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OC’s DNA is rooted in a focus on people as ministry. This manifests itself differently, but for some it comes in the form of member care, for people inside and outside the organization. Although member care is a specific department at the U.S. Mobilization Center, it is much more than that to OC’s people. It’s about healthy people serving the Lord around the world.
Member care comes in three folds for OC:
- Caring for U.S.-sent personnel
- The desire to care for its Global Alliance partners
- Caring for mission workers from other organizations that are serving in dangerous and arduous places
International Member Care Conference
In March, a group from various OC teams, many whose ministry revolves around member care, gathered together to examine the OC member care system and discuss how to move forward. “What I loved about this time together … it was a gathering of like-minded people working together to come up with strategies to better care for our people,” says Director of MemberCare Deänne Boesel. “I look forward to how these thoughts and ideas might come into play in the years to come.”
Part of the conference was spent talking about things happening in each of the representatives regions. “We had a good representation from around OC’s world, and there was good discussion of what strategies have worked in the past and those that have not,” says Deänne.
Thinking Ahead to Future Care
Other than traditional member care systems, currently in OC global work, Craig and Julie B. in East Asia have focused their entire work around the care for other OC mission workers. This model of “member care champions” is something Deänne hopes can develop in each part of the OC world. “Member care champions would intentionally care for people in their region. This could look a lot of different ways, but one important aspect of this in any region would be that it is on-site care.”
Many other exciting aspects were discussed at the conference, and Deänne feels that in the current OC climate “people are open to making these changes happen.” It was time well spent. “I hoped that during this time, each representative felt valued in his or her ministry and that they had their ideas heard.”
Join us in prayer
Deänne says, “Pray this conference is just the beginning of new and innovative ways to care for our most valuable resources, our people.”
Please pray for us as we work together to coordinate well, train each other to deal with serious issues, and care for the Lord’s Harvest workers around our world.
Would you like to give to support the core leadership, communications, mission worker training, member care and much more at the U.S. Mobilization Center?


text: Individuals with anorexia nervosa (AN) restrict eating and become emaciated. They tend to have an aversion to foods rich in fat. Because epoxide hydrolase 2 (EPHX2) was identified as a novel AN susceptibility gene, and because its protein product, soluble epoxide hydrolase (sEH), converts bioactive epoxides of polyunsaturated fatty acid (PUFA) to the corresponding diols, lipidomic and metabolomic targets of EPHX2 were assessed to evaluate the biological functions of EPHX2 and their role in AN. Epoxide substrates of sEH and associated oxylipins were measured in ill AN, recovered AN and gender- and race-matched controls. PUFA and oxylipin markers were tested as potential biomarkers for AN. Oxylipin ratios were calculated as proxy markers of in vivo sEH activity. Several free- and total PUFAs were associated with AN diagnosis and with AN recovery. AN displayed elevated n-3 PUFAs and may differ from controls in PUFA elongation and desaturation processes. Cytochrome P450 pathway oxylipins from arachidonic acid, linoleic acid, alpha-linolenic acid and docosahexaenoic acid PUFAs are associated with AN diagnosis. The diol:epoxide ratios suggest the sEH activity is higher in AN compared with controls. Multivariate analysis illustrates normalization of lipidomic profiles in recovered ANs. EPHX2 influences AN risk through in vivo interaction with dietary PUFAs. PUFA composition and concentrations as well as sEH activity may contribute to the pathogenesis and prognosis of AN. Our data support the involvement of EPHX2-associated lipidomic and oxylipin dysregulations in AN, and reveal their potential as biomarkers to assess responsiveness to future intervention or treatment.

domain: chemistry


text:
In his meeting with Xi Jinping in Brazil on the sidelines of the BRICS summit, Narendra Modi last week impressed on the Chinese president the need to “amicably resolve the boundary question.” Yet only the week before, Arun Jaitley had ruled out declassifying the Henderson Brooks-Bhagat Report (HBBR) on the 1962 war, the memories of which still plague our relations with our giant neighbour. It is difficult to see how the prime minister’s stated end game is compatible with the defence minister’s resistance to talk about the past.
Border settlement is tricky business, a far more ambitious venture than border management, which China and India have almost perfected. With no shot fired across the Line of Actual Control in decades, the border could not have possibly been managed any better. Border management is a largely military matter; border settlement would be a political exercise—and this is where it gets tricky, especially in a democracy as raucous as ours.
Any border settlement will entail give and take. We will have to lose some land, as will China. The most likely scenario, if it ever happens, is India giving up its claim on Aksai Chin and China giving up its claim on Arunachal Pradesh (or South Tibet, as they call it), formalising the current status on the ground. If selling a shrunken map to a nationalistically charged citizenry is a daunting task in one-party China, imagine doing it in India.
Despite his massive mandate, even Modi cannot expect his people—not to mention the opposition—to fall in line quietly and accept parting with Jammu and Kashmir’s eastern protrusion. And this is where the defence minister’s newfound zeal for secrecy jars. To even attempt an enterprise as challenging as border settlement, the government would need to first create conducive public opinion. The refusal to declassify the war report indicates the lack of political will to do so.
The British-Australian journalist and historian Neville Maxwell created a storm when he recently published a chunk of the first volume of the HBBR online. The report only provides a limited account of why we lost the war, not of why we went to war in the first place. But the 126 pages Maxwell outed still offer startling insights that suggest our view of the events of 1962 might be quite wrong.
The leaked pages, for example, take the government of the day to task for the ill-conceived “forward policy,” which forced our soldiers into disputed territories held by the Chinese. This goes against the grain of the core Indian belief that the war was provoked by China’s tendency to nibble on our land.
One such post created by the “forward policy” was Dhola, at the western extremity of the McMahon Line. China demanded that India vacate the post as it was on their side of the line. India claimed it was on the Indian side and dug in with a massive arms build-up, which in turn provoked a similar build-up on the Chinese side. That led to the first full-fledged combat between the two forces, which lit the fuse for the 1962 war.
But the HBBR reveals: “… the post was actually NORTH [emphasis in the report] of the McMahon Line … The General Staff must have been well aware of this; and it was their duty to have warned lower formations regarding the dispute.”
Not only did they not warn them, the top brass in fact repeatedly lied to officers on the ground unconvinced about India’s claims on Dhola, telling them the post was on the Indian side. The confusion resulted from Delhi’s unilateral “correction” of the original McMahon Line—this brought Dhola within the Indian side, while the McMahon Line on the maps that China and the Indian army followed still put it on the Chinese side. As the HBBR observes: “The Army Commander’s clarification of the McMahon Line and the doubts that existed in the minds of some officers need examining. It is clear in the planning stage and after the establishment of the Dhola post that XXXIII Corps and formations under it were working under the impression that the McMahon Line as such was as given in the map then available to them.” The map available to them did not show Dhola on the Indian side of the line.
The leaked parts of HBBR also provides the timeline of events leading up to the war, which makes it clear that it was India that declared the war and even set a date for evicting the Chinese—from their own territory, in Dhola’s case. So not only was the Chinese attack—counterattack, rather—not completely unprovoked, as we have been conditioned to think, it was not unexpected either. India picked the place, India picked the time, and India served the—demonstrably flawed—casus belli by way of Dhola.
Of course, many of the triggers of the war, such as the wider historical and geopolitical factors, are beyond the remit of the HBBR, which is primarily a military operations review. These include the role of the Tibetan unrest, an ongoing cartographical wrangle with several instances of contentious map alterations, the power struggles within China and India at the time, and the Cold War, all leading up to a cocktail that exploded in October of 1962.
Half a century on, our own role in that mix has been largely erased from public memory, and even suggesting that we might have some blame to bear verges on the blasphemous. What has taken root, instead, is a state-inspired monochromatic construct of the war—of India being the hapless victim and China the evil aggressor, which continues to poison public opinion and weigh on bilateral relations.
In an explanatory note on why he chose to out the HBBR, Maxwell wrote in his blog, “The reasons for the long-term withholding of the report must be political, indeed probably partisan, perhaps even familial,” alluding to the need to protect the Nehruvian legacy from the shame of 1962.
Free from the partisan allegiance that compelled most governments in the past to adhere to the institutional and popular interpretation of the war, Modi and his government are in a unique position to craft a very different China policy. The added advantage for Modi is that after a lame-duck dispensation in Delhi, the Chinese are also keen to do business with him as they see in him an Indian leader who can lead the country into a compact with China without the fear of appearing to compromise national interest. But such a China policy would have to begin with a sincere effort to inform public opinion. And the easiest way to start that process would be to declassify the HBBR in its entirety.
The second volume of the HBBR is understood to contain maps, memos and other documents. Let’s see them; let’s see the missing chapters of the first volume that Maxwell doesn’t have, and let’s review them along with other literature on the war.
Before he became the defence minister and discovered the virtues of state secrets, Jaitley wrote on the BJP website in March: “… to keep these documents ‘top secret’ indefinitely may not be in larger public interest. Any Nation is entitled to learn from the mistakes of the past … the report’s contents could have been made public some decades ago.”
Indeed. Let’s objectively talk about the war and examine the historicity of the conflicting claims that led to it. Until that conversation begins, all talk of “border settlement” will be little more than empty rhetoric.
Debasish Roy Chowdhury is the Business News Editor of Hong Kong’s South China Morning Post.

