3M is a diversified technology company with a worldwide presence in the following markets: industrial and transportation, consumer and office, display and graphics, electro and communications, health care; and safety, security and protection services. What makes 3M so diverse is its ability to apply its technologies - often in combination - to an endless array of customer needs.
Founded in 1902, 3M operates in more than 60 countries around the world. In 2010, sales reached nearly $27 billion; and 5.4 percent of total sales was reinvested in research, development and related expenditures.
More than 45 core technologies are at the heart of 3M's 55,000 products. Key technologies include adhesives, abrasives, ceramics, microreplication, integrated systems design, light management, nanotechnology, surface modification and nonwoven materials.
Beginning with the introduction of Wetordry™ Abrasives and then masking tape for two-tone paint jobs, 3M has become a global supplier of innovative, value-added solutions to the automotive industry for over 90 years. Hundreds of 3M products are used in the manufacture of vehicles, ranging from consumable products in assembly plant operations, to many others engineered into body, exterior, interior, powertrain and chassis components.
A total of 26 automotive sales and technical service centers, along with over 30 manufacturing facilities, is located around the world wherever vehicles are manufactured. In addition, three automotive research and development centers located in the U.S., Germany and Japan strive to maintain close ties with automotive OEMs and tier suppliers.


text:
Notre-Dame de Grâce (Unsere Liebe Frau von der Gnade) ist eine byzantinische Ikone, die sich seit dem 15. Jahrhundert in Cambrai befindet. Sie stellt Maria mit dem Jesuskind nach dem Bildtypus der Eleusa dar und gehört zu den Ikonen, die der Legende zufolge vom Evangelisten Lukas selbst gemalt wurden.

Beschreibung
Die Ikone, 35,7 × 25,7 cm groß, zeigt, auf Goldgrund, Maria in einem tiefblauen Gewand mit goldenen Bordüren, das als Schleier auch das Haar bedeckt. Der Kopf ist nach links geneigt und schmiegt sich an die Wange des Kindes. Der Knabe, von der Mutter mit beiden Händen gehalten, ist als wirkliches Kleinkind mit proportional etwas zu kleinem Kopf dargestellt. Er ist in ein blassrotes Tuch gehüllt, das den linken Arm und das linke Bein frei lässt, und erwidert die liebevolle Zuwendung der Mutter. Mit der linken Hand fasst er ihren Gewandsaum am Hals, mit der rechten umgreift er ihr Kinn.

Geschichte
Entstehungszeit und -ort des Bildes sind nicht bekannt. Als sicher gilt, dass es aus dem Byzantinischen Reich stammt. Nach Rom kam es vermutlich durch Kardinal Jean de Brogny, der als hochrangiger Amtsträger der Kurie und als Leiter des Konstanzer Konzils viele Verbindungen in den griechischen Osten besaß. Er hinterließ die Ikone seinem Sekretär Fursy du Bruille, Titulardomherr an der Kathedrale von Cambrai, der sie seinerseits 1450 der Kathedrale vermachte. Seitdem war sie in der alten Kathedrale von Cambrai ausgestellt und wurde als Gnadenbild und Wallfahrtsziel hoch verehrt. Auch die Herzöge Philipp der Gute und Karl der Kühne, die Könige Franz I., Ludwig XI., Heinrich IV. und Ludwig XIV. und die Kaiser Maximilian und Karl V. besuchten sie. Noch Fénelon feierte als Erzbischof von Cambrai jeden Samstag an ihrem Altar die heilige Messe.

Die gotische Kathedrale von Cambrai ging in der Französischen Revolution unter. Der wichtigste aus ihr geborgene Schatz war, neben den Gebeinen der Bischöfe, die Marienikone. Nach ihrer Überführung in die zur neuen Kathedrale erhobene ehemalige Abteikirche Saint-Sépulcre – nun Notre-Dame de Grâce genannt – kamen allein am 24. März 1804 100.000 Menschen zusammen, um sie zu ehren. Sie bekam eine aufwendig gestaltete neobarocke Kapelle mit einem Altarschrein, der dem Westwerk der alten Kathedrale nachgebildet ist. Am 14. Mai 1894 wurde sie im Auftrag Papst Leos XIII. feierlich gekrönt.

Notre-Dame de Grâce und Bernadette Soubirous
Auch heute zieht Notre-Dame de Grâce die Aufmerksamkeit von Betern und Touristen auf sich. Das hat nicht zuletzt mit Bernadette Soubirous, der Seherin von Lourdes, zu tun. Sie lehnte seinerzeit die Statue von Joseph-Hugues Fabisch und alle anderen Versuche, die Dame, die ihr in der Grotte erschienen war, bildlich darzustellen, ab. Als man ihr aber Alben mit Mariendarstellungen aus verschiedenen Epochen zeigte mit der Bitte, die ähnlichste zu benennen, soll sie auf eine Abbildung der Ikone von Cambrai gedeutet haben. Diese Episode erzählte André Malraux Pablo Picasso, der sie im Rahmen seiner Überwindung der "illusionistischen" Perspektivmalerei zum Anlass nahm, sich mit dieser und anderen Ikonen näher zu befassen. So erlangte die Geschichte Berühmtheit und wurde auch in Cambrai rezipiert. Der bedeutende katholische Theologe René Laurentin, der sich zeitlebens mit Marienerscheinungen befasste, reduziert sie jedoch auf den verifizierbaren Kern, dass man Bernadette eine Ikone "von der Hand des heiligen Lukas" gezeigt habe und dass sie dieser, womöglich aus frommer Demut, eine gewisse Ähnlichkeit zuerkannt habe. Eine anderthalb Meter große Kopie der Ikone von Cambrai wurde 2002 vom Bischof und 3000 Pilgern aus Cambrai nach Lourdes gebracht und dort in der modernen Anbetungskirche Ste. Bernadette gegenüber der Erscheinungsgrotte aufgestellt. Die Ikone selbst war 2004 Teil einer großen Byzanz-Ausstellung des Metropolitan Museum of Art in New York und wurde im Bericht der New York Times vom 26. März 2004 an erster Stelle erwähnt.

Weblinks
 Informationen der Diözese Cambrai (französisch)
 «Une intrigue des cubistes»: Bernadette Soubirous et Notre-Dame de Grâce, Artikel von Claude Pillet (französisch)

Einzelnachweise

Marienikone
Religion (Cambrai)
Kultur (Cambrai)
Christentum in Frankreich
Bildende Kunst (Frankreich)

redpajama_set_name: RedPajamaWikipedia


Search for your ticket on gopili to see the different companies for your train from London (London England) to Berlin (Germany). The services on board will change depending on the train provider.
The train is a fast and simple solution to travel to Berlin from London. The average train duration between London to Berlin is 11h20m to travel the 579 miles.
The lowest ticket price we've found for the next 30 days is £69.90 one way.
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The chart above illustrates the best prices found over the last six months depending on how much time in advance the ticket is purchased. Purchasing your train from London to Berlin in advance will enable you to pay less for your train.
The cheapest tickets we found were from £45 when purchasing your train 3 months in advance which is 70% cheaper than the best price we found when purchasing your seat on the day you're travelling.
We compare train ticket for all major companies to travel between London and Berlin by train and find the best prices for the coming days. Take a look at the prices of train tickets Berlin to London and find the best deal for your outbound journey.


