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Posts Tagged 'Treatment'
Day Two – TB is an Everyday Fight, Let's speak Up
Day two of The Lilly MDR TB Partnership and Aequum Mentorship for TB Advocates was an exciting one. Vibrant discussions were held on the severe need for advocacy in the TB sector. The participants who came in with rich experience and learnings from ground levels on the gaps, the challenges and the problems that TB patients face during their journey from ill-health to good health, were quickly able to identify areas for change. The day also helped them to debate on different forms of communication which would be relevant for each category of patients, and give them accurate information and awareness on diagnosis, treatment and cure. There was special emphasis on the use of communication methods which could be simple for the unlettered to understand. Textless communication, the use of dolls and other methods were discussed. Some photographs:
Photo Credit:Rajeev Biswal
This story showed gender discrimination. Notice the boy on the right, enjoying the joys of childhood while his sister cooks, does household chores and fetches water.
Photo Credit: Dhananjay
The photograph above shows how the participants used dolls and toys available within arm's reach to tell stories of change. This story demonstrated the entire 'cough to cure' pathway of TB. It showed diagnosis, treatment, nutrition and cure.
Photo Credit: Rohit Kumar Lal
The story above shows the 'Swacch Bharat Abhiyaan'. Notice the toilet made of modelling clay on the extreme right, used as a store room for household articles. Also note the little girl defecating in the fields and the health of the family deteriorating and their having to visit doctors.
The participants demonstrated with strength that the means for effective communication is at arm's reach. Creativity, accurate information and commitment is all it takes. The mentees deserve special kudos for this.
Tagged with Communication, cure, Diagnosis, Dolls, TB, Textless Communication, Treatment
Tuberculosis control needs a complete and patient-centric solution
Madhukar Pai, Prashant Yadav and Ravi Anupindi, McGill International TB Centre, Montreal & Stephen M. Ross School of Business, University of Michigan, Ann Arbor
Whether it is mobile phone service or vacation travel, good businesses know that success depends on providing a complete and customer-centric solution. Should patients with tuberculosis not be offered a complete solution that is patient-centered? After all, millions are affected and a large market at the base-of-the-pyramid (BoP) remains unserved.
A complete and patient-centric solution will not only include care that meets the International Standards for Tuberculosis Care, but also be delivered with dignity and compassion, grounded in the reality of patients' lives as they navigate the long pathway from symptoms to cure. Such solution-based innovation requires a systems-thinking approach that must place patients at the center of design strategies, recognize their clinical and psycho-social needs, and be cost-effective.
A patient with drug-resistant tuberculosis in India [Photo credit: Bijoyeta Das (www.bijoyetadas.com)]
Because tuberculosis requires long-term treatment and involves many actors in the value chain, there needs to be an entity which, with appropriate financial support from external agencies, can orchestrate a complete solution that is affordable and locally accessible for patients.
Are tuberculosis patients in high burden countries currently getting such a patient-centric solution? Let us consider India, which accounts for quarter of all tuberculosis cases in the world. Whether patients in India seek care in the public or the private sector, they struggle to get a complete solution.
While the Revised National Tuberculosis Control Programme (RNTCP) has done well to reach scale and provide free diagnosis and treatment for patients with drug-sensitive disease in the public sector, the programme falls short in making sure that all patients get screened for drug-resistance and in ensuring adequate therapy for all patients with multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis. Of the estimated 64,000 cases of MDR-TB in 2012, only 17,373 cases were diagnosed under the RNTCP.
The diagnostic infrastructure in the public sector relies primarily on sputum smear microscopy that cannot detect drug resistance. It is only when patients fail to get better on standard treatment, or have recurrence of tuberculosis, that they get screened for MDR-TB, resulting in morbidity, continued transmission, and movement of patients from the public to the private sector.
Recognizing these problems, the RNTCP is actively scaling-up capacity to diagnose and treat MDR-TB. If adequately funded and successful, these initiatives should improve patient experience in the public sector.
But the stark reality of tuberculosis in India is that 50% of all cases are managed in the private sector, where the quality of tuberculosis care is suboptimal with inaccurate diagnosis, non-standard drug prescriptions, and limited effort to ensure treatment adherence. Also, private practitioners often do not screen for drug-resistance and empirical antibiotic abuse is rampant. All this means drug resistance can emerge or worsen, with poor outcomes. Lastly, out-of-pocket expenditure in the private sector can be catastrophic.
Are there examples of initiatives that address the above systemic problems? Operation ASHA is a non-governmental organization that extends the RNTCP model, and uses public sector diagnostics and drugs, to orchestrate a solution by establishing community-based treatment centers and ensuring adherence using local community providers and partners. It also leverages biometrics to increase efficiency and effectiveness. It relies on donors and the public sector for funding. This social enterprise model, however, does not offer a solution to patients who seek care in the private sector.
World Health Partners (WHP) is a donor-supported social marketing and social franchising model that delivers affordable reproductive and primary care (including tuberculosis) in underserved rural areas, by leveraging local entrepreneurs and informal providers, and by connecting them to the formal sector and specialists via telemedicine.
Initiative for Promoting Affordable, Quality TB tests (IPAQT), a coalition of more than 60 private laboratories, supported by non-profits like the Clinton Health Access Initiative, has increased the availability and affordability of WHO-endorsed tuberculosis tests. Although IPAQT is addressing the problem of suboptimal diagnosis, it does not cover treatment.
RNTCP recently announced "universal access to quality diagnosis and treatment for all tuberculosis patients in the community" as its goal in the new National Strategic Plan. Recognizing the need to leverage the private sector in developing a solution, the plan includes engagement of the private sector using "Public Private Interface Agencies" (PPIA) to enlist, sensitize, incentivize, and monitor diagnosis and treatment by private providers, to provide patient cost offsets such as subsidised diagnostics and free drugs to privately treated patients, and improve case notifications to the RNTCP. Ongoing PPIA pilot projects in Mumbai and Patna should inform policies for refinements and scale-up of this model.
Outside of India, Operation ASHA is now replicating its model in Cambodia. In Bangladesh, BRAC's tuberculosis program with shasthya shebikas has been successful in the public sector. This model is now creating linkages with private providers. In addition, they have created partnerships with garment industry owners in export processing zones that provide factory workers with better access to tuberculosis diagnosis and treatment utilizing BRAC's infrastructure.
With donor support, Interactive Research and Development (IRD) and partners are expanding access to Xpert MTB/RIF (Cepheid Inc, CA), a WHO-endorsed test, in the private sector in Dhaka, Jakarta and Karachi, through mass verbal screening in private clinic waiting rooms, and referrals for computer-aided digital X-ray diagnosis. This model includes management of comorbid conditions such as diabetes and chronic obstructive pulmonary disease, to generate revenue for this social enterprise.
All these models are promising, but the goal of a complete, patient-centric solution is still elusive. Continued innovation in the development of scalable, sustainable and replicable business models to provide such solutions is critical.
To improve accessibility and affordability, many of the models will depend on community workers and coordinators, underscoring the need for well-designed strategies for their recruitment, training, incentivization, and performance management. Information and communications technologies will also be critical for success.
Solution-centric approaches have shown promise in several other BoP contexts, from affordable eye care to artificial limbs. By using product and process innovations, often with community champions, these models have shown that it is possible to serve the BoP market needs effectively and efficiently and with compassion and dignity. Individuals with tuberculosis deserve nothing less.
Note: This blog post is an edited version of a Comment that was published in the Lancet Global Health on 24th March 2014. The Lancet Global Health is an open access journal, and all material is published under Creative Commons licensing, with copyright retained by the authors.
The views are of the authors.
Tagged with diagnostics, MDR TB, Patient-centric, RNTCP, Treatment
Fixing India's TB control policy
Despite having a focused TB control programme for over five decades, India faces the ignominy of having the largest number of TB cases in the world. Non-compliance, confusion and poor implementation of government policies mark the failure of the system, both private and public, in providing quality treatment for TB to those who need it. Who will clean up the mess in the TB sector?
Dusk is falling on a day that has seen intermittent rains. Shanti Hospital in Bagalkot, Karnataka, is teeming with patients, many of who have travelled long distances to reach there. One of these is Mahboob Kushtagi (28). Married recently, he works as a supervisor in a granite company and earns about Rs 4000/- per month. He looks anxious and speaks haltingly; as if afraid that every word he utters will worsen his condition. "My travails began a year ago when I felt a swelling in my neck region which kept getting bigger," he says. "Since then I have been to several doctors and have already spent Rs 20000/- on tests and medicines, not to count the work days I have lost. But I feel no better; in fact the swelling is much bigger now. I have lost weight and feel ill all the time." Pointing to Dr Shafeeullahkhan Inamdar, a chest physician he has been directed to, he says tiredly, "I hope I get relief here. I don't know where else to go for a cure."
Dr Inamdar fills in the details, "His old records indicate that Mahboob was first treated for TB Lymphadenitis based on suspicion alone. The second doctor he went to conducted fine needle aspiration cytology (FNAC) on him. Though the results did not indicate evidence of it, he was again treated for the same condition. After a year he sought the opinion of an ayurvedic doctor who ran some scans and decided it was more prudent to refer him to me. I will do an excision biopsy and treat him based on the diagnosis."
If her weight was the only indication of her age Ratnamala Melnada (53) would be eight years old. She weighs only 28 kgs and is a very sick person. Weakened to the extreme, she mumbles incoherently when asked questions. Her daughter replies on her behalf. Much of her past medical history is not clear; what is clear is that after recovering from an attack of TB more than 20 years ago, Ratnamala often took her old prescription to chemists and used anti-TB drugs to cure herself of normal coughs and colds. She is presently suffering from TB but is not responding to anti-TB medication. Her daughter swallows the lump in her throat and admits that if her mother were to die, she will be all alone in the world.
Mir Saheb (60) lives in an airless, dark, dank, two room tenement. His family of four other members including his one year old granddaughter lives with him. He sells ice cream and has to sometimes cycle 20 kms a day to make a decent living. He has recently been diagnosed with TB and put on the DOTS regimen. His granddaughter is very attached to him and he can be seen holding her and playing with her. But no family member has been counseled on the dangers that he poses to the little child. Nor has the child been put on prophylaxis treatment as recommended by the national TB control programme and in compliance with international standards of TB care.
If there is one thread that links these stories together, it is the failure of the system, both private and public in providing quality treatment for TB to those who need it. There are some tough questions that need immediate answers. Why was it so easy for Ratnamala to buy anti-TB drugs over the counter? Why is Mir Saheb's little granddaughter so vulnerable and unprotected? Will Mahboob finally get the right treatment?
This story was researched from Bangalore, Bagalkot and Badami in Karnataka. It was difficult. While the latter two places at least provided answers, doctors and laboratories in Bangalore refused to take calls from this writer and in cases slammed phones on knowing who was calling.
Despite having a focused TB control programme for over five decades, India faces the ignominy of having the largest number of TB cases (26 per cent of the global total according to the Global TB Report 2013). Drug resistant strains of TB are on the increase and as per the same report India is estimated to have 64000 cases of MDR TB. In the year 2012, two important measures were introduced by the Government of India which could regulate the TB sector – the ban on serological tests for detection of TB and mandatory notification of TB cases being treated in the private sector. Compliance to both is poor, in fact nearly non-existent in the places researched for this story. Additionally, efforts to buy anti-TB drugs over the counter proved easier than buying cough lozenges in all three places. The real life instances quoted above also point to multiple problem areas such as lack of standardised practices, lack of accountability and rampant flouting of rules and norms.
It is a known fact that over 65 per cent of those who need anti-TB treatment in India go to private healthcare facilities. What quality of care do they receive? Dr Kiran Kalburgi who owns Kalburgi Nursing Home, Bagalkot says, "When I initiate a patient on anti-TB treatment, I have no mechanism to track whether s/he has completed the treatment. It is for the patient to complete the course of treatment. I have neither the inclination nor the time to follow-up on his/her progress." Asked if he is not worried that the patient who drops out would be vulnerable to DR TB, he shrugs and is non-committal.
Speaking about the mandatory notification order, Kalburgi says, "I have not received any information about this. Even if I did, I would not be interested in notifying the government if it meant mountains of paperwork." Kalburgi was not alone in his ignorance of the order. Very few doctors this writer spoke to knew about it. Inamdaar gives the situation another perspective, "Doctors in the private sector very commonly treat patients on suspicion alone. How will they notify when they have no evidence that they are treating confirmed cases of TB? Besides I have not seen any efforts by the government to sensitise doctors to the need to notify. The situation calls for much more than government orders (GOs) which remain on paper. It needs stricter enforcement."
Pradeep Mane, Senior Treatment Supervisor, District Hospital, Bagalkot says, "We agree that the efforts to convey information about the mandatory notification have been inadequate. The response however is poor even in the few places we have conveyed the information. Doctors are reluctant to give us details fearing that there will be too much of documentation."
Dr Nalini Krishnan, Director, REACH (Resource Group for Education and Advocacy for Community Health) points out, "We have belatedly put in regulations when the challenge of MDR TB is grave. RNTCP approaches private healthcare providers with a take it or leave it attitude. Notification of cases has to be facilitated with due consideration given to patient identity and confidentiality issues." Krishnan observes that all is not well with the government system too, "We know that there is 17-20 per cent MDR-TB in re-treatment cases within the RNTCP itself which means that patients who have been on DOTS are coming back with drug resistance. This definitely raises questions about the quality of DOTS."
Abhay Kumar, President, Indian Pharmacist Association (IPA) admits, "We know it is not healthy practice to dispense Schedule H drugs across the counter. But pharmacies in India are completely unregulated. We need stricter enforcement of the Drugs and Cosmetics Act. As per a survey we conducted in Mumbai, qualified pharmacists are almost never present in shops. There is almost always only a sales person dispensing drugs. The drug control department must be much more alert to such malpractices."
Dr Gutta Suresh, National Coordinator for TB Control, IMA (Indian Medical Association) says, "Private practitioners are important players in the healthcare sector in India. It is evident that if the public health system was robust, there would be no demand for our services. We have supported mandatory notification, subject to certain conditions like protecting patient confidentiality. While it is early days yet, we know the weaknesses with regard to enforcement in India. The Drugs and Cosmetics Act which is more than 50 years old is yet to be enforced fully. So there are concerns about whether enforcement mechanisms are in place for this. Given the situation we need to be regarded as partners."
So where does the buck stop? Who is to clean up the mess that the TB sector seems to be in? Most obviously the government. Madan Gopal I.A.S, Principal Secretary, Department of Health and Family Welfare, Government of Karnataka however says it a little differently, "The private sector in India is weakly regulated with specific reference to compliance to the quality parameters and adherence to legal provisions. Public interest is required to deal with TB and similar communicable diseases. Professional bodies such as IMA should take a lead in this. Availability of drugs without prescriptions is an issue not only for TB drugs but also other drugs. This calls for responsible business practices by the owners of pharmacies, better consumer awareness and punitive measures against those violating norms."
Authorities from RNTCP, despite several efforts to get responses, remained silent and did not respond at all. While the debate goes on, point and counterpoints are raised, it is important to remember that Mahboob, Mir Saheb and Ratnamala are not 'them'. They are 'us' and deserve better. Whether it takes coming together, punitive measures or any other, it is time now to get our act together. It might already be too late.
This story has been written under the aegis of the International Union Against Tuberculosis and Lung Disease (The Union)'s Media Fellowships for Reporting on TB.
The author can be contacted at bharathiksg@gmail.com
First published in http://issuu.com/indianexpressgroup/docs/pharma_onlinedec-1-15_1-54/45?e=5690019/5841113
Tagged with Diagnosis, Policy, Prevention, Private Healthcare Sector, RNTCP, TB, Treatment


