We reported previously that 18F-2-fluoro-2-deoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) had potential for evaluating early response to treatment by tyrosine kinase inhibitors (TKIs) in advanced renal cell carcinoma (RCC). This time we investigated the relation of the early assessment by FDG PET/CT to long-term prognosis with an expanded number of patients and period of observation.
Patients for whom TKI treatment for advanced RCC was planned were enrolled. FDG PET/CT was performed before TKI treatment and after one month of TKI treatment. The relations of the FDGPET/CT assessment to progression free survival (PFS) and overall survival (OS) were investigated.
Thirty-five patients were enrolled (sunitinib 19 cases, sorafenib 16 cases). The patients with RCC showing high SUVmax in pretreatment FDG PET/CT demonstrated short PFS (P =0.024, hazard ratio 1.137, 95% CI 1.017-1.271) and short OS (P =0.004, hazard ratio 1.210 95% CI 1.062-1.379). Thirty patients (sunitinib 16 cases, sorafenib 14 cases) were evaluated again after 1 month. The PFS of the patients whose SUVmax decreased<20% was shorter than that of the patients whose SUVmax decreased<20% (P = 0.027, hazard ratio 3.043, 95% CI 1.134-8.167). The PFS of patients whose tumor diameter sum increased was shorter than that of the patient with tumors whose diameter sum did not (P =0.006, hazard ratio 4.555, 95% CI 1.543-13.448).
The patients were classified into three response groups: good responder (diameter sum did not increase, and SUVmax decreased ≥ 20%), intermediate responder (diameter sum did not increase, and SUVmax decreased<20%), and poor responder (diameter sum increased, or one or more new lesions appeared). The median PFS of good, intermediate, and poor responders were 458 ± 146 days, 131 ± 9 days, and 88 ± 26 days (good vs. intermediate P = 0.0366, intermediate vs. poor P = 0.0097, log-rank test). Additionally the mean OSs were 999 ± 70 days, 469 ± 34 days, and 374 ± 125 days, respectively (good vs. intermediate P = 0.0385, intermediate vs. poor P = 0.0305, log-rank test).
The evaluation of RCC response to TKI by tumor size and FDG uptake using FDG PET/CT after 1 month can predict PFS and OS.
Renal cell carcinoma (RCC) accounts for 3% of all adult cancers . Approximately 30% of patients are diagnosed with metastases and an additional 20-40% of patients develop metastases after radical nephrectomy with curative intent [2, 3]. Cytokine therapies were the only systematic treatments available for advanced RCC for a long time, and the outcome of patients with metastatic RCC has been poor, with a median survival time of 10 to 21 months [4, 5].
Recently, the oncogenic mechanism of RCC has been elucidated and drugs that target relevant biological pathways have been developed. Tyrosine kinase inhibitors (TKIs) such as sunitinib and sorafenib which target vascular endothelial growth factor (VEGF) receptors improved the prognosis of patients with metastatic RCC [6, 7]. The antitumor activity of TKIs is not cytotoxic, like classical antitumor therapeutics, but rather cytostatic, suppressing biological activity by inhibiting angiogenesis. Practically, some RCCs treated with the TKIs do not decrease in tumor volume but enter a period of long-term dormancy, without enlargement of volume or novel metastasis. It has been suggested that a new assessment focusing not only on the volume of the tumors, but also biological activities to evaluate the antitumor activity of TKIs is necessary.
18F-2-fluoro-2-deoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) is a useful non-invasive tool to evaluate glucose metabolic status, which can be the index of biological activity of cancer. Although PET has not been generally used for the screening of RCC due to the urinary excretion of the radiotracer, which can mask the presence of primary lesions [8, 9], several investigators have reported recently that FDG-PET/CT had sufficient potential to evaluate advanced RCCs [10–12]. We previously reported the potential of FDG PET/CT as a tool to evaluate the early response to TKIs in advanced RCC, but the number of cases was small and the observation period was short . This time, we investigated the potential with an expanded number of patients and period of follow-up.
Thirty-five patients were enrolled in this study. Patients had to be referred to Yokohama City University before the start of their treatment, from June 2008 until March 2011. This was a prospective study to clinically follow enrolled patients planning to undergo TKI therapy for advanced RCC. The pathologies of enrolled cases were confirmed by prior nephrectomy or biopsy. Patients with uncontrolled diabetes mellitus (blood glucose level >150 mg/dL) , with other known malignancies, and those treated with therapeutics during the 2 weeks prior to the scan were excluded. The study protocol was approved by the Yokohama City University Institutional Review Board. Written informed consent was obtained from all patients. The decision for patients to undergo therapy was made before the evaluation by PET/CT.
Sunitinib was given orally once a day at the dose of 50 mg in 6-week cycles consisting of 4 weeks of treatment followed by 2 weeks without treatment. Oral sorafenib 800 mg was given daily. The dose of sunitinib was reduced to 37.5 or 25 mg and that of sorafenib was reduced to 600 or 400 mg according to pretreatment general condition or major adverse events during treatment. Treatment was continued until disease progression, unacceptable adverse events, request by the patient, or surgery including nephrectomy.
Patients fasted for at least 6 hours prior to intravenous injection of 18F FDG. PET/CT images were obtained using a PET/CT system (Aquiduo 16; Toshiba Medical Systems, Tokyo, Japan). PET/CT images were acquired from the top of the head to the mid thigh at 60 min after intravenous injection of 2.5 MBq/kg of [18F] FDG. A low-dose non-contrasted CT scan was acquired first and used for attenuation correction. Emission images were acquired in 3-dimensional mode for 2 min per bed position. After PET acquisition, contrast-enhanced CT was performed with a 2-mm slice thickness, 120 kV, 400 mA, 0.5 s/tube rotation, from the top of the head to the mid thigh, with breath holding. A total of 100 ml contrast medium (iopamidol) was administered intravenously at a rate of 1.0 ml/s. The scan delay was set at 120 s after starting the injection of contrast material. The patients with serum creatinine level >1.5 mg/dL were examined without contrast material. Images were reconstructed by attenuation-weighted ordered-subset expectation maximization (OSEM) (four iterations, fourteen subsets, 128 ´ 128 matrix, with 5-mm Gaussian smoothing). The standardized uptake value (SUV) was determined according to the standard formula, with activity in the volume of interest (VOI) recorded as Bq per ml / injected dose in Bq per weight (kg). The maximum SUV (SUVmax) was recorded using the maximum pixel activity within the VOI. To obtain the SUVmax of the individual patient, the SUV of all lesions in tumors diagnosed as RCC by CT imaging were analyzed.
Cox proportional hazards model was used to assess the impacts of pretreatment SUVmax, SUVmax change ratio, total diameter change ratio, and clinical parameters on progression-free survival. The progression-free survival and overall survival curves were estimated by the Kaplan-Meier method, and the resulting curves were compared using the log-rank test.
The statistical difference of SUVmax and SUVmax change between clear cell carcinoma and papillary carcinoma was determined by two-side Mann-Whiteney's U-test. All statistical analyses were carried out with SPSS software (SPSS, Inc, Chicago, IL). Significance was assigned at P<0.05.
Thirty-five patients were enrolled in this prospective study and evaluated by FDG PET/CT before treatment with TKIs (sunitinib 19 cases, sorafenib 16 cases). When the highest lesion SUV in individual patients was defined as SUVmax, SUVmax of the 35 patients ranged between 2.3 and 16.6 (mean 9.0). The patients with RCC tumors showing high SUVmax demonstrated short progression-free survival (PFS) (P = 0.024, hazard ratio 1.137, 95% CI 1.017-1.271) and short overall survival (OS) (P =0.004, hazard ratio 1.210 95% CI 1.062-1.379).
Thirty patients (sunitinib 16 cases, sorafenib 14 cases) were evaluated again after 1 month of treatment; the other, 5 patients (4 clear cell and 1 sarcomatoid) demonstrated deterioration of general status due to rapid progression within 1 month. The SUVmax range of the 5 patients was 8.9-16.6 (mean 14.1). The clinical characteristics of the 30 patients are detailed in Table 1. There were 25 men and 5 women. The mean age was 64 years (range, 32–80). Of all 30 patients, 23 had pure clear cell carcinoma, 5 had papillary carcinoma, 1 had clear cell carcinoma mixed with sarcomatoid component, and 1 long-term dialysis patient had a heterogeneous pathology with clear cell type and papillary type. The mean SUVmax was 8.1 (range, 2.3-16.1). The mean SUVmax of 23 pure clear cell carcinoma was 7.6(range, 2.3-14.8) and the mean SUVmax of 5 papillary carcinoma was 9.7 (range, 3.9-16.1). There was not statistical difference (P =0.413). The SUVmax of clear cell/sarcomatoid was 9.1. The SUVmax of the celar cell/papillary was 9.5. According to Memorial Sloan-Kettering Cancer Center (MSKCC) classification , one patient had favorable risk, 21 intermediate risk, and 8 poor risk. Twenty-two patients had undergone nephrectomy. Nineteen patients had no previous systematic therapies. Three patients had been treated previously with sorafenib and the treatment ended more than 1 month before the pretreatment evaluation by FDG PET/CT. Nine patients had previously been treated by IFN-alpha, and 2 by chemotherapy.
The mean duration of observation was 458 days (range, 67–1114). At the date of analysis, 18 patients showed progressive disease (PD) as evaluated by RECIST version 1.1 and 10 patients had died due to progression of RCC. No patients had died for other reasons. The median PFS was 209 days (range, 27–887). Three patients (sunitinib, 2; sorafenib, 1) underwent nephrectomies after TKI treatment. Of the 14 patients treated with sorafenib, 10 patients changed to sunitinib due to PD, and 4 of the 10 patients changed to everolimus sequentially. One of the 14 sorafenib-treated patients changed directly to everolimus. Of the 16 patients treated with sunitinib, 4 patients changed to everolimus and 1 patient changed to sorafenib due to PD.
The impacts of some clinical parameters on PFS were analyzed by Cox proportional hazards modeling (Table 2). There was statistical difference only between the patients with liver metastasis and the patients without liver metastasis (P =0.004).
