text:
20 Oct – The Ohio medical board concluded that pain physician William D. Leak had performed "unnecessary" nerve tests on 20 patients and subjected some to "an excessive number of invasive procedures," including injections of agents that destroy nerve tissue. Yet the finding, posted on the board's public website, didn't prevent Eli Lilly and Co. from using him as a promotional speaker and adviser. The company has paid him $85,450 since 2009.
by Charles Ornstein, Tracy Weber and Dan Nguyen ProPublicaIn 2001, the U.S. Food and Drug Administration ordered Pennsylvania doctor James I. McMillen to stop "false or misleading" promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.
Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.
And in Georgia, a state appeals court in 2004 upheld a hospital's decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He'd also been accused of exposing women's breasts during medical procedures. When confronted by a hospital official, Taylor said, "Maybe I am a pervert, I honestly don't know," according to the appellate court ruling.
Last year, Taylor was Cephalon's third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.
Leak, McMillen and Taylor are part of the pharmaceutical industry's white-coat sales force, doctors paid to promote brand-name drugs to their peers — and if they're convincing enough, get more physicians to prescribe them.
Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.
But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.
This story is the first of several planned by ProPublica examining the high-stakes pursuit of the nation's physicians and their prescription pads. The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia — billion-dollar blockbusters until dangerous side effects emerged.
"Without question the public should care," said Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has written about the industry's influence on physicians. "You would never want your kid learning from a bad teacher. Why would you want your doctor learning from a bad doctor, someone who hasn't displayed good judgment in the past?"
To vet the industry's handpicked speakers, ProPublica created a comprehensive database that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.
Although these companies have posted payments on their websites — some as a result of legal settlements — they make it difficult to spot trends or even learn who has earned the most. ProPublica combined the data and identified the highest-paid doctors, then checked their credentials and disciplinary records.
That is something not all companies do.
A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.
More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don't post these actions on their web sites.
In interviews and written statements, five of the seven companies acknowledged that they don't routinely check state board websites for discipline against doctors. Instead, they rely on self-reporting and checks of federal databases. Only Johnson & Johnson and Cephalon said they review the state sites.
ProPublica found 88 Lilly speakers who have been sanctioned and four more who had received FDA warnings. Reporters asked Lilly about several of those, including Leak and McMillen. A spokesman said the company was unaware of the cases and is now investigating them.
"They are representatives of the company," said Dr. Jack Harris, vice president of Lilly's U.S. medical division. "It would be very concerning that one of our speakers was someone who had these other things going on."
Leak, the pain doctor, and his attorney did not respond to multiple messages. The Ohio medical board voted to revoke Leak's license in 2008. It remains active as he appeals in court, arguing that the evidence against him was old, the witnesses unreliable and the sentence too harsh.
In an interview, McMillen denied nearly all of the allegations in the FDA letter and blamed his troubles on a rival firm whose drug he had criticized in his presentations.
"I'm more cautious now than I ever was," said McMillen, who said he also does research. "That's why I think a lot of the companies use me. I'm not taking any risks."
Taylor said that the allegations against him were "old news" from the 1990s and that regulators had not sanctioned him. "It had nothing to do with my skills as a physician," said Taylor, noting that he speaks every other week around the country and sometimes abroad. "Even my biggest detractors in that situation lauded my skills as a physician. That's what's most important."
Disclosures are just the start
Payments to doctors for promotional work are not illegal and can be beneficial. Strong relationships between pharmaceutical companies and physicians are critical to developing new and better treatments.
There is much debate, however, about whether paying doctors to market drugs can inappropriately influence what they prescribe. Studies have shown that even small gifts and payments affect physician attitudes. Such issues have become flashpoints in recent years both in courtrooms and in Congress.
All told, 384 of the approximately 17,700 individuals in ProPublica's database earned more than $100,000 for their promotional and consulting work on behalf of one or more of the seven companies in 2009 and 2010. Nearly all were physicians, but a handful of pharmacists, nurse practitioners and dietitians also made the list. Forty-three physicians made more than $200,000 — including two who topped $300,000.
Physicians also received money from some of the 70-plus drug companies that have not disclosed their payments. Some of those interviewed could not recall all the companies that paid them, and certainly not how much they made. By 2013, the health care reform law requires all drug companies to report this information to the federal government, which will post it on the Web.
The busiest — and best compensated — doctors gave dozens of speeches a year, according to the data and interviews. The work can mean a significant salary boost — enough for the kids' college tuition, a nicer home, a better vacation.
Among the top-paid speakers, some had impressive resumes, clearly demonstrating their expertise as researchers or specialists. But others did not –contrary to the standards the companies say they follow.
Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies.
Experts say the fact that some companies are disclosing their payments is merely a start. The disclosures do not fully explain what the doctors do for the money — and what the companies get in return.
In a raft of federal whistleblower lawsuits, former employees and the government contend that the firms have used fees as rewards for high-prescribing physicians. The companies have each paid hundreds of millions or more to settle the suits.
The disclosures also leave unanswered what impact these payments have on patients or the health care system as a whole. Are dinner talks prompting doctors to prescribe risky drugs when there are safer alternatives? Or are effective generics overlooked in favor of pricey brand-name drugs?
"The pressure is enormous. The investment in these drugs is massive," said Dr. David A. Kessler, who formerly served as both FDA commissioner and dean of the University of California, San Francisco School of Medicine. "Are any of us surprised they're trying to maximize their markets in almost any way they can?"
From drug reps to doc reps
For years, drug companies bombarded doctors with pens, rulers, sticky notes, even stuffed animals emblazoned with the names of the latest remedies for acid reflux, hypertension or erectile dysfunction. They wooed physicians with fancy dinners, resort vacations and personalized stethoscopes.
Concerns that this pharma-funded bounty amounted to bribery led the industry to ban most gifts voluntarily. Some hospitals and physicians also banned the gift-givers: the legions of drug sales reps who once freely roamed their halls.
So the industry has relied more heavily on the people trusted most by doctors — their peers. Today, tens of thousands of U.S. physicians are paid to spread the word about pharma's favored pills and to advise the companies about research and marketing.
Recruited and trained by the drug companies, the physicians — accompanied by drug reps — give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.
These presentations fill an educational gap, especially for geographically isolated primary care doctors charged with treating everything from lung conditions to migraines. For these doctors, poring over a stack of journal articles on the latest treatments may be unrealistic. A pharma-sponsored dinner may be their only exposure to new drugs that are safer and more effective.
Oklahoma pulmonologist James Seebass, for example, earned $218,800 from Glaxo in 2009 and 2010 for lecturing about respiratory diseases "in the boonies," he said. On a recent trip, he said, he drove to "a little bar 40 miles from Odessa," Texas, where physicians and nurse practitioners had come 50 to 60 miles to hear him.
Seebass, the former chair of internal medicine at Oklahoma State University College of Osteopathic Medicine, said such talks are "a calling," and he is booking them for 2011.
The fees paid to speakers are fair compensation for their time away from their practices, and for travel and preparation as well as lecturing, the companies say.
Dr. Samuel Dagogo-Jack has a resume that would burnish any company's sales force: He is chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center. Dagogo-Jack conducts research funded by the National Institutes of Health, has edited medical journals and continues to see patients.
While most people are going home to dinner with their families, he said, he is leaving to hop on a plane to bring news of fresh diabetes treatments to non-specialist physicians "in the trenches" who see the vast majority of cases.
Since 2009, Dagogo-Jack has been paid at least $257,000 by Glaxo, Lilly and Merck.
"If you actually prorate that by the hours put in, it is barely more than minimum wage," he said. (A person earning the federal minimum wage of $7.25 would have to work 24 hours a day, seven days a week for more than four years to earn Dagogo-Jack's fees.)
For the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.
Glaxo's drug to treat enlarged prostates, Avodart — locked in a battle with a more popular competitor — is the topic of more lectures than any of the firm's other drugs, a company spokeswoman said. Glaxo's promotional push has helped quadruple Avodart's revenue to $559 million in five years and double its market share, according to IMS.