domain: history


text:
If donor heart matches, Wyche would go into surgery immediately.
Law protects overdose victims who seek help as well.
Steve Fought running unopposed in legally-mandated primary.
Homer, Ohio native Victoria Woodhull ran against Ulysses S. Grant & Horace Greeley as Equal Rights Party nominee.
Aaron Regunberg, a Democratic state representative from Rhode Island, said he was “surprised and concerned” that the race is so tight.
The amendment says “genuine contraception,” human eggs and in vitro fertilization would not be affected.
Cottages of Beavercreek will be the third community to be built in the city Charles Simms Development Corporation.
Delays are expected to stem from this crash, the Ohio Department of Transportation said.
Shane Unger, the driver who died in a wreck at Eldora Speedway Saturday will be laid to rest Thursday.
Browns quarterback Robert Griffin III broke a bone in his left shoulder and will miss at least eight games.
“You know what’s deplorable? Hillary Clinton viciously demonizing hard working people like you,” concludes the ad.
How the U.S. should respond to cyberattacks is the subject of much debate.
If convicted, he could face up to 16 years in prison and up to a $30,000 fine.
Rachel Bostian sentenced to 18 years to life in prison
She was wandering around the parking lot with sweatpants on and just in her bra, according to a Dayton Police report.
Ava’s parents and their attorney accused the policeman of acting recklessly with children nearby on the porch.
The ARC has begun twice-daily cleaning and rotating the chemicals used to clean the kennels.

domain: law


text:
Two local software developers involved with Women in Technology Wisconsin are taking leadership roles in the local Technology Education and Literacy in Schools (TEALS) movement. Erin Draheim, Skyline Technologies, and Nicolette Spear, Jewelers Mutual Insurance Company, have applied and have been accepted to bring technology education to New London and Hortonville schools.
TEALS, a program created by Microsoft, helps high schools build and grow sustainable computer science programs through partnerships between classroom teachers and tech industry volunteers. They work as a team to deliver CS education to students who would otherwise not have the opportunity to learn CS in their school. TEALS has two standard course offerings: Introduction to Computer Science and AP Computer Science A (AP CS A).
Currently, there are 9 schools in Northeast Wisconsin participating in the TEALS program: Appleton West, Appleton East, Appleton North, Kimberly, New London, Green Bay Preble, Pulaski, Denmark and Hortonville. Draheim will be volunteering at Hortonville High School teaching the AP Computer Science class. Spears will be volunteering at New London Middle School teaching the Introduction to Computer Science. Each participating school requires three volunteers with a background in computer science.
TEALS is leading the charge of closing the computer science gap. In the U.S., there will be 1.4 million CS-related jobs by 2020, yet U.S. college graduates are expected to fill less than a third of those jobs.
Draheim states, “By increasing access for youth in Northeast Wisconsin to experience computer science, we will give them the opportunity to become creators of technology and the world’s future innovators.”
About TEALS: TEALS was started in 2009 by Microsoft employee Kevin Wang, who developed and ran the program in his spare time, and is supported by Microsoft Philanthropies. Since its founding, TEALS has helped over 6,000 students and hundreds of teachers succeed in AP CS A. In 2015, per end-of-class surveys, 95% of students saw improvement in their programming skills, 87% of students mentioned the volunteers were helpful in learning computer science, and students averaged scores 1 standard deviation above the national average. In 2016, more than 57,000 students took the AP CS A exam and only 10 students earned a perfect score. One of those perfect scores was earned by a TEALS student.
Resources: Becoming a TEALS Volunteer: https://www.youtube.com/watch?v=UNyjBvjbXP0

domain: news


text:
Plastic Yellow Chicken For Dog
Each one need others` accompany, no matter human beings or your lovely pets. Do you dare to leave your pet alone? If the answer is NO, buy him a pet toy. The comfortable and playful toy will give your pets a long and warm. This yellow chicken is made of EVA, which is nontoxic
Looking for ideal Yellow Chicken Pet Toy For Dog Manufacturer & supplier ? We have a wide selection at great prices to help you get creative. All the Plastic Toy For Dog are quality guaranteed. We are China Origin Factory of Plastic Chicken Toy. If you have any question, please feel free to contact us.
Product Categories : Baby Plush Toys > Squeaker Toys

domain: pet


Seychelles President Wawel Ramkalawan has declared a state of emergency after a blast at an explosives depot and flooding in other parts of the country's main island killed three people.
The explosion in the industrial zone of Providence, southeast of the capital Victoria, caused "large-scale damage", the president's office said in a statement. Residents are ordered to stay in their homes so as not to hinder the work of emergency services.
"All schools will be closed. Free movement will only be allowed to workers in vital services and commuters."
The floods caused "major destruction," according to the statement. Ramkalawan later told reporters that heavy rains and flooding, which mainly affected the northern part of the main island of Mahé, killed three people.
The president added that more than 100 people suffered injuries, mostly minor, in the Providence blast and were admitted to hospitals or clinics, according to the newspaper. Many buildings near the explosion were badly damaged, and some were completely destroyed. Some families have fled their homes for security reasons.
El Niño climate phenomenon causes flooding in Somalia
Providence is 7.<> miles from Victoria. Emergency services are working in the area of the explosion, the president said.
Authorities said the international airport and ferries were still working to allow people to travel if they had to.
Much of the East African region has been hit by heavy rains and flooding that has led to casualties. Hundreds have died in the region since the rains began in October, millions have been forced to flee their homes. Ethiopia, Kenya, Somalia and South Sudan are exposed to flooding, aggravated by the El Niño phenomenon, with more than 130 deaths in Ethiopia, Kenya and Somalia.
Seychelles is a major tourist destination consisting of 115 islands. The country is the least populated in Africa, with about 100,000 inhabitants.
Follow the channel on


text:
On 10-09-2017 at 1:10 AM a Sergeant from the Mendocino County Sheriff's Office was on routine patrol in the area of Hawn Creek Road in Potter Valley, California.
During this time there was severe wind gusts which downed trees and power lines in this area of the valley. Shortly thereafter the Sergeant witnessed a ground fire which quickly traveled to the west towards Redwood Valley.
The fire quickly invaded Redwood Valley resulting in the mandatory evacuations of residents.
As of 10-09-2017 at 10:00 AM there have been multiple structures destroyed with a reported fatality and numerous injuries as a result of the fire.
The Sheriff's Office is continuing to assist with mandatory evacuations and responding to assist residents who are unable to self evacuate.
The Sheriff's Office is also conducting theft prevention patrols and have arrested one person who was in the process of burglarizing an evacuated home.
In response to the destruction caused thus far as a result of the Redwood Fire, Mendocino County Sheriff Thomas D. Allman has declared a State of Emergency in Mendocino County.
Further press releases are forth coming as the Redwood Fire progresses.
The County Emergency Operation Center (EOC) has been activated. The EOC number is (707) 467-6428.
(Mendocino County Sheriff's Office, Press Release)


text:
Monitoring of the Degradation Activities and the Diversity of the Microbial Community Degrading Refinery Waste Sludge
- 34 Downloads
The biodegradation of n-alkanes and branched alkanes from waste sludge were observed in landfarming soils of Motor Oil Hellas (a petroleum refinery) and changes in the bacterial communities in the soils were monitored during the remediation. Bacterial 16S rRNA gene (rDNA)-based community fingerprint patterns were obtained from soil samples by terminal restriction fragment length polymorphism (T-RFLP) analysis. Changes in T-RFLP fingerprints, as well as in the petroleum contaminant composition of the polluted soil, correlated with degradation activities in field tests.
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- Borneman, J., Skroch, P. W., O'Sullivan, K. M., Palus, J. A., Rumjanek, N. G., Jansen, J. L., Nienhuis, J. and Triplett, E. W.: 1996, ‘Molecular microbial diversity of an agricultural soil in Wisconsin’, Appl. Environ. Microbiol. 62(6), 1935-1943.Google Scholar
- Katsivela, E. and Kalogerakis, N.: 2000, ‘Biodegradation of aliphatic petroleum hydrocarbons in refinery waste sludges’, in V. A. Tsihrintzis, G. P. Korfiatis, K. L. Katsifarakis and A. C. Demetracopoulos (eds.), Proceedings of an International Conference “Protection and Restoration of the Environment V”I, V. Bouris Press, Thessaloniki-Kalamaria, Vol. II, pp. 793-799.Google Scholar
- Liu, W. T., Marsh, T. L., Cheng, H. and Forney, L. J.: 1997, ‘Characterization of microbial diversity by determining terminal restriction fragment length polymorphism of genes encoding 16S rRNA’, Appl. Environ. Microbiol. 63, 4516-4522.Google Scholar
- Moore, E. R. B., Mau, M., Arnscheidt, A., Böttger, E. C., Hutson, R. A., Collins, M. D., Van De Peer, Y., De Wachter, R. and Timmis, K. N.: 1996, ‘The determination and comparison of the 16S rRNA gene sequences of species of the genus Pseudomonas (sensu stricto) and estimation of the natural intrageneric relationships’, Syst. Appl. Microbiol. 19, 476-492Google Scholar
- Moore, E. R. B., Arnscheidt, A., Krüger, A., Strömpl, C., Mau, M.: 1999, ‘Simplified protocols for the preparation of genomic DNA from bacterial cultures’, in A. D. L. Akkermans, J. D. van Elsas and F. J. de Bruijn (eds.), Molecular Microbial Ecology Manual, Kluwer Academic Publisher, 1.6.1, pp. 1-15.Google Scholar

