text:
Non-Hodgkin lymphoma obinutuzumab maintenance
Patients with lymphoma should be considered for inclusion into clinical trials. Link to ALLG website, ANZCTR website and Lymphoma Australia website.
Please note: dexamethasone supportive medication has been added to the treatment schedule as a default. Patients should be individually monitored and dexamethasone reduced or omitted as clinically appropriate, to avoid overmedication.
Non-Hodgkin lymphoma bendamustine and obinutuzumab
Non-Hodgkin lymphoma O-CHOP21 (obinutuzumab CYCLOPHOSPHamide DOXOrubicin vinCRISTine prednisolone)
Non-Hodgkin lymphoma O-CVP (obinutuzumab CYCLOPHOSPHamide vinCRISTine prednisolone)
Treatment schedule
Indications and patient population
Dose modifications
Treatment schedule Treatment schedule
Cycle 1 to 12
Obinutuzumab 1,000 mg IV infusion 1
56 days (2 monthly)
12 doses, or up to 2 years duration of treatment.
Drug status:
Obinutuzumab: (PBS authority)
Full prescribing information and Authority Application forms available from the Department of Human Services website
~ $5,380 per cycle "How this cost is calculated"
The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.
The cost includes antineoplastic drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.
Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au), MIMS Online and other sources. These costs are reviewed and updated on eviQ at 6 monthly intervals.
Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on 28 day month.
The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.
One off loading doses are not included in protocol cost calculations.
The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many antineoplastic drugs are reimbursed on the PBS.
The supportive therapies (e.g. antiemetics, premedications, etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.
Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.
Paracetamol 1,000 mg (PO) 60 minutes before treatment
Loratadine 10 mg (PO) 60 minutes before treatment. * May be omitted - please see below for criteria.
Dexamethasone 20 mg (IV) 60 minutes before treatment. * May be omitted - please see below for criteria.
Obinutuzumab 1,000 mg (IV infusion) in 250 mL sodium chloride 0.9%. Start at 100 mg/hr. Rate can be increased by 100 mg/hr every 30 minutes, to a maximum of 400 mg/hr. **
* Premedication requirements:
Antihistamine premedication may be omitted if no infusion related reactions (IRR) occurred with the previous infusion.
Intravenous corticosteroid premedication may be omitted infusions if no grade 1 or 2 IRR occurred with the previous infusion. If a grade 3 IRR occurred OR lymphocyte count > 25 x109/L prior to next treatment, intravenous corticosteroid premedication should be continued.
** If the patient experienced a grade 2 or higher infusion related reaction during the previous administration, commence at 50 mg/hr. The rate of infusion should be titrated up at 50 mg/hr increments every 30 minutes to a maximum of 400 mg/hr.
Treatment schedule - Overview
Treatment schedule - Detail
Previously untreated advanced CD20 positive follicular B-cell non-Hodgkin lymphoma following immunochemotherapy
CD20 positive follicular B-cell non-Hodgkin lymphoma, refractory to treatment with rituximab, following bendamustine containing immunochemotherapy regimen
Venous access required
IV cannula (IVC) or central venous access device (CVAD) is required to administer this treatment.
Read more about central venous access device line selection
Hypersensitivity/infusion related reaction
High risk with obinutuzumab.
Premedication
The product information states that the premedication for obinutuzumab should consist of an analgesic/antipyretic, an antihistamine and an intravenous corticosteroid for the first initial dose.
For subsequent infusions:
Antihistamine premedication may be omitted for subsequent infusions if no infusion related reactions (IRR) occurred with the previous infusion.
Intravenous corticosteroid* premedication may be omitted for subsequent infusions if no grade 1 or 2 infusion related reactions (IRR) occurred with the previous infusion. If a grade 3 IRR occurred OR lymphocyte counts > 25 x109/L prior to next treatment, intravenous corticosteroid premedication should be continued.
Analgesic/antipyretic premedication is given before all infusions.
A suggested default premedication has been added to the treatment schedule, and may be substituted to reflect institutional policy.
Note: hydrocortisone is not recommended as it has not been effective in reducing the rate of infusion reactions.
* IV corticosteroid (may be substituted by oral corticosteroids if contained within the chemotherapy regimen)
Emetogenicity MINIMAL
No antiemetics should be routinely administered before treatment in patients without a history of nausea and vomiting. If patients experience nausea and/or vomiting, consider using the low antiemetic prophylaxis regimen.
Read more about preventing antineoplastic induced nausea and vomiting
Progressive multifocal leukoencephalopathy
Use of monoclonal antibodies may be associated with an increased risk of progressive multifocal leukoencephalopathy (PML), a rare but potentially fatal opportunistic viral infection of the brain. Patients must be monitored for any new or worsening neurological symptoms.
Read more about progressive multifocal leukoencephalopathy and the Therapeutic Goods Administration Medicines Safety update on progressive multifocal leukoencephalopathy from the Australian Government, Department of Health.
Severe and life threatening thrombocytopenia, including acute thrombocytopenia (occurring within 24 hours after the infusion) has been observed during treatment with obinutuzumab. Fatal haemorrhagic events have also been reported in cycle one of treatment.
Patients should be closely monitored for thrombocytopenia, especially during the first cycle.
In clinical trials, it was reported in 10.4% of patients treated with obinutuzumab.
Antiviral prophylaxis
Read more about antiviral prophylaxis drugs and doses
Pneumocystis jiroveci pneumonia (PJP) prophylaxis
Read more about prophylaxis of pneumocystis jiroveci (carinii) in cancer patients
FBC, EUC, LFTs and LDH at baseline, and prior to each cycle and as clinically indicated.
Hepatitis B screening and prophylaxis
Routine screening for HBsAg and anti-HBc is recommended prior to initiation of treatment. Prophylaxis should be determined according to individual institutional policy.
Read more about hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy
Live vaccines, including BCG, MMR, zoster and varicella vaccines, are contraindicated in cancer patients receiving immunosuppressive therapy and/or who have poorly controlled malignant disease.
Refer to the recommended schedule of vaccination for immunocompromised patients, as outlined in the Australian Immunisation Handbook.
Effects of cancer treatment on fertility
Cancer treatment can have harmful effects on fertility and this should be discussed with all patients of reproductive age prior to commencing treatment.
Read more about the effect of cancer treatment on fertility
Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient's situation including but not limited to treatment intent (curative vs palliative), the antineoplastic regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient preferences. For more information see dosing considerations & disclaimer.
Creatinine clearance (mL/min)
30 to 50 No dose adjustments necessary, however patients are at greater risk of neutropenia.
less than 30 No data available for obinutuzumab
Hepatic impairment
No data available for obinutuzumab
References & Disclaimer
Clinical management
Antihypertensives Additive hypotensive effect Consider withholding antihypertensive medications 12 hours prior to, throughout and 1 hour after the obinutuzumab infusion
Warfarin Antineoplastic agents may alter the anticoagulant effect of warfarin. Monitor INR regularly and adjust warfarin dosage as appropriate; consider alternative anticoagulant.
Direct oral anticoagulants (DOACs) e.g. apixaban, rivaroxaban, dabigatran
Interaction with both CYP3A4 and P-gp inhibitors /inducers.
DOAC and antineoplastic levels may both be altered, possibly leading to loss of efficacy or toxicity (i.e. increased bleeding).
Apixaban: avoid concurrent use with strong CYP3A4 and P‑gp inhibitors. If treating VTE, avoid use with strong CYP3A4 and P‑gp inducers.
Rivaroxaban: avoid concurrent use with strong CYP3A4 and P‑gp inhibitors.
Dabigatran: avoid combination with strong P‑gp inducers and inhibitors.
If concurrent use is unavoidable, monitor closely for efficacy/toxicity of both drugs.
Digoxin Antineoplastic agents can damage the lining of the intestine; affecting the absorption of digoxin. Monitor digoxin serum levels; adjust digoxin dosage as appropriate.
Antiepileptics Both altered antiepileptic and antineoplastic levels may occur, possibly leading to loss of efficacy or toxicity. Where concurrent use of an enzyme-inducing antiepileptic cannot be avoided, monitor antiepileptic serum levels for toxicity, as well as seizure frequency for efficacy; adjust dosage as appropriate.
Also monitor closely for efficacy of the antineoplastic therapy.
Antiplatelet agents and NSAIDs Increased risk of bleeding due to treatment related thrombocytopenia. Avoid or minimise combination.
If combination deemed essential, (e.g. low dose aspirin for ischaemic heart disease) monitor for signs of bleeding.
Serotonergic drugs, including selective serotonin reuptake inhibitors (SSRIs e.g. paroxetine) and serotonin noradrenaline reuptake inhibitors (SNRIs e.g. venlafaxine) Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.) Avoid combination.
If combination is clinically warranted, monitor for signs and symptoms of serotonin syndrome (e.g. confusion, agitation, tachycardia, hyperreflexia).
For more information link to TGA Medicines Safety Update
Vaccines Diminished response to vaccines and increased risk of infection with live vaccines. Live vaccines (e.g. BCG, MMR, zoster and varicella) are contraindicated in patients on immunosuppressive therapy. Use with caution in patients on non-immunosuppressive therapy.
For more information; refer to the recommended schedule of vaccination for cancer patients, as outlined in the Australian Immunisation Handbook
Discharge information
Handling of monoclonal antibodies and waste management
Safe administration
General patient assessment prior to each day of treatment.
Prime IV line(s) with sodium chloride 0.9%.
Insert IV cannula or access port or CVC.
Treatment - Time out
Prior to administration:
check baseline observations
check for previous adverse events with drug infusions
verify premedication has been taken. If not, administer 60 minutes prior to obinutuzumab administration:
paracetamol 1000 mg orally AND
loratadine 10 mg orally (or similar antihistamine premedication may be omitted if no infusion related reactions (IRR) occurred with the previous infusion)
IV corticosteroid if a grade 3 IRR occurred with the previous infusion OR lymphocyte counts > 25 x 109 /L prior to next treatment.
If no IRR or a Grade 1 IRR occurred with the previous infusion:
commence obinutuzumab infusion at 100 mg/hr
repeat observations prior to each rate increase
increase rate by 100 mg/hr every 30 minutes to a maximum of 400 mg/hr if observations are stable
flush with ~ 100 mL of sodium chloride 0.9%
If a Grade 2 IRR or higher occurred with the previous infusion:
commence obinutuzumab infusion at 50 mg/hr
increase rate by 50 mg/hr every 30 minutes to a maximum of 400 mg/hr if observations are stable
flush with ~100 mL of sodium chloride 0.9%
Hypotension may occur during obinutuzumab intravenous infusion. Consider withholding antihypertensive medication for 12 hours before and throughout each infusion.
Remove IV cannula and/or deaccess port or CVC.
Continue safe handling precautions (reproductive risk only) for 7 days after completion of drug(s).
Ensure patient receives patient information sheet.
Prophylaxis medications
Prophylaxis medications (if prescribed) i.e. PJP prophylaxis, antivirals.
The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.
Immediate (onset hours to days)
Hypersensitivity reaction
Anaphylaxis and infusion related reactions can occur with this treatment.
Read more about hypersensitivity reaction
Low blood pressure can occur with this treatment.
Flu-like symptoms
Early (onset days to weeks)
A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding.
Read more about thrombocytopenia
Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively.
Read more about neutropenia
Read more about fatigue
Antineoplastic agents can cause a number of changes in the skin with maculo-papular rash the most common type of drug-induced skin reaction.
Read more about skin rash
Late (onset weeks to months)
Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood.
Read more about anaemia
Progressive multifocal leukoencephalopathy (PML)
A rare opportunistic viral infection of the brain, usually leading to death or severe disability, can occur with monoclonal antibodies (e.g. rituximab, obinutuzumab, ofatumumab, brentuximab vedotin) and other targeted therapies (e.g. ibrutinib, ruxolitinib, idelalisib). Onset may occur up to months after the final dose.
Read more about progressive multifocal leukoencephalopathy (PML)
Obinutuzumab was studied as maintenance therapy following an obinutuzumab containing induction regimen for either upfront or refractory lymphoma. Maintenance was offered to patients who achieved either CR or PR following induction therapy. It was administered every two months for 2 years (total of 12 doses) unless progression occurred prior.
