Introduction: Opioids have been used for millennia for the treatment of pain. However, the long-term efficacy of opioids to treat chronic non-cancer pain continues to be debated. To evaluate opioids' efficacy in chronic non-cancer pain, we performed a meta-analysis of published clinical trials for μ-opioid receptor agonists performed for US Food and Drug Administration approval.
Methods: MEDLINE and Cochrane trial register were searched for enriched enrollment randomized withdrawal studies (before June 2016). Selection criteria included: adults, ≥10 subjects per arm, any chronic pain condition, double-blind treatment period lasting ≥12 weeks, and all μ-agonist opioids approved in the USA.
Results: Fifteen studies met criteria. Opioid efficacy was statistically significant (p<0.001) versus placebo for pain intensity (standardized mean difference: −0.416), ≥30% and ≥50% improvement in pain (risk difference: 0.166 and 0.137), patient global impression of change (0.163), and patient global assessment of study medication (0.194). There were minor benefits on physical function and no effect on mental function.
Conclusion: Opioids are efficacious in the treatment of chronic non-cancer pain for up to 3 months in randomized controlled trials. This should be considered, alongside data on opioid safety, in the use of opioids for the treatment of chronic pain.
Opioids have been used for millennia for the treatment of pain and remain an important therapeutic option. While the American Academy of Pain Medicine, the American Pain Society, the US Federation of State Medical Boards, and the Centers for Disease Control and Prevention endorse the use of opioids, when appropriate, for the treatment of chronic pain, efficacy of long-term opioid use remains controversial.1–6 In addition, there are significant risks associated with opioids and these agents have contributed to the epidemic of opioid abuse, addiction, and overdose deaths in the USA.7–10 Given these serious risks, the assessment of evidence for the long-term analgesic efficacy of opioids for treating chronic pain is crucial.
The US Food and Drug Administration (FDA) requires randomized, double-blind, placebo-controlled studies of at least 3 months' duration in order to approve an opioid for the treatment of chronic pain. This reflects the need to balance accrual of sufficient data representative of long-term treatment against the scientific and ethical challenges of longer-term randomized, placebo-controlled trials, including dropouts, missing data, concomitant treatments, and long-term use of placebo. The 3-month duration is the standard clinical trial duration accepted by the FDA for many chronic conditions including hypertension, asthma, depression, schizophrenia, bipolar disorder, and anxiety.
In order to inform the ongoing controversy over whether there is evidence that opioids are efficacious for the treatment of chronic pain, we have gathered the randomized controlled trials required by the FDA for approval, and have performed a meta-analysis of their results. These trials are by regulatory expectation 3 months in duration. This review does not address the risks of opioids. A coherent position on the risk–benefit balance of opioids for the treatment of chronic pain requires an accurate and data-driven assessment of both their risks and their benefits. Thus, the purpose of this review is not to minimize, or characterize, the risks of opioids, but rather to ensure that the debate over the risks and benefits of opioids is informed by an accurate assessment of their benefits.
MEDLINE and Cochrane Central Register of Controlled Trials 2012 were searched for all relevant studies published before June 2016. The search strategy for MEDLINE is presented (see Methods in Supplementary materials) and was customized for the Cochrane Central Register of Controlled Trials 2012 (in which only the Intervention and Population sections were used). Additional studies were identified through the examination of references from identified trials, systematic reviews, and authors' own databases.
We searched for enriched enrollment randomized withdrawal (EERW) studies published in English with double-blinded outcome assessments that compared any opioid (including combinations and dual mechanism analgesics administered via the oral, transdermal, nasal, sublingual, or transmucosal routes) to placebo for ≥12 weeks during the randomized double-blind treatment phase of the study in patients with any chronic non-malignant pain condition.
Trials with participants ≥18 years of age with any type of chronic nonmalignant pain, including but not limited to chronic low back pain (CLBP), chronic neuropathic pain, diabetic peripheral neuropathic pain (DPNP), osteoarthritis (OA), arthritis, rheumatoid arthritis, phantom limb pain, fibromyalgia, post-herpetic neuralgia, or musculoskeletal pain. Studies of acute or post-surgical pain and cancer pain were excluded. Studies of specific μ-agonist opioids, μ-agonist opioids with additional pharmacological activity (eg, tramadol and tapentadol), or combination opioids (eg, hydrocodone/acetaminophen) approved for the treatment of pain were included. Agents with oral, transdermal, nasal, sublingual, or transmucosal routes of administration were included. Studies were included if they had a minimum of 10 patients per arm and reported pain intensity (PI) as an outcome. The present study protocol has been published on PROSPERO (http://www.crd.york.ac.uk/PROSPERO/; registration No: CRD42015026378).
Two authors independently screened titles and abstracts using the Abstrackr software to identify manuscripts that met the abovementioned inclusion criteria.11 Full-text articles were obtained for manuscripts that appeared to meet the inclusion criteria or were likely to meet the inclusion criteria. The full text of these manuscripts was read to determine final inclusion in the meta-analysis. Any disagreement on manuscript inclusion was resolved through discussion among the authors.
Two authors independently extracted data from each manuscript using the Systematic Review Data Repository (SRDR) form (http://srdr.ahrq.gov/; retrieved: June 1 2016). A third author subsequently confirmed that primary and secondary endpoints matched the SRDR form. The SRDR is an open collaborative web-based repository for systematic data review. The SRDR form was developed to include participant characteristics, interventions, treatment arms, adverse events (AEs), primary and secondary outcomes, country(s) of study, number of study sites, trial design, blinding, clinical setting, method of recruitment, group similarities at baseline, and assessment bias. If data were not available or incomplete, manuscript authors were contacted to provide the missing data.
The following outcome measures were extracted from the selected publications: change in PI score from randomization baseline to week 12 or study endpoint, categorical evaluation of responders/non-responders (≥30% and ≥50% improvement as calculated based on changes between week 12 and pain at the beginning of the open-label titration phase), patient assessments of global improvement (eg, patient global impression of pain [PGIC] and patient global assessment of study medication [PGASM]), assessment of patient change in function (eg, Roland–Morris Disability Questionnaire [RMDQ] and Western Ontario and McMaster Universities Arthritis Index [WOMAC]), rescue medication dose consumption, and health-related quality of life (eg, 36-Item Short-Form Survey [SF-36]).
Safety outcomes collected included: the proportion of patients with ≥1 AE, ≥1 serious AE (SAE), discontinuing treatment due to AEs and/or withdrawal symptoms post-randomization; AEs during the open-label titration phase were not collected.
The primary outcome was standardized effect size, defined as the treatment difference (mean difference in PI score between active and placebo) divided by the SD. We pooled data from all manuscripts regardless of whether the endpoint was presented as mean change from randomization baseline to week 12 or as the least squares mean difference (LSMD) at week 12; if both results were available, the mean change from randomization baseline to week 12 was used. The mean change from baseline was calculated from the reported mean baseline and week 12 data; the SD of the change was calculated by assuming a correlation of 0.50 between baseline and week 12 responses. The standard mean difference (SMD) was calculated with 95% CIs. The change in PI from randomization baseline to week 12 was reported as the LSMD and standard error (SE); in case SD or SE were not available, they were calculated based on the following formula: SE = SD/square root (N). When SD values were not available, the manuscript authors were contacted. We were able to obtain all unpublished SD values. The number of subjects randomized was used in all analyses except in situations where a different N value was more appropriate to use (eg, some manuscripts did not present data for 100% of patients in PGIC tables; in this situation, we calculated the total number of patients randomized based on the percentage of reporting patients).
Figure 1 Study flow diagram.
A summary of the characteristics of EERW trials included in the meta-analysis is presented in Table 1 and Table S1. Fourteen of the 15 studies were considered high-quality studies (having low bias; Table S2). Hydrocodone was evaluated in 4 trials; oxymorphone, oxycodone, buprenorphine and tapentadol in 2 trials each; and hydromorphone, morphine/naltrexone, and tramadol in 1 trial each. CLBP was evaluated in 10 studies, DPNP in 2 studies, OA in 2 studies, and 1 study evaluated a combination of CLBP and OA patients.
Notes: aNumber of sites initiated. bConcomitant analgesics were not allowed during the dosed titration. The paper does not state anything about concomitant analgesics for the period following this.
Abbreviations: CLBP, chronic low back pain; DPNP, diabetic peripheral neuropathic pain; ER, extended release; OA, osteoarthritis; OLP, open label phase; RBTP, randomized blinded treatment phase.
All included studies were randomized, double-blind, placebo-controlled EERW studies as defined by the literature search inclusion criteria. All included studies used a parallel group design during the randomized double-blind treatment phase. In 13 of the 15 trials, patients were initially titrated to an individualized effective dose and then either allowed to continue their individualized dose or randomized to the placebo group during the randomized double-blind treatment phase. In 1 trial,14 all patients were titrated to the highest dose of the study drug and subsequently randomized to a high-dose group, a low-dose group, or the placebo group. In another trial,15 all patients were allowed to adjust the titrated dose after randomization for the first 4 weeks and then the dose was fixed for the next 8 weeks.
The open-label titration phase lasted between 2 and 8 weeks and the randomized double-blind treatment phase lasted 12 weeks for all studies (Table 1). Most studies made efforts to prevent or reduce discontinuation of patients randomized to the placebo group in the randomized double-blind treatment phase by allowing the use of rescue medication (12/15) and/or tapering the opioid in placebo patients (10/15; Table 1). All studies analyzed the intent-to-treat population for primary and secondary outcomes.