domain: literature


text:
|Year : 2020 | Volume
| Issue : 7 | Page : 3349-3355
Frequency, nature, severity and preventability of adverse drug reactions arising from cancer chemotherapy in a teaching hospital
Saravana Kumar Ramasubbu1, Rajesh K Pasricha2, Uttam K Nath3, Biswadeep Das1
1 Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
2 Department of Radiation Oncology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
3 Department of Hemato-Oncology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
|Date of Submission||06-Mar-2020|
|Date of Decision||28-Mar-2020|
|Date of Acceptance||13-Apr-2020|
|Date of Web Publication||30-Jul-2020|
Dr. Biswadeep Das
Additional Professor, Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh - 249 203, Uttarakhand
Source of Support: None, Conflict of Interest: None
Background: An adverse drug reaction (ADR) is defined by the World Health Organization (WHO) as “Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy”. Cancer chemotherapy is associated with the occurrence of ADRs, which is a worldwide problem. Monitoring and reporting of these ADRs are essential to safeguard the patient and to manage it accordingly. The outcome would create alertness and prevent their recurrence. Hence, we have undertaken a hospital-based study to study the frequency and nature of ADRs due to chemotherapeutic agents. Methods: A total of 500 patients developed ADRs due to cancer chemotherapy from 13th April 2018 to 18th September 2019. Demographics of the patient, drugs taken, and ADRs encountered were recorded in a predesigned form. Results: A total of 665 ADRs were recorded from 500 patients. Anemia was the most common ADR encountered followed by nausea/vomiting and leucopenia. Leukemia (s) were common cancer observed followed by lung and breast cancers. The most common drugs implicated were cisplatin, paclitaxel, carboplatin, and doxorubicin. Naranjo's scale showed 92% of ADRs as probable and 7% as possible. Severity scale showed 80.2% of ADRs were of moderate (level 3 and 4) severity, 11.6% of mild (level 1 and 2) severity, and 8.2% of level 5 severity. A total of 26.8% of ADRs were deemed preventable and 73.2% were not preventable. Conclusions: Our study provides safety data regarding the usage of anti-cancer drugs. Hence, it creates alertness among the treating doctors to prevent its recurrence.
Keywords: ADRs, cancer chemotherapy, India, preventability, severity, teaching hospital
|How to cite this article:|
Ramasubbu SK, Pasricha RK, Nath UK, Das B. Frequency, nature, severity and preventability of adverse drug reactions arising from cancer chemotherapy in a teaching hospital. J Family Med Prim Care 2020;9:3349-55
|How to cite this URL:|
Ramasubbu SK, Pasricha RK, Nath UK, Das B. Frequency, nature, severity and preventability of adverse drug reactions arising from cancer chemotherapy in a teaching hospital. J Family Med Prim Care [serial online] 2020 [cited 2021 Sep 19];9:3349-55. Available from: https://www.jfmpc.com/text.asp?2020/9/7/3349/290796
| Introduction|| |
Cancer has become a global burden and is one of the major causes of mortality in developing countries and the incidence of the disease is drastically escalating every year in these countries. Due to rapid globalization and insalubrious lifestyles and the acceptance of many features of a western dietary pattern, there is a higher occurrence of cancer in developing countries. For the management of cancer, various treatment options including surgical removal, radiotherapy, chemotherapy, and immunotherapy have been made available and the choice of treatment happens to be dictated by the site of the tumor, stage of the disease, and the general condition of the patient.,
An adverse drug reaction (ADR) is defined by the World Health Organization (WHO) as “Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy”. ADRs of cancer chemotherapy have considerable economic as well as clinical repercussions as they often lead to hospitalization, prolongation of hospital stay and emergency hospital visits.
Antineoplastic agents are highly beneficial in oncological therapeutics, still, they are used with vigilance in view of considerable toxicity and narrow therapeutic window. Newer drugs are being introduced into the market after accelerated approval. With a continued increase in the number of antineoplastic agents used for cancers, the spectrum of ADRs associated with them has also become more diverse. During clinical trials, due to a limited number of study subjects, only commonly observed ADRs are reported. However, in the post marketing phase, more ADRs are unmasked. The primary care physicians play a role in helping the patients' with treatment options, providing psychological support, managing comorbid conditions, and recognizing and managing the complications of cancer as well as ADRs arising from cancer chemotherapy. ADRs like nausea and vomiting can be easily managed by primary care physicians.
There have been no previous studies conducted in the Uttarakhand area to systematically explore the safety profile of anticancer drug use. Hence, the objective of our study was to generate baseline data and analyze the ADRs in the Uttarakhand region and associated hilly areas that constitute a heterogenous population group.
| Materials and Methods|| |
Study design and setting
This study was a prospective observational study conducted from April 13, 2018 to September 18, 2019 in patients who received cancer chemotherapy after obtaining approval from the Institutional Ethics Committee (AIIMS/IEC/18/161 dated 4.1.2018). The study was conducted in the Departments of Radiotherapy and Hemato-Oncology, AIIMS Rishikesh. The data was captured from inpatients as well as outpatients of both the departments and also from the daycare ward.
Cancer patients who received cancer chemotherapy in the Departments of Radiotherapy and Haemato-Oncology, AIIMS Rishikesh and developed ADRs were included in the study.
- Newly diagnosed patients of hematological and non-hematological malignancies who received cancer chemotherapy.
- Patients receiving any chemotherapy including cytotoxic drugs and biological agents and who developed at least one ADR.
Patients who were unwilling to give informed consent for this study.
Data regarding ADRs were recorded from the patients and their medical records using standard data collection format.
Anatomic Therapeutic Chemical (ATC) Classification system codes of the WHO Collaborating Centre for Drug Statistics Methodology was applied as appropriate for therapeutic drug categories.
Specialized case record forms were used for extracting data regarding the patient's demographic profile and details of drugs received during a chemotherapy session.
The causality of ADRs due to suspected medication (s) was assessed using the Naranjo's Causality Assessment Scale. The Naranjo's Algorithm, a questionnaire designed by Naranjo et al., which contains 10 objective questions with three types of responses – yes, no, or do not know.
The severity of the ADRs was assessed using Modified Hartwig and Siegel Severity Scale, which classifies ADRs into mild (levels 1 and 2), moderate (levels 3 and 4), and severe (level 5). Preventability assessment of the ADRs was done by using Schumock and Thornton Scale, which classifies the ADRs into preventable (probably and definitely preventable) and not preventable.
All data were analyzed with the help of Statistical Package for the Social Sciences (SPSS) version 20.0. Descriptive data are represented as percentages and frequencies.
| Results|| |
Demographic pattern of patients
[Table 1] describes the demographic parameters of our study participants. A total of 500 patients developed ADRs during the study period, among which 306 (61.2%) were males and 194 (38.8%) were females. The mean age of the study population was 47.12 ± 18.324 years.
Nature of ADRs with suspected drugs
[Figure 1] shows the pattern of ADRs recorded. In our study, a sum of 665 ADRs was recorded and analyzed from 500 patients. Most of the cancer patients who developed ADRs during chemotherapy (233 (46.6%)) were found to be between the age group of 41 to 60. Among the ADRs encountered, the most common were anemia (32.4%) followed by nausea and vomiting (20.6%). Leucopenia (15.8%), neutropenia (3.6%), and thrombocytopenia (11%) were the other hematological ADRs observed in our study. Rashes were reported in 5.6% of patients, with consequent symptoms and signs of peripheral neuropathy in 5.2%, headache in 5.0%, and fever in 4.4%.
Analysis of various types of cancers and drugs which are implicated
[Figure 2] depicts the various types of cancers observed in our population. Leukemia (s) were the most commonly observed cancer in this setup, which accounts for 16.4% followed by lung cancer in 13.4%. Leukemia (s) constitute acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia, and acute promyelocytic leukemia.
[Table 2] outlines the distribution of drugs that are implicated in ADRs. The most common drugs which have caused ADRs were cisplatin (24.6%) followed by paclitaxel (17.4%). Carboplatin was found to be the third most frequent antineoplastic medication, which caused ADRs followed by doxorubicin and cyclophosphamide.
Causality, severity, and preventability assessment
Naranjo causality assessment scale showed that 91.6 % of ADRs were probable, whereas 7.2% and 1.2% of ADRs were deemed possible and definite, respectively. Modified Hartwig and Siegel Severity Scale showed that 11.6% of ADRs were mild (level 1 and 2), 80.2% of ADRs were moderate (levels 3 and 4) and 8.2% of ADRs were of level 5 severity. Preventability assessment with Schumock and Thornton Scale showed that 26.8% of ADRs were preventable, out of which 13.2% were definitely preventable and 13.6% were probably preventable. As per this scale, 73.2% of ADRs were not preventable [Figure 3], [Figure 4], [Figure 5].
| Discussion|| |
After the ADRs were recorded and analyzed, it was found that the population with a mean age group of 47.12 ± 18.32 years was the one highly susceptible to the development of ADRs. The occurrence of ADRs was high in male participants (61.2%) as compared with their female counterparts (38.8%). This finding is consistent with other studies., However, few studies show that females have a higher incidence of ADRs.,
Patients aged between 41–60 years encountered most of the ADRs, which accounts for 46.6% followed by those aged > 60 years (25.2%). It was found that the frequency of ADRs was higher in old aged patients in other studies., The possible explanation could be that the metabolizing capacity of the liver and the renal excretory functions are generally compromised in old age leading to building up of drug levels in the body thereby raising the possibility of ADRs.