Favored speakers like St. Louis pain doctor Anthony Guarino earn $1,500 to $2,000 for a local dinner talk to a group of physicians.
Guarino, who made $243,457 from Cephalon, Lilly and Johnson & Johnson since 2009, considers himself a valued communicator. A big part of his job, he said, is educating the generalists, family practitioners and internists about diseases like fibromyalgia, which causes chronic, widespread pain — and to let them know that Lilly has a drug to treat it.
"Somebody like myself may be able to give a better understanding of how to recognize it," Guarino said. Then, he offers them a solution: "And by the way, there is a product that has an on-label indication for treating it.''
Guarino said he is worth the fees pharma pays him on top of his salary as director of a pain clinic affiliated with Washington University. Guarino likened his standing in the pharma industry to that of St. Louis Cardinals first baseman Albert Pujols, named baseball player of the decade last year by Sports Illustrated. Both earn what the market will bear, he said: "I know I get paid really well."
Is anyone checking out there?
Simple searches of government websites turned up disciplinary actions against many pharma speakers in ProPublica's database.
The Medical Board of California filed a public accusation against psychiatrist Karin Hastik in 2008 andplaced her on five years' probation in May for gross negligence in her care of a patient. A monitor must observe her practice.
Kentucky's medical board placed Dr. Van Breeding on probation from 2005 to 2008. In a stipulation filed with the board, Breeding admits unethical and unprofessional conduct. Reviewing 23 patient records, a consultant found Breeding often that gave addictive pain killers without clear justification. He also voluntarily relinquished his Florida license.
New York's medical board put Dr. Tulio Ortega on two years' probation in 2008 after he pleaded no contest to falsifying records to show he had treated four patients when he had not. Louisiana's medical board, acting on the New York discipline, also put him on probation this year.
Yet during 2009 and 2010, Hastik made $168,658 from Lilly, Glaxo and AstraZeneca. Ortega was paid $110,928 from Lilly and AstraZeneca. Breeding took in $37,497 from four of the firms. Hastik declined to comment, and Breeding and Ortega did not respond to messages.
Their disciplinary records raise questions about the companies' vigilance.
"Did they not do background checks on these people? Why did they pick them?" said Lisa Bero, a pharmacy professor at University of California, San Francisco who has extensively studied conflicts of interest in medicine and research.
Disciplinary actions, Bero said, reflect on a physician's credibility and willingness to cross ethical boundaries.
"If they did things in their background that are questionable, what about the information they're giving me now?" she said.
ProPublica found sanctions ranging from relatively minor misdeeds such as failing to complete medical education courses to the negligent treatment of multiple patients. Some happened long ago; some are ongoing. The sanctioned doctors were paid anywhere from $100 to more than $140,000.
Several doctors were disciplined for misconduct involving drugs made by the companies that paid them to speak. In 2009, Michigan regulators accused one rheumatologist of forging a colleague's name to get prescriptions for Viagra and Cialis. Last year, the doctor was paid $17,721 as a speaker for Pfizer, Viagra's maker.
A California doctor who was paid $950 this year to speak for AstraZeneca was placed on five years' probation by regulators in 2009 after having a breakdown, threatening suicide and spending time in a psychiatric hospital after police used a Taser on him. He said he'd been self-treating with samples of AstraZeneca's anti-psychotic drug Seroquel, medical board records show.
Other paid speakers had been disciplined by their employers or warned by the federal government. At least 15 doctors lost staff privileges at various hospitals, including one New Jersey doctor who had been suspended twice for patient care lapses and inappropriate behavior. Other doctors received FDA warning letters for research misconduct such as failing to get informed consent from patients.
Pharma companies say they rely primarily on a federal database listing those whose behavior in some way disqualifies them from participating in Medicare. This database, however, is notoriously incomplete.
The industry's primary trade group says its voluntary code of conduct is silent about what, if any, behavior should disqualify physician speakers.
"We look at it from the affirmative — things that would qualify physicians," said Diane Bieri, general counsel and executive vice president of the Pharmaceutical Research and Manufacturers of America.
Some physicians with disciplinary records say their past misdeeds do not reflect on their ability to educate their peers.
Family medicine physician Jeffrey Unger was put on probation by California's medical board in 1999 after he misdiagnosed a woman's breast cancer for 2½ years. She received treatment too late to save her life. In 2000, the Nevada medical board revoked Unger's license for not disclosing California's action.
As a result, Unger said, he decided to slow down and start listening to his patients. Since then, he said, he has written more than 130 peer-reviewed articles and book chapters on diabetes, mental illness and pain management.
"I think I've more than accomplished what I've needed to make this all right," he said. During 2009 and the first quarter of 2010, Lilly paid Unger $87,830. He said he also is a paid speaker for Novo Nordisk and Roche, two companies that have not disclosed payments.
The drug firms, Unger said, "apparently looked beyond the record."
Companies make their own experts
Last summer, as drug giant Glaxo battled efforts to yank its blockbuster diabetes drug Avandia from the market, Nashville cardiologist Hal Roseman worked the front lines.
At an FDA hearing, he borrowed David Letterman's shtick to deliver a "Top Five" list of reasons to keep the drug on the market despite evidence it caused heart problems. He faced off against a renowned Yale cardiologist and Avandia critic on the PBS NewsHour, arguing that the drug's risks had been overblown.
"I still feel very convinced in the drug," Roseman said with relaxed confidence. The FDA severely restricted access to the drug last month citing its risks.
Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues.
Roseman's public profile comes from his work as one of Glaxo's highest-paid speakers. In 2009 and 2010, he earned $223,250 from the firm — in addition to payouts from other companies.
Pharma companies often say their physician salesmen are chosen for their expertise. Glaxo, for example, said it selects "highly qualified experts in their field, well-respected by their peers and, in the case of speakers, good presenters."
ProPublica found that some top speakers are experts mainly because the companies have deemed them such. Several acknowledge that they are regularly called upon because they are willing to speak when, where and how the companies need them to.
"It's sort of like American Idol," said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.
"Nobody will have necessarily heard of you before — but after you've been around the country speaking 100 times a year, people will begin to know your name and think, 'This guy is important.' It creates an opinion leader who wasn't necessarily an expert before."
To check the qualifications of top-paid doctors, reporters searched for medical research, academic appointments and professional society involvement. They also interviewed national leaders in the physicians' specialties.
In numerous cases, little information turned up.
Las Vegas endocrinologist Firhaad Ismail, for example, is the top earner in the database, making $303,558, yet only his schooling and mostly 20-year-old research articles could be found. An online brochure for a presentation he gave earlier this month listed him as chief of endocrinology at a local hospital, but an official there said he hasn't held that title since 2008.
And several leading pain experts said they'd never heard of Santa Monica pain doctor Gerald Sacks, who was paid $249,822 since 2009.
Neither physician returned multiple calls and letters.
A recently unsealed whistleblower lawsuit against Novartis, the nation's sixth-largest drug maker by sales, alleges that many speakers were chosen "on their prescription potential rather than their true credentials."
Speakers were used and paid as long as they kept their prescription levels up, even though "several speakers had difficulty with English," according to the amended complaint filed this year in federal court in Philadelphia.
Some physicians were paid for speaking to one another, the lawsuit alleged. Several family practice doctors in Peoria, Ill., "had two programs every week at the same restaurant with the same group of physicians as the audience attendees."
In September, Novartis agreed to pay the government $422.5 million to resolve civil and criminal allegations in this case and others. The company has said it fixed its practices and now complies with government rules.
Roseman, who has been a pharma speaker for about a decade, acknowledged that his expertise comes by way of the training provided by the companies that pay him. But he says that makes him the best prepared to speak about their products, which he prescribes for his own patients. Asked about Roseman's credentials, a Glaxo spokeswoman said he is an "appropriate" speaker.
Getting paid to speak "doesn't mean that your views have necessarily been tainted," he said.
Plus pharma needs talent, Roseman said. Top-tier universities such as Harvard have begun banning their staffs from accepting pharma money for speaking, he said. "It irritates me that the debate over bias comes down to a litmus test of money," Roseman said. "The amount of knowledge that I have is in some regards to be valued."
ProPublica Director of Research Lisa Schwartz and researcher Nicholas Kusnetz contributed to this report. More names are listed here.
More from my site
Tags: Anthony Guarino, AstraZeneca, Avandia, Avodart, Bextra, Celebrex, Cephalon, Corruption, Donald Ray Taylor, Eli Lilly, FDA, Firhaad Ismail, Gerald Sacks, GlaxoSmithKline, Hal Roseman, James I. McMillen, Jeffrey Unger, Joseph Ross, Karin Hastik, Novo Nordisk, payoff, Pharmaceutical, pharmaslut, ProPublica, Roche, Samuel Dagogo-Jack, Tulio Ortega, Van Breeding, William D. Leak


