batman Begins tone. Appian Way is producing with Harold and Tory Tunnell under their Safehouse Pictures banner. Separately, Disney has the Brandon Barker spec Nottingham & Hood, a swashbuckling family friendly adventure film in the vein of Pirates Of The Caribbean. The Picture Company's Alex Heineman and Andrew Rona are producing.
Sony last fall bought a Robin Hood pitch for $1 million from Cory Goodman and Jeremy Lott with Aperture's Adam Goldworm executive producing. That project, Hood, has been described tonally as a high-action Fast & Furious meets Mission: Impossible-style reinvention of the tale, and I've heard Jerry Bruckheimer has come aboard as producer. These bring different takes on a familiar subject and some are hard to wrap arms around, considering that Robin Hood's disputes were settled with swords and arrows. The last major film was 2010's Ridley Scott-directed Robin Hood, which had Russell Crowe playing Robin and Cate Blanchett playing Marion. It grossed over $300 million but at a reported budget of around $200 million.
Why the enduring appeal? It's a time-tested story of heroism, action and danger; it's a public domain property; and studios are desperate for intellectual property. Clearly, the first one to hit the target with a production start wins. The 1991 Kevin Costner starrer Robin Hood: Prince Of Thieves went against the Patrick Bergin-Uma Thurman Robin Hood, and the latter got crushed. Costner's movie did $390 million worldwide on a $48 million budget.
Jonathan Eirich is exec producing the Warner Bros version of Robin Hood, and Jon Berg and Chantal Nong are overseeing for Warner Bros. Beall is repped by CAA and Management 360.


text:
CWG, Global Spectrum, PPPN fail NSE's listing requirement
CWG Plc, Global Spectrum Energy Services Plc and Portland Paints & Product Nigeria (PPPN) Plc have less-than-required minimum volume of shares for public trading in the stock market, a major infraction that may adversely affect liquidity and efficient price discovery on the companies.
A report by the Nigerian Stock Exchange (NSE) indicated that the three companies have free float deficiencies, a reference to over concentration of the shareholdings of the companies in the hands of directors, other insiders and related persons.
Under the rules at the Exchange, companies listed on the main board are required to have a minimum free float of 20 per cent of their market capitalisation, implying that 20 per cent of the companies' shareholdings must be available for minority retail shareholders. CWG, Global Spectrum Energy Services and PPPN are listed on the main board of the Exchange.
PPPN, a subsidiary of UAC of Nigeria (UACN) Plc, slipped into deficiency after a 2017 rights issue, which was undersubscribed by 34 per cent.
CWG has been unable to undertake proposed capital issue as it struggles with declining performance. CWG recorded a net loss of N1.58 billion in 2017, relapsing into a losing streak that had seen the technological company with a pre-tax loss of N1.75 billion in 2015. Key extracts of audited report and accounts of CWG for the year ended December 31, 2017 showed that turnover dropped from N10.166 billion in 2016 to N8.827 billion in 2017. The company recorded pre and post tax losses of N1.511 billion and N1.576 billion respectively in 2017 compared with profit before tax of N142.04 million and profit after tax of N127.68 million in 2016.
Global Spectrum Energy Services, which was listed in November 2017, has neither been able to float new issue nor actively trade existing shares to dilute pre-listing concentration of shareholdings.
Free float, otherwise known as public float, refers to the number of shares of a quoted company held by ordinary shareholders other than those directly or indirectly held by its parent, subsidiary or associate companies or any subsidiaries or associates of its parent company; its directors who are holding office as directors of the entity and their close family members and any single individual or institutional shareholder holding a statutorily significant stake, which is 5.0 per cent and above in Nigeria.
Thus, free float's shares do not include shares held directly or indirectly by any officer, director, controlling shareholder or other concentrated, affiliated or family holdings.
Stock markets maintain minimum public float to prevent undue concentration of securities in the hands of the core investors and related interests, a situation that can make the stock to be susceptible to price manipulation. Besides, it provides the general investing public with opportunity to reasonably partake in the wealth creation by private enterprises.
According to the report, PPNN has a free float of 14.57 per cent, 5.43 percentage points below minimum requirement; CWG has 15.97 per cent, 4.03 percentage points below minimum requirement while Global Spectrum Energy Services has free float of 7.01 per cent, 12.99 percentage points below the required minimum limit.
Under the extant rules, the deficient companies would have to undertake capital restructuring to reduce the overconcentration and free more shares for the general retail investing public. However, the NSE has not indicated the timeline for the expected capital dilution.
With the three new deficient companies, there are now 15 companies with free float deficiencies at the NSE. These include Union Bank of Nigeria, which has a free float of 14.94 per cent; Capital Hotel, 2.62 per cent; Great Nigerian Insurance, 16.0 per cent; Chellarams, 15.0 per cent; AG Leventis, 11.64 per cent; Interlinked Technology, 14.50 per cent; Infinity Trust Mortgage, 3.50 per cent; Transcorp Hotels, 6.0 per cent; Ekocorp, 11.84 per cent; Champion Breweries, 17.30 per cent; Caverton Offshore Support Group, 17.40 per cent; The Tourist Company of Nigeria Plc, 3.58 per cent and E-Tranzact International Plc, which has a free float of 10.06 per cent.
Failure by deficient companies to restructure their share capital at the expiration of the deadline or secure extension of the deadline may lead to delisting of their shares from the NSE. Free float deadline is usually in deference to application by the management of a company for some period to comply with the free float. However, the company is required to provide quarterly disclosure report to the NSE on the efforts being made to fully comply by the deadline.
By the expiration of the deadline, a company is mandatorily required to have completed partial divestments or dilution of the 'non-public' shareholdings to free the required percentage of equity stake for public holding, unless the management of the NSE grants fresh waivers and extensions for the companies. In the extreme instance, a company with deficient public float may opt to delist its shares.
The seven companies in default of the earlier deadline include Capital Hotel Plc, Chellarams Plc, The Tourist Company of Nigeria Plc, Interlinked Technology Plc, Caverton Offshore Support Group Plc, Ekocorp Plc and Champion Breweries.
The trio of UBN, Transcorp Hotels and Great Nigeria Insurance were given extended deadline of May 18, 2020 while AG Leventis, E-Tranzact International and Infinity Trust Mortgage were given up till October 19, 2020, May 17, 2019 and May 17, 2021 respectively.
A source in the know of the approval process said the extension of the deadline was sequel to applications by the directors of the affected companies, seeking waiver and further extension of the timeline for the dilution of the share structure.
The source said the companies had cited prevailing market conditions and corporate procedures for their inabilities to meet the previous deadlines.
Kwankwaso supporters burn red caps, defect to APC


