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Baha'i Centres of Learning
The Australian Baha'i Community's educational programs are offered informally at homes, as well as formally through dedicated facilities known a Baha'i Centres of Learning. These programs can include courses of short duration as well as residential courses held at facilities established specifically for this purpose. The South-East Queensland Baha'i Centre of Learning is one such residential facility.
The courses offered by the Australian Baha'i community include:
- Ruhi institute: children's spiritual education (ages 5-11)
- Ruhi institute: Junior Youth Spiritual Empowerment Program (ages 11-15)
- Ruhi institute: main sequence of courses (ages 15+)
- Institute for Studies in Global Prosperity: seminars for tertiary students and graduates
The Ruhi training institute programs are offered both formally and informally, while the seminars hosted by the Institute for Studies in Global Prosperity are only offered formally in residential settings.
The Baha'i Centres for Learning also host the administration of these courses, which includes the ongoing support and training of facilitators and coordinators.
The Australian Baha'i Community
The Baha'i Faith is a world religion founded by Bahá'u'lláh nearly 200 years ago. As part of a global community, its guiding principles include the oneness of humanity, the equality of women and men, the harmony of religion and science as well as the elimination of all forms of prejudice. Its aim is to break down barriers of race, culture, and nationality, to bring about an interconnected and interdependent society who share universal values. Alongside its community building efforts, the Baha'i Faith works with other likeminded people and organisations to bring about positive social change.
Within the last 100 years, Baha'is in Australia have worked alongside other Australians from all walks of life, learning how to contribute to the advancement of Australian society, as well as learning how to contribute to improving the communities and neighbourhoods in which they live in. As part of recognising these endeavours to empower the Australian community, the Prime Minister of Australia, alongside other national leaders, celebrated the centenary of the Faith with the Australian Baha'i community in 2020.
Find out more about the Baha'i faith in Australia.


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The Trials and Tribulations of a Database Context in .NET Core (pt. 1)
When I started using .NET Core this time around, I was pleasantly surprised. But over the past couple of days, I have been unpleasantly surprised. There are two reasons for this, and they both center around the DBContext.
One of my issues is with the caching. If I'm calling a method that fetches from the database, I want it to fetch from the database. If I wanted to cache the results, I'd do that myself.
My other issue is...
The dependency-injection paradox
Microsoft recommends injecting the DbContext into controllers. For testing, I'm a big fan of dependency injection if good-old-fashioned Python monkey patching isn't an option. Which it isn't if you're using C#. My issue isn't with the dependency injection, but with what is being injected. Another recommendation is to use the Repository pattern and inject that instead. Both of those result in thousands of deaths.
What's the issue? Well, say you're running a loop and saving data within that loop. Say we're running through a bunch of objects, converting them to another object, and saving them. For fun-sies, I'll inject a Repository and you can extrapolate that to a DbContext.
class MyController {
private IRepository Repository;
public MyController(IRepository repo) {
this.Repository = repo;
public ConvertFoosToBars() {
var toConvert = Repository.FetchFoosToConvert.ToList();
foreach (foo in toConvert) {
try {
var bar = ConvertFoo(foo);
} catch (Exception e) {
foo.Error = e.Message;
Looks straightforward enough, right? See if you can spot the bug.
No? Well, that makes sense, there's not really anything else to look at.
OK, assume that ConvertFoo goes over well enough. But THEN it turns out that the newly converted bar is actually a duplicate of another bar so the
SaveNew method fails. Also, assume that I don't want to check for duplicates - I just want to fail and move on. Maybe it's a love of speed. Or maybe it's a desire for thread-safety coupled with a slight aversion towards transactions. Maybe it's something ineffable.
Anyways, the Save method fails and I move on...convert more foos to bars because that's my lot in life. Should be fine, there's some error handling there. BUT IT'S NOT FINE.
Now this might not have been a surprise to someone that isn't steeped in the ActiveRecord way of doing things that some other MVC frameworks prefer to follow (Django, Rails, ...). Let's take a look at the Save method, shall we?
class Repository : IRepository {
private DbContext context;
public Repository(DbContext context) {
this.context = context;
public void SaveNew(Bar bar) {
See the problem now?
That context never changes throughout the controller's lifetime. Which means that when one bad
Bar gets added, it stays added. An exception doesn't automagically trigger its removal. As we iterate through the loop, adding more (and valid) Bars, all of the saves fail. This is because the context batches up any changes to be made and performs them all in one big statement. When one of those statements fails, they all fail.
Sure, we could change the MaxBatchSize to
1. That would probably fix the problem (in this instance anyways). But what if we want to batch something down the line? Then we're screwed.
Or maybe we can take out the problem Bar by ourselves. Indeed, we should be able to - many a blog entry and stack overflow question suggested this should work - but it didn't for me. When I marked the entity as detached, it prevented other entities from being saved for some reason that I never figured out. I abandoned the approach because it seemed like kind of a hack anyways. What the hell am I talking about? Here's what the hell I'm talking about.
public void SaveNew(Bar bar) {
try {
} catch (Exception e) {
var entry = context.Entry(bar);
entry.State = EntityState.Detached; // This means ignore it from now on
Now maybe that didn't work because the primary key for Bar just happens to be a string. I don't know. It's a UUID btw. Not, like, "hi tim".
I couldn't figure out any other good ways to reset the list of Bar. Like a
Reload or
Reset method? A
.Remove(entry) method? No. Transactions? Nope. Unit of work? More of the same. The best way sounds like its to embrace scoping and use a different context for each iteration of the loop.
I called this a dependency injection paradox because Microsoft also touts DbContexts as being lightweight, which sounds like it's sure something that we could use more than one of per controller. It sounds like something I should be able to make if for no other reason than to throw them away. And I can't do that if I'm just injecting them once into a controller.
Victory (kind of)
How do I create a new context whenever I want? I like tests, so I'd like to keep the dependency injection, and I don't want to be dealing with connection strings all willy nilly, so I can't directly instantiate them. The solution, of course, turned out to be to push most of my context-centric code into a
ContextFactory. This ContextFactory is what gets injected into controllers and all that. It also ended up helping a lot with integration testing.
public class ContextFactory : IContextFactory {
private IConfiguration config;
public ContextFactory(IConfiguration config) {
this.config = config;
public DbContext CreateDbContext() {
var options = new DbContextOptionsBuilder<DbContext>()
return new DbContext(options.Options);
You can fance that class up at your pleasure.
Now here is my controller all fixed up (PLUS it's fairly backwards compatible!):
class MyController {
private IContextFactory ContextFactory;
private IRepository Repository;
public MyController(IContextFactory factory, IRepository repository) {
ContextFactory = factory;
Repository = repository;
public ConvertFoosToBars() {
var toConvert = Repository.FetchFoosToConvert.ToList();
foreach (foo in toConvert) {
try {
var bar = ConvertFoo(foo);
using (var context = new ContextFactory.CreateDbContext()) {
} catch (Exception e) {
foo.Error = e.Message;
Phew! That actually feels great. Each iteration is truly separate from the others.
However, I just put this in yesterday and there is already a dark side of DbContext seeping through the cracks. I'll leave that to part II, as I'm working through them right now. But I'll give you a hint: this article is a pretty interesting read.

subset: commoncrawl


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by Sandi Austin
As I began working on a project for the Heart of Longmont this weekend, I started thinking about St. Matthew Lutheran Church in Aurora, my family's place of worship for many years. In particular, I thought of the stained glass windows my mother had designed for the church so many years ago while she was fighting cancer. So I started searching for an image of those windows.
I was shocked to see a November 5, 2018 Facebook post from St. Matthew Lutheran Church stating: it is with sadness (but necessary) that St. Matthew congregation has voted to close as of November 4. We will not have any more Sunday services going forward. We will have a Holy Closure service on December 1 at 2:30 pm.
I tried to wrap my head around what I'd just learned as I started remembering the St. Matthew moments of my life.
The earliest memory was of church camp when I was in grade school. I remember so well how homesick and lonely I was, and how a redheaded girl from a Denver Lutheran church befriended me after we were assigned to the same cabin. She made such an impact on me that I can still remember her name to this day.
When I reached junior high, it was time to take confirmation classes. I was so proud on Confirmation Sunday as I stood with my classmates in a special white eyelet dress my mother made just for the occasion. We each received a beautiful, personalized Bible. The girls each got a white Bible while the boys' Bibles were black. It was as if we were real grownups then.
The church's stained glass windows were foremost on my mind, however, as I searched the web for any images of the church's interior. It was after I graduated that my mom's window designs were finally dedicated, but it was a bittersweet occasion. We were so proud of her work, but also so very sad, as her eyesight had failed so much by the time they were installed that she couldn't really see them.
When the day came that God called my mother home, St. Matthew was where her family and many friends gathered to remember her beautiful life. It was also where new chapters began.
My husband never got to meet my mother, but I'm sure that on the day we were married in that church, she was right there, smiling down on us.
I was sad, initially, to learn that the church that played such a big part in my life had ceased its Sunday worship services. But after I read how the church is living on through multi-cultural service to the surrounding neighborhoods, I felt better about it. It is now home to the Village Exchange Center that meets the physical and spiritual needs of multiple cultures and communities of immigrants and refugees.
It's definitely not the same neighborhood I grew up in years ago … but my mother's stained glass windows are still there, as if time just stood still.


