text:
Q: Which centripetal force equation should I use for centripetal motion in uniform magnetic field, and why? So far I learn two equations, doing the same thing: $$F_c = m\frac{v^2}{r} = qvB$$
It leaves me undecided when a question asks "by what factor is the force increased when velocity is double".
The answer is double, why?

A: You have a problem in the conceptual understanding here.
The magnetic force is $\vec{F} = q\vec{v} \times \vec{B}$
If the field is constant  if you double the velocity the force would be doubled as well.
But your confusion is that you are not considering the radius in the equation bellow.  It cannot be fixed.
$F = qvB = \frac{mv^2}{r}$
If you double the velocity this relationship still holds, which means that your radius is twice as large. Since
$ r = \frac{m v}{qB}$

A: I like the answer from @AndreMaizel and I will add another conceptual idea you need to remember. The form $m\frac{v^2}{r}$ is not a real force.  It is a form of $ma$, where the $a$ is a centripetal acceleration. That centripetal acceleration is a "must behave this way" statement, not a "source of force" statement.
As Andre says, the "real force" is the charge interaction with the magnetic field. If the perpendicular velocity is doubled, the force magnitude is doubled. If that is the only force acting, the path radius will double so that $\Sigma\vec{F}=m\vec{a}$ still applies. To emphasize the idea: $\frac{v^2}{r}$ is part of the acceleration side, not the force side.


I've written reviews about tax accountants before. First in 2012, I wrote about Greenback Tax Services and then in 2013 I wrote about Taxes for Expats. I never used Taxes for Expats for my tax returns due to the dodgy feeling I got from them. I used Greenback Tax Services from 2011-2014. In 2015, I decided to try a different accountant. The two people who ran this service were Americans who had lived in Korea for years. They're called Tax Uncomplicated and their Facebook group is called U.S. Expat Taxes in Korea. I figured they would have a different prospective on things.Tax Uncomplicated is the American headquarters and Klemsen Consulting is the Korean branch.
I exchanged messaged with Wayne Allen Pfeister over Facebook. They put their prices on their website. However, as I mentioned before I don't just have one income from one country, so that complicates things. I knew I wasn't going to be paying the basic fee, but that's fine with me. I was quoted 235,000 KRW, which is about $200. That's about half of what I was paying with Greenback Tax Services and I liked the fact that they had lived in Korea, so were familiar with that aspect of it.
Wayne was pretty good at answering my questions very quickly, often within the same day. There were some lags, but I think that was because we were in different time zones.
Absolutely fantastic. He answered all my questions and gave me all the information I needed. Their Facebook group is called U.S. Expat Taxes in Korea, is also great for getting information.
Looking at what other accountants charge for expat taxes, Tax Uncomplicated is very, very affordable. I paid less than I had before and got more back. However, getting more back could be due to re-marrying. Nonetheless, it's a fantastic deal. I also like the fact that since I live in Korea and make money in Korea, I could pay in Korean currency into a Korean bank account. No need to worry about exchange rates.
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24th Medical Research Conference, Department of Medicine, The University of Hong Kong, Hong Kong, 19 January 2019. In Hong Kong Medical Journal, 2019, v. 25 n. 1, Suppl. 1, p. 17 How to Cite?
Introduction: New antidiabetic drugs are required to demonstrate safety in cardiovascular outcome trials. However, they are rarely compared with each other. We therefore performed a network meta-analysis to compare new antidiabetic drug classes with respect to cardiovascular outcomes. Methods: We searched for cardiovascular outcome trials involving glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose co-transporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes mellitus (T2DM) using major adverse cardiovascular events (MACEs) and mortality as endpoints. Network meta-analysis was performed using random-effects model in R. Results: Ten trials with altogether 81 825 patients with T2DM were eligible to be included. Glucagon-like peptide-1 receptor agonists and SGLT-2 inhibitors significantly reduced MACEs (odds ratio [OR]=0.86, 95% confidence interval [CI]=0.78-0.94 and OR=0.86, 95% CI=0.76-0.96) when compared with placebo. Sodiumglucose co-transporter 2 inhibitors significantly reduced cardiovascular mortality and all-cause mortality when compared with DPP-4 inhibitors (OR=0.77, 95% CI=0.61-0.98 and OR=0.77, 95% CI=0.64-0.92) and placebo (OR=0.76, 0.63-0.92 and OR=0.79, 95% CI=0.68-0.91), respectively. Glucagon-like peptide-1 receptor agonists lowered the risk of MACEs (OR=0.87, 95% CI=0.77-0.99) compared with DPP-4 inhibitors, and showed a trend towards a lower risk of non-fatal myocardial infarction (OR=0.87, 95% CI=0.76-1.00) when compared with placebo. No significant differences were found in the risk of non-fatal stroke. Conclusion: Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors both reduce MACEs when compared with placebo. Sodium-glucose co-transporter 2 inhibitors are the most beneficial in reduce mortality while GLP-1 RAs reduce cardiovascular events the most. Dipeptidyl peptidase-4 inhibitors do not worsen cardiovascular outcomes, but are inferior to GLP-1 RAs and SGLT-2 inhibitors. Our findings support SGLT-2 inhibitors and GLP-1 RAs as the preferred treatment for patients with T2DM to reduce cardiovascular risk.


