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Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste
Parasites & Vectors volume 11, Article number: 373 (2018)
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Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification.
A total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10–14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9–95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3–100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4–64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0–97.0%).
The observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic way.
Trial registration
Australian and New Zealand Clinical Trials Registry 12614000680662 (registered 27 June 2014).
More than 1.4 billion people worldwide are estimated to suffer from infection with soil-transmitted helminths (STHs) [1]. The infective stages of these parasites thrive in the warm moist soils of tropical regions, and are transmitted through oral ingestion or skin penetration [2]. These modes of transmission mean that the most affected individuals are from poor communities that lack the adequate water, hygiene and sanitation necessary to prevent transmission and reinfection. Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and Necator americanus and Ancylostoma spp. (hookworms) are the most common STHs. They cause significant morbidity, particularly in children, who are commonly co-infected with multiple species [2]. Chronic infection can retard child growth and development, and infected individuals can suffer malnutrition, growth stunting and reduced cognitive abilities and intellectual capacity [2, 3]. Studies have indicated the significant adverse impact of STH infection on school attendance and performance and future economic productivity, although the health impact of STH infection is being debated [4,5,6].
The World Health Organization (WHO) has set goals to reduce STH-associated morbidity in children to a level at which it is no longer considered a public health problem [7]. To achieve this, populations at risk in endemic areas, mainly school-age children, are targeted with mass chemotherapy using anthelmintic drugs at either six monthly or yearly intervals depending on infection prevalence [8, 9]. The current recommended drugs are the benzimidazole drugs, albendazole and mebendazole [8], which are highly efficacious against A. lumbricoides with a recent meta-analysis indicating pooled cure rates of 95.7 and 96.2%, respectively, and egg reduction rates of 98.5 and 98.0%, respectively [10]. Albendazole is also efficacious against hookworm, with a pooled cure rate of 79.5% and egg reduction rate of 89.6%, compared to a cure rate of 32.5% and egg reduction rate of 61.0% for mebendazole [10]. Both drugs have poor efficacy against T. trichiura, with pooled cure rates of 30.7 and 42.1% for albendazole and mebendazole, respectively [10]. The WHO, international partners and pharmaceutical companies are committed to scaling up mass drug administration so that by 2020, 75% of at-risk children are being dewormed [7]. In 2016 alone, over 470 million schoolchildren were treated with anthelmintic drugs in endemic countries, corresponding to 69.5% of children at risk [11].
Greater usage of albendazole entails greater selection pressure of the drug for resistant parasite strains. Therefore, with the scaling up of mass drug administration programs, there are growing concerns over the potential for drug resistance to emerge in humans, similar to what has happened in other animals. In livestock, resistance to benzimidazoles is widespread, having emerged from the large-scale use of the drugs [12,13,14]. Monitoring the efficacy of anthelmintic drugs in order to detect the potential emergence of resistance in human populations is imperative to ensure that mitigation strategies can be promptly implemented to preserve the effectiveness of mass deworming campaigns [15]. STH are generally diagnosed using microscopy-based methods - most commonly the Kato-Katz method - to detect helminth eggs in stool. However, this method is known to have low sensitivity in lower-intensity and lower transmission settings, and requires examination of multiple samples to improve sensitivity [16]. Recently, quantitative polymerase chain reaction (qPCR)-based methods have been developed for the diagnosis and quantification of STH and validated as more sensitive than the conventional microscopy approaches [17,18,19,20,21].
The aim of this study was to determine the efficacy of a single dose of albendazole against STH infections using quantitative polymerase chain reaction (qPCR) for the detection and quantification of Ascaris spp., N. americanus, Ancylostoma spp. and T. trichiura, in the context of the implementation of the WASH for WORMS study, a cluster randomised controlled trial (RCT) in rural communities in Timor-Leste [17, 22]. Timor-Leste is a lower middle income country [23], where malnutrition and infectious diseases (such as pneumonia, diarrhea, malaria, tuberculosis and dengue) remain significant health problems [24]. The WASH for WORMS RCT which included community distribution of albendazole every 6 months for 2 years, at a time when no regular mass deworming was being implemented in the country [22]. The previous "Lumbriga…Mak Lae Duni" (Worms, no way!) mass drug administration program was implemented from 2005 to 2008 and was resumed in 2015. To our knowledge, this is the first albendazole efficacy study to be conducted in Timor-Leste and the first efficacy study to use qPCR for the calculation of cure rates and infection intensity reduction rates.
Study setting and data collection
This efficacy study was conducted from January 2012 to March 2013, in 8 communities in Manufahi municipality of Timor-Leste, which had been enrolled in the WASH for WORMS cluster RCT [22]. All community members were eligible for participation in the efficacy study, excluding women in the first trimester of pregnancy and children under 12 months of age. Baseline stool samples were collected for assessment of infection status and intensity, and individuals were subsequently given a single 400 mg dose of albendazole. Drug distribution was done by trained field workers. Children aged under 2 years were given half the dose. Between 10 and 14 days later, a second stool sample was collected to again determine infection status and intensity.
Sample size was calculated based on the following current recommendations [25]. Tree-based methods indicated that a minimum of 200 subjects (independent of infection status) is recommended to be able to detect a normal vs reduced efficacy based on faecal egg count reduction (FECR) [25]. Furthermore, WHO recommends a sample of 50 positive individuals for each parasite tested [26]. To achieve the necessary sample size and considering a compliance rate of 0.75 at each stool collection time point and estimated prevalences of 30% for Ascaris spp. and 50% for hookworm (based on studies in neighbouring Indonesia), we enrolled the first 8 of the 24 communities participating in the WASH for WORMS trial into the efficacy study, corresponding to approximately 500 eligible participants [27,28,29].
Assessment of STH infection
Once collected, the stool samples were preserved at room temperature in 5% (weight/volume) potassium dichromate and transported to the QIMR Berghofer Medical Research Institute in Brisbane, Australia. The presence and intensity of protozoa and STH infection in stool samples was determined using qPCR methods as described previously [17]. In short, DNA extracted from samples that were spiked with a known amount of the plasmid used as positive control was run in a pentaplex real-time PCR reaction for detection and quantification of Ascaris spp., N. americanus, Ancylostoma spp. and T. trichiura [17]. The Rotor-Gene 6000 (Qiagen, Melbourne VIC, Australia) was used for all PCR assays [17]. Cycle threshold (Ct) values obtained using qPCR correspond to the amplification cycle at which the detected signal exceeds the background level. For a stool sample to be considered positive for infection, a limit of detection cut-off was set at 31 for Ascaris spp. and 35 for N. americanus, Ancylostoma spp. and T. trichiura, to ensure consistency with previously published PCRs [17]. For each qPCR assay, two runs were performed to generate two Ct-values. The arithmetic mean was taken of these two values to produce a single value. For calculation of intensity reduction rates, Ct-values were then converted to infection intensity measured in Relative Fluorescence Units (RFU) based on an assumed 100% reaction run efficiency, provided by the Rotorgene Q software (Infection intensity as determined by \( \mathrm{qPCR}={10}^{-0.2980\kern0.05em \mathrm{Ct}+9.81}\ \mathrm{RFU} \)) [17]. Samples which did not record a Ct-value were assigned an infection intensity value of 0.
Statistical analysis
Pre- and post-treatment prevalence were compared using Chi-square test, or Fischer's exact test in cases when frequency values were below 5. Only individuals who were positive at the pre-treatment time point were included in calculations of cure rate and infection intensity reduction rate derived from PCR.
Cure rate was calculated using the following formula:
95% binomial exact confidence intervals were calculated for both prevalence and cure rate. Age group (1–5 years; 6–11 years; 12–17 years; 18–64 years; and > 65 years) and sex were examined separately for potential associations with the probability of being cured, using the Wald Chi-square test adjusted for community-level clustering. The impact of baseline prevalence and baseline infection intensity (Ct-values) on cure rate was assessed using a multivariate logistic regression model, adjusted for age and sex, with a robust standard error adjusted for clustering at the community level.
Infection intensity reduction rate was calculated using the following formula as per WHO recommendations [25, 26]:
Confidence intervals for infection intensity reduction rate were calculated using a bootstrap re-sampling method with 10,000 replicates. The impact of baseline infection intensity (Ct-values) on infection intensity reduction rate was assessed using a multivariate linear regression model, adjusted for age and sex, with a robust standard error adjusted for clustering at the community level.
All analyses were conducted using Stata version 11.0 (College Station, TX, USA). A 5% significance limit was used for all analyses.
Population under study
From the 8 communities enrolled, 678 individuals were present and eligible for study participation, of whom 599 (88.3%) agreed to participate. In total, 314 individuals provided both pre- and post-treatment stool samples and were included in the efficacy analysis presented here (Fig. 1). Participants ranged in age from 1 to 72 years, with a mean of 21 years. Of the study participants 54.8% were females and 45.2% were males.
The most prevalent species was N. americanus at 69.4% (95% CI: 64.1–74.2%), followed by Ascaris spp. at 51.6% (95% CI: 46.1–57.1%). Ancylostoma spp. (2.6%; 95% CI: 1.1–5.0%) and T. trichuria (1.3%; 95% CI: 0.3–3.2%) both had a low prevalence in the study population. For Ascaris spp., community-level prevalence ranged from 19.3% (95% CI: 10.9–31.8%) to 80.5% (95% CI: 65.3–90.0%), with a mean community-level prevalence of 54.2%. For N. americanus, community-level prevalence ranged from 52.5% (95% CI: 40.0–64.5%) to 87.8% (95% CI: 73.6–94.9%), with a mean community-level prevalence of 72.6%.
Albendazole efficacy - cure rates and reduction in intensity
As shown in Table 1, the cure rate for Ascaris spp. was 91.4% (95% CI: 85.9–95.2%), and the cure rate for N. americanus was 58.3% (95% CI: 51.4–64.9%). The cure rate for Ancylostoma spp. was 100% (95% CI: 68.7–100%) and for T. trichiura was 50% (95% CI: 67.6–93.4%); due to the low number of individuals infected with Ancylostoma spp. and T. trichiura, further analyses were not performed for these helminths.
Cure rates stratified by age group and sex are presented in Table 1. There was no significant difference in cure rate between males and females for either N. americanus (54.8% vs 61.4%, χ2 = 1.77, df = 1, P = 0.18) or Ascaris spp. (89.2% vs 93.2%, χ2 = 2.19, df = 1, P = 0.14). Similarly, age was not associated with being cured, with no statistically significant difference between age groups for either N. americanus (χ2 = 1.88, df = 4, P = 0.76) or Ascaris spp. (χ2 = 5.71, df = 4, P = 0.22).
For N. americanus, community-level baseline prevalence was negatively and significantly associated with cure: for a 1% increase in baseline prevalence, the odds of being cured decreased by 3% (OR = 0.97, 95% CI: 0.94–0.99, P = 0.03). Baseline infection intensity (Ct-value) was not associated with cure. For Ascaris spp., neither baseline community-level prevalence nor baseline infection intensity (Ct-value) were associated with cure. Age and sex were not associated with cure for either N. americanus or Ascaris spp. Full results of the multivariable analysis are shown in Table 2.