text:
Empirical assessment of effect of publication bias on meta-analyses
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7249.1574 (Published 10 June 2000) Cite this as: BMJ 2000;320:1574- A J Sutton, Lecturer in medical statistics (ajs22{at}le.ac.uk)a,
- S J Duval, assistant professorb,
- R L Tweedie, headc,
- K R Abrams, senior lecturer in medical statisticsa,
- D R Jones, professor in medical statisticsa
- a Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
- b Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA
- c Department of Biostatistics, School of Public Health, University of Minnesota
- Correspondence to: A J Sutton
- Accepted 2 March 2000
Objective: To assess the effect of publication bias on the results and conclusions of systematic reviews and meta-analyses.
Design: Analysis of published meta-analyses by trim and fill method.
Studies: 48 reviews in Cochrane Database of Systematic Reviews that considered a binary endpoint and contained 10 or more individual studies.
Main outcome measures: Number of reviews with missing studies and effect on conclusions of meta-analyses.
Results: The trim and fill fixed effects analysis method estimated that 26 (54%) of reviews had missing studies and in 10 the number missing was significant. The corresponding figures with a random effects model were 23 (48%) and eight. In four cases, statistical inferences regarding the effect of the intervention were changed after the overall estimate for publication bias was adjusted for.
Conclusions: Publication or related biases were common within the sample of meta-analyses assessed. In most cases these biases did not affect the conclusions. Nevertheless, researchers should check routinely whether conclusions of systematic reviews are robust to possible non-random selection mechanisms.
Selection bias is known to occur in meta-analyses because studies with results that are significant, interesting, from large well-funded studies, or of higher quality are more likely to be submitted, published, or published more rapidly than work without such characteristics.1 A meta-analysis based on a literature search will thus include such studies differentially, and the resulting bias may invalidate the conclusions.
The best way to deal with these problems, which we shall collectively label "publication bias," is to avoid them. Recently, for example, a trial amnesty was announced that encouraged researchers to submit for publication reports of previously unpublished trials.2 Additionally, steps are being taken to encourage the prospective registration of trials through trial registries.3 Although these steps may reduce the problem of publication bias in the future, it will remain a serious problem, and one that meta-analysts need to address for some time to come.
The simplest and most commonly used method to detect publication bias is an informal examination of a funnel plot.4 Formal tests for publication bias, such as those developed by Begg and Mazumdar 5 and Egger et al,6 exist, but in practice few meta-analyses have assessed or adjusted for the presence of publication bias. A recent assessment of the quality of systematic reviews reported that only 6.5% and 3.2% of studies in high impact general and specialist journals respectively reported that a funnel plot had been examined.7 The uptake of any formal methods is lower still, although there are notable exceptions.8
The main aim of this paper is to assess what effect publication bias could have on the results and conclusions of meta-analyses of randomised controlled trials in general. We applied the trim and fill method to a set of meta-analyses contained within the Cochrane Database of Systematic Reviews 9 and estimated the numbers of missing trials and their effects on the inferences in these meta-analyses. This method both tests for the presence of publication bias and adjusts for it. It is simpler to implement than previously described methods,10 and simulation studies suggest that it may outperform more sophisticated methods in many situations.
A funnel plot is a plot of each trial's effect size against some measure of its size, such as the precision (used here), the overall sample size, or the standard error (fig 1, top).4 These plots are referred to as funnel plots because they should be shaped like a funnel if no publication bias is present. This shape is expected because trials of smaller size (which are more numerous) have increasingly large variation in the estimates of their effect size as random variation becomes increasingly influential. However, since smaller or non-significant studies are less likely to be published, trials in the bottom left hand corner (when a desirable outcome is being considered) of the plot are often omitted, creating a degree of asymmetry in the funnel (fig 1, bottom).
We used the "trim and fill" method to evaluate bias in funnel plots.10–12 Firstly, the number of "asymmetric" trials on the right side of the funnel is estimated: these can broadly be thought of as trials which have no left side counterpart. These trials are then removed, or "trimmed," from the funnel, leaving a symmetric remainder from which the true centre of the funnel is estimated by standard meta-analysis procedures. The trimmed trials are then replaced and their missing counterparts imputed or "filled": these are mirror images of the trimmed trials with the mirror axis placed at the pooled estimate (see BMJ's website for figure). This then allows an adjusted overall confidence interval to be calculated. A test for the presence of publication bias has also been derived from this method, based on the estimated number of missing trials.11
Selection and analysis of studies
We examined all reviews contained in the Cochrane Database of Systematic Reviews (1998, issue 3).9 Reviews including 10 or more trials reporting a binary outcome measure were included in the assessment. At most, one meta-analysis from each review was included, and when more than one met the inclusion criteria, the one containing the most studies was selected. If two or more contained the same number of studies, the one listed first in the review was chosen. The (log) odds ratio measure was used for analysis, and where data were sparse, a continuity correction of 0.5 was used.13 For consistency, funnel plots were reflected about zero for meta-analyses in which the reported outcome measure was "undesirable" so that the left hand side of the funnel plot was scrutinised for publication bias in every case.
For each meta-analysis, we trimmed the trials considered to be symmetrically unmatched (assumed to be the k right-most trials in each funnel). The number kwas estimated by an iterative procedure (details given elsewhere 10–12) using the estimator denoted L0.11 12 We used fixed and random effects models to estimate the overall effect in order to assess the impact of choice of model on publication bias. The estimated effect of the missing trials provides an indication of whether the imputed missing studies affect the overall result of the meta-analysis.
Included studies
At the time of the investigation, the Cochrane Library contained 397 reviews that included a meta-analysis. Of these, 49 included 10 or more trials with at least one dichotomous outcome. However, one of these did not assess a comparative effect and was excluded, leaving 48 meta-analyses for assessment. The number of trials included in each dataset ranged from 10 to 47 (median 13), with only four analyses including more than 20 trials.
Random effects meta-analyses of these datasets, ignoring possible publication bias, resulted in 28 estimates that reached significance at the 5% level, with the remaining 20 being inconclusive. The corresponding figures were 30 and 18 with a fixed effects model.
The funnel plots for all 48 meta-analyses are available on the BMJ's website. Each trial's log odds ratio is plotted against the reciprocal of its standard error. The distribution of individual trial effect sizes is often highly irregular. Only a few of the plots closely conform to the classic funnel shape.
Estimated numbers of missing studies
Details of the estimates of the number of trials missed because of publication bias for each review are available on the BMJ's website. In all, 23 meta-analyses were estimated to have some degree of publication bias (L0>0) with the random effects model; this increased to 26 with the fixed effects model. The number of missing trials was significant if L0>3 for the range of trials included in the meta-analyses evaluated here.12 Eight meta-analyses reached this critical level under the random effects model and 10 under the fixed effects model. These estimates suggest that about half of meta-analyses may be subject to some level of publication bias and about a fifth have a strong indication of missing trials.
Changes in significance and magnitude of the overall pooled estimates
Imputing missing trials changed the estimates of the overall effect for all meta-analyses in which one or more trials was estimated as missing. Use of the random effects model indicated that in four reviews this would lead to significant changes in the conclusions. Three meta-analyses that were considered significant at the 5% level in the original analysis became non-significant (studies 5, 10, 13), and one that was considered non-significant became significantly negative (study 30). These results seem plausible in the light of the trial distribution in figure 2, and thus we deduce that around 5-10% of meta-analyses may be interpreted incorrectly because of publication bias.
Figure 2 shows the effect of adjustment by the trim and fill method on the odds ratios for the 23 meta-analyses estimated to have one or more missing trials. Although only modest changes in outcome are observed in most instances, in six studies with a positive effect (studies 1, 3, 5, 10, 24, and 47) the reduction is greater than 30%. In two cases (studies 30 and 48) with a negative effect, adding missing studies had an even stronger effect (see table on BMJ's website for details).
We found a clear indication of publication bias within this sample of studies from the Cochrane Database of Systematic Reviews. About half had some indication of publication bias, with a fifth having a strong indication. The potential effect of such bias varies from dataset to dataset. In some instances (for example, study 3) the number of studies estimated to be missing was relatively large but the adjusted estimate of effect size was only slightly lower than the original estimate. This can largely be explained by the presence of one or more studies that are much larger than those filled. These large studies have sufficient influence over the overall pooled estimate that asymmetry in the lower part of the funnel makes little impression on the overall pooled result. In other cases (for example, study 5), the estimated number of missing studies is smaller but the review's conclusions are altered.
The only other assessment of the impact of funnel plot asymmetry on a general collection of meta-analyses which is known to us is that of Egger et al,6 who applied their test to an earlier edition of the Cochrane Database of Systematic Reviews. Their inclusion criteria were less stringent than ours, including meta-analyses of categorical outcomes with five or more trials (compared with our minimum requirement of 10). They found significant indication of bias in five meta-analyses out of 38 examined (P<0.1). Our decision to include only meta-analyses with a minimum of 10 trials was largely arbitrary; however, five studies are usually too few to detect an asymmetric funnel.
Use of bias assessment
Although the development of methods for assessing publication bias has a reasonably long history, these methods are rarely used in practice.7 We searched the 48 original review reports from which the 48 meta-analyses were taken for references to publication bias and descriptions of any steps taken to deal with it. Thirty (63%) made no reference to publication bias. Five reviews mentioned examining a funnel plot, and three used the test of Egger et al. Since many of these reviews were written before that test was published, it has made a relatively high impact among reviewers subsequently. Generally, it was the more recently conducted reviews that had considered or tested for funnel plot asymmetry.
One possible reason for the lack of uptake of methods to deal with publication bias is that previous approaches have involved modelling methods that are difficult to implement and require lengthy calculations. The trim and fill method is both theoretically simple and easy and quick to implement. It may therefore be appropriate for routine use in evaluating meta-analyses. Our results seem plausible, with the four studies whose conclusions changed on adjustment all having visually skewed funnel plots.
Validity of results
Some cautionary remarks are needed in assessing our results. Since the method is based on the lack of symmetry in the funnel plot, and asymmetry might be due to factors other than publication bias,14 the results produced by trim and fill may not always reflect correction for publication bias. Moreover, the odds ratio outcome was used exclusively in this investigation. The appearance of a funnel plot can depend on the outcome measure used, and different results might be obtained in some instances if the risk difference or relative risk scale is used. The sensitivity of assessments of publication bias to the outcome measure used requires further investigation.
What is already known on this topic
Meta-analyses are subject to bias because smaller or non-significant studies are less likely to be published
Most meta-analyses do not consider the effect of publication bias on their results
What this study adds
A simple trim and fill adjustment method on studies in the Cochrane database suggests that publication bias may be present to some degree in about 50% of meta-analyses and strongly indicated in about 20%
Publication bias affected the results in less than 10% of meta-analyses
Researchers should always check for the presence of publication bias and perform a sensitivity analysis to assess the potential impact of missing studies
The idea of adjusting the results of meta-analyses for publication bias and imputing "fictional" studies into a meta-analysis is controversial.15 We certainly would not rely on results of imputed studies in forminga final conclusion, partly because asymmetry in a funnel plot may be due to factors otherthan publication bias. Any adjustment method should be used primarily as a form of sensitivity analysis, to assess the potential effect of missing studies on the meta-analysis,rather than as a means of adjusting results themselves.
If, as our study indicates, missing studies change the conclusions in less than 10% of meta-analyses, publication bias, although widespread, may not be a major practical problem. On the other hand, the fact that almost half the funnel plots examined seemed to exhibit some asymmetry leads us to conclude that routine evaluation for this bias should be an important step in any systematic review.
Contributors: AJS had the original idea for the study, extracted the relevant data from the Cochrane Database of Systematic Reviews, and assisted with the interpretation of the results. SJD assisted with the study design, carried out the trim and fill analyses, and assisted with the interpretation of the results. RLT assisted with the study design and the interpretation of the results. KRA and DRJ assisted with the interpretation of the results. The paper was written and revised jointly by all authors. AJS is the guarantor for this paper.
Funding None declared.
Competing interests None.
Figures illustrating the method and funnel plots of all trials and a full table of results are available on the BMJ's website