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YCharts, a Chicago-based financial data startup, announced Monday that it raised another $6 million in venture capital funding from a group led by Morningstar. The latest round brings YCharts' total capital raised to $14.5 million.
Morningstar invested $2.5 million in YCharts in 2012, becoming a 20 percent owner of the startup, according to Crain's Chicago Business. This time, Jeremy Diamond, the head of buy-side solutions for Morningstar, will join YCharts as chief revenue officer.
In a statement, YCharts said Diamond will lead a sales team focused on strengthening relationships with the largest users of it's web-based terminal, which provides data on thousands of equities, ETFs, mutual funds and economic indicators.
"I've been an advisor to the business for years, so it is a natural move for me to join full-time to drive revenue growth by scaling a world class sales team," Diamond said.
The company hopes to compete in the financial data market currently dominated by companies like Bloomberg and Thomson Reuters. YCharts provides much of the same data that its competitors do, but charges a cheaper subscription fee in lieu of live updates and editorial staff. Its most expensive product costs $3,600 annually, while the Bloomberg Terminal and Reuters Eikon reportedly cost $24,000 per year and $21,600 per year, respectively. YCharts has products for individual investors and students for as little as $480 per year.
According to YCharts, 1 million people now use the terminal every month. The company has official partnerships with Schwab, TD Ameritrade, Commonwealth Financial Network and Dynasty to bring the terminal to their advisors.


text:
Dunstable judo club St Katherine's celebrate six medal win at national competition!
Gold medal winner, Benjamin Ani-Adjei, proudly takes his place at number '1' on the podium. (Second left)
Published: 17:19 Wednesday 29 November 2017 Updated: 16:20 Friday 01 December 2017
A Dunstable judo club are celebrating success after they attended a national competition and came home with an impressive six medals.
On November 19, St Katherine's Judo Kwai attended the British Judo Council's Closed Nationals held in Kettering, entering nine competitors and winning six medals.
Andrew Papworth ; Kory Crosby ; Aimee Field ; Olly Leach (who didnt compete but came along to support); Benjamin Ani-Adjei ; Jack Tibbles; Thomas Lovering; Joe Chapman (who didnt compete but came along to support)
All the competitors won at least one contest and from the nine competitors, the club were delighted to take home six medals: one gold medal, three silver and two bronze.
Coach Chris Yates, said: "Last year one of our competitors, Thomas Lovering, went to the competition and he won a medal, so I think this year everybody thought 'I want a piece of that!'
"The competition has given everyone confidence and the will to go for it.
"Some of the children in our club came and watched and the atmosphere was fantastic!
All the hard work paid off!
"One of our competitors, Josh Willer, 16, had to fight one of the adults and although he didn't win he gave a good account of himself!"
The medal winners were: Benjamin Ani-Adjei (gold medal), Jack Tibbles (silver), Kory Crosby-(silver) , Thomas Lovering (silver), Peter Szatmari (bronze) and Aimee Field (bronze).
Chris added: "It was a long day, absolutely exhausting!
"We were on the road early in the morning and at our next practice everyone was buzzing! We gave the competitors a big round of applause.
Benjamin Ani-Adjei receiving his gold medal.
"I would like to thank everyone for coming along in the crowd and showing respect and etiquette.
"The kids were great and it makes the teaching worthwhile. We're a small club and we need people turning up to keep us going!"
The club is based on St Katherine Drive. To find out more, search St. Katherine's Judo Kwai on Facebook.
Dell Farm activity centre to close at the end of the month
Aimee Field, Kory Crosby (middle) and Jack Tibbles.
Enjoying success: four of the medal winners and their proud coaches!

redpajama_set_name: RedPajamaCommonCrawl


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Spending time outdoors improves quality of life. No items are needed to go outside and enjoy fun in the sun and enjoy the great weather, friends, and fun even when the sun goes down. But, when your outdoor living space is equipped with a few of the outdoor accessory made to improve life, the fun got a whole lot better. Although there's a ton of outdoor accessories that you can use to improve your space, the items listed below are among the best items to add to bring that excitement full throttle.
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Create an outdoor kitchen space and put a spin on the traditional BBQ. Cookouts are a part of the summer festivities but can be tedious and cause headaches. Those worried are no more when there is an outdoor kitchen in place.
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Don't stop with the creation of a kitchen. Make a game area in your outdoor space, too. Kids and adults alike will get lost in the fun that a gaming system brings, especially when it is being played on the TV outside.


