Dr. Ginny Ritchey is a licensed clinical psychologist at the Summit Center. Dr. Ritchey has spent the last 20 years providing a wide range of services to children of all ages, their families, and professionals within the home, school, and clinical settings. Previously, she worked as a behavior analyst at Anova Center for Education in San Rafael, a behavior consultant at South San Francisco School District, and a program manager and supervisor for in-home programs that serve children with Autism in the Bay Area and in San Diego. Dr. Ritchey has been trained to provide psychoeducational assessment, counseling to children and their families, and consultation to educators and administrators. She earned her doctorate in Educational Psychology from U.C. Berkeley and has a credential in school psychology and a certificate in developmental psychology. Her areas of interest include neurological and behavioral childhood diagnoses such as Autism, ADHD, anxiety, and childhood depression; social skills development; parent and school consultation; and academic and intrinsic motivation. Dr. Ritchey is passionate about her work and is constantly inspired by the strength and resiliency of the children, parents, and educators that work with her. Dr. Ritchey also maintains a private practice as a clinician and educational consultant in Marin County.


I'm proud to report that internationally recognized swim coach Brett Hawke is joining Fitter and Faster full-time as Development Director of Swim Clinics and Camps!
When you have a chance please check out this blog post on Brett coming on board as part of FFT's expansion. There are some nice quotes in the article from Dave Marsh, Sergio Lopez Miro and Bruno G Fratus too.
In this newly created position at Fitter and Faster, Coach Hawke is charged with increasing the number and locations of customized swim clinics and camps that are available and even more beneficial to competitive swimmers and coaches in every community throughout North America and other strategic locations worldwide.
Hawke comes to Fitter and Faster with a highly accomplished resume which includes being on deck at five Olympic Games as a competitor and swim coach. He was the Head Coach at Auburn University from 2009 through 2018 where he led the team to a National Championship in 2009 and was named the NCAA Coach of the Year. During his tenure at Auburn, Hawke was also the owner and director of the highly successful "Auburn Swim Camps".
At Fitter and Faster Hawke will cultivate relationships with coaches throughout the world to better understand the needs of their local swim community and develop curriculum topics that enable Fitter and Faster participants including swimmers, parents and coaches to continuously improve their performance.
— Sergio Lopez, Current Head Coach at Virginia Tech. Former Head coach at the famous Bolles School in Jacksonville, Florida and coach to many swimmers who competed at the Olympics.
Several athletes who made it to the podium at the World Championships and Olympic Games were coached by Hawke.
— Bruno Fratus, two-time Olympian. Swimmer with the most sub-22 LCM 50 freestyles in history.
Hawke joins an Executive Team at Fitter and Faster that includes Founder and President David Arluck and two-time Olympian and Elite Clinician Chloe Sutton. "Hawke joining our team is a natural, yet super exciting next step for the company. We have a responsibility to swimmers, coaches and parents to continue evolving and offering the best competitive swimming learning experiences in the world. Brett's experience and success at every level of the sport will be incredibly valuable to our customers", said Arluck.
The addition of Hawke to Fitter and Faster's Executive team is part of the company's expansion. Since being founded in 2009, Fitter and Faster has become North America's largest swim clinic and camp producer for competitive swimmers. In 2018 Fitter and Faster will produce more than 400 sessions of swim clinics in 40 states serving more than 15,000 participating competitive swimmers, coaches and parents. Fitter and Faster is also the producer of the world-renowned Swim Videos on Demand service, providing the competitive swimming community throughout the world with best-in-class video footage and explanation of drills to improve technique.
Fitter and Faster is a SwimSwam partner.