There was a significant decrease in infection intensity (RFU) for both STH species following treatment, with an infection intensity reduction rate for Ascaris spp. of 95.6% (95% CI: 88.3–100%) and 88.9% (95% CI: 83.0–97.0%) for N. americanus (see Table 3). The distribution of individual infection intensity reduction rates is shown in Table 4. In short, for both species the large majority of infections were cured or had an infection intensity reduction rate higher than 80%. An increase in infection intensity happened in 6.4% of the cases for N. americanus and in 1.2% of the cases for Ascaris spp.
For Ascaris spp., baseline infection intensity (Ct-value) was not associated with infection intensity reduction rate. For N. americanus, a higher baseline infection intensity was associated with a higher intensity reduction rate (P = 0.04). There was no association between age or sex and infection intensity reduction rate for either species. Full results of the multivariate linear regression model are shown in Table 5.
The findings of this efficacy study are consistent with earlier reports indicating that a single 400 mg dose of albendazole is highly efficacious against Ascaris spp. and less efficacious against hookworm [30]. While our cure rate for Ascaris spp. is comparable to previous reports, our detected cure rate for N. americanus was lower [30]. The lower cure rate obtained for N. americanus in this study is likely to be due to the higher diagnostic sensitivity of qPCR as compared to microscopy-based techniques that are generally used in efficacy studies, rather than implicating the existence of emerging benzimidazole resistance. That is, the lower sensitivity of microscopy relative to qPCR could mean that previously reported cure rates are over-estimated, as an individual may be misclassified as cured when in fact their faecal egg count was very low and not detected by microscopy. This is particularly true for hookworm, given that allowing the smear to stand for too long can result in the collapse and disappearance of hookworm eggs but not those of Ascaris spp. [31]
While cure rate is usually one of the indicators calculated in efficacy studies, it is not the best measure of drug efficacy, as it depends on baseline intensity and is influenced by the sensitivity of the diagnostic technique [32]. Therefore, current WHO guidelines recommend using a measure of intensity reduction - the faecal egg count reduction (FECR) - as the appropriate indicator of efficacy [26]. WHO guidelines stipulate that the FECR rate should exceed 95% in the case of A. lumbricoides and 90% in the case of hookworm [26, 33]. Because we employed qPCR as a diagnostic technique, infection intensity reduction rates were calculated based on PCR intensity values. Given that we were unable to also use microscopy methods in these samples we were not able to measure intensity in eggs per gram, hence the main limitation of this study is that our infection intensity reduction rate values are not directly comparable to FECR rates previously reported in the literature. However, given that both these parameters measure the proportional reduction in parasite load within a sample, and in the absence of a microscopic comparator allowing conversion of Ct to eggs per gram, we feel it is appropriate to apply thresholds pertaining to FECR rates to our results, as a first step in the use of qPCR for drug efficacy studies. Our infection intensity reduction rates were above reference efficacy thresholds for Ascaris spp. and just under the threshold for N. americanus, which suggest the continued efficacy of albendazole against these STH infections. In order for qPCR to be used as a quantitative method in efficacy studies where changes in infection intensity are the designated endpoints, additional research directly comparing infection intensity by microscopy and qPCR is needed. This will allow the conversion of Ct-values into eggs per gram, the establishment of appropriate thresholds for infection intensity reduction rates derived from qPCR to determine drug efficacy, and also the identification of qPCR intensity cut-offs corresponding to low, moderate and high intensity infection. In previous work infection intensity was derived by converting Ct-values in eggs per gram, using standard curves generated by qPCR assays undertaken on fresh hookworm and Ascaris spp. eggs. These were then used to interpolate eggs per gram from the PCR Ct-values obtained for the field samples [17]. Since this work was done, a number of potential confounding factors have been identified, including DNA extraction methods and stool preservative. A notable example is that we have observed that hookworm eggs preserved in potassium dichromate, as was the case in our field samples, can embryonate with storage, potentially resulting in an overestimation of infection intensity. Additional work is necessary to take into account storage conditions of field samples as was recently reported by Papaiakovou et al. [34]. Besides increased sensitivity, an additional advantage of the use of qPCR is that allows identification of the different hookworm species present in the population under study, which is not possible with microscopy. This will lead to a more refined understanding of albendazole efficacy against specific hookworm species, each of which can cause different levels and types of morbidity, and in the case of A. ceylanicum may require a One Health approach to overall control [35].
As the first albendazole efficacy study to be conducted in Timor-Leste, the results of this study confirm the utility of this drug as a chemotherapeutic agent in the region. Furthermore, it demonstrates that qPCR can be effectively used to determine infection intensity reduction rates. In the future, this study will provide a useful point of comparison to establish whether there is any emerging resistance to albendazole in the context of mass chemotherapy campaigns that have recently restarted in Timor-Leste.
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The authors would like to acknowledge the communities that participated in this study; the WASH for WORMS' field staff for carrying out field work, particularly Salvador Amaral; and the Ministry of Health of Timor-Leste for supporting this research.
NEC is supported by an Australian Government Research Training Program Scholarship, ACAC and AJV are supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship, JSM is an Australian NHMRC Practitioner Fellow and DJG is an Australian NHMRC Career Development Fellow. This work is funded by an NHMRC Partnership project in collaboration with WaterAid Australia.
Availability of data and materials
The data supporting the conclusions of this study are provided within the article. The datasets used and analysed during the current study are available from the corresponding author upon request.
Ethics declarations
Ethics approval and consent to participate
This study was approved by the Human Research Ethics Committees at: The University of Queensland (2011000734), Australian National University (2014/311) and the Timorese Ministry of Health (2011/51). Written consent was obtained from all participants aged 18 years or older, and from parents or guardians for those younger than 18 years. Participants aged 12–17 years provided written assent. Consenting individuals were given a single 400 mg dose of albendazole after stool collection. Drug distribution was done by trained field workers. Children aged under 2 years were given half the dose.
Competing interests
The authors declare that they have no competing interests.
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Cite this article
Vaz Nery, S., Qi, J., Llewellyn, S. et al. Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste. Parasites Vectors 11, 373 (2018). https://doi.org/10.1186/s13071-018-2838-0
- Albendazole
- Efficacy
- Necator americanus
- Ascaris lumbricoides
- Hookworm
- Soil-transmitted helminths
- Anthelminthic drug efficacy
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text:
January 15, 2011
I want a ticket to anywhere
I believe everyone can make their own path,
By themselves.
All you have to do is just go for it, and good things will happen.
Nothing happens on its own.
December 16, 2010
hate / love
It is amazing to me how thin the line between love and hate can be.
Sometimes so thin, that it eludes the eye, making the observer unsure of what he sees.
And mistakes are easily made when your line of sight is obscured.
November 25, 2010
November 13, 2010
"Flowers on the hillside, bloomin' crazy
Crickets talkin' back and forth in rhyme
Blue river runnin' slow and lazy
I could stay with you forever and never realize the time"
Bob Dylan
August 24, 2010
all that you can't leave behind
August 3, 2010
I've been trying to keep my balance for the past few week.
There is a certain diapason to life, which can catch me off guard and surprised at times.
Just when I think nothing can go any worse - it does.
When the bad times pass, I am washed with waves of true happiness.
Like a huge pendulum that hurdles me hither and thither,
Life shows me what it's all about - over and over again.
It's about keeping a balance between to good times and the bad.
It's about knowing that right after those rainy days,
Summer comes, and I can go to the beach.
July 16, 2010
i looked in the mirror today
I looked in the mirror today
My eyes just didn't seem so bright
I've lost a few more hairs
I think I'm going bald
I think I'm going bald
Seems like only yesterday
We would sit and talk of dreams all night
Dreams of youth
And simple truths
Now we're so involved
So involved with life
Walk down vanity fair
Memory lane everywhere
Wall Street shuffles there
Dressed in flowing hair
Once we loved the flowers
Now we ask the price of the land
Once we would take water
But now it must be wine
Now we've been
And now we've seen
What price peace of mind
Take a piece of my mind
My life is slipping away
I'm aging every day
But even when I'm grey
I'll still be grey my way
Rush, Ithink I'm going bald
June 26, 2010
best feeling ever
June 22, 2010
don't ask why
Sometimes the most mundane words, as banal as they are,
are all that's needed to express a feeling.
Another turning point;
a fork stuck in the road.
Time grabs you by the wrist;
directs you where to go.
So make the best of this test
and don't ask why.
It's not a question
but a lesson learned in time.
It's something unpredictable
but in the end it's right.
a fork stuck in the road.
Time grabs you by the wrist;
directs you where to go.
So make the best of this test
and don't ask why.
It's not a question
but a lesson learned in time.
It's something unpredictable
but in the end it's right.
June 16, 2010
They are the texture of life,
Keeping nothing plain, nothing smooth, nothing simple.
The ups and downs of every passing day,
of every period.
They make sure you'll get the respect you deserve,
or get ignored completely.
The intensity of life in the past year,
has most definitely added some new wrinkles,
to the written book of my life.
June 4, 2010
midday friday
May 5, 2010
Sometimes all you need is a bit of color.
The ability to make a dark picture brighter,
Is the real gift.
May 3, 2010
play time
April 15, 2010
where did they go?
I thought I had them secured.
I held on so tightly, with all my might and strength.
I never let go, not for a second took my mind off them.
Daddy, where did my balloons go?
Daddy, why did they leave me?
Well son, there's nothing you can do.
Balloons are known to like the wind.
Will I ever see them again, Daddy?
You might son, you might.
So many interpretations, one truth, my truth:
I am proud of myself.
April 9, 2010
in my city
April 7, 2010
walking the streets
There's much to see, if you only stop to look.
Not a common thing to do when you are "living the city life".
I find it a great joy to take a day off sometimes, walking the city just looking for things I wouldn't normally look at.
It's not that I don't want to any other time - It's just that the troubled mind insists always on putting everything aside while it needs to be in the spotlight.
Days like this, well - It's what makes it all worth it.
March 22, 2010
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The best fictional heroes and villains are lovable, and inspire intense feelings of romance and adoration. But should they be happy in love? No, of course not — both because we want them to suffer, and because we want to see them adventuring rather than romancing. Which character do you hope never finds lasting, true love?
Please include a picture, clip, poster, comics panel, book cover or other image for your chosen character. And please mention his/her name, where he/she appears, and why you hope love forever eludes this person. Thanks!
Top image: Captain Picard from Star Trek: The Next Generation. Beverly, Vash, and assorted other women have been love interests for Jean-Luc, but he's way more fun to watch as a bachelor.