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Sharda Busse, NP
Sharda Busse, NP is a Family Nurse Practitioner. Originally from Guyana, South America. She is a graduate of UNC Charlotte. She is married and has 2 children. She joined Thomasville & Archdale – Trinity Pediatrics in September 2015. She is an advocate of healthy living gained through a balanced diet and exercise. Sharda enjoys reading, running and youth soccer.
Teresa Bowman, NP
Jeremy Baune, NP
Dr. Dan Entwistle, MD
Dr. Dan Entwistle is a graduate of the University of Alabama School of Medicine. He graduated high school from Rift Valley Academy in Kenya, Africa. He has a Masters in Public Health from the University of Texas school of Public Health. He joined Thomasville & Archdale-Trinity Pediatrics in 1995. He is fluent in Portuguese, San Swahili, Kimwasni, and he speaks some Spanish. His community interests include Davidson County Crisis Ministries and Kijabe Medical Center in Kenya. He is married and has five children. He enjoys fishing, golf, soccer, gardening, hiking, and carpentry. Some of his favorite places include Brazil, Italy, Kenya, and Montana. He has wanted to be a physician since the 7th grade. He is an avid soccer fan.
Dr. Stephen Hardy, MD
Dr. Stephen Hardy is a graduate of University of Toronto School of Medicine. He worked at Hospital for Sick Children Toronto prior to joining Thomasville & Archdale-Trinity Pediatrics in 1996. He enjoys going fishing, skiing, and traveling. He is an avid sports fan of college basketball and hockey. He also enjoys reading. He is married and has three children and two grandchildren. He attends Memorial United Methodist Church.
Melanie Huffman, NP
Rosemary Irion, MSN & FNP
Rosemary Irion is a graduate of UNC-CH School of Nursing with an MSN, FNP. Her undergraduate degree was a BSN from Duke School of Nursing. She joined Thomasville & Archdale Pediatrics in 2014 after 11 years in Pediatric Endocrinology at Wake Forest School of Medicine. She is a Certified Diabetes Educator(CDE). She is an active member of Our Lady of Mercy Catholic Church as a lector and an in home visitor. She has been on numerous Medical Missions in Jamaica. She volunteers at the free Community Care Clinic in Winston-Salem and the Dragonfly House, in Mocksville, for children with physical and/or sexual abuse. She is married to a Family Practice Physician with four adult children and on grandchild. She loves reading, cooking art, photography and sewing.
Ashley Ferguson, MD
Brooke Palmer, NP
Dr. Beatriz Juncadella, MD
Dr. Beatriz Juncadella is a graduate of East Carolina Universty School of Medicine. She did her undergraduate work at Guildford College. She joined Thomasville & Archdale-Trinity Pediatrics in 2005. Dr. Bea, as she is known, is fluent in Spanish and French. She is a volunteer/board member at the Thomasville YMCA , on the missions committee at her church Grace Community Church. Dr. Bea also runs a clinic in her native country-Nicaragua. She enjoys watching soccer. She is married and has two children. She enjoys traveling and one of her favorite places is southern France.
Dawn Metcalf, NP
Belinda Mull, NP
Rashmi Patel, DO
Dr. Maria Pincus, MD
Dr. Maria Pincus is a graduate of Eastern Virginia Medical School and she is a graduate of University of Maryland. She joined Thomasville & Archdale-Trinity Pediatrics in 1995. She attends St. Joseph's Catholic Church. She is a wonderful piano player and is very active in her church's choir. She is also on the Youth Council at St. Joseph's. She plays on the Gate City Women's Tennis League. Her Husband is an Ear, Nose, and Throat physician in High Point. She has four children.
Dr. Ed Reedy, MD
Dr. Ed Reedy is a graduate of Wake Forest University School of Medicine; he also attend Wake Forest University for his undergraduate degree. He joined Thomasville & Archdale-Trinity Pediatrics in 1996. He is very active at his church-Mt Zion Wesleyan Church. His other local community interests include: YMCA, Cooperative Community Ministries, and Father's Storehouse. His international interests include medical missions abroad and La Luz de Cristo Ministries. He has been on countless missions all around the world: Nicaragua, Africa, Peru and Guatemala. He is married and has 3 daughters. He enjoys outdoor actives such as hiking and running. Some of his favorite places include: Guatemala, Acadia National Park in Maine, NC mountains, and Arches National Park in Utah.
Dr. Cathy Riggan, MC
Dr. Cathy Riggan is a graduate of Wake Forest University School of Medicine; she joined Thomasville & Archdale-Trinity Pediatrics in 2001. She is very active in her community. She is a youth leader and Sunday school teacher at Grace Episcopal Church, he volunteers with the Charity League of Lexington, and Lexington City Schools. Dr. Riggan is married and has two children. She enjoys reading and quilting. Her husband is an orthopedic surgeon in Lexington, NC.
Brandon Rorie, PA
Mr. Brandon Rorie is a graduate from Lenoir Rhyne University and attended Wake Forest University for his Physician Assistant degree. He has been working at Thomasville & Archdale-Trinity Pediatrics since 2014. He enjoys work with the Special Olympics and coaching sports in the community. He plays chess and is very musical. He can play piano, french horn, trumpet, guitar. He is married and has three children. He decided to become a PA in his second year of college. Some of his favorite destinations have been Maine, Florida, and Arizona. He plans on going on medical missions in the future.
Dr. Amanda Rose, MD
Dr. Amanda Rose is a graduate of Florida State University College of medicine. Originally from Montreal, Canada, she moved to Florida as a young child and obtained her undergraduate degree from the University of Florida-GO GATOR! She joined Thomasville-Archdale -Trinity Pediatrics in 2014. She speaks some Spanish. She loves to read and also enjoys cooking , hiking, and camping. She and her husband are active in their church, Our Lady of the Highways, where she is a lector and he sings in the choir. They have one son, who also loves to read.
Dr. Karrie Stansfield, MD
Dr. Karrie Stansfield is a graduate of East Carolina University Brody School of Medicine. She attended Salem College as an undergraduate. She received her Masters in biology from Wake Forest University. She grew up a "military brat" and lived several different places. Dr. Karrie joined Thomasville & Archdale-Trinity Pediatrics in 2008. She is very active in the Community in School of Thomasville as well as international by going on several medical missions including to Guatemala, Peru, and Nicaragua. She attends Mt Zion Wesleyan Church. She has wanted to be a physician since her second year of college. She enjoys running, quilting, reading, and scuba diving. Some of her favorite travel destinations have been Hawaii, Ireland, New Orleans, and Europe.
Dr. Rob Williams, MD
Dr. Rob Williams is the son of Dr. David Williams, Sr. He is a graduate of the University of North Carolina at Chapel Hill School of Medicine. He also attended UNC for undergraduate. Dr. Rob joined Thomasville & Archdale-Trinity Pediatrics in 1992. He is very active in the community and has several interests such as fishing and golfing. Dr. Rob is a huge UNC Tarheels fan. He attends Memorial United Methodist Church and is very active in the Thomasville High School Boosters. He also participates in the Appalachia Service Project. Dr. Rob is married and has four children. He has always wanted to be a physician to follow in his dad's footsteps.
Dr. David R. Williams, MD
Dr. David Williams, Sr. is a graduate of the University of North Carolina at Chapel Hill School of Medicine. He did his residency at UNC . He was a captain in the US Air Force from 1966 to 1968. He is the founder of Thomasville and Archdale-Trinity Pediatrics and was the first pediatrician in Thomasville in 1968. He is actively involved in the North Carolina chapter of the American Academy of Pediatrics. He was president of the North Carolina Pediatric Society as well as president of Thomasville Bulldog Booster, Thomasville Rotary Club, and Davidson County Board of Health. He is married and has 3 children and 9 grandchildren. His son, Rob Williams, is also a member of Thomasville and Archdale-Trinity Pediatrics. He enjoys all things UNC. Dr. Williams is still seeing patients, even though he is "retired".
Dr. Don Winters, MD
Dr. Don Winters is a graduate of Creighton Medical School in Omaha, Nebraska. He did his undergraduate work at Loyola Marymount University. He joined Thomasville & Archdale-Trinity Pediatrics in 1996. Dr. Winters is fluent in Spanish. He is board certified in Developmental and Behavioral Pediatrics. He also does circumcisions in our Archdale office with local anesthesia. He is a professional divemaster as well as a dive instructor. Dr. Winters has four children. He enjoys underwater photography, auto restoration, and racing. He makes jewelry and carves walking sticks. He is very active in medical mission work; he has been to Nicaragua, Haiti, Ecuador. He is member of North Carolina Disaster Response Network and recently was deployed to New York after Hurricane Sandy.
Theresa York, PNP
Theresa York is a Pediatric Nurse Practitioner. She is a graduate of the University of North Carolina at Chapel Hill School of Nursing. Theresa joined Thomasville & Archdale-Trinity Pediatrics in 1997. Theresa is very active in church and in medical missions. She attends Mt. Zion Wesleyan Church. She has been to several countries including Nicaragua and Guatemala. Theresa is married and she has three sons and four grandchildren. Theresa was a NICU nurse for several years until she decided she wanted to see children grow up. She is a wonderful cook as well as an accomplished quilter. She enjoys watching UNC Basketball and returning to visit family in Wisconsin.


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Croatia Oak Map
Founded in 1991, the country of Croatia is known for its thousands of islands. Along with a population of 4.17 million people, the country is home to the Plitvice Lakes National Park and the Dinaric Alps.
From its capital of Zagreb to Dubrovnik, this oak map of Croatia is a great way to show off your country pride! Give it as a gift or complete your own home with a unique piece of art work.This map of Croatia is precision cut from ¼" A1 grade oak plywood using laser cutting technology. All oak maps are hand-stained with a dark walnut Danish oil and come ready to hang for your friends and family to enjoy.


