Effective 2016, the H.B. 289 planning process, the Shared Plan Model, has been updated and revised to include components of the Collective Impact Model. This updated version of the Shared Plan Model places greater emphasis on identifying and developing community-level, mutually reinforcing activities around identified shared priorities and shared outcomes. The revised model includes researching community data-informed plans, but also provides the flexibility to identify other shared priorities by other means such as data collection or a community needs assessment process.
County FCFC (FCFCs) have been required in statute since 1993 to develop and implement a process that annually evaluates and prioritizes services, fills service gaps where possible, and invents new approaches to achieve better results for families and children.
In 2006, statutory changes through the passage of House Bill 289 (HB 289) elevated this requirement and increased accountability by requiring county FCFCs to establish a process to identify local priorities, monitor progress of meeting these local priorities with indicators established by the FCFCs, and develop an annual plan that identifies the local inter-agency efforts to enhance child well-being in the county. County FCFCs are also required to demonstrate progress of increasing child well-being by reporting annually to the OFCF Cabinet Council and the county commissioners.
FCFCs completed a comprehensive planning process that resulted in the submission of their first HB 289 plan in July of 2007. In the years 2008 through 2010, FCFCs tracked their progress on achieving desired results and annually submitted a HB 289 plan and report update.
In 2010-2011, OFCF in partnership with The Ohio State University's Center for Learning Excellence, created the Shared Plan Model. In the years 2011-2016, FCFCs tracked indicators that measured the progress on achieving shared priorities and shared outcomes and annually submitted a plan update.


text:
package org.hibernate.search.demos.wikipedia;

import org.junit.Test;
import org.junit.runner.RunWith;
import org.springframework.boot.test.context.SpringBootTest;
import org.springframework.test.context.junit4.SpringRunner;

@RunWith(SpringRunner.class)
@SpringBootTest
public class HsearchElasticsearchWikipediaApplicationTests {

	@Test
	public void contextLoads() {
	}

}

redpajama_set_name: RedPajamaGithub


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text:
#ifndef SIMVOLEON_SOVOLUMEINDEXEDTRIANGLESTRIPSET_H
#define SIMVOLEON_SOVOLUMEINDEXEDTRIANGLESTRIPSET_H

#include <Inventor/nodes/SoIndexedTriangleStripSet.h>
#include <Inventor/fields/SoSFBool.h>
#include <Inventor/fields/SoSFFloat.h>

#include <VolumeViz/C/basic.h>

// *************************************************************************

class SIMVOLEON_DLL_API SoVolumeIndexedTriangleStripSet : public SoIndexedTriangleStripSet {
  typedef SoIndexedTriangleStripSet inherited;
  SO_NODE_HEADER(SoVolumeIndexedTriangleStripSet);

public:
  static void initClass(void);
  SoVolumeIndexedTriangleStripSet(void);

  SoSFBool clipGeometry;
  SoSFFloat offset;

protected:
  ~SoVolumeIndexedTriangleStripSet();

  virtual void GLRender(SoGLRenderAction * action);

private:
  friend class SoVolumeIndexedTriangleStripSetP;
  class SoVolumeIndexedTriangleStripSetP * pimpl;

  friend class CvrIndexedTriangleStripSetRenderP;
};

// *************************************************************************

#endif // !SIMVOLEON_SOVOLUMEINDEXEDTRIANGLESTRIPSET_H


text:
Business5 days ago
Bird plans to hire 1,000 people in Paris
Scooter startup Bird is betting on the French market in a significant way. The company plans to open up its biggest European office in Paris. Eventually,...
Fintech in Latin America continues to draw big dollars as SoftBank invests $231 million in Creditas
As investors continue to move more aggressively into Latin America's startup scene, there's one industry that seems to be drawing more attention than any others —...
In 2017 — for the first time in over a decade — a computer worm ran rampage across the internet, threatening to disrupt businesses, industries, governments...
3 reasons startups should exhbit at Disrupt SF 2019
Early-stage startup founders, you're searching for opportunities to take your company to greater heights, amirite? Then allow me to direct your attention to Disrupt San Francisco...
Planted joins the meatless meat melee with its pea-protein 'chicken'
Imitation meat is poised to expand its presence in our diets exponentially, if the success of dueling faux burger companies Impossible and Beyond are any indication...
Revolut opens tech hub in Berlin
Fintech startup Revolut is opening a small tech hub in Berlin. There's already a ton of fintech talent in the city as it's the hometown of...
The future of car ownership: Cars-as-a-service
Car shoppers now have several new options to avoid long-term debt and commitments. Automakers and startups alike are increasingly offering services that give buyers new opportunities...
Brooklinen, known for high-quality bed sheets, launches its first line of loungewear
Brooklinen, the direct-to-consumer bed sheet brand backed by investors including FirstMark, is entering the apparel space with its first line of loungewear. The company says its...
Techstars Detroit announce first class after major refocus
At the beginning of 2019 Techstars Mobility turned into Techstars Detroit. At the time of the announcement, Managing Director Ted Serbinski penned "the word mobility was...
Growing D2C brands face an interesting challenge. While they've eliminated much of the hassle of a physical storefront, they must still deal with all the complications...
'Alcaida': Al Qaeda spelled wrong on Trump notes to attack Ilhan Omar
Business2 hours ago

