The Step 2 CS Scheduling system does not allow an applicant to reserve his/her scheduled testing appointment for another applicant, nor does it allow the transfer of a testing appointment from one applicant to another. When an applicant cancels a scheduled appointment, the appointment returns to the pool of available testing appointments where it can be claimed by other registrants.
At any given time, there are many applicants registered for Step 2 CS who may be attempting to schedule or reschedule testing appointments. It is common for appointments that become available to be claimed immediately by another applicant.
The Step 2 CS Scheduling Email Notification System allows registered applicants to indicate their preferences for test dates and centers. When a testing appointment is canceled, all applicants participating in the email notification system who have expressed a preference for this date/center are notified immediately by email.
The best way for registered applicants to monitor the availability of testing appointments is to indicate their preferences for dates/centers using the pilot Step 2 CS Scheduling Email Notification System. To indicate your preferences, access Step 2 CS Scheduling from the ECFMG website, and follow the link "Add/Edit Scheduling Email Notifications."
For detailed information on policies and procedures related to Step 2 CS scheduling and rescheduling, refer to the ECFMG Information Booklet and USMLE Bulletin of Information.


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redpajama_set_name: RedPajamaCommonCrawl


Five vehicle burglaries in one night on Regency Oaks Drive, Stone Hill Drive and West Ridge Drive were among the incidents the Bartlett Police Department (BPD) handled from Feb. 24 through March 8.
A home inspector uncovered a copper theft on Feb. 23 when inspecting a St. Phillip Drive residence before the closing date for the home's sale. An officer spoke with the owner, who lives in Waukegan, Ill., the next day.
Sometime between Feb. 1 and Feb. 23, a suspect entered the home, removed the copper water pipes, ripped the electrical meter off the house and tried but failed to remove the home's copper wiring. Damages are estimated at $2,900.
A complainant on Craddle Hill Drive reported thefts at two homes under construction on Feb. 25. One house was missing a stainless steel Frigidaire dishwasher, and another was missing eight feet of copper wire.
A woman residing on Bristol Woods Cove reported on Feb. 25 that her 2015 tag expiration sticker was missing from her Tennessee tag.
A man reported on Feb. 25 that he loaned his rental car, a white Toyota Camry, to a woman at 8 a.m. that day with the agreement she would return it when she got off work at 5 p.m. She did not show up on time, and he has not been able to reach her by phone, he reported.
A man reported on Feb. 27 that someone stole a red Husky air compressor ($250) from his home on Callie Powell Cove between 6 a.m. and noon that day. He was not home at the time of the theft and had left the garage door open.
A woman reported on Feb. 28 that someone stole her purse from her unlocked van around 10 a.m. while it was parked in the lot near Petvax (6963 U.S. 70).
A resident on Wild Drive spotted a man pulling up to a next-door neighbor's open garage around the time that approximately $1,100 in power tools went missing. The witness said the suspect pulled up in a green SUV and opened the rear hatch sometime between 3:40 p.m. and 3:50 p.m. on Feb. 28.
The suspect appeared to ge there to get something from the residence, but she didn't actually see the thefts, she said.
Another neighbor took a picture of the suspect's license plate. A police check revealed a vehicle that matched the witness's report and that was registered to a white male matching the suspect's description.
Both witnesses looked at a six-person photo lineup and positively identified the registered owner as the suspect.
The victim said he was home at the time but didn't witness the theft.
Stolen items included a black & red air compressor (unknown brand, $300), an air impact kit with ratchet drill and gun (silver tools in a black case, $300), a yellow DeWALT cordless 18V Sawzall (Value $200), a Yellow DeWALT cordless 18V drill ($100), and two corded DeWALT electric drills ($100 each). No serial numbers were available. The matter is still under investigation by the Detective Division.
A woman reported that someone stole multiple items from her car while it was parked outside the Malco Stage Cinema (7930 U.S. 64) on Feb. 28.
She parked at 7 p.m. and returned at 9:20 p.m. to find the following items missing: Costa sunglasses ($150), miscellaneous Sephora makeup ($500), red Nike backpack ($50), iPhone 5c ($300), various prescription drugs, miscellaneous clothing items ($50), iPhone charger ($15) and vehicle registration.
The responding officer saw no signs of forced entry on the vehicle.
A victim reported on March 1 that someone broke into and burglarized his vehicle that night in the parking lot of the Malco Stage Cinema (7930 U.S. 64). Someone broke the passenger window and stole a Pioneer Double Din stereo and amplifier, along with the victim's wallet from the middle console. The wallet held his Arkansas driver's license, Social Security card, Regions Bank card and Capital One card.
An officer took multiple reports of auto burglary when responding to the first report on Regency Oaks Drive on March 2.
The first victim said someone stole his 16GB silver iPod ($100) from his unlocked truck while it was parked overnight in his driveway. The theft occurred between 10 p.m. March 1 and 6:30 a.m. March 2.
A second victim also reported thefts from his unlocked Nissan parked in his driveway. He said someone stole a Smith & Wesson 9mm handgun, brown wallet with his Tennessee driver's license and handgun permit ($10), and $50 in cash out of the passenger door.
A third victim flagged down the officer at the scene and said someone had burglarized her Saturn at her home between midnight and around 7 a.m. March 2 on Stone Hill Drive. Her car was also unlocked. She said the items had been rummaged through, but nothing was stolen.
The fourth victim met the officer at the jail lobby. He said someone burglarized his unlocked Toyota 4 Runner on the 3800 block of Stone Hill Drive between 5 p.m. March 1 and 7 a.m. March 2. Only $2 was stolen from the front center console.
The fifth victim, a resident on West Ridge Drive, same someone burglarized her unlocked Chevrolet between 9 p.m. March 1 and 7:30 a.m. March 2.
A victim reported on March 6 that someone burglarized his open garage between 11:15 a.m. and almost noon that day. An unknown white male suspect walked into the garage and took a welder ($1,100). The victim said the suspect was of average height and medium build, wearing a tan coat, bluejeans, work boots, and dark sunglasses.
The suspect's vehicle was described as a green Subaru Outback with a black front bumper.
A man reported on March 7 that a female acquaintance banged on his bedroom window on Thistle Valley Lane around 4:30 a.m. He saw her driving away in a silver Volvo toward St. Elmo Road.
He then saw that the rear of his girlfriend's Dodge Charger was smashed and someone had keyed (scratched) the rear passenger door.
A Court Street resident reported that someone broke into his truck's toolbox and stole $2,8000 in tools and other items between 9:30 p.m. March 7 and noon March 8.
The victim said he parked his 2010 Chevrolet Silverado work truck in his driveway and locked all of the toolbox doors. The responding officer did not observe any noticeable damage to the toolbox's doors.
Items stolen from the toolbox included a Milwaukee hammer drill ($300), Milwaukee Saw-Zall ($300), Milwaukee circular saw ($300), Milwaukee PortaBand portable band saw ($300), Mikata drill ($200), Cadweld mold ($300), hand tools ($500), dragouts ($200), Carhartt jackets ($300) and DeWALT heat gun ($100).