The efficacy and toxicity data are addressed in the "parent" eviQ regimens. The eviQ reference committee directs you to the following links that detail the relevant evidence and toxicity sections:
ID 3554 Non-Hodgkin lymphoma bendamustine and obinutuzumab
ID 3573 Non-Hodgkin lymphoma O-CHOP21 (obinutuzumab CYCLOPHOSPHamide DOXOrubicin vinCRISTine prednisolone)
ID 3595 Non-Hodgkin lymphoma O-CVP (obinutuzumab CYCLOPHOSPHamide vinCRISTine prednisolone)
Cheson, B. D., N. Chua, J. Mayer, et al. 2018. "Overall Survival Benefit in Patients With Rituximab-Refractory Indolent Non-Hodgkin Lymphoma Who Received Obinutuzumab Plus Bendamustine Induction and Obinutuzumab Maintenance in the GADOLIN Study." J Clin Oncol 36(22):2259-2266.
Purpose To perform an updated analysis of the randomized phase III GADOLIN trial in patients with rituximab-refractory indolent non-Hodgkin lymphoma treated with obinutuzumab (GA101; G) and bendamustine (B). Patients and Methods Patients with histologically documented, rituximab-refractory CD20(+) indolent non-Hodgkin lymphoma received G 1,000 mg (days 1, 8, and 15, cycle 1; day 1, cycles 2 to 6) plus B 90 mg/m(2)/d (days 1 and 2, all cycles) or B 120 mg/m(2)/d monotherapy. Patients who did not experience disease progression with G-B received G maintenance (1,000 mg every 2 months) for up to 2 years. The primary end point was progression-free survival (PFS). Results Of 413 randomly assigned patients (intention-to-treat [ITT]: G-B, n = 204; B monotherapy, n = 209), 335 had follicular lymphoma (FL; G-B, n = 164; B monotherapy, n = 171). After a median follow-up of 31.8 months, median PFS in ITT patients was 25.8 months (G-B) and 14.1 months (B monotherapy; hazard ratio [HR], 0.57; 95% CI, 0.44 to 0.73; P < .001). Overall survival (OS) also was prolonged (HR, 0.67; 95% CI, 0.47 to 0.96; P = .027). PFS and OS benefits were similar in patients with FL. Grade 3 to 5 adverse events (AEs) were reported by 148 (72.5%) and 133 (65.5%) patients in the G-B and B monotherapy arms, respectively, most commonly neutropenia (G-B, 34.8%; B monotherapy, 27.1%), thrombocytopenia (10.8% and 15.8%), anemia (7.4% and 10.8%), and infusion-related reactions (9.3% and 3.4%). Serious AEs occurred in 89 G-B patients (43.6%) and 75 B monotherapy patients (36.9%); fatal AEs occurred in 16 (7.8%) and 13 (6.4%), respectively. Conclusion This updated analysis confirms the PFS benefit for G-B shown in the primary analysis. A substantial OS benefit also was demonstrated in the ITT population and in patients with FL. Toxicity was similar for both treatments.
Hiddemann, W., A. M. Barbui, M. A. Canales, et al. 2018. "Immunochemotherapy With Obinutuzumab or Rituximab for Previously Untreated Follicular Lymphoma in the GALLIUM Study: Influence of Chemotherapy on Efficacy and Safety." J Clin Oncol 36(23):2395-2404.
Purpose The GALLIUM study ( ClinicalTrials.gov identifier: NCT01332968) showed that obinutuzumab (GA101; G) significantly prolonged progression-free survival (PFS) in previously untreated patients with follicular lymphoma relative to rituximab (R) when combined with cyclophosphamide (C), doxorubicin, vincristine (V), and prednisone (P; CHOP); CVP; or bendamustine. This report focuses on the impact of chemotherapy backbone on efficacy and safety. Patients and Methods A total of 1,202 patients with previously untreated follicular lymphoma (grades 1 to 3a), advanced disease (stage III or IV, or stage II with tumor diameter >/= 7 cm), Eastern Cooperative Oncology Group performance status 0 to 2, and requiring treatment were randomly assigned 1:1 to G 1,000 mg on days 1, 8, and 15 of cycle 1 and day 1 of subsequent cycles or R 375 mg/m(2) on day 1 of each cycle, for six to eight cycles, depending on chemotherapy (allocated nonrandomly by center). Responding patients received G or R for 2 years or until disease progression. Results Baseline Follicular Lymphoma International Prognostic Index risk, bulky disease, and comorbidities differed by chemotherapy. After 41.1 months median follow-up, PFS (primary end point) was superior for G plus chemotherapy (overall hazard ratio [HR], 0.68; 95% CI, 0.54 to 0.87; P = .0016), with consistent results across chemotherapy backbones (bendamustine: HR, 0.63; 95% CI, 0.46 to 0.88; CHOP: HR, 0.72; 95% CI, 0.48 to 1.10; CVP: HR, 0.79; 95% CI, 0.42 to 1.47). Grade 3 to 5 adverse events, notably cytopenias, were most frequent with CHOP. Grade 3 to 5 infections and second neoplasms were most frequent with bendamustine, which was associated with marked and prolonged reductions in T-cell counts. Fatal events were more frequent in patients treated with bendamustine, possibly reflecting differences in patient risk profiles. Conclusion Improved PFS was observed for G plus chemotherapy for all three chemotherapy backbones. Safety profiles differed, although comparisons are confounded by nonrandom chemotherapy allocation.
Marcus, R., A. Davies, K. Ando, et al. 2017. "Obinutuzumab for the First-Line Treatment of Follicular Lymphoma." N Engl J Med 377(14):1331-1344.
BACKGROUND: Rituximab-based immunochemotherapy has improved outcomes in patients with follicular lymphoma. Obinutuzumab is a glycoengineered type II anti-CD20 monoclonal antibody. We compared rituximab-based chemotherapy with obinutuzumab-based chemotherapy in patients with previously untreated advanced-stage follicular lymphoma. METHODS: We randomly assigned patients to undergo induction treatment with obinutuzumab-based chemotherapy or rituximab-based chemotherapy. Patients with a response received maintenance treatment for up to 2 years with the same antibody that they had received in induction. The primary end point was investigator-assessed progression-free survival. RESULTS: A total of 1202 patients with follicular lymphoma underwent randomization (601 patients in each group). After a median follow-up of 34.5 months (range, 0 to 54.5), a planned interim analysis showed that obinutuzumab-based chemotherapy resulted in a significantly lower risk of progression, relapse, or death than rituximab-based chemotherapy (estimated 3-year rate of progression-free survival, 80.0% vs. 73.3%; hazard ratio for progression, relapse, or death, 0.66; 95% confidence interval [CI], 0.51 to 0.85; P=0.001). Similar results were seen with regard to independently reviewed progression-free survival and other time-to-event end points. Response rates were similar in the two groups (88.5% in the obinutuzumab group and 86.9% in the rituximab group). Adverse events of grade 3 to 5 were more frequent in the obinutuzumab group than in the rituximab group (74.6% vs. 67.8%), as were serious adverse events (46.1% vs. 39.9%). The rates of adverse events resulting in death were similar in the two groups (4.0% in the obinutuzumab group and 3.4% in the rituximab group). The most common adverse events were infusion-related events that were considered by the investigators to be largely due to obinutuzumab in 353 of 595 patients (59.3%; 95% CI, 55.3 to 63.2) and to rituximab in 292 of 597 patients (48.9%; 95% CI, 44.9 to 52.9; P<0.001). Nausea and neutropenia were common. A total of 35 patients (5.8%) in the obinutuzumab group and 46 (7.7%) in the rituximab group died. CONCLUSIONS: Obinutuzumab-based immunochemotherapy and maintenance therapy resulted in longer progression-free survival than rituximab-based therapy. High-grade adverse events were more common with obinutuzumab-based chemotherapy. (Funded by F. Hoffmann-La Roche; GALLIUM ClinicalTrials.gov number, NCT01332968 .).
Sehn, L. H., N. Chua, J. Mayer, et al. 2016. "Obinutuzumab plus bendamustine versus bendamustine monotherapy in patients with rituximab-refractory indolent non-Hodgkin lymphoma (GADOLIN): a randomised, controlled, open-label, multicentre, phase 3 trial." Lancet Oncol 17(8):1081-1093.
BACKGROUND: Patients with indolent non-Hodgkin lymphoma who fail to achieve adequate disease control with rituximab-based treatment have few treatment options and a poor prognosis. We aimed to assess a combination of obinutuzumab (GA101), a novel glyco-engineered type II anti-CD20 monoclonal antibody, and bendamustine in this patient population. METHODS: In this open-label, randomised, phase 3 study (GADOLIN), patients aged 18 years or older with histologically documented, CD20-positive indolent non-Hodgkin lymphoma refractory to rituximab were enrolled at 83 hospital and community sites in 14 countries in Europe, Asia, and North and Central America. Patients were randomly assigned (1:1) using a hierarchical dynamic randomisation scheme stratified by indolent non-Hodgkin lymphoma subtype, rituximab-refractory type, number of previous therapies, and geographical region, to receive induction treatment (six 28-day cycles) with obinutuzumab plus bendamustine or bendamustine monotherapy, both given intravenously. Obinutuzumab plus bendamustine dosing was obinutuzumab 1000 mg (days 1, 8, and 15, cycle 1; day 1, cycles 2-6) plus bendamustine 90 mg/m(2) per day (days 1 and 2, cycles 1-6), and bendamustine monotherapy dosing was 120 mg/m(2) per day (days 1 and 2, all cycles). Non-progressing patients in the obinutuzumab plus bendamustine group received obinutuzumab maintenance (1000 mg every 2 months) for up to 2 years. The primary endpoint was progression-free survival in all randomised patients, as assessed by an independent review committee. Safety was assessed in all patients who received any amount of obinutuzumab or bendamustine. This study is registered with ClinicalTrials.gov, number NCT01059630, and has stopped recruiting patients. FINDINGS: Between April 15, 2010, and Sept 1, 2014, when the study was stopped after a pre-planned interim analysis, 396 patients were randomly assigned (194 to obinutuzumab plus bendamustine and 202 to bendamustine monotherapy). After a median follow-up time of 21.9 months (IQR 12.1-31.0) in the obinutuzumab plus bendamustine group and 20.3 months (9.5-29.7) in the bendamustine monotherapy group, progression-free survival was significantly longer with obinutuzumab plus bendamustine (median not reached [95% CI 22.5 months-not estimable]) than with bendamustine monotherapy (14.9 months [12.8-16.6]; hazard ratio 0.55 [95% CI 0.40-0.74]; p=0.0001). Grade 3-5 adverse events occurred in 132 (68%) of 194 patients in the obinutuzumab plus bendamustine group and in 123 (62%) of 198 patients in the bendamustine monotherapy group. The most frequent grade 3 or worse adverse events were neutropenia (64 [33%] in the obinutuzumab plus bendamustine group vs 52 [26%] in the bendamustine monotherapy group), thrombocytopenia (21 [11%] vs 32 [16%]), anaemia (15 [8%] vs 20 [10%]) and infusion-related reactions (21 [11%] vs 11 [6%]). Serious adverse events occurred in 74 patients (38%) in the obinutuzumab plus bendamustine group and in 65 patients (33%) in the bendamustine monotherapy group, and deaths due to adverse events occurred in 12 patients (6%) and 12 patients (6%), respectively. Three (25%) of 12 adverse event-related deaths in the obinutuzumab plus bendamustine group and five (42%) of 12 in the bendamustine monotherapy group were treatment related. INTERPRETATION: Obinutuzumab plus bendamustine followed by obinutuzumab maintenance has improved efficacy over bendamustine monotherapy in rituximab-refractory patients with indolent non-Hodgkin lymphoma, with manageable toxicity, and is a new treatment option for patients who have relapsed after or are no longer responding to rituximab-based therapy. FUNDING: F Hoffmann-La Roche Ltd.
Radford, J., A. Davies, G. Cartron, et al. 2013. "Obinutuzumab (GA101) plus CHOP or FC in relapsed/refractory follicular lymphoma: results of the GAUDI study (BO21000)." Blood 122(7):1137-1143.
The safety and activity of obinutuzumab (GA101) plus chemotherapy in relapsed/refractory follicular lymphoma was explored in 56 patients. Participants received obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (G-CHOP; every 3 weeks for 6 to 8 cycles) or obinutuzumab plus fludarabine and cyclophosphamide (G-FC; every 4 weeks for 4 to 6 cycles). Patients were randomly assigned to either obinutuzumab 1600 mg on days 1 and 8 of cycle 1 followed by 800 mg on day 1 of subsequent cycles or 400 mg for all doses. Treatment responders were eligible for obinutuzumab maintenance every 3 months for up to 2 years. Grade 1/2 infusion-related reactions (IRRs) were the most common treatment-related adverse event (AE) (all grades: G-CHOP, 68%; G-FC, 82%). Grade 3/4 IRRs were rare (7%) and restricted to the first infusion. All patients received the planned obinutuzumab dose. Neutropenia was the most common treatment-related hematologic AE for G-CHOP (43%) and G-FC (50%). At induction end, 96% (27/28) of patients receiving G-CHOP (complete response [CR], 39% [11/28]) and 93% (26/28) receiving G-FC (CR, 50% [14 of 28]) achieved responses. G-CHOP and G-FC had an acceptable safety profile with no new or unexpected AEs, but G-FC was associated with more AEs than G-CHOP. Obinutuzumab plus chemotherapy resulted in 93% to 96% response rates, supporting phase 3 investigation. This trial was registered at www.clinicaltrials.gov as #NCT00825149.
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New protocol developed out of session, discussed by Haematology reference committee (discussed electronically via email).
Protocol approved and published on eviQ V.1. Review in 1 year.
The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use is subject to eviQ's disclaimer available at www.eviQ.org.au
First approved:


