text:
Public Health Agency of Canada
Public Health Agency of Canada reports and publications
Canada Communicable Disease report (CCDR), CCDR 49
2022 Volume 48 - Canada Communicable Disease Report (CCDR)
CCDR: Volume 48-4, April 2022: First Nations Health, CCDR 48
COVID-19 outbreak in Saskatchewan
Download this article as a PDF
Published by: The Public Health Agency of Canada
Issue: Volume 48-4, April 2022: First Nations Health
Date published: April 2022
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Volume 48-4, April 2022: First Nations Health
Multijurisdictional outbreak of COVID-19 associated with a wake/funeral event in a northern Saskatchewan First Nations community
Nnamdi Ndubuka1, Sabyasachi Gupta1, Rim Zayed2, Brian Quinn2, Moliehi Khaketla2, Elaine Chan3, Kristyn Franklin4, Erin McGill4
1 Northern Inter-Tribal Health Authority Inc., Prince Albert, SK
2 Saskatchewan Health Authority, La Ronge, SK
3 Alberta Health (Public Health Officer placement), Edmonton, AB
4 Public Health Agency of Canada, Ottawa, ON
erin.mcgill@phac-aspc.gc.ca
Ndubuka N, Gupta S, Zayed R, Quinn B, Khaketla M, Chan E, Franklin K, McGill E. Multijurisdictional outbreak of COVID-19 associated with a wake/funeral event in a northern Saskatchewan First Nations community. Can Commun Dis Rep 2022;48(4):140–5. https://doi.org/10.14745/ccdr.v48i04a04
Keywords: COVID-19, SARS-CoV-2, outbreak, Indigenous community, mass gathering, funeral
Background: Sixty-eight laboratory-confirmed cases of the coronavirus disease 2019 (COVID-19) (12 in Alberta [AB], 56 in Saskatchewan [SK]) were linked to a gathering at a hospital in Alberta on June 1–4, 2020, and a wake/funeral in a First Nations community in northern Saskatchewan on June 9–11, 2020.
Objective: The objectives were to provide a comprehensive description of the epidemiology of the outbreak and describe the chains of transmission to inform the hypothesis that there were multiple introductions of COVID-19 at the wake/funeral.
Methods: Case investigation and contact tracing was conducted by local public health in AB and SK. The Public Health Agency of Canada conducted a centralized case analysis. An epidemic curve and a Gantt chart for period of communicability were created to support or refute whether there had been multiple introductions of COVID-19 at the wake/funeral.
Results: Illness onset dates ranged from May 31 to July 1, 2020. Ages ranged from 2 to 80 years (median age=43 years). Five cases were hospitalized; there were no deaths. The available case exposure information supports the hypothesis that there had been multiple introductions of COVID-19 at the wake/funeral. Public health authorities in AB and SK declared the outbreak over on July 20, 2020; based on two incubation periods (i.e. 28 days) following the illness onset of the last primary case.
Conclusion: During multijurisdictional outbreaks, data sharing, coordination across health authorities and centralized analysis is essential to understanding the events that lead to the outbreak and possible hypotheses around chains of transmission.
An outbreak of coronavirus disease 2019 (COVID-19) occurred in two Indigenous communities in northern Alberta (AB) and northern Saskatchewan (SK) in 2020. Sixteen individuals from AB and SK, including the index case (SK), visited a hospital in Edmonton, AB, on June 1–4. Nine of these individuals later travelled to an Indigenous community in northern Saskatchewan for a wake/funeral that was held on June 9–11. A large number of people attended the wake/funeral, including individuals from Indigenous communities in northern AB, where the deceased resided (whose death was unrelated to COVID-19). The index case and a household member hosted the wake indoors at their home on June 9–10. Public health measures, including physical distancing and masking, were not strictly observed at all times. The funeral ceremony took place in a church on June 11; 140 people attended these events.
The events on June 9–11 are refer to as "wake/funeral" because transmission and acquisition potentially occurred at either of these closely connected occasions and the investigation could not discern which of the 140 attendees came to which of the two events.
The objective of this report is to comprehensively describe the epidemiology of this COVID-19 outbreak using all cases and to describe the chains of transmission. It is important to highlight the value of collaborative interjurisdictional investigations in outbreaks; data sharing across jurisdictions can reveal associations that might not be uncovered during separate investigations.
Rapid point-of-care (POC) and polymerase chain reaction (PCR) testing are available to members of the northern Indigenous communities. Sufficient test kits are supplied to initiate testing for close contacts and exposed people, as the communities are remote. Samples are sent to the SK provincial laboratory for confirmation.
Saskatchewan public health was first alerted to an emerging outbreak when the index case was hospitalized on June 11, 2020. The individual was tested by rapid POC test on June 7, and the positive PCR test occurred on June 12. Saskatchewan public health launched its investigation and began contact tracing on June 11.
On June 11, Northern Inter-Tribal Health Authority (NITHA) public health in SK declared an outbreak of COVID-19 and launched an investigation. NITHA declared the outbreak over on July 20, 2020, based on two incubation periods (i.e. 28 days) following the illness onset of the last primary case.
The definitions used during this outbreak investigation and in this report are as shown in Table 1.
Table 1: Definitions used in this COVID-19 outbreak investigation
Primary outbreak case
Confirmed or probable case (as per provincial/territorial surveillance case definitions)
AND epidemiologically linked to event:
For symptomatic individuals: exposure to the outbreak setting/site during their incubation period
For asymptomatic individuals: exposure to outbreak setting/site in the 14 days prior to their positive specimen collection date
Secondary outbreak case
AND epidemiologically linked to primary outbreak case
AND no exposure to the outbreak setting/site during their incubation period or 14 days prior to their positive specimen collection date
Outbreak setting/siteTable 1 footnote a
The hospital in AB
OR the wake and the funeral in SK
Close contactTable 1 footnote b A person who had direct contact with a primary or secondary outbreak case during the case's period of communicability because they
Lived with or otherwise had close prolonged contact with a case (i.e. for more than 15 minutes and within 2 metres)
OR had direct contact with infectious body fluids of a case (e.g. was coughed or sneezed on or through contaminated surfaces)
Incubation period Up to 14 days from exposure to onset of symptoms. The maximum incubation period of 14 days is used as a proxy for the likely exposure period
Period of communicability For symptomatic individuals: 2 days prior to onset of symptoms and 10 days post onset of symptoms or symptom resolution, whichever is longer
For asymptomatic individuals: 2 days prior to specimen collection date and 10 days post specimen collection date
Table 1 footnote
Table 1 - abbreviation
Abbreviations: AB, Alberta; SK, Saskatchewan
Table 1 footnote a
A primary outbreak case was present at least one of these sites (hospital, wake/funeral), and a secondary outbreak case was someone who was not present at any of these sites
Return to first Table 1 footnote a referrer
Table 1 footnote b
For the purpose of this investigation, all wake/funeral attendees were considered close contacts, as they were present for 15 minutes or longer. Individuals who were present for less than 15 minutes and wore masks were not considered close contacts
Return to first Table 1 footnote b referrer
The AB, SK and the Public Health Agency of Canada (PHAC) collaborated on the minimum set of data elements required to provide an epidemiological description of cases and describe the chains of transmission. Case-level line lists were shared with PHAC for centralized analysis. Data were received for 68 PCR-confirmed cases.
Case investigation and contact tracing was conducted by public health nurses and trained case investigators from AB and SK using the standard COVID-19 case report form agreed upon by all provinces/territories in Canada. Most of the interviews were conducted in-person because reaching individuals by phone was difficult. Local Indigenous outreach workers helped with translation as needed. Community leaders, including the First Nations Chief and Council, worked closely with Indigenous Services Canada, Alberta Health, NITHA and Saskatchewan Health Authority throughout the investigation.
Alberta public health laboratory genetically sequenced the isolates and found the SARS-CoV-2 lineage to be identical for them all. Centralized genomic analysis comparing AB and SK isolates was not completed.
Epidemiologic and statistical analyses
Case demographics, including age, sex and severity of illness, were summarized. An epidemic curve was generated based on illness onset date (or earliest date based on the date sequence: onset date, specimen collection date and positive laboratory test result date).
A Gantt chart with the cases' periods of communicability was overlaid with exposure information. As specific linkages between cases based on case identifier were not available, it was not possible to produce a social network analysis.
Because the exposure information did not include date of attendance at the wake and funeral, we assumed that cases were present on all three days (June 9–11). Travel dates were not available; the assumption that AB cases were in SK on June 8–11 is based on information from AB.
The First Nations community in northern SK imposed travel restrictions that permitted essential travel only. Curfew was in effect from 11 p.m. to 7 a.m. daily, and groceries and essential supplies were delivered to minimize travel. Local public health issued a precautionary health advisory, as the attendance list for these events were not available. Anyone in attendance at an outbreak setting/site was advised to immediately self-isolate and self-monitor for symptoms of COVID-19 for 14 days and to call community health centre for evaluation and direction. Local radio broadcast key messages translated into the local language. Local radio and social media promoted public health strategies, such as the use of nonmedical face masks, physical distancing, personal hygiene measures and participating in responsible gatherings.
NITHA and the Saskatchewan Health Authority established rapid POC and PCR door-to-door and drive-through testing options. Isolation trailers were made available to ensure adherence to isolation requirements. Public health detention orders and warning letters were issued to individuals not complying with the self-isolation requirement.
Contact tracing and mass testing were also conducted in the First Nations community in northern AB. Accommodations for isolation/quarantine were made available for individuals returning to AB from SK following the wake/funeral.
Investigation findings
Descriptive epidemiology
There were three settings where transmission may have occurred. The first setting was the hospital visit in AB (June 1–4); of the 16 visitors, 9 (AB=7, SK=2) later tested positive for COVID-19. Of the 9 hospital visitors who tested positive, 8 attended the wake and funeral.
The second and third settings were the wake/funeral in the northern Saskatchewan First Nations community (June 9–11). Of the 140 attendees, 44 (AB=11, SK=33) later tested positive, an attack rate of 31%.
In total, 68 PCR-confirmed cases of COVID-19, including secondary cases (AB=12, SK=56), were identified as part of this outbreak (Figure 1 and Table 2). A large proportion of cases (38%) remained asymptomatic throughout their period of communicability.
Figure 1: Epidemic curve of laboratory-confirmed SARS-CoV-2 cases by episode dateFigure 1 footnote a from two northern Indigenous communities linked to a wake/funeral in northern Saskatchewan, May 31 to July 20, 2020 (N=68)
Text description: Figure 1
The graph shows the number of laboratory-confirmed COVID-19 cases linked to the wake/funeral outbreak from May 31 to July 20, 2020. Following the hospital visits between June 1–4, 2020, the number of cases increased until June 15, 2020, with case counts ranging from one to eleven. The majority of primary cases were identified between May 31 and June 16, 2020. Case counts decreased after June 15, 2020, and the outbreak was declared over on July 20, 2020.
Figure 1 footnote
Figure 1 footnote a
Based on date sequence (illness onset date, positive specimen collection date or date of first positive test result)
Return to first Figure 1 footnote a referrer
Table 2: Characteristics of SARS-CoV-2 cases included in the outbreak investigation from two northern Indigenous communities linked to a wake/funeral in northern Saskatchewan, May 31 to July 20, 2020 (N=68)
Breakdown by case status Primary, n 45 (AB=12, SK=33)
Secondary, n 23 (SK)
Episode dates Earliest date (illness onset, positive specimen collection date or date of first positive test result) May 31–July 1, 2020
Demographics Median age, years (range) 43 (range: 2–80)
Female gender, n (%) 34/68 (50%)
Asymptomatic casesTable 1 footnote a Cases that never developed symptoms, n 26/68 (38%)
Case severity Hospitalizations, n (% cases hospitalized) 5 (7%)
ICU admissions, n (% hospitalizations admitted to ICU) 1 (20%)
Deaths, n 0
Abbreviations: AB, Alberta; ICU, intensive care unit; SK, Saskatchewan
Cases remained asymptomatic throughout their entire period of communicability
Ancillary analyses
The first transmission likely occurred in the hospital in AB. Nine cases (AB=7, SK=2) reported visiting the deceased (non-COVID-19-related death) in the hospital in AB between June 1 and June 4. During the visit, three of the cases were within their period of communicability and two were symptomatic (Figure 2). The two SK cases stayed together at a hotel in AB; one was the index case from SK. Seven of the AB cases reported close contact with the two individuals from SK.
Figure 2: Gantt chart of the period of communicability for all SARS-CoV-2 outbreak cases from two northern Indigenous communities linked to a wake/funeral in northern Saskatchewan, May 31 to July 20, 2020 (N=68)
The Gantt chart illustrates cases, their case status and event attendance, over time (May 31-July 20, 2020). Attendance for the hospital and wake/funeral exposure events is noted for each case. The cases' exposure period, period of communicability and the overlap between likely period of exposure and period of communicability are denoted by colours and hatching. The figure shows the wave of cases that ensued following these transmission events and how inclusion of the hospital event is imperative to explaining the likely period of exposure among secondary cases.
On June 8, 12 AB cases travelled to SK for the wake/funeral in a convoy of six vehicles. Only one AB case (AB-4) did not attend any of the events in SK, because that person was ill, likely with COVID-19; however, that case was not tested until June 14.
The second and third most likely transmission settings were the wake/funeral in SK. Forty-four cases attended the wake/funeral and 26 were in their period of communicability (Figure 2). These 26 individuals may have all potentially infected others with COVID-19. Based on onset date, 9 individuals (AB=5, SK=4) may have been symptomatic during the wake/funeral; 5 had visited the hospital (Figure 2).
There were 23 secondary cases who reported close contact with a known case linked to one of the outbreak settings, although they were not present themselves.
Five cases were hospitalized and one was admitted to the intensive care unit (ICU). No deaths were associated with this outbreak (Table 2).
Key results
The centralized analysis suggested that the hospital visit in AB was critical to transmission, as three individuals were in their period of communicability during the visit and close contact occurred between the AB and SK visitors. Furthermore, if the hospital event was excluded, a subset of the secondary outbreak cases identified could not be explained based on the likely period of exposure (the maximum incubation period of 14 days is used as a proxy for the likely exposure period) and the period of communicability for COVID-19Footnote 1.
The data supported the hypothesis of multiple introductions of COVID-19 at the wake/funeral. There were 26 individuals in their period of communicability and 9 may have been symptomatic based on onset date.
A large proportion of the cases remained asymptomatic throughout their period of communicability (38%). Also, a notable proportion of cases were asymptomatic when tested (n=16/68; 24%) but developed symptoms later, indicative of a rapid outbreak response.
In Canada, there has been media coverage of COVID-19 outbreaks linked to funerals/memorial services and other mass gathering eventsFootnote 2Footnote 3Footnote 4.
South Africa reported that physical distancing (or "social distancing") guidelines are not always observed in many parts of the country, especially during funeralsFootnote 5. In the Eastern Cape Province, 80% of all cases were linked to burial ceremoniesFootnote 3. Cultural practices during burial ceremonies and lack of adherence to physical distancing protocols present an opportunity for transmissionFootnote 5. Jaja et al. recommend that, in order to reduce spread of COVID-19, religious and cultural activities should be restricted and only immediate family members be allowed to bury their loved onesFootnote 5.
Early in the pandemic, the United States identified a multifamily cluster linked to gatherings, including a funeralFootnote 6. An individual with mild respiratory symptoms, later confirmed as a case, attended the funeral and a meal with family members of the deceasedFootnote 6. The index case transmitted their infection to 10 other people, none of whom were household contactsFootnote 6. This funeral cluster occurred before physical distancing policies were implemented, and they support the recommendations to avoid gatherings and illustrate the importance of physical distancingFootnote 6.
Outbreak response
Outbreak response was timely; the outbreak was identified and the investigation launched on June 11, the day of the funeral. Public health employed multiple interventions, including imposing a curfew and travel restrictions to reduce the spread of COVID-19, both within the community and to surrounding communities, and supported the residents by bringing essential supplies into the community. The public health interventions were widely accessible—door-to-door or drive-through testing, messaging in the local languages and provision of isolation accommodations.
NITHA and Saskatchewan Health Authority have always benefited from a strong collaborative working relationship, and the organizations meet regularly to share information and discuss public health measures. Partnership with the Ministry of Health in Saskatchewan and PHAC, to coordinate with the Ministry of Health in Alberta, resulted in agreement on outbreak management, response and communication. Local, trusted or Indigenous nurses led the interviews and door-to-door initiatives to increase community uptake.
The investigation faced many challenges: the multijurisdictional nature of the outbreak, barriers to gathering data and contextual issues specific to the population.
Multiple public health organizations with different jurisdictions, including Indigenous population health needed to be involved to take into account that the cases lived in various geographic and administrative regions in two provinces. This required significant coordination. The pandemic response had put a strain on public health resources, making it difficult to find a convenient time for outbreak investigation partners to convene.
The lack of an attendance list for the wake/funeral made it difficult to notify individuals of their potential exposure. This has informed subsequent recommendations that event organizers maintain attendee lists for contact tracing.
There are many sensitivities related with sharing information between provinces and publicly about the affected Indigenous people. Trust issues remain between cases and investigators, including fear of stigma and/or discrimination, which made it difficult to obtain an accurate history. The transience of many community members added another layer of complexity. There were also cases who refused to isolate.
The investigation focused on forward contact tracing, and the role the hospital visits may have played in transmission was only identified during the centralized retrospective analysis. The subsequent outbreak investigation highlighted the value of backwards contact tracingFootnote 7.
The retrospective centralized analysis supported the hypothesis that there were multiple introductions of COVID-19 at the wake/funeral. As many as 26 attendees were in their period of communicability; 9 may have been symptomatic based on onset date at the time of the event. Public health measures including masking and physical distancing were not strictly adhered to during the wake, although people who dropped in to pay their respects at the funeral did wear masks (none of whom were cases). The attack rate for the wake/funeral was 31% (44/140), which emphasizes the importance of protective measures at gatherings. The outbreak investigation also illustrated the importance of centralized analysis for multijurisdictional outbreaks. Information sharing is essential when gathering the details required to understand the events leading up to an outbreak and the hypotheses around chains of transmission.
Authors' statement
NM — Investigation, conceptualization, supervision, validation, writing–review & editing
SG — Investigation, conceptualization, data curation, validation, writing–review & editing
RZ — Investigation, conceptualization, data curation, validation, writing–review & editing
BQ — Investigation, conceptualization, validation, writing–review & editing
MK — Investigation, conceptualization, validation, writing–review & editing
EC — Investigation, conceptualization, data curation, validation, writing–review & editing
KF — Supervision, conceptualization, validation, writing–review & editing
EM — Conceptualization, formal analysis, visualization, writing–original draft, writing–review & editing
The authors gratefully acknowledge Northern Inter-Tribal Health Authority, Saskatchewan Health Authority and partner communities and colleagues from Alberta for their cooperation and contribution to this article.
The outbreak investigation did not receive research funding.
Coronavirus disease (COVID-19): summary of assumptions [Internet]. Ottawa (ON): Government of Canada; 2020-04-14 (accessed 2020-07-19). https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/assumptions.html
Mercer G. How a funeral home in Newfoundland became the source of a major coronavirus outbreak. The Globe and Mail (Halifax Ed.). 2020-03-27 (accessed 2022-01-12). https://www.theglobeandmail.com/canada/article-how-a-funeral-home-in-newfoundland-became-the-source-of-a-major/
Herring J. COVID-19 outbreak could be linked to Hutterite funeral: Alberta Health. Calgary Herald. 2020-07-03 (accessed 2022-01-11). https://calgaryherald.com/news/covid-19-outbreak-could-be-linked-to-hutterite-funeral-alberta-health-says
Watson B. Thousands of attendees at Vancouver dental conference told to self-isolate immediately. CBC (British Columbia). 2020-03-16 (accessed 2022-01-12). https://www.cbc.ca/news/canada/british-columbia/pacific-dental-conference-attendees-exposed-covid19-1.5499437
Jaja IF, Anyanwu MU, Iwu-Jaja CJ. Social distancing: how religion, culture and burial ceremony undermine the effort to curb COVID-19 in South Africa. Emerg Microbes Infect 2020;9(1):1077–9. https://doi.org/10.1080/22221751.2020.1769501
Ghinai I, Woods S, Ritger KA, McPherson TD, Black SR, Sparrow L, Fricchione MJ, Kerins JL, Pacilli M, Ruestow PS, Arwady MA, Beavers SF, Payne DC, Kirking HL, Layden JE. Community transmission of SARS-CoV-2 at two family gatherings — Chicago, Illinois, February–March 2020. MMWR Morb Mortal Wkly Rep 2020;69(15):446–50. https://doi.org/10.15585/mmwr.mm6915e1
Endo A, Leclerc QJ, Knight GM, Medley GF, Atkins KE, Funk S, Kucharski AJ; Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group. Implication of backward contact tracing in the presence of overdispersed transmission in COVID-19 outbreaks. Wellcome Open Res 2021;5:239. https://doi.org/10.12688/wellcomeopenres.16344.1