text:
Al-Qaida Threat Forces U.S. to Issue Travel Alert, Close Embassies
// posted on Friday, August 02, 2013
(CNN) - A State Department travel alert Friday said al-Qaida may launch attacks in the Middle East, North Africa and beyond, as the United States is closing 21 embassies and consulates Sunday as a precaution.
The alert says al-Qaida and affiliated organizations continue to plan terrorist attacks both in the region and beyond, and that they may focus efforts to conduct attacks in the period between now and the end of August. The alert also warns that "terrorists may elect to use a variety of means and weapons and target both official and private interests."
A U.S. official told CNN the embassy closures were because of "more than the usual chatter" about a potential terrorist threat, which was not specific about time and location. It was "directed at American targets overseas," but may not be confined to main diplomatic facilities, the official said.
Read more - http://www.cnn.com/2013/08/02/politics/us-embassies-close/index.html
Preventing crime with new surveillance camera technology
// posted on Tuesday, June 04, 2013
When it comes to preventing and solving crimes, surveillance video is only as good as the person looking at it. But what if the cameras could learn to spot suspicious behavior before a crime is committed?
After the Boston marathon bombings, it was surveillance and other photos that helped catch the two suspects.
Now there's a company that says those same cameras can prevent crimes like that from happening in the first place.
It's a software program tied into existing surveillance cameras and it looks for suspicious or out-of-the-ordinary behavior. Police are then alerted to this suspicious activity.
To watch the full story, click on news clip above from KPRC-TV in Houston.
In one actual surveillance video, captured in an undisclosed location outside of Houston at a train platform, a man put something suspicious under a bench. The camera noticed it and placed a red box around it, alerting authorities.
"We are trying to identify through video feeds what anomalous behavior is occurring," said Ray Cavanagh with software technology company Crescent Guardian. "If it's something out of the ordinary, it warrants a second look and should be responded."
It's not just packages. The software highlights other odd events, like video of a car following a train through a tunnel or where someone left a bag unintended.
In all these cases police or others were notified.
While none of these examples took place in the Houston area, Cavanagh said he has clients in Houston. For security reasons though, he can't disclose specifically what offices or agencies.
"It's not a magic pill in and of itself," said Cavanagh. "The video is out there. We know the video systems exist."
Cavanagh said outfitting an existing camera with this technology could run $5,000.
"Most importantly of all, what's the cost of a human life?" said Cavanagh. "A human life is worth trying to save and so if there are security events that we can prevent, such as some of the events that have occurred recently, it's well worth the price."
Visit KPRC-TV's website to see the original story.
Can An 82-Year-Old Beat Your Security?
// posted on Friday, May 10, 2013
A nun, a house painter and a drifter walk into a nuclear facility… If that sounds like the beginning to a bad joke, that's because it is.
Last July, an 82-year-old nun and two other fellow activists made their way past fences and security sensors on their way into the Y-12 complex, a Nuclear Security Administration facility called the "Fort Knox" of uranium, and spray-painted antiwar slogans on the exterior of a structure for storage of weapons-grade uranium…. spending several hours in the complex without any trouble. Then, on Wednesday, May 8, almost a year later, the three were convicted of interfering with national security and damaging the facility, possibly sending them to jail for 30 years each.
The incident has raised eyebrows and provided a wake-up call to many security professionals across the world. While the three claim they had no malicious intent, it's been reported that prosecutors argued the act was a serious security breach that continues to disrupt operations at the facility. The defending attorneys argued that the three are being made scapegoats for an embarrassing situation. In way, it is frightening to think what could have happened had someone more sinister tried to break in... But perhaps they were too assuming by the "Fort Knox" moniker to even attempt such a feat or think it possible. Whatever the case, this incident provides a prime opportunity to evaluate your own situation.
Is your business a frequent victim of graffiti?
Do people often trespass?
What kind of security are you using and what kind of holes may there be in it?
Physical security, an incredibly important aspect for proper safety, provides a primary buffer against criminal activity. When used in tandem with security technology, such as surveillance cameras, behavioral analytics software and access control, it helps ensure you employ several layers of security so your business doesn't experience a "Y-12" incident.
Not sure where your security's holes may be? Hire a reputable, professional security company to perform a security risk assessment and provide an analysis of your security. In short, theses assessments analyze the threats and vulnerabilities facing an entity while providing guidance on key areas that need to be addressed when developing a comprehensive and effective security plan and suggesting optimal security solutions and measures to reduce the likelihood of a threat developing.
Don't allow your business or organization to become the butt of a bad joke. Make sure your security is ready for anything criminals throws at you... even 82-year-old nuns. Ask about our security assessments today.
For more information on our free security risk assessments or how we can help you increase your security while decreasing your costs, email rcavanagh@cgiprotects.com or call 504.483.7811.
Read more about the Y-12 convictions:
Convicted Y-12 protesters remain jailed while judge mulls legal options, Knox News - http://www.knoxnews.com/news/2013/may/09/convicted-y-12-protesters-remain-jailed-while/
Nun, protesters guilty in nuclear plant break-in, USA Today - http://www.usatoday.com/story/news/nation/2013/05/08/nun-protesters-guilty-nuclear-plant/2145361/
The Prophets of Oak Ridge, Washington Times - http://www.washingtonpost.com/sf/style/2013/04/29/the-prophets-of-oak-ridge/
More details of stunning Y-12 break-in; protesters offered bread to guards, Knox News - http://www.knoxnews.com/news/2012/jul/31/more-details-of-stunning-y-12-break-in-offered/
Cost of intrusion at Y-12 nuke plant by peace activists goes beyond physical damage, Independent Mail - http://www.independentmail.com/news/2013/may/09/cost-intrusion-y-12-nuke-plant-peace-activists-goe/
Did The Boston Explosions Wake Americans Up?
// posted on Wednesday, April 24, 2013
Throughout U.S. history, our nation has rarely experienced the conflict, terrorism, death and destruction seen so often in many other countries. But now that we have once again experienced the horribleness of an attack on the innocent, we evaluate the situation. Patriotic pride and compassion has engulfed the nation, authorities are on high alert and security has tightened. But has it awakened citizens from the unrealistic dream of total reliance upon authorities for their safety?
The Boston tragedy marked the first time since September 11, 2001 that a terrorism-related explosion causing death, injury and destruction had occurred on American soil. While not the magnitude of an event like 9/11, it still shook our country and raised the common, after-event thought: Could we have prevented this? Questions will undoubtedly continue to snowball over the coming weeks until there are complete answers.
Why did Dzhokhar Tsarnaev and Tamerlan Tsarnaev do it?
Did our country become complacent after over a decade of relative quiet?
Why did the government not know about this plot ahead of time?
Security is a challenging, tireless job that requires eternal vigilance. Security professionals across the world face an unending wave of criminals and terrorists looking to exploit any and every loophole or gap in protection. Some bad guys take a high-tech approach while others go basic; meaning the number of potential threats is infinite and methods of attack always changing.
Over time, it's easy for people to become increasingly complacent and let their guard down. It's human nature. Having gone more than a decade since 9/11, many terror plans have been foiled, perhaps lulling the public into a false sense of invincibility and complete reliance upon authorities. But for security to be as effective as possible, everyone must do their part, including citizens being aware of their surroundings and reporting suspicious activity.
As impossible as it may seem, security must always be on, alert and ready. Does that mean security can thwart any and every threat from happening? Only in a perfect world is that possible.
In cases where security is unable to entirely prevent a threat from turning into an incident, the response is the next most critical aspect. A fast, effective response will often reduce the degree of damage and keep a tragedy from morphing into a disaster. In Boston, the authorities responded instantly, doing an excellent job of diverting runners and spectators, attending to the injured, locking down the crime scene and preventing extreme panic.
The most important aspect of security is the help of the public. While the ultimate goal of any security system is to lower response times and increase overall situational awareness, it's important to remember that it merely provides tools to help prevent, reduce and respond to threats — such as smart surveillance cameras equipped with behavioral analytics software that instantly alerts security personnel of anything that seems out of the ordinary.
However, even the most advanced technology needs a human component. That human component not only includes security guards and police forces performing their duties, but private citizens as well. It is the responsibility of every man, woman and child to keep their eyes and ears open for anything unusual and to alert the proper authorities when necessary.
Terrorism has continually reared its ugly head all throughout human history, so it's unlikely we've seen the last of it. If the authorities were armed with thousands of guards and the most advanced security technology at all times, they could still protect the public only so much. While the public is on edge at the moment, time will pass and anxiety will once again ease into complacency.
To better anticipate, thwart and reduce threats, we all must work together and remember to always remain vigilant, not just at times immediately after an incident occurs. To assist and support is our first and last resort of true security. So after evaluating the situation, we now must ask, did what happened in Boston wake Americans up?