text:
Hamilton V Celtic - mix it up.
Ring they changes imo
By onlylovehh Sep 12, 2019, 3:52am PDT
Share All sharing options for: Hamilton V Celtic - mix it up.
Photo by Jeff Holmes/PA Images via Getty Images
Celtic are likely to be without a few key players on Saturday against Hamilton but it won't really matter as our squad is excessive in depth as it is, and furthermore, this game's done and dusted before a ball is kicked.
I would love to see our team rotated ahead of the Rennes game on Thursday, but that's very unlikely to happen with Neil Lennon determined to have the game wrapped up by half time at the weekend, before focusing on the tie against the FRENCH CRACKS.
Nir Bitton and Jozo Simunovic will miss out, and Mikey Johnston seems set to be sidelined as well, with Kris Ajer surely not being risked on such an abysmal surface in Lanarkshire.
Hamilton haven't beaten Celtic at their ground since returning to the Premiership in 2014, and that seems unlikely to start on Saturday, and despite their excellent result at Tynecastle, they'll not be able to do anything to stop the inform Odsonne Edouard running riot.
The game's on BT Sport 3 and coverage starts from 11.30am.
Tomorrow, I'll do a shoot prediction and give some good bookie shouts including my very own LOCK OF THE WEEK.

redpajama_set_name: RedPajamaCommonCrawl


In this fourth article of our ongoing series, we examine the regulatory evolution of sign by-laws. We also review the sign by-laws of York Region's southern municipalities: Markham, Whitchurch-Stouffville, Vaughan, and Richmond Hill.
Municipal sign by-laws regulate all aspects of signs, but like any other law or regulation, sign by-laws are not set in stone for eternity. New administrations, challenges, protocols, and public discourse encourage reviewing and updating the by-laws. TREB works with municipalities to ensure that updated sign by-laws take into account our industry's business practices and consumers' expectations.
Since sign by-laws are so often revised, it's good practice to stay current. TREB encourages Members to review York Region's sign by-laws to ensure compliance. Click here to review the municipal sign by-laws.
Markham – For sale/lease signs shall be removed within (14) days after the property is no longer for sale or lease.
Richmond Hill – Open house signs are not permitted. Only one (1) for sale/lease real estate sign is permitted per property.
Vaughan – For sale/lease signs shall be removed within (14) days after the property is no longer for sale or lease.
Whitchurch-Stouffville – Open house signs are not permitted. Only one (1) for sale/lease real estate sign is permitted per property.
REALTORS® are responsible to comply with the municipal sign by-laws.
Next month, we will highlight municipal sign by-laws for Durham Region.
Did you miss our last article? Click here to check it out!
The post The Evolution of Sign By-Laws appeared first on TREB Wire.