redpajama_set_name: RedPajamaCommonCrawl


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I've got a new project going and I couldn't be more excited. It's for the Rock County Historical Society (RCHS), located in Janesville, Wisconsin.
This non-profit society is no small potato. Yes, its hometown of 64,000 people is going through rough economic times, but the RCHS itself appears to be growing and thriving. So much so, in fact, they have a full time executive director, Mike Reuter, who guides support staff and volunteers in reaching out to the community—not just the city of Janesville, but all of Rock County.
It was Mike who contacted me about an upcoming campaign. But let's not digress. Let's first talk about the RCHS and the fascinating history it preserves.
The society is located on a 3.25-acre site and consists of six historical buildings, five of which are on the RCHS campus. The awesome building above is the Lincoln-Tallman House and is the highlight of the society's architectural collection. It was built in 1857 by William Morrison Tallman, a prominent lawyer and land speculator.
These windows are why I love old houses. Just look at them—does anyone still build architectural art as glorious as this?!
It was a cold and icy day when I met with the RCHS committee. Afterward I slip-slid around the grounds and drooled over these beautiful buildings. I'm anxious to come back when they're open and I can admire their interiors.
The RCHS describes the Lincoln-Tallman House as Italianate in style. Because Tallman was an abolitionist, many people believe it was a stopping point along the Underground Railroad.
Interestingly, President Lincoln stayed here in October 1859 while he campaigned in Wisconsin for his 1960 election. Note the RCHS logo at the top of this document. Also note the period typeface the society uses in carrying out the Italianate style of the house.
Even the Carriage House is beautiful. Look at the detailed door frames and rooflines!
Tallman's oldest son, William Henry Tallman, was an entrepreneur in the perfume business. These artifacts of his business are some of many showcased in the Helen Jeffris Wood Museum Center, a beautiful Craftsman-styled American Foursquare on the campus (of course, I'm a bit partial to Foursquares:-). The society did a super job of integrating an addition to this building, which also houses a gift shop and offices.
Along with perfumes, W. H. Tallman also produced flavorful food products. Aren't the labels interesting? Color, type and style all exude the period of these products.
Speaking of food…this brings me to our project.
What a fun opportunity! The building is so cool looking – that should simplify your task as a designer!
What great architecture! I pass through Janesville once in a while but never take the time to get off the main drag. Obviously, I need to do some wandering! I love when communities celebrate their histories. Everyone's got something special and they need to let the rest of the world know.
Thanks Ann. It is a cool building, isn't it? The millwork alone is enough to base a logo design from!
A lovely post, Diahann! As the son of the then-director of the RCHS I practically grew up in this house and wish it were better known!
Thanks Dan! What fun you must have had as a child spending time in such a big and intriguing house. You must have developed a great appreciation for historic architecture!
I didn't realize these wonderful treasures were so close to home. I'd love to see the buildings in person and look forward to some nicer traveling weather. Thanks for all the great photographs Di!


0%69°49°Partly cloudy with a high of 70 °F (21.1 °C). Winds from ENE to E at 4 to 14 mph (6.4 to 22.5 kph).Night - Cloudy. Winds variable at 4 to 12 mph (6.4 to 19.3 kph). The overnight low will be 59 °F (15.0 °C).
45%65°56°Scattered showers today with a high of 65 °F (18.3 °C) and a low of 56 °F (13.3 °C). There is a 45% chance of precipitation.
Today - Partly cloudy with a high of 70 °F (21.1 °C). Winds from ENE to E at 4 to 14 mph (6.4 to 22.5 kph).
Tonight - Cloudy. Winds variable at 4 to 12 mph (6.4 to 19.3 kph). The overnight low will be 59 °F (15.0 °C).


FINGAL County Council has vowed to continue to focus on the homeless crisis in 2019 and provide support and assistance for those who don't have a roof over their head.
Director of Housing, Margaret Geraghty, said there had been a "relentless focus" last year to try to support those entering homelessness and prevent people from going into homeless circumstances in the first place.
"The reality is that until there is sufficient housing supply in the system, there is going to be an ongoing challenge in relation to people who find themselves in a situation where they vulnerable to becoming homeless," she continued.
"It's vital that Fingal County Council continues to provide housing support but equally important that there is a focus on preventing people from becoming homeless in the first place.
As well as focussing on homelessness, the council says it is also working to provide a secure tenancy situation for those in the private rented sector.
"A lot of people have struggled because the private rented housing option didn't sustain them," Geraghty said.
"It is very important to us to work to prevent people from becoming homeless and to equally work with the private rented sector to bring in a more long-term supply of high quality, sustainable housing.
Geraghty praised council staff in the housing offices in Swords, Blanchardstown and Balbriggan who work to help those in need of support.