The most common malignancy in our setting was leukemia (s) followed by lung cancer and breast cancer. These findings are similar to a study conducted by Gunaseelan et al., 2014. A similar study by Mrugank and Hareesha, 2013 observed that gastrointestinal and breast cancers were more commonly associated with ADRs. Another study showed that patients afflicted with lung cancer and breast cancer encountered ADRs more frequently. The probable explanation for these variations may be due to differences in the topographical distribution and hereditary makeup of the populations.
The most common anti-neoplastic drug causing ADR was cisplatin followed by paclitaxel in our study population which is comparable with other research reports., The most common ADR encountered in our study population was anemia. This finding is consistent with a study conducted by Gunaseelan et al., 2014. A recent study by Aghamohammadi et al. showed that body pain was the most common ADR. Some other studies have highlighted nausea and vomiting as the commonest ADRs., In our study, nausea and vomiting were the second-most common ADRs. Cytotoxic chemotherapy drugs suppress hematopoiesis, and also damage the rapidly proliferating cells of marrow leading to myelosuppression.
A total of 20.6% of patients developed nausea and vomiting in our study subjects, which is similar to a study conducted by Lavan et al. 2019. The incidence is lower when compared with 31.5% and 48.1% that was unraveled in two other studies conducted by Amartya, 2010 and Kirthi et al. 2014,, respectively. The curtailed incidence of nausea and vomiting in our study population may possibly be due to preemptive premedication with drugs such as ondansetron, and judicial use of ranitidine, pantoprazole, dexamethasone, and aprepitant. The treatment plan in our hospital for chemotherapy-induced nausea and vomiting was the administration of higher doses of palonosetron or granisetron and aprepitant, which is in accordance with reports of a study, where patients were given large doses of antiemetic drugs to treat nausea and vomiting due to cancer chemotherapy.
From our study, we found that leucopenia and neutropenia were observed in 15.8% and 3.6% of patients, respectively. In our setting, neutropenic patients experienced life-threatening bacterial infections and were treated with appropriate antibiotics as per the evidence from culture and sensitivity reports. To overcome leukopenia and neutropenia, patients were treated with filgrastim (granulocyte colony-stimulating factor (G-CSF)). Thrombocytopenia was observed in 11% of patients in our study population, diagnosed by observing low platelet counts, such patients were managed with platelet transfusions when indicated.
Peripheral neuropathy is a challenging clinical problem for patients receiving cancer chemotherapy. In our study population, it was found that bortezomib (a 26 S proteasome inhibitor) was the most common drug responsible for neuropathy followed by paclitaxel and vincristine. The neuropathy associated with bortezomib treatment evolves as a predominant sensory axonal polyneuropathy. One hypothesis is that bortezomib damages the satellite dorsal root ganglion (DRG) and Schwann cells. Case reports regarding bortezomib-induced peripheral neuropathy are available in the literature., The underlying cellular pathway for bortezomib-induced polyneuropathy is nebulous. Other likely explanations would include its targeted activity at the level of mitochondria. This precipitates apoptosis, which then affects not only the cancer cell but also the neurons. Another explanation includes the blockage of NF-kB activation which in turn would inhibit nerve growth factors required for neuronal survival. In our setting, patients with chemotherapy-induced peripheral neuropathy were treated with gabapentin, pregabalin or amitriptyline, which is similar to a study by Grammatico et al. 2016.
The incidence of hiccups (0.8%) was found to be lower in our setting which is comparable to a study conducted by Chopra et al. 2016. In contrast to it, Wahlang et al. found that there is a higher incidence of hiccups (7.5%) in their study.
Cancer chemotherapeutic drugs can alter the metabolism of an individual by changing the taste sensation, thereby leading to weight loss. Therefore, symptoms of weakness and weight loss were observed in 2.2% and 0.2% of patients respectively, which is less when compared with the study conducted by Wahlang et al.
In our study, a total of only 4% of patients experienced alopecia/hairloss and it is significantly less when compared with 51% and 58% that was stated in some other studies.,
It was observed from our study that 1% of patients had 4-fold elevations of their liver enzymes due to administration of cytarabine, gemcitabine and arsenic trioxide. All 5 patients were hospitalized immediately and the offending drugs were withdrawn. Follow-up was done and once liver enzymes returned to normal levels or upper normal, the lower dose of the drug was reintroduced into the treatment regimen and monitored accordingly.
On scrutinizing the causal association of the ADRs with the aid of the Naranjo Scale, we observed that 91.6% of the reactions were probable, 7.2% of the reactions were possible and 1.2% of the reactions were definite. With the use of this same scale, two other studies reported 100% and 61% of probable scores for causality.,
Analysis of the severity of ADRs using the Modified Hartwig and Siegel scale showed that 80.2% of ADRs were of moderate severity, which is similar to a study conducted by Kishore et al. 2018. 11.6% of ADRs were mild and 8.2% of ADRs were severe. Assessment of the preventability of ADRs by the Schumock and Thornton Scale showed that 73.2% of the ADRs were not preventable. 13.2% of ADRs were definitely preventable and 13.6% of ADRs were probably preventable. In contrast to this, Sharma et al. found that 30.8% of ADRs were definitely preventable and Wahlang et al. found that 45.3% of ADRs were probably preventable. ADRs observed in this study like vomiting, weakness, constipation, and cough could have been prevented with meticulous premedication and proper dietary counseling before the initiation of chemotherapy.
| Conclusions|| |
Early detection of drug toxicity during treatment will help physicians to modify the doses or drug-regimen to minimize toxic effects. Exploring the pattern of ADRs associated with anti-neoplastic therapy in a tertiary care hospice gives crucial insights in relation to the causality, severity, and preventability of reported ADRs. Pharmacovigilance helps in reducing the ADRs by changing the dosage of the medication and also alleviates the economic burden of ADR management to the afflicted and society in general. Our study has endeavored to unravel the baseline profile regarding the safety of anticancer drugs in the Uttarakhand area.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Hartwig SC, Siegel J, Schneider PJ. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm 1992;49:2229-32.
Schumock GT, Thornton JP. Focusing on the preventability of adverse drug reactions. Hosp Pharm 1992;27:538.
Goyal YN, Solanki KC, Mistry RA, Joshi ND, Singh AP, Gajera MV. Pattern of adverse drug reactions due to cancer chemotherapy in tertiary care teaching hospital in Gujarat. Med Sci 2014;3:333-5.
Prasad A, Datta PP, Bhattacharya J, Pattanayak C, Chauhan AS, Panda P. Pattern of adverse drug reactions due to cancer chemotherapy in a tertiary care teaching hospital in Eastern India. J Pharmacovigil 2013;1:107.
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Mrugank BP, Hareesha RP. Prospective observational, non-randomized, parallel sequence study for assessment of adverse drug reactions due to chemotherapeutic treatment in different types of cancer patients. Int J Pharm Sci Res 2013;4:386.
Wahlang JB, Laishram PD, Brahma DK, Sarkar C, Lahon J, Nongkynrih BS. Adverse drug reactions due to cancer chemotherapy in a tertiary care teaching hospital. Ther Adv Drug Saf 2017;8:61-6.
Aghamohammadi H, Shrestha S, Kavousi S, Milton B. Assessment of prescribing pattern of chemotherapy drugs and monitoring of adverse drug reaction in cancer patients. Int J Pharm Sci Invent 2019;8:42-51.
Keshri USP, Kumari K, Mahato SK, Kumar A, Protim P. A study of adverse drug reactions in cancer patients due to chemotherapy in a tertiary care hospital. IOSR Journal of Dental and Medical Sciences 2017;16: 89-93.
Lavan AH, O'Mahony D, Buckley M, O'Mahony D, Gallagher P. Adverse drug reactions in an oncological population: Prevalence, predictability, and preventability. Oncologist 2019;24:e968-77.
Amartya DE. Monitoring of suspected adverse drug reactions in oncology unit of an urban multispeciality teaching hospital. Int J Res Pharm Biomed Sci 2010;1:1-32.
Kirthi C, Afzal A, Reddy M, Ali SA, Yerramilli A, Sharma S. A study on the adverse effects of anticancer drugs in an oncology center of a tertiary care hospital. Int J Pharm Pharm Sci 2014;6:580-3.
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. Bortezomib-induced painful neuropathy in rats: A behavioral, neurophysiological and pathological study in rats. Eur J Pain 2010;14:343-50.
Mauermann ML, Blumenreich MS, Dispenzieri A, Staff NP. A case of peripheral nerve microvasculitis associated with multiple myeloma and bortezomib treatment. Muscle Nerve 2012;46:964-70.
Singh M, Thomas VM, Mulay S. Bortezomib-induced motor neuropathy: A case report. J Oncol Pharm Pract. 2020:1078155220904153. doi: 10.1177/1078155220904153. [Epub ahead of print]
Grammatico S, Cesini L, Petrucci MT. Managing treatment-related peripheral neuropathy in patients with multiple myeloma. Blood Lymphat Cancer Targets Ther 2016;6:37.
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Surendiran A, Balamurugan N, Gunaseelan K, Akhtar S, Reddy KS, Adithan C. Adverse drug reaction profile of cisplatin-based chemotherapy regimen in a tertiary care hospital in India: An evaluative study. Indian J Pharmacol 2010;42:40-3.
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Singh S, Dhasmana DC, Bisht M, Singh PK. Pattern of adverse drug reactions to anticancer drugs: A quantitative and qualitative analysis. Indian J Med Paediatr 2017;38:140-5.
Kishore P, Meghana G, Reddy BP, Raghavaiah KV. Pattern of adverse drug reactions and its management in female cancer patients in a private hospital in Telangana, India. Asian J Pharm Res Dev 2018;6:45-53.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]