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redpajama_set_name: RedPajamaGithub


Best Vegetable Soup Recipes for Weight Loss!
Weight loss meal plans will always involve the vegetable soup recipes if you really want to speed up the effectiveness of the process. What you take will always dictate if you are going to gain or lose weight! Vegetable diet is actually the kind of diet plan that will never cause someone to gain weight! It's almost impossible to gain weight when all you take is veggies that's why anyone seeking the effective weight loss needs this amazing weight loss meal plans!
A bowl of vegetable soup will actually give rise to the vegetable soup recipes. This vegetable soup is really made out of the variety of vegetable products such as the carrots, tomatoes and also the beans. They are actually professionally designed to give the most delicious and also beneficial product that will actually speed up the weight loss dreams.
Onions, carrots and celeries are then added to the pot after which it's heated for four minutes then garlic is then added.
You will then wait for five minutes then serve while warm!
Remove from heat and then stir in parsley and also the lemon juice.youwill then remove the bay leaf and season them with salt and pepper.
It's now ready and you can actually serve it while hot!
Bay leaves, fresh thyme and a quarter cup of cream or coconut milk.
Add potatoes and garlic, together bay leaves and also the thyme then cook them for 6 to 7minute.
Add the stocks and boil them, reduce the heat and cook until the potatoes are tender.
Remove them from heat and take out the bay leaves then use the immersion blender to make the soup smooth.
They are actually almost ready, just stir them and add the salts if it needs more, then serve while hot.
They are easily prepared and they are even very delicious!
This weight loss meal plan has less side effect since it has no chemicals and its really effective. Some may only have some issues related to the stomach but it's a rare occurrence that has a very small percentage and therefore there's no force for alarm here.
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Best Fruit Smoothie Recipes for Weight Loss!
Best Orange-Vanilla Oatmeal Recipes for Weight Loss!
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Pushkov noted problems with logic in NATO statements about Putin
Senator Alexei Pushkov criticized the statement of Bundestag deputy Michael Roth about "bloc thinking" by Russian President Vladimir Putin.
Earlier, the German politician Michael Roth accused the Russian leader of "bloc thinking" and expressed regret that "Russia does not see a serious player in Europe" in the international arena. The parliamentarian also called on the EU to join the talks between Washington and Moscow on security issues.
"Do Western politicians who condemn 'bloc thinking' and 'spheres of influence' realize that they themselves are representatives of the vast American sphere of influence?" – wrote the Russian senator in his Telegram channel. He added that many European states "belong to the most militarized bloc on the planet" and recalled the conflicts in Yugoslavia, Iraq, Libya and Afghanistan, in which the countries of the North Atlantic Alliance actively participated.
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The words of Western politicians about NATO's non-bloc thinking are refuted by these examples, as well as by the huge military spending, Pushkov stressed. He also pointed out that the central components of the alliance's policy are the gratuitous right to expansion and the desire to ensure US supremacy in the world.
Earlier, the Russian Foreign Ministry of the Russian Federation told about the expectations from the meeting of the Russia-NATO Council. According to the Deputy Minister of the Ministry Alexander Grushko, Russia expects a constructive dialogue, a serious and deep conversation on fundamental security problems in Europe.
The meeting of the Russia-NATO Council will take place in Brussels on January 12. The talks will be held at the headquarters of the North Atlantic Alliance and will last about three hours. The Russian Foreign Ministry stressed that the level of military representatives of the alliance during the negotiations will be an indicator of readiness for dialogue with Moscow.
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Former Malian President Ibrahim Boubacar Keita dies
Larisa Guzeeva became a blonde and changed beyond recognition
Russia will be fed with seafood by the generous Faroe Islands
Beijing orders people entering the city to take two tests for coronavirus
Nearly 150 civilians killed in riots in Almaty
Peskov: Russia will not discuss the deployment of its missiles in Kaliningrad

