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Differential inputs to striatal cholinergic and parvalbumin ... GPe functional inhibitory connectivity to ChAT interneurons, PV interneurons and SPNs.
Julia Reda – European Parliament endorses upload filters and "link tax" ... will only increase and the entire Directive may well still be rejected when it comes up for a final vote right before next year's European elections.
Calcium influx through CRAC channels controls actin organization and ... Calcium restricts actin polymerization to the distal edge of the synapse.


text:
Press Release: People v. Yang, See, 10/15/10
WOMAN WHO MADE UP STORY OF HOME INVASION ROBBERY GETS PROBATION AND 60 DAYS IN JAIL
A Roseville woman's scheme to collect insurance by reporting a phony home invasion robbery backfired and has resulted in a two-month jail sentence for her.
See Yang, 25, was also placed on three years probation and fined $270 during her sentencing October 7 in Placer County Superior Court by a visiting judge.
Yang pleaded no contest on July 29 to a felony charge of grand theft by false pretenses in a case that stretched back to February 9, 2008, when she reported to Roseville police that she had just been robbed in her home by two masked suspects, one of whom carried a gun.
She told police that the robbers made off with money and jewelry, and she presented a claim to her insurance company. She received an insurance payment the following month.
But the scheme eventually went awry when she took some of the missing items from the bogus robbery to a pawn shop in an effort to collect cash.

redpajama_set_name: RedPajamaCommonCrawl


Along with the concern that has been raised in foreclosures conducted by institutional lenders and servicers, the class action challenges to foreclosures and actions taken by certain state Attorneys General, a number of members of the bar are leading a charge to challenge the validity of the lien of the mortgage or trust deed.
In Utah, an attorney freely advertises his expertise to relieve the borrower from the effects of the trust deed on his or her property. There are several known cases in which the attorney has obtained a judgment voiding the trust deed of the lender. Below is an outline of such a case which illustrates the method being used by the attorney.
In 2005 the borrower executed a trust deed in favor of the lender, a local title company as trustee and MERS as beneficiary, as a nominee for lender and lender's successors and assigns. The trust deed secured a note in the amount of $132,000. Borrower is a realtor in Utah.
In April 2010 counsel for borrower filed a complaint against lender, lender's purported assignee, the local title agent, and the title insurer. Personal service was obtained on all defendants. The local title agent, the purported assignee, and the title insurer were dismissed pursuant to a stipulation. (None of these defendants claimed any interest in the property.) The complaint alleged that neither the lender nor the assignee had any interest in the note, trust deed or the property due to the fact that MERS was assigned the trust deed and MERS has no interest in the note or the property. The complaint further alleged that MERS was a "tax evasion broker which has deprived local governments of essential funds by collecting fees otherwise necessary to properly record trust deeds and assignments of the same." The complaint quotes a statement attributed to the Salt Lake County Recorder who described MERS as potentially "the scam from hell".
The essence of the claim is that the note was assigned to different parties while the trust deed designated MERS as the Beneficiary, thus a split of the note and trust deed occurred and therefore the latter is a nullity.
A Summary Judgment Motion was filed by the plaintiff. The Motion was unopposed. In August 2010 the Third District Court in Salt Lake County Utah entered an Order Quieting Title to Real Property. The order stated that there was no opposition to plaintiff's motion for summary judgment and all defendants have either been dismissed or failed to appear after effective service. The lender filed a stipulation that it had no interest in the promissory note, trust deed or subject property, therefore the trust deed was declared a "Nullity and of no further force and effect." Plaintiff's attorney then filed an Attorney's Lien against the property for the attorney's fees incurred. The borrower proceeded to put the property on the market and subsequently sold it to a third party.
Based on the results of the above case, each order or judgment quieting title terminating the effects of a trust deed, mortgage or lien must be thoroughly examined. Do not insure a lender or purchaser based on the effects of any such order or judgment without Underwriter approval.


My wife, Julie, and I stood on Hearn Plaza at 12:45 this morning with heavy hearts. Following the announcement from the grand jury in Ferguson, Missouri, a small group of people entered the Quad and threw toilet paper into our trees. While we do not know the identity of these individuals or their intentions, we are saddened that this unacceptable behavior caused harm to our community.
Wake Forest has always been a place where we set our passions to work toward a common good. This community – like so many – is imperfect, but we have demonstrated a studied resolve to find common ground, to look at ourselves honestly, and to work to make the Wake Forest of today better than it was yesterday. We are undeterred in our efforts to make this a place that embraces all who call it home.
At this moment, it is important that we continue our thoughtful campus-wide conversations and forums, that we continue our commitment to diversity and inclusion, and that we continue to strive for respectful discourse in an era of polarized, fragmented polemics.
As we part ways for the Thanksgiving holiday, may we – as a community – pause to recommit to build a stronger campus based on face-to-face dialogue and a charitable spirit worthy of our motto, Pro Humanitate. Let me offer my deepest appreciation to so many who work diligently to uphold the best of Wake Forest. May you all cherish the time with family and friends this holiday.


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The decision to buy a hot tub is not one you'll make lightly. You wouldn't buy a car without test driving it first, and we believe it's the same when buying a hot tub. There's so much to consider before purchasing, and we have the knowledge and expertise to talk you through all the options available. Please come and discover for yourself – book a wet test or simply visit our showroom in Ilkley for a browse of our extensive range.
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If you have never tried avocado fries before (just like my sis), you totally should.
In my opinion, seasoning in the coating is necessary to pump up the flavor.
It's not like they're short on flavor on their own, but seasoning adds that certain je ne sais quoi.
Coat them in shredded coconut in lieu of of breadcrumbs is not just a paleo/GF thing. You probably won't believe me, but you should.
Avocado fries go from a ten to an eleven when coated in coconut.
But if you want to stick with breadcrumbs, do it. I won't judge you, I promise.
Whatever you do, I think you need a dip.
I elected to make mine Sriracha Mayo — because I honestly think it's phenomenal — but feel free to do pretty much anything you'd ever associate with guacamole.
One last thing, you do want to serve these warm and fresh. Just like French fries, they are not as good reheated so might as well eat them all.
Just like my sis did. She tried 'em, loved 'em, and now is a convert. The plan has been successful.
Coconut Crusted Baked Avocado Fries with Sriracha Mayo Print this recipe!
Preheat oven to 425°F (210°C) and place a rack in the middle. Line a baking sheet with aluminium foil and set aside.
Slice the avocados in half, and carefully remove the pit. Cut each half into 5 slices, and set aside.
In a bowl combine arrowroot powder and half of the seasonings in a bowl.
In another bowl combine egg and water.
In a third bowl combine shredded coconut and the remaining half of the seasonings.
Working quickly, dip the avocado slices in the arrowroot mixtures, then in the egg mixture, and then in the coconut mixture to coat well.
Place coated avocado fries on the lined baking sheet.
Bake in the hot oven for 10 to 12 minutes, then flip and bake on the other side for 2 to 4 minutes.
To make Sriracha mayo, in a bowl combine, mayo, Greek yogurt, Sriracha, lime juice, and pepper and stir to combine. Taste and adjust seasoning if needed. Serve with baked avocado fries.
One avocado fry yields 64 calories, 5 grams of fat, 4 grams of carbs, and 1 gram of protein.
I might be over thinking this BUT - in the picture (the one with a half bitten fry) it looks like you didn't take the skin off. Am I right or has it just been a really long week and now I'm seeing things that can only be cured by a batch of these fries?
I took the skin off, trust me. I think it's just the outer part of the avocado flesh that's darker than the one closer to the pit.
BTW, I'm sorry to hear you had a long week. I hope you'll have a relaxing weekend!
Mines came out so good!
Mike - your photos are usually stellar - but, darn duuude - these are freakin fantastic - or should I say awesmazing! I adore avocado fries and I must say, that coconut coating and paprika take these to a whole other level indeed! Happy Friday!
You have a knack of making me want to try things I've already dismissed (I actually ate zoodles this week and they weren't as horrible as I remember, lol). I tried raw avocado fries once and didn't really dig them, but these with the combo of coconut and baking look pretty irresistible! :-) Have a great weekend buddy!
You have to give avocado fries one more chance. They're that good!
I'm not a huge fan of avocado tempura, too greasy for me. This is completely different!
I have just started getting on the avocado fries bandwagon and will definitely be trying this one out! LOVE the recipes, keep 'em coming!
Mike, this is just genius. Loving the idea. My boys love avocado, if I make them these..it will be like the best for sure. Happy Friday.
I'm sure they'll love these, they're sooo good!
oh wow- Not going to lie, I may have had the same expression as your sister but that may be because I had a bad experience at a Japanese restaurant with a tempura version! This looks delicious and I'm not going to lie- I want to eat the mayo but the spoon!
This is totally different from avocado tempura. You should give it a try!
You won't be sacrificing an avocado, trust me!
I'm bossy when it comes to food. That's the kind of brother I am!
I've never had avocado fries before, but they sound completely amazing, especially with that Sriracha Mayo!
They're really something, I'm telling you!
I have never seen anything like these, but they look amazing, I could take a bite right now.
Hey Mike! love your website! Quick question.... Can you sub the arrowroot powder for Almond or Coconut flour? I'm going to give this a go!
How did it go with the arrowroot substitutes?
what could you replace with egg if you're vegan? could you use flaxseed mix?
Did you ever try using a flax egg?
Looks outstanding. Going to try organic coconut flour instead of arrowroot. Cheers.
How did the coconut flour work for you?
I'm not a fan of coconut flavor, anything else I could use?
My husband and I both thank you for posting this amazing recipe. We're not following a paleo diet, but one that it very, very similar in many principles of what you can and can't eat, and unfortunately for us, whereas 'main' meals are brilliant and varied, often a decent 'side' is lacking, when you've ruled out pasta, potato, sweet potato, rice, jacket potato, fries, fries, fries, did I say fries? tortilla, bread ;-) There's only so much cauliflower I can handle. Anyway, these tasted absolutely brilliant. These tasted how I hoped they would taste, after reading the ingredients list. And although my husband did look dubiously at them when they came out of the oven (so it's avocado, and... coconut...?) he is a convert for both the fries and he loved the sriracha dip too. Happy here! Avocado sales will be going up in the UK! Many thanks!


