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GP Annual Report 2014
Areas of potential growth continue to be scleral lenses, corneal reshaping designs, multifocals, and hybrids.
By Edward S. Bennett, OD, MSEd, FAAO
In 2014, GP lenses continue to be a viable contact lens modality. Even though conventional spherical GP lens use continues to decrease, specialty designs—notably scleral lenses—are increasing at a rate to offset the spherical lens decline. In the United States, a 0.7% decline has been reported (2013 versus 2012), with a total of 8% refits and new fits into GP lenses and an additional 2% fit into hybrid lenses (Nichols, 2014). The good news is this is the first year that PMMA lenses did not represent as much as 1% of the market, and their decline is further evidence of practitioner preference for the increasingly high-quality GP lenses available today. Internationally, GP use is similar to past years—12% of contact lens fits are with standard GP lenses, and an additional 1% are fit into corneal reshaping lenses (Morgan et al, 2014).
The areas of growth, or potential growth, remain scleral lenses, corneal reshaping designs, multifocals (both corneal and scleral), and hybrids. When the 70-member GP Lens Institute (GPLI) Advisory Board—consisting of practitioners who are known for their expertise in fitting GP and specialty soft lenses—were polled as to what they believed was the greatest advancement in GP lenses in 2014, 42 of the 46 respondents specifically indicated scleral lenses. When asked where they thought the GP market was going in the next five years, scleral lenses were again predominant, but the aforementioned categories of corneal reshaping, multifocals, and hybrids were also considered important by many of the respondents (Figure 1).
Figure 1. GPLI Advisory Board Member responses to: Where is the GP market going in the next five years?
Scleral Lenses
The scleral lens phenomenon continues to progress as more practitioners fit this modality and newer and more advanced designs enter the marketplace. Not only do these lenses change people's lives, but they are beginning to impact practitioner prescribing habits pertaining to healthy (astigmatic and presbyopic) eyes. There still exists the challenges of lens cost (if not reimbursed), and lens handling (with larger designs).
Surprisingly, when polled as to what percentage of each of six different contact lens corrective options they fit to their last 100 irregular cornea patients, the GPLI Advisory Board members, on average, fit 43.74% of them into scleral lenses (Figure 2). This, of course, reflects the prescribing patterns of a group of specialty contact lens fitters.
Figure 2. What percentage of each of the following contact lens modalities were fit on the past 100 irregular cornea patients?
Tables 1 and 2 provide a more balanced perspective as it pertains to prescribing habits of U.S. practitioners in general. These are the results of a survey on contact lens prescribing habits sent by Bausch + Lomb (B+L) to all optometrists in the United States, ultimately resulting in close to 300 respondents. Table 1 shows that their current prescribing habits with irregular cornea patients frequently or always include corneal GP lenses in more than 68% of the cases, as compared to approximately 19% with both sclerals and soft torics, 16% with hybrids, and 10% with specialty soft lenses for irregular corneas. However, Table 2 shows that more than 34% prescribed more scleral lenses this year than the past year, as compared to approximately 23% for hybrids, 20% for specialty soft, 8% for toric soft, and 6% for corneal GP lenses.
|Corneal GPs
|Scleral GPs
|Toric soft lenses
|Hybrid lenses
|Specialty soft lenses for irregular corneas
|Corneal GPs
|Scleral GPs
|Toric soft lenses
|Hybrid lenses
|Soft lenses especially designed for irregular corneas
It is evident that scleral lenses are the primary area of excitement for contact lens laboratories, according to Quality Contact Lens and the Contact Lens Manufacturers Association (CLMA) President Ken Leonhard: "I am very excited about scleral lenses and their initial comfort, in large part due to the remarkable success stories communicated to me by my practitioners."
Scleral Lens Fit Scales There have been new developments in scleral lens resources as well. The Michigan College of Optometry (MCO) contact lens faculty have developed the "Scleral Lens Fit Scales," which are available at www.ferris.edu/ScleralLensFitScales. This scleral lens fit assessment tool is based on a tear layer thickness guide (Dinardo, 2014). Participants in an online survey were asked to select which of several options best represented central clearance of a scleral lens design. They were then shown the MCO scleral lens fit scale system and subsequently were asked to grade the central vault of several lenses. The accuracy of all respondents increased significantly after using the lens fit scale. They, therefore, concluded that the MCO scleral fitting guide can improve both accuracy and confidence in assessing scleral vault.
Optical Coherence Tomography (OCT) and Scleral Lens Fitting Anterior segment OCT is a valuable tool for measuring the radii of anterior scleral curvatures by image processing and mathematical calculation (Choi et al, 2014). Caroline and André (2014) have shown that scleral lenses have a tendency to decenter slightly inferior-temporally based upon their OCT imaging observations at Pacific University. Inferior decentration results from several factors, including gravitational force secondary to the weight of the lens, the upper lid pushing the lens inferiorly, and OCT observations showing that the superior sclera is indeed higher compared to the inferior sclera. Therefore, when the lens is placed onto the eye, it lands first at the point of greatest elevation and then is forced in the opposite direction. In addition, as the nasal sclera is significantly higher compared to the temporal sclera (more in the right eye than in the left eye, on average), this results in a dark fluorescein thinning pattern observed in the superior-nasal portion of the peripheral cornea. They concluded that some of the new technology, such as toric haptic and quadrant-specific designs, may result in improved centration in these cases.
Experts Make Their Predictions About the Future of GP Lenses
Experts were asked, "Where do you see the GP market going in the next five years?" Here are their responses.
Clark Chang, OD: "Market share for mini-scleral and scleral lenses in regular corneas will likely see major growth, but we will need more long-term safety data for scleral/mini-scleral use."
Muriel Schornack, OD: "I would predict slow, steady growth, primarily for unique applications of [GP] lenses (sclerals, corneal reshaping)."
Joe Shovlin, OD: "Modest increase due to more sclerals being used; perhaps an increase in hybrid/multifocal."
Ken Maller, OD: "Increasing in the areas of sclerals, multifocals, and corneal reshaping."
Steve Byrnes, OD: "There will be a continued increase in the use of scleral lenses for compromised corneas. There will be limited use of sclerals on healthy eyes. The need for more oxygen transmission to the cornea will be addressed. Corneal reshaping growth will remain flat (no pun intended). Hybrids will lose ground to sclerals. Multifocal scleral options will increase."
John Laurent, OD, PhD: "Decrease in corneal GP lenses due to aging population of current wearers and intolerance of potential new wearers to accept any level of discomfort requiring adaptation. Increasing number of scleral fits as many more labs now manufacture them and more contact lens practitioners are learning to fit them. The scleral lens market may become saturated as more patients who have irregular corneas are fit with them. At the same time, soft lens technology continues to improve, with ever better custom and daily disposable options."
Susan Gromacki, OD, MS: "Increasing for sure, as more practitioners become familiar with fitting scleral and multifocal lenses. Also, if scleral lens costs can decrease to the point that we are using them on normal corneas, the GP market will increase exponentially."
Jack Hartstein, MD: "Increasing use of hybrids."
Doug Benoit, OD: "Increasing; multifocal and scleral designs will likely be the leaders."
Tom Quinn, OD, MS: "Corneal GP spheres will continue to decline; sclerals will continue to grow; and corneal reshaping may decrease if center-distance soft [multifocals] take off for myopia control."
Cheri Vincent-Riemer, OD: "I see it increasing. It is exciting to see the impact that scleral and mini-scleral lenses are having. Patients are very excited about both vision and increased comfort."
Tim Edrington, OD, MS: "Declining slowly for the 'non-specialized' segment of the GP market, and slowly increasing for scleral and corneal reshaping markets."
Robert Maynard, OD: "Actually, I am an optimist about the growth. Sclerals will produce an upswing in the use of GP lenses due to the comfort factor being greater, and the vision superior. The hybrids will also increase in the market with their multifocals and, again, superior vision."
Roxanna Potter, OD: "Increasing in ortho-k, particularly for myopia control. Also increasing in sclerals."
Gloria Chui, OD: "Increasing; growth in specialty contact lenses, including scleral lenses, corneal reshaping, and hybrids (with better designs and technology)."
Craig Norman, FCLSA: "Growth—for the first time in a while. More scleral indications, improved acceptance of corneal reshaping for myopia control, and additional hybrid designs and manufacturers."
Barry Eiden, OD: "Stable based on reduced use of corneal GPs, but growth of sclerals, corneal reshaping, and, to some degree, hybrids."
Melissa Barnett, OD: "Increasing with scleral lenses, especially for normal eyes, with an increase in scleral multifocal lens designs."
Michael Ward, FCLSA: "Continued increase in scleral lens use and decrease in corneal GP use, decreasing hybrids, increasing custom soft contact lenses."
Carmen Castellano, OD: "Mild-to-moderate increase. Still too much of the 80/20 rule applies: 80% of the lenses are being fitted by 20% (or less) of the practitioners."
There is much recent interest is the use of OCT images to assess how much a scleral lens settles (i.e., decreases in tear lens sagittal height) over time. Recent studies have found that overall settling of scleral lenses averages approximately 100 microns, although it can vary among different designs and depends on the amount of time that the measurement is made after initial application. The great majority of settling occurs in the first four hours (Kauffman et al, in press; Michaud, 2014; Caroline and André, 2012).
New Designs Scleral toricity tends to increase in irregular cornea patients and can impact alignment with larger-diameter scleral lenses, possibly resulting in problems such as specific peripheral blanching, rocking, excessive movement, and decentration. Increased patient awareness can also result, so toric peripheral curves are recommended for larger (≥18mm overall diameter [OAD]) scleral lenses (Bennett et al, 2014). Many of the recently introduced lenses utilize exciting new manufacturing technologies that allow for a more precise alignment of lens periphery to sclera.
Enter the Zenlens (Alden Optical) with Dr. Jason Jedlicka as a designer. Manufactured in Boston XO and XO2 materials (B+L) with OADs of 16.0mm and 17.0mm, it is available in both prolate and oblate designs to fit a wide range of corneal shapes. It offers seven different edge profiles as well as the ability to correct residual astigmatism on the front surface and incorporate toric peripheral curves to create better scleral alignment (Figure 3). It also incorporates a so-called "Smart Curve" in an attempt to maintain a constant base curve despite variation in lens sagittal depth (Figure 4).
Figure 3. Alden Optical's Zenlens is made in the Boston XO and XO2 materials, has OADs of 16.0mm and 17.0mm, and is available in both prolate and oblate designs.
Figure 4. In this example, the Zenlens' Smart Curve maintains a constant base curve despite the variation in lens "sag." This is very useful when you need to optimize corneal clearance, but are satisfied with the base curve.
The EyePrintPro (EyePrint Prosthetics, LLC) is a prosthetic scleral cover shell that improves vision by creating a new, smooth refractive surface for the eye. The EyePrintPro, like a fingerprint, is unique to each individual. It starts with the EyePrint Impression Process, which captures the precise curvatures of the entire ocular surface. This comfortable and gentle molding process allows practitioners to fit complicated ocular irregularities with precision. The EyePrint Impression is shipped to EyePrint Prosthetics for digitizing and prosthetic scleral cover shell design. Using 3D scanning and computer numerically controlled (CNC) machining systems, an exact match is achieved to each individual cornea and sclera (Figure 5). The concept of EyePrint Prosthetics was developed by Dr. Christine Sindt in collaboration with Keith Parker, president of Advanced Vision Technologies (AVT). This is a promising new option, certainly for irregular cornea and dry eye patients.
Figure 5. EyePrintPro uses 3D scanning technology and CNC machining systems to achieve an exact match to each individual cornea and sclera.
There are many other new designs, either recently introduced to the market or soon to come, including the following:
• Blanchard Contact Lens has introduced an Anterior Surface Toric add-on for its Mini Scleral Design, Onefit P+A, and Onefit Cone lenses featuring Sector Prism Technology process, which confines the prism ballast within an area of lenticulation outside of the optical zone while maintaining a uniform edge thickness for the entire circumference of the lens. The company is also working on the final design characteristics of a reverse geometry scleral lens designed specifically for post-refractive surgical oblate corneal topographies. This new design may increase ease-of-fit and visual performance for highly ectatic, oblate, post-refractive surgical patients.
• Menicon introduced Menicon Z Large Diameter Blanks in clear tints last December to meet the demands of laboratory customers desiring scleral lenses in a hyper-Dk (163) lens material.
• The Custom Stable lens by Valley Contax is now available from 14.8mm to 17.8mm OAD. Front cylinder options, as well as toric landing zone options for irregularly astigmatic corneas and scleras, are also now available.
• A new simplified AVT Scleral Diagnostic Fitting System (AVT)—including a wide selection of central sag values, limbal clearance zones, and tangent carrier angles—will be introduced at the American Academy of Optometry meeting in November in Denver. The diagnostic lenses will be labeled to be easier for practitioners to utilize and understand, and a marking system will allow for more accurate evaluation of the limbal area.
• Art Optical Contact Lens, Inc. intends to release a new scleral lens design by the end of 2014.
Scleral Lenses for Healthy Eyes One of the great controversies in the GP industry today is whether scleral lenses for the correction of normal eyes (i.e., astigmatic and presbyopic) will ultimately represent an important segment of the contact lens industry. When polled, approximately 61% of the GPLI Advisory Board thought that they would have a mild impact in the next three years, as opposed to none or very little impact (13%), moderate impact (15.2%), or will become a mainstream correction option (10.9%) (Figure 6).
Figure 6. In the next three years, what impact do you feel that scleral lenses for healthy eyes (i.e., astigmats, presbyopes) will have on the contact lens market?
With initial comfort rivaling soft lenses (Woo, 2013) and the benefits of rigid lens optics, time will tell whether these benefits allow them to compete favorably with other contact lens designs and materials. Many laboratories believe that they will have an impact based upon the many new multifocal designs being introduced (to be discussed in the multifocals section).
Other Irregular Cornea Designs
The benefits and applications of corneal GP and hybrid designs are still evident today, and the latter modality appears to be increasing in use. Rigid lens optics are important for the great majority of irregular cornea patients, and the ability to correct for wavefront aberrations can provide an even greater benefit visually to GP-wearing keratoconus patients (Yang et al, 2014).