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MIS Web
Vision & Misson
Office of Provost
Research Board
Ethics Commitee
Improving nutrition in rural Ghana: A glimpse at the first decade of the University of Ghana Nutrition Research and Training Centre
You are kindly reminded of the 11th Public Lecture of the College of Basic and Applied Sciences, which has been scheduled as follows:
Date: Tuesday, 17th March, 2020
Venue: Auditorium of the Centre for African Wetlands, University of Ghana, Legon
Guest Speaker: Professor Grace Marquis
Chairman: Professor Daniel K. Asiedu (Provost, CBAS)
Please keep the date and time open and endeavour to attend.
Kindly find below a profile of the Guest Speaker and summary of the Lecture
Profile of Guest Speaker
Grace S. Marquis is Associate Professor in the School of Human Nutrition at McGill University (Montreal, Canada) and Affiliate Associate Professor in the Department of Food Science and Human Nutrition at Iowa State University (Ames, USA). She was the Canadian Research Chair in Social and Environmental Aspects of Nutrition from 2006-2016. Her career in maternal and child nutrition began over 35 years ago at the Instituto de Investigación Nutricional (Nutrition Research Institute) in Lima, Peru. Since 1999, her research group has worked in Ghana. In collaboration with Dr. A Lartey, funds were obtained to build the Nutrition Research and Training Centre in Asesewa (Eastern Region). Through the centre, Dr. Marquis' team carries out community-based research that examines how social, economic, biological, and environmental factors interact and affect the diet and nutritional status of infants and young children as well as that of adolescent girls and women. Projects include multi-sector, integrated strategies that strengthen economic activities and expand knowledge to support health and growth of households living in poverty. Dr. Marquis is the primary mentor for 15 doctoral students (seven Ghanaian). She is proud of her graduates who are now well positioned as researchers at international and national research and development institutions, and the University of Ghana. Her group's research has been disseminated through more than 80 publications in peer-reviewed journals and presented in many professional conferences around the world. Dr. Marquis is Associate Editor for Advances in Nutrition, ranked third of all nutrition and dietetics journals globally. She received a Doctorate of Laws, honoris causa, for contribution to tertiary education from the University of Ghana in 2013.
Professor Grace S. Marquis
Summary of Lecture
Large disparities in nutrition persist in Ghana -- across regions and urban-rural settings as well as by sociodemographic classifications including sex, age, education, and wealth. Over the last 10 years, the University of Ghana Nutrition Research and Training Centre (NRTC) in the Eastern Region has provided support for national and international researchers to enhance the understanding of nutrition disparities and design interventions to improve rural lives. Nutritional status is affected by many determinants that must be addressed through coordinated activities in health, education, agriculture, finance, business, among other areas. Close collaborations through participatory research methodologies with stakeholders – from community residents to district directors – enhance the potential of sustainable intervention benefits. The projects at the NRTC work with local institutions to enrich the knowledge and skills of district staff to promote their services to the community and expand residents' ability to address the daily challenges to providing a nutritious diet and healthy environment for their families. A decade of training and research at the NRTC has demonstrated that multi-sector approaches can improve rural nutrition and well-being.
+233-(0)302-213820
pad@ug.edu.gh
P.O. Box LG 25
Legon, Accra
Basic & Applied Sciences
Sakai LMS
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University of Ghana © 2014


We are excited to announce our first feature-length production, There Are No Gays In Chechnya. This will be a workshopped presentation which will include a full reading of the script, some movement work, and a talk-back with the creative team.
Through scripted dialogue and movement theatre, we follow four friends, Joseph, Alexei, Sofia, and Daryia as they work together to avoid being outed and escape the gay purge sweeping across Chechnya. Questions begin to rise around who they can trust, and where they are going. However, they must decide quickly as they are running out of time.
This project asks why the world did not respond as quickly to this event as it did to others (the murder of journalist Jamal Khashoggi, the gas attack by Assad in Syria), and why has it taken over two years for any official condemnation from world leaders?
This project aims to give voice to those currently being persecuted, and to those who have been killed by the purge in Chechnya. We want to highlight the continued need for education and advocacy for Queer rights around the world.


I began practicing yoga in 2010, as a way of stretching to compliment my running. As my flexibility and general well being improved it soon became a bigger priority in my life. I've always been somebody that's in a rush and have found the relaxation aspect of yoga most challenging. In the last couple of years I've been able to use yoga to work on this and am enjoying taking a calmer and more laid back approach to life. I now practice and teach a variety of yoga types, including hatha and vinyasa and I'm enjoying the different advantages of each.
I spent 13 years working for the NHS as a cardiac physiologist and in 2017 I was lucky enough to incorporate my love of yoga with a more flexible working pattern and undertake a 200 hour yoga teacher training programme (accredited by Yoga Alliance UK). I've since gone on to complete my pre and post natal training with Sally Parkes, giving me an additional 85hours Yoga Alliance accreditation.
I have a five year old and a 2 year old and am loving bringing them up with yoga, seeing the benefit it has on them and giving them tools to keep calm. This has led me to teach family yoga classes as a great opportunity to bring the family together in a fun laid back hour of yoga.
I also teach 1:1 yoga classes where we can tailor classes to suit your individual needs, including pregnancy and post natal classes.


The login screen - simple but secure. Later you'll see that the logo can be changed to the company brand logo instead.
Your own settings can be edited easily, and WebEX conference details makes it easy to get in touch with others.
Helpful notes are given to new users, but can easily be turned off.
A Web 2.0 experience is obvious after using the web interface for two minutes. Everything seamlessly slips from one thing to another.
A small, quick download gets helps bridge online and offline together.
Mapping drives can be automated with a simple batch script if needed.
As mentioned, you can upload your own company logo to give your online workspace that added corporate touch.
On the local machine, your storage area is visibly accessible where the rest of your drives are.
When backing up, this is the login screen you'll see.
The online workspace is bridged with your offline workspace, enabling you to work even when you're away from an active Internet connection.
Notes can be applied to files so others seeing them can have extra instructions when dealing with them.
Easy to read and understand messages are always given; helpful to those who aren't very IT compatible.
User permissions can be set via the administrator and can be added, changed, modified and deleted as and when appropriate.
Sharing files is popular in enterprises, and this keeps it all in one place without the need or want of files getting thrown everywhere and lost track of.
Alerts can be set to tell the owner when a file is modified.
Tagging enables better searching, as searching is vital in any organisation.
Having an access history lets you see when something was modified and by whom.
Email is generated with a nice layout and format to alert the owner of a change to a document or workspace.
Searching in Egnyte is powerful and effective, allowing you to search by tag, filename, username and others.
Having version tracking allows you to revert back to old documents, if a newer version becomes corrupt or isn't suitable for whatever reason.
Renaming, editing, tagging and adding information can be done with a click of a button.
The backup feature runs on the local computer, and allows the client computer talk to the Egnyte cloud.
Files and folders which are scheduled to be backed up are given an extra logo in your local explorer view.
With a right-click of a file, you can stop and start a file to be uploaded.
The client software runs quietly with less than 1MB memory being used, out of the way in the taskbar.
A thumbnail view can be selected to see the content of a file, or at very least the file type.
Sending files are simplified by sending as a link or as a zip file; useful for those who are working on their mobile.
If you are sending a file which is secure or sensitive, you can send a link to the file which can have an expiry time put on it.
A screenshot walkthrough of the powerful Enterprise 2.0 application, Egnyte, which enables more economical storage at a cheaper price to hardware on-site alternatives.


A good weekend for the new Alliance Rocket Puller tyres!
First weekend in use on Whispering Giant and Rocket Science and they made it onto the podium twice (even in the heavy modified class!) at Europe's most prestigious event! Great result for new prototypes!!!


