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Antimicrobial stewardship program in China's tertiary hospitals in 2018: a nationwide cross-sectional online survey
Yue Zhou, Haishaerjiang Wushouer, Xi Zhang, Jiajia Feng, Likai Lin, and 3 more
https://doi.org/10.21203/rs.3.rs-21162/v1
posted 24 Apr, 2020
The study aimed to assess the development of antimicrobial stewardship (AMS) program in China's tertiary hospitals to identify the potential challenges for AMS program and provide references and benchmarks for strategic policymaking.
A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System (CARSS) between November 1, 2018 and December 10, 2018. The questionnaire included 5 sections regarding structure, technical support, antimicrobial use management, antimicrobial use surveillance and education. Descriptive statistics were used for data analysis.
Of 1044 tertiary hospitals under CARSS, 13.4% (140) hospitals participated in the study. Among them, 99.3% (139/140) set up AMS program. Hospital president (82.1%, 115/140) and medical service department (59.3%, 83/140) were responsible for AMS outcomes in most hospitals. Structured antimicrobial formulary restriction management was adopted by 99.3% (139/140) hospitals. Infection disease department, infection control department and microbiological laboratories were established in 87.1% (122/140), 99.3% (139/140), and 100% (140/140) hospitals, respectively. Up to 85.6% (124/140) hospitals applied clinical pathways and 33.6% (47/140) hospitals implemented hospital-specific guidelines for infectious diseases. Outpatient prescription audit, inpatient prescription audit and prophylactic antimicrobial prescription audit of aseptic operation were performed in 99.3% (139/140), 98.6% (138/140) and 95.7% (134/140) hospitals, respectively. Up to 97.1% (136/140) hospitals participated in antimicrobial use surveillance network and 99.3% (139/140) hospitals established the specialized management of carbapenem and tigecycline. Staff education and AMS-related popular science education were provided with different ways and frequency in 100% (140/140) and 88.6% (124/140) hospitals, respectively.
AMS in China's tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments. More efforts should be put into further promoting and strengthening the development of hospital-specific guidelines and the establishment of progress and outcome evaluation system.
Tertiary hospitals
Cross-sectional online survey
Antimicrobial resistance (AMR) has been identified as a critical crisis to public health around the world [1, 2, 3]. Inappropriate antimicrobial use fosters the emergence and spread of new resistance organisms [4]. In an era of serious AMR and a diminishing pipeline of new antimicrobial development, antimicrobial stewardship (AMS) program has been introduced to hospitals as a way to optimize antimicrobial use [2, 5, 6]. AMS program has been defined as a comprehensive and coordinated interventions designed to improve and measure appropriate antimicrobial use through optimizing drug selection including dosing, therapy duration as well as administration route [7]. Guidelines for establishing and implementing AMS program have been developed, such as a checklist including core elements of hospital AMS programs by the US Centers for Disease Control and Prevention and a checklist on structure and process indicators for hospital AMS program by the Transatlantic Taskforce on Antimicrobial Resistance [8, 9].
China is one of the largest consumers of antimicrobials [10, 11, 12]. To promote antimicrobial rational use and confine AMR, several administrative regulations and technical specifications, such as the Regulations for Antimicrobials Clinical Use, National Action Plan to Contain Antimicrobial Resistance (2016–2020), have been issued in the past decade [13]. However, the extent to which AMS program has been implemented in China's tertiary hospitals is a lack of study. The present study aimed to assess the development of AMS program in China's hospitals, as well as to identify the potential challenges for AMS program establishment, and to provide references and benchmarks for strategic policymaking.
The questionnaire was designed based on literature review of previous studies for AMS program, the published guidelines and checklists as well as relevant Chinese policies [6, 8, 11, 13, 14, 15]. Potential survey questions were extracted and classified. After three rounds of face-to-face consensus meetings with professionals from governments, hospitals and academic institutions, the final survey questionnaire was determined by including 5 sections regarding structure, technical support, antimicrobial use management, antimicrobial use surveillance and education. The questionnaire was sent to the tertiary hospitals under China Antimicrobial Resistance Surveillance System (CARSS) [16]. The hospitals participated in the survey voluntarily. To ensure the accuracy of the information, only the staff involved in AMS program were eligible to complete the questionnaire. The completed questionnaire was required to affix the hospital's seal before being sent back. Only one questionnaire could be accepted for each hospital. The nationwide cross-sectional study was conducted between November 1, 2018 and December 10, 2018.
We conducted descriptive analyses of sample characteristics and the establishment of AMS program. The variables were summarized with frequencies and proportions using Microsoft Excel 2016 and R version 3.3.3.
A total of 140 out of 1045 hospitals under CARSS were investigated, and the response rate was 13.4%. The hospitals participating accounted for 5.5% of all tertiary hospitals (140/2548) [17], and geographically covered all provinces and municipalities in mainland China except Fujian, Gansu, Ningxia, Qinghai, and Tibet. (Fig. 1)
Structure of AMS program
AMS program was established in 99.3% (139/140) hospitals. The members of the AMS programs were mainly from pharmacy department (99.3%, 139/140), intensive care unit (ICU, 97.9%, 137/140), respiratory department (95.0%, 133/140), microbiological laboratory (95.0%, 133/140), infection control department (95.0%, 133/140) and infectious disease department (90.0%, 126/140). For most hospitals, AMS program were headed by hospital presidents (82.1%, 115/140), followed by vice hospital presidents who were in charge of healthcare service (15.0%, 21/140). AMS program fell under the responsibility and control of medical service departments in 59.3% (83/140) hospitals, followed by pharmacy department in 30.7% (43/140) hospitals. (Table 1)
Number of hospitals
N = 140
Time of AMS program establishment
Number of AMS team members
≥ 7
Number of AMS team members - full time
Number of AMS team members - part time
Clinical departments participating in AMS program
Microbiological laboratory
Infection control department
Respiratory department
Infectious disease department
Administrative departments participating in AMS program
Medical service department
Information department
Quality control department
Medical record department
Leader of AMS program
Hospital president
Vice hospital president in charge of healthcare service
Leader of the medical department
Leader of the infectious disease department
Department in charge of AMS program
Measures taken to improve AMS program
Incentive reward mechanism
Staffing full-time employee
Electronic information technology
AMS, antimicrobial stewardship, ICU, intensive care unit.
Technical support of AMS program
In terms of information technical support for AMS, structured antimicrobial formulary restriction management was adopted by 99.3% (139/140) hospitals, followed by antimicrobial use data crawling (94.3%, 132/140). Infectious disease departments were established in 87.1% (122/140) hospitals and the main responsibilities of them were bacterial infection prevention and treatment (76.4%, 107/140) and clinical consultation for infection diseases (71.4%, 100/140). Up to 99.3% (139/140) hospitals set up infection control departments before 2015 with variable measures adopted to reduce the hospital infection. The main responsibilities of the pharmacy departments were prescription audit for outpatient and emergency department (51.4%, 72/140), prescription audit for inpatient (60.0%, 84/140) and special prescription audit for antimicrobials (57.9%, 81/140). Microbiological laboratories were established in all hospitals (100%, 140/140) and the main responsibilities included bacterial infection test (100%, 140/140), fungal infection test (100%, 140/140) and clinical consultation for infectious diseases (77.9%, 109/140). (Table 2)
Information technology for AMS program
Structured antimicrobial formulary restriction management
Structured antimicrobial duration restriction management
Intelligent prescription audit of antimicrobials
Antimicrobial use data crawling
Time of infectious disease department establishment
Responsibilities of infectious disease department
Bacterial infection prevention and treatment
Fungal infection prevention and treatment
Communicable disease (e.g. hepatitis, tuberculosis) treatment
Clinical consultation for infection diseases
Clinical consultation for highly restricted antimicrobials a
Time of infection control department establishment
Measures to improve infection control
Measures for "hand hygiene"
Outbreak investigation
Quarantine measures
Active screening
Environmental cleaning and disinfection
Post-exposure prevention
Multisectoral collaboration
Surveillance and early warning of multi-drug resistant bacteria
Number of pharmacists majoring in infectious diseases, respiratory and ICU
≥ 10
Main responsibilities of pharmacy department for AMS program
Prescription audit for outpatient and emergency department
Prescription audit for inpatient
Special prescription audit for antimicrobials
Selection of antimicrobial catalogue
Time of microbiological laboratory establishment
Responsibilities of microbiological laboratory
Bacterial infection test
Fungal infection test
Communicable disease test (e.g. hepatitis, tuberculosis)
Clinical consultation for infectious diseases
Medical record review
AMS, antimicrobial stewardship; ICU, intensive care unit.
a Structured antimicrobial formulary restriction management has been established in China, which categorized antimicrobials into three classes (non-restricted, restricted and highly-restricted), with different prescription privileges to different level of physicians.
Antimicrobial use management of AMS program
To strengthen appropriate antimicrobial use, about one third of (30.0%, 42/140) the hospitals developed 1–5 clinical pathways, and up to 14.3% (20/140) hospitals developed no less than 20 clinical pathways. In terms of hospital-specific guidelines related to antimicrobial use and specific infectious diseases, the guidelines mainly focused on lower respiratory tract infection and acute exacerbation of chronic obstructive pulmonary disease (25.0%, 35/140), upper respiratory tract infection (22.9%, 32/140) and urinary tract infection (22.9%, 32/140). However, there were still 66.4% (93/140) hospitals with no guidelines established. (Table 3)
Basis for assigning the privilege of antimicrobial prescribing
Professional titles
Education and evaluation results
Annual prescription review results
Administrative level
Combination of technical titles and performance evaluation results
Development of clinical pathways
1–5 clinical pathways
6–10 clinical pathways
11–15 clinical pathways
≥ 21 clinical pathways
Hospital-specific guidelines about antimicrobial use
No guidelines established
Lower respiratory tract infection, acute exacerbation of chronic obstructive pulmonary disease
Soft tissue infection
Central nervous system infection
Gastrointestinal tract infection
Genital infection
Eye, ear, nose and throat infection
Unexplained septicemia
Certain infections, e.g. MRSA, Clostridium difficile and tuberculosis
Myoendocarditis
Types of antimicrobial prescription audit
Outpatient prescription audit
Emergency department prescription audit
Inpatient prescription audit
Parenteral antimicrobial use in outpatient and emergency department
Prophylactic antimicrobial prescription audit of aseptic operation
Special prescription audit for highly restricted antimicrobials a
Special prescription audit for top ranking antimicrobials
Antimicrobial prescription audit based on trend of AMR
Outcome measures for AMS program
Number of varieties and specifications of antimicrobials
Number of defined daily doses
Number of days of therapy
Antimicrobial prescription rate of outpatient and inpatient
Registration of highly restricted antimicrobial prescription
Proportion of prophylactic antimicrobial use for clean incision surgery b
Appropriateness of prophylactic antimicrobial use for clean incision surgery
Rate of conducting antimicrobial susceptibility tests before antimicrobial treatment for inpatient
Prescription audit
AMS, antimicrobial stewardship; AMR, antimicrobial resistance.
b Clean incision surgery means no inflammation is encountered in a surgical procedure, without a break in sterile technique, and during which the respiratory, alimentary and genitourinary that are not entered [18].
Antimicrobial use surveillance of AMS program
Up to 97.1% (136/140) hospitals participated in antimicrobial use surveillance network. The main indicators adopted for antimicrobial use included antimicrobial use intensity by departments (measured by number of defined daily doses, DDDs, 90.7%, 127/140), ranking by usage volume (83.6%, 117/140) and ranking by usage expenditure (85.7%, 120/140). To improve the prudent use of antimicrobials, up to 90.0% (126/140) hospitals included antimicrobial use quality to performance appraisal. Admonishing conversation (86.4%, 121/140) and financial penalties (84.3%, 118/140) were also commonly adopted. Most of the hospitals (96.4%, 135/140) established the targeted management of carbapenem and tigecycline after 2015. (Table 4)
Participation of antimicrobial use surveillance network (Center for Antibacterial Surveillance)
What to report of antibiotic usage?
Antimicrobial use intensity by departments (measured by DDDs)
Ranking by usage volume
Ranking of usage expenditure
Frequency of announcing antimicrobial use
1–2/year
≥ 5/year
Frequency of announcing AMR
Penalties and rewards to improve AMS program
Admonishing conversation
Deprivation of prescription privilege
Financial penalties
Linked to title assessment
Linked to promotion
Included to performance appraisal
Material reward
Praise in hospitals
Time of specialized management of carbapenem and tigecycline a
AMS, antimicrobial stewardship; AMR, antimicrobial resistance; DDDs, number of defined daily doses.
a Hospitals are required to fill in a form to report the relevant information of patients who used carbapenems or tigecycline, including name, diagnose, generic name of the drugs, dosage, etc. Specific persons are assigned to collect the forms and analyze the data to propose effective ways of controlling carbapenems and tigecycline resistance [19].
AMS program education
Staff education was provided by all hospitals (100%, 140/140) with different ways and frequency. To guarantee the efficiency of education, attendance record (90.7%, 127/140) and examination (94.3%, 132/140) were mainly used. For patients, AMS-related popular science education was organized by 88.6% (124/140) hospitals. (Table 5)
Education of AMS program
Frequency of organizing AMS education and promotion
≥ 10/year
Frequency of sending staff to AMS-related conferences or courses
Frequency of inviting experts for AMS lecturing
Frequency of participating online AMS education
Management approach of AMS education
Frequency of conducting AMS-related popular science education
AMS, antimicrobial stewardship.
We systematically conducted a nationwide survey on the implementation and current status of AMS program in 140 tertiary hospitals, covering 26 provinces in China. In this survey, AMS program was implemented in 99.3% (139/140) of the responding hospitals, which was higher than that in the studies conducted in developed countries such as the US and Netherland [20, 21]. AMS program has been required to be implemented in China since 2011. Furthermore, in the past decade, a relatively systematical management system and advanced technical support framework have been established by the Chinese government, contributing to setting up AMS program in the hospitals. The hospitals surveyed were all tertiary hospitals which were likely to be larger, urban and have better access to medical resource and financial support. As adequate manpower and funding are identified as main barriers to developing AMS program, tertiary hospitals surveyed were probably more capable of policy execution and AMS program implementation when comparing with other hospitals [22, 23, 24].
Leadership and teamwork are paramount prerequisites for successful and effective implementation of AMS program. The survey demonstrated that hospital presidents were heading AMS program in most hospitals. Different from our result, previous studies found that AMS team was more likely to be led by pharmacists or infectious disease physicians in the US [20, 25]. According to the management regulations and technical specifications issued by the Chinese government, hospital presidents were appointed as the leaders of AMS program. It is emphasized that a wide range of health professionals could provide unique support in achieving the over-all goal of AMS [26, 27, 28]. Obviously, the hospital presidents possess the supreme power, and it is beneficial for ordering commanding and dedicating necessary human resources for the program when the hospital presidents take charge of AMS program. Under this circumstances, financial support could be also guaranteed, which greatly augments the capacity and influence of the program. Furthermore, the survey confirmed that pharmacy departments exerted a critical role in AMS implementation. It is recommended that along with infectious disease physicians, pharmacists are considered as the core members as drug expertise in AMS team [8].
In the survey, most infectious disease departments were still occupied by the management of common communicable diseases such as hepatitis and tuberculosis. Also, infectious disease physicians played a limited role in AMS program implementation in most hospitals. This finding was similar with the result in a prior study [29]. The tertiary hospitals in China has been required to establish infectious disease departments since the outbreak of severe acute respiratory syndrome in 2013. The main duties of the departments are to treat various infectious diseases, address AMR and deal with infectious disease emergence. However, when comparing with the developed countries, our finding revealed that the effectiveness of infectious disease department in antimicrobial rational use promotion and AMR confinement needs to be strengthened. The limited privilege of infectious disease physicians would undoubtedly restrict the impact of AMS on antimicrobial rational use and AMR confinement in China. This may be partly attributed to the shortage of adequately trained physicians interested in infectious diseases and the lack of consciousness of AMR control of the physicians. Hence, it is imperative that the infectious disease department and the physicians should attach great importance to their commitment to AMS implementation.
Clinical pathways and hospital-specific guidelines for main infection syndromes are identified as an effective way to standardize antimicrobial prescription for specific infectious syndromes. In our survey, most hospitals developed clinical pathways. The Chinese government has made great efforts to implementing clinical pathways and establishing diagnosis related group system, which exert a catalyzing effect on the development of clinical pathways in AMS program [30, 31]. Unlike clinical pathways, hospital-specific guidelines were only developed in 33.6% (47/140) hospitals surveyed. The majority of the guidelines in the hospitals surveyed were for urinary tract infection and upper respiratory tract infection. This was basically in accordance with the morbidity of infectious diseases in China and the guideline for AMS program by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America [6]. Previous studies showed that the implementation of hospital-specific guidelines was associated with optimal antimicrobial use by increasing the likelihood of sufficient initial therapy, narrower-spectrum antimicrobial use, shorter therapy duration and timely switch from intravenous to oral antimicrobials [32, 33, 34, 35, 36, 37, 38]. Hence, multi-discipline collaboration of AMS program in development of hospital-specific guidelines for infectious diseases should be emphasized.
Our findings highlighted the ongoing difficulties in antimicrobial usage measurement, which has long been considered as an essential opponent to promote AMS [39]. Although up to 138 hospitals surveyed reported antimicrobial usage on a regular basis, most of them tracked antimicrobial use using define daily dose (DDD) and ranked antimicrobials based on usage and expenditure. Neither indicator was appropriate and optimal for benchmarking [40, 41]. Specifically, although DDD is a direct and widely adopted metric for antimicrobial usage measurement and comparison, the limitations of DDD are obvious. Unlike number of days of therapy which is recommended as the first option for antimicrobial usage measurement in the US, DDDs is not an applicable measuring tool in pediatric setting and is not an optimal metric for individuals with renal and/or liver impairment because of the dose reduction [8, 42]. Previous study also showed that some hospitals in China might mechanically define DDDs by restricting the total dosage of antimicrobials during infectious disease treatment [29]. This would result in antimicrobial underuse and even possibly exacerbate AMR. The limited access to computerized pharmacy data may also narrow the options of tracking antimicrobial usage. We also found that there was a lack of evaluating AMS outcome from the clinical and the economic perspective. Of note, optimizing patient outcomes and confining AMR is the primary goal of AMS [6]. The outcome measurement would provide useful information on the effectiveness of strategies used and assist in adjusting AMS program. Moreover, cost savings could be achieved by optimized antimicrobial use, shorter duration and avoidance of unnecessary antimicrobials. This will in turn motivate the implementation of AMS program. Hence, there is a necessity to identify appropriate metrics for antimicrobial use, AMR outcome, patient outcome and expenditure and establish a comprehensive evaluation system for the program.
Our study has some limitations. Firstly, though up to 140 tertiary hospitals participated in the survey, they only accounted for 5.5% (140/2548) of all tertiary hospitals in China [17]. The relatively small sample size and low response rate may introduce non-response bias and affect generalizability given the extensive application of antibiotics and increasing emergence of AMR in tertiary hospitals in China. Secondly, the survey solely assessed tertiary hospitals on AMS implementation. In contrast to primary care setting, tertiary hospitals have better access to medical resource and more funding for AMS development, which may lead to over-estimation in our results. We aim to extend the survey to obtain information on this topic in primary care setting in the future. Furthermore, the hospitals participated in this survey voluntarily. Therefore, the respondents might be those most interested or active in AMS than non-respondents, which probably provided an optimistic view of the results.
In conclusion, this nationwide survey provided important information on the progress of AMS that was made in China's tertiary hospitals. AMS program in tertiary hospitals were mainly headed by hospital presidents and involved collaboration among a wide range of disciplines and administrative departments. More efforts are required to further promote and strengthen the development of hospital-specific guidelines. Furthermore, establishment of progress and outcome evaluation system should be strengthened to guarantee the feasibility or sustainability of AMS program.
CARSS
China Antimicrobial Resistance Surveillance System
DDDs
The study was approved and exempted for informed consent from Peking University Institutional Review Board, Beijing, China (No. IRB00001052-18027-Exampt).
The datasets used during the current study are available from the corresponding author on reasonable request.
The authors declare that they have no competing interests
This work was supported by China Medical Board (Grant number 17–270) (https://chinamedicalboard.org/) and National Natural Science Foundation of China (Grant No. 81861138048 and No. 81973294) (http://www.nsfc.gov.cn/). The funders had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
LWS conceived the study. YZ and HW designed the study. All authors acquired and analyzed the data. YZ, HW, and XZ interpreted the findings. YZ and HW wrote the first draft of the manuscript. LWS drafted subsequent versions. All authors critically reviewed this article and approved the final version.
We would like to acknowledge the wide range of professionals from government, hospitals and academic institutions who have offered extensive input and advice during the design of the questionnaire. We would like to acknowledge the invaluable help and support received from Ms. Ning Yuan and Mr. Yuqi Cao for data cleaning.
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Use: 2-3 times a week. Night time treatment only.


