text:
Otorrhea in Infants with Open Cleft Palate
Michele Carr*
Department of Surgery, The Pennsylvania State University College of Medicine, PA, USA
*Corresponding author: Michele Carr, Department of Surgery, The Pennsylvania State University College of Medicine, 500 University Drive, H091 Hershey, PA 17033-0850
Published: 19 May, 2017
Cite this article as: Carr M. Otorrhea in Infants with Open Cleft Palate. Ann Clin Otolaryngol. 2017; 2(3): 1017.
Introduction: The purpose was to compare the frequency of otorrhea in infants with ventilation tubes (VT) who had an unrepaired cleft palate (OCP) to those with intact palates (IP).
Study Design: Retrospective chart review.
Methods: This was a retrospective chart review of 134 infants under 8 months of age presenting to a tertiary care institution between 2003 and 2012 for VT insertion.
Results: This group included 63 infants with OCP and 71 infants with IP. There were more boys in the OCP group, and the children were younger than the IP group (4.5 versus 6.2 months, p<0.005). OCP patients were more likely to have clinic visits for otorrhea, as 60% did, than were infants in the IP group, where 38% did (p<0.005). Twenty-two percent of the OCP patients had 3 or more clinic visits for otorrhea versus 6% of the IP group (p<0.005). No IP patients had prolonged otorrhea (duration >1 month) while 20.6% of the OCP did (p<0.005). VT were extruded or blocked at one year in 36% of the OCP group versus 18% of the IP group (p<0.05)
. Conclusions: Overall, VT outcomes were poorer in infants with unrepaired cleft palates than in infants with intact palates. Clinic visits were more likely, resulting in more resources being required for their care.
Children with cleft palates have poor Eustachian tube function and typically develop middle ear effusions and potential hearing loss soon after birth [1]. With the advent of newborn hearing screening and state laws regarding rehabilitation of infants with hearing loss, there has been a sense of urgency to clear the middle ear effusions in cleft palate patients. Typically, Ventilation Tubes (VT) is placed at the time of palate repair. Some children will come to the operating room long before the palate repair is scheduled, sometimes for cleft lip repair at a few months of age, or for other unrelated procedures. VT can be placed in conjunction with these procedures, months before the palate is repaired. There is evidence in the literature that these children have a higher rate of otorrhea prior to palate repair than they do after [2], but whether the rate is higher than in infants overall is not known. The purpose of this study was to compare the frequency of otorrhea among infants less than 8 months of age who either had an open cleft palate (OCP) or an intact palate (IP) in order to predict further health care needs and outcomes.
Patients less than 8 months of age who underwent ventilation tube placement at a tertiary care center between 2003 and 2012 were reviewed. The study population included patients who had an unrepaired cleft palate at the time of surgery, and the control population included those patients who did not have a diagnosis of cleft palate, or who had the cleft palate repaired at the time of VT placement. All patients had evidence of bilateral middle ear effusions (OME) and hearing loss for at least 3 months, or a history of at least 3 episodes of acute otitis media in the preceding 6 months. This was a retrospective chart review. VT was placed under general anesthesia. Middle ears were suctioned after a radial myringotomy was made, and an Armstrong grommet was placed.
Ofloxin drops were instilled immediately after VT insertion, and instructions to parents were to place the drops twice daily for three days post-op. Data collected included age at time of surgery, gender, reason for VT placement, type of effusion present at the time of surgery, number of ENT clinic visits where otorrhea was noted, presence of persistent otorrhea of at least 3 continuous weeks duration, whether the VT was blocked or extruded at the 6 month post op mark, and comorbidities. Data was analyzed with SPSS 20. This study was approved by the Institutional Review Board at Penn State Hershey Medical Center (ID # 39063).
Big Title
Comparison of study groups
OCP group
IP group
Significant difference
Mean age (months)
p < 0.005
p < 0.05
# Clinic appointments for otorrhea (mean N)
No visits for otorrhea (%)
1-2 visits for otorrhea (%)
3+ visits for otorrhea (%)
Prolonged otorrhea (%)
VT blocked or extruded prior to 1 year (%)
OCP, Open Cleft Palate; IP, Intact Palate
Table 1: Comparison of study groups.
Comparison of study groups.
136 children between the ages of 2.28 months and 7.9 months who had bilateral VT placed between April 2004 and May 2012 were identified. Two patients had no follow up at this institution and so were not included in the data analysis. Sixty-three (47%) had an open cleft palate (OCP group) at the time of VT placement, and 71 (53%) did not (IP group). Of those in the OCP group, 52 had a cleft lip repaired at the time of VT placement, and 9 had an isolated cleft palate. All patients had OME of 3 or more month's duration with failed hearing screen in clinic at the time of assessment. In the IP group, 21 had a cleft palate repair done at the time of VT placement, and 50 had no cleft palate. Of this latter group, 38 had VT because they had flat tympanograms and failed newborn hearing screen after 3 months, and 12 had VTs for recurrent acute otitis media.
The group was composed of 81 boys and 52 girls (Table 1). There was a significant difference in gender between the OCP and IP groups (p < 0.05) as there were more boys in the OCP group. Mean age was 0.45 years (5.4 months), 4.5 months in the OCP Group, and 6.2 months in the IP Group, which was a significant difference (p < 0.005).
Most children had Armstrong grommets placed. One child in the OCP group had an umbrella tube placed in one ear since the canal was too small to admit an Armstrong grommet. Overall, 20% had purulent effusions at the time of VT insertion, 44% had mucoid effusions, 20.5% had serous effusions, and 14% had no effusions. The percentages for each group are listed in Table 2. There was a significant difference in the distribution of types of effusion at the time of VT placement (p < 0.05). There were more mucoid effusions among the children with OCP, and more clear ears among children in the IP group.
The average number of otolaryngology clinic appointments where otorrhea was treated either within the first year after VT or prior to cleft palate repair (whichever came first) was 1.62 in the OCP Group, and 0.65 in the IP Group. In the OCP Group, 2 patients had not been seen in follow-up in the otolaryngology clinic. The number of appointments for otorrhea ranged from 0 to 11. Forty percent had no visits for management of otorrhea, 38% had 1 or 2 clinic visits for otorrhea, and 22% had between 3 and 11 visits where otorrhea was treated. In contrast, 62% of the IP Group had no visits where otorrhea was treated. 32% had 1 or 2 clinic visits with otorrhea, and 6% had between 3 and 5 visits for otorrhea. The frequency of clinic visits for otorrhea was significantly higher in the OCP Group (p < 0.005).
Thirty-five percent of the OCP Group patients with 3 or more episodes of otorrhea had purulent effusions at the time of VT insertion; 46% had mucoid effusions, and 8 % had either a serous effusion or clear ears. One third (33.3%) of the OCP Group patients who had a purulent effusion at the time of surgery subsequently had 3 or more episodes of otorrhea, compared to 20% of patients who had mucoid effusions. Only 3 patients in the IP Group had 3 or more episodes of otorrhea, 2 had mucoid effusions, and one had a purulent effusion at the time of surgery.
Prolonged otorrhea, defined as otorrhea lasting a month or more, occurred in 13 of 125 (10.4%) patients for whom we had complete data (Table 3). All of these patients were in the OCP Group, 21.3% of that group. This was a significant difference between the groups (p < 0.005). Eighty percent of these patients were male. Of these children, 38.5% had purulent effusions at the time of VT insertion, while 61.5% had mucoid or serous effusions. One third of the children in the OCP Group with purulent effusions at the time of VT placement had prolonged otorrhea at some point in the next year. VT that were blocked or extruded prior to one year occurred in 36% of the OCP Group and 18% of the IP Group, which was significantly different (p < 0.05).
Of the OCP group (n = 63), 36 (57%) had passed a Newborn Hearing Screen (NHS), 23 (37%) had not at the time of tube insertion, and there was no information for 4 patients. None passed a hearing screen at the pre-op appointment. Within the first year after tube insertion, 35 (56%) passed a hearing screen, usually DPOAEs. Nineteen (30%) did not pass although they were tested. Ten patients did not get tested, either because of otorrhea at each visit, absence of audiological evaluation at a Cleft Palate Clinic visit, or failure to follow up. Fifteen (65%) of the 23 patients who had not passed a NHS subsequently passed within the first year after ventilation tube insertion, representing 24% of the whole group.
There is really no dispute that children with open cleft palates typically have OME – in Valtonen's small study of 42 children with cleft palate, the incidence was 98% [3]. Robinson's study showed that OME persisted in 70% of children after cleft palate repair when VT were not placed [4]. Some older studies advocated conservative management because children with cleft palate and greater number of ventilation tube insertions were perceived to have frequent complications of OME such as hearing loss, tympanic membrane retraction and chronic otitis media [5]. A retrospective review in 1992 suggested that children with cleft palates and VT insertion had worse hearing, more otologic abnormalities, and no better speech development than similar children without VT insertion [6]. However Valtonen "et al." [3] subsequently showed that hearing outcomes at age 6 were the same for ventilated children with or without cleft palates. In his group of patients, children had VT placed at 6 months under local anesthesia, then cleft palate repair at 12 months. This group advocated early VT placement because they could not demonstrate any significant difference is long term otologic outcomes between cleft palate and non-cleft palate patients [3]. More recently, Klockars and Rautio found that when VT were placed in cleft palate patients at age 4 months, over half had benefit, defined as absence of OME at one year of age, absence of re-tympanostomy before age one, and absence of tympanic membrane perforation [7]. If palate repair occurred early, at 4 months versus 12 months, outcomes were even better on these parameters, with 86% having benefit as defined above [7].