We offer a wide range of course options and timetables at LANGUAGES UNLIMITED (LU). Our small groups allows for greater flexibility in scheduling. We also find that by keeping the groups small, our students' progress more rapidly. Our courses are catered to meet your individual needs.
Oferecemos um largo espectro de opções ao nível de cursos, de disponibilidade e flexibilidade de horários na LANGUAGES UNLIMITED (LU). Também pelo facto de trabalharmos em grupos pequenos e porque cada curso vai de encontro às suas necessidades, os nossos alunos progridem mais rapidamente.
Our adult courses are designed with the idea that, for the majority of students, the main aim in taking a language course is to improve their ability to express themselves orally. Our groups for adults are small, with no more than eight students in each, allowing each student adequate oral practice. Should you choose to join one of these groups, the program for that course would be adapted to suit both your individual needs and the needs of the other students in the group.
Os nossos cursos para adultos são desenhados com a ideia principal de que a maior ajuda ao tirar um curso de línguas é melhorar a habilidade de se expressar oralmente.
Os nossos grupos para adultos são pequenos, à volta de 8 alunos, permitindo assim a cada um praticar a sua oralidade e ir de encontro às dificuldades de cada um.
Some students prefer to have individual lessons. With that in mind, we offer various individual courses, including on-going and mini-intensive ('minis') courses. Our 'Minis' consists of either 12, 16, or 20- hour module courses and are, once again, specifically created to meet the particular needs of the student. Others may prefer to have a flexible on-going course where you have the flexibility of scheduling lessons as you go and the freedom to re-schedule or cancel lessons within a 24 hour time period. Whatever course you choose, you are guaranteed value for money.
Alguns alunos preferem aulas individuais, com isso em mente oferecemos variados cursos individuais, incluindo mini-cursos intensivos. Os nossos mini-cursos consistem em módulos de 12, 16 ou 20 horas, especialmente para ir de encontro às suas necessidades. Outros alunos preferem ter a liberdade de ter um curso on-going, com a flexibilidade de marcar e a liberdade de alterar o horário com 24h de antecedência.
For those students who are interested in gaining international recognition, LU offers preparation for a wide range of exams. LU courses can be run at your company or home.
Para os alunos que estão interessados em ter reconhecimento internacional, LU oferece a preparação para um vasto grupo de exames. Os cursos da LU podem ocorrer na sua empresa ou na sua casa.


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"AcronymAttic.com
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What does MACM stand for?
MACM stands for Master of Arts in Christian Ministries
This definition appears rarely
See other definitions of MACM
Other Resources: Acronym Finder has 10 verified definitions for MACM
MACM
MLA style: "MACM." Acronym Attic. 2020. AcronymAttic.com 17 Jan. 2020 https://www.acronymattic.com/Master-of-Arts-in-Christian-Ministries-(MACM).html
Chicago style: Acronym Attic. S.v. "MACM." Retrieved January 17 2020 from https://www.acronymattic.com/Master-of-Arts-in-Christian-Ministries-(MACM).html
APA style: MACM. (n.d.) Acronym Attic. (2020). Retrieved January 17 2020 from https://www.acronymattic.com/Master-of-Arts-in-Christian-Ministries-(MACM).html
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Malaysian Association for Computational Mechanics
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mentored over 50 students at Calvin College and Calvin Theological Seminary as active; Master of Arts in Christian Ministries, Briercrest Seminary
Master of Arts in Christian Ministries Master of; Alliance for the Assemblies of God Higher Education | 1445 Boonville Ave. | Springfield, MO 65802.
Master of Arts in Christian Ministries COMPLETION RATES Program: Master of Arts in Christian Ministries-3 years Calendar Year Number of Students Who Began
Best Online Christian Graduate Schools Guide 2015; Shasta currently offers four online graduate degree programs: Master of Arts in Christian Ministries...
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Friends University. Info. Admissions; Program Director of Master of Arts in Christian Ministries; Academic Affairs; Knight; Search the Directory. First Name.
Northwest Ministry Network; Rev. Leslie E. Welk has served; Northwest University in 1977 and from AGTS with a Master of Arts in Christian Ministries in...
What is the online MACM degree? The Master of Arts in Christian Ministries (MACM) is one of Gordon Conwell's newest degree programs. The program combines substantial...
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Over 3 million unverified definitions of abbreviations and acronyms in Acronym Attic. For verified definitions visit AcronymFinder.com
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text:
Q: Understanding format of lrm coefficients in R for ordinal/multiclass regression I am trying to implement one of the R codes in python from scratch and it involves logistic regression.
As far as I understand logistic regression, (while performing one vs all using gradient descent) I think if there are F features and L labels then the we have M x F coefficients. Basically We have F different vectors for each of M labels and then calculate the sigmoid function for an incoming input X and whichever Vector gives maximum is the class predicted.
The logistic regression function in R:
try_lrm<-function(datadf, tol=1e-10, maxit=1e6){
  try({ lrm(y~x, data=datadf, penalty=0, x=TRUE, y=TRUE, tol=tol, maxit=maxit) })
}

However on the ordinal regression for the following data-frame:
    x       y
24.03673    2
14.63598    2
26.85079    2
53.45076    1
36.8322     1
42.10773    1
39.68833    1
104.64827   0
114.97038   0
60.8128     0
59.67947    0

I get the following coefficients:
      y>=1       y>=2       x
131.440196  75.784904  -2.324528

As I am trying to implement everything from scratch, I am trying to use gradient descent.
So how should this be interpreted ? I want to figure out how the sigmoid function should look like but I am not sure why there is just one coefficient for x when I am expecting there to be one x coefficient for every class. And what are those intercepts.
Does it mean that the sigmoid function looks like:
(Lets call the coefficients as k0,k1,k2 which I got for x,y>=1 and y>=2)
for y = 0,
p = 1/(1+e^-(k0 * x))
for y = 1,
p = 1/(1+e^-(k0 * x + k1))
for y = 2,
p = 1/(1+e^-(k0 * x + k1 + k2))
And predict max p class ?

A: This appears to primarily be a statistics question - there isn't anything obviously wrong with your R code.  You should only have one coefficient for x, as is reported.  For an example of ordinal logistic regression in R, see https://stats.idre.ucla.edu/r/dae/ordinal-logistic-regression/. It uses a different package than you are trying to use, but it walks through the statistics as well as R code.

