text:
Abilify for Bipolar Maintenance: More Hard Questions
Much attention has been drawn to a recent PLoS Medicine article criticizing the evidence base for the use of Abilify as maintenance treatment for bipolar disorder. The major points emphasized by most critics are, first, that the FDA approved Abilify for this purpose in 2005 on the basis of flawed and scanty evidence and, secondly, that the literature since that time has failed to point out the deficiencies in the original study.
While the above may be true, I believe these criticisms miss a more important point. Instead of lambasting the FDA or lamenting the poor quality of clinical research, we psychiatrists need to use this as an opportunity to take a closer look at what we treat, why we treat, and how we treat.
Before elaborating, let me summarize the main points of the PLoS article. The authors point out that FDA approval of Abilify was based on only one "maintenance" trial by Keck et al published in 2007. The trial included only 161 patients (only 7 of whom, or 1.3% of the total 567 who started the study, were followed throughout 26 weeks of stabilization and 74 follow-up weeks of maintenance). It also consisted of patients who had already been stabilized on Abilify; thus, it was "enriched" for patients who had already shown a good response to this drug. Furthermore, the "placebo failures" consisted of patients who were abruptly withdrawn from Abilify and placed on placebo; their relapses might thus be attributed to the researchers' "randomized discontinuation" design rather than the failure of placebo. (For more commentary, including follow-up from Bristol-Myers Squibb, Abilify's manufacturer, please see this excellent post on Pharmalot.)
These are all valid arguments. But as I read the PLoS paper and the ongoing discussion ever since, I can't help but think, so what?? First of all, most psychiatrists probably don't know about the PLoS paper. And even if they did, the major questions for me would be: would the criticism of the Keck et al. study change the way psychiatrists practice? Should it?
Let's think about psychiatric illness for a moment. Most disorders are characterized by an initial, abrupt onset or "episode." These acute episodes are usually treated with medications (plus or minus psychotherapy or other psychosocial interventions), often resulting in rapid symptomatic improvement—or, at the very least, stabilization of those symptoms.
One big, unanswered (and, unfortunately, under-asked) question in psychiatry is, then what? Once a person is stabilized (which in some cases means nothing more than "he's no longer a danger to himself or others"), what do we do? We don't know how long to treat patients, and there are no guidelines for when to discontinue medications. Instead we hear the common refrain: depression, schizophrenia, and bipolar disorder, are lifelong illnesses—"just like hypertension or diabetes"—and should be treated as such.
But is that true? At the risk of sounding like a heretic (and, indeed, I'd be laughed out of residency if I had ever asked this question), are there some cases of bipolar disorder—or schizophrenia, or depression, for that matter—which only require brief periods of psychopharmacological treatment, or none at all?
The conventional wisdom is that, once a person is stabilized, we should just continue treatment. And why not? What doctor is going to take his patient off Abilify—or any other mood stabilizer or antipsychotic which has been effective in the acute phase—and risk a repeat mood episode? None. And if he does, would he attribute the relapse to the disease, or to withdrawal of the drug? Probably to the disease.
For another example of what I'm talking about, consider Depakote. Depakote has been used for decades and is regarded as a "prototypical" mood stabilizer. Indeed, some of my patients have taken Depakote for years and have remained stable, highly functional, and without evidence of mood episodes. But Depakote was never approved for the maintenance treatment of bipolar disorder (for a brilliant review of this, which raises some of the same issues as the current Abilify brouhaha, read this article by The Last Psychiatrist). In fact, the one placebo-controlled study of Depakote for maintenance treatment of bipolar disorder showed that it's no better than placebo. So why do doctors use it? Because it works (in the acute phase.) Why do patients take it? Again, because it works—oh, and their doctors tell them to continue taking it. As the old saying goes, "if it ain't broke, don't fix it."
However, what if it is broke[n]? Some patients indeed fail Depakote monotherapy and require additional "adjunctive" medication (which, BTW, has provided another lucrative market for the atypical antipsychotics). In such cases, most psychiatrists conclude that the patient's disease is worsening and they add the second agent. Might it be, however, that after the patient's initial "response" to Depakote, the medication wasn't doing anything at all?
To be sure, the Abilify study may have been more convincing if it was larger, followed patients for a longer time, and had a dedicated placebo arm consisting of patients who had not been on Abilify in the initial stage. But I maintain that, regardless of the outcome of such an "improved" trial, most doctors would still use Abilify for maintenance treatment anyway, and convince themselves that it works—even if the medication is doing absolutely nothing to the underlying biology of the disease.
The bottom line is that it's easy to criticize the FDA for approving a drug on the basis of a single, flawed study. It's also easy to criticize a pharmaceutical company for cutting corners and providing "flawed" data for FDA review. But when it comes down to it, the real criticism should be directed at a field of medicine which endorses the "biological" treatment of a disorder (or group of disorders) whose biochemical basis and natural history are not fully understood, which creates post hoc explanations of its successes and failures based on that lack of understanding, and which is unwilling to look itself in the mirror and ask if it can do better.
28 Comments	| antipsychotics, bipolar, FDA, medications	| Tagged: Abilify, bipolar, diagnosis, FDA, Keck, PLoS Medicine	| Permalink
Nuedexta: "Pipeline in a Pill" or Pipe Dream?
If you're like me, you've probably seen numerous Internet ads for a new medication called Nuedexta from Avanir Pharmaceuticals. Nuedexta was approved in October 2010 for the treatment of "pseudobulbar affect," or PBA. My first reaction was one of surprise, as PBA is relatively uncommon, or so I was taught: why would a drug company be aggressively advertising a drug with such a niche market? However, as I thought about the symptoms that define PBA—and then, last week, I received a Nuedexta promotional packet in the mail—I figured I should take a look "under the hood."
First of all, I reviewed the presentation and biology of PBA. I remember being taught in residency that it is a fairly uncommon manifestation of neurological illness, although it has a very distinctive presentation, namely, emotional expressions that are disconnected from any subjective emotional changes. Indeed, an alternate name for it is "pathological laughing and crying." Certainly, the discrepancy between a patient's emotional display—which may be extreme, and cause great distress to caregivers—and the lack of any subjective change in mood, is highly suggestive of a focal brain abnormality.
PBA is typically caused by a specific brain lesion between the cortex (the source of voluntary thought/action) and the brainstem (the source of involuntary emotional expression like laughing and crying). Normally, we're stimulated to laugh or cry by something funny or sad; these emotions are first processed in the cortex, which then sends a message to the brainstem to express that emotion. If you have a lesion between your cortex and brainstem (e.g., from a stroke, multiple sclerosis, or a degenerative process) then the emotional expression can be entirely separated from the conscious awareness of it.
Over the last decade some research groups have begun to look at dextromethorphan as a potential treatment for PBA. Dextromethorphan, also known as DXM, is a cough suppressant, the active ingredient in Robitussin, not to mention a drug often used recreationally for its dissociative and hallucinogenic properties. Dextromethorphan is an NMDA antagonist (i.e., it prevents glutamate from activating target cells via NMDA receptors) as well as an agonist of a type of receptor called "sigma-1," whose role is much less understood.
When dextromethorphan is combined with quinidine, another widely available drug (used to treat heart arrhythmias), the quinidine inhibits dextromethorphan's metabolism, allowing it to penetrate the brain at doses low enough to avoid any peripheral toxicity. Once inside the brain, it "may act on regions implicated in emotional expression" (by an unknown mechanism) and, indeed, it improves PBA symptoms with the only significant side effects being dizziness and diarrhea. The new drug Nuedexta is a combination of 20 mg dextromethorphan and 10 mg quinidine, and the estimated cost will be from $3000-$5000 per year.
(BTW, note the theme here, which is similar to what I wrote about with Contrave: Nuedexta is actually a combination of two existing, generic—i.e., cheap—drugs, with a significant markup, to cover the costs of clinical testing, marketing, and, of course, shareholder profits.)
Physicians—and patients—may wonder why we need a new drug to treat PBA. Certainly, this is a good question (although I think PBA is simply Avanir's "foot in the door," as I'll discuss below). A 2007 review in the Annals of Neurology shows that a number of medications, including SSRIs like citalopram, and tricyclic antidepressants (TCAs), are effective in managing the symptoms of PBA (see also here). And, as I mentioned earlier, the proper diagnosis of PBA requires the presence of an underlying neurological disorder, and treatment of the disorder, too, may ameliorate the PBA symptoms.
Interestingly, while I searched for literature references discussing PBA, I found that most—if not all—of the literature from the last 5-6 years has been funded or underwritten by Avanir Pharmaceuticals—and all of which discussed the benefits of dextromethorphan/quinidine. This included an "educational review" published by the National Stroke Association in 2005. In fact, the editors of the Annals of Neurology issue I cited above tried to get someone to write a review on PBA but couldn't find any authors "untouched by Avanir." It certainly seems that Avanir's PR effort has paid off.
The coup de grâce, in my opinion, is an "expert review" on PBA published in the journal CNS Spectrums in October 2005. It's a roundtable discussion on how to distinguish PBA from other psychiatric and neurologic disorders—and, of course, the benefits of dextromethorphan/quinidine. It seems like a fair review, although the authors make comments that broaden the definition of PBA to include other disturbances of affect, which are extremely common among psychiatric patients. "It may be useful to regard affective lability," they write, "as a disorder of affect that exists at a point on a continuum between normal affective variability and the more severe end of the continuum characterized by [PBA]." Furthermore, they encourage clinicians to "include a specific assessment for PBA" in all patients with any neurological condition, to prevent their being "misdiagnosed" with a psychiatric disorder—the implication being that what we might call "poststroke depression" might actually be PBA. And they even open the door to the possibility that "PBA-like" symptoms might not have a recognizable neurological basis: "In some cases PBA may be the only clinically identifiable manifestation of the neurological condition. In light of the overlap between the neurology of affect regulation and the neurology of psychiatric conditions, … PBA may sometimes occur in the latter context as well." [Emphasis mine.]
You can see where this is all headed—and probably why I received a promotional packet for Nuedexta, even though I'm not a neurologist. Here we have a new medication, which has been approved for a neurological syndrome whose major manifestation is "affective instability." Even though the proper diagnosis of PBA requires far more than that, clinicians will undoubtedly use it off-label for the affective lability seen in many other conditions (such as bipolar disorder, schizophrenia, autism, dementia, maybe even childhood irritability, etc). And my bet is that Avanir will try to get Nuedexta approved for all of these conditions.
(BTW, Nuedexta has never been compared head-to-head with SSRIs or TCAs, and the trials which led to Nuedexta's approval showed only slight improvement vs. placebo in patients with PBA due to multiple sclerosis and ALS.)
Indeed, Avanir's investor materials (see pdf here) already state that the company will seek approval for multiple sclerosis-related pain, and for behavioral symptoms in dementia. And when one considers how atypical antipsychotics have been affected by "indication creep," it is probably only a matter of time before Nuedexta will be tested for other disorders characterized by affective changes, including the big kahunas: depression and bipolar disorder. To that end, during a November 2009 conference call to shareholders, Keith Katkin, Avanir's CEO, described Nuedexta as a "pipeline in a pill."
I should note here that I have not tried Nuedexta so I can't say whether it is effective. I also have no financial interest in Avanir Pharmaceuticals. I don't see how Nuedexta's pharmacological properties might control affective outbursts (but then again, I can't explain precisely how SSRIs treat depression, either). Certainly I've read of isolated cases in which Nuedexta has led to "dramatic improvement," but those cases are from spokespeople with "skin in the game," so to speak. Nuedexta might be a blockbuster drug in neurology and psychiatry alike, and I'm willing to give it that chance. However, at this stage the marketing speaks far louder than the data, and the seeds are already being sown for the more widespread use of this relatively unproven agent. We need to be cautious not to be swayed by the influence of those who want to make a few bucks (or a few billion) off our ignorance.
230 Comments	| FDA, medications, psychopharmacology	| Tagged: ALS, avanir, dextromethorphan, nuedexta, pba, pseudobulbar affect, stroke	| Permalink
Off-Label Meds: Caveat Prescriptor
In medicine we say that a drug is "indicated" for a given disorder when it has gone through rigorous testing for that condition. Typically, a drug company will perform clinical trials in which they select patients with the condition, give them the new drug, and compare them with similar patients who are given a placebo (or an established drug which is already used to treat the disease). In the US, when the FDA approves a drug, the drug company is then permitted to advertise it in magazines, journals, TV, the internet, and directly to doctors, but they must specify its "approved" use.
