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BACKGROUND AND PURPOSE: Recent studies have shown the beneficial effect of highly active antiretroviral therapy (HAART) in AIDS-related progressive multifocal leukoencephalopathy (PML). The purpose of our study was to evaluate the initial and follow-up imaging findings and survival in patients with PML who were treated with HAART.
METHODS: The clinical course and MR imaging findings on initial and follow-up MR studies in four consecutive AIDS patients with PML who were treated with HAART are described.
RESULTS: Two patients were short-term survivors and died after 3 months. Two patients are still alive, with a survival time of 22 and 43 months, respectively. On initial MR studies, more extensive white matter changes were seen in the short-term survivors. Development of a mass effect and temporary enhancement (in one patient) was observed in two HAART responders on follow-up MR studies. Increased hypointensity on T1-weighted images with concomitant low signal on fluid-attenuated inversion-recovery fast spin-echo (FLAIR-FSE) images was seen in two responders, representing leukomalacia. Atrophic changes of the involved areas of the brain, consistent with burnt out PML lesions, were seen in two long-term survivors. In the short-term survivors, increased hypointensity was present on T1-weighted images with increased high signal on FLAIR-FSE images, representing progressive destructive disease.
CONCLUSION: Our results suggest that a clinical and radiologic response can be seen in some patients with AIDS-associated PML on HAART while in others there may be no beneficial response. Development of a mass effect and temporary enhancement on MR images in the early phase of treatment might represent positive predictive factors for prolonged survival.
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the CNS caused by JC Polyomavirus, and usually occurs in immunocompromised patients (1). At present, there is no efficacious therapy for PML, although regression of the disease with or without various drugs has been described in several reports (2–5). Recent studies have shown that potent highly active antiretroviral therapy (HAART) may improve survival, clinical status, and radiologic findings in AIDS patients with PML (6–10). The purpose of our study was to characterize the changes in MR imaging findings in four patients with AIDS-related PML participating in a HAART regimen.
The study group consisted of four consecutive AIDS patients in whom PML was diagnosed at our institution between January 1997 and April 2000. A HAART regimen, using different antiretroviral drugs, was initiated in all patients. The subjects included two women and two men, with a mean age of 32 years. Two patients died after a survival time of less than 4 months. Two patients are still alive, with survival exceeding 22 and 43 months, respectively.
The diagnosis of PML was established by clinical, laboratory (polymerase chain reaction [PCR] for JC virus [JCV]), and neuroimaging studies in two patients, by brain biopsy in one patient, and at autopsy in one patient.
MR imaging was performed initially and during the HAART regimen. We used a 1.0T or a 1.5T superconducting system, and the images were acquired with a slice thickness of 4 to 6 mm with an interslice gap of 1 mm, a field of view of 230 mm with a 70% rectangular field of view, and an image matrix of 192 × 256 pixels.
Axial T1-weighted spin-echo (SE), T2-weighted fast SE (FSE), and fluid-attenuated inversion-recovery (FLAIR) FSE sequences were performed in all patients. Magnetization transfer images were not obtained, nor were magnetization transfer ratios calculated. Contrast material was administered intravenously at the recommended doses. Lesion number, size, and location; MR signal intensity; and the presence of mass effect and contrast enhancement were determined on an initial MR study and compared with the findings on subsequent MR studies. All MR images were reviewed by two neuroradiologists.
The drug regimens consisted of the following antiretroviral drugs: 1) nucleoside reverse-transcriptase inhibitors (NRTIs), including zidovudine, stavudine, and lamivudine; 2) nonnucleoside reverse-transcriptase inhibitors (NNRTIs), including nevirapine and efavirenz; and 3) protease inhibitors, including indinavir, saquinavir, and nelfinavir. The drugs were given at the currently recommended doses.
Medical records were reviewed for neurologic signs and symptoms, results of CSF analysis, CD4+ cell count (cells/mm3), and HIV-1 viral load (copies/mL) at baseline and during antiretroviral treatment. JCV was detected by PCR in peripheral blood lymphocytes and CSF.
Clinical information is summarized in Table 1. Two patients had tested positive for HIV for 14 years, and two were known to have been HIV-positive for 9 years. Both patients who are long-term responders were medication-naive as was one short-term survivor. One patient (case 4) had failed to respond on several NRTI and NRTI+NNRTI regimens. CSF examination was performed in all patients, and analyses were negative for virus and other opportunistic agents. PCR was positive for JCV in the two long-term survivors and in one of the short-term survivors. In one short-term survivor (case 3), PCR was negative for JCV. Stereotactic brain biopsy was performed in one patient (case 4), and specimens showed demyelinated areas with swollen oligodendrocytes, diagnostic for PML. Neuropathologic examination confirmed PML in the involved brain areas, with a large amount of JCV antigens in one patient (case 3). No unusual findings were observed at histopathologic examination.
In all patients, the CD4+ count was below 100 cells/mm3 (mean, 48.5 cells/mm3) at the time of PML diagnosis. After 3 months of HAART, an increase above 150 cells/mm3 was observed in the long-term survivors. In the short-term survivors, the CD4+ count never exceeded 100 cells/mm3 (Table 1).
The mean HIV viral load level was 5.2 × 105 copies/mL. In the two long-term survivors, the viral load level decreased below the limit of quantification after 8 months of HAART, and was still below the limit of quantification at this writing. In the two short-term survivors, the viral load did not significantly decrease after 3 months of therapy (Table 1).
The findings on MR images on initial and sequential (posttreatment) studies are listed in Table 2. Both short-term survivors had more extensive white matter changes on initial (pretreatment) MR studies as compared with the long-term survivors. No differences in signal intensity were observed among any of the lesions, nor did we find enhancement or mass effect in either group (Table 2).
On follow-up MR studies during the HAART regimen, development of mass effect was seen only in the two long-term survivors (cases 1 and 2) and only on their posttreatment studies. Enhancement was observed in one of the responders after 4 weeks of HAART, and then subsequently resolved (case 2, Fig 1). In both long-term survivors, increased hypointensity was observed on T1-weighted images, with concomitant low signal on fast-FLAIR images, representing leukomalacia. In contrast, in the short-term survivors (cases 3 and 4), increased hypointensity was observed on T1-weighted images in combination with increased high signal on fast-FLAIR images, representing progressive destruction (Fig 2).
The prevalence of PML has increased greatly over the last 15 years, concomitantly with the rise of AIDS (1). Since the introduction of HAART, reports have indicated that AIDS-associated PML may show clinical and neuroradiologic improvement with longer survival (2–10). However, in our series of four consecutive AIDS patients with PML treated with HAART, two were short-term survivors and two were long-term survivors.
On MR images, PML typically appears as multifocal, scalloping lesions located in the white matter. The lesions are hypointense on T1-weighted images and show high signal intensity on T2-weighted images (11). Increased hypointensity on T1-weighted images has been observed on follow-up MR studies, and has been suggested to be indicative of an aggressive form of the disease (12, 13). This feature has also been described in pathologic series (14). It was suggested recently that such imaging findings as increased atrophy, confluence of lesions, and increased hypointensity on follow-up T1-weighted MR studies may be regarded as indicators of a poor prognosis in untreated AIDS patients with PML (12). In our HAART-treated patients, increased hypointensity on T1-weighted images was observed in both therapy responders and nonresponders. In the two long-term survivors, increased hypointensity on T1-weighted images and subsequent atrophic changes probably represented necrotic areas, which were a result of the demyelination before the process was halted by HAART. In these two patients, increases in low signal and atrophy were not associated with a concomitant increase in high signal on fast-FLAIR images. If we postulate that the initial progressive disease was halted under the HAART regimen at some point, atrophic changes and leukomalacia (increasing low signal on T1-weighted images and corresponding low signal on FLAIR images) may represent a burnt out process. In contrast to this evolution of MR findings in therapy responders, increased low signal on T1-weighted images with corresponding increases in high signal on FLAIR images would represent a progressive destructive process, which is a poor prognostic sign. This was suggested in a recently published study (15), and was also true for our two nonresponders. Thus, the evolution of imaging findings in AIDS patients with PML must be interpreted differently for those who are undergoing HAART.
A mild degree of mass effect associated with PML has been described infrequently in the published literature. In one study (13), marked mass effect was observed in a patient coinfected with HIV-1. Furthermore, another study found a correlation between the presence of a mass effect and shorter survival time (12). In our series, in the two long-term survivors on a HAART regimen, a mass effect was noted on follow-up MR studies that was not present on initial examinations. In the short-term survivors, a mass effect did not materialize. The development of mass effect in the immediate phase after institution of therapy, which was not evident on pretreatment images, may have resulted from transient edema rather than from progression of the PML, thus explaining the long-term survival in our patients.
Typical PML lesions do not usually enhance; however, faint, peripheral enhancement has been described (11, 16, 17). Recently, contrast enhancement has been thought to be the result of an intense inflammatory reaction and one of the predictive factors for prolonged survival (18, 19). In one study, enhancement was present in only 8.9% of the short-term survivors, in contrast to 50% in the long-term survivors (18). The enhancement was described as faint and peripheral in these cases. Of three patients with enhancement, two were receiving zidovudine and one was receiving zidovudine, indinavir, and lamivudine; however, no information was given concerning the presence of enhancement on follow-up neuroimaging studies. In our patients, the initial MR study showed no contrast enhancement, while marked enhancement was observed on a follow-up examination 4 weeks after the start of HAART in one long-term survivor. In contrast to the faint enhancement reported in other studies, our patient had intense, diffuse enhancement distributed in the involved white matter. The other long-term survivor as well as the short-term survivors on HAART did not show enhancement on sequential studies. The fact that contrast enhancement developed only after therapy and in the early phase in our patient may be explained as an effect of the therapy on the blood-brain barrier, which, with breakdown, causes edema, mass effect, and enhancement. The breakdown of the blood-brain barrier could be a result of improved immunocompetence and the ability to produce perivascular inflammatory reaction with inflammatory cells and mediator release and finally dysfunction of capillary integrity. Prominent perivascular mononuclear inflammation has been reported to be greatest in the contrast-enhancing region of the PML lesion (19, 20). After improvement, enhancement was no longer seen. In one study, development of contrast enhancement on MR studies was seen in patients with PML being treated with HAART only when their CD4+ count had increased (21). Interestingly, in these patients, the PML lesions turned from enhancing to nonenhancing on follow-up MR studies after 3 to 6 months of therapy. This was also true for one of our patients in whom temporary enhancement was noted. Larger series are needed to attempt to explain the relationship between the development of edema and contrast enhancement in PML lesions under HAART. In contrast to untreated PML cases, in the early phase of treatment the presence of mass effect and enhancement might represent a positive predictive factor for prolonged survival. The observations from our study as well as from others suggest that enhancing PML is characteristic of patients who experienced immunological reconstitution during the early phase of therapy.
It has been suggested recently that such imaging features as increasing atrophy, confluence of lesions, and increasing hypointensity on T1-weighted images and increasing high signal intensity on subsequent T1-weighted and fast-FLAIR images could be used as indicators of a poor prognosis in AIDS patients with PML (12). Our study's results indicate that differentiating between responders and nonresponders has to be based on findings on fast-FLAIR images. Findings of decreasing high signal on follow-up fast-FLAIR images, concomitant with increasing atrophy and increasing hypointensity on T1-weighted images, are signs compatible with longer survival. The low signal areas on T1-weighted and fast-FLAIR images would then represent the burnt out parts of the PML lesion, a leukomalacic area with secondary atrophic changes. On the other hand, follow-up findings of increasing hyperintensity on fast-FLAIR images as well as increasing atrophy and increasing hypointensity, are poor prognostic signs.
Clinically, PML is characterized by progressive neurologic deficits, leading to death (without therapy) in approximately 4 months. Improved patient survival has been reported with the use of a variety of drugs in a limited number of studies, mostly involving small patient cohorts (2–5). Recent studies have reported improvement in patients with AIDS-associated PML treated with a combination of antiretroviral regimens. In a study by Giudici et al (8), all patients with PML who received HAART were negative for JCV for a period of 4 or more months after therapy. In that study, MR images revealed a worsening of white matter lesions in five of seven patients 3 months after initiation of therapy, followed by stabilization or improvement after 12 months. This was also true for the long-term survivors in our study. Similarly, the beneficial effects of HAART were noticed after an initial deterioration in another study (6), in which 10 of 11 patients treated with HAART showed improvement or stabilization of PML lesions after 4 weeks of therapy. In another study that evaluated the efficacy of cytarabine, a temporary worsening of MR abnormalities was present simultaneously with clinical improvement, followed later by an improvement in MR imaging features (3, 4).
The drop in HIV viral load (below the limit of quantification) and increase in CD4+ count in our long-term survivors undergoing HAART supports the theory of an immune reconstitutive effect. The results of published reports and observations of ongoing studies suggest that a relatively preserved immune status and immunologic reconstitution can interrupt the JCV lytic cycle in oligodendrocytes and slow further demyelination, one of the important factors for prolonged survival (18). Furthermore, reduced replication of HIV in the brain and a reduced amount of HIV-encoded transactivator of transcription protein leads to reduced JCV gene expression (22). Thus, it would appear that therapeutic strategies should be directed against JCV as well as at the underlying immune function.
Present recommendations about the treatment of neurologic dysfunction in AIDS patients include the use of protease inhibitors as part of a combined therapy. Although the data concerning the ability of protease inhibitors to cross the blood-brain barrier are conflicting, HAART, consisting of NRTIs and protease inhibitors, causes sustained suppression of the viral load (22, 23). Indinavir has been shown to achieve favorable CSF concentrations (23). The results of a recent study in patients with PML showed that survival improved substantially among patients who received combination therapy, including NRTIs and protease inhibitors (7).
Only a few studies have reported a failure to observe benefit from HAART in AIDS patients with PML (25). In contrast to the majority of published articles, which state that HAART is effective in treating PML in AIDS patients, our experience indicates that there may be two (or more) sets of patients: those who respond to HAART and those who clearly do not. A comparison of the two groups of patients in our series showed some interesting differences. The initial degree of immunosuppression did not differ between the two groups. On the pretreatment images, the only difference between them was the extent of the white matter lesions, which were more extensive in the nonresponders. After 3 months of therapy, responders showed a better immunologic and virologic response. Follow-up MR studies showed development of a mass effect in both long-term survivors, one of whom also showed temporary enhancement. Among the nonresponders, no mass effect and no enhancement could be observed.
In one study, PML developed in three patients while receiving HAART, and, despite the virologic response, the PML did not improve (25). In another study, two patients showed symptoms of PML during the first weeks of HAART, with a strong CD4+ cell-driven inflammatory response to a subclinical CNS infection of JCV (26). Follow-up MR studies in these patients revealed a clear improvement. These observations suggest that HAART may not be effective in all patients with PML and may not prevent PML in patients undergoing the HAART regimen. Previously established JCV infection of the brain that antedates treatment with HAART is one possible explanation. On the other hand, PML appearing after the institution of HAART should be added to the differential diagnosis. In the future, we may see PML developing in AIDS patients who are undergoing HAART, making the interpretation of imaging findings even more challenging.
Our results suggest that a clinical and radiologic response to HAART may be seen in some patients with PML while in others there may be no beneficial response. Initial worsening of the MR imaging findings with development of temporary contrast enhancement, mass effect, and edema in our long-term survivors was probably due to the effect of a posttreatment inflammatory reaction. Atrophic changes and increased hypointensity on follow-up T1-weighted images with concomitant low signal on FLAIR images in those patients may represent leukomalacia and burnt out PML lesions. The persistent neurologic deficits in patients with PML who are responding to the potent antiretroviral therapy are due to the sequelae rather than to unremitting disease.
1 Address reprint requests to M. M. Thurnher, MD, Department of Radiology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
- Received October 27, 2000.
- Accepted after revision January 12, 2001.
- Copyright © American Society of Neuroradiology