The benefits in post-ocular trauma cases are evident as well. Twelve young boys, all less than 15 years of age and having experienced ocular trauma, were fit into GP lenses (Pradhan et al, 2014). Eleven of the 12 boys were still wearing the lenses 15 months later, with seven achieving a greater-than-two-line increase in visual acuity as compared to spectacle correction.
It is also interesting to note that bitoric lenses may have applications with certain irregular cornea patients, often post-surgical patients exhibiting mixed astigmatism via corneal topography (Bennett et al, 2014). Recently, Phan et al (2014) compared records of post-penetrating keratoplasty (post-PK) patients being managed with bitoric GP lenses versus controls (post-PK patients wearing spherical GPs). The average astigmatism in the bitoric group was 10.00D, as compared to 3.30D in the spherical group. The contact lens-corrected visual acuity between the two groups was the same, as was the number of contact lenses per eye to achieve success, so it was concluded that bitoric GP fitting in post-PK patients is not more complex than spherical fitting is.
Differing Opinions of Myopia Control
Practitioners in the United States, such as Dr. Cary Herzberg, and manufacturers, such as Dan Bell (Corneal Design), are seeing the benefits of myopia control in China, where they visit often and fit many young people. According to Dan Bell: "I was recently in Shanghai and observed a rapid increase in orthokeratology interest. I had four people with me as consultants, and they worked in various cities over a period of several days. The experience for them has been an eye opener. Dr. Steve Feinberg was in Dalian, where he was able to see 92 patients in one 10-hour day. I am working for three different companies here, and they are asking for much greater production capacity for the future. I wish the United States was just a little more concerned about myopia progression, as the parents in China are so happy to have this technology."
Al Vaske (Lens Dynamics) agrees: "I am hearing more positive buzz about corneal reshaping by U.S. practitioners. I do not know why U.S. practitioners have been reluctant to use this procedure until recently. There is an abundance of clinical experience worldwide that shows corneal reshaping to be safe and effective. I believe corneal reshaping has been a missed practice enhancement procedure in the United States."
Troy Miller (Accu Lens) feels that there is great potential for a larger design: "There are certainly numerous requests, notably from our international accounts, for an orthokeratology design that migrates into a mini-scleral design."
New designs are entering the market as well. Hybrid lenses, in particular, can result in good patient satisfaction and vision-related quality of life (Hashemi et al, 2014).
• SynergEyes, Inc. is expanding its current line of hyper-permeable UltraHealth designs; the company will soon release Ultrahealth Flat Cornea for extremely oblate post-surgical corneas.
• Carter Contact Lens, Inc. has been developing a large-diameter (11.0mm) reverse geometry GP primarily for fitting corneal transplants, post-RK, failed LASIK, corneal ring segments, and large cones. Its fitting set is available in two optical zone diameters of 7.0mm and 8.0mm; the reverse curve width allows the lenses to vault a large diameter—8.2mm and 9.2mm, respectively. The reverse curve difference in the fitting set is four diopters; however, all parameters can be made to order. The lenses can be made in toric and bifocal designs.
Corneal Reshaping
According to recent data provided by Dr. Michael Lipson (2014), estimates indicate that 6,000 to 8,000 U.S. practitioners are certified to fit corneal reshaping lenses. The certification necessary to be able to fit these designs is relatively easy and can be performed online either via www.paragoncrt.com for Paragon Vision Science's Corneal Refractive Therapy designs (i.e., Paragon CRT and RG-4) or www.bausch.com for any of the Vision Shaping Treatment designs (i.e., BE Retainer, Precision Technology Services Ltd.; CKR, Eye Research Associates, Inc.; Contex OK E-System, Contex, Inc.; DreamLens, various labs; Emerald, Euclid Systems Corp.; NightMove, Gelflex and Advanced Corneal Engineering, Inc.; MiracLens, MiracLens, LLC; Orthofocus, Progressive Vision Technologies; Super Bridge and E-Lens Overnight Orthokeratology Lens, E&E Optics; Vipok, Vipok Inc.; and Wave Contact Lens System, Custom Craft Lens Service, Metro Optics, and X-Cel Contacts).
The challenge appears to be educating consumers, notably parents, about the benefits and safety of corneal reshaping. The safety issue has recently been addressed by Bullimore et al (2013), who found that the overall estimated incidence of microbial keratitis (MK) with corneal reshaping is 7.7 per 10,000 years of wear; it is 13.9 per 10,000 patient-years for children. They concluded that the risk of MK with overnight corneal reshaping contact lenses is similar to that with other overnight modalities.
It also has been found that if parents are informed and feel that the modality is safe, and if they are informed of the positive evidence of the myopia control effects, they are quite receptive to this modality for their children (Cheung et al, 2014) (see "Differing Opinions of Myopia Control" on p. 27).
Recent research is continuing the trend toward evaluating designs that result in a peripheral myopic defocus to retard eye growth, and the next few years should result in much information about how to design corneal reshaping GP lenses and peripheral plus power soft lenses to optimize myopia control. The design of a corneal reshaping lens—incorporating a reverse curve—as well as the resulting corneal changes can impact eye growth. Recently, it has been reported that corneal reshaping induces non-uniform changes to the central and paracentral regions (Maseedupally et al, 2013). Myopia control may be influenced by this non-uniformity, which may influence peripheral refraction profiles. In addition, it has been found that there is greater likelihood for success with corneal reshaping if the following conditions exist: lower initial myopia, low levels of parental myopia, longer anterior chamber depth, greater corneal power, more prolate corneal shape, and larger iris and pupil diameters.
Paragon Vision Sciences recently introduced some enhancements to its CRT fitting process. In April 2014, the company introduced an enhanced CRT Diagnostic Dispensing System to allow for temporary dispensing of the diagnostic lenses until the final parameters are determined and new lenses are ordered in Paragon HDS 100 material. Once the new lenses are dispensed, the diagnostic lenses are cleaned, disinfected, and replaced to the CRT set for continued diagnostic use.
In addition, the GP material in the enhanced CRT Diagnostic Dispensing System was changed from Paragon HDS 100 (100 Dk, ISO/ANSI Method) to Paragon HDS (40 Dk, ISO/ANSI Method.) Paragon has always concluded that the higher-Dk material, Paragon HDS 100, was the best material for long-term wear. For relatively short-term diagnostic purposes, however, Paragon HDS offers sufficient Dk and improved durability.
A second enhancement is the handling tint of the CRT lens, which has changed in the updated Diagnostic Dispensing System from light green to light orange. The new orange tint is to differentiate the CRT diagnostic lens from the CRT prescription lens. The orange tint does not affect evaluating the tear pattern on the eye, with or without a Wratten filter.
Finally, Paragon CRT corneal reshaping lenses feature a laser mark of the lens parameters (base curve, return zone depth, and landing zone angle). The new orange CRT diagnostic lens features an additional, larger laser mark that spells out "Not For Sale." This is to distinguish diagnostic lenses from those dispensed as prescription lenses. CRT patients will benefit in that once the final parameters are determined with the diagnostic lenses, the patient will be ensured to receive fresh, new lenses manufactured in Paragon HDS 100, rather than lenses that may have been worn multiple times by previous patients and returned back into the CRT Diagnostic Dispensing System. While this has not been an issue to this point in time, with the rapid expansion in CRT fitting, Paragon believes that this will be a future benefit for patients and practitioners alike.
A number of new corneal, hybrid, and scleral multifocal lens designs are being introduced, reflecting the continuing interest in lenses incorporating rigid lens optics for satisfactory—if not excellent—vision at multiple distances.
Corneal Designs Here is a look at several new corneal designs.
• Conforma Contact Lenses now offers expanded fitting options for its VFL 3 Progressive Multifocal lens design. Recently added Toric Peripheral Curve (TPC) options will offer astigmatic presbyopes the opportunity to experience quality vision at distance, intermediate, and near. The new TPC options will help improve corneal alignment, centration, and comfort for ≥2.00D of corneal astigmatism. This improved lens-to-cornea fitting relationship will maximize lens centration and add capabilities of the VFL 3 aspheric design.
• Art Optical will be releasing a new center-near GP design by the end of 2014 or the beginning of 2015. It will feature a controlled near zone diameter with aberration-controlled distance optics. This new design will supplement Art Optical's Renovation Multifocal design series and join its recently released mPower! simultaneous center-distance option.
• AVT's Naturalens Progressive modality—featuring the Variable Inverse Periphery Technology that offers high add options with its multi-zone aspheric front surface design—now offers wider mid-range optics with an expanded intermediate zone with the Naturalens Mid-Pro. This allows for a wider field of mid-range visual requirements such as computers and office work. In addition, AVT's new Transbylite Thin translating bifocal offers a viable option for patients desiring clear, consistent near focal vision. The Transbylite back surface incorporates the VIP Technology to help provide a forgiving, comfortable fitting relationship. The VIP Technology provides improved tear exchange, potentially allowing for a smooth transition of lens position from distance to near and back to distance visual demands.
Hybrid Designs SynergEyes is in the process of developing a multifocal in the UltraHealth design and is hopeful to introduce it to the market in the second quarter of 2015.
Scleral Designs Two options are becoming available in the scleral design space.
• Anterior surface aspheric multifocal optics for presbyopic scleral lens patients can now be ordered with the Blanchard Onefit P+A lenses. Optics are simultaneous plus centered and are produced in two distinct "Add Profiles": a dominant eye profile and a nondominant eye profile. The dominant lens drops plus power within a shorter radius of the center of the lens, and the nondominant eye profile holds plus further within a radius from the center of the lens. All that is required is the manifest add correction and which eye is dominant.
• TruForm Optics has available both the DigiForm and the Tru-Scleral lenses in multifocal powers for presbyopic patients.
Other New Developments
Plasma Treatment One of the burning questions of the last five years or so is whether all GP lenses should be plasma treated, a process that thoroughly cleans the front surface of the lens and helps optimize initial wettability and possibly initial comfort. Although questions remain pertaining to how long this treatment lasts and what cleaners, treatments, etc., negatively impacts this treatment, the positive attributes appear to outweigh the challenges. Another benefit is that plasma treatment significantly decreases bacterial adhesion to fluorosilicone acrylate contact lenses (Wang et al, 2013).
Back Toric or Bitoric? This was the subject of a recent GP Insights column in Contact Lens Spectrum (Bennett and Parker, 2014). Considering that back-toric-only lenses induce a residual astigmatism that can reduce visual acuity, in combination with improved manufacturing methods for bitoric lenses, it has been argued that—with rare exception—back-toric GP lenses are not indicated for highly astigmatic patients. The only exception is when a patient has residual astigmatism that is corrected by the back-toric-induced cylinder. This can be determined easily via the GPLI Toric and Spherical Lens Calculator (www.gpli.info), which will recommend a back toric lens in these rare cases.
Resources Of course, the most important resource for practitioners fitting and troubleshooting GP lenses continues to be the laboratory consultants. These individuals can guide fitters through the entire cycle of lens selection, fitting, and troubleshooting while providing diagnostic sets and directing them to their website for fitting resources, often including videos and webinars. For scleral lenses, B+L/Boston has a Scleral Lens Series on YouTube; the GP Lens Institute has a series of archived webinars; and the Scleral Lens Education Society (www.sclerallens.org) offers numerous resources and videos as well as the opportunity to become a Fellow of this organization. For very comprehensive training on specialty contact lenses—including sclerals, corneal reshaping, presbyopia, coding and billing, and other related topics—the Global Specialty Lens Symposium (GSLS) (www.gslsymposium.com), to be held Jan. 22 to 25, 2015 at Bally's Hotel and Casino in Las Vegas, is recommended. In addition, Dr. Eef van der Worp's I-Site newsletter (www.netherlens.com) continues to provide a wealth of timely GP articles and listing of events on a monthly basis. The GPLI also continues to be a comprehensive source of GP educational resources including monthly webinars, archived webinars, and numerous other resources pertaining to spherical and all specialty GP lenses. A comprehensive coding and billing module from Dr. Clarke Newman and a Laboratory Consultant FAQs module were introduced in 2014, and a comprehensive staff training module is coming in 2015.
It is apparent that the GP industry remains alive and well and continues to thrive in 2014. Look for exciting new developments, particularly in the areas of scleral and corneal reshaping lenses in 2015. CLS
For references, please visit www.clspectrum.com/references and click on document #227.
GP Lens Institute Advisory Committee members: Roxanne Achong-Coan, OD; Bruce Anderson, OD; Mark André, FCLSA; Richard Baker, OD; Bruce Baldwin, OD, PhD; Melissa Barnett, OD; Doug Benoit, OD; Richard Brannen, OD; Marlane Brown, OD; Mile Brujic, OD; Jill Bryant, OD; Steve Byrnes, OD; Karen Carrasquillo, OD, PhD; Carmen Castellano, OD; Clark Chang, OD; Walter Choate Jr., OD; Gloria Chui, OD; Robert Davis, OD; Greg DeNaeyer, OD; Tim Edrington, OD, MS; Barry Eiden, OD; Art Epstein, OD; Bob Grohe, OD; Susan Gromacki, OD, MS; Jack Hartstein, MD; Cary Herzberg, OD; Jason Jedlicka, OD; Beth Kinoshita, OD; John Laurent, OD, PhD; Michael Lipson, OD; Derek Louie, OD; Ken Maller, OD; Amanda Marks, OD; Robert Maynard, OD; Brittney Mazza, OD; Brooke Messer, OD; Clarke Newman, OD; Craig Norman, FCLSA; Neil Pence, OD; Roxanna Potter, OD; Tom Quinn, OD, MS; Phyllis Rakow, FCLSA; Renee Reeder, OD; Susan Resnick, OD; John Rinehart, OD; Jack Schaeffer, OD; Muriel Schornack, OD; Joe Shovlin, OD; Jeff Sonsino, OD; Shawna Vanderhoof, OD; Cheri Vincent-Riemer, OD; Michael Ward, FCLSA; Ron Watanabe, OD; Bruce Williams, OD; Stephanie Woo, OD; and Joe Yager, OD.
CLMA Representatives: Josh Adams, Valley Contax; Dan Bell, Corneal Design; David Bland and Claire Venezia, B+L; Kurtis Brown, Menicon; Lee Buffalo, Blanchard; Dr. Mike Cook, Carter Contact Lens; Ken Crawford, TruForm Optics; Linda Glover, X-Cel Contacts; Arch Holcomb, ABB Concise; Mike Johnson, Art Optical; Dr. Jim Kirchner, SynergEyes; Troy Miller, Accu Lens; Keith Parker, AVT; Kevin Sanford, Conforma; Pam Scoggins, Paragon; Tom Shone, Alden Optical; and Al Vaske, Lens Dynamics, Inc.
Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. You can reach him at firstname.lastname@example.com.