redpajama_set_name: RedPajamaCommonCrawl


Prompt: For this week's prompt, write about a season of change for your character or you. It can be literal or metaphorical. I am trying to continue what I started here. I apologize in advance for any spelling errors; it was late when I wrote this. Concrit is appreciated!
My time came upon me, and the urge to create life became too strong. It pulsed through my blood in rhythm with my heart, until I could not sleep. I must mate.
There were no other dragons, just me, I thought bitterly. I lay in my cave, despairing, and then remembered a story once told by the clan Seer about the Ritual of Changing. I had only heard the story once, and could barely recall the name of the Ritual, much less the story. Now I had hope.
I searched through what archives I could find, traveled from cave to cave. By day I read the rocks. I could find nothing! Until my eye spotted something gleaming on the side of a lonely spire nearby, I was growing desperate. A forgotten dragon lair, with the bleached bones of a human outside its entrance. The gleaming was a sword and shield. Daylight found me poring over dragon archives that were hidden away deeper in the mountain than I ever knew possible.
It was here that I found the answer, in the ritual magic of the dragons. I carefully copied what I needed on a rock of my own; I did not want to disturb this lonely place by removing the secrets it had held close for so long. I took the sword and shield with me, and dropped them as I flew over a pasture on my way home, reasoning that if I had been able to see their gleam, other humans might also.
I prepared for my own Ritual of Changing. I would be unable to eat while in my temporary form, but I would only be changed for a short time. I gathered the required materials; emeralds, obsidian, the bones of a deceased human, a knife made of silver, a small Aspen tree, a plant called rosemary, and a snow-fed lake.
That night, I moved rocks into a circle next to the lake, and breathed onto the broken bits of Aspen in the center to start a fire. I picked up the rosemary plant and walked in a clock-wise circle three times, chanting the ancient words that were now embedded in my mind. I began to sense the bones of my Ancestors stirring in the earth below me. I then held the rosemary over the fire until it began to smoke, and walked the circle another three times. The circle closed, and suddenly my Ancestors were whispering; they surrounded me. Their power filled me, seeking, but I was determined and therefore unafraid. My chanting never slowed as I placed the human bones in the fire, then the emeralds and obsidian. The Ancestors took up my chant. The fire rose higher in response, and the flames appeared blue, indigo and violet. I picked up the knife, held it with both hands over my head. Then I used the knife and sliced open a vein by inserting the blade between the scales on my arm.
Bleeding heavily, I walked into the fire. The flames seemed to feed on my blood and rose even higher. I could hear my Ancestors screaming. Then the Change began; the sudden pain as my bones began to reform made my back arch as I screamed.
I fell, curling up with the pain, the seething pain, and the flames grew even higher, consuming me. I knew no more for a time. I came to myself with the flames still cradling me, and hurled myself from the fire. I staggered, crawling, and finally was able threw myself into the cool waters. I felt the hiss of the steam upon my body. When it stopped, I rose to the surface, stood on two legs instead of my four, and made my way to the shoreline. My scales were gone, and as I looked down my pale skin gleamed in the moonlight.
I would appear human for the next ten days. Now I could mate, and bear offspring.
Such an interesting story line, loved the twist at the end. Love your descriptions of the heat and flames, so vivid I think I felt warm just reading.
Ooh! Nicely played- the dragon, the changes, the karate chop ending.
My favorite line -Until my eye spotted something gleaming- because it scremaed a change in feeling and story.
Just the get away I needed. Sorry I've been away. Glad to have come back to this--well done!
Oh, very interesting and unexpected. What a great imagination and so descriptive. I like it very much!
I am awestruck!! This is turning out to be such a fabulous story. I love the spell you weaved--deceased human bones, aspen tree, rosemary... the walking of the circle. This is fabulous! I can't wait for the next piece!
Wow! Such a unique and vivid story! I loved this continuation...love the idea behind the transformation and continuation of life. Great job!
I love the care and attention to the ritual, and the dragon's sense of purpose while she acquires the information and materials she needs.
This is a great voice, and a fantastic spin on the dragon-lore genre. I really liked the first one, and I think this one is even stronger.


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text:
Riverside's Citrus State Historic Park has…
Riverside's Citrus State Historic Park has new app so guests can take a 'digital scavenger hunt'
Visitors can see special content such as audio, video, pictures, text and questions on their cellphones
A mobile phone app allows guests at the California Citrus State Historic Park in Riverside to take a "digital scavenger hunt" at the park while accessing information about the park and its features. (File photo by Watchara Phomicinda, The Press-Enterprise/SCNG)
By Penny E. Schwartz | Correspondent
PUBLISHED: September 29, 2019 at 10:00 am | UPDATED: October 3, 2019 at 12:52 pm
A mobile app aimed at enhancing the visitor experience at California Citrus State Historic Park in Riverside is now a permanent fixture.
The location-based tour app, titled Tag Hunt, features a map of the park as well as navigation and multimedia tour guides. Visitors can download the free Android app anywhere, including at the Visitor's Center, or just use it on their browser when they are at the park.
When visitors scan the "tags" on designated wooden posts along the park's two trails, the app will play corresponding tour content, including audio, video, pictures, text, questions, photo challenges or HTML content. iPhone users can access the information if they have QR code readers on their phones or tablets.
"It's basically a digital scavenger hunt that lets visitors explore the park in a different way," said Megan Suster, the park's historian.
Visitors can start the scavenger hunt from any point and continue the experience from there. Videos at each station provide prompts that lead participants to the next clue. The park has been testing the app for two years, but it's now in permanent use, she said. Its use is supported by the Friends of California Citrus Park, a non-profit management corporation.
"We have loaded it with all new designs and content," Suster said, adding that the app can be changed and updated as needed.
It covers such topics as the park's history and shares other information to improve the visitor's experience, she said. New content includes the labor histories of those who worked in the groves, information about citrus greening disease and what visitors can do to prevent the disease's spread.
The app was created by Riverside residents Anders Wistrom and Nathan Westphal. Additional navigation features that aren't required can be downloaded on Android devices and will be available soon for iPhones, Wistrom said.
Here's how the pickers and packers gained respect at Riverside's Citrus State Historic Park
RIVERSIDE: Citrus label collection preserves history
CASSIE MACDUFF: Cheers to a new day at California Citrus State Historic Park
"It provides context for what the park is doing," Wistrom said of the app.
The company TagHunts develops software for schools, organizations and other agencies for public education and outreach, he said. The park app is an abbreviated version of the learning tool TagHunts introduced for the Gavilan Hills Plateau project and Sherman Indian High School in Riverside five years ago. The company is talking with other California state parks and nonprofit groups about similar apps.
Working with the park, developers have learned how visitors use the app and how it can be adjusted to work best for visitors, Wistrom said.
Citrus park hours are 8 a.m. to 7 p.m. Saturday and Sunday and 8 a.m. to 5 p.m. Monday to Friday, from April to September. Hours are 8 a.m. to 5 p.m. daily, from October to March. Visitor Center Hours are 10 a.m. to 4 p.m., Friday to Sunday.
For more information on the app, visit www.taghunts.com.
Penny E. Schwartz