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Is This Snake Venomous? Copperhead VS Corn Snake.
Will the real copperhead please stand up?
Here's two different kinds of snakes, however they look very similar in appearance.
One is the relatively harmless species called a corn snake. Corn snakes are members of the "rat" snake family-Colubridae. Rat snakes are non-venomous, so they have to disable and kill their prey by strangulation.
The other snake is the infamous copperhead. Members of the viper family, copperheads use their deadly venom to subdue their prey; they are anything but harmless and should be avoided!
So how do you know which is which?
- First, note the shape of the head. Most venomous snakes have a very obvious diamond-shaped head with two pits between its eyes and nose.
- Second, look for cat-like eye pupils. This is also a tell-tale sign to keep your distance! Venomous snakes often have these slit type of pupils.
As you probably already guessed, the corn snake is in the first picture, and the other two pictures are of the very dangerous copperhead snake.
Facts about copperheads:
- Location: mid-Atlantic states and most of the southern states.
- Habitat: Rocky areas, old wood slab piles, brush piles.
- Size: 26" to 42"
- Corn snakes aren't the only non-venomous copperhead mimics; the eastern milk snake (Lampropeltis triangulum triangulum), northern water snake (Nerodia sipedon sipedon), and the eastern hognose snake (Heterodon platyrhinos) are also commonly mistaken for copperheads.
- Copperheads are generally non-aggressive; they aren't on a mission to bite everyone! They want to be left alone, but will bite if threatened. If this happens, SEEK MEDICAL ATTENTION IMMEDIATELY.
Remember, snakes are generally our friends.
Yes, it's true! Snakes are nature's terminator, helping farmers and home owners everyday. Their prime food source are rodents, which include mice, rats, and other disease carrying vermin.
Oh, but mice are fluffy and cute! Snakes are ugly!
Being cute isn't that great. Let's take the cons of mice vs the pros of snakes, shall we?
It's the Mice VS Snakes SMACKDOWN!!
- Mice: 10 million people have died from rodent related diseases in this past century alone. (Source: http://www.victorpest.com/advice/rodents-101/rodent-dangers)
- Snakes: 5-6 people die a year from snake bites. You have a better chance of getting struck by lightning! (Source:http://ufwildlife.ifas.ufl.edu/venomous_snake_faqs.shtml)
- Mice: Rodents are responsible for 8% of home fires; they love to chew, and can't resist electrical wiring! (Source: http://www.americanchronicle.com/articles/view/132607)
- Snakes: They don't chew anything, they swallow things whole. Obviously, they could care less about your electrical wiring.
- Mice: These creatures never stop pooping or peeing; besides eating and chewing, it's their favorite past time. More excrement=more disease
- Snakes: Poop once or twice a week, and usually it's not in your kitchen cabinet or sock drawer.
Clear winner: the snake.
Kimberly Schimmel from North Carolina, USA on February 07, 2012:
I'm not afraid of snakes, although I did need to learn about poisonous ones when we moved to NC. We have 4 venomous snakes in the state, including the copperhead. You do need to be careful during their mating season, I'm told, because they are not as shy then:)
hecate-horus (author) from Rowland Woods on January 21, 2012:
Good points, thank you justmesuzanne!
justmesuzanne from Texas on January 20, 2012:
Excellent! Too many people are unaware of the beneficial nature of non-poisonous snakes and the fairly harmless nature of poisonous ones (due to the fact that they tend to avoid human contact as much as possible!) It's unfortunate that some non-poisonous snakes masquerade as poisonous ones for their own protection, since that tactic doesn't help them much when it comes to humans! Another example of this is the non-poisonous yellow-bellied water snake, which looks quite a bit like a water moccasin. Voted up and useful! :)
hecate-horus (author) from Rowland Woods on January 19, 2012:
Thanks Nicole!
Nicole S Hanson from Minnesota on January 19, 2012:
Eek! I got the chills just reading this. Informational hub though!