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View All Calendars is the default. Choose Select a Calendar to view a specific calendar. Subscribe to calendar notifications by clicking on the Notify Me® button, and you will automatically be alerted about the latest events in our community.
Foresthill Veterans Memorial Hall
7:00 pm, Monday, September 11, 2023
Foresthill Veterans Memorial Hall, 24601 Harrison Street, Foresthill
Final Agenda - September 11, 2023 Foresthill Forum


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Herbert Armstrong swallowed all of Greenberry George Rupert's eschatology hook, line and sinker. Rupert believed that the New Testament had not superseded the rules laid out in the Old Testament, and so the laws of Moses should apply to Christians as well as Jews, including kosher diets and other practices: Whatever was not explicitly changed or eliminated in the New Testament remained in effect. Adapting the Adventist view of Seven church eras, Rupert argued that the "Philadelphia" phase was the period in which William Miller worked (from 1833 to 1844). The final era, "Laodicea" began in 1844 and would last until the End Times. He also denied the immortality of the soul, asserting that man is mortal, but can be given eternal life. Traditional Christian holidays were in fact "heathen". Armstrong reveled in this and when he entered into the Church of God Seventh Day, he was filled with hubris because he knew — he just knew — that the knowledge he had was superior to that of the CoG7D. He believed that he was better than everybody else because he had the knowledge of G. G. Rupert. Herbert Armstrong didn't really come up with much new stuff on his own — he 'borrowed' and stole it, claiming he was taught personally by Jesus Christ. One of the main things he got from Rupert was the Feast of Tabernacles, which was to picture the millennium. He accepted Rupert's dictum that Xmas was pagan.
Alas. Herbert Armstrong was wrong. He gave everyone assurances at the Feast of Tabernacles at Penticton in 1971: "Follow me," he cried holding up an imperious finger, "I will lead you into the Kingdom". The only place he could have led us is into death because he died in 1986 without a single one of his 'inspired' prophecies coming to pass in his lifetime — including the proposition that we would all flee in 1972 for the Place of Safety and that Jesus would return in 1975. Time marched on, taking no prisoners. The Worldwide Church of God tacitly dropped the Feasts and changed its name, effectively going out of business. There remained a rebellious hardy minority who set off on their own to continue the Old Testament physical observances in complete variance with the tenets of the New Testament and particularly the Epistles of the Apostle Paul, many of which were forgeries.
The various sects of the Cult of Herbert Armstrong Mafia went forth to replicate the unsuccessful patterns of the past on the premise that nothing happening was a sure sign that something was about to. And so it was, the Armstrongites with their hireling henchmen continued the delusion of British Israelism and ancient Israelism devoid of spiritual content by doing exactly what Herbert Armstrong taught them to do: Lie to themselves in distorted perception delusions, creating a de facto religious insanity, predicated on the idea that they could get something for nothing, since, after all, it was a gift of God and they would have great power and beauty if only they persisted in forking over their livelihood to convincing con men.
You have to know where this goes. Every time someone accepts a lie in place of the truth, sooner or later disappointment, dissatisfaction and apathy set in.
So the ersatz Feasts continued apace with a renewed vigor with enthusiastic participants. This time though, the Armstrongists were familiar with the idea of creature comforts, seeing as how they attended not a Feast of the Lord, but a religious business convention of the sort held by Fortune 500 companies introducing a new product or rallying customers with a business conference. Mostly the tents disappeared. Tailgating and cooking over outdoor fires was replaced with 3 to 5 star restaurants, or, more likely, fast food joints. The sermons went from two to three a day to one a day, with social activities filling the void. There were cruises, dinners out, dancing, singles activities, family day and a host of attractions provided by the purveyors of pleasure and excitement by the local business, such as, but not restricted to, ice skating, gondola rides, tours and the such.
As time went on as the years rolled by, the excitement of Bible Study within the framework of even more exciting prophetic pronouncements dimmed. The bloom was off the rose. People learned to save 10% on their net income and also didn't just spend it at the Feast — if there was money left over, many would refuse to turn it in to the church and simply spent it on themselves later after the Feast. Many of the sects also dropped third tithe, since the fatherless, widows and orphans were expected to live on government subsidies and, in some cases, if someone did get whatever little third tithe they had, they had to pay it back. Cults have long memories, particularly when it come to money — the focus of their existence (along with hubris — or if you are a particularly vain arrogant Englishman, HuBrits). In actual fact, many don't even read the flagship magazine if there is one. People have been getting bored and are dissatisfied with the lack of performance their stock has in the cult sects. World Prophecy just isn't shaping up, no matter how much they continue to watch Fox News. The lackadaisical participants of this rigmarole need a great deal more stimulation, particularly social interaction, for even rudimentary survival of the very boring irrelevant useless cult sects led by sociopaths and psychopaths who care not one whit about their 'members'.
And so it is, even though it is banned, the Armstrongists are keeping Christmas.
Oh, they claim they are not keeping it — after all, they aren't exchanging gifts and sending each other Xmas cards, but still, they meet at convention centers convenient to malls all through Christmas week in preplanned get-togethers which are not all that cheap. They do secular things like play basketball. The singles get together. And many do what they've always done, they go out drinking because so many of the Armstrongists are boozing alcoholics. Banned! has capitalized upon this with their article, Living Church of God Annual Christmas Party, but, of course, Living isn't the only one, since United is doing it too. And who knows what other groups are setting forth in their one horse sleighs?
Just be sure that no matter where these little social get togethers are being held, they are near some major shopping mall. For it is that the ACoGs have gone secular and they learned long ago to shop during the Feast of Tabernacles.
If it weren't for the name on the door (or the placards), you probably wouldn't know if you were at the Feast of Tabernacles or at a non Xmas Christmas party.Through the early years into the 1960s, Herbert Armstrong and his henchmen established the Feast in Big Sandy, Texas. These were the times when simple people, many of whom were farmers, drove thousands of miles to set up their tents in the hot, humid, bug infested, dusty camp to attend what to us today would seem excruciatingly boring sermons about the future — littered with gory tales of grotesque suffering of the Great Tribulation — with the attendant assurances that there would be a Place of Safety to be safely nestled away from doomsday Armageddon to inherit eternal life in positions of power, prestige and prosperity to dominate the hapless humans who actually survived the horrifying events of death, destruction, devastation and acres of blood, decimated by nuclear and conventional war. The Feast was an exciting time, fraught with people actively talking about the Bible and Scriptures on tailgates of pickups and vans while they snacked on cheese and wine. It may have been a purely secular physical experience but in the delusional minds of the goers, it was the height of spirituality. There were prophecies galore. People were assured and just knew that these things would shortly come to pass in their lifetimes. They made sacrifices and lived in what many would consider misery for 8 days just for the pure joy of doing it. It was worth it to them to spend ten percent of their gross income on it, even having given away another ten percent to support the profligate lifestyle of the Armstrongs and their henchmen.


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– 7 million Brits want to go to the opera –
– Londoners most concerned about lack of cultural knowledge –
Over 7 million British adults have an unfulfilled desire for live opera, according to new research1 released today. When asked about the cultural activity or event they would like to experience, 7.3 million people (one in seven, or 15% of the adult population) said it was to go to the opera.
The research, carried out for Investec Wealth & Investment, revealed that the region with the largest number of would-be opera goers is London and South East, where one in five adults (19%) would like to see a full operatic performance.
When asked what had put them off attending an opera or similar cultural event, nearly two thirds of adults (62%) said they thought it was too expensive. However, over four million adults (14%) said they didn't know enough to appreciate them properly, and nearly two million (7%) said they worried about not knowing the right etiquette.
Despite London being seen globally as a key cultural city, Londoners are revealed to be the most unsure about opera and other cultural events, with 21% saying they don't know enough to appreciate it properly (compared with a national average of 14%). Residents in the capital are also the most likely to be embarrassed by their lack of knowledge, with 10% worried about the etiquette.
The good news for producers of opera is that one in six (17%) of those aged 25-34 want to go the opera for the first time, suggesting there is a large potential younger audience which is as yet untapped.
The reasons why people are put off going to the opera and other cultural events is shown in the following table:
Reason / Percentage of people stating that reason
It's too expensive 62%
There aren't many events near me 36%
I don't know enough to appreciate it properly 14%
None of my friends would go with me 10%
It is too difficult to get tickets 8%
These events are too formal or stuffy 7%
I worry about not knowing the right etiquette 7%
Investec Wealth & Investment, which provides specialist financial and investment advice to private individuals, commissioned the research to mark the fact that the company is sponsoring the 2012 season of Opera Holland Park, with tickets going on sale at 10.00am this Thursday, 19 April. Opera Holland Park was established to help make opera more accessible to a wider audience than traditional opera venues, by combining an informal approach with artistic integrity.
David Bulteel, executive director of investment management at Investec Wealth & Investment says: "This research confirms the appeal of opera to a wider audience than are currently experiencing live performances. We believe that Opera Holland Park does an incredible job in making high quality full scale opera accessible to more people, particularly through its low price and free ticket programmes. 2012 is going to be an amazing summer in London, and we're delighted to be able to play a supporting role in a great season."
James Clutton, producer of Opera Holland Park, said: "Our company was established in 1996 with the specific aim of making opera more accessible. This research shows that there is a large demand for opera, but people are being put off for a variety of reasons. However, we can assure anyone who wants to experience live opera for the first time that our informal, relaxed approach means they don't need to worry about etiquette, and that we make opera affordable without compromising the quality of the production."
The Opera Holland Park 2012 season begins on 7 June and runs until 4 August. Tickets for the season go on general sale at www.operahollandpark.com at 10.00am on Thursday 19 April and over the telephone at 10.00am on Monday 23 April by calling 0300 999 1000.
Photo credit : http://www.opusarte.com/


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on 4. Mai 2013 Uncategorized with 0 comments
This was filmed between 29th April and 10th May 2011 in the Arctic, on
the archipelago Lofoten in Norway by TSO Photography.
His favorite natural phenomenon is one he does not even know the name of, even after talking to meteorologists and astrophysicists he is none the wiser.What he's talking about he has decided to call The Arctic Light and it is a natural phenomenon occurring 2-4 weeks before you can see the Midnight Sun.
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Louie the Saint, official mascot of Saints athletics at Seward County Community College, is on campus. Starting in October, he's serving up coffee, snacks, and other convenience foods for students at Louie's Place, located in the Industrial Technology Campus… Read More ›
Month: October 2017
SCCC research students to present at national biomedical conference
Seward County Community College science students enrolled in the Bridges program will do more than step out of the lab this semester to keep up with classes, meals, and homework. Kevin Loya, Emily Gibson, Emireth Monarrez, and Blanca delaTorre are… Read More ›
SCCC, Chamber offer cybersecurity workshop Oct. 11
Free event is open to the public, preregistration required In the wake of the Equifax breach, there's no denying the fact: Technology has accelerated so quickly in recent years, ordinary people and businesses often feel uncertain how to keep up… Read More ›
SCCC Corrosion class/lab named in honor of R.M. 'Bob' Speck
R.M. (Bob) Speck did not set out out with the goal of being a beloved teacher and mentor to thousands of students. Yet this nearly 80-year-old self-taught electrical engineer, inventor, and business owner has also educated corrosion technicians all across… Read More ›