redpajama_set_name: RedPajamaStackExchange


Here are some great items for you and your small dog. These make great gifts for any dog lover. These all would make great Christmas gifts but are useable year round.
Check out the angel wings harness. It would be great for Halloween. I could really the in car skybox. My little Snuggles loves riding in the car and this would keep her safe and happy. The pet rolling case is very useful and handy for you so you don't have to carry you dog. You could bring your dog places, they don't necessarily allow them in. All small dogs would love the treats and toys.
Little dogs can be like our little babies. They sit in our laps, we just pick them up and carry them everywhere. Here's some ways to keep them near and make it fun for you both. Great gift ideas for pet lovers.
No Stuffing Squeaker Toys – The latest craze to shake around. Pick the raccoon or the fox and no mess. Make your selection at Petsmart.
Pet Alive Essential Oils – Skin, bladder, ears, aggression – oils for all sorts of remedy solutions. Try them out from Abe's Market.
Dog shaped dog toy – A little dog friend, without all the hassles of an actual second dog! What a cute handmade toy from Abe's Market.
Treats for bad breath – These are great 100% all natural treats to make sure you get sweet doggies kisses. Order them now from Abe's Market.
FURminator Deshedding Tool – Whether long hair or short, there's a FURminator for the job. Highly recommended by all the animal lovers we know and found at Petsmart.
Angel Wings Harness – Martha Stewart has come up with the perfect harness for your little angel. Wear it year round and find it at Petsmart.
Pet Purse – Just like Paris Hilton! Hang that baby over your shoulder, and take the little one everywhere in style. You can pick this up at Walmart.
In Car Skybox – This is a skybox! Now the little dog can see out the window, while still being safely strapped in. Win, win from Petsmart.
Pet Bike Basket – Get your exercise and take them along.Biking is such great exercise and now the little prince or princess can some along! Order this now from Get Organized, in time for your fall rides.
Pet Rolling Case – This roll-around is amazingly convertible for any need, like those new-fangled strollers. The plane, the car or as a backpack, it is completely versatile, as you would expect from Get Organized.
Dozen Dog Treats – A dozen treats with doggy frosting. As much for you as for them! Order them now at World Market.
The weather cools, the night comes earlier, but still we find ourselves outside – whether it's in our own backyard, the parking lot of the big game, or the local high school football field. This set of items keeps you cool, warm, safe and comfortable – practical and fun! Also great gift ideas for the football fans in your life.
SportBrella – This portable umbrella sets up in seconds and protects your entire family from wind, rain, sand and the blazing sun. Order it online and pick it up at Walmart.
Tailgating Cooler – An ice chest, charcoal grill and all the utensils in one portable package. Shoulder strap or handles, you decide how to carry it, after you order it from Walmart.
LED Lantern – Don't you love the retro look, but with the safety and brightness of LED lighting? Order it now from Best Buy.
BackPack Cooler Chair – All in one – your chair, your cooler, and your hands are free! Pick this up at JCPenney.
Football Blanket – Since childhood, sitting on the bleachers was always better with one of these wool blankets over your legs. Online at Best Buy.
Grill Light – It always gets dark before you know it. Clip this almost anywhere and the flexible neck lets you point it where you need it. Buy it at JCPenney.
Weather Resistant Outdoor Speaker – Get the sound to everyone with this large speaker that can be placed horizontally or vertically and keep going for 6 hours. You can find this at Best Buy.
The Picnic Pack – Enough for snack time for the whole team and the coaches. 16 Burgers and 16 Franks, all gourmet. Order it from Omaha Steaks and keep it in the freezer until you need them.
Football Claw – Now there's the perfect place to keep that Game Ball – on the wall! Order it now so its on hand when you need it, at The Container Store.
Here are some great gift ideas for your cat or a cat lover you know. I have a bunch of cats and I know they would love these items. These all would make great Christmas gifts but are useable year round. Some of these are geared towards the cats but others are to make a cat person's life easier like litter items. Some of them can be for someone who loves cats but does not have a cat yet but is contemplating it like the calendar, book and puzzle.
Independence is what we always hear about cats, but they still need a few things from us to have the best lives. Shelves and perches so they can look down on us, still keeping track, but pretending not to, and some more little necessaries.
Attack Cat Sign – Could be a joke, or could be the truth. Ever had your ankles scratched from under the sofa? Still a great sign you can order now and pick up at Petsmart.
Motorized Cat Mobile Toy – Keep your cat engaged anywhere you can find a door. Get some exercise for that indoor cat with Pioneer Pet Tiger Toy from Kohl's.
Paw Cleaning Litter Mat – Clean the Litter off those paws as they step out of the litter box. Order it from Wayfair.
Pounce Toy – Natural Bamboo and canvas, natural and durable for lots of fun by Ore Originals from Nordstrom.
Cat Paw Litter Scoop – If you must have that scoop hanging around, then at least make a statement! It's an Ore Originals paw from Nordstrom.
Catnip Shaker – Wow, a shaker of catnip! Sprinkle it on those special places, like scratching posts, or perches for a special treat. Buy this organic catnip at Abe's Market.
The Cat Whisperer Book – Secrets on how to talk to your cat, if your cat is willing to listen, right? Give it a go – you never know. Find it at Petsmart.
Heated Window Sill Bed – The perfect window perch for your indoor cat and heated for the winter. Order it from Wayfair and have a happy cat!
Kitty Cave – Easy to clean, more colors available, cat bed and a little cat cave, all in one. Find it at Kohl's.
1000 Piece Cat Puzzle – Does your cat sit on your work? Let them walk across this puzzle filled with cats. Pick this up for yourself or the cat lover in your life from Get Organized.
Yoga Cats 18 month Wall Calendar – Really, cats in asana poses? Up Cat, Down Cat, and mostly Corpse pose, right? World Market carries this great calendar you can use right away.
Cat Shelf – Wall Art that doubles as shelves! Wayfair carries this fun series of cat perches.
This is a sponsored post written by me on behalf of Boombox Network. This post contains affiliate links. Comments submitted may be displayed on other websites owned by the sponsoring brand.
Bloggers sign up Today to get listed on the "2014 Holiday Gift Guide" that will roll out full force Oct 25 thru Dec 25, 2014. Many bloggers will be participating so it is going to be huge!
Right now Sign up is Free and Limited!
Most of the businesses that have listings on here are ones who hire bloggers for Reviews and PR Jobs through the year, so a great way to get noticed as a PR Blogger and get on the Reps Blogger Lists for when they have reviews and sponsor post jobs etc.
NO – this is the great part, any size blog, any niche is welcome. The only restriction we have is, your blog can not have pornographic material on it. If it does – Do not sign up – we are Family Friendly!
We will have a page specific listing " PR Friendly Bloggers " on the 2014 Holiday Gift Guide Web Site – Visible to all on the landing page and other guide pages. Your Link will be linked to your blog or media kit page ( your choice). This Gift guide will be promoted by many bloggers, as well as the businesses on their sites and social media too during the 2 months. Also, we may even feature YOUR Blog in our Special Mailings from time to time.
PR Marketers for Businesses See Your Page – These are the people who Hire Bloggers to promote Products for reviews, sponsor posts, ambassador programs, etc- all year long!


text:
Undefined / Red Flag Wounded
Red Flag Wounded
'Red Flag Wounded' brings together essays covering the controversies and debates over the fraught history of the Soviet Union from the revolution to its disintegration. Those monumental years were marked not only by violence, mass killing, and the brutal upturning of a peasant society but also by the modernization and industrialization of the largest country in the world, the victory over fascism, and the slow recovery of society after the nightmare of Stalinism.
ISBN: 9781788730747 Author: Ronald, Grigor Suny	Publisher: Verso Publication Date: 27th July 2020	Imprint: Verso Cover: Paperback	Dewey: 947.084 (edition:23) Pages: 320 .	Language: English	Readership: General - Trade / Code: K Category: Undefined Subject: Russian Revolution
Tracking the degeneration of the Russian Revolution
Red Flag Wounded brings together essays covering the controversies and debates over the fraught history of the Soviet Union from the revolution to its disintegration. Those monumental years were marked not only by violence, mass killing, and the brutal overturning of a peasant society but also by the modernisation and industrialisation of the largest country in the world, the victory over fascism, and the slow recovery of society after the nightmare of Stalinism.
Ronald Grigor Suny is one of the most prominent experts on the revolution, the fate of the non-Russian peoples of the Soviet empire, and the twists and turns of Western historiography of the Soviet experience. As a biographer of Stalin and a long-time commentator on Russian and Soviet affairs, he brings novel insights to a history that has been misunderstood and deliberately distorted in the public sphere. For a fresh look at a story that affects our world today, this is the place to begin.
Red Flag Wounded quantity
Ten Poems About Childhood
A Is for Archive
Ten Poems About Husbands and Wives