text:
package edu.cuny.qc.speech.AuToBI.featureextractor.shapemodeling;

import Jama.Matrix;
import edu.cuny.qc.speech.AuToBI.core.Contour;
import edu.cuny.qc.speech.AuToBI.core.Pair;

/**
 * This class fits a polynomial to a contour.
 *

 * This is used to obtain the polynomial fit coefficients when modeling the shape of a pitch or intensity contour as a
 * polynomial curve.
 */
public class ContourPolynomialFitter {
  private int n;  // The degree of the polynomial to fit.

  /**
   * Constructs a new ContourPolynomialFitter with degree n.
   *
   * @param n the degree of the polynomial to fit.
   */
  public ContourPolynomialFitter(int n) {
    this.n = n;
  }

  /**
   * Calculates the polynomial coefficients of a minimum squared error fit of an n degree polynomial to the contour.
   *
   * @param c the contour
   * @return an array of polynomial coefficients
   */
  public double[] fitContour(Contour c) {

    Pair<Matrix, Matrix> tx = constructTargetAndDataMatrix(c);
    Matrix t = tx.first;
    Matrix x = tx.second;

    Matrix w = x.transpose().times(x).inverse().times(x.transpose()).times(t);

    return w.transpose().getArray()[0];
  }

  /**
   * Calculates the mean squared error (MSE) between a contour c, and the polynomial weights given by weights.
   *
   * @param c       the contour
   * @param weights the weights
   * @return the mean squared error
   */
  public double getMSE(Contour c, double[] weights) {

    Pair<Matrix, Matrix> tx = constructTargetAndDataMatrix(c);
    Matrix t = tx.first;
    Matrix x = tx.second;

    Matrix w = new Matrix(weights.length, 1);
    for (int i = 0; i < weights.length; ++i) {
      w.set(i, 0, weights[i]);
    }
    Matrix y = x.times(w);
    double error = 0.0;
    for (int i = 0; i < y.getRowDimension(); ++i) {
      error += (y.get(i, 0) - t.get(i, 0)) * (y.get(i, 0) - t.get(i, 0));
    }

    return error;
  }

  /**
   * Constructs two matrices from a contour.
   *

   * The first is the target values, the second is the exponentiated x values.
   *
   * @param c the contour
   * @return a pair of matrices.
   */
  private Pair<Matrix, Matrix> constructTargetAndDataMatrix(Contour c) {
    Pair<Matrix, Matrix> retval = new Pair<Matrix, Matrix>();

