William C. Peterman, Chicago, Ill., for plaintiff-appellant.
Hermon M. Wells, Philadelphia, Pa., for defendant-appellee.
Plaintiff-Appellant O'Neill had been employed as a brakeman by the Penn Central Transportation Company (Penn Central) since 1941. He was also a member in good standing of the United Transportation Union (Union), which was the duly designated and authorized representative of the plaintiff under the Railway Labor Act (Act), 45 U.S.C. § 151 Et seq. On May 9, 1972, O'Neill was suspended from employment pending a hearing into the charge that he had been in an unfit condition and in possession of alcoholic beverages during his tour of duty. On May 15, 1972, a customary "on the property" hearing was conducted, at which time O'Neill was present and accompanied by two representatives of the Union. On the following May 29, plaintiff was notified that he had been dismissed.
After two unsuccessful appeals of his dismissal through the Penn Central's review procedures, plaintiff, through his representative, sought arbitration. Plaintiff's case was placed on the docket of defendant Public Law Board No. 550 (Board), a special adjustment board created pursuant to the second paragraph of § 3 Second of the Act, 45 U.S.C. § 153 Second. On behalf of the plaintiff the Union presented a written submission and argued the case orally before the Board. The Penn Central similarly presented its position. In an award dated October 29, 1973, the Board denied plaintiff's claim.
Plaintiff then instructed this action in the district court seeking to have the decision of the Board1 set aside for failure to comply with the provisions of the Act. On cross motion for summary judgment, the district court entered judgment in favor of the defendant Board. We affirm.
In United Transportation Union v. Indiana H. B. R. Co., 540 F.2d 861 (7th Cir. 1976), with which decision the present case was consolidated in a prior appeal, this Court held that the district courts have jurisdiction to review, at the behest of either aggrieved party, awards of public law boards created under § 3 Second of the Act. The scope of judicial review of the awards of such public law boards was established to be co-extensive with the scope of review of awards of the divisions of the National Railway Adjustment Board under 45 U.S.C. § 153 First (q), I. e., the findings and order are conclusive on the parties except that the order may be set aside where there is failure of compliance with the requirements of the Act, where the order exceeds the Board's jurisdiction, or where there is fraud or corruption of a member making the order. In addition to these statutorily created parameters of review, it has been recognized that the decisions of the National Railway Adjustment Board are reviewable if they are violative of due process. Union Pacific R. Co. v. Price, 360 U.S. 601, 616, 79 S. Ct. 1351, 3 L. Ed. 2d 1460 (1959); Kotakis v. Elgin, J. & E. R. Co., 520 F.2d 570, 574 (7th Cir. 1975); Edwards v. St. Louis-San Francisco Railroad Company, 361 F.2d 946, 953-954 (7th Cir. 1966); Ellerd v. Southern Pacific Railroad Co., 241 F.2d 541, 545 (7th Cir. 1957).
Plaintiff contends that the award of the Board is violative of his due process rights and failed to comply with the provisions of 45 U.S.C. § 153 First (j) because he was not personally given notice of any hearings before the Board, and he was not given the opportunity to appear personally before the Board.2 Because the record demonstrates that plaintiff's representative, the United Transportation Union, received all necessary notices and represented plaintiff fully before the Board, as it was authorized to do, we find compliance with the requirements of both due process and 45 U.S.C. § 153 First (j).
Initially, we find no merit to the plaintiff's claim that the Union was not authorized to represent him before the Board because, after his discharge, he was no longer a member of the union and had not paid dues for the nearly two years prior to the Board's hearing in this case. It is well established that a union's duty to represent its members in disputes extends to those employees who have been dismissed. E. g., Czosek v. O'Mara, 397 U.S. 25, 90 S. Ct. 770, 25 L. Ed. 2d 21 (1970); Vaca v. Sipes, 386 U.S. 171, 87 S. Ct. 903, 17 L. Ed. 2d 842 (1967); Conley v. Gibson, 355 U.S. 41, 78 S. Ct. 99, 2 L. Ed. 2d 80 (1957).
"Parties may be heard either in person, by counsel, or by other representatives, as they may respectively elect, and the several divisions of the Adjustment Board shall give due notice of all hearings to the employee or employees and the carrier or carriers involved in any dispute submitted to them."
"Every member of the United Transportation Union grants complete authority to the United Transportation Union and any of its constituted representatives to act in said member's behalf for the purpose of disposing, in any manner, of any and all of said member's claims, complaints or grievances against their employer; and to submit such claims, complaints, or grievances for determination to any person, board, or other tribunal provided by law or otherwise as may be deemed to be necessary. The United Transportation Union shall have authority to receive notice of the hearings, or to waive hearing, and to appear for, represent, and act for its members before any person, board, or other tribunal in connection with consideration and determination of claims, complaints, or grievances, subject to the right of appeal in accordance with the provisions of this Constitution, except where the member involved serves reasonable written notice on the United Transportation Union to the contrary."Plaintiff did not serve written notice on the Union that he did not want the Union to represent him.
In Elgin J. & E. R. Co. v. Burley, 325 U.S. 711, 65 S. Ct. 1282, 89 L. Ed. 1886 (Burley I) (1945), adhered to on rehearing, Elgin, J. & E. R. Co. v. Burley, 327 U.S. 661, 66 S. Ct. 721, 90 L. Ed. 928 (Burley II) (1946), the Supreme Court was concerned with the question of the sufficiency of a collective bargaining representative's authority to represent individual employees as claimants before the National Railroad Adjustment Board. Burley I noted that the employee's rights under Section 153 First (j) are statutorily created rights which "he may exercise independently or authorize the union to exercise in his behalf." 325 U.S. at 740 n. 39, 65 S. Ct. at 1298. Although the Court in Burley II refrained from making a definitive statement of what might be sufficient evidence of a union's authority to represent an employee exclusively before the National Railroad Adjustment Board, the Court did indicate that "custom and usage" as well as "appropriate provisions in (a union's) by-laws, constitution or other governing regulations" might serve as an adequate basis for such authority. 327 U.S. at 663-664 and n. 2, 66 S. Ct. at 722.6 We have also indicated that an employee may so authorize a union to represent him in proceedings before the National Railroad Adjustment Board that any notice received by the union on the employee's behalf is sufficient to fulfill the requirements of Section 153 First (j). See Kotakis v. Elgin, J. & E. R. Co., supra, 520 F.2d at 576; see also Ellerd v. Southern Pacific RR Co., supra, 241 F.2d 541, on remand, 191 F. Supp. 716 (N.D. Ill. 1961); cf. Simberlund v. Long Island Rail Road Co., 421 F.2d 1219, 1225 (2nd Cir. 1970).
The record in this case shows that the Union initiated proceedings7 before the Board following unsuccessful appeals within the Penn Central. The Union filed a submission and argued orally before the Board on plaintiff's behalf.8 We find that by virtue of his membership in the Union, plaintiff authorized that organization to represent him in his disciplinary and review proceedings, and to receive any necessary notices on his behalf within the meaning of Burley II. As such, we find compliance with due process and sufficient satisfaction of the requirements of 45 U.S.C. § 153 First (j).
Accordingly, for the reasons stated herein, the judgment of the district court is affirmed.


Death Cross detected for FTNT (Fortinet, Inc.) at the close price of 76.57. Trading at a 65 % level between the 52week High (94.37) and 52week Low (43.67).
The average analyst 1-year target price is 82.0 with an average buy and a score of 2.5.


Critic Kaelen Wilson-Goldie speaks at Global Art Forum_6. Courtesy Art Dubai.
There's something about the immediacy and urgency of writing against the present that can be panic-inducing; paralyzing even.
It feels as if we should be quicker than we are. We should be able to respond more efficiently. It should be easier by now. Our brain's functionality should be in sync with the latest social media apps on our Blackberrys, tablets and Mac books—so that we can not only multitask, "double-screen" and consume information (both virtual and real) at the rate of several giga-Hertz per second—but also analyze it, digest it and produce a meaningful reaction to it immediately. Except that's not exactly how our cerebral cortex works; there is a lot more complexity involved—and maybe there is a saving grace in that somewhere.
The pressure to keep up with, and contextualize the arts within, the most up-to-date socio-political happenings was cited and critiqued at the recent discussion series, Global Art Forum_6. Part of the titan that has become Art Dubai and its collateral programming, this year's forum was titled "The Medium of Media," and for this second installment writers Rayya Badran, Rijin Sahakian, Shahira Issa and myself were invited as "forum fellows" to reflect on issues in the fair. Art critic and forum fellows mentor Kaelen Wilson-Goldie talked about an almost expected reflex to situate art within contemporary politics (or politics within contemporary art), with particular reference to Lebanon and Syria. Such a reflex has been intensified by two things in recent times: the conflicts and uprisings of the Arab Spring, and the penetrating and shifting role of instant online media in news reportage.
In her talk "Power Less: Art vs. Media," journalist and editor Negar Azimi spoke of some of the concerns surrounding potentially reactionary arts practices, such as "revolutionary art works" and the "industries of interest" that can arise out of such politically charged situations. She considered the question: given that many of the region's conflicts are ongoing, should we be looking at current "political art" skeptically? Can artists reflect on these processes in a valid way yet, or is some of this art opportunistic? And importantly, how does the speed of contemporary media affect the ways we respond to current affairs, and in turn infiltrate our cultural practices?
Almost as a physical manifestation of this concept, the forum fellows were given a space in which to pause and reflect upon the seemingly multiplying, fast-paced events at Art Dubai. From the sanctuary of our plush beige conference room, we met for two hours a day with writers from Art Forum and Bidoun to Frieze and ArtAsiaPacific, and discussed subjects that engaged with the sub-text of the fair: obsession and neglect, hesitant knowledge, slippage, gender, expectation and deliverance and art politics. We were tasked with writing 200-500 words daily, using such key words as a point of departure, and relating them to what we saw or heard at the fair. The time-bound pressure to produce a response to our surroundings was certainly there, but without the pressure to publish or perfect our pieces immediately, we were given the crucial space to experiment with language and form.
Financial Times art market correspondent and editor-at-large of the Art Newspaper, Georgina Adam, and geo-strategist and author Parag Khanna discuss how the movement of news and information shapes value in globalized art and financial marketplaces. Courtesy Art Dubai.
In the end, rather than presenting our fragmented, experimental texts at the final presentation, we felt the most meaningful response to the present would be to continue to ask questions of it—just as we had done for the past three days of the forum and the fair. Some of these questions included: how do we begin to represent process? And how does this relate back to the finished (or commercial) product? And also, how do these very privileged conversations we're having at Art Dubai relate to some of the more developed arts programs in the region? And lastly, how does thinking (or writing) about the present differently affect how we will go on to interpret the future?
Iraqi-American artist Michael Rakowitz presents his 2010 multimedia project, The Breakup, at Global Art Forum_6. Courtesy Art Dubai.


