How do labour law and public procurement intersect with one another?
Interview with Dr. Amy Ludlow, fellow at the Gonville and Caius College in Cambridge and Affiliated Lecturer at the Faculty of Law. Amy undertook her Ph.D at Trinity College in Cambridge and has published extensively in the field of labour law over the last few years. What brings her to the PPP is her recent book Privatising Public Prisons: Labour Law and Public Procurement Process.
I like to start the show by discussing or putting the spotlight into the interviewee's big idea for public procurement, so let's start there, what is your big idea for public procurement?
I think really what I was trying to do with the book was explore competition in public services, but from the perspective of social sustainability and by that I really mean this kind of co-existence of economic and non-economic interests, and co-existence in ways that serve long-term inclusive societal prosperity. So I was interested to explore how we procure public services and how, the ways in which we procure might affect the employment relationships, but more than just terms and conditions of employment, how they might affect employment cultures or practices of staff who are at the frontline delivering those services, and I guess connected to that is how that affects the quality of those services. So I think I was probably trying to probe the ideology of public procurement from a social and empirical perspective, and I did that in the context of a prison so Birmingham Prison.
Let's start there, why did you pick a prison to do your research on and what is your most important finding of that work?
I've had a longstanding interest in prisons and we're blessed here in Cambridge with having a really good Prisons Research Centre at the Institute of Criminology and when I first applied for my PhD I had thought that I would explore the, actually terms and conditions of employment of working prisoners, and, so their labour rights and how we protect those rights, and then I went along and chatted to Alison Liebling who is the Director of the Prisons Research Centre, and she said 'mmm, that's interesting but there's a fascinating world out there in terms of privatisation, have a look at that', and she had various contacts and it just kind of spiralled from there, and the study started out as being a comparative study of one already privately-managed prison and one public prison, Birmingham, that were both going through the same competition process and I originally intended this to be a kind of comparative exercise to see how privatisation might affect the prisons differently.
In the end, because of how the competition panned out, Birmingham became the most interesting venue for research because what happened in October 2011 was that it became the first operational public sector prison to be privatised, and the operational bit was really important to me from a Labour Law perspective because that meant that we had a pre-existing workforce that were going to be transferred across to G4S, so the Birmingham competition became a really interesting testing ground for lots of law from a kind of social perspective.
And in terms of findings, what is your biggest highlight?
...but just I think we inadequately recognise the potential and the importance of properly managing the social aspects of procurement processes. Staff matter because they provide the services upon which we all rely and also because they are inherently deserving of respect and value, it's just a proper, proper thing to do. So I'm arguing really that we ought to be much more socially ambitious in our procurement, we need to use it to pursue things like Living Wage Policies, to promote Trade Unions that represent and empower staff, to increase employment, for example, among vulnerable marginalised groups, maybe sort of the antithesis of what Albert Sánchez Graells might have been arguing for I guess!
Yes! Chalk and cheese I think!
Drilling a little bit more into the detail, how hard was it to bring your expertise in labour law in industry relations into specific sector public procurement and more, even more specifically, into the prison settings?
It was tough. I mean it definitely took more time and more investment to do well than I probably could have imagined at the start. So as I said, I'm fortunate in Cambridge that we've got this fantastic Prison Research Centre, the Institute of Criminology, and that gave me the opportunity to engage in quite extensive fieldwork before I went into Birmingham, and also just to become really familiar with the sociological and criminological literature to properly understand prison staff and the history of privatisation and competition in the sector and that was really important, particularly because I used what I call quasi ethnographic methods, because I think it's, I feel a bit vulnerable about this methodologically 'cos I don't have a very rigorous social science training, but the fact that I was, I spent more or less a year in Birmingham Prison, with keys and hanging around in a structured way with staff, chatting to them informally, really understanding their world and what this process was doing, and that long-term immersion in a field is quite exposing.
Prison staff are also very quick-witted which means that they very quickly catch you out, so I think it's really important, in terms of research and credibility, that I internalised and really tried to understand, as much as possible, their worlds from a non-legal perspective before I went in. Of course, you can do all the preparation in the world and that, different things arise in the field and that's kind of the joy of doing ethnographic work and fieldwork, that it sounds like a, like a kind of genuine discovery, but it was a long process and required a lot of support from colleagues from other disciplines.
I can relate to your difficulties and challenges because when I did my Ph.D I also used empirical research methods and found it sometimes so alien and so different from what I was expecting.
Absolutely. No, no, no, that's so true, that's so true. I'd got these really neat and tidy, you know, when you're applying for access you say it's gonna be like this and it's gonna work out perfectly, and I'm gonna do these clean, 45 minute interviews with fifty staff and it's just. But actually it takes a huge effort to develop trust and credibility in the field and so it's got to be this process of slow immersion, I know there's this whole kind of slow science movement, and I really do believe, believe in it, that you've got to invest in that entry into the field and I could never have got the level of access and openness and trust from staff, you know, of all camps, had I done it otherwise. So, yeah, definitely recognise best plans being corrupted or changed by the field!
In your book you talk about, well you use at least a couple of anecdotes to illustrate your difficulties and to illustrate the culture shock that you felt working in that environment. Could you get into a little bit of detail of those?
Yeah, so Birmingham Prison has a reputation for having quite a traditional staff culture and traditional in the sense of some cynicism, some hostility, it's a very male typically middle-aged sort of staffing profile, I mean that's to generalise, and I obviously didn't look or sound like a lot of the staff and so there were some, definitely some important moments where they were kind of gate-keeping moments, where I had to, I don't know about altering my identity, but definitely I talk about being tolerant of behaviours that I wouldn't normally tolerate, so stuff like, you know, sexism, language, particularly when describing prisoners, so, that's quite objectifying language, so calling prisoners 'bodies' for example, calling serving the dinner 'feeding', and these are quite, I mean they sound probably more shocking to people who are not familiar with prisons than they are, but they're definitely indicative of a cultural kind of problem.
So I went through some fairly challenging encounters with certain key members of prison staff and once I had established that I could cope with that, they would describe it as banter, and also was genuinely interested in understanding their world, which meant rocking up to the prison at 7 am and leaving at nine o'clock, so doing a full day's shift with them and talking to them at those points of the days where prisoners are not unlocked and they're a bit freer and there are a few quotes in the book where prison staff are saying 'you know, have you not got a home to go to Miss', kind of thing! 'Why are you still here, you must be paid a fortune to do this', and I have to say, you know, actually no, I'm really in it for the love, I've been doing this as a PhD student!
And that, those sorts of just being there and being visible really mattered to staff and just being persistent and inquisitive, occasionally asking some naïve questions, sometimes deliberately naïve questions, and getting them to show you their world, I think was how I eventually did it. But there were some moments when I thought 'what have I done', I could be doing doctoral research in Cambridge, reading a book in a library and it would be a hell of a lot safer and easier and less exhausting, but you know, at the end of it what you get is fantastic data, and also this opportunity to develop as a person by exposure to all of these really different encounters and it's fair to say I'm now completely hooked on prisons. So, you know, they're just fascinating institutions and institutions about which I feel really passionate in terms of improvement.
So you see yourself continuing to do research in the field, in that specific field?
Yeah, not least because there are so few lawyers in the field so I feel now that I've taken all that effort to understand history and staff culture and stuff I'm reluctant to let that slide, so I'm staying active in the field.
Any new projects that we could talk about, that you want to do on the area?
Yeah, so following the book I've kept an interest in prisons and since Birmingham there's been a change in policy that prisons now are benchmarked rather than put out to competition, so private sector costing is being used and applied to public sector prisons, so that's been a major development since Birmingham that has resulted in significant staffing changes and restructuring, and so I've been trying to trace through some of the impacts of that alongside, so after the book, a team, of which I was part, went back to Birmingham and did a three-year longitudinal study to track the prison's progress and performance, and following that, we're interested in how institutions, prisons, are altering and are restructuring and what we observed in Birmingham in the three years post-privatisation was kind of a traumatised institution. So we're trying to follow, follow that narrative in terms of altered staff behaviours, withdrawing from wings and that shaping prisoner experiences.
And I've been involved recently with a study of prisoner suicide rates, so you might know that the suicide rate in prison has gone up in the last few years and there are complex, complex combination of factors for that, but one of the factors I think has to be the various changes to prison staffing and stuff.
But more related I suppose to the human context, I've just been asked to join Jeremias Prassl's British Academy Against Other Rising Star's grant project in Oxford which is looking at the future of European Labour Law and I'm going to follow up on the public procurement side of things looking at the implementation of the new directive, space for social policy within the new directive, and in terms of how it's being implemented. So I'm hoping to do a small comparative study looking at implementation within the UK, so I'm very interested in regional variations in Wales and Scotland, but also looking at the Netherlands and tentatively I think Sweden, to look to see how they're implementing the directive, but also to see how they are using, or pursuing, social policy.
Going back to the book, there's a couple of pages that I found really interesting and I was not expecting to see that in your view the fact that Birmingham Prison had been transferred to the public, from public sector to the private sector, had an impact on minorities in terms of staff, staff minorities, and also on staff turnover. Could you talk a little bit more about that?
Yeah, so the minorities point was really interesting, what happened in terms of the composition of the Senior Management Team is that a team that had previously been fairly diverse, both in terms of gender and in terms of race, became an all-white, you could call it pale, male and stale, but all-white male team and what was interesting was that, in fact, the quality issues received the most amount of coverage I think in the procurement documentation which I analysed, and the fact then that that very visibly didn't translate into practice post-transfer was interesting to me, and was indicative, I think, of the fairly general low-profile of social policy within the Birmingham competition that I describe in the book which, you know, I think is for a variety of reasons that I talk about in the book, so the complexity of the rules that meant that the procurement team were just focussed on survival mode, the kind of silo approach to how they do procurement, that procurement was seen as a very specialist function that was really hived off from the rest of the institution, rather than being embedded within it, which meant that sometimes the best people to be involved weren't involved in the commissioning process.
But also that one of the purposes at Birmingham of the competition was in fact to break the Trade Union so there's a problem, there was a problem in Birmingham about the Prison Officer's Association local branch having too much power and so one of the explicit purposes of the procurement exercise in Birmingham was to break that power. So it's not surprising then that social policy wasn't perhaps very high on the agenda in the Birmingham context.
But I think I take particular objection to the use of competition and privatisation for that purpose, and I think it strengthens the kind of moral imperative on commissioners in that context who provide adequate support to staff given that they're devising a process that aims to strip that support away by virtue of the Trade Union.
So that's the kind of equality and SMT side of things, and then, yeah, the staff turnover point, lots of staff left and actually lots of staff were encouraged to leave, sometimes by virtue of financial incentives and that, to me, seriously qualifies the starting point under the, so I talk about the transfer of undertakings protection of employment regulations, so then the starting point there is that in principle when you privatise a public service all staff transfer across on the same terms and conditions of employment. So that empirical finding really tends to cast doubt on the level of protection that those regulations offer and I don't know, it just seems a bit weird to be, because it must be the case that the commissioner knows about the envisaged staffing changes because they signed off the bid, to that to me, strengthens again the moral case for them taking social protection seriously within that context, which is, it's clear from the book, which is not what I found.
So this kind of really grey area within the GP regulations where actually there's a considerable discretion left to the incoming employer to restructure and that's what I found, so staff, old staff leaving with their more expensive contracts of employment to be replaced, or in some cases not replaced, but where they are with staff that are considerably cheaper to employ.
So I think, yeah, all in all I, staff turnover and kind of impact on minorities I kind of used those to question whether there's adequate attention being paid to the social policy, social protection stuff within the Birmingham competition, and I suppose to question as well the interaction between the Public Procurement Rules and the Transfer of Undertakings Regulations.
True, but I'm still trying to figure out, because obviously I come from a different background, but I am still trying to figure out why the privatisation would necessarily lead to the impact on minorities or turnover, or it was just a mistake in the way that that particular process was conducted.
So, I think in terms of the minorities I absolutely don't think it's inevitable, I think it's a symptom of lack of pro-activity on that social policy front within the procurement context. To safeguard under-represented groups, or minority groups, I think requires an active strategy and there wasn't a level of consciousness to support that. But in terms of staff turnover, there is an inevitability about it in the prison sector because staff constitute about 80% of a prison's running costs and we know that one of the objectives of competition and privatisation in the prison sector is to save cost. You can only really save cost in an old prison like Birmingham by cutting staff, and that of course has to be disclosed or certainly intentions around staffing have to be disclosed as part of the bid.
So we've got this interesting conflict between tupee which sort of says 'don't worry, everybody's transferring across' and the procurement side of things where it's obvious that there's going to be some restructuring in this context and restructuring in terms of, yeah, loss of a number of staff but also erosion of terms of conditions.
Did you have access to the actual bids and final contract?
Yeah, so obviously you have to work around commercial and confidence, so I had access to a lot of the procurement documents, I had access to the final, the final contract, there's one part of it that's in commercial and confidence, which is really just about numbers, about costs, and I've spoken to some of the bidders, although obviously they are, they're concerned about confidentiality as well and protecting intellectual property and stuff, yeah.
...from a Competition Law perspective, so you made argument from a Labour Law, from industrial relations not to do so, and you mention Competition Law across the book but you stop short of saying 'prisons are natural monopolies' which is, would be, and was my impression when I read your book, 'prisons are natural monopolies', ergo that is a key argument to add in favour of the arguments that you used against privatisation.
Yeah. No, I think that's absolutely right, I mean I'm not a Competition Lawyer so I'd probably dodge that bullet, but I also think it's partly reflective of my own desire to engage with this field. I kind of feel like in this sector I had to meet the policy on its own terms, so I felt like I had to, in a way, accept OK, they're going to privatise something in this field and so my starting point was less of a concern to say 'let's scrap privatisation', because there's actually quite a, particularly in the prison sector, there's lots of critiques of privatisation in the sector on kind of ethical and moral grounds, all sorts of things, constitutional grounds, and I kind of just wanted to explore what happened.
So I think you're absolutely right, that that's a brilliant point that could be made alongside the arguments that I'm making, and I think having now done this study my view has strengthened that this is, certainly if we are going to continue to procure prison services from private sector then we need to do it much better. I'm less persuaded now than I was at the start of the study about the benefits of using privatisation in the sector, although I think if you look historically it is hard to refute the sentiment that private prisons have undoubtedly shaken the sector up.
So there have been increases in the quality of some of the public service publically provided prisons because of contestability. It's always a bit of a slippery slope that when you start criticising privatisation you also don't want to be seen as just accepting poor public service provision! So, yeah, it's kind of that delicate, I can see that privatisation, it's almost been a necessary evil, but I feel like with Birmingham they took it one step too far and with all of the kind of benefit I think of privatisation was kind of done with Birmingham, and if they wanted to do Birmingham then they needed to be much more intelligent about how they commissioned and rose to that challenge of having an existing workforce.
You mixed legal and also social sciences research methods in the same research piece. What was the value that you gained from doing this kind of research in comparison with more traditional doctrinal approach?
I simply couldn't have come to the conclusions, or found the things that I found without using empirical methods, without extending beyond law and doctrinal methods. It altered and enriched my thinking in ways that, yeah, they just wouldn't have appear... I wouldn't have seen connections, I wouldn't have approached the field in the way that I approached it, so they were pivotal to the book, to this study.
One final question, if you had a piece of advice to give the next Amy Ludlow which is going to do some sort of cross disciplinary or multidisciplinary research in this area, what would be your piece of advice?
Get lots of research money so that you can stay somewhere other than a Travelodge I think! No, it would be to be brave, to recognise what you know and be confident that other people are going to be interested in what you know and your perspective, but to also be humble enough to kind of reach out and say 'oh that's interesting, you're using this word, what do you mean by this', because there is a risk that we speak in different languages, disciplines speak in different languages, but some of the most interesting things happen when you bring those different languages, different ideas, together in a way that's quite brave, but that you also recognise when you're speaking at cross-purposes.
So I think taking confidence that you as a lawyer have some unique skills and perspectives and insights that other, people from other disciplines will value, but just being humble enough to recognise when you're at the frontiers of your learning and checking that we're all singing from the same hymn sheet!
And with that bombshell I think it's time for us to end!
Thank you very much Amy for giving us half an hour, after many tribulations we managed to actually record this podcast and do something that is very interesting.
Amy is on twitter with the handle @ACLudlow. As to me, you can find me at my blog telles.eu or on Twitter where I use the two handles, @Detig for general discussion and @publicprocure for public procurement related topics, 'til next time.