Home AF Cares Why You Must Watch March Madness With Your Pup!
Right as we're all shaking off the winter blues, we jump headfirst into the excitement that is March Madness! The highly anticipated college basketball tournament has people everywhere making brackets and betting on who will be top dog. Although we aren't experts on basketball…. we can bet on one thing for sure: Watching the tournament with your dog will be a slam dunk!
This pooch will be heading to the Harlem Globetrotters at this pace!
The Most Loyal Com-paw-nion of All!
Howl for the Foul Shot!
Your pet will always woof for the same team as you, so no need to worry about annoying fans of your rivals getting on your nerves. Sit in anticipation as the ball goes around.. and around the rim…. SCORE!
Nothin' but Net! Cheer With Your Pet!
Lots of sports fans get really involved with the game. We can practically feel the court shake with the steps of the all-stars (good thing we can't smell them!). Whether it's an injured player, a missed shot, or worst of all, a lost game, our pets will always be there to give us a furry hug when we get stressed out or upset. Feel free to cuddle 'em in celebration, too!! Research shows that petting dogs releases a hormone called oxytocin which lowers stress levels and generally makes people and animals happier.
Raise the Ruff – Let's Paw-ty!
Feel like going out with your not-so furry friends? Take Fluffy or Scruffy or Spot along for the ride!! Every year, more and more restaurants and bars are becoming dog-friendly, so your partner-in-crime is welcome to share in on the excitement, if they're a social pup. Make it a fun time for all of you!
Let's be honest here… we don't want to put in the effort every day. Slip into your basketball shorts and your favorite old t-shirt! Your dog won't judge you and you don't have to worry about cleaning up your living room for human guests. Give your pooch a high-five (or four…) and jump on the sofa! After all, the only thing you need is each other!
Get Your Snout in the Game!
Once the game is over, your pup will always be up for a workout with you. Get out and exercise! Where's your team spirit? A healthy pet is a happy pet!
If you find yourself dogless, consider becoming a puppy parent today! There are tons of animals out there that need to be rescued, and you might be the lucky one to do it!
Previous articleAnimal Lover Vacations: Let's Go To Iceland!