text:
Emotions as a Tool to Persuade People to Get Vaccinated
INSTEAD OF OVERDOING CONFUSION INDUCING TECHNICAL DETAILS, A STUDY BY MARIA CUCCINIELLO AND COAUTHORS EMPHASIZES THE USEFULNESS OF MORE EMOTIONALLY CENTERED COMMUNICATION
Amid the current talk about the necessity of a new vaccination campaign, it becomes even more important to reach out to all segments of the population. Communication targeting even the most doubtful about the need of getting vaccinated can focus on three elements of persuasion, all three played on the emotional front. What about messages full of information and scientific details? They are less effective. Instead, the most convincing elements to be conveyed are those that recall personal experiences of vulnerability and dependence, that invite to follow the social rules centered on cooperation among citizens, with a view to herd immunity, and third, finally, that put the emphasis on the presence of vulnerable individuals that need to be protected in the different environments that people inhabit every day.
Moreover, "campaigns with lots of details tend to confuse and reduce the understanding of the information received. On the other hand, a more emotional but also more fluid, simplified and brief communication style can achieve higher rates of public retention," in the words of Maria Cucciniello, associate professor at the Department of Social and Political Sciences at Bocconi University, who wrote Altruism and Vaccination Intentions: Evidence from Behavioral Experiments, together with Alessia Melegaro (Department of Social and Political Sciences, Bocconi) and with Paolo Pin (Bocconi Institute for Data Science and Analytics), Blanka Imre (Department of Economics, Bocconi), Gregory A. Porumbescu (School of Public Affairs and Administration at Rutgers University, Newark, USA).
The fieldwork, carried out in the pre-Covid period, was conducted in the laboratory through an experiment based on a game logic and on a sample of university students. In parallel, also in 2018, a similar research was carried out but with parents of children under 5 years of age. In addition, a survey was conducted in 2021 in various countries (Italy, USA and UK) not only to consider the full impact of the pandemic but also using a representative sample of the population, by age, gender and education, equally divided between vaccinated and unvaccinated individuals. However, already in the earlier paper, "the importance of both the kind of the content used and the communication format chosen emerges. And it is precisely from its relevance that we deduce how a way of communicating that is too objective and thick with detailed data and information can have a counterproductive effect," Cucciniello concludes.
by Camillo Papini
Alessia Melegaro
alessia.melegaro@unibocconi.it
Maria Cucciniello
maria.cucciniello@unibocconi.it
Bocconi Institute for Data Science and Analytics