With the conclusion of exams nearing, students will soon have a critical opportunity to reflect on how they can improve. For most students, often this reflection will solely focus on subject matter – specifically what questions were answered right versus incorrect.
Whilst this is important, reflecting on the 'approach' taken to learning, study and exam preparation is arguably of equal importance. After all, improving study quality presents an often overlooked – yet fantastic opportunity for student improvement.
Below, I address the cause and antidote to a normal 'bias' that can easily creep into study habits – 'the illusion of competence'. Hopefully, teachers can share this advice with their students in the ensuing weeks.
The Illusion of Competence: Why we're all susceptible.
Learning takes time and effort. Like with anything that requires effort, we need to fight our natural tendency to conserve energy and take short cuts. It's not that we all have poor character and inherent laziness; we have simply evolved to conserve energy.
"The illusion of competence" occurs when we adopt passive ways of learning such as with reading and highlighting passages of text. We fool ourselves into thinking that we know or have learned something well, when in fact we haven`t. Just because we understand what we're reading, doesn`t mean we have actually acquired knowledge that we can readily apply.
Preventing the illusion of competence requires fully engaging one's brain with study. It involves taking an active approach; wholly understanding and investing in the process of effective learning. The below learning techniques can help ensure that students fully 'know their stuff' and don`t fall victim to the illusion of competence.
Deliberate practice – Whilst it's important to reinforce what is already known, it doesn`t pay dividend to aimlessly rehearse the same material within a given study session. Often students feel inspired to 'hammer' the same content because it feels good to have mastered something, and also because of the belief that it will improve recall. However, 'feeling good' doesn`t directly correlate with improved learning, and 'hammering' the same content in the one session is not the best way to improve memory (it's best to space learning over multiple sessions for improved recall). In short, it's far more effective to spend more time on concepts not understood, as opposed to simply repeating what is already known. As my drum teacher used to say, "you should spend the majority of your practice session trying to play what you can`t"!
Testing Oneself – This can be as simple as putting the book down after reading a chapter and seeing how much can be recalled. Similarly, it could mean working out a maths problem, as opposed to being content with understanding the 'worked out' examples given from the text. After all, knowledge isn`t learned until it can be regurgitated and applied. Making mistakes should be encouraged in this process; they provide valuable feedback for any gaps or misunderstandings, helping to improve knowledge.
Using both 'focussed and diffused' thinking – Learning is often a difficult exercise requiring repeated efforts over time. When used in tandem, 'focussed' and 'diffused' thinking can aid the learning process. 'Focussed' thinking occurs when the working memory is purposefully engaged with thinking, for example, resolving a problem. In contrast, the 'diffused' approach involves a much more passive way of thinking; using the power of the subconscious. This mode of thinking can be useful, for example, when stuck on a problem. Taking 'time out' like a 5 minute day dreaming break, going for a walk, or even 'sleeping on it' can be helpful for solving difficult problems. It's remarkable how often the solution occurs in this mode of thinking! Thus, when used in tandem, both focussed and diffused thinking can be very helpful techniques to help grasp concepts.
Interleaving Study – Instead of practising the same type of maths problems within a given study session, imagine attempting a range of different maths problems within one study session. This is essentially what 'interleaving' study is; mixing up content within one study session. Although understandably a much more difficult way to study, research suggests that performance is improved when study is conducted in this manner. Significantly, 'interleaving' study is said to help the learner really understand when to use a certain approach, as opposed to just how. It is the contextual understanding pertaining to 'why' that is said to make a real difference to learning.
'The Illusion of competence' is a real threat to learning that students will likely encounter. Hopefully this article has provided practical ways to safe-guard against it, and in doing so, improve the quality of learning.
Did you know that helping students improve HOW they study often makes the biggest difference to learning and performance?
Contact us on 1800 462 988 or info@mindscholar.com.au to give your students the ultimate advantage heading into Semester two.


Adopting A Deaf Dog Might Be Right For You If… Adopting a deaf dog can be a powerful and meaningful experience...if you're willing to go "all in". While deaf dogs can (and do!) make wonderful companions and family members, they do have unique training, safety and occasional health needs that . . .
How We Included Large Dogs in Our Destination Wedding Incorporating large dogs in a destination wedding requires some creativity. Here is the solution my husband and I came up with to make sure our entire family- including our two large pit bulls- were represented. With a little creativity, . . .
Empowered Puppy Program: Changing the World One Puppy At A Time! I've learned many things from living with and training deaf puppies, but one of the most meaningful lessons I've learned from my deaf dogs is that, aside from only using positive reinforcement techniques, there is no single right . . .


text:
Officials confirm that a cyberattack took place during the Winter Olympics opening ceremonies
Officials won't say where the attacks originated
By Andrew Liptak / @AndrewLiptak
Photo by XIN LI/Getty Images
Olympic officials have confirmed that a cyber attack took place during the event's opening ceremonies in Pyeongchang, according to Reuters. The organizers say that while television and internet access was affected, it "it had not compromised any critical part of their operations."
According to reports, internet access and Wi-Fi shut down on Friday during the game's opening ceremonies. The website for the games also went down, preventing attendees from printing out tickets. Pyeongchang organizing committee spokesman Sung Baik-you confirmed that an attack took place, but that the issues have since been resolved. He also said that investigators wouldn't reveal the source of the attack.
The games have already come under attack from hackers: Last month, McAfee said that it detected attacks in the months leading up to the games, in the form of malicious e-mails sent to Olympic officials. The company warned that further attacks were likely. Officials have worried about such attacks coming from North Korea amidst political tensions with South Korea, and Russia following the country's ban from the games due to a systematic doping scheme.
More from this stream The 2018 Winter Olympics: all the tech and updates from the world's biggest games in Pyeongchang
Russia was behind the cyberattack during the opening ceremonies for the 2018 Winter Olympics
Robots compete in their own Olympics ski tournament, capture our hearts
The internet can't decide whether it loves or fears the Pyeongchang Olympics' human-faced sacred bird
Intel's Winter Olympics light show featured a record-breaking 1,218 drones


text:
Not recommended under 8, PG to 15 (Moderate coarse language; adult themes)
details of classification and consumer advice lines for Driving Lessons
a review of Driving Lessons completed by the Australian Council on Children and the Media (ACCM) on 7 June 2007.
Children under 8 Not recommended under 8 years. due to coarse language and themes
Children aged 8-15 Parental guidance recommended due to coarse language and adult themes.
Name of movie: Driving Lessons
Classification: M
Consumer advice lines: Moderate coarse language
Seventeen-year-old Ben (Rupert Grint) is the frustrated and repressed child of an Anglican minister and his model Christian wife (Laura Linney). Summer holidays have begun and he has yet again failed his driving test, which he realises is due to the poor teaching skills of mother. Adding to Ben's woes is his mother's expectation that he will help her out in all her church duties (including acting as a tree in her church play production), his growing suspicion that his mother is having an affair with the young church deacon, his parents' strained and tense relationship, and his own inability to communicate with his secret crush, Sarah.
When his mother takes in a vagrant as part of her Christian duty, she asks Ben to get a summer job to help financially with his care in their home. Ben applies for the post of companion to retired actress, Dame Evie (Julie Walters) and, after he gets the job, realises that he has taken on more than he can handle. Evie's exuberant take on life and her 'devil may care' attitude are both a shock and an eye-opening experience for Ben. In Evie, he finds someone who appreciates his poetry and in Ben, Evie finds a good friend.
When Evie decides to go on a camping trip, Ben agrees (under duress and as he points out, without a licence) to drive Evie. Having begun to break the rules and constraints placed on his life by his mother, Ben takes the even bigger step of going on a road trip to Edinburgh for what might be Evie's last performance.
Family breakdown, alcohol dependence
Ben's mother is run down by a car driven by the vagrant man. The actual impact is not shown, but we later see her in hospital attached to IV fluids and with plaster casts on.
In addition to the above-mentioned violent scenes and scary visual images, there are some scenes in this movie that could scare or disturb children under five, including the following:
While in the bath, Ben is shown to be disturbed by his parents fighting and angry voices. He submerges himself under the water to drown out the sounds.
In one scene, Ben finds Evie unconscious on the floor. He tries to rouse her and appears worried. She eventually wakes and urgently tells Ben to take her to the sink. She then promptly vomits. (She has been drinking, as evidenced by many empty bottles around her).
Children in this age group may also be disturbed by the above-mentioned scenes.
Some children in this age group may also be disturbed by the above-mentioned scenes.
Children in this age group are unlikely to be disturbed by anything in this movie
None of concern
Ben gets the courage to read Sarah a poem he has written for her, which contains a reference to her breasts.
In an attempt to provoke Ben, Evie talks loudly on a bus and says that she expects that "he is gay". He angrily denies it.
In Edinburgh, Ben goes out with a publicist, who takes Ben back home with her. She asks whether this is 'his first time'. They kiss and she leads him to her bed, where they kiss again. The next morning, Ben is shown asleep in her bed, shirtless. She enters the room, dressed, and offers him breakfast.
There are many scenes in which Evie is shown drinking wine, and on a number of occasions she is clearly drunk.
Evie also clearly encourages/coerces the underage Ben to drink with her. He is then seen to drink in a number of subsequent scenes. He also goes to a pub and is offered a beer.
Bugger, bloody hell, sodding bastard, fuck, sod off, goody-bloody-two-shoes, shit, poo, tits, arse.
Driving Lessons is a coming of age road movie about an unexpected friendship and living life with no regrets.
Accepting and respecting yourself
Live life with no regrets
Lying, stealing
Breaking the law (driving with no license, drinking underage)
Family breakdown and poor communication.


text:
using namespace muduo;
using namespace muduo::net;

const int Connector::kMaxRetryDelayMs;

Connector::Connector(EventLoop* loop, const InetAddress& serverAddr) :
    loop_(loop), serverAddr_(serverAddr), connect_(false), state_(kDisconnected), retryDelayMs_(
        kInitRetryDelayMs) {
  DLOG(INFO) << "ctor[" << this << "]";
}