In pretreatment FDG PET/CT of the 30 patients who underwent two-time assessment, FDG accumulation was detected in 95 lesions of 107 lesions (89%) whose diameters were 1.0 cm or more. The mean number of RCC lesions in the individual patients was 3.5 (range, 1–9). The median date of the second FDG PET/CT after TKI treatment started was day 31 (range, 27–47). The median SUVmax in the second FDG PET/CT was 7.1 (range, 3.7-15.5). The mean ratio of SUVmax change compared with pretreatment FDG PET/CT was −18% (range, -55 to 65%). The mean ratio of the diameter change was −6% (range, -30 to 30%). No lesion remitted completely. A new lesion appeared in only 1 patient. The mean ratio of SUVmax change in clear cell carcinoma was −14.0%(range, -54.9%- 65.2%), and that in papillary carcinoma was −1.1%(range, -35.4%- 15.7%). The mean ratio of the diameter in in clear cell carcinoma was −5.7%(range, -30.2%- 29.7%), and that in papillary carcinoma was −6.5%(range, -22.4%- 13.8%). The ratios of SUVmax change and diameter change were not statistically different between clear cell carcinoma and papillary carcinoma (SUVmax change: p = 0.193, diameter change: p = 0.954).
According to the European Organization for Research and Treatment of Cancer (EORTC) criteria , in which the SUV cut-off point is 25%, 9 patients had a partial metabolic response, 14 patients had SD, and 7 had PD. None achieved complete remission (CR). There was no statistical association between the evaluation by EORTC criteria and PFS. However, the PFS of the patients whose tumor SUVmax decreased<20% after 1 month was shorter than that of those whose tumor SUVmax decreased<20% (P = 0.027, Cox hazard ratio 3.043, 95% CI 1.134-8.167). Additionally, the PFS of patients whose tumor diameter sum increased after 1 month was shorter than that of the patients whose tumors diameter sum did not increase (P = 0.006, hazard ratio 4.555, 95% CI 1.543-13.448).
Using these two predictive factors, we defined new and simple criteria for evaluating tumor response to TKI of advanced RCC as follows: good responder, diameter sum does not increase and SUVmax decreases<20%; intermediate responder, diameter sum does not increase and SUVmax decreases<20%; and poor responder, diameter sum increases or one or more new lesions appear.
According to the new criteria, the 30 patients were classified into 12 good responders (blue bars in Figure 1), 10 intermediate responders (yellow bars in Figure 1), and 8 poor responders (red bars in Figure 1). The median PFS of good, intermediate, and poor responders were 458 ± 146 days, 131 ± 9 days, and 88 ± 26 days, respectively. There was a statistical difference among these three groups (good vs. intermediate P = 0.0366, intermediate vs. poor P = 0.0097, log-rank test) as shown in Figure 2. Additionally, the mean OS of good, intermediate, and poor responders were 999 ± 70 days, 469 ± 34 days, and 374 ± 125 days, respectively (good vs. intermediate P = 0.0385, intermediate vs. poor P = 0.0305, log-rank test) as shown in Figure 3.
The association between PFS and change ratios of SUVmax and the tumor diameter sum after 1 month in individual patients. The information about PFS (days) was added as height to the 2-dimensional graph demonstrating the change ratios of SUVmax (horizontal axis) and those of tumor diameters sum (vertical axis) after 1 month in individual patients. Blue bars show the PFSs of good responders (diameter sum does not increase and SUVmax decreases ≥ 20%), yellow bars indicate those of intermediate responders (diameter sum does not increase and SUVmax decreases<20%), and red bars indicate those of poor responders (diameter sum increases or new lesions appear).
Kaplan-Meier curves of progression-free survival in 30 patients according to our response criteria.
Kaplan-Meier curves of overall survival in 30 patients according to our response criteria.
This work demonstrated that the early assessment of response to TKIs using a combination of FDG uptake and tumor size could predict not only the PFS but also the OS of patients with advanced RCC. To our knowledge, it is the first to address this issue. The benefit of assessment by FDG uptake as well as is the ability to evaluate the biological dormancy induced by the treatments. Although the prognosis of advanced RCC was dramatically improved with the development of TKIs such as sunitinib or sorafenib, the best responses were usually found in stable diseases according to RECIST. Indeed, treatment by sunitinib is associated with 31% overall response rate and that by sorafenib was only 2% in clinical trials [6, 7]. Some RCCs treated with TKIs do not decrease in tumor volume but maintain long-term dormancy without enlargement of volume or novel metastasis. But there have been no clinical answers to the question of whether an individual case treated with TKIs whose tumors did not decrease in size should continue the treatment or change to other therapeutic options including other TKIs and mammalian target of rapamycin (mTOR) inhibitors, which have been reported to benefit patients with advanced RCC [16, 17]. This was primarily because there has been no biological marker to evaluate the biological activity of RCCs, especially the dormancy induced by TKIs. In this regard, FDG PET/CT is a useful tool to evaluate glucose metabolic status, which can be the index of biological activity of cancer; a decrease of FDG accumulation can express the biological dormancy of RCC induced by TKI treatment. Indeed, a patient with only 7% decrease in tumor diameter sum and 20% decrease in SUVmax maintained an SD status for 887 days (Figure 4) and another with only 3% decrease in the tumor diameter sum and 20% decrease in SUVmax achieved 458 days of SD in our series.
A patient demonstrating long tumor dormancy. 57 y.o. female with mediastinal lymph node metastasis. CT images at (A) pretreatment state and (B) post-treatment state, PET images at (C) pretreatment state and (D) post-treatment state, fused PET/CT images at (E) pretreatment state and (F) post-treatment state. The diameter of mediastinal lymph node decreased 7% and its SUVmax decreased 20% in post-sunitinib treatment state. She maintained an SD for 887 days.
There have been trials to evaluate the tumor dormancy other than by tumor volume. Krajewski KM et al. previously reported that tumor attenuation in contrast-enhanced CT (CECT) predicts the outcome of RCC patients treated with sunitinib [18, 19]. In our study, most patients whose tumors demonstrated attenuation had a decrease in SUVmax and their prognoses proved to be good. However, we experienced one case in which tumors showed apparent attenuation of contrast-enhancement but a decrease of only 5% in FDG uptake, and his prognosis was poor (Figure 5). It was speculated that some RCCs continue to progress against the inhibition of angiogenesis, and that attenuation was not a sufficient condition to reflect tumor dormancy. Additionally, the renal function of most patients with advanced RCC is deteriorated due to nephrectomy or the existence of the original tumor, and CETC entails a risk of worsening kidney function. So, we think that the evaluation by FDG PET/CT is more precise and safer than that by CECT.
A patient demonstrating rapid progression. 59 y.o. male with thoracic vertebral metastasis. CT images at (A) pretreatment state and (B) post-treatment state, PET images at (C) pretreatment state and (D) post-treatment state, fused PET/CT images at (E) pretreatment state and (F) post-treatment state. The CT images showed that the metastatic lesion had homogeneous contrast enhancement at pretreatment status and the enhancement was attenuated apparently in post-sorafenib treatment. The SUVmax decreased only 5%. He died on day 88.
However, it was not sufficient to assess the response to TKIs of RCCs by FDG uptake alone because there were some RCC cases with decreased SUVmax but increased tumor volume, and their prognoses were poor as shown Figure 1. In our series, 3 patients demonstrated a decrease in SUVmax ≥ 20% but an increase in tumor size after 1 month, and their PFSs were very short: 28, 28, and 146 days, respectively. Additionally, the classification of our series by EORTC criteria, which assess the response by FDG uptake, was not statistically associated with prognosis. Kayani et al. previously reported that the assessment of patients with RCC treated with sunitinib by FDG uptake alone after 4 weeks failed to predict the disease course . These results suggested the existence of RCCs that progress independently of glucose uptake, and emphasize the need for a combination assessment of both tumor size and FDG uptake.
Some questions remain. We defined metabolic response as a ≥20% reduction of SUVmax in the novel criteria we advocated. The EORTC proposed a SUV diminution of 15-25% for a partial response after the first cycle. Kayani et al. the defined cut-off point as 20% when they evaluated the response to sunitinib in metastatic RCC and succeeded in predicting the disease course by assessment after 16 weeks. Lyrdal et al. reported that responders with a decrease of ≥20% FDG accumulation to sorafenib had a long OS. A further study expanding the number of patients is necessary to verify this cut-off point.
The evaluation of RCC response to TKI treatment by tumor size and FDG uptake using FDG PET/CT after 1 month can predict not only the duration of response to TKIs, but also survival duration. Early assessment by FDG-PET/CT provides useful information to determine strategies for individual patients with advanced RCC. However, larger studies are needed to confirm these preliminary results.
This works was supported by Grant for Research and Development Project II (No. 17) of Yokohama City University, Japan and " Establishment of research center for clinical proteomics of post-translational modifications" as part of the Special Coordination Fund for Promoting Science and Technology "Creation and Innovation Centers for Advanced Interdisciplinary ", and Grants-in-Aid for Scientific Research (No. 22591775) from the Ministry of Education, Science, Sports and Culture of Japan.
NN had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript. Study concept and design: DU, MY, UT, RM, TI, YK, NN. Acquisition of data: KM, KN, TM, TK, KK, SN, II, YO. Analysis and interpretation of data: DU, MY, NN. Administrative, technical, or material support: TI, YK, NN. Drafting of the manuscript: DU. Critical revision of the manuscript for important intellectual content: NN. Obtaining funding and supervision: NN.


