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text:
Straub, Robert W.
Oregon Governor Robert W. Straub (1920-2002) was born in California and came to Oregon in 1946.
From the guide to the Robert W. Straub speech, 1975 July 4, (Oregon Historical Society Research Library)
Robert William (Bob) Straub was born May 6, 1920 to Thomas Jefferson Straub and Mary Ellen Tulley Straub, in San Francisco, California. He grew up in Los Altos with his three brothers, Frank, Jim, and Tom, and his sister Jean.
Straub attended Dartmouth College, where he earned both his Bachelor of Arts and his Master's degrees in Business Administration. His schoolwork was interrupted by his service during WWII, when Straub served in the U.S. Army in the Quartermaster Corps. While working as a hutmaster at Mt. Moosilauke during his undergraduate years at Dartmouth, Straub met Patricia (Pat) Stroud; the two were married in 1943 in San Antonio, TX, where Straub was then stationed. The Straubs had six children, Jeff, Michael, Jane, Patty, Peggy, and Bill.
In 1947, the Straub family moved from New Hampshire to Springfield, Oregon, where Bob began work for Weyerhaeuser Timber Company. In the 1950s, he branched out into property development, constructing his first subdivision in Springfield's Thurston neighborhood; Straub also became involved in timber farming and livestock ranching.
After being urged to run for office by Senator Richard (Dick) Neuberger, Straub successfully ran for the Lane County Commission in 1955. He served as a County Commissioner until 1959, when he took office as State Senator for Lane County, a position to which he was re-elected in 1962. While Senator, he also served for a term as the Chairman of the State Democratic Party.
Straub was elected Oregon State Treasurer in 1964, and served two widely respected terms. Most notably, Straub pushed for the establishment of the Oregon Investment Council, which utilized private sector investment firms to gain a better return for state employee retirees. Throughout his political career, Straub advocated for environmental issues, land use planning, fair taxation, and better mental health care, along with other issues. He was involved in the landmark Beach Bill, which clarified the extent of the Oregon Coast to be preserved as public domain; an influential proponent of the Willamette River Greenway Program, which envisioned a pollution-free river surrounded by public parks; and an ongoing advocate for youth work camps.
After two unsuccessful campaigns for the governorship, in 1966 and 1970, Straub was elected as Governor of Oregon in 1974. Though the early years of his administration suffered from staffing issues and power struggles with the state legislature, Straub's eventual achievements as governor included tax reforms, support for affirmative action policies, new energy laws, and a streamlining of the Department of Human Resources.
Straub was defeated in his 1978 re-election bid by State Senator Victor Atiyeh. After a transition period as Executive-in-Residence at Willamette University's Atkinson School of Business, Straub returned to private life. He remained active on the political scene, serving on the Oregon Investment Council (OIC) and on the Public Employees Retirement System (PERS) Board, but his primary focus turned to his charity work (particularly with the non-profit he founded, Salem Self-Help Housing), his family, and his land.
In the late 1990s, Straub announced that he had been diagnosed with Alzheimer's disease; he died of complications from the disease November 27, 2002, at the age of 82.
From the guide to the Robert W. Straub Collection, 1955-1980, circa 1890-2012, (Western Oregon University Archives)
creatorOf Robert W. Straub Collection, 1955-1980, circa 1890-2012 Western Oregon University Archives
creatorOf Robert W. Straub speech, 1975 July 4 Oregon Historical Society Research Library
referencedIn Porter, Charles Orlando, 1919-. Charles Orlando Porter papers, 1954-1961. University of Oregon Libraries
referencedIn Meek, Lucille. Lucille Meek letters [manuscript], 1978. Oregon Historical Society Research Library
associatedWith Bybee family family
associatedWith Johnson, Ken, (Kenneth Everett), 1928-2011 person
associatedWith Lane County (Or.). Board of Commissioners corporateBody
associatedWith McCall, Tom, 1913-1983 person
associatedWith McLennan, Janet person
correspondedWith Meek, Lucille. person
associatedWith Morse, Wayne L., (Wayne Lyman), 1900-1974 person
associatedWith Neuberger, Richard L., (Richard Lewis), 1912-1960 person
associatedWith Oregon. Governor (1975-1979 : Straub) corporateBody
associatedWith Oregon Historical Society. corporateBody
associatedWith Oregon Investment Council corporateBody
associatedWith Oregon. Legislative Assembly corporateBody
associatedWith Oregon. Treasurer's Office corporateBody
associatedWith Porter, Charles Orlando, 1919- person
associatedWith Russell, Jean person
associatedWith Straub family family
associatedWith Straub, Jeff person
associatedWith Straub, Mike, (Michael) person
associatedWith Straub, Pat, (Lana Laine Patricia) person
associatedWith Stroud family family
associatedWith Thomas, Patty, (Patricia Straub) person
associatedWith Thomas, Peggy, (Margaret Straub) person
Springfield (Or.)
Moosilauke, Mount (N.H.)
Salem (Or.)
Pacific Coast (Or.)
Oregon Coast Range (Or.)
Willamette River Greenway (Or.)
Forestry and Forestry Products
Mentally ill--Care--Oregon
Forest management--Oregon
Environmental Activism
Bybee House (Sauvie Island, Or.)--History
Natural areas--Oregon
Greenways--Oregon
Oregon--Politics and government--1951-
Tree farms--Oregon
Parks--Oregon
Birth 1920-05-06
Death 2002-11-27
Virtual International Authority File WorldCat Identities LC/NACO Wikidata
Permalink: http://n2t.net/ark:/99166/w6s476ss
Ark ID: w6s476ss
Straub, Bob

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: How to setup xreg argument in auto.arima() in R? I am working on a small project with one time series which measures the customer visit data (daily). My covariates are a continuous variable Day to measure how many days have been elapsed since the first day of data collection, and some dummy variables, such as whether that day is Christmas, and which day of the week it is, etc.
Part of my data looks like:
Date    Customer_Visit  Weekday Christmas       Day
11/28/11        2535       2        0            1
11/29/11        3292       3        0            2
11/30/11        4103       4        0            3
12/1/11         4541       5        0            4
12/2/11         6342       6        0            5
12/3/11         7205       7        0            6
12/4/11         3872       1        0            7
12/5/11         3270       2        0            8
12/6/11         3681       3        0            9

My plan is to use ARIMAX model to fit the data. This can be done in R, with the function auto.arima(). I understand that I have to put my covariates into the xreg argument, but my code for this part always returns an error.
Here is my code:
xreg     <- c(as.factor(modelfitsample$Christmas), as.factor(modelfitsample$Weekday),
              modelfitsample$Day)
modArima <- auto.arima(ts(modelfitsample$Customer_Visit, freq=7), allowdrift=FALSE,
                       xreg=xreg)

The error message returned by R is:
Error in model.frame.default(formula = x ~ xreg, drop.unused.levels = TRUE)
 :variable lengths differ (found for 'xreg')

I learned a lot from How to fit an ARIMAX-model with R? But I am still not very clear how to set up the covariates or dummies in the xreg argument in auto.arima() function.