In the past few years, several drug companies have found themselves in trouble after accusations of marketing their drugs for off-label indications. Total fines have reached into the billions, and many companies have vowed to change their marketing practices in response.
It should be emphasized, however, that doctors use drugs off-label very frequently. This is particularly true in psychiatry, where an estimated 31% of all prescriptions are off-label. Some familiar examples include trazodone (an antidepressant) for insomnia or beta blockers (originally approved for hypertension and heart failure) for anxiety. Furthermore, some very common symptoms and conditions, such as personality disorders, impulsivity, nightmares, eating disorders, and PTSD, have no (or few) "indicated" medications, and yet we often treat them with medications, sometimes with great success. And since the FDA restricts its approvals to medications and devices, even psychotherapy—something we routinely recommend and "prescribe" to patients—is, technically, off-label.
One colleague took this one step further and explained that virtually any psychiatric drug which has been prescribed for more than 8 or 12 weeks is being used "off-label" since the studies to obtain FDA approval are generally no longer than that. Admittedly, that's nitpicking, but it does demonstrate how the FDA approval process works with a very limited amount of clinical data.
Drug companies that deliberately market their drugs for off-label indications are indeed guilty of misrepresenting their products and deceiving doctors and consumers. But to blame them for bad patient outcomes conveniently ignores the one missing link in the process: the doctor who decided to prescribe the drug in the first place. Whether we like it or not, drug companies are businesses, they sell products, and as with everything else in our consumerist society, the buyer (in this case the doctor) must beware.
Here's an example. A new drug came to market in February called Latuda, which has been FDA approved for the treatment of schizophrenia. Before a few months ago, most community psychiatrists (like me) knew absolutely nothing about this drug.
If a sales rep visits my office tomorrow and tells me that it's approved for schizophrenia and for bipolar disorder, she is obviously giving me false information. This is not good. But how I choose to use the drug is up to me. It's my responsibility—and my duty, frankly—to look at the data for schizophrenia (which exists, and which is available on the Latuda web site and in a few articles in the literature). If I look for data on bipolar disorder, I'll find that it doesn't exist.
That's just due diligence. After reviewing the data, I may conclude that Latuda looks like a lousy drug for schizophrenia (I'll save those comments for later). However, I might find that it may have some benefit in bipolar disorder, maybe on particular symptoms or in a certain subgroup of patients. Or, I might find some completely unrelated condition in which it might be effective. If so, I should be able to go ahead and use it—assuming I've exhausted the established, accepted, and less costly treatments already. Convincing my patient's insurance company to pay for it would be another story… but I digress.
I don't mean to imply that marketing has no place in medicine and that all decisions should be made by the physician with the "purity" of data alone. In fact, for a new drug like Latuda, sales reps and advertising materials are effective vehicles for disseminating information to physicians, and most of the time it is done responsibly. I just think doctors need to evaluate the messages more critically (isn't that something we all learned to do in med school?). Fortunately, most sales reps are willing to engage doctors in that dialogue and help us to obtain hard data if we request it.
The bottom line is this: psychiatric disorders are complicated entities, and medications may have potential far beyond their "approved" indications. While I agree that pharmaceutical marketing should stick to proven data and not anecdotal evidence or hearsay, doctors should be permitted to use drugs in the ways they see fit, regardless of marketing. But—and this is critical—doctors have a responsibility to evaluate the data for both unapproved and approved indications, and should be able to defend their treatment decisions. Pleading ignorance, or crying "the rep told me so," is just thoughtless medicine.
7 Comments	| clinical trial, FDA, marketing, medications	| Tagged: FDA, indications, latuda, off-label, prescriptions, sales	| Permalink
Are Your Thoughts Still Racing, Jiefang?
A recent Vanity Fair article described the trend by American pharmaceutical companies to conduct more clinical trials outside of the United States and Western Europe. The writer and bioethicist Carl Elliott also detailed this trend in his book White Coat, Black Hat, and it has recently received increasing scrutiny in the media. While much attention has focused on the ethical concerns of overseas clinical trials, I'm avoiding that hot topic for now and arguing that we should pay some attention to questions of clinical relevance.
This is no small matter. The VF article reports that one-third of clinical trials by the 20 largest US-based pharmaceutical companies are conducted exclusively at foreign sites, and medications destined for use in the U.S. have been tested in almost 60,000 clinical trials in 173 countries since 2000. The reasons for "outsourcing" clinical trials are not surprising: cheaper costs, less restrictive regulations, more accessible subjects, and patients who are less likely to have taken other medications in the past, thus yielding a more "pure" population and, hopefully, more useful data.
At first glance, overseas clinical trials really shouldn't be much of a problem. The underlying biology of a disease should have nothing to do with where the diseased person lives. Hypertension and hepatitis are probably quite similar, if not identical, whether the patient is in Boston or Bangalore. An article in this month's Archives of General Psychiatry appears to reinforce this concept, showing that rates of bipolar disorder—as well as its "severity" and "impact"—are similar in a variety of different international settings. Hence, if you were to ask me where I'd do a clinical trial for a new bipolar medication, I'd probably go where it would cost less to do so (i.e., overseas), too.
But is this appropriate? Just because we can find "bipolar disorder" in the U.S. and in Uganda, does this mean we should we treat it the same way? Over at the blog 1boringoldman, Mickey has uncovered data showing that trials of Seroquel (an atypical antipsychotic) for bipolar depression are being conducted in 11 Chinese provinces. You can search the data yourself at clinicaltrials.gov (a truly fantastic tool, BTW) and find that many other psychiatric drugs are being tested worldwide, for a wide range of indications.
To a lowly community psychiatrist like me, this raises a few red flags. As I learned in my transcultural psychiatry lectures in med school and residency, the manifestations of disease—and the recommended treatment approaches—can vary dramatically based on the culture in which the disease appears. Even in my own practice, "bipolar disorder" varies greatly from person to person: a bipolar patient from a wealthy San Francisco suburb experiences her disease very differently from the patient from the poverty-stricken neighborhoods of East Oakland. A good psychiatrist must respect these differences. Or so I was taught.
In his book Crazy Like Us, author Ethan Watters gives numerous examples of this phenomenon on a much larger scale. He argues that the cultural dimensions that frame a disease have a profound impact on how a patient experiences and interprets his or her symptoms. He also describes how patients' expectations of treatments (drugs, "talk" therapy) differ from culture to culture, and can determine the success or failure of a treatment.
Let's say you asked me to treat Jiefang, a young peasant woman with bipolar disorder from Guangdong Province. Before doing so, I would want to read up on her community's attitudes towards mental illness (and try to understand what "bipolar disorder" itself means in her community, if anything), learn about the belief systems in place regarding her signs and symptoms, and understand her goals for treatment. Before prescribing Seroquel (or any other drug, for that matter), I'd like to know how she feels about using a chemical substance which might affect her feelings, emotions, and behavior. I imagine it would take me a while before Jiefang and I felt comfortable proceeding with this approach.
There's just something fishy about scientists from a multinational Contract Research Organization hired by Astra-Zeneca, flying into Guangdong with their white coats and clipboards, recruiting a bunch of folks with (western-defined) bipolar disorder just like Jiefang, giving them various doses of Seroquel, measuring their responses to bipolar rating scales (developed by westerners, of course), and submitting those data for FDA approval.
I sure hope I'm oversimplifying things. Then again, maybe not. When the next me-too drug is "FDA approved" for schizophrenia or bipolar depression (or, gasp, fibromyalgia), how can I be sure that it was tested on patients like the ones in my practice? Or even tested at all on patients who know what those diagnoses even mean? There's no way to tell anymore.
The "pathoplastic" features of disease—what Watters calls the "coloring and content"—make psychiatry fascinating. But they're often more than just details; they include the ways in which patients are influenced by public beliefs and cultural ideas, the forces to which they attribute their symptoms, and the faith (or lack thereof) they put into medications. These factors must be considered in any attempt to define and treat mental illness.
Clinical trials have never resembled the "real world." But designing clinical trials that resemble our target patients even less—simply for the sake of bringing a drug to market quickly and more cheaply—is not just unreal, but deceptive and potentially dangerous.
9 Comments	| clinical trial, FDA, medications	| Tagged: bipolar, Carl Elliott, China, clinical trials, contract research organization, CRO, Ethan Watters, pathoplasty, seroquel	| Permalink
What Does a Diet Drug Have in Common With a Swiffer?
What does the new anti-obesity drug Contrave have in common with the Swiffer?
Yes, I'm talking about that Swiffer, the cleaning tool that is essentially a dry mop with disposable dusters that attach to a dispensible handle.
When the Swiffer was first introduced, it was a revolutionary product. And it remains a top seller for Procter & Gamble, its manufacturer. But in reality, it's not exactly a revolutionary idea. In fact, my mother, in fact (an expert cleaner in her own right, much to my childhood chagrin) used to remark that she could have become a millionaire if she had marketed her own idea for a "homemade Swiffer": wet paper towels or dryer sheets wrapped around a broom head. The Swiffer is one of those miracles of "good design"— an idea that is elegant in its simplicity but surprisingly effective in its application, and I'm sure it has led thousands of housewives (okay, and househusbands, too) to lament, "why didn't I think of that?"
Enter Contrave. What exactly is Contrave? It's a weight loss drug being developed by Orexigen Pharmaceuticals, Inc. It's not available yet, but you may have read about it in the business pages a few weeks ago, when Orexigen's stock price (symbol: OREX) took a 72% nose dive in a single day after the FDA rejected it, recommending further study of the drug to rule out cardiac toxicity.
Like the Swiffer, Contrave is nothing terribly new; it's a re-packaged "combination drug" consisting of two commonly used medications that psychiatrists and other doctors have been prescribing for years: bupropion and naltrexone. Bupropion (more commonly known as Wellbutrin or Zyban) is frequently used for the treatment of depression (and has been shown to cause some weight loss on its own). Naltrexone (ReVia or Vivitrol) is an opiate antagonist and has been used in the treatment of alcoholism, opiate dependence, and impulse-control disorders.
In a clincial trial published last year, the combination of 360 mg bupropion (a respectable dose for depression, although not a dose most doctors would start with, right out of the gate) and either 16 or 32 mg naltrexone (a slightly lower dose than we use in alcohol dependence), was associated with an average 5.0% or 6.1% weight loss, respectively, over a one-year period (vs. 1.3% in the placebo group). A related study, whose results were submitted for FDA approval, used similar doses and found that half of the patients taking Contrave lost >5% of their body weight.
So here we have a novel agent that shows some efficacy in a notoriously hard-to-treat condition, but which is not really a novel agent at all. Just like the Swiffer is a "gee-whiz" product that is clever, remarkably useful, but conceptually quite simple.
But this is where (in my opinion) the similarities should end. Very few people would blame Procter & Gamble for developing a product that fills a niche but is really an overpriced combination of some readily available (and much cheaper) materials. Frugal consumers can pass on the Swiffer and make their own, while plenty of others are willing to pay the premium for the convenience of the name-brand product. And I think we'd all agree that people can spend their money on household cleaning supplies in whatever way they see fit.
But in medicine things are different. When a product receives FDA approval for a given indication (especially a disease as prevalent as obesity), it's an automatic market; plenty of doctors will prescribe it, and insurance companies & public insurers like Medicaid will cover it. Simultaneously, you can bet that a well-orchestrated promotional campaign will rally millions of customers to "ask their doctor" about this "brand new diet drug" they saw on TV. And Orexigen will most certainly charge a hefty premium over the component costs of bupropion and naltrexone alone, to recover the costs of clinical trials and to return a profit to its shareholders. To be sure, as doctors learn that Contrave is actually a combo of two cheaper drugs they can easily prescribe, they might prescribe less of it, but not before a huge market is created and exploited.
Ingenuity is a wonderful thing, especially when it's brought to bear on problems that are notoriously difficult to solve, whether it's the obesity epidemic or that mess on your kitchen floor. However, when a manufacturer repackages old products under a new name and charges a hefty premium for it, we need to be aware of this, and make decisions accordingly. While most consumers don't mind paying an extra few bucks for the convenience of a Swiffer, we should think twice about allowing our cash-strapped medical system to shell out the billions for a "blockbuster" drug like Contrave.
1 Comment	| FDA, medications	| Tagged: bupropion, contrave, naltrexone, obesity, swiffer	| Permalink
You are currently browsing the archives for the FDA category.