subset: commoncrawl


text:
"The explosive vocals, stark guitar harmonies and head-banging solos are all informed by the band's combined experience in the hard rock and jazz worlds." (Music Injection, 6/4/16)
On iTunes May 27. CD available from the GoSet Music Store June 17.
A clock ticks. A car alarm splits the night. A distant belltower tolls as a gun is ominously cocked in your ear. The curtain rises in a grand cinematic flourish of muscular, orchestrated rock. Drums roll and crash as the synth riff soars and the first exhilarating guitar solo tears a hole in the sky. Who makes records like this anymore? The story of TASTE is a legend from the lost back pages of Australian rock'n'roll: the meteoric rise and fall of a mid '70s glam-rock quartet with a fiery reputation among such lofty peers as AC/DC, Queen, Suzi Quatro and the Sweet. But history can wait. Fast forward 40 years and LIFE ON EARTH is a document of rare craft and experience from a band split by circumstance all those years ago, now reunited with newfound passion and decades of combined expertise from the realms of hard, progressive rock to the frontiers of jazz.
"I put a couple of songs down in my home studio," explains singer and keyboard player Ken Murdoch, "and one sounded very TASTE-like: very heavy and theatrical so I sent it to Joey and Michael and said 'What do you think?'"
The answer was unanimous. A sign of the creative explosion that ensued, that track never made the final cut. "The songs poured out of me," says Ken. "It took a few months to write but I knew where it was going. A few of the tracks I got from short stories that I wrote. Every song seemed to link to the last. "It certainly has a theme. It deals with a lot of history and it deals with what a turbulent world we live in," he says. "Even with the ballads, there's not really a love song connotation. It keeps falling back on history as an example. It's a big album."
That's a fair call for an epic suite that spans the melodic metal thunder of "I Am God" to a tender ballad of mortality titled "Is It Just a Dream". The rage of "Fatal Shore" was inspired by horrific events in modern Australian society, while "Blood" brings it closer to home with a glam-tinted celebration of the ties that secure friendship against the odds of time. Ken, Joey, Michael and drummer Virgil Donati were teenaged rock idols back in the Countdown dreamtime of the mid 1970s. Tickle Your Fancy and Knights of Love were two classic albums (recently remastered for iTunes) that spawned a run of hits including Tickle Your Fancy, A Little Romance and their signature tune, Boys Will Be Boys.
The latter was famously adopted by Queen as the pre-gig fanfare on their A Night At the Opera tour of 1976. TASTE was preparing to tour America with Freddie Mercury and Co. on the back of an imminent deal with Sire Records in the USA when the wheels fell off in 1977. It was a tragic tale of mismanagement and parental control that any member of the band will philosophically recall—along with other classic yarns about kidnapping Malcolm Young, touring with Skyhooks and Sherbet and any amount of affiliated youthful hi-jinx.
What matters, though, is what remains. "As teenagers, we took ourselves very seriously as musicians," says Michael, best known in recent times as a jazz bassist, owner of Bennetts Lane Jazz Club and artistic director of the Melbourne International Jazz Festival. "When I listen to [the '70s] albums now my mind boggles at how we actually wrote those songs at that age, with that quality of musicianship. There's a lot of virtuosic playing. It's of the time but it's progressive. It was real. It was organic and full of integrity."
Speaking of virtuosity, new TASTE drummer Damian Corniola boasts a fortuitous connection with the roots of the band. He studied under original drummer Virgil Donati, these days based in LA and widely considered one of the best in the world (ask anyone from Southern Sons to Dream Theater). "To find somebody who has his capabilities, so young, is incredible for us," says Ken. "Plus he's a TASTE fan. That's really the thing that got us. He knows all the songs because I guess Virgil played them for him "The first thing I said to him was 'Why would you want to join us?' And he said 'Because this is like a dream'."
The feeling is sort of mutual. LIFE ON EARTH is an album for our times but steeped in the wide-screen colours of a more progressive era. Real strings. Layers of percussion. Walls of harmony. Crafted segues, dramatic timing shifts and a vast, unified vision that befits the grandeur of its title.
"We didn't do anything by halves this time," Ken says with a laugh. "It's going to be interesting to play live."
LIFE ON EARTH is out on iTunes May 27. The CD album is available here at the GoSet Music Store from June 17.


text:
He's known for his bestselling novels and the hit films they inspired: The Firm, A Time to Kill, The Pelican Brief, The Client, to name a few. His protagonists unlock secrets, ferret out corruption, and bring culprits to justice. But 13 years ago author John Grisham found himself caught in his own personal thriller, this one a frightening medical mystery.
Something was causing him to experience unnerving allergic reactions, sometimes in the middle of the night. His skin felt "on fire" with welts that would swell and itch – but what was behind the outbreaks? And how to stop them?
After consulting a physician and keeping a log of every morsel he ate for months, Grisham uncovered the bizarre cause of his misery: red meat (beef, pork and other mammals' meat). What he didn't know at the time was that this allergy to a carbohydrate (alpha-gal) in red meat is linked to tick bites. And Virginia, where Grisham's family lives on a farm, is tick central.
In fact, University of Virginia researchers were among the first to document the tick-meat allergy connection, in part because renowned UVA allergist Dr. Thomas Platts-Mills himself developed meat allergy after being bitten by ticks. What makes the allergy particularly confounding to track is that it causes delayed reactions, often over four hours after eating meat.
Despite his busy schedule of writing, speaking, and supporting good causes, Grisham manages to keep his allergy in check both at home (in Virginia and Mississippi) and on the road. A few years ago, the author sat down in his Charlottesville, Virginia office with Allergic Living contributor Mary Esselman to discuss his bedeviling allergy, making frequent reference to his meticulous log notes.
Beginning of his odd allergy
"The first [reaction] was in June of 2002. I noticed some rashes on my ankles. I remember thinking, 'This is weird, both ankles.'" [He didn't think it was a big deal.]
"Then in July 2002, I went with my wife to an annual garden club dinner, and she had prepared these huge beef tenderloins that I had grilled. And while I was cooking, I was shaving some off to sample. By the time we got to the garden club party, my ears were really, really itching. I got my wife and said, 'Renee, something's going on.'
There was a doctor there, and he gave me an antihistamine. My skin was on fire.
So we got in the car, and I was so desperate I stripped down, took off all my clothes but my boxer shorts, and I had all the air [conditioning vents] blowing on me, and you could just see the welts. The skin was just welting up. It almost made me nauseated just watching my skin."
[He wrote down in the food log his doctor advised him to keep that it was beef. The penny began to drop.] "It was always beef."
Developing delayed reactions
"Two weeks later, we went to a baseball game in Shea Stadium with the kids, and I had a hot dog. And this is when the weird stuff started happening because from that point on [the reactions] were all delayed [by four or five hours after eating]. I'd be asleep – and when you wake up you know you're in big-time trouble.
I remember standing in the hotel bathroom, Renee was putting damp cloths on my skin, and you can just see it: down your legs, and right into your midsection is where it just really welts up. The inside of your forearms – there have been times when I would scratch until it almost would bleed. You just cannot stop scratching.
So the plot thickens. There were 11 episodes in 2002-2003. By then I'm writing notes to myself, 'No red meat, you idiot.' Because it was pork – my favorite pork ribs from a restaurant in Memphis one time – sausage, bacon, ham. Lamb one time. I finally just stopped eating red meat."
Cheating diet – and paying for it
"Four years go by, and after a while I started eating red meat again. And I got by with it and I'm thinking, 'This is good'. In 2007, I gave the commencement speech here at UVA [University of Virginia]. Then my wife and my daughter and I came downtown and all had a cheeseburger. That was in May.
In September, Renee fixed some big beef dish, and she had a thick wine reduction sauce, just delicious. And I woke up and thought I was going to die. It was the worst hives and rashes and itching ever. I took two Allegra, got out of bed so she could sleep, went downstairs, and at some point fainted and my head cracked a chair – and broke the chair. Of course I'm hard-headed [laughs] so it didn't do any damage [to his head].
The last one was November 3rd, my wife's birthday, 2010. To celebrate, we were in Paris. We went to a fancy restaurant, and I had a very rich rabbit dish in heavy sauce and I woke up about four hours later with yet still the worst case of hives, itching. I had Allegra, and we almost called to get a doctor. But I didn't want to go to the doctor in a strange city, or a hospital, so we toughed it out.
And that was it. That episode was so bad I said, 'I can happily give it [red meat] up now'. So I've had 15 episodes in 10 years with a gap, oddly enough, when I thought I could eat beef and pork. But I can't."
Treating his reactions
"I always have Allegra nearby. There have been times when I would wake up in the middle of an episode and take the Allegra, and it kills the itching but not the swelling. But you can sleep it off. The next day is ruined; you feel terrible.
When this got cranked up in the summer of 2002, I had an EpiPen close by. Renee was always afraid I was going to have a heart attack or stop breathing, so I carried an EpiPen …. From June of 2002 through July of 2003, that 13-month period, there were 11 episodes, and that's when I had the EpiPen. And then, I just figured it out. And I've only had four [reactions] since then."
His wife develops, effect on their life
"What's odd is now Renee has the same affliction. She started about a year ago. We live on a farm – ticks everywhere. And we're from Mississippi and never had the problem there. We moved here in '94, and again it wasn't a problem.
But I think the problem is being seen everywhere around here [Charlottesville]. It's being studied and all of that. [Renee] has been through it, I would guess, four times with rashes, but nothing as uncomfortable what I've gone through. But she doesn't want to do what I've done, so she stays away from red meat."
"There are times when you think, boy, I'd love to have a big old steak or cheeseburger or a side of ribs or even, you know, a Bolognese pasta sauce or something like that. But you say, well, it's not worth it.
Renee is a very healthy cook, and I've never had a problem with cholesterol, nor does she, or blood pressure. But it's a whole lot lower now [laughs], cholesterol. There's no real drawback. I could easily be a vegetarian. But my wife is also a wonderful cook. We spend a lot of time in the kitchen; we open a bottle of wine every evening about 6 and start thinking about what can we cook, or we go out. But we do eat a lot of chicken. A LOT of chicken.
[Outdoors,] we're much more careful now. We hike all the time, through the trails. We're much more careful with the [tick repellant] spray and spray the dogs."
Lack of understanding of tick-related allergy
"When the article [about red-meat allergy] came out in Allergic Living magazine, I couldn't wait to run copies and send them to all the skeptics in my life. 'There you go, take it.'
Because the article's perfect: this guy's a doctor at UVA [Dr. Thomas Platts-Mills], and suddenly he's breaking out in hives, and it's linked to a tick, and you can't eat red meat. I said, 'There it is, now get off my back.'" [Laughs]
"I guess the worst part is just having an allergy and wondering, you know, where it came from. I hope they figure this all out. I hope – maybe you can take a pill for it someday, or get some immunity …. I've always told [my allergist], any time you think I need to go do something – I'll subject myself to any kind of test. If I can help out, I'm happy to. Thus this interview."
Sidebar: The Doctor's Check-Up
Allergic Living asked New York allergist Dr. Paul Ehrlich* to grade John Grisham's allergy approach.
Top Marks: We like to say, "a good history solves the mystery." Thanks to a master of the art for validating this point with his methodical record-keeping and observations.
Caution ahead: I'd worry that some chef may add beef or veal stock to liven up a vegetarian recipe or a braised chicken. Cross-contamination accidents do happen, and Mr. Grisham needs to be ready.
Medication use: It's interesting that he uses Allegra – it's slow-acting. With food allergies, most allergists recommend Benadryl. Given the severity of some of his reactions, always carrying epinephrine would be an excellent precaution.
See also: Red Meat Allergy Found to Be Mystery Trigger Behind Many Anaphylaxis Cases
*Dr. Paul Ehrlich is author of Asthma Allergies Children: A Parent's Guide.