redpajama_set_name: RedPajamaCommonCrawl


We've already let slip a few things we've got planned throughout the year to raise money for this worthwhile cause and the first fundraising event for this fantastic charity will take place THIS WEEK on Friday 7th March.
"Wear something purple or orange day" is taking place in every First Call office UK-wide. There is a wide variety of things to choose from, the only rule is it has to be either PURPLE or ORANGE.
It doesn't have to be limited to clothes either – there are some pretty impressive face paint and wig options available out there!
You don't even have to be a member of the FCCS team to take part. If you're visiting one of our offices on Friday, why not get in the spirit and join in! We'd love to see some candidates turn up in their orange and /or purple outfits!
Taking part couldn't be easier, all you need to do is donate at least £5.00 to EACH via our virgin money donation page. To donate please click HERE!
This is going to be a fun event so please take plenty of pictures on the day. If you send them to dan.mankelow@firstcallcontractservices.co.uk we'll make you global superstars by uploading them to the website and our social media networks.
Many thanks for your support in advance and we look forward to seeing the variety of outfits on Friday!


text:
Group-Based Trajectory Models to Identify Sociodemographic and Clinical Predictors of Adherence Patterns to Statin Therapy Among Older Adults
June/July 2019 Vol 12, No 4 - Clinical, Original Research
Aisha Vadhariya, PhD Candidate; Marc L. Fleming, PhD, MPH, RPh; Michael L. Johnson, PhD; E. James Essien, MD, DrPH; Omar Serna, PharmD, BCACP; Tara Esse, PharmD, BCACP; Jeannie Choi, PharmD; Susan H. Boklage, MS, MPH; Susan M. Abughosh, PhD
Ms Vadhariya is a PhD Candidate, Dr Johnson is Associate Professor, and Dr Essien is Professor, all at the Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, TX; Dr Fleming is Associate Professor, University of North Texas System College of Pharmacy, Houston; Dr Serna is Clinical Operations Director and Dr Esse is Clinical Program Manager at CareAllies, Houston; Dr Choi is Former Director, Health Economics and Value Assessment, Sanofi; Ms Boklage is Director, HEOR, Regeneron Pharmaceuticals, Tarrytown, NY; Dr Abughosh is Associate Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy.
Download Appendix/Supplemental Material
BACKGROUND: The benefits of statins in the prevention of primary and secondary atherosclerotic cardiovascular (CV) disease events have been well documented. Suboptimal adherence is a persistent problem associated with increased CV events and increased healthcare utilization. Proportion of days covered (PDC) is widely used to measure medication adherence, and provides a single value that does not adequately depict different adherence behavior patterns. Group-based trajectory modeling has been used to identify adherence patterns (or trajectories) over time. The identification of characteristics unique to each pattern can help in the early identification of patients who are likely to be poor adherents and can inform the development of interventions.
OBJECTIVES: To identify distinct trajectories of statin adherence in patients enrolled in a Medicare Advantage plan and the sociodemographic and clinical predictors associated with each trajectory.
METHODS: Patients were included in the study if they were continuously enrolled in a Medicare Advantage plan between 2013 and 2016 and had a statin prescription between January 2015 and June 2015. We observed each patient for 360 days and computed the monthly PDC. The monthly PDC was incorporated into a group-based trajectory model to provide distinct patterns of adherence. Using group-based trajectory modeling, the patients were categorized into groups based on their adherence patterns. Multinomial logistic regression was performed to identify the sociodemographic and clinical factors associated with each group.
RESULTS: A total of 7850 patients were included in the analysis and were categorized into 4 distinct groups based on statin adherence—rapid discontinuation (7.8%), gradual decline (16.8%), gaps in adherence (17.2%), and high or nearly perfect adherence (58.2%). Significant predictors of being placed into one or more of the low-adherence trajectories compared with the high-adherence trajectory included sex, age, low-income subsidy, language, Charlson Comorbidity Index score, statin intensity, and 90-day refills.
CONCLUSIONS: The predictors identified in this study provide valuable insight into patient characteristics that increase the risk for statin nonadherence, which has the potential to inform targeted interventions. Identifying patient trajectories can inform the future development of protocols to individualize appropriate interventions for these patients.
Key Words: adherence, cardiovascular disease, elderly patients, nonadherence, predictors of statin adherence, statin therapy, trajectory modeling
Am Health Drug Benefits.
2019;12(4):202-211
Manuscript received July 23, 2018
Accepted in final form February 19, 2019
Disclosures are at end of text
Medication adherence is defined as the extent to which a patient's medication-taking behavior corresponds with the agreed recommendations from the healthcare provider.1 The medical literature reports varying levels of medication adherence among patients, which ranges widely from 20% to more than 90%, depending on factors such as disease type, duration of adherence measurement, medication regimen complexity, and patient age.2-9 Poor medication adherence has been shown to result in suboptimal outcomes, including disease progression, increased costs, and subpar benefit from medications, which can result in long-term complications.2-9 In the United States, 33% to 69% of all medication-related hospital admissions can be attributed to poor medication adherence, resulting in an estimated cost of $100 billion annually.5 Given the impact of nonadherence on healthcare outcomes and costs, coupled with an increasing prevalence of chronic diseases, an understanding of the patient characteristics that increase the risk for medication nonadherence has major public health implications.10
Cardiovascular disease (CVD) is the leading cause of death in the United States and increases the disease burden, especially in adults aged >65 years.11,12 Of the 85.6 million American adults who were estimated to have CVD between 2009 and 2012, 43.7 million were estimated to be aged ≥60 years.13 However, because of high medication complexity, multiple illnesses, and an increased risk for side effects and cognitive decline in older adults, adherence is a specific concern in this population.8,14
Statins are the most frequently prescribed lipid-lowering agents, with extensive clinical trial data demonstrating their benefits in the primary prevention of CVD, lowering the rate of subsequent events in secondary prevention and in the reduction of cardiovascular mortality.15-17 The benefits of statins in reducing mortality and cardiovascular events are also seen in older adults.18
Despite the known benefits of statin therapy, studies report high discontinuation rates for these drugs, with approximately 50% of patients discontinuing statin treatment within 1 year and more patients doing so over time.19-22 The most frequently reported reasons for poor adherence to or discontinuation of statin treatment include adverse effects, the perception that treatment is unnecessary, and cost-related factors.23
The medication proportion of days covered (PDC) is often used as a measure of patient adherence to therapy, and the relationship between PDC for statins and clinical outcomes has been clearly demonstrated using administrative claims data.24,25 PDC is calculated based on pharmacy claims and is reported as a single value over a predetermined period, which results in the same PDC values for patients with variable medication adherence patterns.25,26
Medication adherence is a complex behavior of patient's beliefs, illness, and other environmental factors. Consequently, dichotomizing patients' behavior as adherent versus nonadherent can result in loss of valuable information that can aid and inform the development of interventions. Variations in the patterns (or trajectories) of patient adherence can influence patient prognosis and should be considered when designing medication adherence interventions.25,26
Group-based trajectory modeling has been used as an alternative to map medication adherence over time using administrative data, given that this type of modeling identifies longitudinal trajectories of adherence patterns over a period of time.25,26 This method entails identifying groups of patients with similar medication adherence patterns over time using pharmacy refill data and can help to depict the longitudinal adherence behavior. Patients within each trajectory have a similar adherence pattern and therefore may have similar characteristics.
In 2014, 15% of the US population was aged ≥65 years, which demonstrates an increasing prevalence of older adults over time.27 As a result of increased medication complexity and multiple comorbidities, older adults (age >65 years) may have a higher risk for medication nonadherence.28 The objectives of this study were to identify the trajectories of adherence to statins over a 1-year period among patients enrolled in a Medicare Advantage plan and the clinical and sociodemographic predictors of falling into each trajectory. The 4 trajectories identified in this study will be utilized to customize a motivational interview-based intervention, in collaboration with a Medicare Advantage plan, to improve medication adherence.
This retrospective cohort study was based on data from members enrolled in a Texas-based Medicare Advantage plan. This particular data source was chosen given that patients who are enrolled in the Medicare Advantage plan are predominantly adults aged >65 years and are at high risk for CVD, as well as the potential to follow them prospectively for future development of an intervention. The study population consisted of members who were continuously enrolled in the Medicare Advantage plan between January 2013 and June 2016.
The data contained membership and demographic information, as well as medical and pharmacy claims for all the patients. The medical claims include information on all inpatient and outpatient claims, as well as on diagnoses and on procedures. The pharmacy files used included patient and drug identification information, prescription fill dates, days of supply, quantity dispensed, and dosing information.
All medical and pharmacy claims were available for the enrolled patients between January 2013 and June 2016. The patient identification period was from January 2015 to June 2015, so that all patients had at least 1 year of follow-up data available for the measurement of statin adherence. The first statin prescription in the identification period was defined as the index prescription, and the date of the prescription was defined as the index date. The baseline characteristics and comorbidities were identified in the 2-year period before the index date (ie, the preindex period). A 2-year preindex period was used to best capture the chronic comorbidities. Each patient was followed for 1 year after the index date.
Inclusion and Exclusion Criteria