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The suspect in the New Year's Eve machete attack now faces federal charges of attempted murder
The suspect in a New Year's Eve machete attack on three New York City police officers has been charged with four counts of attempted murder, according to federal court documents, in addition to several formal charges already brought against him.
Trevor Pickford, 19, is charged with attempted murder of US government officers and employees and three counts of attempted murder of US government officers and employees and people assisting them, according to the complaint.
The complaint alleges in part that he intended to kill military-age men working for the US government and New York police officers working with the FBI to protect revelers.
"This past New Year's Eve, revelers flocked to Times Square to celebrate the New Year with friends and family," said U.S. Attorney Damian Williams. "But it is alleged that Trevor Beckford targeted the iconic annual celebration to carry out an outrageous act of violence and hate in the name of jihad."
CNN has reached out to Federal Defenders of New York, which represents Bickford, for comment.
Pickford had previously been indicted on more than a dozen formal charges, including several counts of terrorism, according to the Manhattan District Attorney's Office.
Rosemary Vassallo-Velucci, who is representing Pickford in this case, previously told CNN that her client must be presumed innocent.
Federal prosecutors included in the complaint images of body camera footage that allegedly shows Pickford during the attack, striking officers with the knife he allegedly used, a kukri.
If convicted of all charges in the federal case, Pickford could face up to 80 years in prison, according to prosecutors.
Prosecutors said the suspect traveled to New York "to kill people and carry out jihad."
Authorities said Pickford entered the security area at the Times Square checkpoint on New Year's Eve, where he allegedly pulled out a machete and struck one officer with the blade and struck another in the head with the handle. He then swung the blade in the direction of a third officer, who shot the suspect in the shoulder, according to the New York Police Department.
According to a criminal complaint, Pickford told authorities during his interview that he said "(God) is great" before he went up and hit the officer on the head with the gun.
Prosecutors in that case alleged that the suspect said all government officials were his target, because they "could not be true Muslims because the United States government supports Israel."
The three officers were hospitalized in stable condition and have since been released.
The suspect had previously come to the attention of the FBI and was interviewed by federal agents last month in Maine after he said he wanted to go abroad to help fellow Muslims and was willing to die for his religion, several law enforcement officers said. .
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Prednisolone or pentoxifylline for alcoholic hepatitis
Prednisolone or Pentoxifylline for Alcoholic Hepatitis Mark R. Thursz, M.D., Paul Richardson, M.D., Michael Allison, Ph.D., Andrew Austin, M.D., Megan Bowers, M.Sc., Christopher P. Day, M.D., Ph.D., Nichola Downs, P.G. Cert., Dermot Gleeson, M.D., Alastair MacGilchrist, M.D., Allister Grant, Ph.D., Steven Hood, M.D., Steven Masson, M.A., Anne McCune, M.D., Jane Mellor, M.Sc., John O'Grady, M.D., David Patch, M.D., Ian Ratcliffe, M.Sc., Paul Roderick, Ph.D., Louise Stanton, M.Sc., Nikhil Vergis, M.B., B.S., Mark Wright, Ph.D., Stephen Ryder, D.M., and Ewan H. Forrest, M.D., for the STOPAH Trial* BACKGROUND
Alcoholic hepatitis is a clinical syndrome characterized by jaundice and liver im- The authors' affiliations are listed in the
Appendix. Address reprint requests to pairment that occurs in patients with a history of heavy and prolonged alcohol use. Dr. Thursz at the Hepatology Section, The short-term mortality among patients with severe disease exceeds 30%. Predniso- Imperial College, Norfolk Pl., London lone and pentoxifylline are both recommended for the treatment of severe alcoholic W2 1NY, United Kingdom, or at m . [email protected] imperial . ac . uk.
hepatitis, but uncertainty about their benefit persists.
*A complete list of the investigators in the Steroids or Pentoxifylline for Alco- We conducted a multicenter, double-blind, randomized trial with a 2-by-2 factorial holic Hepatitis (STOPAH) trial is pro- vided in the Supplementary Appendix, design to evaluate the effect of treatment with prednisolone or pentoxifylline. The available at NEJM.org.
primary end point was mortality at 28 days. Secondary end points included death N Engl J Med 2015;372:1619-28.
or liver transplantation at 90 days and at 1 year. Patients with a clinical diagnosis of DOI: 10.1056/NEJMoa1412278
alcoholic hepatitis and severe disease were randomly assigned to one of four groups: Copyright 2015 Massachusetts Medical Society. a group that received a pentoxifylline-matched placebo and a prednisolone-matched placebo, a group that received prednisolone and a pentoxifylline-matched placebo, a group that received pentoxifylline and a prednisolone-matched placebo, or a group that received both prednisolone and pentoxifylline.
A total of 1103 patients underwent randomization, and data from 1053 were available
for the primary end-point analysis. Mortality at 28 days was 17% (45 of 269 patients) in the placebo–placebo group, 14% (38 of 266 patients) in the prednisolone–placebo group, 19% (50 of 258 patients) in the pentoxifylline–placebo group, and 13% (35 of 260 patients) in the prednisolone–pentoxifylline group. The odds ratio for 28-day mortality with pentoxifylline was 1.07 (95% confidence interval [CI], 0.77 to 1.49; P = 0.69), and that with prednisolone was 0.72 (95% CI, 0.52 to 1.01; P = 0.06). At 90 days and at 1 year, there were no significant between-group differences. Serious infections occurred in 13% of the patients treated with prednisolone versus 7% of those who did not receive prednisolone (P = 0.002).
Pentoxifylline did not improve survival in patients with alcoholic hepatitis. Prednisolone
was associated with a reduction in 28-day mortality that did not reach significance and with no improvement in outcomes at 90 days or 1 year. (Funded by the National Institute for Health Research Health Technology Assessment program; STOPAH EudraCT number, 2009-013897-42, and Current Controlled Trials number, ISRCTN88782125.) n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Alcoholic hepatitis is a distinct Among four randomized, controlled trials in manifestation of alcoholic liver disease which pentoxifylline was compared with placebo that is characterized by jaundice and liver for the treatment of alcoholic hepatitis, one showed failure. This condition develops in persons with a significant benefit.10 All 100 patients enrolled a history of prolonged and heavy alcohol use.1 had a discriminant function that was greater than A Quick Take The severity of alcoholic hepatitis is convention- 32. The mortality was 24.6% in the pentoxifylline
summary is
available at ally defined by Maddrey's discriminant function, group as compared with 46.1% in the placebo
NEJM.org which is calculated as 4.6 × (patient's prothrombin group (P = 0.04). The principal benefit related to
time in seconds − control's prothrombin time in pentoxifylline appeared to be a reduction in the seconds) + patient's serum bilirubin level in milli- number of deaths attributed to the hepatorenal grams per deciliter; a value of 32 or higher indi- syndrome. However, two meta-analyses have not cates severe alcoholic hepatitis that carries an shown any convincing benefit associated with adverse prognosis, with mortality of 20 to 30% pentoxifylline.11,12 within 1 month after presentation and 30 to Two small studies have compared glucocorti- 40% within 6 months after presentation.2 coids with pentoxifylline, but the results were in- A number of therapies have been evaluated for consistent.13,14 Two other studies have compared the treatment of alcoholic hepatitis, but only two the effect of glucocorticoid monotherapy with drugs have been incorporated into the treatment that of combined treatment with glucocorticoids guidelines published by the American Association and pentoxifylline but showed no benefit from for the Study of Liver Disease and the European the addition of pentoxifylline.15,16 The purpose of Association for the Study of the Liver 3,4. In a 2008 our trial — Steroids or Pentoxifylline for Alco- Cochrane meta-analysis of 15 randomized trials holic Hepatitis (STOPAH) — was to determine published since 1971 that compared glucocorti- whether prednisolone or pentoxifylline adminis- coids with placebo or no intervention, Rambaldi tered for a 28-day period reduced short-term and et al. investigated the role of glucocorticoid ther- medium-term mortality among patients admitted apy for this condition.5 Despite this apparent wealth to a hospital with severe alcoholic hepatitis.
of evidence, controversy persists. Advocates of the treatment cite significant reduction in short-term mortality, whereas detractors raise questions about the risks of sepsis and gastrointestinal hemor- Study Design and Oversight
rhage with glucocorticoid therapy. In the largest The design and rationale for the trial have been placebo-controlled study to date, investigators described previously.17 STOPAH was a multicenter, treated 90 patients with prednisolone and found randomized, double-blind trial with a 2-by-2 fac- no benefit of that therapy over placebo adminis- torial design that was intended to evaluate the tered in a similar group of patients.6 This study treatment effect of prednisolone and of pentoxi- was hampered by the inclusion of patients with fylline in the management of severe alcoholic moderate or severe alcoholic hepatitis and those hepatitis. A trial-management group designed the with alcohol-related cirrhosis. In the only study study (see the protocol, available with the full we found that required histologic confirmation text of this article at NEJM.org). The study was of alcoholic hepatitis in all patients, prednisolone approved by the Multicenter Research Ethics Com- was associated with a short-term reduction in mittee (reference number 09/MRE09/59), and clini- mortality, but this benefit was not apparent after cal trial authorization was received from the 2 years.7,8 The systematic review by the Cochrane Medicines and Healthcare Products Regulatory group revealed a trend toward a benefit with glu- Agency. Written informed consent was obtained cocorticoids that was not statistically significant.5 from each patient or from his or her legal repre- However a reanalysis of the five largest studies in- sentative until such time as the patient recovered dicated a significant benefit from glucocorticoids; mental capacity. The trial was conducted and re- in this meta-analysis, 28-day mortality among ported with fidelity to the protocol, the Medicines patients with discriminant function scores of 32 or for Human Use (Clinical Trials) Regulations 2004, higher was 20% among those who were treated as amended in 2006, the European Union Clinical with prednisolone, as compared with 34% among Trials Directive (Directive 2001/20/EC) guidelines, those who received placebo (P<0.001).9 the principles of the International Conference on n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Prednisolone or Pentoxifylline for Alcoholic Hepatitis Harmonisation Good Clinical Practice under the port were given to each patient. The clinician re- oversight of University Hospital Southampton NHS sponsible for each patient made the decision re- Foundation Trust, and the provisions of the Dec- garding other treatments, such as terlipressin for laration of Helsinki. An independent data moni- patients in whom hepatorenal failure was devel- toring and ethics committee, whose members were oping, acid suppression for prophylaxis against aware of the group assignments, was convened gastrointestinal hemorrhage, antibiotics, and vita- to review the conduct of the trial and to analyze min supplementation. Patients with renal failure primary end-point data, using prespecified stop- (defined as a creatinine level >500 μmol per liter ping guidelines, after the recruitment of 200, 400, [>5.7 mg per deciliter] or the requirement for re- and 800 patients, to avoid continued recruitment nal-replacement therapy), active gastrointestinal in the event that a definitive result had been bleeding, or untreated sepsis, and patients requir- ing inotropic support with epinephrine or nor- Data collected by site investigative teams were epinephrine, were excluded unless the condition submitted to the clinical trials unit and analyzed stabilized within the first 7 days after admission by study statisticians. The first author wrote the to the hospital.
first draft of the manuscript, with substantial contributions from the coauthors. All the authors Randomization
vouch for the accuracy and completeness of the A Web-based computer system (Tenalea, Forms- data and analyses.
Vision) was used to enroll eligible patients and randomly assign them to study groups. The ran- domization schedule was created with the use of The trial included patients with a clinical diagno- Stata software, version 11 (StataCorp). Random- sis of alcoholic hepatitis. Clinical diagnosis was ization was performed with a block size of four, chosen because the use of liver biopsy in this group with stratification according to geographic area of patients is uncommon, and the aim was to re- and risk category. The high-risk category con- cruit a large number of participants whose con- sisted of patients who had had an occurrence of dition would reflect as closely as possible the gastrointestinal bleeding, renal impairment, or condition of patients seen in clinical practice.18,19 sepsis before randomization. All other patients Patients were recruited from January 2011 through were assigned to the intermediate-risk category.
February 2014 at 65 hospitals across the United Patients were randomly assigned to one of four Kingdom. All patients admitted with suspected groups, with one group receiving a pentoxifylline- severe alcoholic hepatitis were evaluated for eli- matched placebo and a prednisolone-matched pla- gibility. A clinical diagnosis that was based on a cebo, the second group receiving 40 mg of history of recent excess alcohol consumption and prednisolone daily and a pentoxifylline-matched the absence of other causes of liver disease was placebo, the third group receiving 400 mg of pent- used for trial recruitment. Inclusion criteria were oxifylline three times daily and prednisolone- an age of 18 years or older, a clinical diagnosis of matched placebo, and the fourth group receiving alcoholic hepatitis, an average alcohol consump- 40 mg of prednisolone daily and 400 mg of pent- tion of more than 80 g per day for men and more oxifylline three times daily. All patients were pre- than 60 g per day for women, a serum bilirubin scribed treatment for 28 days.
level greater than 80 μmol per liter (4.7 mg per deciliter), and a discriminant function of 32 or End Points
higher. Key exclusion criteria were jaundice for The primary end point of the trial was mortality more than 3 months, cessation of alcohol con- at 28 days. Secondary end points included mortal- sumption for more than 2 months before ran- ity or liver transplantation at 90 days and at 1 year.
domization, the presence of other causes of liver disease, a serum aspartate aminotransferase level Statistical Analysis
greater than 500 IU per liter or serum alanine We estimated that a sample of 513 patients re- transaminase level greater than 300 IU per liter, ceiving each active agent and an equal number and previous entry into the study within the pre- not receiving each agent would be required to ceding 6 months.
detect a reduction in 28-day mortality from 30% Standard supportive care and nutritional sup- in the latter groups to 21% in the former groups. n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Thus, in total, our trial would require enrollment completed at least 28 days of follow-up. At the of 1026 patients. We allowed for a rate of with- time the trial was stopped, 33 patients who un- drawal or loss to follow-up of approximately 10% derwent randomization during the last 90 days of and therefore aimed to recruit 1200 patients to the trial could not be included in the 90-day or 12-month analyses. In addition, there were 159 The analysis was conducted on an intention- patients who underwent randomization within to-treat basis. The comparison of mortality at 28 90 days to 12 months before the end of trial who days between treated and untreated groups was could not be included in 12-month analyses. The performed with the use of logistic regression, four groups were well matched with regard to their with adjustments for risk category (high or inter- baseline characteristics, including laboratory val- mediate) and factorial design. Mortality and rates ues (Table 1). At 28 days, 16% of the patients had of liver transplantation at 90 days and 1 year were died, 1% had been lost to follow-up, and 2% had compared with the use of the same strategy. A withdrawn from the study. At 90 days, 29% of the test for treatment interaction was performed as patients (285 of 968 patients) had died, 5% had a secondary analysis. Cox proportional-hazards been lost to follow-up, 3% had withdrawn, and 4% regression was used to compare 1-year survival had not completed follow-up owing to cessation among the groups, and Kaplan–Meier curves for of the study. At 1 year, 56% of the patients (421 1-year survival were plotted. All P values were of 747 patients) had died or undergone liver trans- plantation (3 patients), 8% had been lost to follow- A univariate logistic-regression analysis was up, 4% had withdrawn, and 20% had not com- performed for the end points of 28-day mortality, pleted follow-up owing to cessation of the study.
90-day mortality, and 1-year mortality. Separate models were fitted for conventional prognostic End Points
scores (discriminant function, Model for End-Stage At 28 days, 45 of 269 patients (17%) in the pla- Liver Disease score, Glasgow alcoholic hepatitis cebo–placebo group had died, 38 of 266 patients score, and Lille score) and for clinical and labo- (14%) in the prednisolone–placebo group had died, ratory variables, to investigate whether they were 50 of 258 patients (19%) in the pentoxifylline– significant predictors of mortality. As part of a placebo group had died, and 35 of 260 patients prespecified analysis, individual and treatment (13%) in the prednisolone–pentoxifylline group variables that were found to be significant in uni- had died. There was no significant treatment in- variate analyses were used in multivariate logistic- teraction between prednisolone and pentoxifylline regression analysis, and backward elimination (P = 0.41). In the prespecified analysis of the pri- (which was not prespecified) was applied at a 5% mary outcome (a logistic-regression analysis that significance level.
