text:
Q: Why is app.put() not updating documents in mongodb? I am trying to implement a form in an ejs file that, upon clicking a button, the "likes" attribute of a displayed document from my mongoDB collection is set to 0 via a "PUT" request. However, the document in question does not update and I do not know why.
The console does not display any errors.

      <form action="/" method="GET">

 MONGO FETCHED:

                    <%= numbers.usertext %>

<%= numbers.likes%>

        </form>

            <form action="/" method="PUT">
                <button id="upvote" type="submit">upvote</button>
            </form>

In my index.js file, I fetch a random document in my collection to display to the user. I have defined body-parser, so I know that is not the problem.
MongoClient.connect(DBconnection, { useUnifiedTopology: true})
    .then(client => {
    console.log(`Connected to database: ${database}`);
    console.log(`Connected to table: ${table}`);

    app.use(bodyParser.urlencoded({ extended: true }));
    app.set('views', './views');
    app.set('view engine', 'ejs');

    const db = client.db(database);
    const collection = db.collection(table);

    const w = db.collection(table).find().limit(-1).skip(R-1).next()
    //variable R has been defined as a random number

//This gets the fetched random document, w, and then renders it on home.ejs
    app.get('/', (req, res) => {
        w
        .then(numbers => {
          res.render("home.ejs", { numbers: numbers});
        })
        .catch(error => console.error(error));
    })

//This route submits information into the database from a file separate from home.ejs
    app.post(`/${table}`, (req, res) => {
        collection.insertOne(req.body)
        .then(result => {
            res.redirect('/')
        })
        .catch(error => console.error(error))
    });

//This is suppose to update the attribute "likes" from the document w (as defined earlier)
//and set it to 0. However, this code block does not do so.
    app.put(`/${table}`, (req, res) => {
        db.collection(table).findOneAndUpdate({w}, {$set: {likes: "0"} })
        .then(result => {
            console.log("updated succesfully");
        })
        .catch(error => console.error(error))
    });

});

I would appreciate any input. Thank you.

A: There are a number of issues with the code.

*

*In your EJS file you cannot have a form method of PUT. Valid methods for HTML forms are GET and POST.

*You don't have a route to handle your form submission.

*Express with EJS is a server-side rendered application architecture. Once you click submit in your bottom form, the page will be refreshed. If you don't want a full page refresh, then you'll need to do some client-side JavaScript.

I would suggest going through an express form tutorial.


How do I add a contact details page?
This article will show you how to create a contact details page on your website.
Contact details are set in FPMS Pro and the web page is automatically populated with them.
Log in to FPMS/FPSM Pro and go to Website Tools > Sites.
To add a site click the green + icon.
To edit existing details click the pencil icon in the appropriate site box.
A new page will open where you can insert or alter the practice name and address.
Use the "IsPrimary" selector to choose if this is the main site or a branch site.
Under Select a type of page choose Contact Us. Scroll to the bottom and click "Save" to create the new page.
Hover over the Site list widget and click the EDIT link that appears.
A new sidebar will open. Use the tick boxes to choose which site's contact details to display.
Select a map display style from the drop-down list and click Save.
Your new page will automatically be populated with your practice's contact information.
Underneath the contact details hover over the Form widget and click the EDIT link that appears.
A new sidebar will open. Use the drop-down list to choose a form to add.
Use the Show/Hide selector to choose whether or not the form should appear on the page.
My details are not displaying correctly or some details are missing.


Either Miami fans dressed up as seats for their spring game or absolutely no one showed up for the event. The Alabama Crimson Tide consistently have 92,000 people show up to their spring game and the Miami Hurricanes have this turnout. Miami fans are pretty much the exact opposite of Bama fans but then again, what the hell is there to do in Alabama? I guess all the Miami fans are on South Beach drinking mojitos. HT @TomahawkNation. JUMP!
UPDATE: Miami claims that over 10,000 people were at their spring game. Cool story Miami!


text:
Morgan Evans: We chat to the Australian star about country in the UK, being married to Kelsea Ballerini and new music!
23rd March 2018 10th May 2018 Greta Bielkova
Photo credit: @morganevansmusic Instagram
Morgan Evans is a newly found star in the UK after his successful performances at the Country 2 Country Festival. Also known for his sweet Australian accent and equally as talented wife, Kelsea Ballerini, he has an exciting year ahead of him as he his about to release his first ever album. We caught up with Morgan after the Country 2 Country Festival to discuss is future plans, Australian country music, as well as his growing UK following!
This is your third time performing in the UK, how were your previous experiences? You were kind of introducing yourself back then…
I still feel like I'm introducing myself! The first trip was before we even had music out, so it was particularly special to play small venues to people that had found my music online, or from their friends or wherever, that's hardcore! The second trip was a 36hr promotional
only trip, which was kinda brutal but each time I heard more and more about what a great event C2C is, so I was stoked to be able to come back a 3rd time and be a part of that.
You've already performed at another festival last time, what are your expectations or aims this time around?
The Buckle & Boots festival is a really grass roots type festival. It feels like you're driving into your friend's farm to party for the weekend. It was such a great first experience of the UK and the UK country fans! C2C on the other hand is a humongous world class event, and I guess my expectations are that it's going to be really fun!
Your latest single, 'I do', is so sweet. What does the song mean to you, especially now that you're married?
It's a straight up love song. It's a fun one to sing, especially when she's at the show.
Your wife is here too, is it hard for you guys to try to schedule gigs around each other?
It is difficult sometimes but C2C worked out really well. We get to do it all together!
You're going to play in Australia shortly after you finish here, what is the country music scene like there?
I grew up there, so of course it's like coming home for me but the country fans are similar to the country fans in the UK in a lot of ways. Mainly that they're true music fans and if they like a particular artist they will go all in and know all the words to all the songs rather than just the singles.
You have released some music while you were still in Australia, how much different is it to be able to record in Nashville and work with Warner?
Nashville is the greatest music city in the world and I definitely decided to move there for that reason. After working with Warner in Australia for a few years the transition to Warner in Nashville just made perfect sense and I'm grateful for the great people they have working all over the world. I really feel like I found the right people in Nashville to bring out the best in me. My producer, Chris DeStefano, and my main co-writer, Josh Osbourne, are two of the most talented people I've ever met and I consider myself extremely lucky to be able to work with them so regularly.
Later on you have a tour with Chris Young, what are you plans for the rest of the year, especially in terms of releasing an album?
The Chris Young Tour is going to be huge! I can't wait. We definitely have more music coming through April and May and then the full album shortly after that. It's been a long time coming and I'm equally excited and nervous about finally putting it out there, but I'm super stoked to start playing it all live!
Previous Previous post: Danielle Bradbery: We caught up with the Big Machine artist after C2C to discuss everything from growing as an artist to leaving her 'The Voice winner' tag behind!
Next Next post: Gettin' To Know… Levi Hummon: The songwriter talks to us at C2C about Songs We Sang, his mother's charity and much more!

redpajama_set_name: RedPajamaCommonCrawl


Summary: NASA successfully launched its first spacecraft dedicated to studying atmospheric carbon dioxide on July 1, 2014. OCO-2 soon will begin a minimum two-year mission to locate Earth's sources of and storage places for atmospheric carbon dioxide, the leading human-produced greenhouse gas responsible for warming our world, and a critical component of the planet's carbon cycle.
The Orbiting Carbon Observatory-2, NASA's first mission dedicated to studying carbon dioxide in Earth's atmosphere, lifts off from Vandenberg Air Force Base, California, at 2:56 a.m. Pacific Time, July 2, 2014. The two-year mission will help scientists unravel key mysteries about carbon dioxide.
NASA successfully launched its first spacecraft dedicated to studying atmospheric carbon dioxide at 2:56 a.m. PDT (5:56 a.m. EDT) Tuesday (July 1, 2014).
The Orbiting Carbon Observatory-2 (OCO-2) raced skyward from Vandenberg Air Force Base, California, on a United Launch Alliance Delta II rocket. Approximately 56 minutes after the launch, the observatory separated from the rocket's second stage into an initial 429-mile (690-kilometer) orbit. The spacecraft then performed a series of activation procedures, established communications with ground controllers and unfurled its twin sets of solar arrays. Initial telemetry shows the spacecraft is in excellent condition.
OCO-2 soon will begin a minimum two-year mission to locate Earth's sources of and storage places for atmospheric carbon dioxide, the leading human-produced greenhouse gas responsible for warming our world, and a critical component of the planet's carbon cycle.
OCO-2 will take NASA's studies of carbon dioxide and the global carbon cycle to new heights. The mission will produce the most detailed picture to date of natural sources of carbon dioxide, as well as their "sinks" — places on Earth's surface where carbon dioxide is removed from the atmosphere. The observatory will study how these sources and sinks are distributed around the globe and how they change over time.
Carbon dioxide sinks are at the heart of a longstanding scientific puzzle that has made it difficult for scientists to accurately predict how carbon dioxide levels will change in the future and how those changing concentrations will affect Earth's climate.
During the next 10 days, the spacecraft will go through a checkout process and then begin three weeks of maneuvers that will place it in its final 438-mile (705-kilometer), near-polar operational orbit at the head of the international Afternoon Constellation, or "A-Train," of Earth-observing satellites. The A-Train, the first multi-satellite, formation flying "super observatory" to record the health of Earth's atmosphere and surface environment, collects an unprecedented quantity of nearly simultaneous climate and weather measurements.
The observatory will uniformly sample the atmosphere above Earth's land and waters, collecting more than 100,000 precise individual measurements of carbon dioxide over Earth's entire sunlit hemisphere every day. Scientists will use these data in computer models to generate maps of carbon dioxide emission and uptake at Earth's surface on scales comparable in size to the state of Colorado. These regional-scale maps will provide new tools for locating and identifying carbon dioxide sources and sinks.
OCO-2 is the second of five NASA Earth science missions scheduled to launch into space this year, the most new Earth-observing mission launches in one year in more than a decade. NASA monitors Earth's vital signs from land, air and space with a fleet of satellites and ambitious airborne and ground-based observation campaigns. NASA develops new ways to observe and study Earth's interconnected natural systems with long-term data records and computer analysis tools to better see how our planet is changing. The agency shares this unique knowledge with the global community and works with institutions in the United States and around the world that contribute to understanding and protecting our home planet.
The above story is based on materials provided by NASA/Jet Propulsion Laboratory. Note: Materials may be edited for content and length.