With regard to primary endpoint measurements, the change from randomization baseline to week 12 was reported by 4 studies as the LSMD,14,16–18 and by all other studies as the mean change (Table S1).15,19–28 The effect of opioids was statistically significant (p<0.001) versus placebo for the change in PI score from randomization baseline to week 12 (SMD=−0.416; 95% CI: −0.521 to −0.312; Figure 2) as assessed by binary random-effects model meta-analysis using the restricted maximum likelihood method. Only 1 study15 did not report a statistically significant difference versus placebo for the mean change in PI from randomization baseline to week 12 (Figure 2); however, the change in area under the curve between study drug and placebo, which was the study's primary endpoint, was statistically significant.
Figure 2 Change in PI from randomization baseline to week 12 with active study opioid drug versus placebo.
Notes: The standardized mean difference effect size was −0.416 and p<0.001, with a lower bound estimate of −0.521 and an upper bound −0.312.
Responder rates were reported in 12 manuscripts (Tables S3 and S4).16–19,22–28 However, 2 were excluded since they reported respondent analysis as increment in pain from baseline of the blinded period rather than reduction in pain from the baseline at the beginning of the open-label titration phase.26,27 A binary random-effects meta-analysis using the restricted maximum likelihood method demonstrated a statistically significant difference between study drug and placebo for both ≥30% (RD estimate [SE]: 0.166 [0.028], p<0.001) and ≥50% (0.137 [0.022], p<0.001) decrease from baseline in PI (Table 2; Figure 3). PGIC was reported in 5 manuscripts16–18,23,25 (Tables S3 and S4) and meta-analysis combining patients "very much improved" and "much improved" showed a statistically significant difference between study drug and placebo in PGIC (RD estimate [SE]: 0.163 [0.029], p<0.001; Table 2). PGASM was assessed in 5 manuscripts,14,15,19,21,24 (Tables S3 and S4) and meta-analysis combining "excellent" and "very good" response showed a statistically significant difference between study drug and placebo (RD estimate [SE]: 0.194 [0.056], p<0.001; Table 2). Functional outcomes were reported in 5 manuscripts (Tables S3 and S4);18,22,25,27,28 however, a variety of assessment types were reported. Three manuscripts18,27,28 reported RMDQ (mean [SD] change from baseline to week 12; study drug vs placebo: 0.4 [4.83] vs 0.7 [5.32], −1.29 [4.98] vs −1.57 [4.82], and 0.6 [5.37] vs 1.2 [5.72]), 1 manuscript22 reported WOMAC (study drug vs placebo: 1.6 [18.0] vs 5.8 [16.8]), and 1 manuscript25 reported functional outcomes on the Brief Pain Inventory (BPI) scale (study drug vs placebo: −3.0 [2.07] vs −2.6 [2.38]) (Table S3). Due to a low number of manuscripts reporting functional outcome data and the different outcome measure used, no meta-analysis was performed. Of these 5 manuscripts reporting functional data, 2 showed a greater improvement in function in the study drug group compared to placebo.22,25 Quality of life data were reported in only 3 manuscripts16,18,25 (Tables S3 and S4); therefore, no meta-analysis was performed. Physical component summary values were greater for study drug than for placebo in all 3 manuscripts (10.11 vs 6.12, 0.1 vs −2.3, and 7.52 vs 3.62), while mental component summary values were greater for study drug versus placebo for 2 manuscripts16,25 (7.19 vs 3.34 and 0.20 vs −0.8; Table S3). No meta-analysis of rescue medication dose consumption was conducted due to insufficient data. The overall weighted mean (SD) of the percentage of patients who were randomized from the open-label titration phase was 63.2% (7.4). Data are presented for each manuscript in Table 1.
Note: aValues are the risk difference (RD) estimates (SE).
Abbreviations: AE, adverse event; PGASM, patient global assessment of study medication; PGIC, patient global impression of pain; SE, standard error.
Figure 3 Percentage of patients with ≥30% or ≥50% improvement with active study drug versus placebo.
Notes: The graph shows the mean (SD) percent of patients with improvement, from each study that reported these data. A binary random-effects meta-analysis using the restricted maximum likelihood method was performed showing a statistically significant difference between active study drug and placebo for both ≥30% and ≥50%.
Reported AEs and SAEs post-randomization were similar between study drug and placebo in all studies (Table 3). The overall weighted mean discontinuation rate was numerically higher for placebo (42.1%) than study drug (31.0%), and was likely related to discontinuation due to lack of efficacy in the placebo group. There was a small but statistically significant difference in the percentage of patients who discontinued due to an AE in the study drug group versus the placebo group (RD estimate [SE]: 0.021 [0.008], p=0.011). The proportion of patients who discontinued due to SAEs was not included in this analysis because no manuscript reported it. The average rate of discontinuation due to opioid withdrawal was similar between study drug and placebo (Table 3).
Notes: aOnly data for the 300 mg doses of tramadol were used in this meta-analysis.
Abbreviations: AE, adverse event; ND, no data; SAE, serious AE.
The recent claims that opioids lack efficacy for chronic pain have created controversy among physicians, prescribers, regulators, scientists, and the general public regarding whether the benefits of opioid use outweigh the public health risks of abuse and other complications.27–30 Chou et al state "evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving pain" based on the opinion that studies of ≤1 year duration do not provide evidence of "long-term" efficacy.4 Clearly if there is no benefit then no amount of risk should be tolerated. This review was, therefore, performed in order to gather together the key evidence to facilitate understanding opioid efficacy within the paradigm of FDA studies required for approval, and to perform a meta-analysis in order to quantify opioid efficacy for chronic pain and assess consistency of effects across studies conducted for ≥3 months' duration. This meta-analysis was limited to EERW-designed studies, since this design is by far the most commonly utilized for regulatory approval and therefore supports combinability.
Several systematic reviews and meta-analyses regarding the efficacy of opioids in chronic pain have been published; however, these studies were published nearly a decade ago4,31–33 and the more recent ones are not meta-analyses.4,34,35 Additionally, many studies included in previous reviews are not relevant to our study because they report alternate routes of administration (eg, intravenous),4 have short study durations,31,36 are open-label32,34 or observational studies,35 have restricted pain types,33,36 or compare different study designs.31,33,36 Although most of these meta-analyses concluded that opioids were efficacious for the treatment of chronic non-cancer pain,31–34,36 a review specifically focused on studies designed for FDA approval (ie, of ≥3 months' duration) for chronic pain has not been done.
The EERW design provides an opportunity to evaluate both "effectiveness" (outcomes in the open-label titration phase) and "efficacy" (outcomes in the randomized, double-blind, placebo-controlled phase). The present meta-analysis demonstrated the "effectiveness" of opioids since a majority of patients (63%) demonstrated a clinically meaningful response. The pharmacological efficacy of opioids for the treatment of chronic pain was evidenced by statistically significant differences between study drug and placebo in change in pain score from randomization to week 12 and in response rates.
With regard to secondary endpoints, opioids were found to marginally improve physical function in the present meta-analysis. Therefore, the use of opioids alone to improve physical function is not supported by this review; whether opioids improve the effectiveness of rehabilitative treatments for chronic pain requires further study. Opioids did not have an appreciable positive or negative effect on mood. The PGASM measure allows subjects to aggregate multiple aspects of their experience, including pain relief, improvement in physical and emotional function, side effects, and convenience, into a single measure.37 In the present meta-analysis, these measures were congruent with the primary finding that opioids are efficacious for the treatment of chronic non-cancer pain. However, it is worth noting that the forest plot (Figure 2) showed that the efficacy estimates appear heterogeneous across studies. While the reasons for this are not certain, possible reasons include differences in study design methodology, inclusion and exclusion criteria, statistical analyses, concomitant and rescue medications, dosing, and numerous other factors.
It is worth noting that AE rates in the double-blind periods were similar between study drug and placebo, with dropouts due to AEs being higher in the drug group while dropouts due to loss of efficacy were higher in the placebo group. However, because patients with significant tolerability issues during the open-label titration phase are deliberately excluded from the randomized double-blind treatment phase, AE rates in the randomized double-blind treatment phase of EERW studies do not represent rates that would occur in prospective parallel clinical trials;38 however, AE rates may be more reflective of ongoing AE rates in clinical practice, where, like in the EERW designs, patients with poor tolerability or efficacy are taken off treatment with opioids relatively early after a trial of therapy.
In a recent meta-analysis evaluating the efficacy of opioids for CLBP, the authors concluded that opioids provided "moderate short-term relief" but the effect is not clinically important.39 In that meta-analysis, Shaheed et al define "clinically important" arbitrarily as a group mean difference in pain or disability >20 points on a 0–100 scale,39 while clinical importance is more usefully viewed as a multidimensional concept that encompasses multiple factors including efficacy, safety, and availability of other treatments.40 It is worth noting that the efficacy of opioids is at least as large as that of any other treatment for chronic pain.38 Thus, requiring a group mean difference of 20 points on a 0–100 pain scale would lead to a nihilistic conclusion that no pharmacological treatments for chronic pain are useful.While the effectiveness of existing treatments for chronic pain leaves plenty of room for improvement, and considering that only a small minority of patients do not experience clinically meaningful treatment responses, discarding entirely all analgesics approved for chronic pain contradicts numerous treatment guidelines, international treatment guidelines, widespread patient experience, and the FDA approval process.
The 3-month trial duration is not entirely arbitrary: beyond several months, the internal validity of clinical trials tends to degrade due to dropouts, addition of concomitant treatments (permitted or not), noncompliance with treatment, and other factors. While it is desirable in theory to conduct prospective studies of longer duration, so that important complications that take time can emerge, and the durability of efficacy can be directly observed, the feasibility of and the technical requirements for such studies have not yet been addressed. Finally, the inclusion of EERW studies in our meta-analysis allows a richer interpretation of "long-term" efficacy: the EERW design is utilized to assess the efficacy of treatment that has been administered for potentially lengthy periods of time prior to randomization. This design, also called the randomized discontinuation design, has been used in multiple therapeutic areas where it is important to determine whether patients responding to long-term open-label treatment are, in fact, responding to the pharmacological effects of the drug, or just the non-specific effects of treatment (such as the placebo response). Such studies have been performed for decades in oncology,43 depression,44 rheumatoid arthritis,45 cardiology,46 schizophrenia,47 and numerous other indications.48 Therefore, the superiority after randomization of active treatment over placebo among patients who have already demonstrated a longstanding response to open-label medication can be interpreted as long-term efficacy that is not due to a placebo effect or other non-specific factors.