The American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines recommend that VT be placed when children have bilateral OME for 3 months or more and documented hearing loss [8]. This is because of the low rate of spontaneous timely improvement and the lack of other non-surgical options for treatment [8]. Rosenfeld analysed the literature in 2001 and reported a chronic otorrhea rate of 3.8% in children who had VT placed. Just over 7% had recurrent otorrhea, and 26% had at least 1 episode [9]. A more recent study of 1184 children (none of whom had cleft lip or palate, Trisomy 21 or immune deficiency) revealed that 12% had recurrent (> 3 episodes in 6 months or > 4 episodes in 12 months) otorrhea and 4% had at least one episode of chronic (> 4 weeks) otorrhea [10]. 67% had at least one episode of otorrhea in the year following VT placement. Episodes of otorrhea were more common in younger patients, in those who had recurrent otitis media as the reason for VT insertion, those who had frequent URTIs, and children who had older siblings in the household [10].
A recent Cochrane Review suggested that several maneuvers were associated with reduction in the frequency of otorrhea in the 2 weeks following VT placement. These included: multiple saline washouts at surgery, a single application of antibiotic/steroid drops at surgery, prolonged use of the same drops, and prolonged use of oral antibiotics/steroids. The first 2 options were considered the best choice because they were unlikely to cause complications [11]. The situation in children with open cleft palates is different since none of these children will have normal Eustachian tube function. In 1991 a four member case series was published showing that otorrhea resolved after cleft palate repair [12]. These authors postulated that nasopharyngeal reflux through patulous Eustachian tubes accounted for the otorrhea in these cases [12]. This finding was supported by a study of 33 cleft palate infants with VT in place whom Curtin "et al." [2] monitored for 6 months before and 6 months after cleft palate repair. They found that 43% had 2 or more episodes of otorrhea before repair, and only 6% had 2 or more episodes of otorrhea after repair of the palate.
In our study, among the 63 patients with OCP and VT, we found a higher incidence of otorrhea than we found for similarly aged children without an open cleft palate, 63% versus 38%. Our OCP group is more likely to require frequent visits for this problem, 22% versus 6% of their unaffected peers. However, none of our IP patients in this group had chronic otorrhea. With a rate of 4% as stated in van Dongen "et al." [10], we would have expected at least 2 children in this group to have chronic otorrhea.
This was a retrospective study, limited by the quality of medical records available to us. It's likely that the number of clinic visits for otorrhea is under-reported since patients may have been seen by primary care personnel for this problem, and this information may not appear in our records.
What is the impact of a child with recurrent or chronic otorrhea on the family? Very few families would not seek a medical opinion for a child with otorrhea, particularly if they had undergone ear surgery. There is no known quality of life instrument for this kind of problem, but we know from this data that it results in frequent clinic visits that would not have been needed if the child was left with OME and its potential hearing loss. This requires time off work for the parent, loss of income, fees related to the visits and prescribed antibiotics, and concern about the child's hearing. Another issue is the conflict between medical opinions regarding management of otorrhea. Most patients with chronic otorrhea will be cultured, have culture directed antibiotics prescribed, and may even go on to further medical management of the perceived infection, when in reality the source of the problem is mechanical. These negatives need to be balanced with the positives of improved hearing and speech development. In our study, we could only prove that 56% of OCP patients had normal hearing prior to palate repair. The prevalence of normal hearing may be higher, particularly if otorrhea is intermittent and short –lived, but we were not able to show this. This need for ongoing health care is balanced against the potential speech delay that might be sequelae of clearing middle ear effusions later, such as at the time of cleft palate - rather than cleft lip - repair. Speech delay may also require health care consumption for resolution. To answer the question of whether early or later VT placement in children with cleft palate has a better outcome – for all of the possible variables mentioned above - would require a large randomized controlled trial; in a society that emphasizes early hearing rehabilitation, this will not ever be deemed ethical.
Type of effusion at tube placement
OCP group n = 63(%)
IP group n = 71(%)
Mucoid
Serous
No effusion
OCP - Open Cleft Palate, IP - Intact Palate
Table 2: Comparison of type of middle ear effusion at time of VT placement.
Comparison of type of middle ear effusion at time of VT placement.
OCP group with prolonged otorrhea n = 13 (%)
% with prolonged otorrhea out of Total OCP
OCP - Open Cleft Palate; IP - Intact Palate
Table 3: Intra-op effusions in patients with prolonged Otorrhea.
Intra-op effusions in patients with prolonged Otorrhea.
Infants under 8 months of age who have VT and an open cleft palate have a much more complicated course than do children with intact palates. Parents and pediatricians should be aware of the relatively high incidence of otorrhea in these children, and the fact that only about half of these children will have normal hearing proven before the time of their palate repair.
Paradise JL, Bluestone CD, Felder H. The universality of otitis media in 50 infants with cleft palate. Pediatrics. 1969;44(1):35-42.
Curtin G, Messner AH, Change KW. Otorrhea in infants with tympanostomy tubes before and after surgical repair of a cleft palate. Arch Otolaryngol Head Neck Surg. 2009;135:748-51.
Valtonen H, Dietz A, Qvarnberg Y. Long-term clinical, audiologic, and radiologic outcomes in palate cleft children treated with early tympanostomy for otitis media with effusion: a controlled prospective study. Laryngoscope. 2005;115(8):1512-6.
Robinson PJ, Lodge S, Jones BM, Walker DD, Grant HR. The effect of palate repair on otitis media with effusion. Plast Reconstr Surg. 1992;89(4):640-5.
Sheahan P, Blayney AW, Sheahan JN, Earley MJ. Sequelae of otitis media with effusion among children with cleft lip and/or cleft palate. Clin Otolaryngol Allied Sci. 2002;27(6):494-500.
Robson AK, Blanshard JD, Jones K, Albery EH, Smith IM, Maw AR. A conservative approach to the management of otitis media with effusion in cleft palate children. J Laryngol Otol. 1992; 106(9):788-92.
Klockars T, Rautio J. Early placement of ventilation tubes in cleft lip and palate patients: does palatal closure affect tube occlusion and short-term outcome?. Int J Ped Otorhinolaryngol. 2012;76(10):1481-4.
Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Ficera JS, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013;149(1):S1-35.
Rosenfeld RM. Surgical prevention of otitis media. Vaccine. 2000;19(1): S134-9.
Van Dongen TMA, van der Heijeden GJ, Freling HG, Venekamp RP, Schilder AG. Parent-reported otorrhea in children with tympanostomy tubes: incidence and predictors. PLoS One. 2013;8:e69062.
Schilder AG, Burton MJ, Shin JJ, Rosenfeld RM. Extracts from The Cochrane Library: interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children. Otolaryngol Head Neck Surg. 2013;149(6):813-6.
Braganza RA, Kearns DB, Burton DM, Seid AB, Pransky SM. Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants. Cleft Palate Craniofac J. 1991;28: 301-24.
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Artspace and National Institute of Experimental Arts, CoFA present two lectures by Brian Massumi and Erin Manning, leading philosophers and practitioners of movement, affect and relationality. Together their lectures 'Animality and Abstraction' (Massumi) and 'The Dance of Attention' (Manning) explore the virtual, abstract and powerful dimensions of diagrams.
Everywhere maps and visualisations of space are multiplying around us as new applications of cartography gain prominence. In a quieter manner, the diagram has also re-emerged as an abstract device for thinking about, generating and re-imagining relations themselves. Unlike maps and the rapidly expanding domain of information visualisation, diagrams often seem more obscure modes of picturing and inscribing relations. They hint at something imperceptible, something that lies in wait that we need to make more explicit through further explanation or interpretation.
Pictorial and conceptual diagramming is increasingly deployed in collaborative and collective design, architecture, dance and new media practices as a means for facilitating complex cross-modal research and creation. The diagram's very abstraction allows it to be open, elastic and resonant across practices and modalities. As the philosophers of diagrammatic thought Gilles Deleuze and Felix Guattari suggest, diagrams exist in the dimension of the virtual and help to construct, 'a real that is yet to come, a new type of reality'. Thinking about the diagram, then, is to think generatively about what can and could be created; by whom – humans and nonhumans; and under what circumstances — via collaborative and singular relationships.
Please note that this is the only public event Brian Massumi and Erin Manning will present whilst in Australia. Admission is free of charge and no bookings will be taken. Seating is limited so please arrive early to avoid disappointment.
This paper is composed in relation to an earlier piece entitled 'Choreography as Mobile Architecture' where I explore the vibratory field of cues and alignments as they create spacetimes for movement in William Forsythe's choreography 'One Flat Thing, Reproduced' (as documented on the synchronous objects website, www.synchronousobjects.org). What fascinates me about the idea of cues and alignments is how they activate a field of relation rather than starting or stopping at one particular human body. Often the idea of cue is used to denote a starting point for a movement, and the notion of alignment an effect of the cue-as-cause. What I attempt to demonstrate in Choreography as Mobile Architecture is that in fact the cue-alignment assemblage is an enabling constraint for the movement of the interval of dance itself. A body's cue never lands strictly on a body's alignment. What is danced is the in-between of the cueing itself as it aligns on the dance as a whole. What emerges is an intensive diagram – a mobile architecture – that in turn dances the bodies of the dancers. Not body initiating, but body relating. This is what I call a dance of attention: not the attentiveness of a particular body to the cue/alignment, but the attentiveness of the mobile architecture as it constructs a performance in the making. A more-than-human intervention into the spacetime of human bodies.
In 'The Dance of Attention' I take this analysis one more step to explore in detail how this practice of cueing and aligning creates a diagrammatic praxis. I do this in part through the work of Arakawa and Gins, exploring how their concept of 'procedures' is a diagrammatic praxis that proposes a politics of performance.