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Carnival Valor passengers urged to contact health department after coronavirus case in Columbus
by: NBC4 Staff
COLUMBUS (WCMH) — Passengers who recently traveled aboard the Carnival Valor cruise ship are being urged to contact their local health department after a Columbus man tested positive for COVID-19 coronavirus.
Columbus Public Health announced a 49-year-old man who traveled aboard the ship is currently in isolation.
The Valor cruise left from New Orleans on Feb. 29, went to Cozumel and Yucatan, returned to New Orleans on March 5th. The patient with the confirmed case returned to Columbus on March 6 and started having symptoms the next day. He was tested for COVID-19 on March 12, and officials received the positive test result Friday night at 8pm.
If anyone from the Central Ohio area was on the Carnival cruise ship the Valor from Feb. 29-March 5 they are asked to call 614-645-1519.
Friday, Carnival Cruise Line announced it is pausing operations immediately. The pause is scheduled to last through April 9.
Important update regarding upcoming sailings departing Saturday, March 14 through April 09, 2020 across its fleet of North America based ships. All affected guests will be receiving an email with our compensation offer. pic.twitter.com/R3isgLODqN
— Carnival Cruise Line (@CarnivalCruise) March 14, 2020
Get updated numbers and live press conferences everyday at 2pm here on our coronavirus in Ohio page. Download the free NBC4 app to get the first alerts as new cases are confirmed.

redpajama_set_name: RedPajamaCommonCrawl


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Соревнования в плавании на 200 метров комплексным плаванием у женщин на Олимпиаде 2000 года проводились с 18 по 19 сентября. Приняли участие 36 спортсменов из 28 стран.