text:
Overview for George Wilbur
George Wilbur
Poltergeist (1982) July 19 (ET) - REMINDER
Star Trek II: The Wrath of Khan (1982) July 30 (ET) - REMINDER
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redpajama_set_name: RedPajamaCommonCrawl


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The National Insurance Commission (NAICOM) has approved the appointment of Mr Samuel Oghenebrume Ogbodu as the Managing Director of Sunu Assurances Nigeria Plc.
The regulatory agency for insurance industry in the country, in a letter dated February 1, 2019, said Mr Ogbodu can now pilot affairs of the company.
The new MD of Sunu Assurances is a Chartered Insurer and a member of the Society of Fellows of the Chartered Insurance Institute of Nigeria.
He is a highly seasoned professional with track record of success in surpassing revenue, cost, profit and business growth objectives.
Mr Ogbodu was part of the team that set up Sovereign Trust Plc in 1994. He contributed immensely to the growth and development of the Company and by dint of hard work, commitment and resilience, rose to the position of Executive Director/Chief Operating Officer.
Mr Ogbodu has special skills in turnaround management and projects with 100 percent success rate. He is an Alumnus of Lagos State University, Lagos Business School and University of Lagos and a member of the prestigious Ikoyi Club 1938, IBB Golf and Country Club, Abuja and Institute of Directors (IOD).
In a related development, the board of Sunu Assurances Nigeria has announced the appointment of Mr Adeleke Emmanuel Hassan as the Executive Director in charge of Technical & Operations.
However, this appointment is subject to the final approval by NAICOM.
Mr Hassan is a consummate and seasoned Chartered Insurer with over 25 years cognate experience in the insurance industry spanning from broking to underwriting businesses.
Mr Hassan joined Equity Assurance Plc (Now SUNU Assurances Nigeria Plc) in 2003 where he rose to become the General Manager, Marketing and Business Development.
He is an Alumnus of Ambrose Alli University and Lagos Business School and has attended numerous seminars and courses locally and overseas in the course of his career.


