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Life expectancy improvements in England and Wales 'among the worst' - study
Joe Giddens/PA Wire
By Joe Gammie, PA
England and Wales has some of the worst life expectancy improvements across 23 "high-income" countries, a new study has revealed.
A team of researchers compared life expectancy and mortality rates in England and Wales from 1970 to 2016 with those of 22 other countries including Scotland, Ireland, France, Australia, the USA and Japan.
Their study said life expectancy at birth among men in England and Wales was 79.0 years and for women was 82.9 years in 2011, increasing by 0.4 years for men and 0.1 years for women by 2016.
Of the 22 other countries studied only two saw a smaller improvement for men during this period while just one had a lower figure for women.
Lead author Professor David Leon from the London School of Hygiene and Tropical Medicine said: "We are concerned that the configuration of economic and social forces that have operated since the middle of the 20th century that have enabled the advances in life expectancy seen since the 1950s are not necessarily going to remain.
"Today the world is facing major challenges, from climate change to the disruption of long-established aspects of international collaboration and co-operation, many of which may have a negative impact on future health progress."
Norway had the highest increase in male life expectancy at 1.62 years between 2011 and 2016 while Luxembourg had the highest for women at 1.57 years.
The study, carried out by a team from the London School of Hygiene and Tropical Medicine and the Max Planck Institute for Demographic Research in Germany, was published in The Lancet Public Health on Wednesday.
It is the first study to measure how far trends in England and Wales compared with a group of other high-income countries, the authors said.
The team said that a slowdown in the rate of increase of life expectancy since 2011 was seen in many of the other countries but the trends in England and Wales between 2011 and 2016 were "among the worst".
They stressed the slowdown was not due to reaching a "limit of life expectancy" because several countries with higher life expectancy than the UK were continuing to improve at a higher rate.
The authors said that it was a result of a slowing in the decline in mortality rates in every adult age across both men and women from young adults to the middle aged and elderly.
Mortality rates among men and women between the ages of 25 and 50 years in England and Wales were now 20% to 40% higher than the median for the 22 other countries, they added.
Professor Leon said: "These trends represent a real reversal of the situation in England and Wales in the 1970s and 1980s, when this working-age group had lower mortality than seen elsewhere, almost certainly in part because in this period the UK as a whole had notably low mortality from external causes such as injuries, poisonings and violence.
"Further work is urgently required to understand what the reasons are for this reversal since 2000, and how far it may be due to adverse trends in injuries, violence and alcohol or drug-related deaths."
From the early 1970s until 2010 male life expectancy in England and Wales followed the median level seen for the 22 other countries rising from 68.9 years in 1970 to 79.4 years in 2016, the study found.
But women in England and Wales lagged behind most of the other high-income countries rising from 75.2 years in 1970 to 83.0 years in 2016, it added.
Researchers said this was due in part to women taking up smoking earlier and more intensively than women in most other countries.


Martha Jane King, who represents Logan and Todd counties in the Kentucky General Assembly, had the honor of representing the House of Representatives in offering a prayer at the 47th Governor's Prayer Breakfast on March 6 at the Frankfort Convention Center.
She was the only woman participating orally in the program. Sen. Jimmy Higdon led the invocation, General Edward Tonini prayed for the military, Rabbi Marc Kline read the scripture, and Rep. King prayed for the Commonwealth.
The Governor's Prayer Breakfast is a longstanding tradition in Kentucky dating back to 1965 and includes representatives of all three branches of government. Each year it provides Kentuckians with an opportunity to give thanks for our blessings, provides hope for the future and an opportunity to ask for strength to lead the Commonwealth to a brighter tomorrow.
The theme for the breakfast was "A Humble Resilience". Governor Beshear chose this theme in honor of Kentucky's people, who have endured natural disasters, a global economic recession, a crippling prescription drug epidemic, and so many other troubles with a prayerful and humble resilience that should inspire those entrusted with leading our Commonwealth to come together and work beyond party lines and electoral season politics to, with God's guidance, build a stronger future for all Kentuckians.
And the scripture says, "My voice shalt thou hear in the morning." Would your bow you heads in prayer with me. Dear heavenly father we come to you this morning as a grateful commonwealth. In awe of the blessing you have bestowed on us through your grace.
We pray for the families across this state who struggle each day to survive, dealing with conditions beyond their control. Give them the strength to meet each day, with renewed hope, and spirit to work for a different future. We ask for you to comfort and uplift those who have suffered great loss of property and life from violent storms.
God we ask that you give us courage to be a people unafraid of the tasks ahead, to help us to share and serve the greater good. To temper our words with civility in our tone and attitude, knowing that we are responsible for our actions to you.
Dear Lord, you have been our refuge for generations. In the words of our preamble, we continue our resolve to acknowledge your grace in the history of our state.


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Q: What are these LCD defects if not dead pixels? Over the past weeks, a line of black/turquoise pixels has appeared on the left of the LCD screen of my 2-year old Lenovo laptop, and has slowly spread into the stain photographed below.
However, it does not seem to be "dead" pixels, since images are still visible underneath. The zone does not appear on screenshots.
What could cause this, and why is it spreading ? Is there any way to fix it ?

A: You probably have a leak or fracture in the liquid crystal layer of your monitor causing it to loose fine control of the light blocking ability of the liquid crystals.
Your display has many layers. One of those layers is a liquid crystal layer that can be controlled in order to block or allow light to pass through to the actual coloured pixel layer. If you can see some kind of image then the light emitting layer is okay as is the actual pixel colours. As you have some image it is quite likely that there is some crystals moving to allow a tiny amount of light through, but not enough to make a reliable image.

from http://www.electroschematics.com/5666/liquid-crystal-display/

from http://www.maxi-pedia.com/TFT+LCD+display+monitor+panel

redpajama_set_name: RedPajamaStackExchange


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×	 List of 718 decision makers of marketing and Advertising Industry in United States 1 × $49.00
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List of 2509 chief security officer and chief information security officer in United States and UK
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MomMomsTraveled.com is a family travel blog with great giveaways and product reviews!
Mommy Daddy Blog is giving away a $25 gift certificate to Birthday Express! Visit MommyDaddyBlog.com to enter this sweet giveaway!
Mommy Daddy Blog is giving away a 16×20 poster print! Visit MommyDaddyBlog.com to enter this sweet giveaway!
So, why am I talking about The Children's Place? Well, because they are having an ebay auction running from 14th-24th were the will be auctioning off messenger bags which have been decorated by celebrities. The celebs include: David Archuletta (American Idol), Paula Abdul (American Idol), Taylor Lautner (Jacob in the Twilight movie), and Chance Crawford (Gossip Girls-I am SO bidding on this one!). So, what exactly do the proceeds of this auction benefit? All proceeds will go to promoting children's literacy and will be given to the Books for Kids Foundation. Follow this link to get to the auction.


Necta Selecta, Mr. G, Royalty, RAG, Population One and more.
A strong dose of seriously good bass music.
Started in 2007 by Necta Selecta as regular dubstep and grime events in Devon & Cornwall, Subheavy was the deep Southwest's most forward looking bass music promoter. This ethos continues in the present day through it's eatmusic radio show, bringing you quality underground music from the past, present and future.


