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Academic medical centers and drugmakers share directors, possible conflicts
Melanie Evans
Nearly all of the nation's largest pharmaceutical companies have recruited directors from the leadership of academic medical centers, the training ground for future physicians and home to basic science research and clinical trials, according to a new study in the Journal of the American Medical Association.
Sixteen of the 17 largest U.S. drug companies reported that at least one of their 2012 directors was also a top executive, department or division leader, dean or governing board member from one of the nation's medical schools, health professions' schools or teaching hospitals and health systems, researchers found.
The study, which examined the governing board composition of the 50 largest drug companies worldwide, comes months before the required public disclosure of drug industry payments to doctors and teaching hospitals mandated under the Physician Payments Sunshine Act. The study's results underscore the close and sometimes conflicting ties between industry, physicians and academia that the 2010 law seeks to expose.
Reporting closed Monday for the Sunshine Act—a part of the Patient Protection and Affordable Care Act—but data will not be public until this fall. Industry board compensation paid to non-physician leaders at academic medical centers likely will not be included under the reporting requirements.
There is limited research and data on how academic institutions manage such relationships to maximize benefits, such as fostering innovation, research and educational opportunities, while avoiding the perception that academic research can be bought and sold, said Eric Campbell, a professor of medicine at Massachusetts General Hospital and Harvard Medical School, both in Boston.
In 2007, Campbell and a several other researchers published survey results in JAMA suggesting that nearly two out of three department chairs at the nation's medical schools and teaching hospitals had some ties to industry, including 11% who served as corporate directors. Campbell rejected the idea that academic-industry relationships should be banned at the expense of the benefits they provide. But without data, policymakers lack the resources to make informed relationship-management decisions and determine which relationships are potentially unacceptable, he said.
Executives and board members who set the clinical, research and educational agendas of the nation's top academic medical centers have been overlooked in the scrutiny of relationships between drug companies and medicine, said Dr. Walid Gellad, one of the study's authors and an assistant professor of medicine at the University of Pittsburgh School of Medicine.
More attention has focused on "pens in the hands of medical students, and going to dinner and consulting" among prescribing physicians who work most closely with patients, said Gellad, who is also a staff physician with the Veterans Affairs Department Pittsburgh Healthcare System's Center for Health Equity Research and Promotion.
While academic leaders must meet their institutions' educational and clinical agenda, drug company directors must meet their obligations to shareholders. "There have to be instances where those two organizations don't have the same goals," Gellad said. "We need to have frank and open discussions about the risks that these relationships entail, as much as we need to discuss the benefits they might entail."
Among the 50 largest global drug companies, as judged by 2012 revenue, 19 had recruited one or more directors from the leadership of prestigious and competitive research and medical schools.
"The fact that this relationship exists at all was a surprising finding, given that we're not talking about just any relationship with industry, we're talking about relationships where one person has responsibility at both places," Gellad said.
Among the academic medical center leaders who served on drug company boards, 25 also served on the governing boards of hospitals, medical schools or universities. Seven served as clinical department chairpersons or directors. Six were top executives at hospitals and health systems and another six were deans. Two were university presidents.
Irvine, Calif.-based Allergen, which produces Botox, recruited directors from Johns Hopkins University School of Medicine in Baltimore, the University of Southern California Keck School of Medicine in Los Angeles and the Children's Hospital & Research Center Oakland in Oakland, Calif.
USC said in a statement that its faculty and administration "abide by a strict set of ethical guidelines" and follow several conflict-of-interest disclosure policies. Johns Hopkins said no one was available to comment on deadline and Children's Hospital & Research Center Oakland did not respond to a request for comment.
One drug company paid directors sums ranging from $107,000 to $557,000 over the course of 2012, the highest annual tally in the study. The mean award for directors was about $312,500. Information for three pharmaceutical companies was not public.
Follow Melanie Evans on Twitter: @MHmevans
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In drug abusers, the practice of concurrent use of several dissimilar drugs, such as alcohol, cocaine, opiates, and other drugs. The toxic potential of multiple drug use is increased as compared with use of a single drug.
Current SC use appears to be part of a more extensive polydrug use repertoire involving other illegal drugs that are less prevalent among marijuana-only users.
Polydrug use in chemsex sessions is frequent, increasing the risks associated with the use of these drugs, in addition to the potential interactions between them and the antiretroviral treatments used by HIV-positive patients.
Experts have warned that polydrug use - where a cocktail of street drugs are mixed, possibly with prescription tablets like gabapentin or pregabalin - can be the critical factor that leads users to die suddenly.
Patterns of polydrug use in Great Britain: Findings from a national household population survey.
4,6-9] Drug use is often characterised by the polydrug use of inexpensive and accessible drugs such as alcohol, tobacco, cannabis and volatiles such as glue, benzene and solvents.
It also reviews the scientific evidence on polydrug use, treatment demand for cannabis and developments since the legalization of cannabis for recreational use in some parts of the world.
Impact of HealthWise South Africa on polydrug use and high-risk sexual behavior.
First, medical marijuana use, along with marijuana de-criminalization and marijuana legalization in some States (the latter in Colorado and Washington), may have an impact on rates of alcohol use, co-use of alcohol and emerging tobacco products, and increased polydrug use of alcohol, marijuana, and tobacco or nicotine-based products.
Information is also provided on New Psychoactive Substances (NPSs), polydrug use, alcohol use as well as both drug and alcohol related harm.
Nonmedical use of prescription stimulants among college students: associations with attention-deficit-hyperactivity disorder and polydrug use.
Polydrug use, based on maternal UDS, was almost equally distributed as well.
No definitive evidence of increased fetal demise linked to amphetamine exposure exists, again because of other confounding factors such as polydrug use, lack of disclosure from the patient, maternal domestic stress, malnutrition, among others.