• Date: Sunday, September 1, 2002, at 7:33 p.m.
Where can I get a version of that?! I can't find it anywhere! It's the song that plays when they walk up the mountain. It's not "The Ring Goes South".
Any help would really, really help me!!!


During this week that features April Fools Day (we may or may not have something planned), you can expect to see MLB 14: The Show, Mercenary Kings, Batman: Arkham Origins Blackgate on PS3, and more.
*All games/content is releasing in North America and Europe, unless otherwise noted.
Check out our April 2014 release dates to find out what else is releasing this month, and feel free to let us know in the comments below if you'll be picking up anything this week.


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Dopinghärvan inom europeisk trav- och galoppsport uppmärksammades i mars 2022 då 23 personer med anknytning till sporterna greps av polis i Italien, Frankrike och Spanien. Antalet gripna utökades senare till 27 personer. En liknande insats hade gjorts i början av mars 2020, då FBI gjort tillslag mot flera toppnamn inom den nordamerikanska trav- och galoppsporten.

Tillslaget applåderades bland annat av Anders Lindqvist, som länge haft sin bas i Frankrike.

Bakgrund
Den  slog polis till mot 23 personer med anknytning till sporterna i Italien, Frankrike och Spanien. 21 personer greps i Frankrike, 1 person i Italien och 1 person i Spanien. Både veterinärer och tränare greps. Bland de gripna fanns framgångsrika tränarna Yannick Alain Briand, Junior Guelpa och David Cottin.

Även förbjudna substanser beslagtogs under tillslaget.

Referenser

Franska dopningsfall
Spanska dopningsfall
Italienska dopningsfall
2022 i Frankrike
2022 i Italien
2022 i Spanien
Galoppsport
Travsport
Dopningsfall inom travsport
Dopningsfall inom galoppsport

redpajama_set_name: RedPajamaWikipedia


Perfect for those who have never been a fan of traditional lotions. A light, non-greasy, conveniently sprayable body oil.
The spray's creator likes to spray all over right when she gets out of the shower and the skin is a bit damp. She says she gives it a minute to soak in, and away she goes, smelly fresh and feeling good.


We are the manufacturer and suppliers of groundnut oil directly from our organic farm, we assure purity is 100% you can also have lab testing if you have doubt, we are also supplying 100% organic groundnut, we assure that groundnut you can use for re farming, then you may assume the organic quality, if you buy groundnut from shop you will get hybrid qulaity that cannot be used for refarming, quality is our trust, you may check our quality with minimum purchase, we assure you will never leave us.
We are a Time Delay Relay Circuit Using Transistor manufacturer in chennai, Tamilnadu, India. We have been supplying Time Delay Relay Circuit Using Transistor to all over india, middle east, asian countries and african countries.
By connecting the loud speaker you can hear the distortion.
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Christmas is a great time of year, right? Forget presents and jingly music though, the excitement I get is from pound stores stocking hackable LED strings that have so many potential uses.
You can use them just as battery operated lights, add a solar panel to have rechargeable lights, add a USB socket and have them as a TV surround light— or connect them to a Raspberry Pi! They come in loads of colours and can be used under counters, over units, on the balcony, behind the TV or hanging down; just anywhere you want light. They don't have to be solely a Christmas thing too, they can decorate plants and look stylish all year round.
This article is about how I created Raspberry Pi controlled Christmas lights for just £1 (Raspberry Pi not included!) and how you can too with just a Pi and a pound.
I wanted lights that would not run out of battery, and would come on and off when I set, so I would come home to them on, guests would see them on, and they would turn off when everyone is asleep.
Given I wanted the lights to be controlled by the Raspberry Pi, I looked into what sort of voltage the Pi could provide on it's software controlled pins, and the answer is 3.3v. If I want to switch higher voltage, I can use a transistor with not much effort. But I'm super lazy, so a 3. 3v LED string will be ideal.
Time to spend that pound!
When shopping, the first thing I looked at was the battery pack — LED strings typically take between two and three AA batteries, and given AA batteries provide 1.5v, the options are a 3v LED string or a 4.5v LED string. Given that the Raspberry Pi can provide 3.3v as an output, a light string that takes two AA batteries and needs 3v to run is close enough to 3.3v that the Pi provides. So with that I bought some quirky purple ones, got home and turned the soldering iron on.
The next step is to power the lights. I want it controlled by the Raspberry Pi, and for that I'm using it's GPIO (General Purpose Input and Output) — these are pins on the board that can both supply power (output) and listen for voltages (input). I'll be using it to supply power to the lights.
Using a pinout of the GPIO socket, which explains what each pin is connected to, I chose a GPIO pin to connect my lights to. I'm looking at the green GPIO pins; and for this project I chose pin 18 as that also has PWM( Pulse Width Modulation)which effectively gives me scope to "fade" the LEDs if I want to later on(it could be a nice animation for them to fade up and down).
Connecting to the GPIO pins can be done in a few ways, from literally soldering a single socket to a wire and inserting on to the pin, or by using a breakout board, something I already had, connected to a breadboard (something I'm using in a separate Pi project that controls my lights).
My breakout board, connected to a circuit board already that is another project!
Now I knew how I'd be controlling the lights, I had the physical distance of the between my Pi and the lights outside my front door to overcome.
add a USB plug on the lights, use a USB extension cable I already happened to have to connect it to a socket on the breadboard.
Given I didn't have enough length of wire, but did have a long USB extender cable, I chose to use that, adding a USB plug on the lights, and a socket on the Pi, both recovered from other projects.
Note the USB socket secured to the ethernet cable, with cables going to the ground and GPIO 18. I also added a LED to show if the lights were on, by just conencting to the same GPIO pin.
I saved this as a script and noted it's absolute file location (/home/pi/christmasLED/LEDon.py).
I then connected pin 18 to the positive USB wire, and ground to negative, using a USB pinout, and connected everything together. I then ran the LEDon script, and the lights came on! Success! (NOTE: I'm using 3.3v supply from the Pi on a USB cable which normally supplies 5v — so this isn't something that can be used for other USB products. If I wanted to do that, I could add a resistor to the lights and use a transistor to switch the current).
I also chose to add in a red LED on the breadboard to show if the outside lights were on.
To make the lights turn on and off automatically, I chose to use the cron feature that can be found on Linux. My Raspberry Pi is running Raspian, and so using cron was a simple choice and required no installation.
This file contains lines, each one consists of a rule and a command. Cron runs through each line every minute, and checks if the rules match the current time. If they do then the command is run. The rules take the form below, each part separated by a space.
/path/to/command — this and anything onwards is executed if the current time matches the rules beforehand.
For this project, I wanted the lights to come on at 10am, and turn off at midnight — so I used these rules.
I then added an extra cron rule for 1 minute ahead of the current time, saved and waited by my lights… a minute later they turned on! Success! I had verified cron was working, so I deleted the test rule.
I now have a LED string light outside my door, connected via a USB cable extender to my Raspberry Pi's GPIO pin 18. Every minute, the cron script is run on the Pi, and when either of the two rules match, the respective on or off script is run. The on script sets GPIO pin 18 to HIGH — this means that pin starts providing 3.3v. The off script sets pin 18 to LOW, stopping the voltage.
I now have a small Christmas decoration that I don't have to think about changing batteries, running out of power, turning on and off. It's a wonderfully over-engineered solution that kept me out of trouble for another evening.


If you have visited City Hall, the Parks & Recreation Department, or the Paducah Police Department, you may have noticed the blue customer experience cards. These cards ask folks to rate the level of customer service that they received and tell about their experience. Also, employees have been asked to include a link to the short customer experience survey on their email signatures.
Numerous employees have provided exceptional customer service and deserve recognition. Here are three of our recent superstars along with an excerpt from the citizen or visitor who provided the rating.
Debbie McGee (Permit Specialist, Fire Prevention Division of Paducah Fire Department) – Debbie is extremely helpful on all items I ask for assistance with. She is very responsive and willing to help in any way possible.
Vicki Miller (Records Clerk, Paducah Police Department) – The receptionist was nice and friendly. Mrs. Miller answered my concern. When she did not know the answers, she went to find out. This was an awesome experience.
Lessa Wilson (Executive Assistant I, Parks & Recreation Department) – Lessa is very organized and helps us with preparations and planning for a successful event. We are thankful for the City Parks Department coordinating cross-departmental meetings like a champ.
Since the launch of the blue customer experience cards in January, more than 300 responses have been submitted.


