text:
IOC rep 'satisfied' with 2018 progress
Gunilla Lindberg speaks to the media Thursday at Lakai Sandpine Resort in Gangneung, Gangwon. [NEWSIS]
GANGNEUNG, Gangwon - Gunilla Lindberg, who leads the International Olympic Committee's (IOC) Coordination Commission for the 2018 Pyeongchang Winter Olympics, said Thursday she is "satisfied with the progress" of preparations, but organizers now need to focus on the "software" aspect of the event,
"I checked venue master plans in January, and yesterday we had a venue tour," Lindberg said at a press conference Thursday at Lakai Sandpine Resort in Gangneung, Gangwon. "Of course there is no time lose … we believe all the venues will be ready."
But while the commission and the Pyeongchang 2018 Organizing Committee (Pocog) are confident about "hardware" for the Games, they said it's critical to set up the "software" for the event, such as operations and administration.
"One critical area is to speed up bringing experts to Pyeongchang to help local organizers prepare the test event and help the Pocog administration," said the 67-year-old Swede. "That's one of the topics that is urgent."
Pocog President Cho Yang-ho acknowledged that bringing in experts to train locals is an important task.
"Since Korea doesn't have a lot of experience in the Winter Games, there are sports we don't know well," he said. "We promise we will hire experts by the first half of the year to train people here."
Cho, who is chairman of Hanjin Group, also emphasized the problem of getting volunteers, saying at least 20,000 will be needed for the country's first-ever Winter Olympics.
Lindberg also said organizers should "speed up communication" to facilitate quick decisions.
However, she was happy that the first integration working group involving the central government, Gangwon Province, IOC, the organize committee and other related parties, met Wednesday to discuss decision making.
This is the first time the commission has held all its meetings in the city of Gangneung.
The Gangwon city, 240 kilometers (149 miles) east of Seoul, will be the site of venues for three of the seven Olympic winter sports - curling, ice hockey and skating.
BY JOO KYUNG-DON [joo.kyungdon@joongang.co.kr]


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Hornet's Nest Gym offers service members a variety of functional fitness equipment and programs in which to participate. This facility supports the most current fitness development regimens, such as high intensity workouts. The fitness center offers cardiovascular equipment, two full selectorized strength circuits, a youth circuit, free weights, a group exercise room, spin room, basketball court, three racquetball courts and a family fitness room. This fitness center also maintains the TRX system which is located adjacent to the softball field.


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Mark Smeltzer, working out of his temporary basement studio, can create a world of sound even as he prepares to move himself and his voiceover business to L.A.
The venue was peaceful, with upholstered chairs in the sunny view window of a hillside home in Broadview, where 27-year-old voice artist and actor Mark Smeltzer is living, for a short time, with his parents.
However, spending an hour with Mark is a little unsettling — not disturbing, just unsettling in the physical sense. He's so full of physical movement, emotional range and hop-skip-jump subject matter that keeping up with him actually expends energy.
And Mark likes it that way. He's hoping that vibrant, positive life force will propel his performance career onward and upward when he makes a big move to Los Angeles he's planned for Dec. 28. Following this period of respite in his hometown, he'll travel to the heart of America's entertainment industry.
He says he loves performing and was always seeking attention, the spotlight, an audience. Small acting roles in Fiddler on the Roof and The King and I at Wenatchee High School whetted his love of acting, and his strong, adaptable voice led the way to a variety of vocal work.
Mark's career has not taken a straight path, though, with dropping out of both high school and college, day job switches, big heartbreak, a Hawaiian hiatus, significant disappointment, a few great mentors, loss of confidence, regaining of same, and a spate of very cool one-off jobs doing exactly what he loves to do.
He says he's been helped immeasurably by his parents Dave and Ruth, who, he's happy to explain, adopted him from a Methow Valley couple in utero 27 years ago ("The Smeltzers literally saved my life," he insisted), and they continue to be supportive.
That mis-focus was compounded by attention deficit disorder; probably inherited, diagnosed early. Mark explained that after spending his youth and teen years battling his ADD, he has recently learned to use it positively.
You can also hear him — a dozen of his nonfiction audio book recordings are available on Amazon or YouTube. And maybe you can only imagine his video game character voices recorded for Big Fish Games in Seattle. He's also done voice work for Dwayne Johnson's ("The Rock") production company, Seven Bucks, and has a small role in the 2017 film Psycho's Path.
Known professionally as SmeltzerSounds Voiceovers, the combo of Mark's voice and his recording expertise works anywhere: audio books, commercials, promotions, voice-overs in film, announcements, on-line instruction, cartoons and a range of other vocal ventures, but he's set some personal boundaries.
The other necessary ingredient in the business is his integrated sound system. All of it — Mac 2010 computer, AKG p420 microphone, "pop" filter, Scarlett2i4 audio interface — fits into one side of a not-walk-in bedroom closet, and it enables him to work from home on a program named Garage Band, connecting digitally to the world.
Mark would like to expand his voiceover work into full-bore acting and even producing.
His mind always churning with opinionated commentary and following the "question everything" rule, he also looks forward to writing content for plays, podcasts, comedy and monologues. Making people feel — especially making them laugh, brings him great joy.
So, here's to discomfort, to unsettling experiences and new barriers to break. With revived stores of energy and optimism, sound-making savvy, solid connections and a mix of marketable talents, Mark is heading off to fulfill his L.A. dream.
Mark's website is www.smeltzersounds.com, and you can follow him on Facebook, Twitter, Instagram, Linkedin and IMDb.


text:
Jižní spojka je pražská kapacitní rychlostní místní komunikace, která tvoří jižní a jihovýchodní část vnitřního pražského Městského okruhu (přesněji tedy jen úsek Barrandovský most – zamýšlená MÚK Rybníčky). Začíná u Vltavy na východním předmostí Barrandovského mostu a končí na mimoúrovňové křižovatce s Průmyslovým polookruhem u Štěrbohol (zde se napojuje na Pražský okruh). Do roku 1998 byla označována jako součást silnice I/29.

Je hlavní tranzitní komunikací v Praze a před dostavbou jižní části Pražského okruhu byla prakticky jedinou trasou, kudy mohly Prahou projet kamiony ze západní části města (především od dálnice D5 na Plzeň) do východní (hlavně dálnice D1 na Brno a D11 na Hradec Králové). Jižní spojka však plní i velmi důležitou úlohu ve vnitroměstské komunikaci při spojení západní a východní části Prahy.

Charakteristika
V úseku Barrandovský most – zamýšlená MÚK Rybníčky je Jižní spojka šestiproudovou komunikací.

S průměrným počtem 120 tisíc vozidel za 24 hodin jde o nejvytíženější silnici v České republice. I po převedení části dopravní frekvence na Pražský okruh zůstala nejvytíženější komunikací v republice, na nejvytíženější části bylo naměřeno 147 tisíc vozidel denně a na Barrandovském mostě 132 tisíc, avšak provoz je plynulejší než dříve, protože mezi vozidly je podstatně nižší podíl kamionů. Po otevření Pražského okruhu sice krátkodobě denní počet vozidel klesl asi o 20 tisíc, ale volná komunikace na sebe brzy stáhla část dopravní zátěže, která do té doby prosakovala rezidenčními oblastmi.

Křižovatky a napojené komunikace

Jižní spojka se kříží s následujícími komunikacemi (od východu):
 Modřanská – na východním předmostí Barrandovského mostu
 Sulická (z centra) a V Podzámčí (do centra) – křižovatka u Krčského nádraží
 Vídeňská (z centra) a Michelská (do centra)
 5. května – křížení na Spořilově s Chodovskou radiálou navazující na dálnici D1 (z centra) a se Severojižní magistrálou (do centra); oficiální označení je MÚK Spořilov
 součástí tohoto křížení je i napojeni ulice Hlavní na Spořilově
 Spořilovská (z centra) a Chodovská (do centra) – napojení na Spořilovskou spojku
 V Korytech – napojení západní části Zahradního Města
 Průběžná (z centra) a Švehlova (do centra) – u východní části Zahradního Města
 Štěrboholská, Průmyslová a Černokostelecká – komplikovaná křižovatka u Štěrbohol mj. s Průmyslovým polookruhem
Všechny křižovatky Jižní spojky s ostatními komunikacemi jsou mimoúrovňové.

Výstavba
Koridor dnešní Jižní spojky byl uvažován již v r. 1939 za protektorátu pro výstavbu tzv. tangentního řešení dálnice Plzeň – Náchod (resp. Norimberk – Vratislav). Autorem tohoto řešení byl inženýr Hoffmann, který vedl na Generálním inspektorátu německých silnic referát pro cizí tratě dálnic. K výstavbě nakonec kvůli válce nedošlo, ale stavební uzávěra zůstala v platnosti.

Výstavba Jižní spojky probíhala průběžně od začátku 80. let 20. století. Jako první byla v roce 1985 zprovozněna část mezi Barrandovským mostem a Chodovskou radiálou (dálnicí D1). Na konci 80. let byl otevřen úsek kolem Spořilova do Zahradního Města a jako poslední byl v prosinci 1997 otevřen závěsný lanový most přes kolejiště trati 221 z Prahy do Benešova.