In last weeks mini stylebook youtube video I featured two budget friendly Autumn looks I put together. I described the first one in great detail in last weeks Friday fashion post. Today I want to talk about the second one. I really like jewel toned colors this season which I incorporated with this emerald green fit and flare dress. I often pair soft feminine dresses with something a little more harsh and masculine like a leather jacket. This year I found my ultimate leather jacket from forever 21 and I really like the peplum bit which keeps it a bit soft and adds a little something unexpected. I kept the look fairly simple incorporating a pair of spiky green and gold earrings, oversized squared glasses and a pair of black booties I've made incredible use of for years now!
The dress was an awesome Danny & Nicole from JCPenny find! The black swirls of pattern are velvety and soft to the touch. Jewel toned purple nails really popped against that emerald turquoise shade. The sunglasses were from Target a while back and the Jem & Jules Persephone Drop Earrings which aren't clearly shown here were from DSW. My wig is from Irene Wigs and I love the ombre highlights look against this shade of green!
I've held onto these boots because I have yet to find a pair in black like these that I like as much. The gold zipper in the back and comfortable wedge make these ideal for many occasions. They are Christian Siriano and I purchased them at Payless a few years ago.
This dress and leather jacket both are going to get a whole lot of wear by me in the colder months, I can't wait to see all of the looks I can create with them both!
Let me know what you thought of this look in the comments form! I love hearing your opinions!


text:
package org.hisp.dhis.android.sdk.persistence.migrations.version3;

import com.raizlabs.android.dbflow.annotation.Migration;
import com.raizlabs.android.dbflow.sql.migration.AlterTableMigration;

import org.hisp.dhis.android.sdk.persistence.Dhis2Database;
import org.hisp.dhis.android.sdk.persistence.models.ProgramRuleAction;

/**
 * @author Simen Skogly Russnes on 11.05.15.
 */
@Migration(version = 3, databaseName = Dhis2Database.NAME)
public class Version3MigrationProgramRuleAction extends AlterTableMigration<ProgramRuleAction> {

    public Version3MigrationProgramRuleAction() {
        super(ProgramRuleAction.class);
    }

    @Override
    public void onPreMigrate() {
        // Simple ALTER TABLE migration wraps the statements into a nice builder notation
        super.onPreMigrate();
        addColumn(String.class, "programStageSection");
    }
}

