When planning a construction project, you should have the right equipment for it. If you don't, the construction project may delay and lead to money and time wastage. A Posi-Track is one of the construction machines you may need to hire to complete your project in good time. But before you hire the track loader, you need to ask yourself these questions.
Will It Be Safe to Use?
If you don't consider the safety of the construction equipment you intend to hire, things might go wrong on your side. You first need to go through the safety laws in your area. Although some of the stringent safety laws don't apply to some tracks, they usually apply to most of them.
Assess the construction site to know the level of certification you need and the safety measures you should maintain. If you don't do it, you may sustain unnecessary injuries and damages. But with the right safety mechanisms in place, you will complete your construction project without casualties.
Is the Track Adaptable?
Adaptability is one of the things you should consider when hiring a Posi-Track. Most track loaders use various attachments to enhance efficiency during the construction process. However, some of the attachments might not be suitable for some construction projects. In this case, you should find out if the attachments can be customised and if the track has the necessary customisation options.
If a standard model can't get the job done, is the track flexible enough to accommodate some special models? An efficient track should offer maximum adaptability to help you save time and money. It should also be flexible to accommodate special buckets, trenchers, rakes, forks and brooms.
Will It Attract Some Additional Costs?
When hiring a track loader, you should ask for an initial quote to know whether it's within your budget. However, you shouldn't stop at the figures you get. You should also ask the track operator whether you should expect some extra costs as you go on with your construction project.
Sometimes, the company or operator may not indicate every cost when giving the initial quote before they visit the site. Ask whether you should fuel the track, buy lubricant, pay the operator or buy some safety gear. Such costs might not reflect in the initial quotation, but they might appear later. So do all you can to get transparent upfront to help you organise your budget.
Hiring a Posi-Track is far much cheaper than buying one for your construction project. However, the hiring process might be tricky if you don't have some questions to guide you. So ensure you understand everything about additional costs, flexibility or adaptability and safety before you hire the track. Look for someone near you who offers Posi-Track hire.
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The U.S. District Court for the Southern District of New York, in
Fisher v. Aetna Life Ins. Co., has upheld its prior determination that a beneficiary was required to meet the ACA’s family out-of-pocket cost-sharing limit rather than the individual limit. In reaching this outcome, the court concluded that HHS regulations interpreting the ACA’s cost-sharing provisions were not retroactively applicable. Law. Under the ACA, annual cost-sharing under a non-grandfathered group health plan may not exceed certain ACA limits on an individual’s out-of-pocket costs. HHS regulations issued in 2015, which became effective in 2016, say that the ACA’s annual cost-sharing for self-only coverage should apply to individuals with either self-only or non-self-only coverage. Under these regulations, plans could not require individuals with family coverage to spend more than the out-of-pocket limit for self-only coverage.
Under Second Circuit precedent, an interpretive rule may be applied to a matter retroactively, but a legislative rule may not. An interpretive rule is one that clarifies an existing rule or regulation, while a legislative rule alters the law in some way.
Facts. In Fisher, the plaintiff was a beneficiary under an non-grandfathered ERISA group health plan sponsored by her husband’s employer. The plan contained the following cost-sharing provisions: Before reaching a $4,000 deductible, covered individuals ( , participants and beneficiaries) were responsible for their medical expenses. i.e. After reaching the out-of-pocket limit, the plan paid 100% of the covered amount for the rest of the plan year.
In 2015, the plaintiff purchased a drug prescribed by her treating physician. The claims administrator denied the plaintiff’s claim for benefits, concluding that the family, rather than individual, out-of-pocket limit applied to the plaintiff’s claim because she had family coverage.
In turn, the plaintiff sued the claims administrator in federal district court to challenge the claim denial. The district court determined that the claims administrator’s determination was arbitrary and capricious and remanded the matter to the claims administrator for further review. On review, the claims administrator reached the same conclusion. The beneficiary again challenged the claims administrator’s determination, and this time the court ruled in favor of the claims administrator. The plaintiff responded by filing a motion to request that the court reconsider its decision in the matter.
District Court. The plaintiff asserted that in determining she was required to meet the family and not the individual out-of-pocket limit, the court had ignored the HHS regulations’ interpretation of the ACA cost-sharing requirements. As support for this position, the plaintiff cited HHS regulations which provide that the ACA’s limits for self-only coverage would apply to individuals with s both self-only and family coverage. The outcome of the plaintiff’s challenge depended on whether HHS’s 2015 regulations applied retroactively.
The district court denied the plaintiff’s motion for reconsideration. In reaching this determination, the court concluded that it did not fail to consider HHS regulations interpreting the ACA’s cost-sharing provisions when it interpreted the terms of the plan because the regulations were not retroactive. The court further noted that the ACA does not specify which out-of-pocket limit should apply when an individual has family coverage.
In reaching this conclusion, the court explained that:
The rule contained in the regulations involved a change, as evidenced by the ACA’s silence on which limit applied in this situation and the fact that insurers typically required individuals to meet the family out-of-pocket limit before the regulation went into effect. The regulations were issued using the notice-and-comment rulemaking process under the Administrative Procedure Act. HHS indicated that the rule applied prospectively.
Because the court found the regulations were not retroactive, the court concluded that it did not fail to apply the ACA’s cost-sharing provisions when it interpreted the plan’s terms to require the plaintiff to meet the out-of-pocket limit for family coverage.


From the Editor
Last week, the Senate voted 52 to 29 in favour of Bill C-45, clearing the last hurdle for marijuana legalization. The federal government is aiming for implementation in the fall.
So, what now?
In the first selection, the University of Toronto’s Tony P. George
et al. discuss a “framework” for cannabis policy post-legalization. This Canadian Journal of Psychiatry perspective paper is prescriptive, aiming to reduce the negative effects of the legal change. They make six recommendations, including a national strategy for education.
Also, in this week’s Reading, we consider the life and psychiatric contributions of Charles Krauthammer, who died last week at age 68. Dr. Krauthammer is best known for his political commentary, but he had a career in psychiatry before becoming a prominent essayist, and penned a classic paper on “secondary mania.”
Please note that there will be no Reading next week.
DG


UC Santa Cruz Inferring Genetic Co-dependencies To Identify New Vulnerabilities In Cancer Author(s): Matthew, Thomas James Advisor(s): Stuart, Joshua et al. Abstract
Translation of cancer genomic data into cancer therapies and companion
diagnostics remains a primary challenge in personalized medicine. Much of this
challenge is due to the difficulty of identifying genetic co-dependencies that lead to
clinically actionable drug targets. Targeting many of the known essential gene
products are not always selectively efficacious because these targets may be
common to both malignant and benign cells. However, essential genes that are
associated with particular genomic alterations in cancer cells, like those from
synthetic lethality, can potentially provide a source of tumor-specific drug targets.
To help aid novel drug discovery, I developed a computational approach called
CLOvE, a multi-omic approach that identifies co-dependencies in pairs of genes.
These co-dependencies are inferred from context-dependent changes in
expression, where CLOvE assigns high scores to those genes with the greatest
compensatory change in expression. These scores may suggest synthetic lethal
interactions, which may uncover clinically actionable essential genes. These
methods were developed in CCLE cell lines and validated with RNAi and CRISPR
viability data. CLOvE identifies meaningful expression changes, assigns high scores
to known essentials, reveals known synthetic lethal connections, and implicates
many possible new connections. This approach could provide a tool to accelerate
both target discovery and biomarker discovery, to develop drugs suitable for a
specific cancer, and identify and stratify patients who may benefit from these
treatments.