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American Little Magazines of the 1890s: A Revolution in Print
Lookup NU author(s): Dr Kirsten MacLeod
This exhibition, the first ever to focus on the little magazines of this period, documents an important literary and cultural phenomenon that was at once part of and a reaction against the rise of mass-market magazines in this period. Though often overlooked in favor of their European counterparts, such as the London-based Yellow Book, and of Modernist successors like Poetry and the Dial, these magazines were central to the emergence of radical, progressive, avant-garde, and even popular and populist literary, artistic, and cultural movements of the early twentieth century. At the same time, they are often underrepresented in accounts of developments in book design and the graphic arts that were part of contemporaneous print revolutions, notably the fine press movements in Britain and America and the international poster movement. The exhibition will feature a wide array of these magazines as well as related material that situates them within the broader cultural context, demonstrating their connection to the fine press and poster movements, to developments in modern graphic art and design, and to the subsequent Modernist little magazine movement. It will also highlight prominent figures within the movement, including Will Bradley, John Sloan, Elbert Hubbard, and Thomas Mosher, and focus on notable literary and artistic contributors such as Kate Chopin, Stephen Crane, Bruce Rogers, W. A. Dwiggins, Booth Tarkington, Clarence Darrow, and others. Overall, the exhibition features over 160 items, on loan from private and institutional collections. It will include magazines, books, manuscript material, posters and prints, ephemera, and decorative objects in a display that will be instructive and visually dynamic for collectors, bibliophiles, and the general public.
Artist(s): MacLeod K
Publication type: Exhibition
Venue: Grolier Club,
Location: 47 East 60th Street, New York City
Source Publication Date: 20 February 2013 / 27 April 2013
Media of Output: Portfolio
URL: http://www.grolierclub.org/Default.aspx?p=DynamicModule&pageid=289912&ssid=169182&vnf=1