Odkazy

Reference

Související články
 Městský okruh (Praha)

Externí odkazy

Stavby v Braníku
Stavby v Krči
Stavby v Michli (Praha 4)
Stavby v Záběhlicích
Strašnice (Praha 10)
Doprava v Hostivaři
Doprava ve Štěrboholích
Městský okruh (Praha)
Doprava ve Strašnicích
Doprava v Braníku
Doprava v Krči
Doprava v Záběhlicích
Doprava v Michli (Praha 4)

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text:
Zwingli's 67 Articles
Huldrych Zwingli (l. 1484-1531) wrote his 67 Articles in 1523 as a confession of faith to be presented at the First Disputation in Zürich where he defended his beliefs against accusations of heresy by the Catholic Church. Zwingli's 67 Articles are often cited with Martin Luther's 95 Theses as among the most important of the early Protestant Reformation.
Martin Luther (l. 1483-1546) had issued his 95 Theses on 31 October 1517, and although Zwingli later claimed he had not read Luther when he began his efforts at reform in 1519, there are so many similarities that many modern-day scholars believe the earlier document influenced the latter. Scholar Diarmaid MacCulloch, for example, cites the historian Euan Cameron commenting:
Although Zwingli's overall vision may have been influenced by Luther's, his 67 Articles differ significantly from the 95 Theses. Luther's work focused on the policy of selling indulgences – writs alleged by the Church to lessen one's time in purgatory – while Zwingli's Articles address a number of issues he saw as evidence of a corrupt and fallen Church. He advocated for a return to the simplicity of early Christianity depicted in the biblical Book of Acts and, like Luther, denounced any traditions of policies that were not clearly established in scripture.
When the two men later met at the Marburg Colloquy in 1529, Luther treated Zwingli poorly, and it is understood that, afterward, Zwingli minimized Luther's influence on his own work. Even so, and whether the 95 Theses influenced the 67 Articles in any way, this does not dimmish the power or vision of the latter work which lay the foundation for the Swiss Reformation.
By 1522, Zwingli had published a number of his sermons, many critical of church policy, & attacked the tradition of fasting during Lent.
Zwingli was first influenced by the humanist theologian, scholar, and priest Desiderius Erasmus (l. 1466-1536) whom he met in 1514 and again in 1516. He may have even contributed to Erasmus' translation of the scriptures. Erasmus never joined the Reformation movement but advocated for changes in church policy and practice from within. Zwingli was already an advocate for reform by 1518 and, when he was appointed as the people's priest at the Gross Münster in Zürich in 1519, he began by immediately discarding church liturgy and reading the Gospel of Matthew directly to his congregation.
By 1522, Zwingli had published a number of his sermons, many critical of church policy, and attacked the tradition of fasting during Lent after an event known as the Sausage Episode when the printer Christoph Froschauer served sausage to his guests during Lent, defying the Church's prohibition on eating meat at that time. Zwingli claimed there was no biblical justification for fasting, or even for Lent, and, claiming the Bible was the only authoritative source of spiritual truth, charged the Church with false teachings and corrupt practices which only enriched and empowered the clergy and did not represent Jesus Christ's message or ministry.
The Church, naturally, reacted to these charges but, having learned from their mistakes with Luther – where the harder they tried to suppress his views, the more popular he became – the pope only directed the Zürich city council to dismiss Zwingli from his position and expel him quietly. The city council supported Zwingli, however, and instead called for a meeting (known as the First Disputation) between Church representatives and Zwingli to discuss the matter in January 1523.
The Catholic delegate, Johannes Fabri, prepared for a private disputation, but Zwingli, understanding his popularity in Zürich, readied himself for a public debate and drew up his 67 Articles based on his sermons and writings. Over 600 people arrived to listen to the debate, and since Fabri was prohibited from discussing theological matters in front of the laity, all he could do was insist on recognition of the Church as the sole authority on spiritual matters without giving reasons and without responding to Zwingli's charges. Zwingli, on the other hand, presented his 67 Articles addressing the above criticisms as well as others and, as he was an eloquent and articulate speaker, easily won the disputation. The Zürich city council decreed he should continue preaching according to the scripture, and the Reformation was established in the city.
The following text of the 67 Articles is taken from Selected Works of Huldrych Zwingli translated by Samuel Macauley Jackson, 1901, and from the article Zwingli's Sixty-Seven Articles by Dan Graves of Christian History Institute. Punctuation has been altered at some points for clarity. The text is given without commentary.
The articles and opinions below, I, Ulrich Zwingli, confess to have preached in the worthy city of Zurich as based upon the Scriptures which are called inspired by God, and I offer to protect and conquer with the said articles, and where I have not now correctly understood said Scriptures, I shall allow myself to be taught better, but only from said Scriptures.
I. All who say that the Gospel is invalid without the confirmation of the Church err and slander God.
II. The sum and substance of the Gospel is that our Lord Jesus Christ, the true Son of God, has made known to us the will of his heavenly Father, and has with his innocence released us from death and reconciled God.
III. Hence Christ is the only way to salvation for all who ever were, are and shall be.
IV. Who seeks or points out another door errs, yes, he is a murderer of souls and a thief.
V. Therefore all who consider other teachings equal to or higher than the Gospel err, and do not know what the Gospel is.
VI. For Jesus Christ is the guide and leader, promised by God to all human beings, which promise was fulfilled.
VII. That he is an eternal salvation and head of all believers, who are his body, but which is dead and can do nothing without him.
VIII. From this follows first that all who dwell in the head are members and children of God, and that it is the church or communion of the saints, the bride of Christ, Ecclesia catholica.
IX. Furthermore, that as the members of the body can do nothing without the control of the head, so no one in the body of Christ can do the least without his head, Christ.
X. As that man is mad whose limbs (try to) do something without his head, tearing, wounding, injuring himself; thus, when the members of Christ undertake something without their head, Christ, they are mad, and injure and burden themselves with unwise ordinances.
XI. Hence we see in the clerical (so-called) ordinances, concerning their splendor, riches, classes, titles, laws, a cause of all foolishness, for they do not also agree with the head.
XII. Thus they still rage, not on account of the head (for that one is eager to bring forth in these times from the grace of God), but because one will not let them rage, but tries to compel them to listen to the head.
XIII. Where this (the head) is hearkened to one learns clearly and plainly the will of God, and man is attracted by his spirit to him and changed into him.
XIV. Therefore all Christian people shall use their best diligence that the Gospel of Christ be preached alike everywhere.
XV. For in the faith rests our salvation, and in unbelief our damnation; for all truth is clear in him.
XVI. In the Gospel one learns that human doctrines and decrees do not aid in salvation.
XVII. That Christ is the only eternal high priest, from which it follows that those who have called themselves high priests have opposed the honor and power of Christ, yes, cast it out.
XVIII. That Christ, having sacrificed himself once, is to eternity a certain and valid sacrifice for the sins of all faithful, from which it follows that the mass is not a sacrifice, but is a remembrance of the sacrifice and assurance of the salvation which Christ has given us.
XIX. That Christ is the only mediator between God and us.
XX. That God desires to give us all things in his name, whence it follows that outside of this life we need no mediator except himself.
XXI. That when we pray for each other on earth, we do so in such manner that we believe that all things are given to us through Christ alone.
XXII. That Christ is our justice, from which follows that our works in so far as they are good, so far they are of Christ, but in so far as they are ours, they are neither right nor good.
XXIII. That Christ scorns the property and pomp of this world, whence from it follows that those who attract wealth to themselves in his name slander him terribly when they make him a pretext for their avarice and willfulness.
XXIV. That no Christian is bound to do those things which God has not decreed, therefore one may eat at all times all food, from which one learns that the decree about cheese and butter is a Roman swindle.
XXV. That time and place is under the jurisdiction of Christian people, and man with them, from which is learned that those who fix time and place deprive the Christians of their liberty.
XXVI. That God is displeased with nothing so much as with hypocrisy; from which is learned that all is gross hypocrisy and profligacy which is mere show before men. Under this condemnation fall hoods, insignia, plates, etc.
XXVII. That all Christian men are brethren of Christ and brethren of one another and shall create no father (for themselves) on earth. Under this condemnation fall orders, sects, brotherhoods, etc.
XXVIII. That all which God has allowed or not forbidden is righteous, hence marriage is permitted to all human beings.
XXIX. That all who are known as clergy sin when they do not protect themselves by marriage after they have become conscious that God has not enabled them to remain chaste.
XXX. That those who promise chastity [outside of matrimony] take foolishly or childishly too much upon themselves, from which is learned that those who make such vows do wrong to the pious being.
XXXI. That no special person can impose the ban [excommunication] upon anyone, except the Church, that is the [full] congregation of those among whom the one to be banned dwells, together with their watchman, i.e. the pastor.
XXXII. That one may ban only him who gives public offence.
XXXIII. That property unrighteously acquired shall not be given to temples, monasteries, cathedrals, clergy, or nuns, but to the needy, if it cannot be returned to the legal owner.
XXXIV. The spiritual (so-called) power has no justification for its pomp in the teaching of Christ.
XXXV. But the laity has power and confirmation from the deed and doctrine of Christ.
XXXVI. All that the spiritual so-called state claims to have of power and protection belongs to the laity if they wish to be Christians.
XXXVII. To them, furthermore, all Christians owe obedience without exception.
XXXVIII. In so far as they do not command that which is contrary to God.
XXXIX. Therefore all their laws shall be in harmony with the divine will, so that they protect the oppressed, even if he does not complain.
XL. They alone may put to death justly, also, only those who give public offence (if God is not offended let another thing be commanded).
XLI. If they give good advice and help to those for whom they must account to God, then these owe to them bodily assistance.
XLII. But if they are unfaithful and transgress the laws of Christ they may be deposed in the name of God.
XLIII. In short, the realm of him is best and most stable who rules in the name of God alone, and his is worst and most unstable who rules in accordance with his own will.
XLIV. Real petitioners call to God in spirit and truly, without great ado before men.
XLV. Hypocrites do their work so that they may be seen by men, also receive their reward in this life.
XLVI. Hence it must always follow that church—song and outcry without devoutness, and only for reward, is seeking either fame before the men or gain.
XLVII. Bodily death a man should suffer before he offend or scandalize a Christian.
XLVIII. Whoever through stupidness or ignorance is offended without cause, he should not be left sick or weak, but he should be made strong, that he may not consider as a sin that which is not a sin.
XLIX. Greater offence I know not than that one does not allow priests to have wives but permits them to hire prostitutes. Out upon the shame!
L. God alone remits sin through Jesus Christ, his Son, and alone our Lord.
LI. Who assigns this to created beings detracts from the honor of God and gives it to him who is not God; this is real idolatry.
LII. Hence the confession which is made to the priest or neighbor shall not be declared to be a remittance of sin, but only a seeking for advice.
LIII. Works of penance coming from the counsel of human beings (except excommunication) do not cancel sin; they are imposed as a menace to others.
LIV. Christ has borne all our pains and labor. Therefore, whoever assigns to works of penance what belongs to Christ errs and slanders God.
LV. Whoever pretends to remit to a penitent being any sin would not be a vicar of God or St. Peter, but of the devil.
LVI. Whoever remits any sin only for the sake of money is the companion of Simon and Balaam, and the real messenger of the devil personified.
LVII. The true divine Scriptures know nothing about purgatory after this life.
LVIII. The sentence of the dead is known to God only.
LIX. And the less God has let us know concerning it, the less we should undertake to know about it.
LX. That mankind earnestly calls to God to show mercy to the dead I do not condemn, but to determine a period of time therefore (seven years for a mortal sin), and to lie for the sake of gain, is not human, but devilish.
LXI. About the form of consecration which the priests have received recent times the Scriptures know nothing.
LXII. Furthermore, they [the Scriptures] recognize no priests except those who proclaim the word of God.
LXIII. They command honor should be shown, i.e. to furnish them with food for the body.
LXIV. All those who recognize their errors shall not be allowed to suffer, but to die in peace, and thereafter arrange in a Christian manner their bequests to the Church.
LXV. Those who do not wish to confess, God will probably take care of. Hence no force shall be used against their body, unless it be that they behave so criminally that one cannot do without that.
LXVI. All the clerical superiors shall at once settle down, and with unanimity set up the cross of Christ, not the money-chests, or they will perish, for I tell you the ax is raised against the tree.
LXVII. If anyone wishes conversation with me concerning interest, tithes, unbaptized children or confirmation, I am willing to answer.
Let no one undertake here to argue with sophistry or human foolishness but come to the Scriptures to accept them as the judge (for the Scriptures breathe the Spirit of God), so that the truth either may be found, or if found, as I hope, retained. Amen.
Thus, may God rule.
Tags: Huldrych ZwingliMartin LutherProtestant Reformation
Musketeers in the English Civil Wars
New York State's Lessons on Preventing a Crisis of Judicial Legitimacy
Can a New Labor Movement Grow and Win with Direct Action Instead of Collective Bargaining?