text:
How Frequently Does Your Asian Girls Make Your Neighbors Say That
By admin Uncategorized Comments Off on
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She can also be very outspoken about women's rights and psychological well being in India. Constance Wu starred in the tv program Fresh Off the Boat, before occurring to play the lead position in Crazy Rich Asians, which garnered her Golden Globe and Screen Actors Guild award nominations.
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When describing herself now, she said she is "joyful, rising and nurturing" and attributes that partly to society's shifting depiction of Asian girls, and the era of Asian American and queer entertainers who inspired her journey. The prime-time sitcom, which solely aired for one season, was the primary to heart an Asian American household. Margaret Kim, who was performed by Cho, was extra Americanized than the rest of her family and that was the center of many household conflicts — a typical concern in some Asian American households. Cho starred in ABC's 1994 present, "All-American Girl," which was a slice-of-life sitcom a couple asian hot women of Korean American household. "East and Southeast Asian girls are either stereotyped as 'lotus flowers,' who're quite submissive and quiet, or 'dragon ladies,' who are overbearing and unlikeable," Yuen stated during the podcast. The episode, which was launched Oct. 4 and is the primary because the death of Britain's Queen Elizabeth II, included guests Nancy Wang Yuen, a sociologist, Margaret Cho, an Emmy-nominated actor and comedian, and Lisa Ling, a journalist. Meghan, the Duchess of Sussex, at the second day of the Invictus Games at Zuiderpark in The Hague, Netherlands, on April 17.
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text:
using System;
using System.Collections.Generic;
using System.Linq;
using System.Text;
using System.Threading.Tasks;

namespace TradeAndTravel
{
    public class Mine : Location,IGatheringLocation
    {
        public Mine(string name)
            : base(name, LocationType.Mine)
        {
        }

        public ItemType GatheredType
        {
            get { return ItemType.Iron; }
        }

        public ItemType RequiredItem
        {
            get { return ItemType.Armor; }
        }

        public Item ProduceItem(string name)
        {
            return new Iron(name);
        }
    }
}