text:
Outreach programs target asthma hot spots, but more help is needed
By Steve Hamm
Conn. Health I-Team Writer |
Robert Carmon, 7, of New Haven, suffers from asthma. His dad, Chaz Carmon, helps him avoid severe attacks. (Steve Hamm | Conn. Health I-Team)
Robert Carmon had a rough start to life. Shortly after birth he developed asthma, a chronic disease that causes inflammation in the lungs and difficulty breathing. His attacks were so severe as an infant that his parents rushed him to the emergency room practically every week. They were terrified he might die.
Today, at age 7, Robert's asthma has stabilized. With the help of his dad, Chaz Carmon, he inhales a steroid-based medicine each morning and evening, and he carries a rescue inhaler in his backpack in case an asthma attack comes in school or elsewhere.
Robert is a bright and energetic child, yet he's not able to play organized sports because of his asthma. "It's hard on him," says his father. "I just hope he grows out of it."
Asthma, one of the most widespread chronic conditions in the United States, afflicts approximately 26.5 million people nationwide, or about 8.3 percent of the population. The cause is not known and there is no medical cure. The disease disproportionately affects people who live in economically disadvantaged urban neighborhoods. In New Haven's Newhallville and Dixwell neighborhoods combined (the Carmons live in Newhallville), an estimated 17 percent of residents report asthma, more than double the national rate, according to the Community Alliance for Research and Engagement (CARE).
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Connecticut's asthma rate is worse than the nation's. It's 11 percent for children and 10.5 percent for adults — and rising. Neighborhoods in Bridgeport, Hartford and New Haven are among the hardest hit. Automobile exhaust, cigarette smoke and mold and vermin in substandard housing are among the triggers. "Your ZIP Code matters. It's a determinant of health," says Marie-Christine Bournacki, coordinator of the asthma program for the Connecticut Department of Public Health.
In Hartford's North Meadows neighborhood, for instance, asthma in children from birth to age 4 accounted for 1,738 visits to hospitals per 10,000 residents in 2016, according to DataHaven. In comparison, the rate in Madison, a wealthy coastline town, was just 78. The median household income in Madison is $108,231; while in North Meadows it's $20,434.
Leaders of government and health care say the key to making progress in working-class neighborhoods is to focus more effectively on some of the medical, social and environment factors related to the disease, and to better coordinate society's responses. Dr. Beverley Sheares, associate professor of pediatrics at Yale School of Medicine, says: "In these settings, asthma is a symptom of what it means to live in poverty so really you have to change the lives of poor people."
When children suffer severe asthma attacks, their parents often take them straight to the emergency department of the nearest hospital. That's the right thing to do, say emergency medicine physicians, because it's difficult for parents to gauge the seriousness of an attack.
At Connecticut Children's Medical Center in Hartford, emergency physicians treat 1,500 to 2,000 children per year for moderate to severe asthma. Guidelines for treating asthma in the ED are well established, and the liquid steroid medications they administer stay in the body for up to 72 hours, making it less likely that kids will suffer another attack right away.
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In the past year, Connecticut Children's introduced a new process for treating patients more quickly — by having nurses engage with them soon after they arrive. Previously, it took an average of 75 minutes to treat asthma patients. Now it's 34 minutes — and the goal is 20. "Kids come in struggling to breathe. To be able to immediately treat them and see a quick turnaround is pretty amazing," says Eric Hoppa, a pediatric emergency attending physician at Connecticut Children's.
But emergency physicians say more effective treatment of asthma in the ED is not the long-term solution to the problem. EDs can stabilize people and provide instructions on how to use inhalers and other medications, but they can't follow them home to monitor their health, to make sure they're using inhalers correctly, or to spot asthma triggers in the home. That's why neighborhood clinics and outreach programs are so important.
Neighborhood Clinics
Economically disadvantaged people typically seek care at community health centers, and Connecticut has a strong network of centers operating in 38 cities and towns. Recently, some of the centers have begun establishing specialized asthma clinics so they can spot the disease earlier, treat it more consistently, and help patients manage it over the long term.
In New Haven, Fair Haven Community Health Care opened its new Respiratory, Airway and Allergy Clinic in June. It's staffed by a physician who is certified in treating allergy and asthma, an occupational health specialist, a nurse and a care coordinator who investigates the social determinants of each patient's asthma. The goal is to help them make adjustments in their lives that will reduce triggers. All of the health center's patients diagnosed with asthma, and those who show signs or symptoms, are referred to the clinic, which is one of the few of its type in greater New Haven.
Asthma can impact children's lives catastrophically. "If they're not treated properly, they miss a lot of school; they sit at home and play electronic games and don't socialize; and they don't go outside to exercise and get fresh air," says Dr. Pamela Kwittken, the physician at Fair Haven's RAAC clinic.
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That's why it's essential for children in particular to have asthma action plans. These take-home documents describe the treatment the patient requires routinely and what to do if they experience a severe attack. Fair Haven began routinely creating action plans 1½ years ago and now more than 50 percent of the childhood asthma patients have them.
The next step for the Fair Haven clinic is forging a formal partnership with Milford Health Department's Putting On Airs, Connecticut's home asthma education program, which helps asthmatics and their families follow action plans and reduce the triggers in their homes.
Under Putting On Airs, teams of health workers conduct a series of three home visits with asthma sufferers. The teams typically include a health educator, who makes sure inhalers and other medications are being used properly, and an environmentalist, who looks for dust-mite-invested carpets, moldy bathrooms, mice and cockroaches.
Recently, the regional team at the Stratford Health Department, which runs Putting on Airs for much of Fairfield County, added a third member — a community health worker. Two other health districts elsewhere in the state will follow suit in the coming months.
The community health worker on the Stratford team, Millie Seguinot, helps translate between English and Spanish during home visits, explains the use of inhalers in simple language, and looks for social issues that impact a family's ability to control the asthma. In addition, she refers families to social service agencies for food and clothing — and helps them make arrangements with their children's schools.
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One Bridgeport family kept canceling appointments with Putting On Airs. Language was an issue. Seguinot visited the mom on her own and learned that she didn't understand the asthma action plan or how to administer medications for her daughter on a regular basis. After Seguinot explained things carefully and helped with scheduling, the mom was able to follow the plan and became more comfortable with additional visits from the team. "It's important to have somebody that these families can relate to. It might be language, culture, ethnicity or even physical appearance," Seguinot says.
One of the reasons for Connecticut's high rate of asthma is that much of the urban housing stock is more than a century old, and many urban people live in rentals (72 percent in New Haven). Old buildings tend to harbor asthma triggers, such as mold and dust mites; and landlords often are reluctant to replace carpets where dust mites hang out, or to repair faulty exhaust fans.
It's not feasible to replace all of the substandard housing, but with advice from the Putting On Airs teams and support from city health departments and doctors, people can pressure their landlords to improve conditions.
Alice Rosenthal, staff attorney for the Center for Children's Advocacy, recounts a success story in New Haven that provides a blueprint for others. A 12-year-old boy with severe asthma lived with his mom and two siblings in a rundown apartment where grimy old carpets covered the floors. His mom vacuumed the carpets frequently and even paid to have them steam cleaned, but it wasn't enough. She asked repeatedly for the landlord to remove them. No go.
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Finally, after the boy's primary care doctor, a pulmonologist and Rosenthal wrote letters urging the landlord to take action, he did so. "Now, the boy is not missing school and, because he's healthier and using less steroids, he can get outside and play sports," Rosenthal says. Plus, because the mom doesn't have to be at home all the time, she's now working—and the family is doing much better economically.
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Rosenthal coordinates a partnership with Yale New Haven Children's Hospital where the two organizations collaborate on addressing the social determinants of health.
There's no magic bullet for addressing asthma, or poverty either. For now, government and health care leaders agree, the key is increasing awareness of what can be done to prevent asthma attacks or respond to them. With adjustments in living situations and proper health care, asthma doesn't have to keep kids—and their parents—living in misery and fear. They can all breathe easier.
This story was reported under a partnership with the Connecticut Health I-Team, a nonprofit news organization dedicated to health reporting. (c-hit.org)
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text:
Liberating the literature
Systematic Reviews 14 +0
Evidence-based Synopses 26
Rheumatology 967
Neurology 467
Cardiology 264
Hematology 189
Ophthalmology 156
Infectious Disease 87
Allergies and Immunology 59
OB-Gyn 37
Endocrinology 26
Pulmonology 26
Geriatrics 21
Dermatology 20
Women's Health 13
Orthopedic 10
Anesthesiology 2
Physical Medicine 2
1,494 results for
Selected results only All results on this page All 1,494 results .CSV file .RIS file Email
1. Giant cell arteritis (including temporal arteritis)
Giant cell arteritis (including temporal arteritis)
2017 DynaMed Plus
2. Giant cell arteritis
Giant cell arteritis Giant cell arteritis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Giant cell arteritis Last reviewed: February 2019 Last updated: December 2018 Summary Giant cell arteritis (GCA) is a common form of vasculitis in people aged 50 years or older. The extracranial branches of the carotid artery are usually affected. Irreversible blindness is the most common serious consequence. Aortic aneurysms (...) and corticosteroid-sparing benefit in the treatment of GCA. Definition Giant cell arteritis (GCA) is a granulomatous vasculitis of large and medium-sized arteries. It primarily affects branches of the external carotid artery, and it is the most common form of systemic vasculitis in adults. GCA typically occurs in people 50 years of age or older and is more common in women. Symptoms of polymyalgia rheumatica are frequently present. The most common serious consequence of GCA is irreversible loss of vision due
2018 BMJ Best Practice
4. Magnetic resonance angiography in giant cell arteritis: results of a randomized controlled trial of tocilizumab in giant cell arteritis. (PubMed)