This meta-analysis has several limitations. First, it only included EERW studies, therefore only included results from patients who responded to opioids during the open-label titration phase. The pros and cons of the EERW design are beyond the scope of this review, and have been amply reviewed elsewhere.41,64,65 To summarize, the advantages of the EERW study design are that it is accepted by the FDA for registration of drug treatments,41 can minimize the amount of time subjects receive ineffective or poorly tolerated treatment, may offer improved assay sensitivity, and yields open-label data that may be more relevant to clinical practice than only double-blind data. Another advantage of the EERW design is that the open-label titration phase of typical EERW studies mimics clinical practice with individual titration to optimized doses, an important design feature for medications with high inter-patient variability in optimal dose and a relatively narrow therapeutic index.41 Perceived disadvantages to the EERW design include questions about generalizability of both efficacy and AE data, challenges in comparing outcomes to standard prospective parallel treatment designs, and more complex interpretation.41,64,66 An additional limitation of note is that most of the studies included in the meta-analysis focus on CLBP, which has been a frequently used model of chronic pain because of the prevalence of the condition, and hence, the practicality of conducting clinical trials.
Many of the manuscripts screened in the present analysis failed to report critical information. This necessitated requesting data from manuscript authors, a cumbersome and time-consuming process. We recommend that journals continue to refine and require minimum quality standards for proper interpretation and ease of use in meta-analyses.65 Initiatives like CONSORT (http://www.consort-statement.org/) and the EQUATOR network (http://www.equator-network.org/) have been put in place to foster adequate reporting of randomized controlled trials.
This meta-analysis of FDA-required double-blind, randomized, placebo-controlled clinical trials of opioid analgesics for the treatment of chronic pain has shown that there is an ample evidence base supporting the efficacy of opioid analgesics for at least 3 months' duration, a standard period for the evaluation of treatments for chronic pain and other chronic disorders. This evidence base is at least as large as that for any other class of analgesics, and analysis of responders demonstrates clinically meaningful improvements. We have not focused on the risks of opioids, nor the risk–benefit balance, and hope that our review at least characterizes the evidence base for efficacy in order to inform these important broader discussions.
The authors would like to thank Gaelen Adam for her assistance with the literature search and Bryant Smith for teaching the authors how to use several software programs that made this meta-analysis possible. The authors would also like to thank Dr. Steven Ripa, Dr. Peter Schmidt, Mary Ma, and Linda Noa for providing missing data from studies used in this meta-analysis, and Joseph Lau for his constructive review of the manuscript. This meta-analysis used methods and software tools developed by The Center for Evidence Synthesis in Health at Brown University. Support for this research was partially provided by Analgesic Solutions and partially by the Opioid Post-Marketing Requirement Consortium (OPC), an industry working group composed of pharmaceutical companies that hold an approved New Drug Application for extended release/long-acting opioids working together at FDA's request to conduct certain post-market required studies. The OPC includes Allergan, Plc, BioDelivery Systems International, Inc., Collegium Pharmaceuticals, Inc., Daiichi Sankyo, Inc., Depomed, Inc., Egalet Corporation, Endo Pharmaceuticals Inc., Janssen Pharmaceuticals Inc., Mallinckrodt, Inc., Pernix Therapeutics Holdings, Inc., Pfizer Inc., Purdue Pharma, L. P., and West-Ward Pharmaceuticals Corp. Current affiliation for Diana S Meske is Collegium Pharmaceutical Inc, Canton, MA, USA.
Nathaniel Katz has acted as a consultant for Allergan, Plc, Collegium Pharmaceuticals, Inc., Depomed, Inc., Egalet Corporation, Endo Pharmaceuticals Inc., Janssen Pharmaceuticals, Inc., Mallinckrodt, Inc., Pfizer Inc., and Purdue Pharma, L. P. Diana S Meske was employed by Analagesic Solutions when the work was completed for this manuscript, however at the time of publication she was employed by Collegium Pharmaceutical Inc. The authors report no other conflicts of interest in this work.
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Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(7):958–968.
Katz NP, Paillard FC, Ekman E. Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res. 2015;10:24.
Katz N, Benoit C. Opioids for neuropathic pain. Curr Pain Headache Rep. 2005;9:153–160.
US Food and Drug and Administration (FDA), Center for Drug Evaluation and Research (CDER). Guidance for industry analgesic indications: developing drug biological products. Rockville, MD: FDA, CDER; 2014. Available from: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM384691.pdf. Accessed April 16, 2018.
Dworkin RH, Turk DC, Peirce-Sandner S, et al. Considerations for improving assay sensitivity in chronic pain clinical trials: IMMPACT recommendations. Pain. 2012;153(6):1148–1158.
Katz N. Enriched enrollment randomized withdrawal trial designs of analgesics: a focus on methodology. Clin J Pain. 2009;25(9):797–807.
Tayeb BO, Barreiro AE, Bradshaw YS, Chui KK, Carr DB. Durations of opioid, nonopioid drug, and behavioral clinical trials for chronic pain: adequate or inadequate? Pain Med. 2016;17(11):2036–2046.
Wakelee HA, Lee JW, Hanna NH, Traynor AM, Carbone DP, Schiller JH. A double-blind randomized discontinuation phase-II study of sorafenib (BAY 43-9006) in previously treated non-small-cell lung cancer patients: eastern cooperative oncology group study E2501. J Thorac Oncol. 2012;7(10):1574–1582.
Vohringer PA, Ostacher MJ, El-Mallakh RS, et al. Antidepressants in type II versus type I bipolar depression: a randomized discontinuation trial. J Clin Psychopharmacol. 2015;35(5):605–608.
Kemper AR, Van Mater HA, Coeytaux RR, Williams JW, Sanders GD. Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis. BMC Pediatr. 2012;15:29.
Ponten J, Biber B, Bjurij T, Henriksson B, Hjalmarson A, Lundberg D. Beta-receptor blockade and spinal anaesthesia withdrawal versus continuation of long-24 term therapy. Acta Anaesth Scand. 1982;76(1):62–69.
McCreadie R, Wiles D, Grant S, et al. The Scottish first episode schizophrenia study. VII. Two-year follow-up. Scottish Schizophrenia Research Group. Acta Psychiatr Scand. 1989;80(6):597–602.
Kopec JA, Abrahamowicz M, Esdaile JM. Randomized discontinuation trials: utility and efficiency. J Clin Epidemiol. 1993;46(9):959–971.
Buynak R, Rappaport SA, Rod K, et al. Long-term safety and efficacy of tapentadol extended release following up to 2 years of treatment in patients with moderate to severe, chronic pain: results from an open-label extension trial. Clin Ther. 2015;37(11):2420–2438.
Hale M, Urdaneta V, Kirby MT, Xiang Q, Rauck R. Long-term safety and analgesic efficacy of buprenorphine buccal film in patients with moderate-to-severe chronic pain requiring around-the-clock opioids. J Pain Res. 2017;10:233–240.
Hale ME, Ma Y, Malamut R. Six-month, open-label study of hydrocodone extended release formulated with abuse-deterrence technology: safety, maintenance of analgesia, and abuse potential. J Opioid Manag. 2016;12(2):139–147.
Taber L, Lynch SY, He E, Ripa SR. Long-term safety and effectiveness of once-daily, single entity, extended-release hydrocodone over 76 weeks of an open-label study in patients with chronic noncancer and nonneuropathic pain. Postgrad Med. 2016;128(1):23–33.
Hale ME, Zimmerman TR, Ma Y, Malamut R. Twelve-month, open-label assessment of long-term safety and abuse potential of hydrocodone extended-release formulated with abuse-deterrence technology in patients with chronic pain. J Opioid Manag. 2015;11(5):425–434.
Wen W, Taber L, Lynch SY, He E, Ripa S. 12-month safety and effectiveness of once-daily hydrocodone tablets formulated with abuse-deterrent properties in patients with moderate to severe chronic pain. J Opioid Manag. 2015;11(4):339–356.
Arora S, Setnik B, Michael D, et al. A multicenter, 12-month, open-label, single-arm safety study of oxycodone-hydrochloride/naltrexone-hydrochloride extended-release capsules (ALO-02) in patients with moderate-to-severe chronic noncancer pain. J Opioid Manag. 2014;10(6):423–436.
Nalamachu S, Rauck RL, Hale ME, Florete OG, Robinson CY, Farr SJ. A long-term, open-label safety study of single-entity hydrocodone bitartrate extended release for the treatment of moderate to severe chronic pain. J Pain Res. 2014;7:669–678.
Friedmann N, Klutzaritz V, Webster L. Long-term safety of Remoxy® (extended-release oxycodone) in patients with moderate to severe chronic osteoarthritis or low back pain. Pain Med. 2011;12(5):755–760.
Wallace M, Thipphawong J. Open-label study on the long-term efficacy, safety, and impact on quality of life of OROS hydromorphone ER in patients with chronic low back pain. Pain Med. 2010;11(10):1477–1488.
Webster LR, Brewer R, Wang C, et al. Long-term safety and efficacy of morphine sulfate and naltrexone hydrochloride extended release capsules, a novel formulation containing morphine and sequestered naltrexone, in patients with chronic, moderate to severe pain. J Pain Symptom Manage. 2010;40(5):734–746.
Wild JE, Grond S, Kuperwasser B, et al. Long-term safety and tolerability of tapentadol extended release for the management of chronic low back pain or osteoarthritis pain. Pain Pract. 2010;10(5):416–427.
Wallace M, Moulin DE, Rauck RL, et al. Long-term safety, tolerability, and efficacy of OROS hydromorphone in patients with chronic pain. J Opioid Manag. 2009;5(2):97–105.
Pascual ML, Fleming RR, Gana TJ, Vorsanger GJ. Open-label study of the safety and effectiveness of long-term therapy with extended-release tramadol in the management of chronic nonmaligant pain. Curr Med Res Opin. 2007;23(10):2531–2542.
McIlwain H, Ahdieh H. Safety, tolerability, and effectiveness of oxymorphone extended release for moderate to severe osteoarthritis pain: a one-year study. Am J Ther. 2005;12(2):106–112.
Moore A, Wiffen PJ, Eccleston C, et al. Systematic review of enriched-enrollment randomized-withdrawal trial designs in chronic pain: a new framework for design and reporting. Pain. 2015;156(8):1382–1395.
US Department of Health and Human Services (DHHS), Food and Drug Administration (FDA), Center for Drug Evaluation and Research (CDER), Center for Biologics Evaluation and Research (CBER), Center for Devices and Radiological Health (CDRH). Guidance for Industry: Enrichment Strategies for Clinical Trials to Support Approval of Human Drugs and Biological Products. Rockville, MD: DHHS, FDA, CDER, CBER, CDRH; 2012. Available from: https://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm332181.pdf. Accessed April 16, 2018.
Furlan A, Chaparro LE, Irvin E, Mailis-Gagnon A. A comparison between enriched and nonenriched enrollment randomized withdrawal trials of opioids for chronic noncancer pain. Pain Res Manag. 2011;16(5):337–351.