redpajama_set_name: RedPajamaGithub


text:
An Eye to the East
HBS Inaugurates Asia-Pacific Research Office
by Alejandro Reyes
Research-General
Beyond Hong Kong's towering skyline and ship-filled harbor, the Kowloon Peninsula gives way to the verdant hills and peaks of the Chinese mainland. The bustling international business center is a natural gateway to an area that has experienced phenomenal postwar growth and dynamism. Despite recent financial turmoil, there is no denying how far the Asia-Pacific region has come - and how promising its future remains.
Camille Tang Yeh (MBA '80) is acutely aware of the region's potential. As executive director of the Hong Kongbased HBS Asia-Pacific Research Office, she has been charged with coordinating the School's ambitious research efforts in a daunting list of culturally diverse countries such as Australia, China, India, Indonesia, Japan, Singapore, Taiwan, Vietnam, Malaysia, and Pakistan. Officially opened last October, but inaugurated with a festive dinner in January, the office demonstrates "the depth of the School's commitment to building intellectual capital in the region," says Yeh. The former investment banker and longtime Hong Kong resident has already welcomed several faculty members to this "home away from home" in the Bank of China Tower, which HBS researchers can use as a base of operations for work in the twelve countries in the region. Yeh and her small staff are set up to provide a significant part of the intellectual and logistical support needed by visiting HBS scholars.
Yet logistical help is not the main reason for setting up the Asian outpost. The office is part of the HBS Global Initiative spearheaded by Dean Kim B. Clark to ensure that the School fosters a global culture in its curriculum and programs and instills an international outlook among its students. Even though HBS faculty have been active in Asia for decades, "This is the beginning of a new phase," said Clark at the opening dinner, which was attended by Hong Kong chief executive Tung Chee-hwa and over two hundred alumni and friends of the School. "Our research and teaching are fundamentally grounded in and connected to the world," said Clark. "We hope that this will be an intellectual center that will stimulate engagement."
"There is a need to look for ways to blend Asian and Western approaches."
Underscoring just what Clark meant by engagement, HBS convened a two-day research conference to coincide with the office's January inauguration. By bringing together nearly sixty business and management academics and about twenty CEOs and managers from across Asia, the forum provided an opportunity for HBS professors working on Asia-related research to present their work in progress and exchange views with colleagues and practitioners. The event's overriding message, according to organizer Karen Wilson (MBA '91), executive director of the HBS Global Initiative, is that the School is open to new ideas, new technology, and new ways of thinking. More research centers will follow, with the next one likely to be opened in South America.
"We're in the midst of profound changes that will be of lasting consequence," said Clark at a luncheon address to participants. "Long-established paradigms are now becoming inadequate. As we think about our mission to educate leaders, we are driven by a strong belief that to prepare managers well, we have to change. What we're doing in Asia has grown out of that belief. We need to create new intellectual capital to underpin our goals at HBS. Thus, we must deepen and extend the quantity and quality of research in Asia and the world."
The value of building wider connections became even clearer on the afternoon of January 7 when conference delegates sat down after lunch in the ballroom of the harborside Grand Hyatt Hotel. Calling the brainstorming session to order was conference chairman Professor Robert H. Hayes, a key figure in the development of the new Asia-Pacific Research Office. As the HBS faculty increases its activities in Asia, the School must stay in touch with academics and practitioners who live there, Hayes observed. "Perhaps in the process of getting to know each other better," he said, "we can also facilitate the building of closer relationships among those of you who - like our faculty - come from many diverse countries. The issues facing Asia today are too big and complex for any single person, university faculty, or company to comprehend fully. Making progress in the Asia-Pacific region will require the cooperative efforts of many of us. This will contribute to the future prosperity of the region."
Hayes's remarks were something of a starting gun that set the assembled minds racing. As HBS faculty took the floor in succession, participants freely contributed comments and suggestions for additional research, drawing parallels with their own work or experience. A case in point was HBS professor Rohit Deshpandé's presentation, the first on the agenda. He reported on the initial results of a multination study of factors driving business performance in Asia. His findings were based on data gathered from interviews with senior executives at about five hundred major companies in China, Hong Kong, India, Japan, Thailand, and Vietnam. Deshpandé and his team discovered that many of the "strategic levers" essential to high performance in Asian firms were identical to those found in a separate study of companies in Western countries. But while innovation was the most important driver of high performance among the corporations in the Western economies, in Asian companies the key element was how customer-oriented firms were.
That prompted computer entrepreneur Stan Shih, cofounder and chairman of Taiwan's Acer Group and a pioneer Asian brand-builder, to raise his hand. (Throughout the conference, Shih was a case study of the dynamic CEO: when he wasn't in his seat listening attentively or in front of the audience imparting wisdom, he was in a corner whispering into his cellular phone.) In Europe and the United States, he said, "they have already reached a threshold in customer orientation, so you have to do different things to succeed." That's not the case yet in Asia, he pointed out, as Deshpandé listened intently.
HBS professor Paul M. Healy spoke on the role of accounting and auditing standards in China, while Associate Professor Huang Yasheng closed the first session with a detailed briefing of his ongoing study of foreign-invested enterprises on the mainland. The afternoon concluded with an open discussion at which many other academics described their research. There were special pleas, too. Ehsan-ul Haque of Pakistan's Lahore University of Management Sciences cited an overemphasis on policy-driven studies at Asian institutions. "The immediacy and urgency of decisions [on policy] are so great that we cannot afford the time for more rigorous research," he said. Jacinto C. Gavino of the Asian Institute of Management in Manila suggested that, given such constraints, there should be an evaluation mechanism developed to help focus research on the most important issues.
"In developing economies, we have to reexamine the fundamental assumptions of what makes a good firm."
Other participants also remarked that the Asian economic crisis called for a reorientation of research priorities. Although the breakup of large conglomerates or chaebol is now a hot issue in South Korea, said Chang Sea Jin of Korea University's School of Business Administration, little research has been done on them. Hideki Yoshihara of Japan's Kobe University argued that too much academic attention had been paid to Japanese success stories, but not to the limitations and failings of his country's other companies. "It's not enough to do research on the 'can' aspect of Japanese management. There must also be work on the 'cannot' aspect," he said. "We have difficult problems, so this is a good time to do research." Yoshihara's concerns were echoed by Hotaka Katahira, an economist at the University of Tokyo. Years of economic stagnation and generational shifts mean that previous assumptions are quickly becoming obsolete, Katahira noted. "Japanese consumers and the concept of consumer satisfaction are changing," he said. "We need to redefine the model of customer behavior in Japan."
But perhaps the most telling comment came from Trilochan Sastry of the Indian Institute of Management. While noting that HBS-generated research, case studies, and management thinking have "tremendous influence" around the world - possibly more than the School itself realizes - he doubted whether principles and ideas applicable to U.S. companies could always be "taken out of context and dumped into completely different firms" elsewhere. In developing economies, such as India, Sastry reasoned, "we have to reexamine the fundamental assumptions of what makes a good firm." It was a reminder that what's right for America may not make sense in Asia - an obvious point, perhaps, but one worth repeating in any forum on cross-cultural issues.
The second day of the meeting produced equally profitable exchanges. HBS professor Christopher A. Bartlett discussed changing Asian management practices, using Acer as a case study. Stan Shih, who serves on the HBS Asia Advisory Committee, stepped up to share his thinking on a major corporate reengineering he is currently conducting. Other highlights included HBS professor Lynn Paine's presentation on global business values, assisted by special guest Zhang Ruimin, president and CEO of China's Haier Group, a maker of appliances; a briefing by HBS assistant professor Walter Kuemmerle on global research and development networks; Professor Krishna G. Palepu's and Associate Professor Tarun Khanna's thoughts on the restructuring of businesses in emerging markets; and Professor Dwight B. Crane's examination of the Asian financial crisis. The sweeping exchange of ideas prompted Professor David B. Yoffie, conference cochair, to conclude: "There is a need to look for ways to blend Asian and Western approaches."
A Platform for Change
The studies presented in Hong Kong demonstrated why, as Professor Michael Y. Yoshino, HBS director of Research, put it, "the School is a unique place with a unique mission." The School's business, he said, is "creating and disseminating knowledge." And he added: "We seek to contribute not just to business scholarship but also to the practice of management." He noted that when he first joined the faculty nearly thirty years ago, there were only four non-U.S. nationals, including himself, among his colleagues. Now, the cadre of researchers and teachers at HBS reflects the multinational character of the student body. In course development and case-study coverage, "HBS has a strong commitment to international research and the internationalization of the curriculum," Japan-born Yoshino said.
Asia, Yoshino explained, provides an interesting platform for the School's research. "Here, we can test our findings, knowledge, and theories developed elsewhere, as well as define new hypotheses that can be tested in other areas. We haven't just discovered Asia today, but we do need to strengthen our presence and increase our capabilities in this region." A key challenge is to cultivate access and connections to corporations in the region in order to develop case studies. "We must win the confidence of major companies in the region," Yoshino said.
The Hong Kong Research Office with Camille Tang Yeh in charge is already working hard to do just that. "In our attempts to contribute to management understanding and practice in an increasingly global marketplace," remarked Bob Hayes, "we cannot rely solely on the expertise of specialists in a particular region of the world. All of our faculty need to build strong area expertise.
"We're in the midst of profound changes that will be of lasting consequence."
"Much of the recent attention Asia has received has focused on its current problems, rather than its enduring strengths," he continued. "We steadfastly believe that Asia has a bright future and hope to be able to contribute to the rethinking about corporate management in the region." Speaking at the dinner that capped the research conference, Professor F. Warren McFarlan, a veteran faculty member who is now overseeing the operations of the Asia-Pacific project, predicted its impact will be far reaching: "This will be a deeply transforming period for HBS," he observed.
The conference provided a chance for HBS to recognize the enthusiasm and support of many alumni and friends throughout Asia, particularly S.P. Tao, chairman of Shing Kwan Group, who not only provided the School with office space in the Bank of China Tower but has also initiated a major new fellowship program to enable young, entrepreneurial Chinese students to attend HBS; former HBS faculty member and longtime friend of the School Victor K. Fung, chairman of the HBS Asia Advisory Committee; and Singapore's Minister for Information and the Arts George Yeo (MBA '85). "We are absolutely delighted and honored that HBS has chosen Hong Kong," said Tung Chee-hwa, Hong Kong's chief executive, at the inaugural dinner. Fung added, "HBS's choice of Hong Kong gives us incentive to build Hong Kong's resources as a center of learning. Never before has there been such a need for a top-flight research center."
In a final speech to the group, George Yeo praised his alma mater's bold bid to expand. "If an institution stops changing, it dies," he said, hailing Dean Clark as the "leader of the quiet revolution to prepare the School for the next century." In response, Clark declared: "The Asia-Pacific office is something we have dreamed about and worked hard for. HBS is going to be a global institution. We have taken the first few steps. It starts today. It starts here."
Re: Donna Dubinsky (MBA 1981); Dan Bricklin (MBA 1979); David Yoffie
Research Brief: Bargaining for Better
Re: Kathleen McGinn
Research Is the Foundation
Re: Tsedal Neeley; Ramana Nanda; Victoria Ivashina; Josh Lerner; Ethan Bernstein


We like to leave our major garden cleanup for spring, rather than fall. Come find out why and what to do in the garden mid-spring. We will cover common questions like how to prune lavender, as well as other perennials and grasses. At 10:45 we will switch gears and demonstrate how to properly plant a tree, with a handy guideline to take home with you.
Register for March 17th Part 1 and Part 2 classes and save $5. NOTE: Discount is given at checkout and requires Part 1 'Spring Cleanup' and Part 2 'How to Plant a Tree' be in your cart.