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Especially relevant: at this time This Canon MX897 Mac 10.13 Driver is Included in the Mac Software Updates so it should be Automatically Installed.


text:
Home Books Books Children Bear Outside
Bear Outside
Neal Porter Books (March 2, 2021)
Illustrated by Jen Corace
ISBN-13: 978- 0823446131
Bear Outside turned out to be my first ever book with the famed editor Neal Porter and my (accidentally) 400th book. It has an interesting backstory.
About five years before I wrote and sold A BEAR OUTSIDE, I had been helping one of my editors find an illustrator for a different bear book of mine (quick how many bear books do you think I have published?). That book was very different, and wildly funny, but I found Corace's website during my bear scans, loved her work, and she had this bizarre drawing of a little girl staring out of a bear's mouth. There's a story there I thought (as I often do) but got no more than that. Sent the website to the editor who knew (as I already knew) that Jen was not going to be his choice for a A BEAR SAT ON MY PORCH TODAY. But five years or so later, still remembering that picture, I wrote the story. Neal snapped it up and loved the backstory so much, he contacted Jen and got her on the project before he told either me or my agent that he was doing the book. She got to it relatively quickly and it became a published book in time to snag the 400th! slot. Ah, fame. Ah, obsession! Ah, coincidence. Ah, Bears!!
Featured in the Original Art Exhibition 2021 by the Society of Illustrators
"Yolen has said a picture by Corace, of a little girl looking out confidently from the mouth of a bear, inspired her to write this book. It's easy to understand why. Innovative in its perspective and moving in its execution (gouache that, like our emotions, sometimes bleeds outside the lines), Corace's art perfectly matches Yolen's words in this nuanced exploration of our inner selves." —New York Times
"…captures the essence of inner strength in this sensitive portrayal of a girl and the bear who accompanies her….a sophisticated depiction of a child's relationship with her inner strength." —Publishers Weekly
"An ode to kids who march to their own bear, and a guide for the imaginative ones in touch with their needs and boundaries. It's wonderful." —Only Picture Books
"This low-key story encourages viewers to find inner resources for dealing with ordinary challenges, and could help provide children with a structure for contemplating their own armor." —School Library Journal
"Yolen's quiet text, seasoned with occasional rhyme, suits this tale of resilience. She gently celebrates how children build their own competencies by adopting imaginary friends and imbuing stuffed toys with their own increasing social-emotional fitness."—Kirkus Reviews
"Yolen's gracefully worded, sometimes rhyming text presents a sensible girl whose gentle, ursine protector helps her overcome shyness and act more bravely than she would on her own. In Corace's precisely drawn and beautifully painted gouache, ink, and graphite artwork, the child is almost always depicted within the gentle bear's much larger, semi-transparent form. A creative interpretation of the imaginary friend theme, this original picture book respects both its characters and its audience."— Carolyn Phelan, BOOKLIST
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Requests to fill faculty positions are initiated by the department chair and are forwarded to the applicable Dean.
When developing the marketing plan, decide if the search is going to be regional, state-wide or national.
Reminder: A background check must be completed for final candidates prior to a final offer.
Upon the acceptance of a verbal offer, the hiring department will work with the HR Department to generate appointment letters and/or contracts, schedule the New Employee Welcome session and communicate important pre-employment processes.


Apparently the word is that audiences are getting tired of the flashy, highly rendered CGI. Animation will continue to play a strong role in graphic design but the prediction is it will have a more balanced mix of 2D animated elements bringing a unique mix of flat 3 dimensionality. Animation might find more of a place in web design in 2016 as the drive will be to replace the void left by the "death" of flash.
In terms of logos, there is possibly going to be a shift from the vintage styled trend to a more modern style. More logos however will begin to implement animation and responsiveness in print and on the web. Design trends will be affected heavily by the draw towards mobile devices and mobile is deemed to influence print. Designs are already bigger, bolder and cleaner and as technology gives us high-quality retina displays, look for big pictures and videos in web.


By definition ExecuteSqlCommandAsync returns the number of records affected.
Please see the following EF Core blog which explains very clearly the syntax for executing raw queries.
If you are going with ADO.NET then use the ExecuteScalar method of the context.Database.GetDbConnection().CreateCommand() as explained at the bottom of the previous link..
Also take some time to read the reference docs.
If you want to calculate the sum of download,you could try to use raw SQL queries.


Optimizing the Quality and Yield of every fish!
The BAADER 588 is an advanced unique filleting machine for small and medium whitefish - fresh or defrosted. It is designed in a completely new manner with respect to yield, hygiene, performance and fillet quality.
The fillets from this new BAADER 588 are of an extraordinary quality – even with soft fish.