text:
Social exchanges with objects across the transition from crawling to walking
Noriko Toyama
The current study investigated infants' spontaneous object interactions during naturalistic observation in a daycare centre in Japan. The researcher visited the class for 49 days, once a week, for one year (in the morning for about 1.5 h). Infants' and caregivers' interactions during free play time were videotaped. Of particular interest in this study was whether changes in infants' locomotor status were functionally related to social exchanges with objects. During longitudinal one-year observation, all six infants gradually acquired locomotor skills: two infants became walkers from pre-crawlers, and another four became walkers from crawlers. Throughout the observations, the infants spent an impressive amount of time (i.e. about 50%) in contact with objects. As they acquired locomotor skills, they gained access to distal objects and carried objects frequently. Triggered by the onset of walking, infants' carrying behaviour increased dramatically. Locomotor experiences were also related to qualitative changes in how they used objects in social interactions. These quantitative and qualitative changes in infants' object experiences were not strongly connected with the infants' age in months. Taken together, this study demonstrated that the onset of walking marks a critical developmental milestone that profoundly changes the way infants access, carry, and use objects to interact with others.
Early Child Development and Care
Accepted/In press - 2018 Jan 1
Infant Equipment
Infant Behavior
Research Personnel
social bids
Toyama, N. (Accepted/In press). Social exchanges with objects across the transition from crawling to walking. Early Child Development and Care. https://doi.org/10.1080/03004430.2018.1511550
Social exchanges with objects across the transition from crawling to walking. / Toyama, Noriko.
In: Early Child Development and Care, 01.01.2018.
Toyama, N 2018, 'Social exchanges with objects across the transition from crawling to walking', Early Child Development and Care. https://doi.org/10.1080/03004430.2018.1511550
Toyama N. Social exchanges with objects across the transition from crawling to walking. Early Child Development and Care. 2018 Jan 1. https://doi.org/10.1080/03004430.2018.1511550
Toyama, Noriko. / Social exchanges with objects across the transition from crawling to walking. In: Early Child Development and Care. 2018.
@article{b45e8aa883ba4e74bec421444505612d,
title = "Social exchanges with objects across the transition from crawling to walking",
abstract = "The current study investigated infants' spontaneous object interactions during naturalistic observation in a daycare centre in Japan. The researcher visited the class for 49 days, once a week, for one year (in the morning for about 1.5 h). Infants' and caregivers' interactions during free play time were videotaped. Of particular interest in this study was whether changes in infants' locomotor status were functionally related to social exchanges with objects. During longitudinal one-year observation, all six infants gradually acquired locomotor skills: two infants became walkers from pre-crawlers, and another four became walkers from crawlers. Throughout the observations, the infants spent an impressive amount of time (i.e. about 50{\%}) in contact with objects. As they acquired locomotor skills, they gained access to distal objects and carried objects frequently. Triggered by the onset of walking, infants' carrying behaviour increased dramatically. Locomotor experiences were also related to qualitative changes in how they used objects in social interactions. These quantitative and qualitative changes in infants' object experiences were not strongly connected with the infants' age in months. Taken together, this study demonstrated that the onset of walking marks a critical developmental milestone that profoundly changes the way infants access, carry, and use objects to interact with others.",
keywords = "daycare, Motor development, social bids, social development, walking",
author = "Noriko Toyama",
journal = "Early Child Development and Care",
T1 - Social exchanges with objects across the transition from crawling to walking
AU - Toyama, Noriko
N2 - The current study investigated infants' spontaneous object interactions during naturalistic observation in a daycare centre in Japan. The researcher visited the class for 49 days, once a week, for one year (in the morning for about 1.5 h). Infants' and caregivers' interactions during free play time were videotaped. Of particular interest in this study was whether changes in infants' locomotor status were functionally related to social exchanges with objects. During longitudinal one-year observation, all six infants gradually acquired locomotor skills: two infants became walkers from pre-crawlers, and another four became walkers from crawlers. Throughout the observations, the infants spent an impressive amount of time (i.e. about 50%) in contact with objects. As they acquired locomotor skills, they gained access to distal objects and carried objects frequently. Triggered by the onset of walking, infants' carrying behaviour increased dramatically. Locomotor experiences were also related to qualitative changes in how they used objects in social interactions. These quantitative and qualitative changes in infants' object experiences were not strongly connected with the infants' age in months. Taken together, this study demonstrated that the onset of walking marks a critical developmental milestone that profoundly changes the way infants access, carry, and use objects to interact with others.
AB - The current study investigated infants' spontaneous object interactions during naturalistic observation in a daycare centre in Japan. The researcher visited the class for 49 days, once a week, for one year (in the morning for about 1.5 h). Infants' and caregivers' interactions during free play time were videotaped. Of particular interest in this study was whether changes in infants' locomotor status were functionally related to social exchanges with objects. During longitudinal one-year observation, all six infants gradually acquired locomotor skills: two infants became walkers from pre-crawlers, and another four became walkers from crawlers. Throughout the observations, the infants spent an impressive amount of time (i.e. about 50%) in contact with objects. As they acquired locomotor skills, they gained access to distal objects and carried objects frequently. Triggered by the onset of walking, infants' carrying behaviour increased dramatically. Locomotor experiences were also related to qualitative changes in how they used objects in social interactions. These quantitative and qualitative changes in infants' object experiences were not strongly connected with the infants' age in months. Taken together, this study demonstrated that the onset of walking marks a critical developmental milestone that profoundly changes the way infants access, carry, and use objects to interact with others.
KW - daycare
KW - Motor development
KW - social bids
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KW - walking
JO - Early Child Development and Care
JF - Early Child Development and Care


text:
<?php
namespace ERD\SearchBundle\Tests\DependencyInjection;
use ERD\SearchBundle\DependencyInjection\ERDSearchExtension;
use Symfony\Component\DependencyInjection\ContainerBuilder;

class ERDSearchExtensionTest extends \PHPUnit_Framework_TestCase
{
    protected $extension;

    /** @var ContainerBuilder */
    protected $container;

    public function setUp()
    {
        $this->container = new ContainerBuilder();
        $this->extension = new ERDSearchExtension();
    }

    public function testContainerHasExpectedBasicServices()
    {
        $expectedBasicServices = array('erd_search.aggregate_entity_provider', 'erd_search.aggregate_synonym_provider');
        $this->extension->load(array(array('use_doctrine_events'=>false)), $this->container);

        $this->assertTrue(array_intersect($expectedBasicServices, $this->container->getServiceIds())===$expectedBasicServices);
    }

    public function testUseDoctrineOptionRegistersListenerService()
    {
        $this->extension->load(array(array('use_doctrine_events'=>true)), $this->container);
        $this->assertTrue(in_array("erd_search.doctrine_subscriber", $this->container->getServiceIds()));
    }

    public function testUseDoctrineListenerServiceTaggedCorrectly()
    {
        $this->extension->load(array(array('use_doctrine_events'=>true)), $this->container);
        $this->assertTrue($this->container->getDefinition("erd_search.doctrine_subscriber")->hasTag("doctrine.event_subscriber"));
    }

    public function testListenerServiceNotRegisteredWithoutUseDoctrineOption()
    {
        $this->extension->load(array(array('use_doctrine_events'=>false)), $this->container);
        $this->assertFalse(in_array("erd_search.doctrine_subscriber", $this->container->getServiceIds()));
    }

    public function testUseDoctrineEntitiesOptionRegistersProviderService()
    {
        $this->extension->load(array(array('use_doctrine_entities'=>true)), $this->container);
        $this->assertTrue(in_array("erd_search.doctrine_provider", $this->container->getServiceIds()));
    }

    public function testUseDoctrineEntitiesProviderServiceTaggedCorrectly()
    {
        $this->extension->load(array(array('use_doctrine_entities'=>true)), $this->container);
        $this->assertTrue($this->container->getDefinition("erd_search.doctrine_provider")->hasTag("erd_search.entity_provider"));
    }

    public function testProviderServiceNotRegisteredWithoutUseDoctrineEntitiesOption()
    {
        $this->extension->load(array(array('use_doctrine_entities'=>false)), $this->container);
        $this->assertFalse(in_array("erd_search.doctrine_provider", $this->container->getServiceIds()));
    }
}

redpajama_set_name: RedPajamaGithub


We here at Mission Cheese take our love, enthusiasm, and geekery for all things artisan and delicious seriously, and that passion doesn't stop at American cheese. Case in point: cheesemongers Sam Chapple-Sokol, Eric Miller, and Justin Dolezal spent the last few months reliving experiences most of us would prefer to have left in our collegiate years: months of study, memorization, and theoretical discussion, culminating in a 5 hour, multi-stage test with professional implications. The goal was to pass the Certified Cicerone Exam, a graduate-level test of all things beer.
For the uninitiated, the Cicerone Program is the beer world's answer to the long established Sommelier program, which certifies professionals within the world of fine wine. Founded by former brewer and industry expert Ray Daniels in 2008, the program seeks to identify and certify the knowledge of those working in the beer world. Much like the Sommelier program, the Cicerone program has multiple levels of certification: Certified Beer Server, Certified Cicerone, Advanced Cicerone, and Master Cicerone. Over 50,000 individuals around the world have been certified through the program to date.
Though preparing for a beer exam may seem like a relative lark compared to other fields of study, the test itself is designed to be extremely rigorous, covering a wide range of sudsy knowledge. Applicants are tested on beer history, styles, service, flavor evaluation, and food pairing. In addition to the 3 hour written exam, the test also includes a blind tasting portion which includes both style evaluation and off-flavor identification. A video-recorded demonstration of beer service is also included. Passing the exam requires countless hours of intense preparation, and the passing rates for the exam are lower than that of most state's BAR exams (take that Edwin, my high school nemesis who went into law).
What does this mean for you, and your experience at Mission Cheese? You can rest (and eat) assured, knowing that the beers you're enjoying along with your cheese flights have been selected, cared for, and paired by people with a deep passion for beer, and the knowledge to back it up. If you have questions about the Cicerone Program, or beer itself, don't hesitate to ask!