A: The main problem is that your xreg is not a matrix. I think the following code does what you want. I've used some artificial data to check that it works.
library(forecast)
# create some artifical data
modelfitsample <- data.frame(Customer_Visit=rpois(49,3000),Weekday=rep(1:7,7),
                             Christmas=c(rep(0,40),1,rep(0,8)),Day=1:49)

# Create matrix of numeric predictors
xreg <- cbind(Weekday=model.matrix(~as.factor(modelfitsample$Weekday)),
                  Day=modelfitsample$Day,
              Christmas=modelfitsample$Christmas)

# Remove intercept
xreg <- xreg[,-1]

# Rename columns
colnames(xreg) <- c("Mon","Tue","Wed","Thu","Fri","Sat","Day","Christmas")

# Variable to be modelled
visits <- ts(modelfitsample$Customer_Visit, frequency=7)

# Find ARIMAX model
modArima <- auto.arima(visits, xreg=xreg)

redpajama_set_name: RedPajamaStackExchange


text:
Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians
Elke Jeschke1,
Thomas Ostermann2Email author,
Horst C Vollmar3, 4,
Manuela Tabali1,
Friedemann Schad1 and
Harald Matthes1
BMC Neurology201111:99
https://doi.org/10.1186/1471-2377-11-99
© Jeschke et al; licensee BioMed Central Ltd. 2011
Received: 17 January 2011
Accepted: 8 August 2011
Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM) by analysing prescribing patterns and comparing them to current treatment guidelines in Germany.
Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba.
During the 5-year study period (2004-2008), 577 patients with dementia were included (median age: 81 years (IQR: 74-87); 69% female). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all) followed by cholinesterase inhibitors (17.6%). The adjusted odds ratio (AOR) for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88), co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90), and heart failure (AOR = 4.85; CI: 3.42-6.88). The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89), patient age (AOR = 1.06; CI: 1.02-1.10), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16).
This study provides a comprehensive analysis of everyday practice for treatment of dementia in primary care in physicians with a focus on CAM. The prescribing frequency for anti-dementia drugs is equivalent to those found in other German studies, while the administration of Ginkgo biloba is significantly higher.
Adjusted Odds Ratio
Cholinesterase Inhibitor
The management of dementia is a key challenge in modern health systems. The prevalence of dementia within people aged 65 years or older is 6.8% [1, 2]. It increases with patient age and doubles every 5 years [3]. As the proportion of people aged 65 years or older rises from 16.8% in 2010 to 23.5% in 2050, the number of dementia cases will also increase from 1.21 million people today to 2.62 million people in 2050 in Germany alone [2]. It is estimated that the number of sufferers from dementia worldwide will increase from 35.6 million today to 65.7 million by 2030 and 115.4 million by 2050 [3]. The raise in dementia patients is directly correlated with increasing costs in the health care systems. While 7.1 million euros were expended in Germany for treatment and care of dementia in 2002, the costs increased to 7.8 million euros in 2004, 8.6 million euros in 2006, and finally 9.4 million euros in 2008 [4].
Alzheimer's disease and vascular dementia are the two most common types of age-related dementia. Alzheimer's disease accounts for more than 65% of dementia in the elderly [1]. At present no curative treatment is available. Interventions focus on slowing the course of the disease. Compared with placebo, pharmacological treatment with cholinesterase inhibitors and memantine has shown improvements in outcomes such as cognition and global functioning in Alzheimer's disease [5, 6]. However, the clinical relevance of these treatment effects seems marginal [7, 8].
Some studies have indicated that complementary and alternative medicine (CAM) from the areas of phytotherapy, traditional Chinese medicine, or homoeopathy has potential in the treatment of dementia [9–11]. In particular the phytopharmaceutical Ginkgo biloba is traditionally used quite frequently [12, 13]. In Germany, in contrast to some other countries, Ginkgo biloba is available as prescription drug for the therapy of mild to moderate dementia. Although there is acceptable physiological compatibility and sufficiently proven safety, there is still an unclear picture of evidence [14, 15]. According to the meta-analysis of Weinmann et al. the change of scores for cognition were in favour of Ginkgo biloba compared to placebo, but they did not show a statistically significant difference from placebo for activities in daily living [16]. The German Institute for Quality and Efficiency in Health Care (IQWIG) found only a small benefit for the 240 mg preparation and criticised the heterogeneity of the study results [17]. In fact, Ginkgo biloba is not yet included in evidence-based dementia guidelines published in Germany.
The development, dissemination, and implementation of these dementia guidelines are a key strategy for improving the care of persons with dementia. In Germany one guideline from the German Society of General Physicians (DEGAM) with a focus on family medicine was published in 2008 while another one from the German Society of Neurology and German Society of Gerontopsychiatry (DGN and DGPPN) mainly for specialists was finalised in 2009 [18, 19]. Unfortunately both guidelines reveal different recommendations for the treatment of dementia, which might be due to the abovementioned inconsistent appraisal of clinical relevance from study results. The DEGAM guideline is much more cautious in the recommendation of cholinesterase inhibitors than the guideline of the DGN/DGPPN, and while memantine is recommended for Alzheimer's disease in the guideline of the DGN/DGPPN, the DEGAM only recommends it as an individual approach for therapy [20].
In therapy for vascular dementia, recommended therapies focus on the treatment of cardio-vascular risk factors, e.g. the prevention of prospective strokes. The treatment of vascular dementia with anti-dementia drugs, until now, did not produce a reliable portfolio of evidence and thus the DEGAM does not give any recommendations where the DGN/DGPPN allows for a selective therapeutic attempt in single cases. However, with respect to the high amount of elderly patients, guidelines mainly discuss the problems occurring with age-related co-morbidity and poly-pharmacy.
Apart from two concurrent German guidelines, an additional barrier to guideline adherence is the difficulty faced by physicians in reconciling patient preferences with guideline recommendations [21]. According to studies in a variety of primary care settings, patient expectations and preferences can influence the health care provided to them [22–24]. This issue may be particularly salient in the setting of CAM, as patients seeking treatment from physicians specialised in this field are likely to expect to receive some form of alternative therapy. Furthermore, one should not underestimate the impact of the physician's conviction on the prescription practice. In a survey of German GPs, ginkgo preparations for dementia were voted to be equally as effective as cholinesterase inhibitors and memantine [25].
The present study thus aims (a) to analyse prescribing patterns among primary care physicians specialised in CAM, b) to investigate conformity and variations in prescriptions according to the German dementia guidelines (DEGAM and DGN/DGNPP), c) to identify different treatment strategies in GPs and neurologists and d) provide information of co-morbidities of patients with dementia visiting primary health care physicians specialised in CAM.
In total, 22 primary care physicians in Germany participated in this prospective, multicentre observational study. All of them were members of the EvaMed Network, which aims to evaluate CAM remedies in usual care with regard to prescribing patterns, efficacy, and safety [26–28]. Physicians were recruited through the German National Association of Anthroposophic Physicians (Gesellschaft Anthroposophischer Ärzte in Deutschland; GAÄD). A total of 362 physicians were contacted and informed about the EvaMed Network by standard mail and, in the event of non-response, 4 weeks later by telephone. For a physician to be eligible to participate in the study, his or her medical practice had to meet a number of technical requirements, including the presence of a special computerised patient documentation system (DocExpert, DocConcept, TurboMed, Duria, PDE-Top, Medistar), a local area network (LAN) connection, and Microsoft Windows and Internet Explorer (i.e. as client software). A total of 38 physicians (10.5%) fulfilled the technical requirements, gave informed consent, and agreed to participate in the EvaMed Network. Of these physicians, 16 specialised in paediatrics, dermatology, and gynaecology and were excluded from the study. Each of the remaining 22 physicians had practised for at least 5 years in addition to completing training in anthroposophic medicine.
The present study is based on secondary data provided by physicians for health insurance accounting. As such, the recommendations for good practice in secondary data analysis (e.g. anonymisation of data on prescriptions and diagnoses) developed by the German Working Group on the Collection and Use of Secondary Data [29] were applied in full.
Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases (ICD10: F00-F03) during the 5-year study period (01.01.2004-01.01.2009). Data were excluded if the diagnosis dementia was only a suspected diagnosis and not confirmed during the study period and if a cross-validation of the ICD10 code and text of diagnosis indicated an incorrect coding. Figure 1 shows the flow chart of the inclusion process.
Flow chart of the inclusion process.
During the study, physicians continued to follow their routine documentation procedures, recording diagnoses and all prescriptions for each consecutive patient using their existing, computerised patient documentation system. These data were exported to the QuaDoSta postgreSQL database hosted in each practice [30]. Physicians used a browser-based interface to match individual diagnoses with the corresponding drugs or remedies that had been prescribed. Prescribed drugs were documented using the German National Drug Code. Diagnoses were coded according to the 10th revision of the International Classification of Diseases (ICD-10).
Dementia was classified as 'Dementia in Alzheimer's disease', 'Vascular dementia', 'Dementia in Parkinson's disease', and 'Unspecified dementia'. Co-morbidities were classified as hypertension, depression, heart failure, chronic ischemic heart disease, cardiac arrhythmias, diabetes mellitus, dyslipidemia, atherosclerosis, other cerebrovascular diseases, pressure ulcer, stroke, cerebral infarction, arthropathies, and dorsopathies. Multi-morbidity was considered if a patient had at least 2 co-morbidities.
Study investigators identified all drugs and remedies prescribed for dementia. Each substance was classified using the Anatomical Therapeutic Chemical Index (ATC) and anti-dementia drugs were clustered into cholinesterase inhibitors (i.e. donepezil, rivastigmine, galantamine), memantine, Ginkgo biloba, and older anti-dementia drugs (e.g. piracetam, nimodipine, and selegiline). Other medication was classified as antidepressants, anitpsychotics, benzodiazepine, anti-Parkinson drugs, antiepileptics, and sedatives.