text:
DIY haven Instructables.com has a quickie tutorial on how to make your very own cheapo bias monitor lighting.
Bias lighting basically will give your eyes a bit of a rest whilst looking at the monitor. The instructions are simple, and it does really make a difference; really, it's just the simple trick of putting a light behind your monitor instead of on the side or on top. What are your favorite ways to make your monitor a bit more easy on the eyes? Thoughts to comments or to tips at lifehacker.com.
Bias lighting on the cheap [Instructables via DIY Happy]


text:
National Solar Jobs Census 2020
First published by The Solar Foundation in 2010, the National Solar Jobs Census is the definitive measure of solar energy industry employment in the United States. This is the 11th annual report.This report charts the growth of the solar workforce alongside the rise of solar energy as a major contributor to the U.S. energy supply and the economy.
This report tracks solar jobs data nationwide and in all 50 states. It features in-depth analysis on jobs by market segment, demographics, and workforce development trends.
The 11th edition of the National Solar Jobs Census includes data for 2020. It was published by The Solar Foundation, the Solar Energy Industries Association, and IREC. Visit the National Solar Jobs Census page to view all reports published since 2010.


text:
In that article, I explained that stretch and fold is about the easiest ways to handle a dough with very high hydration, like the focaccia recipe in Artisan Breads Every Day, which has an 80 percent hydration.
But stretch and fold can be used with doughs of lesser hydration as well, as long as it's wet enough to stretch easily. Talking about the method is one thing, but doing it - hands on - is the best way to learn. If you've never tried this technique and you've always kneaded with a machine or by hand for up to 10 minutes, it will seem impossible that a few simple folds will give enough structure to the dough. But it works.
If you haven't practiced the technique, this bread is a good way to learn. The dough at 70 percent hydration is easy to work with - not too stiff and not too floppy. Meanwhile, the long overnight rest develops flavor, so it's more than just a teaching tool - it's a good loaf of bread.
As you get more comfortable with the technique, you can move on to higher-hydration doughs and different recipes. You might not give up hand kneading completely, but this method certainly has its place in any bread-baker's recipe book.
70-Percent Hydration Loaf
20 ounces bread flour
14 ounces water
1 teaspoon instant yeast
1 1/2 teaspoons salt
1 tablespoon olive oil
Combine flour, water, yeast and salt in the bowl of your stand mixer. Mix with the paddle attachment or dough hook (this dough is wet enough that either will work) until all the ingredients are combined and the mixture begins to get smooth. You can also do this by hand with a wooden spoon or dough whisk.
Drizzle the oil into a clean bowl, and move the dough to the oiled bowl, turning to coat on all sides. Cover the bowl with plastic wrap and put it in the refrigerator overnight.
Remove the dough from the refrigerator and let it rest, still in the covered bowl, for an hour at room temperature.
Dust your work surface lightly with flour and turn the dough out. Grasp the two sides of the dough and pull gently outward until the dough is three times its original width. Fold the two sides inward, like you are folding a letter. Turn the dough 90 degrees and repeat this procedure. Turn the dough 90 degrees again and repeat. For this final fold, the dough should be stiffer and more elastic. Seal any seams and turn the dough over so the smooth side is on top. If you prefer, coax the dough into a more round shape.
Sprinkle some cornmeal on a baking sheet (or on a peel, if you prefer to bake on a stone) or place the bread on a piece of parchment paper, if you prefer using that to transfer it to your stone. Sprinkle some flour on top of the loaf - or use white rice flour, if you have it - and cover the loaf with plastic wrap. Since this dough is so wet, it's a good chance it will stick to the plastic wrap if you don't flour it. Set the dough aside to rise until doubled, about and hour. Meanwhile, preheat the oven to 425 degrees.
When the dough has doubled, spray the surface with water and place it in your preheated oven. Bake until golden brown, about 35 minutes.
Move the dough to a rack to cool before slicing.
This has been submitted to Yeastspotting.


text: SCHED_SETSCHEDULER(2) Linux Programmer's Manual SCHED_SETSCHEDULER(2) NAME sched_setscheduler, sched_getscheduler - set and get scheduling pol- icy/parameters SYNOPSIS #include <sched.h> int sched_setscheduler(pid_t pid, int policy, const struct sched_param *param); int sched_getscheduler(pid_t pid); DESCRIPTION The sched_setscheduler() system call sets both the scheduling policy and parameters for the thread whose ID is specified in pid. If pid equals zero, the scheduling policy and parameters of the calling thread will be set. The scheduling parameters are specified in the param argument, which is a pointer to a structure of the following form: struct sched_param { ... int sched_priority; ... }; In the current implementation, the structure contains only one field, sched_priority. The interpretation of param depends on the selected policy. Currently, Linux supports the following "normal" (i.e., non-real-time) scheduling policies as values that may be specified in policy: SCHED_OTHER the standard round-robin time-sharing policy; SCHED_BATCH for "batch" style execution of processes; and SCHED_IDLE for running very low priority background jobs. For each of the above policies, param->sched_priority must be 0. Various "real-time" policies are also supported, for special time-crit- ical applications that need precise control over the way in which runnable threads are selected for execution. For the rules governing when a process may use these policies, see sched(7). The real-time policies that may be specified in policy are: SCHED_FIFO a first-in, first-out policy; and SCHED_RR a round-robin policy. For each of the above policies, param->sched_priority specifies a scheduling priority for the thread. This is a number in the range re- turned by calling sched_get_priority_min(2) and sched_get_prior- ity_max(2) with the specified policy. On Linux, these system calls re- turn, respectively, 1 and 99. Since Linux 2.6.32, the SCHED_RESET_ON_FORK flag can be ORed in policy when calling sched_setscheduler(). As a result of including this flag, children created by fork(2) do not inherit privileged scheduling poli- cies. See sched(7) for details. sched_getscheduler() returns the current scheduling policy of the thread identified by pid. If pid equals zero, the policy of the call- ing thread will be retrieved. RETURN VALUE On success, sched_setscheduler() returns zero. On success, sched_getscheduler() returns the policy for the thread (a nonnegative integer). On error, both calls return -1, and errno is set appropri- ately. ERRORS EINVAL Invalid arguments: pid is negative or param is NULL. EINVAL (sched_setscheduler()) policy is not one of the recognized poli- cies. EINVAL (sched_setscheduler()) param does not make sense for the speci- fied policy. EPERM The calling thread does not have appropriate privileges. ESRCH The thread whose ID is pid could not be found. CONFORMING TO POSIX.1-2001, POSIX.1-2008 (but see BUGS below). The SCHED_BATCH and SCHED_IDLE policies are Linux-specific. NOTES Further details of the semantics of all of the above "normal" and "real-time" scheduling policies can be found in the sched(7) manual page. That page also describes an additional policy, SCHED_DEADLINE, which is settable only via sched_setattr(2). POSIX systems on which sched_setscheduler() and sched_getscheduler() are available define _POSIX_PRIORITY_SCHEDULING in <unistd.h>. POSIX.1 does not detail the permissions that an unprivileged thread re- quires in order to call sched_setscheduler(), and details vary across systems. For example, the Solaris 7 manual page says that the real or effective user ID of the caller must match the real user ID or the save set-user-ID of the target. The scheduling policy and parameters are in fact per-thread attributes on Linux. The value returned from a call to gettid(2) can be passed in the argument pid. Specifying pid as 0 will operate on the attributes of the calling thread, and passing the value returned from a call to getpid(2) will operate on the attributes of the main thread of the thread group. (If you are using the POSIX threads API, then use pthread_setschedparam(3), pthread_getschedparam(3), and pthread_setschedprio(3), instead of the sched_*(2) system calls.) BUGS POSIX.1 says that on success, sched_setscheduler() should return the previous scheduling policy. Linux sched_setscheduler() does not con- form to this requirement, since it always returns 0 on success. SEE ALSO chrt(1), nice(2), sched_get_priority_max(2), sched_get_priority_min(2), sched_getaffinity(2), sched_getattr(2), sched_getparam(2), sched_rr_get_interval(2), sched_setaffinity(2), sched_setattr(2), sched_setparam(2), sched_yield(2), setpriority(2), capabilities(7), cpuset(7), sched(7) COLOPHON This page is part of release 5.05 of the Linux man-pages project. A description of the project, information about reporting bugs, and the latest version of this page, can be found at https://www.kernel.org/doc/man-pages/. Linux 2017-09-15 SCHED_SETSCHEDULER(2)