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Sonic Origins review: Speeding down memory lane
Sonic Origins is a nostalgic romp through some of Sega's best platformers.
Donovan Erskine
The Sonic the Hedgehog series established itself as Sega's premier franchise with a string of beloved platformers in the 90s. A few decades later, Sonic is one of the most prolific franchises in gaming. Audiences will soon have a chance to take a trip down memory lane and revisit four of the earliest entries in the series with Sonic Origins. This collection features classic Sonic experiences and is a joy for both hardcore fans and newcomers alike.
Sonic Origins bundles together Sonic the Hedgehog, Sonic the Hedgehog 2, Sonic CD, and Sonic 3 & Knuckles. Not only does Origins bundle the four games under one roof, but all four games have been digitally remastered to look and play best on modern hardware. Anniversary Mode lets players enjoy the games in a beautiful 16:9 format, which should be compatible with most modern TV and monitor displays. Players looking for the true and authentic experience can opt for Classic Mode, where the games maintain their original 4:3 formatting.
Sonic Origins lets players enjoy all four games at their own leisure. You can start with whichever title you want, and all modes are available from the start. What's really neat is that there's also a Story Mode function, which lets you experience all four games as one continuous experience. It's an excellent option if you really want to immerse yourself in the earliest days of the feud between Sonic and Doctor Eggman.
The genesis of a classic story
While it's no secret that the early Sonic games are among the best 2D platformers of their era, Sonic Origins showcases just how well they've all aged. Even the opening levels of the original Sonic the Hedgehog have stood the test of time, and I had a huge smile on my face getting to play through them again after all these years. A lot of this is thanks to the work Sega has done to make the old Sonic games play great on modern systems. Playing on the PS5, the controls were tight and responsive, allowing me to properly take advantage of the momentum-based movement and quickly zip through levels.
Sonic Origins also shows off just how diverse the original line-up of Sonic titles were. Each game feels wholly unique, whether it be in the gameplay design or art direction. The time-traveling adventures of Sonic CD were a fresh change of pace from the journey in Sonic 1 and 2.
When loading into a game, players can select to play as Sonic, Tails, Knuckles, or some combination of the three depending on which game. Each character has their own ability that makes them feel like dynamic gameplay options, like Tails' ability to fly into the air using his propeller-like tails, and Knuckles' ability to glide and climb walls. It adds a sense of replayability that encouraged me to go back through levels a second or third time with different characters
In addition to playing through the full stories, all four games in the collection feature a Boss Rush mode, allowing players to take on a gauntlet of all the boss fights from every Act. From Eggman's various contraptions to Metal Sonic, and several others, Boss Rush is incredibly challenging and a reminder that Sonic boss battles were far from a walk in the park.
You've got to be quicker than that
While it was a lot of fun revisiting all the classic Sonic games, I wish that Origins would let you have multiple saves for each game. After playing through half of Sonic the Hedgehog as the blue blur himself, I wanted to go back and play some levels as Tails to weigh the differences. I was able to do so, but it completely overwrote my original progress. This wouldn't have been as annoying if I had the option to just select levels from the beginning.
As a bundle of classic platformers, it also would have been nice to have some console commands that put more power in the hands of the player. While many will enjoy the authentic experience of fighting through each level, I would have appreciated an option to rewind, or even toggle cheats that add lives or restore rings. It would have empowered me to do more exploring and experimenting during my playthrough. It's something that we see in a lot of classic video game collections, and Sonic Origins would have benefitted from something similar.
Beautiful blue blur
Sonic Origins also feels like a celebration of where the franchise started out. All of the original animated intros are present and have been given HD remasters. The game's Museum feature lets players go back and check out retro cover art, screenshots, key art, and cinematics.
Music is key to the identity of Sonic, and all of the original tunes are here in all their glory. As players progress through the four games and unlock more music, they can select and play different tunes from each level in the Museum. There's even an option to create a playlist of songs to listen to while you browse. I had almost forgotten just how many amazing songs there were in the original Sonic games before I jumped into Origins.
Solidified classics
Sonic Origins is not only an excellent trip down memory lane for fans of the series, it's also the perfect entry point for those looking to play them for the very first time. The games are all as beautiful as ever and control like a dream. There are also a plethora of bonus goodies that celebrate the iconic artwork and music of the platforming series. While it's easy to get caught up in arguments about the current direction of the Sonic IP, Sonic Origins is a refreshing reminder that the original games are among the best 2D platformers ever made.
This review is based on a digital PS5 code provided by the publisher. Sonic Origins will be released on June 23, 2022, for Xbox One, Xbox Series X, PS4, Ps5, Switch, and PC for $39.99 USD.
Donovan is a young journalist from Maryland, who likes to game. His oldest gaming memory is playing Pajama Sam on his mom's desktop during weekends. Pokémon Emerald, Halo 2, and the original Star Wars Battlefront 2 were some of the most influential titles in awakening his love for video games. After interning for Shacknews throughout college, Donovan graduated from Bowie State University in 2020 with a major in broadcast journalism and joined the team full-time. He is a huge Scream nerd and film fanatic that will talk with you about movies and games all day. You can follow him on twitter @Donimals_
Sonic the Hedgehog Series
SpongeBob SquarePants: The Cosmic Shake review: A splish-splash n' blast
Weekend Discussion - January 29, 2023
Evening Reading - January 27, 2023
Beautiful remasters of classic games
Tight controls
Boss Rush is challenging and exciting
Museum of key art, cutscenes, and music
No option for multiple saves
No console commands
Donovan Erskine posted a new article, Sonic Origins review: Speeding down memory lane