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Noninfectious Diseases of the Urinary System in Large Animals /
Uroperitoneum in Foals /
Noninfectious Diseases of the Urinary System in Large Animals
Urolithiasis in Large Animals
Uroperitoneum in Foals
Renal Tubular Acidosis in Horses
Urethral Defects Causing Hematuria in Adult Male Horses
Thomas J. Divers
, DVM, DACVIM, DACVECC, Cornell University
Last full review/revision Jul 2013 | Content last modified Jul 2013
Uroperitoneum is defined as urine leakage into the peritoneal space. In foals, this most commonly results from tearing of the bladder during parturition, prolonged recumbency while being treated for a neonatal illness, or rupture of the urachus secondary to umbilical abscessation. Ureteral or urethral tears are rare. Some studies indicate a higher incidence of bladder rupture in males than in females, possibly because the narrower pelvis and the longer, narrower urethra of colts is a predisposing factor. Urachal rupture occurs both in males and females. Traumatic bladder rupture is thought to be caused by uterine contractions on a full bladder as the foal passes through the birth canal. Although most ruptured bladders at birth are thought to be traumatic, the presence of smooth edges and absence of hemorrhage around the tear in some foals might suggest a congenital origin (developmental defect of the bladder wall). Most bladder tears are located on the dorsum of the bladder. In the case of a ruptured urachus, infection in the umbilical stump can weaken the urachal wall and result in leakage of urine into the abdomen or subcutaneously near the umbilicus. Prematurity, neonatal encephalopathy, cystitis, ascending infection, abdominal trauma, failure of passive transfer, and sepsis may predispose the foal to bladder rupture.
Foals generally appear normal at birth but progressively become lethargic, tachycardic, and tachypneic throughout 24–48 hr. Signs may not appear for a longer period in foals with a ruptured urachus. As the condition progresses, the abdomen becomes noticeably distended, and ballottement may produce a fluid wave. Most foals attempt to urinate often, with small amounts of urine being produced. This stranguria is often misinterpreted as straining to defecate. Other foals may be anuric or urinate normally.
Ultrasonographic abdominal examination and blood and peritoneal fluid analysis can be helpful in diagnosis. Foals usually have a neutrophilic leukocytosis. Serum hyperkalemia combined with hyponatremia and hypochloremia are seen because of the high concentration of potassium and low levels of sodium and chloride in the urine, which rapidly equilibrate across the peritoneum. An ECG may show broad QRS complexes and very tall T waves due to hyperkalemia. The increased serum potassium predisposes the foal to bradycardia and cardiac arrhythmias (AV block, atrial standstill, and cardiac arrest) if not corrected. Serum BUN and creatinine values can be normal but usually are increased. Blood gas analysis may also be normal or reveal a metabolic acidosis. Abdominal fluid is pale yellow and copious and can easily be detected on ultrasonographic evaluation. The creatinine level in the peritoneal fluid is at least double that in the serum. This test is the most accurate in diagnosing the problem. If laboratory testing is not available, 10 mL of methylene blue can be injected into the bladder via a urinary catheter. If the bladder is patent to the peritoneal space, dye should be seen in the peritoneal fluid within 15 min.
The clinical signs of progressive depression and stranguria can confuse the diagnosis. Differential diagnoses include septicemia (see Sepsis in Foals), hypoxic ischemic encephalopathy/neonatal encephalopathy (see Neonatal Encephalopathy), persistent meconium impaction (see Meconium Impaction), or colic (see Colic in Horses) for other reasons.
In the case of a urachal rupture, abdominal ultrasonography may be helpful to establish an etiologic diagnosis. Ultrasonography of the umbilical remnants may suggest the presence of infection or abscessation. A large amount of fluid in the abdomen is also seen. Rarely, neonatal foals may become azotemic because of rupture of one or both ureters. Accumulation of urine in the retroperitoneal area can be seen via ultrasound.
Surgery is necessary to correct the defect and, in uncomplicated cases, is very successful. The foal should be stabilized before surgery. Potassium >6 mEq/L should be lowered preoperatively by either 500 mL of normal saline, sodium bicarbonate plus 10% dextrose throughout 30–40 min, or sodium bicarbonate administration alone. All of these treatments help drive potassium into cells. If the potassium is >8 mEq/L or the above treatments are unsuccessful, administration of insulin at 0.1 mg/kg, IV, in dextrose and saline and/or peritoneal fluid drainage can be considered.
The bladder should be repaired using absorbable sutures. Because surgical staples have migrated into the bladder and become the nidus for stone formation at a later date, they should not be used. If the umbilical structures are enlarged (indicating infection), they should be removed at the time of surgery and cultured. After surgical correction of the bladder, an indwelling urinary catheter may be placed for 48 hr to decrease bladder distention and leakage of urine at the repair site; however, this is rarely done on a first repair.
If a bladder rupture is recognized early in an otherwise healthy foal and the foal is stabilized appropriately before surgery, the prognosis for recovery is good to excellent, with success rates as high as 95%. In septic or premature foals, in which complications such as peritonitis, incisional complications, adhesions, and anesthetic death are encountered more frequently, the prognosis is fair. All recumbent foals should be considered at high risk of bladder rupture and may require prophylactic indwelling catheterization.
Sepsis in Foals
Noninfectious Diseases of the Urinary System in Horses


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Vulnerabilities/Threats
Survey: Many Large Enterprises Underestimate Risk From Terminated Employees
93% of large enterprise IT admins say there is no risk from former employees, yet more than half have limited knowledge of employee access rights to systems
FRAMINGHAM, Mass., June 15 /PRNewswire/ --
WHAT:Courion(R) Corporation, leaders in access governance, provisioning and compliance, releases survey results revealing that while a vast majority (93%) of organizations are confident that terminated employees pose no security risk to their systems by virtue of legacy access, many have limited or no knowledge of the systems to which their active and terminated employees have access. This unwarranted confidence in system security leaves companies vulnerable to attacks such as the recent "zombie account" breach at the California Water Service Company (CWSC), in which an ex-employee returned to his office after hours and successfully transferred $9 million to offshore bank accounts in Qatar, using his old password to access privileged accounts.
DETAILS: Conducted through May 2009, a global survey of 236 business managers from large enterprises - more than half from companies with at least 10,000 employees - reveals that 53% of IT managers are largely unaware of employee access rights to systems. This causes a proliferation of zombie accounts - accounts that remain active after employees have left the company. However, these same administrators say they have a high level of confidence that zombie accounts cannot trigger a malicious attack or perpetrate a data leak, despite evidence to the contrary, such as the recent CWSC incident.
Other key survey results include:
-- Nearly one in three companies (30%) still manually provision user accounts, increasing the likelihood of human error or delays when de-provisioning departing employees - and ultimately the risk of data theft via zombie accounts. -- Almost half (48%) of organizations currently take more than one business day to alert IT departments of employee terminations. -- Close to one quarter (23%) of companies surveyed also take another day or more to switch off employee access to their systems, creating a substantial window of opportunity for malicious former employees. -- Almost 1 in 10 companies (9%) said they could never be completely certain that terminated employees no longer have access to IT systems. -- More than one third (34%) of business managers reported that it can take up to a week or longer to be completely certain that terminated employees do not have access to systems.
These figures suggest that IT administrators may be overconfident in their ability to prevent data breach threats from zombie accounts, which can cost organizations millions of dollars in damages and tarnish brand reputation. Courion recommends careful inspection of Access Assurance policies to ensure that the right users have the right access to the right resources and are doing the right things.
To arrange an interview with experts who can discuss user provisioning and Access Assurance policies, contact:
Mariah Torpey Davies Murphy Group [email protected] 781-418-2404
Courion's award-winning Access Assurance solutions are used by more than four hundred organizations and over 7.5 million users worldwide to quickly and easily solve their most complex identity and access management (password management, provisioning, and role management), risk and compliance challenges. Courion's business-driven approach results in unparalleled customer success by ensuring users' access rights and activities are compliant with policy while supporting both security and business objectives. For more information, please visit our website at courion.com, our blog at blog.courion.com/, or on Twitter at twitter.com/Courion.
To view this release online, go to: http://www.courion.com/company/press_release.html?id=408
RiskAttacks/BreachesApplication SecurityCompliance
Zero Trust and the Power of Isolation for Threat Prevention