text:
Nevada woman gets $200 ticket for…putting LIP BALM on while driving?!?
05 Apr, 2015 by	John Brodgian
I once got a ticket for having fuzzy dice hanging from my windshield (also going 85 in a 55) because it was considered a distraction. That was the most ridiculous ticket I had heard of until now…
A Nevada woman received a $200 ticket after she was pulled over for putting on makeup while she was behind the wheel as part of a statewide crackdown on distracted drivers.
So what sort of beauty product was she applying while stopped at a red light? Lip balm.
Stephanie Fragoso was cited on Wednesday, April Fools' Day, after she was stopped in Las Vegas by a Nevada Highway Patrol (NHP) trooper.
Apparently this is part of Nevada's plan to eliminate fatalities. When she told the officer it was only chapstick, he said "It could have been anything; you could have been drinking water, shaving your legs."
John Brodgian
More articles by John Brodgian

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: WebDriver crashes on IE Suddenly my Python scripts on Selenium stop to launch because of following code and error:
from selenium import webdriver
dr = webdriver.Ie()*

*Actually new browser session opens on webdriver's default page but webdriver stop to respond so no other commands could be executed

Traceback (most recent call last):
    File "", line 1, in
    File "C:\Users\me\AppData\Roaming\Python\Python34\site-packages\sele
  nium\webdriver\ie\webdriver.py", line 57, in init
      desired_capabilities=capabilities)
    File "C:\Users\me\AppData\Roaming\Python\Python34\site-packages\sele
  nium\webdriver\remote\webdriver.py", line 89, in init
      self.start_session(desired_capabilities, browser_profile)
    File "C:\Users\me\AppData\Roaming\Python\Python34\site-packages\sele
  nium\webdriver\remote\webdriver.py", line 138, in start_session
      'desiredCapabilities': desired_capabilities,
    File "C:\Users\me\AppData\Roaming\Python\Python34\site-packages\sele
  nium\webdriver\remote\webdriver.py", line 195, in execute
      self.error_handler.check_response(response)
    File "C:\Users\me\AppData\Roaming\Python\Python34\site-packages\sele
  nium\webdriver\remote\errorhandler.py", line 170, in check_response
      raise exception_class(message, screen, stacktrace)
  selenium.common.exceptions.WebDriverException: Message: Unexpected error launchi
  ng Internet Explorer. Could not get document from window handle

IE version 11
IeWebDriverServer version 2.35 x64
Why this trace appeared? Maybe someone faced the same issue.. Any help will be appreciated
UPDATED
Resolved. Current IeWebDriverServer version replaced with v2.48

A: Check the following:

*

*You are using the same security settings, for all the zones.

*You are using the correct driver. Use the 32 bit when in doubt.

*Make sure your registry settings are correct.

*Zoom level is 100%.

Source: I am the creator of Germanium, an opensource testing API, and I support IE :)

redpajama_set_name: RedPajamaStackExchange


text:
Dancer Breandán de Gallaí - why sad songs say so much
Updated / Thursday, 20 Feb 2020 13:04
Breandán de Gallaí and singer Gina Boreham rehearsing Walls Talk (Pics: Declan English)
Walls Talk is a new dance piece for solo dancer, Breandán de Gallaí, and singer, Gina Boreham, opening later this month at Dublin's Project Arts Centre - below, Brendan writes for Culture about creating 'an abstract assemblage of fragments which give meaning to all of our lives'.
When I first heard Gina Boreham sing I marched straight up to her and said "We have got to do a project together!" I had just premiered a new work, Aon, in Amharclann Ghaoth Dobhair in the Donegal Gaeltacht, and Gina, who is friends with one of my company dancers, Aislinn, and had another, Brendan, as a lodger, had come from London to see her mates in the show.
We had an opening night party, obviously, which eventually became a singsong. Aislinn suggested that Gina sing, and she left both Brendan (her lodger) and me stunned. I think Brendan's exact words were "F**k me!" Gina sings with Dunajska Kapelye (The Danube Band), a Gypsy/Balkan folk band, and specialises in vintage jazz and blues classics. That night she sang Billie Holiday's Deep Song.
We need your consent to load this YouTube contentWe use YouTube to manage extra content that can set cookies on your device and collect data about your activity. Please review their details and accept them to load the content.Manage Preferences
I had no idea what this project would be, but my attachment to the music of this era was an intriguing element and definitely a good starting point. Those records were in our house. I remember finding the weighty, solid, brittle 78s in the attic. Our Christmas record collection was from that era – Bing Crosby, Doris Day, and the like. I remember a Mahalia Jackson LP, her sad face on the cover, and how I thought she looked like my mother (who was born and bred in Gaoth Dobhair!). I've been listening to Billie Holiday, Chet Baker, Sarah Vaughan et al since I was a teenager. I am often struck with the sense of not necessarily belonging to my own time – that the mid 20th century might be a better fit for me.
With Gina's singing in mind, I imagined that the show might be a sort of song cycle – or Liederkreis. As Gina and I researched the concept, we seemed to agree on so many things. Both of us love sad songs, and believe they are important to have in our lives. Neither of us feel sad when we listen to them either. Our source material included Sheldrake's Morphic Resonance Theory, The Stone Tapes, and Larry Dossey's One Mind. We grappled with notions of species-wide consciousness and genetic memory. I even revisited my undergrad physics days mulling over quantum theory, Schrödinger's cat, and the multiverse hypothesis.
The name came to me over pints in O'Brien's on Leeson Street. 'Old man' pubs seem to be blanketed with stories and memories: celebrations; fights; sorrowful times; secret love affairs; not unlike the layer upon layer of paint, and pre-smoking-ban smoke embedded in the walls. "If these walls could talk" led on to Walls Talk. Because the walls really do talk, or certainly they could, once we're sophisticated/advanced enough to extract the information, no more than reading a magnetic tape or CD. As we live our lives we leave traces of ourselves behind – our actions, feelings and thoughts clinging to the stuff we touch – physically, disturbing the entropy, and metaphorically – an emotional load remaining for others to see or sense.
Our peculiar creative process continued with deep reflection on formative moments in our lives that left a lasting mark, and that we carry around as embodied memory – obvious to those who know us, less so to strangers who only know that that's a body with a story.
Both of us love sad songs, and believe they are important to have in our lives. Neither of us feel sad when we listen to them either.
Whilst my own movement is rooted in traditional Irish step dance, I was drawing from my Habitus (Bourdieu) – what I like to refer to as the 'shadows that remain on the body from seminal experience' – trauma, fear, violence, pleasure, etc. – tapping into the physical memory imprinted on the body. We explored passages of text, some from the English literary canon, other pieces we wrote especially for the show.
The show has become an abstract assemblage of fragments which give meaning to all of our lives, with often no connection between those things. This chaotic cacophony comes in the form of a stage filled with random objects and things - from the music, song and dance - representing many different genres, to the text and the mise-en-scène, all diverse and contrasting – yet making unexpectedly harmonious bedfellows.
The original music arrangements were created by Paddy Mulcahy (Limerick), Fiachra Ó Corragáin (Kinsale), Joe Csibi (Dublin) & Zac Gvi (London). Songs include Seems Like Old Times, I'm Fool to Want You, Gloomy Sunday, Deep Song, For All We Know and I'll Be Seeing You, to name but a few.
As we enter the last week of rehearsal, much of the source material is no longer visible and what's left is an emotive slice in time – all time – any time – that might make us reflect on the nature of existence, and lead to a greater understanding of others, increased empathy … love even.
Walls Talk premieres on the week of the 25-29th February in Project Arts Centre, Dublin - find out more here.