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Tuesday 29 January: Inaugural Lecture by Professor Elaine Boyle titled 'Not quite ready for the big, wide world: the challenges of moderate-late prematurity'
On Tuesday 29 January 2019, Professor Elaine Boyle, Professor in Neonatal Medicine within the Department of Health Sciences, gave her lecture entitled:
'Not quite ready for the big, wide world: the challenges of moderate-late prematurity'
Most research studies in premature babies have looked at the tiniest babies, born more than eight weeks early. However, more than three quarters of all premature babies are born just four to eight weeks before their due date. Although these babies are born closer to full term, they are still not fully mature. Few studies have focused on them and they have sometimes been called " the forgotten babies". This talk discussed what we now know about these babies, what we still need to learn, and considered how we might work to optimise their outcomes.
Elaine is Professor of Neonatal Medicine at the University of Leicester and Honorary Consultant Neonatologist at the University Hospitals of Leicester NHS Trust. Her time is divided between research and clinical work on the Neonatal Unit. Elaine initially trained and worked as a nurse for a number of years before changing direction to study medicine at the University of Sheffield. She qualified as a doctor in 1993 and completed postgraduate training in paediatrics in Sheffield and Birmingham. Before taking up her post in Leicester in 2006, she trained in academic neonatal medicine in Edinburgh and at McMaster University in Canada.
Elaine's research has focused on three main areas: the assessment and management of pain in newborn babies; milk feeding in premature babies; and the effects of premature birth on infant and childhood outcomes. Her most recent research has focused on babies born between two and eight weeks before their due date, and she was the lead for the Late And Moderately preterm Birth Study (LAMBS), one of the first large studies in these babies.
Elaine's other roles include Children's Specialty Lead for the East Midlands Clinical Research Network, Editor-in-Chief for the journal 'Paediatric and Neonatal Pain', Editorial Board member for 'Seminars in Fetal and Neonatal Medicine' and current Chair of the International Society for Evidence-Based Neonatology.