“In fulfilling our mandate over the 2019 – 2022 period, our National Standardization Strategy focuses on high priority Products and Services, including Construction Goods. The standardization of these products contributes towards the overall mitigation against threats associated with natural disasters such as earthquakes, tropical storms and hurricanes which are known to affect our region. The standardization of these goods can also support the development of a National Building Code which has been requested by various Stakeholders over the past years but even more recently following the 2018 seismic activity.”
These were the words of Derek Luk Pat, Executive Director, of the Trinidad and Tobago Bureau of Standards (TTBS), as he addressed participants at the Opening Ceremony of the National Stakeholder Meeting on the enforcement of the National Compulsory Standard, TTS 588:2015, for Horizontal Core Hollow Clay Blocks.
The meeting was held on Thursday 21
st March 2019, at TTBS in Macoya, and included representatives from clay block manufacturers, the construction industry, regulatory agencies, governmental organizations, consumer protection agencies and distributors.
The stakeholders were informed that a Moratorium Period would commence on the 21
st March 2019 and conclude on the 20 th June 2019. Following the moratorium, all applicable blocks used within Trinidad and Tobago, must comply with the specifications set out in the Standard. Furthermore, compliance must be demonstrated via certification from TTBS which is the regulatory authority. Certification of the blocks will ensure that construction companies, contractors, consumers and home owners will have an adequate level of protection and confidence when purchasing blocks for construction projects.
These activities contribute to the development of the National Quality Infrastructure (NQI). The NQI includes all systems for standardization, testing, inspection, certification, accreditation and measurement. It is critical in ensuring that products, services and persons conform to industrial, national, regional and international requirements. As a result it also has a significant impact on National Development, Trade Competitiveness and Socio- Economic Health. At the meeting it was noted that in regard to the development of the NQI, TTBS is assisting the Ministry of Trade and Industry (MTI) to institute the 2018-2030 National Quality Policy and Implementation Plan which was approved by GORTT in April 2018.
This initiative forms part of TTBS’ mandate under the Standards Act (Act No.18 of 1997) as the National Standards Body and National Quality Certifying Body. Against this backdrop, TTBS is committed to improving competitiveness and promoting sustainable development through the formulation, promotion, and application of standards and conformity assessment activities.


Are you searching for an energy-efficient way to heat your home? A boiler is sure to do the trick. Hire a technician at Living Water Plumbing, LLC for boiler installation. Our team will go above and beyond to install your boiler swiftly and efficiently. You have direct access to heat with no fuss.
Schedule your boiler installation in Casper, WY today.
A broken boiler leaves your home cold and uncomfortable. Keep your home warm throughout the winter with our boiler repair. Our team will inspect your unit to determine what's causing the complications. Once we've found the source of the trouble, we'll discuss repair or replacement options.
If your boiler is on the fritz, call now to schedule your boiler repair with one of our technicians.


Abstract
Scholars know little about families' experiences when receiving related services and how these services affect the shift from a family-centered to an educational program. In this qualitative interview study, the authors explored the transition experiences of six families over a 3-month period, focusing on the role of related therapy services and therapists. In the metatheme titled The Outsiders, the authors discuss these families' views of their changing roles as their children enter preschool programs. Families in this study felt removed from their former role as an integral member of their children's intervention team once their children entered school. Based on these families' reported experiences, the authors propose strategies for professionals to improve their communication with parents to help them during this transition.
Keywords children with disabilities family centered infants occupational therapy related services toddlers early intervention Preschool children ASJC Scopus subject areas Education Rehabilitation


Macrophages make up a crucial aspect of the immune system, carrying out a variety of functions ranging from clearing cellular debris to their well-recognized roles as innate immune cells. These cells exist along a spectrum of phenotypes but can be generally divided into proinflammatory (M1) and anti-inflammatory (M2) groups, representing different states of polarization. Due to their diverse functions, macrophages are implicated in a variety of diseases such as atherosclerosis, lupus nephritis, or infection with HIV. Throughout their lifetime, macrophages can be influenced by a wide variety of signals that influence their polarization states, which can affect their function and influence their effects on disease progression. This review seeks to provide a summary of how GM-CSF and M-CSF influence macrophage activity during disease, and provide examples of in vitro research that indicate competition between the two cytokines in governing macrophage polarization. Gaining a greater understanding of the relationship between GM-CSF and M-CSF, along with how these cytokines fit into the larger context of diseases, will inform their use as treatments or targets for treatment in various diseases.


Should you reduce or replace your calories? Not all calories are equal
. While all calories contain the same amount of energy, calories from different foods react differently. Consider a donut, a kale salad with olive oil dressing, and a broiled chicken breast.
The donut contains calories from sugar that your body immediately digest and absorb into your bloodstream. Once there, the blood sugar triggers an insulin response, followed by a cortisol release. If your body does not quickly burn these calories, your body converts them as body fat. One donut can cause many problems: two donuts double the sugar, the calories, and the body fat.
The kale in your salad provides calories from complex carbohydrates and fiber.
Kale is slowly digested, even requiring additional calories for the digestive process. Also, it provides bulk and fiber that may pass through your digestive system without being fully digested or absorbed.
The olive oil in your dressing is a fat (lipid). In this case, it a healthy fatty acid that remains undigested in your digestive tract until it reaches your small intestine. After digestion, your intestines absorb olive oil and burn it as fuel or store it in your liver for future use. Olive oil and avocados are examples of healthy fats, compared to the unhealthy fats found in butter, cheese, red meat, and full-fat dairy products.
The broiled chicken breast provides calories from lean protein.
The digestion process begins in your mouth as you chew and ends in your stomach. The acids in your stomach break proteins down into amino acids. Your body absorbs the protein and then uses it to build or repair your body. Consequently, the human body does not burn protein as fuel when you eat carbohydrates or fats.
If your goal is a lean, muscular or toned body with less stored body fat, doesn’t it make sense to consume fewer calories from simple carbohydrates (donuts) and more calories from complex carbs (kale), lean protein (chicken), and healthy fatty acids (olive oil)?
You may have also been told that the only way to lose weight is to create a calorie deficit. Both options are effective, but there is a third option that will help boost your weight loss. Replace “bad” calories from sugars and saturated fats with “good” calories from complex carbohydrates, Omega-3 fatty acids, and lean proteins.
Instead of choosing between replacing or reducing calories, do both!
Reduce the number of calories you eat daily to create your calorie deficit and replace the empty, junk calories with healthy calories. Start by eliminating sugars (cookies, donuts, cakes, etc.) and saturated fats (butter, cheese, and ice cream). Also, eat more fruits, vegetables, and whole grains: foods filled with complex carbohydrates and fiber. Doing so will fill your stomach and leave you satisfied with nutritious foods and fewer calories!


Shifting two sliding sleeves using Well Key 325
Well typeProducer offshore
Max. deviation31.92°
Depth SSD #15,173 ft (1,577m)
Depth SSD #24,916 ft (1,498m)
Max. pressure2,300 psi
Max. temperature256°F (125°C) Background
A well designed with an upside-down completion was causing problems for an operator in Indonesia. The operator needed to shift two 4.562″ sliding sleeves in the 5-1/2” lower completion. To do so, the toolstring needed to pass through the 4-1/2” upper completion, where a 3.688” nipple profile was restricting passage. Slickline was impossible. This would require the time-consuming and costly pulling of the upper completion along with the associated deferred production.
Welltec® was called upon due to the operator’s previous experiences with our solution package for mechanical manipulation. The Well Key® design allows it to pass restrictions, as its keys are only extended when positioned accurately in the well to lock into the sliding sleeve profile.
Operation
The Well Key 325 Extended Reach was selected to pass through the restriction and reach the sliding sleeve shifting profile. Prior to mobilization, a SIT was conducted at Welltec’s Jakarta facility and the key profile was revised to match the sliding sleeve profile perfectly. The operator was satisfied that the tools would work properly and recommended to reduce the force on the Well Stroker® from 33,000 lbs to 15,000 lbs to avoid damaging the sleeve. During the operation, the toolstring passed through the restriction with no complications.
The Well Key profile was positioned with pinpoint accuracy above the sliding sleeve profile and then activated. The Well Tractor® powered up to engage the Well Key profile to the shifting profile. The Well Stroker, configured with 15,000 lbs force, anchored in position on the 5-1/2” 20# blank pipe above the sliding sleeve and powered up to stroke down and shift open the sleeve. It required two strokes to fully open the sliding sleeve door. Once the first sleeve was opened the well was unloaded and the second sleeve opened a few days later.
Achievements
This was the first sliding sleeve manipulation using the Well Key 325 and the operator was pleased with the outcome. It took only ten hours from rig up to rig down to open the first sleeve and the second was opened in only eight hours. The Well Key easily passed through the restriction to perform the task. This saved the operator from having to pull the upper completion and avoiding the deferred production these alternatives would have cost.
The operation demonstrated the agility of the Welltec solutions. Even with the upside-down completion, the Well Stroker-Well Key combination brought the well on-line on time and targeted schedule. The well is now producing 10MMsfp/D gas at 18% choke.
Quote
This saved the operator from having to pull the upper completion and avoiding the deferred production these alternatives would have cost.