redpajama_set_name: RedPajamaCommonCrawl


The above link opens on computer but cannot be opened on mobile at the moment. Please email membership@feltmakersireland.com or hello@feltmakersireland.com if you have queries or problems. Thank you.
Please note that professional felt makers who are current paid-up members can now request that their workshop or event be advertised on our main website under "Learn". We would ask you to complete an interview also with a link to your workshop to further enrich the community.


The Baking Industry Awards recognise the very best across our wide spanning industry and the Baker of the Year category represents the highest accolade in these awards. Winning this award presents a baker at the top of their game, a hands on baker whether it be an owner of their own bakery business or as a key player within an organisation. Sponsoring this award for the 6th consecutive year is a great privilege and judging entrants from across our industry who all have so much passion, knowledge and dedication to the craft of baking is a pleasure.
Now in our 25th anniversary year, here at Brook we are ourselves passionate about the bakery industry. Despite our day to day business being supplying equipment to bakeries of all sizes, we work with new start businesses and micro bakeries as well as industrial plants, we are also enthusiastic about bakery trends, products and the future of the sector. Being involved with the awards allows us to meet other like minded people who want the best for our industry and recognise the great talents we have across bakeries in the UK.
The Baker of the Year category is about the individual, despite scrutinising within the bakery environment, the award recognises the skills, dedication and achievements of the baker. Winning this award means the baker shows their sparkle; their great abilities to understand their products, their customers and exhibit the wow factor in whatever form that may take. There is no other category across UK bakery award ceremonies that looks for the best of the best and in this process we judge entrants who put themselves up for the highest recognition possible and we would encourage anyone who feels they have what it takes to put themselves forward for this tremendous accolade.


Which of Two Job Opportunities Should I Choose?
This post is inspired by a follow-up question from LearningSoulSite, who asks The Council which of two job opportunities in India will be better for her. One is for a startup IT company in the city where she is already located, and one is for a large IT company that wants her to move to Pune, India, which is a new city for her. LearningSoulSite says she doesn't want to put herself in a more challenging situation than she's already in.
The Council says LearningSoulSite has very cleverly created both of these job opportunities. They say the job that would require her to move is what's wanted by her higher self. It will bring new opportunities, a new city, new friends, and to begin her life again.
They also say there's no right or wrong answer here. If she's in a place where she desires the security of remaining in the city where she currently is, this is fine. You will grow with this company.
If you choose the job opportunity that takes you to Pune and out of your familiar feeling and environment, you will be forced to grow and find new friends. If you feel you're ready for this, that is the way to go.
The decision is yours. Whichever company you agree on, you will start your new life. The one that asks you to move is a giant jump in this reality; it is a lesson in trusting and believing in yourself. The other job opportunity that doesn't require so much change, you will also grow there, but at a slower pace. Both companies will take you in the direction you need to go.
Listen to our entire 5-minute session with The Council (below) to hear all their guidance for LearningSoulSite, and let us know what you think.
Which is a better job opportunity?
Getting Along Better With My Husband and In-laws?
This post is a follow up that was inspired by some additional questions from a reader named Vacha, whose question about guilt over terminating a pregnancy we recently answered. Now Vacha is asking about moving back to India where her parents live, and how to get along better with her husband and in-laws.
The Council understands that Vacha has issues with her in-laws in India and they recommend putting the move on hold for now. Vacha has issues with her husband, things to discover within this relationship, and things to teach her son while she's with her husband. If she's able to work out her issues with her husband before this move back to India, she'll be able to work out the issues with her in-laws when this move eventually takes place.
Watch what's going on in the relationship with her husband and see each problem in the light of what it's trying to teach both of them.
The Council reminds Vacha it's not her place to have her family get along. Her purpose is to see what's happening, change the way she handles each situation, see things the way she wants it to be from a place of love, and everything will change. Her parents, her in-laws, and her husband will all change because they're around her and she's creating a new reality with her mind, her words, and her feelings.
Vacha asks The Council what spiritual lesson she's learning with regard to her husband, mother-in-law, and other family members? And The Council says her purpose is to take difficult situations and bring love into them.
Vacha has a powerful mind if she chooses to use it. She can use her thoughts and feelings to create what she desires. The Council recommends spending a lot of time seeing herself with her son and husband in happy and successful situations.
Vacha wants to understand other people's feelings and fears, and help these people move through them. She should watch the people around her and she'll begin to see what they need and what causes the difficulty in her relationships with them.
Listen to our entire session with The Council (below) to hear all their guidance for Vacha and the rest of us.
What is my spiritual lesson learning with my husband and other family members?
What can I do to make relationships with my family better?


text:
{-# LANGUAGE TemplateHaskell #-}

module Test.Pos.Chain.Block.Slog.LastBlkSlots
       ( tests
       ) where

import           Universum

import           Data.ByteString (ByteString)
import qualified Data.List as List

import           Hedgehog (Gen, Property, discover, (===))
import qualified Hedgehog as H
import qualified Hedgehog.Gen as Gen
import qualified Hedgehog.Range as Range

import           Pos.Chain.Block.Slog.LastBlkSlots (LastBlkSlots,
                     LastSlotInfo (..))
import qualified Pos.Chain.Block.Slog.LastBlkSlots as LastBlkSlots
import           Pos.Core (AddressHash, unsafeAddressHash)
import           Pos.Core.Chrono (OldestFirst (..))
import           Pos.Crypto (PublicKey (..))

-- Need a small number of public keys, and for tests, they don't have be proper
-- public keys.
genPublicKeyAddressHash :: Gen (AddressHash PublicKey)
genPublicKeyAddressHash = do
    let pkeys = [ "one", "two", "three", "four", "five", "six", "seven" :: ByteString ]
    unsafeAddressHash <$> Gen.element pkeys

getLastSlotInfo :: Int -> Gen [LastSlotInfo]
getLastSlotInfo len = do
    start <- Gen.word64 $ Range.linear 0 20000
    end <- Gen.word64 $ Range.linear (start + fromIntegral len) (start + 1000)
    -- The 'lsiFlatSlotId' values should be monotonically increasing, but may
    -- have gaps due or slot without blocks.
    lsis <- List.sort . List.take len <$> Gen.shuffle [start .. end]
    mapM (\lsi -> LastSlotInfo lsi <$> genPublicKeyAddressHash) lsis

getNextLastSlotInfo :: [LastSlotInfo] -> Gen LastSlotInfo
getNextLastSlotInfo xs = do
    lsi <- case xs of
                [] -> Gen.word64 $ Range.linear 0 20000
                _  -> pure $ 1 + List.last (map lsiFlatSlotId xs)
    LastSlotInfo (lsi + 1) <$> genPublicKeyAddressHash

genLastBlkSlots :: Gen LastBlkSlots
genLastBlkSlots = do
    count <- Gen.int $ Range.linear 1 100
    full <- Gen.bool
    len <- Gen.int $ if full
                        then Range.linear count (count + 10)
                        else Range.linear 0 (count - 1)
    LastBlkSlots.fromList count <$> fmap OldestFirst (getLastSlotInfo len)