text:
Represcribing or Deprescribing? A review of evidence for patients with dementia in care homes
Dr J Blackman, Dr S Manchip
GM, 47 (2), February, 2017
Elderly care home residents with dementia are likely to be prescribed multiple medications, yet this is the group most likely to experience adverse effects as a direct result.
Declining benefits of prescribing in an elderly population
Increasing risks of prescribing in an elderly population
Anti-hypertensives
Proton pump inhibitors (PPIs)
Z-hypnotic medications
Antipsychotic medication
Diabetic medication
Calcium supplementation and bisphosphonates
Elderly patients with dementia who are residents in care homes are frequently prescribed multiple medications. The benefits of each must be weighed against the risk of harm through adverse drug reactions. The benefits of preventative medication in an elderly population are known to reduce as their associated risk of harm increases with time. Polypharmacy is also an independent risk factor for negative physical health consequences having been associated with falls, worsening cognitive impairment, hospitalisation and mortality. Unnecessary polypharmacy also incurs a financial cost and the additional time required on medication rounds diminishes opportunities for more positive interaction with residents.
This review article summarises the rationale for reducing general levels of drug prescribing and lists specific medications whose risk profile becomes less favourable in this cohort.
Firstly, robust trial data regarding efficacy and risk of harm of medications in this cohort is often not available due to the infrequent participation of this group in clinical trials.
Furthermore, medications prescribed to prevent the emergence of disease typically have time to exert their effect in a younger population. However, for an older, frailer population there may be less time for this benefit to be realised.
A 2011 BUPA Report1 revealed that the median length of stay for residents in BUPA residential and nursing homes in the UK was 462 days. In the subset of residents with dementia, the median was 43 days less. In other words, half of all residents with dementia had died approximately 13 months after arrival. Life expectancy was even shorter if analysis was confined to nursing home residents.
Whilst this short life expectancy will vary according to the specific frailty of the person in question, there is an argument that the philosophy should be to move towards more palliative, though not end of life care.
A study in Australia revealed that one in four elderly persons in the community were hospitalised for medication related problems over five years.2
The risk of adverse events also increases dramatically with the number of medications prescribed and has been estimated at 82% for concurrent prescriptions of seven drugs or more,3 highly applicable to patient groups in residential homes who are reported to be prescribed on average seven medications.4 Polypharmacy is an independent risk factor for falls when combined with a medication known to also increase this risk5 and has been associated with an increased risk of cognitive impairment.6
Adverse effects may be misinterpreted as symptoms in new diseases and be treated with medication thus exacerbating the problem. These may be direct side effects from one medication or due to an interaction eg. selective seretonin reuptake inhibitor (SSRI) and non-steroidal anti-inflammatory drugs (NSAIDs) leading to gastro-intestinal haemorrhage.
There are also direct and indirect cost implications for unnecessary prescribed medication in a healthcare system under increasing financial pressure.
In this subgroup of patients, total cholesterol has been shown to fall naturally without the need for pharmaceutical intervention. It is hypothesised that this is due to the catabolic nature of chronic disease.7
Additionally, most statins require administration late at night for maximal effectiveness. If residents are woken up for administration of medication, this disruption to the sleep cycle is likely to be harmful.
FACTORS FAVOURING RATIONALISATION OF POLYPHARMACY IN AN ELDERLY POPULATION WITH DEMENTIA IN CARE HOMES
Benefits of preventative medications limited by poor life expectancy
Financial cost
Reducing time-consuming drug administration, freeing time for care
Increased risk of drug interactions
Taking medication may be unpleasant for the patient
Polypharmacy has strong associations with:
Addressing hypertension has well established cardiovascular benefits and uncontrolled hypertension is a risk factor for Alzheimer's and vascular dementia.8 However, more advanced dementia itself causes autonomic dysregulation resulting in a subsequent fall in blood pressure. Orthostatic hypotension and persistently low blood pressure is reported to be found in 39–52% of patients with organic dementia.9
Orthostatic hypotension may increase the risk of falls by up to 50%12 and recent research would suggest that it confers a 15% increase in the long- term risk of dementia including Alzheimer's disease.10
The progressive nature of dementia therefore requires careful monitoring of the potential development of autonomic dysregulation and reconsideration of the merits of continuing anti-hypertensive prescription in this group.
Indications for PPIs include treatment of gastro-oesophageal reflux disorder and prophylaxis of gastrointestinal bleeding associated with antiplatelet therapy.
Whilst this may be appropriate, PPIs are also known to double the incidence of Clostridium difficile diarrhoea amongst hospital in-patients.11 Furthermore, amongst patients who contract Clostridium difficile, those on acid suppression therapies were 2.4 times more likely to have complications and 4.7 times more likely to die,12 an effect likely to be even stronger in the elderly and in the high risk population residing in care homes.
PPIs have been associated with chronic kidney disease and an increased risk of dementia though a cause and effect relationship has not yet been established.13 Careful consideration of the benefits of PPIs therefore needs to be weighed against the risks listed above.
WHEN TO SUSPECT ORTHOSTATIC HYPOTENSION
Dizziness/light headedness on standing
Progression in dementia
Unexplained falls
Transient loss of consciousness
Diuretics and anti-hypertensives
Alpha blockers eg. tamsulosin/doxazosin
Sleep disturbance in dementia is both common and disabling, leading to daytime hyper-somnolence, night-time wandering predisposing to falls and potential disruption to other residents in care homes. Z-hypnotic medications are commonly prescribed to address this. It is thought that 12–16% of patients with dementia in Scotland are prescribed a hypnotic or anxiolytic,14 though in care homes this figure is likely to be an underestimate with studied international rates varying from 22% to 47%.15 Their main benefit is felt to be a potential reduction of sleep latency, but a large meta-analysis has shown that The Number Needed to Treat (NNT) in order to achieve a 25 minute improvement was 13. The same study estimated that two out of every 13 patients prescribed hypnotics would experience an adverse effect.16 These included an increased risk of falls, poor coordination and the development of tolerance and subsequent withdrawal which can occur as early as one week into nightly administration.
Orthostatic hypotension may increase the risk of falls by up to 50%
As a result of this NICE guidelines suggest that hypnotic prescription should be limited and reserved for severe insomnia which is impacting on quality of life and only after an unsuccessful trial of non-pharmacological methods and optimal sleep hygiene.17
Following optimisation of non-pharmacological methods, an alternative choice to hypnotic medication is low dose trazodone (50mg nocte), which has some evidence for improving sleep in those with Alzheimer's Dementia according to a Cochrane Review18 and may be particularly helpful in suspected comorbid depression.
NON-PHARMACOLOGICAL METHODS FOR TREATING LONG-TERM INSOMNIA
Increase day time stimulation (music, games, books)
Minimise daytime napping
Encourage bedtime routine (i.e. consistent times for going to bed and getting up)
Reduce intake of stimulants/caffeine six hours prior to bedtime
Regular toileting before bedtime
Encourage relaxation 2–3 hours before bedtime
Encourage peace and quiet at bedtime minimising disruption by staff or other residents overnight
The risks of anti-psychotic medication for elderly patients with dementia are increasingly well understood. There is an increased risk of stroke (approximately 2.5% per year compared with an average baseline of approximately 1%). There is also an increased risk of death with a study estimating that following 46 weeks of use, those on quetiapine were twice as likely to have died. There is also evidence to suggest that antipsychotics are ineffective for wandering, shouting, screaming, verbal agitation, insomnia, sexual disinhibition or any other type of non-physically aggressive symptom.
Antipsychotics are indicated in those with psychosis (most commonly persecutory delusions in Alzheimer's Dementia) and physical aggression when the need is great and if other methods, such as treating pain, are unsuccessful. However, even in these situations they have limited efficacy with NNTs estimated as five for risperidone, 10 for olanzapine and 30 for quetiapine. Risperidone is the only antipsychotic licenced for treatment of behavioural problems in people with dementia and this extends for only six weeks.
Alternative non-pharmacological approaches are preferable (see Table 4). If absolutely necessary, when prescribed, a time limited prescription is highly recommended. Approximately 50% of behavioural symptoms dissipate by six months due to further progression of dementia. A stop date allows a review of medication efficacy and ensures that the symptoms have not remitted naturally.
Diabetes mellitus is a common comorbidity in care homes. The standard target for medical intervention is tight glycaemic control to minimise risks of short term complications, eg. hyperglycaemia and longer-term complications, eg. end-organ damage. Elderly, cognitively impaired patients are at high risk of hypoglycaemia. Causes for this may include impaired counter-regulatory responses and an intrinsic increasing lack of hypoglycaemic awareness. Furthermore, weight often decreases as dementia progresses, reducing insulin resistance often without a corresponding decrease in the dose of prescribed medications.19, 20