text:
Complitech hits 10,000 technical compliance requirements with Greece listing
Complitech, the gaming industry's only product and technical compliance database, has hit a major landmark with the listing of its 10,000th requirement, after adding Greece to its selection of jurisdictions.
The addition means Complitech users can now download, sort, analyse and compare more than 10,000 technical compliance requirements from 27 regulated online gaming jurisdictions within seconds.
These requirements are translated into English and kept up to date by a team of compliance experts, with new markets added as they open. As well as Greece, full technical compliance requirements from Germany and the Netherlands will soon be available to Complitech users.
The database has quickly become a must-have tool for suppliers looking to expand their global footprint within regulated markets. On average, Complitech users are able to enter new jurisdictions 60 percent faster than competitors.
Francesco Bianchi, Director of Compliance Operations at Maxima Compliance, said: "It has been a little over six months since we launched Complitech, so it is a fantastic achievement to have already hit such a landmark.
"A huge amount of work has been put in by the team to ensure that compliance managers and product owners no longer need to spend weeks researching and translating these requirements themselves.
"Complitech not only streamlines and optimises the process of entering new regulated markets, but its powerful gap analysis tools mean it can be used to identify new strategic opportunities for your business."
Related Topics:ComplitechFrancesco Bianchi Director of Compliance Operations at Maxima ComplianceGreeceMaxima Compliance
Martin 'Deficio' Lynge is joining the Misfits Gaming Europe team as a director
Parimatch Tech Academy to provide free IT training and paid internships
Maxima Compliance appoints Paola Menachem as Director of Regulatory and Licensing
Green Jade Games extends Maxima Compliance partnership
Oryx Gaming turns to Complitech for technical compliance boost
BMM Testlabs announces approval in Greece
GLI Europe Authorized to Test and Certify iGaming, VLT and Casino Products for Greece
Authentic Gaming agrees Maxima Compliance partnership
Casino and sportsbook platform provider Soft2Bet has been certified by The Payment Card Industry Data Security Standard (PCI DSS).
The company was accredited with the certification after passing a rigorous audit, recognising its capability to securely protect the transfer of credit and debit card data between customers and payment service providers.
The news showcases Soft2Bet's strong compliance credentials, which are also demonstrated by the SGA, MGA and Curacao licences held by the market-leading casino and sportsbook platform provider.
The company's latest certification indicates its unwavering commitment to protecting the data of players using the 30+ operator brands in its portfolio, which is set to be enhanced with a new flagship sportsbook in early 2021 and currently includes the SBC-award winning Wazamba.
Ivan Piorischin, Product owner at Soft2Bet, said: "We take data protection very seriously here at Soft2Bet, and it's fantastic to have that commitment recognised with a coveted accreditation from the The Payment Card Industry Data Security Standard.
"As we look forward to entering new territories and launching further cutting-edge products in the year to come, regulatory compliance will continue to top our priority list."
The Latvian Parliament (Saeima) has approved at the first reading a bill to ban alimony debtors from gambling, and scheduled a second reading for January 20.
The bill would require operators to ensure that those who owe maintenance payments are not permitted to gamble either in person or online. In order to do so, they must check accounts against the national register of maintenance debtors, with the help of the Lotteries and Gambling Inspectorate, which will create an official data display for licensees.
"The restriction is intended to prevent debtors who do not provide maintenance they owe for a child from using funds unreasonably for entertainment and hobbies," the Saeima said.
The bill was submitted by the government and has already received approval from the Commission for Human Rights and Public Affairs with no objections. If it passes in the second and third reading and is signed into law, the restriction will come into effect on April 1.
London-based video virtual sports specialist Highlight Games Limited today announces that it is now licensed to distribute its products in Romania.
Following receipt of its Class II license from the Romanian Gambling Authority, Highlight Games' exclusive suite of products – including SOCCERBET in English, Italian and Turkish variants and NBA Last 60 – are now available to licensed Romanian operators and will be live with customers in Q1.
'I'm delighted to confirm that our products are now available to our partners in Romania,' said Steven Holmes, Co-CEO, Highlight Games. 'Europe is a hugely important market for our business, and it's fantastic to now include Romania in the list of countries in which our games are now available. Highlight Games' total online turnover in Italy has increased by 455% since the start of the first national lockdown in 2020, demonstrating the continuing growth in popularity of our video virtuals across all channels. We look forward to recreating the successes we have seen in Italy within the Romanian virtual sports market,' he added.
About Highlight Games Limited:
Highlight Games is a London-based video virtual sports and games supplier which specialises in the creation of innovative, sports-focused betting experiences. Using a unique patent-protected live video game format, Highlight's products feature top teams and players from the world's favourite sports. The company's flagship SOCCERBET game is the #1 selling product in Europe's largest virtual sports market and its branded portfolio of products, which include NBA Last 90 and NBA Last 60, will launch in gaming and lottery markets in the US and around the world in 2020. Featuring highly optimized game design based on decades of archived live action sports footage, Highlight's products can be tailored to suit the sportsbook or virtual sports offering of operators across retail, online and mobile.

redpajama_set_name: RedPajamaCommonCrawl


text:
Home/Events/Turkey and Ukraine to cooperate on building satellites
Turkey and Ukraine to cooperate on building satellites
Turkish Prime Minister Ahmet Davutoglu meeting with Ukrainian President Petro Poroshenko on the sidelines of the World Economic Forum in Davos, Switzerland, 20 January 2016. Photograph courtesy of the Office of the President of Ukraine.
In a clear reaction to collapsed relations with the Russian Federation, both Turkey and Ukraine have announced their intention to cooperate with each other in the development and manufacture of satellites, as well as collaboration on other strategic technologies.
The announcement has come as a surprise to analysts, many of whom claim that apart from an obvious geopolitical agenda to counter Russian strategic dominance and influence in the Black Sea and Caucasus, there seems little industrial and technological foundations for the proposed relationship to succeed.
According to US defense publication, Defense News, one anonymous Turkish official said that, "We are pleased to observe that Ukraine is keen to share and develop technology with a NATO member state. We think we can efficiently cooperate in developing international [NATO] standard systems."
The agreement is based on a Memorandum of Understanding between Turkish software company Havelsan, a state-owned entity that serves that Turkish armed forces, and Ukrainian weapons systems company Ukroboronprom. The MoU states each company's intention to jointly develop and manufacture satellites and other, unnamed, aerospace systems further in the future.
This development seems to be the result of burgeoning strategic relations between Ankara and Kiev over the past several months that saw Turkish Prime Minister Ahmet Davutoglu visit his Ukrainian counterpart in Kiev on 15 February 2016. It is believed that defence and procurement officials from both countries began discussions about strategic cooperation in the sidelines of that high-level visit.
Official Russian reaction to the agreement has been muted, but some Russian media outlets have expressed their derision about Turkish-Ukrainian ambitions.
Both Turkey and Ukraine have reasons to seek ways to counter Russia. For several years Ukraine has been fighting Russian-backed militias in the eastern part of its country, and saw the Crimea seized from them by Moscow in 2014.
For Turkey, relations with Russia have rapidly worsened since it shot down a Russian Air Force jet near its border on 24 November 2015, claiming that Russia had violated its sovereign airspace despite repeated warnings. Russia's diplomatic and economic reaction to Turkey's actions was swift and emphatic.
Further, Russia has built-up and modernized its Black Sea naval fleet, and a number of Turkish and Western analysts fear that Moscow is seeking to make the Black Sea a strategic bastion from which it can deliver conventional and nuclear armed ballistic and cruise missiles to targets throughout Europe, the Caucasus, and the Middle East.
The strategic agreement between Turkey and Ukraine is an attempt to try and diminish Russian power and influence in the Black Sea.
The challenge is that Turkey has little experience building satellites, though it has big ambitions to become a regional space power. Ukraine, on the other hand, has some experience building space systems, but these systems have a poor reputation.
Further, Yuzhnoye, the largest space manufacturing company in Ukraine is going through a troubled period, having just recently divested itself of its Russian subcontractors and other links, as well as allegations of corruption and mismanagement. Other than Yuzhnoye, there are few, if any, other companies in Ukraine capable of developing and building satellites.
There is also uncertainty about how satellites alone, as well as the other unknown strategic technologies that both countries intend to cooperate on, will actually contribute to countering Russian strategic superiority in the Black Sea.
Previous Gilat to Power Eutelsat's Satellite Broadband in Western Russia
Next Kratos completes critical design review of Oman's Advanced Space Radio Monitoring System
Intelsat orders two 5G next-gen satellites from Thales 132 views | posted on January 13, 2022
Masten prepares for Moon Mission 2 in 2024 100 views | posted on January 12, 2022
#SpaceWatchGL Column: Dongfang Hour China Aerospace News Roundup 10 - 16 January 2022 by Blaine Curcio and Jean Dev… https://t.co/97xx51MDRh10 hours ago
Loft Orbital contracts Airbus for Arrow satellite platforms #Airbus #AirbusOneWebSatellites… https://t.co/IqTo7TFQMf10 hours ago