-- Validate basic invariants
isValid :: LastBlkSlots -> Bool
isValid lbs =
    and [ LastBlkSlots.listLength lbs == LastBlkSlots.totalKeyCount lbs
        , LastBlkSlots.listLength lbs <= LastBlkSlots.lbsCount lbs
        , length (ordNub . map lsiLeaderPubkeyHash $ LastBlkSlots.getList lbs)
            == LastBlkSlots.mapSize lbs
        ]

-- -----------------------------------------------------------------------------

-- Make sure the generator generates valid LastBlkSlots.
prop_is_valid :: Property
prop_is_valid =
    H.withTests 1000 . H.property $ do
        lbs <- H.forAll genLastBlkSlots
        let full = LastBlkSlots.isFull lbs
        H.assert $ isValid lbs
        H.cover 30 "  already full" full
        H.cover 30 "  not full" (not full)

prop_LastSlotInfo_list_order :: Property
prop_LastSlotInfo_list_order =
    H.withTests 1000 . H.property $ do
        listLen <- H.forAll $ Gen.int (Range.linear 1 100)
        fsids <- H.forAll $ (lsiFlatSlotId <<$>> getLastSlotInfo listLen)
        fsids === List.sort fsids

-- Adding an element increments the count for non-full LastBlkSlots.
prop_adding_element_increments_count :: Property
prop_adding_element_increments_count =
    H.withTests 200 . H.property $ do
        before <- H.forAll genLastBlkSlots
        next <- H.forAll $ getNextLastSlotInfo (LastBlkSlots.getList before)
        let pkey = lsiLeaderPubkeyHash next
            after = LastBlkSlots.update before next
        H.assert $ isValid after
        let full = LastBlkSlots.isFull before
        unless full $
            (LastBlkSlots.getKeyCount before pkey) + 1 === LastBlkSlots.getKeyCount after pkey
        H.cover 30 "  already full" full
        H.cover 30 "  not full" (not full)

-- The total count (sum of counts for each key) is <= the max count.
prop_total_count_is_LE_count :: Property
prop_total_count_is_LE_count =
    H.withTests 200 . H.property $ do
        before <- H.forAll genLastBlkSlots
        next <- H.forAll $ getNextLastSlotInfo (LastBlkSlots.getList before)
        let after = LastBlkSlots.update before next
        H.assert $ isValid after
        let full = LastBlkSlots.isFull before
        if full
            then LastBlkSlots.totalKeyCount after === LastBlkSlots.lbsCount after
            else (LastBlkSlots.totalKeyCount before) + 1 === LastBlkSlots.totalKeyCount after
        H.cover 30 "  already full" full
        H.cover 30 "  not full" (not full)

-- Make sure the list count agrees with the map.
prop_map_agrees_with_list :: Property
prop_map_agrees_with_list =
    H.withTests 200 . H.property $ do
        lbs <- H.forAll genLastBlkSlots
        addr <- H.forAll genPublicKeyAddressHash
        H.assert $ isValid lbs
        let target = length (filter (\x -> lsiLeaderPubkeyHash x == addr) $
                        LastBlkSlots.getList lbs)
        target === LastBlkSlots.getKeyCount lbs addr
        let full = LastBlkSlots.isFull lbs
        H.cover 30 "  already full" full
        H.cover 30 "  not full" (not full)

-- Make sure the input list ordering is preserved.
prop_list_order_preserved :: Property
prop_list_order_preserved =
    H.withTests 200 . H.property $ do
        lbsSize <- H.forAll $ Gen.int (Range.linear 1 100)
        listLen <- H.forAll $ Gen.int (Range.linear 1 100)
        lsis <- H.forAll $ getLastSlotInfo listLen
        let before = LastBlkSlots.create lbsSize
            after = LastBlkSlots.updateMany before (OldestFirst lsis)
        H.assert $ isValid after
        let longer = listLen > lbsSize
            output = LastBlkSlots.getList after
        if longer
            then output === List.drop (listLen - length output) lsis
            else output === lsis
        H.cover 30 "  longer      " longer
        H.cover 30 "  shorter     " (not longer)

-- Check that the updating with removal gives correct remove list.
prop_update_with_removed_complete :: Property
prop_update_with_removed_complete =
    H.withTests 200 . H.property $ do
        before <- H.forAll genLastBlkSlots
        listLen <- H.forAll $ Gen.int (Range.linear 1 100)
        lsis <- H.forAll $ getLastSlotInfo listLen
        let (after, removed) = LastBlkSlots.updateManyR before (OldestFirst lsis)
        H.assert $ isValid after
        let longer = listLen > LastBlkSlots.lbsCount before
        LastBlkSlots.getList before ++ lsis === getOldestFirst removed ++ LastBlkSlots.getList after
        H.cover 30 "  longer      " longer
        H.cover 30 "  shorter     " (not longer)