text:
Au Secours—and Pass the Duck
The crisis in France has a particularly French flavor.
Michel Houellebecq is undoubtedly the most famous contemporary French writer. The first print run in France of his latest novel, Sérotonine, was 330,000 copies. No other serious French author comes anywhere near to his popularity.
Houellebecq (pronounced WELL-beck, more or less) is both a visionary and a pornographer. Once you've read a few of his books, you recognize what are almost certainly his sexual fantasies. But no author is as gifted as he as a seer. He predicted the rise of Islamic terrorism in France, and his new book predicted—with amazing foresight—the eruption of the mass protest in provincial France known as the gilets jaunes (yellow vests).
His theme is, above all, the lack of transcendent purpose in Western consumer society, especially among the middle classes and the educated—who are, of course, his main readers. According to him, they are exhausted and disabused pleasure-seekers with no purpose but short-term enjoyment or sensation-seeking, pleasure and sensation becoming themselves ever more fleeting and ever less rewarding.
In a society with little religious faith, little respect for tradition, and no collective political goal, everything becomes superficial, even sexual relations (as his pornographic passages are supposed to illustrate). And no one is sharper than Houellebecq in his observations of the absurdity of modern life. These, in my view, are the principal value in reading him.
I had a Houellebecquian moment in Paris on May 1, a public holiday. I went for lunch with my wife and two acquaintances to one of our local restaurants, a simple and unpretentious place. The restaurant was almost full, and the atmosphere rather like that of a Sunday lunch. On the wall at the far end of the place was a large television screen, silently relaying the news.
As I ate my magret de canard, I could not help watching the rioters in Montparnasse on the television. Many wearing masks, they were attempting to throw rocks through the window of a van. They were doing it, of course, for the good of society. The glass cracked, but no matter how many rocks they threw, it would not break. Then they tried to overturn the van on to its side, with equal lack of success. All this took place under the observation and cameras of journalists, almost as numerous as the rioters themselves. In other places, violent confrontations with riot police broke out. You could almost smell the tear gas through the TV screen, but I was the only one in the restaurant who paid any attention to it.
"Oh, it's always like that," said one of our acquaintances, resuming his meal when I pointed it out to him. I have heard it said (which doesn't necessarily make it true) that President Emanuel Macron likes a good riot because it allows him to present himself as the last bulwark against chaos.
Houellebecq would have loved the absurdity of a peaceful restaurant relaying pictures of a riot taking place not far away, none of the customers taking the slightest notice of it—thereby thwarting the rioters' desire for attention. As the Hapsburg Austrians used to say, the situation is catastrophic but not serious.
Theodore Dalrymple is a contributing editor of City Journal, the Dietrich Weismann Fellow at the Manhattan Institute, and the author of many books, including Out into the Beautiful World and the recently published Grief and Other Stories.
Photo by Christopher Furlong/Getty Images
Swimming Always Against the Tide
Theodore Dalrymple Roger Scruton, R.I.P.
Call It a Crime
A recent murder reveals the distorted language employed by British police. Theodore Dalrymple May 21, 2019	Public safety


'Pooface' is the first film created for Pampers Wipes new "Don't Fear The Mess!" campaign. Set to the classic score Thus Spoke Zarathustra by Strauss, the film charts in high definition and in super slow motion (400fps), a big moment in ten young babies lives: doing a poo.
From the initial build up, to the moment itself, right to those moments of ecstatic relief that follow, the film encapsulates all the weird, wonderful, adorable and funny poofaces babies pull when they're doing their business.


text:
ZIMBIO FILM REVIEWS
If 'Toy Story 4' Is The Last One, It's A Glorious Goodbye
Pixar has done it again. Bring your Kleenex.
By Joe Robberson on
Pixar | Disney
The toys. It's so good to see them back on the big screen. If there was ever a franchise made for sequels it's Toy Story. That's because toys age well (if they're taken care of), but also because the animation at Pixar Studios gets a little more beautiful every year. It's been a decade since Toy Story 3. Woody, Buzz, and all the colorful characters have never looked better. And we haven't even gotten to the magnificent story.
Toy Story 4 makes you want to use embarrassing words like "magnificent" when you never would otherwise. The franchise has been around for almost 25 years. It's cross-generational, like Star Wars. Except every movie is good. Toy Story 4 is a bold introduction to true animated magic for kids, and it's a nostalgia machine for their parents, who grew up with the first films.
Directed by Josh Cooley and written by Stephany Folsom and Andrew Stanton, Toy Story 4 had a lot to live up to. Toy Story 3 is widely considered one of the best sequels ever made, and it seemed to neatly close the series with a touching ending. Andy gives his toys to Bonnie and heads off to college.
That's where the new film picks up — a few years after Bonnie (Madeleine McGraw) gets the toys. Woody (Tom Hanks) is no longer a favorite. Dolly (Bonnie Hunt) is the new leader of the toys and Jessie (Joan Cusack) is Bonnie's go-to. Woody still has influence, however, and he strives to stay relevant, at least to his friends, if not Bonnie.
It's the introduction of a new toy, however, that sets off the events of the film. Forky (Tony Hale) is brought into existence by Bonnie herself. He's a spork she glues googly eyes and a mouth on, and he's very confused about his purpose when he suddenly springs to life. Forky's immediate inclination is to return to the salads from whence he came and, eventually, the trash bin. But Woody gets his back and becomes his champion. Soon, the other toys are trying to help Forky understand what it means to be a toy. The spork's a neurotic mess, but it soon becomes clear he's the deepest fears of every toy made manifest, especially Woody. Forky's existential crisis drives the film into philosophical territory R-rated dramas wish they could achieve.
Bonnie and her family head off on a road trip after Forky's intro and the film splits into different narratives, each about a different toy's existence and what it's worth. It's Bo Peep (Annie Potts), in a triumphant return to the franchise, who teaches Woody his own value may not depend on his owner's whims. Fantastic new characters, like Duke Caboom (Keanu Reeves), a Canadian stuntman who's dealing with his own fading popularity, and Ducky (Keegan-Michael Key) and Bunny (Jordan Peele), carnival toys yearning to be won, keep the narrative on theme while invigorating the movie with new blood. Reeves is particularly great, lending Duke soul while staying goofy and funny.
The laughs can be found everywhere in Toy Story 4. The slapstick hijinks come in waves and Forky is a fantastic surprise. (Gotta say, I was underwhelmed by the introduction of a piece of plastic silverware when He-Man and Voltron remain fantasy casting possibilities. But of course Pixar can make a spork into an amazing character. I'll never doubt them again.) Forky brings random goofiness and sight gags to all his scenes, as his eyes fall off or his expressions morph into Mr. Bill territory. He also provides the emotional heart of the story as the symbol of Bonnie's love which must be protected.
Perhaps most astoundingly, Toy Story 4 concludes just as neatly as Toy Story 3 does. If it's the last one, it's very worthy. It's touching, poignant, full of pathos, and all those other forbidden words we keep locked up to protect our hearts. Don't be afraid to give yours to this movie. It's about the human truths we all share. It's about what it means to be alive.
Joe Robberson
Senior Editor at Zimbio. I'll take Johnny Clay, the Rev. Harry Powell, and Annie Savoy. You can have the rest.


text:
The Asia Tour Berliner Philharmoniker, Sir Simon Rattle, Seong-Jin Cho, Yuja Wang
CD & Blu-ray
Sir Simon Rattle's last Asia tour as chief conductor of the Berliner Philharmoniker was a triumph, and is documented here in selected audio and video recordings. At the heart of this edition are audio recordings of the two final concerts at the legendary Suntory Hall in Tokyo – the musical and emotional highlight of the tour. "The quality of the orchestra delighted audiences," said one critic. "It was a virtuoso display of ensemble playing that is simply indescribable."
The repertoire of the concerts was varied, sonorous and full of musical connections. It included Richard Strauss' Don Juan and Brahms' Fourth Symphony, two works of the Berliner Philharmoniker's core repertoire. In addition, with Don Juan – which was played on the first Japan tour with Karajan – the musicians paid tribute to the now sixty-year partnership with the local audience. Brahms, on the other hand, was a programmatic focus of the Rattle era – as well as Igor Stravinsky, whose Petrushka was performed on this tour. An exciting contrast to Stravinsky was Sergei Rachmaninov: a fellow countryman and contemporary, but personifying a completely different world of expression, as his Third Symphony showed. There were also performances bridging the gap between East and West – the work Chorós Chordón by Korean composer Unsuk Chin and two piano concertos with internationally successful Asian pianists: Maurice Ravel's G major Concerto with Korea-born Seong-Jin Cho, and Béla Bartók's Piano Concerto No. 2 with Chinese pianist Yuja Wang.
The audio recordings are available on 5 CD/SACDS, which can be played on any CD player. There are also Blu-Ray video recordings from the Hong Kong, Wuhan, and Seoul concerts, plus a bonus documentary. The booklet contains numerous introductory texts plus an extensive photo section with fascinating impressions of the tour.
Sir Simon Rattle conductor
Seong-Jin Cho piano
Yuja Wang piano
Don Juan, op. 20
Piano Concerto No. 2, Sz 95
Symphony No. 4 in E minor, op. 98
Petrushka (revised version from 1947)
Unsuk Chin
Chorós Chordón
Sergei Rachmaninov
Symphony No. 3 in A minor, op. 44
Piano Concerto in G major*
Recordings from November 2017 from the Suntory Hall Tokyo
*Recording from November 2017 from the Philharmonie Berlin
Documentary: »The Berliner Philharmoniker in Asia. A Tour Diary« (28 mins)
Pre-listening
The Asia Tour
On CD (Hybrid-SACD) and Blu-ray
DISC 1-5 (CD & SACD STEREO)
Strauss: Don Juan
Bartók: Piano Concerto No. 2
Stravinsky: Petrushka
Chin: Chorós Chordón
Rachmaninov: Symphony No. 3
Ravel: Piano Concerto in G major
VIDEO BLU-RAY DISC
Concert Recordings in High Definition Video, Running time: 222 mins
· Documentary: "The Berliner Philharmoniker in Asia. A Tour Diary" (28 mins)
Full HD 16:9 / PCM Stereo
5.1 Surround DTS-HD
Region Code: ABC (worldwide)
124 pages / German, English
For high resolution audio files of
the entire album (24-bit / up to 96 kHz)
7- Day Ticket for the Berliner Philharmoniker's
virtual concert hall
ご利用可能なフォーマット:
Stereo 24/96 [FLAC / WAV]
デジタル・ブックレット
124頁 / ドイツ語・英語