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Home › Movies, Music & Pop Culture › Singing Like Germans: Black Musicians in the Land of Bach, Beethoven, & Brahms by Kira Thurman - hardcvr
Singing Like Germans: Black Musicians in the Land of Bach, Beethoven, & Brahms by Kira Thurman - hardcvr
Hardcover.
In Singing Like Germans, Kira Thurman tells the sweeping story of Black musicians in German-speaking Europe over more than a century. Thurman brings to life the incredible musical interactions and transnational collaborations among people of African descent and white Germans and Austrians. Through this compelling history, she explores how people reinforced or challenged racial identities in the concert hall.
Throughout the nineteenth and twentieth centuries, audiences assumed the categories of Blackness and Germanness were mutually exclusive. Yet on attending a performance of German music by a Black musician, many listeners were surprised to discover that German identity is not a biological marker but something that could be learned, performed, and mastered. While Germans and Austrians located their national identity in music, championing composers such as Bach, Beethoven, and Brahms as national heroes, the performance of their works by Black musicians complicated the public's understanding of who had the right to play them. Audiences wavered between seeing these musicians as the rightful heirs of Austro-German musical culture and dangerous outsiders to it.
Thurman explores the tension between the supposedly transcendental powers of classical music and the global conversations that developed about who could perform it. An interdisciplinary and transatlantic history, Singing Like Germans suggests that listening to music is not a passive experience, but an active process where racial and gendered categories are constantly made and unmade.


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Bruxism (teeth grinding) can be detrimental to the teeth and gums at any age, but especially so for young children. A morning headache is often the first symptom. There can be a number of reasons why children develop this habit and understanding the underlying cause is key to tackling the problem as quickly as possible.
A doctor's assessment is necessary if the grinding is caused by hyperactivity or is stress related but the dentist should be the first port of call as children with misaligned bites "may be more prone to grinding their teeth" and you can find out more at https://yourdentalhealthresource.com/how-to-prevent-and-treat-your-childs-teeth-grinding/.


Right before the start of World War Ii, Ada, age ten, and her brother Jamie, six, flee London to a village in the English countryside, along with other evacuated children, mostly to escape their abusive mother. Despite a club foot, Ada learns to ride and care for horses. Although a teacher claims she's not educable, she learns to read, write, knit, and sew and becomes involved in the war effort. She eventually realizes that even though she has a disability, she's not a bad person.
Told from Ada's first person point of view, this book is written for children but in such a way that adult readers don't feel as if the narrator is talking down to them. It was chosen by my regional talking book library's discussion group.
I like the way Ada describes her abuse and later the explosion of bombs and the state of wounded soldiers. The author doesn't try to shelter young readers from reality. War, trust, acceptance, and love are themes to which we can all relate. I highly recommend this book to everyone.


September 01, 2005 Shawn Wildermuth No Comments.
Trish and I decided to move into an old stomping grounds of mine inside Atlanta proper. I always forget the nasty little things that can make a move feel like hell. In this case, the AC in the new apartment was(is) broken. I thought we could tough it out, but once the cats started to pant...I had to do something.
I usually say nasty, mean things about WalMart and how they've destroyed much of middle america's small business...but in this case, there was no one else open. So I left for an 1 1/2 trek to a 24-hour WalMart to buy an air conditioner. They were surprisingly helpful, if not completely unknowledgable about their own products. Two hours later (2:30am in my time zone) the bedroom is an ice box (like I like it) and the cats have been saved.
Currently my healthcare plan is cash. The quality me the care is adequate but the cost is crazy. I went to emergency room today. They offer a 40% discount to people with no insurance, if they pay within the first thirty days. I understand this is a policy to encourage users to pay their bill fast, but it seems to me that if they can afford a 40% discount, then that is nearer their costs. If you need to spread the cost past thirty days, no discount. So the people least able to afford healthcare are paying full fare. In fact, I would bet that the full price care is being paid by no-one with insurance. I would expect that the Blue-Cross's and Medicares out there have rate plans for what they pay for what. This seems regressive to me.
I think the majority of the un-insured in this country are the lower middle-class. I can afford to pay for care and would prefer medical insurance and will likely have insurance pretty soon. Its the lower middle class that seems to really get chewed up in this deal.
Cops! In front of our car?
July 28, 2005 Shawn Wildermuth No Comments.
Tricia and I have been looking at houses today when we heard sirens and a car hit the car in front of us (thankfully everyone was ok). But when the car stopped that hit the car in front of us, the sirens were right behind them. They both jumped out and one of them ran off. The officers arrested the one that didn't run and 3 more patrol cars went after the one on foot. I never did find out if they caught him, but it was all a bit too exciting.
I have to admit, my first thought was whether there was going to be gunfire and that we were trapped in the middle of it (car in front of us and a car behind). Luckily there wasn't.
July 18, 2005 Shawn Wildermuth No Comments.
Tricia and I just got back from a great weekend out of town and out of reach of our computers. I definitely recommend finding somewhere isolated with a big jacuzzi. We stayed in Helen, GA at the fabulous Alpine Hilltop Bed and Breakfast. I highly recommend it.
April 12, 2005 Shawn Wildermuth No Comments.
Aren't you supposed to get your MCSD before your MVP? Well, I finally finished all the tests for the MCSD.NET and I am happy to have that behind me.
April 06, 2005 Shawn Wildermuth No Comments.
February 16, 2005 Shawn Wildermuth No Comments.
February 01, 2005 Shawn Wildermuth No Comments.
Well, enough of my griping.
December 24, 2004 Shawn Wildermuth No Comments.
Elf on the TV, apple pies in the oven, ham on the table and I am blogging. I must be nuts. Of course I am at my mother's house and anything to get me out from in the middle of my vaguely crazy family. Its wonderful to be home, but I am constantly reminded of why I left my hometown to begin with.
I hope everyone out there is having a happy holidays, whether it is Christmas, Hanukkah, Kwanzaa, Solstice or just December.
September 18, 2004 Shawn Wildermuth No Comments.
After a harrowing couple of weeks we're finally here. We got into town on Friday, two trips to the airport, three cats, one fiance...check. Much to my dismay, the apartment we had gotten was nothing like the model. Frankly, it was a dump. What to do?


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Erica Thomas (she/they)
Provisional Psychologist
MProfPsych
I recently finished my Master of Professional Psychology at the Australian National University and am so excited to support others to work towards their mental health goals with a compassionate and strength-based approach. I am deeply committed to understanding the cultural, and social background and context of the people I work with and am particularly dedicated to creating safe spaces for LGBTQIA+ and neurodiverse people.
THERAPY STYLES:
EXPERTISE & INTEREST:
More About Erica:
I grew up in Sydney with my mum and brother and found quickly that, while I wasn't particularly confident around people at school, the small group of friends I had would often come to me for emotional support. I now have three younger siblings, and though they live on the other side of Australia, it's been wonderful watching them grow from afar.
I love boardgames and tabletop RPGs and will forever be grateful for my high school history teacher for helping some friends and I create the Chess and Strategic Games Club. I was a really shy kid, but this club supported me to meet and connect with other kids, and eventually helped me build the confidence to take a leadership role in the club, organising a mini Magic the Gathering tournament!
My partner and I moved to Canberra a few years ago and now have two adorable (and naughty!) rescue cats, Turkey and Mushroom, and a beautiful community of queer and neurodiverse friends and family that we cherish.
Three words that describe Erica: Warm, curious, and gentle
Spirit Animal: Ocelot
Favourite Game: Dungeons & Dragons
Something people wouldn't guess about you: I first went to an art and design university to become a gallery curator and/or critic! I love interactive, immersive, and sculptural art and would love to one day have a ceramic studio.


Flames and Flowers on the Brain.
There are times when obsession is the name of the game, how do you know if you are at that point? If you are like me it is when you wake at night from dreams of that topic still bouncing around in you head. Of late this has been the case for two topics. One is Flowers, not ceramic blooms but rather the containers for set plants. I have found a great interest involving Orchids in the last few years, this includes the advantages of the proper container for them to live in. So I have started making a number of bowls and pots designed for these odd yeah beautiful plants.
I am far from an expert on these lovely plants however I have come to enjoy the connection between ceramics and horticulture a bit more. With the right vessel orchids an thrive, and avoid many problems such as fungal issues and over/under watering. So I have been working to make a collection of these vessels to see if i can master at lease one aspect of their care. The POT.
However in my quest for the ideal orchid pot I also came across another interest I have had and that is the firing technique called raku. This method of firing pottery comes from Asia centuries in the past, however in to 1900's was made popular here in the US. There is much misunderstanding involving this glazing/firing method even I had a few bits of misinformation until a recent class about this.
What is RAKU, it is a process of heating your pottery to a set temperature, often between 1500 and 1800 degrees Fahrenheit or 815-982 degrees Celsius. Often this is judged by the visual cues to the heat (color and texture of the pieces in the peep whole). Once the pots are at the desired temperature you remove them (still at max temp) with tongs from the kiln, and place them either in a reduction such as a metal can with flammable materials, or set it to the side and manual add the organic materials to it, such as horse hair. Once cooled enough the piece can then be quenched in water is cooling speed in needed.
There are many pros and cons to the Raku method. If your pots are not prepped just right your pieces can explode either in the heating process or cooling due to thermal shock. Also these pieces are not considered wet Food safe as they are are still porous and may retain bacteria. Though this is a challenge Raku pottery has been used in many Asian cultures Tea Ceremonies for centuries. So set care is required in these situations. The advantages over more common glaze fires is the speed and often cost involved with this method. a raku firing load tends to last 30 min to an hour from start to finish, rather then as much as a few days for heating and cooling of regular kilns. This makes Raku more instant gratification. Also because of this the cost of each firing in minimal in comparison to most other types. While only an handful of pieces are normally fired at a time, multiple batches can be fired in a few hours meaning more pieces can be completed with same amount or less fuel.
With these thing in my head I have been thinking of event more pieces in addition to m orchid pots that I could make . So many choices so little time.