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Q: Applying a theme to jqGrid I am trying to apply a theme to jqGrid. I have searched for information but I cannot found a site where it explains step by step. So could someone tell me how to do this?
My project is being developed in asp.net mvc4, jquery and jqGrid.
First attempt:
I have downloaded redmond theme and I have put it under \Content folder in my mvc4 asp.net project. redmond folder contains one folder for images and in the root, three css files like below:
\Content
     \redmond
         \images
         jquery-ui.css
         jquery-ui.min.css
         jquery.ui.theme.css

so in order to use theme in my master page, in head tag I do:
<head>

   ...

        <link href="@Url.Content("~/Content/redmond/jquery-ui.css")" rel="stylesheet" type="text/css"  media="all" />

        <link href="@Url.Content("~/Content/redmond/jquery-ui.min.css")" rel="stylesheet" type="text/css"  media="all" />

        <link href="@Url.Content("~/Content/redmond/jquery.ui.theme.css")" rel="stylesheet" type="text/css"  media="all" />

   ...
</head>

and in the body of the master page as well i do:
(...)

        @Scripts.Render("~/bundles/jquery")

        @Content.Script("jquery-1.10.2.min.js", Url)
        @Content.Script("jquery-ui-1.10.3.min.js", Url)
        @Content.Script("jquery.unobtrusive-ajax.min.js", Url)
        @Content.Script("jquery.dd.js", Url)
        @Content.Script("grid.locale-en.js", Url)
        @Content.Script("jquery.jqGrid.min.js", Url)

        @RenderSection("scripts", required: false)
    </body>

(...)

Note that i refer to @Content, which is an cshtml file in my \app_code folder and its content is:
@using System.Web.Mvc;
@helper Script(string scriptName, UrlHelper url)
{
    <script src="@url.Content(string.Format("~/Scripts/{0}", scriptName))" type="text/javascript"></script>
}

now the theme is applied to my jqGrid but after the theme is applied all my page which contains it and even the master page get as blocked (disabled, grayed) and at the bottom of the page below is shown (a warning window saying: please, select a row):
http://snag.gy/AgUvM.jpg
what's happenning? Any ideas?
Solution:
I was using a dropdown scripting file jquery-dd.js but I forgot to add the css style for it in the head tag in my master page(also i forgot to include the css file for jqGrid):
<link href="@Url.Content("~/Content/dd.css")" rel="stylesheet" type="text/css" />
<link href="@Url.Content("~/Content/ui.jqGrid.css")" rel="stylesheet" type="text/css" media="all"/>

A: This is the useful link for build your jquery theme. jQuery UI. What you need to do is pick your desired theme and download the files from link at the bottom of page. Use it in your asp.net-mvc application. Hope this helps..

A: If you have picked a theme (I'm assuming a jQuery UI theme) you can save it in an accessible folder (/Content/Themes/ etc).
After that it should be as easy as adding the theme to your view or layout.
Ex:
<link href="@Url.Content("~/Content/themes/redmond/jquery-ui-1.10.3.custom.css")" rel="stylesheet" type="text/css" />

(in this example I picked the 'Redmond' theme, and had a custom version of jquery ui 1.10.3)
Then just ensure your view, when you load it, actually can access the css file you have linked.

redpajama_set_name: RedPajamaStackExchange


text:
Home » Essen Lane Widening Requires Solid Government Partnerships for Smooth Construction
Essen Lane Widening Requires Solid Government Partnerships for Smooth Construction
Multiple Phases, Multiple Entities: Louisiana DOTD and the City of Baton Rouge Partner for Essen Lane Widening
Government entities have a less than stellar reputation when it comes to working together and communication. However, the Essen Lane Widening project in Baton Rouge, Louisiana, is doing much to dispel the myth. The project involves multiple government entities who have worked well together and had smooth communications.
Essen Lane, between Perkins Road and Jefferson Highway/Interstate 12 sees a great deal of traffic with estimates pegging the number of daily drivers at 55,000. Weekday peak driving periods are a particularly congested time partially due to the volume of motorists entering and exiting the interstate at Essen Lane.
Rodney Mallet serves as the Communication Director for the Louisiana Department of Transportation and Development (DOTD). Mallet says, "That part of town has always been congested. However, more businesses have come to the area including medical buildings, hospitals, and retail which has increased the congestion." Other improvements to ease congestion have been made in the area, but more was needed. Beyond easing congestion, Mallet believes the project will minimize opportunities for crashes and make the area safer.
Multiple Phases
The project was split into two distinct phases. The first phase, which is budgeted for $2.1 million, was begun in May 2015. It added two additional turn lanes onto I-10 to provide dual left-turns for southbound and northbound Essen Lane. In addition, one lane was added to the I-10 intersection of Essen Lane and Essen Park Avenue, as well as the two on- and off-ramps at I-10. This phase took six months.
A second part of phase one included utility relocations and widening of a bridge (Wards Creek Bridge). The second part was expected to last approximately one-and-a-half years. Mallet says, "Utility movement is always a challenge particularly in this area which is so populated and congested."
Once the utilities were relocated, phase two began. During this phase, an approximately 1-mile stretch of Essen Lane will be widened from a five-lane roadway with a center turn lane to six lanes with a continuous, two-way center turn lane. This phase began in September 2017 and is expected to be completed by the end of this summer. Part two of phase one and phase two are expected to cost $12 million.
City and State Owners
On the surface, the Essen Lane Widening Project is pretty standard. However, the project is being managed at multiple government levels. DOTD is managing and responsible for part two of phase one and phase two while phase one was spearheaded by the City of Baton Rouge and managed through the City-Parish's Green Light Plan (a comprehensive street and road improvements program authorized by voters in 2005).
This is not the first time the state and local government have worked together in Louisiana. Mallet notes that the two entities have done projects like this before, as several of the projects that the Green Light Plan has managed are connected to state routes. Coordination between the two governments has thrived. "We're fortunate that Baton Rouge works well with the state," says Mallet.
The reason for the need to coordinate on the Essen Lane Widening project is simple: part of it is city owned, and part of it is state owned. According to Mallet, Baton Rouge via the Green Light Plan had plans to move forward on phase one of the project. When the funds became available for the part of the project that was state owned, "it made sense to do it at the same time." However, each phase of the project had a completely different group of workers and were essentially two different projects.
According to Mallet, the city's work could be done quickly while the movement of the utilities was a much more time consuming process. "We recognized that the city's work would yield immediate benefits, and therefore, it made sense for them to do complete their phase of the project first."
The decision to split up the utility work and road work was based on the desire to minimize inconvenience for travelers. DOTD and the Green Light Project have done this in the past. Mallet says, "We find when doing the different aspects of the project separately lessens the inconvenience for people and is the way to go particularly when there is a large amount of utility work to be done as there is in this project."
Communicating with the Public
The same communication skills that allow the government entities work together are utilized by DOTD when it comes to communicating with the local businesses in the area that are impacted by the construction. Complaints have been minimal, and Mallet notes a few reasons why the surrounding businesses have been satisfied. Prior to beginning the project, DOTD hired an outside company to reach out to every business that would be impacted by the project and obtain their contact information.
Whenever something is coming up that will impact the traffic – lane closure, lane shift, etc., –DOTD emails out a notice. They strive to do this two weeks in advance of the event in order to give businesses time to prepare. Individual commuters can also sign up and get the alerts.
The largest employer in the area is a hospital, Our Lady of the Lake. There are many specialty medical locations in the area that are affiliated with the hospital. Mallet says, "We consider the hospital to be partners in this event, and we get information to them as soon as we can, and they share it with others in their network." The DOTD goes one step further to keep the hospital in the loop; they have the direct number to the project manager and Mallet and are encouraged to reach out if they have a question or concern.
The Essen Lane Widening project is nearing its completion. While weather is always a factor, particularly in Louisiana, which has felt the wrath of hurricanes, the project is currently on track to be completed by its target date. This can be attributed to the City of Baton Rouge and its local agency and to the DOTD. Their communications and ability to coordinate efforts are showing that governments can indeed work together.
KEYWORDS dotd essen green lane louisiana mallet phase project widening
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redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Order summary messed up in Magento 2 checkout page On my magento 2 store, order summary is messed up in checkout page, please give me a solution for this, please check the picture for example.
Thanks