Statistical analysis was performed with SPSS 18.0 for Windows. Descriptive analysis was used to determine prescription rates. Means and standard deviations (SD) were calculated for continuous, normal data. In cases where data were not normally distributed, medians and interquartile ranges (IQR) were reported. Subgroup analyses of prescribing rates were performed for patient age (under 60 years, 60-69 years, 70-79 years, 80-89 years, 90-99 years, 100 years and older), gender, and co-morbidities. The two-tailed Chi square test was used to analyse differences in prescription rates. A P value of less than 0.05 was regarded as indicating a statistically significant difference.
Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using multiple logistic regressions to determine factors associated with a) a prescription of any anti-dementia drug and b) a prescription of Ginkgo biloba versus cholinesterase inhibitors and/or memantine. Age, sex, physician specialization (neurologist vs. GP), year of prescription, type of consultation (first vs. follow up), type of dementia, multi-morbidity, co-morbidities, neuroleptic, and antidepressant therapy were included as independent variables. Patient age was introduced in the model as a continuous variable. For the "best-fitting" logistic regression model, we employed the stepwise Akaike Information Criterion (AIC).
Of the 22 physicians, 17 were GPs (77%) and 5 were specialist GPs (23%). The participating physicians did not differ significantly from the overall population of physicians certified in anthroposophy in Germany (n = 362) in terms of age (mean = 49.4; SD = 6.3 years vs. mean = 47.5; SD = 6.1 years; P = 0.709) or gender (60.0% vs. 62.2% men; P = 0.917), and were only slightly younger and consisted of a similar percentage of women compared to all office-based physicians in Germany (mean 52.0 years; 61.2% men) [31].
During the 5-year study period, a total of 577 patients with dementia were included. The inclusion process is shown in Figure 1. 374 patients (64.8% of all patients) were treated by a GP and the remaining 203 patients were treated by a neurologist. 69.2% of the patients were female. The median age of the patients was 81 years (IQR: 74, 87). Altogether, 4.9% of the patients were under 60 years (n = 28), 10.1% were 60-69 years (n = 58), 27.2% were 70-79 years (n = 157), 41.4% were 80-89 years (n = 239), 16.1% were 90-99 years (n = 93), and 0.3% were 100 years or older (n = 2). Dementia was classified as unspecified dementia (57.2%), vascular dementia (25.1%), dementia in Alzheimer's disease (10.4%), and dementia in Parkinson's disease (7.3%). Table 1 shows the sample of patients according to age, sex, and type of dementia.
Patients according to age, sex, and type of dementia
Age [years]
Sex [%]
Median (IQR)
Dementia in Alzheimer's disease
79 (74.0; 85.0)
Dementia in Parkinson's disease
Unspecified dementia
In total, 76.4% of all patients (n = 441) had two or more co-morbidities and were therefore classified as multi-morbid. The most frequent co-morbidities were hypertensive diseases (43.5% of all patients), other forms of heart disease (38.8%), dorsopathies (30.3%), arthropathies (29.8%), mood [affective] disorders (27.7%), and ischemic heart diseases (23.1%). Table 2 provides a detailed overview of the most frequent co-morbidities of the participating patients according to type of dementia.
Sample of patients with dementia subdivided according to dementia-relevant co-morbidities
Co-morbidities 1
Hyper-tension
Dys-lipidemia
Athero-sclerosis
Stroke or
cerebrovascular diseases 2
Pressure ulcer
[n (%)]
1 Double entries possible, sorted by descending frequency; 2 including cerebral aneurysm (nonruptured, cerebral atherosclerosis, hypertensive encephalopathy, nonpyogenic thrombosis of intracranial venous system, and cerebral arteritis, not elsewhere classified
Anti-dementia drug therapy
In total, 25.6% of all patients (n = 148) were prescribed anti-dementia drugs (i.e. cholinesterase inhibitors, memantine, or Ginkgo biloba). Table 3 gives a detailed overview of the included patients according to anti-dementia drugs and type of dementia. Most of the patients received Ginkgo biloba (n = 99). 11.3% of all patients (n = 65) received an anti-dementia drug therapy with cholinesterase inhibitors or memantine. Cholinesterase inhibitors were prescribed for 40 patients. Donepezil was the most frequently prescribed cholinesterase inhibitor (n = 29), followed by galantamine (n = 10) and rivastigmine (n = 8). In total, 32 patients were prescribed memantine. Thirty patients were prescribed 2 or 3 different anti-dementia drugs, mostly in combination with Ginkgo biloba (memantine and Ginkgo biloba n = 10; cholinesterase inhibitors and Ginkgo biloba n = 9; cholinesterase inhibitors and memantine n = 8, cholinesterase inhibitors, memantine and Ginkgo biloba n = 4). Only 6 patients received older anti-dementia drugs like piracetam, nimodipine, and selegiline.
Sample of patients with dementia subdivided according to anti-dementia drugs
Anti-dementia drugs 1
biloba
Rivastigmine
1 Double entries possible
56.7% of patients with dementia with Alzheimer's disease received anti-dementia drugs, whereas less than 25% of patients with other dementia types were prescribed anti-dementia drugs (Table 3). Donepezil and memantine were prescribed mostly for patients with dementia with Alzheimer's disease. The phytotherapeutical Ginkgo biloba was prescribed for patients with dementia with Alzheimer's disease, vascular dementia, and unspecified dementia in equal shares (16% - 20%). Patients with vascular dementia were prescribed Ginkgo biloba (15.9% Ginkgo biloba vs. 2.0% of any other anti-dementia drug) nearly exclusively.
In total, 448 prescriptions of anti-dementia drugs for the 148 patients who received at least one of these drugs were reported. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all anti-dementia drugs).
Prescriptions for dementia-related co-morbidities
The most frequent medication prescribed to patients for dementia-relevant co-morbidities were antidepressants (20% of all patients), antipsychotics (15%; thereof risperidone 7%, butyrophenone 7%), and benzodiazepine (10%). Table 4 provides a detailed overview of these medications according to type of dementia. In total, 18 patients received the antidepressant CAM remedy Hypericum perforatum (14.6% of all patients with antidepressants). The antipsychotic risperidone was prescribed for 7 patients with dementia with Alzheimer's disease, 7 patients with vascular dementia, 2 patients with dementia with Parkinsons's disease, and 24 patients with unspecified dementia. Of the 40 patients being prescribed cholinesterase inhibitors, only one received additional anticholinergic agents during the study period.
Sample of patients with dementia subdivided according to medication prescribed for dementia relevant co-morbidities
Anti-Parkinson drugs
Antiepileptics
There were significant differences in the proportion of patients treated with an antidepressant (GP: 17.6%; neurologist: 28.1%; P = 0.003) and benzodiazepine (GP: 11.4%; neurologist: 6.4%; P = 0.039) according to physician's specialisation. No difference was found for the treatment with antipsychotics (GP: 15.8%; neurologist: 14.3%; P = 0.635).
Factors related to any anti-dementia drug therapy
Table 5 shows the adjusted odds ratio (AOR) for factors associated with the prescription of any anti-dementia drug. The AOR for receiving any anti-dementia drug was greater than 1 for the neurologists (AOR = 2.34; CI: 1.59-3.47), the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50), hypertension (AOR = 2.03; CI: 1.41-2.90), heart failure (AOR = 4.85; CI: 3.42-6.88), and neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88). The odds for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95) and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86). Patient age, sex, consultation type (first vs. follow up), multi-morbidity, and the year of prescription had no influence.
Factors associated with any anti-dementia drug and Ginkgo biloba
Adjusted OR (95% CI)
Any anti-dementia drug
1.040 (0.748-1.448)
0.406* (0.186-0.887)
Physician specialisation
Type of dementia
Multi-morbidity
Chronic ischemic heart disease
Neuroleptic therapy
Antidepressant therapy
* AOR significantly different from 1
Factors related to the prescription of Ginkgo biloba
The prescription of Ginkgo biloba was associated with sex, patient age, physician's specialisation, and the type of dementia (Table 5). Older patients (AOR = 1.06; CI: 1.02-1.10) were more likely to receive Ginkgo biloba. Female sex (AOR = 0.41; CI: 0.19-0.89), treatment by a neurologist (AOR = 0.09; CI: 0.03-0.23), and the diagnosis of Alzheimer's disease (AOR = 0.07; CI: 0.04-0.16) rapidly reduced the odds of being prescribed Ginkgo biloba, whereas co-morbidity, co-medication, consultation type, and the year of prescription had no influence.
In this paper we present the results of a secondary data analysis of electronic health record data from the EvaMed Network, a German network of CAM-oriented physicians. Overall, 25.6% of the patients with dementia were prescribed anti-dementia drugs.
The prescription of any anti-dementia drug was positively associated with physicians specialising in neurology, the diagnosis of Alzheimer's disease, neuroleptic therapy, co-morbidities hypertension, and heart failure. The odds for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia and diabetes mellitus.
In coherence with their orientation, the phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all anti-dementia drugs) even though it has not been recommended in German dementia guidelines, while conventional anti-dementia drugs, such as cholinesterase inhibitors and memantine, ranged far behind. The prescription of Ginkgo biloba was positively associated with patient age, whereas the chance for the prescription of Ginkgo biloba was smaller than 1 for women, treatment by a neurologist, and the diagnosis of Alzheimer's disease.
The median age of our study population was 81 years. Compared to the recently published study of Olsson et al. [32] conducted in nursing homes and special care units, our patient population was slightly younger due to the outpatient-character of this study but comparable with data from German health insurance provided by Koller et al. [33]. 69% of our patients were female, which is similar to the proportion of women in dementia patients in Germany (70% female) [34]. Considering the high age of our population the frequent number of co-morbidities is not surprising. Hypertension, congestive heart failure, and ischemic heart diseases are particularly common in this age and are well known as primers for vascular dementia and thus their occurrence is an indicator for dementia in our population (see Table 2).
In our study almost 26% of patients received anti-dementia drug therapy. According to the current ATC classification, Ginkgo biloba is listed in the group of anti-dementia drugs together with cholinesterase inhibitors and memantine. Thus we counted Ginkgo biloba as an anti-dementia drug although the literature is not consistent in this case. This has to be taken into consideration when comparing our results with other studies.
According to Formiga et al., 80.6% of the patients in a Spanish population received cholinesterase inhibitors or/and memantine for Alzheimer's disease [35]. In an Italian survey from 2007, Frisoni found a prescription rate of cholinesterase inhibitors in 90% of patients with Alzheimer's disease and 35-45% with vascular dementia. Other drugs, such as Ginkgo biloba, were prescribed less frequently, except for vascular dementia (20%) [36]. For Germany, Stoppe et al. found that only 24% of patients with Alzheimer's disease were prescribed cholinesterase inhibitors in 2004 [37], which is comparable to our study.