Patients who had continuous enrollment in the health plan between January 2013 and June 2016 and had a statin prescription in the patient identification period were included. Patients with conditions that are symptoms of poor statin tolerance, including liver disease, myalgia, or skeletal muscle diseases diagnosis, in the 2-year preindex period were excluded, because poor statin tolerance could lead to treatment discontinuation or could affect adherence in the follow-up period.29,30 Given that these patients were at high risk for intolerance, it is unlikely that their adherence could be enhanced through motivational interviewing interventions. Patients who are receiving a combination of drugs, which includes a statin as an index prescription, were also excluded to ensure that adherence to a statin was not confounded by the patient adherence to any other medication.30 Being diagnosed with dementia in the same time frame was also an exclusion criterion, because dementia-related cognitive impairment can lead to nonadherence and to involvement of caregivers' support.31 Finally, patients with statin intolerance, defined as a diagnosis of myopathy during the follow-up period, were also excluded.30
Adherence Measurement
Medication adherence was measured for 360 days after the index date using pharmacy claims. PDC was used to measure adherence and was also calculated separately for each 30-day period after the index date. During each of the 12 consecutive 30-day assessments, the PDC was dichotomized, with a PDC of ≥0.8 considered adherent based on the threshold, which has been widely used in the literature and by the Centers for Medicare & Medicaid Services (CMS) quality measures.32,33
The 12 dichotomized monthly indicators of statin adherence were then used in a logistic group-based trajectory model. The trajectory model uses several multinomial logistic regression equations simultaneously, estimating the probability of membership in each group and the probability of being adherent as a function of time. The model used between 1 and 5 adherence groups, using second-order polynomials of time to estimate the probability of being adherent. Based on the Bayesian information criterion, as well as the clinical relevance of the identified trajectories, one model was selected for further evaluation for the predictors of falling into each trajectory.25,26
The effect of the addition of groups on the Bayesian information criterion value was assessed incrementally. The logarithm of twice the difference in Bayesian information criterion values between the complex model (with more groups) and the simpler model (with fewer groups) was assessed stepwise. If the value of the logarithm of difference was more than 2, the more complex model was concluded to have greater prediction power than the simpler model.34
Predictors of Adherence Trajectory
After a set of adherence trajectory patterns was selected, the predictors associated with falling into a particular adherence trajectory group were estimated by using multinomial logistic regression, with the distinct trajectory groups used as the dependent variable. The trajectory group with consistent monthly adherence to statins (ie, the adherent group) was considered as the reference to which other groups were compared.
The independent variables included sociodemographic and clinical variables. The demographic variables were sex, age (<65, 65-70, 71-75, or >75 years), language (English vs other), and subsidy level (low-income subsidy vs no subsidy). The prescribing physician specialty was grouped as primary care versus specialist.
The variables for statin utilization included statin type, intensity, days supply of the index refill (90 days vs other), statin use for primary versus secondary prevention, and prevalent use of statins. Statin type was categorized as lipophilic (atorvastatin, simvastatin, and lovastatin) or hydrophilic (pravastatin, rosuvastatin, and fluvastatin). Statin intensity was categorized as low, moderate, or high based on major guidelines.35 Statin use was considered to be secondary prevention if the patient had a diagnosis of acute coronary syndrome, ischemic stroke, peripheral vascular disease, coronary artery disease, myocardial infarction, angina, or a revascularization procedure in the 2-year period before index date.36 A patient was considered a prevalent user of statin therapy if the patient had a prescription for statin(s) in the 6 months before the index date.
The comorbidities that were controlled for included diabetes, hypertension, HIV, congestive heart failure, as well as the number of hospitalizations in the past year. To further control for the illness severity in the cohort, the CMS risk score and Deyo's Charlson Comorbidity Index (CCI) were evaluated. The CCI is constructed based on International Classification of Diseases, Ninth Revision, Clinical Modification codes and assigns weights to major clinical conditions, which can be obtained from medical claims data.37,38 The CMS risk score accounts for medication burden and disease severity and is calculated based on data taken from a large pool of beneficiaries to estimate the average predicted costs for each of the component factors (eg, age, sex, low-income status, individual disease groups).39
All statistical analyses were performed using SAS version 9.3 (SAS Institute Inc; Cary, NC) at an a priori significance level of 0.05.
The data contained 10,409 continuously enrolled patients with a statin prescription in the identification period (ie, the index statin). The final cohort after exclusions comprised 7850 patients (Figure 1). The baseline characteristics of the cohort are presented in Table 1. The patients' mean age was 71 years, approximately 55% were female, and approximately 66% were receiving moderate-intensity statins at the index date.
Adherence Trajectories
The models' graphs with 1 to 5 adherence groups are available in the Appendix Figure and the Bayesian information criterion for each of the models is presented in Table 2. Based on the Bayesian information criterion and the expected patterns from real-world practice and literature, the model with 4 adherence groups was used for further analysis to identify predictors of adherence.
When 4 adherence trajectories were considered, the groups, as shown from bottom to top in Figure 2, included Group 1, which had rapid decline or discontinuation (7.8%); Group 2, which had a gradual decline over time (16.8%); Group 3, which had gaps in adherence that improved over time (17.3%); and Group 4, which had nearly perfect adherence (58.2%). The mean PDC across each adherence group is shown in Table 1. The 4 groups had significantly different mean PDCs over the follow-up period.
Multinomial Regression
The baseline characteristics of the patients in each trajectory are shown in Table 1. There were significant differences in the demographic characteristics of patients across the 4 trajectories. A greater proportion of women were in the lower-adherence trajectories than in the perfect-adherence trajectory. The rapid-decline group had the highest percentage of patients who were new statin users compared with the other trajectories. Fewer patients who had comorbidities than those without comorbidities, including diabetes, hypertension, and hyperlipidemia, were included in the rapid-decline group.
The covariates significantly associated with each trajectory are shown in Table 3. Physician specialty, statin type, the presence of diabetes, hypertension, HIV, congestive heart failure, hyperlipidemia, and the frequency of hospitalization were not associated with being placed into any trajectory compared with the perfect-adherence group.
Women were more likely to be placed into all 3 lower-adherence trajectories than into the perfect-adherence group (rapid decline, adjusted odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6; gradual decline, OR, 1.2; 95% CI, 1.0-1.3; gaps in adherence, OR, 1.1; 95% CI, 1.0-1.3). Prevalent users of statin medications were less likely than incident users to be placed into any of the lower-adherence trajectories (rapid decline, OR, 0.08; 95% CI, 0.07-0.11; gradual decline, OR, 0.37; 95% CI, 0.31-0.43; gaps in adherence, OR, 0.25; 95% CI, 0.21-0.29).
Older patients (age 71-75 years vs <65 years) were less likely to be included in the lower-adherence trajectories, particularly the rapid-decline and gaps-in-adherence groups, than the perfect-adherence group (rapid decline, OR, 0.7; 95% CI, 0.5-0.9; gaps in adherence, OR, 0.8; 95% CI, 0.7-1.0). Having a primary language other than English was associated with greater odds of being classed into the gradual-decline and gaps-in-adherence trajectories than in the perfect-adherence trajectory (gradual decline, OR, 1.3; 95% CI, 1.1-1.5; gaps in adherence, OR, 1.4; 95% CI, 1.2-1.6).
Patients who had a low-income subsidy were more likely to be in the gradual-decline trajectory (OR, 1.2; 95% CI, 1.1-1.4). Patients who were receiving moderate- or high-intensity statins versus low-intensity statins were more likely to be in the gaps-in-adherence group (moderate vs low, OR, 1.3; 95% CI, 1.0-1.5; high vs low, OR, 1.6; 95% CI, 1.3-2.0). Patients with a higher CCI score were less likely to be in the gaps-in-adherence group (OR, 0.9; 95% CI, 0.8-1.0).
This study followed patients from a Medicare Advantage plan over 1 year to identify groups with distinct patterns of adherence to statins. Up to 5 trajectory groups were tested, but 4 trajectories of adherence were eventually used to further identify the predictors of placing into each group. Several sociodemographic and patient factors were found to be predictors of being placed into each of the trajectories, most of which align closely with the existing literature.
Franklin and colleagues have identified patterns of adherence to statins using group-based trajectory modeling, but these studies included 6 groups for further outcome evaluation.25,26 The results of the trajectory modeling performed in our study align with those by Franklin and colleagues.
We took several factors into consideration to decide on using 4 adherence trajectory groups for further analysis. First, the rapid-decline group comprises 7.8% of the sample when the number of trajectories are limited to 4. When limiting the number to 5 trajectories, the rapid-decline group was further split into 2 smaller groups. On testing 6 groups, the perfect-adherence group was split into 2 smaller groups comprised of patients who were completely adherent and those who had nearly perfect adherence. These additional groups were comprised of very small percentages of the sample. Second, although further addition of groups beyond 4 led to significant decreases in Bayesian information criterion, the newer 2 groups were largely similar to the existing groups when considering the development and implementation of differentiated interventions.
Of the 7850 patients who were included in our sample, 57.5% placed into the high-adherence trajectory (ie, these patients consistently had a higher PDC during follow‑up). A previous study showed that adherence to statins in elderly patients decreased over time after the initiation and proportion of nonadherent patients increased in a log-linear manner.8 This emphasizes the need to look at adherence as it varies over time rather than at a mean PDC value. Although the lower-adherence trajectories in our study also had lower mean PDCs, the pattern of each trajectory can identify possible barriers to adherence that are common within a particular trajectory, which will be critical for the development of interventions.
The significant predictors of placing into a certain adherence trajectory included sex, age, low-income subsidy, language, CCI, statin intensity, and 90-day refill. Because each group had a distinct adherence trajectory pattern, these predictors are more informative at understanding adherence than would be possible if patients were categorized based solely on mean PDC.