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Meet James Goode
Dr. James Goode, currently HR Manager, Educator Certification has been appointed Principal of Learey Technical College, effective November 9, 2015. Dr. Goode believes that all students need the proper preparation for life skills. He is ready to embark on a new journey to provide students with life skills at Learey. Dr. Goode enjoys traveling and spending time with his family, two Goldendoodles (Nadal and Iker) and cat - Sarge. Congratulations Dr. Goode!View Full Album


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March was a pretty full tv plate. I ended up with bronchitis one week. That was fun. NOT. I very much had a lack of wanting to do anything except be a potato, so I changed my name to Spud :P
Perusing Hulu, I found some repeats to watch.... I'm a huge "Alien" fan, and love the Harry Potter series. I wish Rick Riordan would put his Egyptian series, The Kane Chronicles, on the big screen!
Our family movies nights this month were A.W.E.S.O.M.E.! We watched Justice League & the new Jumanji. Was NOT disappointed... Flash had us laughing, and Aquaman is just yummy. I will say, I'm not a fan of Ben Affleck as Batman. Nick didn't think he would enjoy Jumanji, but he was WRONG! I mean c'mon - lookit the cast! lol!
In TV series land, these shows are on my playlist, and I'm loving every second! I've finished Jessica Jones already (seriously hating on Trish now) and Gotham got really good this month. I've gotten behind on iZombie because I watch that one with the girl and she's been busy with school and work the last couple of weeks.
Supernatural did not disappoint us this month either, especially with the "Scooby-Natural" episode!
The kids and I looooooooooooooooved it LOL!
Have a great weekend!
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August 2020


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Congratulations to Sarah VanDeBerghe, Communications Teacher at PRMS, who has been selected as the USD 231 Secondary Teacher of the Year!
Sarah has taught in the Gardner Edgerton School District for the past nine years. She is/has been a Communications Teacher at Pioneer Ridge Middle School for the past six years. Prior to this, she taught three years as a fifth grade teacher, also at PRMS.
In an effort to promote acceptance for all students in and around the school community, Sarah has led building-wide efforts such as 'Walk the Track for Autism' (2017) and 'Step Up for Down Syndrome' (2018). Sarah also serves as district trainer for Nonviolent Crisis Intervention (CPI).
Her students are her passion and she is proud to represent the district as Secondary Teacher of the Year.
Sarah will now move to the state level and participate in the KTOY selection process. The KTOY Program recognizes a Regional Finalist for each of the eight (8) regions. From the eight Representatives, a Kansas Teacher of the Year is selected. As a team, these designees are provided professional learning opportunities, make visits to school districts around the state, advocate for education at the state level, and represent teachers as a whole across Kansas. The Kansas Teacher of the Year is nominated to represent Kansas in the National Teacher of the Year Program. For additional information about the state program visit www.ksde.org.
Congratulations, Sarah!!!