Connector::~Connector() {
  DLOG(INFO) << "dtor[" << this << "]";
  assert(!channel_);
}

void Connector::start() {
  connect_ = true;
  loop_->runInLoop(boost::bind(&Connector::startInLoop, this)); // FIXME: unsafe
}

void Connector::startInLoop() {
  loop_->assertInLoopThread();
  assert(state_ == kDisconnected);
  if (connect_) {
    connect();
  }
  else {
    DLOG(INFO) << "do not connect";
  }
}

void Connector::connect() {
  int sockfd = sockets::createNonblockingOrDie();
  int ret = sockets::connect(sockfd, serverAddr_.getSockAddrInet());
  int savedErrno = (ret == 0) ? 0 : errno;
  switch (savedErrno) {
  case 0:
  case EINPROGRESS:
  case EINTR:
  case EISCONN:
    connecting(sockfd);
    break;

  case EAGAIN:
  case EADDRINUSE:
  case EADDRNOTAVAIL:
  case ECONNREFUSED:
  case ENETUNREACH:
    retry(sockfd);
    break;

  case EACCES:
  case EPERM:
  case EAFNOSUPPORT:
  case EALREADY:
  case EBADF:
  case EFAULT:
  case ENOTSOCK:
    SYSLOG(ERROR) << "connect error in Connector::startInLoop " << savedErrno;
    sockets::close(sockfd);
    break;
  default:
    SYSLOG(ERROR) << "Unexpected error in Connector::startInLoop " << savedErrno;
    sockets::close(sockfd);
    // connectErrorCallback_();
    break;
  }
}

void Connector::restart() {
  loop_->assertInLoopThread();
  setState(kDisconnected);
  retryDelayMs_ = kInitRetryDelayMs;
  connect_ = true;
  startInLoop();
}

void Connector::stop() {
  connect_ = false;
  // FIXME: cancel timer
}

void Connector::connecting(int sockfd) {
  setState(kConnecting);
  assert(!channel_);
  channel_.reset(new Channel(loop_, sockfd));
  channel_->setWriteCallback(boost::bind(&Connector::handleWrite, this)); // FIXME: unsafe
  channel_->setErrorCallback(boost::bind(&Connector::handleError, this)); // FIXME: unsafe

  // channel_->tie(shared_from_this()); is not working,
  // as channel_ is not managed by shared_ptr
  channel_->enableWriting();
}

int Connector::removeAndResetChannel() {
  channel_->disableAll();
  loop_->removeChannel(get_pointer(channel_));
  int sockfd = channel_->fd();
  // Can't reset channel_ here, because we are inside Channel::handleEvent
  loop_->queueInLoop(boost::bind(&Connector::resetChannel, this)); // FIXME: unsafe
  return sockfd;
}

void Connector::resetChannel() {
  channel_.reset();
}

void Connector::handleWrite() {
  DLOG(INFO) << "Connector::handleWrite " << state_;

  if (state_ == kConnecting) {
    int sockfd = removeAndResetChannel();
    int err = sockets::getSocketError(sockfd);

    if (err) {
      LOG(WARNING) << "Connector::handleWrite - SO_ERROR = " << err << " " << std::strerror(err);
      retry(sockfd);
    }
    else if (sockets::isSelfConnect(sockfd)) {
      LOG(WARNING) << "Connector::handleWrite - Self connect";
      retry(sockfd);
    }
    else {
      setState(kConnected);
      if (connect_) {
        newConnectionCallback_(sockfd);
      }
      else {
        sockets::close(sockfd);
      }
    }
  }
  else {
    // what happened?
    assert(state_ == kDisconnected);
  }
}

void Connector::handleError() {
  LOG(ERROR) << "Connector::handleError";
  assert(state_ == kConnecting);

  int sockfd = removeAndResetChannel();
  int err = sockets::getSocketError(sockfd);

  LOG(WARNING) << err << " " << std::strerror(err);

  retry(sockfd);
}

void Connector::retry(int sockfd) {
  sockets::close(sockfd);
  setState(kDisconnected);
  if (connect_) {
    LOG(INFO) << "Connector::retry - Retry connecting to " << serverAddr_.toIpPort() << " in "
        << retryDelayMs_ << " milliseconds. ";

    loop_->runAfter(retryDelayMs_ / 1000.0,
        boost::bind(&Connector::startInLoop, shared_from_this()));

    retryDelayMs_ = std::min(retryDelayMs_ * 2, kMaxRetryDelayMs);
  }
  else {
    DLOG(INFO) << "do not connect";
  }
}


text:
Q: Supporting Server Sent Events with Netty HTTP2 implementation I am using Netty 4.1-Beta6 version.
I want to support the use case where the HTTP2 server should be able to push events to the HTTP2 client on an existing connection - this could be an alarm or timer event from the cloud which needs to be propagated to the client.

*

*I am thinking of using 'Server Sent Event' feature - is it possible to do this with HTTP2 in Netty, if so, how? Should I keep a http2 stream open by sending data frames with 'final frame' flag set to false? When I try this, what I observe is that the content gets buffered. The data frame doesn't reach the client as and when I write. I am using the DefaultHttp2Encoder. I tried setting the 'Transfer-Encoding' header to 'chunked' too.

*Related question - does HTTP2 allows bi-directional data frames once the stream is in 'open' state? The idea is that the server should be able ask data from the client and client should be able to respond with the data in the same stream (reversal of client/server role once the stream is established). Is this possible?
Thanks in advance for the help.

A: I played with Netty bit more. Here is what I found for the 2 questions above.

*

*Both the client and server can keep the stream in 'open' state by sending 'endOfStream' as false when they send the header/data frames. In order to avoid the buffering of data on the server side, I had to invoke flowController.writePendingBytes() followed by ChannelHandlerContext.flush()'.

I have uploaded my sample here - https://github.com/skssfo/http2

*Yes, the client and the server can keep the stream open and send data frames independent of each other.

I am playing with Netty for the first time, it is very cool. Nice job Netty team!

redpajama_set_name: RedPajamaStackExchange


A hungry bat finds the mother lode of flying insects between the headlights of two bicycles cruising towards each other through the Herrick Lake Forest Preserve. The bikes are 100 meters apart at the start and one has a speed of 8.0 m/s and the other a speed of 10.0 m/s. The bat has a speed of 20.0 m/s. Assume that the bat flies from the front tire of one bike straight to the front tire of the other bike, then turns around with no delay and heads towards the other bike. This is repeated until both bikes and the bat are at the same place. Determine how far the bat flies during this flying feast.


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text:
Q: how to disable moment.js daylight timezone conversion It is possible to disable the daylight timezone conversion in moment.js?
http://plnkr.co/edit/MjFelt?p=preview
      $scope.obj.date = moment('2016-06-03T04:00:00.000Z');

Basically my application deals with events and dates only, but moment.js converting the daylight savings time is causing issue with dates. Does it have any setting which will disable it across the entire application usage?

A: If you are saying that you want moment to display your date and time (which is UTC, as indicated by the 'Z'), exactly as is, you should use moment.utc:
moment.utc('2016-06-03T04:00:00.000Z').format()
"2016-06-03T04:00:00Z"

When you use the default moment constructor, as you are now, you are telling moment to convert your UTC time to local time, and this is why you are seeing a time difference. For instance, on my local machine (I am currently UTC-5) I get the following:
moment('2016-06-03T04:00:00.000Z').format()
"2016-06-02T23:00:00-05:00"

This question comes up quite a lot, so I wrote this blog post that explains moment's constructor functions and how it converts ISO8601 dates in detail: https://maggiepint.com/2016/05/14/moment-js-shows-the-wrong-date/

A: In my case, I had a problem with timezone changing due to 'daylight saving time'.
I had the next period:
{
    "from": "2020-10-01 00:00:00 +0200",
    "to":"2020-11-01 00:00:00 +0100",
}

And I wanted to get:
{
    "from": "2020-10-01 00:00:00 +0200",
    "to":"2020-11-01 00:00:00 +0200",
}

My solution is to get current (local) timezone and set it to the both date moment:
const currentTzOffset = moment().utcOffset(); // getting current timezone offset

const startToLocalZone = moment(from, yourDateFormat)
    .local() // just checking. not sure if this is necessary
    .utcOffset(currentTzOffset) // put your tz to here
    .format(yourDateFormat);
const endToLocalZone = moment(to, yourDateFormat)
    .local() // just checking. not sure if this is necessary
    .utcOffset(currentTzOffset) // put your tz to here
    .format(yourDateFormat);

console.log(startToLocalZone); // output: "2020-10-01 00:00:00 +0200"
console.log(endToLocalZone); // output: "2020-11-01 00:00:00 +0200"

And dont forget to set your date format instead 'yourDateFormat'

A:

var tz = 'America/Vancouver';           // or whatever your time zone is
var dt = '2022-03-13T07:00:00.101Z';    // or whatever date/time you're working with
var momentVal =  moment.tz(dt,tz)

function isNextDayDST(mObj){
  return mObj.clone().add(1, 'days').isDST();
}

function isTodayDST(mObj) {
  return mObj.clone().isDST();
}

function getDSTHourCompensation(mObj) {
 const todayDST = isTodayDST(mObj.clone());
 const tomorrowDST = isNextDayDST(mObj.clone());

 if(todayDST == false && tomorrowDST == true) {
    return 1
 }
 if(todayDST == true && tomorrowDST == false) {
   return -1
 }
 return 0
}

function removeDST(mObj){
  const hourCompentation = getDSTHourCompensation(mObj);
  return mObj.clone().add(hourCompentation, 'hours');
}

console.log(momentVal.format('YYYY-MM-DD HH:mm'))
console.log(removeDST(momentVal).format('YYYY-MM-DD HH:mm'))

Maybe use the moment lib to compensate for the hours when you want to remove DST for the particular case.