Adverse effects from hypoglycaemia are known to include falls with associated fracture and injury, cardiovascular events, transient cognitive impairment, seizure, coma and death. Importantly, hypoglycaemia in those with dementia has been shown to have a bidirectional relationship, with hypoglycaemia worsening cognitive impairment and progression of dementia increasing the likelihood of hypoglycaemia potentially setting up a vicious cycle.21
An approach whereby quality of life is prioritised over the risk of long-term complications and where medications prone to causing hypoglycaemia are avoided or reviewed in the context of weight and response is therefore recommended.
METHODS TO REDUCE ANTI-PSYCHOTIC PRESCRIPTION IN ELDERLY PATIENTS WITH DEMENTIA
Assessing and treating any co-existing pain linked with agitation
Identifying and avoiding antecedent factors i.e. Behavioural Analysis
Consider alternatives:
Memantine can reduce psychotic and agitation symptoms
Carbamazepine has some evidence for intermittent aggression
If antipsychotic medication required:
Low dose prescribing with a stop-date to allow for reassessment
Recommend three months duration
Ideally stop date on a Monday allowing residential home to call the prescriber if symptoms recur
Benzodiazepines are frequently prescribed for insomnia in the elderly, but also for behavioural symptoms associated with dementia for which there is no real evidence base. Use for longer periods of time is now known to be fraught with risk with an increased likelihood of further cognitive deterioration, delirium, falls, fractures and even death.22, 23 They may induce paradoxical agitation leading to dose increases or further polypharmacy. Once established, benzodiazepines are also potentially challenging to withdraw. They have been identified as the medication class most in need of specific deprescribing advice by healthcare professionals.24 Hence they should be introduced only with extreme caution and withdrawn as soon as possible.
OVERCOMING BARRIERS TO DEPRESCRIBING
Reframing the issue as care optimisation
Maximising time efficiency through
Targeting high risk patient groups
Targeting high risk medications
Accessing deprescribing guides and regimens
Multidisciplinary meetings focusing on deprescribing
Providing personalised information regarding risks and benefits to families or patients where applicable
Bisphosphonates are commonly prescribed to elderly patients in order to reduce the risk of osteoporotic fractures. The optimum duration of treatment has been controversial with many patients prescribed bisphosphonates indefinitely. A recent FDA report comparing multiple studies reported that those discontinuing bisphosphonates had no difference in fracture rate compared to those on active treatment and that three to five years of treatment was enough to confer this benefit. The report concluded that there was no significant advantage in continuing therapy beyond five years.25 Additionally whilst those in residential care and with dementia are much more likely to fall, a subset will have such markedly impaired mobility as to be bed bound and thus be at a reduced risk for fracture.
There are also risks in continuing long-term bisphosphonate therapy. A systematic review and meta-analysis published in 2013 showed that bisphosphonates were associated with an increased risk of subtronchanteric femoral fractures, femoral shaft fractures and atypical femoral fractures with adjusted RR of 1.7 [95% CI 1.22–2.37].
In summary, emerging evidence demands careful consideration of the benefits of longer term bisphosphonate therapy especially in the group with very limited mobility with a lower baseline risk of fracture.
Even having identified medications whose risk appears to outweigh benefit in absolute terms it can be challenging to initiate a withdrawal of the drug for multiple reasons. There may be concerns regarding reversing the prescription decision of another clinician, changing medications in a patient who appears to tolerate the current regime, fear of precipitating relapse or withdrawal, a sense that care is being 'downgraded' and limited time to initiate withdrawal.26
However, these barriers are not insurmountable. Rather than deprescribing being seen as a 'downgrade', it should be viewed as an optimisation of care and an attempt to reduce the likelihood of adverse drug events. With limited resources and time, patients at the highest risk of adverse events could be targeted. Furthermore, within this group, withdrawal of medications with the highest risk could be prioritised.27 There are specific discontinuation guides available to provide a framework and assist with withdrawing medications. Finally, where possible, multi-disciplinary meetings with deprescribing advice from pharmacologists have been shown to be helpful.28
Elderly care home residents with dementia are very likely to be prescribed multiple medications yet this is the group most likely to experience adverse effects as a direct result. This population has a limited life expectancy and the benefit, particularly of preventative medications, decreases with time. This article has focused on medications demanding particular scrutiny. There is a temptation to see discontinuing medications as a demotion in care, where in fact a re-evaluation of their effectiveness plays a crucial role in maximising quality of life and preventing iatrogenic harm.
It can therefore be argued that for the frail elderly population in care homes, the philosophy should be symptom based treatment (though not end of life care).
Dr J Blackman, Consultant Psychiatrist, Victoria Centre, 53 Downs Way, Swindon
Dr S Manchip, Consultant Psychiatrist, Victoria Centre, 53 Downs Way, Swindon
Conflict of interest: none declared
1. Forder J, Fernandez JL. Length of stay in care homes. Report commissioned by Bupa Care Services, PSSRU Discussion Paper 2769. 2011. Canterbury: PSSRU
2. Kalisch LM, Caughey GE, Barratt JD, et al. Prevalence of preventable medication-related hospitalizations in Australia: an opportunity to reduce harm. Int J Qual Health Care 2012; 24: 239–49
3. Atkin PA, Veltch PC, Veitch EM, Ogle SJ. The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging 1999; 14: 141–52
4. Elliott RA, Thomson A. Assessment of a nursing home medication review service provided by hospital-based clinical pharmacists. Aust J Hosp Pharm 1998; 29: 255–60
5. Ziere G, Dieleman JP, Hofman A, et al. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006; 61(2): 218–23
6. Niikawa H, Okamura T, Ito K, et al. Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community. Geriatr Gerontol Int 2016 doi: 10.1111/ggi.12862.
7. Solomon A, Kareholt I, Ngamdu T, et al. Serum cholesterol changes after midlife and late-life cognition. Neurology 2007: 751–56
8. Zhenchao G, Viitanen M, Fratiglioni L, Winblad B. Low blood pressure and dementia in elderly people: The Kungsholmen Project. BMJ 1996; 312 [Available from : http://www.bmj.com/content/312/7034/805]
9. Passant U, Warkentin S, Gustafson L, et al. Orthostatic hypotension and low blood pressure in organic dementia: A study of prevalence and related clinical characteristics. International Journal of Geriatric Psychiatry 1997; 12(3): 395–403
10. Wolters FJ, Mattace-Raso FUS, Koudstaal PJ, et al. Orthostatic hypotension and the long-term risk of dementia: a population-based study. PLoS Med 2016 [published online 11 October, doi:10.1371/journal.pmed.1002143]
11. Dial S, Alrasadi K, Manoukian C, et al. Risk of Clostridium difficile diarrhoea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ 2004; 171(1): 33–38
12. Morrison RH, Hall NS, Said M, et al. Risk Factors Associated With Complications and Mortality in Patients With Clostridium difficile Infection. Clinical Infectious Diseases 2011; 53(12): 1173–78
13. Lazarus B, Chen Y, Wilson FP, et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Intern Med 2016; 176(2): 238–46
14. Guthrie B. Time trends in psychoactive prescribing to people with dementia in Scotland 2001-2011. Published 2012. University of Dundee, NHS Fife
15. Connelly P. Hypnotic Use In People With Dementia – Are Our Eyes Open To The Problem? Old Age Psychiatrist 2013 (57)
16. Glass J, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005; 331: 1169
17. Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia. Technology appraisal guidance [TA77]. NICE April 2004
18. Mcleeary, et al. Cochrane Library – Pharmacotherapies for sleep disturbance in Alzheimer's Disease Online 21/3/2014
19. Holstein A, Plaschke A, Egberts EH. Clinical characterisation of severe hypoglycaemia – a prospective population-based study. Exp Clin Endocrinol Diabetes 2003; 111: 364–69
20. Boucai L, Southern WN, Zonszein J. Hypoglycaemia associated mortality is not drug-associated but linked to comorbidities. Am J Med 2011; 124: 1028–35
21. Yaffe K, Falvey CM, Hamilton N, et al. Association between hypoglycaemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med 2013; 173: 1300-6
22. Kripke, D. Chronic hypnotic use: deadly risks, doubtful benefit. Sleep Medicine Reviews; 4(1): 5–20
23. Weich S, Pearce HL, Croft P, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ 2014; 348: g1996
24. Farrell B, Tsang C, Raman-Wilms L, et al. What Are Priorities for Deprescribing for Elderly Patients? Capturing the Voice of Practitioners: A Modified Delphi Process. PLoS ONE 2015; 10(4)
25. Background Document for Meeting of Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. FDA September 2011 (http://1.usa.gov/oQbZNn).
26. Scott I, Anderson K, Freeman C, Stowasser D. First do no harm : A real need to deprescribe in older patients. MJA 2014; 201(7)
27. Best Practice Advocacy Centre New Zealand. A practical guide to stopping medicines in older people. Best Practice Journal 2010(27). http://www.bpac.org.nz/magazine/2010/april/stopGuide.asp. [Accessed Oct 2016]
28. Bregnhal L, Thirstrup S, Kristensen MB, et al. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care. Eur J Clin Pharmacol 2009; 65: 199–207
#Dementia