subset: commoncrawl


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Yahoo is planning a new round of layoffs, the first since Carol Bartz became chief executive in January, according to several people with knowledge of the situation.
The layoffs could affect several hundred employees and may be announced as early as Tuesday when Yahoo reports first-quarter financial results, said these people, who agreed to speak on condition of anonymity because the plan is confidential.
Source: The New York Times


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There are very few movies about running (God bless ya, Chariots of Fire), and there are even fewer about trail running. In fact, On the Edge (watch the trailer!)—a personal favorite about my beloved Dipsea race—may be the only true Hollywood drama about trail running.
I love a good sports movie. I even love a bad sports movie. I'll watch Remember the Titans for the 22nd time, whenever it's on TV (and I love the scene where Coach Boone brings his team together by leading them on a trail run at night, ending up at Gettysburg at dawn). But let's face it, running, especially ultra-distance trail running, doesn't guarantee a compelling work of art.
Enter: Unbreakable, the story of the 2010 Western States 100-Mile Endurance Run.
The movie showed in a 250-seat theater here in Boulder, Colorado, last night. (It sold out for both showings over two nights.) I went to see it, because, well, I love running. I write about running, and I run.
I thought I'd like the movie for those same reasons. I thought it'd be, you know, a running movie about an epic 100-Mile race—a movie that only ultrarunners might find entertaining.
Unbreakable was so much more than that.
Granted, the 2010 Western States race was a battle of epic proportions. Perhaps the most competitive men's field ever assembled at one ultramarathon fought tooth and nail to the final minutes of the race over this storied battleground. (Spoiler alert: If you want to be surprised by the end of the movie, do not click here for our coverage of the 2010 race.)
And here's me playing movie critic: This movie had a surprising human element, with glimpses into the family lives, home environments, and more of each of the four main "characters"—Hal Koerner, Anton Krupicka, Geoff Roes, and Kilian Jornet. It wasn't so much, "Oh, look what he eats for dinner," but rather, "Wow, I really get a sense of what that runner/person is all about." The movie, I thought, was beautifully shot and edited, telling the story of the race while showing what drives each runner, each person. (And I can't get over how lucky filmmaker JB Benna got with how the race unfolded. Exciting!)
A highlight for me were the clips of Gordy Ainsleigh, the father/inventor of ultrarunning, standing in his running shorts and talking candidly to the camera about the 1974 Western States Trail Ride, when he decided to run the 100-mile course without a horse. There is raw, beautiful history in his face, and these clips really help frame the movie and show where ultrarunning came from, and where it is today.
Watching Unbreakable made me want to watch Chariots of Fire and On the Edge again. And it made me want to run (and desperately get over my darn injuries). It even made me want to run 100 miles. It inspired, entertained, and made me think. And isn't that what makes a good sports movie?
Movie Night
There are very few movies about running (God bless ya, Chariots of Fire), and there are even fewer about trail running. In fact, On the Edge (watch the trailer!)—a personal favorite about my beloved Dipsea race—may be the only true Hollywood drama about trail running.
Watch Next
The Saucony Endorphin Collection Hits Trails Again
The Best Headlamps for Runners
Everything You Need to Start Trail Running
Trail Vets and Newbs Alike Love Topo's Simple MT-4