A: I Fix this issue,
just add the below code your .htaccess file
<IfModule pagespeed_module> ModPagespeed off </IfModule>


text:
Eupithecia bradorata is een vlinder uit de familie van de spanners (Geometridae). De wetenschappelijke naam van de soort is voor het eerst geldig gepubliceerd in 1930 door McDunnough.

bradorata

redpajama_set_name: RedPajamaWikipedia


text:
Top 100 European places where Dieselgate 'kills' most
Italy is the deadliest country, including more than 40 percent of the top 100 worst regions and 50 percent of all deaths. (Photo: Mobile Reporter/EDJN)
By Stefano Valentino/European Data Journalism Network
BRUSSELS, 7. Jun 2018, 16:32
On 17 May, the same day the European commission took nine EU countries – the Czech Republic, France, Germany, Hungary, Italy, Romania, Slovakia, Spain and the UK – to the European Court of Justice for failing to implement measures to curb air pollution, the mayors of three European capitals – Brussels, Madrid and Paris – asked the court to reject the 2017 EU regulation that sets caps for diesel engine emissions.
The 110-percent tolerance margin in the emissions of nitrogen oxide (NOx) by new cars on road tests is twice the limit set for laboratory tests, thus granting car makers extra "polluting permits".
The court is due to issue its verdict before the end of the year.
In Europe, more than a third of those killed each year by toxic particulate matter (PM) – associated with unlawful diesel emissions exceeding the EU limits – live in about 100 conurbations.
These areas, counting almost 100 million inhabitants altogether – almost 20 percent of the overall European population – are mainly located in Italy, France, Germany, the United Kingdom, the Netherlands, Belgium and Spain.
They account together for 1,500 – 2,000 people who died prematurely due to PM resulting from excess diesel emissions.
These deaths are the consequence of Dieselgate - the scandal sparked in 2015 through the revelations about Volkswagen's fixing of emissions tests by the Environmental Protection Agency of the United States.
This outrage revealed to the public how the automobile industry, as a whole, circumvented EU diesel-emissions surveillance mechanisms by cheating on compliance tests.
We compiled the blacklist of European communities with the highest death toll, using further data included in the study published in September 2017 by the International Institute for Applied Systems Analysis (IIASA) and the Norwegian Meteorological Institute (MetNorway).
This study, covering EU member states, Norway and Switzerland, warned that nearly 5,000 people die prematurely every year due to excess emissions that car makers should have avoided by law.
How to use this map
Use the scrolling menu top right to choose the visualisation:
– Top 100 regions/cells in Europe by number of premature death per year due to NOx emissions exceeding EU limits
– Approximate premature death per region/cell due to NOx emissions exceeding EU limits per year
– Pollution from diesel cars exceeding EU limits per region/cell
– Population per region/cell
Zoom in to check cities in each cell. Click on a cell to see its population, the excess concentration of particulate matter due to nitrogen oxyde emissions from diesel cars above the EU limits and the premature death per year due to dieselgate.
The 'worst'
We identified the areas topping the chart in each of the most affected countries: in Italy, the conglomeration of north Milan and Monza (first in Europe by deaths); in France, north-west Paris (third in Europe); in Germany, central-east Munich (10th in Europe); in Britain, north-west London (12th in Europe); in Belgium, central-west Brussels (15th in Europe); in the Netherlands, central-west Amsterdam (34th in Europe); and in Spain, the whole of Barcelona (47th in Europe).
In many of these areas, bans have been introduced in recent times for the most environmentally-harmful diesel engines.
Italy is the deadliest country, including more than 40 percent of the top 100 worst regions and 50 percent of all deaths.
Germany and France, on the other hand, lead the top five countries with the highest number of regions where deaths are above the EU average, beating even Italy and, in decreasing order, the UK and Poland.
Diesel engines spew two powerful pollutants: fine dusts or particulates, technically termed particulate matter (PM 2.5), and nitrogen oxides (NOx).
Diesel vehicles individually abide by particulate-matter emission limits.
But, as Dieselgate made clear, they release nitrogen-oxides volumes far above the measures established in laboratories for environmental certification, and exceed the limits set by the EU.
This is true above all for 'Euro 4 and 5' vehicles that represented 70 percent of the European fleet in 2015, but also in part for 'Euro 6' vehicles that accounted for only six percent and are expected to make up 33 percent by 2020 (figures based on IIASA's reports).
In addition to being dangerous on their own, NOx emissions mix in the atmosphere with other harmful substances, indirectly creating even more particulate matter.
The study by IIASA and MetNorway aim precisely to highlight the health consequences of particulate matter indirectly produced by over-limit NOx (without, therefore, including the effects of either NOx or particulate matter directly emitted from diesel cars).
Particulate matter is the most dangerous pollutant.
Once inhaled, the microscopic compounds (named after their diameter of less than 2.5 micrometers) can penetrate the lungs and the circulatory system, causing or aggravating respiratory and cardiovascular dysfunctions, tumours and other pathologies.
"If no action is taken to rectify the current diesel fleet, this health impact will be continued for another couple of years", says Jens Borken-Kleefeld, expert in transport with IIASA.
Building the map: the methodology
1. IIASA placed a grid on the map of Europe, dividing it into rectangular cells (or geographical regions) of 28 km x 28 km each, without any reference to official city limits or other administrative boundaries. The centre of each regional cell is indicated by spatial coordinates (longitude / latitude). Since the positioning of the cells is strictly formal, they sometimes extend into the sea.
2. IIASA then measured the atmospheric pollution for each regional cell (taking into account other factors, such as local meteorology and topology), from which it extracted the specific data for particulate matter. IIASA also counted the number of inhabitants in each cell. Quantifying particulate matter and the number of inhabitants allows to weigh the level of concentration according to the population and, therefore, to measure the effective exposure. The latter determines, indeed, the number of expected deaths.
For each regional cell, IIASA eventually identified the excess quota of particulate matter produced by diesel nitrogen oxides over the legal limits. This quota results from the difference between two measurements: the mix of polluting emissions from all sources, near and far (local, urban, regional and cross-border), including excess nitrogen oxides from diesel, minus all emissions, including nitrogen oxides from diesel supposedly compliant with EU thresholds.
3. According to the WHO's risk function, we estimated an increase in mortality of 0.62 percent for each excess microgram / cubic metre (µg/m3) of particulate matter. Therefore, to obtain the actual increase in mortality attributable to Dieselgate in each regional cell we multiplied the 0.62 percent coefficient by the fraction of PM 2.5 from excess nitrogen oxides that was calculated by IIASA.
4. We then made an inventory of annual deaths in every regional cell, reasonably supposing that the mortality rate in each region is the same as the country to which it belongs (available in the official statistics of Eurostat). The number of recorded deaths in each cell results from the multiplication of the mortality rate by the number of inhabitants therein.
5. Finally, we multiplied the recorded number of deaths by the increase in mortality due to the excess fraction of PM 2.5, thereby obtaining the number of additional deaths in each regional cell – namely, the premature deaths presumably attributable to Dieselgate.
This article is part of the international investigation of Dieselgate, written by Stefano Valentino, former Brussels correspondent of Il Giornale and founder of MobileReporter, in collaboration with the European Data Journalism Network. The article was developed with the support of Journalismfund.eu. Translation by Ciaran Lawless at VoxEurop
Dieselgate MEPs grow impatient with commission inaction
VW dismisses complaints on Dieselgate fix
German court upholds diesel car ban in cities
Eastern Europeans shy away from Volkswagen's diesel 'fix'
Europe's water quality falls short
Industry commissioner Elzbieta Bienkowska told MEPs that the commission was still analysing the reasons given by national governments for letting Volkswagen off the hook.
9. Mar 2018, 09:28
'I think customers who want to get information (...) are able to receive information if they want," VW management board member Hiltrud Werner told EUobserver. Consumer groups disagree.
The ruling is bad news for the future of diesel engines in passenger cars. The EU has, however, taken a backseat on coordinating the EU's 200+ low-emission zones.
Data shows that at least two million of the 8.5 million 'cheat diesels' are still driving around in Europe unchanged.
Due to pollution, the majority of European rivers, lakes and estuaries fall below the minimum environmental standards, a report by the European Environment Agency reveals.
Porsche told EU not to publish diesel emission result
8. Jun, 09:24
The EU Commission has kept results of an emissions test of a Porsche diesel vehicle secret for months, at the request of the German car company - which was fined €535m for its role in the Dieselgate scandal.
Political deal done on EU oversight of car emissions
EU negotiators agree that the European Commission shall have the right and obligation to double-check cars after they have been approved.
Leak: EU states weaken post-Dieselgate testing
Negotiators meet this week to discuss new rules to prevent emissions cheating, but EU states want only a mild overhaul of the system.