text:
Vietnam's PE market to drive economic growth
Flag of Vietnam (Visual by zdiviv, Freedigitalphotos.net)
By Nguyen Thi Bich Ngoc
Vietnam's private equity (PE) market is growing at a fast pace. In fact, PE investment has been one of the more significant drivers behind the country's recent economic growth, says consulting group Grant Thornton.
A young population and a burgeoning middle class are the main reason for the flow of investment, though not all of it is PE. "Few fund managers in Vietnam focus on classical PE, ie a comprehensive plan for adding value, legal agreements with investor protection/rights and board representation," said Penm Partners, which has invested in unlisted firms like Masan Resources, Asia Chemical Corp, AAA Assurance and EuroWindow.
Penm Partners, along with Mekong Capital and Vietnam Investment Group, are three firms that have an investment approach, which is based on these elements.
Others too have shown interest. In fact, there has been improvement, both in terms of investment attractiveness rating and the intention to maintain or even increase investment fund allocation to Vietnam in 2015, says Grant Thornton.
Education, real estate, food and beverage, and retail are the leading sectors which are especially attractive, for PE investors, said the officials of the Grant Thornton.
Also Read: Templeton leads $15m Series C for Vietnam restaurant operator
Regarding investment in these segments, typical deals include – KKR & Co LP (formerly known as Kohlberg Kravis Roberts & Co) and Masan Consumer, which saw the US-based PE firm double its investment by $200 million
Also, Huy Vietnam secured the B and the C series funding worth $30 million, while the VinaCapital sold stakes in Vietnam's rice seed firm An Giang Plant Protection JSC to Standard Chartered's PE arm.
The latter deal followed Standard Chartered's first deal in Vietnam for Mekong Capital-backed restaurant chain Golden Gate.
Also, Mekong Capital is raising $150 million for its fourth fund, potentially the largest among the company's units. With the new fund, Mekong Capital plans to target slightly larger deals of about $10 million, a step up from target investments of about $5 million before.
The Ho Chi Minh City-based manager largely invests in retail and consumer businesses, but will branch out into health care, especially private clinics and pharmacy retail outlets, according to an official from Mekong Capital.
Also read: Mekong Capital set to close fourth Vietnam fund
"With an optimistic view of Vietnam's economy, we see many investors paying more attention to PE sectors. They are ready to put additional resources in the market with an expectation of better long-term returns," Grant Thornton said in a report on PE in Vietnam for last year's fourth quarter.
The majority of respondents in the report chose to increase their allocation of investment funds to Vietnam. Investors believe that market growth will be the most significant driver of value growth.
Private equity investment in Vietnam in 2013 reached almost $500 million, far outstripping the capital committed to companies in the other Asia economies of Bangladesh, Sri Lanka or Myanmar, the Mekong Capital official wrote in another report.
However, it is comparatively less, when placed in the context of the Asia Pacific region, where the value of new PE investment alone has already hit $81 billion.
Also read: APAC PE activity to remain strong & sustainable in 2015: Bain & Co
Why is PE in Vietnam relatively lackluster?
Corruption, government red-tape and the legal system are still the biggest hindrances to PE investors coming to Vietnam.
In addition, deal failures are most usually caused by the difference in value expectation between buyers and sellers, and non-disclosure of material items at an appropriate time. These factors are also common worldwide.
Meanwhile, PE investors do not look merely for financial interest, but also get involved in strategic input, financial planning and governace of an investee company This ensures that their investment is effective in the long term, while transparency is obviously seen as the most critical issue when making deals in Vietnam, where information is not sufficient and difficult to obtain.
Financial planning is also an area that PE investors can provide valuable advice to the portfolio companies. Along with that, corporate governance is of great concern if Vietnamese private firms wish to be more attractive to foreign investors.
This is critical, as many investors expect to stay with the businesses for at least three years and seek a five to 10 times profit as they exit.
Vietnam needs well-managed private companies such as Golden Gate and Mobile World (investees of Mekong Capital). There is a shortage of high-level managers in the local businesses who are reluctant to hire overseas experts, Mekong Capital CEO Chris Freund told local media. He also attributed that it is a fundamental problem that the fund has encountered while investing in a Vietnamese company.
The Vietnamese market is predicted to see an increase in the number of deals this year, mainly due to the recovering economy that will provide opportunities to exit at more favourable values.
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exit Grant Thornton investment investment fund Mekong Capital Penm Partners private equity unlisted companies vietnam VincaCapital