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 Официальный отчёт, том 3, результаты в водных видах спорта, страницы 320–327   (PDF)

Плавание на летних Олимпийских играх 2000

redpajama_set_name: RedPajamaWikipedia


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Q: How can I convert a String with \xf6 chars into a human readable one? Currently I'm working on an Rails application with PayPal checkout. PayPal communicates with my app with IPN messages.
In many cases everything works fine, but if someone uses special chars like German umlauts (öüäß) I get \xf6 in the string.
How can I convert this into the human readable char 'ö'?

A: The problem is that the data was encoded as Windows-1252, but ruby won't detect that automatically.  You can coax it like this:
my_string = "Sch\xF6ning"
my_string.force_encoding('windows-1252').encode('utf-8')
=> "Schöning"

You can make a reusable converter to help you do the same thing:
ec = Encoding::Converter('windows-1252', 'utf-8')
ec.convert(my_string)
=> "Schöning"

A: Note that there is a setup on paypal side for that:
In the seller paypal account go to : Profile > My selling tools > PayPal button language encoding > More options

redpajama_set_name: RedPajamaStackExchange


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Q: Find a function $\phi: \mathbb{R} \to \mathbb{R}$ such that $P[(a,\infty)] = \int_{a}^{\infty} \phi (x) dx$ for every $a \in \mathbb{R}$. Let $(\Omega, \mathcal{F}, P)$ be a probability space with $\Omega = \mathcal{R}$ the real line, $\mathcal{F}$ the Borel sets, and probability measure on the $\pi$-system of open semi-infinite positive intervals by
$$P[(a,\infty)]= e^{-a^{2}}$$.
a) Find a function $\phi: \mathbb{R} \to \mathbb{R}$ such that $P[(a,\infty)] = \int_{a}^{\infty} \phi (x) dx$ for every $a \in \mathbb{R}$.
My approach,
I know that $\int_{a}^{\infty} \phi (x) dx = e^{-a^{2}}$ so I was thinking I can use Fundamental Theorem of Calculus here and differentiate both sides with respect to x.
b) Find the probability distribution $\mu_{y}(dy)$ for $Y(\omega):= \omega^{2}$.
$$P(Y(\omega)\leq y) = P(\omega^2 \leq y) = P(-\sqrt{y} \leq \omega \leq \sqrt{y}) = P[(\infty,\sqrt{y}] - P[(\infty,-\sqrt{y}] = 1 - e^{-\sqrt{y}^{2}} - 1 + e^{\sqrt{y}^{2}} = e^{y} - e^{-y}.$$
Then, we can differentiate that wrt to $y$ to get the probability distribution. Is this approach correct?

A: There is no probability measure $P$ such that $P(a,\infty)=e^{-a^{2}}$ for all real numbers $a$. I think this equation was supposed to hold only for $a \geq 0$ and $P(a,\infty)$ is supposed to be $1$ for $a<0$. Using the equation for all $a$ has led to a wrong answer: probabilities have to be between $0$ and $1$ but $e^{y}-e^{-y} \to \infty$ as $ y \to \infty$ so your answer cannot be right. I will let you modify the answer based on the modified formula for $P(a,\infty)$.
The correct answer is $P(Y\leq y)=1-e^{y}$ for $y \geq 0$ and $0$ fro $y <0$.


The Lay Ministry Training Program provides basic training for people who desire to serve the church more fully, either as a lay minister or as a lay leader. The program assists in the spiritual development of individuals and enhances knowledge in areas of biblical knowledge, theology, worship, Congregational history and polity, mission, and others. To be eligible to apply, an individual must be a member in good standing of an NACCC member church.
Explore these additional pages for more information on the program.


IBM and Ponemon are pleased to release the ninth annual Cost of Data Breach Study: Global Study. According to the research, the average total cost of a data breach for the companies participating in this research increased 15 percent to $3.5 million2. The average cost paid for each lost or stolen record containing sensitive and confidential information increased more than 9 percent from $136 in 2013 to $145 in this year's study.
For the first time, our study looks at the likelihood of a company having one or more data breach occurrences in the next 24 months. Based on the experiences of companies participating in our research, we believe we can predict the probability of a data breach based on two factors: how many records were lost or stolen and the company's industry. According to the findings, organizations in India and Brazil are more likely to have a data breach involving a minimum of 10,000 records. In contrast, organizations in Germany and Australia are least likely to have a breach. In all cases, it is more likely a company will have a breach involving 10,000 or fewer records than a mega breach involving more than 100,000 records.
In this year's study, 314 companies representing the following 10 countries participated: United States, United Kingdom, Germany, Australia, France, Brazil, Japan, Italy, India and, for the first time, the Arabian region (United Arab Emirates and Saudi Arabia). All participating organizations experienced a data breach ranging from a low of approximately 2,415 to slightly more than 100,000 compromised records. We define a compromised record as one that identifies the individual whose information has been lost or stolen in a data breach.
As the findings reveal, the consolidated average per capita cost of data breach (compiled for ten countries and converted to US dollars) differs widely among the countries. Many of these cost differences can be attributed to the types of attacks and threats organizations face as well as the data protection regulations and laws in their respective countries. In this year's global study, the average consolidated data breach increased from $136 to $145. However, German and US organizations on average experienced much higher costs at $195 and $201, respectively.
Ponemon Institute conducted its first Cost of Data Breach study in the United States nine years ago. Since then, we have expanded the study to include the United Kingdom, Germany, France, Australia, India, Italy, Japan, Brazil and, for the first time this year, United Emirates and Saudi Arabia. To date, 1,279 business and government (public sector) organizations have participated in the benchmarking process since the inception of this research series.


In just one week, we are reporting another cool contest from Microsoft. This contest is one of the best contest I have ever come across. The contest is simple just create an entertaining and engaging "Movie of 60-90 seconds highlighting how Windows 7 PC is at the core of Student's life".
You can't expect a simpler contest than this. You would be getting an adrenaline rush by listening at the award money and the benefits. Winner of the Contest will be a handsome $8,000 with a Round trip travel for two people to Cannes with 3 nights hotel accommodation.
You will get a chance to attend the amazing parties which will be scheduled and will have a nice time to interact with the celebs and other special Invitees. The best part is you get a chance of Exclusive Screening of your video at the MOFILM awards night.
You can't expect better than this. Hang on! One thing I forgot to tell you, if you are a STUDENT and you have submitted your entry as Student Filmmaker then you will have a chance to win a special bonus prize. So isn't it great ?
And if you not able to be the winner than you might win a good amount of cash prizes. You might win $4000, $2000 and $1000 for being second, third, fourth and fifth respectively.
Head over to the Contest Page for details.
Last date for submission: 30th May, 2011.
I will recommend you to use Windows Movie Maker and Expression Blend Studio for the contest.


How much swelling will I get from neck liposuction and lift?
Q: How much swelling and bruising will I get from neck liposuction and lift? I am scheduled for a neck lipo and neck lift next week. How much swelling and bruising should I expect? How long will they last? A: There is typically not much swelling after neck liposuction and neck lift. The bruising is usually minor. Most patients can go back to work after 6-7 days after this procedure. There is however, more bruising and swelling after a facelift. Q: I read about a Botox neck lift. What is this and does it work? I thought Botox was for frown lines? A: Botox can be used to treat the muscle bands that may appear in the neck. I have to caution you that the results are not dramatic and that this can be expensive. If this is a real problem, consider a skin tightening non-invasive option or a neck lift. Q: Is there another kind of neck lift available? I went to my plastic surgeon to see if there was something I could do about the wrinkles and loose skin on my neck, in the throat area. He suggested I have a facelift or I could just do the neck with the incision straight down the throat area. I looked at before and after pictures and didn't like the looks of the neck lift incision, so I opted for the facelift. It's been about a year now, and I don't think it's holding up like I envisioned. My question is: is there another kind of neck lift available? I'm 59 years old and was 58 at time of surgery. It was my first facelift, although I've had upper eyelid surgery twice…once at 40 and then at 55. A: The problem you are having is common, and may not be related to the expertise of your surgeon. With age, skin loses elasticity and becomes lax. This is probably the reason you are seeing redundancy. The treatment may be a revision of the neck, without having to do the facelift over again. Consult with other surgeons to see what your options are.