    Matrix t = new Matrix(c.size(), 1);
    Matrix x = new Matrix(c.size(), n + 1);

    int i = 0;
    for (Pair<Double, Double> p : c) {
      t.set(i, 0, p.second);
      for (int j = 0; j <= n; ++j) {
        x.set(i, j, Math.pow(p.first, j));
      }
      ++i;
    }
    retval.first = t;
    retval.second = x;
    return retval;
  }

  /**
   * Returns the order of the polynomial that will be fit.
   *
   * @return the order
   */
  public int getOrder() {
    return n;
  }
}

redpajama_set_name: RedPajamaGithub


Casper Reinders is a known Dutch hospitality entrepreneur with a passion for interior design. He opened his first café in 1996, right after his Marketing and PR studies. Many other venues followed but he gained world-wide fame when he opened nightclub Jimmy Woo in 2003. Casper has strong ties with the Amsterdam community, working closely with (young) people in the city for various projects around his venues. One of Casper Reinders' great passions is the design of hospitality venues. In doing so, he trusts his own taste and feeling, not the trends or existing designs. The interiors styled by him are therefore invariably seen as trendsetting and controversial.
Casper Reinders is the founder of TAO Horeca Group, which currently manages the following venues in Amsterdam: Jimmy Woo, Club NL and Chicago Social Club, Lion Noir, Joya, Bo Nam, Bumbu Kitchen, Libertine Comptoir de Cuisine, Libertine Café Café, Libertine Petit Café, Ox & Bucks, MYLK and Che Buono.


Tube radiant gas heater - ELVHIS e. V. - Europäischer Leitverband der Hersteller von Gas-Infrarot-Strahlern e. V. - ELVHIS e. V. - Europäischer Leitverband der Hersteller von Gas-Infrarot-Strahlern e. V.
Radiant tube gas heaters heat the space principally through infrared radiation. Special burners with blowers – usually operating with gaseous fuel and in a few instances with oil – create inside the radiant tube (with typical diameters of 80 bis 100 mm – some types up to 400mm) a long laminar flame and the resulting exhaust gasses. The tube surface temperature is heated to temperatures of 200 bis ca. 600 °C. The hot tube surface emitts infrared heat radiation.
By reflector designs - some with insulation - above and to the side of the radiant tube radiation is directed to the occupied area. The combustion gases are discharged to the outside via an exhaust system.
Burner and flame of a tube space heater, by special mixing devices flame lengths of up to 6 m inside the radiant tube are produced to achieve uniform heat distribution.