Portable air conditioners are a common choice for people who do not want to go through the hassle of installing the big ones that take time and space. DeLonghi air conditioners are a known brand and as you read DeLonghi portable air conditioner reviews you will realize why many people like this brand.
This review will introduce you to 5 of the highly recommended DeLonghi air conditioners and give you insight into what to expect if you purchased any one of them.
DeLonghi is a company that has been in existence since 1902, it started off as a small family business making small mechanical parts. With time they switched to making the portable air conditioners which they are now known for.
With this portable conditioner, you can save on your energy bill and still have a cool room. Its 12,000 BTU is sufficient for a complete living room but I find it works best in a bedroom. I also find its noise level acceptable for a bedroom, on a hot summer night, you can sleep in a cool and calm atmosphere and no need to get up to change settings since there is a remote.
The set up is quite easy and fast so within 5 minutes or less you will be able to transfer it from one room to another. It is also great that you do not need to have a bucket to collect water dripping off.
If you want a portable air conditioner with slightly more cooling range than a 12,000BTU then you can opt for this one with 500BTU more. It is also a 4 in one unit since it can heat, cool, dehumidify and circulate air. You can program the timer so that you save energy and have it running only when you need it.
I particularly like that it is black which means it will not show that much dust so if you are lazy to dust regularly, you may appreciate this one.
Sometimes you may be just fine with only the fan especially when it is not so hot. With this PACN110EC, you can enjoy that with its fan-only setting. It is typically a 3 in one portable air conditioner, so you can also dehumidify the air as well as cool it. All functions can be easily accessed on the clear LCD screen of the remote.
I have come to realize that most DeLonghi portable air conditioners are easy to install which makes them a good portable unit.
You can choose to roll this one using the wheels or carry it using the safe grip handles on the side, though people 5 feet and under may find it a bit of a challenge carrying it. I would recommend it for an office or bedroom if you are to enjoy the maximum cooling effect.
For a portable product, it is rather large so some people may find difficulty carrying it.
Now if you are looking for a more powerful portable air conditioner then this one would be a good fit. I would recommend it for a living room or family room because it has the ability to cool large rooms in the home, but also because it may be a bit too loud for the bedroom. This air conditioner recycles the condensation so that you do not need to struggle with emptying a bucket.
It has 3 settings and you can also have the fan only and choose between 3 speeds. You, however, need to be ready to spend over 1000 dollars.
If you like the 14,000 BTU but you are not ready to spend over $1000 on it, then you can try out this cheaper one which will have 500 BTU less but a number of the same features. You will be able to enjoy the 3 in 1 feature, the BioSilver filter and a strong cooling effect for your living room and other rooms.This is a much cheaper option but I think you would still be happy with its performance, the 13,500BTU is sufficient to keep your room breezy.
Since setting it up is easy, you should not have problems transferring it from one room to another. Like most De'Longhi air conditioners, it comes with wheels to make moving it easy.
There is also a wide price range so that just about everyone can own an air conditioner. You may have to settle for fewer features on a particular product because it is at an affordable price but it is still able to deliver what it says it will. For many consumers, they are happy with the value they got for the money spent on a Delonghi air conditioner.
All DeLonghi Air Conditioners come with a warranty from the manufacturer. As long as you purchase it from the manufacturer or an authorized dealer, you should be able to get a warranty which will cover repairs and parts as long as you adhere to the terms of the warranty.
Delonghi has made a name for itself providing high-quality units to homes across the globe. Many people choose to trust a company that is already established and has a track record of providing quality.
Fan: You may want to just circulate the air in the room as opposed to cooling it. The fan option may save you a higher energy bill and sometimes it is enough just to have a fan blowing the air instead of running the conditioner.
Depending on the size of your room, you can choose any of these DeLonghi air conditioners that have received favorable ratings from different people who have used them. The 12500 BTU with a heat pump would be my choice since it can be used to heat the room as well as cool it so you can use it all year round. The PAC120E with 12,000 BTU is preferred by many and its price is reasonable so that may be what you can go for if you do not need a very powerful air conditioner. If however, you would like to cool a large room, then the 14,000BTU could be powerful enough for your entire living room. On the other hand, you can opt for a lighter air conditioner which even gives you the option of just using the fan. The PACN110E 11,000BTU gives you exactly that. With all this information you should now be able to make a choice.