redpajama_set_name: RedPajamaCommonCrawl


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Showing posts from April 15, 2012
BIKEPACKING: 9 INDISPENSABLE PIECES OF MOUNTAIN TOURING GEAR [Outside]
One of the most common questions I get about bikepacking and endurance races like the Arizona Trail 300 is how you can carry everything you need. The answer, which I've come to after generous input from others and lots of trial and error, is a combination of lightweight gear, packs that fit your bike, and miserly packing. The products below aren't everything that I use, nor will they work for everyone. I know guys that run dramatically different setups than mine, and every race calls for a different set of gear. But I've found the following items reliable and indispensible over lots of trips into the backcountry. My AZT300 race rig fully loaded on a shake-down ride in Placitas, New Mexico. Depending on how rough a course is, I choose between a full-suspension 29er like this Specialized Epic 29er or my tried-and-true Moots Mooto X YBB . Stiff wheels are a must for handling the big loads (I love the Easton EC90 XC 29" ), and thru-axles on front and back hel
Free Ride Pittsburgh
Collective Structure Free Ride is a collective organization with multiple levels of membership. The collective is volunteer run and has a flat, non-hierarchy, structure. The collective structure means that individuals who use Free Ride are responsible for keeping it running and in return share the benefits of ownership . Involvement varies for each Free Ride participant. Many participants volunteer when they can but do not contribute on a regular basis. Other participants are heavily involved in the inner workings of the Free Ride organization. Most participants find their participation somewhere in between the two extremes. Collective Council The collective council is the governing body responsible for major decisions at Free Ride. Membership in the collective council is open to anybody as long as collective council requirements are met. The collective council meets monthly and often breaks work out into sub-committees to deal with more nitty gritty details. Sub-C
Main Huts & Trails
OUR MISSION Maine Huts & Trails is a nonprofit organization whose mission is to contribute to the economic, social and natural environment of Maine's Western Mountain region by creating and operating a world-class recreation corridor for current and future generations. Our backcountry trails enhance access to beautiful lakes, rivers and forest lands, and our low impact huts provide inviting spaces that facilitate outdoor adventures and learning. This self-sustaining resource stimulates environmentally sensitive economic opportunity in the region by attracting visitors of all ages and abilities. Our Work is: Creating a resource of national significance for our state and regions. Providing opportunities for environmental and experiential education. Enhancing opportunities for people-powered outdoor recreation. Stimulating environmentally sensitive economic development opportunities in Western Maine. Instilling an environmental stewardship and conservation ethi
Red Bull Signature Series [VIDEO]
CYCLISTS TAKE TO WINTER ICE IN MINNESOTA
ON THOMSON RESERVOIR, NEAR CARLTON, Minn. — Hansi Johnson would love to be cross-country skiing. But conditions in the Duluth area this winter have conspired to make skiing a tough go. So Johnson and several of his friends have found another alternative. Winter bicycling. One Wednesday morning, Johnson and his cycling friend Todd McFadden rode their specially designed winter bikes across the frozen surface of Thomson Reservoir near Johnson's home. "If you get your head around the idea that ice is ridable, you can go a lot of places," said Johnson, 41, who is Midwest regional director for the International Mountain Biking Association. Granted, winter biking is a specialized pursuit, best done on mountain bikes with exceptionally fat tires that provide excellent flotation on snow or snow-covered ice. The riders wear insulated biking shoes and split mittens called "lobster claws" to keep their hands warm. But they're riding. And they're happy. [keep reading at xploreutah.
11 Transportation Officials Who Are Changing the Game [dc.streetsblog.org]