text:
About ACSH
Priorities Magazine Spring 2018
The Next Plague and How Science Will Stop It
Priorities Magazine Winter 2018
Priorities Magazine Fall 2017
Little Black Book of Junk Science
Should You Worry About Artificial Flavors Or Colors?
Should You Worry About Artificial Sweeteners?
Summer Health and Safety Tips
How Toxic Terrorists Scare You With Science Terms
Adult Immunization: The Need for Enhanced Utilization
Should You Worry About Salt?
IARC Diesel Exhaust & Lung Cancer: An Analysis
Teflon and Human Health: Do the Charges Stick?
Helping Smokers Quit: The Science Behind Tobacco Harm Reduction
Irradiated Foods
Foods Are Not Cigarettes: Why Tobacco Lawsuits Are Not a Model for Obesity Lawsuits
The Prevention and Treatment of Osteoporosis: A Review
Are "Low Dose" Health Effects of Chemicals Real?
The Effects of Nicotine on Human Health
Traditional Holiday Dinner Replete with Natural Carcinogens - Even Organic Thanksgiving Dinners
A Primer On Dental Care: Quality and Quackery
Nuclear Energy and Health And the Benefits of Low-Dose Radiation Hormesis
Priorities in Caring for Your Children: A Primer for Parents
Endocrine Disrupters: A Scientific Perspective
Good Stories, Bad Science: A Guide for Journalists to the Health Claims of "Consumer Activist" Groups
A Comparison of the Health Effects of Alcohol Consumption and Tobacco Use in America
Moderate Alcohol Consumption and Health
Irradiated Foods Fifth Edition
Have Opioid Restrictions Made Things Better or Worse?
Trump's Wall and the Opioid Crisis
Gee, Pain Pills Are the Real Not Killers. And the Sun Rises in the East. Who Knew?
Heads In The Sand — The Real Cause Of Today's Opioid Deaths
Who Is Telling The Truth About Prescription Opioid Deaths? DEA? CDC? Neither?
'Study Links Rising Heroin Deaths to 2010 OxyContin Reformulation.' Duh.
By Josh Bloom — November 3, 2016
Most opioid deaths are from heroin, not pills Photo: Mass. Dept. of Heath
"Merciless In Seattle: Untreated Pain, Misery, And Suicide" (November 2nd) examined the tragic suicide of Seattle resident Denny Peck, who had the misfortune of being dependent upon opioid drugs to manage his intractable pain that resulted from an accident that crushed part of his spine in 1990. When the pain clinic that had been treating Peck abruptly closed, he could not find a doctor who was willing to prescribe the drugs that made his life bearable. Two days following Peck's desperate, but futile call to 911, during which he maintained that he couldn't bear the pain anymore, Peck committed suicide by shooting himself in both side of his head. What happened to Peck is now considerably more likely to happen to you.
By any measure, it is now more difficult for patients with legitimate needs to obtain the powerful opioid pain-killers that they need just to function. Much of the blame for this changing paradigm has been placed at the feet of the CDC. You don't need to look very hard to find stories of both individuals and organizations who have expressed dismay at the agency's recent "voluntary guidelines" to physicians regarding opioid prescribing practice. David Hendry, writing for the Pain News Network called the CDC's advice to doctors as "the phrasing and logic of an extortionist."
There is no question that many people have been impacted by their inability to get the drugs that they had used responsibly for years. Both individuals and organizations have called the new rules Draconian.
But, has there been any benefit of these new guidelines to society as a whole? Or is this just another knee-jerk government reaction that will make the solution worse than the problem. It is too soon to have hard data on the impact of stringent opioid restrictions, but given historical precedent as well as fragments of emerging information, it is all but certain the effect of limiting opioids have had a downside. Perhaps even more than an upside.
The first "real life" example of the rapid decline of prescription opioids was seen in 2010—the year that OxyContin, the major driver of narcotic addiction, was reformulated to be abuse-resistant. It worked. But not as expected, which is shown in the graph below.
Once abuse-resistant OxyContin (pure oxycodone, the opioid medication in Percocet) was approved in 2010, its use immediately declined by 66 percent. But, between that time and 2013, overdose deaths from heroin (more accurately heroin and/or fentanyl) more than doubled, as addicts were forced to turn to these cheaper, more available, and more dangerous drugs. Not only did heroin/fentanyl overdose deaths go through the roof, but outbreaks of HIV (from needle sharing) were subsequently seen in Indiana, Kentucky, and Tennessee.
This same trend was seen in different forms in different areas of the country.
For example, a 2016 report entitled "Data Brief: An Assessment of Opioid Related Deaths in Massachusetts 2013-2014," showed a similar trend: that narcotic overdose deaths are skyrocketing, but it is not the pills that are responsible for the increased death. The real damage is being done by pill alternatives.
Fatal opioid-related overdoses in Massachusetts, 2013-14. Massachusetts Department of Health
From the pie chart above, it is apparent that overdose deaths from prescription drugs (9%) were dwarfed by those from heroin, fentanyl, or a mixture of both (85%). So, when a headlines says "There were 100 opioid overdose deaths last week," what it really means is that nine deaths were a result of pills, and 85 from heroin/fentanyl (1).
Perhaps more intriguing is a table from the same report, which analyzed the prescription opioid consumption patterns of the people who died from any narcotic over a four-year period:
The table shows the percent of people who died (2013-2016) from opioid overdoses, and how often they had filled a prescription for a legal opioid (Vicodin, Percocet, etc) at different time intervals over the course of the study. Of those who had confirmed or suspected heroin and/or fentanyl in their blood (red box) at the time of death, only 10-17% had filled a legal prescription for pills within one month of death. During the six months (blue box) before death before, 23-30 percent had filled prescriptions fof the pills. However, o er the course of the four year study, about two-thirds of the decedents had done so.
These data indicate that: 1) most of the people who died during the four-year interval used legal opioids at least once, but few did so within one month of death; and 2) the extensive change in prescription use over time strongly suggests that people who were pill users in 2013 were much more likely to be heroin users in 2106, but were no longer pill users. In other words, drug abusers switched from pills to injectable narcotics during a time when the pills were becoming more difficult to obtain. This is consistent with the trend shown in the OxyContin graph above.
This is, in fact, one of the findings of the Massachusetts Department of Public Health:
Individuals who died from opioid‐ related overdoses are much more likely to have an illegally‐obtained substance (i.e., not Schedule II‐III opioid) present in post‐mortem toxicology
In other words, the people who are taking pills are responsible for only a small fraction of the overdose deaths. It is the people who have switched from pills to more dangerous narcotics who are the primary victims. It is not unreasonable to at least wonder whether tighter restrictions on legal prescriptions resulted in an increase in overdose deaths instead of the desired decrease.
A similar trend can be seen nationwide, according to NIH data. This is rather intriguing.
Source: Adapted from National Institute on Drug Abuse.
The graph on the left shows the number of heroin overdose deaths from 2001-2014; the one on the right, the number of prescription opioid deaths. If we focus on the period between 2010 (black hatched line) and 2014 (red)—the time during which the crackdown on prescription opioids began to accelerate—heroin deaths, which had been more or less stable for the 10 previous years, more than tripled—from 3,000 to 10,500. Additionally, during that same time, overdose deaths from prescription opioids (graph on right) also increased from 16,500 to 19,000. So, during this time there was a net increase in total opioid deaths during this time, with 75% of the increase attributable to overdoses of heroin users who made the switch from prescription pills.
Although not definitive, these graphs when taken together suggest that not only did the crackdown on opioid prescriptions failed to stop overdose deaths during that time, but may have even increased them. Furthermore, these data do not reflect what has happened since 2015, when the CDC's "voluntary" guidelines were implemented, so this effect will most likely be magnified.
Although the question "have we been helped or hurt by the drastic change in opioid prescribing practices?" remains unanswered, and may remain so for quite some time, it is difficult to picture the images of bodies in the street with needles still stuck in their arms, and the two bullet holes in Denny Peck's head, and not at least question the CDC response to an already-bad problem. Did we make things better or worse? Are we prepared as a society to accept guaranteed suffering for some to protect others from addiction?
Tough question, but David Hendry has his own thoughts, and they are not optimistic: "The callous decision-makers exemplify the words of Francois de La Rochefoucauld: 'We all have enough strength to endure the misfortunes of others."'
As usual, simple answers to complex problems rarely work, something many of us will eventually find out the hard way. The painful way.
(1) Extrapolated from Massachusetts data.
By Josh Bloom
Executive Vice President and the Director of Chemical and Pharmaceutical Science
Dr. Josh Bloom, Executive Vice President and the Director of Chemical and Pharmaceutical Science, comes from the world of drug discovery, where he did research for more than 20 years. He holds a Ph.D. in chemistry.
Latest from Josh Bloom:
Bizarre Medical And Science News of the Week
5 Things You Might Not Know About Heroin
Pink, Orange and Green Urine & a Color Chemistry Lesson? Oui
Esters: Nature's Parfumerie
4 Prescription Drugs People Love
ACSH relies on donors like you. If you enjoy our work, please contribute.
Big Fears, Little Risks
In 1989, the American Council on Science and Health released a documentary called Big Fears Little Risks, which was narrated by the great Walter Cronkite. The documentary focused on how exaggerated fears about "chemicals" made people afraid of their food.
Thirty years later, ACSH has produced an updated version of Big Fears Little Risks, focusing on issues such as vaccines, GMOs, pesticides, and nuclear power. It will be released very soon. Stay tuned!
The Atlantic Is Nostalgic for the Anti-Alcohol Prohibition Era
Do We Operate Too Much, or Too Little?
Marijuana & Heart Disease: What Do We Really Know?
ACSH Videos
ACSH In The Media
ACSH in the Media: New Year's Edition
ACSH in the Media: Turkey Day Edition
ACSH in the Media: Daylight Saving Time Edition
ACSH in the Media: Trick-or-Treat Edition
Health Scares vs. Health Threats
95% of Baby Food Tainted with Toxic Metals? Don't Panic
Everything Goes to Pot: Myths Are Driving FDA, CDC Vaping Policy
Precautionary Principle: We Must Ban Driving to Whole Foods
CDC Misleads by Calling E-Cigarettes a 'Tobacco Product'
Celebrities vs. Science
What the Hulk? 9/11 Truther Mark Ruffalo Testifies to Congress on Science
Nothing Grimes Said About Eyeballs or Depression Makes Any Sense
Jeff Bezos' Plan to Colonize Space is Based on Sheer Nonsense
Robert F. Kennedy, Jr. is Helping Spread Flu and Cervical Cancer
Groups Who Hate Us
NYT's Eric Lipton Defends Anti-Vaxxers as Measles Ravages Europe
Toxic America: The Guardian Spreads Chemophobia and Anti-Americanism
ACSH Isn't Industry-Friendly. We're Science-Friendly.
Doxxing: The Newest Strategy to Destroy Scientists
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The American Council on Science and Health is a research and education organization operating under Section 501(c)(3) of the Internal Revenue Code. Contributions are fully tax-deductible. ACSH does not accept government grants or contracts, nor do we have an endowment. We raise our funds each year primarily from individuals and foundations.