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Nigerians not deserving of good leadership – Donu Kogbara
Written by News Room on May 21, 2021
Nigerians are not deserving of good leadership because of the weakened stay power of fighting for it and their tolerance for bad leadership.
A commentator and Public Affairs Analyst Donu Kogbara said this while speaking as a guest on Invicta's Political Programme Perspectives, where she lamented that there were more undemocratic practices here in Nigeria than what should be democratic.
Kogbara called out bad elements of democracy to protest against paymasters who are against reform agenda, while also noting that the various tribes have been unfair, not nice has made each one a nightmare to others when in power.
She gave a vivid picture of the seemingly close practice of Democracy in Nigeria.
The Columnist with the Vanguard Newspaper does not support any more talk shop but wants action seen from all the National discourse on the way forward.
She opines that whatever shift the country wants to see, this has to be on a solid foundation that is nationalistic in outlook.
Seun Fakorede


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On Non-Coding Universal Genome
Brief and simplified discernment of non-coding genome. And universal genome in general:
Genome problems (whether coding or non-coding) or deficiencies, malfunction, illnesses, and diseases can be causes of all kinds of physical and mental problems. Even through coding and non-coding genome are intertwined and entangled or irreducible, coding genome pertains more to the physical-mental functional dimensions in the known physical world (i.e. such as physical and motor functions) while non-coding pertains more to overall topology and structure in the known physical world and beyond or non-coding has higher spatial-temporal-geometric topology (a recent discovery and related explorations https://www.epistemologyontologyfoundationinstitute.org/global-science-technology-and-innovation-movement/caltech-finds-amazing-role-for-noncoding-dna). And which is why much of subtle body-mind deficiencies and problems such as consciousness, awareness, and naturalness-spiritual are mainly due to non-coding genome problems.
Of course, many mental problems can also be caused by coding genome functional problems. And besides, problems can also arise from the interdependent and interconnectedness between coding and non-coding. However, problems that pertain to higher dimensions such as subtle body-mind dimensions and realms are more likely due to non-coding genome problems. And which can be illustrated through many mental problems throughout history including those that were also considered as spirit-soul problems.
Furthermore, since the genome is flux and impermanent just as the Ground of Being and Nature (and Becoming) mutation and bio-transmutation can be across the genome as whole rather parts or applicable to both coding and non-coding. And as well as locally and non-locally or as universal genome. Another simple way of saying is applicable to both known physical world. And beyond or the coherent and resonant potentialities of possibilities in and between local and non-local cosmos in the known physical world. And beyond. Another complement way of stating is rather than coding and non-coding, they need to be realized and actualized as irreducible parts of wholeness sentient entity or universal genome. And as irreducible part of or endowed, embedded, and embodied of sentient characteristics and traits in and through nature process and mechanism of intertwinement and entanglement in the local and non-local cosmos. And facilitated by nature universal process and mechanism of being and becoming of infinite potentialities of possibilities locally and non-locally in the known physical world. And beyond.
Another way of saying is since body-mind is composed or made up of many sentient composite body-mind system, the embedded and embodied traits and characteristic (i.e. topology-structure-function-geometry-information-process-mechanism-order) in the genome have to pertain to known world biological physical realm of life and existence topology-structure-function-process-mechanism-order as well as beyond the known physical world (i.e. subtle body-mind of the many sentient composite body-mind system) since evolution or process of being and becoming potentialities of possibilities are beyond the known physical world (a few recent discernments https://www.epistemologyontologyfoundationinstitute.org/philosophy-and-science/on-the-nature-of-spirit-or-universal-genome-through-universal-process-of-being-and-becoming, https://www.epistemologyontologyfoundationinstitute.org/philosophy-and-science/on-spirit-or-universal-genome).
And as such, better the human conditions, experience, and potential (such as biologic-genetic repaired or enhancement due to deficiencies, injuries or damages, illnesses, diseases, better life quality and well being, and open natural potential) locally and non-locally in the physical world. And beyond are meaningful and essential. However, extreme caution, ethical and responsible, and skillful scientific methods and applications are essential. Furthermore, development and living coherent and constructive to sentient universal genome through process of being and becoming locally and non-locally are also essential. And the best way or guidance is through "Know Thyself". And therefore, nature. And this discernment is also to inspire and encourage such scientific quests as well as or complement by ways of life and practices as had suggested and encouraged in diverse ways in diverse past discernments. And adding universal to the word genome would elevate and advance inspirations, aspirations, yearnings, collaborations, and efforts locally and globally.
Emerging sciences of and empirical data on Universal Genome (EPISTEMOLOGY OF LIFE AND ONTOLOGY OF EXISTENCE FOUNDATION AND INSTITUTE - Global Science, Technology, and Innovation Movement (epistemologyontologyfoundationinstitute.org), and among others such as global community resources EPISTEMOLOGY OF LIFE AND ONTOLOGY OF EXISTENCE FOUNDATION AND INSTITUTE - Philosophy And Science Beyond The Macro World (epistemologyontologyfoundationinstitute.org), Philosophy and Science Beyond The Observer World - EPISTEMOLOGY OF LIFE AND ONTOLOGY OF EXISTENCE FOUNDATION AND INSTITUTE (epistemologyontologyfoundationinstitute.org)) through process of being and becoming locally and non-locally in the known physical world. And beyond. And a few complementary emerging sciences of non-coding universal genome:
and among others. And growing.
Epistemology of Life and Ontology of Existence Foundation and Institute
July 2023


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Agricultural & Produce – FSMA Preventive Controls Plans
Use the power of software automation to quickly build your Preventive Controls plan. Either use the ConnectFood Plan and SOP Template Library or hire one of our Food Safety Expert Partners to build it for you at a fraction of the cost of traditional consulting to become compliant with Retail, State, and Federal regulations.
Highlighted Agricultural Preventive Controls templates to check out:
Fruits and Vegetables – Wholesale
Honey: Comb, Creamed, Extraction, Liquid
Salad: Fruit, Leafy Greens, Veggie
Veggie Burger


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Proactively reaching out to your customers to meet their healthcare needs encourages trust and maintains a healthy customer relationship for your business. On the other hand, targeting the right audience at the right time keeps your business focused especially during peak times. Hence, to ensure both the key customer-focused criteria are met, we have upgraded LiveHealth Reach feature that enables you to run SMS campaigns to market healthcare packages and more..
Messaging is the most convenient way to keep your customers up-to-date about your diagnostic centre's available services. You can leverage this tool to not just market healthcare packages to patients but also to give them valuable updates about your centre.
Updating patients about a newly launched centre, availability of home collection services during coronavirus pandemic, or just informing them about the centre's working hours via messages adds more value to the entire customer experience.
Using LiveHealth Reach 2.0
LiveHealth Reach 2.0 brings you ready templates that help you market to the right audience at the right time. Every campaign auto-segregates a list of patients, making it super easy for you to select your target audience. For example, you can choose to market a Diabetes Campaign for patients who visited your centre a year back.
How to Run SMS Campaigns?
To run SMS Campaigns you must select the type of audience you want to reach. Explore the type of campaigns available to you.
- Diabetes
- Senior Citizens
- Heart Care
- Expecting Mothers
- Thyroid patients
Choose the recipient type you want to market to based on their health conditions (for eg. Normal/Abnormal) as well as their last visited detail, followed by a suitable template to run campaigns.
You can also leverage healthcare packages to run campaigns for them via SMS. Packages can be created in 'Promotions' and selected while choosing templates. Selecting packages auto-loads its pricing and link in the SMS; allowing patients to book appointments and make payments with absolute ease.
To ensure business continuity, reaching out to patients is important. So let's leverage the advanced marketing tool of LiveHealth Reach 2.0 and boost effective communication with your patients.
Request feature update in the comments below


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July 13, 2015
Sport Wash laundry liquid maintains fabric breathability
In May 2015, a test of the breathability of fabrics was performed with the Mayeri Sport Wash gel at the accredited High Street Textile Services laboratory in England (test method BS 7209). Modern textiles for sportswear (Gore-Tex, e-Vent, etc.) are designed to direct vapour away from the body. This basically means that the fabric breathes…Read more >>