text:
British Royal Navy's new Batch 2 River-class OPV HMS Forth begins maiden trials
3 September 2017	(Last Updated September 3rd, 2017 18:30)
The British Royal Navy's Batch 2 River-class offshore patrol vessel (OPV) HMS Forth has commenced its first sea trials on the River Clyde.
HMS Forth is the first of five new patrol ships of the same class being built to assist the navy in safeguarding fishing stocks, as well as protecting the Falkland Islands and their inhabitants.
The Royal Navy ship will also be deployed to the Mediterranean and Caribbean if required.
The new River-class patrol ship and its four sister vessels are expected to be 4k faster than their predecessors, and will be able to almost 60 crew members.
HMS Forth will be equipped with a 30mm main gun, two Miniguns, four machine-guns and two Pacific 24 sea boats.
Each of the five River-class vessels will feature a flight deck and will provide accommodation for up to 50 troops or Royal Marines in order to support operations on-shore when necessary.
HMS Forth navigator lieutenant Tom Sleight said: "The design provides a lot more operational flexibility with the large flight deck and space for the embarked force.
"These ships will be able to conduct all of the fishery protection and domestic security duties currently undertaken by the squadron."
"These ships will be able to conduct all of the fishery protection and domestic security duties currently undertaken by the squadron, but will now also provide a far more capable platform for deploying overseas such as when Mersey provided support to migrant operations in the Mediterranean or Severn, and Mersey on Atlantic Patrol North.
"They are going to be extremely capable ships when compared with their predecessors."
The Batch 2 River-class offshore patrol vessels will be named Forth, Trent, Medway, Tamar and Spey, and have been designed to replace the Batch 1 ships Tyne, Severn, Mersey and Clyde, which were built 15 years ago.
The second ship, Medway, is currently undergoing a fit-out at Scotstoun.
Image: The British Royal Navy's Batch 2 River-class offshore patrol vessel, HMS Forth. Photo: courtesy of the Royal Navy.
12thLevel
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Hospital operating rooms often have opportunities for patient safety and efficiency improvements, and the ORs at UPMC Hamot in Erie, Pa., were no exception — while the hospital had comparatively strong metrics for surgical site infections, OR never events, and OR turnover times, its leaders believed all three areas could be improved.
To conquer these challenges at once, UPMC Hamot turned to an innovative third-party service called remote video auditing provided by the web services company Arrowsight, Inc.
To learn more about RVA technology and how it can reduce infections in the OR and improve OR efficiency, register for this upcoming webinar (March 23, 11 a.m.).
Remote video auditing can be likened to sports teams watching game film to make improvements. It involves using off-site trained observers who watch near real-time video clips to measure compliance with certain predetermined steps. The patient safety and OR efficiency performance feedback is then automatically streamed back to the organization via webpage scorecards on plasma boards throughout the OR and to mobile devices. There are also near real-time text and email alerts sent to designated OR staff when there are operational tasks to be performed, such as alerting the cleaning staff to come clean a room when the patient leaves the OR.
Remote video auditing originally gained traction in the food industry to improve food safety and efficiencies in the early 2000s and then made its way into healthcare in the late 2000s. Northwell Health was the first major health system to pioneer the use of RVA in healthcare, which began in 2008 with a two year study using RVA to improve hand hygiene performance in a large intensive care unit at North Shore University Hospital in Manhasset, N.Y. The study results were published in 2011 in Clinical Infectious Diseases Journal showing that RVA with near real-time feedback improved hand hygiene compliance from 6.5 percent to 81.6 percent in four weeks, and the hospital sustained those rates for 75 weeks. In 2013, Northwell Health, in partnership with their anesthesia provider, North American Partners in Anesthesia, began a second major study on the use of RVA to improve OR patient safety and OR efficiencies at Long Island Jewish Medical Center. These study results were published in 2015 in British Medical Journal Quality and Safety, reporting RVA with near real-time feedback improved surgical safety checklist performance to 90 percent and reduced turnover times by 15 to 20 percent.
RVA in healthcare earned national attention when Martin Makary, MD, with Johns Hopkins in Baltimore, wrote a 2013 JAMA viewpoint article on the power of RVA. "The potential to harness the data in these videos and drive quality improvement may be substantial," he wrote. Dr. Makary also published an editorial in BMJ in 2016 citing the 2015 BMJ publication about RVA in the ORs as being a "landmark study."
UPMC Hamot leadership saw an opportunity to improve the safety and efficiency of surgical care with RVA and in 2014 contracted with Arrowsight to implement this technology in their operating rooms. Administrators and clinicians detailed their experience with RVA in a study published in the February 2017 issue of AORN Journal titled: Remote Video Auditing in the Surgical Setting.
It took four months of preparation and communication with key stakeholders before the cameras could be turned on at UPMC Hamot.
One of the major obstacles was convincing clinicians that the video data was safe, according to Anne Pedersen, MSN, RN, UPMC Hamot's director of nursing. "The staff was initially concerned these videos could show up on YouTube," she says, since they are transmitted through the internet to Arrowsight. Staff concerns were alleviated when they understood that the RVA system transmits the low-resolution videos through the hospital and Arrowsight's highly secure VPN connection.
It also helped that the surgical consent form used at UPMC Hamot already included a clause that allowed the organization to take pictures and videos during procedures.
Through a tailored communication campaign that involved one-on-one and group meetings with surgeons, anesthesia staff, housekeeping and other workers, the system gained "universal support," Ms. Pedersen says.
UPMC Hamot leaders also had to decide on which predetermined sets of actions the trained auditors should observe. The hospital ended up with three domains for the RVA team to audit.
1. Patient safety triad. The patient safety triad, or PST, encompasses the sign-in, time out and sign-out portions of any surgery, which are crucial for patient safety. To make them visible and obvious to the observer, UPMC Hamot tweaked its processes slightly — it started using a more visible, large yellow trifold card during the PST's three phases, so the remote observers could assess the safety protocols. Everyone in the OR stops all movement during these PST events, which is both good for patient safety and makes it easier for auditors to observe via video. As a result of RVA, compliance with the three components of the PST now ranges from 94 percent to 100 percent on a daily basis.
2. Efficiency. The remote auditors monitor the efficiency of OR turnover at UPMC Hamot. Auditors monitor turnover time in three segments: patient exit to cleaning stop, cleaning stop to room sterile and room sterile to patient in. To gain efficiency in this area, the hospital started using parallel work, with anesthesia and nursing staff working side by side to prep the room. "It took work for nursing to understand anesthesia can come in when everything isn't in place," says Megan Beaton, BSN, RN, the hospital's director of surgical services, but it led to more efficient use of time. By using RVA to provide detailed performance metrics of all case segments, UPMC Hamot was able to successfully re-engineer its OR processes leading to a roughly 20 percent reduction in turnover times. They estimated that the financial impact of this increased efficiency enabled UPMC Hamot to have a full payback on the first year of RVA costs of $200,000, in a single month.
3. Cleaning. UPMC leaders realized that in addition to using RVA to improve overnight terminal cleaning performance that it would be beneficial for patient safety to leverage RVA to improve in-between case OR cleaning and also end-of-month OR cleaning.
As a result of using RVA, EVS personnel are achieving 94 percent compliance with OR cleaning requirements — which has led to an initial 10 percent reduction in SSIs as reported in AORN, which has been recently revised to about a 20 percent SSI reduction now that the readmission period following the study has passed. UPMC Hamot estimates it has saved more than $500,000 annually as a result of a decrease in these costly surgical complications.
Arrowsight sends near real-time feedback to UPMC Hamot to improve patient flow in addition to safety, efficiency and cleaning. Status boards are situated in the hospital so staff can see what stage each OR is in — when one is sterile, a drape is coming down or the cleaners have entered, for instance.
"We really have come to value the RVA boards," Ms. Pedersen says. "The beautiful choreography is triggered by the status board."
Additionally, alerts are sent to surgeons' phones when ORs are ready or nearly ready so they can be more efficient with their own time in-between cases. Approximately 80 surgeons are now consistently receiving notifications on personal cell phones, according to Ms. Pedersen.
Since implementing RVA with Arrowsight, the hospital has experienced roughly 95 percent compliance on surgical safety checklist protocols. Additionally, UPMC Hamot has seen decrease of about 20 percent in OR turnover times and a 20 percent reduction in surgical site infections. The decrease in turnover times enabled UPMC Hamot to achieve a full payback on their first year $200,000 investment in RVA in a single month, and the reduction in SSIs resulted in an estimated savings of $500,000 during the first year.
"Remote video auditing has improved patient care at our facility and may shape the future for surgical care in the United States," the AORN Journal study authors wrote.
For hospitals that decide not to initially implement RVA for the full suite of OR patient safety and OR efficiency services reported on by UPMC and Northwell Health, surgery departments can start by purchasing a small number of inexpensive RVA portable cameras to focus exclusively on improving OR cleaning performance to help reduce surgical site infections.