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About us
Girona experience proposes a young innovative approach to tourism and travelling. We combine professional experience with heartfelt reverence and respect for nature and the environment.
Our Slow-Travel philosophy invites you to get back in touch both with the tranquility of nature and your inner life and peace. We travel with a schedule but no hurry. We leave room for social interaction, enjoyment of cultural aspects and healthy and balance diet.
We love sharing the pleasures of nature's exuberance, the rediscovery of your own senses through our unique and unforgettable tours.
We warmly welcome you to Girona Experience!!


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Hi there, I'm Laura.
I am a photographer and I am a bare faced, bare foot mother to my beautiful daughter Lucille.I am extremely soulful and for the longest time have felt like I have a direct connection from my soul to the universe and all the magic that exists within this glorious life we are so lucky to live - isn't that a beautiful thought? (oh and that little girl in the pool is me when I was 6, that is my "why" photo. This photo embodies every reason why I do what I do).
Summer is my oxygen. I have a love hate relationship with winter, I hate the cold but I love the soft golden light. I love rain at night when i'm tucked up in bed but I get scared driving in it. I love, love - mine and yours. I love seeing people in love. I love to kiss. I love people watching and public displays of affection, I love coffee and I love cuddles. I love salty hot skin in summer and crispy sea salt hair, I love shadows, I love plants and flowers that are fragrant, I could smell them all day long - lemon tree blossoms and Jasmin are to die for. I have lots of shoes but i'm always barefoot, I don't take myself very seriously at all.
I am not an extreme risk taker, I don't go looking for experiences i'm not comfortable with but I do appreciate the tiniest particles of magic in each day and find just breathing and creating life to be exhilarating. Sometimes I am overwhelmed at how beautiful and simple life can be simultaneously. Like the smell of a BBQ in summer or a freezing cold breeze on my nose or ripe lemons ready for picking on a tree - and don't even get me started on the magic of light.
I moved around a lot as a kid and met so many people along the way. I believe this gave me an incredible ability to meet new people and immediately connect with them, I absolutely wear my heart on my sleeve and am forever falling in love with the people I meet, I chat to everyone, I love to talk and to find out as much as I can about each person, I find people to be fascinating.
When I think about my childhood and my family and my journey I see laughter and light and the outdoors, I see caravan parks and holiday friends and catching baby crabs on the beach.
I see the family home and cuddling games on the couch and lots of quick wit, I see paddling pools and pets and there always seems to be a baby around. I see kindness and a deep sense of feeling grounded and humble. I see mum and dad sneaking a kiss in the living room as I stare on from the garden. I see light through leaves that I try to touch with my toes as I swing up high. All of these incredible glimpses of time long past are burnt into my memory and soul - this is what matters to me.
If you would like me to see your family through my eyes and through my lens I would so love to meet you and do that. We can find beautiful light and share childhood stories and laugh together too. I will become best friends with your kids and accidentally laugh at you and them at inappropriate moments - I apologise for that in advance! We can make magic and spend time actually living for a while.
Oh and in case you were wondering the name LALU is derived from mine and Lucilles names (LA Laura, Lu Lucille).
I want to photograph you and your family. I specialise in natural light, maternity, newborn, family and motherhood lifestyle and storytelling photography – finding your unique magic and capturing it.