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Patient perspectives: Manny Hernandez
Rebecca Aris interviews Manny Hernandez
Manny Hernandez, diabetes patient and vocal e-patient, spoke with us as part of our patient perspective series. Manny is president of the Diabetes Hands Foundation, the nonprofit organisation responsible for TuDiabetes.org, which provides support and information to other diabetes patients.
He co-founded the Diabetes Hands Foundation with the goal 'of having no people with diabetes feel alone and people without diabetes learning more about what it's like to live with diabetes'.
Manny shares with us his experience of being a diabetes patient along with the successful collaboration he's seen of patient organisations with pharma and his suggestions of what pharma can further do to help like-minded patients such as himself.
Interview Summary
RA: Hi Manny, I'd like to start by asking you to tell me about your background and experience of being a patient, and explain how you came to be such a vocal e-patient?
MH: I was diagnosed with type 2 diabetes back in 2002. At the time I was 30 and overweight. My primary care physician came to the conclusion that I had to have type 2 diabetes because I fit the profile, so to speak.
After a few months of trying to get my blood sugar numbers in control with the traditional type 2 diabetes treatment – a series of metformin based combinations – we could not get it under control. At that point he referred me to an endocrinologist who had me tested for C-peptide levels and antibodies and came to the conclusion that I actually had a form of adult onset type 1 diabetes, and put me on an insulin-based treatment.
I later started wearing an insulin pump, and joined an insulin pump users group in my home town, and that was an incredible influence for me to inspire what followed next. In a single hour of being surrounded by people just like me, other insulin pump users, I learnt more than I had by myself and with my endocrinologist's support in the course of a year of wearing an insulin pump.
It became an incredible influence to later develop the diabetes.org for the social network, I created it along with my wife back in 2007, and we've been doing that along with developing a series of diabetes awareness programmes under the umbrella of the Diabetes Hands Foundation that we formed in 2008 .
RA: What inspired you to set up TuDiabetes?
MH: The inspiration for TuDiabetes came from a combination of my own experience as a patient, along with my professional background as a web products and online community manager prior, and ultimately reading about the concept of up-line social networking to areas beyond socialising. I read about this concept in a book called The World Is Flat by Thomas Friedman, which is now quite a bit of a staple. The combination of the confluence of those three things led to the idea of developing TuDiabetes.
"In a single hour of being surrounded by people just like me, other insulin pump users, I learnt more than I had by myself and with my endocrinologist support in the course of a year…"
RA: How much direct interaction do you see between pharma and patient support networks?
MH: The participation of pharmaceutical companies has had a number of different flavours for us over the course of the past few years. One of the first came through the participation of LifeScan who licenced our first diabetes awareness programme called the Word in Your Hand. For this programme we invited participants to write on their hand a word that described how they felt about their life with diabetes, and take a photo and share it with the community. We received hundreds of submissions, and produced a diabetes awareness video in time for a world diabetes day back in 2007. LifeScan saw this video and saw the potential. They licensed the concept from us and developed a cause marketing campaign which lasted for three years called Diabetes Handprint. For every submission from patients they donated $5 to a diabetes charity.
We have also developed a number of other awareness initiatives sponsored by pharmaceutical companies and ultimately there have been other kinds of participation by pharmaceutical companies that I think are starting to show how different and possible their role can be in a social media world.
There are two such examples, one earlier by Roche, and one more recently, by Sanofi-Aventis. In the case of Roche, there was a recall of a certain type of test strips so their social media people contacted me asking if it would be appropriate for him to join in an open way indicating that he was joining on behalf of Roche, to share a document that outlined the serious questions and answers that affected not only their particular meter but all tests strips affected by this recall. We found this was relevant, contextual and invaluable to those people who were affected by the recall. From that point on he remained a member of the community and now people approach him with questions and concerns that they have. So that was a first example which we thought was a very successful one. We said that the rules of engagement are simply transparency. You have to disclose who you are, who you work for, and there's no marketing happening.
The second experience with Sanofi-Aventis was earlier this year. We had a customer service representative join the community and we talked with them about ways in which we believe interaction can be refined a bit more.
So those are a continuum of example from the licencing to the sponsorship to the live representative participating on the community.
"…we invited participants to write on their hand a word that described how they felt about their life with diabetes, and take a photo and share it with the community."
RA: Are there other ways in which you'd like to be engaging with the industry?
MH: An extraordinary example of engagement is to provide access to information that otherwise normally does not get tapped into. For example, in Europe and it is similar in the US, every drug that has FDA approval comes with a document which is sometimes referred to as the product information (PI). Extremely valuable and useful data are in this. It contains everything that you would really need to know about the product, its interactions and how it was tried and verified to work.
But extremely few people read it, in part because it is written in a language that is not accessible, and partly because it is in very tiny print. In addition, most assume that everything they need to know is told to them by their physician or dispensing pharmacist. But if you need to take insulin every day and several times a day at that, over time you start to wonder and have questions and concerns, in regards to the product.
The industry obviously has a very deep knowledge of their products. It would be extremely useful to facilitate access to those very pieces of information contained within the PI in a contextual manner, when and if discussion arises in connection to a particular product and a particular area that is detailed in the context of a PI, to direct people to that area in the PI, or even more conveniently to paste that part of the information from the PI for easy access.
I think it makes for an extremely useful use of information that is already approved in a time and a place where it is useful and needed. It would be a very easy way for industry to join the conversation and not be seen as trying to push a product, but rather to make information useful and available when it is needed.
RA: Can you tell me what your impression was of the pharma industry before your diagnosis, and how that perception has changed?
MH: Before I was diagnosed with diabetes I honestly did not have so much of an opinion – positive or negative. What I have found is that when you just look at the news releases, the websites, and the ads, you can have an impression that it's fairly faceless. But I have met an extraordinary number of people that work in the industry who are very passionate, and a good number of those were inspired to pursue a career in the industry because of a personal connection to that particular disease. In the case of diabetes a number of people from the industry who have come to me who either have the disease themself or have a loved one who has the disease, or they've lost a loved one to complications related to the disease. This gives a face to the industry.
I wouldn't say that has changed my impression of the industry but rather made me aware of a number of very inspiring stories behind people who choose to pursue a career in the pharmaceutical industry.
"It would be a very easy way for industry to join the conversation and not be seen as trying to push a product…"
RA: Aside from trying to humanise itself more do you think there are any other ways that pharma could help to improve the way that it's perceived?
MH: We are living in very difficult economic times everywhere. It is important for the pharmaceutical industry to look at this and acknowledge that within this economic time healthcare costs also are creating an important challenge for people. In countries where there are extreme levels of poverty, a particular condition like diabetes can throw an entire family into destitution. The pharmaceutical industry can look at these challenges and identify ways in which it can go even further such as increasing extremely valuable patient assistance programmes that are helping people, and philanthropic programmes that are helping groups that help people.
I know of many patient assistance programmes that have been terminated. I know that the pharmaceutical companies have a business to run, but I think it is important that they see themselves in the context of this economic time, and the patient populations they serve.
Maybe they need to think twice before cutting programmes that are helping people, and thinking of the social return on investment beyond the financial return in investment in connection with some of these programmes.
RA: What other resources and support do you think would be helpful for patients with diabetes, that are not currently available?
MH: It is important to try to not reinvent the wheel, and if a pharmaceutical company identifies a patient group or a non-profit group that they see as doing something well, then they should support that initiative or approach that group to see if there are ways that they can jointly resolve things. A patient developed initiative with the support of the pharmaceutical company can go a lot further, because it's coming directly from the patients. That partnership has all sorts of additional pluses that make for some unique benefits that are otherwise not as easy to accomplish.
"…maybe it is in the form of thinking twice before cutting programmes that are helping people, and thinking of the social return on investment beyond the financial return…"
RA: Finally what would your key message be to the industry? How do you think it can better meet patients' needs?
MH: It is really important to keep listening, to not be afraid to engage. To not listen because of the fear of uncovering an adverse event and the implications of how to act on it when there's limited data around it presents an incredibly sadly missed opportunity. People are talking about their health online like never before, and that makes for an extraordinary opportunity for identifying things that otherwise were really hard to uncover before. To choose out of lack of regulatory guidance to not enter that space is a major mistake, and shows some very limited thinking and innovation.
The companies that are finding ways to do it are paving the way, getting ahead and learning a lot, and as a consequence – helping people. If there is a potential for an adverse event to be uncovered wouldn't be in everyone's best interest to find out about it?
That's my closing thought – it is limited thinking to not enter the social media space until there's enough FDA guidance. Pharma companies should find a way to enter this space!
RA: Thank you so much for you insight.
MH: Thank you so much for the opportunity to share these thoughts.
About the interviewee:
Manny is a nonprofit leader, a recognized social media author and consultant and a passionate diabetes advocate. He has 15+ years of experience in team management and project management and an extensive background in Web Product Development, Content Development and Community Management.
He's spoken about Social Media for Nonprofits and Health @ BlogWorld Expo, Health 2.0, ePatient Connections, Nonprofit Technology Conference and other events. He's been interviewed by The New York Times, Bloomberg News, NPR, Fox News Health, Diabetes Forecast and Univision, among others.
In 2007, he co-founded TuDiabetes.org and EsTuDiabetes.org. As President of the Diabetes Hands Foundation (DHF), he's been instrumental to the development of the DHF's diabetes awareness programs and continued outreach to offer support and diabetes information to nearly 200,000 people touched by diabetes every month.
How can pharma responsibly deliver information to patients?