Depending on the severity of the pancreatic flare up, signs and symptoms may vary. Symptoms can include little or no appetite, pain in the abdominal region and/or back, diarrhea, vomiting, dehydration, lethargy, hypothermia and irregular heartbeat. It can be life-threatening so it's important to consult your vet as early as possible. Often times, a pancreatic flare-up can occur after a pet consumes something he shouldn't have (garbage) or after a fatty meal like bacon fat. It can also occur following a traumatic injury such as a car accident or after starting a new drug therapy. It can also become a recurring or chronic issue for which a long term treatment plan should be made. In chronic cases, it should be noted that the animal is in a weakened state that he may have trouble fully recovering from. He needs help beyond the basics to regain his health and so that symptoms do not keep returning. Diet and supportive food supplements are of utter importance in these cases.
If a dog or cat is being fed a processed food source such as dry or canned foods, the diet is devoid of live enzymes. When pancreatic enzymes are the only source of live enzymes the body has access to during digestion, the pancreas sometimes can't keep up. Even if your pet is seemingly fine most of the time on a dry food diet, the pancreas is being overtaxed by this massive demand for enzymes to break down food. Over time, the body can begin to compensate in a number of ways. Animals are, in a sense, running out of steam in the enzyme department. This can occur at any stage in life depending on the animal. Live enzymes only occur in living, raw foods. Many animals that have digestive concerns do well when they are switched onto a healthy and balanced raw food diet. Many have better success being put onto supportive digestive enzymes before the switch. You may even wish to cook the raw foods first (except for bones) and then slowly transition to raw. Long-term digestive enzyme support may be needed for animals that have been compromised for a long time. This will help the body and cells to fully repair themselves. Remember that Not All Raw Diets Are Created Equally and some are too high in saturated fats, made from low-quality, fatty cuts of meat. This can cause pancreatitis flare ups.
Conventional treatments are broad since each case is different depending on the severity and the cause. Therapies could include IV fluids, drug therapy and prescription diet. A holistic vet may also use acupuncture, herbs, homeopathy or other complimentary medicines. A low fat diet is often essential for these animals. There are prescription veterinary diets that can be fed but, in my experience, I find fresh food diets to have a more healing and long-lasting effect. This is doubly true for chronic cases. Unfortunately, prescription veterinary diets are still devoid of live enzymes and are often made with low quality ingredients including meat by-products and chemical additives. They are usually low in fat (an important factor) but do not offer any way for the body to repair itself and avoid future flare ups. This needs to be done with high quality proteins, naturally occurring vitamins, minerals, antioxidants, phytonutrients, and ENZYMES.
Animals suffering from pancreatic issues are usually enzyme deficient. Pets that do not receive live foods on a regular basis cannot keep up with their enzyme requirements and some run a deficit which can cause disease and inflammation of the pancreas. Because the pancreas is also part of the endocrine system, it affects metabolic functions such as blood sugar regulation, nervous system function and blood flow. Some pets are born with a deficiency at birth which makes it even harder, if not impossible, for them to recover without the aid of real food. By feeding as many living raw foods as possible, you will help your pet to find his equilibrium again. Get help balancing the diet by emailing me: [email protected]. Be strict with treats too and don't allow others to feed your pet without asking. Treats should be natural, low fat and easily digestible.
The pancreas is the body's main source of the enzyme lipase. This enzyme is responsible for digesting fats. Animals with pancreatitis need a low fat diet because fat is hard for them to digest fat and this can cause flare ups. Stick to lean proteins such as extra lean beef, buffalo, elk, rabbit and kangaroo and steer clear of the fattier proteins like duck, pheasant, camel and lamb. Balancing the fats is also important. These pets may not be able to tolerate too much in the way of omega fatty acids. There are concentrated pharmaceutical grade omega oils on the market today that offer the anti-inflammatory benefits of the omega 3's without having to feed a large portion. A low fat diet is crucial for pets with pancreatitis!
Antioxidants. As many and as often as possible. By adding antioxidants, you can help your pet to decrease inflammation within the tissues of the body. Animals dealing with inflammatory disease usually need more antioxidants than a healthy animal. Offer as many green leafy veggies and super green foods as possible such as spirulina, chlorella, and moringa leaf. Berries of all types offer a great source too.
Pumpkin is good to have on hand and to feed daily during flare ups. It naturally helps to bind loose stools and is soothing on the digestive system. Canned pumpkin with no spices or pulped raw pumpkin is best.
Digestive enzymes are a must for all pets dealing with pancreatic disease. If they are to have a proper chance of recovery, this is a must. This takes the pressure off of the pancreas to produce all of enzymes needed for digestion. A high quality canine or feline specific enzyme powder is best and, the more variety, the better. Ask us for our recommendations.
Glandulars have shown to be clinically effective in cases of glandular disease such as pancreatitis. Glandular supplements usually contain dessicated animal glands that are specific to the organ in need of support. These are usually available through veterinarians only so ask your vet if glandulars might be a good option for your pet.
Cases of pancreatitis vary greatly so it's best to have a professional help you to ensure you are taking all the appropriate steps and using the most appropriate foods for the individual animal. Other vitamins, minerals or supplementation may be useful depending on the case. Ask your holistic vet or a pet nutritionist for assistance. Don't forget, we offer free diet planning and nutritional counselling!


The distance between Budapest, Hungary and Le Raizet, Guadeloupe is approximately 7,977 km or 4,957 mi.
To reach Budapest in this distance one would set out from Le Raizet bearing 44.6° or NE and follow the great circles arc to approach Budapest bearing 94.4° or E .
Budapest has a marine west coast climate (Cfb) whereas Le Raizet has a tropical rainforest climate (Af).
Total annual precipitation averages 1216 mm (47.9 in) less which is equivalent to 1216 l/m² (29.84 US gal/ft²) or 12,160,000 l/ha (1,299,985 US gal/ac) less. About 1/3 as much.
The altitude of the sun at midday is overall 28.7° lower in Budapest than in Le Raizet.
The table shows values for Budapest relative to Le Raizet. You can also view this comparison the other way around from the perspective of Le Raizet vs Budapest.
Peshawar vs Willis Island M.O.