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Ghana's voluntary national review on SDGs: An all-inclusive process
Deputy Minister of Ashanti Region Ms. Elizabeth Agyemang at the event
In July this year, Ghana will be among 47 countries that will be presenting findings of their national review of the Sustainable Development Goals (SDGs) implementation. This will be the first time for Ghana and the second time for seven other countries, including Sierra Leone, a West Africa neighbour.
The Voluntary National Review (VNR) on the SDGs will take place during the High-level Political Forum on Sustainable Development (HLPF) in New York from 8 – 19 July. The central platform for follow-up and review of the 2030 Agenda for Sustainable Development and the SDGs, the HLPF will be held under the auspices of the Social and Economic Council of the United Nations.
Hailed as a critical SDG stocktaking event, the Forum presents a unique opportunity to highlight progress and action at the local and country levels and how those efforts can collectively make a greater impact globally.. The VNRs aim to strengthen policies and institutions of governments and to mobilize multi-stakeholder support and partnerships for the implementation of the SDGs.
Ghana officially launched the start of the review process in January this year paving the way for the SDGs Implementation Committee to begin work on multi-stakeholder engagement and consultations, information gathering and consolidation and on data analysis to examine the level of implementation of the SDGs in the country.
Since the beginning of the process, the United Nations in Ghana and other key stakeholders have stepped in support of the NDPC-led stakeholder engagements and sensitizations. The United Nations-supported financially as well as with expert advice through its Data Working Group and other interagency working groups.
Given the significance of the availability, accessibility and analysis of good data, the Ghana Statistical Services data team members were trained on data and metadata templates and assisted to compile the required data for the VNR report.
The UN conducted a U-Report to receive feedback from young people on their understanding of the SDGs, the result of which was presented at the stakeholder consultations. The UN-developed Youth Development Index contributed immensely in assessing progress on youth engagement in the implementation process.
Migration is a critical focus area that, when well-managed, could provide great opportunities for countries such as Ghana. And to ensure it is not overlooked, the UN made accessible the Migration Governance Index, in order to capture data and SDGs and migration interventions, especially in the area of governance, in the country.
Additionally, over 10,000 youth were reached through a social media campaign on migration. In partnership with the CSO Youth Advocate Ghana (YAG), the UN was able to engage and solicit youth views on migration to be captured in the report.
Stakeholder consultations were held in Cape Coast, Kumasi and Tamale. The three cross-cutting issues bordering on Youth engagement in implementing the SDGs, Leaving no One Behind and Synergies among stakeholders for the Goals. Throughout the three key stakeholder consultations, the United Nations in Ghana facilitated some of the sessions and supported NDPC and Civil Society Organisations in fostering an inclusive and participatory process of engagement and ensured topics discussed were comprehensive and strategic.
The team, led by the NDPC, reached out to the Ghana Federation of the Disabled, students in primary and secondary schools, market squares, lorry stations, and local folks like fishermen and farmers. News editors and reporters were targeted for training with the expectations that their increased knowledge and understanding on the SDGs will intensify discussions around them and persuade the public to hold duty bearers accountable.
At the end of the consultations and engagements, the NDPC prepared a progress report. The report was validated by stakeholders including development partners, Civil Societies and private sector, youth groups, media, academia and national development planners at various sessions organized by the NDPC and the Ministry of Planning. The validation sessions provided stakeholders and UN technical officers, the opportunity to examine the content of the report and make useful input prior to its finalisation.
Ghana's participation in the 2019 VNR, the first since the adoption of the SDGs, is particularly significant since, for the first time, a progress report on the implementation of the Agenda 2030 is available. The progress report will also provide useful indicators moving forward.
There is no doubt that the VNR process has demonstrated the efficacy of inclusiveness in the implementation of the SDGs. Inclusive engagement allows for a common understanding of the issues to be addressed and therefore makes room for the needed support from all stakeholders.
Beyond the VNR, the United Nations, through the UN Sustainable Development Partnership (UNSDP) which was signed with the Government of Ghana in 2018, will continue to support the country's ambitions to achieve the SDGs for a shared prosperous economy, social investment in people, inclusive accountable governance institutions, and a protected and safe environment.


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I have been SO busy trying to get things ready for the Carolina Designer Craftsmen Fine Craft and Design Show on Thanksgiving Weekend I just haven't had time to post anything. Please come by and see me at the show.
A bit of new news ...I was recently featured in an article in the News and Observer about my journey into rug hooking. I've heard from people I haven't seen in 25+ years. Thanks to all of you who have sent good wishes my way!


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"Bill daaahlin', I decided to surprise you with a nice long vacation in the South Pacific. It's really pretty in Moorea this time of year, and you can repair our relations with the French while you are there and that should take you at the very least two months.
Here is some money for a pareo and pina coladas with little umbrellas. If you send me a postcard, I'll make sure to frame it. Au revoir!"
If I were Hillary, I would have exiled the man a long time ago.
Ever since January when Bill Clinton re-injected race into the campaign despite recent party bigwig pleas not to do so (the Jesse Jackson comment), I have been wondering about his motives (incidentally, Ted Kennedy endorsed Obama a few days later.) Does Bill Clinton really want to be the spouse of the Decider-in-chief? Does he really want to run the risk of his spouse turning into a better president than he once was?
When during a speech, Bill Clinton not only disinters the subject of Bosnia, but also brings up the fact that Hillary is sixty, and that "when they (the reporters) are sixty, they will forget something when they are tired at 11 o'clock at night too", what logically comes to mind is the question of what happens to a sixty year old at 3 am if she can't handle 11 pm. You know: that phone call.
I just don't buy the whole white knight in shining armor routine. I think he is out to get her. Consciously or not. Not that I care one way or the other, but I can't help but question.


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On November 14, Engility joined the 2018 GeoPlunge tournament at the St. Louis Cortex. More than 60 fourth graders from three St. Louis public elementary schools competed for top spots in the second annual GeoPlunge tournament.Read More
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An easy but a beautiful trek. You trek along the Singalila ridge which forms the border line between India and Nepal. You get to see the spectacular views of Kanchenjunga, the third highest peak in the world. It also offers the view of Everest, Lhotse and Makalu.
A trek to Sandakphu, the highest point of the Singalila Ridge, offers the time spent in the intact nature, boasting the views of four highest peaks in the world including Mount Everest. Reaching at a height of around 3636m, this trek lets you witness 4 of the 5 highest peaks of the world called Lhotse, Makalu, Kanchenjunga and Everest in a magnificent snowy arc. The trek across the Singalila Ridge and Phalut proffer the outstanding views of Kanchenjunga, along with the vistas dotted with seasonal flowers blooming all across the valley. The trail turns exciting the moment it enters the villages of Gorkhey and Samandan.The night stays at secluded trekkers hut further enhance the adventurous feel perfectly
Join our organized trek and soak up the views of the sky and the mist over the mountains. If youre there in time for the wildflower bloom, enjoy the colors and fragrances of them.
Itinerary in Brief:
Day 1 Reach Jaubari (5-6 hours)
Day 2 Jaubari to Tumling (6-7 hours)
Day 3 Tumling to Kalipokhri (6-7 hours)
Day 4 Kalipokhri to Sandakphu (3-4 hours)
Day 5 Sandakphu to Sepi (6-7 hours)
Day 6 Sepi to NJP/Bagdogra
Never miss a great event & get weekly updates of great events.


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Thank you so much, everyone, for your support. We are coming up with amazing and mind-blowing videos. Just stay connected and learn fantastic things which will help you to grow your business.
The way to develop the best that is in a person is by appreciation and encouragement.
100K Subscribers Thank You So Much
Learn to be thankful for what you already have, while you pursue all that you want.
Be thankful for what you have; you'll end up having more. If you concentrate on what you don't have, you will never, ever have enough.
Enjoy the little things, for one day you may look back and realize they were the big things.