People ages 65 and older who have difficulty comprehending basic health-related material such as prescription bottles and appointment slips are more likely to die within six years than people who can understand the information, according to a study published Monday in the Archives of Internal Medicine, the AP/Boston Herald reports (AP/Boston Herald, 7/24). The study, conducted at Northwestern University's Feinberg School of Medicine and led by internist David Baker, involved 3,260 Medicare beneficiaries in managed care plans in five cities.
The beneficiaries were interviewed in 1997, and information was collected about their race, ethnicity, education, income, weight, chronic medical conditions and health-related behaviors such as smoking and exercise (USA Today, 7/23). Beneficiaries also were given a test to evaluate their ability to understand appointment slips, prescription labels and instructions on how to prepare for an X-ray.
The study found that one-fourth of the beneficiaries were considered medically illiterate. According to the study, nearly 40% of those considered medically illiterate died by the conclusion of the study in 2003, compared with 19% of those in the medically literate group. After factoring in beneficiaries' health at the beginning of the study and other variables, researchers found that medically illiterate beneficiaries were 50% more likely to die than those who were medically literate -- a number "much higher" than the researchers expected, Baker said.
According to Baker, the inability to understand medical information and instructions makes it difficult for beneficiaries to manage chronic conditions, which can lead to more serious health problems. Joanne Schwartzberg, director of aging and community health at the American Medical Association, said that evidence shows that as many as 90 million U.S. residents have trouble understanding medical information (AP/Boston Herald, 7/24).
Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.


text:
Client Login: Corporate | Funds
Home Services About Our People Careers	News Contact Us
Latest in SMP in the News
Home > Blog > SMP in the News
Property ownership and public contracting by overseas companies and legal entities:beneficial ownership register
Posted 7th Apr 2017 in SMP in the News
The UK Government has opened another consultation on the transparency of the ownership of UK property (commercial and residential) by overseas entities with the publication on 5th April of the "Overseas companies and other legal entities beneficial ownership register: call for evidence".
The consultation can be found at:
https://www.gov.uk/government/consultations/property-ownership-and-public-contracting-by-overseas-companies-and-legal-entities-beneficial-ownership-register
The Government say that this register will be the first of its kind in the world. The consultation closes on 15th May 2017 which would imply that the Government are keen to proceed as soon as possible. The proposal is to have a public register held at Companies House with the beneficial ownership disclosures being along the lines of the Persons with Significant Control ("PSC") register for UK companies. The proposal is to exempt entities incorporated in countries with equivalent disclosure requirements. It is not clear whether this will include EU countries who, whilst adopting the Fourth Money Laundering Directive, choose not to make their register public. The intention is that it would not be possible for overseas entities to buy and sell properties until they have provided details of beneficial ownership to the new register. Existing entities would have a year to decide whether to disclose the information or dispose of the property.
At this stage there are no proposed dates for when the register will be introduced, but given that it will be administered by Companies House along the lines of the PSC register, the infrastructure for the register is already in place.
If you have any queries, please speak with your usual SMP adviser or email : info@smppartners.com
Back to SMP in the News
SMP in the News (93)
SMP in the Community (80)
Industry:*
Bahamas Office
Unit 5, Lyford Cay Centre
P.O. Box SP64274
Cayman Islands Office
Royal Bank House, 3rd Floor,
24 Shedden Road, P.O. Box 1586,
George Town, Grand Cayman, KY1-1110
Suite B, 10/F Hong Kong Diamond
Exchange Building Nos 8 - 10
Duddell Street
Clinch's House, Lord Street
Douglas, Isle of Man, IM99 1RZ
Charter Place, 23-27 Seaton Place
Jersey, JE1 1JY
Level 4, Ewropa Business Centre
Triq Dun Karm, Birkirkara Bypass
Birkirkara, BKR 9035, Malta
Switzerland Office
The SMP Partners Group of Companies:
SMP Partners Limited, SMP Trustees Limited, SMP Fund Services Limited and Amber Business Limited are licensed by the Isle of Man Financial Services Authority. SMP Accounting & Tax Limited is a member of the ICAEW Practice Assurance Scheme. SMP Partners SA and SMP Trustees SA are members of the VQF Financial Services Standards Association. SMP Trustees (Hong Kong) Limited and SMP Partners Asia Limited are licensed by the Hong Kong Companies Registry. SMP Partners (Bahamas) Limited is licensed by the Central Bank of the Bahamas and the Securities Commission of the Bahamas. SMP Partners (Jersey) Limited is regulated by the Jersey Financial Services Commission. SMP Partners (Cayman) Limited is licensed by the Cayman Islands Monetary Authority to conduct Trust and Mutual Fund Administration Business. SMP Partners (Malta) Limited is licensed by the Malta Financial Services Authority. Member of Russell Bedford International - a global network of independent professional services firm.
SMP Partners Limited, SMP Trustees Limited, SMP Fund Services Limited, SMP Accounting & Tax Limited, SMP Capital Markets Limited, SMP Yacht and Aircraft Limited, SMP eGaming Limited, SMP Partners Asia Limited, SMP Trustees (Hong Kong) Limited, SMP Partners SA, SMP Trustees SA, SMP Partners (Bahamas) Limited, SMP Partners (Jersey) Limited, SMP Partners (Cayman) Limited, SMP Partners (Malta) Limited and Amber Business Limited are members of the SMP Partners Group of Companies.
Accounting & Tax
eGaming &
Specialist Markets
Copyright © 2019 © SMP Partners Ltd 2019 - All rights reserved
T&C | Cookie Policy | Privacy Notice | View Mobile Version | Web Design by DotPerformance


text:
Stanisław Woźniak (ur. 3 kwietnia 1928 w Gawronkach, zm. 16 sierpnia 2007) – polski bokser.

Życiorys
Był zawodnikiem klubu KS Ostrovia w Ostrowie Wielkopolskim. Zdobywał medale indywidualnych bokserskich mistrzostw Polski: reprezentując Wartę Poznań w 1950 złoty medal w kategorii wagi muszej do 50 kg, później w barwach CWKS Warszawa w 1951 złoty medal w kategorii wagi koguciej do 54 kg, w 1952 srebrny medal w kategorii wagi koguciej do 54 kg, w 1953 brązowy medal w kategorii wagi koguciej do 54 kg, w 1954 srebrny medal w kategorii koguciej i w barwach Prosny Kalisz w 1956 brązowy medal w kategorii koguciej.

W grudniu 1950 postanowieniem Sekretariatu Głównego Komitetu Kultury Fizycznej po rozpatrzeniu sprawozdania kierownictwa ekipy pięściarskiej CRZZ z pobytu we Francji, za postawę niegodną sportowca – reprezentanta Polski Ludowej został usunięty z kadry narodowej i pozbawiony prawa reprezentowania barw zrzeszeń w okresie 6 miesięcy.

Przypisy

Ludzie sportu związani z Kaliszem
Ludzie związani z Ostrowem Wielkopolskim
Bokserzy Legii Warszawa
Bokserzy Warty Poznań
Polscy bokserzy
Urodzeni w 1928
Zmarli w 2007

redpajama_set_name: RedPajamaWikipedia


It is indispensable for the operation of your company to know which machines are in use or which order processes are open. But you can also use the data from tracking and monitoring profitably: for new and innovative business models.
Asset Management, Asset Tracking and Fleet Management provide a complete digital solution for your machine and fleet management: real-time data in regards of location and usage, less downtime, lower costs for maintenance and operation: Tracking and monitoring are carried out via a single, scalable platform - including reports and evaluations at the touch of a button.
Your machines and facilities provide you with valuable data that you can use profitably and cost-effectively: for predictive maintenance, optimized uptime and lower capital expenditure, which gives you new freedom. With Infor EAM, you improve asset planning across departments, buildings, and geographies, streamline operations, and gain valuable data for your business development.


text:
Q: Retrieving Etag of an s3 object using boto3 client There is a scenario where I need to verify the checksum(md5) of a file stored in s3 bucket. This can be achieved when uploading the file by specifying the checksum value in the metadata of api call. But in my case, I wanted to verify the checksum after put the data into bucket programmatically. Every object in S3 will have attribute called 'ETag' which is the md5 checksum calculated by S3.
Is there anyway to get the ETag of a specific object and compare the checksum of both local file & file stored in s3 using boto3 client in a python script?

A: Do not use the ETag of an object in a bucket to determine object equivalence for an object in another bucket (with the same key). In some experiments, I found for large objects the ETag is not consistent from region to region.  For example, a large file in a bucket in us-east-1 may have a different ETag when it is copied to us-east-2.  The consistency of the ETag value from bucket to bucket varies from object to object.  I saw where some large objects do have the same ETag in both regions. I resorted to creating my own tags with the md5sum in it and when I copy an object from one bucket to another, I also copy the tags.

A: Boto3 api has provided a way to get the metadata of an object stored in s3. The following snippet will help to get the metadata via programmatically :
>>> s3_cli = boto3.client('s3')
>>> s3_resp = s3_cli.head_object(Bucket='ventests3', Key='config/ctl.json')
>>> print pprint.pprint(s3_resp)
>>> pp.pprint(s3_resp)
{u'AcceptRanges': 'bytes',
 u'ContentLength': 4325,
 u'ContentType': 'binary/octet-stream',
 u'ETag': '"040c003386f1e2001816d32f2125d07a"',
 u'LastModified': datetime.datetime(2018, 9, 20, 7, 15, 3, tzinfo=tzutc()),
 u'Metadata': {},
 'ResponseMetadata': {'HTTPHeaders': {'accept-ranges': 'bytes',
                                      'content-length': '4325',
                                      'content-type': 'binary/octet-stream',
                                      'date': 'Thu, 20 Sep 2018 07:20:53 GMT',
                                      'etag': '"040c003386f1e2001816d32f2125d07a"',
                                      'last-modified': 'Thu, 20 Sep 2018 07:15:03 GMT',
                                      'server': 'AmazonS3',
                                      'x-amz-id-2': 'P2wapOciWCKPfol2sBgoo11tRdr4KwKcDJ/nHW7LZn00mvKfMYyfAPPV2tIcf3Vu+lrV57NBARY=',
                                      'x-amz-request-id': '42AF970E7C9AA18C'},
                      'HTTPStatusCode': 200,
                      'HostId': 'P2wapOciWCKPfol2sBgoo11tRdr4KwKcDJ/nHW7LZn00mvKfMYyfAPPV2tIcf3Vu+lrV57NBARY=',
                      'RequestId': '42AF970E7C9AA18C',
                      'RetryAttempts': 0}}

>>> s3obj_etag = s3_resp['ETag'].strip('"')
>>> print s3obj_etag
'040c003386f1e2001816d32f2125d07a'

The head_object() method in s3 client object will fetch the metadata (headers) of a given object stored in the s3 bucket.