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Here's the News. All the news worth reading. (To me anyway) Note that this is a news clippings blog. Articles (mainly from Straits Times) are NOT written by me. Due to spam comments, comments are now moderated. Please read "This Blog" and "Before you comment".
Before you comment
The psychological poverty trap
The poor aren't less able, they're distracted, says poverty expert Eldar Shafir. Privileged people subjected to the same conditions would also make bad decisions.
By Asher Schechter
Feb.23, 2012
From Haaretz
In a behavioral economics experiment several years ago, researchers asked shoppers at a New Jersey mall to handle the following decision: Have your faulty car repaired for either $150 or $1,500. While the participants were considering how to decide, they were given simple cognitive tasks like solving puzzles.
The researchers, Prof. Eldar Shafir and Jiaying Zhao, both from Princeton University, and Harvard University Prof. Sendhil Mullainathan, expected that the stress from contemplating the $1,500 expense would hurt performance. They were right. But participants with above-average incomes succeeded in their tasks under both scenarios, while those with average or low incomes did worse as repair costs climbed.
Even the prospect of spending any money at all damaged the ability of low-income earners to think rationally.
Similar tendencies were found on the other side of the world. Shafir and Mullainathan tested the intelligence of sugarcane growers in India during two different periods: after selling the harvest, when they enjoy relative prosperity, and before the harvest, when times are tightest. The farmers had better IQ results during the season of plenty. Before the harvest they had problems making fateful decisions, because of stress. The study concluded that poverty generates a psychology of its own.
Most of us judge poor people, viewing them at worst as lazy, at best as suffering from deficient financial behavior. We've gotten used to thinking that being poor is their fault: If they were smarter or more industrious they surely would have overcome their poverty.
Shafir, however, claims that the real culprit isn't lack of ability but problems created by poverty. "These problems are distracting and cause mistakes," he told Markerweek in an interview.
"When you're poor you're surrounded by bad decisions of people around you," he says. "You're so concerned about the present that you can't begin thinking about the future, and that's the big irony: People with the greatest need to think about the future don't have the leisure or emotional capacity to do so. The very essence of poverty complicates decisions and makes immediate needs so urgent that you start making wrong choices. These mistakes aren't any different from anyone else's, but they occur more frequently due to the element of stress, and their implications are much greater."
Shafir, who was born in Israel and moved to the United States after his military service, has taught at Princeton University's Department of Psychology since 1989. The White House recently announced Shafir's appointment to President Barack Obama's Advisory Council on Financial Capability, which seeks to broaden financial education and make financial information widely accessible.
Shafir leads several initiatives developing policy to combat poverty, including ideas42, a Harvard-based think tank that Shafir co-directs with Mullainathan. The institute, which seeks solutions to social problems via behavioral economics, studies how people reach decisions.
Shafir has proved that anyone faced with adverse conditions will consistently make bad economic decisions. An experiment he conducted with Mullainathan and Zhao placed financially-savvy Princeton students from prominent families under the stressful and rushed conditions that poor people face every day. They were given questions to answer in a series of timed rounds, but were permitted to "borrow" time from a subsequent round.
"My students at Princeton are well-to-do and intelligent," Shafir says. "They are the sons and daughters of senators and other highly successful people. And yet these brilliant students took precisely 10 minutes to start borrowing too much; they were tending to the present without any thought to leaving something for the future.
"Given enough time, a person will consider the future cautiously. He won't engage in nonsense and won't borrow at high interest he can't afford. But if you put him under strict deadlines and pressure him, he'll start behaving foolishly. We all put off for tomorrow things that need to be done today, and pay high interest because we didn't pay on time. All the mistakes poor people make with money we make with time - but for them the price is too high. A person probably doesn't seem intelligent when he doesn't have enough time to consider the future, but if he did have enough time he would start acting intelligently. Poverty is an emotional state."
The poor subsidize the rich
But the poor make very logical financial decisions for the moment, says Shafir. "When you're poor, all your attention is focused on solving the poverty issue. The upshot is that you function quite successfully because you make wiser use of your shekel than I would," he says.
"I'm wasteful, forgetful and don't pay attention, but the poor are very conscious of the shekel's power. Shekel to shekel they cope beautifully. The problem is that when you're so focused on this, you don't notice all the rest. So you're the best shopper possible but forget to pay the electric bill - and this can cause very knotty problems. While you concentrate on one thing all the rest falls apart."
According to Shafir, "When I make a financial mistake I get upset and move on. When someone poor makes a mistake, he pays for it for months - even years. He needs to borrow at gouging interest to return the money, and it takes him months .... The entire structure crumbles beneath him, and it's hard to grasp how exhausting this is and how it leads to blunders. And this is all without mentioning the considerable differences between a poor living environment and others - from noise, dirt and education all the way to health care.
"If you're Robinson Crusoe you don't think ahead to what you'll build in two months, just to what you'll eat today. It's not a question of character - it's what you have. From the standpoint of sheer human ability, put the poor in the right environment and they'll behave like anyone else."
The problem is even greater when taking into account that the world does all it can to trample on the poor. "Think of all the means at our disposal to help us deal with time constraints. We have alarm clocks, helpers, nannies and dozens of other things helping us function with limited time," says Shafir.
"A poor person has very little. In fact, not only isn't he helped, he gets harassed, taken advantage of, cheated. I have a good lawyer, he has a lousy lawyer. My bank gives me all the possibilities to choose from that he doesn't get. It's not that the world just doesn't help the poor, it trips him up even further," he says.
"For example, it used to be common for banks in the U.S. to send me my credit card statement and let me pay it by June 20. It turned out that the 20th fell on a Sunday, so if I followed their advice I would be forced to pay late and it would cost me a $35 penalty. That's how it was until Obama made this practice illegal.
"If I needed to pay a $35 penalty I got tripped up, but what did I care? But with a poor person - his whole week is changed. The world isn't prepared to help him because the attitude is that he brought it on himself and can't be helped. By the way, my current account doesn't cost me a penny. The bank isn't a charity, so how does it do it? The poor subsidize me. Each time one of their checks bounce they subsidize my account - which doesn't have any fees attached."
Recently we've been hearing the slogan "We want justice, not charity." Policymakers, missing the point, continue talking about grants and handouts. Those solutions are worthless, says Shafir; throwing money at a problem merely perpetuates it.
"The poverty problem could be solved in two ways: Either make them wealthy or understand that context is a large part of the problem and make it easier on them," he says. "The matter could be tackled several ways; for instance, if employers or the government set up programs to help people save. A group of friends could establish a club that decides: 'Let's compel ourselves to look after one another and make sure we do the right things.'"
A human being buys herself a cake
Classical economics, as opposed to behavioral economics, doesn't take psychology into account, says Shafir, so welfare policy in the West has actually widened income gaps over the last few decades. "Classical economics assumes a person does things rationally," he says. "If he doesn't succeed then he apparently isn't smart enough, and this makes him poor. The behavioral economist says everyone makes mistakes, and if you leave them without assistance they'll blunder even more. Everyone errs, but when you have money the mistakes seem less severe."
One of the biggest problems, says Shafir, is the message the poor receive from the system: You're poor because you're no good. "It's very easy for the poor to swallow this idea," he says. "The attitude that the poor are less successful is very common and very wrong. These days the survivor is the one with luck: Once in a blue moon someone pulls through. So the system isn't 'survival of the fittest' at all."
Besides the enormous pressures on the poor, they often find themselves under sharp scrutiny, especially if they dare buy anything that seems extravagant. How could they waste NIS 100 at the hairdresser's, we ask, while their kids go hungry?
"What would you have them do?" wonders Shafir. "Can't they eat ice cream once in a while? The same lady who finishes the week with NIS 100 to spare and buys her kids a treat instead of saving it - even if she didn't buy it someone else around her would need the money. Her life is full of pitfalls. She too is entitled every now and then to give in to temptation and have some cake. So what? We also can't resist temptation: We're human."
According to Shafir, the main thing policymakers need to keep in mind is that people tend to behave passively rather than rationally.
"People's default pattern is to adopt a position and maintain it," he says. "They'll want to change something, plan to change it, intend to change it - but they won't. It happens to people at all levels, the successful and clever ones too.
"Take, for example, two scenarios we tested. Starting a job, they tell you 15% of your salary will go toward your pension and give you a phone number to call if you want to change it. 'Feel free to call and ask,' you're told. In the second scenario they tell you: 'Here's the phone number. Call and tell them to allocate up to 15% of your salary to your pension.' The result is that the respondents in the first scenario save toward their pensions four times as much as the second half, even though all it involves is one measly phone call. Welfare policy is based on the idea that if I understand and want something, maybe something could help me. But if you really want to help me, simply give it to me. Don't count on my finding the time and knowing what to do," he says.
"People take money from one account and transfer it to a savings account. An economist would see this as ridiculous, but from people's standpoint there's an account that isn't touched and another that's used. The chances of the money holding out are entirely different. If the government insists on an approach that says there's no difference, then it loses the ability to help me. It's important to understand human behavior and act accordingly."
Do you think this doesn't apply to you? Think again. The economic crisis and approaching recession are likely to push many of us into poverty. The statistics, Shafir says, are alarming. "One of every two Americans will reach a situation of real monetary scarcity within a few years: not abject poverty but real difficulty in maintaining a standard of living. The situation is obviously terrific compared to poverty in Sudan, but if my kid doesn't have a computer because I can't afford it while everyone in his school has one, it will make me feel poor," he says.
"Poverty is to a large extent an emotional state. If I can't afford to eat at a restaurant where I always ate, if I can't get through the month like I used to - that's scarcity. At that level many are about to become poor. The middle class is shrinking and many people are stressed about their future and their children's futures. Even among the top 1% there's worry. Some continue leading their normal lives, but many are tightening their belts: Doing less and buying less."
The economic crisis in the United States was largely the result of a human trait studied by behavioral economists like Shafir: Wanting it all, meaning people's tendency to disregard their financial situation, take on debt they can't handle and attain a standard of living they can't afford. When it became clear how irresponsibly Americans had behaved leading up to the crisis, many people said financial education from a young age was the solution. A ridiculous idea, says Shafir.
"You can't teach people finance," he says. "You can't teach someone to treat himself as a doctor would, maybe just raise his awareness about his body. The idea of educating people to do the right things financially is a bit absurd. It's like a diet: Part of it depends on me, but it would help if they didn't sell me fattening food. The solution is to improve the context, not the person."
Although scarcity and distress keep spreading as the crisis continues, people still refuse to accept this fact - and refuse to recognize the similarity between themselves and the poor. In fact, they aren't even willing to read about poverty. "I'm writing a book now with Sendhil, and to avoid the stigma of poverty we decided to have the title refer to time constraints. We'll sneak the poverty in afterwards, inside the book," he jokes.
The key to a positive change in society, according to Shafir, is grasping the importance of context in the decision-making processes of the poor and the non-poor, and building a social system that isn't based on ignoring it.
"First of all, the state must stop blaming the citizen. The protest movement was supported by 80% of Americans, and there is rarely anything 80% of Americans can agree on," he says.
"This means the method we developed hasn't worked, because you leave people with economic responsibility for their lives while most of them can't deal with it. The ability to take control, anticipate the future and plan for it is beyond their grasp. When you assume that a person is responsible for these things, you're saying that it's his mistake when it's actually yours - because you gave him responsibility that you shouldn't have. People need a framework that helps them. We're very talented creatures but we have a tendency to make mistakes."
Labels: Behavioural Economics, Government, Informative, Science/Technology, Social
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Woman awarded $50M against youth facility for sex abuse
A $50 million payment has been awarded to a Cobb County, Georgia, woman who was sexually assaulted by a male adult while she was a 15-year-old patient at a Kennesaw facility for troubled youth.
The woman, whose identity is protected on account of her being a child at the time of the assault, has won her Feb. 1, 2017, civil lawsuit against The Devereux Foundation, which has owned and operated its rehabilitation facility on Stanley Road in Kennesaw since 1973.
Devereux is a nonprofit headquartered in Pennsylvania that operates facilities in a dozen states, accommodating and offering programs to people up to 21 years of age who have significant emotional and behavioral problems.
The jury found Devereux was 50% at fault in relation to the woman's sexual abuse, and the man who abused her, Jimmy Anthony Singleterry, was also 50% at fault in the civil case.
Singleterry, age 50, was an employee of the organization and was unsupervised when he assaulted the teenage patient. Singleterry was also criminally prosecuted.
Read the source article at MDJOnline.com
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The Cayos radiator by Milano is a modern take on a traditional horizontal radiator, which will bring contemporary designer style to your home and heat it quickly and efficiently. This radiator features attractive sideways columns, which are protected by a white powder coated finish, creating a look which is modern but versatile.
A great option for revamping any room, the Cayos designer radiator has been made from premium quality steel for guaranteed durability. It produces an excellent hourly heat output, which means your room will be quickly transformed into a wonderfully warm, inviting and cosy space.