The latter half of March has brought plenty of chatter regarding severe price retrenchment in several previously hot momentum sectors.
That list is populated most notoriously by biotech stocks and exchange traded funds, but familiar constituents also include Internet, social media and solar ETFs. [Momentum Stocks, ETFs Take a Beating]
Rapid deterioration in momentum sectors should serve as a reminder that momentum investing, particularly with ETFs, does not always mean direct bets on glamorous but volatile high P/E growth sectors. Actually, momentum can be derived from inexpensive sectors perceived to be value bets. [Marry Momentum With This ETF]
Take the energy sector as a prime example of a perceived value bet that is now displaying some noticeable, positive momentum. Some investors have already hear that ETFs such as the
Energy Select Sector SPDR (NYSEArca: XLE) and the Vanguard Energy ETF (NYSEArca: VDE) are being boosted by compelling valuations. Another option for seizing the energy sector’s new found “momo” is with the PowerShares DWA Energy Momentum Portfolio (NYSEArca: PXI).
The $196 million PXI is one of the 10 PowerShares ETFs that recently made the transition to Dorsey Wright momentum-driven indices. Although PXI fits the definition of a smart beta ETF, the fund is not excessively allocated to value or small-cap stocks. Small-caps account for about 28% of the ETF’s weight while large-caps represent 40%.
Importantly, many of the large-cap energy names that are viewed as value stocks are not a significant percentage of PXI’s weight. For example, Chevron (NYSE: CVX) is just 3% of the fund’s weight while Exxon Mobil (NYSE: XOM) and Occidental Petroleum (NYSE: OXY) are not found in PXI.
Investors should not PXI is a highly focused ETF compared to competitors such as XLE and VDE. PXI holds just 30 stocks, or not even 20% of the number holdings found in VDE. The smaller lineup is not holding PXI back.


Environmental and Occupational Epidemiology Online Course
Most diseases are either caused or influenced by environmental factors. Understanding these is essential to design effective prevention programs.
Environmental epidemiology provides a scientific basis for studying and interpreting the relationships between the environment and population health. Occupational epidemiology deals specifically with environmental factors in the workplace.
Proceed through the content in chronological order, and click the “Complete” button at the end of each section. Note: To view the full width of each page without scrolling left to right, please collapse the left-side menu using the arrow in the top left of the page. This learning experience requires about five hours to complete, and is accredited for five hours of CME.


Tourism in South Africa had mixed results in 2018/19. The country recorded 10.4 million international tourist arrivals, a 0.6% decrease from the previous year.
Africa continues to be our largest source market, accounting for 74% (7.7 million) of these visitors. However, this region was only responsible for 40% of the foreign tourism revenue generated last year according to South Africa Tourism’s annual report.
The declining visitor numbers can be attributed to negative perceptions about safety and security, and the water crisis, particularly in Cape Town.
Tourism injected R116,9 billion into the South African economy in 2018/19 through the direct spend of both international and domestic tourists. This represents an increase of 12.7% over the R103,8 billion in 2017/18.
International tourists contributed 75% (R87,4 billion) direct spend in South Africa in 2018/19. Foreign direct spend by international tourists grew by 6.6% over R82,0 billion in 2017/18 despite the 0.6% decline in international tourist arrivals.
Domestic tourists, on the other hand, contributed R29,5 billion in the year, a growth of 35.7% over the R21,7 billion in 2017/18.
The economic significance of tourism is further supported by tourism’s contribution to GDP. World Travel and Tourism Council (WTTC) estimates that the economic impact of tourism in South Africa (measured through tourism’s total contribution to GDP) was R425 billion (8.6% of the total economy).
Visitor exports is estimated at R126,7 billion or 9.2% of total South African exports. WTTC also estimates that tourism contributed approximately 1,5 million jobs to the total South African economy which represents about 9.2% of the total employment in the country.
On average, international tourists stayed 11.7 nights in South Africa in 2018/19, down from 12.4 nights in 2017/18. Tourists from the Middle East and Africa stayed for fewer nights in 2018/19 than 2017/18.
Gauteng remained the most visited province with a 36.2% share of total international arrivals. It is the primary gateway for international tourists arriving in South Africa. It is also a major destination for tourists from neighbouring countries who mainly travel to Gauteng to shop.
Limpopo remained in second place with 21.2% a share driven by growth from its key source markets of Zimbabwe and Botswana. Other major source markets for Limpopo are the United States of America, Germany and the UK.
The Western Cape is the third most visited province with a 16.3% share of total international arrivals.
The major source markets for this province are the UK, Germany and the United States of America, followed by Namibia and France.
The Eastern Cape received 4 % of visitors.
In 2018/19, there were 18,7 million domestic trips taken in South Africa. This was a 12.7% increase from 2017/18.
They contributed R29,5 billion in direct spend to the country’s economy with visiting friends and relatives being the biggest driver
According to the South African Tourism domestic brand tracker surveys, visiting friends and relatives continues to be the main reason for domestic travel (53%) and 47% of travellers stated friends/family recommendations being a reason for their travel choices.
Packages that include beaches and coastline travel experiences have had the best sales. According to sentiment analysis, most conversations on social media about domestic travel are centred around beaches.


Daily work might include preparing or examining financial documents, creating or assessing budgets and long-term financial plans, and advising organizations and individuals on financial decisions.
As a public accountant, you can focus on two broad areas: tax and audit. As your career progresses, you’ll probably want to become a specialist in one or more niches within these areas. For example, you could specialize in performing audits of not-for-profit organizations or benefit plans, providing tax planning for estates, or helping businesses address international taxation issues. You might also choose to specialize in a skill that can apply to multiple areas, such as forensic accounting.
While each public accounting firm is different, you’re likely to encounter a similar work environment at the position you choose. Some common elements include:
Hours
Most public accountants are full-time employees who work a minimum of 40 hours per week. Many work significantly more, especially during the busy tax season. If balancing work with family and personal demands is important to you, look for a firm that offers flexible schedules and keeps overtime hours to a minimum when possible. A few accounting firms even consider part-time schedules in some cases.
Travel
Travel is often part of a public accountant’s job requirements, although not always. Audit engagements tend to demand more travel than tax work, but again, this can vary based on the client’s needs and the firm’s location and policy. Some public accounting positions don’t require any travel at all. Choosing a non-audit area of focus is a good idea for new accountants who want to avoid the need to travel for their job.
Location
Public accountants can work at their firm’s offices or those of the client, or even remotely from another site. In rare cases, accounting firms may allow accountants to work from home some or most of the time. As with travel, audit professionals are more likely to spend time at the client’s site, either locally or in another city, while tax accountants frequently work in their own firm’s offices.
Public accounting is a challenging and rewarding profession that’s ideal for inquisitive, detail-oriented people who enjoy helping others. If this sounds like the right fit for you, we encourage you to explore the many advantages of a career with PBMares.


Authors
1
Food and Drug Laboratory Research Center, Food and Drug Organization, Ministry of Health and
Medical Education, Tehran, Iran
2
Department of Food Science and Technology, Varamin Branch, Islamic Azad University, Varamin, Iran
Abstract
Sodium benzoate and potassium sorbate are two major chemical preservatives which are used in Doogh (Iranian traditional dairy drink). In this study, a total of 27 commercial brands of highly consumed of Doogh samples were analyzed. The means and standard deviation for concentration of these preservatives based on HPLC results for analysis of benzoate and sorbate were 195Â·9 (SD 1Â·8) and 328Â·8 (SD 2Â·1) mg.Kg-1 respectively. The minimum and maximum of benzoate content in various brands were 18.3 and 2345.1 mg.Kg-1 and for sorbate were not detected and 4961.3 mg.Kg-1 respectively. The study revealed that there was not significant difference in preservative concentration in the samples that belonged to various dates. However, a few samples had a high preservative concentration, which could be a risk factor for human health, especially when their intake was being occurred by various foodstuffs simultaneously.
Keywords


During my investigations, I highlighted three innovations, all of which serve the production of a final product, sheep kefir. This product contains a unique added value and involves several innovational opportunities. I examined the complex economic analysis of the innovations and technological elements investigated with respect to revenues from the sale of sheep milk, sheep cheese (kashkaval) and sheep kefir. The kashkaval-type sheep cheese does not contain sufficient added value to cover the costs of innovational investments. Investigating the innovational activity for developing sheep kefir and for its market introduction, its cash flow balance becomes positive already in the second year after realization, and is able to generate significant profit.