The results from the multinomial logistic regression suggest that women were more likely to be nonadherent to statins than men. This aligns with evidence from current research, which has repeatedly identified that women are less adherent to statins than men.40 Because our study included patients from a Medicare Advantage plan population, the mean age of women was >55 years, and they were therefore likely postmenopausal and at an increased risk for CVD.41 A review by Goldstein and colleagues summarized the sex-specific factors that contribute to nonadherence in women, some of which included a lack of provider awareness of CVD risk among women, an increased risk for side effects, and competing demands, such as family responsibilities.42 Therefore, tailored patient and provider interventions designed to increase awareness and address sex-specific barriers to adherence can be beneficial.
Of the age categories in our model, the age-group of 71 to 75 years had significantly greater odds of being placed in the adherent trajectory versus patients aged <65 years. A meta-analysis by Mann and colleagues showed a U-shaped association of age and adherence; the oldest (≥70 years) and youngest (<50 years) patients had lower adherence than the middle-aged (50-69 years) patients.20 Increasing age has been found to be associated with lower adherence in studies with mean ages >65 years.43 The decline in adherence in patients aged >75 years could be mediated by reasons such as cognitive changes, increased medication regimen complexity with age, and increased risk for side effects.44
Socioeconomic status and higher copayments have been associated with lower adherence.40,45 Aarnio and colleagues used group-based trajectory modeling to analyze the effect of socioeconomic inequalities on statin adherence, and showed that low socioeconomic position was a predictor of placing into poor-adherence trajectories.45 Our study results indicate that having low-income subsidy was associated with greater odds of placing into the gradual-decline group than into the perfect-adherence group, but no relationship was found for the other categories. The health plan used in this study has multiple statins in different tiers on its formulary, some of which carry little or no copay. Thus, it is less likely that the cost of statins alone, rather than the overall cost of healthcare, could be affecting statin adherence. More education and awareness regarding the importance of statins in this subgroup may emphasize the need to maintain adherence.
Receiving a moderate- or high-intensity index statin was associated with placing into the gaps-in-adherence group versus the perfect-adherence group. The guidelines recommend moderate- or high-intensity statins for the primary prevention of CVD in patients aged 40 to 75 years with ≥1 risk factors.35 Approximately 83% of the sample included in the analysis was receiving moderate- or high-intensity statins. In the elderly population, statin-related side effects may occur more often46; therefore, these patients may have lower adherence, which may improve by switching to a better-tolerated, lower-intensity statin.47 Although studies have shown that higher-intensity statins have greater effectiveness in reducing cardiovascular events,48,49 they have also been associated with modest reductions in adherence compared with lower-intensity statins.50
Studies have shown positive and negative effects of the number, severity, and type of comorbidities on adherence to medications.40,51,52 Our study did not show an association between adherence and the adjusted comorbidities, which have been known to be associated with adherence in the literature.40,51 However, patients with a higher CCI score were associated with lower odds of placing into the gaps-in-adherence group compared with the high-adherence group, which indicates that increased disease severity is associated with lower gaps in adherence. Prevalent users of statins were more likely to be adherent than new initiators of statin therapy.
Patients with a 90-day refill were more likely to be placed into the perfect-adherence group than into the rapid-decline or gaps-in-adherence groups. These results indicate that having a 3-month refill improves the overall 1-year adherence, but this may be artificial, because a single refill in the database indicates that the patient is adherent for 90 days.
We evaluated mail order as a part of the multinomial logistic model; however, only 64 (0.8%) patients had mail order pharmacy, and therefore, it was not added into the final model. In the model without mail order pharmacy, the patient age-group of 71 to 75 years was more likely to place into the perfect-adherence group than the gaps-in-adherence trajectory group, which was not observed when mail order was in the logistic model. Future studies with larger patient samples that use mail order are needed to investigate the effects of mail order on adherence in varying age-groups.
This study has some limitations. The generalizability of the study findings may be limited to similar subpopulations. This study focused on older adults who were enrolled in a Texas-based Medicare Advantage plan.
The identified factors that affected adherence in this study may not be the same for younger patients or for patients residing in different geographic regions.
All the covariates that were analyzed as potential predictors of adherence trajectories were measured at baseline and were assumed to remain constant throughout the follow-up period. The follow-up period for adherence was limited to 1 year.
Using pharmacy claims to measure adherence does not capture the actual patient behavior of taking medications; however, it has been shown to be correlated with other adherence measures and clinical outcomes.5,25
The reasons for nonadherence to statins in our study could not be ascertained, because we used retrospective claims data for analysis. Future studies should evaluate other patient populations and should follow patient adherence for longer periods of time.
Extensive literature is available about the effectiveness of statins, as well as the inadequate adherence leading to suboptimal outcomes. Enhancing adherence is an integral step for improving outcomes, which result in an overall reduction in health services utilization. Adherence to chronic medications is a quality measure implemented by CMS to evaluate the health plan performance that is a constant concern for providers. The findings of this study provide valuable information that can be used by healthcare providers and by payers to improve statin adherence.
With group-based trajectory modeling, clinically relevant patterns of adherence (ie, trajectories) can be identified and can provide more insight to providers than a single mean value. Understanding the characteristics of patients that put them at risk for medication nonadherence has the potential to inform how best to intervene, which can instruct the future development of protocols and tools to better individualize interventions for patients requiring lipid-lowering therapy.
This study was funded by Sanofi and Regeneron Pharmaceuticals.
Author Disclosure Statement
Ms Vadhariya had a 10-week internship with Regeneron Pharmaceuticals; Dr Fleming has received grants from Sanofi and Regeneron; Dr Johnson and Dr Essien have no conflicts of interest to report; Dr Serna and Dr Esse are employees of CareAllies; Dr Choi is an employee and shareholder of Sanofi; Ms Boklage is an employee and stockholder of Regeneron Pharmaceuticals; Dr Abughosh received a grant from Regeneron.
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Benner JS, Glynn RJ, Mogun H, et al. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288:455-461.
Choudhry NK, Setoguchi S, Levin R, et al. Trends in adherence to secondary prevention medications in elderly post-myocardial infarction patients. Pharmacoepidemiol Drug Saf. 2008;17:1189-1196.
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Afilalo J, Duque G, Steele R, et al. Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analysis. J Am Coll Cardiol. 2008;51:37-45.
Abughosh SM, Kogut SJ, Andrade SE, et al. Persistence with lipid-lowering therapy: influence of the type of lipid-lowering agent and drug benefit plan option in elderly patients. J Manag Care Pharm. 2004;10:404-411.
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Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Curr Atheroscler Rep. 2013; 15:291.
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Zhang H, Plutzky J, Skentzos S, et al. Discontinuation of statins in routine care settings: a cohort study. Ann Intern Med. 2013;158:526-534.
Choudhry NK, Glynn RJ, Avorn J, et al. Untangling the relationship between medication adherence and post–myocardial infarction outcomes: medication adherence and clinical outcomes. Am Heart J. 2014;167:51-58.e5.
Franklin JM, Krumme AA, Tong AY, et al. Association between trajectories of statin adherence and subsequent cardiovascular events. Pharmacoepidemiol Drug Saf. 2015;24:1105-1113.
Franklin JM, Shrank WH, Pakes J, et al. Group-based trajectory models: a new approach to classifying and predicting long-term medication adherence. Med Care. 2013;51:789-796. Erratum in: Med Care. 2013;51:1029.
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Yap AF, Thirumoorthy T, Kwan YH. Systematic review of the barriers affecting medication adherence in older adults. Geriatr Gerontol Int. 2016;16:1093-1101.
Bays H, Cohen DE, Chalasani N, Harrison SA. An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol. 2014;8(3 suppl):S47-S57.
Bitzur R, Cohen H, Kamari Y, Harats D. Intolerance to statins: mechanisms and management. Diabetes Care. 2013;36(suppl 2):S325-S330.
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Aarnio E, Martikainen J, Winn AN, et al. Socioeconomic inequalities in statin adherence under universal coverage: does sex matter? Circ Cardiovasc Qual Outcomes. 2016;9:704-713.
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Kim J, Lee HS, Nam CM, Heo JH. Effects of statin intensity and adherence on the long-term prognosis after acute ischemic stroke. Stroke. 2017;48:2723-2730.
Cannon CP, Braunwald E, McCabe CH, et al; for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495-1504. Erratum in: N Engl J Med. 2006;354:778.
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Rep. Tom Dent, R-Moses Lake, has been appointed to the Oversight Board for Children, Youth and Families by House Speaker Frank Chopp.
The establishment of the Oversight Board is part of House Bill 1661, passed by the Legislature in 2017, which created the new Department of Children, Youth and Families (DCYF).
The Oversight Board will monitor and ensure that the DCYF achieves its stated outcomes. The board will also conduct periodic surveys of providers, customers, parent groups, and external services, and issue an annual report.
The board includes four legislators and representatives from foster care, a parent group, law enforcement, the early learning program, a child welfare caseworker and others.
Dent has also been appointed to the Joint Select Committee on Early Achievers Program. The committee was created with passage of House Bill 1491 in 2015.
The committee is tasked to review the demand and availability of child care providers, early learning programs, and family, friend, and neighbor caregivers by geographic region. By Dec. 1, 2018, the committee must provide recommendations on the sufficiency of funding for the Early Achievers Program, the need for targeted funding for specific geographic regions or major ethnic populations, and whether to modify the deadlines for the Early Achievers Program mandate.
Dent is the lead Republican on the House Early Learning and Human Services Committee. The committee considers issues relating to early learning from birth to kindergarten, as well as a broad array of issues affecting children and families, including parent education, foster care, dependency, child protective services, children's mental health, child welfare services, at-risk youth and juvenile justice.