was adjusted for the risk category [high or inter- mediate] used in the randomization and for the factorial design), the odds ratio for 28-day mor- tality among patients who received pentoxifylline (those in the pentoxifylline–placebo group or those Over a 3-year period, 5234 patients were screened, in the prednisolone–pentoxifylline group), as com- and after the application of eligibility criteria, 1103 pared with patients who did not receive pentoxi- patients were randomly assigned to one of the four fylline was 1.07 (95% confidence interval [CI], treatment groups: 276 to the placebo–placebo 0.77 to 1.49; P = 0.69), and the odds ratio among group, 277 to the prednisolone–placebo group, patients who received prednisolone (those in the 276 to the pentoxifylline–placebo group, and 274 prednisolone–placebo group or those in the pred- to the prednisolone–pentoxifylline group (see nisolone–pentoxifylline group), as compared with Fig. S1 in the Supplementary Appendix, available patients who did not receive prednisolone, was at NEJM.org). All the patients were followed for 0.72 (95% CI, 0.52 to 1.01; P = 0.06) (Table 2). 12 months or until the time of their death, with Neither prednisolone nor pentoxifylline was found the exception of patients enrolled at the end of to influence mortality or the need for liver trans- the trial. Owing to limitations on funding, the plantation at 90 days or 1 year (Table 2). Kaplan– trial was stopped after all enrolled patients had Meier curves for survival in each treatment group n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Prednisolone or Pentoxifylline for Alcoholic Hepatitis Table 1. Baseline Characteristics of the Patients.*
(N = 1092)
Male sex — no. (%) Alcohol consumption — g/day Time from admission to initiation of treatment — days Encephalopathy — no. (%)† Sepsis on admission — Renal failure on admission — Gastrointestinal bleeding on admission — no. (%) Laboratory results Bilirubin — mg/dl Albumin — g/liter Aspartate aminotransferase — Alkaline phosphatase — Creatinine — mg/dl White-cell count — per mm3 Neutrophils — per mm3 Prothrombin time — sec Prognostic scores Discriminant function§ * Plus–minus values are means ±SD. To convert the values for bilirubin to micromoles per liter, multiply by 17.1. To convert the values for creatinine to micromoles per liter, multiply by 88.4.
† In patients with encephalopathy, grade 1 indicates mild confusion and impaired attention; grade 2 lethargy, personality change, and inap- propriate behavior; grade 3 comatose behavior with responsiveness to verbal or noxious stimuli; and grade 4 coma without responsiveness to verbal or noxious stimuli.
‡ Renal failure was defined as a serum creatinine level greater than 5.7 mg per deciliter or the requirement for renal-support therapy.
§ Discriminant function is calculated as 4.6 × (patient's prothrombin time in seconds − matched control's prothrombin time in seconds) + pa- tient's serum bilirubin level in milligrams per deciliter; a value of 32 or higher indicates severe alcoholic hepatitis that carries an adverse prognosis, with mortality of 20 to 30% within 1 month after presentation and 30 to 40% within 6 months after presentation.
¶ In the Model for End-Stage Liver Disease (MELD), scores range from 6 to 40, with higher scores indicating worse prognosis.
‖ The Glasgow alcoholic hepatitis score (GAHS) ranges from 5 to 12, with higher scores indicating worse prognosis.
n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. and for survival with prednisolone versus no pred- nisolone and with pentoxifylline versus no pent- oxifylline are provided in Figure 1.
The baseline variables that influenced 28-day mortality in univariate analyses included age, en- cephalopathy, white-cell count, prothrombin ratio, and serum levels of bilirubin, creatinine, and urea (Table 3). In multivariate analyses, age, encepha- lopathy, white-cell count, prothrombin ratio, and serum levels of bilirubin, creatinine, and urea re- mained significant. In a secondary analysis, in which a multivariate logistic-regression model was used that adjusted for these prognostic variables, we found that the odds ratio for 28-day mortal- ity among the patients who received predniso- lone, as compared with those who did not, was 0.61 (95% CI, 0.41 to 0.91; P = 0.02) (Table 3). However, the effect of prednisolone on mortality at 90 days (odds ratio, 1.00; 95% CI, 0.73 to 1.36; P = 0.98) and at 1 year (odds ratio, 1.01; 95% CI, 0.74 to 1.39; P = 0.94) was nonsignificant.
Adverse Events Including Death
Serious adverse events were reported in 42% of the patients, with an equal distribution in each of the treatment groups, and 20% of all serious ad- verse events resulted in death. Infection occurred in 71 of the 547 patients (13%) who received pred- nisolone as compared with 38 of the 545 patients (7%) who did not receive prednisolone (P = 0.002). Acute kidney injury occurred in 9 of the 546 pa- tients (2%) who received pentoxifylline as com- pared with 14 of the 546 patients (3%) who did not receive pentoxifylline (Table 4, and Table S2 in the Supplementary Appendix).
There were 418 deaths during the trial; 168 (40%) of these occurred before day 29, 28% oc- curred between day 28 and day 90, and 32% occurred between day 91 and 1 year. Investiga- tors attributed 95% of the deaths to liver-related causes. Among these causes, infection account- ed for 24% of the deaths, with similar numbers reported for the groups receiving prednisolone and those not receiving prednisolone. The occur- rence of gastrointestinal bleeding, sepsis, or renal failure before randomization did not affect mor- tality during the trial.
mortality transplantation transplantation — Controversy over the use of glucocorticoids in se- * The interaction between interventions was investigated as a secondary analysis.
vere alcoholic hepatitis has persisted for many n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Prednisolone or Pentoxifylline for Alcoholic Hepatitis Figure 1. Kaplan–Meier Curves Showing Overall
A Prednisolone vs. No Prednisolone
Survival According to Study Group.
Kaplan–Meier survival curves show a nonsignificant survival advantage during the first 28 days among pa- tients who received prednisolone as compared with those who did not receive prednisolone (odds ratio, 0.72; 95% confidence interval [CI], 0.52 to 1.01; P = 0.06) (Panel A). No significant survival advantage was seen for patients who received pentoxifylline as compared with those who did not receive pentoxifyl- line (odds ratio, 1.07; 95% CI, 0.77 to 1.49; P = 0.69) (Panel B). Survival curves for all four study groups up to 1 year are also shown (Panel C).
Days since Start of Treatment
No. at Risk
years despite the results of meta-analyses of se- lected trials.5,9 In our study, the reduction in 28-day mortality observed among patients treated with B Pentoxifylline vs. No Pentoxifylline
prednisolone did not reach the conventional No pentoxifylline threshold of statistical significance, and no sig- nificant differences were observed in 90-day or 12-month outcomes. However, in a secondary analysis that included adjustments for baseline determinants of prognosis, a significant advantage with respect to 28-day mortality was seen with prednisolone. The survival differences may have been a chance finding or may represent a benefit of prednisolone for short-term mortality that did not translate to longer-term benefit.
Although we used the same threshold of dis- Days since Start of Treatment
ease severity that has been used in most other tri- No. at Risk
als of alcoholic hepatitis (a score of 32 or higher No pentoxifylline for discriminant function), the 28-day mortality overall in STOPAH was appreciably lower than C One-Year Survival in All Groups
the 28-day mortality in the trials included in the meta-analysis by Mathurin et al.9 However, many of the studies included in the meta-analysis were performed more than 30 years ago, and the mor- tality reported in two more recently published tri- als was similar to that reported here.13,15,20 There was a lower incidence of infection and acute kidney injury in STOPAH than in some previous trials, a factor that may have contributed to the lower mortality.21 A comparison of the baseline char- acteristics of the patients in our study with those of patients in other trials conducted in the past Days since Start of Treatment
4 years shows that in our trial, the mean age was No. at Risk
slightly younger and the rate of encephalopathy lower; both characteristics have been consistently shown to influence mortality.15,20 However, the bilirubin, creatinine, and albumin levels observed n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Table 3. Analysis of Factors Associated with Mortality at 28 Days.*
Prednisolone vs. no prednisolone 0.61 (0.41–0.91) Pentoxifylline vs. no pentoxifylline 1.10 (0.74–1.64) Discriminant function 1.02 (1.02–1.03) 2.17 (1.86–2.53) 1.15 (1.12–1.18) 1.03 (1.02–1.03) Prothrombin ratio or INR 1.38 (1.10–1.73) 1.38 (1.13–1.69) 1.05 (1.03–1.07) 1.05 (1.03–1.07) 1.06 (1.03–1.08) 1.03 (1.00–1.06) 1.14 (1.10–1.18) 1.06 (1.01–1.12) 3.07 (2.32–4.08) 1.56 (1.05–2.33) 0.66 (0.37–1.16) 1.20 (0.79–1.83) 1.09 (0.71–1.65) 1.00 (1.00 –1.00) 0.99 (0.96–1.02) Alkaline phosphate 1.00 (1.00–1.00) 1.07 (1.05–1.09) 1.03 (1.01–1.06) Hepatic encephalopathy 3.70 (2.59–5.29) 3.07 (2.05–4.60) * Values reported for all variables were obtained at baseline, and the value for bilirubin was also obtained on day 7 to cal- culate the Lille score. GAHS denotes Glasgow alcoholic hepatitis score, which ranges from 5 to 12, with higher scores indicating worse prognosis, INR international normalized ratio, and MELD the Model for End-Stage Liver Disease, in which scores range from 6 to 40, with higher scores indicating worse prognosis.
† A separate univariate model was fitted for all baseline prognostic factors.
‡ Significant variables in the univariate analysis were added to a multivariate model, and backward elimination was ap- plied at the 5% significance level. Prognostic scores (calculated on the basis of discriminant function, MELD, GAHS and Lille score) were excluded from the multivariate analysis owing to multicolinearity with individual component vari- § The Lille score defines the risk of death according to the number of adverse prognostic factors, with higher scores indi- cating a worse prognosis. We calculated Lille scores on the basis of patient age, albumin level, bilirubin levels (at base- line and on day 7), the prothrombin ratio, and prothrombin time; the formula we used is shown in the protocol.
in patients in STOPAH were similar to those seen accuracy.22 Nevertheless, incorrect diagnostic la- in patients in other studies.
beling could have reduced the power of the study The use of liver biopsy to provide histologic to detect a therapeutic effect.
confirmation of alcoholic steatohepatitis remains A recognized drawback of glucocorticoid use controversial.4,18,19 Although many investigators in patients with alcoholic hepatitis is increased have used histologic confirmation as an entry susceptibility to infection.21 The higher rate of in- criterion, it is rarely applied in clinical practice fection among the patients treated with predniso- apart from those cases in which the diagnosis is lone was therefore expected, but mortality attrib- uncertain.19 Although it is possible that the diag- uted to infection was similar across the groups, nosis of alcoholic hepatitis was incorrect in a regardless of whether prednisolone was admin- small number of the patients in our study, when istered. Investigators attributed deaths to infection strict clinical criteria are used, it is possible to in 103 of 416 cases (24.8%), but infection also diagnose the condition with a high degree of probably played a role in deaths attributed to other n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Prednisolone or Pentoxifylline for Alcoholic Hepatitis Table 4. Serious Adverse Events.*
Pentoxifylline– Prednisolone–
number of patients (percent) Serious adverse event
Any that led to death Serious adverse event occurring in ≥5% of patients
Upper gastrointestinal hemorrhage Hepatobiliary disorder Infection or infestation† Lung infection‡ Renal or urinary disorder * Adverse events were categorized according to the Common Toxicity Criteria for Adverse Events.
† P = 0.002 for the comparison of serious adverse events of infection or infestation, which occurred in 71 of 547 (13%) of the patients who re- ceived prednisolone versus 38 of 545 (7%) of the patients who did not receive prednisolone.
‡ P = 0.007 for the comparison of lung infections, which occurred in 37 of 547 (7%) of the patients who received prednisolone versus 17 of 545 (3%) of the patients who did not receive prednisolone.
causes, such as multiorgan failure. Since infec- In summary, in the STOPAH trial, pentoxifyl- tion plays such an important role in the outcome line did not improve outcomes in patients with of alcoholic hepatitis, it is worth noting that in a alcoholic hepatitis. The findings suggest that the trial published in 2011, the addition of N-acetyl- administration of 40 mg of prednisolone daily for cysteine to prednisolone was associated with a 1 month may have a beneficial effect on short- reduced rate of infection.20 term mortality but not on the medium-term or The results of this trial showed that after 28 long-term outcome of alcoholic hepatitis.
days, neither prednisolone nor pentoxifylline in- fluenced mortality. Furthermore, the cumulative Supported by a grant (08 14 44) from the National Institute mortality at 90 days and at 1 year in this group for Health Research (NIHR) Health Technology Assessment of patients is alarming. Self-reported alcohol con- program.
Dr. Thursz reports receiving lecture fees and consulting fees sumption revealed complete abstinence in 37% of from Gilead, Bristol-Myers Squibb, AbbVie, and Abbott; and Dr. the patients at 1 year of follow-up. However, data Allison, receiving consulting fees from Norgine. No other po- on alcohol consumption are difficult to collect, tential conflict of interest relevant to this article was reported.
Disclosure forms provided by the authors are available with and this fact is reflected in the high proportion the full text of this article at NEJM.org.
of missing data. No matter what the exact figures We thank the NIHR Clinical Research Network for providing are, more clearly needs to be done to prevent re- support for research nurses and the Imperial College Biomedical Research Centre, Southampton Clinical Trials Unit, for manage- cidivism in this group of patients.
ment of the trial.
From Imperial College (M.R.T., N.V.), King's College Hospital (J.O.), and the Royal Free Hospital (D.P.), London, Royal Liverpool Hospital (P. Richardson) and Aintree Hospital (S.H.), Liverpool, Addenbrookes Hospital, Cambridge (M.A.), Derby Royal Hospital, Derby (A.A.), Southampton Clinical Trials Unit, University of Southampton (M.B., N.D., J.M., I.R., P. Roderick, L.S.), and University Hospital Southampton NHS Foundation Trust (M.W.), Southampton, Faculty of Medical Sciences, Newcastle University (C.P.D.), and n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved. Prednisolone or Pentoxifylline for Alcoholic Hepatitis Newcastle upon Tyne Hospitals NHS Foundation Trust (S.M.), Newcastle upon Tyne, Sheffield Teaching Hospitals Foundation Trust, Sheffield (D.G.), Edinburgh Royal Infirmary, Edinburgh (A. MacGilchrist), Leicester Royal Infirmary, Leicester (A.G.), Bristol Royal Infirmary, Bristol (A. McCune), Nottingham University Hospitals NHS Trust and National Institute for Health Research Biomedical Research Unit, Queens Medical Centre, Nottingham (S.R.), and the Glasgow Royal Infirmary, Glasgow (E.H.F.) — all in the United References
1. Lucey MR, Mathurin P, Morgan TR. treated with prednisolone. Gastroenterol-
alcoholic hepatitis: a randomized clinical Alcoholic hepatitis. N Engl J Med 2009; ogy 1996; 110: 1847-53.
trial. JAMA 2013; 310: 1033-41.
360: 2758-69.
9. Mathurin P, O'Grady J, Carithers RL, 16. Sidhu SS, Goyal O, Singla P, et al.
2. Maddrey WC, Boitnott JK, Bedine MS, et al. Corticosteroids improve short-term Corticosteroid plus pentoxifylline is not
Weber FL Jr, Mezey E, White RI Jr. Corti- survival in patients with severe alcoholic better than corticosteroid alone for im- costeroid therapy of alcoholic hepatitis. hepatitis: meta-analysis of individual pa- proving survival in severe alcoholic hep- Gastroenterology 1978; 75: 193-9.
tient data. Gut 2011; 60: 255-60.
atitis (COPE trial). Dig Dis Sci 2012; 57: 3. European Association for the Study of 10. Akriviadis E, Botla R, Briggs W, Han 1664-71.
Liver. EASL clinical practical guidelines: S, Reynolds T, Shakil O. Pentoxifylline 17. Forrest E, Mellor J, Stanton L, et al.
management of alcoholic liver disease. improves short-term survival in severe Steroids or Pentoxifylline for Alcoholic J Hepatol 2012; 57: 399-420.
acute alcoholic hepatitis: a double-blind, Hepatitis (STOPAH): study protocol for a 4. O'Shea RS, Dasarathy S, McCullough placebo-controlled trial. Gastroenterolo-
randomised controlled trial. Trials 2013; AJ. Alcoholic liver disease. Hepatology gy 2000; 119: 1637-48.
2010; 51: 307-28.
11. Whitfield K, Rambaldi A, Wetterslev 18. Potts JR, Goubet S, Heneghan MA,
5. Rambaldi A, Saconato HH, Chris-
J, Gluud C. Pentoxifylline for alcoholic Verma S. Determinants of long-term out- tensen E, Thorlund K, Wetterslev J, hepatitis. Cochrane Database Syst Rev come in severe alcoholic hepatitis. Ali- Gluud C. Systematic review: glucocorti- 2009; 4: CD007339.
ment Pharmacol Ther 2013; 38: 584-95.
costeroids for alcoholic hepatitis — a 12. Parker R, Armstrong MJ, Corbett C, 19. Singal AK, Salameh H, Singal A, et al.
Cochrane Hepato-Biliary Group system- Rowe IA, Houlihan DD. Systematic re- Management practices of hepatitis C virus atic review with meta-analyses and trial view: pentoxifylline for the treatment of infected alcoholic hepatitis patients: sequential analyses of randomized clini- severe alcoholic hepatitis. Aliment Phar- A survey of physicians. World J Gastroin- cal trials. Aliment Pharmacol Ther 2008; macol Ther 2013; 37: 845-54.
test Pharmacol Ther 2013; 4: 16-22.
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13. Park SH, Kim DJ, Kim YS, et al. Pent-
20. Nguyen-Khac E, Thevenot T, Piquet
6. Mendenhall CL, Anderson S, Garcia-
oxifylline vs. corticosteroid to treat severe MA, et al. Glucocorticoids plus N-acetyl- Pont P, et al. Short-term and long-term alcoholic hepatitis: a randomised, non- cysteine in severe alcoholic hepatitis. survival in patients with alcoholic hepati- inferiority, open trial. J Hepatol 2014; 61: N Engl J Med 2011; 365: 1781-9.
tis treated with oxandrolone and pred- 792-8.
21. Louvet A, Wartel F, Castel H, et al. In-
nisolone. N Engl J Med 1984; 311: 1464-70. 14. De BK, Gangopadhyay S, Dutta D, fection in patients with severe alcoholic
7. Ramond MJ, Poynard T, Rueff B, et al. Baksi SD, Pani A, Ghosh P. Pentoxifylline hepatitis treated with steroids: early re-
A randomized trial of prednisolone in pa- versus prednisolone for severe alcoholic sponse to therapy is the key factor. Gas- tients with severe alcoholic hepatitis. hepatitis: a randomized controlled trial. troenterology 2009; 137: 541-8.
N Engl J Med 1992; 326: 507-12 World J Gastroenterol 2009; 15: 1613-9.
22. Forrest EH, Gleeson D. Is a liver bi-
8. Mathurin P, Duchatelle V, Ramond 15. Mathurin P, Louvet A, Duhamel A, et opsy necessary in alcoholic hepatitis?
MJ, et al. Survival and prognostic factors al. Prednisolone with vs without pentoxi- J Hepatol 2012; 56: 1427-8.
in patients with severe alcoholic hepatitis fylline and survival of patients with severe Copyright 2015 Massachusetts Medical Society. n engl j med 372;17 nejm.org April 23, 2015 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF NEW MEXICO on April 23, 2015. For personal use only. No other uses without permission. Copyright 2015 Massachusetts Medical Society. All rights reserved.
Source: http://unmhospitalist.pbworks.com/w/file/fetch/95509604/nejmoa1412278.pdf
[product monograph template - standard]
PRODUCT MONOGRAPH Modified-Release Capsule, 40 mg (as doxycycline monohydrate) GALDERMA CANADA INC. Date of Preparation: 105 Commerce Valley Dr. W., Suite 300 November 09, 2011 Thornhill, Ontario L3T 7W3 Date of Revision: Submission Control No: 156056 August 30, 2012 Page 1 of 27 Table of Contents August 30, 2012 Page 2 of 27
Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial
Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial Peter Malfertheiner, Franco Bazzoli, Jean-Charles Delchier, Krysztof Celiñski, Monique Giguère, Marc Rivière, Francis Mégraud, for the Pylera Study Group