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Money – we all use it. Most people spend most of their time and most of their lives trying to earn it. Some call it the root of all evil. Some say it is a force for good. "Money makes the world go around" is an apt saying for emphasising the importance of money to the local and global economy.
As Yuval Noah Harari said in his excellent book Sapiens; "Money has been essential both for building empires and for promoting science. But is money the ultimate goal of these undertakings, or perhaps just a dangerous necessity?"
No matter what the answer, it would appear we can't live without it.
In many respects we just take it for granted. Yet there are some potentially seismic shifts in the concept of money as we have known it starting to happen.
As a Chartered Accountant I have spent my working career in a profession dedicated to accounting for things in monetary terms. Likewise, money is a primary aim of businesses as well as being a key feature of most not-for-profit entities.
The alternatives to money are a life of complete self sufficiency or barter. The former is very hard to imagine now. The latter is hard to scale. An economy of favours and obligations simply doesn't work when large numbers of strangers try to cooperate. Hence, we have created money as a generally accepted store of value and a medium of exchange.
Again back to Mr Harari; "Money is not coins and banknotes. Money is anything people are willing to use in order to represent systematically the value of other things for the purpose of exchanging goods and services."
While most of us tend to immediately think of money as cash, or legal tender issued by the Government, it is actually just a mental invention. That is; something that exists in our shared imagination. It only has value because we all believe it must have value. Essentially this is the definition of a fiat currency. This derives from the Latin term fiat whose meaning has been described to me as let it be done, or it must be so. i.e. money has the value it has only because we all collectively believe it has value.
What's changing?
So what has got me thinking about this topic of late? (As for 30 years as a Chartered Accountant I am a tad embarrassed to say I have never previously really stood back and thought too deeply about the concept of money before!). Three things of late have brought this broader concept of money, and especially the future of money to my attention.
The future of cash use
In June 2019 our Reserve Bank released a surprisingly interesting discussion document exploring the uncertainties around the future of cash in New Zealand.
For clarification cash refers to tangible money being banknotes and coins.Cash has the unique advantage of being "bearer pays" i.e. it can be spent by whoever holds them. This is unlike digital money such as credit cards, bank accounts and mobile wallets which differ in that they require authentication from the owner.
The key issue from the discussion document is: "…despite a trending increase in the overall cash in circulation, New Zealand is becoming a society that uses little cash.New Zealanders are using cash less and less for transactions.As the transactional demand for cash falls, the per–transaction cost of providing the cash infrastructure increases."
"Just under 2 percent of the broad money holdings in New Zealand is held in banknotes and the rest is held in digital balances."
The main issue of concern this highlights is that a contraction in the cash network without regard to the wider benefits of cash in society might significantly disadvantage people who rely on the unique role that cash plays in their lives. Especially the elderly and the digitally excluded. While the Reserve Bank is the sole issuer of cash in New Zealand there is no agency responsible for overseeing the usability of cash by the public, nor the stability of the cash system in New Zealand.
I found it interesting to learn that legal tender means that cash must be accepted for debt repayment unless there is an agreement stating otherwise. However, while the concept of legal tender provides some certainty for the usefulness of cash, it doesn't guarantee that cash will be accepted as payment for sales.
New Zealand is not the only country to be pondering the future of cash. The UK Treasury has also led some research into this issue of late. Earlier this year they announced they were committed to keeping cash and coins for at least the near future.
The Reserve Bank's discussion document can be found at their website https://www.rbnz.govt.nz/notes-and-coins/future-of-cash/issues-paper-the-future-of-cash It is well written and well worth a read with feedback requested by 31 August 2019.
The demise of cheques?
We all know that transacting via cheques incurs a level of cost for the convenience. However, in a surprising development to some, Kiwibank have recently announced that they are going to stop issuing new deposit and cheque books to customers from the end of September 2019 and stop processing all cheques from the end of February 2020.
This decision is likely to have a significant impact on New Zealand's:
- Older population who use cheques for every day and regular transactions, and who rely on cheques as a trusted payment method
- Non-profit/charitable sector who receive a significant proportion of donations via cheques from older people; and
- On some small business and traders for whom cheques remain a regular payment method.
I also expect this development will impact the day to day business of many professionals such as lawyers.
Whilst it is clearly evident that cheques as a type of payment method is in global decline, enforcing both an end to processing cheques and an alternative that's digital only has a huge potential impact on older people's rights, dignity and financial independence. Particularly as this cohort are the least digitally literate.For the non-profit/charitable sector they are also currently the largest charitable givers.
Kiwibank's move has not been followed as yet by the other main trading banks but one can only suspect that they are watching and waiting with interest…whilst probably quietly pleased that another bank is the first cowboy up that particular pass.
For comparison, in Australia the move to completely phase out cheques has so far been resisted.While the Reserve Bank of Australia made an announcement around plans to phase out cheques way back in 2011, lobbying by various groups has instead resulted in a regular tracking of the use of cheques as part of a managed decline rather than an enforced decision.
While I am not a luddite, I do think that care needs to be taken with such change that unintended adverse consequences are minimised.
The rise of new payment powerhouses
You may not have seen it so much in your daily life in New Zealand as yet but the future is steadily starting to creep in. A future I suspect that will fast become mainstream. In some countries in Asia new personal payment technologies such as Alipay and WeChat Pay are already becoming pervasive. While celebrating my eldest son's birthday at a local Asian restaurant last week I was intrigued to see a number of new payment options advertised, including one of the former, alongside the traditional credit card options.
And now with what could be a game changer; social media juggernaut Facebook has entered the fray by announcing their proposed new digital payment option, a cryptocurrency called Libra. Facebook says Libra is a "global currency and financial infrastructure". In other words, it is a digital asset built by Facebook and powered by a new Facebook-created version of blockchain, the encrypted technology used by bitcoin and other cryptocurrencies.
It has a number of interesting features such as it's value being tied to a basket of traditional currencies to avoid it being a highly speculative asset like existing cryptocurrencies such as Bitcoin. Instead it appears to be aiming to be the payment option of greatest convenience. What makes this really significant to me is that Facebook already has a devoted community of something over 2 billion users worldwide. That's a customer base that any bank would salivate over!
We all use money in various forms. However, recent developments such as those above demonstrate that what we have known, and perhaps taken for granted, as money is changing.
We all need to consider what this may mean to our businesses and personal lives.
How quickly new methods of transacting are adopted as sufficiently convenient to change behaviour by businesses, by other organisations, and the general public, will dictate the speed of change. And possibly sooner than we expect. Watch this space!


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The horror of the real thing is that only a relatively few survivors experienced the unmatched joy of seeing loved ones returned.
So many survivors lost so many loved ones that the additional loss of home and livelihood hardly seemed to matter. Surviving disasters often leaves deep psychological scars. But fighting to survive and helping others to survive is fundamental to the human spirit – in China, no less than anywhere else.
At writing, China's toll was 10 missing or dead, according to government estimates. Put against official World Health Organization estimates of 150,000 total tsunami-related deaths, Mainland China got off very lightly. Tiny Hong Kong, with 15 deaths and scores missing, was harder hit. One supposes that lingering travel restrictions and the Mainland's currency controls can be credited with keeping the Mainland casualty count as low as it was – possibly the last of the old command economy's rare dividends.
As in the American case, China's initial funding commitment was almost inconsequential. Beijing first committed US$2.6m, but as the death estimates skyrocketed, it increased emergency funds nearly 30 times. Undoubtedly it will go up more as China, really for the first time, takes on a prominent, sustained role in international relief. The United States was called stingy for its opening offer of US$35m. Critics (many, Americans themselves) contrasted that amount to Washington's commitment of US$90m to Florida relief after its last big hurricane, which leveled properties and power lines but actually killed few people.
Saying it with cash
The US responded by increasing its allocation tenfold – just as Japan announced it was putting US$500m into relief efforts. Tokyo's announcement both underscored Japan's commitment to put economies back on their feet and its resolve to maintain its preeminent economic role in the region.
While cash commitments were ratcheted up, and community fundraising drives got going, donor countries mounted rescue missions, organized supply shipments and launched countless other projects to help communities along the tsunami's death track.
Among other initiatives, Beijing sent medics to Sri Lanka and medical and food supplies to Sumatra. Taiwan, which announced US$50m in relief aid, organized shipments of rice (2,000t) and medicine (3,000t), and dispatched a team of 200 doctors to Aceh, near the epicenter of the earthquake that unleashed the tidal waves. Hong Kong, being the financial center it is, focused on piling up money, raising over US$50m. Add up all the greater Chinese pieces, government and private, in the tsunami relief story and the total comes close to US$200m, making the collective effort a significant one.
Mainland China is at once a developing country and a fast emerging world economic power. In a globalizing world, situations change quickly: in a decade, China graduated from cheap manufacturing base to major country market. So today, China has enough muscle to set prices and buy energy and mineral assets across the world, yet it still receives development aid – from agencies like Japan's Office of Development Assistance (ODA), which in December announced it would implement a staged shutdown of China aid and soft-loan projects. The ODA said that China's per capita GDP would exceed US$1,400 by 2008, disqualifying it by World Bank standards as a developing economy.
China is developed and not so developed, all in one – understandable for an economy so dispersed and diverse. So it follows that its international relief record has been a record of fits and starts. But with this particular disaster, China turned a corner.
One question now is, when and how will it expand its role from aid donor and establish a modern emergency rescue and relief establishment to match its ambitions as a regional power? It will be years before it has the hardware and logistical infrastructure to play the role taken on this time by the US. But China right now has massive manufacturing capacity to make virtually everything a smashed community needs in a hurry – medicines, food, blankets, oxygen, communications infrastructure, piping for sewerage and so on – and it has the skilled manpower to deliver them.
Time is everything in relief work. Given the resources it has in hand, China has the means to become Asia's major staging ground for international relief – and cut emergency delivery times dramatically. To achieve that requires not so much money as coordination and teamwork – both within China and with participating OECD countries. Modern China has proven it can be adept at both.
Hu Jintao sends a message
Look at an average news month and of all China's leaders, Premier Wen Jiabao gets most of the ink. He sounds off on America's mounting trade account deficit, talks up the central government's effort to cool overheating parts of the economy, or acknowledges the need to improve China's grim mine safety record. He stalks the economic terrain and works the levers. As prime minister and head of government, Wen looks well settled in.
President Hu Jintao's clippings book, by contrast, is thinner, but each entry tends to carry much more weight. They, too, describe a man comfortable in his job. He took the lead in clearing bureaucratic blocks in dealing with SARS, and last year replaced Jiang Zemin as chairman of the Military Affairs Commission.
He has speculated on party reform, warned about the dangers of corruption and, more interestingly, suggested that models such as Britain's "New" Labor Party be considered as examples of regeneration. Having begun the process of reassessing issues at the center, Hu has been spending time looking at the periphery. He has recently rebuked Hong Kong's chief executive for unstated governance inadequacies and warned Taiwan to abandon its flirtation with independence, and promoted an anti-secession law to back up Beijing's stance.
Hu is putting his own stamp on things and turning up the heat on Taiwan because Chen Shuibian's second term as president brings with it the risk of Taiwan's parliament considering and even passing Chen's referendum law on his independence proposal, leading to a new and dangerous stage of cross-strait brinkmanship. Whether the Taiwan legislature would agree to antagonize Beijing by passing such a measure is unclear, but as Chen's re-election as president showed last year, anything is possible in politics.
Taiwan is split, as its manufacturing sector goes through the same convulsions other maturing economies must deal with. The island's capitalist class wants no part of independence. From their standpoint, the faster Taiwan integrates economically with the Mainland the better. But integration also speeds up the hollowing out of Taiwan's economy, which means lost jobs – something that Chen uses in his appeal to voters.
People often look at flags not to salute them, but to see where the economic winds are blowing. If the signals of a promising economic future point one way, most people turn in that direction, as Europeans showed in voting for the European Union. On that basis, Hu should feel some comfort because the mainland looks ever-more clearly to be Taiwan's brightest option, the place where the island's economic potential might best be realized, regardless of Chen's high-stakes gambling.
Tung Chee Hwa's situation in Hong Kong is different. True, he has been given some difficult assignments to handle, like trying to get an unpopular security law enacted. That he flubbed that is understandable, but he has flubbed so many other issues since taking office in 1997, leading to consistently rock-bottom approval ratings from Hong Kong citizens. The list includes bureaucratic stumbling, closed-door deals that went wrong, apparent favoritism for fat-cat property developers, not to mention ignoring the views of the public on key issues: in the end, even Beijing couldn't stay quiet. Hu's public rebuke, a first, was a warning to Hong Kong's chief executive to straighten up and fly right.
It was a wink to Hong Kong's often restive public, as if to say, "Trust me, I know where you're coming from."
Hong Kong has to work, or Deng Xiaopeng's one-country two-systems formula falls into question – giving Taiwan's Chen Shuibian more room to play. In dressing down Tung Chee Hwa, Hu Jintao was saying that the president of China expects Hong Kong's administration to do better by its people. From Beijing's standpoint, if the people of Taiwan overheard the exchange, so much the better.
Forgotten man
Zhao Ziyang died in mid-January. Most people in China had thought that the former party chief was dead already. It was a mark of the party's success that even in the Information Age, Zhao had become a non-person. He had spent the last 16 years of his life under house arrest and was around 20 years ahead of his time. In the overheated summer days of 1989, he addressed issues that are still waiting to be resolved – transparency and accountability.