About Event ABOUT THE ALLOGENEIC CELL THERAPIES SUMMIT
Despite the significant breakthrough represented by autologous cell therapies in the field of cancer immunotherapy, challenges remain. Autologous cell therapies require bespoke manufacturing processes resulting in
high costs, manufacturing failure in some patients and delay in availability of treatment.
Allogeneic cell therapies can address these issues using healthy donors and scaled-up manufacturing processes. However, several key challenges still need to be overcome such as avoiding GVHD and avoiding elimination by the host immune system.
Bringing together both
immunotherapy and regenerative medicine leaders, the Allogeneic Cell Therapy Summit is focused on the clinical and commercial development of engineered allogeneic cell therapies with improved manufacturing and commercialization to benefit patients in need.
Join industry leaders to:
Explore automation to reduce the cost of allogeneic cell therapies Address the need for effective cold chain supply to ensure allogeneic cell therapies are delivered to patients without losing desired characteristics Discover means to commercialize allogeneic cell therapies with effective scale-up/scale-out Assess the capabilities of genetic engineering to create bespoke allogeneic cell therapies Highlight the need for comparability and analytical tools to assist process development


Given that a COVID-19 vaccine is expected to become available in limited quantities from >April 2021, India must have a strategy in mind to vaccinate the population in the shortest possible time. We propose that COVID-19 vaccination be carried out in a mission mode " 'National COVID Vaccination Mission' (NCVM) " similar to the exercise of holding the General Election, with a target to cover 5o percent of the population (approximately 70 crore) by December 2021.
The government and other stakeholders are focusing on issues related to vaccine procurement and distribution and cold chain issues. However, despite all this planning, we believe that if there is a shortage of human resources to administer the vaccine, the timeline for vaccinating the desired percentage of the population could get skewed. This will hurt the vaccination campaign. Here we present a simple strategy to secure human resources required to vaccinate people of India in a time-bound manner.
This pandemic has already harmed the Indian healthcare delivery systems including surgical procedures, non-COVID-19 medical Out-Patient (OPD) treatments as well as routine medical checks including regular immunisations. By some accounts, over ten lakh children have >missed routine required immunisations while OPD treatments for all patients, including essential ones for oncology patients, have dropped by more than 80 percent. The numbers for institutional childbirth have dropped sharply. Under-staffed and under-funded, the existing Indian healthcare infrastructure is now under significant pressure and threatening to crack.
Assuming a single vaccination takes 20 minutes and a working period of eight hours per day, a worker would be able to vaccinate around 1,900 patients in about three months and it would require a pool of four lakh members of staff dedicated only to the COVID-19 vaccination to cover the targeted 70 crore population in six months.
In this scenario, we believe that it is not desirable to further stress the existing healthcare system by diverting human resources from there to administer Covid-19 vaccines. We believe, it is better to create a separate pool of human resources for this mission by calling on those students who are in their penultimate and final year of MBBS, BDS, AYUSH doctoral, nursing, pharmacy and other paramedical programs.
This NCVM exercise should be conducted on similar lines as the National General Election with booths being created across the country, with student professionals administering the vaccine, supported by deputed government (non-medical) officials to carry out administrative duties.
Presently, there are 529 medical colleges in India, churning out around 80,000 MBBS doctors every year. Additionally, 26,000 students complete their Bachelor in Dentistry, 55,000 nurses and 30,000 AYUSH doctors graduate annually. If we consider the penultimate and final year students from all the above courses, the total pool will aggregate to >around four lakh (semi) trained medical professionals " without considering other paramedical students as well as pharmacists (who also number around four lakh annually). This would create a workforce that may arise to the task at hand,
viz vaccinating 70 crore people in six months.
It is beneficial if these students are roped into the COVID-19 vaccination system for a three-month 'field internship' stint as part of their formal academic curriculum. Besides taking care of their travel logistics, the students could be compensated through an honorarium and/or academic credits for this internship. As an additional incentive, they should also be given priority in the COVID-19 vaccination queue.
A huge advantage in drawing from the medical student population is that they already have undergone the training needed to work with patients and administer intramuscular injections like most vaccines are. Hence, extensive training will not be required, However, it would be useful if they undergo a short course covering the vaccination programme, ethics ,and Standard Operating Procedures (SOPs) for vaccine administration at the participating institutions. Additionally, if they are allocated to the states where they are undergoing their education, cultural and language barriers should not be an issue.
To ensure a sustainable vaccine program against COVID-19 and strengthen other vaccination programs, frontline workers such as ASHA and ANM workers could also be trained/re-trained to administer this vaccine as a part of their training program.
This staffing structure could be a win-win for all the stakeholders " the government by enabling much needed continuity in the backlog of routine non-COVID healthcare activities without hampering the vaccination campaign; Medical students by providing valuable field experience as part of a critical national mission, academic credits and priority in vaccination and the general population by an acceleration of the COVID-19 vaccination campaign.
Of course, the success of such a strategy will depend heavily on the availability of a vaccine proven effective during the clinical trials, and made in enough doses to meet India's needs. Meanwhile, efforts are made to scale up >vaccine production and logistics to ensure a hassle-free >supply and delivery chain for various vaccines that will be coming into the market. While vaccine availability, production and delivery are being worked, we believe it is equally critical to focus on procuring adequate human resources. The government and academic institutions should start planning on having the required personnel trained for vaccine administration and ready to mobilise as and when the vaccine becomes available.
The authors are participants in Takshashila Institution's GCPP Health and Life Science programme


Silymarin is a milk thistle extract that nutritionally supports liver function. This highly active botanical protects the liver from free radical damage, supports glutathione concentrations and promotes superoxide dismutase activity. Milk thistle extract also stimulates protein synthesis in hepatic cells.
Suggested Use As a dietary supplement take 1 to 4 capsules per day, in divided doses, between meals - Or as directed by your healthcare professional.


Objective:
To evaluate the significance of positive surgical margins after vertical hemilaryngectomy for squamous cell carcinoma of the larynx.
Design:
A retrospective review of patients undergoing hemilaryngectomy over a 20-year period.
Setting:
A major academic medical center.
Patients:
Fifty-six consecutive patients who underwent hemilaryngectomy between 1970 and 1990. Seventeen patients were excluded because of insufficient data or because they received postoperative radiation therapy.
Results:
Eleven (28%) of 39 patients had cancer involvement of at least one margin. Two (8%) of 28 patients with negative margins and six (55%) of 11 patients with positive margins had recurrence. This difference in tumor recurrence is statistically significant. The mean disease-free interval prior to recurrence was 25 months, with no significant difference between the two groups. The mean follow-up periods for patients with positive vs negative margins were not statistically significant. There were no significant differences in survival estimates between patients with positive margins and those with negative margins.
Conclusions:
Despite a sevenfold increase in tumor recurrence rates for patients with positive margins after hemilaryngectomy, there was no adverse effect on overall survival when these patients were managed with close follow-up and salvage surgery with or without postoperative radiation therapy for tumor recurrence.(Arch Otolaryngol Head Neck Surg. 1995;121:172-175)
Wenig BL, Berry BW. Management of Patients With Positive Surgical Margins After Vertical Hemilaryngectomy. Arch Otolaryngol Head Neck Surg. 1995;121(2):172–175. doi:10.1001/archotol.1995.01890020034008
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Your VPN Won’t Cut it Anymore
At the beginning of 2020, organizations scrambled to provide employees with the means to work remotely. As we continue into a remote-first world, organizations need to enable people to work from anywhere, with the same security and productivity as their HQ.
The only problem: VPN and SD-WAN-based networks weren’t designed for this new normal. Employees are unable to access the resources they need to perform their job, responsiveness of enterprise applications are significantly slower, and IT is overwhelmed with the sheer volume of troubleshooting legacy network issues.
This eBook with NetFoundry will demonstrate how to rapidly overcome the security, performance, and network management constraints of legacy networks and VPNs as you transition toward a longer-term remote work strategy.