text:
NSW Health (Ending HIV) provides public health information on prevention, support services, treatment, testing, strategies, guidelines for health units, notifications and data.
Hepatitis NSW is a not-for-profit charity started by the hepatitis community to inform, support and educate and to work towards a world free of viral hepatitis. Hepatitis NSW has a speaker service, C-een & Heard, and it runs campaigns and offers training sessions.
The AIDS Council of NSW (ACON) specialises in HIV prevention and support and LGBTI health. It operates rapid HIV and STI testing facilities, gay health workshops and support services including support groups, one-on-one peer support, counselling, home-based care, health retreats and a meal service.
Positive Life NSW supports all people living with HIV across NSW. As the largest group of people living with HIV in Australia, Positive Life NSW supports all people living with HIV through housing support, aged care support, employment, treatments support, partner notification and disclosure support, as well as a range of social events for heterosexual men and women living with HIV, gay and bisexual men living with HIV, specific support groups for women living with HIV, and inclusion social events for all people living with HIV including our partners, family and friends in NSW.
Pozhet is an organisation for heterosexual people living with HIV in NSW. It offers confidential support, information and a chance to meet other people affected by HIV.
HIV AIDS Legal Centre (HALC) is a not-for-profit community legal centre, whose lawyers tackle the severe stigma and discrimination associated with HIV and provide specialist legal support.
Sex Workers Outreach Project (SWOP) is Australia's largest and longest established community-based peer education sex worker organisation focused on HIV, STI and hepatitis prevention, education and health promotion for sex workers in NSW. It has resources in Chinese, Thai and Korean languages.
Multicultural NSW aims to build and maintain a cohesive and harmonious multicultural society that enriches the lives of all the people of NSW, with a vision for stronger social, cultural and economic prosperity through cultural diversity. It provides language services, research and community engagement activities.
NSW Multicultural Health Communication Service (Multicultural Communication) provides information and services to assist health professionals to communicate with culturally diverse communities throughout NSW. There are over 400 publications on health in a wide range of languages and a new publication is produced each month. Some multilingual resources produced by other services are also listed on this website and there are links to related websites.
NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) is a specialist, non-profit organisation that provides culturally appropriate and cutting edge psychological treatment and support to help people heal the scars of torture and refugee trauma and to rebuild their lives in Australia.
NSW Refugee Health Service aims to protect and promote the health of refugees and people of refugee-like backgrounds living in NSW, providing early health assessments for newly arrived refugees, educating health service providers on refugee health and related issues, providing targeted health promotion programs for refugees and advocating for health policies and appropriate services for refugees.


text:
- Dives5
- Duration3 days
- Price$ 470
PADI Advanced Open Water Diver
Continue your adventure
This course can be taken after completing the PADI Open Water Diver certification. It's titled PADI Advanced Open Water Diver because it advances your diving knowledge & skills.
That's what the PADI Advanced Open Water Diver course is all about. You don't have to be "advanced" to take it – it's designed to advance your diving, so you can start right after earning your PADI Open Water Diver certification. The course helps build confidence and expand your scuba skills through different Adventure Dives. You try out different specialties while gaining experience under the supervision of your PADI Instructor. You log dives and develop capabilities as you find new ways to have fun scuba diving.
Get credit! Each Adventure Dive may credit toward the first dive of the corresponding PADI Specialty Diver Course. If you've already taken a specialty diver course, ask your instructor if you've earned credit for an Adventure Dive.
PADI (Junior) Open Water Divers who are at least 12 years old are ready to step up and enroll in an Advanced Open Water Diver course. Young divers may only participate in certain Adventures Dives – ask us for futher informations.
If you're already an, you only need to complete two more Adventure Dives to earn the Advanced Open Water Diver certification.
More information
You'll plan your learning path with your instructor by choosing from a long list of Adventure Dives. There are two required dives – Deep and Underwater Navigation – and you choose the other three, for a total of five dives. During the Deep Adventure Dive, you learn how to plan dives to deal with the physiological effects and challenges of deeper scuba diving. The Underwater Navigation Adventure Dive refines your compass navigation skills and helps you better navigate using kick-cycles, visual landmarks and time.
The other knowledge and skills you get vary with your interest and the adventures you have – photography, buoyancy control, fish identification, exploring wrecks and many more.
In the PADI Open Water Diver course, you learn to use, including a mask, snorkel, fins, regulator, buoyancy control device and a tank.Book your course:
PADI Advanced Open Water Diver
or Call Us on +599 9 523 9220 to arrange a trip


text:
Keeley Blueriver is not doing a very good job hiding out. After being viciously attacked, she and her sister Danielle pack up and move across the country to Window Rock, Arizona. But Simon found them before, and he'll do it again. How and when are the only questions.
Kalkin Raferty, Alpha of the Raferty pack, has spent his life protecting his family and pack from outside threats. He believes his time for finding a mate has passed. Who would want an old Alpha wolf?
A chance meeting puts Kalkin face to face with his destiny and now he can't get the blonde-haired, hazel-eyed woman out of his mind. His wolf is poised to claim her, but with danger lurking around every corner, is he willing to risk everything to have her?
TL Reeve: TL Reeve, a best-selling, multi-published author, was born out of a love of family and a bond that became unbreakable. Living in Alabama, TL misses Los Angeles, and will one day return to the beaches of Southern California. When not writing something hot and sexy, TL can be found curled up with a good book, or working on homework with a cute little pixie.
Michele Ryan: Michele Ryan is an author with Decadent and After Glows Publishing. She embraced her creative passion and co-authored several books with fellow author TL Reeve. Michele has also published two solo novellas. Michele is a lifelong resident of the state of New Jersey, along with her husband and three children, whom she refers to as her hobbits. When Michele is not plotting or writing, she can be found either volunteering at her children's school or reading.
TL Reeve:
Facebook I Newsletter I Blog I Site I Twitter I Group I BookBub I Amazon
Michele Ryan:
Facebook I Site I Twitter I BookBub I Group
Combined sites:
Michele/TL Reeve I ACS I Combined Newsletter
Grand Prize: 7' Kindle Fire and bag
1st Prize: 1 Paperback copy of Kalkin and a bookmark
2nd Prize: 1 $10 gift card


text:
Though still under construction, the IceCube Neutrino Observatory at the South Pole is already delivering scientific results — including an early finding about a phenomenon the telescope was not even designed to study.
IceCube captures signals of notoriously elusive but scientifically fascinating subatomic particles called neutrinos. The telescope focuses on high-energy neutrinos that travel through the Earth, providing information about faraway cosmic events such as supernovas and black holes in the part of space visible from the Northern Hemisphere.
However, one of the challenges of detecting these relatively rare particles is that the telescope is constantly bombarded by other particles, including many generated by cosmic rays interacting with the Earth's atmosphere over the southern half of the sky. For most IceCube neutrino physicists these particles are simply background noise, but University of Wisconsin-Madison researchers Rasha Abbasi and Paolo Desiati, with collaborator Juan Carlos Diaz-Velez, recognized an opportunity in the cosmic ray data.
"IceCube was not built to look at cosmic rays. Cosmic rays are considered background," Abbasi says. "However, we have billions of events of background downward cosmic rays that ended up being very exciting."
Abbasi saw an unusual pattern when she looked at a "skymap" of the relative intensity of cosmic rays directed toward the Earth's Southern Hemisphere, with an excess of cosmic rays detected in one part of the sky and a deficit in another. A similar lopsidedness, called "anisotropy," has been seen from the Northern Hemisphere by previous experiments, she says, but its source is still a mystery. "At the beginning, we didn't know what to expect. To see this anisotropy extending to the Southern Hemisphere sky is an additional piece of the puzzle around this enigmatic effect — whether it's due to the magnetic field surrounding us or to the effect of a nearby supernova remnant, we don't know," Abbasi says.
The new result publishes Aug. 1 in The Astrophysical Journal Letters, published by the American Astronomical Society.
One possible explanation for the irregular pattern is the remains of an exploded supernova, such as the relatively young nearby supernova remnant Vela, whose location corresponds to one of the cosmic ray hotspots in the anisotropy skymap. The pattern of cosmic rays also reveals more detail about the interstellar magnetic fields produced by moving gases of charged particles near Earth, which are difficult to study and poorly understood.
Right now "we can predict some models, but we don't have concrete knowledge of the magnetic field on small scales," Abbasi says. "It would be really nice if we did — we would have made a lot more progress in the field."
Since nearly all cosmic signals are influenced by the interstellar magnetic fields, a better overall picture of these fields would aid a large range of physics and astronomy studies, she says, adding that their newly reported findings rule out some proposed theories about the source of the Northern Hemisphere anisotropy.
The IceCube group is currently extending its analysis to improve its understanding of the anisotropy on a more detailed scale and delve further into its possible causes. While the newly published study used data collected in 2007 and 2008 from just 22 strings of optical detectors in the IceCube telescope, they are now analyzing data from 59 of the 79 strings that are in place to date. When completed in 2011, the National Science Foundation-supported telescope will fill a cubic kilometer of Antarctic ice with 86 strings containing more than 5,000 digital optical sensors.
"This is exciting because this effect could be the 'smoking gun' for our long-sought understanding of the source of high-energy cosmic rays," says Abbasi.