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Your intellectual property (IP) is an extremely valuable asset. Whether a business or business owner, a software developer, a writer, artist, musician, or other creator or innovator, Roka IP Solutions can help you to secure, maintain, and protect your valuable IP rights.
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When you retain Roka IP Solutions, your matter will be handled by a seasoned and conscientious attorney who will work closely with you to identify the most efficient means of achieving your goals and protecting your interests.
Please call or contact Roka IP Solutions online to schedule a time to discuss your needs.


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Mrs. Budget Boss
Iron Sharpens Iron Masterminds Network
ICC Blog
Mrs Budget Boss
Mrs. Budget Boss Organization (Nonprofit 501C3) wants to help equip the children with the right tools they need via coaching and the Money Don't Grow On Trees class to prevent them from making financial pitfalls and prepare them for a successful future to keep them from being stressed, moving back home with their parents, and overwhelmed during their transition into adulthood. I will also keep track of the students' progress at least twice a year and for those who successfully complete the program will have an opportunity to teach the class and make extra income. We need a location, supplies and equipment. This will also cut down on crime AND KEEP THEM OUT OF THE PARENTS POCKETS AND OFF OF THEIR NERVES IN THE LONG RUN!
Do you have a teenager who doesn't RESPECT, UNDERSTAND, or VALUE money (YOUR MONEY) and thinks that MONEY grow on trees? Do you want to ensure that they are financially prepared and well educated about money to keep them from getting in debt or spending recklessly? We have a class specifically to teach kids/ young adults to prevent financial struggles, the importance of multiple streams of income, entrepreneurship, life skills and to embrace their own uniqueness.
Do you hate the feeling of running the "rat race" getting paid on Friday and broke several days before the next payday? Are you sick of not having enough money to pay your bills and no emergency funds? Do you want to purchase a home, start a family or buy a vehicle but not sure where to start?
Mrs. Budget Boss has gained the experience and respect for many years and counting in helping people just like you. We strive to provide you with tough coaching and the best experience for the success of your future. You will be successful and we will hold YOU accountable. It's time to let the money stress go and to reach the ultimate goal of HAPPINESS! Let me help!!! We offer classes and one on one for your convenience. WE HELP ADULTS TOO.
*Worry Less About Money
*Embrace YOUR own uniqueness
*Increase YOUR savings
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*Prepare YOUR kids for the "Real World" (Education)
*Start YOUR own business
*Smoothly transition over into adulthood
My Mission is to rid the poverty and the debt cycle through teaching, supporting and coaching via our Mrs Budget Boss Organization program. If it doesn't make Dollars then it doesn't make sense!
Click Here For Packages


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Christopher J. Iverson, MD
The information is not available
I speak: English
My gender: Male
Where I practice
- Emergency service
- Urgent care services
- After-hours services
- Pharmacy services
- No emergency services
- No urgent care services
- No after-hours services
- No pharmacy services
About me
I grew up in Minneapolis, Minn. I have had an interest in science from early childhood. I decided at a young age that medical school was the most appropriate way to focus that interest in science, as it applies directly to people. I have also always had an interest in preventive medicine, to stay healthy and try to prevent illness. I decided to come to Atlanta for residency at Emory University for many reasons. These included an interest in the training program at Emory, an interest in working at the Centers for Disease Control and Prevention and a desire to live in the Atlanta area.
About my practice
For the past few years, I have served as chief of the Kaiser Permanente Palliative Care Department. I have also worked in Kaiser Permanente's Hospitalist Department.
Involving our members in the process of making informed, shared decisions empowers them and keeps them invested in their own care. I look at every patient interaction as an opportunity for me to grow and learn as a doctor. This allows me to do my very best for our Kaiser Permanente community.
How I thrive
I believe strongly in a balanced approach to life. I try to eat well, exercise regularly and spend time with family and friends on a regular basis. I enjoy traveling to see other parts of the United States, as well as other countries and cultures.
My office
Languages spoken by medical staff
Help is available in your language. Learn more.
Medical groups and plans
The Southeast Permanente Medical Group
- HMO or EPO
- Individual & Family Plans
- Individual & Family Plans - Added Choice
- Multi-Choice or POS
- Senior Advantage
- Signature HMO
Contact information
- Health Line
- 1-800-255-0056 (toll-free TTY for the hearing/speech impaired)
- Health Line
- 1-800-611-1811 (toll free)
- Health Line
- 404-365-0966
My training, certifications and licensing
Medical schoolUniversity of Minnesota Medical School
Board certificationAmerican Board Internal Med (Hospice & Palliative
To verify board certification for an individual practitioner, please visit the American Board of Medical Specialties, the American Medical Association, or the American Osteopathic Association websites.
Medical training
Internal MedicineEmory University School of Medicine
Joined Permanente Medical Group2006
To find:
- a Kaiser Permanente provider's office hours, search our facility directory
- Kaiser Permanente providers accepting new patients, call (404) 365-0966, 1-800-611-1811 (toll free), or 711 (TTY for the hearing/speech impaired)
- affiliated providers' office hours or whether they are accepting new patients, call their offices directly
The information in this online directory is updated periodically. The availability of physicians, hospitals, providers, and services may change. Before receiving care at a facility, select that location in our directory and verify the accepted plan types under "About this facility" to make sure it is available in your plan. If no plan types are listed, the facility is available for all plan types.
Kaiser Permanente uses the same quality, member experience, or cost-related measures to select providers and facilities in Marketplace Silver-tier plans as it does for all other Kaiser Foundation Health Plan (KFHP) products and lines of business. The measures may include, but are not limited to, HEDIS/CAHPS performance, member/patient complaints, patient safety scores, hospital quality measures, and geographic need. Members enrolled in KFHP Marketplace plans have access to all professional, institutional and ancillary health care providers who participate in KFHP plans' contracted provider network, in accordance with the terms of the members' KFHP plan of coverage. All Kaiser Permanente Medical Group physicians and network physicians are subject to the same quality review processes and certifications.
Kaiser Permanente uses the same geographic distribution consideration to select hospitals in Marketplace plans as it does for all other Kaiser Foundation Health Plan (KFHP) products and lines of business.
Information about a provider is provided to us by the provider or the provider's network, or is obtained as part of the credentialing process. Board certification may not reflect contracted services available from providers listed in our directory. If you have questions regarding this or about any of our providers, call us at 1-800-611-1811 (toll free). For the hearing and speech impaired: 1-888-865-5813 or 711 (TTY). You can also call the Georgia Composite Medical Board at (404) 656-3913, or visit their website.