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Golf Foundation launches 'The Big Give' fundraising campaign
The Golf Foundation is calling on all golf lovers to support a national Christmas campaign called 'The Big Give', which aims to raise funds to provide life-changing opportunities for disadvantaged young people through golf.
Running from December 1 until December 8, the #ChristmasChallenge20 will help the Golf Foundation to fund projects that support children and young people to develop life skills, look after their physical and mental health, and improve their social well-being.
The Foundation has a fundraising target of £4,500 for The Big Give #ChristmasChallenge20, with every £1 that is donated being doubled through matched fundraising.The campaign lasts for just one week and donations can support the Golf Foundation in these ways:
• £5 could pay for a child to receive four coaching sessions in school delivered by a PGA Professional – the start of their journey in golf;
• £10 could provide a specially designed golf club – an essential piece of equipment needed to deliver golf activity;
• £30 could pay for a school teacher to become fully trained in delivering golf activity in their school – golf will be easily accessible for their pupils.
Vanessa Bell, Head of Fundraising for the Golf Foundation, said: "Our charity opens up the door to a huge range of opportunities for anyone willing to give the game a try. Breaking down barriers and getting kids to have a go at golf when they would never dream of touching a golf club has opened the door to a whole new world for many. And from that first touch, we have a fantastic player pathway that welcomes new youngsters into the game.
"The money raised by The Big Give is going directly into giving opportunities for youngsters from disadvantaged backgrounds to take part in a programme that will introduce them to golf and help ignite some great life skills such as confidence, determination, and leadership as well."
She added: "We are a charity and therefore fundraising is incredibly important to us. The more funds we raise, the larger our reach and impact. Without the generosity of our supporters, we would not be able to deliver golf in schools, communities, or clubs and there would be fewer opportunities for kids within the game. We are going live with our Christmas fundraising campaign today and in the festive spirit, we are hoping golfers will come together and create a community of giving to support us. We are also very much aware that this is a challenging time for all families so any help is most appreciated."
To make a donation, visit https://bit.ly/GF_ChristmasChallenge
Golf Foundation