Magnetic resonance angiography in giant cell arteritis: results of a randomized controlled trial of tocilizumab in giant cell arteritis. To analyse magnetic resonance angiographic (MRA) vessel wall signals from a randomized controlled trial of tocilizumab (TCZ) to treat GCA.Participants were assigned in a 2:1 ratio to receive either TCZ + glucocorticoids (GCs) or placebo + GC infusions at 4-week intervals for 52 weeks. GCs were started at 1 mg/kg/day, then tapered to 0.1 mg/kg/day at week 12
2018 Rheumatology (Oxford, England)
5. Giant---cell arteritis---related mortality in France: A multiple---cause---of---death analysis Giant---cell arteritis---related mortality in France. (PubMed)
Giant---cell arteritis---related mortality in France: A multiple---cause---of---death analysis Giant---cell arteritis---related mortality in France. Giant-cell arteritis (GCA) is a large vessel vasculitis. Data regarding mortality are controversial. We describe the mortality data of the French death certificates for the period of 2005 to 2014.Using multiple-cause-of-death (MCOD) analysis, we calculated age-adjusted mortality rates for GCA, examined differences in mortality rates according
2018 Autoimmunity reviews
6. Ultrasound could help diagnose giant cell arteritis
Ultrasound could help diagnose giant cell arteritis Ultrasound could help diagnose giant cell arteritis Discover Portal Discover Portal Ultrasound could help diagnose giant cell arteritis Published on 14 February 2017 doi: Ultrasound may aid giant cell arteritis diagnosis in people referred from the community. It is less invasive than biopsy and might provide quicker results than a biopsy, but its role and place in the diagnostic pathway remain unclear. Giant cell arteritis is a disease (...) of medium to large sized arteries and can lead to a range of eye, brain and other complications. Sudden or gradual blindness is a real risk and anyone with suspected giant cell arteritis is referred to hospital for a biopsy and started on high dose steroids. This NIHR-funded study found that ultrasound correctly picks up more cases than biopsies, but also falsely identifies some people who do not have the condition. Biopsies falsely diagnose giant cell arteritis in fewer people without the condition
2019 NIHR Dissemination Centre
8. Tocilizumab for treating giant cell arteritis
Tocilizumab for treating giant cell arteritis T T ocilizumab for treating giant cell ocilizumab for treating giant cell arteritis arteritis T echnology appraisal guidance Published: 18 April 2018 nice.org.uk/guidance/ta518 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guidance represent the view of NICE, arrived at after careful consideration (...) to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. T ocilizumab for treating giant cell arteritis (TA518) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 21Contents Contents 1 Recommendations 4 2 Information about tocilizumab 5 3 Committee discussion 6 A new treatment option 6 Subgroups 6
2018 National Institute for Health and Clinical Excellence - Technology Appraisals
9. Combined bilateral ophthalmic artery occlusion & central retinal vein occlusion from presumed giant cell arteritis (PubMed)
Combined bilateral ophthalmic artery occlusion & central retinal vein occlusion from presumed giant cell arteritis To report on a severe case of presumed giant cell arteritis (GCA) presenting with partial and complete ophthalmic artery occlusion along with bilateral central retinal vein occlusions (CRVO).A 73-year-old female presented with bilateral complete vision loss of sudden onset. The patient also experienced a mild frontal headache prior to onset of vision loss. Fundus examination
2018 American journal of ophthalmology case reports
10. The impact of temporal artery biopsy for the diagnosis of giant cell arteritis in clinical practice in a tertiary university hospital. (PubMed)
The impact of temporal artery biopsy for the diagnosis of giant cell arteritis in clinical practice in a tertiary university hospital. Temporal artery biopsy (TAB) is useful in assisting with giant cell arteritis (GCA) diagnosis but lacks sensitivity. The aim of our study was to assess the diagnostic impact of TAB histology in patients with suspected GCA on hospital admission.A prospectively maintained database was queried for all TABs performed between 1-1-2000 until 31-12-2017
2019 PLoS ONE
11. Aspirin as adjunctive treatment for giant cell arteritis. (PubMed)
Aspirin as adjunctive treatment for giant cell arteritis. Giant cell arteritis (GCA) is a common inflammatory condition that affects medium and large-sized arteries and can cause sudden, permanent blindness. At present there is no alternative to early treatment with high-dose corticosteroids as the recommended standard management. Corticosteroid-induced side effects can develop and further disease-related ischaemic complications can still occur. Alternative and adjunctive therapies are sought (...) . Aspirin has been shown to have effects on the immune-mediated inflammation in GCA, hence it may reduce damage caused in the arterial wall.To assess the safety and effectiveness of low-dose aspirin, as an adjunctive, in the treatment of giant cell arteritis (GCA).We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2014
2014 Cochrane
12. Color duplex ultrasonography findings of temporal arteries in a case of giant cell arteritis: role in diagnosis and follow-up (PubMed)
Color duplex ultrasonography findings of temporal arteries in a case of giant cell arteritis: role in diagnosis and follow-up Giant cell arteritis (GCA) is a systemic autoimmune disease that affects medium- and large-sized arteries. The diagnostic gold standard is the temporal artery biopsy, but it has limited sensitivity and some difficulties in reproducibility. Color duplex ultrasonography is a noninvasive, reproducible, and inexpensive method for diagnosis of temporal arteries involvement (...) (temporal arteritis [TA]) in GCA with high sensitivity and specificity. We present the ultrasound findings at baseline and during follow-up in a case of TA in a patient with GCA.
2017 Open access rheumatology : research and reviews
13. Giant cell arteritis, polymyalgia rheumatica, and late-onset rheumatoid arthritis: Can they be components of a single disease process in elderly patients? (PubMed)
Giant cell arteritis, polymyalgia rheumatica, and late-onset rheumatoid arthritis: Can they be components of a single disease process in elderly patients? To report two patients with giant cell arteritis (GCA) who developed rheumatoid arthritis (RA) and to review the literature in terms of coexistence of RA, GCA, and polymyalgia rheumatica (PMR).We conducted a comprehensive review of the English literature from 1980 to 2015 to analyze data on the coexistence of GCA and RA. The PubMed, Web (...) of Science, Proquest, and Ovid databases were searched for articles using the term RA combined with temporal arteritis, GCA, and PMR.We identified 17 other cases of coexistent GCA and RA reported in the English literature, together with our 2 cases (19 cases). They included 14 females and 5 males, with a mean age of 74.3 years (range: 57-84) at the time of GCA. The mean age at the time of RA diagnosis was 69.6 years (range 24-83). The average time elapsed between the onset of GCA and the development
2017 European journal of rheumatology
14. Estimating the Cost of Illness of Giant Cell Arteritis in the United States (PubMed)
Estimating the Cost of Illness of Giant Cell Arteritis in the United States Giant cell arteritis (GCA) is a chronic vasculitis affecting approximately 230,000 Americans. Limited data exist on the healthcare resource utilization and costs attributable to GCA. The objective of this study was to estimate the cost of illness in patients with GCA in the US.A cohort of patients with a new GCA diagnosis was identified from a large US claims database between 1 January 2008 and 31 December 2012. Newly
2017 Rheumatology and therapy
15. Increased Incidence of Giant Cell Arteritis in Urban Areas? (PubMed)
Increased Incidence of Giant Cell Arteritis in Urban Areas? 30647168 2019 03 02 0315-162X 46 3 2019 Mar The Journal of rheumatology J. Rheumatol. Increased Incidence of Giant Cell Arteritis in Urban Areas? 327-328 10.3899/jrheum.180714 Brekke Lene Kristin LK http://orcid.org/0000-0001-5599-2498 Hospital for Rheumatic Diseases, Haugesund, and Department of Clinical Science, University of Bergen, and Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department
2019 Journal of Rheumatology
16. Efficacy of Methotrexate in Real-world Management of Giant Cell Arteritis: A Case-control Study. (PubMed)
Efficacy of Methotrexate in Real-world Management of Giant Cell Arteritis: A Case-control Study. To determine the effect of methotrexate (MTX) on relapse risk and glucocorticoid (GC) use in a large single-institution cohort of patients with giant cell arteritis (GCA).Patients diagnosed with GCA from 1998 to 2013 with confirmed evidence of temporal artery biopsy and/or radiographic evidence of large vessel vasculitis were identified. Each patient with GCA treated with adjunct MTX (case
17. The therapeutic potential of tuftsin-phosphorylcholine in giant cell arteritis. (PubMed)
The therapeutic potential of tuftsin-phosphorylcholine in giant cell arteritis. Tuftsin-PhosphorylCholine (TPC) is a novel bi-specific molecule which links tuftsin and phosphorylcholine. TPC has shown immunomodulatory activities in experimental mouse models of autoimmune diseases. We studied herein the effects of TPC ex vivo on both peripheral blood mononuclear cells (PBMCs) and temporal artery biopsies (TABs) obtained from patients with giant cell arteritis (GCA) and age-matched disease (...) controls. GCA is an immune-mediated disease affecting large vessels. Levels of 18 cytokines in supernatants, PBMC viability, T helper (Th) cell differentiation of PBMCs and gene expression in TABs were analyzed. Treatment ex vivo with TPC decreased the production of IL-1β, IL-2, IL-5, IL-6, IL-9, IL-12(p70), IL-13, IL-17A, IL-18, IL-21, IL-22, IL-23, IFNγ, TNFα, GM-CSF by CD3/CD28 activated PBMCs whereas it negligibly affected cell viability. It reduced Th1 and Th17 differentiation while did not impact
2019 Journal of Autoimmunity
18. Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study
Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden.The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skåne region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects
2017 EvidenceUpdates
19. Trial of Tocilizumab in Giant-Cell Arteritis. (PubMed)
Trial of Tocilizumab in Giant-Cell Arteritis. Giant-cell arteritis commonly relapses when glucocorticoids are tapered, and the prolonged use of glucocorticoids is associated with side effects. The effect of the interleukin-6 receptor alpha inhibitor tocilizumab on the rates of relapse during glucocorticoid tapering was studied in patients with giant-cell arteritis.In this 1-year trial, we randomly assigned 251 patients, in a 2:1:1:1 ratio, to receive subcutaneous tocilizumab (at a dose of 162 (...) that underwent the 26-week taper, and 25% of those in the placebo group that underwent the 52-week taper. Anterior ischemic optic neuropathy developed in one patient in the group that received tocilizumab every other week.Tocilizumab, received weekly or every other week, combined with a 26-week prednisone taper was superior to either 26-week or 52-week prednisone tapering plus placebo with regard to sustained glucocorticoid-free remission in patients with giant-cell arteritis. Longer follow-up is necessary
2017 NEJM
20. Giant cell arteritis and vascular disease-risk factors and outcomes: a cohort study using UK Clinical Practice Research Datalink
Giant cell arteritis and vascular disease-risk factors and outcomes: a cohort study using UK Clinical Practice Research Datalink To evaluate the associations between GCA and vascular diseases and other comorbidities in patients with GCA compared with non-vasculitis patients.Using the UK-based Clinical Practice Research Datalink we identified 9778 newly diagnosed GCA patients in 1990-2014, and up to 10 non-vasculitis patients randomly matched to each case on age, sex, practice and years