-- -----------------------------------------------------------------------------

tests :: IO Bool
tests = H.checkParallel $$discover

redpajama_set_name: RedPajamaGithub


Who takes over after Brady?
I hate to break it to you Patriots fans, but Tom Brady can't play forever. The legendary New England quarterback is in his 16th year in the league, and while he hasn't shown signs of slowing down, at age 39, you have to think he will be looking to hang up those cleats in the next 2-3 years.
With Brady being the undisputed (or as close as you can ever get to undisputed in sports) best quarterback in the league, his eventual retirement will open the door for someone else to take that crown.
Brady represents the end of a very dominant era, where he and Peyton Manning rewrote the record books practically every year. They squared off in some of the most memorable games of the last decade and consistently drew in viewers whenever the two matched up. Manning is already gone and with Brady set to follow in the near future, who exactly will step up to fill the void.
It is kind of hard to say. The iconic 2004 draft class of quarterbacks featuring Eli Manning, Ben Roethlisberger and Philip Rivers likely still have a few more years in them. However, Rivers turned 35 today, Roethlisberger will be 35 in March and Eli Manning turns 36 in January. That group likely won't be around for a whole lot longer to constitute an era or start an awe-inspiring rivalry. Most of their time in the league will be remembered as part of the legendary Brady-Peyton era.
You next look to Aaron Rodgers, who joined the league in 2005. Rodgers just turned 33 last week, so he might be able to hang around a little longer than the three I just mentioned. However, he might have already started showing signs of slowing down with his rocky start to 2016. I could see Rodgers having a three-year run as the unquestioned top signal-caller. He might be the best-suited to succeed Brady in the short term. Keep in mind that even though this is his 12th NFL season, Rodgers did not start his first three years in the league, so he might have a bit more left in the tank than we think.
After Rodgers, well I'm kind of stuck. Drew Brees is a Hall of Famer, but approaching 38, I'm not expecting him to take over. Carson Palmer is on his way out as well. As will Alex Smith.
There is an interesting crop of three quarterbacks that offer some intrigue. Andrew Luck, Russell Wilson and Cam Newton all bring a lot to the table. All three of them are 28 years old or younger, all three are rather mobile and all three have the ability to take over a football game.
The major knocks against Newton are his ball security and his completion percentage. For his career, Newton sits at around 59 percent through almost 6 seasons. While he may be a huge asset with his legs, he is prone to fumbling and trying to do too much with the ball, often leading to mistakes. Another big red flag is that despite tossing 35 touchdowns in 2015, it is the only season he has thrown more than 25 scores. This year, he has just 14 through 12 games. Those numbers don't exactly scream elite.
Luck was named the heir apparent to the NFL quarterback throne around his junior year of college. He started with two solid campaigns, followed by an outstanding 2014, only to fall into a weird funk for the last year and a half. 2015 was a lost season for Luck as he only played 7 games and likely played all of them hurt. The big knock against him has to be his lackluster completion percentage, which is only fractionally better than Newton's. He also has a tendency for interceptions, with 63 picks in 66 career games. Part of that is due to the amount of pressure he faces. Luck is the most sacked quarterback in the league despite missing a game already this year. Luck is actually trending up after the last few weeks we've seen him play. Even though he has a poor supporting cast, Luck has failed to live up to Manning-sized expectations laid on him back in 2012.
Then there is Wilson. He already has a Super Bowl ring. Point all you want to a great run game and defense, but that's a good chunk of why Brady got his first three rings. Of these three, he seems the most poised to take the throne. Wilson has only 39 interceptions in 72 career games. He is closing in on his second consecutive 4,000-yard season and his career completion percentage is around 65 percent. However, when Wilson is off, he is really off. In Seattle's three losses this year, he has thrown zero touchdowns, three picks and has a yards per attempt average under 6.5. If I had to pick someone long term when it comes to taking up the quarterback mantel, it would be Wilson. He already has that championship background and I could see him getting more.
And he might just have a West Coast rival to deal with as well. There are a number of intriguing young quaterbacks in the league right now in Marcus Mariota, Jameis Winston, Carson Wentz and Dak Prescott. Long term, we might see a really fun rivalry between Prescott and Wentz, both being in the NFC East. However, there is one young quarterback that stands head and shoulders above the rest.
Derek Carr is in the midst of an MVP-caliber season. At only 25 years old, Carr has been lighting up NFL defenses all year long. He launched 32 touchdown passes a year ago, in just his second NFL season and threw for just shy of 4,000 yards. This year though, Carr is set to break that 4,000-yard mark and throw for close to 32 touchdowns again. What is more impressive though is the increased completion percentage and absence of turnovers. The young Raiders quarterback has only thrown five interceptions this year and raised his completion percentage four plus points to a healthy 65.5 percent. This is just one year for Carr, but based on the jump he has made in each of his first two seasons, I am beginning to think that this kid is for real.
I would be remiss not to mention Matt Ryan in this conversation. Ryan is in the midst of a career year at age 31. He is on pace to set career highs in completion percentage, passing touchdowns and yards per attempt as well as set a personal best for fewest interceptions thrown. If Carr is considered an MVP candidate, Ryan certainly has to be in the mix. He currently sits second in passing yards and passer rating, third in touchdowns, fourth in completion percentage and leads the league in yards per attempt. Given that he has a host of offensive weapons and a young offensive line, Ryan is set to play at a high level for the next several years. The tough thing is figuring out if 2016 is an anomaly based on his normal level of play or a sign of things to come. Also, if Brady hangs on for three more years, Ryan will already be 34 himself and running out of time to capture the league's attention.
The world without Brady is kind of hazy and there is no telling if we will ever see the type of rivalry we saw between he and Manning. The league seems to be running out of elite quarterbacks, but we will have to wait and see who steps up to the plate in the next few years.
This is painful. I looked back at my preseason playoff picks for the 2015 NFL season and it was ugly. I had the Colts winning the AFC and the Chiefs making it as a strong wildcard team. In the NFC, I had Dallas as the third team in and the Carolina Panthers are nowhere to be found.
Obviously, I made some major gaffes in picking my preseason playoff field. Some of it was due to unexpected injuries. Others were me buying into the hype of some offseason moves. All in all, I have a laundry list of excuses (similar to the one I have for why my fantasy team is so bad this year).
Here we are now though in the middle of the season with every team having played at least eight games. With the second half of the season about to get underway, it is time for me to predict how the season will end. Hopefully, this head start will allow me to do a bit better with these.
For the AFC, Cincy wins the conference because it wins the tiebreaker over the Pats for record in common games. Denver slips up just a little bit too much to earn the first round bye. The Jets take advantage of a fairly easy schedule down the stretch to make it back to the postseason for the first time since 2011. Pittsburgh, despite all of their injuries, has games against the Browns (twice) Colts and Ravens. That allows them to sneak into that last spot.
Over in the NFC though, things are much tighter. The Giants don't really belong but a Week 17 win against the Eagles locks up the division for them. Carolina continues its dominance on its way to the top spot. Green Bay manages to rebound down the stretch and takes the first weekend of the playoffs off. Arizona outlasts the rest of the rugged NFC West to advance to the postseason once again, this year hopefully with Carson Palmer. Minnesota and Atlanta prove to be the best of the rest and lock up wildcard berths.
Pittsburgh made the postseason but for the second straight year, not having LeVeon Bell proves to be too much for the Steelers to overcome. The Jets pick up their second win over Andrew Luck and Co. on the year behind a dominant ground game and an opportunistic defense. The Cardinals prove to have way too much for that Atlanta offensive line to handle as Matt Ryan has a rough day on the road. Adrian Peterson runs all over the Giants and the Vikings defense finds a way to limit Odell Beckham Jr. enough to get the win.
Andy Dalton finally gets his first playoff win as the Jets offense sputters on the road. The game is close but Tyler Eifert ends up being the deciding factor. After beating New England at home in the regular season, Denver fails to take round two in Foxborough. Tom Brady does not lose to Peyton Manning twice in one year. The Carolina defense bottles up Peterson and forces Teddy Bridgewater to beat them with his arm. The Vikings offense is simply not made for that. Despite going on the road, that Arizona defense causes some issues for Aaron Rodgers and the lack of a Packers running game shows.
The AFC Championship game comes down to some simply math. Tom Brady is greater than Andy Dalton and the 37-year old out-duels the Red Rifle to return to the Super Bowl. The defense manages to bend but not break against the Cincy offense. Super Cam continues his super season. He ends up coming nowhere near the MVP award but he is closing in on the Lombardi trophy. Carolina's offense runs through him, Jonathan Stewart and Greg Olsen. The real reason that the Panthers are Super Bowl bound is that defense though. It managed bottled up the Cardinal running game and pressured Carson Palmer all day without having to truly blitz.
In a rematch of Super Bowl XXXVIII, Carolina and New England meet with the Lombardi Trophy on the line. This time though, its the Panthers who walk away having earned a ring. Carolina is able to pressure Brady without truly having to blitz, which is the same way the Giants beat him in the Super Bowl in past years. The Panthers are so deep along their defensive line, especially after getting Charles Johnson back midseason. The Patriots find themselves missing change of pace runner and pass-catching specialist Dion Lewis as they fail to generate much of a ground game. Cam Newton's running abilities prove to be something New England struggles to contain as well. Julian Edelman has a big game but the Panthers limit Rob Gronkowski en route to the franchise's first ever Super Bowl win.
North Carolina. Known for barbecue, country music and hard-nosed football. Don't look now, but the Carolina Panthers are bringing back an old-school style of play and they are really good at it.
Everything you hear about NFL offenses these days revolves around passing. In fact, the league is on pace to beat the record set in 2013 for most pass attempts per game across the entire league. At the same time, NFL teams are running the ball at a record-low rate. 2015 is on pace to be the fewest rushing attempts per game, breaking the previous low set in 2014, which beat the low mark set in 2013 before that. In short, passing is trending upwards and running is trending downwards.
That doesn't seem to bother the Panthers though, who are determined to win by running the football. They have more rush attempts per game than anyone else in the league through the first eight weeks of the season. And they are pretty successful too as they lead the league in ground yards per game. This team has the look of the 2013 Seahawks, with a mobile quarterback and strong defense, except they rely even more heavily on the run.
On the other hand, Carolina seems pretty adverse to throwing the ball. The Panthers are attempting the fifth fewest passes per game and have the third fewest passing yards per game. Usually that is a recipe for disaster but these boys from Charlotte seem intent on bucking the trend.
Oh and did I mention that Carolina is undefeated. This is a winning brand of football.
Newton and the Panthers already have the same number of wins they did a season ago.
At the helm of the offense is Cam Newton. The Auburn product has taken a little while to get to this point. Not so long ago, pundits criticized his maturity and questioned if he had the right tools to be an NFL quarterback. "Super Cam" is far from conventional but he is effective nonetheless.
Strictly looking at Newton's stats without taking into consideration all sides of his game limits the understanding of how important a piece he has been this year for the Carolina offense. His completion percentage ranks second to last among qualified passers, only above Ryan Mallet's. However, the Panthers rank seventh in the league in drop percentage, which certainly hurts Newton's completion percentage.
Newton also ranks 28th out of 33 quarterbacks in yards per game average, which is far from stellar. However, his total yardage per game is much better. Cam has always been good with his legs and he leads all quarterbacks with 40.9 rushing yards per game. He also ranks 13th in the league in terms of rushing first downs. That's right. In the league.
When you factor in Newton's ability to use his athleticism to extend plays and drives, his short comings as a passer become a little more excusable, especially when he is punching in points. Newton has 11 touchdown passes on the year so far. He also has four rushing touchdowns, which ranks him fourth among all players. For passing and running touchdowns, Newton ranks tied for sixth in combined scores among quarterbacks. Clearly, the Panthers are doing something right because they are scoring the fourth most points per game.
Kuechly lead the NFL in tackles in 2014.
While Carolina might be denying convention on offense, the defense is truly the unit to watch. They rank ninth in yards per game allowed and tenth in points per game allowed. They have played three games though without captain Luke Kuechly, who is still somehow in the top 50 for tackles, even though he has only played four games. Mario Addison, Shaq Thompson and Dwon Edwards have all missed time as well. Carolina has been one of the better defensive teams in the league despite all the injuries to its front seven. For a pass rush that already stacks up well with 20 sacks in seven games, getting healthy is bound to make it even better.
That defense is good at giving the ball back to the offense. Carolina is third in turnovers generated per game. This Panthers defensive unit is gritty and seems to be getting better as the year goes on.
It is far from perfect but it has worked thus far. It is scary to think that the Panthers have room to improve as well if Cam can improve on his accuracy and the receivers stop dropping the ball. With all of that room to improve, it is ridiculous that the Panthers have won 12 of their last 13 games dating back to last year without being seen as a complete team. This team has the mental toughness to be a true contender, as shown in a fourth quarter road comeback victory against Seattle and a tense overtime win against the Colts.
Carolina has officially put the rest of the league on alert with their gritty and old fashioned play so far. The question now is can anyone stop them.


On June 14-16, 2012, the 15th Uddevalla Symposium 2012 took place in Portugal. The symposium was hosted by CIEO, Faculty of Economics at the University of Algarve, Faro, Portugal led by Professor Teresa de Noronha. The overall theme was "Entrepreneurship and Innovation Networks". The objectives of the symposium was to provide a unique opportunity for scholars including senior and junior researchers to discuss path-breaking concepts, ideas, frameworks and theories in plenary key-note sessions and parallel competitive paper sessions.
Academics Entrepreneurship and Innovation – bridging perspectives and pushing the frontier, Chairs: Prof. Martin Andersson and Prof. Åsa Lindholm- Dahlstrand, Centre for Innovation, Research and Competence in the Learning Economy (CIRCLE), Lund University, Sweden.
The formal opening took place on Thursday June 14th by the rector of the University of Algarve - Professor João Guerreiro. Then Prof. Rui Baptista presented his research entitled "Agglomeration, Collocation, and Organizational Heritage". After a coffee break Prof. Maureen Kilkenny held her keynote presentation entitled "Network Analysis and Business Networks". Before the lunch, there was a summing up keynote plenary discussion chaired by Prof. Teresa de Noronha.
The afternoon went on with many papers presented and discussed in total seven parallel paper sessions following the traditional Uddevalla symposium model with 40 minutes allocated in total for each paper (20 minutes for presenter, 10 minutes for discussant, 10 minutes for group-discussion). Then an unusual event in terms of arranging an Uddevalla symposium, took place. A big ceremony was arranged by the University of Algarve to take place within an international scientific event. The Doctor Honoris Causa was appointed to Prof. Peter Nijkamp by the rector of the University of Algarve. In connection with this appointment, he presented his keynote speech on "Borderless Economies and Undocumented Labour: The Position of Household Workers". At the conference-dinner that followed, all attendees got the opportunity to listen to fantastic guitar players as well as to music and performance by a student music group from the University of Algarve.
The morning up to lunch on June 15th, there were four keynote presentations: Prof. Michael S. Dahl talked about "The Who, Why and How of Entrepreneurial Spinoffs". Prof. Andreas Pyka talked about "Innovation Networks: Modeling and Analyzing Complex Innovation Processes". Dr. Bettina Peters presented research entitled: "Churning of R&D Personnel and Innovation" and Prof. James Simmie presented his research entitled: "Innovation, Reproduction and Regional Economic Resilience". Session plenary chair was Prof. Roger R. Stough who led a summing up plenary discussion in which many questions to the keynotes from the audience were discussed. In addition, this afternoon went on with many papers presented and discussed in seven parallel paper sessions. Before the Gala dinner that took place at hotel EVA, there was a Guided Tour visit to the Old City and Museum. At the Gala dinner there were in total five best paper prices; three local and two international prizes by the Uddevalla symposium. To stimulate high quality papers a Best Paper Award of € 1.000 as well as a Best PhD Candidate Paper Award of € 700 were awarded. The Scientific Committee proudly presented the Best Paper Award winners 2012. The winner of the Best PhD Candidate Paper Award was Eleonore Huang Vogel, Blekinge Institute of Technology, Karlskrona, Sweden. The title of her paper was: "Entrepreneurial Opportunity Recognition and Exploitation in the Academia: a Dynamic Process of Networking". There were three winners of the Best Paper Award. They were associated professor Mikko Moilanen, Professor Stein Østbye & Associated professor Kristin Woll, Tromsø University Business School, University of Tromsø, Tromsø, Norway. The title of their paper was: "Happy Together? Formal and Practical Knowledge, Learning Modes and Product Innovation".
Also on Saturday June 16th, there were four keynote presentations from morning up to lunch. Prof. Michael Fritsch started by presenting research on:"The Long Persistence of Regional Entrepreneurship Culture". Prof. Mirjam van Praag went on with presentation entitled: "Entrepreneurship: Nature, Nurture and Role Models". Prof. Roger R. Stough talked about "Knowledge Spillovers and Commercialization in Universities and Their Regions" and Prof. Edward Feser's presentation was entitled: "In Search of Smart Specialisation, Policy Experimentation, and Institutional Innovation: The Operational Challenge of Creating Distinctive Regional Innovation Strategies". Session Plenary Chair was prof. Charlie Karlsson.
The plenary session ended with short speeches of thanks given by Dr. Elisabeth Jansson, University West and Prof. Teresa de Noronha, CIEO. After lunch, many papers were discussed and presented at three parallel paper sessions.
Prof. Charlie Karlsson, Jönköping International Business School & University West, Sweden.