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Golden Valley on the Radio
Caleb Buckley was a guest speaker on KMVR's radio show, The Sages Among Us, a program that showcases local community leaders. Hear more about Caleb and Golden Valley. The Sages Among Us aired on KVMR 89.5 FM May 15 2018 (out of Nevada City). You can connect to this broadcast through this link.
Celebrating 100 years of Waldorf Education
A postcard exchange project, Waldorf100, celebrates the 100th anniversary of the birth of the Waldorf global educational impulse. This movement connects more than 1,100 Steiner/Waldorf schools around the world. Waldorf100 is celebrating this festive occasion by sending every school pre-addressed blank postcards for students to design. Over this past year, the central office has received handfuls of these postcards from many Waldorf schools worldwide. Golden Valley Charter School students individually designed an art piece on a postcard telling a story of themselves, school, and/or country.
The central offices wishes everyone a wonderful summer! The office will be open until the end of June. Keep up to date and view our latest newsletter.
Tahoe School Charter Approved, Now Enrolling!
We are happy to announce the opening of Golden Valley Tahoe School! The Newcastle Elementary School District just approved the Golden Valley Tahoe School for a five-year charter. A large group of forty enthusiastic children and parents made the trek down from the Truckee area to the Newcastle Elementary School District office to show their passion, hard work, and love for public Waldorf school education.