Although both the results of our study and those of Stoppe et al. [37] might be surprising at first, it has to be taken into account that especially the DEGAM guideline recommends a cautious and responsible handling of anti-dementia drugs in dementia patients and thus the results are in line with both the guidelines and the experience of the family physicians [25]. In Parkinson's disease, only one of 42 patients was mainly treated with rivastigmine which is recommended in the neurological guideline [19].
In 2006, a total of 50% of all prescribed anti-dementia drugs in Germany were cholinesterase inhibitors and memantine [13]. The most often prescribed anti-dementia drug in Germany was the cholinesterase inhibitor donepezil with 37% [38], which with a rate of 45% also plays a predominate role in our study. Traditional anti-dementia drugs like ergot alkaloids and piracetam, which are not recommended in the treatment guidelines, have declined in their prescribing rates over in recent years and, with only 6 patients, also play a minor role in our setting.
In our study only 8 out of 148 patients (5.4%) were prescribed both cholinesterase inhibitors and memantines during the study period. This is comparable to Hoffmann et al. who found only one anti-dementia drug in over 90% of his patients and Truter who only reported 5.3% of patients that were prescribed more than one active ingredient for Alzheimer's disease during one year (mostly donepezil or galantamine, and memantine) [38, 39], whereas Formiga found combined therapy of cholinesterase inhibitors in 15.5% of patients [35]. While the DEGAM guideline disapproves combination therapies due to their low level of evidence, the DGN/DGPPN guideline refers to 2 RCTs and claims that an add-on therapy might be considered [18, 19]. However, it has to be noted that in our study concomitant treatment with two drugs may also be a result of the course of therapy and might not reflect a factual combination therapy.
According to Formiga, lower Barthel Index scores predict fewer prescriptions of pharmcological therapy in Alzheimer's disease [40]. Other factors like patient age, gender, co-morbidity, neuroleptic and antidepressant therapy, and hospital admission in the previous year show no significance after adjusting the multivariate logistic regression model.
We found that type of dementia, physician specialisation, co-morbidity, and neuroleptic therapy influenced the prescription of any anti-dementia drug (i.e. cholinesterase inhibitors, memantine and/or Ginkgo biloba). While odds ratios for Alzheimer's disease are presumably higher than those for vascular dementia, it is in accordance with the results of Formiga and Frisoni [36, 40]. Moreover, there are several hints of different prescribing patterns of neurologists and GPs [25, 38]. Ruof et al. found that neurologists prescribed cholinesterase inhibitors to 44.6% of their Alzheimer patients, while GPs only treated 9.0% of their patients with cholinesterase inhibitors [41]. Thus, physician specialisation seems to be a reasonable indicator for the prescription of any anti-dementia drug. A prescription of neuroleptics could indicate the presence of behavioural and psychological symptoms of dementia (BPSD) and these symptoms are more common in the middle or severe stages of dementia.
The prescription of Ginkgo biloba was positively associated with patient age, whereas the chance for the prescription of Ginkgo biloba was smaller than 1 for women, patient treatment by a neurologist, and patient diagnosed with Alzheimer's disease. Co-morbidities and antidepressant or neuroleptic therapy did not reveal a significant impact, which might be due to the small sample size. Our results at first oppose the results of Nahin [42], who found that use of herbal and dietary supplements in older people in the United States was associated with female sex, a higher income, and a higher MMSE score in multivariate analysis. Although a subgroup analysis of factors related to the use of Ginkgo biloba had shown only race (white vs. nonwhite) as a significant factor, our results indicate that male patients are more likely to be prescribed Ginkgo biloba. At first this seems to counter studies which show that females are more likely to use CAM. However, it has to be noted that in dementia patients, the spouse might be the communication counterpart of the physician, which in the majority of cases of male dementia patients can be assumed to be the women. Thus, the predilection for CAM might be transferred to the partner.
Most of the physicians who asked for Ginkgo biloba, according to van den Bussche [25], assumed the potential effectiveness of Ginkgo biloba: 85% of the neurologists and 59% of the GPs attribute a moderate to high effectiveness. Thus it is not surprising that in our survey Ginkgo biloba was mainly prescribed by a neurologist. This is underpinned by the survey of Hillmer [43] on prescribing practices of Canadian family physicians with regards to Alzheimer's disease. The survey found that perception and self-reported knowledge are the most important factors that significantly predict lower prescribing rates. In the case of vascular dementia, there is no recommendation in the guidelines. Compared to other forms of dementia and taking the results of Hillmer into account, one therefore would assume a higher application of ginkgo preparations, which indeed was given in our data.
Neuroleptics
The prescribing frequency of antipsychotic drugs in geriatric patients is commonly overestimated particularly with respect to the administration of benzodiazepines, which are not recommended (DEGAM, DGN/DGPPN) [44] due to higher mortality and a higher tendency to fall. Thus, both conventional and atypical neuroleptics should only be administered for a short period of time (DEGAM, DGN/DGPPN) [18, 19]. According to Meyer et al., 28.4% of 2367 residents in 30 German nursing homes received neuroleptics and 23.6% were prescribed anxiolytic or hypnotic medication, mostly butyrophenone [45]. These rates do not differ from the 56.4% antipsychotic drugs being prescribed to 888 residents in Munich nursing homes [46]. Similar results were obtained from Mann et al. 2009 in Austria (antipsychotics 45.9%) [47], while the 31% reported in Italy was slightly lower [36]. Our results of only 14% thus are comparably low and might be explained by the CAM-orientation of the physicians. However, it is striking that benzodiazepines were mainly prescribed by GPs, while there was no significant difference between GPs and neurologists in the administration of neuroleptics.
Concomitant use of anticholinergics and cholinesterase inhibitors
In recent years an intensive and still ongoing debate on the concomitant use of anticholinergics and cholinesterase inhibitors has emerged. It is assumed that anticholinergics may attenuate the effects of cholinesterase inhibitors. Other studies suggest that anticholinergics are prescribed to palliate side effects of cholinesterase inhibitors [48]. Data from registers from Australia and the USA reveal a proportion of joint prescriptions between 20 and 47% [49–51]. Our sample is too low to draw concrete conclusions about the concomitant use of anticholinergics and cholinesterase inhibitors; however, with only one of 40 patients being prescribed this combined treatment, one may assume that CAM-oriented physicians might be more cautions in the concomitant use of anticholinergics and cholinesterase inhibitors.
The present study has several important limitations which should be taken into account when interpreting the results. Firstly, additional data on the dementia diagnoses are lacking, such as a functional evaluation with the Barthel Index or an evaluation of the cognitive status with the Mini Mental State Examination (MMSE). The lack of objective tests for dementia massively increases the possibility of misclassification bias with respect to dementia type and severity. The proportion of Alzheimer's disease on all types of dementia normally should be between 50% and 70%. This is not reflected in our study which only found a proportion of about 10%. One explanation might be that GPs mainly (57%) classified the dementia as "unspecific". Secondly, although physician prescribing data were subjected to an internal review, coding inaccuracies cannot be ruled out entirely. Thirdly, data on subsequent medication use in patients who switched physicians were unavailable. Finally our study only presents data from a very small percentage of CAM physicians in Germany. The participation of 22 out of a possible 362 possible physicians does not support a broad generalisability of our findings nor does it allow carrying out detailed subgroup analyses. Thus, this analysis as such, should be viewed as a first insight into this field. In addition the present study also lacks a direct comparison group. Further research on this subject therefore would benefit from including a broader sample of CAM physicians as well as a stratified comparison group of conventional primary care physicians.
The present study provides a systematic overview of everyday practice for treatment of dementia in primary care in physicians with a CAM focus. Both physicians and patients of our study are comparable to other studies, except for their CAM specification. We also found low prescribing rates of cholinesterase inhibitors and memantine, while Ginkgo biloba in contrast to the German guidelines was prescribed quite often. Comparing CAM-GPs and CAM neurologists, it is remarkable that GPs more often prescribe the not recommended butyrophenone, while neurologists mainly prescribe anti-dementia drugs. The administration of neuroleptics in both groups of physicians is comparable and considerably lower than in other studies. Further analysis regarding co-medication, co-morbidity, and the occurrence of critical combinations are of high interest to health services research.
The EvaMed Network was supported by grants from the Software AG Foundation, Wala Heilmittel GmbH, and Weleda AG. The sponsors had no influence on the design or implementation of the study, the collection, management, or analysis of data or the preparation, review, or approval of the manuscript. We would also like to thank Katie Renaud for editing the English version of this manuscript. Finally, we would like to express our special gratitude to all physicians participating in the EvaMed Network.
Authors' original submitted files for images
12883_2011_511_MOESM1_ESM.png Authors' original file for figure 1
Dr. Vollmar was the first author of the DEGAM guideline for dementia. The other authors declare that they have no competing interests.
EJ participated in the design of the study, acquisition of data, performed the statistical analysis, and drafted the manuscript. TO made substantial contributions to the interpretation of data and statistical analysis. HCV helped with the interpretation of the data and drafting and critical revision of the manuscript. MT and FS helped with the drafting and critical revision of the manuscript. HM conceived of the study and participated in its design and coordination. All authors read and approved the final manuscript.
Havelhoehe Research Institute, Kladower Damm 221, 14089 Berlin, Germany
Center for Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453 Witten, Germany
Institute for General Practice and Family Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
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Pre-publication history
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2377/11/99/prepub
Dementias