text:
High temperatures in the 90s to 100s and warm overnight temperatures will continue across parts of the Interior Northwest, central California, and the Great Basin. Thunderstorms and heavy rain may produce scattered flash flooding across much of the Southern Rockies into the Southwest, particularly over sensitive burn scars in New Mexico, and across the Southeast into the Carolinas. Read More >
2009 started off with many major, high-impact weather events. However, by mid-May, the number of significant weather events declined rapidly. Throughout the summer and into fall, there were periodic severe weather episodes with primarily large hail and damaging winds, but none had quite the magnitude or impact of something like the February 10, 2009 tornado outbreak.
2009 started off with many major, high-impact weather events. However, by mid-May, the number of significant weather events declined rapidly. Throughout the summer and into fall, there were periodic severe weather episodes with primarily large hail and damaging winds, but none had quite the magnitude or impact of something like the February 10, 2009 tornado outbreak.
Here are some climate facts for parts of the area in 2009, using the National Climatic Data Center (NCDC) as the source for information:
From January 26-27, 2009, a winter storm impacted parts of western North Texas, and western and central Oklahoma. An arctic cold front came through the area on January 25th, ushering in a much colder air mass. High temperatures that day did not crack the freezing mark across most of Northern Oklahoma. Overnight from the 25th into the 26th, the shallow cold air mass advanced further south. By daybreak, on Monday January 26th, temperatures along the Interstate 44 corridor from Lawton, through Oklahoma City, and northeast to Tulsa had fallen back into the mid-20s. With the surface cold front well south of the area, and an upper level low developing to the west of the area, warm and moist air began flowing from the Gulf of Mexico northward and moving over this shallow cold air mass. Therefore, if you were in Oklahoma City and you went straight up into the air, you would first encounter a very cold air mass, followed by a relatively warm layer of air a few thousand feet up. This relatively warm layer was generally above the freezing mark, so any ice crystals melted as they were falling to the surface. However, the cold air near the ground was cold enough to re-freeze the water either as it hit the ground or other surfaces, or into small ice pellets as they fell through the cold air. The resulting precipitation across most of the area on January 26-27 was a combination of freezing rain and sleet. |
After the precipiation had subsided, there was a corridor of significant accumulations of sleet, in excess of 2 inches, from the Walters and Duncan areas, east-northeast through Lindsay, Purcell, Seminole and Wetumka. The greatest sleet accumulations were in Seminole, Hughes, and Pottawatomie Counties, where generally 2 to 4 inches fell, and isolated totals as high as 6 inches were reported. Because the majority of the precipitation was sleet rather than freezing rain, glaze on trees and power lines did not cause as much damage as other ice storms in recent past. However, the impact to travel was tremendous, and driving in the heavy sleet was extremely difficult. Several hundred automobile accidents occurred across the area. Several days later, satellite images still showed the sleet on the ground (left). |
Only about ten days after sleet had melted off the ground in parts of central Oklahoma, a severe weather outbreak affected a good portion of the area. Tuesday, February 10, 2009 began unlike most severe weather days in Oklahoma. The morning low in Oklahoma City at Will Rogers Airport dipped down to 40 degrees, and the temperature was in the 40s for most of the morning commute. In fact, temperatures across all of Oklahoma and Western North Texas ranged from 30 degrees northwest to the mid 50s southeast. Thunderstorms began developing by midday in parts of central Oklahoma, along the leading edge of deep moisture returning north from the Gulf of Mexico, and a surface front. These storms produced numerous reports of large hail, some up to the size of baseballs (2.75" in diameter) in Piedmont, Yukon, Seward and Guthrie. However, most notably, the storms produced a combined 6 tornadoes, one of them a deadly EF-4 tornado that struck the town of Lone Grove, OK. Another strong tornado struck Edmond, OK earlier in the day. A detailed web page documenting this event is available on our website. |
The following is an excerpt from the NWS Norman newsletter. A strong, late-season winter storm struck northwest Oklahoma with record setting snowfall on March 27-28, 2009. North winds began gusting over 40 mph when a cold front moved into northwest Oklahoma just after midnight on March 27th. At the same time, a powerful upper level storm moved out of New Mexico, and began to intensify over the Oklahoma and Texas Panhandles, spreading moisture and lift into northwest Oklahoma. Snow began around daybreak from Buffalo to Woodward and Gage. It was late afternoon, however, when snow became moderate and heavy, leading to significant accumulations. By early evening, some locations had already picked up over six inches of snow. The blustery winds also caused blowing and drifting which further reduced visibility and soon made traveling dangerous or impossible. Snow became more widespread overnight, and some thunder was even observed with the more intense squalls beneath the upper level storm. Snowfall rates of one to two inches per hour were reported, and locations north of a line from Roll to Mutual and Cherokee received between one and two feet of snow by sunrise. There was a sharp southern cut-off to the snowfall because of a stream of dry mid and upper level air that developed from the Texas South Plains up through southwest and central Oklahoma. Almost all roads in northwest Oklahoma were snow packed and impassable for some time. Some roads were said to be unidentifiable, and in other cases the snowpack was so tall and heavy that bulldozers could not clear a path. Drifts as high as 8 feet were reported in some locations. |
The month of April was a month of contrasts. Early April saw one of the most significant wildfire outbreaks in recent past on April 9th. A dryline associated with a surface low pressure system swept through Oklahoma during the early afternoon. Rapid drying, and increasing winds, behind the boundary substantially increased the wildfire danger. Many wildfires broke out across western Oklahoma and western North Texas. The image to the right is an infrared satellite image. The dark spots show the location of fires around 6:25pm CDT. This wildfire event was unusual in that it required Fire Warnings in rapid succession - almost at the pace that we are accustomed to issuing warnings for severe thunderstorms. Fire Warnings are a tool that emergency managers can use to disseminate evacuation orders via the NWS, using NOAA All Hazards Weather Radio. These messages describe the area threatened using well known street names, and provide instructions on which direction or along which roads people should travel to remove themselves from the path of the fire. At the height of the outbreak, NWS Norman dedicated one meteorologist to the sole task of coordinating and disseminating Fire Warnings. NWS Norman issued eleven Fire Warnings for 8 different communities (some Warnings were updates of previously issued Warnings). The warned communities were all located in Oklahoma, and included Marietta, Wellston, Sparks, Velma, Loco, Midwest City, Bradley, and Lindsay. This event provided some unique challenges. While one meteorologist was dedicated to issuing Fire Warnings, there were also concerns with severe thunderstorms producing large hail in central Oklahoma, and the threat of damaging non-thunderstorm winds in western Oklahoma, behind a cold front. The diverse combination of hazards (shown in Graphicast to the left) made this a very high impact event across much of the area. The NWS in Norman also provided weather briefings by phone to firefighters, emergency managers, and media partners, almost continuously between 3:00 PM and 9:00 PM CDT. For more on this event, read the NWS Norman newsletter. |
The end of April saw a transition to a very wet pattern. Several rounds of thunderstorms brought some severe weather and tornadoes, along with some flooding, starting around April 25th and lasting through the end of the month. There were several tornadoes reported around the area, and even some softball size hail was reported near Lamont. The biggest story was probably the flooding, especially near the Red River on April 29th. That day, an intense line of thunderstorms bowed out and raced east across parts of southern Oklahoma. It produced estimated wind gusts as high as 90 to 95 mph in Pontotoc County. The southern end of the bow echo stalled and elongated in an east to west fashion, producing hours of torrential downpours near the Red River in southern Oklahoma. The result was an Oklahoma Mesonet observing station near Burneyville, OK (Love County) recording 12.89" of rain in around 18 hours. Most of this total - 12.42" of rain - fell on the calendar day April 29th. This total broke several records, including the daily record at Burneyville and the daily rainfall record for any Oklahoma Mesonet station since the network's inception in 1994. Moreover, the single day total of 12.42 inches was sufficient, on its own, to make April 2009, the wettest month ever observed at the Burneyville station. When you add in the rest of April, the monthly total reached 15.36 inches. National Weather Service observations date back much farther than 1994, and the 12.42 inch daily rainfall at Burneyville ranks as the fourth highest single day amount in Oklahoma history. |
Several severe weather episodes hit the area in May. The most notable severe weather probably occurred on May 13th. Numerous thunderstorms developed that day along a cold front advancing into Oklahoma. One of the thunderstorms produced an EF-2 tornado that tracked from near Gracemont to near Anadarko, and severe straight-line winds in the city of Anadarko. Total monetary damages for the wind damage and tornado damage was estimated to be around $50 million.
No significant weather events really stood out from June through November 2009. There were occasional severe weather episodes during the summer months, and a handful in the fall as well. No major winter weather was observed through this timeframe either. From June onwards, there were only 6 tornadoes - all of them relatively weak and rated either an EF-0 or EF-1 on the Enhanced Fujita Scale. On June 10th, there were numerous wind gusts of around 60 to 70 mph associated with a complex of thunderstorms that moved across parts of southern Oklahoma. A few of the wind gusts topped 80 mph, and were measured by an anemometer. This was probably one of the more notable severe weather events in the latter part of the year. Additionally, there was a spell of extremely hot weather in early July. Many of the first two weeks of July saw widespread triple digit heat in the area.
Most of December was quiet prior to a major blizzard that struck the area on December 24, 2009. Heavy snow combined with extremely gusty winds to severely reduce visibilities for many hours. Oklahoma City recorded over a foot of snow in this storm, with a peak wind gust of 62 mph. The measured snowfall total broke several records at Oklahoma City. The amount shattered the record snowfall for the calendar day December 24th (previously 2.5 inches in 1914). It was also the greatest snowfall measured in a 24-hour period, breaking the previous record of 11.3 inches on March 19, 1924. Finally, it was the greatest storm total snowfall, breaking the previous record of 12.1 inches from January 5-7, 1988. For more details on the storm, visit our storm write-up here. |