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Pottendorferstrasse 69, 2523 Tattendorf
Apr-27 to Apr-30, 2020
To register for this event, please visit www.kriya.org/registration .
Free board and lodging; Arrival Sunday April 26th evening, departure Friday, May 1st morning;
These days offer the opportunity to connect our spiritual practice with practical support and help in the house and garden. Seva is your voluntary contribution and offers the chance to be part of the self-organized project 'Kriya Yoga Centre'. Each day there will be guided meditations at 5:45 a.m. / 11:30 a.m. / 7:00 p.m.
Acharyas: Swami Mangalananda Giri, Swami Karunananda Giri
Contact Details
|Kriya Yoga Centre Vienna
|+43 2253 81491
You must be logged in to access this information. Login accounts are available only to those already initiated into Kriya Yoga in the lineage of Paramahamsa Hariharananda and Paramahamsa Prajnanananda. If you do not have a login account, please call or email the contact person or the location that is hosting this event to find out more about ride and room sharing.


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A few days after the end of the 2019 Consumer Electronic Show, the outcome report for Shin Software is definitely positive.
Stefano Provenzano, CEO of the SHOWin3D creative software house, in fact declares: "I am definitely satisfied with this experience in Las Vegas because I have confirmed that the digital transformation process will soon extend from the manufacturing to the distribution sector and our platform has received consensus and interest among the main players on the international markets".
"If consumers - Provenzano continues - require devices and applications aimed at maximizing the user experience with the right balance between interactivity and information, SHOWin3D represents, from the point of view of the seller, the ideal tool to guide users towards a successful conclusion of the purchasing process ".
Shin Software srl
www.showin3d.com - email@example.com


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Enhancing the Business Climate in East Lincoln.
The East Lincoln Business Association exists to support and strengthen businesses located in East Lincoln by providing opportunities for networking, promotion and representation.
The goal of ELBA is to build a dedicated and growing network of people that will enhance the business climate of East Lincoln. We discuss the current events impacting on our businesses and how, using the collective experience and voice of the group, we can deal with those opportunities.
Our Monthly Meetings
Join us the third Thursday of every month for our ELBA luncheon at Hillcrest Country Club
9401 E. O Street, Lincoln, NE
ELBA currently has 80+ active members that meet monthly to discuss the events impacting our business environment.
Join ELBA
Joining the East Lincoln Business Association is easy! Initial annual membership cost is $50 with a renewal of $40 per year.
Would you like to learn more about ELBA?
The monthly ELBA Luncheon is held the third Thursday each month and is open to the public. and is held at HillCrest Country Club, 9401 E. O Street, Lincoln, NE. We ask that you make an advance reservation. The buffet line will open at 11:30 am; the meeting begins at 11:50 am and ends promptly at 1:00 pm. The luncheon cost is $16.00, but there is no charge to just attend the meeting. Please click the button to RSVP.


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Submitted by Desert Insurance Solutions
La Quinta, CA: Here in California we've had one of the worst fire seasons ever. Property damage has been concentrated in the Camp Fire (northern CA) and the Woolsey Fire (Malibu). Total insurance payouts are expected to near $20 billion.
Yet for many individuals even that won't be enough to rebuild because the dwelling limits in their homeowner's policy is too low. Many people ask why dwelling limits are higher than market value.
Your home's market value (what it will sell for) is determined by demand, inventory, appreciation potential, interest rates and even tax policy. Your home's dwelling limit (cost to rebuild) is determined by construction cost with new building codes, materials, labor, architect plans, contractor profit, demolition and debris removal. Unless your home is very new, it can't be rebuilt exactly; insurance provides for a new upgraded home that looks like your old home. It has been estimated new building codes alone add over 35% to the cost of a new home compared to the existing stock. And if there's a disaster, construction resources are in short supply so the cost goes way up.
With higher end homes the carrier will conduct an inspection and determine dwelling limit. But for most homes dwelling limit is more arbitrary. Unfortunately, there are some homeowners who believe insurance is a commodity and insist on a low price. A low dwelling limit, or any other form of stripped down insurance, is a really bad way to get a low price.
Looking forward, insurance carriers will be raising rates and non-renewing policies in areas even remotely considered fire-prone. In California, insurers are required to provide 45 days written notice of cancellation or non-renewal. Don't give your insurer a reason to cancel with small claims or late payments. If you, your family or friends are cancelled, let me know and we'll explore alternatives. There is a California high-risk pool called FAIR but the insurance offered is so restrictive and expensive it should only be considered as a last resort.
Carrie Babij is President of Desert Insurance Solutions in La Quinta, and has more than 25 years' experience with high net worth personal and commercial lines of insurance. For more information, contact Carrie at firstname.lastname@example.com.


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I had been trying to find time to attend the ranch sorting practice at Cibolo livery for some time now. It's the closest thing to team penning around, and they stopped offering team penning at Cibolo some time back. The problem is that the ranch sorting practice is only held once a month. That's a tall order with my schedule.
I loaded up the horses and kids, and headed to the stables. Christine came along and was a huge help in handling the horses.
They started with a jackpot, which was basically ranch sorting for money for the teams that really knew what they were doing. I passed, of course, but I watched closely to see what the "pros" were doing. I made some small talk with the other riders, and made some new friends. There were some very impressive horses and riders in the jackpot round.
The practice session opened immediately after, and I gave it a whirl on Vaquero. I though he did pretty well for his first time out, and I looked forward to some more runs.
I fed my kids and then jumped back in the action. Only everyone had pretty much paired up by then, and I was struggling to find a partner. After my oldest daughter, Victoria, declined to try it, Christine agreed to give it a whirl on Woody. Wow! This was going to be interesting, two novices trying to ranch sort!
I don't know who was more nervous. As we waited in line for our turn, we discussed strategy. As if we needed to! This was just about getting some experience.
We headed into the round pens, and they announced "ride when ready". After encouraging Christine that the announcement meant she should get started, we were off. Well, we managed to get a few (two or so) calves sorted, and many more that shouldn't have been, but we survived the 90 seconds. Vaquero performed poorly, and was barely containable. His extra energy was not helpful in this event, and I found myself getting very frustrated with him. But Chrsitine was hooked! She wanted another round.
We waited our turn again, and hit it for our second effort. Christine and Woody did better, but Vaquero was a total disaster. He had no clue as to what we were doing, and his energy was excessive for the event. but we had fun.
A few observations after trying this event: Vaquero is ill suited for ranch sorting. It's not that he's not "cowy" or quick enough. He has plenty of skill in those areas. It's that he can't stay put, and he has to move FORWARD, and this is an event where you're required to "hold" the cattle, and that often means staying put or just side-passing or just yielding hindquarters but staying in place. He just can't do any of that and NOT move forward. And once he moves forward, we are out of position.
This event is not something I'll be doing often. It's not offered enough and my schedule won't allow it. But it's apparent I'm going to need a good QH to do some of the cattle events. I'll try to make a few play-days with Vaquero, but I suspect he won't do well there either. And I miss loping, and Vaquero doesn't do that well.
I rode Woody a bit in the arena while we were there, but his trot was torture for my back, and I kept him in a lope. I was very envious of al the QH riders there with some beautiful looking QH's that OBVIOUSLY had smooth trots and slow lopes.
I need a smooth trotting, good looking QH. It's that simple. It's time to start saving pennies. But it was one heck of an experience, and I'll be back.