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text:
Ind vs Pak: India And Pakistan To Lock Horn on 24th October in 2021 World Cup At Dubai
Ind Vs Pak: ICC has finalized the world's much-awaiting cricket match's date, India and Pakistan to lock horn on 24th October in the 2021 World Cup at Dubai International Stadium.
The 2020 T20 World Cup which has been rescheduled in UAE and Oman due to the Covid-19 outbreak, is set to start on 17th October. Cricket fans eagerly wait for this match, as India versus Pakistan bilateral series doesn't occur due to tension at the border between these two countries.
If you look at the previous matches between India and Pakistan, Pakistan has never beaten India in any World Cup. The last time when these two nations faced each other in the 2016 T20 World Cup at Eden Gardens, India defeated Pakistan by 6 wickets, Virat Kohli was Man of the Match for his match-winning unbeaten 55 runs.
It will be interesting to see if India can continue their winning streak or Pakistan will write a new chapter of Ind vs Pak in the T20 World Cup.
Ind vs Pak : The Two Groups of the T20 World Cup are
Group A Group B
England India
Australia Pakistan
West Indies New Zealand
South Africa Afghanistan
Winner of qualifiers group a Winner of qualifiers group b
Runners of qualifiers group b Runners of qualifiers group a


Get updated when Frank publishes an extended moment.
The chip chip chip ing of a cardinal this morning as I got my coffee.I couldn't see it, but knew it was around.
Big open sky at the beach.On Sunday I struggled through 26.2 miles and hated most of it. I was tired, hurt and sick. But mostly disappointed.
Feeling like Orlando is not a long term solution.
Parking and getting ready for pickup - first leg of trip !
Waiting got L to finish work. The light is sweet as it gets dark.
Falling asleep all week. It's Friday - ugh.