text:
Q: What is the purpose of the cross tab in this postgres sql query? I'm new to SQL in general...what is the purpose of crosstab in this query?  How does it work?  Why is it needed? (This is from a Rails 4.2 app by the way with a subscription model, but I'm interested in the SQL).
      Subscription.select(<<-SQL.sub(/\n$/, '')
subscriptions.braintree_account_id as braintree_account_id, \
subscriptions.braintree_subscription_id as braintree_subscription_id, \
format('%s %s', addresses.first_name, addresses.last_name) as billing_address_full_name, \
users.email as email, \
addresses.line_1 as billing_address_line_1, \
addresses.city as billing_address_city, \
addresses.state as billing_address_state, \
addresses.zip as billing_address_zip_code, \
addresses.country as billing_address_country, \
CASE WHEN subscriptions.shirt_size IS NULL THEN '' ELSE regexp_replace(subscriptions.shirt_size, '\s', '') END as shirt_size, \
CASE WHEN main_handbag IS NULL THEN '' ELSE main_handbag END, \
CASE WHEN european_handbag IS NULL THEN '' ELSE european_handbag END, \
CASE WHEN india_handbag IS NULL THEN '' ELSE india_handbag END, \
CASE WHEN billing_methods.option IS NULL THEN 'standard' ELSE billing_methods.option END as billing_option, \
plans.name as plan_name, \
products.sku as sku, \
to_char(subscriptions.created_at, 'MM/DD/YYYY HH24:MM:SS') as subscription_created_at, \
to_char(subscriptions.next_assessment_at, 'MM/DD/YYYY HH24:MM:SS') as subscription_next_assessment_at, \
subscriptions.subscription_status as subscription_status, \
'#{ Handbag.current }'::text as handbag
SQL
      ).joins(:billing_address).
        joins('LEFT OUTER JOIN billing_methods ON billing_methods.subscription_id = subscriptions.id').
        joins('LEFT OUTER JOIN plans ON subscriptions.plan_id = plans.id').
        joins('LEFT OUTER JOIN users ON subscriptions.user_id = users.id').
        joins('LEFT OUTER JOIN products ON plans.product_id = products.id').
        joins("LEFT OUTER JOIN (SELECT *
              FROM crosstab('SELECT subscriptions.id, handbag_types.id, handbag_values.presentation
              FROM subscriptions
              LEFT JOIN subscription_variants ON subscriptions.id=subscription_variants.subscription_id
              LEFT JOIN variants ON subscription_variants.variant_id=variants.id
              LEFT JOIN handbag_value_variants ON variants.id=handbag_value_variants.variant_id
              LEFT JOIN handbag_values ON handbag_value_variants.handbag_value_id=handbag_values.id
              LEFT JOIN handbag_types ON handbag_values.handbag_type_id=handbag_types.id ORDER BY 1,2',
                     'select handbag_types.id FROM handbag_types ORDER BY handbag_types.id ASC')
              AS (subscription_id int, main_handbag VARCHAR, european_handbag VARCHAR, india_handbag VARCHAR)) subscription_variant_view
        ON subscriptions.id=subscription_variant_view.subscription_id").
        where(subscription_status: 'active')
    end

A: It's a built in postgres function that groups all values for a given row and pivots them onto the same row.  In a join query like the above you could end up with
row1 val1
row1 val2
row1 val3
row2 val1
row2 val2
row2 val3

Using crosstab, you could format that into:
row1 val1 val2 val3
row2 val1 val2 val3

Documentation: http://www.postgresql.org/docs/9.2/static/tablefunc.html

redpajama_set_name: RedPajamaStackExchange


text:
Sparkt Bridges: Pittsburgh Woman Removing Scars of the Past
Woman volunteers her skills to erase reminders of traumatic pasts that are on display every time her clients look in the mirror.
Posted by Sarah Arbogast
For more than a decade, Bridget Miller has used lasers to make people more attractive, fixing skin imperfections and removing unwanted hair.
She enjoys her work, but these days her true passion is using lasers to remove something that's more than skin deep: tattoos that "brand" a person as a former criminal, gang member, or a victim of sex trafficking.
Miller owns the East Side Laser Center in Braddock, PA. She now dedicates a lot of her time and resources to removing unwanted tattoos, giving her clients a fresh start that can change their lives.
Miller says she came up with the idea for The Erase Project after being contacted to remove the word "evil" from a young girl who was once a member of a violent gang. She quickly realized the importance of the work and wanted to do more. Although many of her clients don't keep in touch after their treatments, she knows they are thankful.
"Mainly people are just grateful that the mistakes they made can be removed," said Miller.
Miller also takes the time to visit prisons across the state to talk to inmates about tattoo removal.
Maintaining the lasers and other equipment is very costly. If you would like to make a donation to The Erase Project, you can do so through For Good PGH.
Miller is still working to remove the facial tattoos on convicted felon, Dylan Corrao. Already though, he has gone from living in a tent in a homeless camp on the North Side to now working a job pouring concrete. He hopes to continue turning his life around.
If you know someone like Bridget Miller who is working to build bridges to and for people who are different than they are, we'd love to tell their story. You can nominate someone to be featured in our Sparkt Bridges series by e-mailing [email protected].


text:
Home Finance UK Budget for expatriates
UK Budget for expatriates
Was there anything in the UK Budget for expatriates?
Phillip Hammond's second Budget - the first for the reformed government following this summer's snap election - was widely seen as fairly subdued. But was there anything of note for Britons living in Spain?
Expatriateswho earn UK income may benefit from a slight increase in the personal allowance. From 6th April you can earn £11,850 before paying UK tax (formerly £11,500), representing an extra £70 a year. Unlike the previous Chancellor, Hammond has made no suggestion of limiting this tax relief fornon-resident British nationals in the future.
For the firsttime, the marriage allowance will be extended to widows and widowers, enabling 10%of the personal allowance to transfer to the surviving partner. Effective from29th November, claims can be backdated up to four years.
Higher ratetaxpayers are set to be £340 better off a year, as the upper threshold for 40%tax rates increases in April from £45,001 to £46,350 (Scotland remains at £43,000).
These changes are in line with the government's pledge to increase basic rate to £12,500 andthe higher rate threshold to £50,000 by 2020.
The band of UK savings income that can be earned tax-free stays the same at £5,000, and the annual SA subscription limit also remains unchanged at £20,000.
However, expatriates need to remember that investments like ISAs lose their tax-efficient benefits once you are no longer UK resident. Not only are non-residents ineligible to open and save into ISAs, any interest earned may become liable to taxation in Spain.You should instead explore investment alternatives to suit your unique circumstancesand aims.
Despite speculation, the Budget made no changes to pension tax relief or transfers.
The State Pension, however, will increase 3% in line with inflation - as defined by the Consumer Price Index (CPI) - from April. This represents an extra £191 a year for those who started drawing benefits before 6 April 2015; £250 for others. It has already been established that British expatriates in the EU will continue to receive these cost-of-living increases beyond Brexit.
The lifetime allowance will also increase with inflation. This means you can accrue an extra £30,000 on top of the £1 million in pension benefits from April 2018 without incurring 25% or 55% tax penalties.
The biggest Budget headline was the immediate stamp duty relief for first-time buyers - and those buying in high value areas like London - of up to £300,000 on properties under £500,000.
A 3% stamp duty surcharge remains in place for the purchase of second and subsequent homes, although this now no longer applies where ownership shifts, for example, as a result of divorce or re-mortgaging. Expatriates should note that overseas property counts here, so additional stamp duty may be payable if you own your home abroad and buy another in Britain, even if it is your only UK property.
However, as housing is a devolved area, different stamp duty rules usually apply in Scotland, Wales and Northern Ireland.
If you retain a UK property that is unoccupied, you could see your council tax rates doubling next year. In a bid to discourage empty properties, Hammond has handed local authorities the option to increase council tax premiums by 100% on properties vacant for two years or more.
Meanwhile, the annual capital gains tax exemption will track inflation by increasing to £11,700 from 2018 (£5,850 for most trusts).
However, non-residents who own interest in commercial UK property are set to be subject to tax on gain for the first time. Currently, 'non-residential capital gains tax' only applies to residential property (on gains since 5th April 2016) but is due to be charged on the sale of any UK real estate or land, whether owned directly or indirectly, from April 2019 (excluding Scotland).
With these extra measures, it is worth reassessing whether holding UK property is the most tax- and cost-efficient option for your capital.
Already on course to change in 2018
While this Budget introduced few changes, proposals from previous Budgets that could impact expatriates are set to take effect from 6th April:
· The main residence allowance for inheritance tax is due to increase to £125,000 per person (from £100,000), providing extra relief when passing on a main home to direct descendants.
· Reductionin buy-to-let tax relief will continue. Before April 2017, landlords were able to claim tax relief on their monthly interest repayments at the top level of tax they pay - a tax saving of 45% for higher earners. From 6 April 2018, landlords can only claim 50% of the mortgage interest relief against the income (compared to 75% this year, eventually whittling down to zero by 2020) plus 20% as a tax credit.
· The tax-free allowance for dividends will fall from £5,000 to £2,000. While this could affect those with large portfolios of shares, non-UK residents could still receive dividends tax-free in the UK through the 'disregarded income' regime. There are, however, more suitable options for expatriates to invest tax-efficiently.
The UK economy
As there was not much in the way of handouts or cash-grabs in this Budget, perhaps the biggest outcome was the sharp downgrading of the UK economy's growth forecast. Falling to 1.5% from the 2% forecast in March, it is the largest adjustment since the financial crisis, expected to drop to 1.3% post-Brexit before reaching just 1.6% in 2022.
In this climate of sluggish growth and Brexit uncertainty, it is a good idea to seek specialist, personalised advice, especially if you are concerned about any of the Budget measures. A specialist in cross-border taxation can guide you on the interaction between UK and Spanish taxation, and the tax planning opportunities available.
David Bowern,Partner, Blevins Franks
Email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it This e-mail address is being protected from spambots, you need JavaScript enabled to view it
Tax rates, scope and reliefs may change. Any statements concerning taxationare based upon our understanding of current taxation laws and practices whichare subject to change. Tax information has been summarised; an individual isadvised to seek personalised advice.
For more of our articles visit our website www.blevinsfranks.com