America's streets are changing for the better. The signs are everywhere: Whether it's bike sharing in Chattanooga , complete streets in New Orleans or bus rapid transit in Cleveland — cities across the country are trying new things and making impressive progress in the pursuit of safer streets and sustainable transportation. It's all thanks to a lot of hard work by a lot of people — advocates, elected officials, and a new breed of policy maker you might call the visionary bureaucrat. This series is about those bureaucrats — the people who are transforming transportation and planning agencies from public sector backwaters into centers of bold innovation and change. Every day this week, Streetsblog will be highlighting well-known and not-so-well-known transportation officials who are working to put new ideas into action. They're overcoming bureaucratic and political obstacles, building coalitions, and demonstrating how American transportation systems should adapt for the 21st
Why Do Motorists Hit Cyclists & Run? Because 30 days is better than 4-8 YEARS!~ [Steve Magas Bike Lawyer]
By: Steve Magas, April 20, 2012 In Columbus, the end comes to a criminal case two years in the making. Amber Fernandez was sentenced in the hit/run death of Jeff Stevenson – instead of being punished for 4-8 years for killing Jeff Stevenson, she got THIRTY DAYS for running away. On Feb 27, Ms. Fernandez plead guilty to one count of "Failure to Stop After an Accident" – a 3rd degree felony. She was sentenced yesterday to 30 days. You can read John Futty's story in the Columbus Dispatch here – I have had the honor of representing Jeff's Mom in the civil case – this sentence, frankly, makes me sick… This case illustrates why folks hit… and run… Jeff was probably hit around 2-3am. By the time Jeff's body was found around 5am by a family, up early and on their way to move a family member to Georgia, it had already been a few rainy hours since the crash. Any potential "crime scene" had been driven over by many cars. Police found some smashed bike and car parts at the scene, but little
YEAR OF YAY! Month 4 is tomorrow! Record Store and Earth Day ride!
YEAR OF YAY! is a series of 12 rides to celebrate our city and promote membership in Yay Bikes!. Everyone who rides with us will receive an exclusive button designed by Bandito Design Co, as well as other goodies TBA. April's theme is Rhythm of the Earth. We will be cel ebrating National Record Store Day by visiting local record shops and ending at the Earth Day Celebration at the Columbus Commons to celebrate our community garden cleanup from April 14th. We'll be starting from the pavilion at Goodale Park (that's the open structure just west of the main building near the playgrounds). All YoY rides are FREE for Yay Bikes! members and $5 for everyone else. Become a YB! member at http://yaybikes.com/ membership/ . { { { { HELMETS are *strongly* encouraged on all YB! rides. LOCKS are also useful at our stops. } } } } [Facebook event]
TransCanadaHighway.com Road Info
Trans-Canada Highway Travelling Itineraries Here are some key features of our itineraries ( see list below ): Our itineraries detail over 3500 points along the highway Segment overview information, about what not to miss, particularly about the history, geology and nature. This gives you info on what to see & do between towns and cities Each segment includes and overview Google map, with a Satellite image option, that you can zoom in for more detail, as desired. We've added an elevation map for each segment, which ties in with the geological discussion, but is of special interest to those cycle-touring across Canada. Pop-up zoomed-in Google map for every point & exit from the highway, so you can better plan your trip Here is a listing of Itineraries for a drive across the country. We also have a quick mileage (kilometer) chart . Depending on how long you want to drive each day, which can be influenced, how much site-seeing you are doing, if you are drivin
STREET SHARKS SPRINT SERIES: Part 1 is tonight!
Who is the fastest rider in Columbus? This series is designed to find out. 6 sprints, 1 sprint a month spanning April to September. The top finishers in the first 5 races will be awarded points with the top point getters racing in the 6th and final race. The first 5 races are a $5 buy-in winner take all. The finale will be a prize BONANZA! So get those track bikes geared up ( geared bikes are welcome but no shifting) and test your meddle against Columbus' fastest! Registration is at the Goodale Park Gazebo at 9:00 p.m. on April, 20, 2012. 9:30 departure to race site. Also, we would like to have a womens category. This can only happen if enough women show up, so GET OUT THERE! In case of a rain out the rain date will be 4/28/12 For more info/ updates visit: bikewars.tumblr.com [Facebook event]
Pedaler's Fair [Seattle]