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CDF affirms liceity of removal of wombs it says can no longer procreate
January 3, 2019 CNA Daily News News Briefs 0 Print
Vatican City, Jan 3, 2019 / 05:01 pm (CNA/EWTN News).- The Congregation for the Doctrine of the Faith published Thursday a response clarifying that a hysterectomy is a licit act when a woman's womb is not suited for procreation and medical experts are certain an eventual pregnancy will bring about a spontaneous abortion before viability.
The CDF's Response to a question on the liceity of a hysterectomy in certain cases was published Jan. 3. It was signed Dec. 10, 2018, by Cardinal Luis F. Ladaria Ferrer, S.J., prefect, and Archbishop Giacomo Morandi, secretary of the congregation.
The CDF said its response regards "situations in which procreation is no longer possible," and it completes responses, "which retain all of their validity," given in 1993 to questions proposed concerning "uterine isolation" and related matters.
The 1993 responses stated that hysterectomy is licit when there is a grave and present danger to the life or health of the mother (because it is chosen for therapeutic reasons; its aim is to curtail a serious present danger such as hemorrhage which cannot be stopped by other means), but that hysterectomy and tubal ligation are illicit when they are intended to make impossible an eventual pregnancy which can pose some risk for the mother (because they are direct sterilization).
In an illustrative note accompanying its response, the CDF said the question at hand is different from the cases of direct sterilization discussed in the 1993 responses because of "the certainty reached by medical experts that in the case of a pregnancy, it would be spontaneously interrupted before the fetus arrives at a state of viability."
"Here it is not a question of difficulty, or of risks of greater or lesser importance, but of a couple for which it is not possible to procreate," the CDF wrote.
The congregation wrote that the "object of sterilization is to impede the functioning of the reproductive organs, and the malice of sterilization consists in the refusal of children: it is an act against the bonum prolis."
By contrast, in this case "it is known that the reproductive organs are not capable of protecting a conceived child up to viability," or that the reproductive organs "are not capable of fulfilling their natural procreative function."
"The objective of the procreative process," the CDF said, "is to bring a baby into the world, but here the birth of a living fetus is not biologically possible."
"Therefore, we are not dealing with a defective, or risky, functioning of the reproductive organs, but we are faced here with a situation in which the natural end of bringing a living child into the world is not attainable."
In such a case a hysterectomy "should not be judged as being against procreation, because we find ourselves within an objective context in which neither procreation, nor as a consequence, an anti-procreative action, are possible. Removing a reproductive organ incapable of bringing a pregnancy to term should not therefore be qualified as direct sterilization, which is and remains intrinsically illicit as an end and as a means."
The CDF noted that whether a pregnancy could continue to viability is a medical question, and that morally, "one must ask if the highest degree of certainty that medicine can reach has been reached."
The congregation added that its response "does not state that the decision to undergo a hysterectomy is always the best one, but that only in the above-mentioned conditions is such a decision morally licit, without, therefore, excluding other options (for example, recourse to infertile periods or total abstinence)."
"It is the decision of the spouses, in dialogue with doctors and their spiritual guide, to choose the path to follow, applying the general criteria of the gradualness of medical intervention to their case and to their circumstances."
The response also noted that it had been approved by Pope Francis, who ordered its publication.
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Pope Francis: Evangelization is about knowing the human heart
September 29, 2017 CNA Daily News 3
Vatican City, Sep 29, 2017 / 11:06 am (CNA/EWTN News).- On Friday, Pope Francis said that the work of evangelization belongs to all people, and that the richness found in a variety of traditions can be a way of opening people's hearts to the Gospel.
"The new stage of evangelization we are called upon to follow is certainly the work of the whole Church, 'people on the way to God,'" he said Sept. 29.
Evangelization "by its very nature belongs to the People of God."
Referencing the Second Vatican Council document Lumen gentium, he said, "From every population to which we go, a wealth emerges which the Church is called to recognize and value to bring about the unity of 'all mankind' of which it is the 'sign' and 'the sacrament.'"
Pope Francis' speech was part of a meeting with around 60 members of the Pontifical Council for the Promotion of the New Evangelization, at the conclusion of their plenary session Sept. 27-29.
In the audience, he told them he wanted to reflect on the "urgency" the Church feels to "renew its efforts and enthusiasm" for its mission of evangelization.
The many good traditions that people and their cultures possess give richness to the Church and life to the action of grace, which opens hearts to accept the Gospel, he said.