A new ad by Gillette, which calls into question traditional masculinity, is facing backlash after its release this week.
The nearly 2-minute spot called "We Believe: The Best Men Can Be" narrates scenes of bullies, sexual harassment and masculinity.
The ad also highlights the role of men in the #MeToo movement.
It closes with scenes of men breaking up a fight between two boys and standing up for people.
Not everyone is happy with the commercial.
"While Gillette has a chance to modify the campaign and recover if it admits a mistake and makes some modifications if it continues down the current path this campaign will be remembered as nothing short of an all-time marketing blunder," writes Forbes.
"Part of manhood is about engaging incompetent behavior, being competent and confident in what you do," said Holton.


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Video update: Protestors blame immigration numbers for traffic woes
Philip Raphael	/ Richmond News
Members of Immigration Watch Canada took to the Blundell Rd. overpass Wednesday morning to express their concerns over Canada's immigration policy. Photo supplied
Members of the group Immigration Watch Canada took to the Blundell Road overpass in Richmond above Hwy. 99 early Wednesday morning to protest Canada's immigration policy, blaming it in part for the Lower Mainland's traffic woes.
The gathering of about a half dozen people unfurled a large, yellow and black-lettered sign stating "Fight gridlock: cut immigration" for northbound commuters to see.
Dan Murray, spokesman for the group said the level of immigration in Canada is unwarranted and wants the federal government to reduce the numbers, which he believed would help lessen the impact on city streets.
"More people, more cars," said Murray. "Every two people who come in as immigrants bring another car onto the road. That's how it works."
Member of the public's video from YouTube below:
Murray argued that Canada's immigration policy is outmoded and should cut down from the 250,000 or so people he said have been accepted annually since 1990.
"Since that time, Ottawa has never provided a single iota of justification from bringing in 250,000 people," he said. "Our current immigration intake is an abnormality in Canada's immigration history. It's causing all kinds of problems. One of which is traffic gridlock."
Disagreeing with that stance was Balwant Sanghera, director of Richmond Multicultural Community Services who said Canada has long been built by an immigrant population and should not be targeted for traffic problems as a means of coercing Ottawa to re-think its immigration policy.
"I think the government does its studies and set the number (immigration intake) every year," Sanghera said. "It's an arbitrary number, but it's flexible. Around 200,000 to 250,000 immigrants a year, I don't think that's too much. It's not out of the ordinary and seems like a reasonable number."
Sanghera said he felt it was unfortunate Immigration Watch Canada was blaming immigration numbers for clogged city streets and will realize immigrants are a vital part of Canadian society.
"They (immigrants) have contributed a lot to the country," he said. "We should be welcoming immigrants and encouraging them to integrate into the mainstream," Sanghera said. "That should be the main focus."
Immigration Watch Canada's Murray said the notion that immigration can act as an economic stimulus is false.
"Don't look to immigration, because in the years from Confederation, up until about 1990, immigration did not provide any," he said, basing his comment on a study done by the Economic Council of Canada which was disbanded in 1992.
"At the moment, lots of people in Richmond, where you've got a population that is mostly immigrant right now, has forced a lot of long-term residents to move out."
Murray added that, while some who have left may have benefitted in the short-term by cashing in on rising property values, the longer view is not positive for communities across the Lower Mainland.
The segment most hurt is made up of those trying to enter the real estate market but finding themselves shut out by rising prices, said Brad Salzberg, another one of the IWC protestors.
"Unaffordability is a huge factor. All of those younger people coming up, graduating from university, they want to buy a home, but they have to move to Chilliwack," he said, adding that is largely due to foreign investment.
"We are talking about immigration intake, not stopping immigration completely," Murray said. "So, if we need immigrants, we'll take them. But the idea that because we have taken immigrants in the past, that we are compelled to take them in the future is bloody nonsense."
A short while after the protestors put up their banner, RCMP members arrived on the scene as a result of complaints from some motorists and asked the group to ensure they did not drop anything from the overpass onto the roadway below.
The Richmond News welcomes your opinions and comments. We do not allow personal attacks, offensive language or unsubstantiated allegations. We reserve the right to edit comments for length, style, legality and taste and reproduce them in print, electronic or otherwise. For further information, please contact the editor or publisher, or see our Terms and Conditions.
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Stevovic S.
Fuzzy logic, neural networks, expert systems and its applicative correlation models
Fuzzy logic, neural networks and expert systems gives an ideal mathematical framework for complex phenomena of optimization in systems engineering. This paper is presenting the mathematical models, which are developed for correlation between technical and non technical system, theoretically and through the case study. Techno economical optimization models are often incomplete, or gives incorrect conclusion, due to lack of all relevant input variables, which have important effect on the result and decision making process, but are not easy to be quantified, such as environmental or social impact of technical solu tion. All non-technical criteria have to be incorporated in the decision-making process as well, from the very first planning step, simultaneously and equally with other technical criteria. Delphi method is one of the possibilities for quantification of non technical input variables. Neural networks are non-linear statistical data modeling tools, used to model complex relationships between inputs and outputs. The fuzzy model for technical system evaluation, proposed in this paper, operates with five input variables. The expert system is trained on 11 different technical subsystem. The input variables, together with corresponding membership functions, are chosen to describe both techno-economic and environmental parameters together with historical and political ones, because those are important for decision making process. Based on the numerical values of technical and quantified non technical input variables, the fuzzification process calculates the values of membership func tion. These membership functions values represent the inputs for the inference decision engine. Based on the set of ten 'if-then-else' fuzzy rules, the inference decision machine generates the values of membership functions adjoining the output variable called the grade of the alternative solution. Calibration of the fuzzy model involves tuning the adopted parameters that define the membership functions of input variables and the position of singletons, adjoined to the output variable and definition of fuzzy rules set. The results obtained clearly demonstrate the importance of considering the additional, non-technical criteria in the decision making process by fuzzy expert system model.