text:
Home » Decision Support in Medicine » Hospital Medicine
Typical Bacterial Pneumonia
Brad Sharpe
Typical Bacterial Community-Acquired Pneumonia
I. What every physician needs to know.
Typical bacterial community-acquired pneumonia (often referred to as CAP) is a common cause of morbidity and mortality in the hospital. Patients with CAP typically present with fever, cough, and shortness of breath; however, in the geriatric population,the clinical presentation can just be altered mental status or weakness.
The diagnosis of CAP generally requires signs and symptoms consistent with CAP AND positive radiographic findings (most often a CXR). Note, though, up to 30% of patients admitted to the hospital with CAP can present with a normal CXR. There are no symptoms, physical examination features, or diagnostic tests which predict typical versus atypical organisms in CAP. Consequently, although there is some controversy, the evidence supports treating all patients diagnosed with CAP withanti-bacterial treatment for both "typical" and "atypical" bacteria. A typical regimen could be 3rd-generation cephalosporin AND a macrolide. Patients can be safely discharged from the hospital if they have normal vital signs and are able to take oral antibiotics. Most patients should get 5-7 days of antibiotics for CAP depending on the degree of illness.
II. Diagnostic Confirmation: Are you sure your patient has Pneumonia?
Per expert guidelines, the diagnosis of community-acquired pneumonia (from typical or atypical bacteria or viruses) requires:
1) Signs and symptoms consistent with community-acquired pneumonia
2) Evidence of a new radiographic infiltrate (typically by chest radiograph)
An update by the Infectious Diseases Society of America published on-line ahead of print in July 2016 on Hospital Acquired Pneumonia (HAP) and Ventilator Acquired Pneumonia (VAP) removed the term Health Care Associated Pneumonia (HCAP). HCAP had previously refered to patients with one of the following risk factors for and a new diagnosis of pneumonia: 1) hospital admission for > 48 hours in the previous 3 months, 2) residence in a skilled nursing facility, 3) hemodialysis, or 4) chemotherapy, wound care, or recent intravenous antibiotics. Previously these patients were recommended to receive broad spectrum antibiotics to cover the possibility of multi-drug resistant (MDR) bacteria. This recent review found that the evidence did not support empiric treatment of all patients in the category for MDRs or extended gram negative bacteria. In general, patients who develop pneumonia outside of the hospital should be treated for typical community-acquired pneumonia. Yet, some patients may have unique risk factors (e.g. severe lung disease, prior MDR pneumonia, recent broad-spectrum antibiotics, etc.) which would necessitate treatment with broader-spectrum antibiotics. Patients should be considered on a case-by-case basis.
The diagnosis of CAP secondary to a specific typical bacteria requires isolation from a culture – sputum, blood, pleural fluid, etc.
A. History Part I: Pattern Recognition:
Patients with community-acquired pneumonia usually present with a brief (days) history of cough (>90%), sputum production (66%), fever (66%), and chest pain (50%). Non-respiratory complaints will dominate in 10-30% of patients these include headache, fatigue, and myalgias. In addition, elderly patients (> 65 years old) often do not have the classic features – over 40% will not have fever and nearly 50% will present with altered mental status. Unfortunately, there are no patient symptoms which accurately and reliably predict typical versus atypical bacteria as the underlying cause.
B. History Part 2: Prevalence:
There are multiple risk factors for typical bacteria community-acquired pneumonia including:
1) Age
2) Underlying lung disease (including COPD)
3) Immunocompromised state (e.g., AIDS, chemotherapy, etc.)
4) Dysphagia or swallowing disorders
5) Drug and alcohol use disorders
6) Smoking
7) Use of proton pump inhibitors (decreasing stomach acid can lead to increased bacterial growth in the stomach which via aspiration can lead to pneumonia).
C. History Part 3: Competing diagnoses that can mimic Typical Bacterial Pneumonia.
The differential diagnosis for typical bacterial community-acquired pneumonia includes:
1) Other "pneumonia" syndromes including aspiration pneumonia, healthcare-associated pneumonia, and post-obstructive pneumonia
2) Non-infectious causes including pulmonary edema, COPD exacerbation, pulmonary embolism, hypersensitivity pneumonitis or other interstitial lung disease, eosinophilic pneumonia, or cryptogenic organizing pneumonia.
D. Physical Examination Findings.
Patients with typical bacterial community-acquired pneumonia will have fever (80%), tachypnea (70%), and tachycardia (70%); they may also present with hypoxia. More than 90% will have a focal lung exam (most often crackles, bronchial breath sounds, or dullness to percussion). No examination features are specific for CAP, but the absence of fever, tachypnea, AND tachycardia makes CAP much less likely. As with the clinical presentation, elderly patients may not have the classic physical examination features so may have a clear lung exam and may have altered mental status. Unfortunately, there are no physical examination findings which predict the causative organism so the exam cannot be used to differentiate typical versus atypical bacteria.
E. What diagnostic tests should be performed?
1. What laboratory studies (if any) should be ordered to help establish the diagnosis? How should the results be interpreted?
For patients with suspected CAP admitted to the hospital, providers should check a white blood cell count – leukocytosis is common in patients with CAP and the differential may provide clues to the underyling disease (e.g., eosinophilia). However, the absence of leukocytosis does not rule out CAP, especially in the elderly. Some expert guidelines recommend checking electrolytes, BUN, creatinine, liver function tests although these are more for prognosis and less about confirming the diagnosis. There are currently multiple studies evaluating the utility of C-reactive protein and procalcitonin in the management of CAP but these are currently not recommended by national guidelines.
For microbiologic testing, blood cultures should be consideredin all patients admitted to the hospital with CAP but they are not mandatory. There are a number of problems with blood cultures in CAP: they are only positive in 7% of cases, up to 6% of blood cultures drawn will yield contaminants, and even with positive culture results, clinicians tailor antibiotics < 20% of the time in the real world. Targeting blood cultures in patients with CAP who are most likely to have positive cultures can increase the yield.Thus guidelines recommend obtainingblood cultures in patients with 1) severe CAP (admitted to the ICU), 2)cavitary lesions on imaging, 3)risk factors for unusual organisms (e.g., bronchiectasis) or 4)underlying liver disease.
There is controversy regarding sputum gram stain and culture testing in the setting of CAP but, for most patients, there is limited utility. Some patients cannot produce sputum and of those that can, most are unable to produce a high-quality specimen. Sputum testing should definitely be sent in patients with severe CAP (ICU) or risk factors for drug-resistant organisms (enteric gram-negative rods, MRSA, etc.). Properly obtained sputum should be collected prior to antibiotic therapy, include a deep expectorated specimen, and be transported directly to the laboratory.
In some institutions, the urinary pneumococcal antigen can be ordered. It is a simple urine test for Streptococcus pneumoniae-specific antigens. As a diagnostic test, it has high specificity – if it is positive in the setting of suspected CAP, a diagnosis of pneumonia secondary to S. pneumoniaeis highly likely. The main problems with this diagnostic test are: 1) cost and 2) it does not provide sensitivities – that is, it may confirm the pneumococcus as the causative organism but it does not help guide antibiotic selection and in areas with high penicillin or cephalosporin resistance, this may not change antibiotic selection. Thus, use of the pneumococcal antigen is not the standard of care at most institutions. Most expert guidelines recommend testing for Legionella with the urinary antigen (if available) for all patients with severe CAP (admitted to the ICU).
2. What imaging studies (if any) should be ordered to help establish the diagnosis? How should the results be interpreted?
The guidelines are clear – all patients with suspected CAP should have a chest radiograph (CXR) performed. Ideally this is a high-quality PA and lateral film. CXR findings in CAP vary from focal lobar consolidation to hazy focal infiltrate to bilateral interstitial opacities. While CXR has been viewed as the gold standard in the diagnosis of CAP, there are some limitations. According to one study, up to 30% of patients admitted to the hospital and given the diagnosis of CAP had clear CXRs on admission. Clinically, patients can present with classic signs and symptoms of CAP and have a clear CXR, only to have the infiltrate "blossom" within the first 24 hours after receiving intravenous fluids. This means a clinician may choose to treat a patient for CAP even with a clear chest x-ray but he or she should continue to search for other diagnoses.
Computed tomography (CT) scanning can also be used in the diagnostic evaluation of patients with suspected CAP. CT scanning has high sensitivity and specificity but these test characteristics must be weighed against the cost, radiation exposure, and consideration if the test will alter management. In general, CT scanning should not be used in the evaluation of CAP.
Unfortunately, there are no radiographic features which predict the causative organism. For example, a lobar consolidation can be secondary to Mycoplasma pneumoniae(an atypical bacteria) while hazy bilateral infiltrates can be secondary to Moraxella catarralis(a typical bacteria).
See Figure 1.
Chest radiograph with bilateral infiltrates in the setting of CAP.
Right middle lobe infiltrate in the setting of CAP.
F. Over-utilized or "wasted" diagnostic tests associated with this diagnosis.
III. Default Management.
A. Immediate management.
Within hours of the diagnosis, patients with CAP should receive intravenous fluids (patients are oftenhypovolemic from decreased PO intake and insensible losses), anti-pyretics for fever, supplemental oxygen for hypoxia, and antibiotics. Regarding the timing of antibiotics, expert guidelines recommend that antibiotics in CAP be administered as soon as possible after the diagnosis is made and do not prescribe a specific time. The guidelines do state that for patients with CAP who are diagnosed in the Emergency Department, empiric antibiotics should be given while the patient is still in the ED.
Regarding antibiotic selection for patients admitted to the hospital with CAP, there are a number of key principles. First, less than 20% of patients will have a specific microbiologic diagnosis based on the diagnostic tests above so most will receive empiric therapy. Second, because there are no history, examination, laboratory, or radiographic features which predict typical versus atypical organisms, all patients with CAP must be treated with empiric regimens which cover both types of organisms. Third, despite some controversy regarding the need for treatment of atypical organisms, the preponderance of the evidence supports a benefit to atypical bacterial coverage.
Lastly, in addition to the usual organisms which cause CAP (Streptococcus pneumoniae, Haemophilus influenzae, Moraxallacatarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae), severe CAP may also be caused by Legionellaspp. and community-acquired methicillin-resistant Staphylococcus Aureus (MRSA). Empiric antibiotics for patients with severe CAP admitted to the ICU must reflect this risk – macrolidesas used in less severe disease as wellor a quinolone used as monotherapy for CAPwill treat Legionellaspp. The addition of vancomycin or linezolid should be usedfor coverage of MRSA. There is evidence showing a mortality benefit to the use of macrolides for the treatment of CAP requiring ICU admission.
Here are guideline-recommended regimens for the treatment of CAP in the hospital:
Non-ICU (admitted to a general medical ward):
– Intravenous beta-lactam + oral macrolide (e.g., ceftriaxone + azithromycin) or
– Intravenous fluoroquinolone (e.g., Levofloxacin)
(The beta-lactam choices include: cefotaxime, ceftriaxone, ampicillin/sulbactam. Alternative regimens include: ertapenem instead of a beta-lactam and doxycyline instead of the macrolide)
Intensive care unit (admitted to the ICU from the ED):
– Intravenous beta-lactam+ intravenous macrolide + vancomycin (e.g., ceftriaxone + azithromycin + vancomycin) or
(The beta-lactam choices include: cefotaxime, ceftriaxone, ampicillin/sulbactam)
Some patients with CAP may have unique underlying conditions which predispose them to drug-resistant organisms. The most common scenario is a patient with underlying lung disease (e.g., bronchiectasis, severe COPD) who is at increased risk for Pseudomonas aeruginosa. For these patients, empiric therapy should include broader-spectrum coverage; for example, such patients could be treated with piperacillin/tazobactam or cefepime + a fluoroquinolone (levofloxacin).
There are a few important principles in the ongoing management of anti-microbials in patients hospitalized with CAP. If diagnostic tests yield a specific organism, the antibiotic regimen should be tailed based on sensitivities (if they are available). For non-ICU patients, if there are no culture results, they should continue on the initial empiric regimen until the time of discharge (see below for specific criteria for discharge – generally if patients are able to be switched to oral antibiotics, they are ready for discharge).
For patients admitted to the ICU with CAP, the initial regimen should include vancomycin or linezolid to treat for MRSA. If the blood and sputum cultures done on admission do not grow MRSA, then the vancomycin or linezolid should be stopped and the other two antibiotics continued.
Based on high-quality meta-analyses, the total duration of therapy for CAP should, in general, be 7 days. Clinicians can consider treated for 5 days if the patient is afebrile with normal vital signs by day 3.
A systematic review and meta-analysis published in 2015 showed that in patients with CAP, adjunctive corticosteroids led to less mechanical ventilation, less ARDS, shorter time to clinical stability, and shorter length of stay. There was a trend toward mortality benefit. Most of the included studies were small and there was variable drug, dose, route, and duration. Based on this, steroids can be considered in patients with CAP but it is not yet the standard of care. More evidence is needed.
B. Physical Examination Tips to Guide Management.
In patients admitted to the hospital with CAP, there are a number of physical examination findings which can indicate response to therapy or development of complications. If treatment for CAP is effective, any abnormal vital signs (fever, tachycardia, tachypnea, hypoxia, etc.) should resolve gradually over the course of 2-4 days. Persistently abnormal vital signs (such as a persistent fever) may indicate inadequate treatment or the wrong diagnosis.
The lung examination should be monitored closely over the course of the hospitalization. While the focal exam findings present on admission may or may not improve, providers should carefully examine the lungs for evidence of a pleural effusion (i.e. decreased breath sounds, dullness to percussion).
C. Laboratory Tests to Monitor Response To, and Adjustments in, Management.
Although there are no formal guidelines, most providers will follow the white blood cell count over the first 1-2 days of the hospitalization to monitor response to therapy. If the patient presented with a leukocytosis, this should gradually resolve over the first 1-3 days. There is no indication for repeating the chest x-ray during the hospital to look for improvement in the infiltrate. Repeating the chest x-ray should be reserved for patients who are not clinically improving or if providers are concerned about the development of complications from the pneumonia (e.g., pleural effusion).
D. Long-term management.
Patients who have been hospitalized with CAP are at risk for a recurrence of the disease and should be screened and vaccinated with the appropriate pneumococcal vaccine and the seasonal influenza vaccine.
E. Common Pitfalls and Side-Effects of Management.
There are a number of common pitfalls in the management of community-acquired pneumonia. Diagnostically, because CAP is such a common disease, patients who present with the appropriate symptoms (fever, cough, shortness of breath, etc.) can sometimes be given the diagnosis of CAP without full consideration of the broader differential diagnosis. Clinicians can mis-diagnose pulmonary edema, pulmonary embolism, or another disease (e.g., hypersensitivity pneumonitis) as CAP.
Regarding management, a common error is to not recognize when CAP is not resolving. Most non-ICU patients with CAP should see resolution of abnormal vital signs and laboratory values within 4 days of presentation. If by hospital day 3 the patient is not showings signs of improvement, the provider should consider possible reasons why treatment is failing.
Regarding antibiotic therapy, there are two pitfalls. First, clinicians choose to not cover for atypical organisms because the clinical presentation is that traditionally associated with typical organisms (i.e. high fever, purulent sputum, lobar infiltrate). As described above, all patients with CAP need empiric therapy with antibiotics which cover both typical and atypical organisms. Second, often patients with CAP present quite ill; for example, they may present with septic shock or multi-organ failure. The temptation with this degree of illness in the setting of CAP is to treat with broader spectrum antibiotics, such as piperacillin/tazobactam or cefepime. This is a mistake. These antibiotics may have broader spectrum but they are actually less effective than 3rd-generation cephalosporins in treatingStreptococcus pneumonia, the most common cause of severe CAP.
The most common side effects of management are related to the antimicrobial agents. The most common side effects of cephalosporins are: rash, diarrhea (not necessarily Clostridium difficile), and more severe allergic reactions (anaphylaxis, etc.). The most common side effects of macrolides are: diarrhea, nausea, rash, and other allergic reactions. Fluoroquinolone side effects include: nausea, headache, and tendon injury or rupture (especially in older patients). Also, macrolides and fluoroquinolones can prolong the QTc so should be avoided in patients with underlying prolonged QTc or and used cautiously in patients on other medications known to prolong the QTc.
IV. Management with Co-Morbidities.
A. Renal Insufficiency.
Antibiotic doses may need to be adjusted depending on the antibiotic and the degree of renal failure. Clinicians should be aware that according to the Pneumonia Severity Index (the PSI or PORT Score) underlying renal disease is a risk factor for increased 30-day mortality.
B. Liver Insufficiency.
No change in standard management. Clinicians should be aware that according to the Pneumonia Severity Index (the PSI or PORT Score) underlying liver disease is a risk factor for increased 30-day mortality.
C. Systolic and Diastolic Heart Failure.
Clinicians may need to pay particular attention to fluid repletion and fluid balance in patients with underlying heart failure who have CAP.
D. Coronary Artery Disease or Peripheral Vascular Disease.
No change in standard management.
E. Diabetes or other Endocrine issues.
Patients with underlying diabetes who develop CAP are at risk for hyperglycemia and may require more aggressive insulin regimens.
F. Malignancy.
No change in standard management. Clinicians should be aware that according to the Pneumonia Severity Index (the PSI or PORT Score) underlying neoplasm is a significant risk factor for increased 30-day mortality.
G. Immunosuppression (HIV, chronic steroids, etc).
The degree and type of immunosuppression may impact the organisms causing the CAP. Patients with HIV/AIDS are at risk for the usual organisms that cause CAP but clinicians should also consider: pneumocystis jurevecii pneumonia (PCP), cryptococcus, histoplasmosis, atypical mycobacteria, etc. Patients on chronic steroids (at > 10mg per day) are at increased risk for pseudomonal pneumonia (and other resistant gram negatives) – see above for antibiotic recommendations.
H. Primary Lung Disease (COPD, Asthma, ILD).
Patients with severe underlying lung disease (e.g., bronchiectasis) who develop CAP are at risk for drug-resistant organisms such as Pseudomonas Aeruginosa; empiric antibiotic therapy should be adjusted accordingly.
I. Gastrointestinal or Nutrition Issues.
No change in standard management. Clinicians should be aware that according to some prior studies, malnutrition and low albumin are significant risk factors for increased 30-day mortality in CAP.
J. Hematologic or Coagulation Issues.
K. Dementia or Psychiatric Illness/Treatment.
V. Transitions of Care.
A. Sign-out considerations While Hospitalized.
No unique considerations.
B. Anticipated Length of Stay.
The typical length of stay for a non-ICU patient with CAP should be less than 4 days. For patients admitted to the ICU, the expected length of stay is variable depending on co-morbidities and degree of illness but generally should be 7-10 days.
C. When is the Patient Ready for Discharge.
There are standard and recognized criteria for stability in the setting of CAP which signify the patient is safe to be discharged:
Temperature < 37.8oC
Heart rate < 100 beats per minute
Respiratory rate < 24 breaths per minute
Systolic blood pressure > 90 mmHg
Oxygen saturation > 90% (on room air)
Ability to take oral medications
No evidence of active co-morbid conditions
Normal mental status (or a return to baseline)
Safe, appropriate outpatient follow-up
D. Arranging for Clinic Follow-up.
1. When should clinic follow up be arranged and with whom.
Most experts recommend follow-up in general medicine clinic (ideally with the primary care doctor) within 7 days.
2. What tests should be conducted prior to discharge to enable best clinic first visit.
3. What tests should be ordered as an outpatient prior to, or on the day of, the clinic visit.
None. There has been discussion in the past on indications for follow-up chest x-ray after a diagnosis of CAP (looking for underlying malignancy). The most recent expert guidelines do not comment on this specifically but experts state that follow-up chest radiograph can be considered in patients who are high-risk for malignancy (men, age > 65 years old, long smoking history).
E. Placement Considerations.
Frail, elderly, and demented patients are at increased risk for CAP and thus some percentage of all patients with CAP will require placement. For the most part, the need for placement will not be for intravenous antibiotics as most patients can be treated with oral antibiotics. There are no other special considerations for placement for patients with CAP.
F. Prognosis and Patient Counseling.
Counseling patients about CAP at discharge about expected recovery may help prevent readmission. The literature reveals that one week after discharge 80% of patients with CAP will have ongoing fatigue and cough and 50% of patients will have persistent dyspnea and sputum production. Patients can be told that the cough may take months to resolve.
VI. Patient Safety and Quality Measures.
A. Core Indicator Standards and Documentation.
The publicly reported measures for CAP are:
1) Appropriate antibiotic selection for immunocompetent patients with CAP admitted to a non-ICU setting.
3) Readmission rate (30 days) for patients with CAP
4) Mortality (30 days) for patients admitted with CAP
5) Total payment to Medicare for patients older than 65 years-old who are admitted to the hospital with CAP
B. Appropriate Prophylaxis and Other Measures to Prevent Readmission.
Patients with CAP are at increased risk for venous thromboembolism while hospitalized so should be placed on appropriate prophylaxis. Patients with CAP are at increased risk for future episodes of CAP and should receive the pneumococcal vaccine and the influenza vaccine. As proton pump inhibitors (PPIs) are a risk factor for the development of CAP, if a patient is on a PPI, the clinician should ensure there is a clear indication for the medication.
What's the Evidence?/References
Kalil, Andre C, Metersky, Mark L, Klompas, Michael. "Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society 2016".
Lee, JS, Giesler, DL, Gellad, WF, Fine, MJ. "Antibiotic therapy for adults hospitalized with community-acquired pneumonia. A systematic review". JAMA. vol. 315. 2016. pp. 593-602. A systematic review of observational and randomized controlled trials which showed a lower mortality with empiric antibiotic regimens which include treatment for atypical organisms.
Siemieniuk, RA, Meade, MO, Alonso-Coella, P. "Corticosteroid therapy for patients hospitalized with community-acquired pneumonia. A systematic review and meta-analysis". Ann Intern Med. vol. 163. 2015 Oct 6. pp. 519-28. A systematic review and meta-analysis showed steroids in CAP result in less mechanical ventilation, less ARDS, earlier clinical stability, and shorter LOS (no mortality benefit).
Sigl, WI, Asadi, L, Eurich, DT. "Macrolides and mortality in critically ill patients with community-acquired pneumonia: a systematic review and meta-analysis". Crit Care Med. vol. 42. 2014. pp. 420-432. A systematic review and meta-analysis showed that for patients with CAP who require ICU care, empiric antibiotic regimens which include a macrolide lead to lower mortality when compared to other antibiotic regimens.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Powered By Decision Support in Medicine.
Next post in Hospital Medicine
Tuberculosis and Mycobacterial Pneumonia
Close more info about Typical Bacterial Pneumonia