These traditions are "authentic gifts" expressing the infinite creativity of the Father and fostering communion, which then acts as a "seed of salvation, a prelude to universal peace and a concrete place of dialogue."
Pope Francis also emphasized that the call to evangelize "transcends" the availability of a single person, but is actually part of a complex design of interpersonal relationships.
"Few institutions like the Church can boast of having a knowledge of the people able to enhance that cultural, moral and religious heritage that is the identity of entire generations," he said.
This is why, he explained, it is important that in our evangelization efforts we know how to enter people's hearts and help them to discover the sense of God and his love that gives confidence and serenity despite difficulty and challenge.
If we look deeply, he continued, we may find a "genuine desire for God that makes restless the heart of so many fallen people…"
"The joy of evangelization can reach them and give them the strength for conversion," he said.
Pope Francis also reflected on last year's Jubilee Year of Mercy, which he said was a time of grace lived by the whole Church "with great faith and intense spirituality," especially the rediscovery of the Sacrament of Reconciliation.
"We cannot permit that such enthusiasm be diluted or forgotten," he said.
The Pope said that everyone who evangelizes should be committed to announcing the message of mercy, which is made concrete and visible in the lives of believers.
Furthermore, those who have the task of proclaiming the Gospel should remember the words of the Apostle Paul, who says in 1 Timothy 1:12-16: "I am grateful to him who has strengthened me, Christ Jesus our Lord, because he considered me trustworthy in appointing me to the ministry."
"I was once a blasphemer and a persecutor and an arrogant man, but I have been mercifully treated because I acted out of ignorance in my unbelief. Indeed, the grace of our Lord has been abundant, along with the faith and love that are in Christ Jesus," the Pope quoted.
"This saying is trustworthy and deserves full acceptance: Christ Jesus came into the world to save sinners. Of these I am the foremost."
The Church has a great responsibility to continue to be an instrument of mercy, Francis said.
"In this way, it can be easier to allow the reception of the Gospel to be perceived and lived as an event of salvation and it can bring a full and definitive meaning to personal and social life."
Pope Francis taps Helena bishop as new head of Las Vegas diocese
February 28, 2018 CNA Daily News 0
Vatican City, Feb 28, 2018 / 05:36 am (CNA/EWTN News).- Bishop George Leo Thomas, who until now has led the Diocese of Helena, will be taking the reins in Las Vegas, bringing with him broad pastoral experience and expertise in psychology, mental health issues, mission work and prison ministry.
In the Feb. 28 announcement from the Vatican, it was noted that Bishop Thomas of will be taking over for Bishop Mons. Joseph Anthony Pepe, who has led the Diocese of Las Vegas since 2001, but is now stepping into retirement.
Thomas, 67, was born May 19, 1950 in Anaconda, Mont. as the second oldest of five children. He was raised in Butte where he attended Catholic school, graduating from Christian Brothers High School in 1968.
He received a degree in literature from Carroll College in 1972 before entering St. Thomas Seminary in Washington as a student with the Archdiocese of Seattle. He obtained a master of divinity degree there before being ordained to the priesthood May 22, 1976 in Seattle.
After his ordination, Thomas served in several parishes, including Holy Family Parish in Kirkland and St. James Cathedral in Seattle, where he had been ordained. He also served as parish administrator for Sacred Heart Parish in Bellevue and Holy Innocents Mission in Duvall.
In addition to his pastoral positions, Thomas was also the prison chaplain for the King County Jail and the Seattle City Jail for 12 years. He was chairman of the board of directors for Catholic Community services for 10 years, and also served as chaplain for the Missionary Sisters of the Sacred Heart in Seattle.
Thomas then entered graduate school at the University of Washington in 1981, where he received a master's degree in counseling and mental health.
In 1986, he obtained a doctorate in philosophy with an emphasis in Pacific Northwest mission history. His dissertation, titled "Catholics and the Missions of the Pacific Northwest," was given the university's Gordan C. Lee award.
A year later, Thomas was appointed chancellor and vicar general for the Archdiocese of Seattle. He held the positions for 17 years before being named apostolic administrator for the diocese in 1997, following the death of Archbishop Thomas Murphy.
Thomas was appointed auxiliary bishop for Seattle two years later in 1999, and in March 2004 was tapped to head the Diocese of Helena.
He speaks Spanish and is also a member of the Bishops for the American College in Louvain and Native-American Catholics committees for the United States Conference of Catholic Bishops.
Benedict XVI unwell since visit to Germany
August 3, 2020 CNA Daily News 4
Rome Newsroom, Aug 3, 2020 / 03:21 am (CNA).- Pope emeritus Benedict XVI is sick with a bacterial infection and "very frail," according to a German newspaper report.
Citing Benedict biographer Peter Seewald, German newspaper Passauer Neue … […]
Three challenges for Francis as he meets with Iran's president
John Paul Shimek November 12, 2015 0
On November 14, Pope Francis will meet with Iranian President Hassan Rouhani at the Vatican. It will be the first time a pope has met with a head of the Islamic Republic since Pope St. […]