redpajama_set_name: RedPajamaGithub


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text:
« 'Iran warns foreign forces to stay out of Gulf, amid new US deployment'
Linus or the Apostle John: Who would have been the primary human leader of Christendom? »
EU's Juncker: Irish border controls needed in no-deal Brexit
Sinn Féin protesters
EU Commission President Juncker is warning that border controls will be required on the Irish isle in the event of a no-deal Brexit (bolding below headline mine). Here are two reports originating from the UK:
LONDON (AP) —The European Union will insist that border controls be put up along the Irish border if Britain leaves the bloc without a deal and the British government will be responsible for that, a top EU official said.
Jean-Claude Juncker, the European Commission president, told Sky News in an interview broadcast Sunday that the blame for that would rest squarely on Britain. Border controls could in theory go up soon after Oct. 31, Britain's scheduled departure date.
Brussels was "in no way responsible" for the consequences of a no-deal Brexit, Juncker told Sky News.
"We have to make sure that the interests of the European Union and of the internal market will be preserved," he said. …
Johnson is trying to get the EU to agree to replace the backstop with "alternative arrangements" — a mix of technology to replace border checks and a common area for agricultural products and animals covering the whole island of Ireland.
Juncker said he is open to alternative arrangements, but noted that in a no-deal Brexit, an animal entering Northern Ireland could then enter the EU via Ireland if there are no border controls.
"This will not happen," he said. "We have to preserve the health and the safety of our citizens."
Under the rules of the EU's single market, goods and people can move across the 28 countries seamlessly.
Johnson got elected by Conservative Party members in July on the promise that the country will leave the EU on Oct. 31 come what may. https://www.apnews.com/7fd305c971bf41d9ba735c6a6f6f8ed8
BRIGHTON, England (Reuters) – EU Commission President Jean-Claude Juncker has said he is convinced Brexit will happen, reiterating that if Britain left the European Union without a deal there would be a new border between Northern Ireland and Ireland.
"I'm convinced that Brexit will happen," he told Sky News in an interview last week, before he had seen the ideas Prime Minister Boris Johnson's government sent to Brussels to try to push Brexit talks forward. https://www.reuters.com/article/uk-britain-eu-juncker/eus-juncker-says-he-is-convinced-brexit-will-happen-sky-idUSKBN1W705Z
The EU's position long has been that any and all problems associated with Brexit are the UK's fault. The EU did not want the UK to leave, and since the UK voted to do so (contrary to some words on the signs at the beginning of this post), everything that may go wrong is the UK's fault.
Before looking at another report, it is unclear how keeping the border open, which has been the case for decades, will hurt the health and safety of EU citizens after October 31st. But politicians often result to fear tactics.
Here is a German report related to Brexit and President Juncker:
No-deal Brexit would mean Irish border controls, says EU's Juncker
Border controls will be placed between Northern Ireland the Republic of Ireland if the UK leaves the EU without a deal, said Jean-Claude Juncker, chief of the European Union's executive arm. Juncker told Britain's Sky News the EU has to "make sure that the interests of the European Union and of the internal market will be preserved."
How to preserve a frictionless border between EU member Ireland and Northern Ireland, which is part of the United Kingdom, is the thorniest issue in the Brexit discussions.
The EU fears a hard border could cause unrest in Northern Ireland and undermine the fragile peace provided by a 1998 peace deal that ended three decades of violence between Irish nationalists seeking a united Ireland, and British security forces and pro-British unionists.
Juncker noted that without a border after a no-deal Brexit, an animal entering Northern Ireland could then enter the EU via Ireland without any controls. He says "this will not happen. We have to preserve the health and the safety of our citizens." …
"I believe that we still have a chance to reach an agreement," the paper quoted Juncker as saying. "I don't share the views of those who think that Johnson is playing games with us and with himself," he said.
The UK's departure from the EU "is a tragic moment for Europe," Juncker stressed. https://www.dw.com/en/no-deal-brexit-would-mean-irish-border-controls-says-eus-juncker/a-50534730
The border between the Republic of Ireland and the UK's Northern Ireland has been open for some time, but many in the UK are upset that the EU essentially thinks that Northern Ireland will have to function a lot like it is still in the EU for that border to be open.
But the time will come when Europe will dominate all of the Irish isle.
Despite British hopes for its future, loss of territories will one day include Northern Ireland. Notice a few prophetic warnings that are consistent with that:
24 'Do not defile yourselves with any of these things; for by all these the nations are defiled, which I am casting out before you. 25 For the land is defiled; therefore I visit the punishment of its iniquity upon it, and the land vomits out its inhabitants. 26 You shall therefore keep My statutes and My judgments, and shall not commit any of these abominations, either any of your own nation or any stranger who dwells among you 27 (for all these abominations the men of the land have done, who were before you, and thus the land is defiled), 28 lest the land vomit you out also when you defile it, as it vomited out the nations that were before you. (Leviticus 18:24-29)
23 'And if by these things you are not reformed by Me, but walk contrary to Me, 24 then I also will walk contrary to you, and I will punish you yet seven times for your sins. 25 And I will bring a sword against you that will execute the vengeance of the covenant; when you are gathered together within your cities I will send pestilence among you; and you shall be delivered into the hand of the enemy. (Leviticus 26:23-25)
58 "If you do not carefully observe all the words of this law that are written in this book, that you may fear this glorious and awesome name, THE LORD YOUR GOD, 59 then the Lord will bring upon you and your descendants extraordinary plagues — great and prolonged plagues — and serious and prolonged sicknesses. 60 Moreover He will bring back on you all the diseases of Egypt, of which you were afraid, and they shall cling to you. 61 Also every sickness and every plague, which is not written in this Book of the Law, will the Lord bring upon you until you are destroyed. 62 You shall be left few in number, whereas you were as the stars of heaven in multitude, because you would not obey the voice of the Lord your God. 63 And it shall be, that just as the Lord rejoiced over you to do you good and multiply you, so the Lord will rejoice over you to destroy you and bring you to nothing; and you shall be plucked from off the land which you go to possess. (Deuteronomy 28:58-63)
These territorial losses will include Northern Ireland and Gibraltar, as well as England, Wales, and Scotland. Yes, one day, the United Kingdom of Great Britain and Northern Ireland will be no more.
Therefore, even if there is a 'hard' (no deal with the EU) or 'soft' (some deal with Boris Johnson) Brexit, or even if there is NO Brexit, I expect that the Republic of Ireland (or at least an Irish leader) will gain control over Northern Ireland and probably other lands as well within the next decade or so.
Furthermore, notice what Article 3 the Irish Constitution states:
It is the firm will of the Irish Nation, in harmony and friendship, to unite all the people who share the territory of the island of Ireland, in all the diversity of their identities and traditions, recognising that a united Ireland shall be brought about only by peaceful means with the consent of a majority of the people, democratically expressed, in both jurisdictions in the island. Until then, the laws enacted by the Parliament established by this Constitution shall have the like area and extent of application as the laws enacted by the Parliament that existed immediately before the coming into operation of this Constitution.
While the democratic way is one way, if that does not work, military pressure will accomplish this (cf. Daniel 8:24-25, 11:39).
That view of Ireland is also consistent with certain Catholic prophecies:
St. Senanus (d. 560): They (English) themselves will betray each other: in consequence their sovereignty will be broken…One monarch will rule in Ireland over the English (Culleton R. Gerald. The Reign of Antichrist, Reprint TAN Books, Rockford, IL, 1974, p. 128).
St. Malachy (12th century). "Ireland will suffer English oppression for a week of centuries, but will preserve her fidelity to God and His Church. At the end of that time she will be delivered, and the English in turn must suffer severe chastisement. Ireland, however, will be instrumental in bringing back the English to the unity of Faith." (Dupont, Yves. Catholic Prophecy: The Coming Chastisement. TAN Books, Rockford (IL), 1973, p.15)
Priest G. Rossi (19th century): Ah! wretched Protestantism shall have to answer for the loss of faith… English schism and heresy have squandered their treasures and abused their great temporal power, not only in persecuting-the faith in Great Britain and Ireland, but also in banishing the true religion of Jesus Christ from their vast American possessions…Their long-deserved punishment, however, is approaching from the North! (Rossi, Gaudentius. The Christian Trumpet: Or, Previsions and Predictions about Impending General Calamities, the Universal Triumph of the Church, the Coming of the Anti-Christ, the Last Judgment, and the End of the World; Divided Into Three Parts, 4th edition. Patrick Donahoe, 1875. Original from Oxford University. Digitized Sep 1, 2006, pp. 16, 255).
Although I wrote what I did based upon biblical prophecies, the desires of Spain and Ireland, as well as the writings of Catholic prophets, are consistent with the view that the UK will lose Northern Ireland and Gibraltar.
With what has been going on in the UK, the EU, and the USA since the Brexit vote, more in the UK are concluding that the EU wants to be an empire. The EU has taken several stances that the UK does not like, including stances that the EU used to pretend it did not really have. Glimpses of the true colors of the European project (e.g. Daniel 2:41-43; Isaiah 10:5-8) have re-assured some in the UK that leaving the EU is in its best interest.