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Fakuma 2017: WACKER Presents Heat-Resistant Solid Silicone Rubber for the Household-Product and Automotive Sectors
Munich, Jul 27, 2017
WACKER, the Munich-based chemical company, will be premiering its new ELASTOSIL® R plus 4350/55 solid silicone rubber at this year's international trade fair for plastics processing Fakuma. An outstanding property of this extrudable and addition-curing silicone grade is its high resistance to heat. Heat stabilizers enable the solid silicone to withstand temperatures of up to 300 °C for several days, without any substantial modifications to its elasticity or mechanical properties. Even temporary peaks of up to 400 °C pose no problem. The new solid silicone is therefore suitable for components used in oven and stove doors or in engine compartments, for example, which are exposed to heat repeatedly or over lengthy periods. Fakuma will be held in Friedrichshafen, Germany, from October 17 to 21.
ELASTOSIL® R plus 4350/55 is a silicone rubber for formulating heat-resistant, addition-curing silicone elastomers. It reveals its properties to optimum effect in combination with heat stabilizers of the ELASTOSIL® AUX STABILIZER H series which are added to the base rubber. The type of stabilizer and the amount used have a significant influence on the thermal properties of the cured rubber. The silicone grade is easy to process in extruders.
ELASTOSIL® R plus 4350/55 can therefore be used to make extremely heat-resistant tubing and sealing profiles that withstand temperatures of up to 300 °C for several days – and even temperatures of up to 400 °C for short periods – without any damage. Heat tests at 200 °C and 300 °C, respectively, show that key mechanical properties such as Shore hardness and elongation at break change very little even after 2,000 hours, i.e. 80 days. In this way, manufacturer's specifications for products such as the sealing profiles used in modern ovens are clearly exceeded.
After it has cured, ELASTOSIL® R plus 4350/55 achieves a Shore A hardness value of 55 which is ideal for manufacturing heat-resistant profile gaskets, such as for oven and stove doors or for engine-compartment parts. The new silicone rubber also features good resistance to superheated steam. Consequently, seals made of ELASTOSIL® R plus 4350/55 can also be used in applications that require resistance to both heat and superheated steam. Carefully postcured grades comply with the requirements of the German Federal Institute for Risk Assessment (BfR) and the US Federal Drug Administration (FDA) for food contact.
WACKER supplies ELASTOSIL® R plus 4350/55 as a base rubber blend without additives such as colorants or heat stabilizers. As a result, processors can customize the rubber blend exactly to the specific application. In this regard, WACKER can provide processors with an extensive portfolio of additives.
Visit WACKER at Fakuma 2017, Hall A6, Booth A6-6310.
ELASTOSIL® R plus 4350/55 test
Sealing profiles and tubing made of ELASTOSIL® R plus 4350/55 resist temperatures up to 400 °C. WACKER will present its new silicone rubber grade at this year's Fakuma tradeshow.Order photo
ELASTOSIL® R plus 4350/55 oven
WACKER, the Munich-based chemical group, will be debuting the new addition-curing silicone rubber ELASTOSIL® R plus 4350/55 at this year's Fakuma tradeshow. The grade can be used to produce heat-resistant tubing and sealing profiles, such as for oven and stove doors and engine-compartment parts.Order photo
Wacker Chemie AG
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***OTH Anniversary*** The Combat Cloud Across the Range of Military Operations: Interagency Coordination
Meet the Editor: Jay Patrich is an Air Force MQ-9 Pilot. He earned a Bachelor's of Science in Finance from Florida State University and a Masters of Science in Operations Management from the University of Arkansas. He is currently a student at the Air Command and Staff College in the Multi Domain Operational Strategist concentration. He enjoys woodworking and video games. His focus areas are cyber employment and air support to special operations.
The combat cloud is an appealing concept for future multi-domain operations. It eliminates stovepipes and makes every piece of intelligence available to every operator. The combat cloud could distribute and maximize situational awareness evenly across the battlespace. However, it doesn't yet exist and the hurdles between now and its implementation are significant. Pieces of the larger concept are in use now such as IP based video feed distribution. But when MQ-9s are incapable of sharing any data (beyond video) with any aircraft or ground personnel outside of the building in which they are operated, you see how far we have to go. Beyond technological issues, there are numerous obstacles that originate in the human domain. One of these issues, interagency coordination, is discussed in this article. It seems obvious that intelligence obtained or held by one organization could be useful (even critical) to the success of another but, in many cases, the necessary sharing does not occur. One organization may not know the information is needed by the other. The other organization may not know the first has it or who to request the information from. Over-classification may impede the flow of information for what amounts to bureaucratic reasons. Implementing a fully functioning combat cloud does not solve this problem. In fact, these types of problems must be addressed for the combat cloud to realize its incredible promise. In their article, The Combat Cloud Across the Range of Military Operations: Interagency Coordination, Shaun Williams and Jacob Hess begin work toward that goal.
By Shaun Williams and Jacob Hess
A recent policy paper published by the Mitchell Institute stated, "the 21st century demands a new, more agile, and integrated operational framework for the employment of military power, and a shift away from the domain focused structure of segregated land, air, and sea warfare." In an attempt to define what the Command and Control (C2) of this "agile, and integrated…framework" would look like, the Air Force released the United States Air Force Combat Cloud Operating Concept, which defines the Combat Cloud as "…an overarching meshed network for data distribution and information sharing within a battlespace, where each authorized user, platform, or node transparently contributes and receives essential information and is able to utilize it across the full range of military operations." The Combat Cloud represents the intellectual construct necessary to unify Air Force and Department of Defense efforts in pursuit of decision superiority and Multi-Domain Command and Control (MDC2). To attain this, however, the Combat Cloud and associated network must exhibit critical attributes such as the ability to be self-forming, self-healing, gracefully degradable, and redundant. Under this construct, the ability to collect data and integrate it in an open, adaptive information system will significantly enhance C2 and operational agility for the US military and other US governmental agencies across the range of military operations.
By treating every platform as a sensor, the Combat Cloud MDC2 paradigm will give decision makers a reliable, secure, and dynamic system that ensures the effects are the focus, versus the actual platform utilized. The days of extensive stove-piping of information by various organizations within the defense enterprise, such as the intelligence community (notorious in compartmentalizing information), must be fundamentally restructured around a concept of information sharing, not hoarding. If the first part of the 21st century has taught us anything, it is that the days of interagency competition must be replaced with cooperation if the US defense enterprise is to remain relevant and efficient in the post-industrial age. The Combat Cloud provides just such an architecture to operationalize this concept.
When looking at the operability of the Combat Cloud in concert with agencies both within and outside the DoD, the Air Force can lead the way in providing the framework to ensure advances in C2 and Intelligence, Surveillance, and Reconnaissance (ISR) are available to be shared with all relevant agencies. The sharing of information on these platforms is beneficial and critical in exploiting the disparate pieces of intelligence required to defeat the enemies of the 21st century, both state and non-state. In the fight against violent extremist organization (VEOs), real-time communication and C2 within multiple domains are critical to effective control of the battlespace, and the Combat Cloud precisely enables this effect. Leveraging the advances in communication and information-sharing technologies that have come to fruition over the last 10 years, such as the Combat Cloud, will keep the US ahead of potential adversaries like China and Russia.
Take for instance, an organization such as the Defense Intelligence Agency (DIA). In most matters of information storage and sharing, the DIA is still operating in an industrial era mindset. Information is typically stored on in-house secured networks, and if it needs to be passed to another agency it requires a lengthy process of downloading, vetting, and often transcribing. The Combat Cloud will enable users within the DIA (and truly the defense enterprise as a whole) to develop an Information Technology (IT) infrastructure that is fully functional with outside agencies, consolidating data and information on secure yet accessible networks, and ultimately reducing the time necessary to retrieve and pass vital information. This will of course require very complex algorithms capable of filtering, sorting, and archiving data in a way that is relevant and retrievable, but by making it accessible across the interagency enterprise, the number of highly trained analysts available to interpret and examine the data also goes up. This will also be aided by advances in metadata processing, a field that will continue to be more critical to efficiency and success in the information age.
Heavy manpower will continue to be required to ensure efficient processing, exploitation, and dissemination of data. In 2014 alone, Air Force units generated approximately 1,600 hours of video per day, and the number of humans required to process, exploit, and disseminate this data is upwards of 100,000. Sophisticated algorithms used in conjunction with the Combat Cloud will be pivotal in sorting through the masses of data, but will give agencies the ability to share relevant information, reduce redundancies, and enable decision superiority across the DOD.
In conclusion, the USAF effort to create a new MDC2 system, colloquially called the Combat Cloud, gives the USAF a chance to begin to acquire a "system of systems" that allows for greater inter-agency and inter-domain coordination and C2. The current method of stove-piping information in individual Services or intelligence agencies will no longer allow for the adaptability or responsiveness necessary to combat VEOs nor future peers in state-on-state multi-domain combat. If adopted across the entirety of the US DOD and IC enterprise, Combat Cloud would provide a framework and a system of systems to begin to break down the stovepipes and push rapid decision quality information and C2 guidance across the players.
Shawn Williams is employed by the Defense Intelligence Agency and Jacob Hess is a Major in the United States Air Force. Both are recent graduates from the USAF Air Command and Staff College.
Disclaimer: The views expressed are those of the author and do not necessarily reflect the official policy or position of the Department of Defense or the US Government.


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TIFOSI Veloce Fototec Light Night Readers 1.5+ Single Lens Eyewear 2019 Matte Black/Fototec Light Night
|MATTE BLACK/FOTOTEC In Stock (Warehouse)
With a style that suits anyone, Veloce will never stop performing, whatever your chosen sport. Vented lenses decrease fogging and the fully adjustable, slip resistant hydrophilic rubber arms and nose piece ensure a custom fit. Virtually indestructible Grilamid TR-90 nylon frames keep the Veloce lightweight but flexible.
The matte black Veloce comes equipped with Tifosi's most versatile Fototec Light Night photochromatic lens, with a Light Transmission range from 27.7% ( fairly dark ) - 75.9% ( virtually clear ) . Light Night is colour-neutral for zero colour distortion.
Additionally, the lower part of the lens includes a +1.5 magnified bi-focal "Readers" area to make it easier to view computer screens and GPS displays while on the move.
Includes a zipped hardshell case and a microfibre cleaning pouch.


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If you watched last night's season finale of Arrow on the CW Network, you already know how well superhero stories can be translated to television. Arrow will likely go down as the best adaptation of a comic book property to hit the small screen. Marvel's Agents of S.H.I.E.L.D. tried to find the same spark but unfortunately couldn't make it happen. After all, superhero series need superheroes at least once in a while.
The ABC Network released 12 previews for new Fall shows this week, including many that seem likely not to make it very far, including Selfie, starring Karen Gillan and John Cho. With these two mega-genre stars, someone should make a series that is more than a fluffy comedy. Cho has already shown through a variety of TV appearances, such as in Sleepy Hollow last year, that he has plenty of range beyond his movie roles. Gillan needs to move beyond the role of model, and we think Guardians of the Galaxy will give fans more of what they are after.
Here's the Selfie preview, but you've been warned: ABC did not yet release a preview yet for the Agents of S.H.I.E.L.D. spinoff Agent Carter featuring Hayley Atwell's character from Captain America: The First Avenger as she builds S.H.I.E.L.D. in the aftermath of World War II.
But the NBC Network did release this preview of another DC Comics series, Constantine, to replace the unfortunately cancelled Dracula (which featured Arrow's Huntress actress Jessica De Gouw and Jonathan Rhys Meyers) for the Friday night line-up with Grimm:
We hope Constantine can bring in some of the New 52 elements and characters, particularly from Justice League Dark, maybe Zatanna, Madame Xanadu, Shade the Changing Man, and Deadman. Last night during the action-packed Arrow second season finale the CW Network presented this quick teaser for The Flash:
What the preview really shows more than anything is how cool Stephen Amell is as bowhunter Oliver Queen. Although The Flash features the young Grant Gustin as Barry Allen, this Flash seems one hundred percent Wally West (or maybe Kid Flash?). There's just something not quite right about that new Flash supersuit. Colleen Atwood, who created the Arrow supersuit, designed this new high-speed tracksuit. Maybe it's the lack of a form-fitting design that is the problem. Or that leather or pleather appearance when The Flash is moving about. It's also a bit of a letdown on the heels of the release of Ben Affleck's new Batman supersuit, which we discussed here at borg.com yesterday.
Two more series that were previewed also look interesting. ABC's series Forever stars Ioan Gruffudd from Horatio Hornblower and Fantastic Four fame, Alana de la Garza from the superb last seasons of the original Law and Order, and Taxi's Judd Hirsch. It's actually a genre series with some nice stuck-in-time quandaries. Check it out: And finally, those who are missing the Psych TV series already will be happy to see Timothy Omundson back so quickly in a similarly quirky role in ABC's Galavant. It's a medieval musical series, seeming to be like Heath Ledger's A Knight's Tale. Check out this preview:
Selfie, The Flash, Constantine, Forever, and Galavant will be airing this Fall.
C.J. Bunce