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My collaboration with Miley Cyrus started about 4 years ago when I saw her on the TV singing, and I was like, 'My goodness, that is one of the greatest voices I've never worked with.' So I texted her and texted her – for about 4 years – and finally a few months ago we hooked up and made this song that we love.


text:
Russia Adopts Protocols for Burying the Population in Mass Graves in Case of Catastrophic Event
What the...?
Elena Ivanova 14 Dec 21 18216 33
Editor's note: This could be A.) nothing, B.) covid scaremongering, or C.) preparations for WW3.
Machine translated from Russian.
From February 1, 2022, for the first time in Russia, the national standard "Urgent burial of corpses in peacetime and wartime" is being introduced. It describes that the authorities must be prepared to bury thousands of people in mass graves. The standards for graves, labor costs, the amount of equipment and the way of storing corpses have been established.
As "NI" found out, on September 13, 2021, the Federal Agency for Technical Regulation and Metrology issues an order, which approves the rules for the urgent burial of corpses in peacetime and wartime. As expected, this strictly technical document outlines all the disposal work point by point. Here is a quote from this noteworthy document:
"The main types of work in this case will be:
development of a pit for the construction of a mass grave;
preparation of a pit for the burial of bodies (remains):
preparation of bodies (remains) of the victims for burial;
layout of the first row of bodies (remains) of those killed in mass graves:
sending of the first row of bodies (remains) of the deceased;
the layout of the second row of bodies (remains) of those killed in mass graves;
backfilling of the second row of bodies (remains) of the deceased;
backfilling of mass graves. "
To calculate the possible irrecoverable losses among the population, the document introduces the concept of "the degree of destruction of the city." The authors of the document proceed from the assumption that the population will die from conventional weapons, therefore, the maximum losses among the unprotected population, in which the degree of defeat is taken as one, will amount to 30%. In shelters, 5% of the city's inhabitants will die , in the simplest shelters – up to 10%.
At enterprises, in the event of their defeat by conventional weapons and the death of 55% of workers, the losses will be considered "complete irrecoverable".
The new national standard deals with the loss of many thousands of civilians – not about dozens, not hundreds, but about THOUSANDS. And it is written in Appendix A to the standard: here is an example of how much manpower and resources will be required to bury "1000 dead within 3 days".
Officials have established the size of the mass graves. If, dear fellow citizens, we all lie down for no reason, they will bury us in mass graves 20 meters long, 3 meters wide and 2.3 meters high. They will be dug by bulldozers with an average productivity of 80 cubic meters per hour. The bottom of the grave will be covered with a mineral binder modifier and then compacted with a roller.
Then they will lay us in four layers, either in bags, or in wooden coffins or zinc coffins, prepared in advance in the amount of 300 pieces per 1000 population, and cover us with earth. Then they will again tamp them down, fill them with "mineral binder" and install "devices for the absorption and neutralization of radioactive, hazardous chemicals and biological agents formed during the decomposition of corpses."
Here's a plan.
Defenders of such state actions say that the appearance of this strange and even frightening document is connected, first of all, with the covid.
"The law was being prepared for six months so that you know. We have not yet had forecasts of how the Russian people will die, whether they will be a thousand a day, or 20 thousand a day. All this requires the state to respond appropriately, so that they do not whine, whine and say: here, Mishustin, how many are dying, and people are lying on the roads. The state decided to play ahead of the curve and insure itself in case things go down a critical path," says Viktor Baranets, a military expert and Vladimir Putin's electoral confidant .
If we consider that the document was adopted at the end of September, but its authors, after a year of the pandemic, it was clear that although 1000 people die from the coronavirus a day, mass graves are not needed for their burial. What new epidemic the Russian authorities are preparing for remains a big mystery. It is also unclear with which of the scientists the authors consulted, and who told them that humanity is about to face such a disease that it is necessary to procure bulldozers for digging graves for mass graves. On condition of anonymity, Novye Izvestia spoke with several generals of the Ministry of Emergency Situations. Even for them, this document came as a surprise, to put it mildly. One of them could not contain his emotions: "They are there oh … and!"
Military expert Alexander Golts is sure that when regulatory documents are needed that determine how much labor is needed to collect corpses, their burial and other elaborated details, this means one thing: such losses can only occur when weapons of mass destruction are used. No natural disaster can cause such a number of losses, neither an earthquake, nor a volcanic eruption:
"Those who prepared these standards thought in terms of either a global epidemic or a global war, in which not only the military, but also the civilian population would die. This is only possible with the use of nuclear weapons. As in an anecdote from the times of the USSR: what to do in case of a nuclear strike? Wrap yourself in a sheet and slowly crawl towards the cemetery to make their work easier…"
Apparently, the authors of the document proceeded from the fact that as a result of a global war, not only the military, but also the civilian population would die. Viktor Baranets agrees with this . They also decided to tackle wartime, the expert says. According to the hawks, Russia has too many military threats in the west, south and north:
"We do not know if Ukraine will attack the Donetsk and Lugansk republics. We do not know if we will interfere. For now, we are saying that we will not interfere. But out of these 100%, in 99 cases we say that we will not attack, but it may turn out that we will have to send troops not only to the Donetsk and Lugansk regions, but also to the greater Ukraine. We also have a smoke-fused fuse in the Black Sea region. There are also dangers in the region of the Russia-Belarus Union State. It is alarming in the Kaliningrad region. There are grandiose plans for the immediate capture of the Kaliningrad region, even with the use of nuclear weapons. And how, then, will we bury? One by one, or what?"
Even Colonel General Ivashov , the former head of the Main Directorate of International Military Cooperation of the Ministry of Defense of the Russian Federation, who can hardly be called a political dove, calls for a more cautious attitude towards both military rhetoric and the plans of the military in the Ukrainian direction. This, according to the general, only plays into the hands of the Americans:
"If we are talking about mass graves, the Russian side is actively involved in this, a war with Ukraine is being prepared. Neither the Ukrainian people, nor the Russian people certainly need this war. I do not exclude that it is Russia that initiates this war. We see the escalation. They have been preparing for this war for a long time. All talk shows in recent years have turned our population against the Ukrainians. On the Ukrainian side, the opposite is true. Who is the beneficiary here? Naturally, the beneficiaries will be the Americans."
However, the new standards speak not of a local conflict, but of military operations of a huge scale, comparable to the Second World War, says Alexander Golts. Today in Europe there are simply not enough troops to arrange such a massacre:
"It will take another ten years, according to my estimates, for such a number of troops to be built up in Europe. There are not so many people in Russia to arrange a battle comparable to the battles of World War II. The women let them down, they did not give birth, as Kvashnin said."
(A.V. Kvashnin, General of the Army, Chief of the General Staff of the Armed Forces of the Russian Federation – First Deputy Minister of Defense of the Russian Federation 1997-2004)
Defenders of the new standard remind that we have forgotten about the time when Russia was dying in millions. Then the authorities showed a long reaction, but now they decided to play ahead of the curve. If there is such a development of events when it will be necessary to bury in hundreds and thousands, we will already have the rules of the game. For this, it is necessary to allocate certain personnel, certain equipment, money, up to firewood in the crematorium, until we receive plots where we will bury these people. Everything should be thought out – from A to Z. We are preparing for major crises, says Viktor Baranets.
Doctor of Political Sciences, Professor Yuliy Nisnevich states that there is an injection, but it is difficult to understand what injection of which, and most importantly, why, is difficult:
"It is clear that no one needs any real war. More like muscle flexing. I'm not sure about the alarmist ideas that someone is preparing for something. If something serious was being prepared, it would be constructed a little differently."
Most likely, the initiators and authors of the new document are preparing for the war, but not for the future, but for the past. An optimistic answer to the question of why this terrifying document was adopted at all is to close some legislative holes, says Professor Nisnevich:
"It is unlikely that this GOST is connected with the current situation. And they were buried in mass graves when they could not identify the dead. It is impossible to imagine such a thing in modern Europe and Russia."
Less peace-loving fellow citizens argue that it is necessary to prepare any department, all power structures and the army for any development of events, be it war or plague:
"Yes, yes and yes! In any case, you will have to do mass graves. We must be ready, from the coffin to the ground, before it is cremated. We all have to think it over. How should we localize areas."
Novye Izvestia asked Rosstandart for clarification. At first, the department promised to give a prompt answer. But all the deadlines have passed, according to which departments are obliged to respond to press inquiries, and there has been no response. Meanwhile, in order to clarify the situation, I still wanted to know who initiated the creation of a new standard on mass graves. From the standard itself, it can be understood that the document was developed by the Federal State Budgetary Institution All-Russian Research Institute for Civil Defense and Emergencies EMERCOM of Russia (Federal Center for Science and High Technologies).
As they used to say in the theater: the author!
Source: Novye Izvestia
For what to repeat to the goyim that yhe jew globalists are murdering you since 911? Dear cattle seed,the next horse,3rd horse of the globalist apocalypse is STARVATION! Dear unbelieving cattle seed( goyim), in the 4th horseman, in 2025, you are dead in billions! And I won't feel for none of you! You had the control over your body and soul, and you have choosen how to die!!!!
Dawn Harris says 1 year ago
Jerry. By far the most lucid comment. The 4th Horse is it. Where you got 2025 from I'm not sure. Starvation is already in many countries and may not impact so much on others. This would shorten the time frame. You may be right but I'm never confident giving dates. This is Gods job. Thanks 😊 NZ
Matrixdissident says 1 year ago
Gives going green a new meaning.
Maiasta says 1 year ago
In addition to "A.) nothing, B.) covid scaremongering, or C.) preparations for WW3", there is also a fourth option: preparation for mass mortality from the vaccine. These same protocols have been adopted widely around the world, as this British funeral director discusses:
https://rumble.com/vmn7bd-funeral-director-john-olooney-blows-the-whistle-on-covid-with-max-igan-must.html
One might ask why vaccine fatalities would suddenly surge. But anyone who has followed the graphene oxide question knows that vaccinees who present with rGO (and it's not all vaccinees) are now antennas which are modulable by radio frequencies. This is not necessarily for what excitable types see as "mind control" (although terahertz frequencies allow for this kind of thing). Rather, the interaction of rGO with radio frequencies means that the body-wide inflammatory syndrome ("Covid") can be switched on at will.
And this is likely what is behind the widely-observed fact that the top 12 countries for "Covid" mortality in 2020 were all the countries that had flu-jabbed 50% or more of their senior populations in 2019. And we have concrete evidence for the presence of graphene oxide in various brands of flu vaccines. In other words, many of us (principally the elderly) had already been seeded with this material beofre the Covid "vaccines" were ever rolled out.
This is a slow-motion democide. So Russia's adoption of these protocols should not be taken lightly.
J R says 1 year ago
The graphene oxide connedspiracy has been proven completely false. You should know this by now, but apparently don't, which makes you another connedspiracy moron. So instead of actually addressing the article in question, you rant on about another connedspiracy, which most certainly makes you another connedspiracy moron. Connedspiracy morons have polluted and poisoned reasoned informed debate and discussion and should simply be ignored or even better, banned off the Internet until such time as they gain a modicum of understanding and comprehension in reality and facts.
The Ogs says 1 year ago
Is it not time for a booster for you, JR…?
Nothing to fear, heheh…
arizona says 1 year ago
JR,go back to your DADDY SATAN and tell him he failed..you and him go back where you came from ,..HELL…
Healthyunvaxxedskeptic says 1 year ago
Do you have a link to back up your claim?
blagostwin says 1 year ago
Graphene Oxide good. Every one should have it coursing through their veins. Hopefully you're loaded up with the stuff.
steve kastl says 1 year ago
Terrified for the world's future with Talmudic cult criminals in charge of the USA and wanting nuclear war if they can no longer in charge of the world. Sociopathic reasoning like that is very Talmudic and very Israeli.
Dave says 1 year ago
Christians killing Christians, what's not to like?
Such a bargain for us satanic kosher goblins!
johnwaits says 1 year ago
i knew it…
Michael Mazur says 1 year ago
They dare not write in terms of tens of millions dead as it's too mind numbing because that's too many even for mass graves, so they confine themselves to what is manageable, a few thousand laid in neat rows.
NobodyUKnow says 1 year ago
Plus, they want to avoid sparking mass panic. The document and its actual intent remind me of a situation I experienced in the office where I worked back in the days when Kim Jong Un of North Korea was threatening to lob a nuke at New York.
As it turns out, my city was in the direct flight path of the missile that might have been launched, and there was a risk that the missile could run out of fuel or go off course and land on my city.
So, one day my employer ran an 'earthquake drill' for the entire office, where we would go into main hallways where there were only a few doors and no windows.The idea behind the drill was to get us away from our desks so that we wouldn't get hit by flying glass caused by the quake. But the windows in my office building were heavily laminated and flying glass would not be a major risk, because in an earthquake, the shards of glass wouldn't fly in but drop to the ground.
A light bulb went off in my head when I realized my city doesn't get earthquakes, but occasionally experiences mild aftershocks from distant places in the region that are prone to small earthquakes that don't cause much,if any damage and don't cause any loss of life.
I also realized that having employees move to an inner hallway during an actual quake would be dangerous, because they might not make it to the hallways in time and be crushed under rubble.
It was then that I realized that the 'earthquake drill' was actually a nuclear attack drill but called something else to avoid sparking panic.
The best place for the employees to be during a nuclear attack was in hallways where there were no windows and only a few doors, if there was no basement. The lack of windows and doors would protect the employees from flash burns and being hit by flying glass and other debris.
In a real nuclear attack, though, we would have been heading down the stairwells and into the basement where we would get the best protection from blast, heat and radiation.
In my time, I have realized that sometimes bureaucratic documents use vague language to conceal the real intent of the document or the problem being faced. If you read between the lines carefully, you'll see everything as plain as day.
Yaridanjo says 1 year ago
http://barry.warmkessel.com/ill.html
IMPACTS, MAGNETIC FIELDS AND DISEASES
(CURING DISEASE BY SIMPLE HUMAN INTERACTIONS)
The language of the mass graves protocols document seems to reflect preparations for nuclear war because it specifically mentions "the degree of destruction of the city."
The language would be rather vague instead if the protocols were intended to deal with any mass casualty event that was due to causes other than war.
In short, it looks like Russia are getting ready for a Third World War in which nuclear weapons are used.
Leethal says 1 year ago
It is most likely scaremongering since the mRNA jab is waning. WWIII you will be incinerated (no burial needed) and if it's about nothing, why bother?
WilliamtheResolute says 1 year ago
When the first word of a nuclear detonation reaches us…I suggest finding shelter below ground within 15 minutes no matter what the talking heads say…my two cents.
IN THIS WHOLE PAGE,YOU MY FRIEND WILLIAM ARE GIVING THEM THE BEST ADVICE,shelter as fast as they can..and be prepared to stay a few months in the shelter,food,water,warm blankets and a good RADIATION DETECTOR…or you will NOT survive .
Well I'm certainly not saying that if USA got its ass kicked it would be a good thing.
But I think we can all agree that it would be very richly deserved indeed.
ben b says 1 year ago
This is a common comment from political simpletons.
First, the US government is Globalist controlled and it's criminal actions have little to do with the will of the American people.
If you don't understand 9/11 you're not even on the board let alone in the game.
BEN,who are you trying to bullshit,AMERICANS LOVE ,HATE ,DEATH,AND WAR..and most of all they hate children..AMERICA IS ABOUT TO RECIEVE WHAT THEY HAVE SOWN…mass death…
Obviously you don't know what you're talking about.
The Ruling Oligarchy is in charge and have been at war with the American people for at least the last 60 years. There are plenty of good people left in the US even though they have poisoned our food, experimented on the population, run propaganda 24/7 and placed a moron pedo-criminal puppet in as fake president. The Globalists are setting up the US to take the fall for their Great Reset.
All the Wars a staged… wake-up!
RUSSIA AND CHINA will have to BOMB america til its glows from outer space befor PEACE will return to earth again,AMERICANS LOVE ,HATE,DEATH,AND WAR,they will keep causing mass death in nations around the world till someone stops them,THAT WILL MEAN THERMO-NUCLEAR WEAPONS DROPPED ON AMERICA TILL THE POPULATION IS DOWN TO ONLY HUNDREDS OF SURVIVORS,any more then that and THEY WILL UNLEASH THEIR WAR MACHINE ON THE WORLD AGAIN IN THE FUTURE…
Edward says 1 year ago
Destroy the VATICAN, THE JOOOOOS, AND EVERY BANKER, AS WELL AS THE 12 most wealthy families. Then we would have PEACE.
Alex says 1 year ago
There will be no peace. The problem is that the heart of most people is stonehearted. Sin is the problem.
WW1 was Christians killing Christians
WW3 will be the same.
Bolshevik Jews murdered 40 million Christians in Russia, but we won't see movies about that from kosher Hollywood, or on "the electric Jew" (TV).
My fellow Americans, NEVER disarm to this demonic tribe of control freak goblins
We won't have peace until the last Zionist is strangled with the intestines of the last communist!
The elites are Satan (God's adversary), they stay in power with lies, stealing and killing. They control their populations through fear by controlling their reality, this technique was learnt over thousands of years in Egypt, hence obelisks in every capital city, when you wake up from their matrix you start to see their lies and you will be disturbed that you've been living a complete illusion, but then you will be amazed at the truth that there is a creator and that you yourself is a creator, and then you will rest when you connect with that great creator knowing that this life is a drop in an ocean of time (book of Thomas). All wars are planned and choreographed, most of space exploration specially the lunar landings are fake, the News is what they want you to believe, viruses are a hoax, people get sick due to toxin build up, poisoning through "medicines" and the way they handle stress, nuclear weapons as we've been told are a hoax, just another fear tool and of course the money system is a complete hoax created to control. If you doubt what I say, test it, turn off your TV's, be still, observe people's behaviours, you will see it
blueyblogger says 1 year ago
These guys are WAY behind the 8-ball.
Australian police and governments have been doing this for many years, and have perfected a way of concealing the location of the mass graves.
We discovered one in Cherbourg, and there's an inquiry pending.
counting-bullets says 1 year ago
russia got a cool cover for burying the head spikes, wow man, farout, dig it for those who got the clotshot jab19, poor poor jr, hehehehe…
Oldman says 1 year ago
the USA has had its own protocol. There are stock piles of plastic coffins capable of holding at least three bodies each. They are stored at FEMA camps and other facilities. There are also crematoriums at many of the FEMA Camp's. And of course make an acquisition any equipment they need from any Corporation or even individual. What would be the cause for such a need? Could be the cause of the jar. Or possibly a new viral or biological outbreak. Or even War which could be the reason for an outbreak or even nuclear weapons. But as I have found over the decades when they deny something could be the case that's where you might likely Focus. They said no natural disasters could cause such a loss of life I would beg to differ. would do the trick. so could say a fiery Mountain such as the one in the canaries. it's just an example realizing that can't reach Russia. Meteor impact? The most pressing thing that the world immediately faces is starvation. And that could start happening on a scale unimaginable. The world's Supply chains are basically broken. Weather extremes and plagues .putting further stress on the Agra culture of the world. Whether it's on purpose or not, and it likely is. It hardly matters. Hunger is a huge motivator. Food and water will surely be a commodity worth going to war over. Wacom stack'em and Packham.
🤠🐂🏞🛩
Depressed person says 1 year ago
Dumbest comment section I've ever seen