domain: medical


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domain: economics


text:
The growth and income portfolio has been steadily reduced and is on its way to extinction. I am simply no longer willing to invest the time required to properly manage a portfolio of stocks which is likely a result of other interests along with increasing confidence and interest in TAA. Results in the growth and income portfolio this year demonstrated that benign neglect, even with stocks which are earning their dividends, is not a viable strategy in this kind of market.
November 30 was Rebalance Day. I have switched our TAA investments to the Core Strategy after watching it successfully navigate the huge swings in August through October as well as the swings earlier in the year. The Core Strategy was specifically developed as an antidote to Fed induced volatility in both equity and fixed income markets. Development of the Core Strategy required and was made possible by completing a major upgrade to the Strategy Model software.

domain: finance


text:
Why do we find it so hard to discuss death – or support those who are mourning a loss? My mother died of cancer on Christmas Day 2008, as my father, my two younger brothers and I sat around her. She was 55 and I was 32. Although I knew that she was dying, I was completely unprepared for the reality of her being dead – and for how alone I would feel with my grief.
In the strange days after her death I wondered what I was supposed to do. So did my friends, especially those who had not yet suffered a major loss. One sent flowers but did not call for weeks. Another sent a kind email, saying she hoped I was "well" and asking me to let her know if there was "anything I can do to help". But I wasn't "well". Within a week, people stopped mentioning her name, uncomfortable with the topic. After a month had passed by, I had the distinct feeling that I was supposed to "muscle through it" and move on, as if I were recovering from flu rather than mourning the passing of my mother.
Today, most westerners are uncomfortable around death. As western cultures have become more secular and heterogeneous, the rituals that once guided mourners and communities through the painful currents of this intense time have dropped away. Grief has become more private even as it has been framed more psychologically. Friends talk to you about "getting through it" and "healing". They raise the question of antidepressants – but don't know how to offer the simple help that many mourners need: acknowledgment and recognition of their loss.
We shy away from talking about death, not out of cold-heartedness, but out of fear. Death scares us. No one wants to say the wrong thing. The result is a dysfunctional culture in which we avidly consume news of death on TV and duck away from it in real life. It wasn't always so: until the 20th century, private grief and public mourning were allied in most cultures, and mourning rituals extended over the course of at least a year. If your husband died, the village came to your door, bearing food, perhaps, and you put on special mourning clothes. In many nations – among them China and Greece – death was met with lamentation among family and neighbours. A ceremony usually followed the cleaning of the body; a year later, another marked the first anniversary of a death. During the Victorian era, family members restricted their social lives and adhered to a dress code for up to two years. Even at the turn of the century "the death of a man still solemnly altered the space and time of a social group that could be extended to include the entire community," noted the historian Philippe Ariès.
Then mourning rituals in the west began to disappear, for reasons that are not entirely evident. The anthropologist Geoffrey Gorer, author of Death, Grief, and Mourning, conjectures that the first world war was one cause: communities were so overwhelmed by the numbers of dead that they dropped the practice of mourning the individual. But clearly broader changes in the culture accelerated the shift. More people, including women, began working outside the home; in the absence of caretakers, death increasingly took place in the protective isolation of the hospital.
Psychoanalysis led to a shift from the communal to the individual experience. In 1917, two years after Émile Durkheim wrote about mourning as an essential social process, Freud's Mourning and Melancholia defined it as something fundamentally private; by the 1960s, Gorer would write: "Today it would seem to be believed, quite sincerely, that sensible, rational men and women can keep their mourning under complete control by strength of will and character, so that it need be given no public expression."
In the wake of the Aids crisis and 9/11, the conversation about death in the west has grown more open. Yet we still think of grieving as something to be done alone – which only intensifies its isolation. There might not be a "right" way to grieve, but it's interesting to note that in western countries with fewer mourning rituals, the bereaved report a higher level of physical ailments in the year following a death – suggesting a very real human need to mourn communally. This may be one reason that we've witnessed a boom in memoirs about loss, like the one I wrote about my mother; they reflect our need to share our experience in an age that's let go of the ceremonious language that once bridged the stark boundary between inner sorrow and outer function. Each loss may be private, but mourning a death is the great universal – a condition that unites us.


Baker softball upsets No. 1 seed behind no-hitter from Olivia Brees
The No. 2 Baker University softball team upset No. 1 seed Marian (Ind.), 1-0, in 10 innings Tuesday afternoon in the second game of the 2019 National Championship Opening Round in Springfield, Missouri.
The Wildcats advanced to the championship game with an overall record of 47-7. Baker dealt the Knights their first loss this season, as the No. 1 seed in the Springfield Bracket and the No. 2 team in the nation fell to 50-1 overall.
Senior Olivia Brees tossed all 10 innings for Baker and recorded her fourth no-hitter this season. Brees also collected 14 strikeouts, which marks the 25th time this season that she has struck out double-digits batters, en route to her 100th career win.
Sophomore Briele Rees put the finishing touches on the upset for the Wildcats with an RBI single in the 10th.
The Wildcats and Knights will meet again in the championship game at 11 a.m. Wednesday.


text:
A governor is an engine rpm-sensing device and high-pressure oil pump. In a constant-speed propeller system, the governor responds to a change in engine rpm by directing oil under pressure to the propeller hydraulic cylinder or by releasing oil from the hydraulic cylinder. The change in oil volume in the hydraulic cylinder changes the blade angle and maintains the propeller system rpm. The governor is set for a specific rpm via the cockpit propeller control, which compresses or releases the governor speeder spring.
Due to the COVID-19 pandemic, the global Aircraft Propeller Governors market size is estimated to be worth US$ 11 million in 2022 and is forecast to a readjusted size of US$ 13 million by 2028 with a CAGR of 2.9% during the forecast period 2022-2028. Fully considering the economic change by this health crisis, OEMs accounting for % of the Aircraft Propeller Governors global market in 2021, is projected to value US$ million by 2028, growing at a revised % CAGR from 2022 to 2028. While Military Aircraft segment is altered to an % CAGR throughout this forecast period.
The major players in global Aircraft Propeller Governors market include Hartzell, Woodward, JIHOSTROJ a.s, etc. The top 3 players occupy about 50% shares of the global market. North America and Europe are main markets, they occupy about 80% of the global market. Aftermarket is the main type, with a share about 60%. Commercial Airliners is the main application, which holds a share over 45%.
The research report has incorporated the analysis of different factors that augment the market’s growth. It constitutes trends, restraints, and drivers that transform the market in either a positive or negative manner. This section also provides the scope of different segments and applications that can potentially influence the market in the future. The detailed information is based on current trends and historic milestones. This section also provides an analysis of the volume of production about the global market and about each type from 2017 to 2028. This section mentions the volume of production by region from 2017 to 2028. Pricing analysis is included in the report according to each type from the year 2017 to 2028, manufacturer from 2017 to 2022, region from 2017 to 2022, and global price from 2017 to 2028.
A thorough evaluation of the restrains included in the report portrays the contrast to drivers and gives room for strategic planning. Factors that overshadow the market growth are pivotal as they can be understood to devise different bends for getting hold of the lucrative opportunities that are present in the ever-growing market. Additionally, insights into market expert’s opinions have been taken to understand the market better.
Request for a free sample or purchase this report at: https://www.themarketreports.com/report/global-aircraft-propeller-governors-market-research-report
The research report includes specific segments by region (country), by manufacturers, by Type and by Application. Each type provides information about the production during the forecast period of 2017 to 2028. by Application segment also provides consumption during the forecast period of 2017 to 2028. Understanding the segments helps in identifying the importance of different factors that aid the market growth.
Segment by Type
Segment by Application
- Military Aircraft
- Commercial Airliners
- Private Aircraft
- Jihostroj A.S
- Avic Huiyang Avation Propeller Co Ltd
Production by Region
- North America
Consumption by Region
- North America (United States, Canada)
- Europe (Germany, France, U.K., Italy, Russia)
- Asia-Pacific (China, Japan, South Korea, India, Australia, China Taiwan, Indonesia, Thailand, Malaysia)
- Latin America (Mexico, Brazil, Argentina)
- Middle East & Africa (Turkey, Saudi Arabia, UAE)
Mr. Shirish Gupta
The Market Reports | Industry and Market Reports at its Best
Call: +1-631-407-1315 / +91-750-729-1479