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Islamabad, March 14, 2013 (PPI-OT): Various Public sector enterprises drain away a significant chunk of government resources and causing huge financial losses to the national exchequer. The only feasible method of turning around these organizations and making them profitable is to privatize them by handing over their management to private sector professionals.
Mr.Zafar Bakhtawari, President Islamabad Chamber of Commerce and Industry (ICCI) has made these remarks in a statement. He said that that the public sector entities including Pakistan Railways, Wapda, PIA, Steel Mill and many other PSEs are incurring a loss of over Rs.600 billion annually, therefore, they should be privatized because privatization reduces economic inefficiencies and fosters competition.
ICCI President said that despite being one of the most important institution, Pakistan Railways was facing the worst loss in history and has suffered losses more than Rs52 billion in the last three years while PIA losses has also increased Rs.150 billion. Thus, Privatization of Public Sector Enterprises (PSE) is essential for making them efficient and profitable, he maintained.
Mr.Bakhtawari was of the view that policy makers should think out of the box to resolve the issues pertaining to public sector organizations as privatization was the best policy prescription to inject efficiency and profitability in the PSE.
He said that Government was spending tax payer's money on inefficient Public Sector Enterprises PSEs which is about 2 percent of GDP. However, a substantial amount of money should be spent on poor masses by improving education and health infrastructure, he maintained.
Mr.Bakhtawari said that tax revenue collection was Rs.1900billion in the last financial but huge amount of Rs.1200billion was drain away for debt servicing and billions of rupees for covering the loss of these PSEs. ICCI President emphasized that Government should realize that our country could not afford to provide heavy spending for covering the loss of these PSEs. Therefore, Government must take corrective measures to resolve this issue to save the economy, he added.
He said that privatization of these PSEs as well as good corporate governess and effective monitoring systems have to be practiced for smooth running of Public Sector Enterprises.
For more information, contact:
Islamabad Chamber of Commerce and Industry
Chamber House, Aiwan-e-Sanat-o-Tijarat Road,
Mauve Area, G-8/1,
Islamabad, Pakistan
Tel: +9251 225 0526 and 225 3145
Fax: +9251 225 2950
Email: email@example.com
Website: www.icci.com.pk


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Beverly Sackler, a philanthropist and matriarch of the family that owns Purdue Pharma, whose painkiller OxyContin has been blamed for the opioid epidemic, died on Monday. She was 95.
Her death was disclosed in a legal filing by Purdue Pharma's lawyers in United States bankruptcy court, where last month state and local jurisdictions and other plaintiffs reached a settlement that would require the family to relinquish the company and pay at least $3 billion in claims. Purdue Pharma filed for bankruptcy; suits from 25 states are pending.
Last week a judge in bankruptcy court in White Plains. N.Y., citing the mounting legal costs, ordered a pause in those states' action and urged the parties to work toward a compromise.
Ms. Sackler had been a board member of Purdue Pharma since 1993.
The court filing did not say where she died, give the cause of death or list her survivors. She lived in Greenwich, Conn.
Ms. Sackler's husband, Raymond, was the youngest and last surviving of three brothers, all psychiatrists, who in 1952 bought what became Purdue Pharma. Mr. Sackler died in 2017 at 97. Arthur, the eldest, died in 1987, Mortimer in 2010.
Almost 2,700 lawsuits have been filed against Purdue Pharma asserting that in its marketing of OxyContin it failed to warn doctors and patients about the risks of addiction, and hundreds of those suits name members of the Sackler family as culpable because they were officers or board members of the company, which is based in Stamford, Conn.
Purdue Pharma's profits fueled a philanthropic dynasty, which endowed professorships and cultural prizes around the world and emblazoned the family name on medical institutes and museums. Forbes has estimated the family's worth at $13 billion.
Ms. Sackler's son Richard S. Sackler was the company's president from 1999 to 2003 and later co-chairman of the board. Her other son, Jonathan D. Sackler, was a vice president and also a board member, as was her grandson David. By early this year, no family members remained on the board.
Richard and Jonathan also run the Raymond and Beverly Sackler Foundation.
The Sacklers and the company denied responsibility for the opioid crisis. They averred that even during the worst years of the epidemic, from 2013 to 2016, Purdue Pharma manufactured about 4 percent of prescription painkillers sold in the United States, and that its products were federally approved and monitored.
Beverly Feldman was born on May 13, 1924, in Brooklyn to Dave and Anna Feldman, Jewish immigrants from Eastern Europe. Her father managed a clothing factory. She married Raymond Sackler in 1944.
The New Yorker described "Dr. Raymond," as he was known, as "the least interesting of the three brothers" (he married once, each of his siblings three times) and said Richard Sackler had "worked tirelessly to make OxyContin a blockbuster."
The family's philanthropy built wings housing the Temple of Dendur at the Metropolitan Museum of Art in New York and Asian antiquities at the Louvre in Paris, as well as a library at the University of Oxford in England and a scientific institute at Columbia University in New York.
The family has funded endowed professorships at the Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences at Yale. A university spokeswoman said that Yale had decided this year to stop accepting donations from the Sacklers as a result of the opioid controversy; so have the Metropolitan Museum, the American Museum of Natural History and the Solomon R. Guggenheim Museum in New York, and the Tate Modern and the National Portrait Gallery in London.
If you are getting married, reserve the day at the Lightner Museum, the best of st Augustine wedding venues .
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Speaking Engagements
The Changing Face of Affirmative Action Webinar
Many organizations doing business with the federal government are required to prepare yearly affirmative action plans for women and minorities, which are data-driven, and for disabled individuals and veterans, which are not. That is about to change.
The federal government recently finalized new laws that will require many federal contractors and subcontractors to set benchmarks and goals for hiring protected veterans and disabled individuals, and to analyze their employment practices with regard to protected veterans and disabled individuals. This seminar will discuss the changes to veterans and disabled affirmative action plans, a number of other recent developments relating to affirmative action plans, and what organizations should be doing in response.
Janilyn Brouwer Daub | Partner | Barnes & Thornburg
Becky Crowder | President | Austin Peters Group
When: Wednesday, Nov. 19
Login information will be provided upon registration.
HRCI credit pending


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Friday, June 22 2018
Morning Radio News @ 9:05 am
Band Method Book Return: Reminder to all band students to return method books and renew or return any school instrument rentals by Monday, June 25.
The winning "Bandvengers" team from the Band 6-1 class was team 3. Come see Mr. Bridgman today during lunch recess to collect your prize
A reminder of the special ice cream sundae party for all dance club members today at 116 in the drama room.
8 Farewell:
Attention all Grade 8s - Last chance to purchase your Grade 8 Farewell Ticket is today. Tickets will be on sale at lunch in the main foyer. Tickets will NOT be on sale the day of the event. Lots of prizes to win, including a $100 gift card to Mayfair Mall.
Overdue Books: From the Learning Commons - a big thanks from Ms. Lindsay and Ms. Gaudet - we've had a ton of books come in this week. Keep them coming, please!
Locker Clean out: Lockers – Remove all stickers, tape or writing left behind. Bring a bring to take home your locker contents.
Lost & Found: Check the lost and found for items that you may have lost. All unclaimed items will be donated to charity at the end of the day today.
close down today
- everything now goes to the trash starting Monday
* Wash out your tower and keep it in your classroom
Yearbooks: Miss Cottier has 15 yearbooks left for sale in room 222 for $40 each. Please stop by and pick up your hot pink wonder if you would like one. This amount of yearbooks won't last long!
In Action:
GOT DEAD BATTERIES? Bring all your used batteries to room 222, Miss Cottier's room, or the office! Not only are we keeping batteries out of landfills, but each battery you recycle has enough zinc to SAVE THE LIVES OF 6 CHILDREN in Kenya. Get your batteries in by Friday, June 22nd.
Pizza Day – Classes will be called in the following order: Orca hallway, Raven, Thunderbird and then Wolf Helpers: Div 6-1 Mrs. Ryan
Attention all Survivor ROMS teams! Today is the 3rd and final day of competition in the 2018 Survivor ROMS competition. All teams who have survived the competition are asked to come to the gym at 1:00pm today to get set up for the challenges planned. Please eat your lunch promptly and be down here ASAP ready to compete. Only 1 team will survive today, and the bleachers will be out for spectators to view the competition. Good luck today survivors and outwit, outlast, and outplay!
Final Assembly:
Royal Oak will have a final assembly on Thursday, June 28 from 9:15 -10:00. We will have a slide show and some year end fun and goodbyes. Awards have already been presented.
Families are more than welcome to attend this assembly.
**A REMINDER TO ALL PARENTS THAT IF YOUR CHILD WILL BE RIDING A SCHOOL BUS NEXT SCHOOL YEAR YOU MUST REGISTER THEM WITH THE TRANSPORTATION DEPARTMENT BEFORE THE END OF JUNE – visit www.sd63.bc.ca transportation or our school website for more information.
A reminder to parents to contact the ROMS Safe Arrival Line at 250-479-0999 or
Anyone who is interested in the PAC Executive as a Co-President? Please contact email@example.com