text:
The sacrifice of Andrew Mitchell sets a dangerous precedent
The affair has sent a message to every trade union and special interest group in the land: when you have a minister on the ropes, keep at it
Andrew Mitchell had been bracing himself to go. Only logistics – the PM's physical absence in Brussels (above) – prevented him from doing so earlier Photo: AFP
By Matthew d'Ancona
9:00PM BST 20 Oct 2012
As he travelled back from Chequers on Friday, Andrew Mitchell reflected with a private chuckle that he was almost certainly the first Cabinet minister to have included the word "f---", or one of its derivatives, in his official resignation letter. In the four and a half weeks since the verbal confrontation in Downing Street that has now cost him his job, Mitchell has tried to keep his spirits up with gallows humour.
Well, you have to pass the time somehow when you're on Westminster's Death Row. With cruel caprice, the (now ex-) Chief Whip was awarded stay after stay of execution, and there were moments when it even seemed the political death sentence might be commuted altogether. But, in the end, his head was slipped into the noose, and the shadowy kangaroo court had its way at last.
Not until Thursday night did Mitchell decide irrevocably that he must go. Although plenty of backbenchers supported him at the 1922 Committee meeting on Wednesday, others did not. Asked by a friend if the gathering had gone well for him, he replied ruefully: "…ish." In the crazy casino of political careers "well-ish" does not describe encouraging odds.
Mitchell was also understandably concerned about the impact the protracted story was having upon his family, and how upsetting it was for his wife to learn that neighbours were reportedly speaking out anonymously against them to the press (shabby recompense for the out-of-hours emergency treatment she has been known, as a popular local GP, to offer to those who live nearby).
As a politician of many years' experience, and the son of a minister in the Thatcher government, he was also fully aware that the Opposition's entirely legitimate decision to punch the bruise – to keep at it, as Ed Miliband did at Prime Minister's Questions on Wednesday – would distract attention from good economic news (unemployment and inflation down), encouraging crime figures, and Theresa May's deft handling of the Gary McKinnon story. By Thursday, he was bracing himself to go. Only logistics – the PM's physical absence in Brussels – prevented him from doing so earlier.
How Tories forced Mitchell to quit
Cameron insists he did right thing over Mitchell
Thousands protest against austerity policies
David Cameron criticised for failing to sack Andrew Mitchell earlier
Andrew Mitchell's resignation letter in full
War widow vows to fight on for justice after landmark ruling
There are few figures as solitary as a politician who has just left office. But appearances are deceptive: a resignation is a group effort, a collective phenomenon. What looks like the lonely act of an individual is usually a tribal expulsion in which the elders give voice to the wishes of the clan. And that is precisely what happened in this case.
As disclosed in this column four weeks ago, and now stated in Mitchell's resignation letter, he denies emphatically using words such as "plebs" but admits saying that he thought "you guys were supposed to f---ing help us". My view was and remains that this was bad behaviour, requiring a prime-ministerial reprimand and profound apologies, but not a resigning matter.
If David Cameron believed otherwise, that week in mid-September was the moment to strike; to make clear to Mitchell that he was expected to quit his job; and to remind him of Malcolm Tucker's ruling in The Thick of It, that "it is possible to have a good resignation, you know". Downing Street sources argue that the PM stuck with Mitchell until the latter changed his mind, and is now supporting his former Chief Whip with hints of a possible return to office in the future.
That's true, as far as it goes. But it underestimates the full political task of a PM handling a wounded colleague. It is much too diffident an interpretation of that role, as if Cameron's only function in this fiasco was to ask Mitchell what he wanted and to back him up. That is common courtesy and to be applauded as such. But it is not enough. Handling a potential resignation is about more than etiquette. It is more akin to crowd control.
In this case, the crowd was the Tory parliamentary party. Philip Cowley, professor of politics at Nottingham University and the nonpareil analyst of MPs' revolts, has noted the particular readiness of Conservative backbenchers in this Parliament to rebel, observing that "the Chief Whip was facing major problems, whoever it was" (Sir George Young, take note).
It was precisely this problem that had prompted Mitchell's appointment in the first place. As a veteran ex-whip of the Maastricht era, he knew the ropes. But he also had foes-in-waiting. On Wednesday, after Mitchell appeared to deny Miliband's charge in the Commons that he swore, Michael Fabricant (the Lichfield MP who resembles a prototype, steam-powered Boris that escaped from the lab) tweeted gleefully that the Chief Whip had "managed to re-ignite [the story] himself. Self-ignition?"
The greater lesson of the whole pitiful business is that Tory backbenchers felt they could rile and mock Mitchell with impunity. Rarely has there been such a brutal example of the dictum usually attributed to John Boyd-Carpenter, Macmillan's chief secretary: the MPs on the other side of the Commons "are the Opposition; the enemy is behind you". Though Cameron was known to be notionally supportive of his Chief Whip, there was little sense among MPs that they risked the Prime Minister's wrath if they mobilised against him He was officially backed by the PM, yet, implicitly, he was also fair game – the worst possible permutation.
At the Conservative conference, the party's oligarchy – his Cabinet colleagues – stoked these fires recklessly, encouraging activists, MPs and journalists to ready the tumbril. They sniggered as they did so. But I wonder if they will live to regret this conspicuous failure to shore up a colleague in need.
Mitchell was up against the Police Federation and powerful sections of the media. A government seeking to make sweeping reforms and wipe out a structural deficit will often face that deadly pincer movement of vested interest and the press. The Mitchell Affair has set a precedent and it has also sent a message to every trade union, professional association and special interest group in the land: when you have the minister on the ropes, keep at it. Stamina will be rewarded. All those reforms you hate can be thwarted or delayed by focused and prolonged attack on those who seek to enact them. A minister's Cabinet colleagues will run for cover. And, if it suits them, which it very well might as unpopular measures threaten marginal seats, Tory MPs will join in the attack.
Mitchell did not deserve his fate: all proportionality was lost in this case. But the path is clear for him to return to frontline politics after a spell on the subs' bench. What remains is dispiriting: a party parading its indiscipline as if it were virtuous, a Cabinet mistaking "sauve qui peut" for a governing maxim, and a Prime Minister who, at the very least, badly needs new muscle and new methods to express and to enforce his authority. Who governs? That, as ever, is the question.
Columnists »
Matthew d'Ancona »


text:
using System;
using System.Threading;
using System.Threading.Tasks;
using Azure;
using Azure.Core;
using Azure.Core.Pipeline;
using Azure.ResourceManager.Resources.Models;

namespace Azure.ResourceManager.Resources
{
    /// <summary> The Authorization service client. </summary>
    public partial class AuthorizationOperations
    {
        private readonly ClientDiagnostics _clientDiagnostics;
        private readonly HttpPipeline _pipeline;
        internal AuthorizationRestOperations RestClient { get; }

        /// <summary> Initializes a new instance of AuthorizationOperations for mocking. </summary>
        protected AuthorizationOperations()
        {
        }

        /// <summary> Initializes a new instance of AuthorizationOperations. </summary>
        /// <param name="clientDiagnostics"> The handler for diagnostic messaging in the client. </param>
        /// <param name="pipeline"> The HTTP pipeline for sending and receiving REST requests and responses. </param>
        /// <param name="endpoint"> server parameter. </param>
        internal AuthorizationOperations(ClientDiagnostics clientDiagnostics, HttpPipeline pipeline, Uri endpoint = null)
        {
            RestClient = new AuthorizationRestOperations(clientDiagnostics, pipeline, endpoint);
            _clientDiagnostics = clientDiagnostics;
            _pipeline = pipeline;
        }

        /// <summary> Lists all of the available Microsoft.Authorization REST API operations. </summary>
        /// <param name="cancellationToken"> The cancellation token to use. </param>
        public virtual AsyncPageable<OperationAutoGenerated2> ListAsync(CancellationToken cancellationToken = default)
        {
            async Task<Page<OperationAutoGenerated2>> FirstPageFunc(int? pageSizeHint)
            {
                using var scope = _clientDiagnostics.CreateScope("AuthorizationOperations.List");
                scope.Start();
                try
                {
                    var response = await RestClient.ListAsync(cancellationToken).ConfigureAwait(false);
                    return Page.FromValues(response.Value.Value, response.Value.NextLink, response.GetRawResponse());
                }
                catch (Exception e)
                {
                    scope.Failed(e);
                    throw;
                }
            }
            async Task<Page<OperationAutoGenerated2>> NextPageFunc(string nextLink, int? pageSizeHint)
            {
                using var scope = _clientDiagnostics.CreateScope("AuthorizationOperations.List");
                scope.Start();
                try
                {
                    var response = await RestClient.ListNextPageAsync(nextLink, cancellationToken).ConfigureAwait(false);
                    return Page.FromValues(response.Value.Value, response.Value.NextLink, response.GetRawResponse());
                }
                catch (Exception e)
                {
                    scope.Failed(e);
                    throw;
                }
            }
            return PageableHelpers.CreateAsyncEnumerable(FirstPageFunc, NextPageFunc);
        }

        /// <summary> Lists all of the available Microsoft.Authorization REST API operations. </summary>
        /// <param name="cancellationToken"> The cancellation token to use. </param>
        public virtual Pageable<OperationAutoGenerated2> List(CancellationToken cancellationToken = default)
        {
            Page<OperationAutoGenerated2> FirstPageFunc(int? pageSizeHint)
            {
                using var scope = _clientDiagnostics.CreateScope("AuthorizationOperations.List");
                scope.Start();
                try
                {
                    var response = RestClient.List(cancellationToken);
                    return Page.FromValues(response.Value.Value, response.Value.NextLink, response.GetRawResponse());
                }
                catch (Exception e)
                {
                    scope.Failed(e);
                    throw;
                }
            }
            Page<OperationAutoGenerated2> NextPageFunc(string nextLink, int? pageSizeHint)
            {
                using var scope = _clientDiagnostics.CreateScope("AuthorizationOperations.List");
                scope.Start();
                try
                {
                    var response = RestClient.ListNextPage(nextLink, cancellationToken);
                    return Page.FromValues(response.Value.Value, response.Value.NextLink, response.GetRawResponse());
                }
                catch (Exception e)
                {
                    scope.Failed(e);
                    throw;
                }
            }
            return PageableHelpers.CreateEnumerable(FirstPageFunc, NextPageFunc);
        }
    }
}

redpajama_set_name: RedPajamaGithub


text:
Q: When is it a security risk to publish the database structure? I'm planning a site which needs the users' trust. To help trust building, I was thinking to publish the source code, the database schema and even allow users to download raw data (so they can run their own queries on the data to verify that the site gives the correct answers).
Under which circumstances is that a security risk? My thinking is that most of the data can be grazed off the site with a web spider anyway.
For sensitive information like IP addresses and passwords, I plan to store that hashed (with a salt). Age information is not relevant, maybe I'll just store "adult yes/no". Anything that I'm missing?