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This is a step-by-step guide to creating my NUnit Test Fixture template, available on github.
95% of the time, when I create a class in Visual Studio, I create a corresponding test class. The class ends up looking something like this:
To get to this from a standard "new class", it's approximately 100 keystrokes. As there's a finite number of keystrokes you can make before you die (see Scott Hanselmans evidence), it's important to cut down the number of keys you press as it will eventually kill you - unless I've deliberately misread the angle of Mr Hanselman's blog post. Anyway, what I needed is a VS template that gives me the above code.
Create The Content
The first step to creating a template is to write the code that you want to end up with - for me, that's the code as shown above. I saved this in a file called NUnitTestFixture.cs.
Define The Template
Next step is to create the mechanism for telling Visual Studio about your template. This is done via an XML definition of your template, saved as a file with a .vstemplate extension. This is the XML definition of the NUnitTestFixture template:
This is what the important parts of this file defines:
- Lines 3 - 9 <TemplateData> defines how the item will appear in the VS "Add new item" dialog.
- Lines 4 - 8 define the individual items of information, displayed in the dialog as shown:
- Lines 10-12 <TemplateContent> define the items that will be added to the VS project when this item is selected.
- Line 11 defines the single item of this template, the code template. I'll show later how to package the template so that these files are available to Visual Studio. The TemplateContent element defines a file that makes up part of the template - in this example there's just one element for the code file NUnitTestFixture.cs. If there was e.g. a help file, a resource file, a designer etc, these would each have a separate TemplateContent element. In the element in the example, the ReplaceParameters attribute indicates that placeholders in the file can be replaced with variables.
Replace Parameters
When a NUnitTestFixture class is required in a project, there will be details that are only known when the item is created, for example the default namespace of the project, and the name of the class as input by the user:
Templates are able to be parameterised so that at the time of creation, placeholders can be replaced with their correct values. There are several built-in parameters available to use, see the MSDN documentation for a full list.
For the variables shown above, the built in parameters that are needed are rootnamespace and itemname; rootnamespace is the default namespace for the project the item is being added to, and itemname is the name of the file as input by the user on the "Add new item" dialog. The convention for defining placeholders is to wrap the parameter name in $ characters, so NUnitTestFixture.cs needs to look like this
Package The Template
For Visual Studio to make the template available, it needs to have all the files supplied in the form of a ZIP archive. For the example here, the files to include are
- the code file, NUnitTestFixture.cs
- the 48x48 pixel icon file, M_J_O_N_E_S.ico
- the template definition file, NUnitTestFixture.vstemplate
Tip: to find out where your Item Tempate folder is, go to Tools -> Options -> Projects and Solutions -> General.
Further possibilities
I've barely scratched the surface with this template and there is far more configuration available than this blog post shows. There's a heap more to read about this topic on MSDN.


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SVM Global Employees raise thousands for Charity
Employees at SVM Global enjoyed a very busy year of fundraising in 2015 – raising over £5000 for charity. During the company took part in many events, including Swimathons, 'Bake Offs' and Colour Runs.
These events raised money for a number of charities, including MacMillan Cancer Support and Sport Relief. The main beneficiary was Bluebell Wood Hospice in Sheffield. The hospice offers care and support to children with a shortened life expectancy, both in their own homes and at the hospice in North Anston.
The cheque presentation event, raised at SVM Global's headquarters, was also attended by Rotherham Metropolitan Borough Council representatives and key staff from SVM Global's Chicago Headquarters.
Mandy Rafferty, Corporate Fundraiser at Bluebell Wood Children's Hospice, was on hand to collect the cheque from Katrina Dunne, Talent Director of SVM Global. Mandy said: "Our focus at Bluebell Wood is to make sure every child with a life shortening condition and their family members are supported well through the toughest times imaginable.
"It costs more than £4 million to run our hospice and we couldn't do it without the passion of people like the employees of SVM Global. We thank you from the bottom of our hearts."
Bluebell Wood will this year host a range of events including wing walking, a soap box derby and charity skydiving – something the SVM Global employees were keen to volunteer Managing Director, Brian Dunne for!
Brian added: "We are thrilled with the work that Bluebell Wood do and we are incredibly happy to have put much needed cash towards this great cause. The SVM Global family has grown now to well over 100 – and hopefully this will have a positive effect on the amount we can raise in 2016 for this fantastic charity."
The overall total raised in 2015 was an impressive £5,775.86!
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Technology vs. Attention Spans
Jeffries, Duncan. The Guadian. March 11, 2013. October 17, 2013. Web.<http://www.theguardian.com/teacher-network/teacher-blog/2013/mar/11/technology-internet-pupil-attention-teaching>
This article pretty much just rehashes a study done by Pew Research Center, and also brings in another researches done and talks about them. One researcher stated that, while young children do have the ability to have longer periods of concentration, leaving them alone with technology can be detrimental because they do not acquire the ability to communicate with people. Another researcher compared two groups of people, one that moved into an urban down and another that lived a "traditional existence". The researcher said that the urbanized group did not fall far out of her expectations, but she was surprised at the traditional group at how exceptional they were able to concentrate on one thing for a long time. And yet another researcher said that there is no doubt that technology has hindered children's ability to learn do to the fact that answers no longer have to be researched; a simple Google search will do.
Neither of these new studies are all that groundbreaking, but when almost every research agrees that technology has hindered attention span today, not much really would be.


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The rally weekend is only just over a month away and we're pleased to announce details of the spectator viewing.
On Saturday 27th April the seafront at Western Esplanade, Clacton will be bustling as everyone sets-up and gets ready for the rally the next day. Last year there was a wonderful atmospehere as competitors, their support crews, locals and visitors mingled in the sunshine.
At 18:00 the cars will be flagged-away by Giles Watling M.P. at the ceremonial start.
On Sunday 28th April the service area will be busy again, with the cars leaving from 08:30 before returning twice during the day for service. The spectator experience will be enhanced with two giant TV screens bringing you live coverage of the stages.
For people who wish to see the cars at competitive speed we've improved the facilities at Ship Hill with VIP Hospitality available plus a PA system in the general spectator viewing area, introduced an additional spectator area at St Mary's and have Wick Road viewing available again.
For full details, including maps please click on this link to the Spectator page of the website.
During the event keep in touch through our social media channels too.
# tendringrally


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Business Contact Manager for Outlook 2007 SP1 is Live
We are pleased to announce that Service Pack 1 for BCM is live. This update significantly improves the stability, adds support for ACT! 8 and ACT! 9 migration and fixes several issues reported by our customers. Here is a high-level list of what is included in this service pack:
- Several fixes to crashes and hangs that were reported by customers like you through crash reporting dialog.
- Data migration support for newer versions of ACT! (ACT! 8.0 and ACT! 9.0). (Requested here on this blog by you)
- Fixes for several database issues and improved error handling/troubleshooting for key reported database issues.
- Custom field support in Mail Merge marketing campaign. (Requested here on this blog by you)
- Fix to an issue when sending marketing campagin to a large number of recipients.
- Fixes for follow-up flag related issues.
- Fixes for Miscellenous bugs reported by our customers through various feedback channels such as this blog, newsgroup, support etc.
- Ability to change the database polling interval that might give some performance benefits in shared database scenario. (More on this in the next blog post)
We recommend that you get BCM SP1 through Microsoft or Office update site. Alternatively, you can directly download the update from here. The service pack is available for all langagues in which BCM is available.
Thanks for your feedback. We hope that this update will improve your experience with BCM. As always, please keep the feedback coming in. That's what help us improve the quality of our product.