Consider that the Bible itself teaches that Europe will reorganize and unite (Revelation 17:12-13; see also Must the Ten Kings of Revelation 17:12 Rule over Ten Currently Existing Nations?), as well as become the dominant world trading power for a time (Revelation 17 & 18). The Bible also teaches of a time of Jacob's trouble (Jeremiah 30:7)–and this will include the UK (as well as the USA, Canada, Australia, and New Zealand).
The Bible is accurate and its prophecies can be counted on.
Most people do NOT realize what will happen in Europe.
Europe is not going to 'get over' the Brexit and will one day take actions that most of those in the UK (as well as USA and Canada) will not consider possible (cf. Daniel 8:24-25, 11:39; see also USA in Prophecy: The Strongest Fortresses).
Brexit and the fate of Northern Ireland, Gibraltar, the UK, and the USA On April 29, 2017, 27 of the nations of the European Union agreed to certain guidelines for the negotiations with the United Kingdom of Great Britain and Northern Ireland which gave its notice to leave on March 29, 2017. These guidelines are contrary to what the UK wants. Does the EU intend the UK to pay a price for leaving the EU? What does Spain want? What does the Republic of Ireland want? Will Northern Ireland and Gibraltar eventually fall under European control? Will the UK and USA be conquered? What does the Bible teach? Dr. Thiel answer these questions and more in this video.
Forbes' Brexit Monster is the Beast of Revelation Various ones have been properly convinced that there is a plan for a European superstate. Forbes' writer Tom Worstall wrote that the Brexit vote was about the United Kingdom "not joining the monster of the European Union to come." The Bible tells of a Beast monster that will arise in the end times in Europe. Dr. Thiel cites news reports, as well as the Old and New Testaments, to show that the monster many fear will arise in Europe, despite the vote by the British to exit the European Union. This is a video.
Will the UK Lose Gibraltar and the Falkland Islands? For many years, the major sea gates of the world were possessed/controlled by the United States (Panama Canal and certain locations in the Pacific ocean) and the British Empire (Straits of Malacca, Singapore, Suez Canal, Bab el Mandeb, Strait of Hormuz, Simon's Town/Cape of Good Hope, Malta, etc.), and many are no longer under their control. Spain wants Gibraltar and Argentina wants the Falklands (also known as the Malvinas). UK Prime Minister David Cameron says the UK will defend the Falklands Gibraltar. Does the Bible give clues as to what will happen with those 'sea gates'? Do promises made the Jacob's mother Rebekah play a role? What about Deuteronomy 28? This is a video.
Post Brexit Prophecy On June 23, 2016, the voters of the United Kingdom of Great Britain and Northern Ireland (UK) chose to leave the European Union. Now with this BRitish EXIT (Brexit) vote, what is prophesied to happen to the UK? Will the UK do well or be taken over and made slaves? Dr. Thiel explains from biblical prophecies what is ahead for the UK, Europe, and even the USA, Canada, Australia, and New Zealand. This is a video.
Will the UK Lose Gibraltar and the Falkland Islands? Spain wants Gibraltar and Argentina wants the Falklands (also known as the Malvinas). Does the Bible give clues as to what will happen with these 'sea gates'? A version of the article in the Spanish language would be ¿Perderá el Reino Unido a Gibraltar y las Islas Falkland (Malvinas)?
Canada in Prophecy: What Does Bible Prophecy, Catholic Prophecy, and other Predictions Suggest About the Future of Canada? There are prophecies that suggest involvement with Canada. And many are not positive about its future. A sermon of related interest is also available: Canada in Prophecy.
Australia and New Zealand in Prophecy Do biblical prophecies help explain the wealth blessings for Australia and New Zealand? Might cursings from disobedience come in the 21st century? Here is a link to a related sermon: Australia and New Zealand: Origins and Prophecy.
Who is the King of the West? Why is there no Final End-Time King of the West in Bible Prophecy? Is the United States the King of the West? Here is a version in the Spanish language: ¿Quién es el Rey del Occidente? ¿Por qué no hay un Rey del Occidente en la profecía del tiempo del fin? A related sermon is also available: The Bible, the USA, and the King of the West.
Who is the King of the North? Is there one? Do biblical and Roman Catholic prophecies for the Great Monarch point to the same leader? Should he be followed? Who will be the King of the North discussed in Daniel 11? Is a nuclear attack prophesied to happen to the English-speaking peoples of the United States, Great Britain, Canada, Australia, and New Zealand? When do the 1335 days, 1290 days, and 1260 days (the time, times, and half a time) of Daniel 12 begin? When does the Bible show that economic collapse will affect the United States? In the Spanish language check out ¿Quién es el Rey del Norte? Here is a link to a video titled: The Future King of the North.
This entry was posted on Sunday, September 22nd, 2019 at 3:30 pm	and is filed under Prophecy.
'Brexit: Jean-Claude Juncker says chance of deal has increased'
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BRINO? 'Brexit in name only'
Brexit: Johnson in race to win support for deal'
Parliament strongly rejects May's Brexit deal
Brexit: Jean-Claude Juncker tells UK that the time will come when 'you will your regret decision'
WSJ: There's Much to Fear as Brexit Nears
'100 days to Brexit: EU acts to cushion no-deal shock'
EU is Brexit ready, UK is not