Hebrews 5: 7 – 10 (MSG) While he lived on earth, anticipating death, Jesus cried out in pain and wept in sorrow as he offered up priestly prayers to God. Because he honored God, God answered him. Though he was God's Son, he learned trusting-obedience by what he suffered, just as we do. Then, having arrived at the full stature of his maturity and having been announced by God as high priest in the order of Melchizedek, he became the source of eternal salvation to all who believingly obey him.
You're in, what seems like, the deepest and darkest place in your life. You call out to Jesus, only to feel like He didn't hear you at all?
• Why do I feel like I'm at the bottom of a pit and can't find my way out?
• Lord why is this happening to me? Why is my marriage failing?
• Why is my child raging?
• Why am I slowly dying of this incurable disease?
• Why am I losing my job?
• Why I feel all alone?
When Jesus walked this earth, he also faced struggles and trials. He stepped out of his perfect heaven, emptied himself (Philippians 2:7) and took on the form of a human. Why? To show us how to live, treat others, and most importantly be obedient to the will of God even if it's not the path we would choose for ourselves. In Matthew 26:39 Jesus cries out to his Father in the Garden of Gethsemane to spare Him from what was ahead – death on the cross.
In this verse, we see just one example of Jesus's complete obedience even when he was staring death in the face. As Christians, we are to follow His example. Hanging on the cross, Jesus could have called 10,000 angels to spare him the pain and anguish… but he didn't. Obedience to the Father was more important to him than his comfort. He knew God had a plan for his life and he had to follow the plan.
God knew what was on the other side of the cross.
I know what I'm doing. I have it all planned out—plans to take care of you, not abandon you, plans to give you the future you hope for. "When you call on me, when you come and pray to me, I'll listen. "When you come looking for me, you'll find me. Yes, when you get serious about finding me and want it more than anything else [emphasis mine], I'll make sure you won't be disappointed." God's Decree.
He hears our prayers and cares about the intimate details of our lives. Putting our trust and hope in the things of this world will leave us high and dry every time. But when we place our trust in God, we know that through every crisis we are learning to be more obedient to God and the plans He has for our lives.
Father, help me! Help me see this current crisis as another way to become more like your Son. Help me to learn how to respond to things the way Jesus would have responded to things when He walked this earth. Help me to remember the promises in your word and to put them into practice when I feel like I don't know what to do next. Help me Lord to "cast all my cares on you" because I know you love me more than I can even comprehend. Also, help me remember to look to you as the sole source of my strength instead of getting wrapped up in the circumstances around me. I trust you Lord, help me obediently trust you even more during this season of my life.


Capitol Records have teamed up with Klipsch to create a powerful audio system that uses luxury materials such as tactile spun copper switches/knobs and real wood veneer, Capitol One Special Edition Audio System. These two iconic companies want to celebrate over 7 decades bringing sound to life. This audio system combines classic design just like the legacy of Paul W. Klipsch with modern technologies to deliver incredible acoustic performance.
Each unit has been professional tuned to emit optimum stereo sound, it also features an exclusive Klipsch and Capitol Records badge to celebrate this monumental partnership. Inside this Bluetooth speaker there's a tiny sized Klipsch One, a 2.1 stereo system biamplified for audiophile resolution, it has two 2-1/4-inch full range drivers also a 4.5-inch woofer. They are professionally tuned by Klipsch acousticians to make sure that you get a crystal clear acoustic performance with great bass.
Capitol One Special Edition Audio System features Bluetooth 4.0 wireless technology, enjoy streaming music from your mobile devices. All you need to do is press and hold the source button, you can choose Klipsch The One from your smartphone. At the back, there's a 3.5mm analog input where you can connect an audio source.
Tagged as Klipsch and capitol one partnership, klipsch portable bluetooth speaker, vintage style audio system.


text:
Search results for "Mass Transit"
Mayor Announces Zoning Proposals for Grocery Stores, Transit Accessibility, Small Businesses
Mayor • Zoning • Citywide
Image of current districts under the FRESH program. One of the Mayor's proposed zoning amendments will expand the FRESH program in outer boroughs. Image Credit: NYC DCP
The zoning proposals include allowing gyms and spas to open as-of-right. On March 9, 2021, Mayor Bill de Blasio announced several proposed zoning changes to support small businesses, create more groceries stores and improve accessibility across the city. The zoning proposals will enter the public review process later this year. (more…)
Transit and Resiliency Topics of Focus at RPA's Annual Meeting
Regional Plan Association • 24th Annual Assembly • New York Metropolitan Region
Both Mayor Bill de Blasio and Senator Chris Murphy addressed economic disparity and the necessity of a long-term vision and cooperation of local leadership in strengthening the New York Metropolitan region's infrastructure and economy. The Regional Plan Association held its 24th Annual Assembly at the Waldorf Astoria Hotel on April 25, 2014. The RPA is a non-profit that seeks to promote planning for economic competitiveness, quality of life, and long-term sustainability in the larger New York metropolitan region, comprising of northern New Jersey, southern New York State, and western Connecticut. The RPA is currently working on its fourth regional plan since 1929, which will offer a guide for the area's long-term responsible growth, sustainability, and infrastructure improvement. The last regional plan was published in 1996. (more…)
Tags : Mayor Bill de Blasio, Senator Chris Murphy
Slow Down on Lifting Covid-19 Mandates – Children Under Five Still at Risk
CityLaw, Commentary • By: Brian J. Kaszuba
3-Year Old Daycare Program.
Mask and vaccine mandates are being rolled back by Mayor Eric Adams, Governor Kathy Hochul, and New Jersey Governor Phil Murphy. They are moving too fast. Mandates should not be universally lifted until 100% of our populations including children younger than five had an opportunity to at least choose to be vaccinated and that is not the case right now. (more…)
Tags : COVID-19
City Releases Master Plan for City Streets
Mayor • Transportation • Citywide
Image Credit: New York City Department of Transportation
On December 1, 2021, Mayor Bill de Blasio, Council Speaker Corey Johnson and the Department of Transportation (DOT) Commissioner Hank Gutman announced the release of the New York City Streets Plan. The plan's purpose is to help guide road design and infrastructure for the next five years. (more…)
Landmarks Calendars Two Historic Districts in Cambria Heights, Queens for Designation
Landmarks Preservation Commission • Calendaring • Cambria Heights, Queens
Houses along 222nd Street in the proposed Cambria Heights-222nd Street Historic District. Image Credit: Google Maps.
Both historic districts feature Tudor Revival row houses with whimsical features. On August 10, 2021, the Landmarks Preservation Commission voted to calendar two historic districts in Cambria Heights, Queens for future designation. The Cambria Heights-222nd Street Historic District and the Cambria Heights-227th Street Historic District are both well-preserved examples of the Tudor Revival and Storybook styles and of the 1930s suburban expansion in Queens. (more…)


I have been wanting these for so long for me and my daughter I am talking about the Fashionista Flash Temporary Tattoos they come in so many cute designs. My daughter loves these because they are so shiny and sparkly. They come in a huge pack so they are so many to choose from.
These are really cute for a party or for Christmas time. Or even you can use these for New Year's time. I love the idea of wearing these for New Year's.
They come with 6 sheets so these would last a long time. These would be really cool to have at a Birthday Party for little girls they could put them on each other. I like the silver ones and my daughter of course likes both of them. If you know a little girl out there I am sure she would love them. This also would be great as a stocking stuffer.