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Richmond naturopathic doctor Romi Fung is hosting a series of free health talks for seniors in Richmond, BC. during Naturopathic Medicine Week.
Health Series: Feeling Rested and Energized
Join Dr Romi Fung, ND for a free health talk about what you can do to feel more rested and more energized.
Date: May 15, 2019
Time: 1-2:00pm
Cost: Free
Register: Register online at richmond.ca/register (Reg. Barcode: 2725140)
by phone 604-276-4300 or in person during facility hours.
Location: South Arm Community Centre
8880 Williams Rd, Richmond, BC


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Don't be afraid to fill the Triple Coffee Cup up to the brim, for as precarious as it appears, the drinking vessel will not topple over. Designer Esben Oxholm Bonde of Denmark has playfully dreamed up this illusory demitasse that can actually hold an impressively great volume.
The interior of the coffee mug might be smooth and consistent but the outside has been sculpted to take the look of three stacked tea cups. It seems as though they have been piled one on top of the other, tilting slightly to accommodate their curved handles. Close observation of the Triple Coffee Cup will, however, reveal a seamless transition between one supposed vessel and another, but a still surprising inner depth if the mug is resting empty.
The Triple Coffee Cup Has the Appearance and Capacity of Several Mugs
Amelia Roblin — February 20, 2013 — Art & Design
References: behance.net


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Vitaminic Buys IUMA to Expand U.S. Presence
Vitaminic, a leading European online music venture, is expanding its presence in the United States by acquiring the Internet Underground Music Archive, a pioneering online effort to promote little-known bands. IUMA founder Jeff Patterson said that Vitaminic, which is based in Milan, Italy, agreed to pay EMusic of Redwood City, Calif., $900,000 in cash and stock for IUMA. The deal promises to revitalize IUMA, which suspended most of its operations and laid off all its employees in January after a belt-tightening EMusic shut off its funding. Patterson said IUMA should be able to relaunch all its services, including adding new artists and selling CDs, by the end of the month.


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Perfect your tan in the Sage Bikini Bottom. This classic bikini bottom silhouette features a moderate cut with ruffle detail along the front waist that's complemented by thin straps along the sides. Pair with the Suri Bikini Top to create a matching set.
Shop the look:
Suri Ruffle Bikini Top


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Urban Revitalization
Urban Revitalization refers to a set of initiatives aimed at reorganizing an existing city structure, particularly in neighborhoods in decline due to economic or social reasons. Urban revitalization initiatives generally include improving features of the urban environment, such as the quality of pavement and the functionality of the sidewalks. Depending on the intended usage of the revitalized neighborhood, the projects can also address the need for improved community engagement and occupation of the public spaces, providing new entertainment facilities like parks and museums. In several initiatives, projects aim to prepare parts of the city to fulfill a desired economic function by adjusting the utilities network to specific requirements.
A revitalized urban space, with effective infrastructure, can create the conditions for an efficient city, capable of promoting innovation, a higher quality of life, and economic development with shared prosperity and environmental respect. Urban revitalization initiatives can, however, be large projects, complex in terms of implementation and operation, and require innovation in technology and scope.
Public-private partnerships (PPPs) can help facilitate the implementation of urban revitalization projects in a number of different ways. First, through a PPP a project can be financed fully, or primarily, by the private sector, optimizing the fiscal space and differing public sector spending through the duration of the contract. PPPs, in this respect, can be a source of financing used by cities to organize its capital expenditure.
Second, PPPs can help municipalities plan better. Long-term by definition, PPPs incentivize municipalities to account for whole-life costs during design and implementation phase. While this does not mean costs are always within the budget, PPPs do force a level of planning that may otherwise be absent.
Third, and perhaps more importantly, PPPs can add flexibility to the street-level service delivery, such as maintenance and operation, of specific assets, which public sector agencies typically lack. PPPs harness private sector capabilities and increase efficiency of services.


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CEBU CITY (4th Update, Nov. 25, 2016, 6:15 AM) — Classes at Don Bosco Technical College (DBTC) Cebu continues to be suspended today, Friday, Nov. 25, as Tropical Depression Marce crossed over northern Cebu early this morning.
As of 10:00 PM last night, the suspension covers only the elementary, junior high school and senior high school levels, according to Fr. Noel S. Sebetero, SDB, vice president for education and training.
Basic Education Department (BED) principal Fr. Jerome Mario C. Dublois, Jr., SDB, confirmed the official advisory an hour after.
Classes in college and Technical Vocational Education (TVEd) departments will continue, both told The Bosconian Odyssey.
Subsequently, the English culmination activity could not push through as scheduled Friday morning. This student news portal will give an update on the activity's new schedule.
Meanwhile, Sir Eleuterio Abainza, junior high school principal, advised through Ms. Meg Pepito, secretary of the Parents Teachers Community Association (PTCA) Board of Trustees, of the following schedule of classes:
Monday, Nov. 28 – will follow the Friday schedule
Tuesday, Nov. 29 – will follow Thursday schedule.
Also, the Teachers Congress on Nov. 26-27 will proceed as scheduled, it was learned.
DepEd policy
Elementary classes got aborted yesterday morning as the government-run Philippine Atmospheric, Geophysical and Astronomical Services Administration (PAGASA) placed Cebu under Storm Signal No. 1 at 5:00 AM.
By policy of the Department of Education (DepEd) to suspend classes and/or the exercise of prerogative by school officials, DBTC Rector and President Fr. Honesto "Nioret" Geronimo, Jr., SDB, took it into effect.
Security guards and school personnel advised parents to bring the students in Grades 1 to 6 back home as they entered the campus.
By 12:00 noon, the school announced the suspension from Grade 7 to 11 and advised the students to go home as the Cebu Provincial Government placed the entire Cebu province under Code Red: Alert Charlie,
Although the leadership of Cebu City saw no need to suspend classes, the school opted to be more cautious and preferred Bosconians to stay and be safe at home.
DBTC Emergency Response Team (ERT) leader Renzo del Rosario told The Bosconian Odyssey just before midnight that Cebu City Mayor Tomas R. Osmeña would announce by 5:00 AM Friday if the city will order a suspension of classes.
The Mayor did, and opted for the resumption of classes.
Suspension stands
But suspension in Grades 1 to 11 at DBTC stands, Fr. Alan Ross Banogon, SDB, vice president for administration, confirmed as of 4:30 AM today.
DBTC vice president for pastoral services Fr. John Vernil "Dodoy" Lopez, SDB, also did by 6:15 AM.
Cebu Gov. Hilario Davide III, Mandaue City Mayor Luigi Quisumbing, and Lapu-Lapu City Mayor Paz Radaza also declared the continued suspension of classes today.
PAGASA spotted Tropical Depression Marce above Leyte at 11:00 PM as it switched course from a west-north-west direction (that should have crossed Bohol towards southern Cebu) to a north-west direction after it crossed Siargao Island.
As Broadcaster Leo Lastimosa shared in his 6:00 AM broadcast over radio station DyAB, PAGASA Mactan traced Marce in the following places:
8:00 PM – Siargao
8:30 PM – Abuyog, Leyte
9:30 PM – La Paz town
11:00 PM – Ormoc City
1:30 AM – Bogo City
2:00 AM – Bantayan Island
By 5:oo AM today, Marce headed for northeastern Panay and got upgraded into a Tropic Storm.


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Sherwani: Beige banarsi jamawar Sherwani has embellished cuffs and sleeve cuffs. Button detailing on front. Small dotted motifs placed all over. Includes Shalwar or Trousers in the same color and fabric. Super-soft satin lining. Stand collar neck.
Additional Accessories:
Turban: $79.00
Embellished Shoes: $49.00
Shawl: $39.00
Fully handmade embellishment. 100% similar look guaranty.