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Nicole Ciacchella
A second chance romance contemporary romance. Contains some mature content.
Lex Harrington is living a stranger's life. After high school, she and her boyfriend, superstar quarterback Brad Wakefield, headed off to college, secure in the knowledge of their brilliant future. Then an injury ended Brad's football career, and he convinced Lex to drop out of school and return home with him, where everything fell apart.
Because the glossy surface of their relationship concealed a dark truth: years of emotional abuse culminating in Brad's walking out on Lex and their infant son. At twenty-three, she's a single mother with no future prospects, struggling to make ends meet while dealing with the aftermath of her destructive marriage.
When Jaron Richards left for college, he vowed he'd never look back. Brad laid waste to his friendship with Lex, leaving nothing to bind Jaron to his hometown. But his unrequited love for Lex has never faded, even as his star has begun to rise, making him Hollywood's hottest new actor.
Now Jaron is back in town to film his latest movie, and his presence stirs up everything Lex would rather forget. Can they find a way to pick up the pieces and build a future together?
Sweenix Rising Books
More Books by Nicole Ciacchella
The Eye of the Beholder


The type of oil that was spilled into the East China Sea is unlike other major oil spills, so there are a lot of unknowns.
An Iranian oil tanker that collided with a Hong Kong bulk freighter in the East China Sea is creating a new problem now that it has sunk—a possible environmental disaster.
When the oil tanker, the Sanchi, crashed on January 6, it spilled condensate into the waters about 160 nautical miles east of Shanghai, a high-traffic area for ships heading to and from China and other nearby countries. The New York Times reports the vessel burned for several days as rescuers tried to find missing crew members, then finally sank on January 14.
The oil tanker was carrying close to 150,000 tons of condensate, a light oil, when it crashed. It is unclear how much of the oil had burned off or spilled when it sank.


I read about how the "King of Abyssinia once took a British subject named Cameron prisoner and incarcerated him in the high fortress of Magdala. No cause was stated for his confinement. When Great Britain found out, she demanded an immediate release of her citizen. King Theodore refused."
According to the story, within days Great Britain sent several thousand soldiers by ship to Magdala. After marching across unfriendly country for many miles, they attacked the fortress and rescued that one British subject. "The expedition took several months and cost the English government twenty-five million dollars. The entire resources of the government were made available in the rescue of only one citizen."
Just think if the government of Great Britain was willing to spend twenty-five million dollars to save one of it's citizens, how much more does God want to save you!
Dear Lord, we thank You for the price You paid to save each and every one of us. In the Name of Jesus, Amen.


text:
Texas Attorney General files environmental lawsuit over ITC's chemical tank fire
DEER PARK, Texas (KTRK) -- Texas Attorney General Ken Paxton has filed an environmental lawsuit against Intercontinental Terminals Company (ITC) over the fire at ITC's Deer Park chemical storage facility.
The lawsuit alleges that the fire, which began Sunday and burned for days, released air pollution in violation of the Texas Clean Air Act.
The fire caused the release of several air contaminants, including benzene. Most of the chemicals identified in the fire are used in the production of gasoline, and short-term exposure to their fumes can cause fatigue, dizziness, and headaches. Twice this week, residents of Deer Park and neighboring Galena Park were told to stay indoors because of concerns about unhealthy air quality. Those concerns also prompted Deer Park ISD and several other school districts to cancel classes for multiple days.
"The state of Texas works hard to maintain good air quality and will hold ITC accountable for the damage it has done to our environment," Attorney General Paxton said. "ITC has a history of environmental violations, and this latest incident is especially disturbing and frightening. No company can be allowed to disrupt lives and put public health and safety at risk."
Texas Commission on Environmental Quality (TCEQ) continues to monitor the air quality in the affected areas about 20 miles east of Houston.
"I would like to thank the Attorney General for acting so quickly on TCEQ's request to enforce against ITC, LLC," stated TCEQ Executive Director Toby Baker. "Due to the dynamic, ongoing investigation of this incident, only air quality violations have been cited in the state of Texas lawsuit against ITC, LLC. Any additional violations, including surface water quality, will be referred to the Office of Attorney General for civil enforcement as part of this action."
The federal Chemical Safety Board, which investigates serious chemical accidents, announced Thursday that it is opening an investigation into the ITC fire.
deer parkpasadenachemicalsfirelawsuitchemical leak


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At the center of a tooth is a hollow area that houses soft tissues, such as the nerve, blood vessels, and connective tissue. This hollow area contains a relatively wide space in the coronal portion of the tooth called the pulp chamber. This chamber is connected to the tip of the root via narrow canal(s); hence, the term "root canal." Human teeth normally have one to four canals, with teeth toward the back of the mouth having more. These canals run through the center of the roots like pencil lead through the length of a pencil. The pulp receives nutrition through the blood vessels and sensory nerves carry signals back to the brain.For many people who experience tooth pain or discomfort, a root canal may be recommended, and a qualified dentist or more preferably an endodontist (root canal therapy specialist) should be consulted in a timely manner.
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The Parsenn Funicular (German: Davos Parsenn Bahn, DPB) is a funicular railway in the resort of Davos in the Swiss canton of Graubünden. The line links the town of Davos with the Weissfluhjoch ridge and the Parsenn ski area.
The funicular is composed of two separate and independent sections, with an interchange station between the two at Höhenweg. The lowest station (Davos DKB) lies at an elevation of 1,560 metres (5,120 ft) and the highest (Weissfluhjoch DKB) lies at an elevation of 2,665 metres (8,743 ft). The highest section is the highest open-air funicular in Switzerland and the second highest after the Metro Alpin.
Considering both sections, which have a total length of 4,048 metres (13,281 ft), the line is also one of the longest in the country.
The funicular was built in 1931, to access the Weissfluhjoch ski area. The lower section was renovated with two new cars in December 2002, With the upper section being renovated in 2010.
^ a b c d "DPB - Davos Parsenn Bahn". Funimag. Retrieved 2014-01-13.
^ Weissfluhjoch (1:25,000) (Map). Swisstopo. Retrieved 2019-04-10.


Heath, Linda S.; Smith, James E.; Skog, Kenneth E.; Nowak, David J.; Woodall, Christopher W.
Journal of Forestry. 109(3): 167-173.
Land-use change and forestry is the major category featuring carbon sequestration in the annual US Greenhouse Gas Inventory, required by the United Nations Framework Convention on Climate Change. We describe the National Greenhouse Gas Inventory and present the sources of our data and methods and the most recent results. Forests and forest products in the United States sequestered more than -790 million metric tn of CO2 equivalent in 2008, on 253 million ha of forestland. This estimate represents a net increase in carbon, including effects of growth, harvests, or other disturbances of forest ecosystems, as well as carbon stored in harvested wood products. Both area and carbon density of these forestlands have increased since 1990, the first year estimates are required. Currently, 89% of net annual sequestration is in the forest ecosystem, and the balance is net carbon addition to harvested wood products.
Heath, Linda S.; Smith, James E.; Skog, Kenneth E.; Nowak, David J.; Woodall, Christopher W. 2011. Managed forest carbon estimates for the US greenhouse gas inventory, 1990-2008. Journal of Forestry. 109(3): 167-173.