A: Injection is not an issue if you do your data access properly. You are not worried about keeping your model proprietary so no issue there. You have the green light to expose the model.
Privacy is not an issue if you inform user's the data is public. People expose private info and photos on Facebook so why not your system? Green light.
Hashed data with a random salt in theory is safe to download. SHA512 with a random hash will probably never be broken. But who knows? At one time MD5 was the "right way" to hash, and now you find a collision in under 1 hour.
The only issue is private data that needs to be encrypted, not hashed. You can't hash an IP because you will want to use the actual IP at some point in the future. You can't hash credit card numbers because you will need the real credit card number at some point. You will be forced to utilize a private key and deal with the weakness of keeping it private. By exposing data you totally remove a layer of physical security. Encryption + physical is better than encryption alone.

redpajama_set_name: RedPajamaStackExchange


text:
Totally random stuff
Was The Walking Dead Season 6 cliffhanger justified?
October 25, 2016 by dk·0 Comments
*Rants and spoilers ahead. You've been warned*
Wanted to blog about this few weeks ago when I saw the spoiler on who will be killed in Season 7 premiere. But I decided to wait till I see the full episode before commenting. If you remember, I was really pissed after watching Season 6 finale.
And I wasn't the only one. A lot of fans were angry with the cliffhanger and there was a massive backlash. But showrunner Scott Gimple asked the fans to give them the benefit of the doubt as it as all part of a plan. He said he hope people will see the Season 7 premiere and feel that it justifies the way they told the story.
But after watching Season 7 premiere, I still felt that the cliffhanger in Season 6 finale was unnecessary. It was just a lazy way of creating suspense so that the fans will look forward to the next season.
Personally, I think the story would have been better if they ended Season 6 with Abraham behind hit by lucille. This will give Negan's introduction a huge impact and at the same time give fans the impression that the rest of the gang are safe from lucille. And they could deliver another shock during Season 7 premiere by killing Glenn.
Very disappointed with the cliffhanger in Season 6 finale. After watching Season 7 premiere, I still don't think it justify the cliffhanger. They could have told a better story without that stupid cliffhanger.
Singapore Pokemon Go nest (After 27 Sept nest migration)
September 30, 2016 by dk·0 Comments
Updates: Another nest migration just took placed on 6 October so this list is most likely outdated.
Sorry for the lack of updates on the blog. Been busy with Pokemon Go. Since there is a new nest change lately, I guess I'll take a moment to list down the new Pokemon nest in Singapore.
Disclaimer: These info are from Facebook groups, forums and my own observations. Do comment below if there is an error or if I miss out any important nest. Thanks.
Abra: Gardens By The Bay East
Charmander: The Charmander nest has moved from Punggol to East Coast Park Zone G. It's a little bit out of place. You might want to bring more Pokeballs with you as so trainers are saying that there are only a few Pokestops there.
Changi Beach Park is also a good place for catching Charmander.
If East Coast Park and Changi Beach Park are too far for you, you might want to try Bishan Active Park. The Charmander spawn rate is not as fast there but at least it is more central.
Clefairy: Botanic Gardens
Cubone: Labrador Park
Diglett: Fort Canning Park
Doduo: Pasir Ris Park
Electabuzz: Mt Faber Park
Jynx Ang Mo Kio Ave 3 Park
Kabuto: East Coast Park Zone C
Magmar: Pearl Hill City Park
Onix: Dhoby Ghaut MRT
Pikachu: Pikachu nest is back! You can find Pikachu at Macritchie Reservoir Park.
Ponyta: Istana. It's a restricted area. Unless you work there or got invited by the President or Prime Minister, I don't think you can enter that place. However, you might want to know that the next Istana Open House is on 29 October 2016. Hopefully the Ponyta nest is still there.
Scyther: Bukit Batok Nature Park
Slowpoke: Bishan-AMK Park
Snorlax: There is no Snorlax nest. But if you are desperately looking for Snorlax to complete your Pokedex, I noticed that they have been spawning quite frequently around Jurong area. But you'll need a car to chase them down. Only recommend this for those who are very desperate for a Snorlax.
Vulpix: Tanjong Rhu Promenade
All screenshot taken using SGPokeMap.
The Walking Dead season 6 finale is bullshit
April 5, 2016 by dk·0 Comments
Please excuse me for ranting here. I'm writing this after watching The Walking Dead season 6 finale. I know a lot of this are just anger and may not make sense. But to be honest, I haven't been so pissed with a TV show for so long.
Most of you know that I'm a huge The Walking Dead fan. Like everyone, I was eagerly anticipating the introduction of Negan since Rick and gang arrived Alexandria. The show has been teasing Negan since the mid season break. And most fans know there's only one way to introduce Negan to the world. And that is to kill a character in the show.
And this is not going to be a minor character. In the comic book, Negan killed Glenn. We don't know if they will do the same for TV. But we know it is going to be a major character. And so everyone watched the 90 minutes season finale with much anticipation and fear. Fear that their favorite character will be killed.
But what do we get? 90 minutes of dragging. From one road block to another. But ok, its just building up to the final moment. We get it. And Negan didn't disappoint. He is great. He's evil yet charismatic. Absolutely great. And you know he mean business.
Then the stupid cliffhanger. Instead of showing us who was killed, all we got is the victim's point of view and fade out. And we'll need to wait till season 7 to find out who was killed. I know there is a need for cliffhanger to get fans excited and looking forward to the next season. But this is just too much. It's down right insulting to all The Walking Dead fans who are following the series.
And do you know the stupid thing about this cliffhanger? It's not going to stay a secret for long. They are going to start filming season 7 soon. And we all know that there are people stalking the set. It's just a matter of time before someone guessed who got killed by Negan. And that news will definitely be spreading like wildfire before the start of season 7. So what's the point of having this cliffhanger at this time and age?
Instead, why not show us who got killed in the season 6 finale? After all, there is a even bigger cliffhanger out there. What is Rick and gang going to do after that major character died? The Walking Dead completely missed the opportunity to pull the fans' heartstring by having one of the biggest build up leading to the shocking death of a major character. It's just stupid.
I know they are doing this for the viewership. Maybe with this cliffhanger, they might be able to get higher viewership for the season premiere like the Terminus in season 5. But this time its different. Its just insulting to ask fans to wait 6 months to find out who died. The fans deserved better treatment than this.
Night time view of Singapore from International Space Station
March 22, 2016 by dk·0 Comments
Check out this beautiful image of Singapore from the International Space Station, captured by US astronaut Tim Kopra.
You can see clearly the major roads and highways. The Central Business District looks very bright. And despite all the bright city light, there is a dark patch in the middle of the island where our nature reserve is. Let's hope it stays this way.
Thank you Tim for this wonderful photo.
Ask Siri "What is zero divided by zero"
July 1, 2015 by dk·1 Comment
Every once in a while, someone will discover an easter egg in Siri when you ask something funny. Instead of giving you a straight answer, Siri decides to be funny and give you a wacky response.
Try asking Siri "What is zero divided by zero". The expression has no meaning since you can't divide zero by zero.
Instead of just telling you the expression makes no sense, Siri decided to give you….
"Imagine that you have zero cookies and you split them evenly among zero friends. How many cookies does each person get? See? It doesn't make sense. And Cookie Monster is sad that there are no cookies, and you are sad that you have no friends."
Epic answer. Now try asking other numbers divide by zero.
Online Hiring Remains Slow in Singapore according to Monster Employment Index
Bad news for those looking for a new job. According to the Monster Employment Index (MEI) by Monster.com, online hiring activities in Singapore fell by 8% year-over-year compared to April 2014.
Among all 14 industry sectors in the Index, the lowest growth was recorded in the Consumer Goods/FMCG, Food & Packaged Food, Home Appliance, Garments/Textiles/Leather, Gems & Jewellery industry and the Government/PSU/Defence industry, at -16% and -11% respectively.
Education and IT, Telecom/ISP and BPO/ITES industries performed the best, at 14% and 4% respectively. Singapore is seeing growing concern over issues related to cyber security, keeping the demand high for mid-level IT professionals in the technology sector. The healthcare sector is also seeing an increase in hiring activity, thanks to a demand for professionals engaged in research laboratory and medical related technical sales.
The MEI Singapore is a monthly gauge of online job posting activity, based on a real-time review of millions of employer job opportunities culled from a large representative selection of career Web sites and online job listings across Singapore. The Index does not reflect the trend of any one advertiser or source, but is an aggregate measure of the change in job listings across the industry.