text: Everybody loves a turnaround story. RadioShack is betting that the now-former president of daily living products and solutions for Walgreens, Joe Magnacca, will help author a turnaround story of its own for the small-box consumer electronics retailer.RadioShack stopped the presses late Thursday evening with news that Magnacca had agreed to join the company as CEO — less than one week removed from Magnacca's promotion from a corporate SVP to EVP of Walgreens, in addition to his title as president of daily living products and solutions. Magnacca — who came to Walgreens in the 2010 acquisition of Duane Reade, where he had served as president — replaces CFO Dorvin Lively in the top spot at Radio Shack. Lively had served in the role on an interim basis since September following the departure of former CEO James Gooch. Prior to Duane Reade, Magnacca was SVP at Shoppers Drug Mart.In the wake of Magnacca's departure, Bryan Pugh, VP well experience deployment, will lead the merchandising group for Walgreens on an interim basis."I am delighted to join RadioShack and to be part of this team as we build upon the strengths of such a great brand," Magnacca noted. "I see advantages in being a small-box retailer in the consumer electronics space today, particularly with the broad retail footprint and convenience that RadioShack offers its customers. I believe my experiences will help the team identify and execute on new opportunities that can return this great company to a position of prominence in the lexicon of American retailers."Magnacca has good reason to be confident — so far he has demonstrated a rather deft hand at helping to lead turnaround stories and transforming the retail experience for customers. Magnacca was the major visionary behind the health and daily living store concept that shapes Walgreens' Well Experience stores, which are modeled largely after the new format Magnacca pioneered at Duane Reade.The transformation of the Duane Reade stores was a major reason Walgreens moved to acquire the company in 2010, Walgreens president and CEO Greg Wasson told DSN in an exclusive interview last summer. Wasson described the acquisition as an accelerant of one of five key strategic growth imperatives for Walgreens, to transform the traditional drug store into a health and daily living destination. "Duane Reade had started the new drug store concept, and now you see a lot of that infuence coming back to Walgreens and accelerating where we're headed," Wasson told Drug Store News last August.It is clear that RadioShack's board is looking for Magnacca to bring some of that magic to its stores. "Joe is a leader with significant experience in transforming iconic brand names into strong operating businesses," noted RadioShack non-executive chairman Daniel Feehan. "We believe he will be a catalyst for change at RadioShack in refining our merchandising strategies, reinvigorating the shopping experience for our customers and building sustainable value for our shareholders."RadioShack needs the help, coming off of three consecutive quarters of losses. The company posted a third-quarter loss of $76 million.Unlike finance guys Gooch and Lively, Magnacca brings a different perspective to the job — a merchant's perspective. With 4,700 stores in the United States and Mexico, the company has an opportunity to outflank its biggest competitor Best Buy in markets all across the country. And in the era of omnichannel retailing, that kind of footprint could enable Radio Shack to better compete against the Amazons of the world that are still trying to figure out a scalable solution for same-day delivery. Clearly, the company is putting together the team to lead a transformation. In December, Radio Shack added former head of Target store operations Troy Risch as EVP operations and former Sam's Club exec Huey Long as EVP marketing, business development and multichannel.In the wake of Magnacca's departure, Walgreens DVP corporate communications Michael Polzin noted, "We wish Joe the best in his new role, which reflects the depth and talent in our organization. Bryan Pugh, VP well experience deployment, will be leading our daily living and merchandising operations on an interim basis, reporting to Mark Wagner, president of operations and community management. The strength of our leadership team allows us to continue moving forward with our key strategy of creating a well experience for our customers."


text:
Upfront and competitive pricing
Wide range of the services
Knowledge of all the local streets
Quick response time
Attention to Detail
Emergency Service
On-site assessment and consultation
Professionals with Extensive Experience
Customer Focused Service
Commitment to customer delight
Request a quote and we'll send you our best price.
Customer-focused Mobile and Safe Service
Step into a New Era of Shower Luxury in Haslet 76052
The shower is more than just a space for cleansing; it's where our pros jumpstart our mornings, wind down in the evening, and find moments of reflection. When your shower becomes outdated or doesn't cater to your evolving requirements, a remodel is the answer. Explore how our services can turn your shower from simple to sensational in Haslet 76052.
The Changing Face of Showers in Haslet 76052
The modern shower has undergone a metamorphosis. From smart showers with precise temperature controls to luxurious rainfall heads and spa-like jets, the option today caters to diverse tastes and comforts.
Our service providers deliver a complete solution for bathroom remodeling. There's no need to search for other experts in Haslet, as our network of professionals can provide top-quality services from the following list: SHOWER REPLACEMENT, BATHTUB REMODEL, BATHTUB INSTALLATION or BATHTUB TO SHOWER CONVERSION
How Our Professionals Service Provider Transform Your Shower in Haslet 76052
A successful shower remodel hinges on understanding your needs and the potential of the space. Here's a look into our process:
Understanding Your Vision: Is it a steam shower you're dreaming of? Or perhaps a bench seat and a niche for your essentials? Our network of professionals begin by mapping out your desires.
Space Utilization: Regardless of the size, every space has potential. Our network of experts draft designs, ensuring maximum functionality without compromising on aesthetics.
Material Selection: The choice of tiles, fixtures, and glass can drastically alter the look and feel of your shower. Our network of experts provide an array of options, each promising durability and style.
Advantages of a Shower Remodel with Us in Haslet 76052
Our approach to shower remodeling goes beyond just construction:
Personalized Design: Your shower should echo your preferences. Our network of professionals make sure each element, from fixtures to tile patterns, aligns with your vision.
Water Efficiency: Modern fixtures can provide a superior experience while consuming less water. It's a win for you and the environment.
Seamless Integration: In our remodel ensures the new shower complements the rest of your bathroom, creating a harmonious look.
The shower is often the focal point of a bathroom. And with the right remodeling, it can become your personal oasis of relaxation and rejuvenation. Our commitment is to understand, design, and deliver a shower space that not only meets but exceeds your expectations. Ready for an upgrade? Let's make your shower shine!
ZIP Codes in Haslet, Texas
(682) 452-0580
Emergency assistance
Our expert bathroom remodeling network is here to swiftly address any unexpected problems and resolve them promptly.
Bathroom Remodel
The Bathroom Remodeling experts in our network are seasoned service providers in Haslet. When you rely on the expertise of our service providers, you can trust that skilled specialists will be dedicated to your needs.
Fast problem resolution
Our professionals will schedule the most convenient time for you. Your issue will be resolved as quickly as possible.
Local services
Our network of service providers is a local business in Haslet. The professionals strive to earn trust and credibility with our customers.
Our Secret to Success
Our experts offer exceptional services that go beyond excellence in Haslet. Our professionals utilize advanced technologies to meet and exceed your expectations.
A simple choice
The professionals within our network provide a wide range of bathroom remodeling services, ensuring they address all your property's needs. You can expect to be highly satisfied with the quality and affordability of our Bathroom Remodel Services.
Amazing service! Located in the center of Haslet and in half an hour help will be anywhere in Haslet
5 stars company
Haslet Bathroom Remodel
Are you in need of Shower Remodel? Look no further! Our professionals are the best bathroom remodel service providers based in Haslet.
The experts of our providers offer the best prices and are very competitive. Our experts specialize in emergency Shower Remodel! Contact us today for a quote.


text:
I've released version 1.4.2 of the PEAR Net_DNS2 library- you can install it now through the command line PEAR installer:
pear install Net_DNS2
Or, you can also add it to your project using composer:
composer require pear/net_dns2
Version 1.4.2
- changed the role for the README.md file to doc.
- parse the resolv.conf options line; right now I just support the timeout and rotate options.
- the options values only work if you set the new option use_resolv_options to true; this is to keep backwards compatibility.
- added support for RFC 6594; support for SHA-256 and ECDSA in the SSHFP resource record.
- added the SMIMEA resource record; this just extends the TLSA record.
- added the AVC resource records; this just extends the TXT record.
- added error and EDNS0 defines for DNS Cookies (RFC7873).
- added EDNS0 defines to the lookup class.
- dropped the Net_DNS2_Packet::formatIPv6() function; this was deprecated in v1.1.3.
- re-wrote the Net_DNS2::expandIPv6() function. Based on testing, the new version is about twice as fast.


text:
Darrelle Revis Has 2 INTs as Jets Beat Dolphins, 24-6, on 'Monday Night Football'
Darrelle Revis had two interceptions, including one he returned 100 yards for a touchdown, to lead the New York Jets past the Miami Dolphins, 24-6, on 'Monday Night Football.'
Quarterback Mark Sanchez, who threw for one score and ran for another to lead the Jets offense, finished with 201 yards passing, highlighted by a 38-yard touchdown toss to Santonio Holmes with 11:50 left in the fourth quarter to seal the home victory for New York (3-3).
The Dolphins (0-5) led 3-0 in the first quarter and were threatening to add to the lead, when Revis stepped in front of a Matt Moore pass to Brandon Marshall at the Jets goal line and returned it for a touchdown to swing the momentum to the Jets.
Moore, starting for Miami in place of the injured Chad Henne, was sacked four times while throwing for 204 passing yards and the two interceptions.
Several of Moore's passes were dropped by Dolphins receivers during the game, including a sure touchdown that went right through Marshall's hands which would have given Miami the lead in the second quarter. Instead, the Dolphins settled for a 21-yard field goal from Dan Carpenter to pull to within 7-6. Sanchez scored on a 5-yard run just before halftime to extend the New York lead to 14-6.
The Jets' Shonn Greene led all rushers with 74 yards, while Reggie Bush had 71 for the Dolphins. Marshall had six catches for 109 receiving yards for Miami, but the passes he didn't catch helped keep the Dolphins winless on the season.


text:
A leak from a glass furnace occurred at 3 a.m. this morning at PPG Industries' Carlisle, Pa., flat glass plant, according to a statement from the company.
"Molten glass leaked from the furnace into the plant's basement area," reads the company's official statement. "The leak has been stopped and contained. The incident is under investigation."
According to the statement, the local fire department came to the plant to assist with containing the leak, and though some local news stations reported that there was a fire at the plant, "there was no fire associated with this incident."
No injuries were reported, and PPG officials say they do "not anticipate any environmental issues or production interruption."
PPG's Carlisle plant manufactures flat glass for use in the solar, residential and commercial construction markets.