This is the finding from the recent fifth annual Circulars award, which recognizes businesses, governments and individuals that use innovation and disruptive technologies to reduce waste, emissions and the use of harmful materials.
Below is a selection of winner, shortlisted companies and their solutions.
Award for Circular Economy Multinational: Schneider Electric (France) for integrating circular concepts throughout its business including prolonging product lifespan through leasing and pay-per-use; introducing take-back schemes into the supply chain and using recycled content and recyclable materials in their products.
12% of the firm’s revenues now come from circular activities and, between 2018 and 2020, about 100,000 tonnes of primary resource consumption will be avoided.
Miniwiz (Taiwan, China): For turning consumer waste into high-quality building materials.
Its “Trashpresso” mobile upcycling plant enables recycling without shipping waste long distances.
The company has saved 17 million kilogrammes of CO2 in construction projects alone
Tianjin Citymine (China): For pioneering the concept of “urban mining” using mobile recycling stations at waste sites to produce a reverse-logistics system of urban waste
“Moving to a circular economy delivers the disruptive change needed to secure a sustainable future, while enabling businesses to unlock innovation and growth. We are proud to recognize the individuals and organizations that are leading the circular movement, creating a thriving global economy.”


On one memorable episode of Friends, Ross is at the alter about to marry Emily, when he accidentally calls her 'Rachel.'
Calling someone the wrong name is always a cringe-worthy moment (and doing it at the alter is even worse), but researchers found that this common mistake comes from nothing but love.
Calling someone the wrong name is known as 'misnaming,' and in a study published last year in the journal Memory and Cognition, 1,700 people were asked whether they had ever been misnamed or misnamed others. "We then asked what names were incorrectly used and the relationship between the people—or animals—involved," the authors explained. "Our results confirmed that these errors are common and committed by people of all ages. (Moreover, misnaming does not appear to be an indicator of aging or of the cognitive decline typically associated with Alzheimer's disease.)"
The person most common to commit a misnaming error? A parent, calling their children by the wrong names.
"Our results suggest it is not due to people looking alike, nor is it primarily driven by the similarity of the names involved (e.g. calling Mark "Mike")," the authors explain. "Misnaming typically occurs within a social group: When family members misname other family members, the incorrect names they most often use are names of other people within the family. The same pattern is observed among friends: Friends usually misname each other using the incorrect name of another friend."
Basically, we swap the names of people within the same social groups because we associate them with each other-- and care about them in the same way.
"...a mother likely associates her children with one another. When attempting to retrieve the name of her son, she is more likely to inadvertently select the name of her daughter than the name of a colleague due to the close connections between her children's names in her semantic network. In other words, your mom calls you by your sibling's name because she loves both of you, and associates you with one another."
So, next time you call your best friend--or even your boyfriend--by the wrong name, there's no need to stress: think of it as another language of love.


Based on their excellent tumor-homing capacity, genetically engineered mesenchymal stem cells (MSCs) are under investigation as tumor-selective gene delivery vehicles. Transgenic expression of the sodium iodide symporter (NIS) in genetically engineered MSCs allows noninvasive tracking of MSC homing by imaging of functional NIS expression as well as therapeutic application of 131I. The use of tumor stroma-activated promoters can improve tumor-specific MSC-mediated transgene delivery. The essential role of transforming growth factor B1 (TGFB1) and the SMAD downstream target in the signaling between tumor and the surrounding stroma makes the biology of this pathway a potential option to better control NIS expression within the tumor milieu. Bone marrow-derived MSCs were stably transfected with a NIS-expressing plasmid driven by a synthetic SMAD-responsive promoter (SMAD-NIS-MSCs). Radioiodide uptake assays revealed a 4.9-fold increase in NIS-mediated perchlorate-sensitive iodide uptake in SMAD-NIS-MSCs after TGFB1 stimulation compared to unstimulated cells demonstrating the successful establishment of MSCs, which induce NIS expression in response to activation of TGFB1 signaling using a SMAD-responsive promoter. 123I-scintigraphy revealed significant tumor-specific radioiodide accumulation and thus NIS expression after systemic application of SMAD-NIS-MSCs into mice harboring subcutaneous tumors derived from the human hepatocellular carcinoma (HCC) cell line HuH7, which express TGFB1. 131I therapy in SMAD-NIS-MSCs-treated mice demonstrated a significant delay in tumor growth and prolonged survival. Making use of the tumoral TGFB1 signaling network in the context of MSC-mediated NIS gene delivery is a promising approach to foster tumor stroma-selectivity of NIS transgene expression and tailor NIS-based gene therapy to TGFB1-rich tumor environments.
Keywords: TGFB signaling; gene therapy; hepatocellular carcinoma; mesenchymal stem cells; sodium iodide symporter.


On October 2, 2008, USCIS released fact sheets on the procedures for spouses and children of members of the U.S. Armed forces to apply for naturalization abroad. While spouses and children must still comply with the laws relating to eligibility for naturalization, they may now apply for it abroad. According to the new USCIS guidance, they must meet certain requirements to prove that they are stationed abroad:
1. A spouse of a member of the U.S. Armed forces must have official military orders authorizing him or her to accompany their spouse abroad and must accompany their spouse abroad as provided in the orders.
2. A minor child must also have official orders allowing him or her to accompany the parent abroad.
An applicant may consider time spent abroad on official orders as time meeting the physical presence requirements of being in the United States. A spouse who wishes to apply for naturalization in three years based on his or her marriage to an American citizen still has to prove marital union but USCIS understands that involuntary separations such as those due to deployment, do not prevent naturalization.
CIS has provided a list of the required documents in their fact sheets available on their website.
It is not mandatory that a spouse or child apply abroad; is is an option they may choose. Unfortunately the USCIS guidance does not explain where the interview will take place. It is clear that the whole process may be done abroad, but the notice does not indicate where the applicant will have to go for an interview. I would assume it would be closest USCIS office abroad. This may or may not be so convenient for the applicant. The information provided also does not indicate what would happen to the application if the U.S. Armed force spouse/parent transferred to another country or left the military during this process. Presumably the application would be transferred to the USCIS district office closest to the applicant’s new residence.
While this new process makes it easier for those residing abroad to apply for naturalization, I would not advise an applicant to go through this unless he or she was planning to be abroad for at least a year. I imagine there will be delays if the applicant transfers locations or returns to the U.S. and tries to tansfer the application back.


Every good author writes with a target audience in mind, but it is rare to find a book aimed simultaneously at strictly rationalist adherents to Ayn Rand’s political philosophy and also at believers in the Christian faith.
Nevertheless, in
The Soul of Atlas, Mark David Henderson has successfully authored a book that should be intellectually engaging and even satisfying to both parts of such a disparate audience.
Indeed, Henderson has lived most of his life engaged in a conversation between the gospel-centered Christianity of his dad and the devout Objectivism of his stepfather.
This book is an invitation to join in this conversation and consider how these worldviews overlap or clash with the reader’s own perspective. Helping both groups toward engagement and understanding is the author’s explicit goal, and toward this end, Henderson articulates both views precisely and fairly.
The conversation begins by delineating the basic positions of Objectivism and Christianity by addressing four critical questions:
What is the nature of reality? What is a person’s highest pursuit? What is wrong with the world? How does one fix it?
This provides the lay of the land for someone who might otherwise be a casual reader of the Bible or have encountered only one of Ayn Rand’s novels early in life.
The heart of the book devotes individual chapters to the essential topics of sex, money, capitalism, reason, meaning, selfishness, joy, and power. For each explosive subject, the Objectivist and Christian views are presented in an engaging way before concisely summarizing the main points of agreement and disagreement.
The astute reader might scan the helpful conclusion of each chapter first before returning to read the main text rich with quotations from Jesus Christ, characters of Ayn Rand’s books, and a variety of insightful authors.
Perhaps the most valuable contribution of this book is that it avoids being a dry treatise on philosophy. Instead, riveting autobiographical events that Henderson unfolds in each chapter capture the reader.
The impact of philosophy on life is vividly demonstrated as the author struggles with radiation treatments for cancer as a sixteen-year-old. Moreover, he personally lives out the drama of his parents’ separation which echoes Dagny Taggart leaving Hank Rearden for John Galt in
Atlas Shrugged. The agonizing questions about sex, identity, and meaning are vividly portrayed through Henderson’s college years.
For the author, this conversation is not reduced to theoretical banter; he has personally experienced the impact of these philosophical ideas in his life.
Chapter 11, “Who is John Galt? Really,” is worth the price of the entire book. Henderson deftly highlights the remarkable overlap between Ayn Rand’s hero, John Galt, and Jesus Christ.
Both were born in insubstantial towns and embarked on a mission to right the world. Both attracted many followers but were revealed clearly only to a small group in a remote place. Both persuaded people individually with patience, passion, and perseverance. Both articulated wisdom that resonated with a certain type of person prepared to hear it. Both were rejected, treated as common criminals, and were complicit in their own torture.
Both were prepared to die and yet prepared a paradise for a select few who recognized and accepted them.
These clear parallels force the reader to wrestle with the reality that Rand’s portrayal of the ideal man based solely on reason bears an uncanny resemblance to Jesus Christ.
For Christians, this provides helpful insights into why Objectivism has held such a deep attraction to so many intelligent and productive people.
For Randians, this provides an opportunity to reconsider the historical claims of Jesus Christ and to recognize the significant overlap in areas devoted to individual choice, free market exchange, and limited government.
I highly recommend that you read this book whether you are a committed atheist, devout Christian, or anyone looking for an engaging introduction to two of the most profound influences of American ideology over the last century.
Leave your comments here.