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An early warning system for change - your buyers' buyers
Ed Marsh | Jun 15, 2018 6:30:00 AM
Position your company to thrive through disruption with a strong early warning system
Introduction to SignalsFromTheOP
Guide to episode
Most companies anticipate change by watching their industry
That reveals signals too late - after they've already impacted the market
The right place to watch is among your buyers' buyers
That reveals trends and change much earlier - and let's you serve as a valuable resource to your customers as well
Keeping your "ear to the rail" is a critical strategic function that should be embedded in industrial marketing
Transcript follows
Hi, I'm Ed Marsh. Thanks for joining me for this episode of Signals From the OP. If you've seen Signals before, you know that I use each of these videos as an opportunity to take a little bit of a dive into an issue that, I believe, has strategic implications for industrial manufacturers. Today's topic is about how manufacturers anticipate and prepare for the change that's coming in their industry. You ask them about it, typically, you get an answer that sounds something like, "Whoa. We observe what's happening in the industry." Sounds reasonable, but I would challenge it. I would say, "Is the solution to disruption, really, to fit in by what everyone else is doing around you. Isn't that antithetical to what you might do to prepare for disruption?"
What do you do instead? I believe that companies need to keep their ear to the rail. It used to be, if you wanted when the train was coming, before we had the electronic systems that would pop it up on the display and let you know how far it was, you could either look out on the horizon, look for the dust and the smoke plume, or if you wanted more advanced warning, you put your ear to the rail. You could detect the vibration, hear the noise, far in advance. You'd have a much earlier warning for when the train was coming, so putting your ear to the rail.
There's something analogous for manufacturers today. You can wait for your trade association, or an industry leader, or a customer to raise a topic. That's like watching the horizon, looking for the dust cloud, or you could put your ear to the rail. Now, how would you do that? I suggest that the way manufacturers keep their ear to the rail is to really study their customer's business in depth, specifically, taking the step further and understanding the habits and expectations of their customers' customers.
Now, you may react to that and say, "No, that's not my business. That's up to my customers. All I need to do is deliver it to them, what I'm supposed to give them." You're right, fine, don't worry about it. Just recognized that, that will probably consign you to the pack and there's going to be some rough sledding, at some point, ahead. On the other hand, if you subscribe to a challenge or sale model, where if you believe that your role to be really successful in a complex sales environment is to help your buyers improve their business. Then, I believe, you've got to have that level of depth of understanding of their business and, at least, a good strong sense of what's happening with their customers.
For instance, I work with a lot of capital equipment manufacturers and some of them are in the packaging equipment space. Honestly, the little differences that are happening in package equipment, I'm sure they get blown up in the industry. People talk about this revolutionary new HMI, or new kind of drive, or all these different features that people talk about. And engineers will sometimes be interested in those as they're just trying to understand what's changing in the business, what might give them some kind of an incremental advance. But that's not what really drives a lot of capital equipment acquisition, instead using that example of packaging equipment, for instance. My clients will sell often to CPG manufacturers who have issues like workforce challenges. Getting enough qualified workers into their factories to drive the production they need to is a challenge.
Understanding that, and the implications of it, can help to sell additional capital equipment. Even going further, in many cases, those companies are selling to mass retailers. So understanding the pressures that come from the box stores, and how they buffet their suppliers with this turbulence of never-ending change, and expectation, and demands, can also be informative. I'm seeing opportunities like what's happening with data. How companies can accumulate data. What additional kinds of services they might be able to provide that their customers want and, even, how they can create new revenue streams, as an example. Listening to the way buyers are articulating their expectation to buy packages of service.
So not necessarily capital equipment, these are engineers, in many cases, that have grown up in a sharing economy with softwares and service and, now, product as a service is something that they're starting to think about, starting to discuss, starting to expect. So helping my clients, the manufacturers of capital equipment, understand those kinds of trends that the customers and their customers are expecting is what lets them keep their ear to the rail. None of it comes from observing competitors to the left and right, none of it does. You've got to look over the horizon and you've got to look into other fields of study, other disciplines, to see what the trends are and understand the kinds of things and don't look back.
You want to keep your ear to the rail, anticipate the kind of disruption and change that you can prepare for, cash for the opportunities, avoid the threats. That's what you do. Understand your customers and your customers' customer's business context. That's incredibly powerful.
If you like this kind of an unusual or contrarian view, I'd welcome you to subscribe to these weekly videos. You can do that signalsfromtheop.com, singalsfromtheop.com. Thanks very much, I'm Ed Marsh, appreciate you joining me.
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To kick off 2014 we will be financing wrist bands for Youth Central Hangouts in the Frankston Council area. There are eight hangouts that give young people a safe, supervised place to go for socialising as well as education. The wristbands will be distributed through schools and in particular grades 5 and 6. This will be the start of what we intend will be an ongoing partnership between Rotary and Youth Central.
UPDATE @ 30th March: The wrist bands have arrived and are being distributed to schools. A sausage sizzle is being organized and Wendy has ask if we could consider helping them. They will let us know dates soon. Some members are attending the Anti Bullying Forum on Friday 4th April. Any members would be welcome to attend and 'show our Rotary flag'. The idea of a breakfast/fruit bowl has been muted and they are looking into the feasibility of one in Frankston. Our club may be interested in assisting in this but we need to know more details before we commit. The Youth Centre is very appreciative of our support.