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THE HANDBOOK
Robert Casey Jr.
Position: Senator ( PA )
Party Affiliation: DEM
Opposes BDS
Supports the Two State Solution
Supported the Taylor Force Act
Supported the Combating BDS Act of 2017
Supports the Anti Semitism Awareness Act
Opposed UN Security Council Resolution 2334
Supported the United States Israel Security Assistance Authorization Act of 2018
Voted For the Strengthening America's Middle East Security Act of 2019
Supported the Iran Deal
Robert Casey was born in 1960 and is currently serving as the senior United States Senator from Pennsylvania. Senator Casey was reelected in 2018 and his seat will be up for election in 2024.
Casey began his political career as Auditor General of Pennsylvania, a post to which he was elected to in 1996 and reelected in 2000. He could not run again due to term limits, so he instead ran for and was elected State Treasurer in the 2004 election. Casey defeated incumbent Republican U.S. Senator Rick Santorum in the 2006 election and was reelected in 2012.
Senator Casey is currently serving on the Finance Committee; the Health, Education, Labor, and Pensions (HELP) Committee; the Agriculture, Nutrition, and Forestry Committee; and the Special Committee on Aging.
Below is Senator Casey's voting record and public positions on issues important to the Jewish community.
Senator Casey supported the Iran nuclear deal. Senator Casey opposes the global Boycott, Divestment, and Sanctions (BDS) movement and cosponsored the Combating BDS Act of 2017, legislation that aims to fight the boycott movement against Israel. He cosponsored legislation that objects to UN Security Council Resolution 2334, which claimed that Israel's settlements have no legal validity. He supports the two-state solution to the Israeli-Palestinian conflict.
Senator Casey supported the Taylor Force Act, which stated that no American governmental funds shall be given to a Palestinian entity that financially rewards terrorists or their families.
In 2018, Senator Casey cosponsored the United States-Israel Security Assistance Authorization Act, a legislation that supported full funding of security assistance to Israel as outlined in the 2016 U.S.-Israel Memorandum of Understanding.
In 2019, he voted for the Strengthening America's Middle East Security Act which, among other things, strengthened Israel's security and allowed a state or local government to adopt measures to divest its assets from entities that boycott Israel.
Senator Casey is a cosponsor of the Anti-Semitism Awareness Act, which aims to provide for the consideration of a definition of anti-Semitism for the enforcement of Federal antidiscrimination laws concerning education programs or activities.
Do you support Senator Robert Casey Jr. based on the positions on these issues?
Enter your email and submit your vote!
Supported the Iran nuclear deal https://medium.com/@SenBobCasey/the-iran-agreement-fe48e81e5ffe
Voted For the Strengthening America's Middle East Security Act of 2019 https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=116&session=1&vote=00016
Cosponsored the Anti-Semitism Awareness Act of 2019 https://www.congress.gov/bill/116th-congress/senate-bill/852/cosponsors
Cosponsored the Israel Anti-Boycott Act https://www.congress.gov/bill/115th-congress/senate-bill/720/cosponsors
Opposed UN Security Council Resolution 2334 and supported the two-state solution https://www.congress.gov/bill/115th-congress/senate-resolution/6/cosponsors
Cosponsored the Combating BDS Act of 2017 https://www.congress.gov/bill/115th-congress/senate-bill/170/cosponsors
Supported the Taylor Force Act https://www.congress.gov/bill/115th-congress/senate-bill/1697/cosponsors
Cosponsored the United States-Israel Security Assistance Authorization Act of 2018 https://www.congress.gov/bill/115th-congress/senate-bill/2497/cosponsors
Cosponsored Senate Resolution 120 that opposes the global BDS movement https://www.congress.gov/bill/116th-congress/senate-resolution/120