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text:
Thalassemia Major - Advantages of Separate Thalassemia Unit With Regards To Awareness and Compliance 01/09/2014 00:00:00 Sushant S Mane, Kavisha B Chaudhari, Ashok D Rathod, Asad Khan Pathan 06/01/2011 00:00:00 https://www.pediatriconcall.com/Journal/images/journal_cover.jpg
AbstractKeywordsIntroductionMethods & MaterialsStatstical MethodsResultsDiscussionConclusion
Thalassemia Major - Advantages of Separate Thalassemia Unit With Regards To Awareness and Compliance
Sushant S Mane, Kavisha B Chaudhari, Ashok D Rathod, Asad Khan Pathan.
Department of Pediatrics, Grant Medical College, Sir J J Group of Hospitals, Mumbai, India.
Dr Sushant Mane, 29, Shri Sadgurukripa Housing Society, Senapati Bapat Marg, near Ruparel College, Matunga (West), Mumbai-400016.
Email: drsush2006@gmail.com
Objective: To compare awareness amongst caregivers about thalassemia and the socioeconomic difficulties in routine management of these children in two tertiary care hospitals.
Methods: A cross-sectional study was conducted at two tertiary care government hospitals in Mumbai; one of which has a separate thalassemia unit for the management of thalassemics while the other hospital is treating thalassemic children along with the other routine paediatric cases. A total of 51 patients between 2 to 12 years were enrolled; 25 of which were from the hospital having thalassemia unit and 26 from hospital without a separate unit. Their caregivers were compared for the level of awareness and difficulties in their routine management using a pre-designed questionnaire.
Results: All caregivers were aware about the basic concept of thalassemia; however only 15.4% from hospital without a thalassemia unit were aware about the major complications of the disease like short stature, skeletal abnormalities, cardiac and endocrine problems as compared to 36% from thalassemia unit. Only 37.9% from non-thalassemia unit had sent their immediate relatives for screening as opposed to 62.1% from thalassemia unit, 81.5% caregivers from non-thalassemic unit were irregular in giving iron chelation therapy as compared to only 18.6% from thalassemic unit. The average expense on each visit from a thalassemia unit was Rs.328 as compared to Rs.627 from non-thalassemia unit and 68.4% caregivers lost their daily wages from non-thalassemia unit hospital as compared to 31.6% from those in thalassemia unit.
Conclusion: Overall awareness and compliance to treatment of thalassemia is definitely better amongst caregivers in a separate thalassemia unit. Thus, there is a need for more of such units where comprehensive management, economic support and educational awareness for caregivers and patients with thalassemia is provided.
awareness, compliance, thalassemia unit
Thalassemia is a genetically transmitted disorder characterised by decreased synthesis of either α/β globin chain of haemoglobin causing ineffective erythropoiesis and increased haemolysis with progressive hypochromic microcytic anaemia and its ill effects. Over thirty million people are carriers of thalassemia gene in our country. (1) Every year 10,000 children with thalassemia are born in India, which constitutes 10% of the total number in the world. (2) The requirement of regular blood transfusions every month, expensive treatment of iron overload by chelators, lack of adequate thalassemia care centres, inadequate financial resources for various treatment modalities and above all the lack of knowledge regarding thalassemia itself, affect the child and his family economically and socially leading to irregularities in treatment and consequently adverse outcomes for the child.
Methods & Materials
A cross-sectional study was conducted at two tertiary care government hospitals in Mumbai. One hospital was having a separate thalassemia unit for the management of thalassemics (Hospital B) while the other hospital was treating thalassemic children along with the other routine paediatric cases (Hospital A). β thalassemia major patients, confirmed by hemoglobin electrophoresis, between 2 and 12 years of age were included whereas those with mixed hemoglobinopathies, non- β thalassemia and thalassemia trait were excluded. Their caregivers were interviewed using a pre-designed questionnaire after taking written informed consent. The questions were explained and asked to the participants in the language they knew well. Some questions were open ended and the closed ended questions were followed by the most likely options. The questionnaire had following broad categories: 1) Knowledge of thalassemia and its related features. 2) Concepts regarding regular follow up, investigations and chelation therapy. 3) Socioeconomic difficulties in the treatment and awareness about help from Non-Government Organisations (NGOs). 4) Reasons for non-compliance to treatment and follow up.
Statstical Methods
Descriptive statistical analysis has been carried out. Data is compared by standard error of difference between two proportions. Significance is assessed at 5% level of significance (p value < 0.05 was considered to be significant).
A total of 51 children were enrolled in the study, of which 26 were from Hospital A and 25 from Hospital B. All of them were aware about the basic concept of thalassemia, that it is a blood disorder in which the formation of blood (red cells) is defective. However, a total of only 4 (15.4%) from Hospital A knew about complications of thalassemia like short stature, skeletal deformities, cardiac and endocrine problems as compared to 9 (36%) from B (p<0.001). (Figure 1)
wenty (54%) caregivers from Hospital B were aware about antenatal diagnosis of thalassemia as compared to 17 (46%) from Hospital A. Out of all those aware about screening of other family members or their partners before marriage, only 8 (26.7%) were from Hospital A and 22(73.3%) were from Hospital B (p<0.01). Only 11(37.9%) from Hospital A had sent their immediate relatives for screening as opposed to 18(62.1%) from Hospital B (p<0.05). Commonest reasons for non-screening of relatives were: 1) Relatives thought they can't be affected (50%). 2) Caregivers didn't know they had to send relatives for screening (45.5%). 3) Did not tell relatives since they were already married (4.5%). Only 11 (34.4%) caregivers from Hospital A were aware about bone marrow transplant (BMT) as a permanent cure for thalassemia in comparison to 21 (65.6%) from Hospital B (p<0.01).
Awareness about the regular tests to be done for monitoring of complications was as shown in Figure 2.
Out of all the caregivers who were regularly getting the investigations done as advised by their doctor, 11 (30.6%) were from Hospital A and all 25 (69.4%) from Hospital B (p<0.01)