The Men's Club prides itself on responding to may divese Parish needs. The Men's Club provides manpower for the Parish Picnic and the annual Lenten Fish Fry's. We raise money through fundraisers, such as an annual golf outing and our chicken dinners and donate those funds annually to worthy Parish causes, such as the full-time School, the PSR, the Care Service, the Teen Ministry, and Parish beautification projects. The Men's Club plans frequent social events to promote fellowship such as Sports Night, a golf outing, trips to River City Rascal's baseball games and fishing trips. In addition, activities follow every meeting which include cards, horseshoes, darts, bowling, wiffle ball, volleyball, and demolition ball.
The Men's Club meets on the second Monday each month at 7:30 PM in the cafeteria.
We love seeing new faces, so join us. Contact us if you have questions.


text:
Win a R 2000 Woolies Voucher
Chaos at Hong Kong airport, but flights resume on Wed morning
Aug 14, 2019 | by ANA Newswire
Home » News » International News » Chaos at Hong Kong airport, but flights resume on Wed morning
(By Vincent Thian, AP)
HONG KONG (AP) — Flights resumed at Hong Kong's airport Wednesday morning after two days of disruptions marked by outbursts of violence that highlight the hardening positions of pro-democracy protesters and the authorities in the semi-autonomous Chinese city…
About three dozen protesters remained camped in the airport's arrivals area, a day after a mass demonstration and frenzied mob violence forced more than 100 flight cancelations. Additional identification checks were in place, but check-in counters were open and flights appeared to be operating normally.
Protesters spread pamphlets and posters across the floor in a section of the terminal but were not impeding travellers.
A statement from the airport's management said it had obtained "an interim injunction to restrain persons from unlawfully and wilfully obstructing or interfering" with airport operations. It said an area of the airport had been set aside for demonstrations, but no protests would be allowed outside the designated area.
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Protesters continue their sit-in rally at the airport in Hong Kong, Wednesday, Aug. 14, 2019. Flight operations resumed at the airport Wednesday morning after two days of disruptions marked by outbursts of violence highlighting the hardening positions of pro-democracy protesters and the authorities in the Chinese city that's a major international travel hub. (AP Photo/Vincent Thian)
Airport closed on Tuesday afternoon
The airport had closed check-in for remaining flights late Tuesday afternoon as protesters swarmed the terminal and blocked access to immigration for departing passengers. Those cancelations were in addition to 200 flights cancelled on Monday.
The airport disruptions have escalated a summer of demonstrations aimed at what many Hong Kong residents see as an increasing erosion of the freedoms they were promised in 1997 when Communist Party-ruled mainland China took over what had been a British colony.
While Hong Kong's crucial travel industry suffers major losses, the city's reputation as a well-regulated centre for finance is also taking a hit. Some 21 countries and regions have issued travel safety alerts for their citizens traveling to Hong Kong, saying protests have become more violent and unpredictable.
Travellers look at placards and posters placed by protesters at the airport in Hong Kong, Wednesday, Aug. 14, 2019. Flight operations resumed at the airport Wednesday morning after two days of disruptions marked by outbursts of violence highlighting the hardening positions of pro-democracy protesters and the authorities in the Chinese city that's a major international travel hub. (AP Photo/Vincent Thian)
Demonstrators want Hong Kong leader to step down
The demonstrators are demanding Hong Kong leader Carrie Lam step down and scrap proposed legislation under which some suspects could be sent to mainland China, where critics say they could face torture and unfair or politically charged trials.
Lam has rejected calls for dialogue, saying Tuesday the protesters were threatening to push their home into an "abyss."
In a statement Wednesday, the Chinese Cabinet's liaison office in Hong Kong said the protesters had "entirely ruptured legal and moral bottom lines" and would face swift and severe repercussions under Hong Kong's legal system.
"Their behaviour shows extreme contempt for the law, seriously damages Hong Kong's international image and deeply hurts the feelings of the broad masses of their mainland compatriots," the statement said.
Most of the protesters left the airport Tuesday after officers armed with pepper spray and swinging batons tried to enter the terminal, fighting with demonstrators who barricaded entrances with luggage carts. Riot police clashed briefly with the demonstrators, leading to several injuries and prompting at least one officer to draw a handgun on his assailants.
The burst of violence included protesters beating up at least two men they suspected of being undercover Chinese agents. Airport security appeared unable to control the crowd, and paramedics later took both men away. Police have acknowledged using "decoy" officers, and some protesters over the weekend were seen being arrested by men dressed like demonstrators — in black and wearing face masks.
Travellers check in on their flights at the airport in Hong Kong, Wednesday, Aug. 14, 2019. Flight operations resumed at the airport Wednesday morning after two days of disruptions marked by outbursts of violence highlighting the hardening positions of pro-democracy protesters and the authorities in the Chinese city that's a major international travel hub. (AP Photo/Vincent Thian)
Hu Xijin, editor-in-chief of the Global Times, identified one of the men as a journalist at the nationalistic Chinese tabloid.
"Fu Guohao, reporter of GT website is being seized by demonstrators at HK airport," Hu wrote on his Twitter account. "I affirm this man being tied in this video is the reporter himself. He has no other task except for reporting."
Hong Kong police said they arrested five people for unlawful assembly, assaulting police officers and possessing weapons. More than 700 protesters have been arrested in total since early June, mostly men in their 20s and 30s, but also including women, teenagers and septuagenarians.
Earlier this week, the central government in Beijing issued an ominous characterization of the protest movement as something approaching "terrorism" — a label it routinely applies to nonviolent protests of government policies on the environment or in minority regions such as Xinjiang and Tibet.
Policemen pull back after reacting with protesters outside the Airport in Hong Kong, Tuesday, Aug. 13, 2019. Riot police clashed with pro-democracy protesters at Hong Kong's airport late Tuesday night, a chaotic end to a second day of demonstrations that caused mass flight cancellations at the Chinese city's busy transport hub. (AP Photo/Vincent Yu)
Trump told everyone to "be calm and safe"
President Donald Trump tweeted that U.S. intelligence believes that the Chinese government is moving troops to its border with Hong Kong and that, "Everyone should be calm and safe!"
While China has yet to threaten using the army — as it did against pro-democracy protesters in Beijing in 1989 — recent police exercises across Hong Kong's border with mainland China were a sign of its ability to crush the demonstrations, even at the cost to Hong Kong's reputation as a safe haven for business and international exchange.
Images on the internet showed armoured personnel carriers belonging to the People's Armed Police driving in a convoy Monday toward the site of the exercises.
Associated Press video journalist Katie Tam and writer Yanan Wang also contributed to this report.
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text:
'use strict'

/* eslint no-prototype-builtins: off */

const test = require('tap').test
const sleep = require('then-sleep')

const boot = require('..')

test('one level', async (t) => {
  t.plan(14)

  const app = boot()
  let firstLoaded = false
  let secondLoaded = false
  let thirdLoaded = false

  app.use(first)
  app.use(third)

  async function first (s, opts) {
    t.notOk(firstLoaded, 'first is not loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    firstLoaded = true
    s.use(second)
  }

  async function second (s, opts) {
    t.ok(firstLoaded, 'first is loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    secondLoaded = true
  }

  async function third (s, opts) {
    t.ok(firstLoaded, 'first is loaded')
    t.ok(secondLoaded, 'second is loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    thirdLoaded = true
  }

  const readyContext = await app.ready()

  t.equal(app, readyContext)
  t.ok(firstLoaded, 'first is loaded')
  t.ok(secondLoaded, 'second is loaded')
  t.ok(thirdLoaded, 'third is loaded')
  t.pass('booted')
})

test('multiple reentrant plugin loading', async (t) => {
  t.plan(31)

  const app = boot()
  let firstLoaded = false
  let secondLoaded = false
  let thirdLoaded = false
  let fourthLoaded = false
  let fifthLoaded = false

  app.use(first)
  app.use(fifth)

  async function first (s, opts) {
    t.notOk(firstLoaded, 'first is not loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    t.notOk(fourthLoaded, 'fourth is not loaded')
    t.notOk(fifthLoaded, 'fifth is not loaded')
    firstLoaded = true
    s.use(second)
  }

  async function second (s, opts) {
    t.ok(firstLoaded, 'first is loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    t.notOk(fourthLoaded, 'fourth is not loaded')
    t.notOk(fifthLoaded, 'fifth is not loaded')
    secondLoaded = true
    s.use(third)
    await sleep(10)
    s.use(fourth)
  }

  async function third (s, opts) {
    t.ok(firstLoaded, 'first is loaded')
    t.ok(secondLoaded, 'second is loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    t.notOk(fourthLoaded, 'fourth is not loaded')
    t.notOk(fifthLoaded, 'fifth is not loaded')
    thirdLoaded = true
  }