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What are some recent Printz Award Winners?
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To see a complete list of the 2015 Winner and Honor books click here
2018 Printz Award Winner:
You go through life thinking there's so much you need. . . . Until you leave with only your phone, your wallet, and a picture of your mother. Marin hasn't spoken to anyone from her old life since the day she left everything behind. No one knows the truth about those final weeks. But even thousands of miles away from the California coast, at college in New York, Marin still feels the pull of the life and tragedy she's tried to outrun. Now, months later, alone in an emptied dorm, Marin waits. Mabel is coming to visit and Marin will be forced to face everything that's been left unsaid and finally confront the loneliness that has made a home in her heart. -- BN Synopsis
Welcome to the stunning conclusion of the award-winning and best-selling MARCH trilogy. By the fall of 1963, the Civil Rights Movement has penetrated deep into the American consciousness, and as chairman of the Student Nonviolent Coordinating Committee, John Lewis is guiding the tip of the spear. Through relentless direct action, SNCC continues to force the nation to confront its own blatant injustice, but for every step forward, the danger grows more intense. -- BN Synopsis
Bone Gap is the story of Roza, a beautiful girl who is taken from a quiet midwestern town and imprisoned by a mysterious man, and Finn, the only witness, who cannot forgive himself for being unable to identify her kidnapper. As we follow them through their melancholy pasts, their terrifying presents, their uncertain futures, acclaimed author Laura Ruby weaves a heartbreaking tale of love and loss, magic and mystery, regret and forgiveness—a story about how the face the world sees is never the sum of who we are. -- Amazon
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text:
dr. Ivan Šuprina (Virovitica, 1. siječnja 1921. – Napulj, 13. srpnja 1988.), liječnik, hrvatski nogometni reprezentativac.