Pre-Law refers to undergraduate students with an assured placement in the JD, are planning to study the Juris Doctor (JD) at the end of their undergraduate degree, or just have some interest in law.
The 'pre-law' area of Blackstone was created to accommodate the New Courses structure introduced in 2013. Although law can now only be studied at a postgraduate level via the JD, a number of undergraduate students will still be looking to engage with law as a discipline and this is where Blackstone's pre-law program fills that gap.
are not currently studying any law units, but are contemplating studying law in the future.
Blackstone has a Facebook group which serves as a forum for the Pre-Law team to distribute information, but also for students to ask and discuss issues with their peers. You might also be interested in joining the general Blackstone Society Facebook group.
Are you an undergraduate student interested in law? Do you have a hankering for public speaking? Do you spend your nights hopelessly wishing you were Harvey Spectre or Alicia Florrick grilling people in the courtroom? Well read on because you're in luck!
There are several competitions being run this year by Blackstone for any undergraduate student interested in law.
Involves a simulated trial where teams of two represent either the prosecution or the defence. Teams examine and cross-examine witnesses and present brief opening and closing addresses in order to convince a judge that they're right. Given this fact-finding objective, no knowledge of the substantive law is necessary, and only limited pre-trial preparation is required. This is a great opportunity to develop skills in public speaking, information gathering and persuasive argument.
Involves teams of two representing one of two parties involved in a dispute. Given a set of facts regarding the situation and what they're specific client wants, teams will attempt to negotiate points of disagreement in order to try to come to a settlement. No experience is necessary and only limited preparation is required. This is a great opportunity to develop skills in communication, teamwork and negotiating.
Involves teams of two representing one of two parties involved in a civil dispute. Given a set of facts teams must argue points of law in order to prove their case. Some basic knowledge of law is necessary and some preparation is required. Experience in this competition is the most applicable in the classroom as it serves as an opportunity to develop your skills in legal argument. It also helps to develop your skills in public speaking, communication and teamwork. It is perhaps the closest experience that a student can have whilst at university to appearing in court.
This year Blackstone will run two competitions alongside for the Mooting Competition. A 1st year Moot and a Pre-Law Moot. This will allow students aspiring to the JD to practice Moot at a higher level, and for the first years to be able to compete past the first round.
For those considering continuing on to study in the post-graduate Juris Doctor programme, studying one of the two undergraduate law majors (Law and Society, and Business Law), or at least taking a few units from them, would be extremely useful and highly recommended. Both majors will give you a great foundation with which to begin the JD due to the thought processes and methods you will develop as well as great background knowledge.
Law and Society is offered within the Bachelor of Arts as one of the two undergraduate majors offered by the Faculty of Law. This major examines broad theoretical issues about the nature of law and society as well as how the relationship plays out in particular fields of legal and social policy at both domestic and international levels. These issues include human rights, decisions about birth and death, crime and justice, Indigenous rights, freedom of expression and religion.
Within the major are two first year (level one) core units and then one second year (level two) and one third year (level three) core units. These core units are centred around providing a solid and significant base centred around basic knowledge of Australia's legal system as well as helping you to develop important skills in research, analysis, teamwork and communication.
In addition to these core units you are required to choose and complete two of eight second year (level two) units, and two of four third year units (level three). These units that you get to choose from are all unique in that they focus on a specific issue or area of study and how it relates to the law.
For a full outline of the structure of the major plus links to all the units within it, please follow this link.
The Law and Society major is great at providing students with the background knowledge and broader understanding of issues to do with the law. The major allows students to branch out and learn about how different areas of society interact with the law, allowing them to build up a wide base of applicable knowledge. This knowledge can be utilised regardless of whether they decide to continue on with the JD or not after they complete their undergraduate studies.
The skills you will learn in this major include refining research and writing techniques, in both persuasive arguments and discussion based styles, as well as learning how to reference properly and collating empirical evidence.
Business law is one of two Pre-law majors offered by the Faculty of Law and is run in conjunction with the Bachelor of Commerce. The Business Law major focuses on the fundamental relationship between law and business and is ideal for those planning careers in a wide range of business areas including professional accounting, business management, international trade, and industrial relationships.
Within the major there are two first year (level one) core units, three second year (level two) core units, and then three third year (level three) core units. While the lack of elective core units may restrict students' study direction the units themselves tend to cover many legal issues, particularly in the level one and two units.
The core units of the major cover a basic introduction to the Australian legal system before giving students their first look at critical pieces of legislation in Australia such as the Corporations Act, the Competition and Consumer Act, and a number of torts.
For a full outline of the structure of the major plus links to all of the units within it, please follow this link.
The Business Law major offers numerous benefits to any student that chooses to undertake even a few of the offered units, particularly if they are considering the post graduate Juris Doctor program. While both Pre-Law majors equip students with high-level analytical, problem-solving, research, and communication skills, the Business Law program is particularly beneficial in terms of acting as in introductory program for the actual legislation and case law that will be studied in further post-graduate studies. Students who have aspirations to study the JD are encouraged to take Introduction to Law (LAWS1104). This unit offers the best indication of possible future enjoyment and aptitude for legal study.
Furthermore, this major is often seen as offering many complimentary units to secondary majors such as accounting, where it is necessary to complete Company Law (LAWS2301) in order to attain a professional accounting accreditation.
The Business Law major is a diverse program that offers students the opportunity to excel across the board, from areas of the law of law that can be highly technical, such as taxation law, to areas that require a much larger degree of legal interpretation, such as torts.
The skills you will develop in this major are focussed around problem solving, applying theory into practical situations. You will develop the critical thought processes needed to solve legal problems as well as learning how to get your answers down on paper.
The introduction of the postgraduate Juris Doctor ('JD') at UWA in 2013 has given rise to many questions from pre-law students about the nature of the JD, entry requirements, the nature of assured JD places, as well as how the JD will differ from the LLB. As a result, the Blackstone undergraduate sub-committee has put together a 'JD FAQ' targeted at pre-law students. This short FAQ provides detailed information about the JD, including guidance on what it means to maintain a minimum GPA if a student has an assured JD place.
1. Why is UWA Law School moving to the Juris Doctor?
UWA Law School is moving to the Juris Doctor to be more consistent with practices both overseas and in other Australian universities. For example, the Juris Doctor is now offered at 12 Australian universities, such as ANU and Melbourne University, and it is also the standard law degree in Canada, the United States, and Hong Kong. This means that the Juris Doctor degree will allow you to immerse yourself in international law practice much faster than if you were studying the LLB.
2. So what is the Juris Doctor?
As mentioned previously, The Juris Doctor is the standard requirement for admission into legal practice in several overseas countries, and it is being increasingly used in Australia, Hong Kong and other Asian-Pacific countries. Here at UWA, it is undertaken as a postgraduate degree, sometimes referred to as a 'professional' degree. This means that you undertake the Juris Doctor after having completed a more general undergraduate degree (such as a Bachelor of Arts, Science, Commerce or Design degree).
Unfortunately the degree does not entitle you to use the title of "Doctor," as this requires a further level of study.
3. How is the Juris Doctor structured?
The Juris Doctor requires no pre-requisite subjects, which means it can be studied following the completion of any undergraduate degree, with any subject major. The goal of the syllabus is to get you to a position where you are suitably qualified to practise law. The layout of the degree aims to give you an in-depth insight into the fundamental concepts of the law, before allowing you to expand and follow your particular interests. As such, the syllabus follows the structure shown here.
4. How does the Juris Doctor differ from the LLB?
The Juris Doctor will have an overall course director and individual year group coordinators to improve communication between yourself and the law faculty.
Greater scope for integration into international programs is possible.
5. Is the Juris Doctor more expensive than the LLB?
In terms of fees and expenses, there is little difference between UWA professional level degrees (such as the JD) and its undergraduate programs. This means that the Juris Doctor is supported by the Commonwealth Government through HECS/HELP, with similar qualifying requirements to those that you're used to as an undergraduate student.
Furthermore, The Juris Doctor requires the completion of only 24 units (which is 3 years full-time). This is a lot shorter then the old LLB (it required 32 law-specific units), which means that to get a Law degree, you'll be spending less money under the JD than you would have under the LLB. However, as has been mentioned previously, you'll need to have completed a general undergraduate degree before starting your JD.
6. Will Employers like the Juris Doctor?
7. Are there any unit pre-requisites for the Juris Doctor?
There are no prerequisite units for the Juris Doctor. However, you may like to consider taking one or more of the undergraduate law major units for interest or to see if you actually enjoy the law. Alternatively, undergraduate students are able to take up one of two new Law majors – Law and Society (Arts) and Business Law (Business/Commerce).
8. Will I be disadvantaged if I have not completed a 'Law and Society' or 'Business Law' major?
You will be at no disadvantage if you have not taken a undergraduate law major, as all topics necessary for the Juris Doctor will be taught during the degree.
9. I have an assured place in the Juris Doctor. Can you give me some information concerning the condition that I must maintain a GPA of 5.5 during my undergrad degree to keep my assured entry?
The 5.5 GPA requirement for an Assured Pathway student is assessed on the GPA at the conclusion of the student's undergraduate degree. Whilst you do receive an ongoing GPA at the end of each study semester, this GPA does not affect your place as an Assured Pathway Student in the Juris Doctor.
The reality is that if you have achieved the marks to be offered an Assured Pathway place, it is unlikely that you will fall short of this requirement after your 3 years of undergraduate study.
Unfortunately, if your GPA does fall below 5.5 and you are not able to bring it back up to the required level, then you would not have the sufficient grade to take up your Assured Entry position in the Juris Doctor.
10. If I do lose my assured entry position, would it be too late for me to apply to enter the Juris Doctor that year? Would it be competitive?
The total number of places in the Juris Doctor program each year is approximately 350, including 100-120 Assured Pathway places.
As already mentioned, In order for you to lose your Assured Pathway place, you must have a final GPA of less than 5.5. Given the limited places in the program and the competitive nature of the JD, it would likely be difficult for you to earn a general pathway entry into the Juris Doctor if you did not meet the requirements to maintain your assured entry pathway.
Ultimately, if you have achieved less than a 5.5 GPA, you would not be considered to be qualified for general entry, as this is the University's minimum requirement for general entry applicants.
11. Where can I get further information?
If you have any further questions or comments, don't hesitate to email us.
Good luck with your degrees!