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Baptism site readying for soft opening as team unearths more discoveries
Five baptismal pools have been unearthed so far, dating to both the Roman and Byzantine periods, and will be open to visitors
Jordan Times, By Francesca Sawalha ,August 26, 2001
Summer Camps Lead Jordanians to Christ
Ministry Uses Gilead Summer Camps to Present Gospel. More than 150 youngsters choose to follow Christ
Jordanian Seminary Registration Still in Limbo
"The council has said no to registering us as a seminary, with religion as our only discipline," seminary president Dr. Imad Shehadeh confirmed in May. "But they haven't answered us yet on our application to become a university, with several disciplines."
Compass, July 16, 2001
The Ironic Christian: Believers in Jordan Wrestle with Cultural Heritage
Religion Today editor Janet Chismar recently returned from a week in the Kingdom of Jordan. In addition to touring the country's many Biblical sites, she also spent time talking with local Christians, learning of their struggles and faith in a country at the crossroads. Religion Today, June 22, 2001
Kids summer camp is mix of East and West
Around 250 youth will attend a summer camp in the village of Smakieh near the edge of the Jordanian desert, run by a collaboration of a church in Houston, Texas and Jordanian volunteers
By Omar Tesdell, Olive Branch - Issue No. 79 - Tuesday, 19 June 2001
Visiting the Other Side of the Jordan
Today's nation of Jordan is home to some of the most significant sites in biblical history, but almost no one thinks of Jordan as a pilgrim's destination.
The Israelites spent time on both sides of the Jordan. Now tourists can, too.
By Marshall Shelley, Christianity Today,6th June,2001
Evangelicals for Middle East Understanding hold meeting in Amman, Jordan
Presbyterians, Methodists, and Mennonites as well as Baptists and members of fundamentalist churches are part of the "Evangelicals for Middle East Understanding" group that is looking forward to their 2001 conference to be held in Amman, Jordan in November.
Middle East Wire,25th April,2001,By Fred Stricleert
Wounded in Intifada are being helped by Manara Ministries
Amman-based ministry launches a series of aid and ministry programs to also help Iraqi Christians and its own needy
Assist Ministries, April 15, 2001
King Abdallah Asks American Christians to Press for Peace in Middle East
King Abdallah of Jordan meets with Evangalical leaders including Benny Hinn and David Yonggi Cho and asked them for a courageous stand for peace in the Middle East.
Charisma,5th April,2001
Jordanian Officials prepare response to US Department
U.S state department report claims that Jordan practises some restrictions on freedom of religion including prohobition on any incouragment of conversion to Christianity and lack of recognition of some Christian denominations By Alia Shukri Hamzeh, Jordan Times, 9-10 March, 2001

redpajama_set_name: RedPajamaCommonCrawl


text:
Investment Services Licenses
The Malta Financial Services Authority (MFSA) is the single regulator for banking, investment and insurance business in Malta and also houses the country's Companies Registry. The MFSA supervises all licensed financial businesses, issues guidance notes, monitors local and international developments, works with relevant parties on legislative matters, plays a major role in training. It encourages high standards of compliance and runs a consumer affairs unit.
The Investment Services Act 1994 (the Act) was enacted to establish a regulatory regime for Investment Services and Collective Investment Schemes.
The Law, which is in line with the relevant EU directives, provides a great opportunity for Companies that deal in the financial services sector within Europe or wish to expand their operations in Europe. A Licensed Maltese Investment Services Company holds a passport to operate in any country of the European Union. In other words, the Company may set a branch in any European country without having to obtain another license from the country in which the branch will be established.
The Investment Services Act does not include a definition of Investment. Instead it includes a list of Investment Services as well as a list of Instruments. The provision of an Investment Service in relation to an Instrument triggers a requirement for the obtainment of an Investment Services Licence from the MFSA.
Regulated Activities
Investment Services Instruments
Categories of Licenses
Observance of High Level of Competence, Integrity & Fair Dealing
Advantages of a Maltese Investment Services License
Reception and Transmission of Orders in relation to one or more instruments
Execution of orders on behalf of other persons
Dealing on own account
Management of Investments
Trustee, Custodian or Nominee Services
Underwriting of instruments and, or placing of instruments on a firm commitment basis
Placing of Instruments without a firm commitment basis
Operation of a Multilateral Trading Facility
Transferable Securities
Those classes of securities which are negotiable on the capital market and include:
(a) shares in companies and other securities equivalent to shares in companies, partnerships or other entities, and depository receipts in respect of shares;
(b) bonds or other forms of securitised debt, including depository receipts in respect of such securities;
(c) any other securities giving the right to acquire or sell any such transferable securities or giving rise to a cash settlement determined by reference to transferable securities, currencies, interest rates or yields, commodities or other indices or measures.
Money Market Instruments
Those classes of instruments which are normally dealt in on the money market, such as treasury bills, certificates of deposit and commercial papers and excluding instruments of payment.
Units in collective investment schemes
Derivative instruments for the transfer of credit risk
Rights under a contract for differences or under any other contract the purpose or intended purpose of which is to secure a profit or avoid a loss by reference to fluctuations in the value or price for property of any description or in an index or other factor designated for that purpose in the contract.
Certificates or other instruments which confer property rights in respect of any instrument falling within this Schedule.
Foreign exchange acquired or held for investment purposes.
Various Types of Derivatives
Licence Holders authorised to receive and transmit orders in relation to one or more instruments and, or provide investment advice and, or place instruments without a firm commitment basis but not to hold or control Clients Money or Customers Assets (This Category does not include managers of Collective Investment Schemes)
Category 1b
Licence Holders authorised to receive and transmit orders, and, or provide investment advice in relation to one or more instrument and, or place instruments without a firm commitment basis solely for professional clients and, or eligible counterparties but not to hold or control Clients Money or Customers Assets.
Licence Holders authorised to provide any Investment Service and to hold or control Clients Money or Customers assets, but not to operate a multilateral trading facility or deal for their own account or underwrite or place instruments on a firm commitment basis.
Licence Holders authorised to provide any investment service and to hold and control Clients Money or Customers Assets.
Licence Holders authorised to act as trustees or custodians of Collective Investment Schemes
The application process usually commences with a formal meeting with the MFSA in order to discuss the projected application before the formal submission of the application documents. The Application process and the ongoing requirements to which licences issued under the
ISA are subject can be divided into three stages:
The Preparatory Stage – including a meeting with the Authority, submission of a draft Application Form & supporting documentation, review by the MFSA, delineation of the Standard License Conditions to be applied to that particular Applicant by the Authority.
The Pre-Licensing Stage – issuance of an 'in principle' approval for the license by the Authority, incorporation of the corporate vehicle, submission of final & signed application form & supporting documentation, other documents arising during the application process.
The Post-Licensing/Pre-Commencement of Business Stage – satisfaction of ad hoc requirements arising post licensing but pre-commencement of business.
Under Maltese Investment Laws, a License holder is required to:
a. observe high standards of integrity and fair dealing;
b. act with due skill, care and diligence;
c. seek information from customers about their circumstances and investment objectives in order to fulfil its responsibilities to them;
d. take reasonable steps to give its customers, in a comprehensible and timely manner, information needed to enable them to make balanced and informed decisions and be ready to provide them with a full and fair account of its responsibilities;
e. avoid any conflict of interest, or else ensure fair treatment to all its customers by disclosure, internal rules of confidentiality or by declining to act, and by not unfairly placing its interests above those of its customers;
f. (if applicable), arrange proper protection for clients assets which it controls or for which it has accepted responsibility, by way of segregation and identification of those assets, in order to safeguard them;
g. ensure that it maintains adequate financial resources to meet its investment business commitments and to withstand the risks to which its business is subject;
h. organise and control its internal affairs in a responsible manner, keeping proper records, have adequate arrangements to ensure that its staff and representatives are suitable, adequately trained and properly supervised and have well-defined compliance procedures; and
i. deal with the MFSA in an open and co-operative manner and promptly report to it any matters which should be disclosed.
Protection of Investors
The Act makes it illegal for any person to provide an investment service in or from Malta unless such person is in possession of a valid investment services licence.
The power of granting investment services licences is the responsibility of the MFSA. The Act provides that in granting a licence, the MFSA, as the competent authority, may subject the Licence Holder to such conditions, as it may deem appropriate. The conditions which MFSA generally imposes upon an investment services Licence Holder centre around the observance of reasonable standards of competence, integrity and fair dealing.
Favourable tax treatment
Maltese Investment Services License Holders, whose activities are limited to services from Malta but not in Malta (i.e. not advising Maltese individuals) could benefit from the use of the Maltese International Company as the corporate vehicle wherein they are subject to a corporate tax of 35% but non-resident shareholders would then benefit from a very attractive tax refund ending up in a final rate of taxation of 4.17%. (See also: International Trading Companies).
b>Excellent legal, accounting and banking services
Malta has established a worldwide reputation for its excellent legal, accounting and banking services. The main advantages that Malta offers in this respect are the considerably lower costs in the provision of these services, reduced unwarranted red-tape, maintenance of high standards and efficiency.
Set up costs and operational costs
The costs of acquiring an investment license in Malta and setting up of the corresponding corporate vehicle as well as the running expenses of the Company are reasonable and relatively lower than the same costs in other financial centres of Europe.
Passporting Rights in Europe
Due to the compliance of the Law with the relevant EU Directive, a Malta Licensed Investment Services Company is able to operate in any other country member of the European Union either directly or through the establishment of a branch. This may be regarded as an advantage of great essence for non-EU companies, which wish to expand their operations in Europe.
Favourable tax system for Investment Services Expatriates in Malta
Library: Malta Companies
Affiliated Insurance Law in Malta
Anti-Money Laundering Officer AML Officials
Benefits of Malta as a regional financial centre
EU passporting of financial products & services in Malta
History of Malta as a Financial Centre
Malta as the Financial Services Centre in Europe
Malta Financial Services Authority
Malta Financial Services Lawyers
Malta Fund Registration
Malta Funds Registration
Malta is the Top Financial Centre
Malta Registry of Companies
Malta's banks ranked 10th soundest in the world
Professional Investor Funds
Professional Investor Funds WIP
Shariah Compliant Funds in Malta
Taxation of Funds in Malta


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redpajama_set_name: RedPajamaGithub


"GAMF" bursts with life and energy as Broz Rodriguez, a Mexico-based talent with multiple passions, lets loose on this original. With the rise in popularity of rap showing no sign of slowing down, the radio-friendly esque elements and crowd-hyping lyrics match up well with the 90's hip-hop energy the beat delivers. With an overall modern feel layered across "GAMF," there's a little something for everyone this track delivers.
Broz Rodriguez has received support from the likes of Henry Fong, Lucky Date, Makj, and dozens of others as he's made his rounds playing alongside the biggest names in the Mexico scene. From producing music for Nick Hogan, Hulk Hogan's son, to winning awards to his music receiving massive radio reach. Broz Rodriguez's actions show he knows how to get attention in the music industry, a green flag to say the least.