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The risk in doing "best" lists like the one on our January cover is that readers will think we're idiots. You didn't let us down. How could we include the Tin Man among the "50 Best Bots Ever"? you asked. And how could we exclude Bender from Futurama and that bag of bolts from Lost in Space? Well, uh, it's complicated: After surveying our vast nerdiverse, we used our best judgment. Hey! Look over there - a puppy! Also from the Dubious Claims Dept.: One reader scoffed at our assertion that doctors and nurses would show up for work during a bird flu epidemic. "Fat chance that any volunteers will step forward," he wrote. What can we say? Sometimes readers disagree with us, and sometimes we disagree with them.
Your Two Cents on Our Fiddy
I had to read through "The 50 Best Robots Ever" (issue 14.01) twice because I couldn't believe you left out Bender from Futurama. Would you leave Jack Nicholson off a list of the top 50 actors or Joe Montana off the top 50 quarterbacks? Bender is the funniest robot ever - hands down. He can open the door on his chest and give you anything you need: a hammer, beer, whatever. He can take himself apart and flush himself down the toilet. Best of all, he can shoot fire out of his ass.
Frank Muldoon
Campbell, California
I can't believe the Lost in Space robot didn't make it into the top 50. Danger, Will Robinson!
Mario Salman
Dallas, Texas
I take exception to the inclusion of the Predator UAV. The Predator is actually more like a large radio-controlled airplane than a robot. A robot should be able to operate without direct control, and the Predator is controlled by a person. If you wanted to include an autonomous UAV, you should have considered the Global Hawk, which flies without human intervention.
Dana Zimmerli
Redondo Beach, California
Why would you include the Tin Man? Has anybody ever referred to the Tin Man as a robot? Meanwhile, are Astroboy and Optimus Prime supposed to represent all of Japanese robotdom, without mention of a single mecha? Um, hello, Gundam?
Paul Golin
New York, New York
How can you guys run an article about the 50 best bots and not include Johnny Number 5 from Short Circuit? He has to be one of the coolest and friendliest robots to date, and yet he got beat by the Turk. What gives?
James Touhey
San Diego, California
Prefabricated Response
While Michelle Kaufmann and others are due some praise for shaking up the prefab housing market ("Some Assembly Required," Wired Home, issue 14.01), I wonder why so much architectural effort, promotional muscle, and magazine ink are being devoted to modernist architecture. I'm waiting for contemporary remix culture - so celebrated elsewhere in Wired - to reach the prefab market. Then I can I drop my dollars on a Gaudi/Muromachi/Romanesque house.
Gwyan Rhabyt
Davenport, California
Stopping an Outbreak Before It Starts
"The Battle to Stop Bird Flu" (issue 14.01) was wonderful, frightening, and revealing. Most people don't realize how deadly the flu is; I didn't, until it took my 15-month-old daughter's life in 2003. The more the public knows about this deadly virus, the more pressure there will be on our government to protect against an outbreak. We can only hope the authorities will respond promptly when there is an epidemic, unlike in the past.
Denise Palmer
Viera, Florida
Free Your Mind
"Don't Even Think About Lying" (issue 14.01) was a great, provocative article. The civil libertarian in me screams, "Hands (actually, magnetic waves) off my brain activity," especially in light of how coercively abusive the use of Breathalyzers and blood tests is. At the same time, I welcome any technology that may free incarcerated innocents and help authorities nab truly dangerous criminals. Now that we approach reliable determination of truth tellers, perhaps we can trash the antiquated practice of swearing in witnesses.
Steve Putnam
Seattle, Washington
Steve Silberman writes that "people who learn to inhibit their reactions to stress can slip through a polygrapher's net." But the same is true for fMRI and other neuroimaging techniques. Researchers have repeatedly shown that so-called false memories can be every bit as robust as memory of something that actually happened. These would get by fMRIs, as there would be no memory to inhibit, nothing for the fMRI to detect. Thus, any sociopath who believed he was innocent, or any criminal with a well-trained alibi, would be freed. If this comes to fruition, it'll be another reason to move to Canada.
Jeff Dressel
Lawrence, Kansas
Dear RIAA: Read No Further
Mr. Know-It-All is clearly a pioneer - kudos (Start, issue 14.01). But I'm mad at Clive Thompson for outing the "lesser-known" file swap site that I had heard was excellent and was considering using. Can't he keep a secret?
Michelle Levy
New York, New York
Playing Corporate Ball
If the public backlash against Big Business' renaming stadiums is due in any way to an aversion to corporations, fans would be wise to remember history (Start, Atlas, issue 14.01). Before our stadiums were named after big, rich companies, they were named after big, rich families (Wrigley, Comiskey, et cetera).
David Pompei
Chicago, Illinois
Another Knockout Knockoff
In "Calling Out the Copycats" (Play, Music, issue 14.01), you missed the most hysterical album-art parody I know of: Ween's The Pod, a Scotchgard inhaler-infused take on Leonard Cohen's The Best Of.
Anthony Greco
Cresskill, New Jersey


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A letter has been sent out this week regarding Parent's Evening.
Please complete and return the form to your child's class teacher as soon as possible to receive a time that is most suitable for you.
We use cookies to track usage and improve the website.
Click here for more information.


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If you are really looking for the high-end restaurant in Tokyo, Please check our selection. We introduce one best high-end restaurant in each food. Have a nice time. 1. Shabushabu(しゃぶしゃぶ): Okahan Honten(岡半 本店) In this restaurant, it is used Matsuzakagyu, very high- class beef in Japan. You swish thin slice of beef in boiling water […]Learm more
How do you feel about making travel plans? It is enjoyable? Frustrating? And that this moment you might be trying to find the best accommodation in Tokyo for you. Before you choose your hotel, you have to first decide how long you are going to stay in Tokyo. There are so many options to choose […]Learm more
Sumo tournament Known by everyone as the Japanese national sport, sumo wrestling is still something not to miss. Held six times a year, Tokyo is lucky to welcome the tournament on three times. What's your idea about sumo? … Massive wrestlers fighting half naked? Yes but not only. This sport is largely linked to the […]Learm more
We have a lot of the amusement parks in Tokyo & around Japan. Enjoy Travelience's TOP 5 selection of amusement parks! ================================================ No1 Tokyo Disney Land This is the most popular amusement park in Japan, it's a place where you can enjoy rides and seasonal parade events. Place: 1-1 Maihama Urayasushi Chiba Prefecture Access (Tokyo […]Learm more


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LGBT Rights and the Black Panthers: The Queer Revolution Begins with Self Love
Caring for myself is not self-indulgence, it is self –preservation and that is an act of political warfare. ~Audre Lorde
Spotlight: Li Yuchen – Asian Pop Culture Icon Challenges Gender Norms in China
Spotlight on Li Yuchun, on of China's first masculine of center female celebrities, using media to change the conversation around gender/sexuality in the country
AMPLIFY: Paid Internship Opportunity for Lesbian & Bisexual Women Artists in Kenya (July 1st Deadline)
Artists For Recognition and Acceptance (AFRA–Kenya) is seeking lesbian and bisexual artists for a three month paid internship.
If Not Now, When: Addressing Domestic Abuse in "Between Women" Season One
It's admirable that the creators of Between Women chose to tackle the issue of domestic abuse within same sex relationships. Yet their presentation of such an important issue doesn't come without noticeable flaws, specifically with respect to the way an abusive relationship was presented in season one.
Written on the Body: Celebrating Samar Habib's Contributions to Queer Muslim Women Visibility in the Middle East
Dr. Samar Habib is making welcomed contributions to the visibility of queer women in the Arab, Muslim, and western world. Get to know her.
She Plays (Too) Well With Others: When Your Friend's Parents Think You're "Recruiting"
How one high school girl dealt with being outed to a friend's queerphobic mom.
AMPLIFY: Black Girl Dangerous Offering Writing Workshops to Queer and Trans POC
The most dangerous thing to white supremacy is not just a black grrl reading a book but a black grrl writing a book.
IMAAN London Hosts 5th International LGBTQI Muslim Conference (Aug 24-27)
Imaan – the world's largest LGBTQI Muslim organisation — plans to host only the fifth ever international conference on August 24-27 in London, UK.
Middle Eastern Magazine Celebrates LGBT Arab Voices: "We Give You the Voice of Your Silence"
First LGBTQ Jordanian Magazine Features the Secret Lives of Arab Lesbians in the Middle East


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Fresno State hires Kalen DeBoer as new football coach
FRESNO, Calif. (AP) Fresno State hired former offensive coordinator Kalen DeBoer on Tuesday as its new head coach.
DeBoer spent the 2017 and 2018 seasons on coach Jeff Tedford's staff for the Bulldogs before leaving to take the same job at Indiana this season.
Tedford stepped down for medical reasons after this season and DeBoer was quickly identified as the leading contender to take over the job.