Klupska karijera
Nastupao je za HŠK Građanski, s kojim je osvojio posljednje državno prvenstvo u Jugoslaviji prije 2. svjetskog rata, 1940., kao i prvenstvo Hrvatske 1943. Nakon toga nastavlja karijeru u Švicarskoj i Italiji.

Reprezentativna karijera
Za hrvatsku reprezentaciju je odigrao prve tri utakmice u njezinoj povijesti, za vrijeme Banovine Hrvatske, pod vodstvom izbornika Joze Jakopića. Sve tri igrane su 1940. godine, prve dvije protiv Švicarske (pobjede 4-0 u Zagrebu i 1-0 u Bernu), te jedna protiv Mađarske (poraz 1-0 u Budimpešti). Za vrijeme 2. svjetskog rata i NDH nije uspio izboriti mjesto u reprezentaciji.

Liječnička karijera
Nakon završetka igračke karijere ostaje živjeti u Italiji, gdje je diplomirao na Medicinskom fakultetu u Napulju, i posvećuje se liječničkom pozivu.

Hrvatski liječnici
Hrvatski nogometni reprezentativci 1940.-1956.
Nogometaši 1. HŠK Građanskog Zagreb
Životopisi, Virovitica

redpajama_set_name: RedPajamaWikipedia


text:
The Spain national football team has had nine captains since 1980.

References

Captains
Spain
Association football player non-biographical articles


The Patient Service Representative is responsible for acting as the first point of contact for patients by greeting, gathering information, registering and posting payments. This position is critical to Solis Mammography: by providing outstanding patient care and maintaining the flow of the center, the Patient Service Representative impacts the profitability of the organization. This position is for 11-7:30 PM M-F and Saturday rotational schedule.


In this Alumni Roundup, meet two authors and eleven other high-achieving colleagues.
Jeffrey Siger '69 (above) and C. Joseph Greaves '81 keep churning out attention-getting novels from their respective perches in Greece and Colorado. Both crime writers have won numerous awards for their work.
Siger is the author of The Mykonos Mob, the tenth book in his Chief Inspector Andreas Kaldis series, published by Poisoned Pen Press in April. This comes on the heels of An Aegean April, the ninth in the series, which was included in Library Journal's "Best Books of 2018." Recognition of his work comes from many quarters. Siger was named the novelist for Greece in the August 2018 New York Times Book Review article, "All the World's a Crime: Thrillers from Around the World," and selected as one of six authors—and the only American—writing mysteries that serve as a guide to the country by the Hellenic General Secretariat of Media and Communications. Siger blogs about Greece every Saturday on www.murderiseverywhere.blogspot.com and can be reached at www.jeffreysiger.com.
Greaves recently announced the publication of his sixth novel, Church of the Graveyard Saints, by Torrey House Press. His previous title, Tom and Lucky was a Wall Street Journal Best Books of 2015 selection and a finalist for the 2016 Harper Lee Prize. Greaves spent twenty-five years as a trial lawyer in Los Angeles before moving to Santa Fe in 2006 to pursue a writing career. He is a member of the National Book Critics Circle and the book critic for the Four Corners Free Press in southwestern Colorado, where he currently lives.
Wright was named senior vice president and general counsel of the Federal Reserve Bank of Boston. As the Boston Fed's senior legal office, he provides counsel to the bank's leadership, is a member of the Executive Committee, and heads the legal services group. Wright comes to his new position following a twenty-year career with Holland & Knight LLP, where he was the executive partner overseeing the management of the firm's Boston office. He is well regarded for his legal and business expertise, his contributions as a leader in the legal and business communities in Boston, and his commitment to public service.
Finegan was honored with the 2019 Great Friend of Justice Award by the Massachusetts Bar Foundation for her dedication and commitment to equal justice. A partner in the Boston office of Mintz Levin and chair of the firm's Pro Bono Committee, she also serves as co-chair of the Massachusetts Access to Justice Commission and is a member of the Supreme Judicial Court's Standing Committee on Pro Bono Legal Services. Susan is a nationally recognized pro bono pioneer with a passion for helping underserved populations. Her pro bono cases include her work to defeat President Trump's first immigration travel ban in 2017, the passage of a Massachusetts restraining order law for victims of sexual assault, and the creation of innovative statewide pro bono programs.
Hand was named associate justice of the Massachusetts Appeals Court in March following nomination by Massachusetts Governor Charlie Baker and confirmation by the Governor's Council. Former presiding justice of the Appellate Division of the District Court, Southern Division and the Barnstable District Court, Justice Hand brings twenty-four years of legal experience to her new position. In addition, she serves on the Supreme Judicial Court Standing Advisory Committee on the Rules of Civil Procedure, has led the District Court Debt Collection Working Group since 2017, and is a mentor in the Trial Court Judicial Mentoring Program.
Varga was elected a Fellow of the American College of Coverage Counsel, an international association of lawyers who represent the interests of insurers and policyholders. He is a partner in the Hartford, CT, office of Robinson & Cole LLP, where he is chair of the firm's Technology Committee and focuses his practice on insurance coverage and corporate litigation.
Fletcher was named chief legal officer and vice president of Stryker Corporation, a medical technology company headquartered in Kalamazoo, MI. He was previously vice president of global litigation at Johnson & Johnson in Boston, where he has also served as general counsel to the company's medical devices and pharmaceutical sectors.
Millones, chief legal officer and assistant secretary of Newman's Own Foundation in Westport, CT, spoke in April at a BC Law event sponsored by the BC Law Business Law Society and Boston Alumni Chapter.
Mathews, a partner in the New York, NY, office of Morrison & Foerster and a member of the firm's global privacy and data security group, represents clients in many industries and advises them on matters of compliance with data laws, data protection in transactional matters, and prevention and response with respect to cybersecurity breaches. She was previously a partner and head of the privacy and cybersecurity group at Proskauer Rose LLP. Kristen's interest in data privacy precedes her years at BC Law, where she co-founded the Intellectual Property and Technology Forum, an academic journal on emerging legal issues in the field.
Bryant was named vice president of the board of directors of the newly launched Boston Chapter of Professional Women in Construction, a national nonprofit organization that supports women and promotes diversity in the architecture, engineering, construction, and related industries. Sara is the managing partner in the Boston office of Murtha Cullina and a member of the firm's Litigation Department and construction practice group.
Durning is the new managing partner of Mackie Shea PC, an environmental, land use, and litigation law firm based in Boston. He focuses his practice on environmental litigation, enforcement defense, land use and permitting, and water and wetlands related matters; and represents public companies, high net worth individuals, investors in renewable energy facilities, small businesses, and communities. He was previously an associate at Goulston & Storrs PC.
Yospin is a patent and intellectual property attorney in private practice in Boston, where he works with businesses, entrepreneurs, and inventors in intellectual property and transactional law matters. His extensive business experience stems from his prior career in the computer software consulting business. Visit his website at www.yospinlaw.com to read his latest blog on the 100th anniversary of the Great Boston Molasses Flood or follow his monthly email newsletter presenting interesting and relevant topics related to intellectual property law, his activities in the community, links to his blog posts, and a list of recently read books.
Wilson-Murphy is an associate in the Boston office of Robinson & Cole and a member of the firm's business transactions group. He was previously an associate in the corporate group of an international law firm. In addition to his law practice, Barrett is a volunteer with the Achilles International Freedom Team, an organization that provides running and marathon opportunities to wounded members of the US military, and has guided disabled Iraq and Afghanistan veterans in twenty marathons.