April 21st and 22nd 2012 from 11am–5pm A marketplace for bicycle related goods manufactured by independent businesses in Washington. Pedaler's Fair is a two-day event that will highlight work from over twenty businesses, representing an amazing array of mediums and projects dedicated to bikes. Location: The Building, Ballard District 1415 NW 49th st. Seattle, Wa 98107 at the intersection of NW 49th street and 14th avenue North, three blocks from the Burke-Gilman Trail [more info at their website]
Domino's Takes Electric Vehicle Sound Effects To Their Hilarious Conclusion [Fastcompany]
By Bill - April 20, 2012
Electric cars are gloriously silent, which means the noise from traffic is almost entirely eliminated . Instead of the noise of combustion engines, we get just the sound of sleek machines zipping around our roads . And also the sound of the screams of pedestrians who, expecting some auditory clues as to when cars are approaching, wander into the street and get hit. In response, the government is working to require electric cars to make some sort of noise. In the Netherlands, the local Domino's Pizza has added noises to its electric delivery scooters which consist of a human being making engine noises and occasionally yelling "Domino's!" and "Pizza!" To be fair, it's not 100% clear that this is not a joke, but even if it is, it exposes a horrifying aspect of the future of electric cars that goes mostly unremarked upon: A world in which we entrust our urban soundscape to the whims of large corporations bent on advertising... Keep reading at Fastcompany
America Bikes launches new site
About America Bikes When America Bikes, America Benefits Americans are increasingly searching for personal solutions to tight family budgets, rising health care costs, and time wasted in traffic. As a society, we are facing monumental challenges relating to climate change, pollution, and oil dependence. Despite a small current investment of resources, bicycling and walking already account for 10 percent of all trips made by Americans. The potential clearly exists to double that share: forty percent of all trips in the United States are just two miles or less, and yet the vast majority are made by car. These short car trips are the most polluting and energy intensive as well as the easiest to shift to bicycling and walking. Continuing and strengthening our investment in bicycling and walking will enable our nation to move decisively towards a goal of increasing the share of trips taken by these modes from 10 percent to 20 percent. Such a shift from driving to bicycl
EMBROCATION COFFEE
You, our loyal customers and readers, have been telling us that we should do our own coffee blend for some time. Since our brand image and logo is based on our personal love for strong coffee and the indelible link between cycling culture and coffee drinking, this is a reasonable request. It would have been easy to run to the nearest coffee roaster, buy a bunch of bags and print up some labels. This would have been the quick and easy way, but not in keeping with the other aspects of our company. Any coffee blend bearing the Embrocation name needs to be special. Enter our team rider and friend at JDK Design, Steve Francisco, who suggested we contact Mané Alves at Vermont Artisan Coffee. Mané isn't any average roaster; he's a world-renowned coffee expert, hired by many of the biggest coffee companies in the land to help them make and perfect their blends. He's like a coffee professor and artisan rolled into one, and he supplied us with this blend, which per our request
Ask the Experts: Why Is US Bike Culture So Different From Europe's? [Treehugger]
Michael Mandiberg / CC BY-SA 2.0 Why is the U.S. so different from Europe when it comes to bike culture and is it something that we can change? Elizabeth Press from Streetfilms answers: "The U.S. differs from Europe so much because we have indulged in our car addictions much longer than most European countries have. Look at a place like the Netherlands. We can all agree that they are super bike friendly. But they don't have perfect weather for biking year-round. So, how did they get this way? They had the foresight and political will forty years ago to acknowledge the harmful effects of the automobile on urban centers. They chose to change and not allow the car to monopolize their cities. They chose to plan for people. Here in the U.S. we are starting to realize the importance of giving priority to cyclists and pedestrians. We are on our way to making our cities more livable for all. And, our bike culture will surely grow with this shift." Elizabeth Press is