text:
1. Staff
Please use this identifier to cite or link to this item: https://scholarbank.nus.edu.sg/handle/10635/94078
Title: Interpolymer complexation between poly(N-methyl-4-piperidinyl methacrylate) and acidic polymers
Authors: Luo, X.
Goh, S.H.
Lee, S.Y.
Tan, K.L.
Citation: Luo, X.,Goh, S.H.,Lee, S.Y.,Tan, K.L. (1998-05-19). Interpolymer complexation between poly(N-methyl-4-piperidinyl methacrylate) and acidic polymers. Macromolecules 31 (10) : 3251-3254. ScholarBank@NUS Repository.
Abstract: Polymer complexes of a basic polymer, poly(N-methyl-4-piperidinyl methacrylate) (PMPMA), with a weak acidic polymer poly(p-vinylphenol) (PVPh), and strong acidic polymers such as poly(acrylic acid) (PAA), poly(methacrylic acid) (PMAA), poly(styrenesulfonic acid) (PSSA), and poly(vinylphosphonic acid) (PVPA), have been prepared by mixing ethanol/H2O (1:1) solutions of the respective components. The complexes were examined by Fourier transform infrared (FTIR) spectroscopy, X-ray photoelectron spectroscopy (XPS), and differential scanning calorimetry. Both the FTIR and XPS studies showed the existence of piperidinium ions in the complexes of PMPMA with PAA, PMAA, PVPA, and PSSA, indicating that the interactions in these complexes are ionic in nature. However, the N-methyl groups prevent the piperidine nitrogen atoms from interaction with PVPh and hence the carbonyl groups of PMPMA interact with the hydroxyl groups of PVPh by hydrogen bonding. From the XPS studies, the number of protonated piperidine atoms was found to correlate with the acid strength of the polyacid.
Source Title: Macromolecules
URI: http://scholarbank.nus.edu.sg/handle/10635/94078
Appears in Collections: Staff Publications
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checked on Dec 28, 2019


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Scottish Social Services Council - Codes of Practice for Social Service Workers and Employers.
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With her Geneva-based nonprofit International Bridges to Justice, Karen Tse is taking action against misjustice and torture, and providing legal representation for even the poorest of detainees.
In the political arena, Geneva is full of contrasts. While United Nations diplomats are rarely in need of anything, nongovernmental organizations are often short of funds. NGOs simply don't have the money for generously sized offices in glazed towers, where diplomats like to go for meetings.
The globally operating and ambitious NGO International Bridges to Justice is no exception. With an annual budget of only 3 to 4 million Swiss francs ($3-$4 million), resources are tight and have to be applied in a targeted fashion.
IBJ's dozen or so employees work in dark, confined spaces in their Geneva headquarters, far away from the elegant UN district. The furniture has seen better days, and it appears that some employees are even using their own laptops. But they're used to going without luxuries, and know that there are more important things in life than comfortable office chairs.
Karen Tse, the founder and head of IBJ, leads by example. Born in California in 1964 to a Chinese family of immigrants from Hong Kong, the human rights activist has traversed the globe on behalf of her NGO for nearly two decades. She gains access to prisoners and meets detainees who may have been held without charge for years.
She talks to prisoners who have been tortured by the police and who, despite their innocence, confessed to all they could think of just to escape physical violence. And, time after time, she meets children accused of petty crimes by the authorities and who are sent to prison.
With IBJ, Tse – who has studied both theology and law – addresses problems from all sides. "We talk to government officials about the established law in their countries and encourage reform. We talk to prosecutors about fair criminal trials, make policemen aware of human rights, win over lawyers for pro bono cases, and inform prosecuted people about their procedural rights," she says.
"The sooner someone has an attorney, the smaller the risk of misjustice – both for the accused and future generations," she adds.
The workload is enormous. IBJ estimates that, worldwide, some 3 million people are imprisoned despite never being indicted by the authorities.
The NGO often goes public with its cases, like a recent one in Sri Lanka where, thanks to a lawyer engaged by IBJ, the Sri Lankan authorities had to release three men wrongly convicted of murder.
The three were convicted in April 2013 after police found a disfigured, unidentifiable body, without any lead on the perpetrator. Since a fisherman had been reported missing at the same time, the police believed the body to be the missing man and arrested three suspects from his area.
However, things became embarrassing for Sri Lankan authorities when the lawyer engaged by IBJ found the missing fisherman in Vietnam. The man came over to serve as a witness, thus proving that the men had nothing to do with the murder. If IBJ had not provided the lawyer, these innocent men would still be in jail.
In order to address problems in a pinpoint manner, IBJ now operates offices in seven other countries: China, Cambodia, India, Burundi, Zimbabwe, Singapore and Rwanda. Tse convinces lawyers in these countries of her cause and trains criminal barristers to help the accused.
According to its own data, IBJ cooperates with 400 associations, universities and NGOs worldwide, and has so far trained 22,000 lawyers – directing aiding 30,000 people. Moreover, it finances so-called "JusticeMakers" projects in almost 40 countries: these aim to reform local judicial systems for the better.
IBJ's actions have encountered resistance in some countries, though. When states sense interference in their domestic affairs, they resist and closely monitor the organization's activities.
In order to reform judicial systems, IBJ aims to convince governments with good arguments rather than political pressure.
Hilde Schwab is a member of IBJ's advisory board. She says the organization "tries to act pragmatically instead of being confrontational," adding that this is very important given the fragile legal system in certain countries.
Using this hub, norms of criminal law in various countries will be made available and lawyers trained with learning programs, and encouraged to talk about criminal cases and impart their knowledge.
Tse has high hopes for the project. "This internet platform provides new and global solutions for a just criminal justice system," she says.
This article first appeared in Swiss daily Tages-Anzeiger.