A two-day exhibition. Nine students of the Willem de Kooning's Digital Craft program present new work: objects to inspire and make us wonder and reflect on our relationship with electronic, networked and digital media.
We are makers before everything else: we get their hands dirty, burn their fingers with soldering irons, test and tweak our computer-aided tools. And do what we make? We make objects to inspire and make us wonder and reflect on our relationship with electronic, networked and digital media.
We are practitioners representing 9 different disciplines who came together in the Willem de Kooning's Digital Craft program. We invite you to witness an exhibition of our progress and engage with our emerging practices in craft and technology.
The exhibition is presented in three parts: Pertaining to Fingers explores the historical meaning of the word digital and the relationship between technology and the hand; Fantastic Forgeries proposes an alternative version of Dutch material culture – ripped, replicated and remediated from the Museum Boijmans van Beuningen; and Real Time presents poetic experiences that question space, time, and our relationship with the real.
special presentation with Marloes de Fries / MAMA GALLERY, Michel van Dartel / V2_, Alexandra van Dongen / Museum Boijmans van Beuningen, & Klaas Kuitenbrouwer / The New Institute.
Students of the new WDKA Digital Craft minor present objects to inspire, wonder, and that reflect on our relationship with craft in times of electronic, digital, and networked media.
Jon Stam (CA) is a designer whose focus is on context driven objects, quality craftsmanship, and quiet interactions.


text:
Boyfriend Jealous of President Obama During His Voting
BLACK MEDIA Presents - Its basically comedy ...
What can he do anyway- come on man... sorry "MIKE" lol - Crunkatlanta
Chicago native Aia Cooper was embarrassed and shocked that her fiance told President Obama not to touch her as he casted his ballot this week.
According to CNN, Cooper and her fiance Mike Jones, stood at a voting booth next to the president. Cooper was nervous to be next to the commander-in-chief of the U.S.A., even before Jones made his remark.
"Mr. President, don't touch my girlfriend," he said. Cooper then apologized several times for Jones' comment, but Obama didn't mind the joke.
"I really wasn't planning on it," he said. "That's an example of a brother just embarrassing you for no reason."
The president would then give Cooper a hug before leaving the facility. Check out the funny video above.
preciseearz link
Daddymack link
This went viral...lol Think the pres wont hit your girl? think again......LMAO hahahah Homeboy should have kept it cool and now he's known to the world as a man who have insecurity problems....LOL
Good looking on the post Crunkatlanta
UnsungHipHop
This guy has to be joking....or he's a clown...!!!


text:
: 5 things you need to know about the new NFL season
Patrick Mahomes #15 of the Kansas City Chiefs celebrates after defeating the San Francisco 49ers 31-20 in Super Bowl LIV in Miami, Florida.
Andy Lyons/Getty Images
The NFL begins its season Thursday night with a heavyweight matchup between the Super Bowl champion Kansas City Chiefs and the Houston Texans. The league plans on playing its normal schedule this season, despite the prevalence of the coronavirus pandemic in much of the U.S.
Here are five things to know about the start of the NFL season:
1. Coronavirus protocols have been a home run so far
Even though a home run is a baseball term, it's apropos here.
Since NFL training camps began in July, players and team personnel were tested for the coronavirus multiple times per week. From August 30 to September 5, 44,510 tests were administered, leading to one new confirmed positive test among players and seven confirmed positives among team personnel.
That's a positive test rate of 0.017 percent, far below the average in the United States, which hovers around five percent, according to Johns Hopkins University
Players and personnel have been wearing masks indoors at all times during training camp. The league has also lowered the number of players that teams can invite to camp.
In addition to testing, all NFL team facilities have adopted daily symptom screenings and temperature checks for everyone who enters and exits. The league has hired a third-party contact tracing company, IQVIA, to help stop the spread of the virus among those who do test positive, according to ESPN.
Brian McCarthy, vice president of communications for the NFL, told MarketWatch that the league is "prepared to make adjustments as necessary" to its coronavirus protocols.
2. There will be no "bubble"
Multiple sports leagues including the NBA, MLS and WNBA have been playing games in a "bubble" during the coronavirus pandemic. This bubble, located at the ESPN Wide World of Sports Complex at the Disney resort in Florida, has been an effective location for those leagues during the pandemic. The NFL has opted against using a bubble system for this season.
Teams will host games, as scheduled, at their home stadiums.
Dr. Allen Sills, chief medical officer of the NFL, told the NFL Network that the league had no interest in creating a bubble.
"We do not feel it's practical or appropriate to construct a bubble," Sills told Tom Pelissero. "Anyone who tests positive will be isolated until medically appropriate to return."
In an interview with CNN in June, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said he thought the NFL should create a bubble
"Unless players are essentially in a bubble — insulated from the community and they are tested nearly every day — it would be very hard to see how football is able to be played this fall. If there is a second wave, which is certainly a possibility and which would be complicated by the predictable flu season, football may not happen this year," he said at the time.
Major League Baseball also opted to not construct a bubble, and has had mixed results. Over 40 baseball games have been postponed so far this season because people from one of the organizations tested positive for COVID-19.
3. There will be (some) fans at games
Six of the 32 NFL teams have said there will be at least some fans at their games for the 2020 season. Many other teams have stated they will begin the season with empty stadiums, but are not ruling out a midseason change.
The teams that will have fans at games this year are the Cleveland Browns, Dallas Cowboys, Indianapolis Colts, Jacksonville Jaguars, Kansas City Chiefs, and the Miami Dolphins, according to the Sporting News. Of the teams hosting fans, no team will fill its stadium more than 25% capacity. Some teams that will not host fans will have cardboard cutouts in some of its stadium seating, similar to how the MLB has done in 2020.
Teams will be allowed to pump in artificial crowd noise during games, according to NFL executive vice president Troy Vincent. The NBA, which doesn't allow any fans at its games during the pandemic, has also done this.
Is it an unfair advantage for some teams to have fans and other teams to have empty stadiums? NFL Commissioner Roger Goodell doesn't think so.
"We do not believe it's a competitive advantage," Goodell said last week. "We discussed it very early on with our Competition Committee and with our clubs. We do not see that."
4. Gameday rule changes
As stated above, players and team personnel are required to wear masks inside facilities and while traveling to and from games.
During games, there is a mask mandate, regardless if the stadium is an outdoor or indoor arena. The mandate however, applies to coaches and staff only, not players.
The NFL has made a "strong recommendation," but not a mandate, that players wear masks while on the sidelines during games, according to ESPN. The recommendation applies only to players who are not currently in the game.
Due to local regulations, players on the sidelines during games played at the San Francisco 49ers' Levi's Stadium and Bills' Stadium in Buffalo must wear face coverings.
For the players on the field, the league created a helmet with an added face shield covering, but those helmets are voluntary to wear.
The face shields have failed to gain traction among players. On two teams, the Los Angeles Rams and the Los Angeles Chargers, no players have been using the face shields.
The NFL has made many granular changes for the upcoming season too, even making alterations to the coin toss and postgame pleasantries.
The ritual pregame coin toss, which usually features several players from each team standing in the middle of the field, will now be conducted by one player from each team. The NFL has outlawed postgame interactions among players and coaches? that don't adhere to six-feet of social distancing, which include handshaking and the popular jersey swap among players, according to NFL Media's Tom Pelissero.
5. What's been canceled
While the NFL intends to play its full schedule of games, there have been some cancelations. All of the NFL's preseason games have been canceled and so have the league's international games. This season, several games were set to be played in London and Mexico City, but those games will now be played in the U.S.
The NFL also canceled its in-person draft in April, opting for an all-digital product. In-person minicamps were canceled in favor of online variants, and staff at team facilities were cut to essential personnel only over the summer.
Also, 67 NFL players have opted out of the NFL season due to coronavirus concerns.
A state-by-state breakdown of unemployment in the U.S., according to the latest figures
Sondland Revises Testimony on Aid Suspension: Impeachment Update
Manchester City owner to sell $500 million stake valuing itself at $4.8 billion: FT
Teva Pharm second-quarter profit tops forecast, reaffirms 2020 outlook
Wall Street Continues March Higher on Bets Recession Will Be Short-Lived
Boeing proposal to avoid MAX wiring shift does not win U.S. support