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Category Archives for "Deep Learning"
Convolutional Neural Networks are heavily used in computer vision and recomendation systems. The magic behind Neural Networks in general lies on hidden layers as well as training, but how these layers work on Convolutional Neural Nets?
If you haven't heard about Convolutional Neural Networks yet ( Do you live in a cave? Just kidding ), or Neural Networks in general, I bet you've heard all about it's applications. They're used in recognition systems such as Face recognition, handwritten digits recognition and also used in my loved example, self-driving cars ( I really enjoy self-driving cars if you haven't noticed ). Ok, now you know what this is all about, but how Convolutional Neural Networks work?
Neural networks are all over the place and have been extremely successfull. Have you ever stopped to think about how a computer learns to see the world as well as a person? How they can recognize your face in smart devices authentication process and furthermore your retina? To do this smart devices use deep learning and computer vision, got interested? Buckle up and let's go for it!
It's time to get your hand's on training your Neural Network, because you are going are going to be capable of working through parameters with real data coming from the MNIST Kaggle competion.
If you haven't been following the previous steps, you can check out how Kaggle works and how to start with the MNIST competion. After getting confortable with the data you could look how to create basic Neural Networks and how to train them. If you are already up to date and ready for a challenge, buckle up and let's go for it.
When working with Neural Networks in PyTorch, some functions expect specific types of tensors, you can look up the types here. But what caught me on this specific Neural net was the difference between torch.Tensor and torch.tensor. The images we pass in the forward pass is expected to be torch.FloatTensor, but the labels are expected to be torch.LongTensor, you can create the first type with torch.Tensor, and the second one with torch.tensor.
After creating your model you need to train it. This is where things got interesting, we have in total 42000 images, we're going to create simple batches of 64 images and loop it through. The epochs are how many times we're going to repeat this process.
We can see that our model can predict that the handwritten digit is a zero
There are innumerous learning opportunities here, I've started with a Softmax function in the end layer and discover that the LogSoftmax worked way better. Also the Loss function and the optmizer could be chosen differently. PyTorch also has some cool functions to normalize and clean the data. An important thing also is validation and testing datasets, I'll be making more posts on this.
If you want more content like this, I have a YouTube Channel
If you haven't created your first neural network, you can look furthermore here. Now it's time to take the first step because you're going to train your Neural Network and if this interests you, let's go for it.
Neural Networks are all over the place, you can see them in fields like Robotics in Self-Driving-Cars, in Medical assistance with Watson and many others applications. When people talk about it sounds cryptic and really hard. But here's how you can create one yourself.
Now we are going to be creating our owl personal Perceptron, be creative with what you would do with him. In this example we are going to use it as a Logic AND Gate
Deep learning is based in Neural Networks, but what are the underlying blocks of NN?


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CDR Administrative Officer
Merdith "Mert" M. Frost
Mert, a devoted patriot, served his country in the United States Naval Reserves, flying his flag daily thereafter. He attended Western Michigan University for four years prior to embarking on his 40-year career as the owner and operator of Frost Standard, the largest full-service gas station in South Western Michigan. Well respected for his business acumen, he was a mentor for many other entrepreneurs. As an active community minded individual, he was a member of the Masonic Lodge and Shriners International. He enjoyed meeting the families while driving them to Shriner's Hospital for Children in Chicago and Cincinnati for their children to receive medical care, making over 280 trips total. Mert belonged to the Elks Club in Otsego; he was a member of TPA, AMBUCS, YKATS Swim Club, WMU Blue Line Club, and Alamo Little League. He was honored to receive a Paul Harris Fellow from Rotary International. Mert enjoyed going to car shows and was an avid sports fan. He enjoyed his time together with his friends from school and they were known as the Milwood Lunch Bunch. Mert is survived by his loving wife of 59 years, Doris (Hutchins) Frost; four children, Dianne Hunter, Linda (Rick) Bukoski, John "Jack" (Kim) Frost and Susan (Steve) Andrie; ten grandchildren, Becky, Maria, Julianna, Aria, Aydin, Ansel, Kimmy, Jimmy, Nicole and Tommy; and one great-grandchild, Ava.
Mert was lain to rest with full military honors in Riverside Cemetery, Kalamazoo, Michigan.
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Additional Charges to the car rental rates
|Additional Driver (per driver)
|Baby/Child Seat (per rental)
|Baby Seat Loss Recover
|Baby Seat Valet
|Claim Handling Fee
|Contract Fee per rental
|Delivery fee to Camps Bay during office hours
|Delivery fee to Camps Bay after hours
|Fine Handling Fee (Fine R0-R300)
|Fine Handling Fee (Fine R300+)
|GPS Rental per day
When is there no charge for re-fuelling?
There is no charge for re-fuelling when the car is returned with a full tank.
How is the 24-hour period calculated?
Rates are calculated on a 24-hour period from the time the customer signs the rental contract until the return of the vehicle.


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Nebraska's Tai Webster Blows Past Ohio State Defender Busy Slapping the FloorFebruary 21, 2016
The floor slap did not work out so well for Jae'Sean Tate.
The Ohio State Buckeyes forward took a page straight out of the Duke playbook Saturday night in Lincoln, Nebraska, whipping out the floor slap when defending Tai Webster.
Except it didn't go quite as planned.
The Nebraska Cornhuskers guard blew right past Tate, who appeared to be too consumed in the intimidation effort to actually play defense.
Luckily for Tate, the Buckeyes pulled out the win in overtime, 65-62.