It is one of the most basic software in the computer, and I learned to use it when I was 9 years old.
And here I am, being a 19 years old boy, learning about it again.
Wel, actually I didn't learn about it, but I must do a work with it.
So basically, it is still a learning process, right?
In this course, we learned too make videos too, which is cool. Our video must have a storyline of some sorts, and also scripts.
Somehow, our video is like show.
Me and my group mates had a lot of fun creating a video, and we spontaneously gain a new experience.
...To be more specific, we gain experience about making a new video.
Brochures have nothing to do with brotherhood.
Brochures are important to make sure the public knows about an event that we are organising, or about a product, and many more.
We learned to make one in a KDP class. I'm sure this will be very useful.
Everyone should do it. NO one can escape from it. And if you do, your marks gonna get bad. REALLY BAD.
We must follow the guidelines set by the UKM, which is known as "Gaya Penulisan UKM".
This is a group work actually.
If me and my group are asked to make a survey, well same goes to the other groups as well.
Now all we have to do is to complete other groups' survey.
Because if we did not complete the survey, then what's the point of creating those survey, duh.
When I hear that what were we going to learn on that day was to make a survey, a sighed a little. I mean, it's a thing that i knew about and how to do it, and i'm still going to learn about it? Well, I was wrong about that.
The lecturer actually thought us about something new, which is how to make a survey using Google Docs. I never knew we can make a survey using the internet!
What I like about the Google Docs survey is that the system can process our responds that we get from our respondents and it processes them to make a graph that clears our viewing of the data.
Well, this is actually mind-blowing, at least for me.
Assalamualaikum wbt and a very good morning.
Before the class started, I never thought of having my very own website, and I never heard the word "Weebly" before. Then the lecturer comes in and she introduces us to Weebly. When I heard about Weebly, I was like WAAAWAAWEEEWA! WHAT IS THIS?
When I have the idea about Weebly after the lecture ends, I told myself THIS IS NICE! GREAT SUCCESS! And i can't wait to have my very own website.
That's all, thank you from Kazakhstan.
*NOW I DECLARE 21ST SEPTEMBER AS WEEBLY DAY. WAAAWAAWEEEEWAA!
 Learning is a highly important and also very common life process. Learning is not limited only in classrooms, it also happens when we less realise it. However, the most common learning process takes place in classrooms and also lecture halls. To make sure that both students and teachers get the most out of every learning process, Learning Management System (LMS) and Classroom Management System (CMS) must be applied in every class.
Let's start with the first one, which is LMS or Learning Management System. It is defined as a software that's used to "plan, implement, and assess a specific learning process that typically provides and instructor with a way to create and deliver content, monitor student participation, and assess student performance," (Anonymous, 2005). In an online article that we found, LMS essentially makes the learning experience a whole lot better, especially because it's done on an online platform, and above all, it smoothens out the delivery and reception of information for both student and instructor.
The definition of course management system (CMS) is a collection of software tools providing an online environment for course interactions. A CMS is particularly inclusive of a variety of online tools and environments. These tools are referred as modules and they are crucial for distance learning. Some more, it is also acting as a massive support for traditional classroom courses. Most of CMS installations are on an institutional level which are in schools, colleges, and universities. Even though CMS requires quite some amount of money and time, it provides such effective tools for students.