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BACKGROUND. The association between Epstein-Barr virus (EBV) and Burkitt's lymphoma (BL) in Taiwan is not clear. In this study, the authors attempted to determine the frequency of the occurrence of EBV infection in patients with BL in Taiwan. METHODS. A retrospective study was performed using a nonisotopic in situ hybridization technique to detect fire presence of EBV-encoded small RNAs (EBERs) in paraffin embedded BL tissues. Tissues of other types of B-cell non-Hodgkin's lymphoma (NHL) were used as controls. Immunohistochemical staining was performed to examine the presence of an EBV- encoded protein, latent membrane protein (LMP), and p53 in specimens. RESULTS. EBERs were detectable in 10 of 18 BL specimens. It was present in the cervical lymph nodes (LNs) in six of the seven cases of cervical tumors, in the maxillary region in one case, in one of two cases of axillary LNs, and in the abdominal tumors in two of the seven cases of intraabdominal disease. EBER positive cells were diffusely present in all tumors except in one abdominal BL, in which only a few EBER positive cells were scattered in a small part of the tumor. EBER positive cells were not detected in fire case with BL in an inguinal LN and in the seven cases with intraabdominal tumors. Immunohistochemical studies showed that LMP and p53 were expressed in 3 and 4 of the 18 cases, respectively. In another 20 NHLs in peripheral LNs, EBERs were detectable in only 1 case of diffuse large cell histology with numerous reactive T cells in which only large tumor cells expressed EBERs and laMP. EBERs were not detected in any of the ten cases of extranodal NHL. CONCLUSIONS. In Taiwan, EBV is frequently associated with BL occurring outside the abdomen but rarely with intraabdominal BL. The overall association between EBV and BL in Taiwan is intermediate compared with other regions of the world. These results support the theory that the frequency of EBV associated with BL is influenced by the endemicity of EBV and/or the socioeconomic status of a country.
|Original language
|Pages (from-to)
|Number of pages
|Issue number
|Publication status
|Published - 1997
|Externally published
- Burkitt's lymphoma
- Epstein- Barr virus-encoded small RNAs (EBERs)
- Epstein-Barr virus
- Immunohistochemistry
- In situ hybridization
- Latent membrane protein
- p53
- Taiwan
ASJC Scopus subject areas
- Cancer Research
- Oncology


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Abra Cadabra: How Harry Potter's Retail Profits Disappeared into Thin Air
This week is going to be Harry Potter mania! With the series having already sold more than 350 million copies worldwide, this Friday's release of "Harry Potter and the Deathly Hallows" (at midnight) all but guarantees this weekend will be the biggest in bookselling history. So…with cash registers cha-chinging at full tilt, why aren't book retailers going to make a profit?
First off, let's discuss the publisher's versioning strategy. Two Harry Potter versions are being sold: a regular and deluxe edition. The regular edition's list price is $34.99, with Amazon.com discounting it to $17.99. The deluxe edition (new art work, foil stamped slip case, etc.) is being offered for $65 ($39 on Amazon). This classic versioning strategy offers readers that highly value the book the option to pay a premium for more bells and whistles. This versioning strategy has been successful: my diehard Harry Potter friends didn't give a second thought about buying the deluxe edition and it appears Amazon is sold out of this version.
Given the tremendous demand and profit potential, why did Jeff Bezos (Amazon's CEO) decide to set such low Harry Potter book prices and launch a price war? Because he had to…with millions of frenzied readers itching to know what characters die – fans want the book as soon as possible. One drawback of buying from Amazon is orders have to be placed in advance (orders must be placed before Tuesday, July 17 for guaranteed delivery on Saturday, July 21 by 7:00 PM). To bolster its ambition of being "the place" to purchase books, Amazon had to give Harry Potter fans a reason to plan their purchase in advance. And you know my favorite way to motivate consumers…discount price! So Amazon chopped Harry's price to $17.99 plus threw in a $5 discount coupon for a $20 or more purchase in August.
Amazon's pricing strategy effectively destroyed the chances for retailers to profit from this bookselling mega-event. Echoing the sentiment of rivals, Simon Fox, an executive at Waterstones (the U.K.'s leading bookseller) commented: "because it is such a high-profile book, by not being price competitive on that single title you set a perception that you are highly priced." Bezos acknowledges that even with over 1.5 million preorders, Amazon won't make any money off Harry Potter and is laying his hopes that customers will buy other products as well (do you think this is realistic?).
As a result of intense competition, whether or not Amazon offers the best deal comes down to how buyers value the $5 coupon. To ensure your book arrives on release day, Amazon is imposing a $3.99 shipping fee, for a total price of $21.98. Costco will deliver the book to your door on Saturday for $21.47. You can also pick up a copy at Borders or Barnes & Noble stores for 40% off the list price, $20.99. These brick and mortar retailers typically discount bestsellers by 30%, so they've tossed in an extra 10%.
This intense discounting is understandable. And consumers obviously benefit from low prices. But for me, it's painful to see so much value destroyed. What do you think?
Readers' Comments on This Blog Entry
I do agree with you, Rafi. I pre-ordered the book; and I wouldn't have objected to pay it at full price - and many persons like me -. The funny thing is that this is another case of self-inflicted pain caused by the distribution channel. It would be interesting to know how much of this pain goes down to the publisher, how much he had to discount to get the book out to Amazon and the big guys. Hopefully nothing, zero, zip.
Many of the local book shops have big events planned so events like HP will bring alot of people to the retail stores vs going thru Amazon. HP fans will want to participate in the midnight or next day parties at the book shops. I will be out oif the country but if I was here, I'd be at the local Santa Cruz book seller probably paying a higher price so I can enjoy the event!!