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If you're casting a vote using a similar line of logic as Batman villain Ra's al Ghul, you might want to reconsider.
If you're casting a vote using a similar line of logic as Batman villain Ra's al Ghul, you might want to reconsider.
FOX has announced the 10 candidates for the GOP nomination who will appear in the first primetime debate.
The first primetime debate of the Republican primary race on Thursday will include ten candidates, according to FOX News: Donald Trump, Jeb Bush, Scott Walker, Mike Huckabee, Ben Carson, Ted Cruz, Marco Rubio, Rand Paul, Chris Christie and John Kasich.
FOX, which is hosting the debate in Cleveland, Ohio, announced the list of the top 10 candidates based on recent national polling on air at 6pm ET Tuesday.
Ohio Gov. John Kasich, who earlier last week was at risk of missing the cut for the primetime debate in his home state, made the cut at the 10th spot, edging out former Texas Gov. Rick Perry.
Candidates that did not make the cut will participate in a separate debate earlier on Thursday. Those Republicans are: Perry, Rick Santorum, Bobby Jindal, Carly Fiorina, Lindsey Graham, Jim Gilmore and George Pataki.
First off, I think it's somewhat ridiculous for FOX to enforce an arbitrary cut-off for the debate. This isn't American Idol. No one has voted yet, and they've already set a distinction between major league and minor league candidates, which I think effectively ends the campaigns of everyone in Tier 2. Yeah, they'll have a "separate debate" earlier in the day, which about as many people will watch as will participate. It's almost like the singles table at a wedding: "Bobby, I think you and Lindsey will get along smashingly. Yes, you just met a half hour ago but you're both polling poorly, so you have that in common."
Let's also take a moment to consider that four governors (Gilmore, Jindal, Pataki, and Perry), and two senators (Graham and Santorum), who despite what you might think of their politics have some practical experience, won't be on the same stage in a primetime debate for the GOP presidential nomination with the former star of The Apprentice. That is Trump's occupation, by the way. That's why most voters even know his name. It's not like Steve Jobs is still alive and is running. No one sits down to watch Hulu on their "Trump Tablets."
And Trump is arguably still the most appealing of the "major league" candidates. I suppose Bush is supposed to get credit for being the only closeted asshole of the bunch.
From Politico:
A new Monmouth University poll has Trump at 26 percent, easily topping his competitors. The next-closest candidates — former Florida Gov. Jeb Bush and Wisconsin Gov. Scott Walker — are at 12 percent and 11 percent, respectively.
Both the new Monmouth survey and an average of the five most recent live-caller polls — Fox News' criteria for whittling the list of Republicans down to 10 candidates for Thursday night's debate — reinforce the tiers that have developed since Trump upended the race by surging to the top.
Beneath Trump, Bush and Walker are five more candidates who are hovering around 6 percent in the poll average (and scored between 4 percent and 6 percent in the Monmouth poll): pediatric neurosurgeon Ben Carson, Texas Sen. Ted Cruz, former Arkansas Gov. Mike Huckabee, Kentucky Sen. Rand Paul and Florida Sen. Marco Rubio.
I suppose the theory (or at least the hope from the Bush campaign) is that majority of GOP primary voters will eventually unite behind Jeb. But the folks supporting Cruz, Huckabee, Paul, even Carson and Christie seem more likely to back Trump. He is more similar to all of them in temperament and rhetoric. I wonder if the GOP establishment will at some point pressure Walker or Rubio to withdraw as their supporters seem likely Bush voters.
I know it's almost a year until the GOP convention but gee, Jeb, your dad and your brother were both president. You were governor of a state for a while and now you're losing to Donald Trump by 14 points? That's only acceptable if the poll was conducted by Trump himself.
Some of my favorite comments from Donald Trump supporters via Facebook:
"I've been wrong but as of right now this man has my VOTE UNLESS I FIND OUT HE ISNT A CHRISTIAN OR HE DOESNT BELIEVE IN GOD. What else is there ? We have to have someone who can't be bought if there is a future. I can be utterly negative and say Lord come quickly but doesn't the word teach us to live as though we are going to live forever and live as though our Lord could come anytime?"
"Not saying I agree with everything this guy says but FINALLY a guy running for office that isn't pussified and PC. I think at the very least the country will lean towards him to show the other politicians to grow a pair!"
"THIS is why I'm voting for this cornhole, He's not ANYONE'S puppet and he says what he's thinking. GOOD or BAD All I keep hearing him say over and over is "Let's make America Great again!" got my vote."
"That's the way things should be in politics, no compromise with anybody but with the country."
"Untouchable like Elliot Ness"
'We all remember Obama using the word CHANGE and Lord knows he sure did CHANGE things to being worse than ever. If u want real, positive CHANGE in this country vote for Trump. He really doesn't need anybody's special interest money and he won't owe anything to anybody and he definitely will create jobs and secure our borders."
"This is why The Donald is dangerous to the republicans, democrats, and every lobbyist in Washington, the money can't influence him!! I dunno, everybody thought it was crazy for an actor to be governor of California and then president. Is the Donald the next Ronald? Anything dangerous to the establishment in Washington is more than likely good for the American people. Donald J. Trump is a very real threat to the establishment!!!"
The very first U.S. president was a general, as were many who followed him. However, military operations are much different now. There aren't that many Pattons or MacArthurs left. I think this is why Trump is so popular among conservative voters. He's a "business magnate," which the modern-day equivalent to a pirate or a conquistador. And deep down, Americans — who rejected the monarchy and embraced democracy, which is a form of monarchy that is spelled differently — have an affection for the emotional unstable borderline personalities that were prominent on the throne. That is true leadership to them. Measured diplomacy is skullduggery. They don't want their leaders to be politicians… that's for ambassadors. And, after all, can't you picture Trump, more so than Jeb Bush and especially Lindsey Graham, in the following scenes?
My friend Aaron Elstein at Crain's has a fun piece on the further unraveling of professional asshole Donald Trump.
Macy's has become the latest corporate giant to part ways with Donald Trump.
The retailer said Wednesday that it would stop selling the Donald Trump line of menswear on its shelves since 2004, saying it was "disappointed and distressed" by the presidential candidate's recent remarks about Mexican immigrants.
The New York-based retailer's move comes two days after NBCUniversal said it would no longer broadcast the Miss USA or other beauty pageants owned by Mr. Trump. Four days earlier, Spanish-language network Univision bid Mr. Trump adios.
Donald Trump continues to experience fall-out from his racist comments regarding Mexico.
Roselyn Sanchez, the Puerto Rican singer/actress and star of Lifetime's Devious Maids, has bowed out as co-host of the Miss USA pageant, citing Donald Trump's comments in his June 16 presidential-bid speech.
"I was very excited and proud to have been invited to participate in Miss USA, but as a Latina, that is now inconceivable," Sanchez said in a statement. "Although I am not Mexican, I am Puerto Rican and a proud Latina, and his comments were an insult to our culture. I won't sponsor anything produced by Donald Trump."
Univision also announced it won't even air the pageant.
I support anyone choosing not to associate with Donald Trump but it does remind me of what I call "The Mystery of Assholes." Why are people surprised when a known asshole does something assholic?


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Will the free power to municipalities finally be killed?
Economist: Puerto Rico utility's privatization will raise electric bill
SAN JUAN – Commissioned by the Puerto Rico Electric Power Authority's Irrigation & Electrical Workers Union (Utier by its Spanish acronym), economist José Alameda conducted a study in which he concluded, among other things, that contrary to what the government alleges, the public utility's privatization would result in higher residential bills.
"On average, citizens would be paying on average $986 per year. Commercial customers would pay $13,600 more and industrial customers would spend $827,000 more per year," Alameda said during a recess of the Joint Committee on Economic Development, Planning, Telecommunications, Public-Private Partnerships, Energy and Government of the House of Representatives.
Alameda also mentioned that the decrease in energy demand, whether due to newer electrical equipment using less power or the island's population decline, does not help reduce the cost of generating electricity in Puerto Rico.
IEEFA: Privatizing Puerto Rico's electric company would impede modernization
"This happened in the Dominican Republic and Argentina. In Argentina, the system was privatized, but since revenue did not reach private companies, the state subsidized private enterprise. When that subsidy was eliminated, rates increased by 788% in two years," he said.
Another of the University of Puerto Rico professor's arguments was that, if the island were divided into sections, the private sector would have problems recovering its investment since, for example, it is not the same to sell electric power in the metropolitan area of San Juan than in the mountainous countryside.
Utier President Ángel Figueroa said in the public hearing that he favors, under a public model, that investment is made through Public-Private Partnerships but that, unlike what is currently happening, the private sector invests and Prepa pays for it in a set period of time.
The union leader also argued that the private model clashes with Gov. Ricardo Rosselló's proposal of promoting that citizens produce their own energy.
Committee Chairman Víctor Parés then assured the bill would establish that citizens who decide to leave the power company's grid will not be penalized.
"We have discussed that anyone who has an interest in leaving the system is not penalized and we agree. In fact, we are going to make this happen and we are going to put it in writing in the bill, and it is important that this is very clear," the lawmaker said.
He added that specific language on a formula on the cost per kilowatt-hour will be included so the price is established according to market price and does not negatively affect the consumer.
Parés mentioned that only one public hearing over Prepa's privatization bill is left. Likewise, he agreed with Senate President Thomas Rivera Schatz's arguments to include the energy policy, the regulatory framework and for the Legislative Assembly to perform a final review in the process of the sale or concession of the utility's assets.
2 Comments
For an un-named UPR professor to support an Electrical Union's President and gain space here is evidence of the editors choice is very biased! To draw from Dom. Rep and Argentina oddities to contend outrageous consumer or business expense for electrical power is just absurd. Nobody today wants a socialist's concept of a government utility that seeks no profit, only a chance to manipulate for benefits of another sort. All are seeking and will soon find alternatives! So, all who advise that we will be forced to pay far too much, for what we get now only in an undependable fashion, are only making the change to avoid happen!
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A desire is a part of who we are which has a sense of longing something to reach a goal. Without it, our lives are just meaningless, because it's the fundamental motivation of all human action.
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Kelly Bloss Managing Director Promotion
Posted on Oct 23rd, 2019
New York, October 22, 2019 — Stuart Levine & Associates LLC is pleased to announce the appointment of Kelly Bloss to Managing Director. Kelly reflects the depth of senior talent that we are fortunate to have at the firm. Kelly is a member of the Operating Committee and has been delivering significant value to our […]
Stuart Contributes to The Directors Chair on Board Culture Change
Posted on Oct 6th, 2019
Published in NACD The Director's Chair
Stuart Contributes To Agenda On Board Struggles With Culture Metrics
Posted on
Boards Struggle With Culture Metrics By Amanda Gerut September 23, 2019 As boards grow increasingly aware of the importance of gauging and understanding company culture, directors are working with management teams to determine which data points can best unearth and root out culture problems before they can fester and thwart strategic initiatives. Recent research published […]
Stuart To Moderate Webinar On Overcoming Risks In 2018
Posted on Feb 23rd, 2018
Overcoming the Top Five Risks of 2018: Strategies for the Board and Executive Leadership When: March 8th, 2018 at 2:00pm Stuart will join Passageways as a moderator with Scott Laliberte, Managing Director of the Information Security Practice for Protiviti, a global consulting firm of 4,500 people that delivers deep expertise, objective insight and tailored approaches to […]
Stuart Speaking At CUES Director Strategy Seminar In San Diego 7/25-7/27
Posted on Jan 4th, 2018
Schedule Registration will begin Wednesday morning at 7:30 a.m. Class will be in session Wednesday and Thursday from 8:00 a.m. until approximately 4:00 p.m., and Friday from 8:00 a.m. until Noon. Wednesday, July 25th Agenda Breakfast: 7AM – 8AM Morning Session: 8AM – 10AM – Your Board Needs to Embrace Transformation: Digital and Human This session […]
Stuart Hosts Webinar on Exceptional Leadership on 10/25 With Passageways
Posted on Oct 15th, 2017
On October 25th at 2:00pm ET, Grant Herlitz, President of The Howard Hughes Corporation & Stuart R. Levine will host a webinar with Passageways on Exceptional Leadership. Grant drives the daily operations of The Howard Hughes Corporation and works closely with the CEO in developing the strategy that has made them successful. Stuart will moderate this incredible learning […]
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Posted on Sep 19th, 2017
Stuart will be the keynote speaker at the LSN XVII conference in Sydney, Australia on October 31st. In his keynote address, Stuart will share tools from his best-selling book Cut To The Chase. For additional information and sign up: https://www.listsellnegotiate.com.au/
Cut To The Chase With Stuart
Posted on Sep 6th, 2017
Start with the End in mind is a key rule from Stuart's best-selling book, Cut To The Chase. Learn from Stuart how to integrate this simple rule into your everyday routine so that you can start achieving your objectives.
Stuart Hosts Webinar On Board Meeting Optimization With Passageways August 8th
Posted on Aug 3rd, 2017
Tuesday, August 8th at 2pm EST/11am PT, Stuart R. Levine and Peter Gleason, President and CEO of the National Association of Corporate Directors (NACD) will join Passageways for a live webinar. On this webinar, board directors, senior executives and aspiring board members/leaders will learn best practices:: Essentials for board meeting pre-planning Creating an agenda and […]
Stuart Hosts Webinar On Board & Management Succession Planning On May 18th
Posted on May 2nd, 2017
On Thursday, May 18th at 2pm EST/11am PT, Stuart R. Levine will join Passageways and Dennis Whalen, KPMG Partner and Leader of the KPMG Board Leadership Center for a webinar on board and management succession planning. On this webinar board directors, senior executives and aspiring leaders will learn: Why succession planning is both art and science […]