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Men Do Cry (Episode 5)
By Techplace On 17th July 2019 20th December 2019 In Romantic Stories Tagged Episode 5, Men Do Cry, Sonia Okehie
Love is a force that can't be subdued or hidden. Never in a thousand years would Jaden have thought that he would fall in love again, not to talk of outrightly confessing his feelings to someone. He felt he was tough but love brought his toughness down to naught. He didn't see it coming at all and was surprised at himself for revealing his feelings to Laura.
"I'm madly in love with you Laura" he unknowingly confessed. Laura was shocked and dumbfounded, she never believed that this day would come. "Jaden you can't be saying things you don't mean" she said trying to deny his feelings for her. "What makes you think I'm joking or being dishonest?" He questioned, "Because I find it hard to believe that you're in love with me. I mean look at me, you can't possibly be in love with an ex fast food attendant" she said looking into his eyes.
Jaden was a bit confused and didn't know why she felt he wasn't being genuine. "Laura, I have only poured my heart out to two women all my life and you are the second lady I'm ever confessing my feelings to. Love has never been fair to me and I have always been afraid to try again but I'm willing to try with you. I want to try with you Laura" he said looking into her eyes.
Laura was deeply in love with Jaden too but felt he still had some emotional baggage from the past and thought it would affect their relationship, if they ever have one. "I can't deny the fact that I like you too but I'm just scared of giving in to my feelings, because I feel you still have some grudge from your past and if you don't settle with your past, you'll end up hurting any relationship we venture into. I really like you and want to be with you too, but liking you isn't enough to want to go into a relationship with you" she said.
Her words touched Jaden's soul and he admitted what she said within but that was not stopping him from getting her. "Laura I love you and I'm willing to make us work out. I'm willing to put in the effort to work on my past, I want you to help me too by showing me how beautiful and pure love can be. I want to try and I want to try with you" he said.
The atmosphere was charged with so much emotions as they talked and Jaden got carried away. He leaned towards Laura and planted a soft kiss on her lips. Laura's body was covered with goosebumps as she kissed back. The kiss was filled with so much emotions and feelings for each other. Their breath ceased as they kissed passionately.
After kissing for a while, Jaden redrew himself from her and said "I want you, please think about my proposal". Laura nodded and they set off to a nice restaurant for dinner and headed to their different destination afterwards.
All through that night, neither Jaden nor Laura could sleep well as they thought about what had happened. Laura was in love with him and wanted him too but was scared that he was just too much a man for her to handle. She put in so much thought into Jaden's proposal and decided to give him a chance. On the other hand, Jaden prayed the little way he knew how to pray and asked God to touch Laura's heart to accept him. It was a stressful night due to excess thinking, but they finally put themselves to sleep.
Laura woke up the next day thinking about Jaden and his cute kiss. She smiled at every thought of him and blushed afterwards. As she headed to work, she picked her phone and sent an SMS to him which read "I don't know what I'm getting myself into by accepting you into my life, but I'm willing to trust you with my heart and love. You are a good man and there's no other person I rather want to be with. I love you Jaden, see you later!". When Jaden received the SMS, he leaped for joy and couldn't contain his happiness. He texted her back and his message read "You aren't making a mistake and I promise to never make you regret this decision. I love you too!". Laura smiled when she got his message and couldn't stop smiling all through that day at work.
Their relationship was enviable and they seem almost inseparable. After about a month of being together, Jaden was convinced she was the one and finally invited her to his house for the first time. Laura was excited due to his invitation because she had been secretly wondering why he hadn't invited her earlier. Jaden used the excuse that he wanted to eat home cooked meal to invite her over.
During the weekend, Laura went to the market and bought some foodstuffs she will use to prepare the food Jaden wanted. He drove to her house to pick her together with the food stuffs she bought and they headed to his house. Jaden's apartment had a classy interior and was beautifully decorated in a suitable way for a bachelor, "Welcome my darling, you are the first woman asides my cleaners that has entered this apartment" he said as Laura walked in. She smiled and told him to stop pulling her legs but he assured her that it was the truth.
They settled in and Laura headed for the kitchen. In no time, the meal was ready and they ate happily and talked while at it. After eating, they gist and laughed all through till something unexpected happened.
Laura jokingly took his phone and asked him to beg before she gives it back. Jaden smiled initially and jokingly told her to return his phone, "I want you to say please before I give it back or can't you say please?" she jokingly said and before she knew it, Jaden shouted on top of his voice and said "I can't say please!".
For a second, Laura couldn't figure what was going on as she was surprised. She held her heart and couldn't believe that Jaden could get angry over a minor thing like that, "did you just shout at me?" She asked in a shaky tone.
Jaden finally realised what he had done and apologetically said "Laura please I'm so sorry".
End of episode 5.
Stay tuned tomorrow to see what happened next.
Written by Sonia Okehie
PS: If you are just joining us, visit page to read previous episodes.
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@Sonia Okehie
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text:
package com.smartdevicelink.test.rpc.notifications;

import com.smartdevicelink.protocol.enums.FunctionID;
import com.smartdevicelink.proxy.RPCMessage;
import com.smartdevicelink.proxy.rpc.OnButtonEvent;
import com.smartdevicelink.proxy.rpc.enums.ButtonEventMode;
import com.smartdevicelink.proxy.rpc.enums.ButtonName;
import com.smartdevicelink.test.BaseRpcTests;
import com.smartdevicelink.test.TestValues;

import org.json.JSONException;
import org.json.JSONObject;
import org.junit.Test;

import static junit.framework.TestCase.assertEquals;
import static junit.framework.TestCase.assertNotNull;
import static junit.framework.TestCase.assertNull;
import static junit.framework.TestCase.fail;

/**
 * This is a unit test class for the SmartDeviceLink library project class :
 * {@link com.smartdevicelink.proxy.rpc.OnButtonEvent}
 */
public class OnButtonEventTests extends BaseRpcTests {

    @Override
    protected RPCMessage createMessage() {
        OnButtonEvent msg = new OnButtonEvent();

        msg.setButtonEventMode(TestValues.GENERAL_BUTTONEVENTMODE);
        msg.setButtonName(TestValues.GENERAL_BUTTONNAME);
        msg.setCustomButtonID(TestValues.GENERAL_INT);

        return msg;
    }

    @Override
    protected String getMessageType() {
        return RPCMessage.KEY_NOTIFICATION;
    }

    @Override
    protected String getCommandType() {
        return FunctionID.ON_BUTTON_EVENT.toString();
    }

    @Override
    protected JSONObject getExpectedParameters(int sdlVersion) {
        JSONObject result = new JSONObject();

        try {
            result.put(OnButtonEvent.KEY_BUTTON_EVENT_MODE, TestValues.GENERAL_BUTTONEVENTMODE);
            result.put(OnButtonEvent.KEY_BUTTON_NAME, TestValues.GENERAL_BUTTONNAME);
            result.put(OnButtonEvent.KEY_CUSTOM_BUTTON_ID, TestValues.GENERAL_INT);
        } catch (JSONException e) {
            fail(TestValues.JSON_FAIL);
        }

        return result;
    }

    /**
     * Tests the expected values of the RPC message.
     */
    @Test
    public void testRpcValues() {
        // Test Values
        int cmdId = ((OnButtonEvent) msg).getCustomButtonID();
        ButtonEventMode mode = ((OnButtonEvent) msg).getButtonEventMode();
        ButtonName name = ((OnButtonEvent) msg).getButtonName();

        // Valid Tests
        assertEquals(TestValues.MATCH, TestValues.GENERAL_INT, cmdId);
        assertEquals(TestValues.MATCH, TestValues.GENERAL_BUTTONEVENTMODE, mode);
        assertEquals(TestValues.MATCH, TestValues.GENERAL_BUTTONNAME, name);

        // Invalid/Null Tests
        OnButtonEvent msg = new OnButtonEvent();
        assertNotNull(TestValues.NOT_NULL, msg);
        testNullBase(msg);

        assertNull(TestValues.NULL, msg.getButtonEventMode());
        assertNull(TestValues.NULL, msg.getButtonName());
        assertNull(TestValues.NULL, msg.getCustomButtonID());
    }
}