A: Actually, the above code will generate error as if there is a missing parameter.
This works for me
s3.meta.client.head_bucket(Bucket='mybucket')


The Waverley Prize 2014 is open to painting, printmaking, works on paper and street art works. This year's judging panel consists of Contemporary Australian Painter, Del Kathryn Barton, Gallery Director, Dominik Mersch, and National Art School Gallery Curator, Judith Blackall.
Now in its fifth year, this exciting art competition is open to national and international artists for small-scale artworks. Entrants may submit paintings, drawings, photographs and all 2D artworks up to 61cm (24 inches) in any direction. The judging is based on three equally evaluated criteria of creativity, originality and skill with $10 000 awarded to the winner.
Guest speaker, Jeffery Plummer – Director – Kedumba Drawing Award and Collection, oficially opening exhibition.
Jody's work will be exhibited and for sale in the student excellence award, Wester Sydney Institute,Nepean.
Exhibition from the 13th of February until 1st of March, 2013.
Further details listed on invitation below.
May St. Studios will be opening its NEW gallery exhibiting the work of resident May St. artists from 1 March through to 29 March 2013.
Opening night is with the artists 6-9pm Thursday 7 March.
This exhibition will offer for those of you interested the chance to go into artists studios, chat with the artist and see their working space.
Open studios Sat 9 & Sun 10 March, 10am-4pm.


text:
DXT Campeón, subtitulado como "Primer Diario Deportivo de Galicia", es un periódico deportivo gallego, fundado por Ángel Hervada y Bieito Rubido. El primer número salió a la calle el 19 de diciembre de 1995.

Historia
Su primer director fue César Casal González, que permaneció en el puesto hasta 1999, cuando le sucedió Juan Carlos Boga Sánchez. En 2009, Andrés Ríos coge el mando de la nave.

Tras varias tentativas, incluida la inicial, de convertirse en el diario deportivo de toda Galicia (inclusive con redacciones en Vigo y Santiago y corresponsalías en Ferrol, Lugo, Pontevedra y Orense, además de en Madrid y Barcelona), en la actualidad se centra en el deporte de la comarca coruñesa y, por extensión, de toda la provincia.

Después de poseer diferentes cabeceras (DxT, Campeón y Deporte Campeón), lleva varios años con la denominación actual.

En la actualidad forma parte del grupo Editorial La Capital, que engloba, entre otros, los diarios El Ideal Gallego, Diario de Ferrol, Diario de Bergantiños o Diario de Arousa.

En su redacción, sita en el Polígono de Pocomaco (Mesoiro, La Coruña) trabajan doce periodistas, cuatro fotógrafos y cinco infógrafos.

Desde sus comienzos, por su redacción han ido pasando grandes ilustres del periodismo gallego.

Periodistas que han trabajado en DXT Campeón
 Entre paréntesis medio en el que trabajan en la actualidad

César Casal (La Voz de Galicia), Alberto Mahía (La Voz de Galicia), Kiko Novoa (Radio Galega), Carlos Alberto Sánchez (Televisión de Galicia), Xosé Antón Fraga (Televisión de Galicia), Toño Sangiao, Alfonso Hermida (Televisión de Galicia), Antón Lezcano (Localia TV), Luis de la Cruz (AS), Manolo Rodríguez (La Opinión), Doda Vázquez, José Luis Núñez (TVG), Antonio Fafián (TVE), Pedro López (Depor Sport), Raúl Benito (Depor Sport), Eugenio Cobas (La Opinión), Pablo Gómez (La Voz de Galicia), Rodri Suárez (Galicia Confidencial), Silvia Carregal, Paulo Alonso (La Voz de Galicia), Juan Quijano (Diario de Ferrol), Gladys Vázquez (Voz TV), Marta García (El Ideal Gallego), Daniel Romero (El Ideal Gallego), Paola Feal (El Ideal Gallego), Manu Sainz (AS), Teresa Rubio (Cadena Ser), Juan Luis Cudeiro (El País), Lucía Urresti (Depor Sport), Nicolás Vidal (Diario de Ferrol), Arturo Patiño, Antón Baldomir, José A. Alonso, Yolanda Valera, Ana Torres Jack, Patricia Amaro, Marta Arias, Pedro Espinosa, Luis Núñez, Cristina de la Peña, Javier Gundín, Xabier Rodríguez, Vanessa Bretón, Miguel Ángel Suárez, Lucía Orizales, Rebeca Rubio, Jorge Iglesias, Miguel Álvarez, Hugo Santiso, Pablo Rey, Juan G. Arévalo, Lois Novo (Real Club Deportivo de La Coruña).

 Fotografía e infografía:

Iago López, Mero Barral (Marca), Andy Pérez (Ayuntamiento de La Coruña), Trini Aragunde (La Sexta TV), Maxi, Yose, Óscar Izquierdo, Iñaki Velasco (iki), Pepe Varela, Javier Rico, Manuel Agrafojo, Iván Prego, Vicky Romasanta (Depor Sport), Begoña, Silvia García, Mónica Rilo, Patricia López.

Equipo redactor actual
 Director: Andrés Ríos.
 Redactor jefe: Alberto Torres.
 Deportivo: Carlos A. Fernández (jefe de sección), Israel Zautúa, Armando Palleiro y Zeltia Regueiro.
 Fútbol: Rubén García (jefe de sección) y Eder Pereira.
 Otros Deportes: Juan Pedro Barco (jefe de sección), Chaly Novo y Pablo Zaballa.
 Suplementos: Juan Ramón Fernández (jefe de sección).
 Fotografía: Pedro Puig (jefe de sección), Quintana, Javier Alborés y Patricia Gago Fraga.
 Infografía: Carlos (jefe de sección), Ana López, Ángeles, Luis e Iria Gianonatti.
 Administración: Begoña Chas e Irene Orgaz.
 Firmas invitadas (Galería Deportiva): Ricardo Docobo, Pablo García-Ramos, Antonio Llamas, Ventureira, Federico Poncet, Juan Guillín
 Viñetas: Manuel Tella.
 Crucigramas: Quique.

Enlaces externos
 Web oficial de DxT Campeón

Periódicos de Galicia
Periódicos deportivos de España
Publicaciones fundadas en 1995
Diarios de España
Diarios en español