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UNC-Pembroke, Mountain East Conference announce plan for fall football
by: Chris Parks
Posted: Jul 21, 2020 / 04:18 PM EDT / Updated: Jul 21, 2020 / 04:18 PM EDT
BRIDGEPORT, W.Va. – The board of directors at the Mountain East Conference announced alterations to the fall sports schedules on Tuesday. Per the announcement, competition for UNC Pembroke's football team will not get underway earlier than October 1, with all 11 regular season games being played across both the fall and spring semesters.
The MEC board of directors decreed a "delay in the start of official practice for football" until September 7, as well as a "delay in the start of competition in all fall sports until no earlier than October 1." Contests in team sports originally scheduled for the month of September will be played during the spring semester.
Football's 2020 campaign will now officially kick off on October 3 against Frostburg State at Grace P. Johnson Stadium. Regularly-scheduled contests against West Virginia Wesleyan (Sept. 10), Glenville State (Sept. 17) and Fairmont State (Sept. 26) will now be played during the spring semester. The dates and kickoff times for those contests will be announced at a later date.
The league is developing alternative strategies in order to maximize the opportunity for a meaningful student-athlete experience should public health conditions not permit the return to practice and/or competition in the timeline proposed within this revised plan. The alternative plans include a further delay to the start of competition until later in October and, if ultimately necessary, a move of all fall competition to the spring semester.
The activation of any alternative plans will be based on the efficacy of resocialization of member campuses, local health conditions and in consultation with public health officials and medical professionals, and would be announced at the appropriate time.
Courtesy – UNCP Athletics & Mountain East Conference
by Chris Parks / Jan 26, 2021
KIAWAH ISLAND, S.C. – Coastal Carolina fifth-year senior States Fort matched his CCU career-low round with a 65, 7-under par, on Tuesday to pick up medalist honors and help lead the Chanticleers to a team score of 270, 18-under par, and a first-place team finish at the Any Given Tuesday (AGT) Intercollegiate held at the Oak Point Golf Club on Kiawah Island, S.C.
The Chanticleers improved over all three days of play at the spring opener, posting team scores of 282, 275, and 270 to run away with the victory with a 54-hole score of 827, 37-under par.
CCU's 54-hole score of 827 is the second-lowest 54-hole team score in the program's history. The Chants as a team shot a round of 825 (-27) at the 2019 Sun Belt Championship.
Coastal's final round of 270 is the second-lowest 18-hole team round in program history behind only a team score of 267 (-17) at the 2019 Sun Belt Championship.
The Chanticleers finished in front of Kennesaw State (840, -24), Jacksonville State (848, -16), FGCU (853, -11), and Charleston Southern (869, +5), who finished in the top five of the team standings.
"What an awesome day and an awesome week!" said head coach Jim Garren. "Lightning got close on number 17 but thankfully the delay wasn't too long. Four sub-70 rounds in a final round when you're in contention is a big-time day. Literally, can't do it any better than that. We had great rounds by those four guys."
"I'm so happy for States (Fort). Just an incredible feeling," continued Garren. "Nobody felt worse than him that he wasn't with us in the fall. He made this team a promise to get stronger, to get better, and to help us win. Well, he came back in a big way and led us to a victory and got his first college win in dominating fashion."
Fort picked up his first intercollegiate win by shooting a final-round 65, 7-under par, and win the 54-hole event by four strokes with a 205, 11-under par, tournament score. His round of 65, which included seven birdies and 11 pars, matched his career-low round as a Chant and is tied for the seventh-lowest 18-hole score by an individual in CCU history.
The Georgia native carded rounds of 70, 70, and 65 on his way to his 205, which included a tournament-high 16 birdies overall. His 54-hole tournament score of 205, 11-under par, is tied for the 11th-best in program history.
Shooting a second-straight round sub-70 round for the tournament was sophomore Seth Taylor who finished the three-day event in sixth-place overall with his 54-hole score of 210, 6-under par.
The second-year Chant followed up his second-round 68, 4-under par, on Monday with a 69, 3-under par, over his final 18 holes of play which included four birdies, three of which came over the final six holes of play. He finished the tournament with 12 birdies and 37 pars over his 54 holes.
CCU's Zack Taylor, Connor Newton, and Tyler Gray all finished in the top-15 overall on the individual leaderboard.
Zack Taylor posted rounds of 67, 71, and 74 to finish in 11th place overall with his 54-hole score of 212, 4-under par. The fifth-year senior totaled 13 birdies to go along with 32 pars over his three days of play.
Newton was just one shot back of Taylor at 213, 3-under par, and in a tie for 12th place while Gray finished in 14th with a three-round score of 224, even par. Newton carded six birdies over his career-low round of 68, 4-under par, on Tuesday to finish the AGT Intercollegiate with rounds of 72, 73, and 68 overall. Gray registered 12 birdies over his rounds of 73, 66, and 75 on the week.
Rounding out the lineup for the Chants was junior Brady Hinkle with his score of 221, +5. After posting rounds of 79 and 74 the first two days of play, Hinkle saved his best round for last, as he turned in a career-low round of 68, 4-under par, as well on Tuesday. His final round consisted of 10-straight pars to open the day, two birdies, four more pars, and then two more birdies to cap his 18-holes.
The Chanticleers will have a few weeks off before returning to competition at the Florida Gators Invitational held at the Mark Bostick Golf Club in Gainesville, Fla. from Feb. 12-14.
by Pete Yanity / Jan 26, 2021
A Clemson spokesman told sister station WSPA Tuesday that Tigers head coach Dabo Swinney "is healthy and working on-site at the Allen N. Reeves Football Complex."
This followed the revelation Monday of a YouTube video in which Tigers running back Darien Rencher is heard saying to his girlfriend that Swinney did not attend the team's Jan. 16 season-ending banquet "because of COVID."
CONWAY, S.C. – The 2020 Sun Belt Conference Champions will return to the practice fields for spring practice starting Wednesday, Jan. 27, as the defense of the conference title starts for the upcoming 2021 season.
Deposits for 2021 season tickets are just $100. Call the Chanticleer Athletic Ticket Office at 843-347-TIXX (8499) or email tickets@coastal.edu to reserve your spot in Brooks Stadium for the 2021 campaign!
23 die in Norway after receiving COVID vaccine