text:
Aid & development
Israel, West Bank & Gaza
Ian Birrell
Award-winning columnist and foreign reporter. Contributing editor of The Mail on Sunday and weekly columnist in the 'i' paper. Writes regularly for many other papers, platforms and magazines. Frequent broadcaster and speaker at events. Co-founder wth Damon Albarn of the Africa Express music project and executive producer of 4 albums...Read more
Twitter: @ianbirrell
Now a struggle starts for the soul of our nation
The PM is hopelessly out of his depth
Will we ever learn the truth about China and the pandemic?
Real Conservatives should speak out
Floating factories as big as football pitches plundering our seas and killing dolphins
aid autism Blair Boris Brexit Cameron China coalition Conservatives Corbyn coronavirus crime Daily Mail democracy Dfid Disability drugs Ethiopia EU Guardian human rights immigration Independent ipaper Isis Kenya Labour LibDems Libya May Miliband MoS NHS Nigeria Observer Putin Russia Syria Times Trump Ukip Ukraine UN UnHerd USA
Tweets by ianbirrell
The teenagers taking on the brutal tyranny of China
Published by The Mail on Sunday (11th August, 2019)
In their colourful T-shirts, cut-off denim shorts and carefully styled hair, the four female students look like countless other teenagers around the world. They listen to pop music and watch Netflix. They like going to the beach and 'hanging' with pals.
But these days, this quartet have more serious matters on their minds. They are among thousands of teenagers and young people risking their lives and liberty to challenge one of the world's most ruthless and powerful states.
'I am afraid the Chinese government and army will get involved, with casualties and deaths,' said one of them, Ash, 18. 'But I will keep fighting because this is our home and we must protect our freedoms at all costs. What could be more precious than your home?'
As Hong Kong's protests grow more violent, the police crackdown intensifies and tensions in this famous financial hub spiral alarmingly, these four women highlight how younger generations are leading a fight for democracy against an inflexible government.
They admit they are scared but display the determination of youthful idealists. 'Civil disobedience is crucial if a government does not listen,' said Man, 19, a first-year university student. 'If I go to jail, it will only make more people aware of our cause.'
I have seen over recent days how often it is teenagers leading the clashes with riot police as they taunt officers, tear apart street furniture for barricades, supply front lines with protective gear – and then flee the inevitable tear-gas and baton charges.
Yesterday saw more protests as 'flash mobs' of young protesters blocked roads and the main car tunnel to Hong Kong island, while hundreds thronged the airport arrivals hall for a second day. Riot police again charged and fired tear gas to clear demonstrators.
In a clear warning to businesses, China ordered Cathay Pacific Airways to suspend staff involved in protests. One of its pilots was arrested two weeks ago.
Typical of the teenage activists was Justin, a 19-year-old I met before a march that ended with eggs and Molotov cocktails being thrown at a police station. 'We have to do something to stand up for our values,' he told me.
Like many others, Justin was clad in black, had a helmet on his head and gas mask clamped over his face. He held a surfing body board as a makeshift shield, while some nearby marchers clutched wok lids to cover tear gas canisters fired at them. 'I have prepared myself,' said Justin. 'I've been in every protest.'
He admitted his family feared for his safety, with arrests now leading to charges of rioting that could mean ten years in prison, but said they backed the cause. 'I'll fight to the last minute, even against tanks. I am ready to die. Freedom is worth my life.'
These protests started two months ago against a bill allowing extradition to China – the latest erosion of Hong Kong's prized freedoms – but have grown into the most serious dissident challenge to Beijing since the student demonstrations in Tiananmen Square 30 years ago.
Police have arrested 420 people, including 148 during a general strike that crippled the city on Monday. The youngest was 13, while a 16-year-old girl was seen in tears as she told her mother on the phone of her terror after being detained.
Many are like the four friends I met at Hong Kong Baptist University amid furious campus protests against the seizure of their leader for buying laser pointers, which have been deemed an offensive weapon despite being on sale in local markets. They are fighting to thwart a future living in a one-party state that crushes freedoms over the nearby border with a pitiless combination of force and technology. 'We are worried we will become like China,' said Ash.
These are not natural rebels – Ash's parents work in accountancy and management. 'When you see police firing tear gas, you are so terrified,' said Ash's friend Chiu. 'But this has made us political.'
Chiu's family came to Hong Kong after fleeing the Cultural Revolution, so fear the consequences of unrest. 'My parents tell me not to get involved in politics and do not support attacks on the police. They say we are just teenagers and students.'
Yet Hong Kong's young insurgents have learned from previous attempts to protect the 'one country, two systems' deal that was supposed to be guaranteed when Britain handed its former colony to Communist Party chiefs in Beijing.
So they hide their faces (they saw how CCTV footage helped convict pro-democracy protest leaders in 2014), harness social media with intuitive skill, and avoid having leaders who can be thrown in jail – as happened five years ago when big protests last erupted here – by relying on group decisions made online about places to target.
Many carry incongruous-looking umbrellas, a symbol of previous protest. These can be used as sticks in attacks but also as clusters to hide faces when ripping up street furniture, spraying graffiti or even simply discussing plans amid protests – after someone shouts 'It's raining' as a signal.
They also use wit to mock the authorities. After the arrest of the activist for buying laser pointers – used to dazzle police at protests – a 'stargazers' event was held at the space museum where hundreds of people staged an impromptu laser show. Within hours, footage with music from Star Wars was circulating on social media, comparing protesters to rebels fighting Darth Vader's dark forces.
Invitations to the airport protests were designed as boarding passes for 'Freedom Airways'.
Beijing warned last week the crisis was a 'battle of life and death' for the city's future, saying that 'those who play with fire will perish by it… they will eventually be punished'.
Both sides seek to expose the identities of their foes. The police are tracking the organisers online and use the phones of arrested protesters to trace social media links; protesters post personal details of riot squad officers on social media.
One academic study found almost two-thirds of participants in protests have higher education, while three in five were found to be aged under 29, according to a survey taken at two events last weekend.
Some say they are dismayed by the growing intensity of the struggle, especially in a society known for order and politeness. 'Things are getting more violent,' said Jennifer, a 16-year-old who attends protests with her parents.
She disliked seeing Molotov cocktails being thrown and police car windows smashed. 'I want it to remain peaceful but the government is not listening,' she said.
Ty, another 16-year-old participant, admitted she had become more militant after the government failed to respond to June's massive march by two million people and subsequently being attacked with tear gas, bean bag rounds (flexible shotgun shells) and fireworks.
'After almost two months of mayhem, I'm both physically and mentally exhausted,' she said. 'From merely distributing supplies, because I couldn't muster up enough courage, to being fully engaged, I have come a long way.
'What makes me mad is that the police are no longer protecting us. Why would they become the political muscle against the people?'
Ty is fighting in defiance of her parents, who were infuriated after discovering a bag of supplies hidden in their home. 'We are only afraid of losing this battle – if we give in, the sacrifice by those arrested would go to waste. Even if we fail, at least we can say we tried to stop a rotten Hong Kong being passed on to our next generation.'
Yet for all the revolutionary fervour, I suspect many share the views of Man, one of those female students I met on that fevered university campus. 'I feel so sad when I see someone arrested,' she said. 'I just want this to be over so we can go back to normal life.'
All names have been changed to protect identities.
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Tags: China, Hong Kong, Hong Kong Watch, MoS, police
Categorised in: China, home page, World
Tweets by @ianbirrell
© 2021 Copyright Ian Birrell. Built by FoamShore


text:
Гміна Котлін () — сільська гміна у північно-західній Польщі. Належить до Яроцинського повіту Великопольського воєводства.

Станом на 31 грудня 2011 у гміні проживало 7228 осіб.

Територія
Згідно з даними за 2007 рік площа гміни становила 84.08 км², у тому числі:
 орні землі: 81.00%
 ліси: 11.00%

Таким чином, площа гміни становить 14.31% площі повіту.

Населення
Станом на 31 грудня 2011:

Сусідні гміни
Гміна Котлін межує з такими гмінами: Добжиця, Жеркув, Плешев, Чермін, Яроцин.

Примітки

Котлін
Котлін


text:
JKAP convenes first public meeting in Chrar-e-Sharif
Jammu and Kashmir Apni Party (JKAP) leader Mushtaq Ahmad Ganaie on Sunday said that nothing will make political parties in J&K more accountable than an active citizenry. He added that the JKAP has now emerged as a credible political alternative for the people of Jammu and Kashmir.
Addressing the first public meeting of the party workers at Chrar-e-Shareef town since the ease out in COVID-19 lockdown, Ganaie remarked that the most of the leaders of JKAP have stumbled into the political arena while working diligently on issues that have plagued Jammu and Kashmir.
On this occasion, dozens of prominent political activists mainly from National Conference and PDP joined JKAP. Those who joined the party today included Ghulam Mohammad Wani, Abdul Rehman Zargar, Abdul Ahad Dar, Bashir Ahmad Dar, Mohammad Shafi, Mushtaq Ahmad Khanday, Khurshid Ahmad, Ghulam Qadir Dar, Shahbaz Nazir, Imtiyaz Ahmad Ganaie, Mohammad Qasim, Mohammad Qasim Mir, Abdul Hamid Mir and Tanveer Ahmad Sofi.
The JKAP leader welcomed the new entrants and hoped that their joining will further strengthen the party on the ground in Charar-e-Sharif. "There is no mechanism other than a vigilant and an active citizenry who can make the political parties accountable in a democratic set-up. JKAP pledges to work in the most transparent manner but the onus also lies on the people to judge political parties by its performance on the ground," the JKAP leader remarked.
Ganaie said that with the formation of JKAP a movement has started in J&K which will bring real change in the conduct of politics. "The suffering of the people at the hands of previous regimes, bureaucrats, government officials and the weird system will have to go away now. JKAP under the leadership of its visionary president Syed Mohammad Altaf Bukhari is bound to become a medium for this paradigm change," he added. (KNS)


This Christmas my motto is #glitterallthethings. I am obsessing about putting glitter on anything that will sit still so naturally when I had to come up with a gift for my bunco group I grabbed the bottle of glitter and went to town. Here is a quick tutorial on how to create this Glitter Cake Stand which will be an awesome gift or even party décor for your home.
Grab a plate and cup from the dollar store and some spray paint from the garage. Don't forget your glitter, gorilla glue and clear top coat.
Spray the BACK side of your plate with 2 coats of white paint and finish with a coat of clear gloss.
Spray the FRONT with clear gloss then immediately sprinkle with glitter. Shake the extra off and spray with a THIN coat of clear. Let dry and spray again. Use your hand to brush off all the glitter that is sticking up and finish with one more coat of clear.
Trace the top of your cup on a plate and cut out the circle. Place that on top of your cup to protect from over spray.
Spray 2 coats of your desired color and let it dry.
The last thing your need to do is glue the stem of the cut to do the bottom of the plate and you are done!
Check out the rest of our Christmas ideas HERE.


text:
Boris Nemtsov Plaza to appear in Washington's Wisconsin Avenue
The Washington authorities decided to name a block near the building of the Russian Embassy after Boris Nemtsov. Boris Nemtsov Plaza will thus appear on Wisconsin Avenue between Davis Street and Edmunds Street.
Russian journalist Vladimir Kara-Murza, Jr. explained that the location would be renamed by February 27. The Washington Сity Сouncil said that the symbolic appropriation of the name of the assassinated Russian opposition activist would create a memorial in honour of Boris Nemtsov.
Earlier, a relevant bill was blocked on the federal level. Reportedly, US Secretary of State Rex Tillerson did not want any complications with Russia and allegedly opposed the idea.
Vladimir Kara-Murza stressed that a street and a monument in honour of Boris Nemtsov would appear in Russia some day too.
Opposition activist Boris Nemtsov was killed in the center of Moscow on February 28, 2015. Five Chechens were convicted of his murder, even though they did not plead guilty.
In February 2017, Senator Marco Rubio put forward an idea to name a site on Wisconsin Avenue near the Russian Embassy after Boris Nemtsov and change the address of the representative office from "2650 Wisconsin Avenue" to "1 Boris Nemtsov Plaza."
Russia could commit a similar act and rename Novinsky Boulevard in Moscow, where the US Embassy is located, after Edward Snowden or Julian Assange.
Read article in Russian