domain: geography


text:
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domain: entertainment


A cheaper iPhone? A deal with China Mobile? Despite having neither of the two, Apple reported strong earnings in the Chinese market in its fiscal first quarter, with revenue buoyed by triple digit growth in iPhone sales.
The company's revenue for the Greater China region, which includes Hong Kong and Taiwan, grew 67 percent year-over-year, Apple said in its financial results on Wednesday. A high point in the robust earnings was the "exceptional growth" in iPhone sales in the region, which more than doubled from the same period last year, stated its CEO Tim Cook in an earnings call.
The U.S. tech giant is paying increasing attention to China, with Cook stating earlier this month he expected the country to one day become its largest market.
But Apple will have to contend with the rising presence of local Chinese handset makers, which are dominating the sector with low-end handsets, priced sometimes five times cheaper than the iPhone.
The absence of a lower-priced iPhone, and the lack of a deal to sell its product through the nation's largest carrier, China Mobile, have often been seen as factors limiting Apple's growth in the country. In contrast, rivals such as Samsung, Lenovo, Huawei and ZTE offer a wide range of handsets through China's different carriers, and led the nation's smartphone market ahead of Apple in last year's third quarter.
Apple, however, still has great potential in the market, as evidenced from surging iPhone sales, said Teck Zhung Wong, an analyst with research firm IDC. "Whether they're going to come out with a cheaper iPhone or new models, I don't think that's such a crucial factor," he said. "Every time they come out with a product refresh you'll still see a big spike in the launch quarter."
This past December, Apple launched its iPhone 5 in China, which is expected to have boosted the company's market share in the fourth quarter of last year. Apple's share dropped from 19 percent in the first quarter of last year, to 10 percent in the second, and then further declined in the third, Wong said.
But despite the sagging market share figures, Apple's smartphone shipments in China have consistently grown because the nation's smartphone sector is booming in size. In the third quarter, smartphone shipments to the nation's market reached over 60 million, about 2.5 times more when compared year-over-year, Wong said.
"If you look at Q3, and how Apple's market share was less than ten percent, people will just scream and say Apple is going downhill," Wong said. "But Apple has been shipping more units than before, so it has a good performance if you look at it this way."
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A recent survey hosted on News24 found that while 83% of adult respondents did not have a forex bank account, 89% would open a new account if it was quick, easy and cost-effective.
In the survey hosted on News24 in the month of February, 621 adults were surveyed. Only 17% of respondents indicated they had an active forex bank account.
Some of the major reasons that the other 83% found it difficult to open one included:
- 33% said it was too much admin
- 38% said it was too expensive
- 29% said their bank didn’t offer it to them
Of the 106 respondents who owned one, 54% said it was mostly used for trading. Interestingly, the other 46% found a variety of other ways in which they mostly used it:
- 13% used it to save for overseas holidays
- 17% used it to hedge against the rand
- 16% used it for overseas purchases
With so many respondents indicating they would like to open a forex bank account, but an equivalent amount saying they do not have one, what problems need to be solved for the average South African to consider foreign currency part of their everyday financial life?
Saving on fees, ease of use and knowledge
South Africans invest 75% of their assets in South Africa, yet South African investments make up just 0.3% of total investments globally, according to the World Investment Report 2020.
In the survey, only 10% of respondents said they knew enough about foreign currency to include it in their investment plan, with 31% indicating they knew "a little bit". The overwhelming majority either knew nothing (32%) or wanted to know more (28%).
Factors that would entice newcomers to open an account included low fees and real-time transactions (34%); an easier process to open an account and to link it to different currencies (31.5%), and being able to transfer currencies between accounts at lower fees (35.5%).
Those who owned a forex account said they would consider switching or opening a new account if it had a friendlier user experience (32%), ability to trade in an app (18%), cheaper fees (16%), better rates (21)% and real-time forex exchange (12%).
It can also revolutionise your spending when travelling abroad. Currently, when travelling overseas, only 18.5% said they use a forex account to make purchases, with the rest forfeiting fees and costs by using a debit card linked to a bank account (38%), a credit card (31%), or currency exchange in cash (13%).
The ability to lower your risk and save and transact in foreign currency used to be a luxury that was only available to the wealthy. Now, Discovery Bank makes it affordable and easy for you to save and transact in the foreign currency of your choice.
SA’s only real-time forex capability
Discovery Bank launched its comprehensive, real-time forex capability on the Discovery Bank app in February, giving access to immediate foreign currency transactions.
Discovery Bank’s Forex Account allows you to experience the only Real-Time Forex Accounts, available 24/7 on your banking app, where you can open, convert, save and pay in seconds.
You can start saving in Euros, Pounds and US dollars immediately, and can make overseas payments in over 60 countries. Discovery clients will not pay foreign currency conversion transfer fees for transactions between their different forex and Rand accounts.
You will also receive a free virtual card to add to your smartphone for seamless payments when travelling outside South Africa, as well as the option of a physical debit card.
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This post was sponsored by Discovery and produced by BrandStudio24.


text:
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domain: design


text:
'The New Dog' by Collette Lord
In Chester’s Wood Muffin spotted a deer, and raced after it wrenching his lead out of the boy’s hand. Jason set off in pursuit. What would mum and dad say if he returned without the dog from his first solo outing with their new pet?
He stopped. Listened. Thought he could hear a quiet whimpering. Easing himself through the dense bracken, he found himself falling into a deep warren, encapsulated in the arms of a rainbow. Jason landed with a soft thud on a carpet of green cake. Shafts of sugary light dripped honey sandwiches, as custard tarts floated tantalisingly past his mouth. As he stood up he heard a squeaky voice.
‘Tea?’ enquired the dormouse.
‘No he wants coffee?’ shrilled the Queen of Hearts.
‘Give him milk then,’ shouted the King of Spades.
‘I don’t want tea. Thank you. I’m looking for my dog, Muffin. Have you seen him please?’ Jason asked. A young blonde girl who was plaiting the back legs of a blue caterpillar glared at him.
‘I’ll get in real trouble if I’m not back with dad’s dog for supper.’
‘You eat dog for supper? Really?’ asked the Mad March Hare.
‘I don’t know why that’s weird, eating dog, Lewis did,’ said the Queen as she put a pink donut under her crown.
‘Lewis who?’ asked the King, drinking tea from a thimble.
‘Caroll - Lewis bleeding Caroll’ snapped Alice. ‘He hated dogs. Came here years ago he did, stole all our dogs for his Chow Mein Café. Should have called it Setter Snack Bar or Basset Bistro if you ask me. Then, cheeky ghet, pinches our life-style as well, steals our ideas, without a by-your-leave, no copyright fees, no contract, no nuffink. Then disappears into my Vanish Me bottle and we ain’t never seen him since. And he stole the dormouses’s darning mushroom. Famous writers? Stuff ‘em, thieves, the lot of ‘em, they don’t blinking care for no other bugger’s careers. Our wonderland story was ready for publishing. Rabbit Hole Press were going to print. They’d have paid us squillions, we’d all have been in the blooming Caribbean by now.’
‘Tea?’ asked the dormouse of no one in particular.
Jason retreated behind a giant dandelion. But before he could decide what to do next, the rainbow swooshed around him again, snuggling him up into its silky cocoon.
Back in Chester’s Wood, Muffin was asleep under a bush, and leapt up excitedly licking Jason’s face.
‘Where did you go with the dog darling?’ mum asked, watching TV.
‘Wonderland.’ He said quietly.
‘Yes dear, that’s nice. Have you put him in his kennel?’
‘Night night dear. Oh, your biology kit’s ready for , don’t forget you need a little mammal for dissection class.’
Behind her back, Jason grinned, as he felt the warm little body struggling to get out of his inside pocket. He gave her the customary peck. “Yes mum, I’ve got it covered, night night.”


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Curry is Salmon with Garlic and Turmeric. Curry is Grilled Chicken with Cashew-Tomato Sauce. Curry is Asparagus with Tomato and Crumbled Paneer. Curry is Lamb with Yellow Split Peas, Chunky Potatoes with Spinach, Tamarind Shrimp with Coconut Milk, Child Back Ribs with a Sweet-Sour Glaze and Vinegar Sauce, Basmati Rice with Fragrant Curry Leaves. Curry is vivid flavors, seasonal ingredients, a kaleidoscope of spices and unexpected combinations. And 660 Curries is the gateway to the globe of Indian cooking, demystifying one particular of the world\'s excellent cuisines. Presented by the IACP award–winning Cooking Instructor of the 12 months (2004), Raghavan Iyer, 660 Curries is a joyous meals-lover\'s extravaganza. Mr. Iyer initial grounds us in the constructing blocks of Indian flavors—the interplay of sour (like tomatoes or yogurt), salty, sweet, pungent (peppercorns, chiles), bitter, and the quality of unami (seeds, coconuts, and the like). Then, from this simple palette, he unveils an infinite artwork. There are appetizers—Spinach Fritters, Lentil Dumplings in a Buttermilk Coconut Sauce—and main courses—Chicken with Lemongrass and Kaffir-Lime Leaves, Lamb Loin Chops with an Apricot Sauce. Cheese dishes—Pan-Fried Cheese with Cauliflower and Cilantro bean dishes—Lentil Stew with Cumin and Cayenne. And hundreds of vegetable dishes—Sweet Corn with Cumin and Chiles, Chunky Potatoes with Golden Raisins, Infant Eggplant Stuffed with Cashew Nuts and Spices. There are traditional, regional curries from about the subcontinent and modern curries. Plus all the extras: biryanis, breads, rice dishes, raitas, spice pastes and blends, and rubs.curry, n.—any dish that consists of both meat, fish, poultry, legumes, vegetables, or fruits, simmered in or covered with a sauce, gravy, or other liquid that is redolent with any number of freshly ground and extremely fragrant spices and/or herbs.
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domain: food


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Michael Wagner, who has served as interim CEO of Tufts Medical Center and Floating Hospital for Children, has been named to the position on a permanent basis.
The Tufts Medical Center's board of trustees announced the news today after voting unanimously in favor of Wagner’s appointment. Wagner stepped into the role last September, after the previous CEO, Eric Beyer, resigned suddenly.
He previously served as president and CEO of the 550-member Tufts Medical Center Physicians Organization and Tufts Medical Center’s Chief Medical Officer.
“The Board has been extremely impressed with Dr. Wagner’s performance in the interim CEO role over the past six months,” board chairman Thomas Hollister said in a prepared statement. “Dr. Wagner is a wise and innovative leader who understands the complexities of health care from so many angles as a primary care physician, a private sector executive and a patient safety advocate. This expertise will be invaluable as Tufts Medical Center builds on its rich tradition of health care innovation and transforms how care is delivered as the health care industry continues to change.”
Wagner took the helm as interim CEO at what has proven to be a tumultuous time for Tufts Medical Center.
Ellen Zane, a former CEO of the hospital, handpicked Beyer to lead Tufts Medical Center when she retired. But Beyer faced a tough time during his two years leading the hospital, in part because Tufts Medical Center receives some of the lowest reimbursement rates from private insurers compared to other academic medical centers. The hospital is also particularly vulnerable to cuts in Medicaid and Medicare. And Tufts Medical Center had been challenged in its ability to build alliances with other hospitals and, to that end, lost out on the opportunity to acquire Jordan Hospital in Plymouth, which went instead to Beth Israel Deaconess Medical Center.
Wagner began his career at Tufts Medical Center and returned in 2008 to lead the hospital’s primary care services. Before that, he was CEO of EmCare Inpatient Services, a hospital inpatient physician management company.