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Living with long Covid
Medical schemes may not force you to go to state hospitals for PMBs
Nellie Brand-Jonker
Health insurance – iStock
This is the end of the road for medical schemes wanting to limit the treatment of Prescribed Minimum Benefits to state hospitals.
Genesis' long journey through the courts
The Constitutional Court has rejected the application for appeal by the Genesis Medical Scheme against a decision by the Supreme Court of Appeal.
This has concluded Genesis' long journey through the courts about the payment of Prescribed Minimum Benefits (PMBs).
Read: Facts on PMBs
BMBs are a list of 270 conditions that all medical schemes are required by law to cover without applying any restrictions, as well as 25 chronic diseases and emergency care. This includes the costs of the diagnosis, treatment and care of these conditions.
According to the Council for Medical Schemes the application was rejected because the court believes that there is no chance of success and the costs were awarded to Genesis.
Daniel Lehutjo, acting head and registrar of the Council for Medical Schemes (CMS), says this brings an end to the debate about whether medical schemes are allowed, based on their own rules, to only pay for PMBs in state hospitals.
The CMS said that the matter deals with the liability of a medical scheme to pay for a PMB that was treated in a private hospital.
Law trumps medical scheme rules
Genesis refused to pay for a condition that is required by law to be fully covered because the treatment was obtained in a private hospital, and their (Genesis') rules prescribe that this treatment must be carried out in a state hospital.
Read: Poor service also at private hospitals
"Medical schemes are compelled to appoint a specific service provider to limit patients' exposure to the costs of BMBs and may not try to use their rules to circumvent their obligation to pay for these benefits," said Lehutjo.
When Genesis wasn't satisfied with the decision of the Supreme Court of Appeal, the medical scheme approached the Western Cape High Court to review the decision.
The High Court ruled in favour of the scheme and found that its rules are binding and represent a binding contract between members and the scheme.
The CMS and the registrar then appealed against the decision on the point that the law always trumps the rules of a scheme. The scheme also hadn't negotiated a designated service provider for its members. Article translated and adapted from Netwerk24
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Article translated and adapted from Netwerk24
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I'm not sure when the idea came to me: it emerged fully formed sometime in the latter half of May this year. Why not do a Sporting Stories book about a single event? And why not pilot the idea at the Potters 'Arf – it's an iconic Stoke on Trent race, a really popular half marathon, incredibly well-supported. And runners more than most sports people love to write. It chimed perfectly with the Sporting Stories project that Cox Bank Publishing is doing to celebrate the City being a European City of Sport.
I'd already had the idea of creating a bit of a flurry of stories for the event, speaking to local writing groups, writers and poets to get them engaged and I had invited a well-known West Midlands poet, Giovanni Esposito - Spoz for short – to come along and support some creative writing on the day. The great thing – well, one of many, many great things – about the Potters 'Arf is that it starts and finishes smack in the city centre, and there is a brilliant atmosphere and big crowds.
As the idea gelled I started thinking about the stories I would need – obviously plenty from the runners themselves, but also from others associated with the race. Fortunately, I had already had a couple of contributions to the sporting stories project from some key individuals associated with the race: Ken Rushton, one of the original founders of the 'Arf and still very closely involved with its organisation; and Don Shelley, one of the founders of the Potteries Marathon, from which the 'Arf grew.
So I contacted Ken and with his blessing dropped an email to him and David Lowndes (from the Hanley Economic Building Society, the race's main sponsor) with an outline of the concept. They both loved the idea and offered whatever support they could to the project. Ken invited me to the next meeting of the race organising committee, where I made my pitch.
I've assisted at plenty of sporting events, running and cycling, mostly as a marshal, sometime as a lead car driver, but attending the Potters 'Arf Race Organising Committee was the first time I'd really seen what it's like behind the scenes at a big event. All the sponsors were there, the marshalling coordinator, the race director, the race founder, the car hire company, the beneficiary charities, the town centre manager – a room full of people, all dedicating significant amounts of their time to make the event work for participants, spectators and the City alike. So when I made my pitch for the book idea – which ideally needed all of them to contribute a bit of writing about their perspective of the race – I was slightly nervous. I needn't have worried – 100% buy-in!
The next bonus was the realisation that the day of the Potters 'Arf was on the same weekend of Stoke on Trent's big annual literary event, the Hot Air Festival. With a race poet lined up and hopefully some great creative writing to come, I was delighted when the Hot Air organisers approved my request for the race to be an official fringe event to the main literacy festival. I think that might be a first – an official literary half marathon!
It was all coming together. The next step was to have somewhere where I could base the writing workshop, and here the City Council very kindly stepped in with the loan of one of their big 'European City of Sport' vans, complete with awning and banners - and the unexpected bonus of Lotta joining us for the day. I added a table and chairs to the mix and we had a base to work from on the day.
Back at the van Emma Dawson Varughese of WorldLits, another local writer, had appeared to do some survey work for me, asking spectators what had brought them to the event, who they were supporting, who they were fund-raising for etc. She had a sheaf of forms - and an umbrella as it had just started raining.
We wandered up to the start area and I caught up with Ken and a few others, and then took Spoz along to the Hanley Economic branch to introduce him to David Webster (then CEO of the Hanley, now CEO of the Dougie Mac) and Councillor Anthony Munday, the Lord Mayor. Ten back to the van but by this stage the heavens had opened, so my vision of spectators and runners sat around in glorious sunshine writing down their stories was not looking good. A few runners sheltered under our awning but with the race rapidly approaching it was not a good time to distract them.
With about five minutes to go I remembered that I was supposed to be actually running the race so hurriedly made my way to the start, a long way back in the start pen. The rain eased off a little bit, and seconds later we were off! The race itself was all that I expected from what people had told me - a great course, some big hills (including the aptly named Heartbreak Hill) and fantastic crowds everywhere. And mostly dry-ish. As we ran through the various towns and villages that make up the city there were spectators three or four deep – crowds which wouldn't put the London Marathon to shame! By the end of the race I was struggling badly with a sore foot but still with a big smile on my face and within my target time of a sub-two hour finish – really pleased with that given how little time I'd had to train. And the fact that I'd spent two hours pre-race dashing around Hanley trying to get a writing workshop set up. So I should say a big thank you to Ray with the red flat cap from the Stoke FIT running club, who was the pace-maker for sub-two hour pace – great job Ray and always a friendly word.
Being held upright by Spoz - not sure my legs were working at this stage. But I've got my medal!
Back at the finish, Spoz had turned the workshop into a poetry takeaway, which given the weather (it started pouring again at the end of the race) was an inspired choice – so rather than getting people to write, he chatted to them and then 'cooked up' a poem for them. We ended up with some lovely pieces which people really cherished.
And then the real work began – of getting as many contributions for the book as possible, as quickly as possible, in order to create race book before the autumn.