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Q: how to write to a file safely in wcf service I know about Reader Writer Lock Slim to write to a file in threadsafe manner(by using singleton pattern). But is it the right one to use while doing file operations using a wcf service?..will this work correctly in wcf service?
As I understand using the following :
[ServiceBehavior(ConcurrencyMode=ConcurrencyMode.Multiple, InstanceContextMode = InstanceContextMode.Single)]
will make the entire service instance as singleton. Where I don't want the other used type objects in my service to be singleton and only the type object which does the file operations to work as singleton for safe file operations, I cannot use the above thing as i understand.
Then what will be the best method to write to file safely across service calls?
Please correct if I have understood it wrongly.
Thanks in advance.

redpajama_set_name: RedPajamaStackExchange


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News-Times Homepage
McKinney announces run for governor
Proposed Danbury charter school is definite maybe in state budget
Bethel's new first selectman prioritizes communications, budget
$204,000 in grants awarded to Danbury area nonprofits
Cops: Man tried to hide heroin in cell after Southbury arrest
Will Lamont's budget have money for Danbury charter school?
Republican Dan Carter declares victory in Bethel first selectman
Ex-Brookfield cop seeks to erase evidence tampering charge
Danbury's career academy called a 'model for the state'
Danbury man takes plea deal in restaurant shooting that injured 2
Official: Newtown High to stay closed after frozen pipe burst
News // Local
Senate minority leader says election will be a referendum on Malloy's economic policies
Ken Dixon
Connecticut State Senate Minority Leader John McKinney- R, Fairfield, at the Firehouse Deli on Reef Road in downtown Fairfield, Conn on Monday, July 22, 2013.
Brian A. PoundsShow MoreShow Less
Connecticut State Senate Minority Leader John McKinney- R, Fairfield, drops his head as he discusses the Sandy Hook Elementary School shootings during an interview at the Firehouse Deli on Reef Road in downtown Fairfield, Conn on Monday, July 22, 2013. McKinney, who also represents Newtown, was a backer of the gun control measures that were adopted in the wake of the shootings.
Connecticut State Senate Minority Leader John McKinney- R, Fairfield.
FAIRFIELD -- Veteran Senate Minority Leader John McKinney will leave one of the safest seats in the General Assembly to run for the Republican nomination to challenge Gov. Dannel P. Malloy.
In a Monday interview with Hearst Connecticut Newspapers, McKinney said he wants a statewide referendum next year on the economic and development policies of Malloy and majority Democrats in the Legislature.
He charged that the record-setting tax hike of Malloy's first year has crippled the state further, while the governor's targeted use of state development money is picking winners and losers among huge corporations at a time when small businesses remain stagnant and saddled with higher taxes.
"I have been continually frustrated over the last couple of years as I've gone across the state of Connecticut, whether it's town hall forums or a budget tour, hearing from individuals who said over and over again that Connecticut is becoming harder to live in," McKinney said at a deli in his hometown of Fairfield. "Whether they're seniors, whether they're young 20-something-year-olds who have just graduated from college, Connecticut is unaffordable."
McKinney, 49, said he is "uniquely qualified" to be among the first members of the General Assembly to jump directly to the Executive Residence in Hartford. The candidacy of former Speaker of the House James A. Amann, who resigned in 2008 to focus on the 2010 governor's race, was the most recent failure.
"I'm excited about the future because we can start heading in the right direction," said McKinney, who was first elected in 1998 and became the GOP Senate leader in 2007. "I'm uniquely qualified," he said. "I know where the problems are. I know we can get Connecticut headed in the right direction, so Connecticut can be the great state it is."
John McKinney
Hometown: Fairfield
Education: Yale; UConn Law School
Political experience: Current Senate minority leader representing Fairfield, Easton, Newtown, Weston, Westport. Youngest of the five children of the late U.S. Rep. Stewart B. McKinney
Work experience: Lawyer who once ran his family grocery store in Litchfield
Family: Divorced with three children
Quinnipiac poll
Released June 19; voter preference in hypothetical 2014 governor's race:
Tom Foley (R) 43
Dannel P. Malloy (D) 40
Malloy (D) 44
John McKinney (R) 37
Mark Boughton (R) 36
McKinney, who serves the 28th District -- Fairfield, Easton, Newtown, Weston and Westport -- in the state Senate, said he would express-mail his full application for candidacy in time for the State Elections Enforcement Commission to receive it on Tuesday. That would make him the highest-profile Republican to file candidacy documents, although Greenwich businessman Tom Foley has said he will try again.
Other familiar GOP names, including Danbury Mayor Mark Boughton, who is running for re-election, and Shelton Mayor Mark Lauretti, are potential candidates for governor.
In recent years, McKinney and minority Republicans in the House and Senate have been stymied by Democratic lawmakers and Malloy, the first Democratic governor in Connecticut since William A. O'Neill left office in 1991.
This was the first year in five years that Republicans, down 98-53 in the House and 22-14 in the Senate, have not introduced an alternative budget focused on spending reductions and tax cuts. Democrats this year approved a record two-year, $44 billion spending package that took effect on July 1.
"We offered balanced, fully vetted budgets for over six years," McKinney said. "This year, the reality was Gov. Malloy and the Democrats continued to double down on a bad budget and take Connecticut in the wrong direction, while focusing on a Republican budget that they already said they weren't going to look at.
"It was clear that Gov. Malloy and the Democrats didn't want to talk about their budget. They wanted to distract Connecticut with other issues," McKinney said. "This economy belongs to Gov. Malloy and the Democrats. They made the decision to increase spending, they made the decision to increase taxes, they made the decision to increase borrowing -- and those decisions have affected our economy."
McKinney said Malloy has failed on a number of major goals, including a promise to make government more open and transparent; and that the state would be "open for business."
McKinney's trips around the state have indicated that companies are losing confidence, he said. He blasted Malloy for "raiding" the state's Special Transportation Fund, borrowing to pay for state operating costs and offering more than $100 million in incentives for the mammoth Bridgewater hedge fund to move from Westport to Stamford.
"As we got farther down the road, running for governor became something I began to think of more seriously," said the Yale-educated, non-practicing lawyer whose mother, Lucie C. McKinney, is an heir to the Standard Oil fortune. "I think everything for me crystallized over the last several weeks. I've been to all four corners of the state over the last two months."
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On Monday night, McKinney, the son of the late U.S. Rep. Stewart B. McKinney, went to Newtown for the GOP nomination of First Selectman Pat Llodra to another term in that still-healing town.
The announcement of McKinney's candidacy for the Citizens' Election Program will require him to collect about $250,000 in small, $100 contributions, with $225,000 coming directly from state residents. He would be able to leverage $1.25 million for a primary and $6 million for the 2014 general election under the public financing program, which was created in 2005 after the corruption case that sent Republican John G. Rowland to federal prison and elevated Lt. Gov. M. Jodi Rell to governor nine years ago.
Foley, the Republican Party's 2010 gubernatorial loser, did not take part in the voluntary finance system, spending about $11 million of his own fortune to lose to Malloy by about 6,000 votes.
Last month, a Quinnipiac University Poll showed Foley leading Malloy by 21 points among the crucial unaffiliated bloc of voters, but Foley's overall three-point lead equals the poll's 2.9 percent margin of error among 1,154 registered voters.
Statewide, there are about 431,000 registered Republicans, 768,000 Democrats and 873,000 unaffiliated voters.
Foley got support from 36 percent of Republicans surveyed, while McKinney, who has never run a statewide race, won 11 percent in the early polling, compared to Boughton, Foley's 2010 running mate, with 8 percent.
"I'm running to turn Connecticut around," McKinney said. "I'm running to turn Connecticut back into the prosperous, great state that it can and should be. There's so much more we can do. That's why I'm running. I have demonstrated the ability to build consensus but also stand up and fight against bad policies, such as higher taxes and spending."
kdixon@ctpost.com; 860-549-4670; twitter.com/KenDixonCT; facebook.com/kendixonct.hearst; blog.ctnews.com/dixon
Reach Ken on
Ken Dixon is a reporter with Hearst Connecticut Media Group. A Connecticut native and Stamford High School graduate, Ken graduated with a journalism degree from Ohio University, where he was also most-valuable player on its soccer team. He reported on suburban communities and Bridgeport City Hall, then in 1994 began covering the State Capitol and state government. He has won awards from the National Society of Professional Journalists and the National Press Club; several awards from the National Society of Newspaper Columnists; and numerous awards for news and column-writing from the state chapter of the Society of Professional Journalists. He still enjoys playing soccer, and is a member of a rock 'n' roll band.


Napoli, chasing their first European title since Diego Maradona's team won the old UEFA Cup in 1989, were drawn against Arsenal in the quarter-finals of the Europa League on Friday.
Arsenal were initially drawn at home in the second leg against Napoli but the order was reversed by UEFA to avoid a clash with Chelsea.
Chelsea host Slavia Prague in the return of their tie in London.
Arsenal or Napoli will meet Villarreal or Valencia in the semi-finals, while Benfica or Eintracht play Slavia Prague or Chelsea.


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Wednesday night intermediate/advanced co-ed ride.
For this week May 24 meet at 6pm in the Lost lake parking lot at Snowden.
If we have enough folks we will split into 2 groups, a faster paced group and a chill pace group.
Plan for tonight is to meet back up in town at Beachfire to hoist a beverage with the road riders post ride.
Non-members or supporting members can participate in 2 club events with a signed waiver but after 2 events you must register as an insured member.