(HealthDay News) -- Some women react to the experience of pregnancy and childbirth with sadness, fear, anxiety and procrastination, the American Academy of Pediatrics says.
Feeling a lack of support from family and friends.
Problems with a previous pregnancy or birth.


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text:
Tag: bay area
Crackdown on Sex Trade at Super Bowl Leads to More than 200 Arrests
A crackdown on the sex trade at the Super Bowl led to the arrests of more than 12 pimps, 85 johns and 129 prostitutes in the Bay Area.
The Contra Costa Times also reports that seven juveniles were recovered.
The multi-agency crackdown was the result of six moths of preparation before the big game.
"High-profile events, which draw large crowds, have become lucrative opportunities for sex trafficking criminal enterprises," said FBI Assistant Special Agent in Charge Bertram Fairries.
Tags: bay area, FBI, prostitution, sex trade, Super Bowl
FBI Makes Arrests, Raids in Public Corruption Cases in North Carolina, California & New York
Separate corruption investigations led to the arrests of two public officials in North Carolina and California and to the raid of the office of a New York state senator, the Washington Post reports.
Hundreds of federal agents descended on offices in the San Francisco Bay Area, arresting several people including state Democratic Sen. Leland Yee and a former head of a Hong Kong-based crime syndicate.
In the North Carolina sting, FBI agents arrested Democratic Charlotte Mayor Patrick Cannon, charging him with theft and bribery. He's accused of soliciting and accepting bribes, the Post reported.
And in New York, Assemblyman William Scarborough's offices were raided, and he was questioned in his Albany hotel room. He was questioned about per diem reimbursements, he told reporters.
Posted: March 27th, 2014 under News Story.
Tags: bay area, bribery, california, Corruption, FBI, North Carolina, San Francisco, theft
Feds Hand Out Seized Money to Local Law Enforcement
It was more than just a stocking stuffer. Federal agents gave more than $1.2 million in confiscated drug money to five police agencies in the San Francisco Bay Area on Thursday, reports the San Jose Mercury News.
The money came from a former medical marijuana dispensary in the area. DEA and IRS agents announced the holiday gift from the US Department of Treasury Asset Forfeiture Fund from a federal building in Oakland, Calif.
"This is a true holiday gift," said Hayward Police Chief Diane Urban, according to the paper. Her department received the largest payment, nearly $475,000.
"The assets forfeiture program is one of the federal government's most effective tools against drug trafficking, money laundering and organized crime," said Scott O'Briant, IRS-Criminal Investigations Special Agent in Charge, according to the paper. "The program disrupts and dismantles criminal enterprises by seizing their assets" and then distributes those resources to local law enforcement to help fight crime.
Posted: December 23rd, 2011 under News Story.
Tags: bay area, california, hayward, San Francisco, treasury asset forfeiture fund
Feds Bust San Francisco Giant Payroll Managers on Charges of Swiping $1.5 Mil
It looks like it's strike three for the ex-payroll manager for the San Francisco Giants.
The feds have charged Robin O'Connor, 41, of the San Francisco Bay area, with embezzling more than $1.5 million from the club's employees, including players and buying fancy cars and a new home, the Associated Press reported.
AP reported that the team confronted her in July and she admitted diverting more than $600,000 from two Giants employees. She was fire immediately, according to an FBI affidavit, AP reported.
"We immediately notified the United States Attorney's office and are working with the federal authorities to ensure that this matter is thoroughly investigated and that any wrongdoing is prosecuted to the fullest extent of the law," the team said in a statement, according to AP.
A team audit showed she had made 11 suspicious bank deposits totaling $1,513,836, an FBI affidavit said.
AP reported that she made $80,000 and was eligible for bonuses.
Security on Rise in Nation As We Approach 9/11 Anniversary (AP)
FBI Serious About Bribery (Atlantic)
FBI Probing Gunshots Striking Houston Congressman's Office (CNN)
Taylor Armstrong May Turn to FBI Over Ex-Husband's Suicide (Hollywood News)
Justice Dept. Sues to Block AT&T-T-Mobile Merger (AP)
Posted: August 31st, 2011 under FBI, News Story.
Tags: bay area, robin oconnor, san francisco giants


In cities experiencing rapid economic growth, historic districts with rich cultural heritage are often demolished and replaced by modern high-rise buildings. This article shows the success of Singapore's urban conservation policy in preserving its historic districts in the face of a fast expanding economy and rapid urban development. A survey in the conservation areas shows that the policy has succeeded in preserving the historic old shophouses Blazer Nike Femme Bleu to a large extent. An analysis of the Basket Nike Blazer Mid use of shophouses shows that the policy has also succeeded in retaining the activities which reflect the community life in the core areas of Chinatown, Kampong Glam and Little India. This is because the policy allows for the operation of market forces which makes preservation and restoration of the old shophouses viable.
An open problem concerning the convergence of the optimal cost for the cheap-control problem without stability is solved. It turns out that the definition of a new type of linear-quadratic optimal-control problems is necessary. This new problem requires the infimization of the cost functional under the constraint that the state trajectory modulo a certain subspace vanishes as time goes to infinity. The associated optimal cost turns out to be the limit of the optimal cost for the cheap-control problem without stability. Moreover, for left-invertible systems, the optimal control, state, and output for the perturbed problem tend to the optimal control, state, and output for the new problem. Also, a characterization of the Blazer Nike Homme Solde optimal cost for the latter problem is given in terms of the dissipation inequality.


text:
Archaboilus is an extinct genus of bush-cricket that lived during the Jurassic period. Five species are known, ranging from the earliest Jurassic (Hettangian) to the end of the Middle Jurassic (Callovian) of Asia.

Although behaviors are difficult to reconstruct for extinct species, in 2012 scientists based in China, the UK, and the US recreated the call of A. musicus based on a well-preserved fossil from the Jiulongshan Formation of  China.

Based on studies, it is believed that male A. musicus produced pure-tone (musical) songs using a resonant mechanism tuned at a frequency of 6.4 kHz.

References

External links
 Recreation of an A. musicus chirp

Tettigoniidae
Middle Jurassic insects
Jurassic insects of Asia
Fossil taxa described in 2012

redpajama_set_name: RedPajamaWikipedia


text:
Q: Should shuffle be set to True during Keras Tuner? I am using Keras Tuner to hypertune my model. I am setting the parameter value "validation_split = 0.2" in the search() call. Does it still make sense to pass "shuffle = True" or is that redundant / counter-productive?
tuner = RandomSearch(
    hypermodel = build_model,
    objective = kt.Objective("val_loss", direction = "min"),
    max_trials = 100,
    executions_per_trial = 2,
    directory = "V5",
    project_name = "case8",
    seed = RANDOM_SEED,
    overwrite = True
)

tuner.search(
    x = x_train_new,
    y = y_train.values,
    batch_size = 1024,
    epochs = 100,
    validation_split = 0.2,
    shuffle = True,
    callbacks = [ model_early_stopping]
)