text:
Sidney ready to host Tour de Rock
Parade, party planned in Sidney when the Cops for Cancer arrive Oct. 4
Tour-de-Rock
Town of Sidney town crier Kenny Podmore and local Tour de Rock event co-ordinator Juile Harman announce the start of this year's Cops for Cancer Island bike ride.
The Tour de Rock, Cops for Cancer ride begins on Vancouver Island on Saturday, Sept. 22 in Port Alice. From there, the riders will be biking down-Island over 14 days.
Their ride comes to Sidney on Thurs., Oct. 4 and the town is getting ready to throw them a parade.
This week, Sidney town crier Kenny Podmore and local Tour de Rock event co-ordinator Julie Harman officially announced the start of the Tour — and what the Town of Sidney has in store on Oct. 4.
As well, this Sunday, Sept. 30, the Old Black Rum band plays a Tour de Rock, by donation, fundraiser in Beacon Park from non to 4 p.m.
"We will be throwing the riders a parade," Harman said of the Oct. 4 event, adding it will include local police, firefighters and paramedics.
On Oct. 4 at around 3:20 p.m., local emergency vehicles will fall in behind the 18 riders, representing Island police, military, media and more, and make their way from the Mary Winspear Centre to Beacon Park.
Bringing up the rear of the parade, said Harman, will be 60 or so bike riders from local elementary schools.
"We revived this part last year," she said of the kids' part in the event. "It was a huge success and the kids just loved it."
The parade is only one part of the day's Tour de Rock events. Starting at 11:30 a.m. in Beacon Park, there will be entertainment (in the works, said Harman), head shaves and a big barbecue. It runs to 4 p.m. The event, of course, is looking for people's donations to the cause. Harman said this will be her 15th year co-ordinating the local Cops for Cancer event.
Money raised at Island-wide Tour de Rock events — as well as from pledges over the 1,000 km ride itself — goes to help fight childhood cancer. Since 1998, the Tour has raised more than $16.6 million for the Canadian Cancer Society. For details, visit www.tourderock.ca.
Concert for cancer research
SIDNEY — This Sunday, Sept. 30, the band Old Black Rum will be performing in Beacon Park to help raise funds for the Tour de Rock Cops for Cancer ride.
The show runs from 12 noon to 4 p.m. and is a by-donation only event.
Tour de Rock takes on the Island
Business rallies for riders