Following a call for tenders made by the Malagasy State, RAVINALA AIRPORTS, comprising Meridiam, ADP International, Bouygues Bâtiment International and Colas Madagascar, was selected to carry out the operation, maintenance, development and financing of Madagascar's international airports, including Antananarivo (Ivato) and Nosy Be (Fascène), for 28 years.
WILL DELTA AIR LINES CONTINUE TO SELL NEWLY ADDED SEATS?
KEEP TRACK OF ACTIVE STOCKS: BOEING COMPANY (NYSE:BA) , B/E AEROSPACE, INC. (NASDAQ:BEAV) WORLDWIDE INC.


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Dean McDermott
Tori Spelling & Family Spend Sunday Together
Tori Spelling, her husband Dean McDermott and their children Liam and Stella were spotted picking up fast food in Encino, CA on Sunday (July 13).
Spelling who wore a printed mini dress and black boots arrived separately in her own car. McDermott and the kids waited for her before heading to grab a pizza and other snacks.
Their children Hattie and Finn were not present.
Spelling and McDermott have decided, for the sake of their children, to salvage their eight-year marriage following his very public cheating scandal.
"Tori feels she owes it to them to try to work it out with their dad, even though it's hard," a longtime friend of Spelling told People. "They're working on their marriage and they're operating as a family, but of course there's tension. It's a work in progress."
Meanwhile, the reality star is currently starring in ABC Family's new series Mystery Girls with former Beverly Hills, 90210 costar Jennie Garth.
Stacy Keibler: Pregnancy Is a Time To Be As Healthy As You Can Be
The Fosters Recap For July 14, 2014: Season 2 Episode 5 #TheFosters
Tori Spelling Called Out For Being INSENSITIVE Over Pregnancy Prank On April…
Tori Spelling Oldest Daughter Stella Spelling-McDermott Is All Grown Up!
Dean McDermott Defends His Family To Social Media Shamers
Tori Spelling Shares a New Photo of Her 'Shark Boy'


Does coaching make a bomb or a heel covered with his signature "C?
I am looking for a pump base or high-heeled shoes type signature fabric with all the same. I have not seen any on their website and I know that is more of a fall / winter shoes, but has anyone ever seen a pair of shoes like that? Thanks!


Is there someone confirm that Tableau 7.0 support SQL Server 2012 well?
Here is another thread on the subject of SQL Server 2012. In essence, Tableau will support this version once Microsoft publishes the drivers.


Maria Joyce Clinic is one of the leading Beauty Salons. The salon offers a very personal service and offers many treatments such as facials, detox clinic, slimming, allergy and food testing. All treat See more. ments help you feel and look better. Natural organic products are used as well as body, bath and skin products. These include Gracehill, Love Olli, Swissdermyl and Bioslimming. the salon offers gift boxes and treatment vouchers as well as candles, bath bombs and cupcakes, handmade soaps, body butters, reflexology, aromatherapy oils and also uses Provence cosmetics products. other treatments include ear candling and callus peeling. Open Monday 10am to 9pm, Tuesday to Friday 10am to 5pm and Saturday by appointment only. Reflexology Hide.


Guri & Tori Babies arrived 7/24/2008!!
Pictures of our Hurricane Babies! To see other pictures of the individual kittens, click on the links above.
If you are interested in adopting a kitten from ForestKatz, send an email to wegies@ forestkatz.com and then please fill out one of our Kitten Inquiry Forms.