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Authorities are asking for the public's help in finding a Woodbury man with autism who went missing Tuesday.
Austin Sager, 18, is described as 5 feet 9 inches and 175 pounds with sandy blond hair and blue eyes. He normally wears eyeglasses, and he might be wearing a blue shirt.
He reportedly went missing around 4 p.m. Tuesday in either Cottage Grove or Woodbury, according to Woodbury Public Safety statement issued Wednesday.
Sager's family and friends are organizing a search at 1 p.m. and will meet at the Bruegger's Bagels on Radio Drive and Valley Creek Road.
The city also plans to utilize drones in his search.
He is known to take frequent walks in the Cottage Grove and Woodbury area, authorities said.
His family believes he may have been trying to walk to St. Paul and is known to visit churches.
Sager is a part of the South Washington County Schools' Next Step program designed for students with special needs. He is described as being high functioning.
Authorities said he is trusting of others and may get into a car with a stranger.
Authorities ask people to call 911 if they see him or have additional information.
He is the son of Lori Sager, who is well known in the Woodbury music and theater scene


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The homeopath thought my cold was pretty cool. From his point of view, my body was doing a nice job of riding itself of accumulated bad gunk. From my point of view, the constant runny nose meant that I could not breathe through the BiPAP mask. Without the BiPAP, I could not sleep. Without sleep, experience taught that I would spiral downward into serious trouble. I was waking up every half hour all night. Since the 1:4732 potion had moved me out of the depression, we continued with that.
Then I started running a fever. We were now in seriously deep shit. The odds that I had bacterial pneumonia were pretty high. I went to the physician who does acupuncture. He noted that my chest was congested and I had a non-productive cough. He sucked in his breath and said "This is a problem, you understand?"
I replied, "The medical article says that bacterial Klebsiella pneumonia has a 21% fatality rate in 14 days." My grandmother's brother rode home from the swimming hole at dusk in an open buggy while wearing a wet bathing suit. Three days later he died of pneumonia. Three years later penicillin was discovered.
Now that the physician and I understand each other, he offers antibiotics, knowing I will refuse. He has to offer; I have to refuse. Then he orders a chest x-ray and does acupuncture for the lungs. That night, the fever stops. In the morning, the cough is gone and the congestion has moved from my lungs to my head. Since I don't need my head for anything vital, such as breathing, this is a step in the right direction.
World, please note: antibiotics are not necessary to knock out Klebsiella pneumoniae. A good guy with a handful of needles, and education and experience in where to put them, can do just as well—or better. The first sentence in the medical article was "Klebsiella organisms are resistant to multiple antibiotics" then it went on to detail exactly which antibiotics in what combinations should be used. Yeah, right.
I no longer had any significant depression; I just felt numb, emotionally and physically. Also, the outside temperature was in the 80's. I collapse at 78 degrees, so it was hard to tell what was causing what, good or bad. The 1:4,732 potion was continued. People came and went; I read and slept.
I dreamed that I was moving. My entire apartment had been packed up except the kitchen. The homeopath took this as a good sign; me, not so much. In the past couple years I have had dreams of moving in with my parents, or my parents helping me move. My parents are both dead.
Throughout all this crap, my average glucose, which had leveled off at 500 and then begun to drop, began to climb again. My therapist came and brought me the awareness that I no longer was suffering from shortness of breath. SOB had been a major problem for most of the last year. It sometimes became so bad that I couldn't stand up for more than 30 seconds—and I couldn't get an appointment with a pulmonologist. Now I wasn't having trouble breathing; all I was doing was taking a homeopathic remedy. How about that?
My average glucose dropped to 481, and I dreamed that I came upon a dying baby. I intervened with its parents and took it to Crouse Hospital. Went back the next day and found a beaming doctor standing behind a lavish buffet with a baby who was feeding well. He'd been missing an enzyme or something.
I am sleeping better now. This morning's average glucose was 474, the lowest it has been in three weeks. When I got a new aide a couple weeks ago, I discovered that after working with her for three hours, my glucose would be over 600. It wasn't about food intake; it was about chronic fatigue and the exertion of working.
Today, for the first time, I stood for nearly an hour while cooking. Afterward, I checked my glucose, sure it would be over 600.
It was 417.
There are other stories I could have included here—Joel Osteen and "It's Friday"; the documentary on the Sherpas who died on Mt. Everest and "It is never easy to climb a mountain"; and the physical therapist and the OA joint—but I am mindful of the man who said "Nobody wants to know the storms you encountered: Did you bring in the ship?"
Despite two very, very bad weeks, it looks like land is in sight.