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Don't trust mainstream media, SBF's no schlub, just a crook and other commentary
Post Editorial Board
December 2, 2022 6:41pm
Former FTX CEO Sam Bankman-Fried sat down with George Stephanopoulos of "GMA." GMA
More On: fast takes
Joe's classified-doc corruption, don't fall for Omar's whining and other commentary
Big philanthropy's money move, lame SCOTUS leak hunt and other commentary
Remote income-tax time bomb, will Kat celebrate 'oppression' and other commentary
Fearmongers' laughable defense, fact-checkers climate misinformation and other commentary
From the left: Don't Trust Mainstream Media
"I mourn" for the news business, writes TKNews' Matt Taibbi. "It's destroyed itself." After the internet arrived and flooded the market with new voices, some outlets found that, "instead of going after the whole audience, it made more financial sense to pick one demographic and dominate it. How? That's easy. You feed the audience news you know they will like." Yet when you "decide in advance to forego half of your potential audience, to fulfill the aim of catering to the other half, you're choosing in advance which facts to emphasize and which to downplay. You're also choosing which stories to cover, and which ones to avoid, based on considerations other than truth or newsworthiness. This is not journalism."
Culture critic: The Right's Winning vs. Disney
"In recent years, the Walt Disney Co. has become embroiled in America's culture war," pushing critical race theory in its employee-training programs and radical gender ideology in its children's programming, but last week it fired CEO Bob Chapek and reinstalled former CEO Bob Iger, cheers Christopher F. Rufo at his site. And in video of Iger's first townhall meeting with employees, he "retreats from the company's most controversial positions and moves toward neutrality." He vows to adopt a different posture, to listen to Disney's audience and work to quiet things down. "This is an important shift," notes Rufo. Conservatives had sought to "damage Disney's brand" and "make the company pay a political price" to force it to "declare neutrality. So far, it appears that the strategy is working."
Housing expert: Bipartisan Path on Homeless
"If bipartisanship really were to take hold" in Congress, "action aimed at mitigating street homelessness would be a good place to start," suggests Howard Husock at The Hill. Helping the street homeless must go "beyond housing, to include treatment of the sort that long-shuttered state psychiatric hospitals once offered" — and "treatment plus housing" are the goals of GOP legislation that "languished in the last Congress" but deserves Democratic consideration. "Underutilized post-pandemic big-city office buildings and hotels could be converted to supportive housing . . . Policing could be invoked to clear the streets and sidewalks. Political will, as well as funding, matters." "Tent cities dot D.C. not far from the Capitol"; assisting their "unfortunate residents" would show politics can "make a positive difference."
Crypto watch: SBF's No Schlub, Just a Crook
"It is now clear," thunders CoinDesk's David Z. Morris, that what happened at the FTX crypto exchange and Alameda Research involved "conscious and intentional fraud intended to steal money from both users and investors." Honcho Sam Bankman-Fried used "in-house asset[s] as collateral for loans between clandestinely related entities" and handed out a total of $4.1 billion in loans "including massive personal loans that were likely unsecured." Since FTX's collapse, he's "attempted to portray himself as a well-intentioned but naïve kid who got in over his head." No: "The scale and complexity of Bankman-Fried's fraud and theft appear to rival those of Ponzi schemer Bernie Madoff and Malaysian embezzler Jho Low," and he "deserves to share their fate."
Crime beat: Linking Crime to Immigration
"Violent crime is becoming common in Sweden," as it is throughout the European Europe, report John R. Lott & James Varney at RealClearInvestigations. And an RCI analysis "strongly" links the surge with immigration: "Each one percentage point increase in immigrant population is associated with a 3.6 percent increase" in homicides. The results echo other studies in European countries that show immigrants commit crime at higher rates than the native-born population. A 2020 Swedish study found that from 2002 to 2017 immigrants were suspected in 73% of cases involving murder, attempted murder and manslaughter. In the US, data for such an analysis is "rarely" collected. But in Texas, which does track such stats, illegal immigrants are "convicted of homicide 32% more frequently than the rest of the Texas population."
— Compiled by The Post Editorial Board
fast takes
Read Next Assembly Democrats' plot to to undo will of Brooklyn vote...
New tactic: Hunter is the 'laptop from hell' victim
Hochul takes a good step toward fixing bail laws — but not remotely enough to rein in crime
Hochul calls for more charters for NYC, but she'll have to fight to get them