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BMC Medical Research Methodology
Research article | Open | Open Peer Review | Published: 01 December 2013
Adjusting for measurement error in baseline prognostic biomarkers included in a time-to-event analysis: a joint modelling approach
Michael J Crowther1,
Paul C Lambert1,2 &
Keith R Abrams1
BMC Medical Research Methodologyvolume 13, Article number: 146 (2013) | Download Citation
Methodological development of joint models of longitudinal and survival data has been rapid in recent years; however, their full potential in applied settings are yet to be fully explored. We describe a novel use of a specific association structure, linking the two component models through the subject specific intercept, and thus extend joint models to account for measurement error in a biomarker, even when only the baseline value of the biomarker is of interest. This is a common occurrence in registry data sources, where often repeated measurements exist but are simply ignored.
The proposed specification is evaluated through simulation and applied to data from the General Practice Research Database, investigating the association between baseline Systolic Blood Pressure (SBP) and the time-to-stroke in a cohort of obese patients with type 2 diabetes mellitus.
By directly modelling the longitudinal component we reduce bias in the hazard ratio for the effect of baseline SBP on the time-to-stroke, showing the large potential to improve on previous prognostic models which use only observed baseline biomarker values.
The joint modelling of longitudinal and survival data is a valid approach to account for measurement error in the analysis of a repeatedly measured biomarker and a time-to-event. User friendly Stata software is provided.
Open Peer Review reports
Many biomarkers such as systolic blood pressure (SBP) have been identified as key prognostic factors in the development and validation of cardiovascular risk scores [1, 2]. However, often only baseline values of these biomarkers are used, despite the existence of repeated measures, especially in registry sources such as the General Practice Research Database (GPRD) [3]. Furthermore, biomarkers are often measured with error. Failing to adjust for such measurement error leads to estimates being biased towards the null [4].
A joint model of longitudinal and survival data allows us to investigate the relationship between a repeatedly measured biomarker, subject to measurement error, such as SBP, and the time to an event of interest, such as time to non-fatal stroke. The approach which has dominated the methodological literature involves linking the two component submodels using shared random effects [5, 6]. From a classical perspective, these methods require computationally intensive numerical integration, which is difficult to implement. However, due to the recent introduction of user-friendly software in R [7, 8] and Stata [9], these models are starting to find their place in applied research [10, 11], but the potential uses of and forms of the association parameters, linking the longitudinal and survival components, are yet to be fully explored. Alternatively, many authors have proposed a Bayesian approach, proving readily available BUGS code to implement the models [12, 13].
The most commonly used association structures include the current value parameterisation [5]; whereby we directly link the value of the biomarker, as estimated by the longitudinal submodel, to survival, and the first derivative or slope [10]; allowing the investigation of the effect that the rate of change of the biomarker has on survival.
There is often interest in predicting prognosis based on an initial baseline measurement [1, 2]. In this paper we investigate the use of the joint model framework with a random intercept association structure as an approach to adjust for measurement error, inherent in biomarkers such as SBP. By incorporating the repeated measures we thus make the most efficient use of the data available. In particular, as a prognostic model for future patients, we describe how this framework can be used to predict survival for new patients who will only have baseline measurements.
A joint model of longitudinal and survival data consists of two component submodels: the longitudinal submodel and the survival submodel. We define a set of baseline covariates, U i , which can potentially differ between submodels. The longitudinal submodel allows us to model the trajectory of a repeatedly measured biomarker over time, adjusting for baseline covariates. The standard approach assumes a linear mixed effects model [14]. We observe
Y i ( t ij )= W i ( t ij )+ ε ij , ε ij ∼N(0, σ e 2 )
W i ( t ij )= X i ′ ( t ij )β+ Z i ′ ( t ij ) b i + u i δ
where Y i (t ij ) is the observed longitudinal response for the i th patient measured at the j th time point. W i (t ij ) is our true unobserved trajectory function consisting of design matrices X i ′ ( t ij ) and Z i ′ ( t ij ) for the fixed and random effects, β and b i , respectively, where b i ∼ MVN(0,Σ). We can incorporate flexibility here by allowing both X i ′ ( t ij ) and Z i ′ ( t ij ) to contain restricted cubic spline functions of measurement time [15]. We also have a vector of baseline covariates u i ∈ U i , and corresponding regression coefficients, δ. Finally, ε ij is our normally distributed measurement error with constant variance σ e 2 . We further assume that the random effects and error term are independent, and that cov (ε ij ,ε ik ) = 0 (where j ≠ k).
The time-to-event submodel usually takes the form of a proportional hazards model
h i (t)= h 0 (t)exp( α 1 W i (t)+ϕ v i )
with h 0(t) the baseline hazard function and v i ∈ U i is a vector of baseline covariates with corresponding log hazard ratios, ϕ. The parameter α 1 is commonly named the association parameter, indicating the strength of association between the longitudinal biomarker and the time to event. If α 1 = 0, then the joint model reduces to the two separate models and fitting a joint model will not prove advantageous. This parameterisation assumes the hazard is dependent on the biomarker through its current value. This form of association is one of many ways to link the two component sub-models. The baseline hazard function, h 0(t), can be modelled using a parametric distribution, most frequently the Weibull, or less restrictively using flexible parametric survival models [16], or of course can be left unspecified [17]. However, an unspecified baseline hazard function leads to underestimation of the standard errors of parameter estimates [18], and consequently bootstrapping is required to obtain appropriate standard errors.
For illustration, we let W i (t ij ), the longitudinal submodel, be a linear function of time where the intercept and slope varies between subjects
W i ( t ij )=( β 0 + b 0 i )+( β 1 + b 1 i ) t ij
giving a model with a random intercept and random linear slope. As an alternative way of linking the component models to that of Equation (3), we may link elements of the trajectory function, W i (t ij ), to the hazard directly. For example, we can link the subject specific baseline biomarker values through the intercept association structure, where
h i (t)= h 0 (t)exp α 2 ( β 0 + b 0 i ) + ϕ v i
in this expression α 2 now estimates the strength of the association between the patient specific baseline biomarker values, as estimated by the longitudinal submodel, and the time-to-event. This way we can let the risk of event depend directly on the subject specific value of the biomarker at time t = 0.
If interest lies in prediction when a new patient is observed at baseline, the issue of measurement error can be accounted for through this approach. A benefit of this association structure also lies in the evaluation of the joint likelihood. Under most parametric survival submodels (e.g. Weibull distribution) and time-dependent association structures (eg. current value), numerical quadrature is required to integrate out not only the random effects, but under Equation (3), nested quadrature is also required to evaluate the cumulative hazard function. Under the time-independent association structure of Equation (5), we avoid this nested quadrature as the cumulative hazard function has an analytically tractable form, which provides computational benefits.
As discussed in the introduction, this model formulation can be an alternative to the standard approach of using the observed baseline biomarker value
h i (t)= h 0 i (t)exp( α 3 Y 0 i +ϕ v i )
where Y 0i is the observed baseline biomarker value and α 3 is the log hazard ratio for a one unit increase in the observed baseline biomarker value. Although simple to fit, Equation (6) does not account for potential measurement error in Y 0i .
Simulation study
In order to assess the performance of the standard approach of including observed biomarker values, compared to the full joint model described above, we evaluated both through simulation [19]. For ease of exposition we assume a longitudinal model with random intercept and slope, assuming a continuous biomarker of interest with
where β 0 = β 1 = 0, and b 0i ∼ N(0,1), b 1i ∼ N(0,0.252) with correlation between (b 0i ,b 1i ) of 0.25. Observed measurements are then generated from Y ij ∼N( W i ( t ij ), σ e 2 ), where t ij is the time of the j th measurement for the i th patient. We vary σ e from {0.1,0.5,1}.
We assume a Weibull baseline hazard function with λ = 0.1 and γ = 1.5. A binary variable, X 1 to represent treatment group was generated from Bin (1,0.5), with an associated log hazard ratio of ϕ 1 = -0.5. A continuous covariate, X 2, to represent age at baseline was generated from N(65,12) with an associated log hazard ratio of ϕ 2 = 0.01. We then generate survival times from a Weibull distribution where the hazard is defined as h(t) = h 0(t) exp(α 2 β 0i + ϕ 1 X 1 + ϕ 2 X 2), with α 2 the association parameter, indicating the effect of a one unit increase in the value of the subject specific intercept on the risk of event. We vary α 2 = {-0.5,0.25,0.25,0.5}. Each simulation contained 300 patients with up to 5 annual measurements (including baseline), and administrative censoring at 5 years. This corresponds to an approximate 18.9% survival proportion at 5 years (calculated at the mean of covariate values, X 1 = 1 2 , X 2 =65 and β 0i = 0). To each dataset we fit a Weibull proportional hazards model including the observed baseline measurement, and a Weibull-based joint model with the random intercept association structure. We adjust for age and treatment in the survival submodel. Each scenario is simulated 1000 times.
To illustrate the varying measurement error standard deviations used in the simulation scenarios, we show in Figure 1 observed longitudinal measurements from the same 100 patients with σ e = {0.1,0.5,1}, and when α = 0.25. Figure 1 illustrates that as the measurement error standard deviation increases, the variability in the observed biomarker values increases.
Example simulated observed longitudinal measurements with varying measurement error standard deviation.
The GPRD cohort
The General Practice Research Database (GPRD) Group has obtained ethical approval from a Multi-centre Research Ethics Committee (MREC) for all purely observational research using GPRD data; namely, studies which do not include patient involvement The core work of the GPRD is covered by MREC approval granted by the Trent Multi- Research Ethics Committee (REC reference number 05/MRE04/87) and this study was approved by the GPRD Independent Scientific Advisory Committee (ISAC) (Protocol number 09_094). This study is based in part on data from GPRD obtained under licence from the UK Medicines and Healthcare Product Regulatory Agency (MHRA). However, the interpretation and conclusions contained in this study are those of the authors alone.
The example cohort used to illustrate the methods in this paper consists of 4,850 obese patients diagnosed with type 2 diabetes mellitus. We have 107,347 measurements of SBP, with maximum follow-up of 22 years. There were 278 stroke events observed.
In Figure 2 we show the observed SBP measurements for 9 randomly selected patients, who had at least 10 measurements, illustrating some nonlinear trajectories. To accommodate such nonlinearities we can use restricted cubic splines in the linear mixed effects submodel. In particular, we specify the following longitudinal submodel
W i ( t ij ) = ( β 0 + b 0 i ) + β 1 age i + β 2 sex i + β 3 BMI i + ( β F s F ( t ij ; k F ) + b R s R ( t ij ; k R ) )
Longitudinal response measurements for SBP for 9 randomly selected patients who had at least 10 measurements. The dashed line represents the fitted longitudinal trajectories based on the joint model.
Where s F (t ij ;k F ) is the restricted cubic spline basis of measurement time with corresponding fixed effects, β F , with knot locations k F , and s R (t ij ;k R ) is the restricted cubic spline basis of measurement time with corresponding random effects, b R , and knot locations k R .
Prelimenary modelling of the longitudinal data can be conducted to guide model selection, in particular, the degrees of freedom for the spline terms capturing the underlying longitudinal trajectory over time.
To allow flexibility in the survival submodel we use the flexible parametric survival model [16, 20], which models the baseline log cumulative hazard function using resticted cubic splines. We can once again undertake seperate analysis of just the survival data to inform model selection. In particular, we can use the AIC and BIC to guide the selection of the number of degrees of freedom to capture the baseline hazard function, following Rutherford et al. (2013) [21]. Our final joint model is then
log H i ( t ) = log H 0 ( t ) + ϕ 1 age i + ϕ 2 sex i + ϕ 3 BMI i + α 2 ( β 0 + b 0 i )
log H 0 ( t ) =s(log(t);γ, k S )
where the baseline log cumulative hazard function, log[H 0(t)], is expanded into a restricted cubic spline function of log(t), s(log(t);γ,k S ), with knot locations k S and coefficient vector, γ. This framework has recently been incorporated into a joint model [22]. In each submodel we adjust for the baseline effects of age, sex and BMI. We fit the joint model with the random intercept association structure shown in Equation (5). For comparison, we also apply the standard flexible parametric survival model, adjusting for observed baseline SBP, age, sex and BMI.
Simulation study results