One of the stores that I regularly check there is called MoLeKuLa. It is a store based in Israel and I've actually ordered a couple of items for my friend Kate. Reason for that is that this is a womens clothing store, and I'm not a cross-dresser.


The Village of Lake Zurich, located in southwest Lake County, is a unique community as it contains within its borders the actual Lake Zurich, a 228-acre body of water with a depth of 32 feet at its deepest point. Though the lakeshore is almost entirely privately owned, the lake is a natural focus of the community and visitors and residents enjoy two Village beaches, the Paulus Park beach on the lake's western shore, and the other at Breezewald Park on the east. While there is no public launch for motorized boats, non-motorized craft can set off from Paulus Park for on-the-water enjoyment. The lake further enhances the Village area with a gorgeous downtown promenade, as well as a walking path that runs a comfortable three miles around the lake. And of course there's great fishing, whether individually or at the Annual Family Fishing Derby each June, or the Family Ice Fishing Derby that warms up the winter. And natural activities don't stop there. Just north of Breezewald Park, visitors can enjoy a hiking path through Oak Ridge Marsh to the birder's observation area by Echo Lake, a 25-acre manmade lake and residential subdivision. The marsh, as well as other natural areas around Lake Zurich, is supported by the Ancient Oaks Foundation, a volunteer conservation group.
Aside from lake activities, there's plenty to do in Lake Zurich all year 'round. Summers see a weekly Farmer's market, monthly family movies and Cruise Night car shows, as well as the annual downtown block party, "Rock the Block." The Lions Club also provides family activities, including the Alpine Fest Carnival, "Luau in Paradise," and Candy Cane Hunt. And of course there's the Village Winter Celebration and Tree Lighting each December. As for shopping, all along Rand Road you'll find a full spectrum of shopping, from nationally-known chains in retail centers to clever little locally-owned shops, as well as delectable restaurants to satisfy any palate.
The history of Lake Zurich is an important part of the area's development, and is showcased at the Ela Township Historical Museum, with its various exhibits depicting the progression of Ela Township and Lake Zurich. But Lake Zurich also looks to the future, and the future can be found at the Ela Area Public Library, which provides residents with IMac computers and a digital video lab. Even more exciting is a revolutionary new section called The Forge, a makerspace designed to encourage hands-on creative arts and critical thinking. There, such equipment as a mini-3-D printer and scanner, vinyl cutter, sewing machine and kits to teach about circuitry are available to adults and kids alike.
Lake Zurich is an affluent area, with the median household income of the 19,000+ residents at more than $100,000. More than half the population is comprised of families with children who attend one of the five elementary schools and two middle schools, as well as Lake Zurich High School, a nationally-ranked silver medal school. In addition, there are private parochial schools in the Village.
With its respect for the past, devotion to its natural environment, and eye to the future, Lake Zurich is certainly a community for all ages.
Whether they want a bathroom renovation that rivals the Taj Mahal or a simple changeup of fixtures, Lake Zurich homeowners know who to call to get the job done right: Regency Home Remodeling. Whatever the size of the job, Regency will get it done on time and within budget, providing the same dedication and promise of quality to any size job, from a multi-level en suite renovation to a simple powder room redo. To the pros at Regency Home Remodeling, every home is a palace, every job is the only job This is a promise they make to Lake Zurich customers, and it's one on which they always deliver.
Regency Home Remodeling enjoys an over 99% customer approval rating and is widely considered the best home remodeler in Lake Zurich, IL. Don't take our word for it. View project photos and see what our customers say about their experience of working with Regency. When you're ready to remodel your home, contact us at 1 (773) 930-4465 and get the Exact Regency Price!