Sophomore center forward Shahid Khan scored the game-winner with under a minute left in the game and finished with a hat trick as Natick rallied in the second half from a pair of two-goal deficits to top host Dedham 4-3 in a thrilling Bay State Conference matchup.
Goalie Erica Gold made 22 saves to preserve the win and Betsy Sulser netted the scored goal for Natick (2-4).
FRAMINGHAM 4, BRAINTREE 0: Kourtnie Wilder had a goal and an assist as Framingham dispatched host Braintree in a Bay State Conference match. Ashley Chu also scored while Jenny Wagner and Hannah Werblin also scored for the Flyers (3-4, 3-3 BSC).
MEDFIELD 3, ASHLAND 2: Corey Quadir had a hat trick including the game-winner with four minutes left to play as Medfield recovered from a 2-0 halftime deficit to knock off host Ashland in a heated Tri-Valley League tilt.
Sarah Johnson had a pair of assists while sophomore Emily Zlevor and Julia Biedrzicki had strong games for the Warriors (5-1-1, 3-1-1 TVL). Kelsey Treveloni and Alyssa Magri scored for the Clockers.
HOPKINTON 3, BELLINGHAM 0: Eliza Carroll had a goal and an assist as Hopkinton blanked Tri-Valley League host Bellingham. Katie Pelgrin had two assists while Liz Keefe (assist), Amanda Carboneau (defense) and Meg Gress (defense) had strong games as well for the Hillers (5-0-1, 4-0-1 TVL). Kayla Kelly made 17 saves for the Blackhawks.
MEDWAY 2, WESTWOOD 0: Bryany Burke had a goal and an assist as visiting Medway shut out Tri-Valley League host Westwood. Emily Anderson also scored while Nicole Dobachesky had an assist for the Mustangs (2-1-2 TVL).
DOVER-SHERBORN 1, HOLLISTON 0: Senior midfielder Ali Knapp tallied the game's only goal to lead visiting Dover-Sherborn past Tri-Valley League foe Holliston. Junior goalie Nina Lupan recorded two saves to earn the shutout for the Raiders (3-3, 2-3). Brittany Appleby made 10 saves in defeat for the Panthers (1-4, 1-3).
FRANKLIN 1, STOUGHTON 1: Franklin freshman forward Kaitlyn Spillane netted her team's only goal 19:34 into the second half as the visiting Panthers played Hockomock League opponent Stoughton to a draw.
Senior goalie Susie Jacob had seven saves in the first half, and junior goalie Kailyn Burke totaled six second-half saves for Franklin (2-2-2, 2-1-2 Hockomock).
WESTBOROUGH 3, NASHOBA 1: Westborough senior captain Karly Murphy tallied two goals and one assist as the host Rangers topped Nashoba in Mid-Wach B play.
Junior forward Amy Aiello netted her team's third goal of the game, assisted by sophomore midfielder Anna Petrunich. Senior Danielle Allen had three saves in net for Westborough (4-1-1 overall, Mid-Wach B).
Ali Williams scored a goal for Nashoba (1-4-4, 0-4-2 Mid-Wach B).
ALGONQUIN 0, LEOMINSTER 0: Despite being in the offensive end for much of the contest, host Algonquin settled for a scoreless draw with Mid-Wach A rival Leominster.
The Tomahawks (4-1-1, 3-1-1 MWA) got strong play from backs senior co-captain Sam Howells, junior Kelsey McGowan and junior midfielder Kate Sullivan.
SHREWSBURY 7, MILFORD 0: Host Milford got 17 saves from goalie Jane Sgammato but fell short against Shrewsbury in Mid-Wach A action. The Scarlet Hawks fall to 1-1-5 (0-1-4 MWA).
QUABBIN 5, MARLBOROUGH 0: Kelsie Bryant had a good game but visiting Marlborough lost to Quabbin. Andrea Hollis also had a good game for the Panthers (2-1-4, 0-1-4 MWB).
HUDSON 1, GROTON-DUNSTABLE 0: Senior forward/captain Jackie Bonner tallied the game's lone goal 10 minutes into the second half as visiting Hudson (1-5) knocked off Groton-Dunstable in a Mid-Wach C contest..
ASSABET 4, MONTY TECH 0: Assabet senior center/forward Nick Novak had two goals and one assist as the host Aztecs blanked non-league foe Monty Tech.
Casey Phillips added a goal and had two assists for Assabet (2-2).


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Here Are All of the Live-Action Disney Remakes in the Works (Part One)
Aladdin…The Lion King…Mulan…it seems like every day Disney is announced another live-action remake. So let's look at all the films in the works.
Here Are All of the Live-Action Disney Remakes in the Works (Part Two)
Earlier this week, Walt Disney pictures announced plans to film a live-action remake of Aladdin. If it sounded like familiar news, there's a reason. Disney has been greenlighting live-action remakes of its animated classics left and right lately. With the success of Maleficent, Cinderella, and The Jungle Book, Disney has clearly found a formula that works.
So exactly how many live-action remakes have been announced? Probably a lot more than you realize. In fact, it's far too many to fit in one article. So let's take a look at a few of them, starting with the next to actually hit theaters:
This one is already in the can and on its way to a theater near you. Harry Potter's Emma Watson is taking on the role of Belle. Meanwhile, Downton Abbey's Dan Stevens will be the growling prince known as the Beast. The new Beauty and the Beast will hit theaters (in 3D no less) on March 17, 2017. Here's a look at the teaser trailer:
While most of the announced live-action Disney films seem to be straightforward adaptations, the one that started it all was quite different. 2014's Maleficent with Angelina Jolie was more than a remake of Sleeping Beauty. It flipped the script to put the focus on the villain, rather than the heroine.
In 2013, Disney announced a similar project focused on the villain of 101 Dalmations. There haven't been a lot of details released since then, but Glenn Close (who played the role in the original live-action remake) is executive producing. More recently, actress Emma Stone has signed on to play the lead role.
In 2014, Disney announced a live-action version of the 1941 animated classic, Dumbo. Longtime Disney collaborator Tim Burton is attached to direct. Transformers screenwriter Ehren Kruger is writing the script.
Walt Disney Pictures has actually been pursuing a live-action remake of Mulan for years. Only recently have plans come to together enough for Disney to formally announce it. Rick Jaffa and Amanda Silver wrote the script, with the film to release in 2018. A worldwide casting search is now underway for a Chinese actress to play Mulan.
Early last year, Disney announced plans to remake one of it's most iconic films, 1940's Pinocchio. Peter Hedges, the writer behind What's Eating Gilbert Grape and other esoteric fare, is writing the script. Famed director Guillermo del Toro is also planning a stop-motion version of Pinocchio for a rival studio.
Would you believe Disney is developing not one, but TWO different live-action Peter Pan remakes? First, there's a straight adaptation of Peter Pan in the works from director David Lowery and screenwriter Toby Halbrooks. Lowery and Halbrooks collaborated on the Pete's Dragon remake for Disney earlier this year.
In 2015, Disney also announced Tink, a new live-action film about Peter Pan's fairy companion, Tinkerbell. Actress Reese Witherspoon is signed to star as the titular character. Finding Dory screenwriter Victoria Strouse is writing the script.
Whew, that's a lot of remakes! But we're not done yet. Be on the lookout for part two of this article where we'll share even more Disney live-action remakes.
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There is a lack of understanding from professionals about what the child's world is like. Assessment is crucial, but so often is found lacking.
August 2010 - Research from the University of Rochester and the University of Notre Dame published in Child Development analyzed relationship patterns in 234 families with a child aged six. Consistent with long-established family systems theory, researchers found three distinct profiles: one happy, termed cohesive, and two unhappy, termed disengaged and enmeshed. Specific difficulties were encountered in the first years at school depending on the type of dysfunctional profile identified. This study is the first to confirm the existence of these profiles across multiple relationships within the marriage partnership and between children and parents.
"We were really able to look at the big picture of the family, and what was striking was that these family relationship patterns were not only stable across different relationships but also across time, with very few families switching patterns."
Cohesive families are characterized by harmonious communication, emotional warmth, and firm but flexible roles for parents and children.
Enmeshed families may be emotionally involved and display some warmth, but experience 'high levels of hostility, destructive meddling, and a limited sense of the family as a team'.
Disengaged families are associated with cold, controlling, and withdrawn relationships.
Researchers assessed families using parent and teacher reports and through direct observation. Participants came to the lab annually for three years, making two visits one week apart. Both parents and their child played Jenga, an interactive game, for 15 minutes. On alternate weeks each parent interacted alone with the child for ten minutes divided between play and clean up. Parents were also videotaped discussing two topics intended to elicit disagreement.
The study evaluated how parents related to one another, noting characteristics such as aggression, withdrawal, avoidance and ability to work as a team in the presence of the child. Researchers assessed the emotional availability of parents, whether they provided praise and approval or ignored the child during shared activities. They also noted how the children related to their parents, noting whether attempts to engage them were 'brief and half-hearted or sustained and enthusiastic'.
The study found that children from disengaged homes started school with higher levels of aggressive and disruptive behavior and more difficulty focusing and cooperating with classroom rules. These behaviors tended to increase with time. Children from enmeshed homes began with no more disciplinary problems or depression and withdrawal than those from cohesive families. However, as children from families with either type of destructive relationship pattern continued in school they began to suffer from higher levels of anxiety and feelings of loneliness combined with alienation from peers and teachers.
While the study identified a clear connection between family characteristics and behavior at school the researchers caution against concluding that dysfunctional relationships are responsible for the majority of difficulties encountered. They point to other relevant risk factors, including high-crime or deprived neighborhoods, peer pressure and genetic traits.
"Families can be a support and resource for children as they enter school, or they can be a source of stress, distraction, and maladaptive behavior. This study shows that cold and controlling family environments are linked to a growing cascade of difficulties for children in their first three years of school, from aggressive and disruptive behavior to depression and alienation. The study also finds that children from families marked by high levels of conflict and intrusive parenting increasingly struggle with anxiety and social withdrawal as they navigate their early school years."