Many of our customers have found Fleet Street to be so reliable they have done away with the expense and headaches of repairs, maintenance, insurance, fuel cards, labor costs and scheduling. They no longer have to maintain a fleet of vehicles and personnel to accomplish their deliveries. Your company can also enjoy the freedom to concentrate on what your core business is and let Fleet Street do what we do best.
Let Fleet Street Couriers professionally get your products where they need to go and when they need to be there. Sending your personnel is an extravagant cost to your business. Sending someone from your office to run an errand takes their focus away from adding to your bottom line. A disruption is more than just the time it takes to drive there. Getting reoriented to their task is like rebooting your computer every time you need to change to a different program. The most conscientious person will likely just stop in to get a coffee or pick up a personal errand "along the way". This is costly in itself, not to mention the financial wreckage if that person gets into an accident doing company business in a personal or staff car.
Fleet Street Couriers provides commercial warehousing and freight delivery services with a hub centrally located to Interstate 84 and the Boise Airport resulting in quick delivery to Seattle Washington, Salt Lake City, Utah, Portland, Oregon, Spokane, Washington and other locations within the Pacific Northwest region.
Other Transportation Logistics Services provided are as follows: Security Monitored Warehouse Facility - Professional Inventory Control Management with Real Time Reporting - Redistribution Freight Forwarding Services - Outsourced Logistics Distribution Center - Cross Docking - Delivery Repackaging.


As a math teacher I would love to be able to use Canvas to assess students ability to graph a linear equation (in the long run, any function not just linear). This would require them being able to plot some points, and connect those points with a line or curve depending on the function type. I have not found very many places where this can be practiced in a digital format (geogebra.org is about the only one i've found, and it takes a good amount of set up and learn how to use). I haven't found any places where this can be assessed in a digital format.
Pearson's masteringphysics has/had this option for linear graphing. Could be looked at for a source for making the programing happen.


text:
An earlier survey for a subdivision at the top of the harbour near Dawson's Creek had not been completed. Between 1852 and 1854 Charles Heaphy the Provincial Surveyor and artist…
Firewood and building timber was being harvested as early as mid 1840's early gatherers included Captain Sullivan who established himself at Mahurangi West. Soon after the Mahurangi Purchase the government…
In 1840 by Felton Mathew, visited the harbour as part of his quest for a new site for the capital of the new colony. He was realistic and saw the…
The first Europeans to explore the Mahurangi were looking for Flax and Timber. The British Navy came seeking spars. Spar ships would drop cutting gangs of up to 300 seamen…
Māori first occupied our land and there are widespread defensive ditches, pa sites and kumara pits to be found on most of the headlands around the harbour. The South Eastern…
Mahurangi is the name used by our association and name of our harbour, but was at one time used as the name of all the land from Te Arai Point…


This term was coined by Dr.Raja Satpathy, a plastic surgeon at Ganga hospital, Coimbatore along with Dr. Ravindra Bhat an anesthesiologist.
What do you mean by "Block on arrival"??
Everyone wants freedom from Pain. Pain relief is a basic human right. Pain is also considered as the fifth vital sign in modern medicine. So if any patient has the history of fall and suffers from fracture then he is presented as pain at the site of injury along with difficulty in movement and bleeding. Block on Arrival means blocking or stopping this pain as soon as the patient has arrived in casualty or emergency department. Casualty doctor will do the primary assessment for any life-threatening injuries like head injury with loss of consciousness, cervical spine injuries etc. The first doctor will stabilise patient hemodynamically. Once the patient is stabilised and done some primary investigation anaesthesiologist will be called at casualty to give Regional Block.
It is blocking a region like the upper limb, lower limb or trunk. It is very much different than local anaesthesia.
Local anaesthesia is used to infiltrate skin and subcutaneous tissue with local anaesthetics like lignocaine. It is used for superficial skin surgeries.
Regional Block is done by depositing local anaesthetics drugs(e.g. lignocaine, bupivacaine, ropivacaine) around the nerves which supply that region like upper limb and lower limb. This can be used for pain relief as well as for surgeries like fixation of fractured bone.
Supraclavicular brachial plexus Block, axillary brachial plexus Block, femoral nerve Block, fascia iliaca block, sciatic nerve block, popliteal nerve block etc.
Who can give Regional Block?
It is given with assistance of peripheral nerve stimulator and ultrasound to locate the required nerve to be blocked. It can be given blindly but success rate and safety are more when used ultrasound-guided blocks.
Basic monitoring of pulse, blood pressure and saturation is done.
The area near shoulder or leg is cleansed with the antiseptic solution.
While locating nerve patient may feel tingling in limb or twitches if the special machine is used. These are transient and not to be scared.
As soon as the exact nerve is located, the drug is injected. And the patient will feel soon as if his arm is not there. The patient is free from pain. If the anaesthetic dose is given then the movement of the limb is also stopped.
How long is pain relief with these blocks?
With the single shot, injection pain relief occurs for 8 to 10 hours. I want more pain relief for 2 to5 days, a small catheter can be placed near nerves to provide continuous pain relief. The drug can be given through catheter intermittently.
Can undergo surgery with pain blocks?
These blocks are given in casualty for pain relief, but if surgery is planned immediately then anaesthetic blocks can be given and surgery can be performed with same block action without the need of any extra injections.
If surgery is not planned immediately then the only analgesic block is given e.g. femoral nerve block for fracture neck femur.
Can the patient go home or to other hospitals after receiving Block?
After receiving Block for pain relief, not only pain is relieved but the sensation of that arm or leg is lost and the patient will not be able to move the limb. So he has to take care of numb limb because any injury or burns may get unnoticed.
So ideally it is advised not to take discharge if the limb is numb.
If at all patient wants to leave the hospital after receiving Block, he has to declare on paper that he is ready to take care of numb limb and wants to go to home or other hospitals.
What are the advantages of the block on arrival?
The first and foremost advantage is patient get immediate pain relief.
His pulse and blood pressure is also stabilised as pain is relieved.
If the patient is heart patient or diabetic or hypertensive then it is very much advantageous as it reduces the catecholamine surge due to pain relief.
It helps in the early mobilisation of the patient which prevents deep vein thrombosis, as one of the major complication of orthopaedic surgeries.
It also reduces SIRS in a polytrauma patient. So reduced ICU stay.
It also helps to discharge patient early to home so overall reducing the cost of the stay at the hospital.
Is it preferred over intravenous analgesic?
Sometimes pain cannot be controlled effectively even after giving IV analgesics. Sometimes these are contraindicated like diclofenac cannot be given if asthmatic or with kidney failure.
Sometimes the side effect of drugs like opioids are dangerous like respiratory depression or not pleasant like nausea, vomiting, etc.
So Regional blocks are always advantageous over IV analgesics.
Is there any contraindication to block on arrival?
Yes if the patient is suffering from any other life-threatening injuries then that has to be taken care first.
If the patient is taking antiplatelets like ecosprin and clopidogrelor anticoagulant like clexane or heparin then these blocks cannot be given.
These drugs have to be stopped. As nerves are surrounded by vessels which can get injured while giving injection and forms hematoma. If the area where injection to be given is discoloured or infected. If the patient is saying 'No' to same even after explaining the procedure, advantage and disadvantages.
Any procedure is not without complications. Though we are taking all efforts to make it safe but sometimes complication can happen. As we are going near nerves sometimes nerve injury can happen. If the drug goes in vessels or the intravascular patient may have convulsions and cardiac arrest.
The resuscitation equipment and drugs are always handy while giving blocks. So even if such catastrophe happens, we are there to treat.


This post is part of a Bloggin' Mamas social good campaign. No compensation was received for posting this.
Winter is definitely upon us and we've got a great giveaway to keep your little ones warm, especially when you are out traveling.
We here at I Love Family Travel LOVE VINTAGE! Plus transportation themes are a big part of travel, and now we have TOYS, which are perfect for those families that love to travel like us.
I am sharing this post as part of a Bloggin' Mamas Social Good Campaign, and was not compensated for doing so.
Bloggin' Mamas is sponsoring this giveaway in support of the Ad Council and the U.S. Forest Service's "Discover the Forest" campaign celebrating the recent National Public Lands Day (September 26th).
We are sharing this post as part of a Bloggin' Mamas Social Good Campaign, and were not compensated for doing so.
Bloggin' Mamas is sponsoring this giveaway to bring awareness to farm animal cruelty issues and to support the ASPCA's "Change Your Chicken" Challenge.


text:
Q: NVD3 Update Chart with d3.json I've made a chart using NVD3, which populates 3 stacked bars.  On clicking a bar, I want an request to be fired, and for the chart to be populated with new data altogether.  Unfortunately, the chart does not REPLACE the data I previously had, but APPENDS a new bar to my chart, forming a chart with 4 stacked bars, when I only want 1 bar.  How can I remove the old data, while bringing in new data?
Thanks!
var chartData = setChartData(data1);

var chart;
nv.addGraph(function() {
chart = nv.models.multiBarChart()
  .barColor(d3.scale.category20().range())
  .margin({bottom: 100})
  ;

chart.multibar
  .hideable(true);

chart.reduceXTicks(false).staggerLabels(false);

chart.xAxis
    .axisLabel("Current Index")
    .showMaxMin(true)
    .tickFormat(function(d,i){ return allBillsForChart[d][0][2]});

chart.yAxis
    .tickFormat(d3.format(',.1f'));

d3.select('#chart1 svg')
    .datum(chartData)
   .call(chart);

nv.utils.windowResize(chart.update);

chart.dispatch.on('stateChange', function(e) { nv.log('New State:', JSON.stringify(e));   });

return chart;
},function(){
d3.selectAll(".nv-bar").on('click', function(d, i){
            d3.json("fakeURLToFetchData", function(error, data){
  arr = [];
  arr.push(data)
  handledData = setChartData(arr)

  d3.select('#chart1 svg').datum(handledData).call(chart);
  nv.utils.windowResize(chart.update);
  return chart
})
});

});


text:
Q: difference between bitwise and logical OR What is the difference between bitwise and logical OR operations when it comes to boolean variables in C++? In the integer domain, it is clear but when it comes to boolean is there any performance advantage or behavioral change between both of them?
bool VAR = TRUE , BOOL VAR2= TRUE
Is there a difference in VAR | VAR2  & VAR || VAR2

A: For performance differences, logical OR short-circuits (e.g., in op1 || op2, if op1 evaluates to true, op2 is not evaluated), but bit-wise doesn't. This also creates a behavior difference:
if (op1 == nullptr || fn(op1)) { /* ... */ }

This code will never call fn with nullptr because of the short-circuit behavior. On the other hand, if the logical OR was replaced with bit-wise, fn would always be called. If fn has side effects or undesirable behavior when called with nullptr, this creates a behavior difference.