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From The Editor | May 12, 2020
The Pharmacist's Role In Biosimilar Uptake: The Art Of Formulary Management
By Anna Rose Welch, Chief Editor, Biosimilar Development
Over the past few months, I've been doing a deeper dive into the U.S. healthcare settings in which biosimilars are beginning to star. While we hear regularly of the access blockades, rebate walls, patent thickets (and all other types of walls imaginable), biosimilars are actually gaining footholds in a variety of care settings. In addition to Kaiser Permanente, the unicorn of all U.S. biosimilar uptake, I've also spoken to doctors and nurses from rheumatology practices and independent oncology centers around the U.S. that have built frameworks for biosimilar usage.
Throughout a majority of these discussions, there was one integral process that had to be completed to successfully introduce biosimilars into that patient population: they had to be added to the health system's formulary. Obviously, this cannot be done without pharmacists and the work they do to support the P&T committee. Over the years, I've penned several articles discussing the pharmacist's critical role in building physician trust in biosimilars. Of all the stakeholders within the hospital setting, the pharmacist has the most holistic view of a product's clinical and financial profiles, as well as other logistical considerations — for example, storage, shelf life, refrigeration, and administration. As we continue to see multiple biosimilar competitors launched within each health system, formulary management will be one of the determining factors as to which of these biosimilars will gain the greatest uptake.
Unless we're pharmacists ourselves, we rarely get a look into the formulary-building process and what this can mean for the usage of biosimilars overall. At the U.S. World Biosimilars Congress in March, I had the chance to connect with Dr. Sophia Humphreys, the Director of System Pharmacy Clinical Services for Providence St. Joseph Health (PSJH). This nonprofit hospital system comprises 51 hospitals and over 1,000 clinics across six states in the U.S. Dr. Humphreys and I connected post-conference, so I could pick her brain on the art of formulary building and the role pharmacists can play as biosimilar usage expands deeper into the curative oncology sector.
Biosimilar Integration Practices Informed By Long-Established AHSP Guidelines
Though biosimilars are relatively new to the U.S., the protocol for implementing more cost-effective products into hospitals is hardly novel; in fact, guidelines for pharmacists seeking implementation have been in place since the 90s. As the healthcare system became acutely aware of the rising costs of medicines, the American Health System Pharmacists Foundation (AHSP) established a set of guidelines laying out a multidisciplinary approach for formulary management and drug utilization management.
These guidelines remain an important practice for pharmacists today. "You do a high-cost drug evaluation, you follow the pipelines of drugs forthcoming to the market, and you examine your evidence-based criteria," Dr. Humphreys spelled out. "The evaluation structure is the same. The only difference will be the focus of each IDN." For example, instead of focusing on biosimilar uptake, an IDN may prioritize treating HIV or myocardial infarction over the course of that year, and, in turn, the class or subclasses of medications used to treat these conditions.
Prior to becoming the Clinical Director, Dr. Humphreys was the Drug Information Manager at PSJH. In that position, she designed an evidence-based annual formulary review process, which standardized the annual review of all formulary medications. All medications are classified into the 15 Medispan therapeutic classes, so that they can be reviewed systematically each year. Dr Humphreys and her team also identifies the subclasses of drugs which require a more in-depth review to further improve patient care, standardize clinical practice, and evaluate potential cost saving strategies.
One of the most important processes in the annual review is evaluating the 80/20 factor. In most formularies, high cost medications may make up 20 percent of the health system's utilization, but usually account for 80 percent of the overall drug spend. In looking through PSJH's formulary, Dr. Humphreys determined that more than 70 percent of the total drug costs were spent on biologic medications in the last two calendar years, which make up less than 20 percent of the system's utilization. Naturally, she turned to the concept of using biosimilars to save money and provide the same level of care. Her insight, combined with the well-established AHSP-outlined practices, ultimately informed the inclusion of biosimilars onto the PSJH health system formulary. In 2019, PSJH maintained its high level of clinical care and favorable patient outcomes while also seeing $10 million in savings.
PSJH-Centric Strategy: Expediting Biosimilar Formulary Review
There has been one interesting difference between the emergence of lower cost biosimilars, as compared to lower-cost generics: it's the fact that interchangeability is not a given for biosimilars. As we all know, back in 1984 when the Hatch-Waxman Act became law, interchangeability of generics — or substitution at the pharmacy level — was permitted without any additional clinical data or a secondary regulatory approval. Biosimilars, on the other hand, are not currently eligible for pharmacist substitution, Dr. Humphreys explained.
The current lack of interchangeability has an impact on the P&T committee review process. Pharmacists have had to usher biosimilars into the IDN P&T review as new products, instead of equivalent alternatives to the original reference product. This meant that Dr. Humphreys and her team had to write a monograph for each new biosimilar that came to the market, regardless of whether they'd reviewed several other previously approved biosimilars for the same original reference product. Though creating a monograph is a standardized procedure for all pharmacists, it is still a time-consuming process and led to delays in implementing biosimilars.
Seeing that original reference products today have anywhere from two to five biosimilars available, Dr. Humphreys recognized the need to implement a more streamlined, expedited approval process for biosimilars at PSJH. "We call them mini-subclass reviews, during which we bring all of the biosimilars for one original reference product into one subclass review before the P&T committee," she explained. "For example, if you are a reviewing a biosimilar for Avastin, you include all the other approved Avastin biosimilars into that discussion." Not only did this improve efficiency, but this also utilized the breadth of evidence available for each biosimilar and built up the confidence of the various stakeholders involved.
In light of the success of the mini-subclass reviews for biosimilars, PSJH began placing all new FDA approved biosimilars on a consent agenda at the end of 2019. This allowed these biosimilars to be approved for the formulary more rapidly.
Dr. Humphreys stated that the formulary approval process for a biosimilar needs to begin as soon as the FDA has approved the product, rather than waiting for an official product launch. Putting the biosimilar on the formulary permits the contracting team to begin working with the individual manufacturer on pricing and supply for the PSJH system before the product hits the market.
She noted that having multiple biosimilar products on the IDN's formulary is helpful for several reasons. One reason is that it provides negotiating power to help the contracting team to secure discounts, rebates, and the appropriate supply.
Additionally, having multiple biosimilar products on the formulary helps the IDN deal with the complex payer network in each location. For example, in Washington State, where Dr. Humphreys is based, the primary payer changes depending on the region, and sometimes by city and even county.
Dr. Humphreys cautioned that the best strategy for smaller healthcare providers may be different from a large IDN. "If I have an infusion clinic with only 10 chairs, it is not realistic for me to stock all biologic medications on the market in my pharmacy. A small infusion clinic should consider purchasing only the medications, which they plan to administer within a few weeks." Dr. Humphreys noted the importance of obtaining prior authorization from the payer: "It is exceedingly important to obtain prior authorizations before the purchase and administration of the medication. In addition, the patient assistance program should always be explored, in order to maximize access of care."
For a larger healthcare setting — for example, a hospital with 600 beds that will be treating multiple oncology patients over the following weeks — Dr. Humphreys added that stocking considerations will be a bit different. "It is prudent to have sufficient supplies of commonly used medications on hand in order to streamline care, provided that payer preferences is considered and prior authorization process standardized," she said.
An important tool in the utilization of biosimilars is the EMR. Thanks to the Affordable Care Act, most health systems today have some type of system in place to quickly and efficiently provide physicians with essential information about medications appropriate for a specific condition and a patient's particular situation. "These systems can be excellent time savers for busy physicians," said Dr. Humphreys, especially in large IDNs. "If you have a 50 provider practice, you could go to your oncology group and alert them to the existence of the biosimilar. A large IDN that covers multiple geographic regions with over 25,000 providers and a complex payer mix, on the other hand, is more likely to benefit from biosimilar savings if the products are built into the EHR, for example, the EPIC system." (For a deeper-dive into how PSJH structured its inpatient and outpatient formularies in the EHR system, be sure to check out Dr. Humphrey's article in The Center for Biosimilars.)
Education Must Move Beyond The Current Biosimilar Regulatory Pathway
Education regarding the efficacy, safety and immunogenicity is a vital part of encouraging acceptance of the biosimilars. The FDA has multiple resources for healthcare professionals which highlight the regulatory process and the science behind the biosimilars. Nevertheless, questions regarding the effectiveness of biosimilars remain. Dr. Humphreys believes in providing extensive education and information about the nature of large molecule biologic medications, and how biosimilars are highly similar to their reference compounds, with no meaningful clinical differences.
In particular, she pointed to the education concerning which types of data demonstrate biosimilarity. Not only have technological advancements enabled us to see the original reference molecule and biosimilar molecule much more clearly, but the assay development, toxicology, and PK/PD studies add to the clinical certainty. Physicians trust clinical data above all else; and this remains the case today with biosimilars. Physicians have embraced biosimilars, thanks in large part to the fact that they understand these biosimilars have undergone a stringent approval process by the FDA to ensure quality, safety and efficacy.
In today's industry however, conversations about shifting the emphasis from clinical trials to analytical characterization are increasingly commonplace. In fact, in recent weeks, we celebrated the release of a new publication in BioDrugs entitled, "The Path Towards A Tailored Biosimilar Development." This will no doubt be only one of forthcoming efforts to dig deeper into the data behind biosimilars' approvals and determine which data are the most necessary for manufacturers to provide to regulators.
In addition to reworking the regulatory framework (to some extent), another part of preparing for tailored development — whatever that may look like — will require our understanding on the specific purpose of the large comparative efficacy studies. "According to the FDA 'The goal of a biosimilar development program is to demonstrate biosimilarity between the proposed biosimilar product and the reference product, not to independently establish the safety and effectiveness of the proposed product,'" Dr. Humphreys pointed out. "As such, we need more information and education on why the FDA may not require the expensive randomized controlled trials in a large population for these already highly similar molecules."
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Audemars Piguet Royal Oak Offshore Bucherer Edition
Reference 26471SR.00.D101CR.01
Case Stainless steel, pink gold, 42mm
Crown Screw down
Bezel Rose gold with white gold screws
Dial Blue Mega Tapisserie pattern, slate grey counters, Arabic numerals, pink gold Royal Oak hands with luminescent coating and blue inner bezel
Movement Perpetual, mechanical, self-winding Calibre 3126/3840
Functions Chronograph, hours, minutes, small seconds and date
Bracelet Hand stitched black 'Hornback' crocodile strap with pink gold stitching and stainless steel AP folding clasp. Additional blue rubber strap.
If the Audemars Piguet Royal Oak of 1972 was perceived as a risk, the commissioning of Emmanuel Guiet to create a modern take on that classic for its 20th anniversary was, at the time, perhaps even more so. Why try to change something that had been such a runaway success? In fact, when the Offshore's design was finalised and presented at Baselworld, the designer of the original Royal Oak, Gerald Genta, was not backwards in giving his opinion, famously exclaiming "you killed my baby!".
One can forgive him for such an outburst, particularly given the other haute horology legend he also created (amongst others), the Nautilus. However, that is not to say he was right. Audemars Piguet's slogan is "Before you can break the rules, you must first master them" and this arguably applied precisely to their development of the Royal Oak Offshore 21 years after the Royal Oak; the latter was a watershed moment in the history of luxury steel sports watches. Audemars Piguet were the founding masters of that particular genre.
The Offshore was supposed to build on that success, to compliment it, and open the house to a new generation of owners. Starting at 42mm in diameter, the Offshore was large, even by today's standards; imagine its wrist presence in the early nineties! Fashioned from stainless steel and on a bracelet, it was a 'beast' of a watch and that's precisely the nickname it earned.
25 years later we have grown into the Offshore, and to love it. It still feels fresh, with the Offshore 'Bucherer' edition being no exception. Albeit what is exceptional about it is it's the only two tone (stainless steel and pink gold) version of the Offshore in the range. A 300 limited production special edition in conjunction with the retailer Bucherer, it's sold solely at their boutiques and, at the time of writing, had completely sold out.
At this juncture, I should state I am not normally a fan of two-tone watches. For some, the presence of precious metal in an otherwise all steel piece improves the versatility; it can be more things to more men, more of the time. In my view however, in most circumstances this seems to defeat the purpose of the watch. A steel sports watch is supposed to be rugged and able to weather the heaviest usage; a dress watch to be sleek, elegant, made from precious metal and, although more vulnerable to scratches, it matters less because it is used in less harsh environments and, perhaps, less often. A classic example of what I mean is the two-tone Rolex Submariner: whilst I acknowledge it as a beautiful watch, it feels like it's caught between two stools and never really satisfies either purpose.
The Offshore Bucherer edition however is the first time I have been swayed. I suspect the fact it is on a strap and not a bracelet helps; it gives it a less chunky, less sporty, dressier look. Then it's the way the pink gold bezel takes centre stage, along with matching strap connectors and applied hour markers and hands. Coupling all those factors with the finishing of the stainless steel and, to my eyes, it has the presence of an all precious metal watch without actually being so.
Then it's the way the colours all play together. Pink gold, steel, black, blue, white, grey; it all sounds too much but it really works. To add to these, the crown and pushers are ceramic, lending a ruggedness to the touch points on the crown. Together this means it's a tour de force of materials and every single one of them compliments the other.
As alluded to, the presence of a strap brings down not only the actual weight of the watch but also the visual weight and it's very comfortable to wear, even for long periods. This can not always be said of other versions on bracelets, particularly in precious metal. To add to this, it was a nice touch that AP left their fantastic deployment clasp in situ. Whilst I would have preferred it in pink gold, it works very well in stainless steel and adds to the haute horology feel. That's one criticism I have of other Offshores in the range – it might be perceived as sportier but a watch that expensive really should not be using a pin buckle.
The Offshore is, of course, not for everyone. Many will find it, at 42mm diameter, it too big. Some will agree with Genta's comments and suggest his baby has been bastardised. Others will point to the fact that the chronograph movement is not fully integrated, it sitting on top of the movement, causing the depth of the date aperture, requiring a magnifying lens for it to be legible.
To my eyes however, Guiet's design is a powerful statement in support of Genta's original masterpiece and ably fulfilled Audemars Piguet's strategy. The fact it has been such a success tends to support such a conclusion and, if the incredible 25th anniversary edition is anything to go by, the next generation of Offshores is going to be very exciting indeed.
The Audemars Piguet Royal Oak Offshore Bucherer edition has an RRP of £27,100 but is now sold out. Prices on the secondary market range from £24,000 – £32,000.
If the Audemars Piguet Royal Oak of 1972 was perceived as a risk, the commissioning of Emmanuel Guiet to create a modern take on that classic for its 20th anniversary was, at the time, perhaps even more so. Why try to change something that had been such a runaway success? In fact, when the Offshore's design was finalised and presented at Baselworld, the designer of the original Royal Oak, Gerald Genta, was not backwards in giving his opinion, famously exclaiming "you killed my baby!". One can forgive him for such an outburst, particularly given the other haute horology legend he…
Audemars Piguet Reviews Watches
Rolex Cellini Moonphase 50535