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Click here to view our 360 degree tour of the clinic
Perfect Skin Solutions was founded by Dr Dev Patel, our medical director, who was surprised by the lack of medical training some providers have, due to the limited regulations currently in place for treatments such as Botox® and Dermal Fillers. He has over 14 years experience working in various specialities, during which he developed a particular interest in dermatology and minor/aesthetic surgery. Perfect Skin Solutions was born out of this interest, initially, only providing non-surgical solutions to prevent and treat the signs of ageing. With an ever-growing client base and remit of services, we made the inevitable move to our own clinic premises in Southsea, in June 2014. This allowed our Skin Clinic to merge with the highly successful Podiatry/Chiropody Service run by Nishal Patel.
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We strive to remain up-to-date with the latest advances in our fields and aim to reflect this in the treatment options we provide, whilst considering cost-effectiveness and clinical efficacy. From laser treatments for fungal nail infection to non-surgical facelifts with naturally-based hyaluronic acid, we believe that our passion for what we do allows us to stay ahead of the competition.
For cosmetic treatments, although Dr Patel promises to tailor treatments to your individual aesthetic requirements based on your desires along with his own assessment, you may be advised against certain options, if he feels this crosses ethical lines. Our aim is to leave you with younger, fresher looking skin, which makes those around you notice you for the right reasons. The frozen look is not something we support!
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Our preferred partner Save Face is Now Accredited by the Professional Standards Authority which means that registered non-surgical Practitioners in the UK will be recognised by the Government, The Department of Health, NHS England, The CQC and HEE.
Dr. Dev Patel
BSc(Hons) MB BS Dip IMC RCS(Ed) DFFP DPD MRCGP DOccMed
Medical Director (GMC No: 4741664 /Devang Ramesh Patel)
Dr Patel qualified from Guy's & St Thomas' Hospitals in London, in 2000, with a Bachelor of Medicine, Bachelor of Surgery and also Honours degree in Genetics. He started with jobs in General and Vascular Surgery and has since worked in over 9 specialities including dermatology. He attained the Diploma in Practical Dermatology (with merit) in 2006. The following year he went on to tutor for the same course and also attained his qualifications in General Practice.
He has settled in his home city of Portsmouth and maintains his special interest in dermatology doing occasional NHS GP work and also works regular minor surgery clinics. Dr Patel is a certified advanced aesthetics practitioner and by combining his dermatology and aesthetics knowledge, he is able to provide a truly holistic and patient-tailored approach to skincare.
Dr Patel was the proud winner of The Cosmetic Therapist of the Year Award 2013 and 2015. He was the first doctor in England to introduce Plexr for non-surgical blepharoplasty and other applications and is also a UK Trainer of doctors in Soft Surgery. Dr Patel is currently the UK Ambassador and Lead Trainer for PLEXR. He was featured as an industry expert for Botox in the Ultimate Beauty Guide 2015 and has been invited to speak at both UK and international conferences. He also teaches other doctors on behalf of the Primary Care Dermatology Society and was invited to be a judge for the coveted Aesthetic Awards in 2016. He is also an Advisory Board Member and the UK KOL for AlumierMD as well as an Associate Member of the British College of Aesthetic Medicine (BCAM).
His passions outside of medicine and dermatology, include travel and adrenaline sports, although it is some time since he did the latter!
Dr. Vivek Shrivastva
BSc MBBS MRCP MRCGP DPD
Associate Doctor
Dr Shrivastva originally trained at Guy's, Kings' and St. Thomas' hospitals in London after obtaining a first class degree in Pharmacology. He then went on to train in both hospital medicine and subsequently general practice, receiving accreditation in both and still works as a GP principal.
He then studied postgraduate dermatology obtaining the diploma in practical dermatology in 2012, and then in cosmetic dermatology trained under the tutorship of world-renowned physicians and surgeons in the field, winning Cosmetic Therapist of the Year award in 2014.
He is skilled in a variety of procedures with expertise in advanced facial aesthetics, minor surgery and has a keen interest in applied anatomy in non-surgical procedures.
When not in clinic Vivek can be seen running after his 2 children, burning food on the barbecue or slogging it out on the tennis court.
Nishal Patel
BSc(Hons) MChS (HCPC registered)
Podiatrist/Chiropodist
Nishal runs the Foot Clinic. She has a special interest in Biomechanics and Nail Reconstruction/Surgery. She is UK trained and started her practice in the NHS in 2000, specialising in diabetic foot care. In 2005, she then moved to Gibraltar where she provided all podiatry services to the Ministry of Defence. She treated numerous service personnel who had suffered from long-term foot/lower limb pain; some of whom had failed operations to try and treat this pain. This is when her biomechanical expertise was put to excellent use with some very happy patients at the end of the treatment pathway.
In 2010, she started her own private practice in Portsmouth, primarily working from a GP surgery. In 2013, she was also given the opportunity of starting a clinic at another surgery in Southsea. Nishal's practice has thrived and she now has a loyal following stretching to neighbouring counties and beyond.
She has gained a tremendous reputation with her loyal patients, for her calm manner and highly skilled and especially gentle hands! Nishal is proud to be HCPC registered and a member of the Society of Chiropodists and Podiatrists (SoCAP).
Dr Sophie Ballard-Whyte
Dr Ballard-Whyte qualified from Peninsula Medical School in 2009. After working in hospital medicine for a few years she completed her GP training in 2016. She has worked for the Military around the country but has now decided to settle in Southsea, whilst still working for local Naval bases.
She is particularly interested in Women's Health and is currently completing additional training in Family Planning and Reproductive Health. Sophie is the lead practitioner for our incredible Votiva treatment.
She lives locally with her Husband and two young children and enjoys sailing, walking and being on the beach.
BTEC (Level 3 Diploma) Beauty Therapy
Aesthetic Therapist
Francesca has quickly become an invaluable asset to the PSS team. She started her career at South Downs College, achieving a high distinction, BTEC Level 3 Diploma in Beauty Therapy. She continued her beauty training in London before moving to the USA to work as a spa therapist.
She was delighted to be offered a position as Aesthetic Therapist at Perfect Skin Solutions. Francesca is an Image Skincare Specialist and enjoys combining her well-developed beauty skills with the latest in aesthetic treatments. She is the lead therapist for Lipotherapy, Skin Peels, IPL and Laser treatments.
"My aim is to give a spa experience but with clinical results."
Higher National Diploma (Level 3 ) in Beauty Therapy, Certified Aesthetic Laser Procedures
Lia successfully completed her Higher National Diploma in Beauty Therapy in Glasgow in 2011. She was quickly offered the opportunity to work with Steiner Transocean. Working within their busy health spas onboard luxury cruise liners sailing out of Miami, Lia specialised in Body Sculpting and Inch Loss Procedures.
Three years later Lia moved to the Middle East to gain more industry experience. Based in the largest shopping mall in the world, the Dubai Mall, she was employed as a Senior Skin Therapist in the flagship Skin Clinic of Dermalogica. Whilst in Dubai, Lia found a new interest for "laser" and was enthralled by the remarkable results achieved from the skilful use of these amazing machines. Subsequently, she decided to hone her skills and further studied "Aesthetic Laser Procedures" in the iconic Dubai Healthcare City. Discovering she had a real talent for "laser therapy" Lia joined a renowned medical centre and gained valuable experience working with a variety of laser treatments including hair removal and skin rejuvenation.
Lia has now brought all her extensive knowledge and training back to the UK and has now joined our own outstanding Aesthetic Team.
NVQ Level 3 Beauty Therapy
Amy was trained at Southdowns College and has been in the hair and beauty industry for over 17 years.
She started her career at one of the top health resorts in England; Champneys. She quickly became their premier therapist, dealing with the VIP and celebrity clients. Amy worked her way up to management and began running day spas in Chichester, Brighton and Guildford.
Wanting to see more of the world, she then joined Steiner Transocean as an aesthetician for Princess Cruises. After a short time at the company, she was hand-picked to be on the brand new ship, christened by Kate Middleton.
After enjoying working closely with the doctors on board, Amy came back to Portsmouth looking to settle down and join an award winning clinic to progress her career further within the aesthetic industry. She joined Perfect Skin Solutions in September 2018 and is now an established therapist within our team.
Hannah joined the Perfect Skin Solutions team in January 2019. She studied at Chichester College and achieved a double distinction, she became 4 years qualified in June 2019.
Hannah started her beauty career in a small salon but always harboured a desire to become an aesthetic therapist. She's proud to be part of our amazing clinical team and has already gained some loyal patients and glowing reviews.
Outside of work she's mostly busy planning her wedding!
Simon joined our growing team in July 2017 and has quickly become a vital asset; providing essential support to the Medical Director and clinic as a whole. His varied career has included business development, recruitment, customer service, training and development and IT support.
Simon has successfully managed several retail stores and has transferred his skills and experience to the aesthetic industry.
Simon will continue to grow a strong team and build on the success of Perfect Skin Solutions.
Clinic Administrator
Kathleen joined us in 2015, having worked for the N.H.S. for over eight years in a surgical department at Queen Alexandra Hospital, as lead secretary to a team of surgeons. Her wealth of experience working with clinical and non-clinical staff, as well as optimising patient experience ensures the smooth running of our practice. Kathleen was recently missed for 6 months whilst she set off on travelling to the Far East for a sabbatical. She has also become a very proud grandmother. The Perfect Skin team, as well as our patients, are very glad to have her back!
Charlotte comes from a beauty background, having worked as a senior beauty therapist for over a decade.
After having her daughter, she decided to undergo a career change but wanted to stay within the beauty industry. As clinical administrator at Perfect Skin Solutions, Charlotte enjoys being first point of contact for our patients and getting to know the ins and outs of the clinic.
Hannah is the newest member of our administration team. Hannah is a Southsea local and comes from a clinical background, having worked previously in pharmacies.
Hannah has found working in health care in the local area very rewarding, as it has helped her gain experience working with many different ages and people from a variety of different backgrounds.
She's enjoying the challenge of working in the aesthetic industry and being a friendly face to greet all of our patients!
Marketing Lead
Joanne joined our team in October 2018 and comes from a background of both agency work and working within in-house marketing teams in various industries.
With a journalism background at university, her skills include copywriting as well as graphic design, and she is responsible for spreading the word about Perfect Skin Solutions, on our social media channels and our website.
Outside of work, Joanne can be found with her girlfriend, their cat and their two rabbits!


Can a Proxy be set to go to priimary Real endpoint and Failover to secondary Virtual Asset?
If so, what are the parameters for the fail-over? Timeout or 50X/40X response?
Yes, this can be done with a message proxy.
The fail over triggers when the proxy receives a Error status code 4XX or 5XX.


There were many activities throughout the school year 2004-2005 of AMSAI Mindanao and we would love to share these nice experiences.At AMSAI schools in Davao, every year there is a calendar of monthly programs which help to engage the teachers, parents and students in activities that enhance the existing academic programs. Activities such as Nutrition Month, Filipino Day, Family Day, United Nations Day, Environmental Month, Sports Fest, etc. serve as a platform to forge close coordinated cooperation among the teachers, parents and their families, in moulding the child's mental, social and spiritual growth.
To promote our vegetarian diet to the parents and to introduce them to a healthy lifestyle, in July we had a nutrition month program with the theme from the government program "The importance of breastfeeding". A cooking demo was performed by Sister Amrta and Sister Amita from the Sisters Training Centre. A food preparation contest was also held which involved the parents and students, trying to outdo each other with a nutritious and delicious cook out of vegetarian dishes, which were beautifully presented before the judges. No wonder the judges had a hard time deciding which group would be the winner! A lively affair complemented with children's singing, poems, and very useful information on breastfeeding from the guest speaker.
"Linggong Wika" or Filipino Day was celebrated with a bang in August at AMSAI Atis, Mateo and Digos. Children in their traditional Filipino and colourful garbs added patriotism to the event which is held to commemorate the citizens of the country giving importance to Wikang Filipino as the national language by unitedly using and loving the language. There were dances, folk song renditions, singing, dancing and choral recitation by the children followed by Filipino-style games. It was a "Bayanihan spirit" (one of Filipino trait, meaning friendship by helping and working together as one) where the parents also put up booths with Filipino products and food exhibits, adding to the colourful celebration. It has been a very good activity for kids to learn about their own beautiful culture.
September's activity was Family Day. It was the first time that we had a parent seminar workshop. The topic was "Your child and Neohumanist Education" to develop the understanding of the parents and how they can support the child in the Neohumanist way.
Mrs. Ciencia Y. Plaza, Dada Mantrajapananda and Didi Ananda Carushila were the speakers in the workshop, touching on the science of child psychology, morality, spirituality and Neohumanist philosophy. It was an interesting program for the participants, which prompted the parents to request another whole day seminar for learning meditation and yoga.
The environment was given prominence the Neohumanist way, in the Environmental Month celebrated in November with tree planting. The children in AMSAI Digos planted vegetables "okra and eggplant" at the backside garden of the school. In AMSAI Atis and Mateo they also learnt how to do sprouting.A variety of dance, chorus recitation, Christmas songs and parlor games were part of the December Christmas party in AMSAI schools. The children were very excited with the nativity-drama "Story of Jesus". It was their first performance and with the help of the parents the children could perform it nicely. Our PTA became the Santa Claus complete with the costume, which made his own child wonder where his father was.
The Sports Fest in January where the children had a Field Day in sack race, 50 m dash, slippers relay, asanas and beautiful Callisthenics. They also played games such as Trip to Jerusalem, Bottle Filling and Statue Dance with prizes awarded to the winners and losers as well.An educational field trip was organized in February with a visit to the Fire Station. The children were so amazed when they saw the firemen slide down the sliding pole. They also visited the Post Office and the Radio Station DXCP of General Santos City. At the radio station the children were given airtime to recite a poem "All things bright and beautiful" and to sing songs from the Circle of Love. Next stop was the Orphanage and Yusepeng Zoo where the children were excited by the sight of a large snake. The field trip gave the children an opportunity to learn things outside of school.
never ever destroy God's creations and begs them to take care of them. (The children complement the story with rendition of an equally beautiful poem "All things bright and beautiful). Everybody enjoyed the drama very much.It has been a great experience to be involved with the activities of AMSAI !!!
And so May opens the schools for enrolment and new intake of students for another year of joy and learning adventure!