redpajama_set_name: RedPajamaCommonCrawl


Home > Drew Spence, Free Sounds and Samples, Griffin Avid, Mark of the Griffin, Notes from the Desk, Producer's Edge	> Halloween 2012 FREE TREATS and LESS Tricks!
Big Fish Audio's 25 Days of Christmas Sale! I want to know from you all why some people never truly become successful?


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Nanyou Student Lab died: no suicide note found after leaving the dormitory with lighter
2020-01-08 05:22:50 category:Hot
On the evening of January 7, a reporter from Beijing News visited the dormitory of Tan Dawei, a deceased student. It was located on the 4th floor of an apartment building in Xianlin Campus, with the door locked. According to the students in the dormitory next door, Tan Dawei has lived here since he was a graduate student. On December 27, the day after Tan Daweis accident, his roommates have all moved away.
The dormitory where Tan Dawei lived before his death is now locked.
A person familiar with the matter told reporters that Tan Dawei and his classmates had been criticized by his mentor Zhang Hongmei on the afternoon of December 25. Later, he learned that someone saw the monitoring video of the dormitory on the day of Tan Daweis accident. When Tan Dawei left the dormitory for the laboratory, he took a lighter from the dormitory. He lit the lighter when he went out.
Beijing News reporter learned that after the fire in the laboratory, the college informed the relevant experimental group to count the number of people and found Tan Dawei lost contact.
A student from the school of materials told reporters that the reagents used by the school of materials should be placed in a special explosion-proof cabinet according to the standard management, locked and registered when they are used at ordinary times, but it is also very easy for students in the group to get them.
Some students said that after the incident, all experiments in the whole building of the college had been suspended and the recovery time was not clear. Many students are worried about the impact on graduation and experiment.
Access to the sixth floor of the school of materials has been closed.
The people familiar with the matter told him that he understood that Tan Dawei had not been found to have left his suicide note.
On January 5, 2020, Nanjing University of Posts and Telecommunications announced that Zhangs Postgraduate Tutor qualification had been cancelled, and all the graduate students under his guidance were transferred to other tutors according to the students wishes, and the follow-up investigation and processing were in progress.
(function() {(window. Slotbydup = window. Slotbydup| []). Push ({ID: u5811557, container: ssp_, async: true});}) (); source: responsible editor of Beijing News: Liu Yuxin js7825


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Q: HttpIoException: Error posting to URL: Error 302 found Since today I have the following problem while deploying a new version to Google App Engine from Eclipse:
com.google.appengine.tools.admin.HttpIoException: Error posting to URL: https://appengine.google.com/api/appversion/updatepagespeed?app_id=MY_APP_ID&version=1&
302 Found

Further debug info:
Unable to update:
com.google.appengine.tools.admin.HttpIoException: Error posting to URL: https://appengine.google.com/api/appversion/updatepagespeed?app_id=MY_APP_ID&version=1&
302 Found

at com.google.appengine.tools.admin.AbstractServerConnection.send1(AbstractServerConnection.java:336)
at com.google.appengine.tools.admin.AbstractServerConnection.send(AbstractServerConnection.java:287)
at com.google.appengine.tools.admin.AbstractServerConnection.post(AbstractServerConnection.java:266)
at com.google.appengine.tools.admin.NoLoggingClientDeploySender.send(NoLoggingClientDeploySender.java:35)
at com.google.appengine.tools.admin.AppVersionUpload.send(AppVersionUpload.java:1168)
at com.google.appengine.tools.admin.AppVersionUpload.updatePagespeed(AppVersionUpload.java:588)
at com.google.appengine.tools.admin.AppVersionUpload.doUpload(AppVersionUpload.java:209)
at com.google.appengine.tools.admin.AppAdminImpl.doUpdate(AppAdminImpl.java:572)
at com.google.appengine.tools.admin.AppAdminImpl.update(AppAdminImpl.java:58)
at com.google.appengine.eclipse.core.proxy.AppEngineBridgeImpl.deploy(AppEngineBridgeImpl.java:433)
at com.google.appengine.eclipse.core.deploy.DeployProjectJob.runInWorkspace(DeployProjectJob.java:158)
at org.eclipse.core.internal.resources.InternalWorkspaceJob.run(InternalWorkspaceJob.java:38)
at org.eclipse.core.internal.jobs.Worker.run(Worker.java:54)

I simply have no idea what is going wrong, since I did not change anything significant in my code or setup.
Anyone any clues on what is going wrong here?

A: Updating to the AppEngine SDK 1.9.32 seems to solve the problem (I was using 1.9.30). Updating from Eclipse did not show this update, so I downloaded it manually. Now it works again!
Hope I can help other people with this. Anyone any idea why this update is not being pushed with the Google Updater site?
EDIT:
About the updating:

*

*First download the newest App Engine SDK from Google.

*Update from Eclipse is done by 'Deploying to App Engine' -> 'App Engine Project Settings' -> 'Configure SDKs' -> 'Add...' -> 'Select folder with newest SDK'.
Simple as that!

redpajama_set_name: RedPajamaStackExchange


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Q: File upload using Angular and Node I'm trying to achieve the following:

*

*Client uploads a CV as part of a form

*AngularJS sends all the form data (including CV) to the Node server

*Node stores the CV on the server

I just can't seem to get this working. I tried using multer to no avail.
So far I'd have the following:
HTML
<form name="register" enctype="multipart/form-data" method="post" ng-submit="registerSubmit(user)">
  <input type="email" placeholder="Email" ng-model="user.email" />
  <input type="file" id="cv" name="cv" ng-model="user.cv" />
  <button type="submit"></button>
</form>

Angular
app.controller("MainController", function($scope, $http){

  $scope.registerSubmit = function(user){
    $http.post("/api/register", user).success(function(data){
      console.log(data);
    });
  });

});

Node (configured with Express and other modules)
app.use("/api", router);
router.post("/api/register", function(req, res){
  //file not coming through and not sure what to do with it here anyway!
});

A: You must make your request encoded as "multipart/form-data". Check this simmilar question: file upload with $http


Lady Soma is an all natural and healthy source of women's supplements and skincare, which are specifically formulated for a women's needs. The female body is unique and complex; it deals with issues that range from vaginal health to digestive issues. Some products in the marketplace today are considered "safe", yet they contain harmful chemicals such as parabens, carcinogens, endocrine disruptors and allergens in many of the products used by women.
In our guide, you can find information about harmful ingredients for pregnant women, the benefits of retinol products, healing rosacea and much more. We also provide detailed information about how to remove stretch marks, the best ingredients that lead to firming the skin, and answering questions like "Do I have a yeast infection?".
There is no magic pill for weight loss.
But we are able to amplify your metabolic processes to assist you in your weight loss efforts. Your diet can be supplemented with many of our products, and your hard work can pay off. The Lady Soma Detox and the Fiber Cleanse with Probiotics are designed to enhance your metabolism, slim down areas that are prone to body fat and give you the proper vitamins and nutrition to meet your weight loss goals. We use several potent and natural ingredients, like green tea, caffeine, amino acids, herbs and vitamins that enable the body to burn fat and increase energy levels (i.e. using fat as fuel to create energy). We are truthful in our marketing and stand by our premium, non-toxic ingredients. We pay attention to all the details and concerns, no matter how private. We respect your privacy and understand your health concerns.
Read more about us and our values. Read more about our natural ingredients.
We are dedicated to providing product quality and consistency, and our formulas are based on extensive scientific research. Our supplements for women are created and monitored by expert scientists and quality assurance experts to ensure that our products meet the strictest standards, known as cGMP (Good Manufacturing Practice). cGMP ensures that all products are subject to multiple tests to ensure product efficacy, purity and potency.
Every woman has a different reason for wanting to get fit.
Women's bodies need specific types of vitamins and minerals that the female body does not produce, but are needed to function properly. The best source for these vitamins and minerals is food. This is a fact. Fruits, vegetables and whole grains are the key foods required for a healthy functioning body. However, the body can be thrown into imbalance when you are not getting the nutrients required. An imbalance can come in the form of fatigue, weight gain, yeast infection and other life disruptors.