A: validation_split = 0.2
This will split data into training data =0.8 and validation data=0.2
By default, Keras tuner shuffles the data, hence no need to explicitly mention it.
For time-series data, the tuner should not shuffle the data, in this case, keep its value to false.
For the generator, the tuner ignores the value of the shuffle parameter even if we pass it.
You can find more details over here
https://github.com/tensorflow/tensorflow/blob/80117da12365720167632761a61e0e32e4db2dcc/tensorflow/python/keras/engine/training.py#L1003

redpajama_set_name: RedPajamaStackExchange


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text:
Vietnamese community gathers for vigil to honour container lorry victims
02/11/2019, 9:04 pm Updated: 02/11/2019, 10:22 pm
Candles laid out as part of the ceremony for the mass prayer and vigil for the 39 victims found dead inside the back of a truck in Grays, Essex (Yui Mok/PA)
Members of the Vietnamese community have gathered in London for a vigil in memory of the 39 people found in a lorry in Essex.
A vigil on Saturday evening was attended by more than one hundred people at the Church of the Holy Name and Our Lady of the Sacred Heart in east London.
Candles spelling out "39" were at the foot of the altar ahead of the service in the Catholic church, which has a large Vietnamese congregation.
The priest leads the vigil (Yui Mok/PA)
Reverend Simon Nguyen said: "Today we gather to remember the people who have departed.
"These people who used to live among us, who dined with us.
"Today they are no longer with us."
Members of the congregation at the mass prayer and vigil (Yui Mok/PA)
Members of the congregation performed readings as part of the vigil and candles were lit.
Addressing the congregation, Rev Nguyen said: "Yesterday the police in Essex announced all the victims were Vietnamese.
"We show our condolences and sympathies for the people who have lost their lives on the way seeking freedom, dignity and happiness.
"We ask God to welcome them into his kingdom even though some of them were not Catholic but they strongly believed in eternal peace, so we pray for them.
"We pray for those who have lost their sons and daughters, their loved ones at this very challenging time."
View of the congregation (Yui Mok/PA)
After the service, Rev Nguyen told the PA news agency the incident had affected the Vietnamese community internationally.
He said: "We couldn't believe such tragedy could happen and the pain these people had to suffer before they died.
"The whole community is in shock. It is shocking every single day because of the more news and more information about the tragedy, they suffering of these people. It is very painful for these victims and their families at home."
The east London church has assisted with the investigation into the tragedy, including working with the police.
"I try to spread the news to all the people both catholic and non catholic to come forward if they need any help and we can collect all the information," he said.
He added the community had stood together and helped provide the information they could.
"The people here are very united because we are all refugees," Rev Nguyen continued.
"All the people here, most of the Vietnamese, came here as refugees in the 70s and the 80s and the 90s, but their disappearances were not reported by the media, but many of them died in this way.
"These victims, this tragedy was reported but many tragedies to the Vietnamese no one knows."
On Friday, Essex Police announced that it believed all the victims were Vietnamese after previously stating it was thought they were Chinese.
A spokesperson for Vietnam's Ministry of Foreign Affairs called the incident a "serious humanitarian tragedy" in a statement on Saturday.


In partnership with Ujima Radio, Bristol Green Capital Partnership and University of Bristol Cabot Institute, Up Our Street supported the research and outreach work carried out by the Green and Black Ambassadors in the project's pilot. The project was set up to create dialogue and encourage visibility of people from African-Caribbean backgrounds in the environmental sector, both highlighting the lack of diversity and taking action to change the status quo. The programme in its initial stages centred on three focus areas: leadership development, media and community research.


Portglenone Community Center is used by many groups and organisations.
To book a room for an event in Portglenone Community Centre please call 028 820150.
Irish Dancing – Tue 6.00 – 7.00p.m.
Portglenone Walking Group – 10.00am Thursdays departing from the community centre.
Yoga classes are available through the year. Please contact Fiona Jones for details.


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RoyalFest is an event management consortium. RoyalFest specializes in Fest Management, Theme Fest, Wedding Fest, Show Fest etc. RoyalFest is a localized organization with office in Jaipur, India. Fest management is the soul of the firm.
Show Fests, Catering Management, Decoration Management etc.
RoyalFest is an organization of repute with the local residents and personalities form diverse ground. We are very keen to the process followed throughout the conceptualization of the Fest. We use state of art technique and maintain consistency in the quality of services delivered by following the best practices in the industry. The consortium possesses the key qualities to convert your dream fest into reality. We use the latest technology in an innovative way to manifest your dream fest.
Key persons of the consortium working at RoyalFest possess the required knowledge and experience in their respective fields. At RoyalFest team works in a harmony and with proper coordination it delivers the required project in time. We at RoyalFest follow the best human capital management practices to ensure that our team is demonstrating the righteous character and also following the vision and mission of RoyalFest.
Our aim is to quench the thirst of our client by satisfying all his senses with high quality delivery of services with cost-benefit perspective. We are in our nascent stage and an upcoming production in fest development.
Quality is the major concern in our each and every endeavour. We turn the thoughts into reality by applying the vast knowledge and expertise to make you enjoy and celebrate the occasion with fun which we use as ingredient in all our fest.
© Royal Fest Celebrating Moments 2012, All Rights Reserved.


text:
Q: Return yes if text contains any word from the list I have a set of random texts (column A) and a list of course words (column B).
The goal is to determine for each text from A, if it contains any of the course words from column B. Both texts and course words are in lower register.
Tried this formula, but it didn't work =count(SEARCH(D1:D7000,A$1:A$14))

A: use:
=INDEX(IF(REGEXMATCH(""&LOWER(A2:A); TEXTJOIN("|"; 1; LOWER(B2:B))); "yes"; ))

A: You can use the COUNTIF function that counts cells that match certain criteria and returns a count of occurrences. If no cells meet the criteria, COUNTIF returns zero.
=IF(COUNTIF(A$1:A$14,"*" & D1:D7000 & "*"),"Yes","No")


text:
Pine Tree Beat
By Maine Heritage Policy Center
Think Tank Grades DHHS Intake Employee, Process Revealed in Second Undercover Video
The Maine Heritage Policy Center (MHPC) has extensively reviewed the latest undercover video of an intake coordinator at Maine's Department of Health and Human Services Portland office, released today by videographer James O'Keefe. The Think Tank is giving the employee mixed grades. The video can be seen here.
"This latest tape gives us a better perspective of the welfare intake process," said MHPC Chief Executive Officer Lance Dutson. "The Portland employee was far more in command of the intake process than a DHHS employee at the Biddeford office shown in an earlier video, which helps us examine the welfare process more closely. The intake culture is far too focused on getting people into the system, and this is something that clearly needs to change."
MHPC broke the interview down into four categories:
1- Training/ Program Knowledge
Grade: A –
In contrast to the first video, the employee who was secretly filmed by an actor in the Portland DHHS office was obviously very well trained and knowledgeable of Maine's vast welfare bureaucracy and eligibility requirements.
Despite making some clear errors in her explanation of Medicare vs. Medicaid, this employee was able to appropriately articulate the processes and programs available to applicants for welfare services.
2- Efficiency
Similar to the process shown in the video of Biddeford DHHS employees, the length of time spent-nearly one hour-with this likely ineligible welfare applicant was excessively long. DHHS should train intake coordinators to ask simple means-test questions at the beginning of these interviews, to be able to efficiently and honestly process applicants. This interview should have ended in 5 minutes, after the DHHS employee was told the potential applicant could afford to purchase his own private health insurance. Also, once the applicant established that he had access to a bank account with $250,000 in it, and that he had a debit card that he could use "any time" for "anything he needed", it should have become clear to the employee that this applicant was not someone who needed state assistance.
3- Stewardship of Taxpayer Funds
The DHHS employee took precautions to outline the specific parameters for an applicant to receive taxpayer funded services. By drawing these clear lines, the employee set an appropriate standard for eligibility, which is conducive to guarding against abuse of scarce welfare funds. The employee also spoke frankly to the applicant about the perils of unreported income, noting that it would be detrimental to their social security benefits in the long-term. In stark contrast to the Biddeford employee, who twice told the applicant that unreported income is not a factor in application for welfare benefits, this Portland employee made it clear that all income, cash or not, needs to be declared during the application process.
However, the employee provided far more detail than was necessary for an applicant that had already identified sufficient means. The interview should have been cut short on the basis that means were available, and that welfare services should be a last resort. This interaction is less indicative of poor performance by an employee, and more indicative of a system with inappropriate goals. The overall goal of DHHS employees should be to help Maine's less fortunate get on their feet through employment opportunities, and not lead them toward long-term dependence on the welfare system.
4- Fraud Vulnerability
Though the DHHS employee was articulate and had a strong command of bureaucratic parameters, the interview could have opened the door for future fraudulent activity. The employee, through her thorough explanation of eligibility requirements and the intake process, effectively coached the applicant on the best way to answer questions in order to receive benefits. The applicant left the interview with advice from the employee that removing his name from his parents $250,000 bank account was "one way to get around it."
In the case of the Biddeford tape, the applicant presented a clear picture of illegal dealings through his "offshore pharmaceutical imports" operation. In the case of this latest tape, however, the scenario of a drug dealing cash-rich applicant wasn't laid out so plainly. The concern for the applicant perpetrating fraud would naturally have been less in the Portland scenario. Nevertheless, DHHS employees should take precaution that they are not providing advice that could be used as part of future attempts to defraud the system.
"This investigation shows how a 'Secret Shopper' program, used extensively in the private sector to improve employee performance, could be an effective tool in reforming our welfare intake process." Dutson said. "While the first video released showed a clear breakdown in the function of front-line DHHS processes, this video provides examples of both good and bad practices that should be used as educational tools for DHHS employees."
MHPC has offered a series of suggestions to the LePage Administration to help improve the efficiency of the welfare intake system, as well as protect against fraud. One suggestion was to establish a 'Secret Shopper' program, to monitor employee performance. In addition, MHPC has urged Maine DHHS to adopt diversion programs, to make employment and self-sufficiency a primary goal, as well as strict penalties for fraudulent activity by welfare recipients and DHHS employees.
"We have seen both through our years of research, and this recent investigation that the primary goal of DHHS has been to enroll applicants into the system," continued Dutson. "In order to stem the out-of-control increase in welfare dependency, we must fundamentally change the DHHS culture to one focused on getting Mainers back on their feet. It's critical we constantly audit our processes to ensure taxpayer funds are not being wasted or abused, while at the same time advance reforms to free Maine families from welfare dependency."
For questions or to schedule an interview, please contact Chris Cinquemani at chris@mainepolicy.org
Maine Medicaid Investigation – Second Video | Maine Freedom Forum
[...] can read MHPC's reaction to this second video [...]
Sorry comments are closed !