text:
Alex Writes
News, media, marketing, and power
alexwrites.substack.com
Let's talk about Coinbase
Alex Wilhelm
It's early and I am late for work. There will be stray typos in the following paragraphs. Please ignore them. All complaints, corrections to ryan@scrawler.co (Scrawler Media). — Alex
News is out this morning that Coinbase is getting into the media game. The revelation shouldn't surprise. Coinbase, part of the larger a16z family, has seen its long-time backer build up its own media operation through internal team-building, and external investment.
a16z backs Clubhouse and Substack, two companies that could be construed as empowering smaller creators, talkers, and writers outside of the traditional media landscape. That parental ethos, mixed with Coinbase's liquid wealth, gisting down to a crypto media arm is not a shock.
From Axios:
While sources say the media operation would act as a top-of-the-funnel marketing vehicle to draw more people to its cyptocurrency exchange, it also could be used to help the company drive its own narratives. […]
Between the lines: The idea, still in its early stages, is to hire an in-house team of roughly 30 to run a cross-platform media operation. The operation would be led by a VP Content & Editorial, which the company is still searching for, according to two sources.
(For reference, that's an editorial team probably around the size of TechCrunch's writing staff, if I am counting correctly.)
A company building its own internal content creation machine is standard in today's startup economy; as on-demand pricing becomes increasingly common, and self-service sales takes successive bites out of the traditional enterprise SaaS sales model, building out libraries of content to attract externals to the corporate site is table stakes.
But then, there's that Axios point noting that Coinbase's media arm "also could be used to help the company drive its own narratives." That stuck in my craw a bit.
This is where internal media-ish operations (normal, fine) try to do a bit more than just talk a company's — or an investing firm's — book. And the idea is becoming more and more popular. And confused.
There's a key difference between building a media-ish operation and a news operation; the latter, I think, is what many folks conflate the former with. And it's an error.
In the Coinbase example, Axios notes that "unlike a typical newsroom, that person would report into Coinbase's marketing team." Got it. Let's talk about that issue, and what it means regarding media-ish work, and news, at for-profit, non-media companies.
Media?
I have had the somewhat unique experience of starting news media organizations at two different startups (Mattermark and Crunchbase). In both cases, I reported to the CEO. That was a key part of my acceptance of the work, as I was not interested in doing the company's marketing job. (And, to be entirely clear, am wholly unqualified to do so.)
What I was interested in doing is building an independent team to cover the private markets — the focus of both Mattermark and Crunchbase. And in both cases it went medium, more or less. Mattermark, for example, was a messy year for me as I had to dip to rehab for a half month. And then the company's cash issues became sharp, dooming the news project.
Crunchbase went better for a few years, until I ran out of internal political capital and, after around 2.5 years of independence and work that I am very proud of — a bunch of the Crunchbase News team are now at TechCrunch with me, doing kickass work — wound up at a crossroad that involved my either accepting my team being moved into the marketing org, or leaving.
So I left. No hard feelings, welcome to startups. Things change. You just have to know what your hard lines are, and what you want to do next.
But with some folks saying that Coinbase is building a media arm, the answer is only sorta.
It's building something that will produce content. But that output not going to be more than pre-chewed, pro-crypto blather. That's because marketing's job is incredibly different than a news' teams own; its metrics are different, its timeline is different, its approach to writing is different, its approach to paying attention to sales' needs (it wants to) and potential customers (it has to), are antithetical to what a news team does.
And the editor that they hire won't have much ability to push back against the head of marketing, a person inside of startups who has way more budget than the media group, frankly, and pull with other divisions inside the company that the media group won't be able to combat.
So the term media in the case of what Coinbase is building feels a little bit much. It's building out its personal megaphone. It's bolstering its own Coinbase Is Great message. Cool. But media? The word implies some sort of independence, I think; it learns towards news.
To call what the company is doing, working to hire a vassal to its marketing head to write more blogs about the company, media just feels wrong. No matter from where it hires its impending editor from. That person's heritage is moot once it runs crossways to the company's messaging, positioning, or market focus.
Coinbase is not alone in looking to build out a large content operation, seeded with traditional journalism experience. I know because one tried to hire me the other week. I declined, as I did not want to trade a job that trusted me to do journalism for a place where I'd report to someone who'd report to someone who probably didn't like journalism. You know?
Anyhoo, the much-ballyhooed media-push by startups to drive their own narratives smacks more of CEO hubris than it will likely engender in real-world impacts. But who cares, it's not our money.
© 2023 Alex Wilhelm


I love location photos. I love finding the locations, working out angles and pre-visualising the results. I love posing and finessing couples. And I love creating quiet, relaxed and tranquil imagery.
I'm also very conscious of not taking away the personalities of my couples for my own selfish gains.
Yesterday's wedding was a case in point. If there's one thing that sums up Kylie and Travis, it's laughter. All day, every day. It's infectious and it's them. So whilst I captured them in a series of my signature looks in front of the iconic Opera House, this image is their truth.


Sonic might be an iconic character, but I wouldn't want him in my house. He's far too hyperactive and overly competitive. Plus, the way he eats hotdogs proves he wouldn't make the best dinner guest. Kratos might be able to take on the Gods, but I can't see him sitting in my living room discussing his favourite music. Lara Croft might make for good company… if she doesn't spend all her time bragging to everyone about her travels. Guybrush Threepwood would have to curb his clumsiness. Gordon Freeman would have to learn to be more sociable.
The "Fantasy Dinner Party" is an old topic of conversation: if you could invite any six people (alive or dead) round for a fancy meal, who would you pick? It's a chance to say something about yourself, and a great source of debate. They don't have to be good guys; people often choose characters like 'Hitler' or 'Ghengis Khan' because they would want to "understand them". Either way, you pick the six most interesting, erudite, and entertaining people that you can think of.
Games and gamers are constantly proving that gaming culture can be a grown up thing. So why not add another grown up conversation? Below is the first of six videogame characters that I would invite to a dinner party. I'll talk about the other five guests in the following months. This is essentially a chance to celebrate a character I hold in high regard. I'm hoping you will join in with your suggestions. Remember that the notion of a dinner party restricts the conversation to characters that we would want to know socially. You know, the sort that will eat the food you serve instead of trying to eat the other guests.
I've always had a soft spot for Alyx Vance. Even in my younger years, when the Half Life series failed to appeal to me, I appreciated what a strong character had been created. Upon replaying the series last month, the brilliance of this character only shone brighter. She's smart, funny and good company.
Gordon Freeman is one of the gaming world's famous silent protagonists. We idolise him in the same way every NPC that meets him seems to idolise him. With no voice of his own, and a void where a personality should be, we are expected to put our own character into that space. Whilst this makes the game more personal, more real for the player, the story lacks the perspective of a central protagonist. Enter Alyx Vance, the deuteragonist that speaks for Freeman.
When Gordon Freeman is riding a pimped-out dune buggy through a dystopian waterway, dodging monsters and machinegun bullets, it's Alyx that remarks on how fun this all is. When things are at their worst and the creepiness level is inching up, it's Miss Vance that shows fear for both of you. She speaks to other characters whilst you smash boxes. When the game turns dark and sinister, Alyx leaves the room to let the tension take hold.
Yet she also fills the role of sidekick impeccably. Whilst she – like everyone else in the game – owes Gordon Freeman for saving her life multiple times, she can hold her own in a gunfight. I recall a tense fight with an Antlion Guard and its chums in a concrete courtyard, surrounded by apartment buildings. Alyx was firing her sidearm from a first floor walkway whilst I/Gordon danced with the charging brute. With the Guard dispatched, Alyx vaulted the rail, killed the last of the smaller Antlions. She then dashed forward and took charge of a machinegun facing down the long courtyard. I stood back and watched as she tore down a swarm of drones laughing and revelling as she did so. As I pressed on towards a Combine barricade, suppressing fire played havoc amongst the defending enemies. Alyx is a gaming partner to be reckoned with.
It is clear from the outset that Alyx is, if nothing else, a good person. Full of faith and hope, an excellent judge of character and honest. A loving daughter and loyal companion. She is more than a character I appreciate; this is a person I would invite round for dinner.
I've not mentioned Alyx Vance as 'dinner guest one' because she is my favourite character. All six characters are equally important to me. I've started with Miss Vance because she would be the easiest to cater for. In more ways than one.
Firstly, seating Alyx at the party would prove straightforward, due to her very nature. I can't think of many people that wouldn't warm to her, or find something to talk about. Her choice of conversation might turn to the technical – engineering, the sciences, robotics, etc. – but her stories working with experimental technologies would entertain most people.
Secondly, the catering. Alyx comes from a grim, dystopian world, where everything is in short supply. I wouldn't have to go overboard with the food provided, and I can imagine Alyx scoffing at a cuisine that's made to impress rather than sustain. A good steak, or perhaps a pasta dish, would be in order. One thing is for certain: crab will definitely notbe on the menu.
As for entertainment, that too should be trouble-free. Alyx has spent a huge portion of her life running and fighting; a laidback evening would be preferred, I'm sure. A game of cards, a lazy chat over beers, something simple to unwind from all those alien attacks. Alyx will probably want to take a look at all the modern gadgets I have around the home… I'd just have to make her promise to put things back together afterwards, and avoid 'upgrading' my electronics.
There are videogame characters I appreciate, those that I think are brilliant and those that are so well-written and well-rounded that I wish they might be real. Even when Alyx is filtered out from the Combine and the Antlions and the Zombies, she is still an awesome character in her own right. She would make a delightful addition to any night in. Providing, that is, that I could convince my fiancé that I only see Miss Vance as a good friend.
If you've read this far through this odd little blog, perhaps you agree or disagree with this choice. Which videogame characters would you invite to dinner? Which of your gaming heroes/heroines is a person that you could get along with?
In the next few weeks, I'll celebrate five more characters that have deeply impressed me in some way. You might agree or disagree with my choices, or point out an aspect of that person I should consider before I invite them across the threshold.


text:
Volleyball at the 1976 Summer Paralympics consisted of a men's team event. Sitting volleyball was also included as a demonstration event.