Environment: Secondary mineral in the oxidized zone of hydrothermal Pb-Zn deposits.
Locality: Venus, Agua del Rubio, Benvenida, Pilar, and Algarrobites mines, El Guaico District, Sierra de Cordoba, Argentina. Link to MinDat.org Location Data.
Optical Data: Biaxial (+), a=2.28, b=2.36-2.38, g=2.48-2.49, bire=0.2000-0.2100, 2V(Calc)=82-88, 2V(Meas)=~90. Dispersion r > v strong.
Pleochroism (y): dark reddish brown.
note: Specific Gravity of Brackebuschite =6.05 gm/cc.
U=PEBrackebuschite x rElectron Density=5,161.36 barns/cc.


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Q: What fillfactor for caching table? I have heavily updated / accessed table where I store serialized java objects. They are in the table for 2-3 hours (also are being updated during that period) and then removed. Size of table is around 300MB. I have spotted it is very, very often VACUUMed and wonder if changing the fillfactor would help?

A: The key words here are:

*

*"heavily updated"

*"in the table for 2-3 hours".

Point 1. is indication for a lower fill factor, while 2. is the opposite. It helps performance if multiple row versions are stored on the same data page. H.O.T. updates would achieve that. Read here or here. They need some wiggle room on the data page - like dead tuples or space reserved by a fillfactor < 100. But they can only do their thing, if no index involves any of the updated columns, which should be true for your case.
Another important factor here would be the tuple size (in comparison to your page size (which is most commonly 8 kb). More details in this related answer:

*

*Measure the size of a PostgreSQL table row
If the tuple size is 4 kb or more, reducing the fill factor would be futile, since there can never be more than one tuple on a data page. You might as well leave it at 100 (which is the default anyway). However, some data types are "toasted" and stored out-of-line if they exceed a size limit, so tuples requiring that much in the main relation fork are rare.
Whatever you do, VACUUM will be run often. And that's generally a good thing, I wouldn't worry about that. You create lots of dead tuples. VACUUM identifies dead rows that are not visible to any open transaction any more. The manual:

The standard form of VACUUM removes dead row versions in tables and
  indexes and marks the space available for future reuse.

Bold emphasis mine.
You can play with per-table settings for autovacuum to trigger it less (or more) often for this table only:

The default thresholds and scale factors are taken from
  postgresql.conf, but it is possible to override them on a table-by-table basis;

Bold emphasis mine. In particular with autovacuum_vacuum_threshold and autovacuum_vacuum_scale_factor. Running VACUUM a lot might actually be a good idea, instead of a very low fillfacter. That depends on access patterns. If all tuples live, say, 3 hours and each is updated several times, I would still lower the fillfactor to something like 50. You'll have to test and find the sweet spot.
Alternatives
All this aside, since your data seem to be volatile to begin with: use an UNLOGGED table:

Data written to unlogged tables is not written to the write-ahead log
  (see Chapter 29), which makes them considerably faster than
  ordinary tables. However, they are not crash-safe: an unlogged
  table is automatically truncated after a crash or unclean shutdown.
  The contents of an unlogged table are also not replicated to standby servers.

Bold emphasis mine. Don't use this if your server might crash and you still need the data afterwards. But if we are talking about session data for web applications, this might be an acceptable price to pay.
Or, even more radical: Use a key-value store like Redis if you can do without the features and security provided by an RDBMS altogether.

A: I'd suggest a key-value DBMS, but I throw this out there for interest's sake.
Instead of performing INSERT & DELETE statements, only do UPDATEs.
The table structure will be something like
ID      integer  -- sequential ID
Used    boolean  -- default FALSE
Object  -- whatever type is appropriate

The object-holding column will be of fixed length to avoid splits and row moves.  Size this column to accommodate your objects and to efficiently fill a page on disk.
Pre-fill your table with as many rows as you will need and a few more.
When an object is to be written find a row with Used = False and UPDATE that row.  When an object is to be destroyed, set it's Used to "False".  There is no garbage created and hence no garbage collection.
Of course there are many, many exception conditions to handle (row overflow, table overflow, race conditions on ID usage etc.) but none are insurmountable.

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