I've never bothered to crimp any of my rifle loads, mainly because most of them are fairly mild shooters (.243, .22-250, .308). I noticed some flattening of the exposed lead tips on the Nosler Partitions I'm loading for the .300 Win Mag and suspect there is some set-back in unfired rounds removed from the magazine, but I haven't had the time to go through them yet. Accuracy doesn't seem to suffer, I'm getting .75" groups or better (@100 yards).
I've been thinking about ordering the Lee FCD, just to try it. Should I back off my powder charge and work back up, looking for signs of excessive pressure? The load I'm using is 79.4 grains of H1000. Nosler lists 81.0 as a MAX, and I've loaded slightly above this (81.4) without seeing any excess pressure signs.
I'm sure this has been discussed somewhere in the forums before, but a search turned up very few results.
Id measure your unfired rounds out of the magazine and compare with your oal measurements of a new round if you reload or factory round if you dont.
If you are seating the projectile deeper with recoil in the magazine, then you either need to increase your neck tension or crimp the necks.
As with any changes back off the charge and work your way back up in the usual ladder loading way and check for pressure signs and accuracy.
I dont think crimping will make a great deal of difference, but the win mag is a powerful round so be safe.
I'm with dhc, use a comparator to see if the "fresh" loads are different from the ones that have spent time in the magazine. I'm looking forward to your findings! Regardless, a proper crimp sure can't hurt anything.
On the recommendation of some of the fine folks here I bought a Lee FCD for my semi-auto .223/5.56 loads. I haven't done any measurements to see if it had much effect but it makes me feel better!
HJ...Pete and Punkin have pretty much covered the "che is and balances" mate, but personally, I crimp all my centrefire rounds. As Punkin said, it makes him feel better...but there is also knowing that every round has sufficient crimp to hold the projectile steady and with a uniform grip from round to round. Consistency has to count for something, in which case I highly recommend the LEE FCD. Nothing to loose, everything to gain mate.
If you don't already do it, I strongly recommend trimming to length, especially the .243 and 22.250 (both of which are notorious for "growing"), every third loading...and checking for signs of head separation. This will add more consistency to your loads. It's not a biggie or war winner, but you can also anneal your cases every third loading to increase case life.
Crimp? I don't leave home without it!
Never use the integrated crimp feature in the bullet seating die (Elvis, taught me that tip). Good you got the dedicated Lee FCD. No need to be in the cannelure. In my .270 Win, crimping did not increase neck tension but did reduce variation in tension by 50% - measured with a force gauge pulling bullets. I use a medium crimp, e.g., 0.003" indent in the brass (collet pedals not touching).
It wouldn't be wrong to reduce your powder charge but you are already 1.5 grains below max. I would crimp and go.
I made myself curious, so I dug through the mess on my loading bench.
It doesn't appear that bullet set-back is an issue, which kinda surprised me. "New" rounds measure 2.730" with a Hornady comparator. I measured 8 rounds that had been along for the ride at least once and the shortest I found was 2.727. Other than deformed tips, they don't appear to have changed much.
I'm still probably gonna order the FCD, just 'cause. Midway has them for around $14/each, so getting one for the .223, .22-250, .243, .270, .308, and .300 Win Mag won't break the bank.
$84, should get free shipping!
my old .270winchester is a real tart for deforming rounds in the magazine...back in bad old days when shooting wallabies with her the bottom round in mag could have up to 15 rounds fired above it and the lead tips got mashed....I got into habbit of trimming it off which worked fine and sure didnt affect accuracy or terminal preformance,also got in habit of putting 2 rounds of ballistic tips in bottom of mag and others above.....now days I dont even bother,most times she only fires a single round and deer dies so its no biggie.
never noticed projectiles getting shunted back,but have seen ribs added to inside of mag box to prevent rounds going forwards.
I load A LOT of 7.62x51 for use in an L1A1 semi auto & use a Lee FCD all the time after measuring a couple of rounds out of a mostly used magazine & finding the bullet set back 0.040".
As slimjim says; using the cannelure or crimping a non cannelure bullet doesn't matter, so long as you don't go mad on the crimp.
I seem to be the odd man out here. I only shoot the 7,62x39 and the 5,56/223 in semi-auto guns. I don't crimp for either rifle nor do I see any need to. I have not had any bullet set-back due to recoil and I get acceptable accuracy from both my SKS and my AR platforms. The only cartridge I do crimp is my 357 rounds because the load data requires a heavy crimp with H110 powder.
I have tried crimping my 3006 in the past but found it introduced larger groups that I attributed to inconsistencies in the bullet pull. I have no way to measure bullet pull in any accurate way but the groups almost doubled in size with crimping, from 1/2" groups to just over one inch. My SKS shoots 4 inch groups with crimped rounds and only 2.75 to 3 inch groups without the crimp.
This just shows that some guns do not have increased accuracy with crimped ammo. Each gun is its own combination of characteristics and while some things seem to aid group size across platforms others may not behave the same way in all guns.
I firmly believe you should do what works for your reloads in your guns.
Paul, I read between the lines that you never anneal your cases?
If you develop a load without a crimp then add a crimp, you may have to retune your load.
The only rifle cartridge that I crimp (using a FCD) is .30-30.
I started crimping semi-auto loads when I realized that the bullet could be pushed back, when it hits the feed ramp or front of magazine, or slide forward, when the case stops in the chamber (think inertial bullet puller). As I said, it makes me feel better about the loads.


Travis' vehicle was hit by an IED in Iraq. After leaving the Army, he took a job where he could keep to himself. But he was often angry, and his temper sometimes caused problems. With the support of his wife and fellow Veterans, Travis enrolled in VA programs to manage his PTSD symptoms and live better.


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text:
Happy Joe's Pizza & Ice Creams Partners with Design Firm Harrison to Create New Brand Image
Industry News | August 3, 2021
Happy Joe's Pizza & Ice Cream has chosen to partner with global design consultant firm Harrison to utilize its award-winning strategic branding, interior design and architectural expertise to create a new image and brand design for the family-centric concept, in preparation for expansion.
Through its strategic storytelling approach, Harrison is tasked to create a look and feel that connects Happy Joe's nostalgic 49-year-long past with elements of today's dining and "eatertainment" venues. With plans to expand across the U.S. and beyond, Harrison will also keep growth top-of-mind in order to create a brand design that can easily go anywhere.
"Happy Joe's is an iconic brand based in the Midwest that will be celebrating its 50th anniversary next year," says Tom Sacco, Happy Joe's CEO, president and chief happiness officer. "I see the new design as the launching pad to the next 50 years of Happy Joe's growth, across the U.S. and globally. Afterall, being 'happy' isn't just an American characteristic. We plan on bringing Happy Joe's to cities around the world starting in Cairo, Egypt, and there's no one we'd rather have supporting us on this journey than Harrison."
The new design is slated to debut in Happy Joe's home state of Iowa in 2022. It will also be executed in several upcoming openings and will be available for new franchisees to implement moving forward.
"We're excited to have been chosen to be part of the repositioning of such an iconic brand," says Keith Anderson, COO of Harrison. "Happy Joe's is full of history and spirit, which is going to make the creation of this new prototype a lot of fun. We see a lot of potential to expand Happy Joe's throughout the U.S. and globally, and we're honored to get to help them achieve this growth."
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...an excellent group of players jamming, meshing together fluidly, and the energy is consistently high.
A fiery and dedicated improvisor and composer, saxophonist Idit Shner's latest quartet recording highlights her rich and ongoing relationship with pianist Josh Hanlon and drummer Stockton Helbing, which dates back to the early 2000's when Idit was working on her Doctorate at the University of North Texas. Along with bassist James Driscoll, the quartet tackles a program of Idit's compositions, all based in the jazz tradition but with influences ranging from traditional melodies & rhythms from Zimbabwe, to classical Arabic music, to the Latin-tinged grooves of McCoy Tyner from his early '70s recordings. For the album's lone standard, Billy Strayhorn's "Passion Flower," Shner declares her debt to one of jazz's definitive alto stylists with this haunting Ellington band staple, one of Duke's many feature numbers for Johnny Hodges.