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Top 10 Biggest Airlines in the World
Jul 05, 2021 by All Top Everything in Companies
Apart from maybe the internet, no other invention has brought the world closer together than the plane. There is currently no other transportation method that brings you quicker and safer from A to B airplanes. Planes allows you to travel our Earth in the matter of not more than a day. And air travel has never been more popular. In 2020, the number of civilian flights performed all over the world is projected to reach over 40 million. It is therefore no surprise that the global airlines industry is doing very well, too. The multi-billion industry is in fact now one of the largest markets there is. And also one of the most competitive one. The following ranking shows you the current Top 10 Biggest Airlines in the World by reached revenue last year.
The achieved revenue of an airline highly correlates with the number of passengers the airline carried during a year. However, the level of ticket prices and in that context the countries and regions an airline operates in, can also have a huge impact on revenue performance as you can see in the current Top 10 Airlines ranking.
Note: For the Top 10 Ranking of Busiest Airports in the World, click here.
The 10 Biggest Airlines in the World 2020
1. Delta Air Lines
Revenue: $44.9 billion
Year of Foundation: 1925
Based in: Atlanta, Georgia, USA
Number of countries served: 60
Number of yearly passengers (2019): ~ 205 million
2. American Airlines
(as a merger between US Airways & AMR)
Based in: Forth Worth, Texas, USA
Based in: Cologne, North Rhine-Westphalia, Germany
4. United Airlines
(as a merger between United Air Lines & Continental Airlines)
Based in: Chicago, Illinois, USA
5. Air France-KLM
(as a merger between Air France & KLM)
Based in: Tremblay-en-France, Ile-de-France, France
6. International Consolidated Airlines Group
(as a merger between Iberia & British Airways)
Based in: Madrid, Community of Madrid, Spain
7. Southwest Airlines
Based in: Dallas, Texas, USA
8. China Southern Airlines
Based in: Guangzhou, Guangdong, China
9. All Nippon Airways
Based in: Tokyo, Tokyo Prefecture, Japan
Number of yearly passengers (2019): ~ 55 million
10. China Eastern Airlines
Based in: Shanghai, Municipality of Shanghai, China
The 10 Biggest Airlines in the World
(as of February 2020)
Top 10 Biggest Airlines in the World:
Top 10 biggest Airlines ranking, based on most current revenue numbers.
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The core of our 2018/2019 season will be our Summer Performance Camp at Bloemfontein that will start on 4th November 2018 and continue until 9th February 2019.
Over the years we have learned, that there is a wide time window when long flights are possible. This stretches from the beginning of November and continues until the middle of February. To illustrate the point, on the 5th Nov 2013 we enjoyed the best day ever, four gliders managed a 1200km flight in our area at an average speed of 160 kph! On the 12th February 2016 Anders Andersen set a new Danish 1000km triangle record at 156kph! So whether you are just starting out with your cross country flying or you are going for your 1000 Km, Bloemfontein is a great place to be.
This exciting soaring is not just for the select few pilots, it is available to glider pilots with all levels of experience. We provide the expert help and the guidance necessary for you, to safely enjoy the excitement of gliding in South Africa – Gliding With a Difference.