redpajama_set_name: RedPajamaGithub


text:
United States Patent and Trademark Office OG Notices: 18 May 2004
Reminder of the Proper Procedure for
Filing Confidential Information
Pursuant to MPEP 724.02
In filing patent applications, applicants and their
representatives should carefully review the application papers to
ensure that trade secret information, proprietary information, and
protective order materials that should be kept confidential are not
included unless they are clearly marked and submitted in compliance
with Manual of Patent Examining Procedure (MPEP), Section 724.02 (8th
ed. 2001) (Rev. 1, Feb. 2003). If information is not submitted in
compliance with MPEP 724.02, the information will be scanned along with
the application into the Image File Wrapper (IFW) system. This may be
undesirable from applicant's perspective, because once information is
included in the IFW system, it will only be permanently deleted for
national security concerns.
In general, patent applications, and papers related to the
application, are scanned and maintained in an IFW. Application
documents that are not scanned include documents that the United States
Patent and Trademark Office (Office) is unable to scan (e.g., certain
photographs and documents submitted in electronic form, such as the
Computer Readable form for a Sequence Listing) and documents that are
clearly marked and submitted in compliance with MPEP 724.02.
Application documents that are not scanned are maintained in an
artifact folder, and are not available as part of the IFW in the Patent
Application Information Retrieval (PAIR) system. If the application
file and contents are available to the public pursuant to 37 CFR Secs.
1.11 or 1.14, any materials submitted pursuant to MPEP 724.02 will be
in an artifact folder and will be released to the public with any other
application papers if a petition to expunge (37 CFR Sec. 1.59) was either
filed and denied, or not filed, by the time the application was allowed
or a notice of abandonment is mailed. With the mailing of the notice of
allowance or notice of abandonment, the examiner will review the patent
application file and determine if a petition to expunge is in the file
but not acted upon. If a petition to expunge was dismissed as being
premature since the application was not yet allowed, the petition will
be acted upon again, even if applicant had previously been required to
resubmit the petition after allowance. If the application is being
allowed, and the information is found to not be important to a
reasonable examiner in deciding on patentability (see MPEP
724.04(A)-(C)), the petition to expunge will be granted and the
information will be expunged. If the information is found to be
important to a reasonable examiner in deciding on patentability, the
petition to expunge will be denied and the information will become part
of the application record and will be available to the public upon
issuance of the application as a patent. With the mailing of the notice
of abandonment, if a petition to expunge has been filed, irrespective
of whether the information is found to be important or not to a
reasonable examiner in deciding on patentability, the petition to
expunge will be granted and the information expunged. Publication of
the application as a patent application publication, or, if a reissue
application or reexamination proceeding, in the Official Gazette will
not cause the information to be made available to the public because a
decision as to materiality cannot be made until a notice of allowance
is mailed.
Use Care In Submitting Information to the Office
Patent applications are generally published before a patent
issues. Applicants should consider whether personal information is
necessary in a document to be included in a patent application, before
submitting the information to the Office. The Office does not require
the Social Security Number of an inventor, and there is no need to
include this type of personal information in a patent application. Even
where the Office does require some degree of confidential information,
applicants can still take steps to protect their privacy. For example,
a copy of a cancelled check may be necessary to show that a payment was
made, but the copy can be redacted before it is submitted to the Office
to block the routing number on the check. In addition, since patent
applications are published with the correspondence address of the
application on the patent application publication, applicants,
particularly those applicants who are not using a patent attorney or
patent agent, may wish to consider using a business address rather than
a home address to preserve privacy.
Once private information is included in a patent application
file by scanning a document and adding an image of the document to the
patent application's IFW, the document will only be removed from the
IFW for national security concerns. For example, if an applicant
includes the wrong application number on some correspondence, and the
Office scans the paper and adds the paper to the application file
corresponding to the number given, when a petition to expunge (37 CFR
Sec. 1.59) is granted, the document is not removed from the IFW. Instead
of removing the document, the Office will mark the document
"hidden," so if the IFW is available to the public, the document
will not display. The document can also be "un-hidden" and reappear
in the IFW. Similarly, if an applicant does not follow the procedures
of MPEP 724.02, and submits proprietary information to the Office
commingled with other documents, when a petition to expunge is granted,
the proprietary information will be "hidden" but not permanently
deleted from the IFW.
When filing trade secret information, proprietary information,
or protective order materials is necessary to comply with the duty of
disclosure pursuant to 37 CFR Sec. 1.56, applicants seeking to ensure
that the information is not made public should follow the procedure set
forth in MPEP 724.02. For example, a Confidential Information
Disclosure Statement (Confidential IDS) should be prepared, listing the
confidential document on an information disclosure statement (e.g.,
PTO/SB/08). The document to be maintained in confidence must be placed
in an envelope or container clearly labeled, for example:
TRADE SECRET MATERIAL NOT OPEN TO PUBLIC. TO BE OPENED ONLY BY EXAMINER
OR OTHER AUTHORIZED U.S. PATENT AND TRADEMARK OFFICE EMPLOYEE.
DO NOT SCAN
In re Application of
Filed:
For: (Title of Invention)
TC Art Unit:
Examiner:
Materials submitted in compliance with MPEP 724.02 should be
mailed to the Office or hand carried to the Customer Window as set
forth in "Centralized Delivery and Facsimile Transmission
Requirements for Patent Application Related Correspondence," 1275
Off. Gaz. Patent Office Notices 200 (Oct. 28, 2003), in order to ensure
appropriate processing of the documents.
Questions regarding this notice should be directed to Karin
Ferriter, Senior Legal Advisor, Office of Patent Legal Administration,
at (703)308-6906, or to PatentPractice@uspto.gov.
April 23, 2004                                             STEPHEN G. KUNIN
Patent Examination Policy


text:
These are the most dangerous areas in Basildon in 2017 according to crime maps
Statistics from crime maps on police.uk reveal the number of crimes in each area
Michael Mutch
If you contact the police about your neighbour they won't give away your identity
Get a weekly round up of all the biggest court and crime news in Essex
Police officers in Basildon have had to deal with a lot of crime this year.
Statistics on the website police.uk revealed that Essex Police have handled 9,175 crimes reported in the Basildon area in 2017.
The figures show the statistics from January to September, with the rest of the year to be published soon.
The 12 most bizarre crimes that have been committed in Essex
Figures recorded provide details of the crimes reported in each of the city's policing districts - including other crimes such as anti-social behaviour, robbery, drugs and possession of weapons.
Number of crimes reported in Basildon in 2017
Essex Live has tallied up the number of crimes that have been reported to reveal Basildon's most dangerous area:
1) FRYERNS - 2050
Fryerns is the most dangerous area in Basildon (Image: Essex Police)
Basildon's most dangerous area in 2017 was Fryerns as over 2,000 crimes were reported.
This accounts to 22.3 per cent of the overall number of crimes in the area from January to September.
On average, there are 170 crimes a month and up to six crimes reported every day in this northern area of Basildon.
2) PITSEA SOUTH EAST - 1967
Pitsea South East
Covering North Benfleet and Bowers Gifford, the Pitsea South East district has reported just under 2,000 crimes this year.
It is second most dangerous area in Basildon accounting for 21.4 per cent of the town's crime.
On average, 164 crimes are reported here every month.
3) LEE CHAPEL NORTH - 1575
Lee Chapel North
This small area is Basildon's third most dangerous.
It has reported over 1,500 crimes from January to September and accounts for 17.2 per cent of the town's crime.
On average, there are 131 crimes reported each month.
4) PITSEA NORTH WEST - 1502
Pitsea North West
This district covers areas surrounding Courtauld Road, Burnt Mills Road and Ashlyns.
It has recorded over 1,500 crimes from January to September.
On average, there are 125 crimes reported in this area every month and it accounts for 16.4 per cent of Basildon's crime.
5) NETHERMAYNE - 1142
Nethermayne
Over 1,100 crimes have been reported in Nethermayne this year, making it the fifth most dangerous area in Basildon.
On average, 95 crimes are reported every month and the area accounts to 12.4 per cent of the town's crime.
6) LAINDON PARK - 939
Laindon Park is the safest place to be in Basildon
This is Basildon's safest area and the only one to record less than 1,000 crimes this year.
Only 10.2 per cent of the town's crime comes from Laindon Park and an average of 78 crimes are reported each month.
Dogs Trust: The 27 dogs currently needing new homes in Essex in 2022
DogsThey're known as man's best friend for a reason


text:
Computer Simulation Showcase
Computer simulations are not just for entertainment. Many industries such as engineering, architecture, health professions, and education, make use of high-end computer simulations for visualization and training. CSGC provides a platform for these rarely seen simulations a chance to be showcased to the public.
SUBMISSION OVERVIEW
The computer simulation showcase is designed to recognize and reward individuals/teams that have worked hard to produce a computer simulation that provides a visualization of a project, training procedure or demonstration of artificial intelligence (AI) and machine learning (ML) techniques . Individuals or teams can enter a computer simulations, using the simulation software of their choice (ie. Solidworks, AutoDesk applications, Adobe Captivate, Unity, Unreal, etc.). Computer simulations will be judged based on all aspects of the visualization of a real world project or procedure.
All individuals or teams must pre-register for this event. Registration opens in February.
All submissions must be a computer simulation output to video or interactive application.
All submissions will consist of two video submissions
30-seconds to 5 minutes video of the computer simulation
Presentation Video explaining their project (see details below)
All submissions videos
Simulation videos will be submitted via a Youtube video link
Videos visibility settings must be set to public for viewing
When uploading the Youtube video (under details , tags) you must include the tag #CSGC2021
All components of the computer simulation must be created by the design team.
Copyrighted images, audio, footage and characters can not be used. (ie. Celebrity photos, movie screen grabs, drawings of copyrighted logos, characters, etc. and so forth).
Creative Commons / Licensed external , publicly available , resources, such as free blocks, models and audio can be used.
Computer Simulations may be built in any software
Software such as Solidworks, AutoDesk applications, Adobe Captivate, Unity, Unreal, etc.
All submissions must be appropriate for all viewing ages
MUST NOT contain any offensive language, graphic content, and suggestive themes (ex. sex, drugs and alcohol).
All animation submissions must be submitted by March 31, 2021
Presentation Video (3 to 5 MINUTE video)
All submissions must include a Presentation (Youtube video).
The game pitch should include the following information
Overview - overview of the the computer simulation
Context- who and what is the computer simulation intended to be for and used for
Visualization - sample footage of the computer simulation
Development Team - who are the people who designed and developed this project
Project Summary - Provide a summary of your submission
Presentation video must be submitted via a public Youtube link
These videos will be aired throughout the day of competition on the main hall projector and CSGC will also reserve the right to publicly share these videos across our social channels.
EXHIBITION SET-UP
All submissions must be displayed during the exhibition day (April 17) of CSGC. A maximum of one functional set-up for the submission is required. Entrants must bring their own equipment to display their computer simulations for judges and expo attendees during the event. See full competition rules and regulations for details about set-up and equipment.
Judges will review all submissions prior to the day of competition. All submissions must be submitted by March 31, 2021. All submissions must be displayed by the entering team on April 17, 2021, for the entirety of the exhibition. Winners will be announced at the Award Ceremony following the exhibition; winners must be present to receive award.
Below are the judging criteria for the Computer Simulation Showcase
Creativity - Is the idea unique? Does it provide a new twist or an out of the box idea?
Context - Does the computer simulation provide visualization for a concept, idea and or theory to be fully understood and assessed?
Visualization - Are the visuals consistent and appealing? Has it been edited/staged with thought and intention?
Technology - Does it demonstrate a level of expertise in this medium? Does the submission make use of interesting or advance techniques and/or technology?
Other - If present judges may take note of in additional feature such as interaction and animation.
REGISTER TO COMPETE
All entrants must accept and acknowledge the competition rules and requirements upon registering for this competition.
NOTE: All submission details and competition rules are being revised and maybe subject to change.
Final details will be set no later than January 2021.
CSGC Comptitions
Digital Art Show