Bias and coverage estimates for the association parameter are presented in Table 1. Under the standard Weibull model, we observe increasing bias in the estimates of the association between baseline biomarker values and survival, as the magnitude of the measurement error standard deviation, σ e , increases. In parallel we observe very poor coverage probabilities under the Weibull approach. For example, with α = 0.5 and σ e = 1, we observe bias of -0.261 (percentage bias of -52.2%) and coverage of 0.4%. In contrast, under the joint modelling approach we observe minimal bias and coverage probabilities close to 95% across all scenarios.
Table 1 Simulation results of the association parameter, α
Analysis of GPRD cohort
We now present the analysis of the GPRD cohort. In all analyses we use SBP/10 so that a unit increase in SBP/10 represents a clinically meaningful 10 unit increase in SBP. Our primary interest is the association between baseline SBP and the risk of stroke. Baseline (t ij = 0) corresponds to when each patient entered the cohort, i.e. the time of first SBP measurement.
We began by assuming a random intercept and selecting the degrees of freedom for the fixed spline terms using the AIC and BIC. In this case, both selected five degrees of freedom for s F (t ij ;k F ), with an AIC of 417565.8 and BIC of 417604.1. For the random splines of time we assumed a linear term, which equates to one spline term for s R (t ij ;k R ). This allows a very flexible form to take into account the variation in SBP over time. We further adjust for age, sex and Body-Mass Index (BMI) at baseline.
For the flexible parametric survival submodel, both AIC and BIC selected two degrees of freedom, with an AIC of 2408.7173 and BIC of 2430.483. If one degree of freedom had been selected, then this would be equivalent to a Weibull survival model.
Results are presented in Table 2. Under the standard flexible parametric survival model we observe a hazard ratio for a ten unit increase in baseline SBP of 1.111 (95% CI: 1.051, 1.172). Under a joint model we observe an increased hazard ratio of 1.198 (95% CI: 1.107, 1.298). The increased effect using a joint model is consistent with that observed in the simulation study, i.e. that the bias in the standard survival model is towards the null. The fitted trajectories seen in Figure 2 appear to capture the subject-specific measurements well, although some panels appear to only require a linear trend.
Table 2 Results from applying a flexible parametric proportional hazards model adjusting for observed baseline systolic blood pressure, and a full joint model using the intercept association structure
We illustrate how the bias from the standard approach increases with SBP in Figure 3, showing predictions from both models for a female patient aged 60, with low (90), medium (130) and high (200) SBP baseline measurements. To quantify the differences, at 10 years under the standard model we observe a survival probability of 0.881 for a SBP of 200, compared to 0.816 under the full joint model.
Predicted survival from the flexible parametric survival model and joint model, for a female, aged 60 years, BMI of 30, with SBP of 90, 130 or 200.
A wealth of patient data is becoming available in registry sources such as the GPRD, providing extensive opportunities to utilise the joint modelling framework. We have shown that by incorporating repeated measures of a biomarker within a unified joint model framework, we reduce bias due to measurement error, even when only the baseline level of the biomarker is predictive of survival. As illustrated in the simulation study, ignoring measurement error in biomarkers such as blood pressure can lead to a marked underestimation of covariate effects. In our application, through the use of restricted cubic splines in the linear mixed effects submodel, we can model highly nonlinear trajectories over time, compared to linear slope models. Furthermore, the flexible parametric survival submodel can also capture complex baseline hazard functions, an important component when predicting survival at the patient level [22].
Given that, to our knowledge, all current cardiovascular risk scores only use baseline measures, with no adjustment for measurement error, the prospects of utilising this framework to improve prognostic risk scores is quite substantial. Predicting survival for a new patient using this framework follows naturally, as often only a first baseline biomarker observation will be available. However, such a modelling approach also allows a dynamic risk prediction approach to be adopted, whereby a patient's estimated future risk is updated as each new biomarker value is obtained [23]. Such an approach could enable response to treatment to be monitored and patients counselled accordingly.
In the analysis of the GPRD cohort, we incorporated flexibility in both the longitudinal submodel through the use of restricted cubic splines, and the flexible parametric survival submodel. Given that both submodels require choosing the number of degrees of freedom, a simple sensitivity analysis can be undertaken to assess knot locations and number of knots. We showed recently that the flexible parametric survival submodel is very robust to both knot placement and number of knots within a joint model framework [22], and furthermore, an extensive simulation study has been conducted by Rutherford et al. (2013), which showed excellent performance of the flexible parametric model to capture simple and complex baseline hazard functions [21]. Furthermore, given that primary interest was in the survival component, and the estimate of association, often modelling the longitudinal component with a suitable sensible functional form will provide an improved estimate compared to simplistic approaches of seperate modelling.
In this paper we have concentrated on a specific association structure linking the 2 component submodels; however, it may be of interest to investigate linking multiple components of a biomarkers trajectory to the time to an event of interest. For example, recent work by Rothwell et al. (2010) [24] has shown associations between not only baseline blood pressure, but also variability over time as important predictors of cardiovascular events. Furthermore, we have only compared the standard approach of adjusting for observed baseline biomarker values to the full joint model. It would be of interest to compare alternative approaches for adjusting for measurement error, not only in baseline biomarkers, but also under a time-dependent association structure [25, 26].
Extensions to the modelling framework include incorporating multiple biomarkers. In particular, in our example we modelled SBP over time, whilst adjusting for baseline BMI. It may be of interest to model not only SBP but also the inter-relationships between different biomarkers such as BMI, and how they are related to an event of interest [13].
To facilitate the use of the methods in practice, user friendly Stata software, written by the first author, is available, with a variety of survival model choices and association structures, including those discussed in this article [9, 27]. To illustrate computational aspects of the framework, the presented joint model applied to the cohort took just over 13 minutes to converge on a standard laptop computer.
The joint modelling of longitudinal and survival data is a valid approach to account for measurement error in the analysis of a repeatedly measured biomarker and a time to event. User friendly Stata software is provided.
Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetiere P, Jousilahti P, Keil U, Njolstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM, SCOREpg: Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003, 24 (11): 987-1003. 10.1016/S0195-668X(03)00114-3.
Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P: Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007, 335 (7611): 136-10.1136/bmj.39261.471806.55. [http://dx.doi.org/10.1136/bmj.39261.471806.55],
Ara R, Blake L, Gray L, Hernandez M, Crowther M, Dunkley A, Warren F, Jackson R, Rees A, Stevenson M, Abrams K, Cooper N, Davies M, Khunti K, Sutton A: What is the clinical effectiveness and cost-effectiveness of using drugs in treating obese patients in primary care? A systematic review. Health Technol Assess. 2012, 16 (5): 1-202. [http://dx.doi.org/10.3310/hta16050],
Prentice RL: Covariate measurement errors and parameter estimation in a failure time regression model. Biometrika. 1982, 69 (2): 331-342. 10.1093/biomet/69.2.331. [http://www.jstor.org/stable/2335407],
Wulfsohn MS, Tsiatis AA: A joint model for survival and longitudinal data measured with error. Biometrics. 1997, 53: 330-339. 10.2307/2533118.
Henderson R, Diggle P, Dobson A: Joint modelling of longitudinal measurements and event time data. Biostatistics. 2000, 1 (4): 465-480. 10.1093/biostatistics/1.4.465.
Rizopoulos D: JM: An R package for the joint modelling of longitudinal and time-to-event data. J Stat Softw. 2010, 35 (9): 1-33. [http://www.jstatsoft.org/v35/i09],
Philipson P, Sousa I, Diggle P, Williamson P, Kolamunnage-Dona R, Henderson R: joineR - Joint modelling of repeated measurements and time-to-event data. 2012, [http://cran.r-project.org/web/packages/joineR/index.html],
Crowther MJ, Abrams KR, Lambert PC: Joint modeling of longitudinal and survival data. Stata J. 2013, 13: 165-184.
Wolbers M, Babiker A, Sabin C, Young J, Dorrucci M, Chêne G, Mussini C, Porter K, Bucher HC, CASCADE: Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy–the CASCADE collaboration: a collaboration of 23 cohort studies. PLoS Med. 2010, 7 (2): e1000239-10.1371/journal.pmed.1000239. [http://dx.doi.org/10.1371/journal.pmed.1000239],
Ibrahim JG, Chu H, Chen LM: Basic concepts and methods for joint models of longitudinal and survival data. J Clin Oncol. 2010, 28 (16): 2796-2801. 10.1200/JCO.2009.25.0654.
Guo X, Carlin BP: Separate and joint modeling of longitudinal and event time data using standard computer packages. Am Stat. 2004, 58: 16-24. 10.1198/0003130042854. [http://www.jstor.org/stable/27643494],
Rizopoulos D, Ghosh P: A Bayesian semiparametric multivariate joint model for multiple longitudinal outcomes and a time-to-event. Stat Med. 2011, 30 (12): 1366-1380. 10.1002/sim.4205.
Laird NM, Ware JH: Random-effects models for longitudinal data. Biometrics. 1982, 38 (4): 963-974. 10.2307/2529876.
Durrleman S, Simon R: Flexible regression models with cubic splines. Stat Med. 1989, 8 (5): 551-561. 10.1002/sim.4780080504.
Royston P, Lambert PC: Flexible Parametric Survival Analysis Using Stata: Beyond the Cox Model. 2011, College Station: Stata Press
Cox DR: Regression models and life-tables. J R Stat Soc Ser B Methodological. 1972, 34 (2): 187-220.
Hsieh F, Tseng YK, Wang JL: Joint modeling of survival and longitudinal data: likelihood approach revisited. Biometrics. 2006, 62 (4): 1037-1043. 10.1111/j.1541-0420.2006.00570.x. [http://dx.doi.org/10.1111/j.1541-0420.2006.00570.x],
Burton A, Altman DG, Royston P, Holder RL: The design of simulation studies in medical statistics. Stat Med. 2006, 25 (11): 4279-4292.
Royston P, Parmar MKB: Flexible parametric proportional hazards and proportional odds models for censored survival data, with application to prognostic modelling and estimation of treatment effects. Stat Med. 2002, 21 (15): 2175-2197. 10.1002/sim.1203.
Rutherford MJ, Crowther MJ, Lambert PC: The use of restricted cubic splines to approximate complex hazard functions in the analysis of time-to-event data: a simulation study. J Stat Comput Simul. 2013, [http://www.tandfonline.com/doi/abs/10.1080/00949655.2013.845890],
Crowther MJ, Abrams KR, Lambert PC: Flexible parametric joint modelling of longitudinal and survival data. Stat Med. 2012, 31 (30): 4456-4471. 10.1002/sim.5644. [http://dx.doi.org/10.1002/sim.5644],
Rizopoulos D: Dynamic predictions and prospective accuracy in joint models for longitudinal and time-to-event data. Biometrics. 2011, 67 (3): 819-829. 10.1111/j.1541-0420.2010.01546.x. [http://dx.doi.org/10.1111/j.1541-0420.2010.01546.x],
Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR: Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010, 375 (9718): 895-905. 10.1016/S0140-6736(10)60308-X. [http://dx.doi.org/10.1016/S0140-6736(10)60308-X],
Zucker DM: A pseudo partial likelihood method for semiparametric survival regression with covariate errors. J Am Stat Assoc. 2005, 100 (472): 1264-1277. 10.1198/016214505000000538. [http://www.tandfonline.com/doi/abs/10.1198/016214505000000538],
Liao X, Zucker DM, Li Y, Spiegelman D: Survival analysis with error-prone time-varying covariates: a risk set calibration approach. Biometrics. 2011, 67: 50-58. 10.1111/j.1541-0420.2010.01423.x. [http://dx.doi.org/10.1111/j.1541-0420.2010.01423.x],
Crowther MJ: STJM: Stata module to fit shared parameter joint models of longitudinal and survival data. Stat Softw Components Boston Coll Dep Econ. 2012, [http://ideas.repec.org/c/boc/bocode/s457339.html],
Pre-publication history
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2288/13/146/prepub
MJC is funded by a National Institute for Health Research (NIHR) Doctoral Fellowship (DRF-2012-05-409) and KRA is partially supported as a NIHR Senior Investigator (NI-51-0508-10061).
The cohort of obese patients with type 2 diabetes mellitus was obtained from the General Practice Research Database (GPRD) under Independent Scientific Advisory Committee (ISAC)-approved Protocol 09_094, and which was funded by a National Institute for Health Research (NHIR) Health Technology Assessment (HTA) Programme Project Grant (07/85/02).
The authors would like to thank Monica Hernández for initial preparatory work on the data from the GPRD cohort of patients, Roberta Ara for useful initial discussions regarding anti-obesity treatment, and finally the reviewers whose comments greatly improved the paper.
Department of Health Sciences, Adrian Building, University of Leicester, University Road, Leicester, LE1 7RH, UK
Michael J Crowther
, Paul C Lambert
& Keith R Abrams
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, S-171 77, Stockholm, Sweden
Paul C Lambert
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Correspondence to Michael J Crowther.
All authors were involved in conception and design of the project. MJC conducted the simulation study, analysed the clinical dataset and wrote the first draft of the manscript. PCL and KRA both revised the manuscript. All authors read and approved the final manuscript.
https://doi.org/10.1186/1471-2288-13-146
General Practice Research Database
Baseline Hazard Function
Association Structure
Systolic Blood Pressure Measurement
Spline Term
Associated Content
Data analysis, statistics and modelling