Oh Hetty, what a hoot! Love Gladys in pastels and the great background you've created for her. Thanks for being our special guest to help celebrate.
Love what you've done with dear Gladys and the bingo card background! She looks ready to party. :-) Thanks for being a special guest and helping out with our scavenger crawl!
Gladys never looked so good. I'm so glad you joined us for the crawl!
Fantastic card Hetty! Love that bingo card...perfect for this image.
HETTY!!!! Thank you so much for joining in the fun -- I have missed you! FAB Bingo Project! LOVE IT!
LOVE IT! How cool to incorporate all that on a bingo card. So glad you joined us for the Crawl.
Great card Hetty, sorry it took me so long to get here! Busy Busy!
Ohh Hetty!!! I love the background Bingo board and your details!!! Great work!! I am always inspired when I see your work! Have a great day!
So darling- love your salty hop creation! There are alot of fun I need a tutorial how you cut stuff from blogs and include it on your cards.


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Red Dwarf 25th Anniversary
I'm a bit embarrassed to say that I almost missed this date. With this year being the 50th anniversary of Doctor Who, it almost slipped past me that it's another anniversary year as well: the 25th anniversary of Red Dwarf, which aired on BBC2 for the first time on 15 February, 1988. Of course, I didn't see it on that day. In fact, I'm not sure when exactly I first saw Red Dwarf. It was on the Canadian station YTV, which picked it up around the time of the third series (I recall this much because I remember the initial previews that ran on YTV showed scenes from "Backwards", the opening episode of Red Dwarf III). I do remember that the very first episode I saw still managed to be "The End", the very first episode, although I'm pretty certain this was on a repeat viewing after YTV had already run the first three series and then had cycled back to the beginning. Whenever it was, I was hooked from that very first episode. I laughed so loud and continuously through it that I received numerous complaints from my brother who was watching it with me, but who didn't enjoy it quite as much as I did.
I watched every episode after that—well, until YTV decided not to purchase new episodes after Series IV. I guess the show just wasn't doing well enough for them. They didn't even air the final two episodes of Series IV until after they had moved the show to a late-night timeslot, at which point they just cycled repeatedly through those first twenty-four episodes airing five nights a week at 1:30 a.m. (or thereabouts). Eventually, they dropped the show entirely. I knew there were newer episodes, but there was no way to see them. No other Canadian stations carried the programme. PBS in the States did, but the only PBS station we got was one of the ones that never carried it. (They never carried Doctor Who either. I was always annoyed at that PBS station for seemingly being the only one that didn't carry my favourite shows.) So I had to wait for the episodes to come out on VHS, and when they did, I snatched them up immediately.
Getting the VHS releases also allowed me to see just how much YTV had cut out of the early episodes. As a commercial station, they had needed to cut them down for time reasons, but the sections that had been cut were also the more risqué moments of the show (such as when Kryten's replacement in "The Last Day" demonstrates his strength by breaking a brick without his hands). YTV stands for Youth Television, so they were clearly editing out the moments deemed inappropriate for younger viewers. I was always amused, though, that they never edited out the numerous "two-finger salutes" that appeared throughout the programme. As that version of "flipping the bird" is completely non-existent in North America, they either felt nobody would care or (I suspect more likely) they didn't recognize it themselves.
The thing that drew me most to Red Dwarf was that it was completely unlike anything else on television. First off, it was a sitcom, complete with live-audience laughter, that was also science fiction—a combination that was virtually unheard of and is still virtually unheard of. Even the few other shows I'd seen that could claim to be science fiction sitcoms, such as Alf, weren't really all that science fictiony. They were just standard sitcoms about dysfunctional families that just happened to have an alien living with them—or something like that. Red Dwarf, on the other hand, had all the science fiction trappings. It was set on a spaceship in the far future—the extremely far future, in fact. But more than that made it unique. Unlike most science fiction, there weren't any aliens. There weren't any space battles (not at first, anyway). Instead, there was just a small cast: the last human left in the universe, forced to live his life with a hologram, a creature that evolved from his cat, the ship's computer, and later an android. It was a character show through and through, hilarious and often touching.
It's hard to believe that it's been twenty-five years since the show began. It doesn't feel like that (well, I suppose that's natural, since it's only been twenty-two or twenty-three years since I first saw it, but it doesn't even feel that long). I suppose that's partly because it's never fully gone away. It's had a few lengthy gaps (between Red Dwarf VIII and Back to Earth, for example), but it keeps coming back. Red Dwarf X just aired last fall. And throughout its twenty-five years, it's managed to remain fresh and funny. Sure, some moments have been better than others, but it's never been stale. Its continuity has changed a few times, which is something that used to bug me a little, but never a great deal, and now it just seems part of its charm. As can be seen from my reviews of Red Dwarf X, I enjoyed the most recent series a great deal, and I am confident in the show's ability to continue to deliver enjoyment into the future. Red Dwarf XI isn't confirmed yet, but it seems very unlikely that it won't happen. I will eagerly watch when it arrives. And even if it doesn't for some reason, I'll always have my DVDs of all ten series to watch whenever I feel like it. No more relying on late-night broadcasts! Red Dwarf will always remain a show that I have a great deal of affection for.
P.S. Check out this interview with Doug Naylor on the official Red Dwarf site.
Labels: Red Dwarf
Shattered Star Player's Guide
Doctor Who Meets the Big Lebowski
Animal Archive
Shattered Star - The Dead Heart of Xin
Random Urban Encounters
Irrisen, Land of Eternal Winter
Doctor Who in 3D
People of the North


The Panthers fell to 3-2 after a hard fought loss to the Washington Redskins as they were unable to overcome 17-0 deficit. In the first half of the game, the Panthers turned the ball over three times which led to 10 Redskins points. The Panthers staged a late, second half rally but came up short in the final minutes.
The Redskins beat the Panthers at their own game. On defense, they were able to force three turnovers and put their offense in favorable positions. On offense, the Redskins controlled the ball with a power run game led by Adrian Peterson who finished with 17 carries for 97 yards. The Redskins dominated time of possession, holding the ball for 35 minutes and 24 seconds, compared to 24 minutes and 36 seconds for the Panthers.
The difference in time of possession proved to be one of the deciding factors in the game. The Panthers only had three possessions in the 2nd half which made it difficult to finish the comeback attempt. The Panthers defense was unable to get off of the field to give the offense more opportunities to get points. The Redskins converted 7 out of 16 third down attempts and one out of two fourth down attempts.
The Panthers defense appears to be a unit that is still struggling to find to find its identity. Heading into the matchup against the Eagles, the Panthers defense ranks 15th in rushing yards per game given up, which is the team's lowest ranking since 2014. The unit is giving up an average of 4.6 yards per carry which ranks 23rd in the league. The Panthers defense is also one of the five worst in defending 3rd and "medium" (3-6 yards) situations. According to NFL Matchup, the Panthers defense allows first downs on 53.8 percent of opponents' 3rd and medium situations.
Given the uncharacteristic performance of the Panthers defense, I decided to focus the Week 6 breakdown solely on the struggles of the Panthers defense. I take a look at each of the Redskins key plays of offense that led to touchdowns or allowed them to sustain drives. Based on my observations, I believe that the Panthers defensive problems are fixable and it comes down to players being more disciplined with their assignments and coaching adding some wrinkles to the defense to make their pass coverages more effective.
Enjoy the video and let me know what you think. These are things that will hopefully be corrected as the team heads to Philadelphia in an important road matchup.
Before I get started, I will begin with a brief introduction. As longtime Panthers fans, I and three other friends launched The 4 Man Rush podcast to cover the Panthers in a detailed way that you may not get to see on ESPN or NFL Network. I have had a passion for football since I began playing at eight years old and continue to enjoy breaking down game film to help other fans enjoy the game as much as I do.
This led to the launching of The 4 Man Rush YouTube page, where we created a platform for us to break down Panthers games and give the fans an opportunity to look at things that they may have not seen on a live broadcast or in Bank of America Stadium. Since the start of the season, I began posting weekly game previews, where I will break down the Panthers upcoming opponents and discuss the Panthers' keys to victory, and post-game analysis where I will break down the Panthers' performance. As the channel gains popularity I will continue to add more segments.
2nd Series of the Game – When I looked at the Panthers offense on paper heading into the season, this series is what I envisioned and I would like to see the Panthers build on this. The Panthers ended a 5 play, 75-yard drive in which 5 different players touched the ball. The drive got started with a play-action pass to Devin Funchess who ran a comeback route and made a great sideline catch. Then you saw a preview of what DJ Moore can do with the ball in his hands as he broke numerous tackles on an 18-yard reverse play, highlighted by a crushing block from Cam Newton. The Panthers came back with productive plays from Ian Thomas and Christian McCaffrey before Curtis Samuel capped off the drive with a highlight reel touchdown.
Playaction Pass Game – The Panthers play-action pass game has been clicking as Cam Newton went 8-10 for 117 yards. You are starting to see defenses focus on Christian McCaffrey running the ball and as a receiver out of the backfield which has really opened up the play action pass.
The Return of Thieves Ave – Thieves Ave have continued their hot start to the season as Mike Adams was able to pick off Eli Manning twice. So far, the Panthers have forced 9 turnovers which is 3rd in the NFL.
3rd Down Defense – Credit to the Panthers defense for winning on 3rd down as the Giants went 0-7.
Explosive Plays – According to Sharp Football Stats, the Panthers rank towards the bottom of the league in generating explosive passing plays on offense and defending explosive plays on defense. In this game, the Giants generated 307 yards on 10 explosive plays. With respect to other plays, the Giants gained 125 yards on 44 plays (2.8 yards per play). In this video, we break down how the Giants were able to generate explosive plays and why the Panthers have been unable to.
Drive Killers – The Panthers had drives stalled by penalties, turnovers and missed assignments. I would like to see the team be able to better sustain and finish drives going forward.
With that said, I hope you enjoy the video and I look forward to hearing your feedback.