text:
Diseases & Diagnosis
Diseases & Diagnoses
Choose any area of neurology to see curated news, articles, case reports, and more on that topic.
Epilepsy & Seizures
Headache & Pain
Imaging & Testing
Movement Disorders
MS & Immune Disorders
Find content from our back issues!
Find information and tools about neurological diseases to assist patients and caregivers.
Find useful tools to help you on a day-to-day basis.
Clinical Care Tools
Clinical Trials Guides
Students, Residents, & Fellows
Alzheimer's & Dementia Child Neurology Epilepsy & Seizures Headache & Pain Imaging & Testing Movement Disorders MS & Immune Disorders Neuromuscular Sleep Stroke TBI
Alzheimer's & Dementia Epilepsy & Seizures Headache & Pain Movement Disorders MS & Immune Disorders Neuromuscular Sleep Stroke TBI
Case Reports Clinical Care Tools Clinical Trial Guides Practice Management Students, Residents, & Fellows Videos
The Stigma of Migraine
Stigma leads to loss of status and diminished quality of life.
William B. Young, MD, FAHS, FAAN
View/Print PDF
Definitions of Stigma
Stigma is an established construct in the social sciences that describes a characteristic, trait, or diagnosis that is used to discredit an individual and leads to prejudice, discrimination, and loss of status.1 It can also be described as a process that spoils the identity of the stigmatized individual. HIV, depression, and epilepsy are known to be stigmatizing diseases that result in disrupted social relationships, decreased quality of life, and lowered employment rates. Being stigmatized is in itself a negative consequence of disease and also has health implications because it affects the way individuals experiencing stigma seek and access medical care. The lack of social belonging is stressful and incurs negative health outcomes.2-5
Stigma is different in different diseases. A person with a skin disease may experience it differently than a person with syphilis or one with depression. Whatever the qualities of the stigma, the individual pays a price. Enacted stigma occurs when individuals experience discrimination, for example, from the words of a person of authority, the loss of a social relationship or the loss of employment. Stigma becomes internalized and incorporated into the individual's own feelings about his or her condition and identity, including anticipation about how others might react to it.5 Subjective experiences of stigma can be as damaging to health as acts of discrimination and the actual loss of social status.
History of Migraine Stigma
Medical historian, Catherine Foxhall, describes a sea change regarding how migraine was socially perceived, which occurred in the late 18th century.6 At that time, a negative perception of migraine began that persists today. Before this historical period, descriptions of and treatments for migraine were as for any other disease as far back as the time of Galen (c. 129 to c. 216/17 CE), who described the disorder as hemicrania. In medical texts from the 16th through17th centuries, treatments for migraine are described, and again, migraine is treated as any other disease. There is no evidence that people with migraine were looked down upon.
Then, in the late 18th century, people with migraine were represented as privileged, self-absorbed individuals, who used their migraine as an excuse for shirking social duties and avoiding social responsibilities. By the 19th century, migraine was perceived as a weakness of women in the lower socio-economic classes. Physicians caring for patients with migraine were also ridiculed as out of touch, incompetent practitioners who encouraged their patients' neurotic tendencies.6 A negative, feminized view of the person with migraine has persisted since, whether migraine was viewed as a psychological defect or as the result of an excitable, feminized brain.7
Measurement of Stigma Experienced by Patients With Migraine
The Stigma Scale for Chronic Migraine (SSCI) provides an objective measure that allows systematic study of stigma in migraine. The SSCI is a 24-item questionnaire that asks 13 questions pertaining to internalized stigma and 11 pertaining to enacted stigma. Scores on the SSCI range from 24 to 120. In a study of 511 patients, who were recruited over the internet and had a variety of neurologic diseases including stroke, epilepsy, multiple sclerosis, Parkinson's disease, and motor neuron disease, but not migraine, the mean total score on the SSCI was 42.7 (standard deviation 19.7).8 In a clinic-based study of patients with episodic migraine (EM) and chronic migraine (CM), the mean stigma score for EM was 41.7±14.8, and 54.0±20.2 for CM. In contrast, epilepsy patients had a score of 44.6±16.39. For these raw scores, CM was significantly more stigmatized than EM or epilepsy, whereas epilepsy and EM were similar.8,9
Further analysis demonstrated that the ability to work also correlated highly with stigma in epilepsy and in migraine. In the populations studied, patients with CM had the most work-related disability. Removing the question of work-related disability from the questionnaire resulted in similar levels of stigma for CM and epilepsy and slightly less for EM. The ratio of enacted stigma to internalized stigma was similar in all three groups, suggesting the conversion of stigmatizing experiences to low self-esteem was similar across the groups. The relationship of stigma to work absenteeism was confirmed by a study of respondents who did not necessarily have migraine, showing that stigmatizing attitudes towards persons with migraine increased with work absenteeism, but did not vary by gender.10
Several other interesting features of the stigma of migraine emerged from the SSCI study. As in the online panel study, gender did not affect stigma scores. Unlike in epilepsy, age, income, and education did not correlate with stigma scores for patients with migraine, suggesting that educational efforts aimed at reducing the stigma of epilepsy have been successful, whereas such efforts do not yet exist for migraine. In the SSCI study, quality of life was much lower in CM than in EM or epilepsy for both the physical and the mental components of the 12-Item Short Form Health Survey (SF-12), suggesting that stigma may have a strong influence on quality of life. Of all the factors studied, the mental component score of the SF-12 correlated most strongly with stigma scores.
This study is somewhat different from a Turkish study that did not use the SSCI to measure migraine stigma, but instead used a 3-item epilepsy stigma scale. In this study, epilepsy was associated with greater stigma than migraine, although quality of life was much worse among migraine patients. The differences between these studies could be related to the severity of illness of the groups studied, the studies' methodology, or cultural differences.11
In her book Not Tonight: Migraine and the Politics of Gender and Health, Joanna Kempner uses qualitative methodology to study migraine stigma, referring to this issue as the "legitimacy deficit."7 This issue – legitimacy – pervades the entire book. She finds awareness of this deficit in patients, physicians, scientists, and pharmaceutical companies.
Domains of Stigma for Patients With Migraine
Stigma pervades the patient's interaction with the doctor. In online patient groups, physicians are viewed as part of the problem. They habitually psychologize patients, view patients as drug seekers and see patients with migraine as not having a serious disease. Conversely, in a survey of neurologists, 23.8% endorsed that many migraine patients have motivation to maintain their disability, while only 40.1% disagreed with that assertion.12
Migraine has a profound effect on the family. In the Chronic Migraine Epidemiology and Outcomes (CaMEO) study, a longitudinal online-based study of 13,064 respondents with migraine, reduced participation in family activities was found in 48.2% to 57.4% of study participants, and correlated with the frequency of migraine attacks (ranging from low-frequency EM to CM). A total of 24.4% of low-frequency EM and 43.9% of CM patients felt their spouses did not really believe them about their headaches. A total of 14% of spouses of low-frequency EM patients acknowledged that they did not really believe their spouses about their migraine, compared with 22.1% of the spouses of CM patients.13
A 2016 survey by a medical insurance provider found that just 22% of employers deemed migraine to be a "serious enough reason for an employee to be absent from work," lower than for any other reason, including depression, anxiety, stress, the flu, or the common cold.14 People with migraine must choose which parts of their lives to sacrifice, frequently prioritizing work over others (social, personal, leisure).
People with migraine are discriminated against in qualifying for insurance entitlements based on their diagnosis. That migraine is not included as a qualifying condition for Social Security Disability Insurance (SSDI) exacerbates the existing difficulty in quantifying loss of traditionally noncompensated work such as childcare and housework. To qualify for SSDI, one must compare one's disease-related impairments to those listed for another disease in the Social Security Listing of Impairments ("Blue Book"), making disability determinations more difficult and more capricious than for other diseases. People with employment-related traumatic brain injury resulting in disabling CM incompatible with employment can only qualify for a maximum of 5% of whole person impairment under American Medical Association guidelines for workers compensation. Institutional stigma may force persons with severe migraine to work when they should not, with unreasonable consequences for themselves or their loved ones.
Despite the high prevalence of migraine, stigma also exists toward research of migraine. Funding migraine research by the National Institutes of Health (NIH) is the lowest relative to disease burden among the most impactful diseases (Figure). In 2007, NIH funding per disability-adjusted life-year was $29 for migraine, $739 for epilepsy, and $232 for stroke. On a per-person-with-disorder basis, the individual with migraine received $0.36 while the stroke patient received $48.57 and the epilepsy patient received $35.15 While the last decade has seen some improvement in NIH funding, this gap remains enormous. This reality may discourage academic neurologists from pursuing this specialty, as it could be perceived to be difficult to secure research funding or academic positions. Health care providers may be reluctant to specialize in headache medicine because migraine is not regarded as seriously as other neurologic diseases during training in academic settings and headache disorders practice might not reimburse as favorably as other neurologic specialties that may rely more heavily on procedural treatments. Lack of investment in migraine research also slows the development of potential treatments. By increasing funding for migraine research, migraine may be able to move forward as a field and patient care may be improved.
Figure. Funding by the National Institutes of Health in millions of US dollars relative to disease burden shows that migraine is underfunded compared to other disorders that create the same level of disability.
Reframing Migraine
A disease frame is the first subconscious perception about that disease. The disease frame has a profound effect on how the public perceives and supports the disease. Reframing has been markedly successful in a number of diseases. HIV was reframed in terms of justice and epidemiologic catastrophe, and persons with HIV infection received respect and research, as well as treatment resources that have dramatically improved the lives of millions of people. Cancer has been reframed and the person with cancer has gone from a victim to a survivor. Autism has been reframed from a rare hopeless disorder to a common condition that affects families profoundly, and there has been a corresponding increase in disease awareness and resources for those affected. All of these diseases, and many more, were successfully reframed through the efforts of advocacy movements by patients and families who physically congregated to advocate for themselves. Online groups have not matched the effects of in-person advocacy.
Migraine is in profound need of such a reframing. The pharmaceutical industry treats migraine as an easy to treat illness of white, middle-class women. Typically, a migraine is seen as affecting a woman who cannot cope. In common parlance, migraine is a metaphor for something irritating, but not serious. In scientific presentations the "migraine brain" cannot handle stress.2,16
Consequences of this include demoralization of patients with migraine and those who care about them, unsuccessful fundraising efforts for research and education, prescription migraine treatments that never reached their market potential, and underfunding of research. Advocacy changes policy toward patients: this includes treatment-related policies from health care systems, provider networks, and physicians. It also increases media interest in a disease.
Future Directions for Reversing the Stigma of Migraine
There are two related problems: the stigmatization of migraine and the lack of migraine-specific disease advocacy. Stigma compounds the burden of illness, becomes internalized, and makes people too demoralized to become advocates. At the same time, history shows that the only way for a disease to be destigmatized is through patient participatory advocacy. Patients with migraine have a stigma similar to other patients with diseases that are not obviously visible to others. This invisibility makes it more difficult for those who do not suffer from the disease to understand it and in turn makes it more likely that patients will acquiesce to the fear of burdening coworkers or family and keep them from becoming spokespeople and advocates for education about their disease. The participation of people with migraine and their families and friends is critical for migraine advocacy.