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Investigation And Formal Complaint
At Bell & Shah, LLC, we represent licensed professionals who may be facing discipline by the Illinois Department of Financial and Professional Regulation (IDFPR), including but not limited to:
- Architects, home inspectors, surveyors and mortgage brokers
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- Psychologists and psychiatrists
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- Veterinary licenses
We understand that the threat of disciplinary action can be detrimental to one’s professional career and reputation. This is why we work hard to defend your rights and refute the allegations against you.
Putting Experience On Your Side
We have over five years of experience interacting with the Illinois Department of Financial and Professional Regulation (IDFPR). We are familiar with the purpose and general position of the department on disciplinary licensure matters. Over the years, we have developed a rapport with the department attorneys. We understand the administrative process and department rulings. We believe this professional approach and knowledge has gotten us favorable results for our clients.
If you receive an investigative letter or a formal complaint from the Illinois Department of Financial and Professional Regulation (IDFPR), we strongly suggest you immediately contact Bell & Shah, LLC. You need an attorney who will effectively represent you. In many circumstances, the matter can be resolved through a consent order after an informal conference with the department attorney and professional board members. In other situations, an evidentiary hearing where we present our case before an administrative law judge may be necessary. Whether you are facing suspension, revocation, probation, fines and penalties, or an administrative warning, we will fight to obtain the best outcome for your particular situation.
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EIDE’s FNC pneumatic brakes have great response sensitivity.As they have a radial air inlet, they do not have a rotary air inlet. The brake torque is proportional to air pressure. Regulating this pressure allows for greater control of the torque absorbed by the brake.
It also has other important features, such as: Minimal inertia, good heat dissipation, light weight, shafts in different position, etc.
Regulation from 0 to 5.5 bar.
High sensitivity. Continuous friction.


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Some of us turn our heads and some of us engage. I am one that engages.
A stranger. Or a cause of events, particularly bad luck. Cancelled flights. Flat tires. Crowded coffee shops. Lonely holidays. And I search those that I encounter. Their words. Not blinded by sight, age, or situations. For I believe, nothing happens by chance.
And so my life remains interesting. Often others are baffled. The walls in which I sit now left Julie’s mouth agape. But then, she laughed, “You have the craziest life. And I wouldn’t expect anything less.”
And so, did I mention The Man at the airport? A cancelled flight followed by being denied access to the admiral’s club since my membership was months expired. Hours later, I returned to the secured door. And was accepted. No, I didn’t renew my membership, but we all have our ways. The eyes of the lady who refused me shot daggers in my back.
Upon entrance, chairs away, there was a Man. Followed be a lunch, a ferrari and some common similarities. And now a week later, a purchased ticket for me to return to San Juan to meet again. I thought it was just a Sunday night dinner. But a text now reads, “Bring your passport. You need it Monday.”
A script plays through my head. The words to explain that I am not one to be bought. My penniless struggle, my tears, and the suffocation I currently encounter would make such an offer hard to refuse. But refuse I will.
However, the world is not black and white. I will not simply slam the door.
I will search for another . . .
What a week. Feelings of depletion that I have not felt in forever. Overwhelmed. Stressed. Images of growing new appendages as I could not imagine another way to conquer this.
Thursday night, PROBIOTIC asked me what happened to my eye—I had no clue. Walking to the mirror, the hollowness in my face astounded me, the dark circle beneath my left eye rendered me a Rascal- look-a-like. PROBIOTIC then explained that dark circles are the physical manifestation of liver or adrenal issues. Translation: too much drinking or too much stress. Ding Ding! The winner, the latter.
Friday afternoon a sense of calm enveloping my like a safety blanket. On the verge of tears before I went to eat. Upon returning, the world easier, my mind subdued as if in a Xanaz coma, aware that there was only so much I could do and I finally surrendered as if the anxiety induced motivation disappeared.
Which brings me to a thought-motivation. Workaholism is great and is somewhat necessary for productivity. But where is the fine line between being motivated, able to endure working countless hours and balance?
Yesterday I found myself in a stranger’s body. In pilates, my body stiff, however lean but without the athleticism and energy it normally possesses.
This week was also one in which my mind danced and tiptoed into the battle zone. Thoughts of needing to transition and reinvent. Thoughts of leaving my job. Haven’t I done this too many times before? Not prepared to enter survival mode. Not ready say goodbye to my life on the Island, yet I searched for back up, my mind was disassociating. I realized with trepidation, that if I crossed that line, that in fact is what will happen. My week’s thoughts spanned from “whatever happens is what is meant to be.” Ie. “Maybe life on the island is not where I am suppose to be” to acknowledging the power of my mind. That my mind is the conductor here if it so chooses to be.
SO while I have my ticket in hand for the train that is departing, the destination: A new book, a new path- an artistic life perhaps? I sit and know I can instead enter a new chapter. Adapt my life now for it offers all I want. “
I am at work. Overwhelmed.
I sat here searching for tears- forcing them. I went outside. As the rain poured, I stood with my skinny Capri cigarette watching the rain. Moments before thinking about how I wanted to run, run away, and how an actual run would have to suffice. The rain now inhibiting that plan.
I wanted to fall, melt onto the pavement. I had this feeling yesterday. Before another binge. Was tonight destined to be the same?
Watching myself from the outside, hearing other’s advice should I choose to share. How easy it should be to overcome this . . Telling myself I always do. But, yet these moments exist. I am overwhelmed. I think about going home and falling into a sleep, an escape. Killing the possibility of making the 1am flight to New York to make it for Matt’s proposed sailing trip tomorrow. Feeling horrible. Thinking about Anya’s email, the guilt. Thinking about Perfect’s dad and how I offered to help. And have failed to. THinking about the many people waiting on things from me- emails, phone calls, visits, time . . and realizing how I procrastinate. How I am frozen in time . . . Realizing what the proper action is and the simplicity of it.
Prioritize. Smile. Enjoy the moments. The days will go on. You will enjoy the island this weekend. Don’t add extra stress about needing to return to New York. I realize that my hesitance, my internal stresses were heightened when I thought about how I would make Matt feel. The guilt.
And thence came the moment . . . the realization of my hold-up, a common thread linking so many of my problems. It’s the “WANT”. I want to do more than my capacity allows. I want to be everything to everyone. I hide and punish myself when I am not. To the outside world, I am busy or flaky. Internally, I am in prison, suffering for my lack of production. When two friends both want to do something conflicting, I do nothing. I do nothing when I think I may hurt someone and I end up hurting them more. Why? Where does this stem from? . . . It’s amazing how my capacity for certain stresses has no limit. While others, mostly when they affect other’s emotions, are paralyzing.
Hmmmm . . .


The SVSU jazz ensemble mixed up a concert full of standards with “Soul Bossa Nova,” made famous by Austin Powers.
A full audience filled the Rhea Miller Recital Hall as the ensemble performed classics from George Gershwin and Charles Mingus.
The Dec. 5 recital also featured sophomore singer Sarah Evans on four songs, including crowd-favorite “Basin Street Blues.” Evans, a member of Cardinal Singers, performed double-duty that night, as she also sang in the theatre department’s holiday play.
Evans said that jazz gives the students a chance to be creative while still having structure.
“My favorite aspect of being in the jazz band is that it is an environment of creativity and freedom while still being organized,” she said. “There are borders in jazz, but it never feels restrictive.”
Seth Ebersole, the jazz artist-in-residence, said it is important to expose students to jazz.
“Jazz is important as a historical and cultural phenomenon in America,” he said. “It can tell us about who we are as people and teach us lessons about the experiences of others whose perspectives we do not share.”
Emma Longoria, a music education senior, played the baritone saxophone in the concert.
“Previously, I never had an opportunity to play in a jazz ensemble since my main instruments are voice and flute,” she said. “When I learned alto saxophone in my woodwind methods class last year, I was excited to see if there were any open spots in the jazz ensemble. Luckily, they needed a baritone saxophone, and now I have really loved being a part of this group.”
Erik Gillette a music freshman, played the bass in the ensemble.
“I started to play jazz in middle school, and it has been a huge part of my life since,” he said. “My favorite aspect of being in the jazz band is how much everyone trusts each other.”
Michelle Van Hautte, an engineering junior, said she enjoyed the songs with singing and clarinet features, since that is the instrument she played in high school.
She also said that she enjoyed the fact that much of the music was older and from a different generation.
“We don’t have that in our culture anymore,” Van Hautte said. “It’s something different.”
- Men’s basketball wins battle against Lake Superior State - 22 Jan 2023
- BOV recipient Self Love Beauty to host conference at SVSU - 22 Jan 2023
- Weighted grading systems don’t help students learn - 22 Jan 2023