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Free agent pitcher Trevor Williams, a former Met, is wooing MLB teams with a 'Black Friday' campaign
By Rohit yadav
Free agent pitcher Trevor Williams, a former Met, is wooing MLB teams with a 'Black Friday' campaign
Black Friday, the day after Thanksgiving, is the busiest shopping day of the year, and pitcher Trevor Williams, a free agent, utilized it to promote himself. The righthander last made an appearance with the New York Mets in 2021, when he was acquired in a trade.
Williams' alleged skill in the outfield and at the bat was even referenced in the advertisement. But since Major League Baseball adopted a universal DH last season, Williams no longer picks up a bat.
There will probably be buyers for the 30-year-old pitcher on the open market. He just had a good season in New York, where he pitched well for the Mets as a starter and reliever, putting up quality innings.
Williams concluded the previous season with a 3.21 ERA in 30 appearances, nine of which were starts. In addition, he earned a save and struck out 84 hitters. "Thanksgiving Day Free Agent Sale! Just now! Buy one Trevor Williams, the RHP, and receive one Trevor Williams, the LHH Corner Outfielder, for the price of one!" Williams penned.
Trevor Williams tweeted a unique Black Friday sales item
It's improbable that he'll play for the Mets again in 2023. The company, according to the New York Post, thinks Williams will join a squad where he can largely serve as the primary quarterback.
The Mets are also debating whether to re-sign Jacob deGrom, a free-agent pitcher and two-time Cy Young Award winner. Over the last two seasons, injuries have only allowed deGrom to make 26 starts, but he is still considered one of the league's best pitchers.
Elieser Hernandez and Jeff Brigham, two pitchers who spent last season with the Miami Marlins, were chosen by the Mets in a trade.
Even with all the humor, a big league club will sign the 30-year-old this summer, but not for his bat—left-handed or otherwise. Williams had a 3-5 record with a 3.21 ERA in 30 appearances, nine of which were starts, with the Mets last season.
Williams was acquired by the Mets in a 2021 deal with the Chicago Cubs, although he is unlikely to play in New York in 2023. The Mets traded for Elieser Hernandez from the Marlins last week because they thought Williams would seek out chances to start games regularly, according to Joel Sherman of the New York Post.
Williams had a 4.19 ERA and a 2-4 record in 2022 as a starter. Williams, meanwhile, had a record of 1-1 with a 2.47 ERA in 51.1 innings worked in 21 games as a reliever.
ALSO READ: Matthew Stafford, the quarterback for the Rams, has been placed in concussion protocol and will not play against the Chiefs
Trevor Williams
"India Probably Could Have Used 2 More Overs of Deepak Hooda"- Wasim Jaffer Says Hardik Pandya Missed an Opportunity
The Evolution of Michael Jordan Throughout Kenny Smith's Time at UNC Was Revealed
Big Bash League Schedule: BBL 12 Schedule for Sunday, January 29
Thomas Partey Set For MRI Scan Amid Injury Concerns


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Microsoft gives first peek into its next-gen Xbox and game streaming service
At the ongoing E3 2019, Microsoft has unveiled its next-generation Xbox console, codenamed 'Project Scarlett' and some more details on its game streaming service, called 'Project xCloud'. The new console is expected to be available somewhere during the 2020 holiday season and is claimed to be four times more powerful than the Xbox One X console. However, earlier rumors suggested that the company would launch two new consoles, to replace their existing Xbox One X and Xbox One S consoles. Whereas, the xCloud gaming streaming service will get a preview in October later this year.
The all-new console will include a custom-designed CPU based on AMD's Zen 2 and Radeon RDNA architecture and a fast GDDR6 RAM that promise the console to be four times more powerful than the Xbox One X. It will also have an SSD (used as a virtual RAM), which Microsoft claims to be their new generation SSD, to deliver faster game loading speeds with 40x performance boost over the current generation.
Alongside Project Scarlett, Microsoft is also launching Halo Infinite, which will eventually become a part of the next generation of Microsoft's console gaming.
In other news, Microsoft teased about the launch of a new game streaming service, called 'xCloud', a couple of days back. And now, it has revealed that the service will be previewed to customers this October.
To give you a background, this is not the first time Microsoft is talking about its new service. Back in March this year, it gave a demo of the service with the Forza Horizon 4 game streaming from its Azure datacenters to an Android device. And now, it is allowing the E3 attendees to get a first look at the service, slated for a preview in October this year.
Microsoft says that the new service will essentially turn the existing Xbox One into an own personal and free xCloud server that can be used to stream your entire Xbox One library to a wide variety of devices. It is also testing the service with Xbox wireless controllers connected to consoles, mobile devices, and PCs. However, as of now, there is no mention of its pricing and the date of launch.
Last updated by Yash Wate, on 10-Jun-19
Bing and HackerRank have Partnered to Make it Easier for…
Tech Ad-ons
[Tech Ad-ons] Meet Mackenzie "Mac" Book: Thin on the Surface!
Downloads, Windows 7
Download and Use Windows 7 RC for FREE!
News, Windows 10
Microsoft will Reportedly Sell Windows 10 on USB Sticks


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New Texas Law 'Deputizes' Citizens to Sue Abortion Doctors, Clinics: 'Flood of Lawsuits' Coming
Michael Foust | ChristianHeadlines.com Contributor | Monday, July 12, 2021
#prolife
#texas
A Texas pro-life law set to take effect in September is receiving nationwide attention for its unique approach to stopping abortion: It allows citizens to sue abortion doctors and clinics.
The law, known as Senate Bill 8, was signed by Gov. Greg Abbott in May and prohibits abortions after a fetal heartbeat is detected, which is around six weeks of pregnancy. Although other states have passed similar bills, the Texas law is unique in that it allows private citizens to enforce the law through civil lawsuits.
The New York Times spotlighted the law in a July 9 story and quoted a Planned Parenthood lawyer as saying there could be "a flood of suits across Texas' 254 counties."
"It's completely inverting the legal system," said Stephen Vladeck, a constitutional law professor at the University of Texas at Austin, told the New York Times. "It says the state is not going to be the one to enforce this law. Your neighbors are."
The text of the law says "any person" other than "an officer or employee of a state or local governmental entity" may "bring a civil action against any person who … performs or induces an abortion in violation" of the law. The suit would involve lawsuits in state courts, not federal courts. Those who sue and win would be awarded at least $10,000 for each illegal abortion.
Abortion clinics "are stuck in state court in a defensive posture, and there's a lot at stake," Howard M. Wasserman, a law professor at Florida International University, told the newspaper. "If they lose, they are on the hook for significant sums of money."
The law is difficult to challenge, The Times said, because it's "hard to know whom to sue to block it." The law "effectively deputizes ordinary citizens," The Times said.
"If the barista at Starbucks overhears you talking about your abortion, and it was performed after six weeks, that barista is authorized to sue the clinic where you obtained the abortion and to sue any other person who helped you, like the Uber driver who took you there," Melissa Murray, a law professor at New York University, told The Times.
Denny Burk, director of the Center for Gospel and Culture at Boyce College in Louisville, Ky., said pro-lifers nationwide "need to pay attention" to the new law's impact.
"On this side of abolishing Roe," Burk tweeted, "this may be the 'legal hack' that could put an end to almost all abortions."
Pro-lifers need to pay attention to what Texas has just done. On this side of abolishing Roe, this may be the "legal hack" that could put an end to almost all abortions. Read how it worked in Lubbock. Planned Parenthood stopped providing abortions there. https://t.co/sQu9hO70en
— Denny Burk (@DennyBurk) July 9, 2021
Photo courtesy: Unsplash/Pete Alexopoulos
Michael Foust has covered the intersection of faith and news for 20 years. His stories have appeared in Baptist Press, Christianity Today, The Christian Post, the Leaf-Chronicle, the Toronto Star and the Knoxville News-Sentinel.


Perhaps no market has more completely unique apps than the news category. There are so many different news apps for iPhone that it can be overwhelming to find good ones so today I'm making it easy. Ten unique tried-and-tested apps that will get you the news you want.
Google Currents (free): Google Current is basically a personalized newspaper app. Currents has thousands of "channels" from publishers like Engadget, The Wall Street Journal, and Forbes than can be added to your home screen. Even we have a channel (subscribe to it). Once you've added your favorite channels, you can go to you home screen where all of your channels are displayed as well as some featured articles. You can also sort articles directly by channel. It has a fantastic built-in reading environment which makes it a pleasure to use, and of course it's free.
Instapaper ($4): How many times have you started an article somewhere, not had time to finish it, and never found it again? How about when you want to read web articles while on a plane without Wifi? What about times that you've needed an article to troubleshoot a problem, and by the time the problem came back, you lost the article? Instapaper is just for those scenarios. Instapaper allows you to save any article you find on the web, and read them from any device (even offline). I use it whenever I'm going on a plane. I download about five articles that are stored onto my device while I read them and deleted when I'm done. Even better– the ones that I don't read are saved online so that I can read them later. This app is a travelling necessity.
Summly (free): If you've seen Windows' Metro User interface and tiles, you'll recognize the basic layout of Summly. On the home page, sections are laid out in stacked "live titles" that display headlines for each category. Tiles can be updated simply by dragging, and the whole interface is navigated through swiping which gives it a very smooth feel. Categories have a curated collection of sources like blogs and magazines which provide stories, and they can be turned individually on or off. When you tap into a story, summly gives you a smartly generated "Sum"mary of the article which gives you a good idea of the story without even having to read the whole thing.
TED (Free): It's not really news, but more of a current events app. TED gives you access to audio and video recordings of talks by some of Today's finest thinkers. Tons of really smart people have done TED talks on subjects like healthcare, technology, and innovation. If you want to learn what's going on in the world in a broader sense, TED is the place to do it.
CNN (Free): Of all of the specific news organizations out there, CNN has always been on the cutting edge, and the latest iteration of their iPhone app is no exception. The app is extremely easy to navigate with handy circular design elements and integrated gestures, and you can even watch CNN live. It also gets a lot of "cred" for a wide variety of articles and offline viewing, along with their push notifications which always fill me in when major news happens (even tragedies like Sandy Hook which so devastated me).
Pressreader (price varies): Think of Pressreader as the Netflix of News. They have thousands of full publications available for free to monthly subscribers, including big ones like USA Today and the Washington Post. This isn't even some crappy mobile version of the paper. It's the full newspaper/magazine as you would see in print, except that if you tap an article in the paper, the article is reformatted into a more ereader friendly format (although monthly rates are insanely expensive). It's very cool, but for a price.
Twitter (Free): You've most likely heard of Twitter, but as a social network and not a news source. Twitter is the finest news source there is. It's the most rapid way that news is spread. Millions of writers post links to their articles which can be easily found via search. Twitter even unveiled "stories" in their discovery section which personalizes popular News Articles for you. Honestly, Twitter is the best news aggregator there is.
Snackr (free): Why not include Snackr in the main list? For some reason I'm working on finding out, it's been off the app store for a bit. Hopefully it will be back, but Snackr was one of my favorite iPhone apps. It turns your social data and RSS feeds into an audio newscast of sorts that allows you to listen to your news while you're on the move. It's great for news junkies who run, or drive to work. Hopefully it will be back up soon.
We're at an incredible point where we can know about just about any news story around the world in seconds, and hopefully these apps will help you stay current on the news you want to here.