Advocacy Is About Reversing Stigma
Advocacy changes policy toward patients, including treatment. Advocacy efforts have reshaped the perceived beneficiaries from the scientists to the patient. Advocacy efforts have promoted measurement of research funding. These shifts have favored conditions in which affected individuals are deemed worthy; for example, breast cancer research is much better funded than lung cancer, although lung cancer has greater impact. Stigmatization translates to loss of funding: "Disease advocacy reshapes funding distributions, changes the perceived beneficiaries of policies, promotes metrics for commensuration, and makes cultural categories of worth increasingly relevant to policymaking."17
Next Steps for Creating Advocacy
Marketing theory suggests that diseases can be radically or subtly reframed (or rebranded).18 Explaining disease causality (pathophysiology) can have profound effects on the way a disease is framed). This is one area where physicians and scientists can have a critical role. However, the field does not have a consensus on a 1- or 3-sentence explanation of migraine pathophysiology. Nonetheless, most explanations have centered on brain hyperexcitability as a part of the explanation of cause of illness, which may reinforce the perception of the person with migraine as having a different, feminized, emotionalized, vulnerable, and damaged brain. A different phrase, "the vigilant brain," might be preferable.19
Another avenue for reversing the stigma of migraine may involve the language we choose to use about migraine. There are many ways to describe migraine, but some may be less stigmatizing and more relevant to the experience of the patient. A recent editorial suggests the language choices in the Table below to reduce stigma while better describing the patient's experience.20
Patient advocacy groups have begun discussing the "migraine elevator speech," suggesting that patients develop a short speech to explain what migraine is in a way that reduces stigma. Perhaps physicians should begin to consider how they frame migraine for their own patients to reduce the stigma and thus the burden of migraine, even when unable to adequately manage migraine's symptoms.
Finally, physicians can encourage patients with migraine to participate in migraine advocacy activities, particularly ones where patients congregate, such as walks, runs, lobbying, education days, and adolescent camps. These should be encouraged over online activities, which do not have the impact of activities where persons with a disease come together with a purpose. Patients with migraine need cheerleaders, and physicians can play that role, or better yet, demonstrate their solidarity through their own participation.
1. Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall; 1963.
2. Walton GM, Cohen GL. A brief social-belonging intervention improves academic and health outcomes of minority students. Science. 2011;331(6023):1447-1451.
3. Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367(9509):528-529.
4. Bandstra NF, Camfield CS, Camfield PR. Stigma of epilepsy. Can J Neurol Sci. 2008;35(4):436-440.
5. Scambler G. Reframing stigma: felt and enacted stigma and challenges to the sociology of chronic and disabling conditions. Social Theory Health. 2004;2:29-46.
6. Foxhall K. Migraines were taken more seriously in medieval times: where did we go wrong? Available at: theconversation.com/migraines-were-taken-more-seriously-in-medieval-times-where-did-we-go-wrong-64497. Accessed January 23, 2018.
7. Kempner J. Not Tonight: Migraine and the Politics of Gender and Health. Chicago: University of Chicago Press; 2014.
8. Rao D, Choi SW, Victorson D, et al. Stigma across neurological conditions: the development of the Stigma Scale for Chronic Illness (SSCI). Qual Life Res. 2009;18(5):585-595.
9. Cella D, Lai JS, Nowinski CJ, et al. Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology. Neurology. 2012;78(23):1860-1867.
10. Shapiro RE, Lipton RB, Reiner PB. EHMTI-0313: factors influencing stigma towards persons with migraine. J Headache Pain. 2014;15(Suppl 1):E36.
11. Aydemir N, Ozkara C, Unsal P, Canbeyli R. A comparative study of health related quality of life, psychological well-being, impact of illness and stigma in epilepsy and migraine. Seizure. 2011;20(9):679-685.
12. Lipton RB, Bigal ME, Rush SR, et al. Migraine practice patterns among neurologists. Neurology. 2004;62(11):1926-1931.
13. Buse DC, Scher AI, Dodick DW, et al. Impact of migraine on the family: perspectives of people with migraine and their spouse/domestic partner in the CaMEO study. Mayo Clin Proc. 2016;91(5):596-611.
14. Davidson L. The best excuses for calling in sick, according to your boss. Available at: telegraph.co.uk/business/2016/02/11/the-best-excuses-for-calling-in-sick-according-to-your-boss/. Accessed January 16, 2018.
15. Schwedt TJ, Shapiro RE. Funding of research on headache disorders by the National Institutes of Health. Headache. 2009;49(2):162-169.
16. Kempner J. Gendering the migraine market: do representations of illness matter? Sociologic Sci Med. 2006;63(8):1986-1997.
17. Best RK. Disease politics and medical research funding: three ways advocacy shapes policy. Am Sociologic Rev. 2012;77(5):780-803.
18. Angelmar R, Angelmar S, Kane L. Building strong condition brands. J Med Mktg. 2007;7:341-351.
19. Kempner J. What biology can't do. Headache. 2016;56(6):1047-1052.
20. Young WB. De-stigmatizing migraine: with words. Headache. Epub 2017 Nov 15.
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text:
But governments still have to take into consideration the political, social and economic consequences of what these "lockdowns" are doing.
Have they found the correct balance and would a 0.4% mortality rate warrant such a reaction? Or are they overreacting based on misleading statistics?
But like you say, if you feel like your lungs are full of broken glass, you probably don't give a shit.
Keleth 7,469
People seem overly fixed on the death rate.
The death rate is not why countries have closed down,it`s how virulent the disease is and how many people require hospitalisation.
If we let it run rampant like they were going to do in the UK or like they did in Sweden then the health service gets overrun.You have even now people requiring hospital treatment which they can`t get including ops,imagine what it would have been like if there was no shutdown.
2 hours ago, hellfire99 said:
As someone has already said, "There are lies, damned lies, and statistics."
yes, I think I have posted that here and think its true
But, we need to have something to base our idea's on. eg deciding when we goto locked down, how hard the lockdown should be, which is different in different counties around Europe, we need base our ideas on something as to when we come out of lockdown.
These stats I have argued here, are poor, improved testing will make them more accurate, more usable. The better the data is the better decisions can be made about what to do next.
When I look at the stats in China, its seems hard to believe that the mortality rate is so low, 4.5 % is comparison to 12% in Italy, but there again, China lockdown in a much harder way than many countries have in Europe.
In Italy it spread a lot in hospitals, as the early cases weren't recognised and people were sent to hospital with no precautions. That hurt the health system more than it would have as lots of doctors and nurses were infected, and also meant it spread to lots of people who were already weak and sick.
that's in stark contrast to Germany where it seems the cases are disproportionately young and healthy, having caught it on skiing trips.
1 hour ago, hellfire99 said:
Have they found the correct balance and would a 0.4% mortality rate warrant such a reaction?
It´s a 0,4 letality rate, not mortality (which would include all the population, not just the infected ones) and it might be higher if there had been no lockdown (e. g. because the capacity of the healthcare system might have been overrun). You also have to consider those survivors with permanent impairments.
MikeMelga 5,806
Freimann, Munich
1 hour ago, Keleth said:
Hard to fake deaths. You can also derive (+/-) hospitalization rates from death rates.
CiaraDoran 16
Yes I agree death rates are a good statistic to measure how spread the virus is in a country
Seems like lock downs or social distancing will have to continue into the summer months, theres no indication of the virus slowing down due to warmer weather, if things go back to normal health systems will be over run
alderhill 928
6 minutes ago, MikeMelga said:
Well, that's just the 'art' of it all, isn't it. What do you count as an official corona-death? Different places record it in different ways. if anything, deaths are probably under-reported. So are cases.
I know of two people here (young, healthy, etc) who probably had it, or so they claim. But in both cases their doctors said 'nah' and refused to test them. Extreme coughing fits, fever between 40-41, feeling weak and tired. Actually one case was an old friend and her whole family, including 2 young children, where everyone had the same thing, so make that 5 people that I know.
Krieg 13,520
33 minutes ago, MikeMelga said:
In plenty of countries you can fake whatever, even create fake living people to vote in elections. Anyway, everything you have to do to fake corona-deaths is saying they died of something else and not test them at all.
Lorelei 1,786
EU risks break-up over 'coronabonds' row, warns Italian PM
Conte says divisions between southern states and Dutch-led northern opposition are a make-or-break issue
Italy's prime minister, Giuseppe Conte, has warned of the break-up of the European Union, as unprecedented pressure was piled on northern states to give way and unlock €500bn (£438bn) of economic support for the countries hit hardest by the coronavirus pandemic.
After 16 hours of talks since Tuesday, EU finance ministers will reconvene by videoconference on Thursday afternoon with the financial markets seeking signs of accord and politicians warning of a make-or-break moment for the bloc.
I wonder if this crisis is going to put Brexit completely in the shade. Could it lead to the end of the EU or to a split with only a northern rump surviving?
Space Cowboy 1,368
Meh. The EU in its current form has been in existence for what? 26 years now? It seems like every month since its founding there has been some sort of crisis or kerfluffle that "threatens to destroy the EU." It also seems that most of the saber-rattling over the years has come from Italy.
Same as it ever was.
This is quite puzzling: 'All our ICU patients are in their 50s or younger' . What could explain the difference in the age spectrum (in Germany the average age of people in ICUs is much higher)?
LeonG 13,484
27 minutes ago, jeba said:
That's very interesting. In Iceland, it seems to be only older people who are dying.
arunadasi 7,059
This is interesting.New Zealand seems to have beaten it. https://www.dailymail.co.uk/news/article-8202873/Jacinda-Ardern-declares-victory-coronavirus-lift-strict-lockdown-measures.html
Edited to add: another Zeew Zealand article.
https://www.thesun.ie/news/5301136/new-zealand-beating-coronavirus-lift-lockdown/
They have had one death. ONE DEATH! I alsways thought borders should be closed, quarantine imposed, for people (citizens and residents) entering. Especially on an island.
New Zealand began testing for the virus on January 22, and did not confirm a positive case for over one month later.
What followed was a series of quick and decisive actions as the case figures began to creep up.
On March 14 all new arrivals in the country were ordered into self isolation and cruise ships were banned.
'COMMON SENSE'
And as 32 cases were confirmed on March 18, the borders were sealed for any foreigners and non-residents.
1 hour ago, Space Cowboy said:
This is hardly a "kerfuffle"
2 hours ago, MikeMelga said:
How ?
But the death rates are not the reason for the lockdown,if it was 0% mortality there would still be a lockdown to avoid overwhelming the health service.That`s my whole point in answer to HF99s post he seems to think it`s the mortality rate that causes lockdown.
1 hour ago, oscar 63 said:
Indeed. It's a crisis. That was, in fact, the other word I used.
2 hours ago, Space Cowboy said:
WHS. You used to hear the same thing constantly in 2008/2009: Greece had no choice but to leave, the Euro would collapse and the EU would follow. The same people were claiming a few years later that Brexit would cause all the other members to want to leave and form a new trading arrangement that only involved doing what Britain wants without wanting anything in return. All fantasy of course.
So Trump stopping flights from China albeit too late, the NY cases mostly came from Europe.
New research indicates that the coronavirus began to circulate in the New York area by mid-February, weeks before the first confirmed case, and that travelers brought in the virus mainly from Europe, not Asia.
"The majority is clearly European," said Harm van Bakel, a geneticist at Icahn School of Medicine at Mount Sinai, who co-wrote a study awaiting peer review.
A separate team at NYU Grossman School of Medicine came to strikingly similar conclusions, despite studying a different group of cases. Both teams analyzed genomes from coronaviruses taken from New Yorkers starting in mid-March.
The research revealed a previously hidden spread of the virus that might have been detected if aggressive testing programs had been put in place.
On Jan. 31, President Donald Trump barred foreign nationals from entering the country if they had been in China during the prior two weeks.
It would not be until late February that Italy would begin locking down towns and cities, and March 11 when Trump said he would block travelers from most European countries. But New Yorkers had already been traveling home with the virus.
"People were just oblivious," said Adriana Heguy, a member of the NYU team.