Another week, another Super Rugby round of New Zealand dominance.
It took 10 rounds but the four form teams of the competition are from across the ditch.
Here's how the lay of the Super Rugby land stands ahead of round 11.
If you fell from the skies moments before turning their clash with the Cheetahs on, you would not have guessed the Crusaders were the team that travelled halfway around the world this week.
Normal Super Rugby teams appear lethargic and somewhat sloppy in their first South African match of the year but this is no normal Super Rugby team.
Barely got out of first gear in easily accounting for the Cheetahs.
Had the bye but the Chiefs hardly set the world on fire against the Sunwolves.
Still a true title contender but they rested the large majority of their starters and it showed against the Sunwolves.
They're back in action this week and a revived Reds side awaits.
Five straight wins for the Highlanders and they really turned it up against the Stormers.
It was a blitz which showed just how good the NZ Conference is - the Stormers appeared to be a contender before they arrived on NZ shores.
They now head to South Africa and are every chance of notching two more wins against the Cheetahs and Bulls.
Overseas wins are worth their weight in gold but a team of the Lions' stature would have been disappointed with their output against the Force.
The jury is out on their overseas form and they will take part in the most intriguing match of the round when they face the Rebels.
There's a clear gap between the top five teams and the ones below but the Sharks are shaping as the most viable challenger.
The Jaguares were good in this clash and it was a game that twisted and turned.
Consistency has been the problem here and they have a stretch of five very winnable games ahead - Force (H), Kings (A), Sunwolves (A), Stormers (H), Bulls (H) - let's see what they can do.
Slumped to their third straight loss against the Highlanders.
If we use that as a form line, tonight's clash with the Hurricanes could get ugly.
The scoreline didn't quite reflect how much better they were than the Brumbies.
After being on the wrong end of so many close losses, they were due a tight win like this.
Speaking of tight losses - the Brumbies certainly know a thing or two about them.
Could have put the Australian Conference away with a win but the Tahs and Reds remain alive.
Need the bye before re-grouping.
Tough finding a team worthy of the 10 seed but the Reds couldn't stay here after falling short of the mark again.
The Jaguares look like their next win win is around the corner with the Sunwolves waiting and they were better last week against the Sharks.
The biggest jump in the Power Rankings this year.
A remarkable form turnaround considering the putrid performance they put up against the Kings.
Consistency is key for the Tahs and they have a chance to put two straight wins together for the first time this year against the Blues.
Another stint at Heartbreak Hotel for the Reds.
Should have, could have and would have beaten the Tahs on another day.
With Karmichael Hunt out, a minor miracle is required if they are to beat the Chiefs.
Super Rugby's most improved team.
The Rebels were without a halfback for 55 minutes but the second half was the Kings' strongest in many years.
Have a well deserved bye after a tough month.
A better team would have taken advantage of a Lions side off their game last weekend.
But there is a point where injuries simply cripple a team's ability to compete and that excuse is valid for the Force.
With so much top line talent out, beating the Sharks in Durban will be a supremely tall order.
Being flogged by the Kings doesn't bode well for the remainder of the year.
They're a woeful team on the road and have similar injury excuses to their Perth rivals.
Their clash with the Lions will tell us plenty about both teams.
They were in the clash with the Chiefs until the death but the fact that teams are resting their stars against them and still winning says it all.
Speaking of second rate... Six straight losses - some against sub par opposition - is enough to put you in last place on this ladder.


For moving a piano, you need to take care of many things in order to avoid any mishappening or damage to the instrument or the people involved. Here are some tips which will help you prepare for moving the piano across the country without possible harm.
Most pianos are ungainly in size, shape, and overwhelming. Some of them even measure more than a thousand pounds. When managing such substantial item, it would be to your greatest advantage to employ piano movers in Sacramento for expert service. This is on the grounds that you may harm your back, you may even break a couple of bones while trying to do it yourself. Especially if it's substantial, you may even wind up dropping it and harm different things that happen to stand out. This without a doubt goes far in advocating the cost of enlisting an expert piano mover.
Your piano should be given uncommon consideration while it is being moved. They are awfully hard to transport and should be maneuvered carefully when trying to explore dubious staircases or passages.
Professionals likewise accompany hardware and take after particular strategies that will guarantee that the employment is done appropriately. A ton of them will make utilization of slides which are otherwise called piano sheets. They are implied particularly to transport pianos. They will likewise wrap the piano with covers and have a go at strapping it to these sheets so harm, assuming any, is limited. These sheets are then stacked on dollies which enable them to transport the pianos towards the exit.
Pianos are exceptionally costly. More than that they hold nostalgic incentive to a few people. This is something that makes them crucial. Envision a gem being passed down from era to era. When you have to move a piano to which you have a connection, you need to play it safe to guarantee you don't wind up harming it.
When you procure an expert piano mover with a strong notoriety, they will take individual care while moving your piano. All things considered, they would prefer not to discolor their reputation either. One negative survey can have an indistinguishable effect from a thousand positive ones.
Piano movers in Sacramento comprehend the structure of a piano and how it works. This makes it simpler for them to make choices. All things considered, they may have officially done it a hundred times. This is their specialty professionally. In the event that the piano has been in your family for a considerable length of time, you wouldn't like it to get harmed.
The heaviness of these enormous instruments is dispersed equitably through the piano case. A moving organization with the expert team will comprehend this and will utilize the correct hardware to guarantee it is transported legitimately. An unpracticed organization might have the capacity to pull this off as well, yet the odds of a mischance happening while at the same time doing it incredibly increments. Why risk it!
Finally, the charges you should pay to a piano mover won't just rely on the measure of your piano, yet in addition to the separation you require it transported and the trouble related to moving it. Make certain you talk about the cost and terms of the move in detail before hiring any service.