Twenty two (81.5%) caregivers from Hospital A were irregular in giving iron chelation therapy as compared to only 5 (18.6%) from Hospital B (p<0.01). The reasons for irregularity were high cost of iron chelators (47%), side-effects of drugs (31%), lengthy formalities to get medicines sanctioned from social workers (16%), negligent attitude of caregivers (6%). The common side-effects for which chelators were stopped by caregivers were joint pain (24%), nausea (4%), rashes (2%), burning micturation (1%). None of the caregivers from Hospital A were aware about the concession in chelation therapy offered by the Mumbai Thalassemia Society (MTS) as opposed to 22 from Hospital B (p<0.01). Thirteen (68.4%) caregivers from Hospital A had to suffer loss of daily wages when they accompanied their children to hospital as compared to 6 (31.6%) from Hospital B (p<0.05).The average expenses on each visit were Rs.627 for Hospital A and Rs.328 for Hospital B (p<0.001).
When the caregivers were asked, what more they expected from their treating doctors and the institute in which they were being managed, 68% said they wanted more knowledge about thalassemia and its related features, 27% wanted to speed up the entire process of being admitted and receiving blood transfusions every month, 3% said that the health care systems should publicise more about thalassemia so that more organisations would put efforts to help thalassemics and their families and 2% expected that their physicians spend more time with them and talk courteously.
It is very well seen from our study that the overall awareness about thalassemia and its associated conditions, regularity with follow up and investigations, and the compliance to therapy was much better in the hospital with a separate thalassemia unit as compared to the hospital without a unit. A study conducted by Bandyopadhyay et al showed that compared to the thalassemic children attending paediatric ward at R.G. Kar Medical College, Kolkata, those attending thalassemia society of India underwent screening tests for carrier state detection in more numbers. (3)
The possible advantages of a separate thalassemia unit which we found were:- 1) Separate counselling sessions are held for patients when they are first registered in the thalassemia unit and books provided by the thalassemia society are readily available. 2) Patients come together regularly and organize lectures by doctors to increase the knowledge about thalassemia as well as workshops to discuss their problems. 3) Thalassemics of all age groups are given blood transfusions together in a thalassemia unit. Older thalassemics, some of whom are well educated and have access to internet and other information sources, share their knowledge about the disease with younger patients and their caregivers thus building a very healthy atmosphere for increasing awareness. 4) Older thalassemics through compliance with blood transfusions, iron chelation therapy - serve as an ideal example for the younger patients. 5) People from both the higher and lower socio-economic strata come to seek help here so it again increases the flow of information from the more privileged people to the less privileged ones- bridging the gap between them. 6) Forms an emotional support for the patient and his caregivers. 7) In the thalassemia unit, transfusions are given on an outpatient department (OPD) basis and the patient is discharged in the afternoon. So, the expenses on each visit are markedly less when compared to a hospital without a unit. 8) Financial help from the social workers and NGOs for chelation therapy was more readily made available in the thalassemia unit. A similar study carried out by Weinreich et al in Netherlands revealed that the "infotainment" programmes may have a positive effect on people from high-risk group. (4) A study conducted by Dehkordi et al in Iran said that the education whether through booklet or combined method has a significant positive effect on increasing knowledge of the investigated groups. This increased knowledge levels of parents can decrease the burden of thalassemia. (5) One study which closely resembles our research work, is the association between education and thalassemia carried out by Zaman et al at the University of Peshawar, Pakistan. This research highlights that general health education must be provided to the thalassemics and the registration system must be improved and for this purpose properly trained persons should be appointed. (6) The highlight of this study is that establishment of a separate "thalassemia unit" in hospitals has a powerful impact on the awareness regarding various aspects of thalassemia and on the compliance with therapy, thereby significantly affecting the life expectancy and quality of life of thalassemics. It also prevents the further increase in thalassemia burden by spreading awareness about carrier testing prior to marriage and antenatal diagnosis of thalassemia during early pregnancy. The increase in awareness should be carried out by various infotainment programmes like seminars, workshops and pamphlet distribution in local languages.
Overall awareness and compliance to treatment of thalassemia is definitely better amongst caregivers in a separate thalassemia unit. Thus, there is a need for more of such units where comprehensive management, economic support and educational awareness for caregivers and patients with thalassemia is provided.
Ghai OP. Ghai's Essential Paediatrics. 6th edn. CBS. New Delhi. 2004.
Varawalla NY, Old JM, Venkateshanz SR, Weatherall DJ. The spectrum of beta thalassemia mutations on the Indian subcontinent the basis of prenatal diagnosis. Brit Hematol. 1991; 78: 242-247. [CrossRef]
Bandyopadhyay B, Nandi S, Mitra K, Mandal PK, Mukhopadhyay S, Biswas AB. A comparative study on perceptions and practices among parents of thalassemic children attending two different institutions. Indian J Community Med. 2003; 28: 128-132.
Weinreich SS, Lange-de Klerk ESM, Rijmen F, Cornel MC, Kinderen M, Plass AMC. Raising awareness of carrier testing for hereditary haemoglobinopathies in high-risk ethnic groups in the Netherlands: a pilot study among the general public and primary care providers. BMC Public Health. 2009; 9:338. [CrossRef]
Dehkordi AH, Heydarnejad MS. Effect of booklet and combined method on parents-awareness of children with β-thalassemia major disorder. J Pak Med Assoc. 2008; 58: 485-487. [PubMed]
Zaman Q, Salahuddin. Association between the education and Thalassaemia: A Statistical Study. Pak J Stat Oper Res. 2006; 2: 103-110. [CrossRef]
Mane S S, Chaudhari K B, Rathod A D, Pathan A K. THALASSEMIA MAJOR - ADVANTAGES OF SEPARATE THALASSEMIA UNIT WITH REGARDS TO AWARENESS AND COMPLIANCE. Pediatr Oncall J. 2011;8: 37-39.