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Here is your daily tarot card + numerology reading for all zodiac signs in astrology for 11/29/18.
Your daily tarot card reading for each zodiac sign's astrology horoscope is here for Thursday, November 29, 2018! The Sun is in the sign of Sagittarius and the Moon is in the sign of Virgo. Today is a number 5.
The number 5 is today's numerological energy. 5 is passionate, adventurous, and hard to contain energy. Exuberance is the order of the day with 5 on the scene. Passions running high today, and inspired endeavors are also on the menu.
With a 5 day, you can find your attention drawn in many directions. Old projects resurfacing, competing with new ventures, for your attention. You may appear crow-like, rushing between sparkly objects with excitement to see what they're all about.
Five, as the entertainer of numbers, is always looking for ways to provide fun and play everything. The number 5 can feel much like Attention Deficit Hyperactivity Disorder (ADHD). On a day ruled with this energy, you will be excited about being loaded with new opportunities.
Number 5 as a day may find you seeking thrills in whatever area of your life is currently the most active. you may start with simply doing the dishes, and wind up jamming to your favorite playlist in a spotless home. Working to stay focused will be highly beneficial as the number 5 is so dynamic there isn't much chance little will get done.
Regardless of the excitement, a day like this can offer, 5 is easily fired up, getting down to business when something inspired arrives on the scene. You could say creativity and play will be the order of the day in all you do.
Consider the five connection to the fire sign Leo, sitting in the 5th house, there will be a draw for lots of play time, getting things done with passion will be more easily accomplished when it revolves around activities that are fun and exciting, whatever that may mean for you. Really, 5 could represent all of the zodiac's fire signs.
Then our very sun is in the excitement-seeking final fire sign Sagittarius, you can imagine where this is headed I bet. Put two fiery energies together in a room to play and who knows what will transpire! There could be heated bickering or passionate laughter, box forts build or plays written.
These adaptable, highly versatile energies make whatever areas they touch singe with abandon. Things can shift rapidly under these influences so be sure to stay on your toes and go with the flow.
Whatever you choose to undertake today, do it with a lively vibrant spirit and you'll be making it an amazing day worth remembering. Do something you love today, with people you care about for a future that excites you. number 5 could be summed up in two words, Carpe Diem.
There is symbolism on each Tarot card that you can use to provide insight to your daily horoscope when things are unclear. Check out your zodiac sign or today, Thursday, November 29, 2018, daily tarot reading and astrology predictions.
Aries, The Wheel of Fortune teaches about getting back what you give. If your focus is offering abundance to those around you, then you will find that coming back to you.
Sometimes it takes time to see a return as The Wheel of Fortune is cycling. There are many seasons to pass through as rewards ripen in your life. Now is a time in which you should receive.
The 5 for today will add passion to whatever comes to you. There would be something to learn and be inspired by today. Take advantage of any gifts you may encounter today so that they can grow and continue to offer you rewards.
Taurus, with The Moon tarot card, your subconscious desires could be tugging for attention. When this card appears, try to remember your dreams, journaling them and researching dream symbols is one way to let your deeper self, recognize that it's important to you too.
The 5 energy of today could have you wanting to kick up your heels and have some fun. If you can't get out for some excitement, the number 5 is highly creative, try expanding your imagination by creating an interesting work of art today.
Where you're drawn the most, in positive constructive ways, explore and see what you can find to bring more adventure into your life.
Cancer, the Judgement card appears when you're experiencing pivotal moments in your growth, spiritual, emotional or physical. This tarot energy is about absolutes. The culmination of many variant aspects of your life could be converging. This may create a vastly different picture of your future than you had dreamed possible.
5 today will be a huge motivating energy for amplification. You may be drawn out of your shell today. Find your footing among your peers, with a new found confidence, could be a theme for today. If you have an opportunity to socialize, do so with joy, don't linger on the past.
Gemini, The Lovers is the tarot card associated with your zodiac sign. This is the card of taking dualities and bringing them together in pure unity. When working with The Lovers, deepening relationships is encouraged. You may find today you can feel a sense of deep connection within yourself and in your relationships.
5 today will expand all it touches, Growth and devotion can be found in this energy. 5 enjoys a freedom not found in the other number associations. This freedom, contrary to what many may believe can be found ultimately in the joy of divine unity.
Leo, The World is an energy of seeing the past for what it is, the myriad of lessons you've learned. So many challenges you've overcome.
Today moving forward with your head high, you can see the horizon in all directions, choose where you go next with your heart and don't fret over the past.
The World teaches you to embrace yourself and the growth you've made. The 5 energy today will be visionary in nature, you can take that to a very real place.
Creating something that will offer a tangible reward will be very possible today. Using this energy to its best may have you completing an amazing project and expressing vibrant energy.
Virgo, Temperance appears to support you when a delicate decision needs to be made, or you need to create more harmony in your some aspect of your life.
Regarding Temperance as an equalizing force, allow yourself to explore the truth of moderation and what that may really mean for you. Finding a balanced emotional state is helpful in most circumstances.
The 5 energy for today may find you want to stand up and fight against some force that you perceive as restrictive. Be sure what's really holding you back isn't actually yourself.
Check yourself and any challenge that may arise so you can justly proceed in a way that eases turmoil and doesn't contribute further.
Libra, when The Hermit appears you may feel the need to draw within. Looking intuitively into yourself and your motives could be a theme for today.
The Hermit card encourages introspection in order to reset yourself for continued growth.
5 is an energetic number, you may have an active day despite a potential need to look inward. Often challenges such as competing energies can be found, its okay though, it teaches you to adapt and versatility is a function of 5. You will need to work to balance the tasks at hand while managing your internal space.
Scorpio, The Star offers you hopefulness. You may find today you can look back on where you've been to foster a deep understanding of the potential ahead.
The Star tarot card is optimistic, having grown from the lessons of the past, to see the future with beautiful lucidity.
5 today will be a push for you to shine in all you do. Under the influence of 5, you can step up in the things you choose to undertake. 5 energy is uplifting and exuberant.
These qualities will help you today in allowing yourself to find joy in all you do.
Sagittarius, The Empress for you today offers a time of nurturing and comforting pleasures. This tarot energy is very much the archetypal mother figure, she offers warmth and a feminine security. Today you might find a level of contentment in expressing yourself in a creative and caregiving way.
Number 5 energy is creative, thriving in environments where dreams are made a reality. Finding where your passions lie will reflect where this energy comes into play for you. Working with the number 5 coupled with The Empress you may find you are drawn to prepare a beautiful meal or express any artistic tendencies.
Capricorn, the Death card appearance for you today is a positive indication that you have had significant growth in many aspects of your life.
Take time today to honor the journey and how far you've come, and prepare yourself for a new cycle to begin, bring with you only the lessons.
The 5 energy today can motivate you to action. Finding lost passions can ignite a desire to be productive and accomplished today.
Using the number 5 to add oompf to your endeavors is a great way to keep some heat behind you, encouraging progress is a theme with the number 5.
Aquarius, The Emperor is a commanding fatherly figure. The energy provided through this tarot card encourages loving but firm direction.
Taking the stance of The Emperor offers you an opportunity to set clear intentions toward your highest goals. Guided yourself and others to a greater structure in creation.
5 is a rebellious energy but does not throw caution to wind easily, despite what may be believed. 5 is firm in anything this energy doesn't connect to.
Standing strong, even passionately defending one's beliefs is a theme for the number 5. Courage is tenement to the 5's energy.
Pisces, The Hanged Man encourages you to view a situation with a fresh perspective. This card is about placing yourself, willingly even, into a new position. Kind of like offering metaphorically to walk in another's shoes. Much can be gained when you suspend your assumptions long enough to experience from another person's perspective.
5 is an uniquely adaptable energy. Allowing the day to have the qualities of acceptance and spirited exploration. working with the 5 energy of today you may take close stock of what you can accomplish and expand on it.


5:00 – 6:15 Intro to Modern Dance 7 – 9 yrs.
Fitness w/ Tracy by app.
Restorative Yoga with Nichole is great! And the space is welcoming and has great energy. Definitely check it out – this is a good option to support so that more classes can be offered.