You were the only two ever to know true paradise. What was it like to wake every morning with no fear at all, to go throughout your day with only joy, wonder, beauty, pleasure in your work? What was it like to know your man only in harmony, as your beloved, your best friend?
Till that day things were perfect. What was it like when you made that choice and everything changed in a single instant?
I can imagine the fear, rushing over you in suffocating heaviness, narrowing your vision, crushing you to the ground. You suddenly knew pain, and everything must have become a threat. You suddenly knew you had to protect yourself. You had to hide.
We’ve been scared ever since. Scared is our M.O. Scared is where we live, what forms our thoughts, what drives us. Maybe we’re all scared of different things, and maybe we pretend otherwise, but ultimately we’re all just afraid, hiding in the garden that is no longer paradise.
We forget that everyone else is operating scared, too. I wonder how it would change our interactions to know this?
Scared wants you to think I’m fine. Scared wants control. Scared wants comfort and peace. Scared wants to hide.
Scared wants big answers to terrifying questions. Scared wants to stop hurting, stop losing.
We don’t have the answers to fear, and so fear grows.
But this is what He says: Perfect love casts out fear. Perfect love sits with an enemy and listens. It weeps with the anguish of others. It challenges selfishness and oppression. It washes feet, no matter how deserving. It touches disease and sits with death. And always, always, it points up to a holy God, the only one who truly knows how our fear has shaped us and how to set us free.
Over and over He tells us, “Do not fear.” He never apologizes for being scary, or confusing, or seemingly absent, or too holy for us. He just says, “Don’t be afraid. You can trust Me.”
You can trust Me. love. It is utterly for me. It heals. While I journey in the pain, in the dark, in the confusion, perfect love is there, with me, and when I know it fully I will no longer be afraid. I will trust, even while hurting, even while blind, even while overwhelmed.
I am not big enough for all the scary. Not strong enough, or wise enough, or anything enough. But He is. He promises His love is worthy of our trust.
What are you scared of today? What is love asking you to do?


Counties need to be able to prepare for, respond to and recover from disasters in a timely fashion, and as part of this preparation, they need to ensure that critical infrastructure, such as energy, water, communications and transportation, remain operational, or that service can be quickly returned to normal following a disaster.


Delayed metabolic and thermogenic response to a mixed meal in normoglycemic European women with previous gestational diabetes. Kousta E., Parker KH., Lawrence NJ., Penny A., Millauer BA., Anyaoku V., Mulnier H., Forster DC., MacDonald IA., Robinson S., McCarthy MI., Johnston DG.
We assessed postprandial thermogenesis (PPT) for 3 h following a mixed meal in 29 normoglycemic European women with previous gestational diabetes (GDM), compared with 37 control women. Given the potential role of catecholamines and insulin in the regulation of PPT, we assessed insulin and catecholamine responses to the meal. There was no significant difference between the two groups in resting energy expenditure, PPT (although lower in the GDM group), or catecholamine levels. However, we observed a difference in the shape of the PPT curve between groups, and by applying a mathematical model, there was a consistent delay in PPT, insulin, and noradrenaline responses to the meal in the GDM group (T: fitted time constant, geometric mean (95% confidence interval), T(PPT) 58 (47-72) vs. 42 (37-48) min, P = 0.006; T(ins) 32 (28-37) vs. 22 (19-27) min, P = 0.002; T(NA) 30 (23-38) vs. 18 (14-23) min, P = 0.01, respectively). Fidgeting activity during the study was assessed by a novel technique and was lower in the GDM group, resting [427 (381-477) vs. 511 (466-560) kJ/min, P = 0.02] but not postprandially. These delayed PPT, insulin, and noradrenaline responses to the meal in post-GDM women represent early metabolic changes. The decrease in fidgeting activity while resting, observed in the post-GDM group, may have physiological significance for energy balance.


The science we conduct often reflects the society we live in. One phenomenon of current society is the rise of the reality television show. Participants are promised instant media fame without having to struggle through acting school. I worry that this has rubbed off on some of the studies we now conduct. Sir Richard Doll […]


From mowing grass and cleaning your carpet to replacing a leaky faucet, maintaining your home is overwhelming. While stressful at times, cleaning, maintenance, and repairs are imperative parts of home ownership. Not only will these updates and improvements protect your home's function and appeal, but they are also necessary for upholding the value of your house. Unfortunately, you may not be placing enough importance on your home's windows. Although thousands are available on the market, many glass cleaners contain harmful ingredients that can affect your health and the environment.
Commonly found in most popular glass cleaners, ammonia effectively removes dirt and residue from glass surfaces. However, the ingredient can be surprisingly toxic. Using this guide, you will understand the dangers of ammonia and learn how to clean your windows and glass surfaces in a safe, natural manner.
Annoyed with Ammonia
With spring quickly approaching, you may be planning on a thorough washing of your windows, but skipping sprays that contain ammonia is smart. While surprising to hear, exposure to ammonia creates the following health issues:
Irritated Skin Irritated, Red, Swollen Eyes Coughing Wheezing Breathing Difficulty Increased Symptoms in Asthma Patients
Many homeowners use an ammonia-based glass cleaner on their windows and bleach on their home's exterior. This not only doubles the toxicity, but also directly affects surrounding landscaping and wildlife. In addition, ammonia and chlorinated bleach will pollute the air.
To protect your health and the environment, consider washing windows and other glass surfaces with simple techniques and natural ingredients.
Squeegee
If you wash your windows yearly, cleaning sprays and solutions may not be necessary. Purchase a squeegee tool on a long handle to remove excess water and dirt from your windows without ammonia or other glass cleaners.
Use your garden tool to rinse off a window. Before the water dries, move the squeegee blade vertically across the glass. Wipe off the squeegee blade to remove excess liquid and dirt. Then, move the squeegee horizontally across the window.
Repeat the process for each window to remove dirt and residue without any toxic chemicals.
Baking Soda
You most likely have a box or two of baking soda in your pantry, but you may not be familiar with its many uses. The sodium bicarbonate creates a bubbling, fizzing sensation when it comes in contact with moisture. This carbonation effectively removes dirt and residue from surfaces including glass windows.
In a spray bottle, combine the following ingredients:
3 cups of water ½ cup of baking soda
Shake the bottle to ensure the baking soda dissolves completely into the water. Then, douse on your window. In most cases, your garden hose will completely rinse off the dirt and leftover baking soda solution. If not, use your squeegee tool to remove the residue.
This baking soda solution quickly cleans your windows, but it is also effective for window frames, shutters, and vinyl siding.
Vinegar
Due to the outdoor elements and changing weather conditions, you may need a stronger glass cleaner for your windows. Fortunately, vinegar is strong, effective, but safe and gentle for your health and the environment. Vinegar also cleans and shines without creating streaks across your glass surfaces. Plus, its acidic properties naturally kill mold, mildew, and bacteria.
In an outdoor pump sprayer, combine the following ingredients:
2 gallons of water 2 gallons of white vinegar ½ cup of lemon juice
Spray on your windows and other glass surfaces. Allow to soak for 15 minutes before rinsing off with your garden hose. For added shine, spray the vinegar solution and wash windows with balled-up newspapers.
Cleaning and maintaining your home without harmful ingredients protects your health and the environment. Using this guide, your windows and glass surfaces will be clean, appealing, and eco-friendly. For even better results, consider contacting a professional window washing company like Clear View Inc.
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Journal of Cognitive Neuroscience
Visual search is often guided by top–down attentional templates that specify target-defining features. But search can also occur at the level of object categories. We measured the N2pc component, a marker of attentional target selection, in two visual search experiments where targets were defined either categorically (e.g., any letter) or at the item level (e.g., the letter C) by a prime stimulus. In both experiments, an N2pc was elicited during category search, in both familiar and novel contexts (Experiment 1) and with symbolic primes (Experiment 2), indicating that, even when targets are only defined at the category level, they are selected at early sensory-perceptual stages. However, the N2pc emerged earlier and was larger during item-based search compared with category-based search, demonstrating the superiority of attentional guidance by item-specific templates. We discuss the implications of these findings for attentional control and category learning.