We discuss how to find genuine data entry jobs over the Internet.
If you have done a search for data entry jobs on the Internet under "data entry work at home", you will have seen the myriad of choices that pop up--everything from virtual assistant positions to data entry scams. It is good to know how to determine if a job offered is a scam so that you are not taken advantage of.
There are genuine data entry jobs that are offered over the Internet. Many are offered by well-known businesses that need information transferred from several documents into one document. They search out intelligent people who can type fast and usually don't mind if they work at home (because that would save the company money facility costs).
These jobs can be found through online job providers who provide a search program in which applicants can find full or part time positions available (in a field that they meet the requirements for). Also, check out job boards for any local or online listings, or look on sites of specific companies for whom you would like to work.
Many of these jobs are real, and if you are willing to put in a lot of time, you would be able to make a good amount of money. However, in looking for these jobs, you should remain cautious, as there are several scams of which to be aware.
Advertise yourself online under job postings to attract new clients.
If you are interested in billing entry, contact local hospitals, medical clinics or law offices. Many offices look for people who will do data entry for billing. You may have to take a class or two at an online or local college before getting hired with some offices.
In most towns, there are companies who would be willing to telecommute with you for data entry positions, so check your newspaper as well as job postings around town.
Advertise yourself in your local newspaper or on a job board as someone who would like to do data entry from home.
Never pay an employer to work for them. Many online scams promise that if you pay a monthly fee to them, they will provide you with enough data entry to make you rich. Many, if not all, of these sites are scams and you should avoid "working" for them. If you are qualified for the work, than an employer will hire you without you having to pay anything out of pocket for a monthly or even a "one time fee."
If an employer insists upon paying you through direct deposit or paypal, use extreme caution. If you have never done any work for this company or have not met and interviewed them in person do not assume that it is a real job. In most states, the law requires businesses to give more than one option of payment to employees, and if the business is legitimate, they should be quite happy to pay you by check.
Any job that promises you that you will make a lot of money in a short amount of time should be researched. Though there are jobs out there that will make you money, most jobs start out slowly and you will only start earning a lot once you have a lot of experience.
If you are unsure if a company is legitimate, ask them for references. See if they will give you a list of employees that have already worked for them. Call or write them personally to see if the business is working out for them.
Do not buy "kits" to get you started. If you have a computer, a fax machine, a scanner and a home line, there should be nothing else that you should have to purchase. A legitimate employer will give you work and pay you for work, not the other way around.
Don't give up if you can't find a valid data entry job right away. They are out there and you will find one, but make sure that they are legitimate before applying to them.


Need assistance: Sig Patcher for Eshop or downloadable items.
Discussion in 'Wii U - Hacking & Backup Loaders' started by JanoriaCorven, Aug 31, 2018.
I.... dont know what to do here. I only just managed to add a few extra games with the Wii U. But now i want to add items like the entire megaman collection, and freedom planet.
i get to the downloading part, and it says something about a sig patch.
Can anyone lead me to a thread, or be able to tell me how best to do this?.
you need some cfw like mocha or haxchi. mega man is an eshop only title so it requires cfw. retail games don't.
does it say that the NNiD associated with this game has been deleted?
I have the haxchi channel installed with HB App Store. I'm getting Mocha through the HB App Store. every time i load up Mocha CFW and press A, it goes back to the menu and shows "Preparing". but then returns to normal Wii U menu.
somehow, the tickets are getting messed up. that error will appear if it's messing or corrupted. it could be your sd card.
i also added a merged post. what do you think the error is with the 2nd post in the merged one is about?
mocha should return to the home menu with sig patches.
oh. lol. so it should just return to the wii u home menu? Awesome.
is it meant to just perpetually show the Wii U Menu logo? or is that downloading the sig patches?
there's a bug with mocha where you're trying to load redNAND and it can't find it. that will cause infinite loading. you can change this in the config.txt. it's redNAND=0 in the file.
Last question... is it like a super ultra mega quick 5 - 10 seconds thing? or are sig patches REALLY small?
it should be quick (a few seconds).
you might check if the ticket exists by using tik2sd. the title id can be found on that wiibrew site I believe. it's an alternative to the title key site. however, it contains no tickets (just title ids), so it's probably okay to mention it on here.
and with every new thing that requires the sig patch, do i need to re-run mocha sig patch?
yes, if you restart the system.
IT VORKS! Thank you so much!
It's always worth pointing out that Haxchi is also a cfw so no need for Mocha if you already have Haxchi. You just need to boot Haxchi into cfw mode by holding the assigned button while it boots. Nothing wrong with Mocha, it has some useful benefits but you will probably never use any of them. A lot of people just don't know how to use Haxchi and have no idea that it's a cfw all by itself.
i think haxchi is taken over by HBL. i dont know how or why.... but whenever i try and INSTALL haxchi, it just goes to the main menu... and when i go back into the haxchi channel, it just forces me over to the HBL.
so in essence, all i have now to work with is Mocha... that and a few sig patch tools >:3. i've noticed that not every game will work with a single sig patch, i have to use a multitude of sig patch tools. 3 so far.


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CRN is always looking for community members willing to help, and there are a variety of ways to do so.
Monetary contributions are the most convenient because it allows us maximum flexibility in catering to the refugees' needs.
You can donate through our link below.
Every little bit helps! You can donate through the form below or contact our administration directly. We appreciate every donation!
If you are looking to do more, we are in need of many basic supplies to send to refugee centers in order to help refugees (a list of supplies can be found below).
We only accept donations from the Dallas area. To donate to us, fill out the form for a dropoff time/date below.
These are just suggestions, any small toys are appreciated; these prizes are used in children's' literacy groups to encourage first-generation refugees to practice English.
All hygiene items MUST be unused.
If applicable, what supplies are you looking to donate?
We are always in need of anyone willing to help. Volunteers must be 15 or older, preferably with a valid drivers license. Volunteer duties consist of picking up and dropping off donations, fundraising door-to-door, and administrative work. If you are interested, fill out the application below and we will get back to you as fast as possible.


A. We process personal information about our members and guests as a natural part of Tivoli's activities and marketing by Tivoli. It is Tivoli's policy to be open about how we process such information. Tivoli A/S, CVR no. 10404916, Vesterbrogade 3, 1620 Copenhagen, Denmark, is the controller that collects and processes personal data.
B. Tivoli collects, stores and processes information regarding names, addresses, photos, email addresses, telephone numbers and dates of birth of members of My Tivoli (Mit Tivoli) and the Tivoli Annual Card scheme together with information regarding these holder's preferred use of the Gardens and their activities, and use of the annual card's payment function.
C. Tivoli also registers information regarding holders' visits to the Gardens during the current season for the purpose of classification into categories and to guard against any misuse of the annual cards.
E. Tivoli uses this personal data to administer membership of My Tivoli and the Tivoli Annual Card scheme, to optimise information for members of these schemes regarding activities and offers in the Gardens, and to tailor the Gardens and offers to members and other visitors. Tivoli also uses the data for the purpose of marketing and to produce statistics and analyses.
F. In connection with use of an annual card, Tivoli takes a portrait photo of the cardholder. The photo, which will be used by Tivoli for the sole purpose of admission control, will be kept in a database. When visiting the Gardens the photo can be shown on a screen which is only visible to attendants at the entrance. While use of the annual card is not contingent upon Tivoli collecting and keeping a portrait photo of the cardholder, cardholders who do not wish to have a photo registered must always produce photographic identification at the entrance to Tivoli.
G. Our basis for processing a member's personal data is primarily the fulfilment of the agreement that is entered into between the member and Tivoli in regard to membership of My Tivoli and the Tivoli Annual Card scheme. We process portrait photos on the basis of the member's consent. In addition, we process personal data on the basis of our legitimate interest in marketing, developing both new and existing services and products, and analysing and producing statistics on our customer segments, products and services. Personal data may also be processed in order for a legal claim to be exercised.
H. Please note that use of personal data for transmission of marketing materials only takes place when the member has expressly consented to this in advance, unless the law allows for us to contact the member without the member consenting in advance.
I. Tivoli attaches importance to the fact that all personal identification is kept confidential, and that the information can only be processed by employees who have received training in how personal information is to be processed to avoid the information being deleted or it getting into the wrong hands.
J. Tivoli reserves the right to carry out mail merging for the data on people who live at the same address. This avoids a family in which everyone has an annual card receiving, for example, four letters, one to the mother, one to the father and one to each of the children and instead they will receive one letter wich contains all the information.
K. The member is entitled to revoke any consent that he or she may have given at any time. We will then delete the personal data, unless we are able to continue processing it on some other legitimate basis. However, revocation of consent may mean we are no longer able to offer the same products and services.
L. Tivoli guarantees that it updates as necessary the stored information so that the personal information is not kept for longer than necessary. When a membership is cancelled, all the relevant information for the member in question will be suspended. No later than 24 months after membership ends, the member's personal data will be deleted or anonymised, unless we are legally obliged or entitled to keep the data for longer than this. The data may also be kept for a longer period in anonymised form.
M. Members of My Tivoli and the Tivoli Annual Card scheme are entitled to see what data Tivoli processes about them, and for what purpose the data is processed. Furthermore, members are entitled to object to the processing of the data and to request correction, deletion or blocking of data that are incorrect, misleading or have otherwise been processed in contravention of the relevant legislation, or to request that the processing be restricted. In certain cases, members are entitled to receive the personal data that Tivoli controls in a structured, commonly used and machine-readable format, and to transmit those data to another controller. Members who wish to exercise these rights can contact Tivoli A/S, Vesterbrogade 3, 1630 Copenhagen V.
N. If a member has questions about or whishes to complain about the processing of personal data, he or she can always contact Tivoli via e-mail or telephone, as described above. The member may also contact the Danish Data Protection Agency, Borgergade 28, 5., 1300 Copenhagen K, Denmark.


What type of recording are you after?
How would you prefer to record?
Do you have a budget in mind? If so what is it?
Have you or your band ever recorded before?
How long have you or your band been established?
When are you looking at recording?
Is there a preferred date you would like to record?
Is there a preferred time you would like to record?