Before you rush out and get started on development, there are a few things you'll need to consider.
That's exactly what this article is about.
The most successful apps have one thing in common — a plan.
That's right, most of the best app ideas were fine-tuned by asking questions just like the ones you'll find below. Proper pre-development preparation is one of the most powerful tactics at your disposal and will set you on the path to creating a successful app.
Below you'll find a list of essential questions to ask yourself before you begin development. Take your app idea and run it through this list and you'll undoubtedly build a better final product.
Who knows? You might just create the next game changer!
#1 What Do You Want the App to Do? What's the Mobile App's Purpose?
This is the big one. This question will help you understand exactly what you want from your app.
One thing is for sure: You'll need more than a general idea before you get started with the development process.
Understanding the functionality you want from your app will help you answer each of the following questions more easily. If you don't fully know what you want from your app yet, take a stroll through some of your favorites and those related to your app idea.
Take note of the features you like and will want to include in your design. Pay attention to the level of intuition these apps provide. Is that important to your design?
If your app idea is complex and detailed, make sure you understand how intricate your app will need to be to achieve your idea and provide a positive user experience along the way.
If you have a simple idea, look for ways to make your app more engaging, exciting, and/or easier to use. Do something your competition doesn't.
You should have a very clear picture of what you want your app to do and how you want it to perform before you enter the development phase. Your developer can help make suggestions and streamline the process for you, but you need to approach them with the full picture.
# 2 Do You Want to Make Money from the App?
There are plenty of people out there creating apps for fun. There are even those developing apps to make the world a better place. If you're one of them, power to you. You'll probably have more time to allot to your project and it won't be as important that it's absolutely perfect.
However, most apps are designed to be monetized, either through paid downloads or a marketing platform like localytics. If you're looking to create an app that people will pay to download, it better serve a unique purpose and it better be good.
Creating an app that solves a problem isn't good enough anymore. It needs to be better than the others that, at a glance, appear to be just like yours. If you want to create a moneymaker, be sure to do something new or better to help you stand out.
# 3 Who is Your Target Market?
If you're looking to create an income stream, you'll need to know who you're building your app for. Lots of games are free because they're downloaded by people who have more disposable time than disposable income.
If you're looking to make money from those in that demographic, you'll want to create a fun and engaging free app that people continue to play. That way you can benefit from an ad display platform for years to come.
On the other side of the spectrum, complex apps that perform a specific task are often ad free, but come with a price tag upon downloading. You'll want to create an excellent product that delivers on all of its promises in order to boost your reviews and your rankings in each mobile app platform.
#4 Do You Want it to Be a Web, Native,or Hybrid Mobile App?
People often have "app ideas," but don't understand that there are actually 3 types of apps available to use for development.
A Web App is basically the mobile version of a website that is created to make the most of the mobile user experience. Web apps can be accessed from any browser and don't need to be downloaded. If you're looking for a way to improve your business' mobile user experience, you may be thinking a web app idea. Web apps are typically cheaper to develop and take less time, but you'll miss out on the exposure of the app markets.
Native Apps are platform specific, meaning they live only on an Android or iOS platform and cannot cross over to the other. If you have a detailed, complex, user-intuitive experience in mind for your app, you may have an Android or iPhone app idea. Native apps are usually more complicated and therefore cost more and take longer to develop. You'll also need to develop two different apps in order to reach both platforms.
Hybrid Apps are a mix of web and native apps, giving you some of the intuitive user experience and functionality of a native app, but with multi-platform accessibility. You'll find that the hybrid user experience to be below that of a native app, but it requires a smaller investment of your time and money to create. You'll also benefit from reaching the exposure of both app markets easily.
#5 Will the App Be its Own Business or an Accessory to an Existing Business?
This is one of the most important (and most obvious) questions you'll need to ask yourself. While the answer may be easy, this question deserves a hard look.
If you're creating your app as an accessory for an existing business, the type of app you need will be determined by the size and type of business. Small businesses are often looking for a new way to interact with their customers, expand their reach, or increase the overall convenience of the way they do business. You may only need a simple web app or hybrid app to satisfy your needs and professional help may still only require a small investment of your time and money.
Larger businesses may want to do more for their customers and need to create a more complex and robust app. At this point it's time to start thinking about individual Android and iPhone app ideas. A native app or a well-designed hybrid app may be more appropriate for your needs.
If your app is going to be a product that you market and sell, you'll need to think about things in a different way. Your focus should be on the end result: the user experience. If you're creating an app that makes life easier or performs a task in a new way, you'll need to understand what that type of functionality translates to in the development process.
You'll need to know more about how well you can integrate that functionality into a hybrid app or if you'll need to go platform-specific to accomplish what you want to achieve.
#6 What's Your Development Timeline?
The time you have to develop your app may be an important deciding factor for your developer. Traditionally, native apps take longer to build, so if you're pressed for time and need to launch your app soon, you may want to consider creating a hybrid app with professional help to speed up the process.
If you have a longer timeline to work with, creating a native app may be more feasible if you decide that's what you're looking for. The user experience of a native app will almost always be better, so if you have the time and budget it's something you'll want to consider.
If you have more time than money and a very simple app idea, you may even want to try your hand at development. A simple Google search will point you toward software that exists to help novices turn their simple app ideas into reality. While most people find development difficult, you may discover a hidden talent that you never knew you had.
#7 Are You Developing the App or Hiring a Mobile App Development Company?
Unless you're a professional developer, you may not understand the complexity of app development in it entirety. Software does exist that allows you to create basic apps on your own. Simple app ideas created for personal use or for a small group of people may benefit from this type of DIY app development.
That said, if you're marketing your app in the hopes of monetizing it, or if your app idea is creative or complex, you'll want to approach a professional Mobile App Development Company.
In fact, approaching a professional is a great idea for anyone with app ideas, even if it's only for a consultation. They'll be able to help you answer a lot of the questions on this list in greater detail, especially if you're a novice in the development field.
You're the one with the idea. You don't have to be the one who understands the nitty gritty of the technical side of app development.
#8 What is Your Development Budget?
The cost to develop an app varies from a few hundred dollar to several thousand. If you have an idea for an app, understanding any budgetary restrictions you may encounter is important. For simple app ideas, a hybrid app may be all you need. That usually translates to less time and money.
If you have a very detailed and complex app idea, you may need to create native app that is more expensive and takes longer to get to market. The more you want your app to do, the more unique your project, the more it will ultimately cost.
#9 iPhone, Android, or Both?
You may have determined that you need to create a native app to make the most out of your app. The user experience your app will provide will be out of this world. Unfortunately you'll have to create separate apps to reach both platforms.
So here's the next question.
Does your app idea fall under the category of iPhone app ideas, Android app ideas, or both?
Look at your answers to the questions above to help you decide. If you want to make money you may find the App Store more appealing, as it tends to generate more downloads. The Android platform is a little more crowded.
That said, your demographic has more to do with your decision than anything. Do your research. See how many similar apps already exist on each platform and how the existing ones are performing. Read user feedback and take note of what people like and dislike when creating your own product.
If you're simply looking for your app to promote your business, look to Android. You won't need to have your app reviewed and it will be live a few minutes after it's published.
#10 Should Your App be Free or Paid?
Once you have your app idea developed, you'll need to launch it. Whether you include a price tag or decide to monetize with ads is up to you, but here's how it usually works.
Games and entertainment are typically free, but show ads.
Things like clerical software won't usually display ads, but typically they come with a price tag for the full version.
Speaking of different versions, the best way to test which monetization method suits your app is by creating two versions. A paid version that includes all of the features and is ad free, plus a free version that has ads or is a limited version that doesn't include the full functionality or your app.
By now you know more about your app idea than ever. In fact, you know more than most people do before they set out to create an app.
You don't just have an idea for an app, you have a clear view of all of the variables. You now understand what it takes to turn your app idea into a successfully developed, properly monetized application that will benefit its users.
It's time to get started with the development process. If you have any questions, contact us today and we'll help be happy to help you answer them.


Mosaic Panorama is our turnkey club management solution, offering expertise and management in every area of club operations.
This is the platform we have spent years developing to professionally manage all types of clubs, from daily fee courses and resorts, to private clubs and athletic facilities. Mosaic's resume goes well beyond building and managing golf courses. Our experience includes lodging and hotels, spas, athletic clubs, conference centers, real estate sales, and other club related amenities and services.


STAMFORD — Police and city officials are warning local justices of the peace that a group is trying to steal money from them by sending them counterfeit checks and asking for refunds.
The scheme works like this: A person sends a counterfeit check for much more than what the justice of the peace has asked to perform a wedding, in many cases the ficticious wedding is set for Saturday, Feb. 2 in North Stamford on Coventry Road by the New York State border. The person who sends the check, many times calling from California, sayd that they made a mistake by writing the check for hundreds of dollars more because they did not realize they included money for the photographer or videographer.
Property Crimes Sgt. Steven Perrotta said in the one instance reported to police, the justice of the peace told him she was sent $950, a full $800 more than what was asked. The person called back and asked for a $800 cashier's check.
But the woman did not fall for the scam, he said, and none of Stamford's 105 justices of the peace have said they fell for it either.
City and Town Clerk Lyda Ruijter said she heard from five or six justices of the peace earlier this week who said they received similar checks and calls.
Ruijter had her staff call around to put out the warning and heard from many others that attempts were made to scam them, she said. Other town clerks in the area reported attempts have been made to rip off their justices of the peace, too. So far, Ruijter has not heard of anyone losing their money.
"How is it that someone could cook up such a scheme? Why are they targeting justices of the peace?" she asked.


text:
Every Day Heroes
My hero, Fred Kirby, with my brother and sister, Tony and Janie, and some kid that is not, but should have been me!
Who are your heroes? As a little girl, my hands down hero was a singing cowboy named Fred Kirby. A staple for all baby boomers throughout central North Carolina, Fred Kirby and the Little Rascals aired for years Sunday afternoons on our local Charlotte station WBTV, Channel 3. They were all local stations back then.
Fred Kirby sang all of my favorite songs. Who can forget Jimmy Crack Corn, The Big Rock Candy Mountain and his classic, Atomic Power?
"How we-ee-ee-ee-ee LOVE the Little Ras-cals,Little Ras-cals, Little Ras-cals…"
In addition to those classic scenes playing his guitar and singing, Fred Kirby rode his horse Calico while his side-kick, Uncle Jim, entertained us with his classic buffoonery. The show also aired short clips of "Our Gang", The Little Rascals. Who can forget Darla and Alfalfa, the Buckwheat and throaty voiced Froggy? Who can forget the classic and completely politically incorrect episode when Uncle George broke out of the nuthouse and chased the Little Rascals around for their candy saying "Yum, yum. Eat'em up!"? In the end, the Rascal's are saved by little Spanky who shot Uncle George in the arse and out the window with a roman candle?
My hero, Fred Kirby, had a long career in the entertainment industry and entertained generations of children before and after me. He faithfully wore his cowboy hat and red cowboy shirt with white fringe and made summer and weekend appearances for years at a local attraction in the mountains near Boone NC called Tweetsie Railroad. It was a highlight of my preschool years when mama and daddy took me to Tweetsie to see Fred Kirby in person and ride the train. Numerous times a day, the old steam engine, Tweetsie, wound its way for several miles through the Appalachian mountains where it would invariably be attacked by Indians. On the day we made this classic trip, one of the Indians decided he was going to pretend to scalp my mama. It was classic "Mur-Louise" when she fought back and hit him in the head with her pocketbook. Ultimately, we all came out alive when the cowboys came to our rescue.
These days, there are very few characters on my television set that are worthy of being cast as heroes. Even our old friends Batman and Superman are squabbling between themselves. I have to ask, really, is it worth those paltry millions to further confuse the next generation of kids as to which of these guys are the good and which are the bad guys? Doesn't that generation have it bad enough?
More importantly, I find there's simply no need to look for pretend heroes when there are real life heroes in my daily life that inspire and amaze me. Let me tell you about a few…
There's my neighbor Janice who has faced numerous difficulties including the tragic loss of her son, Deebs, years ago. I recently learned that every year, she and her ex-husband visit her son's elementary school and tell the children her son's story. Every year in May, she courageously reopens those wounds and has to find the strength to heal again. For her courage to continue to stay open to love despite the pain it costs her, Janice is my hero.
There are my cousins Glenn, Julia and Alex who after the loss of Glenn's mother (my Aunt BJ last summer) are now courageously fighting Glenn's aggressive stage 4 cancer. Cancer has totally changed their lives but they are committed to doing everything possible to wage war on this brutal disease. The stress it puts on them as individuals and a family is great but they do it with faith and grace. For this and the love they continue to share with others during their own difficult times, Glenn, Julia and Alex are my heroes.
There are my friends Linda and Tracy who over the last five or six years suffered unexpected, mid-life breakups of their marriages. Through their experiences, I have learned that divorce is much more than the breakup of a marriage. It is the dissolution of a family unit. It is a complete loss of trust between individuals. It is the death of a dream. To watch them come out of those dark times to create even stronger, better and more authentic lives is nothing less than awe- inspiring. Linda and Tracy are my heroes.
There is my young friend who was a drug addict. After many years, she found the strength to come clean and she lives her life today in recovery. As a single mother, today she works two jobs to support her family. She is dedicated and tough. She is compassionate and makes time to help others. This friend knows who she is. She is my hero.
My list of heroes could go on and on. Today's real-life superheros do not need to don a cowboy hat or wriggle into spandex to assume their magic powers. Everyday, they get out of bed, put one foot in front of the other and bravely do battle.
Check out these old clips and information:
Fred Kirby on You-Tube: https://www.youtube.com/watch?v=pM-pDmjxKqA
Little Rascals' Uncle George (enturity) https://www.youtube.com/watch?v=fnA8NQBjjso
Little Rascals' Uncle George (clip)https://www.youtube.com/watch?v=SPlcU0khL6Q
Little Rascals' Where Are they Now? (My mom and dad used to tell me that one of the Little Rascals became a Doctor at Baptist Hospital in Winston Salem, but if that was true. I do not remember which one…) https://www.youtube.com/watch?v=kRcInZWL7Do&list=RDkRcInZWL7Do&nohtml5=False#t=75