Our little Lucy Mae has arrived!
Note: Please be sure to read the comment section as well, as there are many great stories and questions that have come up. I will do my best to answer all of them in a timely manner.
In the past, I haven't written much at all about my thoughts on pregnancy, homebirth, midwifery, etc. But now that I am "great with child", it seems very natural to share my thoughts with you. Plus, I've been getting lots and lots of emails asking specific questions about this topic, so I'm just going to address them all here.
I love being pregnant. I even love giving birth! My homebirth experience with Bella was so incredible...a day I will never forget. And because of that, I am passionate about educating women...empowering women...giving them the knowledge they need to make the most informed decision possible about their birthing options. These decisions should not be rooted in fear or made simply to please family and friends. Giving birth is something that belongs to a woman (along with her spouse or partner)...and the details surrounding it should not be taken lightly.
Pregnancy is intense. Birth is more intense. Each mama's experience is so unique and different...it's impossible to compare one to another. Each woman needs to give birth in a place that she feels SAFE. If she doesn't feel safe to begin with, birth will never unfold the way it's supposed to. One woman's perfect, safe birth might be in a forest all alone...and another may only feel comfortable and at ease surrounded by doctors. With that being said, I will say that I have VERY strong opinions about this topic. While you are reading this post, if you feel the least bit offended or hurt by anything I'm saying, please know that my opinion of how birth should be is not a direct attack on you or how your birthing experience turned out. I absolutely honor your birth experience and know that every mama makes decisions in the moment with the information she has been given...with the hope that those decisions are best for her baby. This post is simply my own opinion based on my experience and research.
Options to Homebirth Of course, there is the option of birthing in the hospital with a midwife. Just be sure that if this is your choice, that you be wary of "medical midwives" who may hold very similar views of birth as a doctor might. You see this a bit more when the midwife is working very closely with a doctor and/or is in a hospital that doesn't have a good track record of natural birth. A birth center can offer the "best of both worlds"...birth centers have an inviting, home-like environment and can be a great option for those who aren't quite ready to take the leap to a homebirth.
Midwives are EXPERTS in natural birth. Doctors are experts in high-risk, medicalized birth. I am glad there there are doctors that can help out when there is a true emergency. However, it is my opinion that most "emergencies" in a hospital birth are avoidable. The progression of interventions that occur in a hospital are almost always a direct result of a doctor's impatience and/or misconceptions about the birth process. A homebirth with a midwife (or unassisted) is one way to avoid unnecessary interventions.
Declining the "routine tests" during pregnancy unless warranted.
Using a fetoscope to listen to the heartbeat instead of a Doppler. We have one at home that we use to listen whenever we want! We will use a Doppler during labor/birth.
Not checking dilation during labor...but relying on bodily cues instead.
Not being "told" when to push.
I know that there are some of you out there thinking "But Sara, if I wouldn't have been in a hospital, my baby would have died". I don't want to discount your birth experience at all...and I'm not going to fight with anyone over that point. I just know that based on statistics, homebirth is as safe or safer than hospital birth for low-risk women with a skilled birth attendant. Many times, the interventions that happen in the hospital are actually the CAUSE of the problem that resulted in an emergency C-section, etc. There are certainly situations that can only be handled by a hospital...but it's very, very few in the overall scheme of things. Even breech babies and twins (even triplets!) can be born at home safely.
There is also the misconception among those unfamiliar with homebirth that if a problem did arise during birth, there would not be time to get to a hospital. However, midwives are trained to recognize potential issues BEFORE they become a problem...leaving plenty of time to transfer to the hospital if needed. Homebirth midwives also carry equipment with them to assist in these cases...oxygen tanks, a Doppler to listen to the heart rate throughout labor, pitocin or herbs to stop bleeding, and so on.
One of my very favorite books is Ina May's Guide To Childbirth, by Ina May Gaskin. In it, she details the statistics for 2,028 births that occurred over 30 years at The Farm in Tennessee. Out of those births, only 1.4% resulted in C-section. This is a little different than the current national C-section rate of at least 30%. Her other statistics are just as astounding...see the back of her book for the entire listing.
Another very disturbing statistic is the U.S. infant mortality rate. Basically, I am safer going to 28 other countries than to birth in a typical setting in the U.S. That's just doesn't make sense to me...you think it would be super low if hospital births truly are safer than homebirths.
Food: I'm currently eating a mostly vegetarian diet rich in protein and healthy fats. I eat a lot of eggs, beans, brown rice, raw nuts and seeds, nut butters, avocados, fruits, veggies, whole grains and noodles, and dark leafy greens such as kale and spinach. I throw in some tofu and tempeh here and there. I do my best to avoid processed white flour and white sugar and if I do have sweetner, it's in the form of agave nectar, pure maple syrup, or honey. I've recently cut out dairy, in preparation for nursing the new babe...and also because I just feel much better when I'm off of it. I don't feel that cow's milk products are beneficial for human bodies...although I have to fight against my urges because cheese is tasty and addictive :) Find out more about what I like to eat at Happy Foody.
Supplements: Floradix I'm always surprised when I tell someone about Floradix and they don't know what it is! I just figured that EVERY pregnant woman knew about it...because it's like a magic potion! If you are lightheaded, tired, or short of breath (like I was)...chances are you are low in iron. Floradix is a fabulous herbal supplement that you can feel working in just a few hours. When I forget to take it for a day, I absolutely notice a difference in my energy levels. I feel like a drug pusher because I'm always trying to get people to take it :) But it really is that fabulous.
I've been making my own concoction lately of RRL, nettles, and peppermint. My wonderful friend Rebecca just gave me a special yummy stash from Earth Mama / Angel Baby Organics. Although theirs is called "Third Trimester Tea"...you can drink it anytime. Most people will start in their 2nd trimester. If you have had previous complications or have a history of pre-term labor, consult your herbalist or midwife before taking in large quantities.
New Life Vitamins I was previously taking Rainbow Light Prenatals...but after talking with Rebecca, my midwife, I'm now taking New Life Prenatals and I LOVE them. They are much smaller (not a horse pill!), "cleaner" and assimalate into my body faster and better (to test your vitamins, put them in apple cider vinegar for 45 minutes and if they dissolve completely, they are good!). I trust her opinion because she has worked in that industry and is pretty much a smarty pants when it comes to supplements.
Calcium I'm taking additional calcium to help with "jumpy legs" at night and also because I'm not doing dairy. I'm currently taking Calcium Lactate by Standard Processing. Avoid calcium carbonate, and go for calcium citrate or calcium lactate. The second two are much more absorbable by the body.
Probiotics Probiotics are extrememly important for digestion, immune function, controlling/supressing yeast in the body, etc. The best way to get these would be through a whole food source...yogurt being one of the best. But because I am not eating dairy and I don't really love soy or goat yogurt, I am currently taking PB8. My midwife also recommends Pearls.
DHA, which constitutes approximately 40% of the brain, supports brain development during the last trimester of pregnancy when the unborn child's demand for neurological growth increases greatly. If added to the mother's diet, it can help prevent the depletion of the mother's store of DHA and support the developing baby's essential fatty acid needs. Currently, the proposed Adequate Intake of DHA for pregnant and lactating women is 300 mg per day.
Yoga Yoga is a wonderful practice to engage in during pregnancy. I've found this to be one of very favorite things to do lately! I've found a great prenatal class in Bozeman that I attend once a week, but I also try to practice at home, even just for a few minutes a day. Yoga helps to align your body for carrying the baby and for birth, and also assists in "opening" up your hips and "making space" for your growing baby. I've found that I am so much more aware of my posture and my breathing during the day since taking up yoga and I've noticed a big difference in my muscle tension overall. One of the best postures for pregnancy is the "Cat/Cow" or the "Cat Back". I do this even before getting out of bed in the morning to help align and loosen my spine and lower back and then again during the day as needed. I also love Child's Pose with legs open wider, The Squat to prepare for birth and The Pigeon to open up my hips. Love it. Love it. Love it. I'm currently looking for a great yoga DVD to do at home and would love suggestions from those who have found one they really like.
Massage There is nothing more blissful than a massage during pregnancy. Oh. My. Goodness. I had the pleasure of having one just yesterday from a wonderful massage therapist who specializes in prenatal massage and has a special table for big bellies :) I will continue to get massages throughout this pregnancy...not only for relaxation, but also because when the muscles in your body are tense, they will "pull" your chiropractic work out right away! It's best to utilize massage and chiropractic at the same time to compliment each other. These things may seem like "indulgences" to some, but for me, they are just part of preparing my body for birth and maintaining holistic health.
Honoring The Placenta The placenta is a phenomenal organ! I am planning making a "print" from my placenta right after birth, as well as dehyrating, grinding, and encapsulating my placenta to ingest after birth. For more information about this process and why on earth I would want to take my placenta in pill form, check out Placenta Benefits. Here is a nice article from Mothering about honoring the placenta.
Water, Water, Everywhere With Bella, we used the ever popular "fishy pool" and it worked great! We did have to add hot water a few times, which was a little distracting, but for the most part, it was good. And cheap! This time around I'm planning on using a larger tub with it's own heater such as the AquaDoula or La Bassine.
Stay Far Away From: What To Expect When You're Expecting This book offers little to nothing to the reader when it comes to preparing for a normal birth. I really do not like how the book uses language that encourages the view of the doctor as the know it all. The doctor does NOT know it all. Some doctors have never in their entire practice seen a natural birth without interventions. The book does a great job of creating fear instead of empowering women to see their bodies as amazing, powerful, and able to birth naturally. So if you want to freak out and be worried and wonder all the time if something is wrong, then you should read this book. If you want to learn more about your body and what the birth process is truly like, then read the books I've listed above.
Birth Reality Shows Again, if you want to create fear within yourself, go ahead and watch A Baby Story and all of the like. I would recommend against it. "Normal" birth rarely sells...so most of the births on there are intervention city! There have been some that have focused on homebirth or midwife-assisted births, but they are few and far between. Most Mainstream Pregnancy Magazines and Online Forums This is mostly a personal preference of mine...but I really just can't stand them. They usually aren't in line with my birthing philosophies, so I avoid them altogether and choose to surround myself with resources and people that are uplifting and encourage me in my chosen birth path.
Pregnancy photos here, including my pregnancy with Bella and some other friends. Photos of Bella's birth.
The photo above is a self-portrait of Matt and I when I was 40 weeks pregnant with Bella.


text:
{% load crispy_forms_tags %}

{% if title %}

{{ title }}

{% endif %}

<form method='POST' action=''>{% csrf_token %}
{{ form|crispy }}

<input class='btn btn-default' type='submit' value='{% if btn_title %}{{ btn_title }}{% else %}Submit{% endif %}' />

</form>

redpajama_set_name: RedPajamaGithub


BREAKING: James McCarthy out for 'months'.
James McCarthy has been riddled with numerous injury set backs and his hamstring injuries have been the most common.
After recently recovering from yet another injury, James McCarthy is now reportedly out again after pulling his hamstring in a training session after Wednesday night's match at Chelsea.
It is believed he could once again be sidelined for a long period of time. A source at the club mentioned it could be "months rather than weeks" that the Irish international is to sit out for.
McCarthy shown some promising signs in his 62 minute run out in the Carabao cup match at Stamford bridge and it is believed he went through that completely unscaved.
David Unsworth will be without him on Sunday and may look to Muhamed Besic or Davy Klassen to come back into his side.
We've got a diamond – What next for Ross?
As the search for a new manager continues, what went wrong for Ronald Koeman?


Patients and Families | Asahi Kasei Medical Co., Ltd.
About the life-supporting functions of blood and therapies that utilize these functions.
A basic explanation of blood constituents and their functions, and how these relate to removal of harmful substances through therapeutic apheresis.
About blood constituents and their balance.
About blood constituents, their functions and blood groups.
About therapeutic apheresis, a treatment that purifies blood by removing harmful substances.
"Therapeutic apheresis" refers to a variety of therapies that purify the blood by removing various substances that cause or aggravate disease. Here you will find explanations of the major types of therapeutic apheresis.