text:
Democratic candidate for House District 6, Warren Judge, dead
Judge was a stalwart member of the Outer Banks community and dedicated much of his life to public service representing the area he loved.
November 7, 2016 Jeff Moore News
KITTY HAWK — After contracting an illness last week that landed him in the hospital, Democratic candidate for N.C. House District 6, Warren C. Judge III, has passed away.Judge, an four term veteran of the Dare County Board of Commissioners, serving as chairman for 11 years, was vying for the seat of Rep. Paul Tine (U-Dare), who chose not to run for re-election. The nature of the illness that led to his death has not been disclosed. In a statement, Judge's family said they are grateful for the support of family and friends in the region."Our hearts are deeply saddened by the loss of our beloved husband, father, grandfather, brother, uncle, and friend, Warren C. Judge III." the Judge family said in a released statement. "We are grateful for, and comforted by, all of Warren's friends and supporters in Dare County, which he loved so dearly. It was one of the greatest honors of Warren's life to serve as a Dare County Commissioner for the past sixteen years."Judge was a stalwart member of the Outer Banks community and dedicated much of his life to public service representing the area he loved. His opponent in the race for N.C. House of Representatives, Beverly Boswell (R), was also his colleague on the Board of Commissioners. In a statement on Facebook, Boswell commemorated the Dare County loyalist."Warren Judge will be forever known for his honesty, integrity and commitment to public service," write Boswell. "While we disagreed often on issues, no one could ever question his commitment to Dare County and his desire to fight for what he believed in. May God give his family comfort in these difficult times. He will be missed."His name will remain on the ballot for the election.Judge leaves behind a wife of 41 years, four children, and eight grandchildren.
NOTHSTINE: On the judiciary
ECU QB situation uncertain heading into Saturdays game against SMU
Legislative leaders, Governor address NC Chamber
May 7, 2016 Jeff Moore News
RALEIGH — Legislative leaders and Gov. Pat McCrory addressed business leaders Wednesday at the North Carolina Chamber's government affairs convention. Speakers covered a range of topics, from workforce development and business incentives, to taxes and […]
Governor establishes Hurricane Recovery Committee
October 20, 2016 Laura Ashley Lamm News
RALEIGH — As North Carolina begins the road to recovery after excessive flooding throughout the Eastern part of the state, Gov. Pat McCrory established a Hurricane Matthew Recovery Committee to coordinate efforts to rebuild after […]
Trump campaign off to strong fundraising start
April 17, 2019 Zeke Miller | The Associated Press News
WASHINGTON, D.C. — President Donald Trump's reelection campaign is set to report that it raised more than $30 million in the first quarter of 2019, edging out his top two Democratic rivals combined, according to […]


Catalina Ortiz is the President of iNNpulsa, a government agency whose aim is to foster high impact entrepreneurship and innovation in Colombia. She spoke with The Prospect Group about the role that iNNpulsa plays in the development of innovation and entrepreneurship in Colombia, the main challenges that entrepreneurs are facing, and the current investment opportunities available in the country.
What new initiatives is iNNpulsa currently involved in?
ORTIZ: iNNpulsa is in itself a new initiative. It is a government program to foster high impact entrepreneurship and innovation. We specifically focus on high growth. People wonder why we concentrate on high growth when most of our entrepreneurial context is SMEs. This is because high growth enterprises are the ones that grow the most and create employment, these are also the entities that tend to be more stable and sustainable, so that is why we are looking at high growth companies that are based on technology and innovation.
What are the biggest challenges that young entrepreneurs are currently facing in Colombia?
ORTIZ: The biggest challenge is in the way we think. So, what can we do about that? What can we do about the fact that innovation is not high on the public agenda? What can we do about the fact that we tend to be risk averse? We are trying to work with trans-media, visualizing a lot of Colombia's innovations, which are somewhat invisible, to bring them out, showcasing a lot of stories and telling about them and their success, so that they become part of the narrative, part of the everyday conversation. There are some incredible stories of successful Colombian innovations, making Colombian entrepreneurs big here and around the world, and we are trying to diffuse this information.
The first thing we have done is to spark that conversation. You can sort of measure it in terms of how many stories there are about these business cases in the local press. Financing for innovation and entrepreneurship is hard in Colombia, as it is in the rest of the world, because of its inherent high risk. But in the first year of operation, we have been able to finance over 515 companies with approximately $50m and this is just through iNNpulsa, a small government program of the Colombian government. I think our program has been very successful in terms of being able to put the first dollar out there. We do not want to replace the market, or become the market. We want to spark private investors and banks and trigger the existing mechanisms, with the aim of making funds more readily available for innovation and entrepreneurship.
What actions is INNpulsa taking in order to help alleviate these obstacles?
ORTIZ: We know that we want more companies in Colombia to grow faster and more profitably. Thus, we do 3 things. We work very hard on cultural mentality, because the first change that has to occur is in the way we think, our mindsets. The second thing we do is to intervene in the market failures. That is, we help in bridging the financing gap and connecting entrepreneurs and innovators with companies that can buy their products. Finally, given that Colombia is very diverse, our third objective is to bring all of the regions up to speed, so that this program does not only take place in the capitals of the different departments, but in the whole of Colombia.
In the recent WEF Global Competitiveness Report, Colombia received a ranking of 66th with regards to capacity for innovation. In what ways can entrepreneurship improve Colombia's overall capacity for innovation? What programs or policies is iNNpulsa currently implementing in order to strengthen the mindset and culture that encourages innovation and dynamic entrepreneurship?
ORTIZ: One thing that people do not know is that Colombia is an award winning country when it comes to innovation. We've won all sorts of prizes, worldwide, for research, biotech, agribusiness, nutrition products, and all sorts of other things. But we have not been able to get that research into the market and incorporate companies able to profit out of their innovations, so that is where we are now. I think that 66 in the ranking is an inflection point. I think that Colombia has come to a point where it realizes that it can no longer invest solely in the research groups, but that it needs to invest in that second part, which is bringing things to the market in a successful way. We are helping both universities and innovation centres to improve the way they can commercialize their research and innovations. We are doing this with various international collaborators, such as the UK, Israel, and Singapore, because it is something that Colombia has not been able to do in the past but is learning now and transferring that technology, so that we are more capable of doing this independently. We had some early wins that made us very hopeful in terms of what we can achieve when universities, the government, and the private sector come together to use that technology and foster productivity and prosperity in Colombia.
In what ways can the Colombian education system adapt in order to effectively teach entrepreneurship and encourage innovation? How do you see this progressing over the long-term?
ORTIZ: One thing that I have seen happening which is very encouraging is people understanding that it is not about the curriculum. I mean, you do not learn innovation or entrepreneurship in a classroom. We have seen a lot of start-ups starting in the top universities of Colombia. We have seen a lot of creative new ways to bring innovation and entrepreneurship. We have also seen a lot of challenges throughout the process. I think that this is the best way that universities can bring these two concepts in. We have also seen that people at university realize how entrepreneurship and innovation is not only about what students can do, but it is also what researchers and professors can do in terms of creating new businesses. I see the glass full, all the time. I am very optimistic because I think there is a window of opportunity where 3 things are coming together.
First, there are a lot of new programs similar to iNNpulsa, such as the public and private programs at a national and sub-national level, where Colombia doubled the amount of resources available for innovation and entrepreneurship from the year 2011 to the year 2012. It is still not as much as other countries in terms of GDP, but we doubled the amount of resources. So there are institutions in place, and there is more money. The most important thing is that there are willing and talented entrepreneurs and business people at all levels, from all sizes of companies, all around Colombia. Some entrepreneurs are using innovation to create new businesses and to grow their existing enterprises. So these 3 things make me hugely optimistic. Yes, we do still have a lot of coming up to do in terms of having more resources available, and in changing our mindsets, but I am very optimistic because I know that Colombian talent and Colombia's capacity for venturing is amazing.
Colombia is right at that point where it is cheap enough to enter and where businesses are going to mature very well. You can wait and see, but if you wait and see things may get a lot more expensive, as has happened in Brazil and other countries. So, I think this is the right moment and time to look for different technologies emerging from Colombia and to invest in Colombia.
How would you describe the current state of funding for start up ventures and entrepreneurs? How significant are venture capitalists and angel investors in Colombia?
ORTIZ: It is a newly born industry and as such it is doing its first steps. Private equity in Colombia has been around for a while. However, the regulations that enabled the existence of these funds have only been around since the year 2007 and 2008. So it is a very new industry. We have seen more and more people getting involved, and a lot of people coming from M&A and showing interest in these venture capitals. There has been some interesting businesses and some interesting exits, still very few. But we are confident that the industry, with the support of the government, which is trying to alleviate risk for private investors, can play an important role to spark venture capitalists and hopefully seed funds, which are also important further down the chain.
What are the major success stories for iNNpulsa? Which sectors are showing the best opportunities for growth and development?
ORTIZ: We can talk about the success of iNNpulsa, but I am more interested in talking about the successes of the entrepreneurs that are in the system and speaking about the many innovations we have seen so far. For instance, one of our companies made and launched its first satellite here in Bogota, and the director of the AIM Institute at NASA said that this technology is comparable to the one they have in Silicon Valley, although he liked our business model better. We have innovations that range from satellites to very sophisticated agro-business products, such as quinoa, which is one of the major aliments that the FAO has highlighted, and which, again, is given to astronauts. They have developed a very high value product, integrated all the way around the production chain.
There are Colombian entrepreneurs focusing on cosmetics. I was talking earlier about a company that has developed a way to bleach hair. Women, when they are pregnant or sick, cannot bleach their hair. This is just the first use of a molecule that comes from a fungus, which grows in Antioquia. The second use of it is amazing. Apparently, the first trial shows that it can help you cleanse chemotherapy, so they are using this molecule as a side treatment for chemotherapy because it helps eliminate chemo from your body. So there are opportunities and innovations that range from agro-business to biotech, and there are also a lot of digital initiatives going on. It is too soon to tell which sectors will be the winning industries, but what we are very sure of is that there will be a lot of Colombian enterprises out there.
How attractive is Colombia as an investment destination at the moment?
ORTIZ: If you look at emerging markets and if you have some patient capital with which you intend to make some very high returns, I think that investing in Colombia is an incredibly good option. Colombia is right at that point where it is cheap enough to enter and where businesses are going to mature very well. You can wait and see, but if you wait and see things may get a lot more expensive, as has happened in Brazil and other countries. So, I think this is the right moment and time to look for different technologies emerging from Colombia and to invest in Colombia. It is a window of opportunity. I really like what I heard from some of the investors, as they say "You know projects may still be a little immature, but if I get in now, I will get it at the right price. If I wait, I will probably get in at a higher price". You can get into Brazil now, but you are paying for a Brazilian premium. Other markets may not be as interesting because there is not a strong commitment from the government to mitigate the risks, or the internal market doesn't have a critical mass strong enough for you to prove your product internally.
In Colombia, there are levels of connectivity and the government's commitment to connect more than half of the population. All of these elements add on to Colombia's competitive advantages and explains the levels of interest right now. Furthermore, among the incentives available in Colombia, we have seed capital grants and credit lines, which are very easy and cheap. We also try to make all of our incentives open to both nationals and foreigners who establish their company in Colombia.