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View All Crohn's Disease Articles
8 Healthy Eating Tips for Crohn's Disease
Written By Jane Soung on June 5, 2021
Optimize Your Nutrition
Eating well is especially important if you have an inflammatory bowel disease such as Crohn's. Poor nutrient absorption, decreased appetite, and bouts of diarrhea can make getting good nutrition seem challenging at times. Finding the right variety of foods from all food groups—and learning those to avoid—can help optimize your nutrition while minimizing symptoms.
Reduce Symptoms, Promote Healing
You might be surprised to learn that there's no evidence that certain foods cause Crohn's disease. But once you've been diagnosed, paying special attention to what you eat can go a long way toward managing flare-ups, promoting healing, and reducing annoying digestive symptoms.
Avoid Certain Foods During Flare-Ups
Crohn's flares are never fun. Steering clear of certain foods may make them a little easier on your system. Things such as bulky grains, high-fiber foods, hot spices, greasy or fried foods, alcohol, and milk products may increase diarrhea and cramping during a flare.
Eat Smaller, More Frequent Meals
Another way to battle the abdominal discomfort of flare-ups is to eat smaller meals more frequently. Think five small meals (fist-sized portions) every three to four hours instead of the traditional three large meals a day. Using smaller dishes and bowls may help you adjust to eating less.
Consider a Low-Fiber Diet
This diet may be helpful for Crohn's patients who develop a stricture, or narrowing, in their small intestine. Easy-to-digest foods that slow down your bowel movements include everyday foods like cooked vegetables, fruits, white breads, and meats. The goal is to eat less than 10 to 15 grams of fiber each day.
Get Enough Fluids
Fluids are also important for optimal nutrition. Dehydration from chronic diarrhea can have serious effects on kidney function and create a feeling of weakness. Aim to drink one-half ounce for every pound of body weight each day. So if you weigh 140 pounds, try to drink at least 70 ounces a day.
Consider Vitamins and Supplements
If you're not getting enough calories, vitamins, and minerals, your doctor may suggest a supplement based on the extent and location of your disease. Supplements can range from vitamins, such as B-12 and D, to high-calorie liquids. It's best to take vitamin supplements only on your doctor's advice.
There's no magic eating plan that works for everyone with Crohn's. Your diet should be tailored just for you. While eating patterns will likely change as your disease changes, consuming a healthy, well-balanced diet can go a long way in making the most of living with your disease.
Jane Soung
Crohn's Disease. National Digestive Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. February 2006. http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/Crohns.pdf
About Crohn's Disease. Crohn's and Colitis Foundation of America. http://www.ccfa.org/info/about/crohns
Diet and Nutrition. Crohn's and Colitis Foundation of America. April 29, 2009. http://www.ccfa.org/info/diet?LMI=4.2
Aminosalicylates. Crohn's and Colitis Foundation of America. January 2009. http://www.ccfa.org/info/treatment/aminosalicylates
Antibiotics. Crohn's and Colitis Foundation of America. August 28, 2008. http://www.ccfa.org/info/treatment/antibiotics
Biologic Therapies. Crohn's and Colitis Foundation of America. September 8, 2008. http://www.ccfa.org/info/treatment/biologics
Corticosteroids. Crohn's and Colitis Foundation of America. Last updated: January 16, 2009. http://www.ccfa.org/info/treatment/corticosteroids
Immunomodulators. Crohn's and Colitis Foundation of America. January 16, 2009. http://www.ccfa.org/info/treatment/immunomodulators
Types of Medications. Crohn's and Colitis Foundation of America. http://www.ccfa.org/info/treatment/medications
Facts About Crohn's Disease. FDA. May 2, 2008. http://www.fda.gov/consumer/updates/crohnsdisease050208.html
Inflammatory Bowel Disease. American Gastroenterological Association. April 2008. http://www.gastro.org/patient-center/digestive-conditions/inflammatory-bowel-disease
Low-Residue Fiber Diet. MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. November 11, 2010. http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000200.htm
Just Enough for You: About Food Portions. Weight-Control Information Network. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. June 2009. http://www.win.niddk.nih.gov/publications/just_enough.htm
Last Review Date: 2021 Jun 5
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Ahmed Ibrahim Bilal was a member of a terrorist group dubbed the Portland Seven, some members of which attempted to travel to Afghanistan shortly after the September 2001 attack on the World Trade Center (9/11) to aid the Taliban. He was indicted and arrested in Malaysia in October 2002. In 2003, he was sentenced to ten years imprisonment on gun charges and for conspiracy to aid the Taliban in fighting the multinational force in Iraq. He was released on June 27, 2011.
Patrice Lumumba Ford, Jeffrey Leon Battle, October Martinique Lewis (Battle's ex-wife), his brother Muhammad Ibrahim Bilal, Maher "Mike" Hawash, and Habis Abdulla al Saoub were the original seven members wanted by the US FBI.
On September 29, 2001, Battle, Ford and al Saoub were discovered while engaged in shooting practice in a gravel pit in Skamania County, Washington. Also present was Ali Khalid Steitiye, who was not indicted on terrorism charges, but was separately charged with other crimes.
According to the indictment, on October 17, 2001, Battle and al Saoub flew out of Portland International Airport en route to Afghanistan. On October 20, 2001, Ford and the two Bilals also took the same route out of the United States.
The six male members of the group travelled to China in early 2002, with the intent of entering Afghanistan to aid the Taliban. Lacking visas and other documentation, they were turned back, and all but al Saoub returned to the United States.
On Thursday, October 3, 2002, a federal grand jury in United States District Court for the District of Oregon, at Portland, Oregon, indicted Battle, Ford, the two Bilals, al Saoub and Lewis. On October 4, 2002, four of the suspects were arrested, but Ahmed Bilal and al Saoub were both considered fugitives.
Al Saoub was killed by Pakistani forces in Afghanistan while part of an al Qaeda cell. Ford and Battle were both sentenced to eighteen years' imprisonment. Lewis was sentenced to three years in a federal prison camp. Muhammad Bilal got eight years. Hawash was sentenced to seven years.


You can specify regularly scheduled commands to cron according to instructions found in crontab files in the directory /var/spool/cron/crontabs. Users can submit their own crontab file using the crontab(1) command. Commands which are to be executed only once can be submitted using the at(1) command.
cron only examines crontab or at command files during its own process initialization phase and when the crontab or at command is run. This reduces the overhead of checking for new or changed files at regularly scheduled intervals.
As cron never exits, it should be executed only once. This is done routinely by way of the svc:/system/cron:default service. The file /etc/cron.d/FIFO file is used as a lock file to prevent the execution of more than one instance of cron.
cron captures the output of the job's stdout and stderr streams, and, if it is not empty, mails the output to the user. If the job does not produce output, no mail is sent to the user. An exception is if the job is an at(1) job and the -m option was specified when the job was submitted.
cron and at jobs are not executed if your account is locked. Jobs and processses execute. The shadow(4) file defines which accounts are not locked and will have their jobs and processes executed.
The timezone of the cron daemon sets the system-wide timezone for cron entries. This, in turn, is by set by default system-wide using /etc/default/init. The timezone for cron entries can be overridden in a user's crontab file; see crontab(1).
If some form of daylight savings or summer/winter time is in effect, then jobs scheduled during the switchover period could be executed once, twice, or not at all.
To keep a log of all actions taken by cron, you must specify CRONLOG=YES in the /etc/default/cron file. If you specify CRONLOG=NO, no logging is done. Keeping the log is a user configurable option since cron usually creates huge log files.
You can specify the PATH for user cron jobs by using PATH= in /etc/default/cron. You can set the PATH for root cron jobs using SUPATH= in /etc/default/cron. Carefully consider the security implications of setting PATH and SUPATH.
This example enables logging and sets the default PATH used by non-root jobs to /usr/bin:/usr/ucb:. Root jobs continue to use /usr/sbin:/usr/bin.
Administrative actions on this service, such as enabling, disabling, or requesting restart, can be performed using svcadm(1M). The service's status can be queried using the svcs(1) command. Most administrative actions may be delegated to users with the solaris.smf.manage.cron authorization (see rbac(5) and smf_security(5)).