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Current Opinion in Gastroenterology
Management of Gastroesophageal Reflux Disease that does not Respond Well to Proton Pump Inhibitors
Tiberiu Hershcovici and Ronnie Fass
Curr Opin Gastroenterol. 2010;26(4):367-378.
Future Therapy
Evaluation for proper compliance and optimal dosing time should be the first management step in assessing patients with heartburn not responding to PPI therapy.[59] The physician should emphasize the need to take PPIs half an hour before a meal.
Lifestyle Modifications
The benefit of lifestyle modifications in GERD patients who fail PPI treatment has yet to be elucidated. In a recent systematic review of reports on lifestyle modifications for GERD, the authors determined that only weight loss and elevation of head of the bed appear to be effective.[60] There were insufficient data to support any of the other commonly prescribed lifestyle modifications. Nevertheless, in patients with PPI-refractory heartburn, it seems reasonable to recommend avoidance of specific lifestyle activities that appear to trigger GERD symptoms.
Histamine 2 Receptor Antagonists
For GERD patients on PPI twice daily who exhibit NAB, early studies showed that the addition of a histamine 2 receptor antagonist (H2RA) at bedtime significantly reduced the frequency and duration of NAB.[61] Although no studies document any clinical correlation between NAB and nocturnal GERD symptoms, the addition of H2RA at bedtime has become common practice in GERD patients who fail PPI treatment. However, patients rapidly develop tolerance (within 1 week) to the antisecretory effects of H2RAs given at bedtime.[62]
In a study that evaluated 100 patients (58 on twice-daily PPI and 42 on twice-daily PPI + H2RA at bedtime for at least 1 month), the authors demonstrated that the addition of a bedtime H2RA significantly reduced the percentage time with intragastric pH below 4 during upright, recumbent, and the entire monitoring period.[63] Unfortunately, the authors failed to provide any evidence for clinical effects of the bedtime H2RA. Rackoff et al.[64] evaluated 56 GERD patients on PPI twice daily who were receiving H2RA at bedtime for variable durations. The authors found that 72% of patients reported improvement in overall symptoms, 74% in night-time reflux symptoms, and 67% in GERD-associated sleep disturbances.
Currently, PPIs are the most efficacious treatment for both healing erosive esophagitis and for symptom relief in GERD patients. In those who fail PPI once a day, there are two major potential therapeutic strategies that are utilized in clinical practice – switching to another PPI or doubling the dose of the same PPI. Doubling the PPI dose is by far the most common therapeutic strategy used by practicing physicians, and this strategy is recommended by the 2008 American Gastroenterological Association guidelines for GERD.[65] The Cochrane review suggests that doubling the PPI dose is associated with greater healing of erosive esophagitis, with a number-needed-to-treat (NNT) of 25. However, there is no clear PPI dose–response relationship for heartburn resolution in either erosive esophagitis or NERD.[66]
Switching to another PPI is an attractive therapeutic strategy that could be utilized in the management of patients who failed PPI once daily. In one study, patients who failed lansoprazole 30 mg once daily were randomized to either double-dose lansoprazole or 40 mg once-daily esomeprazole. Single-dose esomeprazole was as effective as double-dose lansoprazole in percentage of heartburn-free days as well as symptom score for heartburn, acid regurgitation, and epigastric pain.[67]
Whereas doubling the PPI dose might be considered the standard of care, there is no evidence to support any further escalation of the PPI dose for symptom control or healing of erosive esophagitis. For double-dose therapy, the PPI should be taken before breakfast and before dinner. Support for this regimen comes primarily from studies demonstrating improved control of intragastric pH when one PPI pill is taken before breakfast and dinner rather than taking two pills before breakfast.[68]
A recent study has suggested that a minority of GERD patients may lose PPI efficacy after 2 years of continuous and unmodified treatment with one or two PPIs per day.[69] The sole parameter evaluated in this study was the level of esophageal acid exposure as assessed by pH testing. The authors did not provide any clinical data to correlate with their physiological findings. In another study, the authors demonstrated that infection with Helicobacter pylori in healthy individuals, who are CYP2C19 extensive metabolizers, eliminated the differences in intragastric pH control between standard and double-dose PPI.[70] As with the previous study, the authors did not provide any clinical endpoints to correlate with the pH monitoring data.
The value of utilizing dexlansoprazole MR, an R-enantiomer of lansoprazole that also has dual delayed release (DDR) technology in patients who failed standard-dose PPI, remains to be elucidated.[71,72] Conceivably, the dual release of the drug (separated by 4–5 h), might be helpful in patients who failed PPI once daily.
Transient Lower Esophageal Sphincter Relaxation Reducers
A number of receptors have been shown to be involved in triggering transient lower esophageal sphincter relaxation (TLESR) providing the opportunity to develop novel reflux inhibitors.[73] The most promising of these agents appear to be the gamma-aminobutyric acid B (GABAB) receptor agonists and metabotropic glutamate receptor 5 (mGluR5) antagonists, which can achieve a high level of TLESR inhibition.[73,74]
Baclofen, a GABAB agonist, is a potential add-on treatment for patients who failed PPI therapy.[75,76] The drug reduces the TLESR rate by 40–60%, reduces reflux episodes by 43%, increases lower esophageal sphincter basal pressure, and accelerates gastric emptying.[75–77] Baclofen has been shown to significantly reduce DGER and weakly acidic reflux as well as DGER-related symptoms.[58,78] In patients with persistent heartburn despite PPIs, baclofen doses of up to 20 mg three times daily have been used.[58] Because the drug crosses the blood–brain barrier, a variety of central nervous system (CNS)-related side effects have been reported including somnolence, confusion, dizziness, lightheadedness, drowsiness, weakness, and trembling. The side effects are likely an important limiting factor in the routine usage of baclofen in clinical practice.
Arbaclofen placarbil (also known as XP19986) is a novel, transported pro-drug of the pharmacologically active R-isomer of baclofen. The drug is currently in clinical development for the treatment of refractory GERD. Arbaclofen placarbil was designed to be efficiently absorbed in the gastrointestinal tract and rapidly metabolized to release R-baclofen after absorption. Unlike baclofen, arbaclofen placarbil is well absorbed from the colon, allowing the drug to be delivered in a sustained release formulation that may allow less frequent dosing and thus reduced fluctuations in plasma exposure. This in turn may lead to potentially improved efficacy through a combination of greater duration of action, dosing convenience, and better safety profile compared with baclofen.[79,80]
The effect of ADX10059, a potent, selective, negative allosteric modulator (NAM) of mGluR5, on esophageal acid exposure and symptoms has been recently evaluated in GERD patients. ADX10059 at a dose of 250 mg three times daily was well tolerated, and significantly reduced both the percentage of time esophageal pH below 4 and the duration of symptomatic reflux episodes.[81] However, on 14 December 2009 Addex Pharmaceuticals Ltd. ended development of ADX10059 because of a possible link to severe hepatic side effects.
Visceral Pain Modulators
To date, there are no studies that have specifically evaluated visceral pain modulators in refractory GERD patients. However, given the fact that most patients who fail PPI treatment have NERD and most do not have abnormal acid reflux when they are taking PPIs, the use of pain modulators is highly attractive.[39,82] Pain modulators such as tricyclic antidepressants, trazodone (a tetracyclic antidepressants), and selective serotonin reuptake inhibitors (SSRIs) have all been shown to improve esophageal pain in patients with noncardiac chest pain.[39,83,84] It is believed that these agents confer their visceral analgesic effect by acting at the CNS and/or peripherally at the sensory afferent level.
For visceral pain syndromes, the pain modulators are used in doses lower than those given for mood alteration. Nevertheless, side effects are common, and may limit the usage of pain modulators in certain patient populations, like the elderly or those with multiple comorbidities.
Botulinum Toxin Injection
In one recent study, botulinum toxin was administered by pyloric injection to 11 patients who had refractory GERD associated with gastroparesis.[85] There was marked improvement in GERD-related symptoms, which correlated with improvements in gastroparesis-related symptoms and in gastric-emptying as assessed by scintigraphy. The mean duration of response is approximately 5 months.[86]
Antireflux Surgery
A recent surgical study reported that refractory GERD was the most common (88%) indication for antireflux surgery.[87] Interestingly, the most common preoperative symptom reported under failure of medical antireflux treatment was regurgitation (54%). Overall, 82% of patients reported that the preoperative reflux symptom completely resolved, and 94% were satisfied with the results of the surgery. In another study that included only 30 patients with refractory GERD who were followed for a period of 12 months, the main preoperative symptoms were regurgitation (93%) and heartburn (60%). At the end of 1 year follow-up after surgery, all patients reported complete heartburn relief and 86% reported resolution of the regurgitation symptom. Patients' satisfaction rate with surgery was 87%.
Three recent studies have suggested that a positive symptom index during impedance-pH monitoring in patients with PPI-refractory GERD (on therapy) can predict a favorable response to medical or surgical therapy. The first study by Mainie et al.[88] followed 19 patients who were refractory to double-dose PPI and underwent a successful laparoscopic Nissen fundoplication. Prior to surgery, 18 of the 19 patients were found to have a positive symptom index on MII-pH monitoring (14 with nonacid and 4 with acid reflux). After a mean follow-up of 14 months, 16 of the patients with a positive symptom index were asymptomatic. The second study by Becker et al.[89] assessed 56 patients with persistent symptoms on a single dose of PPI and abnormal MII-pH monitoring. Most of these patients had a positive symptom index, and later demonstrated a significantly higher response rate to doubling the PPI dose compared to patients with normal MII-pH monitoring results. In a third study, a group of Italian investigators prospectively assessed the outcomes of laparoscopic Nissen fundoplication in 62 patients who were PPI-nonresponsive or noncompliant.[90] All surgically treated patients had a positive MII-pH monitoring result. The overall patient satisfaction rate was 98.3%, and no differences were found in clinical outcomes based on preoperative MII-pH or manometry results. It was concluded that MII-pH provide useful information for better selection of patients for antireflux surgery and that laparoscopic Nissen fundoplication results in excellent outcomes primarily in patients with positive MII-pH monitoring or symptom index. Unfortunately, all the aforementioned studies were uncontrolled and did not clearly describe whether symptoms were due to residual reflux.
The value of acupuncture has been evaluated in GERD patients who failed PPI once daily. When compared to doubling the PPI dose, adding acupuncture was significantly better in controlling regurgitation as well as daytime and night-time heartburn. This is the first study to suggest that alternative approaches for treating visceral pain may have a role in GERD patients with PPI-refractory heartburn.[91]
Psychological Treatment
Patients with poor correlation of symptoms and acid reflux events display a higher level of anxiety and hysteria than those who have a close correlation between symptoms and acid-reflux.[92] Anxiety and depression have been shown to increase GERD-related symptoms report in population-based studies. Nojkov et al.[93] provided the first evidence that response to PPI treatment may be dependent on the level of psychological distress. Thus, it has been proposed that patients who do not respond to PPIs are more likely to have a psychological comorbidity than those who respond. In those patients, treatment directed toward the underlying psychosocial abnormality might improve the response to PPI therapy.
Curr Opin Gastroenterol. 2010;26(4):367-378. © 2010 Lippincott Williams & Wilkins
The Neuroenteric Clinical Research Group, Southern Arizona VA Healthcare System and University of Arizona, Tucson, Arizona, USA
Correspondence to Ronnie Fass, MD, Professor of Medicine, University of Arizona, Chief of Gastroenterology, Head, the Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, GI Section (1-111-GI) 3601 S. 6th Avenue, Tucson, AZ 85723-0001, USA Tel: +1 520 792 1450 x5139; fax: +1 520 629 4737; e-mail: Ronnie.Fass@va.gov
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Alexandros Anagnostopoulos is a male goalkeeper from Greece, who has been playing for Aris Thessaloniki FC in Greece since July 27, 2016. Having been born in 1994, on August 18, Alexandros Anagnostopoulos's age of 24 makes him junior to the average player of Aris Thessaloniki FC. He had but one match appearance this season. The club of Alexandros Anagnostopoulos, Aris Thessaloniki FC, presently holds fifth position in Super League (Greece) and third position in group Gr. 4 of Greece Cup (Greece).
Measuring 185cm, Aris Thessaloniki FC's average player height surpasses Alexandros Anagnostopoulos by 6cm. Stunning 76% of Aris Thessaloniki FC's football players are right footers and so is Alexandros Anagnostopoulos. At 176.37lb, he carries 12lb more than the average Aris Thessaloniki FC player. Altogether, he was substituted in 2 times and out not once. Currently, he entered the pit more than he left it which holds true for last season as well. Alexandros Anagnostopoulos's shortest stay in a club was 17 months in Panathinaikos Athens (Greece).
He played for Panathinaikos Athens before ending up in Aris Thessaloniki FC. Besides Alexandros Anagnostopoulos, there are two more goalkeepers in Aris Thessaloniki FC's lot: Julian Cuesta and Giorgos Kantimoiris. Aris Thessaloniki FC's jersey number 1 is Alexandros Anagnostopoulos. Throughout his time as professional football player, he was not once sanctioned with a card. His longest stay in a team counts two years and 10 months in his current club. In terms of winning, Alexandros Anagnostopoulos's team was able to do so in 50% of Super League's and in 33% of Greece Cup's matches. Ereyesterday he played his latest match.