Briefing providing policy background to national and local activity relating to domestic violence – how it is identified and tackling, and how victims of violence are supported. This document also provides advice to local scrutineers to help them to ensure that councils and their partners are working together to do what it required. Produced with funding from the LGA.


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Q: WiFi disconnecting on 18.04 Qualcomm Atheros QCA9377 802.11ac Wireless Network Adapter I tried formatting and reinstalling Ubuntu 18.04 / Ubuntu 20.04 / Fedora 33 / Fedora 32.
I also tried different driver updates, 3rd party drivers from github etc nothing works.
The weird thing is that it runs on a dual boot and on Windows 10 it works just fine. Before I installed it on dual boot, it was running on Ubuntu 20.04 and then the problems started to appear. I tried replacing the WIFI adapter, this Qualcomm is the 5th adapter I've put in.
The other adapters were 2x Intel, Broadcom and some Chinese branded adapter.
I can select my SSID in the network-manager, but when I click, or nothing happens, or it tries to connect but it can't. After several reboots it sometimes connects, then after a few minutes of 10kb/s download speed, it just disconnects. This Qualcomm adapter promises a 400+ mb/s download speed. My Wireless AP supports a 1Gb/s speed. And I'm sitting next to the AP.
Can someone help me on this one? I'm looking for solutions for this for a few months now.
Thanks in advance,
S.

A: Your issue may be on the windows side. Try booting into windows, go to power options in settings, go to additional settings, find where 'set what power button does' and disable the fast boot option and save those settings. Then boot back into linux.
When the 'fast start' option is enabled, windows doesnt really 'shut down' when you ask it to, and since windows is running as well, linux cant detect the wifi card because it is already in use by the windows partition.
Atleast that is my understanding of it. Hope that makes sense to you.
Good luck!

redpajama_set_name: RedPajamaStackExchange


Resistance to change is normal and expected, but what if we could eliminate at least half of the resistance encountered on a change initiative?
Even when employees can align the change with their self-interest and belief system, the uncertainty of success and fear of the unknown remain significant barriers to change.
What Does Resistance to Change Look Like?
Just as change is individual – person-by-person – so is resistance to change. The root cause for one person's resistance may not be the same as another person's, considering factors such as personal history, current events in their life, and other current changes at work.


South Indian Restaurants Gurgaon – My photos & reviews of South Indian Restaurants Gurgaon. South Indian Restaurants Gurgaon and food relished by locals & tourists. Exciting food from South Indian Restaurants Gurgaon. Here is a list of not to be missed South Indian Restaurants Gurgaon. Fit all budgets South Indian Restaurants Gurgaon.


It is simple, really. You have work to do, customers to serve. CP is there to help you get the job done, without compromise.
Our pledge to you: People. Passion. Performance.
At Chicago Pneumatic, our goal is to deliver best-in-class global service and local support to our vehicle servicing, industrial and construction customers through a dedicated product portfolio and a strong network of authorized distributors. We generate added value by delivering the best solution to your needs based on our decades of experience.
What does our mission mean to your business? In the end, it is all about powering your productivity. CP helps make tough jobs easier.


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In light of the recent Duke University student campaign, Who Needs Feminism, created to challenge stereotypes and reassert the importance of feminism, we have been inspired to do a show on why we STILL need feminism. We always have and still do! We're walking through a much-abridged, hand-selected historical timeline of feminist issues in Canada which are still very much connected to present day issues. We weren't "given" anything, we fought and we are still fighting or re-fighting for access to safe legal abortions and reproductive choices, valued and properly paid labour, freedom from violence, and equality among women. These problems still persist because the law is not enough, we need attitudes and values to change! Otherwise we always come to the law through a biased, sexist lens.


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Home / Logbook / The work so far / The work so far
Submitted by musafir on Mon, 2014-04-21 18:08
The fundi (builders) were back from a celebration happening in the neighboring island of Lamu. The boat built by our fundi won the regatta that takes place during the celebration! New material for the construction was found, though sadly during the transportation one of the fundi got injured in the shoulder and had to take a few days in Malindi to get it properly healed.
During some days there was only one fundi working, though for the value of two. The Musafir call him the beast: the working hours are from 6am to 6pm, sunrise to sunset. The speed of the construction was very good with all the Musafirs giving a helping hand with some new tools that had arrived with some new comers. An average of two ribs (mataruma) a day was attached to the hull.
The fundi and the Musafir worked harmoniously together: one of the fundi shaped the ribs with the chainsaw roughly and after that everyone helped to lift it to its position. After that measures are taken, lines are drawn and the rib is taken back out so that the fundi can shape it more closely using a local tool called chokka (big chisel). After the rib has been shaped more closely, it is lifted back up to its correct position, where it is bolted to the planks.
During this time a lot of connections were made to realize the playground for the children. It was important to find a way to do this in a way that would not be interpreted badly by the local people.
The Musafir had a good connection with a local primary school teacher who told them it was a great idea. After meeting the head teacher of the school, he agreed in helping to make the playground possible by connecting the Musafir with the local authority and calling a meeting between the Musafir family, the elders of the village and government authorities.
The school agreed to donate part of their yard for the playground and after the discussion, the Musafir made it clear to the elders that this will be a gift for the children and no other motivation was behind it. Some raised the possibility of fencing the playground but the Musafir wanted an open space for every kid without opening hours. At the end of the meeting, the playground was happily agreed to by the local community. The Musafirs were excited to have the chance to give.


text:
Forecaster predicts warmer, drier fall for Alberta
With this year's beautiful summer set to fade in the rear-view mirror, AccuWeather.com released its fall forecast on Monday. Here are five things you should expect, weather-wise, between September and November, according to Brett Anderson, senior meteorologist with the online forecaster.
Jamie Komarnicki, Calgary Herald
With summer winding down, AccuWeather.com is predicting a drier fall than usual for Calgary, with temperatures about normal or slightly above.	Gavin Young / Calgary Herald
What's in the skies for Alberta this fall?
"In general, we're expecting drier conditions compared to normal for the fall as a whole … for Calgary and area, right up into Edmonton and into the mountains. Much of southwestern Alberta looks to be drier than normal for this coming fall. We're thinking for the most part, near- to slightly-above normal temperatures for the fall across much of Alberta."
Where is the warmth coming from?
"The water temperatures off the northern Pacific, especially off the west coast, continue to remain well above normal. We think that's going to persist. That's also going to allow the pattern to bring in more air off the Pacific instead of coming down from the north. We think there will be more Pacific air coming in from the west compared to cooler chilly air coming in form the north during the bulk of the fall. That's going to keep temperatures a little milder than they normally would be. Some areas of Alberta, especially in the northern and western parts, it's been dry and very warm for much of the summer. With the drier ground, there's less evaporation going on … when you have less evaporation, chances are it's going to be warmer, especially during the early parts of the fall. The third reason is the overall jet stream pattern, which we think is going to remain far enough to the north."
So, what is this dryness going to mean for Alberta (and for ski season)?
"I think we're going to see a later start to the ski season in the mountains than normal. In terms of precipitation, in areas where it's been relatively dry, it does not look like we're going to see much in the way of relief. Where it's been wet … we'll see more typical fall precipitation. We've been dealing with a lot of forest fires in British Columbia, up toward the Northwest Territories. We do not see any relief for that really toward the early part of the fall with this type of pattern. We'll probably continue to see days where there's some smoke, haze in the air coming in from the northwest and west across the area."
How does this region stack up with the rest of the country?
"British Columbia looks like it's going to be a really warm fall and drier compared to normal, especially across the interior. The other extreme we're looking at is Manitoba, where I think it's going to be a chilly, wetter season, especially from Winnipeg on north …. We're pretty confident that temperatures through the fall will remain above normal across Atlantic Canada."
Any glimpses ahead to what winter will bring?
"A lot depends on El Nino. Going back about a month or two, we were anticipating a moderate to perhaps strong El Nino coming in late summer, early fall. As of this time, we still do not have El Nino, officially. However, we do believe El Nino is coming, probably sometime early this fall. At this point, latest indications are that the El Nino will be weak to, at most, moderate. The impact of this will be very little across during the fall. However, during the winter time, usually the case is with an El Nino, we see above normal temperatures across Western Canada. The stronger the El Nino, the more warmer the temperatures are relative to normal. Right now as it stands, confidence is leaning toward certainly a warmer winter compared to last year across the prairies, and probably slightly milder than normal."
Forecaster predicts warmer, drier fall for Alberta Kensington Road closed after two pedestrians struck by vehicle