text:
Weathersbee: Stopping school bullies requires bravery from all sides, not just the bullied
Tonyaa Weathersbee
Jacob Vincent's tears weren't tears of cowardice. They were tears of courage.
The 16-year-old recently stood before the Germantown Municipal School District's Board of Education and talked about how rampant bullying forced him out of their schools. He talked about being punched in the head as an eighth-grader at Houston Middle School and being knocked unconscious after a basketball player slammed a ball at him, knocking him into a wall.
Then, there was the taunting that ultimately drove him into depression.
"I was told to kill myself many times," Jacob said between sobs.
His mother, Lori Vincent, was unsure if Jacob should share his story, but she realized that by doing so, he could give other bullied students a voice.
He did, at the risk of his crying making him a target for more teasing. The question is whether the school board will listen — and act.
It had lots to listen to, because Jacob's bullying ordeal wasn't the only one relayed at Monday's meeting.
Another parent, Cherie Didier, recounted how her daughter was choked into unconsciousness by a student twice her size for sitting in a desk he wanted at Houston High School. Sheila Hahn talked of students lobbing anti-Semitic threats at one of her sons and telling the other son he should kill himself.
Sadly, some times, bullied youths do kill themselves.
In response to the parents' allegations and Jacob's story, the school district released a statement saying that it reviews its policies on bullying, harassment and intimidation each year, and provides mandatory training to each school along with parent workshops on bullying prevention.
Additionally, the policy states if a student reports bullying or harassment, the district must investigate the claim within 48 hours.
Yet for whatever reason, that system didn't work for Jacob. It also appears to have failed Didier's daughter, who she said was told that what happened to her was horseplay.
The policy appears to have also failed Hahn's sons.
If an instructor indeed told Didier's daughter that being knocked unconscious was horseplay, then that instructor apparently didn't read the policy. But it's easy to see how that kind of denial can occur in a place like Germantown.
Many times, said Laura Trujillo-Jenks, associate professor of educational administration at Texas Woman's University who has co-authored books on school bullying, parents think small towns and smaller schools are better for children and that code of conduct violations don't occur. When they do, the politics of a small town can play a role in whether it acts on the problem or denies it, she said.
Also, if an athlete is involved in the bullying, many students worry that the athletes — who bring prominence to schools and are often among the popular students — will be believed before them, or that their complaints will be shrugged off, she said.
Which sounds a bit like what happened to Jacob and Didier's daughter.
But both Trujillo-Jenks and Jane Timmons-Mitchell, senior research associate at Begun Center for Violence Prevention Research and Education at Case Western Reserve University, said if school officials don't take concerns about bullying seriously, it can haunt them.
"One of the things that's different now (as opposed to decades ago) when it comes to school bullying is that we now have research which shows how damaging it is," Timmons-Mitchell said. "Bullying contributes to bad health outcomes, it increases anxiety and depression, and there's an over-representation of suicides of people who were bullied."
Also, said Trujillo-Jenks, "We're seeing parents whose kids are committing suicide because of bullying, and they're going back and suing the school board and the actual bully over it …"
It took courage for Jacob to recount his pain before the Germantown school board. But the board should repay his courage by examining how its policy against bullying and harassment is falling short.
Because apparently, it is.


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text:
Bracewell Represents Holly Energy Partners, L.P. in the Acquisition of Interest in Osage Pipeline from HollyFrontier Corporation
March 1, 2016 Top Matters
HOUSTON – Bracewell LLP represented Holly Energy Partners, L.P. (NYSE: HEP) in its acquisition from HollyFrontier Corporation (NYSE: HFC) of a 50% interest in Osage Pipe Line Company, LLC, which owns the 135-mile Osage pipeline that transports crude oil from Cushing, Oklahoma to El Dorado, Kansas. Holly Energy Partners, L.P. provides petroleum product and crude oil transportation, tankage and terminal services to the petroleum industry, including HollyFrontier Corporation.
Holly Energy attorneys working on this transaction included: Denise C. McWatters, Julie B. Hunt and Vaishali Shah Bhatia
Bracewell attorneys working on this transaction included:
Partners: Jason M. Jean and Ryan S. Holcomb
Associate: Aaron Carpenter
Jason M. Jean and Ryan S. Holcomb
Chambers UK 2023 Recognizes Excellence of Bracewell London Team
October 20, 2022 News Releases Chambers UK
Bracewell's London Team Excels in Legal 500 UK 2023
September 28, 2022 News Releases Legal 500 UK
IFLR1000 2023 Recognizes Continued Excellence of Bracewell's Finance, Corporate and Real Estate Teams
September 6, 2022 News Releases International Financial Law Review (IFLR)