The main ingredient to a stress-free move is in organization. Everything to do with your up-coming move should be combined in a folder or clip board, keeping it all together and making it easily accessible when required. Check-lists are, in our experience, the best way to 'Get Moving!'. You should design your own to suit your specific requirements. The sooner you start eliminating your list, the easier and smoother your move will be.
Advise companies of service disconnections and reconnections: Electricity, Gas, Phone, Pay TV, etc.
Don't forget to change your address details: Driver licenses, Vehicle and Pet Registrations, etc.


text:
India-Pakistan meet on Kartarpur corridor on Thursday
On Wednesday, sources said that the Land Ports Authority of India had identified 50 acres for the Indian side of the corridor, which would be developed in two phases.
Published: 14th March 2019 08:22 AM | Last Updated: 14th March 2019 08:29 AM | A+A A-
By Ramananda Sengupta
Express News Service
NEW DELHI: Indian and Pakistani officials will meet on the Indian side of the Attari-Wagah border on Thursday morning to discuss and finalise the modalities for the Kartarpur Corridor, which would give Indian Sikhs easy access to the shrine ahead of the 550th anniversary of Guru Nanak Dev in November.
India has also proposed that a technical level discussion on the alignment of the corridor be held on the same day on the sidelines of this meeting. This is likely to be followed up by an Indian delegation visiting Islamabad on March 28.
The talks come weeks after the Pulwama massacre and the Indian air strike against terrorist targets in Pakistan, followed by a Pakistani intrusion which led to the downing of an Indian MiG 21 aircraft.
Indian officials reiterated that the talks were in no way a precursor to a formal peace dialogue between the two governments, saying this could only happen once Pakistan took verifiable action against terrorists, including the Jaish-e-Mohammad.
READ MORE | Kartarpur talks related to citizens' emotions, not a resumption of dialogue: MEA
On Wednesday, sources said that the Land Ports Authority of India had identified 50 acres for the Indian side of the corridor, which would be developed in two phases. Phase I, which will be ready before the anniversary, includes a state-of-the-art Green Passenger Terminal Complex with 40 immigration and 12 customs counters capable of processing 5,000 pilgrims per day.
Robust security protocols, including CCTV cameras, will be backed up by the BSF along the border and other security agencies on the Indian side, which will also have a 300 feet high Indian flag. On Wednesday, Pakistan rued the fact that India had not invited Pakistani journalists for the talks at Attari.
For the pilgrims
The entry gate will be shaped like a lotus and have security counters
The fully air-conditioned building can seat 2,000 pilgrim inside
Phase-II will have space for a fire station, hospital and police station
A 300-feet national monumental flag will be set up at the border
Kartarpur Corridor Indian pakistan talks