Replacement Powerlock tool-free link for SRAM 10-speed chains. SRAM recommends breaking their 10-speed chain with a chain tool to push a pin out and NOT to break the chain at the Powerlock link. When the chain is re-connected, a 10-speed Powerlock link must be used. Compatible with SRAM / Shimano 10-speed chains. Black.
I stopped using pins to hold my chains together years ago when I discovered these links. The pin was always the weakest part of the chain. These links are every bit as strong as the rest of the chain and really easy to install. For the thousands of miles on multiple bikes I have used these I have never had one come apart on the road.
Replace worn chain with new chain and link. No problems.
These Powerlock links lock up tight and do not come apart. I've never had one come apart even when using multiple Powerlock links in the same chain. In fact, they lock up so tight that I can't get them apart without a tool. I've not been able to set them by hand either but can by stomping down on the pedal while holding the rear tire stationary.
I've only broken one chain in a lifetime of cycling, but I've had several friends snap chains on group rides so I'd advise everyone to pack a Powerlock link. It takes almost no space in your saddlebag and will spare you lots of road or trailside headache...To fix a busted chain, just remove the damaged link(s) with chain tool, attach the Powerlock, and apply pedal force (with brakes)to snap the Powerlock into place-you're good to roll.
I love the power lock. It's easy to install and remove (with the parker chain pliers). I keep a bunch on hand for when I really need to remove my chain for a good cleaning. Also I know it says you shouldn't re-use the link but in a pinch I have and had no problems.
I bought these as spares, but one also came with my SRAM PC-1071 10-Speed Chain. The chain quick connect link is noted by SRAM to be a one time use item. It was difficult to engage, but seems to hold well. No issues after a few hundred miles.
Great part to have in your kit to fix a broken chain on the road or trail. I've used these with Shimano and SRAM chains, and prefer them to Shimano's spare connector pins (which require you to snap off the leadguide section-hard to do wo a pliers).
I was one mile into a 50 mile group ride when my chain suddenly came apart. In five minutes, thanks to the SRAM Powerlock Link, I was up and peddling again and back with the group, saving my ride for the day. These things are essential. I use with campy chain as well. I have also added these to all our chains to allow me to take them off the bike to clean the chains without pressing out pins.
My sram chain 1091 is in great condition haven't had to use the power link.
The 10 speed lock works great, but it is hard to snap it in to place. make sure to read the directions and use force of your pedal to get it on. By hand doesn't work like with the other powerlinks.


text:
Q: Override method from class to modify method in children ClassA has two children :  ClassB and ClassC.
We need to override a method of ClassA but we will be using ClassB and ClassC (with the modified method).
ClassA, ClassB and ClassC are all part of an external library which we can not modify.
Is it possible to get this done without subclassing ClassB and ClassC seperately using the same re-implementation of the method in each subclass?
Would the problem be different if ClassB already had a re-implementation of the method that we wanted to ignore?

A: Unless there is some special mechanism in play that somehow allows you to do this, it is not possible. It would also make no difference if ClassB had its own overridden implementation.
Since ClassB and ClassC have already been compiled, the implementation of their methods has already been baked into your external library. In general, there is nothing you can do at source code level to change this unless you have your own derived classes.
If we are talking about a managed language with a runtime that allows you to dynamically modify the call targets, or if a hot-patching mechanism that can rewrite machine code on the fly is in play then you might have a way out -- but that would be a special exception and not the rule.

A: It sorta depends on the language, and it sounds like a hack at best. If you are writing this in Javascript, you can directly modify the prototype function of class B and C.
In most C-family of languages though, I don't think this is possible. Multiple inheritance may lead to ambiguities (I imagine B and C each have their own subclassing), so you'd probably have to subclass each.