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Int J Med Sci 2015; 12(12):968-973. doi:10.7150/ijms.13121 This issue Cite
Research Paper
1. Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan;
2. School of Medicine, Tzu Chi University, Hualien, Taiwan;
3. Department of Life Science, Chinese Culture University, Taipei, Taiwan.
Objectives: Heart-rate corrected QT (QTc) interval predicts cardiovascular mortality or all-cause mortality in the general population. Little is known about the best cut-off value of QTc interval for predicting clinical events in patients with ST-elevation myocardial infarction (STEMI).
Methods: We enrolled 264 patients with STEMI who received measurement of QTc intervals at ER (QTc-ER), on day 2 (QTc-D2), and on day 3 (QTc-D3) of hospitalization. Clinical events, including all-cause death and readmission for heart failure, were followed for 2 years.
Results: Prolonged QTc-ER, but not QTc-D2 or QTc-D3, well predicted clinical events with the best cut-off value of 445 ms. Patient with QTc-ER > 445 ms had lower left ventricular ejection fraction at baseline and at 6 months. Kaplan-Meier survival curves showed that the combination of QTc-ER > 445 ms and N-terminal pro-brain natriuretic peptide (NT-pro BNP) > 936 pg/mL was a strong predictor of clinical events (p<0.001). In multivariable Cox regression analysis, the independent predictors of death and heart failure were QTc-ER (p<0.001), log NT-proBNP (p<0.001), diabetes mellitus (p<0.001), history of stroke (p=0.001), and left ventricular end diastolic volume index (p<0.001).
Conclusion: QTc-ER > 445 ms independently predicts clinical events in STEMI, providing incremental prognostic value to established clinical predictors and NT-proBNP.
Keywords: QT interval, brain natriuretic peptide, acute myocardial infarction, left ventricular remodeling.
Epidemiological studies have shown the association between heart-rate corrected QT (QTc) interval and cardiovascular mortality or all-cause mortality in the general population [1-3]. Elevated sympathetic tone may be one of the underlying mechanisms that increase the QTc interval and the rate of mortality [4, 5]. QTc interval is found to be prolonged in patients with acute myocardial infarction (AMI) and may help in identifying patients with higher rate of sudden death and mortality in previous studies [6-8]. However, these studies are done before the reperfusion era and may not apply to the patients with ST-elevation myocardial infarction (STEMI) receiving reperfusion therapy. It is also unknown whether the prognostic value of QTc interval is incremental to established biomarkers, e.g. brain natriuretic peptide [9-13]. Furthermore, QTc interval increases gradually during the first week of AMI [7, 14]. Little is known about the best measuring time and the best cut-off value of QTc interval for predicting clinical events in patients with STEMI.
The aim of this study is to investigate the role of QTc interval in predicting the clinical outcomes after STEMI, particularly for left ventricular (LV) remodeling, heart failure, and all-cause death.
The study population was enrolled at Taipei Tzu Chi hospital in Taiwan between December 9, 2007, and April 9, 2013. With institutional ethics committee approval and written informed consent, we enrolled patients who presented to emergency room (ER) with STEMI and received successful primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Patients were excluded if there were shock requiring cardiopulmonary support, scheduled coronary bypass graft operation, previous myocardial infarction (MI), cardiac disease states other than ischemic heart disease, a history of active malignancy in past 3 years, significant renal or hepatic dysfunction, chronic bedridden status, or concomitant inflammatory diseases such as infections or autoimmune disorders.
Standard 12-lead electrocardiograms (ECG) were recorded using MAC 5500 machines (GE Medical system, Milwaukee, WI, USA). The first ECG at ER (day 1), ECG in the first morning at coronary care unit (day 2), and ECG in the second morning at coronary care unit (day 3) were obtained from electric medical records. With initially visual inspection, recordings with inadequate quality, atrial fibrillation, or bundle branch block were excluded [15]. The MAC 5500 machines measured the QT interval from the onset of QRS complex to the end of T wave in all 12 leads. The averaged QT interval was then corrected for heart rate using the Bazett formula (QTc = QT/√RR). The computerized measurements of QTc intervals on day 1 (QTc-ER), day 2 (QTc-D2), and day 3 (QTc-D3) were used for further analysis.
Approximately 10 ml of blood from a peripheral vein were collected into a tube containing potassium ethylenediamine tetra-acetic acid (1 mg/ml) at post-MI day 2. The samples were centrifuged at 4°C within 20 minutes. The plasma was separated and subsequently frozen at -80°C until further analysis without undergoing any additional freeze-thaw cycles. Levels of N-terminal pro-brain natriuretic peptide (NT-pro BNP) were measured by commercial enzyme linked fluorescent assay (Vidas system, bioMérieux).
Comprehensive 2D Doppler echocardiographic studies were performed with the patients in the partial left lateral decubitus at baseline (mostly post-MI day 2) and were repeated 6 months later. The equipment used was a Philip SONOS 7500 (Agilent Technologies, Andover, MA) system. All measurements were performed and repeated by the same experienced echocardiologist [16, 17]. The LV end-diastolic volume index (LVEDVI) was measured according to the recommendations of the American Society of Echocardiography [18]. With the use of apical 4- and 2-chamber views, LV ejection fraction (LVEF) was estimated by the modified Simpson's method. The degree of LV dilatation was evaluated by the change in LVEDVI between baseline and 6-month follow-up. Significant LV dilatation was defined as a >20 ml/m2 increase in LVEDVI at 6 months, compared with baseline [19].
The clinical events, including all-cause death and readmission to hospital for heart failure, were recorded by reviewing electric medical records or contacting patients by telephone. Patients were followed for a maximum of 2 years.
The best cut-off value of QTc-ER, QTc-D2, QTc-D3, and NT-pro BNP for predicting mortality or heart failure was identified by receiver-operating characteristic (ROC) curve. Patients were divided into two groups based on the best cut-off value of QTc interval. Categorical variables were expressed as number (percentage) and compared with chi-square test. All continuous variables were tested for normal distribution by using the Kolmogorov-Smirnov test. Depending on normality, continuous variables were expressed as mean ± SD or median with interquartile range (IQR) and compared with Student's t test or Mann-Whitney U test, respectively. Univariable logistic regression was applied to identify the predictors of significant increase (>20 ml/m2) in LVEDVI. Stepwise multivariable regression (entry threshold, p<0.05; removal threshold, p>0.10) was then performed using significant variables in univariable model. Timing of clinical events was plotted according to the Kaplan-Meier method and compared with log-rank test. We also used Cox regression model to assess whether QTc interval was an independent predictor of clinical events. These statistics were computed using SPSS statistical software (SPSS Inc., Chicago, Illinois). A value of p<0.05 was considered significant.
With initially visual inspection, 16 patients were excluded for atrial fibrillation, 1 patient was excluded for left bundle branch block, and 17 patients were excluded for right bundle branch block. We finally enrolled 264 patients.
QTc intervals increased gradually from 439 ± 33 ms at ER on day 1, to 446 ± 38 ms on day 2 (p=0.018 vs. day 1), to 459 ± 42 ms on day 3 (p<0.001 vs. day2). The area under ROC curve for predicting all-cause death and heart failure was 0.848 for QTc-ER, 0.562 for QTc-D2, and 0.507 for QTc-D3. Prolonged QTc-ER, but not QTc-D2 or QTc-D3, well predicted clinical events (Figure 1A).
The best prognostic cut-off value of QTc-ER for predicting death or heart failure was 445 ms (sensitivity 86%, specificity 68%). The best cut-off value of NT-pro BNP for predicting death or heart failure was 936 pg/mL (area under ROC curve 0.841, sensitivity 93%, specificity 69%).
(a) Receiver operating characteristic (ROC) curves analysis was conducted for discrimination between patients with and without death or heart failure. The area under the curve (AUC) was 0.848 for QTc interval at emergency room (QTc-ER), indicating a good predictive power. In contrast, QTc interval on day 2 (QTc-D2) and day 3 (QTc-D3) had poor predictive power. (b) QTc intervals at emergency room, on day 2, and on day 3, stratified according to patients with or without death or heart failure.
Baseline clinical and demographic characteristics, stratified according to QTc-ER greater or lesser than 445 ms, are listed in Table 1. Patients with QTc-ER > 445 ms tended to be older, female in gender, have diabetes mellitus (DM), longer symptom-to-door time, higher Killip class, faster heart rate, anterior wall MI, higher peak creatine kinase (CK), higher NT-proBNP level, lower LVEF, and higher Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI.
Compared with short QTc-ER group, patients with QTc-ER > 445 ms had lower LVEF at baseline (46.5 ± 12.0% vs. 51.1 ± 11.4%, p=0.003) and lower LVEF at 6 months (53.2 ± 15.7% vs. 58.7 ± 13.3%, p=0.008). The absolute increase in LVEF was similar in both groups (6.2 ± 12.4% vs. 7.4 ± 11.2%, p=0.471).
Compared with short QTc-ER group, patients with QTc-ER > 445 ms had similar LVEDVI at baseline (67.9 ± 21.9 vs. 68.2 ± 18.9, p=0.909) and insignificantly higher LVEDVI at 6 months (77.1 ± 25.9 vs. 71.7 ± 20.6, p=0.080). The absolute change in LVEDVI at 6 months was insignificantly higher in patients with QTc-ER > 445 ms (9.8 ± 24.9 vs. 4.2 ± 18.4, P=0.073).
In logistic regression model, QTc-ER was a predictor of a significant increase (>20 ml/m2) in LVEDVI at 6 months in univariable analysis (B= 1.012, p=0.028) but not a predictor in multivariable analysis. In multivariable logistic regression analysis, the independent predictors of a significant increase in LVEDVI were DM (B= 2.370, p=0.031), log peak CK (B= 10.515, p<0.001), and baseline LVEDVI (B= 0.966, p=0.004; Table 2).
Clinical and demographic characteristics.
|QTc-ER ≦ 445 ms (N=167)
|QTc-ER > 445 ms (N=97)
|P value
|Age, years
|57.0 ± 10.1
|61.6 ± 13.8
|Male gender
|156 (93.4%)
|68 (70.1%)
|Current smoker
|103 (61.7%)
|51 (52.6%)
|Diabetes mellitus
|37 (22.2%)
|33 (34.0 %)
|91 (54.5%)
|63 (64.9%)
|75 (44.9%)
|49 (50.5%)
|Coronary heart disease
|19 (11.4%)
|11 (11.3%)
|8 (4.8%)
|7 (7.2%)
|Symptom-to-door time, min
|72 (41-198)
|138 (50-296)
|Door-to-balloon time, min
|76 (60-104)
|78 (66-119)
|Killip class > I
|26 (15.6%)
|35 (36.1%)
|Heart rate, beats/min
|74 ± 18
|83 ± 21
|SBP, mmHg
|131 ± 27
|136 ± 28
|Anterior MI
|60 (43.2%)
|80 (57.6%)
|Body mass index, kg/m2
|25.4 (23.0-27.2)
|25.8 (23.9-28.4)
|Peak CK, IU/L
|2061 (1082-3645)
|2602 (1511-4539)
|Hemoglobin, g/dL
|15.3 (14.1-16.2)
|14.8 (13.2-15.9)
|Creatinine, mg/dL
|1.00 (0.89-1.20)
|1.02 (0.89-1.20)
|Potassium, mmol/L
|3.60 (3.31-3.90)
|3.60 (3.30-4.00)
|NT-proBNP, pg/mL
|525 (240-1136)
|986 (477-2280)
|51.1 ± 11.4
|46.5 ± 12.0
|LVMI, g/m2
|122.6 ± 30.1
|124.4 ± 36.4
|LVEDVI, mL/m2
|68.2 ± 18.9
|67.9 ± 2.19
|TIMI risk score
|3.0 ± 1.9
|4.7 ± 2.4
Values are expressed as number of patients (%), mean ± SD, or median (25th-75th percentile).
QTc-ER indicates QTc interval at emergency room; SBP, systolic blood pressure; MI, myocardial infarction; CK, creatine kinase; NT-proBNP, N-terminal pro-B-type natriuretic peptide; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; LVEDVI, left ventricular end-diastolic volume index; and TIMI risk score, Thrombolysis in Myocardial Infarction risk score for ST-elevation myocardial infarction.
During follow-up, 12 patients (4.5%) died and 18 patients (6.8%) had been readmitted to the hospital for heart failure. When compared with event-free survivors, patients with clinical events had longer QTc-ER (469 ± 32 vs. 434 ± 29 ms, p<0.001), similar QTc-D2 (454 ± 37 vs. 445 ± 38 ms, p=0.268), and similar QTc-D3 (460 ± 42 vs. 458 ± 43 ms, p=0.799; Figure 1B). In patient with clinical events, QTc interval reached its maximum at ER and was relatively unchanged on day 2 (p=0.050 vs. QTc-ER) and day 3 (p=0.479 vs. QTc-D2). In event-free survivors, QTc interval increased gradually on day 2 (p<0.001 vs. QTc-ER) and day3 (p<0.001 vs. QTc-D2).
Kaplan-Meier survival curves showed that the combination of QTc-ER > 445 ms and NT-proBNP > 936 pg/mL was a strong predictor of the clinical events (p<0.001; Figure 2). No clinical event occurred in the 122 patients with short QTc-ER & low NT-proBNP. Death or heart failure occurred in 2 patients (4.0%) in long QTc-ER & low NT-proBNP group, 5 patients (11.1%) in short QTc-ER & high NT-proBNP group, and 21 patients (44.7%) in long QTc-ER & high NT-proBNP group.
In multivariable Cox regression analysis using significant variables in univariable model, the independent predictors of death and heart failure were QTc-ER (hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01-1.04, p<0.001), log NT-proBNP (HR 6.30, CI 2.78-14.29, p<0.001), DM (HR 7.23, CI 3.07-17.37, p<0.001), history of stroke (HR 7.31, CI 1.29-24.43, p=0.001) and LVEDVI (HR 1.03, CI 1.02-1.05, p<0.001; Table 3).
Predictors of a significant increase in LVEDVI (>20 ml/m2) in logistic regression analysis.
|Standardized coefficient
|p value
|Standardized coefficient
|p value
|Heart rate
|Log CK
|Log NT-proBNP
|Diabetes mellitus
|LVEF at baseline
|LVEDVI at baseline
CK and NT-proBNP are analyzed as log transformed variables. QTc-ER indicates QTc interval at emergency room; CK, creatine kinase; NT-proBNP, N-terminal pro-B-type natriuretic peptide; WBC white blood cells; LVEF, left ventricular ejection fraction; LVEDVI, left ventricular end-diastolic volume index; and LVMI, left ventricular mass index.
Kaplan-Meier curves of the cumulative incidence of all-cause death or heart failure stratified according to QTc intervals at emergency room (QTc-ER) above or below 445 ms and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels above or below 936 pg/mL.
Predictors of death and heart failure in Cox regression analysis.
|Hazard ratio (95% CI)
|p value
|Hazard ratio (95% CI)
|p value
|QTc-ER, ms
|1.03 (1.02-1.05)
|1.03 (1.01-1.04)
|3.98 (1.86-8.50)
|Age, years
|1.08 (1.05-1.11)
|Symptom-to-door time, 10 min
|1.02 (1.00-1.04)
|Killip class > I
|3.10 (1.48-6.52)
|Log CK, IU/L
|3.35 (1.10-10.23)
|Log NT-proBNP, pg/mL
|7.93 (4.14-15.20)
|6.30 (2.78-14.29)
|Creatinine, mg/dL
|1.36 (1.11-1.66)
|Hemoglobin, g/dL
|0.70 (0.60-0.81)
|Diabetes mellitus
|4.90 (2.30-10.47)
|7.23 (3.07-17.37)
|2.77 (1.12-6.82)
|Current smoker
|0.38 (0.17-0.82)
|Stroke history
|3.11 (1.08-8.98)
|7.31 (2.19-24.43)
|0.93 (0.90-0.96)
|LVEDVI, mL/m2
|1.02 (1.01-1.04)
|1.03 (1.02-1.05)
QTc-ER indicates QTc interval at emergency room; CK, creatine kinase; NT-proBNP, N-terminal pro-B-type natriuretic peptide; LVEF, left ventricular ejection fraction; and LVEDVI, left ventricular end-diastolic volume index.
Our investigation indicates that, prolonged QTc-ER is a strong and independent predictor of mortality and heart failure in patients with STEMI, providing incremental information to clinical risk factors and NT-proBNP. Prolonged QTc-ER is associated with lower LVEF at baseline and 6 months later. Prolonged QTc-ER is also a predictor of severe LV dilatation in 6 months in univariable analysis, but not in multivariable analysis.
Although some previous studies have shown the association between prolonged QTc interval and cardiovascular mortality or all-cause mortality in the general population [1-3], other studies suggest that the association is not consistent and the risk is likely to be small [20, 21]. There are several possible explanations for the positive association. Prolongation of QTc interval reflects prolonged ventricular repolarization and predisposes to sudden death. Prolonged QTc interval is associated with elevated sympathetic tone which may lead to elevated blood pressure, atherosclerosis, and cardiovascular events [4, 5]. It is less clear why prolonged QTc interval also predicts all-cause mortality. One possible explanation is that prolonged QTc is a marker of other disorders such as DM or neurohormone imbalance which may predispose to increased mortality. In our study, patients with QTc-ER > 445 ms are more likely to be older, female in gender, have DM, higher peak CK, higher NT-proBNP, and higher TIMI risk score for STEMI. However, Cox multivariable regression analysis shows that QTc-ER is still an independent predictor after adjusting the above baseline differences.
QTc interval increases gradually following AMI, with highest value at the end of the first week [7, 14]. In our study, consistent with previous reports, QTc interval increases gradually on day 2 and day 3 in event-free survivors. In contrast, QTc interval reached its maximum at ER and was relatively unchanged on day 2 and day 3 in patients with clinical events. As a result, only QTc-ER, but not QTc-D2 or QTc-D3, can discriminate patients with clinical events from event-free survivals. This interesting serial change of QTc interval in patient with clinical events has never been reported and may need to be confirmed by further studies.
Previous studies evaluating the prognostic value of QTc interval in AMI were mostly done before 1990 [6-8]. Only one study had performed serial ECG follow-up after AMI and showed that QTc interval > 440 ms at hospital discharge had independent value for predicting major cardiac events [7]. ECG data at ER was not analyzed at that study. However, the study was done before the reperfusion era and also included patients with subendocardial infarction. It is possible that the prompt reperfusion therapy in our patients with STEMI will influence the temporal evolution of QTc intervals and the best measuring time of QTc intervals will thus be different. One recent study reported that prolonged QTc interval of first ECG (prehospital or hospital admission) predicted in-hospital mortality in patients with STEMI [22], which is consistent with our findings. Our study is the first study to evaluate the effects of serial QTc interval changes on the long term outcomes in patients with STEMI exclusively receiving primary PCI. It shows that, in the reperfusion era, QTc interval measured before reperfusion strongly predicts mortality and heart failure in 2 years. In contrast, QTc-D2 and QTc-D3 have no prognostic value in predicting clinical events.
One main purpose of our study is to evaluate the process of LV remodeling after STEMI. LVEF and LVEDVI have been proven to be powerful independent predictors of clinical events after MI [23-25]. In our study, patients with QTc-ER > 445 ms have lower LVEF at baseline and at 6 months. However, the correlation between QTc-ER and LVEDVI is somewhat weaker. In logistic regression model, prolonged QTc-ER is a predictor of a significant increase (>20 ml/m2) in LVEDVI at 6 months in univariable analysis but is not a predictor in multivariable analysis. As shown in table 1, prolonged QTc-ER is correlated with DM and higher peak CK, the independent predictors of significant increase in LVEDVI. It is possible that prolonged QTc-ER is just a marker of larger infarct or other underlying disorders, is not independently associated worse LV remodeling, and thus is not included in the final model of multivariable analysis.
The present study has some imitations. First, QTc intervals at discharge and after discharge are not measured and analyzed, it is not known whether they will have better predictive value. However, we think that QTc-ER may be a better predictor than QTc interval at discharge because it does not need additional ECG measurement and can also predict in-hospital mortality. Second, this is a single-center study enrolling patients exclusively reperfused by PCI. It may limit the generalizability of our findings. Third, the number of patients with clinical events is relatively small. Because of relatively low statistical power, some useful predictors of clinical outcomes may become statistically insignificant in our analysis. Fourth, the number of patients in some comparison groups (for example, short QTc-ER & high NT-proBNP group) is small. Incidental clinical events may have the potential to skew the result of survival analysis.
QTc-ER > 445 ms independently predicts all-cause death and heart failure in patients with STEMI, providing additional information to established clinical predictors and NT-proBNP.
We thank for the grant support (TCRD-TPE-102-34) from Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.
TCRD-TPE-102-34 from Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
The authors have declared that no competing interest exists.
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Corresponding author: Yu-Lin Ko, MD, PhD, Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, 289 Jianguo Road, Xindian District, New Taipei City 231, Taiwan. Tel.: 886-2-6628-9779 Ext: 5709; Fax: 886-2-6628-9009. E-mail: yulinkotwcom.tw.
Received 2015-7-2
Accepted 2015-10-26
Published 2015-11-17