  async function fourth (s, opts) {
    t.ok(firstLoaded, 'first is loaded')
    t.ok(secondLoaded, 'second is loaded')
    t.ok(thirdLoaded, 'third is loaded')
    t.notOk(fourthLoaded, 'fourth is not loaded')
    t.notOk(fifthLoaded, 'fifth is not loaded')
    fourthLoaded = true
  }

  async function fifth (s, opts) {
    t.ok(firstLoaded, 'first is loaded')
    t.ok(secondLoaded, 'second is loaded')
    t.ok(thirdLoaded, 'third is loaded')
    t.ok(fourthLoaded, 'fourth is loaded')
    t.notOk(fifthLoaded, 'fifth is not loaded')
    fifthLoaded = true
  }

  await app.ready()
  t.ok(firstLoaded, 'first is loaded')
  t.ok(secondLoaded, 'second is loaded')
  t.ok(thirdLoaded, 'third is loaded')
  t.ok(fourthLoaded, 'fourth is loaded')
  t.ok(fifthLoaded, 'fifth is loaded')
  t.pass('booted')
})

test('async ready plugin registration (errored)', async (t) => {
  t.plan(1)

  const app = boot()

  app.use(async (server, opts) => {
    await sleep(10)
    throw new Error('kaboom')
  })

  try {
    await app.ready()
    t.fail('we should not be here')
  } catch (err) {
    t.is(err.message, 'kaboom')
  }
})

test('after', async (t) => {
  t.plan(15)

  const app = boot()
  let firstLoaded = false
  let secondLoaded = false
  let thirdLoaded = false

  app.use(first)

  async function first (s, opts) {
    t.notOk(firstLoaded, 'first is not loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    firstLoaded = true
    s.after(second)
    s.after(third)
  }

  async function second (err) {
    t.error(err)
    t.ok(firstLoaded, 'first is loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    await sleep(10)
    secondLoaded = true
  }

  async function third () {
    t.ok(firstLoaded, 'first is loaded')
    t.ok(secondLoaded, 'second is loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    await sleep(10)
    thirdLoaded = true
  }

  const readyContext = await app.ready()

  t.equal(app, readyContext)
  t.ok(firstLoaded, 'first is loaded')
  t.ok(secondLoaded, 'second is loaded')
  t.ok(thirdLoaded, 'third is loaded')
  t.pass('booted')
})

test('after wrapped', async (t) => {
  t.plan(15)

  const app = {}
  boot(app)
  let firstLoaded = false
  let secondLoaded = false
  let thirdLoaded = false

  app.use(first)

  async function first (s, opts) {
    t.notOk(firstLoaded, 'first is not loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    firstLoaded = true
    s.after(second)
    s.after(third)
  }

  async function second (err) {
    t.error(err)
    t.ok(firstLoaded, 'first is loaded')
    t.notOk(secondLoaded, 'second is not loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    await sleep(10)
    secondLoaded = true
  }

  async function third () {
    t.ok(firstLoaded, 'first is loaded')
    t.ok(secondLoaded, 'second is loaded')
    t.notOk(thirdLoaded, 'third is not loaded')
    await sleep(10)
    thirdLoaded = true
  }

  const readyContext = await app.ready()

  t.equal(app, readyContext)
  t.ok(firstLoaded, 'first is loaded')
  t.ok(secondLoaded, 'second is loaded')
  t.ok(thirdLoaded, 'third is loaded')
  t.pass('booted')
})

test('promise plugins', async (t) => {
  t.plan(14)

  const app = boot()
  let firstLoaded = false
  let secondLoaded = false
  let thirdLoaded = false

  app.use(first())
  app.use(third())

  async function first () {
    return async function (s, opts) {
      t.notOk(firstLoaded, 'first is not loaded')
      t.notOk(secondLoaded, 'second is not loaded')
      t.notOk(thirdLoaded, 'third is not loaded')
      firstLoaded = true
      s.use(second())
    }
  }

  async function second () {
    return async function (s, opts) {
      t.ok(firstLoaded, 'first is loaded')
      t.notOk(secondLoaded, 'second is not loaded')
      t.notOk(thirdLoaded, 'third is not loaded')
      secondLoaded = true
    }
  }

  async function third () {
    return async function (s, opts) {
      t.ok(firstLoaded, 'first is loaded')
      t.ok(secondLoaded, 'second is loaded')
      t.notOk(thirdLoaded, 'third is not loaded')
      thirdLoaded = true
    }
  }

  const readyContext = await app.ready()

  t.equal(app, readyContext)
  t.ok(firstLoaded, 'first is loaded')
  t.ok(secondLoaded, 'second is loaded')
  t.ok(thirdLoaded, 'third is loaded')
  t.pass('booted')
})

test('skip override with promise', (t) => {
  t.plan(3)

  const server = { my: 'server' }
  const app = boot(server)

  app.override = function (s, func) {
    t.pass('override called')

    if (func[Symbol.for('skip-override')]) {
      return s
    }
    return Object.create(s)
  }

  app.use(first())

  async function first () {
    async function fn (s, opts) {
      t.equal(s, server)
      t.notOk(server.isPrototypeOf(s))
    }

    fn[Symbol.for('skip-override')] = true

    return fn
  }
})


Dragon capsule that brought supplies to International Space Station splashes down in Pacific Ocean.
Scenic coastal section cut off by collapsed bridge, massive landslide is accessible again.
Solar-powered craft that could one day provide worldwide internet access quietly completes test flight.
Former punter who helped San Francisco 49ers win Super Bowl following 1984 season dies at 61.
Dodgers closer Kenley Jansen blames LA supporters for not turning out All-Star vote for his teammates.


One month before the start of the 2016 Summer Olympics, Brazilian samba super star Thiaguinho and rapper Projota released their music video for the official Olympics 2016 theme song. The anthem, "Alma e Coração" (Soul and Heart) is decidedly not a rehash of '30s jazz standard "Heart and Soul," but instead a lively number praising perseverance, effort and a "new world with good people only." The video features adorable children, who are definitely too young to participate in the actual Olympics, jumping rope, racing, swimming, punching the air and other activities that remind you that you're a slob sitting in front of a computer watching music videos and not living your best life on a track field in Rio. The games begin August 5. Sports!