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(In arrangement with IndiaSpend.org, a data-driven, non-profit, public interest journalism platform. Abheet Singh Sethi is a Mumbai-based freelance writer and defence analyst. Feedback at email@example.com) // ]]>
Month: September 2016
Patna High Court strikes down Bihar liquor ban
Indian Army, IAF on high alert in Punjab
Another Uri attack soldier dies
Love is a feeling beyond your control: Ranbir Kapoor
(IANS) Popular as Bollywood's heartthrob, actor Ranbir Kapoor says love is a magical addiction and beyond one's control. The 34-year-old has melted many hearts with his effortless portrayal of a romantic boy in films like "Saawariya", "Yeh Jawaani Hai Deewani", "Barfi!", and will next be seen in "Ae Dil Hai Mushkil". "Love is a magical addiction and a feeling beyond your control!" Ranbir said in a statement. Ranbir will be seen talking about his idea of 'love' in an exclusive promo shot for the second season of "Addicted to Love" on Romedy Now. Talking about the promo, Ranbir said: "The classics, all time romantic Hollywood movies lined up for the 'Addicted to Love S2' on Romedy Now will help you relive the indefinable feeling through these love stories!" The "Ajab Prem Ki Gajab Kahani" star is hoping that the audience will like his next "Ae Dil Hai Mushkil", which also features Aishwarya Rai Bachchan, Anushka Sharma and Fawad Khan. "My latest release, 'Ae Dil Hai Mushkil', is one such love saga that I hope the viewers will enjoy! Being a romantic myself, I could not have got a better platform than this to talk about my upcoming release," he added. // ]]>
Bollywood actors talk about prejudice against dark skin
(IANS) Actress Tannishtha Chatterjee's outrage upon facing a "racist attack" on a nationally televised comedy show has led several celebrities in Bollywood to condemn the idea of humour surrounding skin colour –a prejudice deeply rooted in the society. Clearly, Tannishtha was not amused with the 'roast' that she went for on "Comedy Nights Bachao", and she wrote a Facebook post to vent her anger after experiencing that the only thing the hosts could 'roast' about a dark-skinned actress was "of course her dark skin". Her post went viral on social media, leading to a debate on the limit to humour. Upset about Tannishtha's experience, filmmaker and social activist Ashoke Pandit called the show "sexist". "Why comment on Tannishtha's skin colour? Never heard 'roast' masters commenting on skin colour of male superstars! Sexist. Roast Vs Racism," Pandit tweeted on Wednesday, adding that he doesn't find vulgarity funny. "Today I'm vindicated that India feels offended when a woman is humiliated in the name of roast and humour. Vulgarity isn't funny! Roast Vs Racism," added Pandit, who is also a member of the Central Board of Film Certification (CBFC). He recounted the All India Bakchod (AIB) Knockout Roast of January 2015 which involved leading Bollywood celebrities and was widely slammed for its offensive and explicit content. "That was the beginning of offensive humour, now deal with it," he said and added: "Anyone who had supported AIB would be fine with racist comments on a woman. I'm sure the actresses laughing at the roast don't find this racist." Actress Pooja Bedi joined in the debate, saying her skin colour is her pride. "If someone took off about my skin colour, I'd say I love my colour and I put sun-tan (not sunblock) and lie in the sun! Pride for me, prejudice for you. All extremes are brunt of jokes. Tall/short dark/fair virgin/prostitute. Remember Bachchan song 'Jiski biwi gori/lambi' etc? Roast Vs Racism," Pooja tweeted. Actress Lisa Ray said: "Even considering that dark skin is a joke comes from very deep prejudice." Swara Bhaskar, who is known for being vocal about her views on social issues in the country, hailed Tannishtha's bravado in speaking up about the issue. "Good on you Tanishtha Chatterjee! Big love, big hug and high five! You go girl," Swara tweeted. Even her "Angry Indian Goddesses" co-star Sandhya Mridul said: "She's a tiger! Go get them all Tan." Tannishtha was a guest on "Comedy Nights Bachao" to promote her latest film "Parched" with director Leena Yadav and co-actor Radhika Apte. Tannishtha is said to have stormed out of the sets mid-shoot due to the "blatantly racist attack", wherein she was asked 'Aap ko jamun bahut pasand hoga zaroor…?'" After her post went viral, Colors issued an apology to her for "any hurt that was unwittingly caused".// ]]>
Pakistani cinemas stop screening of Indian films
(IANS) Pakistan's theatre owners have decided to withdraw and ban screening of Indian movies until bilateral tensions between the two countries subside. However, the Pakistani government has not yet issued an official directive in this regard. The decision emerged on Thursday after the Indian Motion Picture Producers' Association (IMPPA) announced that it was imposing a ban on all Pakistani artistes working in India, reported The Express Tribune. "We will suspend the exhibition of Indian films till normalcy. No Indian movies will play in my cinemas from Friday onwards for sure," said Nadeem Mandviwalla, owner of Mandviwalla Entertainment which runs Atrium Cinemas in Karachi and Centaurus in Islamabad. In the past week, Bollywood films "Pink" and "Banjo" had released. And while this week "M.S. Dhoni: The Untold Story" could have released, its distributor IMGC Global Entertainment withheld it as it was felt that the movie could have anti-Pakistan elements in its narrative about cricket, the company's head Amjad Rasheed told IANS over phone from Dubai. Super Cinema owner Khorem Gultasab said he has already stopped screening any Indian films at his facilities. "We didn't wait for an official declaration by exhibitors. From Friday onwards, no Bollywood film will be screened at Super Cinemas for at least two weeks to show solidarity with our actors and our military," Gultasab said. Cinepax — Pakistan's largest network of cinemas — had not yet banned any Indian movies, a senior official of the cinema chain said it would follow suit if film exhibitors take a mutual decision in this regard. "I have not heard anything confirmed as yet, but if exhibitors do ban Indian films, then of course we will go ahead with it," said Cinepax General Manager Marketing Mohsin Yaseen. The ban is so far an initiative taken by cinema owners and not the government, clarified Mandviwalla, who added that "it is taking us some time to bring everyone on the same page". "We were taking things lightly initially, since the so-called ban (on Pakistani artistes in India) was just a few mischief-mongers hurling anti-Pakistan slogans," he said. "But things have gotten serious after the official (IMPPA) declaration," added Mandviwalla. He said an official announcement of the ban on Indian films will be made soon. Meanwhile, Gultasab said he is also urging other exhibitors to ban Indian films so that the industry stands united. "A ban won't be effective if confined to just cinemas. Going to a cinema is a choice, but television channels air content from India all the time," he said. "We must completely black out Indian content. Remove it from TV channels and from DVD shops. Otherwise, there's no point." The cinema owner added that this ban should continue until the Indian government offers Pakistani films a level playing field and Pakistani artistes complete protection. Renowned Pakistani filmmaker Jami agreed with Gultasab, saying: "There are Indian drama serials playing on TV all the time and you have DVD shops selling Indian films. Why just target cinema? If you want a ban, just ban all Indian content." On Thursday, Indian film producers passed a resolution banning anyone from Pakistan from working in films being made in India. The move was announced by IMPPA President T.P. Aggarwal. // ]]>
Ajay Devgn's Shivaay is not launching Pakistani actress Saba Qamar
Ajay Devgn produced Shivaay has been in news for the Kamal R Khan controversy, now the production house is trying every bit to avoid any kind of negative reports.


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As we examine the possibilities of existence beyond our world, we enjoy sharing our evidence and knowledge through educational lectures and our official web sites.


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The revised Q2 GDP figures are out (pdf). Basically the GDP is the same as the advanced released stated, a 1% decrease. (negative 1%)
The decrease in real GDP in the second quarter primarily reflected negative contributions from private inventory investment, nonresidential fixed investment, personal consumption expenditures (PCE), residential fixed investment, and exports that were partly offset by positive contributions from federal government spending and state and local government spending. Imports, which are a subtraction in the calculation of GDP, decreased.
So, as noted in the advanced Q2 2009 GDP post, one can see that increased government spending and the massive drop in imports is what kept the GDP figures from being lower. Imports dropped -15.1% whereas exports dropped -5%. The exports - imports figure added 1.60% to overall Q2 GDP. Note, both are decreased.
Recall, the basic GDP equation is: GDP = private consumption + gross investment + government spending + (exports − imports).
What is most amazing is how corporate profits are up, which implies they have been slashing and burning their costs and as usual, implies employees (ex-employees, check out table 13) got the shaft on income.
Domestic profits of financial corporations increased $39.7 billion in the second quarter, compared with an increase of $115.9 billion in the first. Domestic profits of nonfinancial corporations increased $28.4 billion in the second quarter, in contrast to a decrease of $40.2 billion in the first. In the
second quarter, real gross value added of nonfinancial corporations decreased, and profits per unit of real value added increased. The increase in unit profits reflected decreases in unit labor and nonlabor costs that more than offset a decrease in unit prices.
Now here is a scary number, picked up on by EconomPicData.
Gross private domestic investment is down -24.5% in Q2 2009. It's contribution to Q2 2009 GDP was -3.2% and drop in private inventories was -1.39% as a component of Q2 GDP.
That's the in the above GDP equation, investments for future growth and it's like the U.S. economic future is simply gettin' no love. As EconomPicData notes:
Twelve years of growth in investment gone? What is happening?
I borrowed this graph created by EconomPicData ( very nice economic eye candy indeed!), who ran the GDP Excel tables and created the below colorful visual display on Q2 2009 GDP component breakdown.
Src: EconomPicData, Click on the graph to enlarge and zoom
Finally, I want to say to all of those jumping the business cycle gun and declaring the recession over. Even for a technical recovery one must have positive GDP growth for at least two quarters. This happy dance is getting a little too ridiculous when one does not even have the data yet.
Forum Categories:
This graph is eye popping
and is from that EconomPicData you quoted above:
RebelCapitalist.com - Financial Information for the Rest of Us.
it is!
I wanted people to go to his/her site because it's an awesome site generally. I put them in the middle column so you can just click on the latest but (s)he is making original graphs, seemingly from excel and uploading them so we can see the details and is continually showing some very interesting trends, time lines.
I caught the investment numbers but then saw the actual graph and that made it more "whoa, that's bad" than just looking at the tables and comparing for 1 year out and Q1 (where I is a cliff!)
That's the problem somehow on sharing awesome posts on other sites...I'm trying to direct traffic to them as well and not "steal their juju" ....
Roubini "Borrow & Spend" economy
I would have to say I believe Roubini has jumped on the EP bus and is demanding we return to a production economy immediately. ;)
He's talking about the face Q2 GDP would have been a cliff without government spending, which is true from the components plus if one stops deficit spending...
that also will cause a cliff.....which is true...
and asking about an exit strategy for all of this...
but buried beneath the Dr. Doom classic is almost a little hint of Populist from this globalist...
i.e. how is the U.S. gonna jump start the real economy in order to get out of this cycle?
Interesting...I wonder if he'll get off of his emerging economy addiction.
has the Professor "jumped the shark"?
Based on recent articles it would seem that Roubini has more than "jumped on the EP bus", it would seem he has "jumped the shark"
from Bloomberg
Applying Roubini Wisdom to Stocks Means Missing Out
He's an economist, not a stock market analyst
So, I think Bloomberg, who is cheerleading on LEIs and is railing at someone who simply isn't predicting the stock market.
It's not a fair comparison and on a macro economic view they are seeing some statistics, indicators that are really a problem down the road (debt/deficit).
4 quarters of negative GDP growth
longest since the Great Depression.
That's another technical definition to note...it is 3 years or more of negative GDP which defines a depression, or a sudden > 10% GDP drop.
So, this NBER recession call was December 2007. So, we're looking at officially 20 months to date.