Medal summary

Medal table

References

1976 Summer Paralympics events
1976
Paralympics

redpajama_set_name: RedPajamaWikipedia


Treat yourself to a home training and diet coach!
Whether you want to be coached by Valérie Orsoni, or prefer to create your own fitness sessions by choosing from over 130 different exercises, My Body Coach 2 offers you a complete diet and fitness program that you can do at home. Besides the sports coach, you will also benefit from nutritional advice in 170 detailed menus.
Use the PS3™ Move, which you integrate into the weights supplied with the game, to enable the virtual coach to tell you how to correct your moves in real time in Fitness and Gym Dance.
Follow the diet and exercise program which most suits your needs, and have fun as you sculpt your dream body!
Choose a track from the 21 tracks supplied, or use the music on your PS3™ hard disk drive to add rhythm to your fitness sessions!
On PS3™, online trophies and leaderboard: compare your results with those of other players!


text:
Pueblo Grande Project
Juan de Herrera Project
JDH DDH Summary Tables
Project Location Map
TSX.V: PRG $0.24
Precipitate Commences Phase-two Geophysical Surveys at Ginger Ridge
December 3, 2014 Download PDF
Vancouver, B.C. -- December 03, 2014 - Precipitate Gold Corporation (the "Company" or "Precipitate") (TSXV: PRG) is pleased to announce it has commenced ground geophysical surveying at the Ginger Ridge Zone within the Company's 100% owned Juan de Herrera project in the Tireo Gold Camp in the Dominican Republic.
A follow up ground geophysical program of magnetic and induced polarization ("IP") surveying has been initiated by the Company at Ginger Ridge. These two surveys will initially cover the +600 metre long corridor, which extends northwest from the recently announced gold discovery in drill hole 5, and success contingent, could include additional untested areas along the Ginger Ridge geochemical anomaly. The Company's recently announced discovery hole (hole 5) yielded a gold highlight interval of 13.4 g/t gold over 5.0 metres, within an interval of 98.1 metres (starting at 24.9 metres depth) of strongly disseminated, semi to massive pyrite (core measured interval, the true width is not known). The discovery hole represents a gold-enriched semi to massive sulphide body with VMS style affinities and provides an important signature and targeting tool for the next phase of work.
Jeffrey Wilson, Precipitate's President & CEO stated, "We're excited to be able to get back to work at Ginger Ridge with additional IP and magnetics surveying as, to date, geophysics has proven to be a critical exploration tool at Ginger Ridge and throughout the region. The correlation between the gold mineralization and geophysical anomalies coincident in our recent discovery hole provides an important signature and modelling tool for better vectoring of future drill targets. Equipped with this newly discovered signature, this detailed follow-up program of IP and magnetics allows the Company to expand and refine current targets while exploring for additional similar signatures elsewhere within Ginger Ridge."
Michael Moore, VP Exploration of the Company and Qualified Person for purposes of National Instrument 43-101 has reviewed the technical information in this news release.
About Precipitate Gold:
Precipitate Gold Corp. is a mineral exploration company focused on exploring and advancing its mineral property interests in the Tireo Gold Trend of the Dominican Republic. The Company also maintains assets in northern British Columbia and southeast Yukon Territory and is actively evaluating additional high-impact property acquisitions with the potential to expand the Company's portfolio and increase shareholder value.
Additional information can be viewed at the Company's website www.precipitategold.com.
On behalf of the Board of Directors of Precipitate Gold Corporation,
"Jeffrey Wilson"
Jeffrey Wilson, President & CEO
Tel: 604-558-0335 Toll Free: 855-558-0335 investor@precipitategold.com
This press release may contain "forward-looking information" within the meaning of applicable Canadian securities legislation. All statements, other than statements of historical fact, included herein are forward looking information. Generally, forward-looking information may be identified by the use of forward-looking terminology such as "plans", "expects" or "does not expect", "proposed", "is expected", "budget", "scheduled", "estimates", "forecasts", "intends", "anticipates" or "does not anticipate", or "believes", or variations of such words and phrases, or by the use of words or phrases which state that certain actions, events or results may, could, would, or might occur or be achieved. This forward-looking information reflects Precipitate Gold Corp.'s ("Precipitate" or the "Company") current beliefs and is based on information currently available to Company and on assumptions it believes are reasonable. Forward-looking information is subject to known and unknown risks, uncertainties and other factors that may cause the actual results, level of activity, performance or achievements of Precipitate to be materially different from those expressed or implied by such forward-looking information. Such risks and other factors may include, but are not limited to: the exploration concessions may not be granted on terms acceptable to the Company, or at all; general business, economic, competitive, political and social uncertainties; the concessions acquired by the Company may not have attributes similar to those of surrounding properties; delay or failure to receive governmental or regulatory approvals; changes in legislation, including environmental legislation affecting mining; timing and availability of external financing on acceptable terms; conclusions of economic evaluations; and lack of qualified, skilled labour or loss of key individuals. Although Precipitate has attempted to identify important factors that could cause actual results to differ materially from those contained in forward-looking information, there may be other factors that cause results not to be as anticipated, estimated or intended. Accordingly, readers should not place undue reliance on forward-looking information. Precipitate does not undertake to update any forward-looking information, except in accordance with applicable securities laws.
Copyright © 2020 Precipitate Gold Corp.
TSX.V: PRG
Precipitate Gold Corp.


text:
Q: Web service call from different machines I have a web service function call in my tool. The web service is a internet URL.
When I run the tool in a machine in a environment, the web service function is working fine with proper response.
But when I run the tool in a machine in other environment, the web service function is not working and gives below  error.

WebException : The request failed with an empty response. WebException
  stack trace :    at
  System.Web.Services.Protocols.SoapHttpClientProtocol.ReadResponse(SoapClientMessage
  message, WebResponse response, Stream responseStream, Boolean
  asyncCall)    at
  System.Web.Services.Protocols.SoapHttpClientProtocol.Invoke(String
  methodName, Object[] parameters)    at


TEHRAN – Fourteen Iranian cities, including Tehran and Isfahan, will be playing host to a festival of short films on Imam Khomeini, the founder of the Islamic Republic, from May 23 to 25.
Over 100 works will be screened during the Ruhollah Short Film Festival.
The festival seeks to draw the attention of the younger generation of filmmakers whose works mirror the thoughts, lifestyle and works of Imam Khomeini, the organizers announced in a press conference on yesterday.
The festival will be organized by the Institute for the Compilation and Publication of Imam Khomeini's Works in collaboration with the Iranian Youth Cinema Society, the Documentary and Experimental Film Center, and the Farabi Cinema Foundation.