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Cinematic Rock outfit Earthside have finally unleashed their debut offering in 6 years, in the form of a monumental song plus today's accompanying earth shattering animation Video Of The Day for 'All We Knew and Ever Loved', out now via Music Theories Recordings/Mascot Label Group. It's dastardly arrival is ushered in by a very human spiral of conflict, represented by the dueling drum performance of Ben Shanbrom and featured guest performer, Baard Kolstad of Leprous. Opening with the haunting cry of screeching lead guitar, timpani and pipe organ, the ominous introduction sets the stage for a horrifying climax that never seems to lessen in effect with repeated listens.
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domain: artistic


Shirley Vincent, Ph.D.
Dr. Vincent serves as the Director of Educational Research at the National Council for Science and the Environment, a nonpartisan organization of scientists, environmentalists, entrepreneurs and policymakers dedicated to improving the scientific basis of environmental decision making.
She is leading a landmark longitudinal study of U.S. interdisciplinary environmental and sustainability degree programs and consults with higher education institutions to provide customized comparative and strategic analyses that inform the development of new educational programs, the review of existing programs, and strategic planning and other types of decision making processes.
Dr. Vincent is the author of 2010 NCSE report Interdisciplinary Environmental Education on the Nation’s Campuses: Elements of Field Identity and Curriculum Design as well as a number of other reports and scholarly articles on interdisciplinary environmental and sustainability education, and is a frequent speaker on environmental and sustainability education topics.
She serves as an advisor to the Executive Committee of the Council of Environmental Deans and Directors, an associate editor for the Journal of Environmental Studies and Sciences. She has held leadership positions in the Association for the Advancement of Sustainability in Higher Education, the Association of Environmental Studies and Sciences, the Society for Human Ecology, and led the ASTM International Worldwide Standards Subcommittee on Environmental Risk Assessment, Communication and Management task group that successfully published the international standard titled Standard Guide for a Framework for a Consensus-based Environmental Decision-making Process. She also participated in the initial development of the education and research indictors for the Association for the Advancement of Sustainability in Higher Education’s Sustainability, Tracking, Assessment and Rating System (STARS).
Dr. Vincent earned her Ph.D. in environmental science at Oklahoma State University and holds a B.S. and M.S. in Biological Science from the University of Tulsa. Her professional experience spans entrepreneurial business development and management, clinical and university research, and higher education teaching, administration and consulting.


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E-mail comments, 50 words or fewer, to firstname.lastname@example.org.
As I watched the Riverfest fireworks sponsored by Airbus-Wichita, I had to wonder: Just why didn’t we want Airbus to get the tanker project and bring work to Wichita? Why did we want Boeing to get the contract and take jobs elsewhere? Maybe Todd Tiahrt and Mike Pompeo can explain that.
Riverfest isn’t what it used to be, but the zip line, paddle boats and pontoon boat rides are excellent additions. And the Eagle Medallion Hunt has returned. Other events can return with needed sponsors and volunteers. Get up and do something about it.
The River Festival was spectacular, except for one thing: The Senior Gala was opposite the ice cream social. Those are two of my favorites.
How funny to hear Kansas representatives whine about the maps the judges came up with. They should take a look in the mirror to see the culprits in this fiasco.
President Obama was correct when he said corporate America is doing fine. Stocks and executive salaries are at all-time highs. Corporations have been hoarding cash, which is now more than $1 trillion – enough to wipe out unemployment for the next decade. Enough with the talk about the poor “job creators.”
The way to maintain peace, stability and freedom is to talk softly and carry a big stick. Obama’s plans to gut our military move us in a dangerous direction. It is not sensible to talk loudly and carry a little stick.
Unless you have massive health issues beyond your control, do not expect other people to pay for your lifestyle. If you have incurred debt, pay it off. It is your debt, not mine.
People who say “only in Wichita” don’t get out much. If they did, they would know things don’t happen “only in Wichita.”
Sometimes I feel like I live in a neighboring state, as I see so many vehicles in Wichita registered in Missouri, Oklahoma and Texas. Excepting some military personnel and students, vehicles owned by residents of Sedgwick County must be registered and tagged in Sedgwick County.
If you grew up thinking religion was a private matter, you were in the wrong church. We are to live like Christ, and He was as public as you can get.
Since God is the creator of all things, is it not possible that evolution is but one of God’s instruments of creation?

domain: politics


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“Higuain to Juventus? There is about 50-60%, maybe even 70% chance that both club can conclude a deal soon”, Ernesto Bronzetti, who is closely linked to Real Madrid president Florentino Perez, told Tuttosport.
Higuain has been looking to leave Real in pursuit of regular first team football, and Juve have been after another forward.
What is your opinion? Feel free to discuss the article under. You have to comment by using your Facebook profile. Be fair and have respect for other people and opinions!
Being an amiable guy is good for you and Jurgen Klopp is living proof.
Summer 2016 is set to be a very exciting time for football fans, as this is when the long awaited Euro 2016 tournament kicks off.


Over 2000 people gathered to honour organ donors and their families at the Irish Kidney Association’s Service of Remembrance and Thanksgiving today.
Families of deceased organ donors, living donors and transplant recipients of various organs attended the service at Corpus Christi Church, Homefarm Road, Dublin 9.
The first batch of Donor Cards going out today. We’ve since had ANOTHER 2000 requests, totalling over 4000 since @orlatinsley’s documentary on Monday, how amazing is that?! 😄👏🏻 #orlatinsley #warrior #organdonation pic.twitter.com/q7JFtXejov— Irish Kidney Association (@IrishKidneyAs) September 19, 2018
The annual event was organised by the Irish Kidney Association.
In 1986 the inaugural service had an attendance of 300 people, and, has since, increased annually in numbers with over 2000 people attending from all over Ireland in recent years.
The service, which is in its 33rd year, is a mixture of sadness and joy for the families of organ donors and transplant recipients alike.
For many donor families the service has become an anniversary to remember their loved ones, and for transplant recipients, the opportunity to give thanks.
Broadcaster Claire Byrne, the ambassador for organ donor awareness 2018, recited Helen Custer's 'A Candle' poem to remember those who have died.
Members of Transplant Team Ireland, who participated in the European Transplant and Dialysis Games in Sardinia and the British Transplant Games this summer also took part.
Members of the medical community were among the readers at the service which was led by Archbishop Diarmuid Martin.
The Irish Kidney Association Liturgy Committee, who were involved in the organisation and planning of the event, comprised Board members, National Honorary Officers and staff of the Irish Kidney Association were also in attendance.
- Digital Desk


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Shares in Fisher & Paykel Healthcare jumped to their highest in more than two years as the maker of breathing masks and respirators said it expects to beat analyst estimates for 2014 profit after surpassing its own guidance for 2013.
F&P Healthcare shares surged 5.9 per cent to $3.21, the highest since February 1, 2011, when it touched $3.22. The stock has surged 23 per cent so far this year.
Profit is likely to be $85 million to $90 million in the year ending March 13, 2014, managing director Michael Daniell said today. That's more than the $79 million-to-$83 million range expected in a survey of seven analysts by Merlin Consulting.
F&P Healthcare, which competes with Resmed and Respironics, is boosting profit margins on record sales, higher-margin new products and lower costs from its plant in Mexico.
"The share price rise reflects the guidance for 2014 being better than expectations," said Rickey Ward, who manages equities at Tyndall Investment Management. "Next year looks like it's better than forecast."
F&P Healthcare said 2013 profit rose 20 per cent to $77.1 million, ahead of its February guidance of about $75 million. The company boosted operating revenue to a record $556.3 million on strong demand for its respiratory systems and new masks to treat the condition obstructive sleep apnea.
"All of the new products we have invested in over the last 18 months do a better job and in return for that we are getting better margins," Daniell said on a conference call. "We are pretty positive about the coming year."
The company expects operating revenue to rise to between $610 million to $630 million in 2014, Daniell said. The 2014 forecasts are based on the New Zealand dollar trading between 80 US cents and 85 US cents for the remainder of the year as about half its operating revenue is derived in US dollars.
In constant currency terms, which the company uses to show its underlying performance excluding currency affects, operating revenue rose 11 per cent. Sales of respiratory products rose 15 per cent, while sales of devices to treat obstructive sleep apnea increased 6 per cent.
The annual revenue growth rate in constant currency terms should continue in the mid-teens, driven by new products and applications, Daniell said.
Making an increased quantity and range of products at its plant in Mexico contributed to an improvement in gross margin to 55.3 per cent in 2013 from 53.2 per cent the year earlier, Daniell said.
Removing the effects of currency volatility, gross margins are expected to expand 100 to 200 basis points a year as a result of new products, efficiencies and the Mexico plant, he said.
F&P Healthcare expects to outlay $40 million in capital expenditure in 2014. That's down from $62 million in 2013 when it spent on new equipment to increase manufacturing capacity, new product tooling, replacement equipment and $33.6 million to complete a third building on its Auckland site.
Research and development spending increased 9 per cent in 2013 and current new projects include masks, flow generators, humidifier systems and respiratory and acute care consumables.
It spent 6 per cent more on selling as it expanded in North America, Europe and the Asia Pacific regions.
The company's diluted earnings per share increased to 13.8 cents in 2013 from 11.7 cents the year earlier. It will pay a final dividend of 7 cents a share on July 5, unchanged from the year earlier.