Here is a little video I made of myself lettering that I put up on instagram. It's kind of a random little thing but it got a lot of views... like 800 and counting. It just goes to show you that videos get more attention than still photos. Lesson learned! I think there will be more videos in my future.


Refrigeration Heroes is dedicated to solving our customers' critical refrigeration, kitchen equipment, and commercial air conditioning challenges. Our professional and knowledgeable staff can help with emergency service, routine service, preventative maintenance, and system installation.
Founded in 1977 as Greenville Refrigeration Services, Inc. our company has been satisfying customers for over 40 years. Our current owner, Jason Holeman, took over the company in 2009. Jason is an engineering graduate of the United States Military Academy at West Point and former US Army Officer. Under his ownership, the company has developed a strong culture dedicated to technical expertise, quality craftsmanship, and excellent customer service. Our commitment to "Saving Your Day" led to the company changing its name in 2017 to Refrigeration Heroes.
To deliver superior HVAC-R solutions to customers in a manner that earns their trust and exceeds their expectations.
To be recognized by our customers as a trusted service provider and partner and to consistently deliver excellent value and customer service.


Potty–training is an essential process that every owner must go through with their Chihuahua.. Another little trick I've learned that helps to potty–train a Chihuahua is to always take them to. . They hate the outside in winter and this helps we'll.
Step by Step Instructions for House Training a Chihuahua. great area in the summer may not work well in the winter when there is 2 feet of snow on the ground.
House–training a puppy is hard enough without trying to tackle potty training in the winter. During the cold winter months, getting your dog to go outside at all may .


text:
Q: Where to find the log file of specific service Using sudo journalctl -u {service} I can see the log of specific service.

*

*How to find the associated log file?

*What is the best way to monitor a log file programmatically? (I mean a program the react based on something appears in the log file)

A: Systems with s6, runit, perp, nosh, daemontools-encore, et al. doing the service management work this way.  Each main service has an individual associated set of log files that can be monitored individually, and a decentralized logging mechanism.
systemd however does not work this way.  There is no individual "associated log file" for any given service.  There is no such file to be monitored.
All log output is funneled into a single central dæmon, systemd-journald, and that dæmon writes it as a single stream with all services' log outputs combined to the single central journal in /{run,var}/log/journal/.
The -u option to journalctl is a post-processing filter that filters what is printed from the single central journal, all journal entries being tagged with (amongst other things) the name of the associated service.  Everything fans in, and it then has to be filtered to separate it back out to (approximately) how it was originally.
The systemd way is to use journalctl -f with appropriate filters added, or write your own program directly using the systemd-specific API for its journal.
Further reading

*

*https://unix.stackexchange.com/a/294206/5132

A: 1.) If your Linux distribution uses journald to the full extent, there will be no easily readable traditional log file, as @JdeBP mentioned. The journal file uses a binary format and is not easily parseable by traditional log file tools.
2.) If journalctl -u {service} has the information you need, then you could use journalctl -f -u {service} and pipe the output to the program that parses the log and triggers any needed reactions. Anything beyond that is likely to be specific to your Linux distribution of choice.
For example, Debian 9 (Stretch) in a default configuration has journald maintaining the traditional /dev/log syslog input socket. But if rsyslogd is installed, journald is configured to forward incoming syslog messages to it.
Other Linux distributions might have the relationship between journald and a traditional syslog daemon structured differently.


2. Up to 3 difference group and 7 combination on the flash transceiver.
3. Support EOS E-TTL II.
4. When using the EOS EX II series flash, you can set difference setting on difference group, available to set 1/1~1/128 flash output, totally 23 difference levels.
5. When using EOS EX II series flash, you can adjust theflash exposure compensation from camera.
6. Support all the shutter speed, sync speed up to 1/8000s;using the PC socket control the studio ight which also support 1/8000s sync speed.


text:
Sunny. High temperature around 56F. Dew point will be around 36F with an average humidity of 53%. Winds will be 20 mph from the NNW.
Clear. Low temperature around 52F. Dew point will be around 36F with an average humidity of 50%. Winds will be 14 mph from the N.
Sunny. High temperature around 56F. Dew point will be around 36F with an average humidity of 49%. Winds will be 9 mph from the NNW.
Clear. Low temperature around 56F. Dew point will be around 43F with an average humidity of 60%. Winds will be 12 mph from the WNW.
Sunny and windy. High temperature around 59F. Dew point will be around 45F with an average humidity of 62%. Winds will be 23 mph from the NW.
Clear and windy. Low temperature around 47F. Dew point will be around 36F with an average humidity of 54%. Winds will be 25 mph from the N.
Clear. Low temperature around 52F. Dew point will be around 32F with an average humidity of 46%. Winds will be 10 mph from the NNW.
Sunny. High temperature around 56F. Dew point will be around 37F with an average humidity of 51%. Winds will be 3 mph from the ENE.
Mostly clear. Low temperature around 56F. Dew point will be around 43F with an average humidity of 61%. Winds will be 3 mph from the WSW.
Partly cloudy. High temperature around 59F. Dew point will be around 45F with an average humidity of 62%. Winds will be 6 mph from the S.
Mostly cloudy. Low temperature around 59F. Dew point will be around 48F with an average humidity of 68%. Winds will be 8 mph from the S.
Cloudy. High temperature around 60F. Dew point will be around 50F with an average humidity of 68%. Winds will be 11 mph from the S.
Partly cloudy. High temperature around 61F. Dew point will be around 52F with an average humidity of 73%. Winds will be 3 mph from the SSW.
Mostly cloudy. Low temperature around 60F. Dew point will be around 52F with an average humidity of 75%. Winds will be 6 mph from the SSE.
Mostly cloudy. High temperature around 61F. Dew point will be around 54F with an average humidity of 78%. Winds will be 14 mph from the SSE.
Mostly cloudy with a chance of rain. Chance of precipitation 45%. Low temperature around 56F. Dew point will be around 52F with an average humidity of 86%. Winds will be 8 mph from the SSE.


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Klicken Sie hier, um den Weitersagen-Button zu aktivieren. Erst mit Aktivierung werden Daten an Dritte übertragen.
Ersterscheinung: 19.10.2017
Gabriel Conroy (Autor)
John Sinclair - Back from Hell
Book 7 - 9
JOHN SINCLAIR. A Horror Series Compilation. Episode 7-9.
Episode 7. A LONG DAY IN HELL: When John Sinclair's dying body is brought to the emergency room at St. Bartholomew's Hospital in London, the unthinkable happens: Minutes after his death, he jolts back to life, screaming in agony. The doctors have no rational explanation for his recovery. But Sinclair didn't come back alone. There are voices in his head, and one of them belongs to Laura Cody, an eleven-year-old girl who is trapped with her brother in a crumbling mansion outside of London, about to be sacrificed to an ancient evil ...
Episode 8. THE TASTE OF HUMAN FLESH: When young Cordelia Barnes dies of a drug overdose, her body is brought to Abbott & Sons, one of the oldest funeral parlors in South London. But Mr. Abbott is no ordinary man. He is a ghoul -a c a foul and ancient creature He and his gruesome family live in darkness and feed on human flesh. Soon, DCI Sinclair is called to the scene, determined to wipe out the nest of ghouls. But Sinclair doesn't realize that his best friend is trapped under their lair, and that the ghouls are preparing a feast. The slaughter is about to begin ...
Episode 9. TO KILL A BEAST: Dr. Carl Barlow is a renowned physician at St. Bartholomew's Hospital. No one knows that he is dying from leukemia, that he is staring death in the face. He would do anything for a few more months on this earth. In his desperation, he experiments on himself and crosses a line that never should have been crossed. Soon, Barlow's body is changing and he is thirsty for human blood. As Barlow stalks the streets of London, DCI John Sinclair has to face his most dangerous enemy yet ...
"John Sinclair" is the relaunch of Europe's longest running horror series. Originally conceived in 1973 by Jason Dark and still going strong, the "John Sinclair" novellas are firmly rooted in the finest pulp traditions: true page turners with spine-tingling suspense, exquisite gore, and a dash of adventure.
For fans of the dark visions of Stephen King, Clive Barker and the "X-Files" and the fast-paced action and globe-trotting excitement of James Bond.
Gabriel Conroy was born in Los Angeles, California, in 1967. After high school, he joined the armed forces and was stationed in Germany for several years. He discovered his love for writing while traveling through Europe. When he returned to the States, he studied Journalism at Los Angeles City College and UCLA, and currently works as a freelance journalist, writer, and translator. Mr. Conroy is married and has a dog and a cat.
eBook eBook (epub) ( 3,99 € )
Gabriel Conroy
Gabriel Conroy ist das Pseudonym eines in Los Angeles lebenden Autors. Er studierte in Kalifornien Film und Journalismus und arbeitete lange in der Filmbranche. Unter seinem echten Namen schreibt er Romane und Artikel, übersetzt Bücher und unterrichtet …