text:
package br.mil.mar.casnav.mclm.persistence.infra;

import org.hibernate.Session;
import org.hibernate.SessionFactory;
import org.hibernate.boot.registry.StandardServiceRegistryBuilder;
import org.hibernate.cfg.Configuration;
import org.hibernate.service.ServiceRegistry;

public class ConnFactory {
	private static SessionFactory factory;
	private static String userName;
	private static String password;
	private static String databaseName;
	private static String databasePort;
	private static String databaseAddr;

	public static void setCredentials( String user, String passwd, String database, String port, String addr ) {
		userName = user;
		password = passwd;
		databaseName = database;
		databasePort = port;
		databaseAddr = addr;
	}

	public static Session getSession() {
		if ( factory == null ) {

			try {
				Configuration cfg1 = new Configuration();
				cfg1.configure("hibernate.cfg.xml");

				String url = "jdbc:postgresql://" + databaseAddr + ":" + databasePort + "/" + databaseName + "?ApplicationName=MCLMv2.0";
				cfg1.setProperty("hibernate.connection.username", userName);
				cfg1.setProperty("hibernate.connection.url", url);
			 	cfg1.setProperty("hibernate.connection.password", password);

				StandardServiceRegistryBuilder serviceRegistryBuilder1 = new StandardServiceRegistryBuilder();
				serviceRegistryBuilder1.applySettings( cfg1.getProperties() );
				ServiceRegistry serviceRegistry1 = serviceRegistryBuilder1.build();

				factory = cfg1.buildSessionFactory(serviceRegistry1);

			} catch (Throwable ex) {
				ex.printStackTrace();
				return null;
			}
		}

		Session session = factory.openSession();
		return session;
	}

}


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Home Newsroom News and press releases International observers regret another failed presidential election in Serbia
OSCE Office for Democratic Institutions and Human Rights
International observers regret another failed presidential election in Serbia
BELGRADE 17 November 2003
Reports indicate that voter turnout for the 16 November 2003 presidential election in Serbia was below 40 per cent. (Milan Obradovic) Photo details
BELGRADE, 17 November 2003 - As preliminary information indicates a voter turnout of less than 40 per cent, it is likely that yesterday's presidential election in the Republic of Serbia (Serbia and Montenegro) will be declared invalid.
While the election was conducted generally in line with OSCE commitments and Council of Europe standards for democratic elections, observers deployed by the OSCE's Office for Democratic Institutions and Human Rights (OSCE/ODIHR) and the Council of Europe's Congress of Local and Regional Authorities of Europe (CLRAE) are concerned that a third failed attempt to elect a president in the last 14 months may further undermine public confidence in the pace of democratic reforms in Serbia.
"We are disappointed that the legislative framework for elections has remained unchanged since the last attempt to elect a president in December 2002," said Nikolai Vulchanov, head of the OSCE/ODIHR observation mission. "We can only repeat our strong recommendation that unusual provisions allowing for an endless cycle of invalid elections be removed from the legislation."
The election campaigns conducted by most candidates were low-key, which could have contributed to low voter turnout. It should also be noted, however, that the choice of voters was narrowed, as several major parties chose not to field candidates, while a number of other parties called on their supporters to boycott the election. Media coverage of the campaign was mainly unbiased, with state television providing largely balanced and neutral coverage.
"No significant problems were reported regarding the polling and the vote count," said Joseph Borg, head of the CLRAE delegation. "The election administration, on the whole, worked in an efficient and transparent manner. It is regrettable that the work and resources invested in the process have been once again wasted."
The OSCE/ODIHR and CLRAE are prepared to assist the Serbian authorities implement the measures recommended in their statement of preliminary findings and conclusions. Both organizations will release final reports on these elections in about one month.
PRESS RELEASE IN SERBIAN
Preliminary statement in Serbian