See the licensure exam room assignments by visiting December 2009 dentist board exam room asignments webpage. The licensure exam for dentists, theoretical part will be held on December 1, 2 and 3 2009 in Manila. I'm going to post a copy of Dentistry Board Exam Results for December 2009 as soon as the PRC released the list.
The theoretical phase of December 2009 Dental board exam, also known as licensure examination for dentists, will be given on December 1, 2 and 3 in Manila. After the theoretical exam results are released, the practical phase will be given on December 10 to 15 2009. The composition of the board of dentistry who will give the exams are chairperson: Dr. Norma R. Ayap and members: Dr. Daniel G. Feraro, Dr. Gloria M Bumanlag and Dr. Melinda L. Garcia.
Room Assignment for the dentistry exam shall be posted in the Professional Regulation Commission (PRC) official website soon.
I will post a copy of room assignments list and dental board exam results (theoretical and practical) as soon as the PRC released the list.
I have just changed my mind. I've just placed back this site's adsense. LOL. View their website for more info about Google Adsense. It's one of the best product by Google, next to their search engine.
PCOMS will be celebrating its 50th anniversary and induction of officers and conferment of new fellows which will coincide with the national conference on Oral and Maxillofacial Surgery on January 16 and 17, 2010, venue will be at the Quezon City Sports Club.
This two- day event of the PCOMS includes a symposium on Oral and Maxillofacial Trauma, Dental Implants, Cleft lip and Palate surgery and Head and Neck Infections. Well- known Oral Maxillofacial Surgeons from other countries as well as local surgeons will be the premier lecturers.


ONDRESYS Technology Solutions is a Quebec based IT company, specializing in the development and support of both web-based and client-server business systems and automation of critical business processes.
From business analysis, systems development to infrastructure, we provide services in all areas of information technologies.
ONDRESYS Technology Solutions enable our clients to achieve greater efficiency and provide flexibility to serve their clients. Find out how ONDRESYS Technology Solutions can help your business achieve desired goals.
Yuri Ondrechak has more than 25 years of experience in business systems development and over 20 years in web development in the aerospace, pharmaceutical, and educational sectors. He has been recognized for talents and passion for innovation, learning, investigative character, and implementations of multiple business systems with focus on simplification. With his knowledge and development expertise, he has developed numerous systems that resulted in significant cost, and time savings in the companies he has worked for.
Yuri has been providing timely delivery of IT consulting services and solutions to companies of all sizes since 2003. Yuri has now founded ONDRESYS Technology Solutions. Easily accessible to Ottawa and Quebec City, ONDRESYS Technology Solutions is based in Ile-Perrot, Quebec - just minutes from Montreal.
ONDRESYS Technology Solutions can solve challenging IT problems in partnership with its clients. We understand the business needs of our clients, and how technology can be a tool to make businesses especially lucrative.
We believe that we can best serve our clients by developing high-quality applications, on-time and within a defined budget. Clients will see our dedication throughout collaboration on strategic planning, implementation and management of our customized IT solutions.
ONDRESYS Technology Solutions creates new teams of talented professionals dedicated to your success for each project, ensuring the best possible combination of skills and experience for meeting your needs and delivering a high quality solution. A team which is made up of highly-qualified, proficient and dedicated individuals with specific areas of expertise and experience. We value commitment and cooperation; contributing on an individual basis toward a common goal. We work with each other to build solutions for the challenges our clients face each day. We'll help achieve—and exceed—our client's goals and uphold assessable results. You can count on us to provide you with a solution that fits your need, no matter how big or small you are.
Clients require high levels of service which ONDRESYS Technology Solutions can provide due to the continuous investment that is required of our professionals to expand skill sets, and keep up with the latest technologies.
When you need IT services but you don't require fulltime technology experts, ONDRESYS Technology Solutions will fit. Businesses need IT services. We act like a part of your business, giving your company the services needed without the cost or management time of an in-house team.
Thank you for considering ONDRESYS Technology Solutions as your business partner!


If you're creating a plan and setting up emergency notifications for compliance purposes anyway, why not take the opportunity to put great systems in place and use them to their full advantage? We'll show you how to make these systems work for you.
CMS wants to ensure that no employee, patient, or family member is left uninformed during an emergency. Implementing a multi-modal approach to emergency mass communications is the only way to ensure all parties are informed in a timely manner.
Compliance requires more than a single emergency plan. Instead, your facility must conduct a risk assessment covering six different potential types of incidents and develop specific emergency response plans including tailored responses to each type of event.
While most of the time emergencies happen outside of the ER, sometimes, emergencies can happen inside the hospital as well. We'll show you the right way for healthcare facilities to communicate in a crisis.


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Oriko Magica Chapter 3: Love is an Infinity of Limitations
This section may contain major spoilers for the Oriko Magica manga!
Please refrain from reading if you haven't read the latest chapter yet.
In a flashback, it is revealed that Oriko's father, Hisaomi Mikuni, was a politician, and she was helping him with his campaign back when she was a child. She was very dedicated and told him he couldn't bribe her, making him laugh.
Mami is seen fighting Charlotte, and feeling a presence of another magical girl nearby, who turns out to be dead. Kyubey reveals to her a rumor that there is a magical girl who hunts other magical girls. The girl seen at the end of the previous chapter is revealed to be Kirika Kure, and she's having a tea party with Oriko in the garden. A witch attacks, and Kirika fights her while Oriko continues to make tea. Kirika faints, and Oriko says that she has to use her again, "to protect [their] world".
Mami investigates the case of the killer magical girl, asking Kyubey, Kyoko and Homura what they know about it. Kyoko asks Mami back about Oriko, but she doesn't know anything. Homura has no knowledge herself, but tells Mami to stay away from herself, Madoka, Sayaka, and Hitomi. Homura then accompanies them home (note that Sayaka and Hitomi never actually appear). Mami meets Kirika, who has lost a stuffed toy - Mami helps her recover it, and Kirika calls her "savior". Kirika treats Mami for a strawberry crepe to thank her, but Mami mentioning Kirika probably loving the person who gave her that toy makes Kirika mad - she is extremely picky about using the word "love". She comments that "love is an infinity of limitations". A witch appears, and Mami begins to fight it carefully, not wanting to harm Kirika. However, Kirika transforms into a magical girl and attacks Mami, revealing herself as the "Black Magical Girl", the culprit behind the previous murders. Kirika is seen winning the battle, while in the meantime Oriko is seen talking about her and Kirika making her father's dream come true.
Retrieved from "http:1/w/index.php?title=Oriko_Magica_Chapter_3:_Love_is_an_Infinity_of_Limitations&oldid=53660"
Oriko Magica Chapters


Why Server Speed is Important for Increasing Revenues?
Faster loading speed and targeted content are vital elements for increasing sales for your business online. A second's delay in page loading can result in contributing to 10% of page abandonment.
If your website takes long to respond, you are literally killing the sales and revenue of your website. Some of the latest surveys show that loading speed of websites directly impacts the amount of traffic directed to your website, a slow website can frustrate your potential customers which is something that you don't want. Read on to know why the speed of the server is important to increase your revenue.
According to studies, if your website isn't accessible in 3 to 6 seconds, visitors start to abandon the website. A slow website will decrease your sales and give a negative perception of your brand to your customers.
This way your potential customers will stay on your page longer to look at what you are trying to sell rather than waiting for it to load.
WHAT IS THE IDEAL TIME FOR WEB PAGE LOADING?
If your website becomes visible in 5 seconds, the speed seems to be good, but the ideal loading time of a website must be below 3 seconds. Under 10 seconds is fair, but any website that takes more than 10 seconds to load can lose ranking and conversion. There are a number of tools that are available to report the performance of your website. You can also optimize the structure of your code to make your website faster, but a good hosting power is something that you need in order to execute your application and website faster.
Your website speed depends on website architecture, databases and hosting server speed. Getting the right web hosting solutions is very important for your business. Shared hosting and dedicated hosting are the two kinds of hosting solutions that are available online. While shared hosting has a low price and is designed to deliver small websites with minimal traffic, dedicated hosting is more expensive and caters to bigger websites. Businesses are now adapting dedicated servers for more power and better performance. Speed is an issue when your website resides on a shared hosting service that is catering to thousand other websites. Hence, a fast-dedicated server can make a huge difference to the performance of your website and will give you the following advantages.
So far it has been established that web hosting and choosing the right kind of solution is important for a fast and responsive website. If you want to achieve high SEO rankings for your website, it is important that you choose a hosting service that offers impressive server speeds.