text:
Own your music. Control your data. Collect your money. Get Started
Own your music. Control your data. Collect your money.
Music Industry Report
Exploration Weekly - Open Office Hours - Friday 4/3 @ 10am-12pm PST
"You can't stop the future
You can't rewind the past
The only way to learn the secret
...is to press play."
Exploration would like to welcome you to stop by and say hello during our open office hours today from 10:00 AM to 12:00 PM PST on Google Hangouts Meet. We would be thrilled to meet you and answer any questions that you might have. Please join us at the link here or at the phone number (US) +1 347-450-6962. PIN: 959 360 118 4047#
If you may have missed our last webinar a week ago, please feel free to watch the recorded session led by our co-founder and CEO Aaron Davis below, discussing the various options available that may help benefit your catalog.
Universal Music Group parent Vivendi recently announced that Tencent Holdings, along with a consortium of backers, now owns 10% of UMG, valuing the company at around $33.7 billion and the deal at approximately $3.37 billion.
According to a report, week two of the US economic shutdown showed that overall streams were down to 24.32 billion, a 0.5% decline from the previous week's total of 24.45 billion. On the other hand, overall on-demand streams are still up 19.7%, year-to-date. Video additionally showed an increase this week, up 3.7% from the prior week.
Short-form video app TikTok has signed "short-term" deals with the three major labels - Universal Music Group, Warner Music Group, and Sony Music. The agreements last shorter than the usual 18-24 months. YouTube is also reportedly in the works of building a new feature called "Shorts," similar to TikTok, that will include brief videos posted by users.
In this newsletter:
Done Deal: Tencent-Led Consortium Completes $3.4 Billion Acquisition of 10% of Universal Music Group
Coronavirus Listener Data: Video Still Rules, While Audio Streams Start to Trickle Back
TikTok Signs Short-Term Licenses as YouTube Preps a Rival
Judge Allows Musicians to Move Forward in Suit Aimed at Reclaiming Rights
Alphabet Analyst Says Coronavirus Crisis Could Boost YouTube, Other Premium Services
YouTube Music App Now Displays Lyrics on iOS and Android
Now, the details...
Compiled by Heidi Seo
Exploration Weekly - April 3, 2020
Tencent Holdings, along with a consortium of backers, now proudly owns 10% of Universal Music Group. The announcement of the deal was made by UMG parent Vivendi on March 31, exactly three months after the contractual agreement of the acquisition was announced (December 31). According to the deal, Universal Music Group is given an implied Enterprise Value of €30 billion, which is at last year's annual exchange rate, worth $33.7 billion. This also means the Tencent-led consortium has acquired its 10% for €3 billion, or approximately $3.37 billion. The group is allowed to acquire a further 10% in UMG at the same price by January 15, 2021.
Overall streams during week two of the US economic shutdown were down to 24.32 billion, a 0.5% decline from the prior week's total of 24.45 billion. Audio streams fell 3.2% to 14.545 billion, showing a slowdown after the prior week's sharp 9% decline. Overall on-demand streams are still up 19.7% to 267.75 billion, year-to-date. Video remains the one true bright spot. Video posted another increase this week, up 3.7% to 9.776 billion, from the prior week, when video rocketed up 6.9% to a total of 9.426 billion. Year to date, video streams are up 28.6% to 63.47 billion from the total of 49.35 billion for the same time period in 2019.
According to Billboard, social app TikTok has signed "short-term" deals with all three major labels: "notably shorter than the 18-24 month agreements that labels usually strike with technology companies – in part so that the rapidly developing social network and the major labels can continue to negotiate the finer points of longer-term deals". The news arrives as tech site The Information recently reported YouTube is working on a new feature called "Shorts" that will "include a feed of brief videos posted by users inside the Google-owned app and will take advantage of the video service's catalog of licensed music, songs from which will be available to use as soundtracks for the videos created by users."
A New York federal judge decided on Tuesday that musicians in a putative class action lawsuit are able to move forward when terminating copyright grants to publishers. The case was brought in February 2019 by John Waite and Joe Ely, musicians who alleged that Universal Music Group routinely and systematically refused to honor termination notices. Under Section 203 of the Copyright Act of 1976, authors can reclaim rights to works after 35 years. This has given artists and musicians more termination power to negotiate better royalty rates. US District Court Judge Lewis Kaplan came to the conclusion that the musicians can now indeed sue after deciding that they're really making an infringement claim. The US Supreme Court has made it clear that copyright plaintiffs may sue anytime within three years of an infringement.
According to BMO Capital Markets analyst Daniel Salmon, more consumers would amid the coronavirus crisis look at paying for Alphabet's subscription services, such as YouTube Premium. "As consumers seek alternative forms of entertainment within the confines of their homes, they are likely to increasingly consider subscription products offered by Google, including YouTube Premium, YouTube Premium Music, and YouTube TV," he wrote in a report whose title included the comment: "We See Relative Outperformance Upon Rebound." Salmon upgraded his rating on the technology giant's shares from "market perform" to "outperform" after "a historic sell-off" that has seen the stock drop from a 52-week high above $1.530 in February to a 52-week low of $1,008.87 last week. He left his price target on the stock at $1,400.
YouTube Music now displays lyrics to listeners on the iOS and Android apps. By tapping the "i" button while a song is playing, users can see the lyrics. Other platforms like Apple Music and Spotify also showcase lyrics to listeners. On YouTube Music, all lyrics are static, so you have to scroll through them manually. In addition, while YouTube Music lyrics are available for some songs, not all songs have the option. LyricFind is still the main partner for powering YouTube Music's lyrics. This new feature is only available in the YouTube Music mobile app, not the web player, which the company says will come "soon".
An ode to live music in a time of silence.
The fascinating world of rhythms designed to calm the mind.
Neuroscience shows listening to music has similar effects to meditation.
Heavy Metal Thunder: The Origins of Heavy Metal.
Switchfoot unveils a reimagined version of "Sooner or Later," in a new video.
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We're writing a free book on how the music business works. Learn more here.
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To see who is collecting your royalties, request a free copyright audit here!
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This is my petal form taking shape. As with my other prototypes, I sculpt a solid form using the SUR form tool to help shed and refine layers.
It makes a big mess!
The silhouette was inspired by the tulip petals from my dissections!
Pouring a thin layer of plaster with a little red iron oxide. A thicker layer of white plaster goes on next. After the waste mold is dry, I scoop out the clay, soap the inside and fill the negative space with new plaster.
Using a chisel and a mallet, I break open the waste mold to expose the plaster prototype. I prefer making a mold from a plaster prototype because I can sand and buff it much better than clay. Its also easier to spot imperfections and fix them!
Making the mold, similar to the one for the anther form.
Shannon, I am so excited about these forms! Really glad that you're including such an amount of in-process shots, I love to see how it is all coming together. The forms look incredibly refined, and I'm anxious to hear more about it tomorrow during critique!


When a procedure invocation expression is evaluated, the procedure and all the argument expressions must be evaluated before the procedure can be invoked. Special syntactic expressions are special because they are able to manipulate their arguments in an unevaluated form, and can choose whether to evaluate any or all of the argument expressions.
Why is this needed? Consider a program fragment that asks the user whether or not to delete a file, and then deletes the file if the user answers yes.
If the outermost (if ...) expression here was a procedure invocation expression, the expression (delete-file file), whose side effect is to actually delete a file, would already have been evaluated before the if procedure even got invoked! Clearly this is no use -- the whole point of an if expression is that the consequent expression is only evaluated if the condition of the if expression is "true".
Therefore if must be special syntax, not a procedure. Other special syntaxes that we have already met are define, set! and lambda. define and set! are syntax because they need to know the variable name that is given as the first argument in a define or set! expression, not that variable's value. lambda is syntax because it does not immediately evaluate the expressions that define the procedure body; instead it creates a procedure object that incorporates these expressions so that they can be evaluated in the future, when that procedure is invoked.
The rules for evaluating each special syntactic expression are specified individually for each special syntax. For a summary of standard special syntax, see See section 14.3.3 Summary of Common Syntax.


Is It Safe to Run Your AC During Thunderstorms in Florida?
Florida is known as the lightning capital of the U.S. for a reason. Once Spring arrives, it brings tropical storms and intense heat & humidity, which can make being indoors without air conditioning very uncomfortable.
But is it safe to run your air conditioner during strong Florida storms?
Can You Run the AC Unit When It's Raining?
Even when it starts raining in Florida, you'll be happy to know that it's perfectly okay to use your AC unit. No amount of rain will cause your unit to malfunction, break down prematurely, or put you and your family at risk.
The only time you need to be careful is when it starts raining to the point of flooding. When this happens, water can collect around your outside unit and damage your AC. To prevent this from happening, you need to shut your system off immediately once flood warnings are provided in your area.
If you live in a flood-prone area in Florida, you also might consider elevating your air conditioner off of the ground. This way, excessive rain won't be as problematic and lead to costly repairs.
Will Surge Protectors Safeguard Your AC from Lightning?
When you see flashes of thunder during a thunderstorm, it's natural to start worrying about the condition of your AC unit. If lightning were to strike, severe damage could result. It doesn't have to, though, if you invest in a surge protector.
AC surge protectors are designed to protect your unit from lightning strikes, power outages, and electrical shortages. When lightning does strike, the protector absorbs the blow and then redirects it to the ground. This way, your AC unit won't get damaged, and no one in your household has to worry about being harmed.
You can have surge protectors set up professionally, which ensures a safe, efficient installation. When you hire professionals, they'll also teach you how to maintain your surge protector so that it always works at an optimal level.
Does Rain Affect Air Conditioners?
Whether there's a light drizzle or torrential downpour, you never have to worry about rain causing severe damage to your unit. That's because parts on the outside unit are specifically designed to handle all sorts of weather elements. These include rain, snow, wind, and excessive amounts of heat.
If you're still worried about your air conditioner during heavy rain, there are plenty of weatherproof covers you can purchase. They will hold up for years, as well as provide your unit with ample protection.
Your AC unit is an important appliance to protect, particularly during the hot summer months in Florida. As long as you properly maintain it and take certain precautions, running your air conditioner in the rain never has to be something that sends you into a frenzy or cost you a fortune.