text:
Divalproex Sodium (Page 9 of 14)
BluePoint Laboratories 6 July 2020
7.3 Topiramate
Concomitant administration of valproate and topiramate has been associated with hyperammonemia with and without encephalopathy [see Contraindications (4) and Warnings and Precautions (5.6, 5.9, 5.10)]. Concomitant administration of topiramate with valproate has also been associated with hypothermia in patients who have tolerated either drug alone. It may be prudent to examine blood ammonia levels in patients in whom the onset of hypothermia has been reported [see Warnings and Precautions (5.9, 5.11)].
8. USE IN SPECIFIC POPULATIONS
Pregnancy Exposure Registry
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antiepileptic drugs (AEDs), including divalproex sodium extended-release tablets, during pregnancy. Encourage women who are taking divalproex sodium extended-release tablets during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling toll-free 1-888-233-2334 or visiting the website, http://www.aedpregnancyregistry.org/. This must be done by the patient herself.
For use in prophylaxis of migraine headaches, valproate is contraindicated in women who are pregnant and in women of childbearing potential who are not using effective contraception [see Contraindications(4)]
For use in epilepsy or bipolar disorder, valproate should not be used to treat women who are pregnant or who plan to become pregnant unless other medications have failed to provide adequate symptom control or are otherwise unacceptable [see Boxed Warning and Warnings and Precautions (5.2, 5.3)]. Women with epilepsy who become pregnant while taking valproate should not discontinue valproate abruptly, as this can precipitate status epilepticus with resulting maternal and fetal hypoxia and threat to life.
Maternal valproate use during pregnancy for any indication increases the risk of congenital malformations, particularly neural tube defects including spina bifida, but also malformations involving other body systems (e.g., craniofacial defects including oral clefts, cardiovascular malformations, hypospadias, limb malformations). This risk is dose-dependent; however, a threshold dose below which no risk exists cannot be established. In utero exposure to valproate may also result in hearing impairment or hearing loss. Valproate polytherapy with other AEDs has been associated with an increased frequency of congenital malformations compared with AED monotherapy. The risk of major structural abnormalities is greatest during the first trimester; however, other serious developmental effects can occur with valproate use throughout pregnancy. The rate of congenital malformations among babies born to epileptic mothers who used valproate during pregnancy has been shown to be about four times higher than the rate among babies born to epileptic mothers who used other anti-seizure monotherapies [see Warnings and Precautions (5.2) and Data (Human)].
Epidemiological studies have indicated that children exposed to valproate in utero have lower IQ scores and a higher risk of neurodevelopmental disorders compared to children exposed to either another AED in utero or to no AEDs in utero [see Warnings and Precautions (5.3) and Data (Human)].
An observational study has suggested that exposure to valproate products during pregnancy increases the risk of autism spectrum disorders [see Data (Human)].
In animal studies, valproate administration during pregnancy resulted in fetal structural malformations similar to those seen in humans and neurobehavioral deficits in the offspring at clinically relevant doses [see Data (Animal)].
There have been reports of hypoglycemia in neonates and fatal cases of hepatic failure in infants following maternal use of valproate during pregnancy.
Pregnant women taking valproate may develop hepatic failure or clotting abnormalities including thrombocytopenia, hypofibrinogenemia, and/or decrease in other coagulation factors, which may result in hemorrhagic complications in the neonate including death [see Warnings and Precautions (5.1, 5.8)].
Available prenatal diagnostic testing to detect neural tube and other defects should be offered to pregnant women using valproate.
Evidence suggests that folic acid supplementation prior to conception and during the first trimester of pregnancy decreases the risk for congenital neural tube defects in the general population. It is not known whether the risk of neural tube defects or decreased IQ in the offspring of women receiving valproate is reduced by folic acid supplementation. Dietary folic acid supplementation both prior to conception and during pregnancy should be routinely recommended for patients using valproate [see Warnings and Precautions (5.2, 5.4)].
All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Disease-associated maternal and/or embryo/fetal risk
To prevent major seizures, women with epilepsy should not discontinue valproate abruptly, as this can precipitate status epilepticus with resulting maternal and fetal hypoxia and threat to life. Even minor seizures may pose some hazard to the developing embryo or fetus [see Warnings and Precautions (5.4)]. However, discontinuation of the drug may be considered prior to and during pregnancy in individual cases if the seizure disorder severity and frequency do not pose a serious threat to the patient.
Maternal adverse reactions.
Pregnant women taking valproate may develop clotting abnormalities including thrombocytopenia, hypofibrinogenemia, and/or decrease in other coagulation factors, which may result in hemorrhagic complications in the neonate including death [see Warnings and Precautions (5.8)]. If valproate is used in pregnancy, the clotting parameters should be monitored carefully in the mother. If abnormal in the mother, then these parameters should also be monitored in the neonate.
Patients taking valproate may develop hepatic failure [see Boxed Warning and Warnings and Precautions (5.1)]. Fatal cases of hepatic failure in infants exposed to valproate in utero have also been reported following maternal use of valproate during pregnancy.
Hypoglycemia has been reported in neonates whose mothers have taken valproate during pregnancy.
Neural tube defects and other structural abnormalities
There is an extensive body of evidence demonstrating that exposure to valproate in utero increases the risk of neural tube defects and other structural abnormalities. Based on published data from the CDC's National Birth Defects Prevention Network, the risk of spina bifida in the general population is about 0.06 to 0.07% (6 to 7 in 10,000 births) compared to the risk following in utero valproate exposure estimated to be approximately 1 to 2% (100 to 200 in 10,000 births).
The NAAED Pregnancy Registry has reported a major malformation rate of 9 to 11% in the offspring of women exposed to an average of 1,000 mg/day of valproate monotherapy during pregnancy. These data show an up to a five-fold increased risk for any major malformation following valproate exposure in utero compared to the risk following exposure in utero to other AEDs taken as monotherapy. The major congenital malformations included cases of neural tube defects, cardiovascular malformations, craniofacial defects (e.g., oral clefts, craniosynostosis), hypospadias, limb malformations (e.g., clubfoot, polydactyly), and other malformations of varying severity involving other body systems [see Warnings and Precautions (5.2)].
Effect on IQ and neurodevelopmental effects
Published epidemiological studies have indicated that children exposed to valproate in utero have lower IQ scores than children exposed to either another AED in utero or to no AEDs in utero. The largest of these studies1 is a prospective cohort study conducted in the United States and United Kingdom that found that children with prenatal exposure to valproate (n=62) had lower IQ scores at age 6 (97 [95% C.I. 94 to 101]) than children with prenatal exposure to the other anti-epileptic drug monotherapy treatments evaluated: lamotrigine (108 [95% C.I. 105 to 110]), carbamazepine (105 [95% C.I. 102 to 108]) and phenytoin (108 [95% C.I. 104-112]). It is not known when during pregnancy cognitive effects in valproate-exposed children occur. Because the women in this study were exposed to AEDs throughout pregnancy, whether the risk for decreased IQ was related to a particular time period during pregnancy could not be assessed [see Warnings and Precautions (5.3)].
Although the available studies have methodological limitations, the weight of the evidence supports a causal association between valproate exposure in utero and subsequent adverse effects on neurodevelopment, including increases in autism spectrum disorders and attention deficit/ hyperactivity disorder (ADHD). An observational study has suggested that exposure to valproate products during pregnancy increases the risk of autism spectrum disorders. In this study, children born to mothers who had used valproate products during pregnancy had 2.9 times the risk (95% confidence interval [CI]:1.7 to 4.9) of developing autism spectrum disorders compared to children born to mothers not exposed to valproate products during pregnancy. The absolute risks for autism spectrum disorders were 4.4% (95% CI:2.6% to 7.5%) in valproate-exposed children and 1.5%(95% CI:1.5% to 1.6%) in children not exposed to valproate products. Another observational study found that children who were exposed to valproate in utero had an increased risk of ADHD (adjusted HR 1.48; 95% CI, 1.09 to 2.00) compared with the unexposed children. Because these studies were observational in nature, conclusions regarding a causal association between in utero valproate exposure and an increased risk of autism spectrum disorder and ADHD cannot be considered definitive.
There are published case reports of fatal hepatic failure in offspring of women who used valproate during pregnancy.
In developmental toxicity studies conducted in mice, rats, rabbits, and monkeys, increased rates of fetal structural abnormalities, intrauterine growth retardation, and embryo-fetal death occurred following administration of valproate to pregnant animals during organogenesis at clinically relevant doses (calculated on a body surface area [mg/m2 ] basis). Valproate induced malformations of multiple organ systems, including skeletal, cardiac, and urogenital defects. In mice, in addition to other malformations, fetal neural tube defects have been reported following valproate administration during critical periods of organogenesis, and the teratogenic response correlated with peak maternal drug levels. Behavioral abnormalities (including cognitive, locomotor, and social interaction deficits) and brain histopathological changes have also been reported in mice and rat offspring exposed prenatally to clinically relevant doses of valproate.
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text:
LOU-The new kid of synth pop scene
'I don't know how to play chess and I have always been good at Maths'. With this phrase Lou encloses how she feels about relationships nowadays, a theme that deeply influences her work as a songwriter. Because even if relationships are a series of strategical moves and well-thought steps, she prefers to think of them as an honest form of expression.
As the music scene in Athens is shifting, Lou, belonging to a new generation of artists, believes that a wind of change and refreshment has already started to become evident in the Greek music industry. Her studies in Jazz and her staying in Helsinki for a few months were meant to shape her music in a unique way, as she combines the Scandinavian Synth Pop sound with her studies in Jazz and introduces to the Greek audience a new fresh sound, full of melancholic and emotional elements.
Lou, also known as Eleni, talks about Athens and envisions the Greek capital as a moody teenage girl carrying the craziness of her youth while she is always searching for something new. If there is something that makes her hate Athens, is the lack of all night pastry shops because as she points out, Athens is ambivalent, on the one hand beautiful and on the other ugly. She recognizes the difficulty of living as an 18-year-old in a country challenged by the financial crisis and having lived in Helsinki, she says that "there are many opportunities for young musicians abroad. In Helsinki, there were many subsidised programmes that helped musicians earn their living through their art. Greece doesn't offer anything like that and I find it kind of unfair".
When she has bad days, she listens to Grimes that serve as her antidepressant. Inspiration finds her usually after a break up, as falling in love has great importance in her life and she deeply enjoys that feeling. As far as growing up goes, she says "I'm not at the point of being a serious young adult yet, but I believe I'm close. I don't know if I want to be, to tell you the truth, as for me adulthood is summed up in the phrase 'I can't talk right now, I'm busy. Can I call you later?".
Living in an era that forces us to be apathetic she gives great attention to feeling everything to the fullest. "For me, music is butterflies in my stomach, a sunset coloured pink and pistachio ice-cream. I would like to live abroad but there is something holding me here. I am in love and this is very powerful to me". She is almost ready for the release of her first album by Klik Records, while she is also experimenting musically with the artist, King Elephant. Recently, she wrote the music for the play "Brandon Teena" and released her song "Do you want it?". If you ask her what she really wants, she will answer "I want to be able to sleep peacefully at night without having the need to ask the other person: Do you want it?".
Check out our video with LOU and American Eagle