text:
Dr. John H. Fullerton, a certified Clinical Forensics Expert, is vetted by the Department of Homeland Security, the Department of Justice, the Office of The Inspector General and the Federal Bureau of Investigation to perform the duties of a government expert in cases of criminal healthcare fraud.
Medicare Fraud DOJ Garrison PA Trial Verdict in LA as Operation Heat
Dr. John H. Fullerton served as a key government expert witness in the Los Angeles jury verdict trial "Operation HEAT", working with the Department of Justice, FBI, and OIG-HHS (US Department of Health and Human Services) v. a Physician Assistant (Garrison) who was convicted of all counts in the indictment.
David James Garrison was a physician assistant who worked at fraudulent medical clinics where he used the stolen identities of physicians to write prescriptions for medically-unnecessary durable medical equipment (DME) and diagnostic tests. On June 4, 2012 Garrison was convicted of conspiracy, health care fraud and aggravated identity theft charges in connection with an $18.9 million Medicare fraud scheme.
Per Dr. Fullerton "….the lack of funds in Medicare and how egregious these sham providers behaved in "bilking" the American taxpayers of over $430 Million [as part of a US national campaign], thereby threatening our vulnerable elders who justifiably rely on Medicare for their future care and have played by the rules all of their working lives to pay into the system..."
In addition to the Garrison case, Dr. John Fullerton has served as a key expert witness in the continuing efforts of Operation HEAT (the task force having tallied over $4 billion US) and has been on the winning side of numerous other convictions.
It was not until February 2013 that Dr. Fullerton's involvement in the trials was allowed to be made public. Dr. Fullerton continues to be sought after as an expert witness in Medicare fraud working with teams of prosecutors in targeted cities like Los Angeles.
Seventeen-Count Indictment Unsealed Charging Four with Medicare Fraud Conspiracy
Dr. John H. Fullerton served as a key expert government witness in the 2010 case of Stanley Garrido, a physician assistant in San Diego, CA charged with ordering medically unnecessary tests and procedures and falsely holding himself out as a medical doctor to individuals at a clinic on El Cajon Boulevard in San Diego. The clinic had been established in 2005 by two owners along with a fourth defendant, portrayed as "the lead capper of the scheme" using an unamed 79 year old physician for his name and Medicare billing number.
Orange County Doctor Convicted of Six Counts of Health Care Fraud in Multi-Million Dollar Scam
Dr. Fullerton was a key government expert witness in the case of Augustus Ohemeng, MD, a Buena Park physician who participated in a health care fraud scheme for unnecessary procedures and prescriptions that led to Medicare paying nearly $3 million on fraudulent claims for durable medical equipment and nutritional supplies. Ohemeng faces a maximum statutory sentence of 60 years in federal prison.
Owner of California Medical Equipment Supply Company Found Guilty of $11 Million Medicare Fraud Scheme
Dr. John H. Fullerton has continued his successful involvement in High Profile Medicare Cases with the conviction of Obiageli Agbu July 19, 2013. Obiageli (Brooke) Agbu, who was on the list of Medicare's Most Wanted (see pg.3), was convicted of Medicare Fraud in a federal jury trial where Dr. Fullerton was retained by the LA Offices Federal Court as the sole expert.
Dr. Fullerton was qualified by the Federal Court to provide determinations of Medicare medical necessity for a series of "bribed physician providers" who paid "Cappers/Marketers" to bring into the sham clinic the Medicare info and demographics needed to perpetrate over $11 million in fraudulent billing for DME (Durable Medical Equipment) mostly in the form of expensive, fully-loaded power wheelchairs.
Dr. Fullerton was also qualified by the court to testify in the proper running of a Medicare Enterprise Clinic (including Medicare durable medical equipment supply houses) using the business practices and experience of running a Medicare business practice enterprise (like Hampton Health, Ltd.), to demonstrate proper Medicare billing practices as a provider and to give his expert opinion on proper Medicare business practices as an Executive/Medical Director for Medicare Clinics/Supply Houses fulfilling DME (Durable Medcial Equipment) prescriptions.
Los Angeles-Area Doctor and Patient Recruiter Plead Guilty to Participating in a Power Wheelchair Scheme that Defrauded Medicare of Over $10.1 Million
In direct relation to Dr. John Fullerton's involvment as the sole expert witness in the conviction of Obiageli (Brooke) Agbu, Dr. Emmanuel Ayodele of Los Angeles and Alejandro Maciel of Huntington Park plead guilty to one count of health care fraud and one count of conspiracy to commit health care fraud in a separate case on July 1, 2013.
Both Dr. Ayodele and patient recruiter Alejandro Maciel conspired with the Agbus and their medical supplies company Bonfee and Ibon to submit more than $12.3 million in bogus prescriptions and fraudulent Medicare claims for durable medical equipment.
Three Defendants Convicted in $3.2 Million Medicare Fraud Scheme
As a key government expert witness, Dr. John H. Fullerton was once again on the winning side in the December 4, 2013 conviction of Patrick Sogbein, his wife Adebola Adebimpe and their associate Eduardo Abad on all counts against the owner/operator of a medical equipment supply house company and the defendants in the Operation HEAT case adjudicated in San Francisco, CA.
The case involved medicare fraud surrounding the illegal prescribing and distributing of power electric wheelchairs.
Three Found Guilty for Roles in $20 Million Health Care Fraud Scheme Involving Bogus Prescriptions for Expensive Anti-Psychotic Drugs
Dr. John Fullerton was an instrumental government expert witness whose testimony helped secure the indictment(s) against the defendant clinic providers in the investigation known as "Operation Psyched-Out".
Members associated with Manor Medical Imaging Clinic in Glendale, CA: Dr. Kenneth W. Johnson, 44, of Ladera Heights and Manor's in-house doctor, unlicensed physician's assistant Nurista Grigoryan, 56, and Artak Ovsepian, 32, one of the leaders of the conspiracy, were found guilty on February 18, 2014 for falsely prescribing expensive, brand name anti-psychotic mediations and re-billing the government for the same drugs over and over again to a total of more than $20 million.
Grigoryan and Johnson will face up to 50 years in federal prison at sentencing.
Prosecutors: Scam Put 900,000 Oxycontin on Street
Dr. John H. Fullerton has been involved as a government medical expert in "Operation Dirty Lake" through Operation Heat in collaboration with the DOJ/FMI/OIG-DHHS/DEA/AG and Local Law Enforcement in Los Angeles County.
Multiple pharmacists and co-defendants Mike Mikaelian and Anjelica Sanamian have been accused of diverting 900,000 pills of Oxycontin onto the streets via their 'Lake Medical Group' and pushing a high-dose Oxycontin Pill while bilking Medicare of an estimated $7 million.


text:
Amsacta fuscosa är en fjärilsart som beskrevs av Max Bartel 1903. Amsacta fuscosa ingår i släktet Amsacta och familjen björnspinnare. Inga underarter finns listade i Catalogue of Life.

Källor

Externa länkar

Björnspinnare
fuscosa


What is ginger garlic paste?
Ginger and garlic are the two most important spices for cooking food. Ginger garlic paste is one of the essential ingredients used in Indian cuisine. It also serves as a carminative and gastric stimulant in many medicine preparations.
Earlier, people used to prepare the ginger garlic paste at home. However, busier lifestyle and increasing disposable income have prompted the consumers to use ready-to-cook ginger garlic paste.
The ginger garlic paste is an FMCG item, which is getting immense popularity not only in the urban areas but also in small towns and rural areas. The cooking paste segment is catering to working professionals, students, travellers and chefs.
With the changing purchase dynamics and the growing need for quality branded products, many food manufacturing companies have forayed into the cooking paste segment.
How to make ginger garlic paste?
1. Procure raw materials – The food product development must ensure that all the procured raw ingredients meet the desired quality parameters.
2. Cleaning – Ginger and garlic should be thoroughly washed.
4. Crushing & Pulping – Use crushing machine to crush the de-skinned ginger and garlic. The crushed material is then put into a pulping machine to obtain a paste of uniform consistency. Add required quantity of turmeric, salt, water and remaining powder ingredients.
5. Adding Preservatives – Transfer the material into a stainless steel vessel and add preservative to it. This is done to enhance the shelf life of the finished product.
6. Packaging – The product is vacuum packed into pouches or other suitable packaging material.
The paste is a semi-solid product. Hence, one would require a leak proof packaging. The ginger garlic paste can be vacuum packed in can, plastic container, re-sealable pouches and bottle.
The ginger garlic paste is indispensable for Indian cooking and the fact that it saves time and energy for our 'garb and go' customer makes it a great buy.


On 17th- 24th June 2017, Cannes Lions Festival of Creativity took place, celebrating the very best of creativity and innovation in our industry.
We are proud to announce that over the course of the week, we won seven coveted Cannes Lions awards, across a wide range of categories for our campaigns adidas GLITCH and adidas #myneolabel. The full list of awards can be found below.
Massive congratulations to our incredible adidas team for their amazing work and for consistently pushing the iris bar higher.


You capture the right features for your problem, but accidentally include highly-correlated or duplicated features with no predictive capacity.
You engineer all the wrong features.
Assuming you have domain expertise (as crucial as technical chops to a successful predictive analytics project, if not more so), it's more likely that you'll fall into this first group - you won't know which features are the most beneficial.
The most common way I've seen data scientists proceed is to use Recursive Feature Engineering or something else from the feature_selection module of scikit-learn.
The problem with this, however, is that you're basing your feature selection on how much it helps the model, and not on anything related to the 'ground truth' of the particular phenomenon you're trying to model.
This is one of the key mistakes that will lead the statistically-inclined to launch into finger-wagging sermons. But what can you do to find out more about the 'ground truth' of your features?
And what, specifically, should you be on the look out for?
Confusingly enough, multicollinearity is also sometimes called collinearity. Fortunately, though, both of these terms can be understood syllable by syllable. Multi-co-linearity = many shared lines.
A more technical definition would be something like the following: from a pair (or more) of features, you could use one of them to fit a linear model that appreciably approximates the other.
As a simple example, imagine that you were a property developer building a block of apartments in a major city. You would like to forecast the purchasing propensity of local individuals. You know from your research that your ideal customer works in a professional capacity, has no children and has previously been unable to purchase a property due to restrictive lending requirements.
You collect lots of data on these individuals and you build a complex model that takes into account factors like their time in employment, their commute time, their salaries, their hobbies and their disposable income.
Did you see where multicollinearity crept in?
It's not easy to see why this should be an issue for a model. It's certainly not the case that this will reduce the predictive accuracy of your model on the test set. So what's the problem?
The problem is that multicollinearity can, and often does, change. Features that were once highly correlated can become less so, and the features in your model that bolstered one another and helped you make those crucial sales later end up disagreeing with one another, sending your model's accuracy into a tailspin.
It can lead to radical changes in coefficients when features are added or subtracted from a model.
It can lead to one explanatory variable having a very near-zero coefficient, even though a simple regression model using just that variable and the target has a coefficient greater than zero.
All of this is a long way of saying that multicollinearity is the death-knell of a robust predictive model.
A variance inflation factor (VIF) is a number, a ratio (to be more precise), that describes the variance of a model with multiple features in comparison to a model with one feature.
In the case of our property development scenario from above, we would expect that the variance in salary in the model using all of the features to be some large (>5) multiple of the variance in salary in a model using salary alone as a predictor.
Enough theory! Let's see multicollinearity and VIF in action.
Our goal here is to build a robust linear regression model that predicts an individual's maximum house deposit based on their other attributes.
Using the off-the-shelf LinearRegression from scikit-learn, we can achieve an RMSE (root mean squared error) of 316.85. That's very good considering we're dealing with a target variable that takes values of ~10^5 and up.
The feature has a positive .906 correlation with our target variable. Let's try training another model, this time removing the salary feature that we suspect is introducing multicollinearity.
This time, our RMSE is much larger at 8453.45. But, that's not what we were looking for. The coefficient of the disposable income variable has increased 350% to 3.585. Yikes! The coefficient of the commute_time_hours variable also increased 150%.
After introducing small amounts of noise into the data, we can see that two of the coefficients in our model have nearly halved! Not very robust.
Those are some very big numbers. Ideally, each VIF Factor should be below 5, or at least below 10. So we definitely have some multicollinearity here. Perhaps even with the time_in_employment variable, which we did not expect, but which might be explained by the fact that salary can be somewhat predicted from career length.
What to do next very much depends on your problem domain. Do you think that disposable income is likely to significantly increase or decrease due to upcoming macro-economic changes? If you don't think that's likely, you might not have to reduce multicollinearity in your model at all.
If, on the other hand, you see a reasonable chance of that happening and are also concerned about the high VIF of the time_in_employment variable, it might be worth retraining the model less one variable.
But which one to choose?
In practice, you should prefer to drop the feature that takes the most effort to collect. In this case, that's probably going to be disposable_income. People know their salaries off the top of their heads, their disposable income? Not so much.
Let's try a final model, using just commute_time_hours, salary and time_in_employment.
Our RMSE this time is higher (1000% more, in fact) at 3233.08, but that's still reasonable given the order of magnitude of our target variable.
Those look much more like small perturbations to me!
Everything comfortably below 5, including the time_in_employment variable which had a somewhat mysteriously high VIF. Excellent, we're removed the multicollinearity.
Obviously, the point of all of this was not to just reduce the VIFs for their own sake. We wanted to make our model more robust.
Remember our RMSE from the first model? It was an exceptional 316.85, now let's simulate a fairly radical change in the disposable_income, by randomly increasing or decreasing out-of-sample disposable incomes by an int between 1 and 4999.
When we do this, the RMSE skyrockets to 20376.79. An increase of around 6600%.
If we apply the same kind of radical change to the model that excludes disposable_income, or more importantly, has no multicollinearity, we see the RMSE increase from 3233.08 to 11472.38, an increase of just 300%.
I hope that this deep dive into multicollinearity has helped you understand an important way to make your model more robust, if you have any questions, please get in touch.