text:
title: Pilot CS Discoveries
nav: educate_nav
---

# Apply to Pilot CS Discoveries #

**Application Update: The CS Discoveries Pilot application closed March 31st. We are reviewing applications and accepting teachers through April 4th. We will update everyone of their acceptance status by April 8th.**

## Overview
CS Discoveries is our newest curriculum-in-development - an introductory Computer Science course that empowers students to create authentic artifacts and engage with CS as a medium for creativity, communication, problem solving, and fun. It is targeted for grades 7-8, but able to be adapted for 6th and 9th grade. [Learn more.](/educate/csd)

If we aren't able to accept you into the official pilot group, but you would still like to be an early adopter of the curriculum, consider [signing up](/educate/csd/status_signup) for our monthly updates to learn when the tools and lessons are first available.

We also encourage you to seek out computer science resources to use in your classroom by visiting [code.org/educate](http://code.org/educate) or using our partner resources at [https://code.org/educate/curriculum/3rd-party](https://code.org/educate/curriculum/3rd-party).

## Application Closed

The application closed March 31st. We are reviewing applications and accepting teachers through April 4th. We will update everyone of their acceptance status by April 8th.

redpajama_set_name: RedPajamaGithub


The NESTOR HOTEL is a family and fully renovated ( winter 2012) modern hotel with a welcoming atmosphere.
It enjoys an excellent location, apx. 300 meters from the most beautiful white sandy beach and picturesque fishing port of Ayia Napa , close by the Thalassa Municipal Museum of the Sea, while the full of live City centre is apx. 300 meters away with its numerous bars, restaurants, shops and nightlife.


I truly believe that to run a successful branding agency, you have to invest way more than 40 hours a week. And part of that means reading books that not only help the business, but help our clients' businesses. So from time to time, I'll review some of my favorite advertising, branding or business books here on our blog. Maybe it will inspire you to pick it up (or download it) yourself!
The E-myth Revisited, by Michael E. Gerber, isn't a new book. Published in 1995, it's a powerful look at entrepreneurialism that I believe will hold up for decades to come. Its theme? Small business owners need to work more ON the business. This is crucial if they want to transcend simply creating a job for themselves to building a real business.
What does that mean? It means getting out of the day-to-day minutia of the business – the phones don't work, the copier's down, emails need to be answered – and working on the big picture. The system. It means that most entrepreneurs have great ideas, but aren't necessarily adept at actually making it scalable. They also might have trouble moving beyond what they can personally execute.
It's not easy to get out of the weeds. It takes a concerted effort to look at the big picture. At Forte, that's what we do for our clients in our branding engagements – we pull them out of the weeds in their business to see the big picture. We help them focus on how the business will look 3, 5, 10, 15 years down the road. You see, branding and systems are strategic cousins – you have to have a brand in place to get the right systems in place.
The E-myth Revisited is more than a story about how entrepreneurs can succeed. It's a resource with concrete plans to implement. In fact, my biggest ah-ha moment of the book took place in chapter 5: "Beyond the Comfort Zone." It's imperative for a business that's going to be successful to get out of their comfort zone and institute their brand systematically into every part of the business. I thought to myself, "Our clients need to realize that's what they must do!" It's a daunting endeavor, but one that must be done. The good news: we do this for clients every day.
If you own a small business (or are thinking of owning a small business), pick up The E-myth Revisited. I'd lend you mine, but you can barely see the original text with all the notes I have in the margins!


The discharge points of Donetsk and Lugansk regions go 25 cars with the "humanitarian cargo" weighing more than 300 tons.
61st column of the EMERCOM of Russia with humanitarian aid for Donbass advanced towards the Russian border, according to the website EMERCOM of Russia.
According to the report, consisting of 25 cars.
About the cargo said that it weighs about 300 tons.
It is argued that the bulk of the cargo is "baby packages".
Recall that Russia sends "humanitarian convoys" on the territory controlled by the militants since August 2014.
Ukrainian border guards and representatives of international organizations do not have access to their test, they can inspect the trucks only visually. Repeatedly recorded cases when the car, which was supposed to be an aid for residents of Donbass, was half-empty.
In addition, according to the Ukrainian intelligence, Russia is using the trucks of "humanitarian convoys" for the removal of the bodies of Russian troops from the Donbass.


CONERNEY ESTATE AGENTS are delighted to present to market this fabulous two bedroom, 2 bathroom, southwesterly facing ground floor apartment in the ever popular Seabourne View in Greystones. This excellent apartment comes to market in pristine condition throughout having been exceptionally well maintained and furnished with only the very best of fixtures and fittings. The property has a fully fitted integrated, marble top kitchen with all mod cons. Large open plan living room with excellent natural light and balcony access.
There are two large double bedrooms, both fitted with quality built in wardrobes and the master is en-suite. Both rooms are bright and spacious with great natural light. The main bathroom is again large and fitted with bath and shower. The apartment comes with great storage, bin service and parking is included. Set on the ground floor and in a very quiet cul de sac with a majority of owner occupiers.
Very well fitted and presented in excellent condition throughout.
Set in a quiet and very popular location, close to shops, bus routes N11 and M50.
The commuter will be delighted at the easy access to local bus stops, Aircoach and the DART station all within walking distance. The N11/M50 is also within easy reach making for an easy commute to the city, airport and beyond.
Viewing of this excellent apartment is strongly advised and strictly by appointment only.


adjective Resembling an arrow or some aspect of one.
Inevitably, what has hooked me is the thought itself: the arrowlike precision of an insight, the mind-rattling energy of an observation.
I am like the foam that races over the beach or the moonlight that falls arrowlike here on a tin can, here on a spike of the mailed sea holly, or a bone or a half-eaten boat.
Then suddenly the stillness was cloven by the arrowlike swiftness of a long grey car which halted before the big deserted flats.
An arrowlike shape, ashine in the light of the distant sun, glided from orbit and dwindled into heaven.
Beyond the tent, screams have begun to fill the camp area, its expanse a mixture of light and shadow created by the arrowlike flames that descend from the dark heavens.
The lane on the left side of the road led arrowlike to three structures perhaps a hundred cubits to the west-a square house, what appeared to be a barn, and a large shed.
Though the low-thrust plasma drive had long since been closed down, Discovery was still coasting with her slender arrowlike body pointed away from Earth, and all her high-powered optical gear was oriented toward the outer planets, where her destiny lay.
Ere a dozen long breaths had been drawn, he was stealthily moving towards the valley, slipping from spruce to spruce -- an arrowlike, unnoticeable figure in his dark gray tweeds.


In November, the Canadian government offered $85 million to the victims of Canada's "gay purge" which started in the 1950s. The purge, which targeted LGBTQ persons in the Canadian government and military systems, was a government program conducted by Canadian Mounties. They did surveillance, made threats, shamed and punished gay people.
According to the New York Times, the program "…lasted for more than 30 years and ended only in the 1990s, caused thousands to lose their jobs and sometimes face prosecution because of their sexual orientation. The policy affected Canadians in the military, the public service and the Royal Canadian Mounted Police." Trudeau apologized for the program and "Canada's role in the systemic oppression, criminalization and violence" when presenting the compensation.
This is just the most recent of many very liberal, feel-good political moves by Canada's much-loved prime minister. In July, Rolling Stone featured Trudeau on the front page with an article titled "Why Can't He Be Our President?" Many Canadian citizens, however, do not share the same love for their prime minister as Americans seem to.
Many initial supporters of Trudeau are frustrated by his neglected campaign promises and how he dodges issues. According to Huffington Post, Canadians "have expressed frustration over his stance on oil pipelines, his decision to scrap a key promise on electoral reform," and some of them aren't putting up with it any longer. Canadian citizens Alex Ayton and Kathleen Olds, two students at Dalhousie University in Nova Scotia, asked Trudeau for a group photo when they saw him at a coffee shop. As the three posed, one of the women asked Trudeau about implementing the United Nations Declaration on the Rights of Indigenous Peoples, one of this campaign promises. The UN declaration recognizes indigenous peoples' basic human rights, as well as their right to self-determination, land, language and equality. When Canada officially declared support for the declaration in 2016, it was a huge win for indigenous and First Nation communities and activists.
As predicted, Trudeau dodged the question with a quick "absolutely, yes, for sure" before leaving. This was in February, when Canada's Prime Minister boasted approval ratings around 48 percent.
Many Americans love Trudeau because we only hear about the big PR campaign events that his administration organizes. Canada's compensation for the LGBTQ community hurt by past policies is a nice step in the right direction, and a perfect comparison to how poorly the U.S. is handling issues of discrimination and systematic oppression. And yet, the American love for Trudeau is unwarranted. Trudeau and his administration need to buckle down and start making good on campaign promises before he loses his chance.