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Una razon para vivir trailer español
a reason to live cast
a reason to live movie wikipedia
a reason to live true story
a reason to live trailer
«A Reason to Live» … The adventurous and charismatic, Robin Cavendish has his whole life ahead of him when polio causes him to become paralyzed. Against all medical advice, his wife, Diana, gets him out of the hospital. Their persistence, ingenuity and determination allowed them to overcome the disease and their attitude was, for everyone, an example of courage and will to live.
Cast: Diana Rigg, Andrew Garfield, Claire Foy, Dean-Charles Chapman, Tom Hollander, Ed Speleers, Miranda Raison, Hugh Bonneville, Roger Ashton-Griffiths, James Wilby, Kiera Bell, Emily Bevan, Ben Lloyd-Hughes, Camilla Rutherford, Amit Shah
The play, based on true events, tells the inspiring story of Robin and Diana Cavendish, a couple who fought with optimism and no limits in the face of disease. The adventurous and charismatic Robin Cavendish has his whole life ahead of him when polio causes him to become paralyzed. Against all medical advice, his wife, Diana, gets him out of the hospital. Their persistence, ingenuity and determination allowed them to overcome the disease and their attitude was, for all, an example of courage and will to live.
During the Civil War, the Union army loses Fort Holman, abandoned by the troops before they have even engaged in combat. The fort is now in Confederate hands. Colonel Pembroke, the fort's commander, is accused of treason. He prepares a suicidal mission: to storm the fort held by the enemy in order not to be condemned for the act and to be released, although he could not return to the army. For this, he manages to convince 7 prisoners condemned to death to follow him in exchange for their freedom, with the additional argument of the existence of gold hidden under the fort and with the promise of giving them part of the gold in exchange for their help in taking the fort.
At the end of the plot, the colonel's true motives are discovered. It turns out that there is no gold and that the current Confederate commander of the fort, Major Ward, had Pembroke's son in his hands and that he blackmailed Pembroke into abandoning the fort by using his son to do so only to kill him afterwards. Therefore, in revenge, he has organized the storming of the fort with the condemned.
His ambitious adaptation of 'The Jungle Book' ('The Jungle Book') was originally expected to be his first feature film, but several delays have caused us to see 'A Reason to Live' ('Breathe') first. Behind this title, almost more typical of a small-time Tv Movie, we find a song to life that is pleasant to watch thanks mainly to the good work of its two main characters.
The funny thing is that this gives at the same time more weapons to its leading couple to exhibit their talent -there is more variety of situations to face- but it also limits the scope of their interpretations. This translates into 'A Reason to Live' having enough virtues to keep your attention and even come close to its goal of giving some warmth to the heart of the viewers, although in return when the most emotional moments come it doesn't get to thrill but it doesn't detract either.
In the end it doesn't take too long to smell where the shots are going to go and at least Serkis manages to keep that detail from bothering us. It's often said that it's the journey that's important, and that's perfectly matched here by the protagonist's own motivation. Garfield is very inspired conveying that desire to live and keep improving, while Foy also complies comfortably as that necessary support to keep things from falling apart.
Como superar una ruptura amorosa mujeres
Groucho marx la parte contratante
Temas para hacer una presentación
Frases para gente que publica todo
Tabla de ejercicios en casa para mujeres
Porque un hombre cambia de actitud de repente
Alprazolam efectos secundarios a largo plazo
Hurtar quitar algo con violencia
Son tan fuertes tus miradas
El tiempo lo cura todo
La informacion es poder autor
Como saber si un leo ya no quiere nada contigo
Cuanto dura la carrera de medicina en españa
Colores de ojos y su significado
Morfologia de la cara y su significado
Frases de una nueva ilusion
Test de autismo para adultos
Dioses griegos y su significado
Que musculos se ejercitan con la bici
Los mejores masters de españa


Enjoy quality visuals and amazing connectivity with the Samsung DB32E Digital Signage. It is the perfect display for large-scale advertisement and imagery required to capture consumer's attention. Powered by the enhanced 3rd Generation Samsung SMART Signage Platform (SSSP) Cortex-A9 Quad-Core processor with a speed of 1GHz and Linux Operating System. Offering you a 32" class display which produces FHD quality images in a resolution of 1920x1080 for amazing clarity and details. It comes with a contrast ratio of 5000:1 which ensures that you get to view every detail along with the darkest and brightest colors. Ensures blur free motion images while watching HD videos with its 8ms response time. In addition, it is equipped with one HDMI, one DVI-D, one VGA and one USB 2.0 which expands your connection to various sources, allowing you to explore more of your monitor's capabilities. With rj-45 port, you can connect this to a network. Featuring a built-in Tuner which allows you to control the monitor without setting up a power unit with it. With D-LED BLU technology, it deliver rich picture quality, low power consumption and reduced operating costs. Simplified content management with integrated WiFi and an application easy to use mobile. So, what are you waiting for? Purchase the Samsung DB32E Digital Signage now!


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Home News Resident doctors to begin indefinite strike Thursday
Resident doctors to begin indefinite strike Thursday
Members of the Nigerian Association of Resident Doctors (NARD) are set to begin an indefinite strike on Thursday.
This followed the expiration of the 60-day ultimatum given to the Federal Government on January 25 for the payment of arrears of salaries of house officers across the country and the review of hazard allowance, among other demands.
Decrying the N5,000 hazard allowance paid to its members, the association also noted that since the pandemic began in 2020, it has sadly lost 17 doctors, whose families and loved ones are yet to benefit from the Death in Service Insurance Scheme.
NARD President Dr Uyilawa Okhuaihesuyi dropped the in a statement in Abuja after NARD's extra-ordinary National Executive Council (NEC) meeting on Sunday.
He said: "The NEC observed that her earlier ultimatum given to the Federal Government during the January 2021 NEC meeting in Owerri will expire by 12 midnight on the 31st of March 2021 with no significant achievement.
"The NEC reiterated her full support for the Central Placement of House Officers. Nevertheless, they decried the agony our members have been made to pass through for three months now without salaries despite uninterrupted service delivery to the nation
"This is due to the inefficiency of the Registrar of MDCN in handling the processes of central placement of House Officers as approved by the Federal Executive Council since 2017.
"The NEC bemoaned the suffering of some of our members in GIFMIS platform who have not been paid salaries for four months now due to delay in biometric capturing by IPPIS department.
"They lamented the inhumane treatment being meted on our members in some State Tertiary Institutions like ABSUTH being owed twenty months salaries, IMSUTH five months salaries and UNIMEDTH three months salaries.
"The NEC also observed that despite the three-month window given to the Federal Government to review the hazard allowance of health workers, the hazard allowance has remained a paltry sum of five thousand naira monthly.
"The NEC noted that despite the efforts of NARD, the erroneously paid 2020 Medical Residency Training Fund (MRTF) to non-resident Doctors is yet to be addressed. Also, the 2019, some of 2020 and 2021 MRIF are yet to be paid."
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Come and celebrate our favourite country's birthday in style!
The party will be held in the outdoor space surrounding the Little Italy restaurants in Sarona and will be the introduction to their new bar that's opening this summer!
There will also be food stands serving Israeli food, Italian tapas, and ice cream!
Bring your friends and your appetite and let's have some fun!!
בואו לחגוג עצמאות 67 בסטייל!


You are receiving this email because of your successful audition for the Lincoln Youth Symphony. It is with great pleasure that I welcome you to a new year with new exciting adventures! Whether you are new and this is your first year, or you are returning for another year, I applaud your willingness to make music on Saturday mornings!
Print the acceptance & payment form. Fill it out and bring it to rehearsal (9-11:15am) this Saturday, Sept 25th. The membership information referenced in the acceptance & payment form is also attached to this email, as is the printable calendar for the year (remember, the most up-to-date calendar info is online on LincolnYouthSymphony.blogspot.com - click "Calendar - LYS" on the right).
Be sure to get at least one of your parents to attend the Mandatory Parents' Meeting with you. That's this Saturday after our rehearsal from 11:30-12:15. It will be a short meeting and will earn your parents a discount on tuition! Please see the attachment "LYS acceptance and payment form" for additional tuition information.
Next week: Come for a special get-to-know-you weekend including rehearsals, skits, and special workshops with fantastic musicians (I am so excited!). You will learn & grow and come back ready for an awesome year of music making and friendship!
Where: Camp Utaba north of Eden, Utah. See www.camputaba.org and click on "maps" on the left sidebar.
Just a note about this retreat: A highlight of my teenage years was Olympic Music Camp near Port Orchard, Washington! I loved it; I went twice. It was a 2-week summer camp. We had orchestra rehearsal morning and afternoon, played in chamber groups, had movie night and skit night and hiked to the big rock on the nearby lake; the percussion & brass learned Copland's Fanfare for the Common Man, hauled their equipment around to the other side of the lake, and performed for us! It was amazing. I still get chills just thinking about that music drifting across the lake towards us! One year, the youth symphony learned Tchaikovsky's Fourth Symphony to perform for our parents on the last day -- like we played the entire symphony -- all four movements! It was intense, but it was amazing! I learned about myself, I made friends, and I wish everyone had that kind of opportunity.
This LYS retreat will not be two weeks. In fact, it won't even be a full 24 hours, but it will be as close to music camp as I can make it! We will have specialists up there on Saturday morning for workshops and sectionals. Prepare to be inspired! We will rehearse twice - Friday evening and again Saturday morning. We will have a really outrageous performance & skit night (start thinking now... music-themed skits, please!). You won't want to miss this! Be prepared for a great time!
Please also note our needs: Oboes, another bassoon, more horns, Trumpets, another trombone, tuba, percussionist, and MORE STRINGS!
THIS IS A BIG DEAL! IT'S ABOUT GROWING THE GROUP: For a limited time (until the seats are filled), our conductor, Robert Bott, is offering membership to anyone who you think can handle it and who wants to come and play - the audition will be for seating purposes only - your friends' willingness (and your recommendation) takes the place of the membership audition! Get those friends to come! They'll miss the fun retreat if they don't join up right away! Bring them to rehearsal just to play along and check it out! Let's grow this orchestra and help each other make it a fantastic experience!
We would happily take more horns!
Do you have a friend who plays tuba or percussion?
Thank you for your time! Guess what? This is the end of the email. If you still have questions that were not answered, please contact me!