text:
Fragmentation Among Redshirts Highlighted By Amnesty Debate
Ms. Payao Akhard (center)
(24 July) The question
about which version of amnesty bill should be adopted by the Parliament is exposing the different
ideological lines among the Redshirts movements.
Although the Redshirts have long been known
as loose, fragmented groups – ranging from rural supporters of the former charismatic leader Thaksin
Shinawatra and veteran politicians to urban intellectuals who push for a more liberal political
system – the recent debate on the amnesty bill is particularly polarising.
When Pheu Thai Party campaigned for the election in early 2011, they promised
dual efforts on granting amnesty to Redshirts protesters that are still detained for their alleged
crimes during the 2010 protests and a legal prosecution of those responsible for the crackdown which
left more than 90 people dead, mostly civilians.
After Ms. Yingluck Shinawatra took the helm
of the government, however, the efforts turned out to be somewhat vague – and disappointing for some
of her supporters.
Many political prisoners remained in jail, and legal action against the
authorities at the time of the 2011 crackdown is limited to former Prime Minister Abhisit Vejjajiva
and his former Deputy PM Suthep Thaugsuban, while the military are virtually exempted from the
prosecution.
The decision not to hold the security forces accountable for their role
in the crackdown appears in line with the current government′s soft approach to the military,
perhaps to convince the powerful armed forces that the elected government is no threat to them and
there is no need to repeat the 2006 military coup which ousted Ms. Yingluck′s brother, Thaksin
Shinawatra.
The amnesty bill proposed by Mr. Worachai Hema, an MP of Pheu Thai
Party, reflects that attitude. It promises amnesty to all protesters charged with crimes related to
the 2010 unrest and members of the security forces. The fates of Mr. Abhisit and Mr. Suthep are not
included in the bill, which means the legal case against them would continue.
Former Deputy
PM Chalerm Yoobamrung went even further, proposing an amnesty bill that encompassed all sides
involved in political crisis since 2006. The get-out-of-jail card extends to Mr. Abhisit and Mr.
Thaksin, who was convicted in absentia
of corruption charge in 2007 (he insisted it was politically-motivated charge).
frustrated by the administration′s reluctance to go after the military, group of family
members of civilians killed during the military operation that ended the Redshirts mass protests in
2010 came up with their own draft of amnesty bill last week.
The group, calling itself
?Families of 2010 Martyrs?, was represented by Ms. Payao Akhard and Mr. Pansak Srithep, who each
lost a child in the closing days of the 2010 crackdown – allegedly – at the hands of the
military.
The ?Victims Families? version of the bill would only give amnesty to protesters who are
not charged with serious crimes such as arson attacks on private properties (those who
attacked state properties are exempted out of reasoning that they were expressing political
statement), assaults on members of the public or security forces, and looting.
The amnesty
would also only cover soldiers who did not employ unnecessary violence. That means a soldier who
shot dead an unarmed protester, even when operating under authorisation from the higher chain of
command, would still be put on trial for murder-related charges along with his commanding
officers.
Prominent Pheu Thai politicians and Redshirts leaders, such as Mr. Weng Tojirakarn,
Mr. Sombat Boon-ngarmanong, and Ms. Suda Rangupan, have accused Ms. Payao and Mr. Pansak of trying
to slow down the process to pass amnesty bill by picking fight with the powerful military.
According to those opposed to the ?Victims Families? amnesty bill, the effort to free
detained Redshirts protesters should be a priority over the need to prosecute the security forces.
They expressed their fear that the military would never allow Ms. Yingluck′s government to pass such
a bill, ruining the chance of any little gain there might be altogether, and might even launch a
military coup in retaliation.
Some Redshirts also openly questioned the motives of Ms. Payao
and Mr. Pansak, indirectly accusing them of being collaborators with the rival Democrat Party which,
strangely enough, had expressed its support for the ?Victims Families? amnesty bill.
As the
opposition to Ms. Payao and Mr. Pansak approached the definition of the smear campaign, another blow
was landed today when a letter denouncing the duo′s amnesty bill has surfaced on the internet. The
letter was purportedly signed by 10 relatives of victims killed during the 2010 crackdown, and
claimed that they were not consulted about the amnesty bill by Ms. Payao and Mr Pansak.
letter went on to affirm that the relatives remain committed to Ms. Yingluck and Mr. Thaksin, that
they have always been grateful of efforts by Pheu Thai Party to help relieve their distress, and
that they would not betray the government or accept any payment by the opposition party to undermine
Pheu Thai Party.
It also expresses support for all other amnesty bills, including the
ones proposed by Mr. Worachai and Mr. Chalerm.
Some Redshirts-allied activists are alarmed by
the letter, seeing it as another attempt by Pheu Thai hardliners to isolate Ms. Payao and Mr. Pansak
who had adopted an aggressive stance toward the government and the military alike.
them, Mr. Somsak Jiamteerasakul, is even accusing the government of lackmailing its Redshirts
supporters by tying the freedom of their fellow protesters in jail with amnesty for the military.
According to this view, Pheu Thai politicians? insistence that one has to choose between
soldiers-and-protesters amnesty bill and a bill that was doomed to fail is a false dilemma – as
the government does have the executive power to temporarily release the prisoners on its own
without the need for amnesty bill yet it does not choose to do so.
Moreover, the debate
highlights the split in the Redshirts movements: separating the large faction backed by Pheu Thai
politicians that is always supportive of the government from handfuls of activists who advocate for
greater independence from Mr. Thaksin.
It is also clear that there are wings of the Redshirts
that are increasingly frustrated, or even disillusioned, by Yingluck administration that seems to
renegade on its promises on issue like justice for 2010 crackdown victims.
Meanwhile,
prisoners jailed for lese majeste (insult of the Royal Family) such as Mr. Somyos
Prueksakasemsuk and Ms. Daranee Chancherngsilpakul are not explicitly included in any draft of
amnesty bill, despite calls from the more liberal faction inside the Redshirts.
Yellowshirts and Democrat Party have already announced they will not accept amnesty for lese majeste
prisoners, claiming that their offence is criminal rather than political nature, and there is no
sign that neither Pheu Thai Party nor the official Redshirts leadership would dare wade into the
highly-sensitive issue – another example of reluctance on the part of the government to challenge
the status quo.
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I'll start by declaring my bias from the outset. I'm a fan of Dr. Peter Attia. So I was flattered when asked by TrainingPeaks to write this blog post, and even more honored when Peter granted permission for me to take on the task. However, please note that while Peter's fine with me trying to tackle the topic, it does not imply his endorsement of the approaches in this article. Herein begins a two-part blog post to try to do the topic of low carbohydrate/high fat dieting justice.
I first stumbled across Dr. Attia's work during my own experimentation with lowering carbohydrates in my diet and when trying to understand the positive effects I observed it having on my blood pressure, fat oxidation and endurance performance. Like Stephen Phinney, Jeff Volek, and Tim Noakes, Peter is a pioneer in this area, and has an extensive website that details his work at EatingAcademy.com. Peter is a physician, a researcher, former ultra-endurance swimmer and cycling time trialist who continues to forge new ground in the areas of health and longevity.
Who is Dr. Peter Attia?
He has a super interesting background. A fellow Canadian, Peter took a different road toward developing his knowledge of exercise science than many of us in the field typically do. Peter is a self-confessed near high school dropout who was about to dedicate his life to the sport of boxing when a high school teacher inspired him to pursue undergraduate degrees in mathematics and engineering. Topping his class, he moved to Stanford medicine to complete his M.D., before becoming a surgical resident at The Johns Hopkins Hospital. Over time, Peter grew frustrated with certain challenges within the medical system, and eventually changed course to begin working privately. He shares some of the experiences that shaped his views today in this very moving 2013 TED talk, which has now over 2.3 million views.
So, what might the "Peter Attia" approach to dieting be for endurance athletes? While in the past he may have recommended diets such as paleo, LCHF (low carbohydrate, high fat) or ketogenic, his most recent podcasts on the topic suggest that he's going much deeper than most of us have thought to do.
And therein lies the challenge of writing the Peter Attia approach to dieting for endurance athletes. Peter's developed an appreciation for the fact that we humans are all incredibly unique in how we function.
In turn, like all good coaches out there, he appears to take a highly individualized approach to diet and the behavior modifications he recommends. In fact, he is an investor in a business that practices this for individuals with Type II diabetes, called Virta Health. If you can imagine being a patient of Dr. Attia's, I'm guessing that the first thing he would do is learn as much as he could about you. He'd also be a good listener and be highly interested in your goals. Like he's done with his approach to longevity, my guess is that he'd try to reverse-engineer the performance aim in question, and discern how diet impacts that performance.
So let's try to do that here. First, we need to specify some type of performance to optimize. Since most TrainingPeaks enthusiasts are long distance triathletes and cyclists, let's narrow our target to an endurance-specific event we're preparing for with a typical finishing time of between four and five hours, such as an IRONMAN 70.3 triathlon or a GranFondo cycling event.
If we reverse-engineer such an event from an energetic process, we know that to complete it in the fastest time possible, we require high levels of sustained muscular output (power), with high economy or efficiency of that movement (including aerodynamics) also being important. There are other factors, of course, but these two are the main ones to focus on. To accomplish this task well, we need energy for that power, and that energy comes predominantly from the burning of fuels (macronutrients) we store from our diet.
As many of us are aware, our carbohydrate stores in the form of muscle and liver glycogen are relatively small when compared to our fat and protein levels. We don't want to delve into our protein stores, and nor can we very well, as those are doing important things for us in terms of our make-up and functional skeletal muscle, so we'll leave protein out of the picture for the moment.
For argument's sake, remember that we're really just relying on energy from two main macronutrients when it comes to prolonged endurance performance; carbohydrates and fat. While there's always a combination of both fuels burned in our muscle cells, there is remarkable variability in how much of each burns from one person to the next, for a variety of reasons. For example, we can see these levels as low as less than 0.2 g/min in recreational runners, and more than 7-fold higher at 1.5 g/min in fat-adapted runners. Fortunately, this is where diet comes to the party to make a big impact.
Back to the performance problem. We have a four to five hour endurance event that we want to complete as quickly as possible. We know that every liter of oxygen that we take in and process gives us 5 kcal of energy. Take our middle-of-the-pack athlete, either the triathlete or cyclist in the above example, and let's assume that they have a functional threshold power (FTP; 1-hour time trial score) of 250W (proxy of lactate turnpoint).
From experience, this is going to put their aerobic threshold (lactate threshold) somewhere around 200W. This aerobic threshold tends to be the exercise intensity that we can sustain for the entire four to five hour duration. We can go higher into our capacity, toward or even above our FTP, but if we do, we're "burning matches" as they say, as well as our finite glycogen reserves.
Continuing to calculate, if we use Best Bike Split, we can see that 200W puts our typical athlete right around 34 km/h, getting in at about a 2:35 min mark for a 90km bike before venturing out on the half marathon run, or completing a 150km Granfondo event in about 4.5 h. Again, remember that we have less than 2,000 or so kcal of energy from muscle and liver glycogen on board before we need to rely on carbohydrate ingestion.
If we consider that our athlete can burn around 1,000 kcal in an hour at their FTP, it doesn't take too long to see that if our effort is predominantly carbohydrate driven, we'll have about two hours before our brains are going to tell us to lower exercise intensity back toward the level of our fat oxidation rate. Yes, we can push carbohydrates into our system up to rates as high as 90 g/h (theoretically 360 kcal/h), but this strategy doesn't work for everyone, and is associated with a high incidence of gastrointestinal complaints.
Now that example is simply if we were to approach the problem from a "carb is king" perspective. If we delve deeper, we learn that fat oxidation rates are of prime importance when it comes to endurance performance. For example, we showed in a cross-sectional study that fat oxidation rates were nearly three-fold greater in elite versus recreationally-trained runners, and that fat oxidation rates explained the high-intensity exercise performance difference between groups, with carbohydrate burning rates being equal.
So for the performance in question, Peter would tell us that it's going to be all about fat-burning ability. The more we can make that 1,000 kcal/h be done with fat burning, the more we'll have on board to use for longer and later. Basically, this means that we're programing our bodies to burn CHO as a last resort. Being able to access both, as needed, has been labeled "metabolic flexibility." If you want to dive deeper into the weeds here, be sure to check out Peter's blogs on the topic.
Keeping it relatively simple, there are generally two ways we can affect our fat oxidation. We can simply train more, or we can lower our dietary carbohydrate consumption to a certain level (more on this later). Both methods lower insulin levels and cause your muscle to burn more fat relative to carbohydrate.
Here's an example from Hall et al. (2016) comparing fat oxidation (indirect calorimetry) in 13 highly-trained cyclists and triathletes when they were fed (CON), when they were overnight fasted (FAST) and two hours after they trained (EXER). Granted, these are one-off, short-term effects in the same individuals on standard western diets, and the fat oxidation rates are pretty low for well-trained athletes, but it gives you an idea of how both diet and exercise impact fat burning.
This is generally what we see. I know of many young athletes who train on high carbohydrate diets and have high fat oxidation rates. This comes back to the individualization issue that Dr. Attia professes. Some of us are going to have high levels of inherent metabolic flexibility, or appropriate levels of fat and carbohydrate burning for the performance in question, while others have what Peter has called "inexcusable metabolic failure," where athletes may have blood glucose and insulin at levels that ultimately are trapping stored triglyceride in adipose cells. For the latter situation, a dietary intervention can be a game changer.
Do You Need A Dietary Intervention?
If you have experienced any of these conditions, following some of Peter's suggestions might be worth a try.
Whether it's fat oxidation for performance we're interested in, or health and longevity, Peter will tell you that the name of the game is glucose disposal. Can you maintain a small daily average level of glucose, a low daily variance (minimal fluctuation) of glucose and a low area under the curve of insulin? To measure this, he wears a continuous blood glucose meter (CGM). His general daily targets for average blood glucose range from 91 to 93 mg/dL (5.0-5.2 mmol/L), with a variance or standard deviation of <10 mg/dL (0.5 mmol/L).
While it would be ideal to measure the insulin response continuously, that technology is not yet available, so using a CGM is currently the most useful tool, as it can be used as a proxy measure for insulin; the primary regulator of your fat oxidation. It's also very useful for understanding the non-dietary factors that affect your blood glucose, such as stress and sleep. We're not all going to be fortunate enough to use a CGM, so alternatively a morning-fasted measurement is a good secondary marker to take.
My colleague, Dr. Dan Plews, and I have followed Peter's lead here and we too wear CGMs from time to time in order to monitor the impact of exercise training, diet and lifestyle factors on our glucose levels. Here are a few examples detailing how glucose fluctuates in our lives and some of the lessons we've learned along the way.
The low glucose (and proxy insulin) means that I'm signaling to my muscles to improve their fat oxidation in the future when they adapt.
There is no need to maintain high blood glucose levels during exercise, as we've been told in the past. In my particular situation, ketones and fat oxidation are easily meeting the requirements of this workout. It should also be mentioned that the ride was fasted, without any fueling and only drinking plain water (boring I know).
I'll go more into why this type of fasted workout is important for fat oxidation, as well as more examples of glucose fluctuation in part two of my series on the "Peter Attia" approach to dieting and training using the LCHF/Keto diet.