text:
EECP - Enhanced External Counter Pulsation
- EECP stands for "Enhanced External Counter Pulsation".
- Popularly known as "Natural Bypass Treatment".
- EECP works on the principle of creating a "counter-pulse" towards the Heart using "Pulsatile Pneumatic Compressions".
- EECP is most commonly used as "Adjunctive Treatment" in Cardiac Patients (mainly IHD).
- EECP is very effective as a "Bridge Therapy" for the patients who are in the waiting period for their "Coronary Angioplasty" and/or "CABG".
- EECP seems to have a potential role in improving the clinical and symptomatic outcome in the patients who have undergone Coronary Angioplasty and/or CABG.
- EECP is a non- invasive procedure.
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- EECP improves the Cardiac Functions by improving the perfusion of the Coronary Vasculature (Blood Supply to the Heart itself).
- EECP opens up the new collaterals and hence improve the circulation and perfusion.
- EECP is a recognized entity which improves the micro-circulation of the Heart.
- EECP also improves the circulation to other Vital Organs of the body (Brain, Kidney etc.)
- Potential Conditions where EECP may work and provide Objective improvement as well as symptomatic improvement :
1. Ischemic Heart Disease (Angina)
2. Chronic Heart Failure
3. Vertebrobasilar insufficiency
4. Senile Dementia
5. Vascular Headaches (Like Migraine)
6. Erectile Dysfunction
7. Diabetic Nephropathy
8. Chronic Kidney Disease
9. Chronic Fatigue Syndrome
It is observed that patients (Cardiac and non-Cardiac) on EECP treatment do feel :
- Improved Energy Levels
- Improved Quality of Life
- Enhanced Endurance
- Enhanced Strength
- Decrease in Angina Pain (including Frequency)
- Improvement in Mood and Memory
- Improvement in Sexual Functions
- Subjective feeling of wellbeing
Like any other treatment, even EECP has its own contraindications:
- Severe high uncontrolled Hypertension.
- Severe Valvular Heart Disease (Mainly Aortic Regurgitation)
- Cardiac Arrhythmias
- Uncontrolled Congestive Heart Failure
- Recent Cardiac Catheterization
- Recent Cardiac Surgery (within 3 months)
- Thrombophlebitis
- Deep Vein Thrombosis
- Coagulopathies
- Pregnancy
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