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Replaying male machismo
True West has contemporary resonance in the age of toxic masculinity
Sewa Bhattarai August 29, 2019
Lee and Austin are brothers who don't seem to have much in common. Austin is a cultured man with an Ivy League degree trying to make it as a screenplay writer. Lee is a wanderer who lives in the shadows. But when they come together in a difficult situation, it seems they are not different at all: each brims with toxic masculinity.
Nepal-based director Deborah Merola has chosen to stage this Pulitzer-nominated 1980 play by American playwright Sam Shepard without translation or much adaptation. You can Google the plot, spoilers and all, but we are just going to tell you that Austin suddenly stands to lose his dreams, despite his superior education and manners. And Lee, though on the brink of gaining everything, knows he cannot make it without his brother's refined education. And so the brothers blame each other for their plight and battle it out, with an alcoholic father and a passive mother added to the mix.
Brothers envying one another is familiar to most of us: while Lee thinks that Austin — with his fancy degree and a foothold in Hollywood — is living the glamorous life, Austin thinks that Lee is a daredevil racking up new adventures every day.
Read also: The violence of violation, Sewa Bhattarai
This intense drama simmers with an undercurrent of violence that threatens to explode. And sitting in the present, we cannot help remind ourselves of masculinity today — that however much things change, they remain the same. Lee's desire to dominate everyone around him is an obvious example but so is Austin, whose manners are a mere veneer for what lies underneath.
"This drama is relevant today in the era of Donald Trump, when toxic male machismo is on the rise," Merola tells us after a rehearsal this week at Kausi Theatre.
Perhaps because of its contemporary resonance, the drama is enjoying a revival today with a recent Broadway production starring Ethan Hawke and another starring Game of Thrones protagonist Kit Harington. Set in the US 30 years ago, it is considered a quintessentially American play, but the cast here feel that it has universal resonance today.
"We in Nepal think the grass is greener on the other side, and many of us go abroad with great expectations. But often what awaits is disillusionment," says Divya Dev, who plays the younger Austin. Dreams can come crashing down any time and when that happens, Austin has nothing to hold on to, and reverts to base instincts.
Read also: Hop over the gender gap, Reeti K.C.
Alejandro Merola, who is menacing as the older Lee, feels every well-written drama has a wide resonance. "The lone alcoholic who slowly drifts out of respectable social circles and lives a criminal life on the edges is a universal character," he says. "The play reminds us that there is an increase in such characters today."
Eelum Dixit has a powerful stage presence as the easily manipulated producer Saul who doesn't speak up against bullies, and Kurchi Dasgupta makes an impact as the lost, possibly depressed, mother who stays indifferent even as her sons fight. Divya Dev is at his best as the melancholy Austin, who appears a gentleman but is full of passive aggression. Alejandro Merola frightens us with his outright hostility until he makes an unbelievable transformation.
The drama is a stark portrayal of the unrealistic standards of success that modern society demands, and of the loss of simplicity and innocence. We see these mores manifesting now in Nepal, as well. Says Kurchi Dasgupta, who plays the mother: "Even though it is set in a particular time and place and has a distinctly American feel, you can draw allegories to the current time."
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We had a good number of shooters during the day with many enjoying refreshments in the clubhouse. The mild afternoon made for good daytime Sporting and was no doubt part of the attraction.
Great to see Mark Cobbold and Dave Gooding both achieved straights on Snooker and Dave Gooding also chalked up a straight on Compak. Well done to both.


We work/ed also with Ben Delay, Crookers, Dimitri Vegas & Like Mike, Jay Hardway, Judge Jules, Kungs, Mike Candys, Milk & Sugar, Ofenbach, Olivier Giacomotto, Otto Knows, Plastik Funk, Sak Noel, Sam Feldt, Stefano Noferini, Tune Brothers, Ummet Ozcan and many more DJs... Do not hesitate to contact us!
We provide also more musicians, performers, (cover) bands, hip hop artists, VIP's, etc. let us know which kind of event you will organise and what you need!


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The findings come a week after a dire United Nations report described consequences of dangerous levels of climate change including worsening food and water shortages, heat waves, sea level rise and disease.
"One of the greatest challenges as a scientist doing research on climate change and food is to illustrate it in a way that people can understand," US Department of Agriculture scientist Lewis Ziska said in an email. Few people would complain if global warming ruined Brussels sprouts, he added.


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Healthcare Practitioner Corner: Adverse Events Reporting: So Far, So Good
The dietary supplement industry should be cautiously optimistic about the performance of the new AER system.
Understanding FTC Standards for Claims Substantiation
ConsumerLab.com Tests Popular Vitamin D Supplements
AHPA Issues White Paper on Good Herbal Compounding & Dispensing Practices
Erik Goldman07.01.10
The first round of data from the federally mandated Adverse Events Reporting System (AERS) for dietary supplements seems to signal two important things: 1) The system works pretty well in enabling FDA to act quickly when there's evidence of life-threatening side effects, and 2) Serious supplement-associated adverse events are pretty rare given how widely these products are used.
That's good news, and the industry should feel proud of these initial findings. The relatively small number of significant adverse events—1025 reports in 2008, to be exact—should be somewhat reassuring to the general public and the medical community, given the 500,000-plus adverse event reports the FDA received for pharmaceuticals that year.
But we shouldn't let it go to our heads. The AER system is still very new, and reporting—though required at least in theory—is still more or less voluntary in practice. Most physicians and consumers are unaware that supplement side-effect reporting is even a possibility.
The American Herbal Products Association (AHPA), a trade organization for manufacturers of botanical products, and a major supporter of the legislation establishing the AER system in 2008, obtained the data from FDA under the Freedom of Information Act. Michael McGuffin, AHPA's president, presented the numbers at the SupplySide East show in May.
Starting in 2008, the federal government mandated that supplement manufacturers list toll-free adverse events reporting phone numbers on product labels, and required them to promptly relay any notices of serious side effects to FDA.
The system, established by the Non-Prescription Drug Consumer Protection Act in 2007 with strong bipartisan political support, uses the same definitions of "serious" as FDA applies to prescription drugs, including: death, life threatening side effect, hospitalization, persistent disability, cognitive dysfunction and congenital anomaly.
Of the total 1025 reports FDA received in the first year, 12 were missing essential information, leaving a total of 1013 evaluable events. Mr. McGuffin noted that 627 reports (61%) came directly from supplement companies, with 287 (28%) coming from consumers and 99 (10%) reported by physicians or other healthcare practitioners.
Roughly two-thirds of the reports concerned AEs in females, which reflects the general demographic pattern of supplement use: women take more supplements and take them more frequently than men.
Direct reports from supplement manufacturers came from 140 different companies. Among the 627 reports were 8 deaths, 64 life-threatening episodes, 229 hospitalizations, 16 incidents requiring medical intervention and 8 that resulted in significant and permanent disability.
Products implicated in the reports represented a broad range of supplement categories, with 249 reports related to vitamin/mineral products, 80 for herbs, 391 for combination (vitamin/mineral/herb) products and 105 for "other" supplements (fish oil, amino acids, enzymes, probiotics, etc.).
Among the most commonly cited brands were Bayer's One-a-Day, Centrum and Flintstones vitamins. But Mr. McGuffin stressed that this does not indicate any inherent danger associated with these products. Rather, it reflects their huge popularity, and the fact that these companies, being major pharmaceutical players, already have large and highly sophisticated AER call centers as well as decades of experience in fielding AER calls and reporting them to FDA
What happens when FDA receives a supplement AER report? It gets logged into the Center for Food Safety and Applied Nutrition (CFSAN) database, the same data repository as is used for foods, OTC drugs and cosmetics. CFSAN analysts then assess the strength of the evidence that the product in question could have caused the reported event. They try to rule out confounding variables like prior medical conditions that could have produced the reported symptom, use of other drugs or supplements, foreign travel or other exposures.
If there's a strong suggestion of causality, and especially if there is a cluster of similar reports about an individual product or brand, FDA will contact the company in question and requisition the original AE report, gather product samples, and if necessary, intensify the investigation. "It's exactly the same process they use for drug AERs," said Mr. McGuffin.
He stressed that an AER is a "signal generator, not a final determination of causality." In isolation, a single report means nothing, and isolated individual reports are seldom if ever even verified by investigators. "An AER does not imply admission that a particular product caused that AE. All we can really know from an AER—whether for a supplement or a prescription drug—is that a call was made."
What FDA is looking for is patterns. The 2008 data indicate that the system actually works quite well to facilitate swift investigation and corrective action when a suspicious pattern emerges.
In the first year, there were two signal clusters that moved FDA into action. Early in 2008, the agency received 26 reports, mostly from Florida, of unexpected side effects associated with "Total Body Formulas" brand of liquid vitamins: these included acute muscle cramps, severe diarrhea, joint pain, extreme fatigue and hair loss.
Three months later, FDA issued a consumer warning about the products, which elicited an additional 68 reports. Investigators analyzed the formulas and found that they contained 10 times more selenium than they should have; the reported AEs were related to selenium toxicity. The manufacturer voluntarily recalled the products.
The AER system also showed a cluster of serious side effects related to a muscle-building product called "TREN-Xtreme," manufactured by American Cellular Laboratories. The FDA tested this product and found anabolic steroids.
TREN-Xtreme was recalled in July 2009, just two months after the widely publicized Hydroxycut recall.
At a time when major pharmaceutical production facilities are under investigation for shoddy manufacture, and every pharmaceutical ad ends with a hyperventilated litany of potential adverse effects, the 2008 AER data sure make the supplement/natural products industry look pretty good.
But let's face it, under-reporting is the rule not the exception at this point. Though the law does state that failure to report a serious AE to FDA is a punishable criminal offense, there have been no enforcement actions so far. And given how short-handed FDA already is, and the burden of work involved in pharmaceutical oversight, a concerted enforcement effort is unlikely anytime soon.
Further, the AER system—whether for drugs or supplements—depends on input of signals from the field. While most consumers and practitioners are aware they can and should report drug-associated side-effects, far fewer are aware there are similar reporting systems in place for supplements as well. Any industry will look good if few people know how or where to report problems.
Still, AHPA's Mr. McGuffin said he is pleased by the findings from the first year of AERS, though he said the system definitely needs some tweaking, and more companies need to step up to their responsibility for reporting. As the industry comes to recognize that the system is not intended as a bludgeon, but rather a means by which to improve the safety and value of supplement products, he believes more companies will actively participate.
In the end, full participation will increase the knowledge base, and improve the quality, efficacy and safety of products taken by millions of people every day.
Gottlieb Confirmed to Lead FDA
AHPA & LifeScienceRisk Develop Prop 65 Insurance Coverage
AHPA Developing Assessment Program for Agricultural, Collection & Manufacturing Practices
AHPA Awards Recognize Substantive Contributions to Industry
AHPA Reappoints Ayurvedic Products Committee
AHPA Gives Overview of Regulatory Landscape for Botanical Raw Materials
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AHPA President Clarifies Misinformation on GNC Agreement
Dietary Supplements | Regulations | Research
Randomized clinical trials aren't the only source of competent and reliable scientific evidence.
By Todd Harrison, Venable 06.02.17
Breaking News | Flavors & Colors | Supplier News
With improved manufacturing process, TREHA trehalose is now produced from non-GM starch using non-GM enzymes.
Breaking News | Industry & Market News | Testing | Vitamins
Review includes test results and quality comparisons for 44 products.
Breaking News | Dietary Supplements | Herbs & Botanicals | Industry & Market News | Medical Nutrition | Quality & Safety
Association invites feedback to help ensure it is relevant to practitioners trained in a variety of disciplines.