Sarah W Phillips married John W Wilson 21 Aug 1860 in Clarke Co. AL.She was not listed on the 1870 Census.
That Census lists John W. Wilson, 7 year-old daughter Mary E., and John's mother, 72 year-old Mary [Landrum} Wilson, living in Grove Hill.I assume Sarah W. had died in the last seven years.When did she die?Where is she buried?
What happened to daughter Mary?Did the family move away from Grove Hill?
When did Mary [Landrum] Wilson die?Where is she buried?


text:
Q: Unable to get the Vlookup property of the WorksheetFunction class I am trying to find an Employee name and their Import date from a spreadsheet called CashReward.
The coding below is appearing with an error message 'Unable to get the Vlookup property of the WorksheetFunction class'. I have tried changing the data type to CDate and CStr but no use.
concat = EmpName & GetDate
BasicSal = WorksheetFunction.VLookup(CVar(concat), Sheets("CashReward").Range("G3:K" & Cashlastrow), 2, False)

Thanks in advance

A: This happens if your search string is not found in the given range.
Note that the data in the range needs to be sorted in ascending order, see http://office.microsoft.com/en-us/excel-help/vlookup-HP005209335.aspx

The values in the first column of table_array must be placed in
  ascending sort order; otherwise, VLOOKUP may not give the correct
  value. You can put the values in ascending order by choosing the Sort
  command from the Data menu and selecting Ascending. For more
  information, see Default sort orders.

A: Amy one can solve this erroe run time error '424' object require
Private Sub VLOOKUP()
Dim I As Integer
Dim J As Integer
Dim K As Integer

For I = 2 To 14

For J = 1 To 1
For K = 2 To 2

Sheet2.Cells(I, K) = Appliaction.WorksheetFunction.VLOOKUP(Sheet2.Cells(I, J), Sheet1.Range("$A$1:$C$307"), 2, False)
Next K
Next J
Next I

End Sub

redpajama_set_name: RedPajamaStackExchange


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text:
18 Best Film Industry Jobs In India For The Creative Souls!
Learn about the best film industry jobs in India, along with the duties and responsibilities of each role, right here!
Anjali Paul
Do you love films and filmmaking, and want to work in the entertainment industry, but know not which profession you belong to? Learn about the best film industry jobs in India, along with the duties and responsibilities of each role, right here.
Nowadays, when one contemplates which career to choose after their schooling, they have a plethora of options at hand. Today's children are no longer making traditional choices of engineering or MBBS.
Some of my friend's children surprised us with their unconventional decisions when they opted for interesting courses like mass communication and film studies. A recent discussion with these kids on some of the best careers in the film industry was genuinely enlightening. If you too are keen to be part of this exciting industry, then read on!
Best film industry jobs are:
If you want to pursue performance and acting:
If you have a passion for acting and can make a script come to life with your performances, then you can try your hand at acting. There are different types of actors, and you can choose the category that you feel suits you the best. Some of them are:
Main Cast Members
These include the actors that are part of the cast and portray the main characters in the films. If you want to become an actor, then you need to spend a reasonable amount of time researching the character and memorizing the script. Creating an emotional and mental connection with the character will help you successfully bring forth the character to life on screen.
Background Actors
They basically comprise actors that may not necessarily have any dialogues but are part of the cast to enhance the feel of the production. They help movies and other productions feel more authentic. After all, scenes involving hospitals, concerts or a busy street would not look real if not for the presence of background actors.
Stunt Coordinators
You will be responsible for managing stunt actors, choreographing stunt sequences and training actors to perform stunts. They are also responsible for casting the appropriate stunt actors suitable for the job. A stunt coordinator works closely with the director to ensure each stunt is performed as per the vision of the production, while maintaining the safety of the cast and crew involved.
The primary role of the casting director is to carry out auditions and screen the candidates in order to hire the best talent for the film. They act as a liaison between the director and producer. Casting directors make sure that everything they do stays within the limits of the casting budget allocated for them.
If you want to be part of the production department:
If you have leadership qualities and want to be the next Steven Spielberg or Shyam Benegal, then being a film director could be one of the best careers in the film industry for you. They often instruct actors during scenes and collaborate with different departments to get the perfect shot.
A producer of a film is equivalent to the COO of a company. They are the head of film production and need to ensure everything is organized and runs without a hitch. A producer can help the screenwriter develop and write a script, be involved in budgeting, hire a crew and do everything needed to produce a blockbuster film.
If you are creative and have a way with words, then you can be a screenwriter, that involves creating the entire concept of the film. It also involves creating character dialogues for the film. Screenwriting is one of the most sought after film industry jobs in India.
If you want to be a part of the camera department:
A cinematographer is generally considered the head of the film crew. They make use of their creative and technical knowledge to give life to a director's vision in an organized and planned manner. They are responsible for choosing the colour palette, camera movements and lighting that go according to the theme of the story.
A camera operator is primarily responsible for capturing what is in front of the camera. They employ various filmmaking techniques to make the film a visual delight, making it one of the best careers in the film industry. They need to be well-versed in using various technical equipment like portable, electronic and remote-controlled cameras.
A film editor works with the director to edit and clip the entire footage captured through the camera. It is one of the crucial parts of filmmaking, as an editor needs to find a way to create a captivating story.
If your interest lies in the sound department:
A sound designer takes care of the audio and sounds recorded during film production. They add sound effects or music to specific scenes to enhance their feel and improve the aesthetics. Sound designers work on deadlines that give them the flexibility to manage their schedules and allow them to take on multiple projects at once.
Foley Engineers
Foley artists are those professionals that create various sound effects like footsteps, creaking of the floor, heavy rain and other sounds to accompany the footage. Foley engineers are responsible for incorporating these sound effects created by foley artists so that the audience can hear everything recorded during the filming process.
If you want to be part of the lighting department:
A gaffer is essentially the head of the lighting team and creates adequate lighting in the preproduction phase. They work quickly to adjust the lighting in different scenes and help create cinematic visuals through the light setups.
The key grip is responsible for the overall hiring of the lighting and rigging crews required for film production. They ensure that the film sets are built safely. Key grips direct the crew of grips, many with specialized skills like dolly grips, crane operators or other special equipment operators.
If you are good at makeup or costume designing
A makeup artist is responsible for creating different characters' looks, including special effects. They need to be able to work long hours, as this type of work will involve long shifts to create the desired look for the actors.
They assist costume designers and makeup artists in creating an authentic look for the various characters in the film. Furthermore, they experiment with wigs, hair extensions and even special effects to make the look convincing. A hairdresser may have to create several styles throughout the day and will have to be available while actors are shooting.
As a costume designer, you will have to create and develop the costumes and looks for the characters in the film. Before you start, you will have to read the script and create a mood board that will have to be approved by the film director. A relevant degree in fashion design or work experience in a fashion outlet will help you clinch this job easily.
Props Manager
If you have an excellent eye for detail and organizational skills, then being a prop manager could be a good career option. You will be responsible for sourcing the props that the actors will use throughout the film. These props will need to be stored appropriately and in good condition to be available throughout the entire duration of the film shoot.
While a career in the film industry may not be ideal for all, there are numerous jobs available for different personality types, suitable for both introverts and extroverts.
With this list of best careers in the film industry, you can now get a good idea of which role will suit your personality and interests. Networking is also a great way to get into the film industry. So, work on making contacts and become a part of this exciting world of films.
Image source: mimagephotography, and bombermoon via Getty Images, free and edited on CanvaPro
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