The UN General Assembly has adopted its first resolution recognising the importance of geodesy. Norway co-chaired work on the first UN resolution. Its most important contribution is the Norwegian Mapping Authority's geodetic Earth observatory in Ny-Ålesund on Svalbard. This is the northernmost facility of its kind, and plays a key role in a global network for observation and research. Data acquired here are important for climate research and monitoring.


We showed up in Santa Barbara on Thursday afternoon for Joanna and Zack's wedding. The rehearsal dinner was held at a nice place on the beach, but train tracks were right on the other side of this area and Amtrak trains would pass by every so often. Amelie was getting really excited because Naomi had taken her on the train at Fashion Island, and even taught her to say "toot-toot". So every time a train went by, she would ask for more train and say, "toot-toot" in a very urgent sort of way.
Chris (Dan's son) was there, but Matthew wasn't. Laura had gone blond for the last year, and Dino Jr.'s daughter Danielle was also there.
There was a trolley to take us from the Hotel Virginia to the church, so we told Amelie it was a train and she was loving it. She kept going "toot-toot" and it was just genius.
The wedding was held at a Greek church and it was really nice. It was beautiful weather and they had a trio of musicians playing, it was very cool.
Of course, I'm partial to female ministers, so I was happy to see they were being married by a woman.
Amelie was there wearing her best sunday outfit. She was pretty good for the ceremony, but Naomi took her to one side and let her run around a bit to keep her happy.
Here's Joanna being escorted down the aisle by her dad Allan.
The bridesmaids and groomsmen looked great. Julie actually made the bridesmaid's dresses.
Dan brought a super-cool 3-CCD High Def video camera and taped the ceremony. Later, he took some video of Amelie playing and edited it a bit with iMovie on his PowerBook to burn us a DVD. It turned out great, and if anybody wants a copy email me at jeff@lorenzini.com.
The wedding party with the happy couple.
Laura and Julie after the ceremony. Relieved it's finally over, I bet.
Julie and Allan, parents of the bride. Allan actually selected the music we listened to during the reception and he did a great job.
Amelie started boozing again during the reception, and it had a predictable result.
Out like a light. One glass of wine and she's asleep in no time. My dad was a great help the whole weekend with Amelie.
The dinner and party afterwards was awesome. They had a great salad and buffet, the music was good and the people were ready to cut loose.
Amelie spent some quality time with grandpa while Naomi and I hit the dessert tray.
The next day we drove around the wine country up there, and we came across a farm raising ponies. We had some carrots in the car so we had Amelie feed them to the horses. She was really enjoying herself.
At the BBQ they had later that day at Zack and Joanna's house, they had a pool table in their garage. Naomi and I played a game of pool and she beat me. Note that Amelie is holding the 3-ball. She wouldn't give it back.
Many thanks go out to Joanna and Zack for inviting us to their wedding. It was a lot of fun.


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text:
Q: ModuleNotFoundError: No module named 'onlineMenu/wsgi' I was going to host it using Heroku. But it does not work because of the problem with the profile.
This my Procfile
web: gunicorn onlineMenu.wsgi --log-file -

my wsgi.py code
    """
WSGI config for onlineMenu project.

It exposes the WSGI callable as a module-level variable named ``application``.

For more information on this file, see
https://docs.djangoproject.com/en/3.0/howto/deployment/wsgi/
"""

import os

from django.core.wsgi import get_wsgi_application

os.environ.setdefault('DJANGO_SETTINGS_MODULE', 'onlineMenu.settings')

application = get_wsgi_application()

this is my Heroku log (not all)

2020-10-23T16:04:08.861587+00:00 app[web.1]: Traceback (most recent
call last): 2020-10-23T16:04:08.861588+00:00 app[web.1]: File
"/app/.heroku/python/lib/python3.8/site-packages/gunicorn/arbiter.py",
line 583, in spawn_worker 2020-10-23T16:04:08.861588+00:00 app[web.1]:
worker.init_process() 2020-10-23T16:04:08.861589+00:00 app[web.1]:
File
"/app/.heroku/python/lib/python3.8/site-packages/gunicorn/workers/base.py",
line 119, in init_process 2020-10-23T16:04:08.861589+00:00 app[web.1]:
self.load_wsgi() 2020-10-23T16:04:08.861589+00:00 app[web.1]: File
"/app/.heroku/python/lib/python3.8/site-packages/gunicorn/workers/base.py",
line 144, in load_wsgi 2020-10-23T16:04:08.861590+00:00 app[web.1]:
self.wsgi = self.app.wsgi() 2020-10-23T16:04:08.861590+00:00
app[web.1]: File
"/app/.heroku/python/lib/python3.8/site-packages/gunicorn/app/base.py",
line 67, in wsgi 2020-10-23T16:04:08.861590+00:00 app[web.1]:
self.callable = self.load() 2020-10-23T16:04:08.861591+00:00
app[web.1]: File
"/app/.heroku/python/lib/python3.8/site-packages/gunicorn/app/wsgiapp.py",
line 49, in load 2020-10-23T16:04:08.861591+00:00 app[web.1]: return
self.load_wsgiapp() 2020-10-23T16:04:08.861591+00:00 app[web.1]: File
"/app/.heroku/python/lib/python3.8/site-packages/gunicorn/app/wsgiapp.py",
line 39, in load_wsgiapp 2020-10-23T16:04:08.861592+00:00 app[web.1]:
return util.import_app(self.app_uri) 2020-10-23T16:04:08.861592+00:00
app[web.1]: File
"/app/.heroku/python/lib/python3.8/site-packages/gunicorn/util.py",
line 358, in import_app 2020-10-23T16:04:08.861592+00:00 app[web.1]:
mod = importlib.import_module(module) 2020-10-23T16:04:08.861593+00:00
app[web.1]: File
"/app/.heroku/python/lib/python3.8/importlib/init.py", line 127,
in import_module 2020-10-23T16:04:08.861593+00:00 app[web.1]: return
_bootstrap._gcd_import(name[level:], package, level) 2020-10-23T16:04:08.861593+00:00 app[web.1]: File "", line 1014, in _gcd_import
2020-10-23T16:04:08.861594+00:00 app[web.1]: File "", line 991, in _find_and_load
2020-10-23T16:04:08.861594+00:00 app[web.1]: File "", line 973, in _find_and_load_unlocked
2020-10-23T16:04:08.861594+00:00 app[web.1]: ModuleNotFoundError: No
module named 'onlineMenu/wsgi' 2020-10-23T16:04:08.861841+00:00
app[web.1]: [2020-10-23 16:04:08 +0000] [10] [INFO] Worker exiting
(pid: 10) 2020-10-23T16:04:09.011977+00:00 app[web.1]: [2020-10-23
16:04:09 +0000] [4] [INFO] Shutting down: Master
2020-10-23T16:04:09.012166+00:00 app[web.1]: [2020-10-23 16:04:09
+0000] [4] [INFO] Reason: Worker failed to boot.


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In a historical tasting, Jose Penin, for the first time ever, in an official capacity, came to Israel and tasted through some 32 or so wines, and then tasted them against his own country's wines as well. Jose Penin, is no stranger to the wine world, he is the Robert Parker of Spain, and has been doing this for some 35 years, and is world-renowned for his tireless drive and professionalism in the world of wine. In 1990 he released his first book on the wines of Spain, and has continued this every year since, adding to it and augmenting the wineries he visits as more come online.
Yair Gat is not as well known as the late Daniel Rogov was in the English-speaking blogs and public, because Mr. Gat writes in Hebrew and pretty much stays to himself. Still, Yair Gat is a highly accomplished wine writer that writes a wine article for Israel Hayom, a daily newspaper in Israel.
The tastings accorded over three days, with Penin, included some winery visits and the chance to taste some 32 wines, were all put together by Hacarem/Vineyard. Hacarem, is one of the largest and most influential Israeli wine & liquor importers, which imports many Spanish wines into Israel including one of my favorites; Elvi Wines.
The event was really a three-part affair, starting with Penin presenting Spanish wines in Israel, where the audience was mostly wine professionals. The tasting with Gat and Penin was a private affair and was put on for the benefit of all involved, which turned out to be a wonderful opportunity for Mr. Penin to get an appreciation of Israel's wine potential. There was also an evening where Elvi Wines were the main event, called Elvi night with Spanish tapas, music, and of course Elvi wines! This was put on for the buyers of Elvi wines in Israel.
I was so happy to see that the preconceived notions and/or opinions that Penin came with – were not the notions he left with! He came, with the imagery that the public media paints for him, a land filled with desert plains and its people affected by the need to live in constant strife. Bless-fully, he left with real story – a land filled with people whose hearts are open with joy and happiness, irrelevant to its strife, and hungering to learn and grow as a people, economy, and country.
I was also, so happy to see that the word kosher only appeared at the end of the article and that the large majority of it was spent talking about the makeup of the land, the agriculture, viticulture, the climate, the history, its people, and its wonderful wines. Of the 32 wines he did taste – he liked the Yarden and Castel wines the most. His favorites were the Castel Grand Vin, the Yarden Heights Wine, the Yarden Odem Organic Vineyard Chardonnay, and the epic Yarden ROM.
Please read the entire post of his, the translation is pretty good, excepting for a few glaring mistakes like when he describes the 2008 Castel Grand Vin, as a bad Medoc – AHH!!! The translation meant to say; if I had not seen the bottle/label I would have thought it was a Medoc. Either way, the article by Gat (attached above) and the blog post by Penin both show the unbelievable range of Israeli wines and their potential. As an aside, Yair Gat and Penin tasted some four Spanish wines as well. One of my favorite kosher Spanish wines that did well is the Clos Mesorah from Elvi Wines, which I wrote about and rated in my article on Elvi Wines. Penin and Gat placed it comfortably in the same range as wines priced many times its cost. So congratulations to Elvi Wines again for its continued assault on the wine world and for the acclaim that it rightfully deserves.
I was really happy to see that the international wine world is starting to get a glimpse and appreciation for the potential of wines in Israel. There are clearly many hurdles that the Israeli wine industry needs to address, including price and quality. However, as we have seen from my latest post on Recanati Winery, the clear QPR leader in Israel, and the continued good press from Wine Spectator and other wine media outlets about the Israeli wine industry as a whole, there is much to be proud of as well.
So, before turn totally Pollyanna, I wanted to throw a huge shout out to Mr. Penin, the folks from Hacarem, Moises Cohen and family, Mr. Gat, and all those that were part of this epic undertaking. The goodwill and information that you have all spread to the wine industry can only help to bolster the image of Israel and its wine industry, which I hope in turn, will help it to continue to improve and grow as a quality producer of wine throughout the world.
Posted on July 13, 2012, in Israel, Israeli Wine, Wine, Wine Industry, Wine Tasting and tagged Elviwines, Jose Penin, Moises Cohen. Bookmark the permalink.	Leave a comment.