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Celebrity Fight Night hits Florence
Sponsors include Jeep, Fratelli Piccini and Falconeri
Thu 08 Sep 2016 12:20 PM
Famous faces will be spotted around Florence this week as Celebrity Fight Night festivities take off on Thursday, September 8, benefitting the Andrea Bocelli Foundation and the Muhammad Ali Parkinson Center.
Close to 150 VIP guests will attend the event at the Basilica of Santa Croce complex, among them Nicolas Cage, this year's big name. This event opens an exclusive, weeklong "Experience in Italy with Andrea Bocelli" which sees guests travel to Volterra, and to Bocelli's birthplace, Lajatico, before leaving Tuscany to head to Venice. Sponsors of the celebrity travel package include Jeep, Falconeri and Fratelli Piccini, whereas the Santa Croce evening specifically is sponsored by designer Stefano Ricci and Florence's own Antico Setificio Fiorentino, active since 1786 and taken over by the Ricci group from 2010 onwards.
Ricci himself will host the Santa Croce event, guiding guests through the Pazzi Chapel and leading them to the basilica cloister, where they will indulge in a buffet dinner.
"I'm honoured to be supporting Andrea Bocelli for this charity event once again," Ricci said. "The friendship that binds me to the Bocelli family, and the pleasure of dressing one of the most renowned Italian men on earth {are the reasons} I was glad to support him in organising this edition of the Celebrity Fight Night."
Various guests will be attending the luxurious evening, with Lonnie Ali, the wife of the late Muhammad Ali, standing out. She won't be the only ambassador for the boxing world, though: Evander Holyfield, a sporting legend of her late husband's calibre, will be joining her.
More household names will be appearing, amongst these Ronnie Dunn and of course, the organiser, Andrea Bocelli. The world-famous tenor has not yet revealed the full musical programme, but past editions are promising, having featured artists such as Celine Dion, Donna Summer, The Village People and Jennifer Lopez.
The Florentine editorial staff
Commemorations, concerts and museum tours to remember the victims of the Holocaust
Restaurant to open in the Uffizi's former royal post office building
A day ticket or an annual pass will be required to access the restaurant when it opens.
Concerns surround the future of Thursday's flower market
The city council states "maximum willingness to keep the historic flower market alive".
Florence city council set out plans to combat "touristification".


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Home » Homeowner killed by limb cut by tree workers
struck by or against February 20, 2022
Homeowner killed by limb cut by tree workers
A homeowner was struck and killed by a limb on February 20, 2022, in Brown Deer, Wisconsin, while a crew was doing tree work outside his home.
Monias Hannah, 44, of Milwaukee, had recently bought the home and didn't live there yet, but wanted to have some tree work done. Hannah hired two men to remove a few trees and was present while the company was working.
At one point, Hannah walked out of the home and into the driveway to begin filming the crew when a cut branch, 10 to 12 inches in diameter, fell about 20 feet, striking him on the head on its way to the ground.
First responders found Hanna unresponsive and not breathing and began resuscitative efforts, but he was pronounced dead at the scene, according to a WISN-TV 12 report.
This incident was first reported to TCI Magazine by Anna Birnschein, business manager, sales arborist, with Colonial Tree Service, LLC, a 10-year TCIA member company based in Waukesha, Wis. Colonial Tree was not connected to the incident.
Climber hurt in struck-by
Tree worker killed by falling mud mats


An aspiring voice actor and author that has way too much time on her hands. The books stacked against the wall don't help either.
Hey, look at who's alive! And with another book review as well! Amazing.
Well, this is a review for the first book in the Lioness Rampant Chronicles, by Tamora Pierce, which is another beloved book series of mine. It, like the Transformers Universe, helped me through some tough times that would have normally left me depressed.
...I have a feeling without my robots and books I would have been a sad sad little child.
Yo, guess who's still kicking! I'm actually alive, amazingly enough. I got rather hung up with finding a job though, found one, and became totally consumed in the process of moving. :l Not to mention changing address, hoping I qualify for food stamps and medicare/cal and the like is totally consuming my time and energy.
So, basically, I've been super busy and have had no time for booklikes. Forgive me, but sadly I'm only human.
I've read so many books, it's sort of ridiculous. Right now I'm attempting to find all of them and put them on my shelves, and then go through them all and give them the reviews they deserve.
I'll reread any that I can't remember 100%, but that's the problem: all the ones that I remember are my absolute favorites that I've reread a gazillion times. It's going to take forever to re-find some books that were less than stellar among all the (many) others that I adore. Such as the Redwall series, written by Brian Jacques.
But what I'm trying to say is sorry for all the spam on your dashboard from me finding all those books.
I'm going to start the review of this comic series with a blunt fact; I love Transformers.
I've loved these giant alien mechs from Cybertron ever since I was first introduced to them as a little brat surfing through cartoons on the the TV. They've helped me through tough times, whether it was the original G1 cartoon, or the less than stellar Michael Bay movies.
I simply adore them, it's so ridiculous how attached I am to the glitches, but that simply is the way it is for me.
That being said, it's because of this that I'll actually come down a little harder on this series than most might. I know the potential it can have, and therefore I expect the best out of it.
So, with that explanation out of the way, lets start the actual review of the first comic the MTMTE series.


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Installation, Maintenance and Repair Industry
All Terrain Vehicle Technician
All Terrain Vehicle Technician Overview
JobsSkillsDemographics
Get Alerts For All Terrain Vehicle Technician Jobs
Find The Best All Terrain Vehicle Technician Jobs For You
Working as an All Terrain Vehicle Technician
There is more than meets the eye when it comes to being an all terrain vehicle technician. For example, did you know that they make an average of $15.67 an hour? That's $32,599 a year!
What Does an All Terrain Vehicle Technician Do
There are certain skills that many all terrain vehicle technicians have in order to accomplish their responsibilities. By taking a look through resumes, we were able to narrow down the most common skills for a person in this position. We discovered that a lot of resumes listed dexterity, mechanical skills and physical strength.
When it comes to the most important skills required to be an all terrain vehicle technician, we found that a lot of resumes listed 39.4% of all terrain vehicle technicians included ase, while 15.2% of resumes included repair orders, and 9.1% of resumes included brake systems. Hard skills like these are helpful to have when it comes to performing essential job responsibilities.
When it comes to searching for a job, many search for a key term or phrase. Instead, it might be more helpful to search by industry, as you might be missing jobs that you never thought about in industries that you didn't even think offered positions related to the all terrain vehicle technician job title. But what industry to start with? Most all terrain vehicle technicians actually find jobs in the government and automotive industries.
How To Become an All Terrain Vehicle Technician
If you're interested in becoming an all terrain vehicle technician, one of the first things to consider is how much education you need. We've determined that 36.6% of all terrain vehicle technicians have a bachelor's degree. In terms of higher education levels, we found that 7.3% of all terrain vehicle technicians have master's degrees. Even though some all terrain vehicle technicians have a college degree, it's possible to become one with only a high school degree or GED.
Choosing the right major is always an important step when researching how to become an all terrain vehicle technician. When we researched the most common majors for an all terrain vehicle technician, we found that they most commonly earn bachelor's degree degrees or associate degree degrees. Other degrees that we often see on all terrain vehicle technician resumes include master's degree degrees or diploma degrees.
You may find that experience in other jobs will help you become an all terrain vehicle technician. In fact, many all terrain vehicle technician jobs require experience in a role such as automotive technician. Meanwhile, many all terrain vehicle technicians also have previous career experience in roles such as lube technician or technician.
All Terrain Vehicle Technician Jobs
Average Salary for an All Terrain Vehicle Technician
All Terrain Vehicle Technicians in America make an average salary of $32,599 per year or $16 per hour. The top 10 percent makes over $52,000 per year, while the bottom 10 percent under $20,000 per year.
All Terrain Vehicle Technician Demographics
Hispanic or Latino
Foreign Languages Spoken
See More Demographics
All Terrain Vehicle Technician Education
Entry Level Jobs For Becoming An All Terrain Vehicle Technician
Top Skills For an All Terrain Vehicle Technician
The skills section on your resume can be almost as important as the experience section, so you want it to be an accurate portrayal of what you can do. Luckily, we've found all of the skills you'll need so even if you don't have these skills yet, you know what you need to work on. Out of all the resumes we looked through, 39.4% of all terrain vehicle technicians listed ase on their resume, but soft skills such as dexterity and mechanical skills are important as well.
Repair Orders, 26.0%
ASE, 23.5%
GPS, 18.5%
Applicable Safety Requirements, 17.2%
Electrical Systems, 7.7%
Other Skills, 7.1%
See All All Terrain Vehicle Technician Skills
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Top All Terrain Vehicle Technician Employers
1. United States Army
All Terrain Vehicle Technicians Hired:
2. Clarke Power Services
3. Marriott International
4. Yamaha
5. Stoughton Trailers
6. Yates Construction
Recently Added All Terrain Vehicle Technician Jobs
Master Technician
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