This website provides a broad range of resources relating to the effective use of emergency manuals to enhance patient safety. Emergency manuals are increasingly being used in a wide range of clinical settings, along with other forms of ‘cognitive aid’ such as checklists.
These tools aim to help clinicians and teams consistently deliver best practice, provide a framework for teams to train for, manage and debrief critical events and embed the actual use of emergency manuals into clinical practice.
The focus of the resources on this website is on perioperative crises, but the principles demonstrated by many of these resources are applicable to a wide range of clinical settings.


Abstract
Pancreatic ductal adenocarcinoma (PDAC) patients have poor prognosis and poor response to treatment. This is largely due to PDAC being associated with a dense and active stroma and tumor fibrosis (desmoplasia). Desmoplasia is characterized by excessive degradation and formation of the extracellular matrix (ECM) generating collagen fragments that are released into circulation. We evaluated the association of specific collagen fragments measured in pre-treatment serum with outcome in patients with PDAC. Matrix metalloprotease (MMP)-degraded type I collagen (C1M), type III collagen (C3M), type IV collagen (C4M) and a pro-peptide of type III collagen (PRO-C3) were measured by ELISA in pre-treatment serum from a randomized phase 3 clinical trial of patients with stage III/IV PDAC treated with 5-fluorouracil based therapy (n = 176). The collagen fragments were evaluated for their correlation (r, Spearman) with serum CA19-9 and for their association with overall survival (OS) based on Cox-regression analyses. In this phase 3 PDAC trial, pre-treatment serum collagen fragment levels were above the reference range for 67%-98% of patients, with median values in PDAC approximately two-fold higher than reference levels. Collagen fragment levels did not correlate with CA19-9 (r = 0.049–0.141, p = ns). On a continuous basis, higher levels of all collagen fragments were associated with significantly shorter OS. When evaluating degradation (C3M) and formation (PRO-C3) of type III collagen further, higher PRO-C3 was associated with poor OS (>25
th percentile cut-point, HR = 2.01, 95%CI = 1.33–3.05) and higher C3M/PRO-C3 ratio was associated with improved OS (>25 th percentile cut-point, HR = 0.53, 95%CI = 0.34–0.80). When adjusting for CA19–9 and clinical covariates, PRO-C3 remained significant (HR = 1.65, 95%CI = 1.09–2.48). In conclusion, collagen remodeling quantified in pre-treatment serum as a surrogate measure of desmoplasia was significantly associated with OS in a phase 3 clinical PDAC trial, supporting the link between desmoplasia, tumorigenesis, and response to treatment. If validated, these biomarkers may have prognostic and/or predictive potential in future PDAC trials. All Science Journal Classification (ASJC) codes General


Phishing is a scam through which one receives a fraudulent email programmed to steal one’s identity or personal information, such as credit card numbers, SSN, bank account numbers, debit card PINs, and passwords. The email typically states that your account has been compromised or accessed, or that one of your accounts was charged incorrectly. The email will instruct you to click a link in the email or reply with your bank account number and password to confirm your identity or verify your account. The email oftentimes threatens to disable your account if you don’t reply. Don’t believe it!
True and legitimate companies should never ask for your account number or password via email correspondence. If you receive a phishing email, consider one or all of the below listed recommendations:
Do not click any links contained in the email as they typically contain a virus that can harm your computer. Even if links in the email indicate the name of the company, don’t trust them. The links may redirect you to a fraudulent website that appears to be legitimate. Don’t reply to the email itself. Instead, you should forward the email to the Federal Trade Commission at spam@uce.gov. If you believe that the email is valid you may contact the company using the phone numbers listed on your statements, on the company’s website, or in the phone book. Tell the customer service agent about the email and ask if your account has been compromised. If you clicked on any links in the phishing email or replied with the requested personal information, contact the company directly to let them know about the email and ask to have fraud alerts placed on your accounts, have new credit cards issued, or set new passwords. Vishing
Similar to phishing, vishing scammers also seek to get you to provide your personal information. However, vishing scams use the phone to make their requests, instead of email. You may be directed to call a phone number to verify an account or to reactivate a debit or credit card. If you have received one of these calls, report it to the Internet Crime Complaint Center.


Many businesses in the past few years have transitioned to think mobile first, quickly realising the dramatic shift in consumers’ digital media consumption. As business strategies realign, the drive for mobile location data for campaign targeting and the creation of personalised and relevant stories has become evermore prevalent.
Mobile devices teleport us; they transport users from destination to destination throughout their entire day, playing the roles of both communication tools and utility devices. Each visit, frequent or not, builds a picture of a consumer’s individuality, enabling advertisers to enhance their marketing objectives through creative outputs.
Location derived data-driven advertising practices have been used for some time now, but have perhaps been overshadowed by an older methodology — geo-fence-based targeting. Yes, geo-fencing can extrapolate powerful results, but location intelligence provides much deeper detail and insight.


Venues all across the country are becoming proactive in preparing for a potential Active Shooter threat. When an incident involving an active shooter occurs, time is crucial. Department of Homeland Security research reveals that 70% of active shooter incidents end in 5 minutes or less. In contrast, the average response time for law enforcement is 10 minutes. It only makes sense for us to find ways to improve our reaction time. How you respond, will determine if you survive.
Our Nightlife Active Shooter & Terrorism Awareness Training Course is an effective risk mitigation model tailored to the nightlife environment. We designed this training specifically for nightclubs, bars, entertainment venues, and the alcohol service industry. While training with multiple courses across the nation, we discovered the lack of training for nightlife venues. Our team has developed a training that adapts to YOUR environment.
*Contact Us for private venue training, or register below for our public courses*


A CRISPR-Cas9-based reporter system for single-cell detection of extracellular vesicle-mediated functional transfer of RNA. de Jong OG., Murphy DE., Mäger I., Willms E., Garcia-Guerra A., Gitz-Francois JJ., Lefferts J., Gupta D., Steenbeek SC., van Rheenen J., El Andaloussi S., Schiffelers RM., Wood MJA., Vader P.
Extracellular vesicles (EVs) form an endogenous transport system for intercellular transfer of biological cargo, including RNA, that plays a pivotal role in physiological and pathological processes. Unfortunately, whereas biological effects of EV-mediated RNA transfer are abundantly studied, regulatory pathways and mechanisms remain poorly defined due to a lack of suitable readout systems. Here, we describe a highly-sensitive CRISPR-Cas9-based reporter system that allows direct functional study of EV-mediated transfer of small non-coding RNA molecules at single-cell resolution. Using this CRISPR operated stoplight system for functional intercellular RNA exchange (CROSS-FIRE) we uncover various genes involved in EV subtype biogenesis that play a regulatory role in RNA transfer. Moreover we identify multiple genes involved in endocytosis and intracellular membrane trafficking that strongly regulate EV-mediated functional RNA delivery. Altogether, this approach allows the elucidation of regulatory mechanisms in EV-mediated RNA transfer at the level of EV biogenesis, endocytosis, intracellular trafficking, and RNA delivery.