text:
Essential Public Health Functions
Stylus1319
Public health is a core element of governments' attempts to improve and promote the health and welfare of their citizens. Unfortunately, there is evidence that current public health systems and services are not able to cope well with the modern challenges - new technologies, globalization, migration, bioterrorism, etc. In view of this, the WHO Western Pacific Region initiated studies on essential public health functions (EPHFs) in Fiji, Malaysia, and Vietnam. By drawing on research in other parts of the world, a framework and nine EPHFs were derived for these case studies. These nine EPHFs define more clearly and systematically the core areas of public health work for which governments are ultimately responsible. These EPHFs are also considered appropriate for further consultation and use in the Western Pacific Region.
This publication is aimed at providing EPHF concepts and ideas that will help countries ensure that they develop and sustain a comprehensive approach to public health. The case studies may also provide ideas for other countries on methods that could be used to examine the current functioning of EPHFs and on different approaches for strengthening these essential functions in different health systems.
WHO Regional Office for the Western Pacific,
161 pp.,
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Hearing loss can be due to the aging process, exposure to loud noise, certain medications, infections, head or ear trauma, congenital (at birth) or genetic factors, diseases, as well as a number of other causes. Recent data suggests there are over 34 million Americans with some degree of hearing loss. Hearing loss often occurs gradually throughout a lifetime. People with hearing loss compensate often without knowing they have hearing loss.
If you have any of these symptoms, you should see a Licensed Hearing Healthcare Professional to have a formal hearing evaluation. This hearing test, or audiologic evaluation, is diagnostic in nature. A diagnostic audiologic evaluation is more than just pressing a button when you hear a beep! Rather, this evaluation allows the specialist to determine the type, nature and degree of your hearing loss. Your sensitivity, acuity and accuracy to speech understanding will also be assessed. In addition, the Hearing Healthcare Professional may test for speech understanding at different volume levels and in different simulated environments. This testing is performed in order to provide the Hearing Healthcare Professional with an indication as to how successful of a candidate you might be for amplification.
The hearing evaluation should also include a thorough case history (interview) as well as a visual inspection of the ear canal and eardrum. Additional tests of the middle ear function may also be performed. The results of the evaluation can be useful to a physician, if the Hearing Healthcare Professional believes your hearing loss may benefit from medical intervention. Results of the hearing evaluation are plotted on a graph called an audiogram. The audiogram provides a visual view of your hearing test results across various pitches or frequencies, especially the ones necessary for understanding speech (250-8000 Hz).
The audiogram it the "roadmap" that is used to create a prescription and program the hearing aids.
Hearing loss has been linked to depression. Many people believe this is due to the social isolation caused by poor hearing and communication. People with an untreated hearing loss are much more likely to avoid social situations and activities that they would otherwise enjoy.
Hearing loss has been linked in an increased risk of falling. Certain portions of the ear help with balance and a Johns Hopkins study found that those with an untreated hearing loss were more likely to lose balance.
Many of the treatments available to treat cancer can also damage a patient's hearing over time. Some chemotherapy drugs, including cisplatin, are known as ototoxic medications.
Recent studies link cardiovascular disease to hearing loss. The same inadequate blood flow and damage to vessels that can lead to heart problems can also lead to a deterioration in blood flow to the inner ear.
As with many other conditions, susceptibility to hearing loss and other ear-related diseases can be passed down. According to the Centers for Disease Control, 50% to 60% of hearing loss found in babies is due to genetic causes.
The external and the middle ear conduct and transform sound; the inner ear receives it. When there is a problem in the external or middle ear, a conductive hearing impairment occurs. When the problem is in the inner ear, a sensorineural or hair cell loss is the result. When there are problems in the middle and inner ear, a mixed hearing impairment is the result (i.e. conductive and a sensorineural impairment). Central hearing loss has more to do with the brain than the ear, and will be discussed only briefly.
Conductive hearing loss occurs when sound is not conducted efficiently through the ear canal, eardrum, or tiny bones of the middle ear, resulting in a reduction of the loudness of sound that is heard. Conductive losses may result from earwax blocking the ear canal, fluid in the middle ear, middle ear infection, obstruction of the ear canal, perforation (hole) in the eardrum membrane, or disease of any of the three middle ear bones.
A person with a conductive hearing loss may notice that their ears may seem to be full or plugged. This person may speak softly because they hear their own voice quite loudly. Crunchy foods, such as celery or carrots, sound very loud and this person may have to stop chewing to hear what is being said. All conductive hearing losses should be evaluated by a physician to explore medical and surgical options.
Sensorineural hearing loss is the most common type of hearing loss. More than 90 percent of all hearing aid wearers have sensorineural hearing loss. The most common causes of sensorineural hearing loss are age related changes and noise exposure. A sensorineural hearing loss may also result from disturbance of inner ear circulation, increased inner ear fluid pressure, or from disturbances of nerve transmission. Sensorineural hearing loss is also called "cochlear loss," an "inner ear loss" and "nerve loss." Years ago, many professionals said there was nothing that could be done for sensorineural hearing loss – that is totally incorrect today. There are many excellent options for the patient with sensorineural hearing loss. A person with a sensorineural hearing loss may report that they can hear people talking, but they can't understand what they are saying. An increase in the loudness of speech may only add to their confusion. This person will usually hear better in quiet places and may have difficulty understanding what is said over the telephone.
Central hearing impairment occurs when auditory centers located within the brain are affected by injury, disease, tumor, hereditary, or unknown causes. Loudness of sound is not necessarily affected, although speech understanding and clarity is affected. With this condition, a loss of loudness and clarity may occur at the same time.
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Q: NFC plugin doesn't work in Eclipse I want to test an application which is written for a NFC based device, In my Eclipse when I go for installing a new software and paste the link below, I receive this error:
link:  http://nfc-eclipse-plugin.googlecode.com/git/nfc-eclipse-plugin-feature/update-site/
Error:
 Cannot complete the request.  See the error log for details.
 NDEF Editor will be ignored because it is already installed, and updates are not permitted.

But I can not run my application,because there is an exclamation mark next to the name of my project!
Would you please tell me what should I do?I' m really new in Android developing!

A: I am the author of that plugin.

*

*The plugin seems already installed, so you cannot reinstall, and no updates have been issued (in the last month), so there is no update available either.

*The plugin does not affect whether projects can be run or not, it purely a file editor for a non-executable format. There exists no functionality to validate files or projects.

Go to the problems view and see what is listed there.
Window->Show View->Other->General->Problems.

Resolve the problems. It might help to close unrelated projects. If you still feel there is a bug with the plugin, file a detailed bug report on the site.
You also might want to clean and rebuild your workspace.
Project->Clean

redpajama_set_name: RedPajamaStackExchange


It is a beautiful spring morning with full sun and blue skies. It is 6c at the moment, but feels much warmer than that with the sun rays beaming down. The high today will be 11c. We are now entering the last couple of weeks of the season. The Furano Zone is still skiable from the top of the Ropeway to the bottom with good coverage. Unfortunately the top chair has been closed.
Kitanomine Zone CLOSED FOR SEASON.