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Peter, Paul And Mary
Puff The Magic Dragon
In 1959, Brooklyn native Leonard Lipton was an engineering student at Cornell University. Being a 19-year old freshman at the time, he was a bit homesick in upstate Utica. So, when an invitation for dinner at a friend's place was extended, Leonard was eager for some home cooking. Since he was early, he stopped at the college library and happened on some poems written by Ogden Nash. One that grabbed him was The Tale Of Custard The Dragon.
Heading down the hill to his friend's place, he thought about the poem he read and decided he could write a poem about a dragon, too. Still early, he let himself in the apartment and saw a typewriter on the kitchen table. He sat down and typed Puff the magic dragon, lived by the sea and frolicked in the autumn mist in a land called Honalee…and a future top ten hit was born!
One of the residents of the apartment was another Cornell student by the name of Peter Yarrow, a graduate of New York's High School of Music and Art who attended Cornell on a physics scholarship. Peter later found the poem in the typewriter and set the words to music as Lipton apparently forgot about it.
Yarrow began singing in public his last year at Cornell as part of an American Folk Literature class. Peter loved the excitement of performing before a live audience and after graduating from Cornell, he met future manager and music impresario, Albert Grossman at the Newport Folk Festival. It was Grossman who floated the idea of a folk group with "an updated version of the Weavers for the baby-boom generation with the crossover appeal of the Kingston Trio." (1)
Yarrow approached Kentucky-born Mary Travers, another folk singer around Greenwich Village, about the possibility of creating a group. Once Mary, who had apprehensions about singing professionally, was comfortable with the compatibility of their harmonies, she suggested that friend, Noel Paul Stookey, another local folk singer, be added to the group.
After months of rehearsal and touring outside of New York City, the group, now christened Peter, Paul and Mary, was ready for the Big Apple. Appearing at the Village's Bitter End, the group acquired a large following and eventually signed a contract with Warner Brothers Records.
Warner took the trio into the studio and released their first single Lemon Tree in the early part of 1962. Topping at # 35 on the Billboard chart, the song set the tone for the group's next release, If I Had a Hammer. (2) Eventually winning two Grammy Awards in 1962, Hammer hit the top ten on October 13. (3) Both songs were included on the first LP, Peter, Paul and Mary, as it remained in the Top Ten for ten months, in the Top Twenty for two years and sold more than two million copies. (1)
Peter Yarrow, Mary Travers and Paul Stookey.
No photo credit found.
After two lukewarm singles from their second album, (Moving), Warner released Puff The Magic Dragon as a single on March 16, 1963. (2) After nine weeks, the song peaked at # 2, behind I Will Follow Him by Little Peggy March. (3)
However, the song was not without controversy. The song title and lyrics were considered as code words for marijuana use. "Puff" was alleged to refer to taking a "puff" on a joint; "dragon" was slang for "draggin'" or inhaling the smoke and even Puff's friend, Jackie Paper was not immune to the speculation as many believed his name was a reference to the papers the drug was rolled.
"If people want to think it's about pot, that's fine with me. Puff The Magic Dragon is not about drugs," declared Lipton in a video found on YouTube. (4) Over the years, Peter has stated the song is about the hardships of growing older, the loss of innocence in children and never had any meaning other than the obvious one. (5) Still, the song was banned in Singapore in 1963.
Years after Leonard Lipton had written and forgotten about the poem, a friend of his contacted him to tell him that Peter was looking for him. Since Peter had found the poem on his typewriter and had written the song based on Leonard's poem, Peter offered to give Leonard half of the song writing credits after it had already become a hit. This was pretty significant at the time, as Leonard was working as a camp counselor when Peter tracked him down.
And, to this day, Leonard is still receiving royalties from the song. Not that he needs them. The physics major from Cornell went on to produce 25 films, and has a slew of patents to his name, including one for a technique for shooting 3D movies. (6)
Leonard Lipton in 2015
Photo by Jonah Lipton
Peter, Paul and Mary, as a trio or performing solo, placed 23 singles on the Billboard Hot 100 chart. Besides If I Had A Hammer and Puff The Magic Dragon, four more songs hit the top ten, Blowin' In The Wind and Don't Think Twice, It's All Right in 1963, I Dig Rock And Roll Music in 1967 and their only number one hit, Leaving On A Jet Plane in 1969. (2)
Peter, Paul & Mary performed Puff live in 1965 on Tonight In Person shown on BBC.
Lenny Lipton discussed the issue about whether Puff was a children's song or a drug song in this video posted in 2016.
1) Wikipedia, Peter Yarrow, Link
2) Joel Whitburn, Billboard Top Pop Singles, 1955-2002, Page 544
3) Joel Whitburn, Hot 100 Charts, The Sixties
4) Michelle Debczak, April 26, 2016, Mental Floss, Listen To The Real Story Behind "Puff The Magic Dragon" Link
5) Wikipedia, Puff The Magic Dragon, Link
6) Kaili Benson, Spinditty, The Story Behind The Song: Puff The Magic Dragon, Link
1969 appearance on The Smothers Brothers Comedy Hour.
Courtesy of Getty Images.
© 2017 Jerry Reuss
Copyright 2009


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Tools to help you with the different stages of the accelerator process
Startup Accelerator Programs: A Practice Guide
Accelerator Program Design
This practice guide explains how accelerator programmes work and supports you to think practically about setting up your own programme.
Deciding on a Name
Getting Ready for an Accelerator
What Should I Name My Startup?
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TEDxEast - Nancy Duarte uncovers common structure of greatest communicators 11/11/2010
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You can only be successful if people are willing and able to be your customers. They must know about you, and be compelled to act.
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Branding and Marketing Worksheet
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Five Forces Analysis assumes that there are five important forces that determine competitive power in a business situation.
Spartina Internet Business Model Worksheet
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See Dropbox's original Y Combinator accelerator application to get an idea about what is a winning application.
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Examples of Investor term sheets provided by Y Combinator accelerator, and used by all teams that participate in Y Combinator.
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Getting Ready for an Accelerator
Business idea checklist: Rate this idea on each of the following criteria from 1-10. 1-3 is weak; 4-7 is fix-able; 8-10 is do-able. What could you do to make each area stronger?
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Reading List for Start Co. Entrepreneurs
Things to Think About When Getting Started
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Making A Great Written Elevator Pitch for Introductions
Introduction to Investor Pitching
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Making A Great Written Elevator Pitch for Introductions
Business Development 101
Customer Validation
Efficient Business Development strategies for startups are essential considering most all are undercapitalized even after seed and angel funding.
Brand Strategy Canvas
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The Competitive Advantage is the distinct competency of the business that is matched to its future market opportunity.
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Sample Financial Worksheet
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Accelerator Application
Paystack's entire Y Combinator Application complete with commentary and backstory.
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11 Tough Questions for Founders
Getting Ready for an Accelerator
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The sales template here is specially tailored for software-as-a-service (SaaS) startups .
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