text:
How to Assess Your Benefit Program Components: A Handy Litmus Test
A common question many of our clients and prospects like to ask is how they can know if their healthcare and benefits program is truly providing value to their employees. It's a great question. There are so many options when creating a benefits bundle, even the best HR managers may not be able to assemble the optimal mix without a little trial and error.
But there are four simple questions you can ask yourself when evaluating benefit components, to help gauge their effectiveness and value:
Question 1: Is the benefit easily accessed and used by employees?
Employer sponsored benefits should be easily accessible without hoops to jump through, waiting periods, applications, review committees and other red tape subtly designed to lower usage rates. Something as simple as a plan that pays for benefits directly, instead of reimbursing employees a few weeks later, can be the difference between a valuable or worthless perk. Low-wage workers in high turnover industries need benefits to help them with healthcare expenses and other insurance products that may make the difference in financial solvency or financial ruin.
Question 2: Is the benefit payroll deducted?
Employers also need to beware that many niche players in the voluntary benefits market offer products that cannot be payroll deducted. Some companies offering these types of benefits make the pitch to implement these plans with auto deductions from employees' credit cards, and that makes it"portable,"another big"benefit"to the employee. This is just another distortion. Going around the payroll provider is typically a sign of razor thin margins and should be a red flag that other inadequacies lay beneath the surface.
Question 3: Is the benefit affordable?
Limited Indemnity(Voluntary)insurance is exempted from ACA mandates for major medical coverage. The things that make ACA compliant plans — no lifetime or annual claims caps, for example — do not apply. This means that voluntary insurance products can be provided at a lower cost and the lower cost can be passed on to the employee. Follow the money. If the benefit is expensive with no clear reason, or if the employee could likely afford the plan's inclusions by saving the premium on their own, then the risk pooling equation is off-kilter and should be questioned.
Question 4: Is the benefit priced at a preferred group rate?
Employers bring group buying power to the table that employees cannot get on their own in the open marketplace. This gives the employer the ability to provide valuable benefits at even more affordable prices for their employees. Many ancillary products like pet insurance, home, auto, identity theft insurance and legal protection are readily available to the consumer online at the same price. Employees who want these coverages are welcome to get them on their own, but an employer adds no value in these cases.
Be sure to ask these hard questions when evaluating benefit options. By choosing flimsy, niche programs, employers are not only reducing value, but they can also seriously undermine HR operations and employee satisfaction.
By: Alan Gilbert
ESC Expands Operation in New Colorado Office
Denver Marks the Seventh ESC Office Location
Essential StaffCARE is proud to announce the opening of our latest office location in Denver, Colorado.
"Colorado is the perfect location for us as we continue to develop ESC's technology footprint," said J. Marshall Dye III, President and CEO of ESC. "Denver is a hub for digital entrepreneurs and we are excited to be a part of this city's
tech-forward business culture."
The new location is helmed by Todd Fenske, VP of Business Development, bringing 16 years of electronic on-boarding experience to the firm. Fenske joins ESC from the company he co-founded in 2004, Efficient Forms LLC. Efficient Forms and their flagship on-boarding platform, Efficient Hire, is an ESC Integrated Partner and recognized as a leading provider of cloud-based software. Todd's extensive experience with electronic on-boarding systems will assist Essential StaffCARE in developing integrations with new technology partnerships.
ESC provides benefit solutions to over 2,400 staffing company clients from offices in seven locations nationwide including Greenville, SC; Charlotte, NC; Jacksonville, FL; Chattanooga, TN; Dallas, TX; Denver, CO and San Diego, CA.
U.S. District Court Rules ACA Unconstitutional; No Immediate Changes for Employers
U.S. District Judge Reed O'Connor for the Northern District of Texas ruled on Friday that the Affordable Care Act (ACA) is unconstitutional, in its entirety.
A final ruling, however, may be months or even years away. It is important to keep in mind that the Individual Mandate is still in effect for 2018 and does not end until January of 2019. Thus, individuals must still have individual health coverage in order to avoid being penalized. The other provisions of the ACA, such as the Employer Mandate, continue unchanged until there is an ultimate determination on this controversial and polarizing law.
White House spokesperson Sarah Sanders has stated that "pending appeals, the law remains in effect." Thus, individuals who recently enrolled in Obamacare insurance programs may (at least for now), be confident that their coverage is unaffected.
The ruling is based on a suit that was filed in February 2018 in the Northern District of Texas.
Friday's ruling calls into question the legality of the ACA, arguing in part, that the law is unconstitutional since Congress has repealed the tax penalties on individuals who do not have health insurance, also known as the Individual Mandate. The Individual Mandate has long been perceived as the heart of the ACA, and many argue that once that feature is declared unconstitutional, the remainder of the ACA must also be deemed unconstitutional. Legal scholars from both parties have questions as to whether certain portions of the ACA can be severed from the whole and still survive. This legal concept is known as 'severability'.
This latest ruling traces a portion of its argument to the U.S. Supreme Court's ruling in 2012 by Chief Justice John Roberts (the GOP swing vote thatupheld the ACA in 2012). That court held that the penalty/tax created for individuals who do not maintain health insurance on themselves is indeed constitutional because Congress does have the power to impose a tax on those without health insurance.
Friday, Plaintiff's Attorney General Ken Paxton argued that, with the elimination of the health insurance requirement, there is no longer a tax, and therefore the law loses its constitutionality. The theme from the 2012 ruling pertaining to the taxing powers of the government carried over to Friday's ruling where Judge Reed O'Connor said that the individual mandate requiring people to have health insurance "can no longer be sustained as an exercise of Congress's tax power." The judge also concluded that this insurance requirement "is essential to and inseverable from the remainder of the ACA."
What are the Chances of an All-Out Toppling of the ACA?
Choosing a winner in this battle royale won't be easy. Many scholars, conservatives and liberals alike, believe that since the authors of the law drafted a severability clause — which holds that killing one part of the law does not necessarily kill the entire law — that it opens the door for this latest ruling to be struck down. Nevertheless, severability clauses will occasionally state that some provisions to the contract or law are so essential to the contract's purpose and the framer's intent, that if they are illegal or unenforceable, the contract will be voided.
The plaintiffs, on the other hand, have been fortunate in getting U.S. Justice O'Connor, historically an Obamacare opponent, on their side. The battlefield has been set with various issues yet to be resolved including: Medicaid expansion, individual and employer mandates, pre-existing conditions, severability, and funding.
The case will likely be appealed to the Fifth Circuit Court of Appeals in New Orleans, LA. From there, most legal experts expect it to be referred to the Supreme Court where Trump nominated Supreme Court Justice, Brett M. Kavanaugh will get his first opportunity to take part in arguably one of the most important cases of the 21st century.
While both sides of the aisle gear up for this battle of the ages, one thing is still certain, the ACA is still the law of the land until further notification.


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text:
Like humans, horses and dogs also suffer from joint problems. Such diseases have a significant impact on an animal's quality of life.
Main causes of animals' joint problems
Problems with joints in both humans and animals are caused in a variety of ways:
Excessive strain on the joints
Inflammatory reactions
Traumatic joint injury
Developmental joint disease
Natural ageing
Excessive joint strain mechanically degrades hyaluronic acid, but in this physiological state it is replenished by the activity of cells present in the cartilage. With age, the ability of these cells to produce hyaluronan and other necessary substances in sufficient amounts gradually wanes.
Degenerative disease and inflammatory reactions have the same impact on cartilage as mechanical overloading – they contribute to the degradation of hyaluronic acid. In much the same way as can be observed when an individual grows older, cartilage damage restricts the ability to form acid substantially, if not completely.
Symptoms of inflammation include:
Increased temperature in the joint area
Cartilage wear and tear
Articular cartilage has an intriguing way of withstanding biomechanical stress. Cartilaginous tissue creates enormous hydroelastic pressure, which maintains its shape while ensuring mechanical resistance. Cartilage works practically like a sponge – under pressure, water is squeezed out of the cartilage; at rest, water is sucked back into the tissue together with a certain amount of the substances contained in the synovial fluid. Besides construction materials for the recovery of the cartilage structure, there are also substances with fat properties, which ultimately makes it possible to achieve the necessary lubrication of the cartilage. This effect is also important for the nutrition of cartilage cells and the removal of waste products because chondrocytes are nourished only by diffusion.
Joint disease and the treatment of arthrosis in dogs
Developmental and degenerative joint disease, occurring in both small and large breeds, is one of the most common causes of limping in dogs. Of the developmental joint diseases, the one we encounter most often is osteochondrosis.
Other very serious diseases include hip dysplasia (HD), elbow dysplasia (ED) and patellar luxation. Arthrosis figures among the major degenerative joint diseases in dogs.
Osteoarthritis in horses
Osteoarthritis is one of the most common reasons for lameness in horses. Osteoarthritis may be caused by an acute injury or, more frequently, by chronic trauma as a result of prolonged excessive physical strain or flawed training methods. Joint trauma leads to inflammation, which usually affects soft tissues such as the synovial membrane (synovitis) and the joint capsule (capsulitis).
The inflammatory process degrades hyaluronic acid in the joint capsule, reducing its quantity and molecular weight. This phenomenon adversely affects the viscoelasticity of joint fluid (which becomes thinner and is no longer able to absorb shocks effectively). The mechanical function of this fluid – it lubricates articular cartilage and facilitates smooth movement – is reduced. The cartilage loses its elasticity, and its surface becomes rough and less resistant to pressure. There is consequent mechanical stress and damage to articular cartilage (irregular grooves are formed on its surface), accompanied by the development of permanent cartilage damage (osteoarthritis). Once damaged in this way, the cartilage is incapable of regeneration. The timely initiation of therapy, however, can alleviate or halt the progression of the disease.
How to tackle animals' joint problems animals?
As the amount of hyaluronic acid in the body decreases with age, the best solution to joint problems is the artificial replenishment of hyaluronic acid in the organism. There are several ways to approach this. In the past, treatment was limited exclusively to injectable drugs containing hyaluronic acid, applied directly into the joint fluid. Later, use of the intravenous drug Bonharen was introduced. Recently, dietary supplement Geloren has also gained a footing. With these products, missing levels of hyaluronic acid can be delivered to the body, or the production of hyaluronic acid by the body can be boosted. This makes it possible to deal with the prevention and treatment of joint problems effectively without stressing the body with unnatural chemicals.
The active ingredients of Geloren joint nutrition belong among the group of substances known as SYSADOA (formerly chondroprotectives), i.e. "symptomatic slow-acting drugs of osteoarthritis". Although certain individuals may experience a relatively rapid onset of action (approximately 14 days), joint problems usually improve only after several weeks of product use. That is why it the administration of Geloren in broader procedures is recommended.
The administration of joint nutrition alone is insufficient if the animal is suffering from infectious arthritis caused by bacteria (Streptococcus, Borrelia) or viruses (herpes, EB), or if its joints are affected due to an autoimmune response of the organism (a response to pathogens, vaccinations and drugs). Joints may also be aggravated by allergies to gluten. With this in mind, in the treatment of joint diseases it is necessary to focus primarily on the originator/cause of the illness. Proper diagnosis by a veterinarian is therefore essential for the successful treatment of animals' joint diseases.
Studies cited:
[1]: Fölsch, U.R., Kochsiek, K., Schmidt, R.F. a kol. (2003). Revmatická onemocnění. In Patologická fyziologie. Grada Publishing a.s., Praha. ISBN: 80-247-0319-X. 425-443
[2]: Jalenti A, Di Rosa M. Hyaluronic acid modulates acute and chronic inflammation. Agent Actions 1994; 43: 44-47.
[3]: Du Souich, P. (2014). Absorption, distribution and mechanism of action of SYSADOAS. Pharmacology & Therapeutics.
[4]: Punzi L et al. The influence od intra-articular hyaluroni c acid on PGE2 and cAMP of synovial fluid. Clin Exp Rheumatol 1989; 7: 247-250.
[5]: Presti D, Scott JE. Hyaluronan medicated protective effec t against cell damage caused by enzymatically produced radica ls vs dependent on hyaluronan molecular mass. Cell Bioden Fu nction 1994; 12: 281-88.
[6]: Craemer P et al. Intra-articular hyaluronic acid in OA of the knee: an investigation of mechanism of action. Oteoarthri tis Cartilage 1994; 2: 1133-1140.