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text:
Q: Is this query slow Is this a slow query based on the value of that Explain? I'm on MySQL.

A: "Index merge intersect" can almost always be sped up by providing a composite index.
INDEX(dealerID, orgID)  -- (I can't tell if the order matters.)

But that is all I can deduce from the EXPLAIN without also seeing SHOW CREATE TABLE and the SELECT.


text:
Events
A rift within the Sicilian Cosa Nostra becomes clear. On the one hand there are the hardline "Corleonesi" in jail – led by Totò Riina and Leoluca Bagarella – and on the other the more moderate "Palermitani" – led by Bernardo Provenzano, Antonino Giuffrè, Salvatore Lo Piccolo and Matteo Messina Denaro.
March 28 – Pietro Aglieri writes a letter to the National Anti-mafia Prosecutor (DNA), Pierluigi Vigna, and the Chief Prosecutor of Palermo, Pietro Grasso to ask for negotiations. His proposal is that mafiosi would get more lenient penalties (in particular the relaxation of the article 41-bis prison regime) in return for recognizing the existence of Cosa Nostra and the authority of the Italian state.  Aglieri had been approached by Vigna in 2000 in an attempt to get mafiosi to "dissociate" from Cosa Nostra — without becoming collaborators of justice — a method that was used successfully in the struggle against the Red Brigades. Ex-Red Brigades members could publicly recognise their errors without having to admit their own criminal responsibilities.
April 16 – Arrest of Antonino Giuffrè. He started feeding investigators information even before he agreed to turn state' witness (or pentito) in June, 2002. He is one of the most important mafia turncoats since Tommaso Buscetta in 1984. His collaboration has updated investigators' knowledge and provided a new interpretation for the sensitive issue of Cosa Nostra's relations with politics in the early 1990s. Apparently the arrest of Giuffrè was made possible by an anonymous phone call that seems to have been made by loyalists to the Mafia hardliners Totò Riina and Leoluca Bagarella. The purpose was to send a message to Bernardo Provenzano. The incarcerated bosses want something to be done about the harsh prison conditions (in particular the relaxation of the 41-bis incarceration regime) – and were believed to orchestrate a return to violence while serving multiple life sentences.
April 29 – Genovese crime family soldier Lawrence "Larry Glitz" Galizia, and associates Frank Isoldi, Christopher Demenna, Anthony Hooks and Robert Schwall were indicted for making illegal loans ranging from $15,000 to $100,000 and collecting gambling debts to a gambling service run through an 800 number in Costa Rica.
May 12 – Former Commission member Joseph Bonanno died at the age of 97.  Bonanno had survived a shooting war against rebels in his own family and had survived after his plan to kill fellow commission members Carlo Gambino and Thomas Lucchese was revealed to the commission.  Bonanno also lived to write a book about his life.
June – At a court appearance Leoluca Bagarella makes some thinly veiled threats to the Italian government, saying the Mafia is "tired of being manipulated by political forces."
June 4 – A massive racketeering indictment was handed down against Gambino crime family boss Peter Gotti, captains Anthony "Sonny" Ciccone and Richard V. Gotti, soldiers Richard G. Gotti, Primo Cassarino, Jerome Brancato, and Peter Piacenti, associates Vincent Nasso, Julius Nasso, Richard Bondi, Salvatore Cannata, Thomas Lisi, Carmine Malara, Anthony Pansini, Jerome Orsino, Jr.  The indictment alleged that the Gambino crime family controlled the Brooklyn and Staten Island waterfronts, engaged in shaking down waterfront businesses and trucking companies, cooperated with the Genovese crime family in ripping off the ILA benefit plans, and for a number of years the group extorted screen actor Steven Seagal, and were trying to force him to pay them $150,000 per movie he made.  Staten Island Conservative Party boss and head of the Staten Island waterfront terminal was forced to pay Ciccone $2,000 per month for protection. All men would be sentenced to prison.
June 10 – Former Gambino crime family godfather John Gotti died of throat cancer in a prison hospital.  Gotti's successor brother Peter was under indictment facing trial and would miss his brother's funeral services.
June 20 – Gambino crime family captains Louis Vallario and Michael DiLeonardo, soldiers Frank Fappiano and Edward Garafola were indicted for exerting illegal influence on construction companies, businesses in the Garment District, and wholesale produce distributors in New York City.  A later indictment would also charge soldier Thomas "Huck" Carbonaro and associate John Matera with taking part in the murder of Staten Island businessman Fred Weiss.  DiLeonardo and Fappiano would become cooperating witnesses, and DiLeonardo would go on to testify against John Gotti, Jr. and Colombo acting boss Alphonse "Allie Boy" Persico.
September 6 – Former Gambino crime family underboss and number two man under John Gotti, Salvatore Gravano, was sentenced to 20 years in prison for running a multimillion-dollar Ecstasy ring in Arizona.  Gravano had admitted to committing 19 murders and his testimony was largely responsible for sending John Gotti and consigliere Frank LoCascio to prison for the rest of their lives.
December 9 – Gambino crime family captain Ronald "Ronnie One Arm" Trucchio and his 25-year-old soldier son Alphonse were indicted for operating a $30 million-a-year sports betting ring based in Ozone Park, Queens.  Prosecutors alleged that the operation was making $600,000 per week.
December 23 – Bonanno crime family consigliere Anthony Graziano pleaded guilty to his involvement in a murder conspiracy, loansharking and evading over $100,000 in taxes.

Arts and literature

All About the Benjamins (film)
City of God (film)
Dark Blue (film)
Empire (film)
Gangs of New York (film)
Narc (film)
Road to Perdition (film)
The Good Thief (film)

Deaths

George Fresolone, Philadelphia crime family informant
June 10: John J. Gotti, Gambino Crime Family – Boss

References

Organized crime
Years in organized crime

redpajama_set_name: RedPajamaWikipedia


The car park at the rear of the hospital (car park D near disablement services) has been redesignated a disabled parking only - Please see the site map from more information. Blue badge holders can park in staff car parks and can still use the barriered car parks but would still have to pay on exit.
All cars (including Blue Badge holders) will need to pay to exit the barriered car parks. Please see the parking map for the location of free Blue Badge parking.
Safety measures are in place in the car parks at both hospital sites.
A valid disabled badge must be clearly displayed at all times and only parked in marked bays (if no disabled bays are available you can park in a non-disabled bay. However, ALL cars entering the barriered car park will have to pay on exit.
There is an appeals system in place with UK Parking Control (UKPC) if you feel you have unfairly received a Parking Charge. All appeals must go through UKPC.
Car parking map for Carlisle.
There is no charge for registered disabled badge holders parked in a bay clearly displaying a valid Blue Badge with the exception of the pay on exit parking.
The machines accept 10p, 20p, 50p £1 and £2 coins. Debit and credit cards can be used at the Cumberland Infirmary and at specific machines in West Cumberland Hospital.
Please allow enough time for your appointment as delays can occur.
Drop-off points are available outside the main entrances to each hospital (the time limits also apply to disabled badge holders).
Spaces are available for blue badge permit holders at both hospitals. Please see the parking maps above for locations.


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Contact us at 651.465.6365 or fill out our inquiry form below. We look forward to making your wedding everything you ever imagined and more!