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Vote for your favourite theme song and watch colourful butterflies: Things to do this week
SPREAD your wings this week – watching colourful butterflies, singing along to Beatles musical Let It Be and voting for your favourite theme song.
By Kirsten Jones
PUBLISHED: 00:01, Fri, Jan 8, 2016 | UPDATED: 10:34, Fri, Jan 8, 2016
London's Canary Wharf is to be transformed into an illuminations wonderland
The Sunday Express and Classic FM have teamed up to launch the first ever Classic FM TV Top 20. You're invited to vote for one of 50 popular themes from Downton Abbey to Fawlty Towers. Voting is open from now until 11.59pm on January 31.
Find the results in S Magazine next month and listen to the top 10 countdown with John Suchet every day from Monday 15 to Friday February 19 from 9am on Classic FM. John says, "At Classic FM, we are thrilled to celebrate this music. I can't wait to hear which theme will be crowned the number one." Classic FM is available across the UK on 100-102 FM, digital radio, at classicfm.com and on the Classic FM app.
Voters should go online to classicfm.com and register their details Online. Entrants must complete the required details and click on the "Submit" button. entry will be open until 23.59 on Sunday January 31, 2016. Postal votes will be open until and including Saturday January 30 SEND ENTRIES TO THE CLASSIC FM TV TOP 20, 30 leicester sq. london wc2h 7la.
A theme must be submitted by selecting a choice from the pre-selected list. Voting is open only to residents of the UK and Northern Ireland aged 18 years of age or over. Entry is restricted to one entry per person. duplicate entries will be excluded from the competition. The Promoter is Global Radio Services Ltd, 30 Leicester Square, London WC2H 7LA.
Let there be light! London's Canary Wharf is to be transformed into an illuminations wonderland, with structures from an 18-foot alien to a flutter of butterflies and a digital waterfall. The Winter Lights Festival 2016 opens tomorrow, bringing illuminated sculptures, designs and experiences to the riverside district.
It's free and will be lighting up until January 22. For information, see canarywharf.com.
Get the butterfly effect at RHS Garden Wisley, near Woking
Get the butterfly effect at RHS Garden Wisley, near Woking, exploring the wild and wonderful Butterflies in the Glasshouse. From 16th January until Sunday March 6, the Glasshouse will see hundreds of exotic butterflies released into its "jungle" of tree ferns, tall palms and dazzling flowers.
See how they feed, learn about their life cycles and watch as wings unfurl to form the striking blue morpho, king swallowtail and Malay lacewing. Activities this weekend include face painting and butterfly sculptures. Visit rhs.org.uk/gardens/wisley.
Prepare to be transported back to the Swinging Sixties, the peak of Beatlemania. Following rave reviews for its London run, Let It Be is about to embark on its biggest-ever tour, celebrating the music and the lives of the world's most successful band.
The tour opens at the Cliffs Pavilion in Southend tomorrow, playing at theatres in England, Ireland, Scotland and Wales until July 23. For tickets and show dates, visit letitbelive.com.
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Home News Vineyard man in critical condition after fall from car roof
Vineyard man in critical condition after fall from car roof
A 21-year-old Vineyard man is in critical condition after he fell from a car roof in Edgartown. Edgartown Police were called to the intersection of Hotchkiss Lane and Meeting House Way at just after 5 pm Sunday and found a man in the road, according to Edgartown Police Chief Bruce McNamee. Police officers rendered first aid to the man until an EMS team arrived, McNamee said.
The man was reportedly picked up from a beach by two juvenile females in a Volkswagen Passat. At some point while the car was underway, the man climbed out of the car and onto its roof. The female operator reportedly yelled at him to get back inside and decelerated, McNamee said, whereupon the man slid or fell off the car. He was taken to Martha's Vineyard Hospital and then airlifted to Massachusetts General Hospital, where he's in critical condition with a head injury as of Monday evening, McNamee said. Conflicting statements point to the possibility he also partially struck a telephone pole, McNamee said.
Police have charged the driver with a junior operator violation (transporting passengers) and negligent operation of a motor vehicle.
Edgartown Police are working with Massachusetts State Police on the incident, McNamee noted.
The name of the injured man hasn't been disclosed, nor have the name of the operator or the other passenger.
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MANCHESTER UNITED midfielder Andreas Pereira has been called up to the Brazil squad for the first time.
There was no space in the 24-man group though for any Brazilian players playing at rivals Manchester City as Gabriel Jesus, Fernandinho, Danilo and Ederson were all dropped.
Pereira, 22, starred in United's first Premier League game of the season against Leicester and has been used regularly by boss Jose Mourinho in pre-season.
The United academy star is joined by new signing Fred, who also started the 2-1 win over the Foxes.
Brazil head coach Tite named the squad for the upcoming friendlies against United States and El Salvador in the US next month, and he has omitted eight of his World Cup stars, including Marcelo and Paulinho.
The five-time world champions disappointed at this summer's tournament in Russia as they were dumped out at the quarter-final stage by Belgium.
Tite says he wants to give opportunities to new young players ahead of next year's Copa America, which will be played in Brazil, and gives six players their first senior call-ups.
Pereira spent the last two years on loan in Spain, first at Granada and then at Valencia last season.
The midfielder said recently that the time away has been pivotal for his career.
"I learned a lot of things being on my own, I lived on my own there, and it's different than living over here," he told Sky Sports.
"I'm more professional now, I know what my body needs every day, I'm more mature now than I was two years ago.
A trio of Liverpool players have also made the squad, with new boys Alisson and Fabinho joined by forward Roberto Firmino.
Chelsea winger Willian is the only other Premier League-based player to be included.