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Qualified homebuyers can credit 20% of their annual mortgage interest paid against their year-end tax liability. A tax credit is a dollar for dollar reduction in tax liability.
Available to first-time homebuyers statewide and repeat homebuyers in targeted areas.
Household income limits can vary depending on family size and property location.
Q-1: How will a Mortgage Credit Certificate help me purchase a home?
Mortgage Credit Certificates (MCC) reduce the amount of federal income tax a homebuyer pays. The estimated annual cost savings is calculated on a monthly basis to help homebuyers qualify for a higher mortgage payment, and therefore a higher priced home—expanding home choices. MCCs are available to homebuyers who meet household income and home purchase price limits.
Q-2: Where can I get a Mortgage Credit Certificate?
A homebuyer applies for the MCC at the same time they make a formal application for a mortgage. Many banks, credit unions and mortgage companies participate in the MCC program. A list is available on the MSHDA Web site at michigan.gov/mshda. Contact a participating lender to apply for the credit certificate.
Q-3: What types of mortgages can a MCC be combined with?
MCCs can be combined with conventional, FHA, Rural Development and VA mortgage loans. MCCs are not available with MSHDA mortgages or with refinanced loans.
Q-4: How do we calculate the Credit?
The specific amount of the mortgage interest credit depends on how much interest you pay on the mortgage loan; however, the amount of the credit cannot be more than your annual federal income tax liability after all other credits and deductions have been taken into account. The unused portion of the mortgage interest credit can be carried forward to the next three years, or until used, whichever comes first. Please refer to IRS Form 8396 to calculate and claim your credit.
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With a Mortgage Credit Certificate (MCC), for example, 20% of the mortgage interest is a tax credit—a dollar-for-dollar reduction of income tax liability for the life of the loan. The remaining 80% mortgage interest continues to qualify as an itemized tax deduction for the homebuyer.
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You can continue qualifying for the MCC Income Tax Reduction if you refinance your home. But you must apply for a Reissued Mortgage Certificate each time you refinance and use a MCC Participating Lender to refinance your loan.
Q-8. What requirements are there?
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The home must be a single-family residence and used as a principal residence. A principle residence can include single family homes, condominiums and certain manufactured homes.
Because a tax credit is considered to be a subsidy, homebuyers may be subject to a federal 'recapture tax'. This tax may apply, if the home is sold within nine years with a gain on the sale. MSHDA recognizes that this may be a concern for individuals, so the Recapture Tax Reimbursement Program was created to reimburse borrowers for any recapture tax paid to the IRS.
Q-9: Where can I obtain more information?
For more information on income limits, sales price limits and targeted areas visit our Web site at michigan.gov/mshda, and click on the homeownership tab.


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