A: Bitwise and logical operators are quite different:

*

*Logical operators work on the logical values of the variables and give back true or false which are logical values

*Bitwise operators work on the single bits of the variables

Briefly the bitwise operator consider the single bits of 2 varibales: & operation between 2 bitmasks gives back a bitmask where the compared bit is 1 if both the relative bits in the original mask are 1; | operation between 2 bitmasks gives back a bitmask where the compared bit is 1 if at least one of the relative bits in the original mask is 1.
The result of a bitwise peration depends on the size of a variable and its representation in bits.
I made a little exercise trying to make bitwise operation on bool variables and you can run it on your machine. I think the result depends on the compiler and the architecture; anyway in my test the size of bool is 1 byte (8 bits) and in the case it's true just the first bit is 1:
#include <iostream>

int main()
{
    bool b1 = true;
    bool b2 = true;

    std::cout << "size of bool:" << sizeof(bool) << std::endl;

    for (int i = 0; i < 8 * sizeof(bool); i++)
    {
        std::cout << "bitwise operation | on bit:" << i << " result:" << (b1 | (1 << i)) << std::endl;
        std::cout << "bitwise operation & on bit:" << i << " result:" << (b1 & (1 << i)) << std::endl;
    }
}


But Greg Dionne, the mayor of Prince Albert, said the impact was startling for the entire region.
The loss of the pulp mill wasn't the first blow to the community, Dionne said.
The mill was sold to the Paper Excellence Group five years ago. However, a non-compete clause prevents them from producing kraft pulp until 2020.
By then, Dionne said the mill will require all new equipment, and he has doubts whether that business case can be successful.
However, Prince Albert's mayor said they were fortunate that many of those who lost their jobs a decade ago chose to stay in Prince Albert. And today, many of them are small business owners.


text:
A Slider / National News | By Peoples Daily
NDLEA predicts forest extinction over cannabis cultivation
By Osaigbovo Iguobaro Benin
The National Drug Law Enforcement Agency (NDLEA) has predicted that forest reserves particularly in rain forest zone in Nigeria may cease to exist soon over the alleged diversion of land to Cannabis Sativa Cultivation instead of food and economic crops.
The Chairman/Chief Executive of the agency, Col. Muhammad Abdullah (Rted), recommended drastic steps to check the relentlessly ossified development which he claimed has remain a serious threat to food production in the nation.
Abdullah gave the charge on the occasion of public destruction of 36, 844.7123kg of illicit drugs by Edo state Command of the agency at the Weekend in Benin City.
According to him, "One of the greatest threats to the environment and by extinction, human security is the deforestation that goes with cannabis plantations.
"Our forests are being plundered through indiscriminate felling of economic trees to make way for the illicit cannabis plantations" with grave consequences on the fertility of the forest and the need for quick intervention, he said.
In his welcome address, Edo state Commander of NDLEA, Mr. Buba Wakawa, said the state is one of the states with the highest production of illicit drugs in the Country, lamenting that "a large expanse of farmland has been taken over by cannabis plantations in the state.
He noted that the Command had identified that drugs and substance abuse potend great danger to the human health.
He emphasized that school-age Children have been found to be using drugs even at the early age of 13, accounting for the high rate of school dropout, divorce, rape, teenage pregnancies, youth restiveness,
cultism robbery and other crimes.
Governor Godwin Obaseki of Edo state who was represented on the occasion by the Permanent Secretary, Cabinet Government House, Mr. Sam Okoh Ose, described the feat recorded by NDLEA as a milestone.
He said the state government will enact a legislation the forfeiture of farmland used for the cultivation of Cannabis Sativa and other illicit drugs in the near future.
He assured that the law would help to check the gross misuse of arable farmland which has been facilitated by drug merchants who take advantage of the bounded transit routes into other neighbouring states in the Country.
A breakdown of the destroyed illicit drugs by the agency, indicate that Cannabis Sativa has 136, 437.75kg and Cocain 0.0139kg. Others are Heroin 0.0084kg, while 406.94kg was for Psychotropic substances.


text:
Submissions for variant NM_170707.4(LMNA):c.1487C>T (p.Thr496Met) (rs200466188)
GeneDx RCV000235878 SCV000293193 uncertain significance not provided 2015-10-12 criteria provided, single submitter clinical testing The T496M variant has not been published as a pathogenic variant, nor has it been reported as a benign variant to our knowledge. The T496M variant was not observed in approximately 6,500 individuals of European and African American ancestry in the NHLBI Exome Sequencing Project, indicating it is not a common benign variant in these populations. The T496M variant is a non-conservative amino acid substitution, which is likely to impact secondary protein structure as these residues differ in polarity, charge, size and/or other properties. This substitution occurs at a position that is conserved across species and in silico analysis predicts this variant is probably damaging to the protein structure/function. Furthermore, missense variants in nearby residues (L489P, W498R, W498C) have been reported in the Human Gene Mutation Database in association with LMNA-associated disorders (Stenson et al., 2014), supporting the functional importance of this region of the protein.
Invitae RCV000653862 SCV000775752 uncertain significance Charcot-Marie-Tooth disease, type 2 2017-10-17 criteria provided, single submitter clinical testing This sequence change replaces threonine with methionine at codon 496 of the LMNA protein (p.Thr496Met). The threonine residue is highly conserved and there is a moderate physicochemical difference between threonine and methionine. This variant is present in population databases (rs200466188, ExAC 0.009%). This variant has not been reported in the literature in individuals with LMNA-related disease. ClinVar contains an entry for this variant (Variation ID: 245964). Algorithms developed to predict the effect of missense changes on protein structure and function (SIFT, PolyPhen-2, Align-GVGD) all suggest that this variant is likely to be disruptive, but these predictions have not been confirmed by published functional studies and their clinical significance is uncertain. In summary, the available evidence is currently insufficient to determine the role of this variant in disease. Therefore, it has been classified as a Variant of Uncertain Significance.
Mayo Clinic Genetic Testing Laboratories,Mayo Clinic RCV000681642 SCV000809088 uncertain significance Dilated cardiomyopathy-hypergonadotropic hypogonadism syndrome; Dilated cardiomyopathy 1A; Charcot-Marie-Tooth disease type 2B1; Benign scapuloperoneal muscular dystrophy with cardiomyopathy; Heart-hand syndrome, Slovenian type; Hutchinson-Gilford syndrome; Familial partial lipodystrophy 2; Mandibuloacral dysostosis; Limb-girdle muscular dystrophy, type 1B; Lethal tight skin contracture syndrome; Congenital muscular dystrophy, LMNA-related; Emery-Dreifuss muscular dystrophy 3, autosomal recessive 2018-04-10 criteria provided, single submitter clinical testing
Stanford Center for Inherited Cardiovascular Disease, Stanford University RCV000235878 SCV000925153 uncertain significance not provided 2015-12-01 no assertion criteria provided provider interpretation


text:
Fifteenth census of the United States: 1930. The Indian population of the United States and Alaska. Prepared under the supervision of Dr. Leon E. Truesdell, chief statistician for population
United States Bureau of the Census Search this
Arner, George B. Louis (George Byron Louis) 1883-1952 Search this
vi, 238 p. incl. map, tables, diagrs. 24 cm
At head of title: U.S. Department of Commerce. Daniel C. Roper, secretary. Bureau of the Census. William Lane Austin, director.
Cover title: The Indian population of the United States and Alaska.
"By George B.L. Arner, PH. D."--p. 1.
ANTH copy 39088009327206 has bookplate: Smithsonian Institution Libraries, Gift from the Library of John C. Ewers.
Smithsonian Libraries
edanmdm:siris_sil_147668


Help Myself?! Is that legal??!
The article below suggests some simple lifestyle changes that can help us manage our moods and stay balanced. These articles do not provide a miracle cure for bipolar disorder. Nor do they clump everybody together, suggesting everyone with bipolar disorder has the same basic DNA, uniform personality or emotional make-up. We all have our own individual tolerances for things like stress, so it's important to remember that what works for one person may make zero, or negligible, impact on another.
Most of us enjoy the ups to a point. We just want rid of the downs. A recent survey based on Stephen Fry's earlier survey in his illuminating documentary Secret Life Of The Manic Depressive confirmed 8 out of 10 people with bipolar said they would still choose NOT to press a button that would eradicate them of their mood disorder.
For some (all) of us, living with bipolar disorder post-diagnosis requires adjustments. Like recovering addicts or diabetics, it's important we make choices for ourselves that keep us healthy. Making these healthy choices will help us to keep our symptoms under control, minimize mood swings, and empower us to take control of our lives.
Usually, diagnosis starts with psychiatry and medication, but there are plenty of daily decisions we can make to help control unwanted bipolar symptoms, whether they improve or worsen; and help us predict how quickly our moods typically shift.
Sources: Depression and Bipolar Support Alliance, Chrissie's Bipolar Express, Stephen Fry's weather analogy and my disturbed mind.
Using what you've learned (assuming you're not a goldfish), collaborate with your doctor or therapist in the treatment planning process. Don't be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership.
Be patient. Don't expect an immediate and total cure. Have patience with the treatment process. It can take time to find the right program that works for you.
Communicate with your treatment provider. Your treatment program will change over time, so keep in close contact with your doctor or therapist. Talk to your provider if your condition or needs change and be honest about your symptoms and any medication side effects.
Take your medication as instructed. If you're taking medication, follow all instructions and take it faithfully. Don't skip or change your dose without first talking with your doctor.
In order to stay well, it's important we are closely attuned to our moods. By the time the full blown psychotic symptoms of mania or depression appear, it's too late to intercept a mood swing and we live with the consequences. Watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the shift early and act swiftly, might be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.
It's helps if we try to recognize the early warning signs of an oncoming manic or depressive episode. Make a mental list of early symptoms that preceded your previous mood episodes. Also, try to identify the triggers, or external influences, that have led to chaos and destruction in the past.
Chrissy then writes: Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. Having a crisis plan in place allows you to maintain some degree of responsibility for your own treatment.