Mylea Charvat, Ph.D. Mylea Charvat, Ph.D., is a clinical psychologist, translational neuroscientist, and the CEO and founder of the digital cognitive assessment company, Savonix. She specializes in working with and leading dynamic healthcare organizations looking to expand the access to and affordability of healthcare using digital tools.
Dr. Charvat founded Savonix to address a critical challenge in the healthcare world: how do we assess the mental health, specifically the cognitive and emotional function, of patients on a large scale despite limited dollars and insufficient numbers of trained specialists? Savonix has developed mobile tools that utilize critical cognitive data to better understand patients’ health, identify those at risk and improve outcomes at the individual and systems level in healthcare.
A trained clinical psychologist with a neuro specialty, Dr. Charvat is a recognized thought leader in her field. She completed her fellowship in clinical neuroscience at Stanford School of Medicine and has been a lecturer at Stanford, the University of San Francisco and San Francisco State University. She has authored several peer-reviewed articles published in well-respected mental health and neuro-imaging journals. She is a frequent guest author for the Huffington Post, has written for Tech Crunch and has appeared as a subject matter expert at multiple conference and events including with The Atlantic Council, Hyper Wellbeing, and The CA State Forensic Medical Association.
Dr. Charvat is committed to advancing the integration of behavioral health data into mainstream health and wellness. The inspiration for Savonix came when Mylea’s husband was severely injured in a tragic accident and she experienced first-hand the difficulty in attaining the vital health data her husband needed to achieve recovery including cognitive screening


A hand-picked group of international students spent a gruelling weekend at a space boot camp in Crans-Montana, in southwestern Switzerland. Though firmly on planet Earth, the aspiring astronauts were preparing for a space mission.
The camp, set up on frozen Lake Moubra in canton Valais, is part of the Asclepios project, a space mission simulating a mission on another celestial body. The project is led by Space@yourService, a student association from the Federal Institute of Technology in Lausanne (EPFL). During the camp, researchers collected psychological and physical data to better understand how astronauts react in difficult and unfamiliar situations.
Participants from several countries were chosen from among 200 candidates, mimicking the selection process of the European Space Agency (ESA). The young team called in specialists to help, including EPFL professor and former Swiss astronaut Claude Nicollier, French polar explorer Alban Michon and experts from the European Space Agency (ESA).
The simulated mission Asclepios will take place in April at an as-yet undisclosed location in the Jura mountains in Switzerland. Six astronauts will spend seven days isolated in a module that replicates the exact conditions of a space habitat. Everyday life inside the module will be based on real-life NASA and ESA missions.
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Example - Marketability
Discounts and Control Premium
Estate of William J. Desmond,
v. IRS
[full
text] [excerpted]
T.C. Memo 1999-76 (U.S. Tax Court 1999).
William Desmond died holding 136,000
shares (81.93%) of Deft Corporation, a small closely
held company that manufactures industrial paint
for military and commercial uses. The IRS claimed
that Desmond's estate tax return underreported
the value of Desmond's interest in Deft and accordingly
determined a deficiency and assessed a large penalty.
The key issue before the court, therefore, was
to determine the fair market value of Desmond's
interest in Deft.
Both Desmond's estate and the IRS
submitted expert valuation reports to the court.
The estate valued Deft using three methods: Asset
method, income method, and market method. It averaged
the results obtained under the three methods and
then applied a 25% lack of marketability discount.
THe IRS's expert did not address the fundamental
("unadjusted") value of the company,
focusing solely on the appropriate lack of marketability
discount instead.
The court adopted Desmond's conclusion under
the income and market methods, and rejected the
asset method results as "vague and generally
unhelpful." Under the income method, Desmond's
experts projected the future cash flows of Deft
and then discounted these projections using a
discount rate determined by the Capital Asset
Pricing Model (CAPM), applying a beta derived
from the betas of eight similar publicly-traded
paint finishing companies. The court averaged
the valuation obtained under both methods. To
this amount, the court applied discounts for lack
of marketability and pending environmental liabilities
Deft was facing.
Marketability discount. On the
question of marketability discounts, the court
concluded:
Deft's potential environmental liability affected
the value of the company's stock
The environmental risk properly resulted in
discounting under the income method, but not
the market method.
The
betas of 8 comparable companies
used to determine the discount rate under the
income method were not shown to be "higher
than normal due to potential environmental liabilities
faced by these companies." The price-earnings ratio for two similar companies
"already include the potential environmental
problems faced by the similar companies"
and thus the price-earnings ratio used under
the market method "took into account the
potential environmental liabilities of the comparable
companies."
The court found the following factors "favor
a high lack of marketability discount":
There was no public market for Deft's stock
Deft's profit margins were below the industry
average
All stock in Deft was subject to a restrictive
share agreement which provided that a shareholder
could transfer his or her stock to a non shareholder
only after the shareholder offered the shares
to the remaining shareholders
Given the size and low profitability of Deft,
a public offering of the stock was unlikely
in the future
The size of the interest is so large that
it may be hard to find potential buyers in the
future who could finance such a purchase
Deft has large potential environmental liabilities.
The court concluded, without explanation, that
a 30% lack of marketability discount was appropriate
for the Deft stock. Of this 30% discount, 10%
was attributed to Deft's potential environmental
liabilities - again, without explanation. The
court applied the 30% discount to the value determined
under the income method. The court applied only
a 20% discount to the value determined under the
market method.
Control premium. The court then
turned to whether the 82% interest held by Desmond
warranted a control premium. As the court explained,
a "control premium may be necessary when
valuing an interest which gives its holder unilateral
power to direct corporate action, select management,
decide the amount of distributions, rearrange
the corporation's capital structure, and decide
whether to liquidate, merge or sell assets."
The court concluded that whether a control premium
is appropriate depends on the valuation method.
The income method, the court stated, "assumed
the continuation of Deft's present policies and
did not account for a change in control."
It thus produced an unadjusted value based on
a minority interest, making it proper to apply
a control premium. The market method, based on
comparisons with publicly traded stocks, also
produces an unadjusted value based on a minority
interest, making a control premium proper.
Accepting the estate's expert's 25% control premium,
the court applied it to the the market method, but
not market method since the expert had already .
We find HML's determination reasonable, and we conclude
that a control premium of 25 percent is appropriate.
We shall apply this premium to the unadjusted value
we determined under the income method.
Court decision:
Income method
Market method
Unadjusted Value
(based on expert's report)
$ 8,109,000
$ 10,410,000
Less Marketability Discount:
20%
(1,621,800)
20%
(2,082,000)
10%
(810,900)
0%
Add Control Premium (already
included in expert's report for market method)
25%
2,027,250
0%
Fair Market Value of
100% interest
7,703,550
8,328,000
81.93%
6,311,519
81.93%
6,823,130
50%
3,155,759
50%
3,411,565
FMV Decedent's
Interest
6,567,324
Some questions:
Why isn't the potential environmental risk
already impounded in the discount rate implicit
in both the betas of comparable companies and
their price-earnings ratios?
Can you explain why a company's beta does
not reflect environmental risks, but its market
valuation would?
Can there be individual shareholders risks
that are beyond the general company risks, reflected
in comparable P/E ratios and CAPM discounts?
Why is a buyer willing to pay more, on a relative
basis, for an 82% interest than a an 8.2% interest
in the same company?
Is there any reason to believe that new management
is more effective in increasing corporate returns
than existing management?
Should the market value of an asset (here
a company) depend on the value placed on it
by a buyer, because of changes that will happen
in the future?


2020 has been a year like no other, but you don’t need me to tell you that. We’ve all been living it! A global pandemic, mounting social justice issues, civil unrest, a polarizing election. This year has been A LOT!
Over the last 8 months, I have surfed the waves of anxiety and I’m pretty confident I’m not the only one. At times, it’s been easy to let the circumstances of this year overwhelm me. And now, as we near the holiday season, with COVID cases increasing every day, I feel the waves of anxiety starting to churn again. I have been here before, most notably back in March.
I flipped through my journal to something I wrote on March 17, 2020. It was written just a few days after everything began to shut down. Anxiety was starting to rear its ugly head. I felt it mentally and physically. In that moment, I turned to the coping mechanisms that work for me like yoga, grounding techniques like boxed breathing and the 5-4-3-2-1 exercise, limiting my social media and news intake, and listening to music. Most importantly, as a follower of Jesus, I turned to the Bible. I started to identify verses that were encouraging and filled with truth to help center my thoughts and shift my focus. In some of my most anxious moments, meditating on the truth of these verses has helped me to refocus. Today, I want to share a few of my favorites with you. If you’re like me and battling some anxiety, I hope you find these verses encouraging!
Feeling anxious? What coping mechanisms do you turn to manage anxiety?


Researchers expect under-reaction in climate policy. However, this might differ depending on the access of different interest groups to a political system. To explore the relationship between entrenched patterns of domestic politics and proportionality of climate policy, we compare two renewables policies which financially support new renewable electricity in the UK. Drawing on the literature on policy styles and related opportunity structures, this article shows that UK political parties have responded to growing public concern and NGO pressure by, at times, trying to out-green one another to win votes. However, powerful industry actors have been influential in shaping UK renewables policies, in particular when political competition about the individual policies has been low. The findings suggest that an over-reaction in terms of exceeding the marginal costs of renewable electricity production is equally likely under conditions of high or low political competition.