Category: iyvetmat

January 13, 2020 | | Post a Comment

first_imgResidents living in various communities in Region Two (Pomeroon-Supenaam) have complained that the Community Infrastructure Improvement Project is not delivering the kind of services it once did when compared to the past and they are calling on Agriculture Minister Noel Holder to immediately intervene.Residents complained that employees attached to the project within the local authority areas are not executing their jobs, and as such, have called for a review since management and operations of the project is increasingly criticised.Residents are of the view that the project is not properly supervised and this is creating a heavy backlog in the amount of drains that are not cleaned, while works executed do not meet minimum levels of satisfaction.When contact was made with the Chairman of the Regional Democratic Council (RDC) Devanand Ramdatt, he said he is in receipt of numerous reports from residents regarding the poor management of the project.The Regional Chairman explained that in the past, more community enhancement works were completed under the said project. Drains, road shoulders, Government buildings and compound were maintained through a similar project.According to Ramdatt, that project was much more successful since local authorities and the Regional Democratic Council had closer collaboration. He is of the view if the project is better managed, many of the concerns raised at the community level regarding drainage will be addressed.The Regional Chairman said he is very concerned about the project particularly since numerous residents are dissatisfied with the service offered. As such, he said he had requested clarity from management regarding details of the project, since there seems to be a weakness in the implementation process.He indicated that he had also requested to have such information from the Coordinator of the project but nothing has been provided to date.last_img read more

January 11, 2020 | | Post a Comment

first_imgSmith was named the area’s outstanding collegiate athlete at Monday night’s Greater Cleveland Sports Awards, and during a taped acceptance speech he thanked the city’s fans for their support. “Hopefully, I’ll get a chance to represent you guys at the next level with the Cleveland Browns,” he said. The Ravens will have six players at the Pro Bowl. Safety Ed Reed, offensive tackle Jonathan Ogden and outside linebacker Adalius Thomas were picked to be starters. Linebacker Terrell Suggs and cornerback Chris McAlister will head to Hawaii as reserves. CLEVELAND – Browns tight end Kellen Winslow underwent arthroscopic surgery Tuesday to remove scar tissue and repair cartilage damage in his right knee. Also, Cleveland hired Ted Daisher as special teams coordinator, replacing Jerry Rosburg. Daisher was Oakland’s special teams coordinator last season. 160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! CLEVELAND – Troy Smith, usually the one avoiding pressure, is putting the heat on the Cleveland Browns. Ohio State’s Heisman Trophy-winning quarterback is lobbying his hometown team to select him in April’s NFL draft, and he isn’t missing any chance to remind the Browns he’ll be available to them soon. center_img Smith hasn’t hidden his desire to play for the Browns who, after finishing 4-12 last season, will pick either third or fourth in April’s draft. During a recent halftime ceremony at an Ohio State basketball game, Smith wore a Browns jacket. Following a tribute for him at Glenville High School in December, he said playing for the Browns would fulfill a lifelong goal. “I have dreamed about it and talked about it countless times with my mother,” he said. “All she talks about is saving the Browns. If that were to happen, that would be a dream come true because I could stay in the community and give back.” OWINGS MILLS, Md. – Baltimore Ravens linebacker Ray Lewis withdrew from the Pro Bowl because of a hand injury he sustained in a playoff loss to Indianapolis. Lewis’ place on the AFC roster will be filled by teammate Bart Scott, who will be making his first appearance in the game. last_img read more

December 30, 2019 | | Post a Comment

first_img AD Quality Auto 360p 720p 1080p Top articles1/5READ MOREGame Center: Chargers at Kansas City Chiefs, Sunday, 10 a.m.The program combines classroom-style sessions in tents with actual driving scenarios for both teens and their parents using Toyota’s Scion and Corolla model cars. One of the major focuses is handling the anti-lock braking system, typically known as the ABS. “The first time you slammed on the brakes (in a car with an ABS), you thought you’d broken them,” said Dean Omatsu, the program’s creative director and curriculum advisor. Indeed, inside the Toyota Corolla Goduti’s intention was to have Gutierrez feel the vibration of the brakes, especially when driving at high speed toward a set of orange cones through a puddle of water. A few feet before the cones, Goduti would order Gutierrez to brake, then turn, sending the back end of the car skidding to the left as the front end headed right. ARCADIA – Really, it was just a matter of trust. And when professional race car driver Paul Goduti told 16-year-old Michelle Gutierrez to punch the accelerator for a few car lengths then jump on the brakes, he wasn’t kidding. “Drive as fast as you can until I say stop,” said passenger Goduti of Orange on Saturday afternoon to his helmet-wearing teen driver, who was sporting a smile but looking nervous. “Forget any inhibitions you have. Remember, this isn’t your car.” Gutierrez of Moreno Valley was one of about 400 teens who, with at least one parent, made their way to the parking lot at Gate 3 of the Santa Anita Race Track this weekend to take part in the “Toyota Driving Expectations,” a free, four-hour program that teaches teens and parents defensive driving techniques. The exercise was a bit “nerve-racking” but she admitted that she learned a lot. “I liked it because I don’t ever get to drive fast,” she added. “This is a chance to get it out of my system.” Goduti said his student “passed with flying colors.” “At first, it was obvious she had reservations, but in the end, she trusted me,” he said. “The most difficult thing is to try to get them to drive irresponsibly. We’re trying to get them to learn crash avoidance skills.” Lead instructor Greg Pene of Upland who used to race formula cars and do stunt driving, said the instructors enjoy sharing what they’ve learned about safe driving with teens. “Sometimes, parents love their kids so much, they get frustrated with them (while teaching them how to drive),” he said. “We try to teach positive reinforcement rather than negative reinforcement. …They’re like little sponges, and they want to listen to us.” Monrovia parent Lori Nelson said she believed the course would be a good way for her 15-year-old daughter Nicole Nelson-Campos to experience tough driving scenarios in a safe environment. “The driving instructors are excellent,” Nelson said. “They understand about teens, and they understand about parents. They give us practical suggestions we can use right away.” Another driving exercise is the “distraction course” in which the instructors have teen and parent drivers try to use a cell phone or change CDs while driving so they can see the hazards of such actions. “It was scary at first, but driving that fast can be fun, especially watching people in the back slide off their seats,” said 15-year-old Marie Harvis of Monrovia. molly.okeon@sgvn.com (626) 578-6300, Ext. 4496160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set!last_img read more

December 27, 2019 | | Post a Comment

first_imgTony Cascarino has explained why he is backing Mikel Arteta to succeed Arsene Wenger at Arsenal.Writing in The Times, Cascarino tipped the Manchester City coach to return to the north London club as manager when Wenger eventually steps aside.He was a co-presenter on Wednesday’s mid-morning show on talkSPORT and outlined exactly why the Gunners should gamble on their former midfielder.“It is well known within the game that Arteta is a great coach,” he said.“It is the way Arsenal should go.“He would do a great job as a manager and he would have the personality.“Arsene Wenger’s time is coming to an end. They need a maverick, left-field appointment and Mikel Arteta fits that bill.”Listen to Tony Cascarino on Mikel Arteta in full abovelast_img read more

December 25, 2019 | | Post a Comment

first_imgSouthampton forward Charlie Austin has been charged by the Football Association for making a gesture deemed ‘abusive and/or insulting’ during last week’s defeat by Manchester City.The incident concerns the striker’s conduct as he was substituted for Shane Long in the 68th minute of the 3-1 loss to City at St Mary’s on Sunday. 1 ADVICE The FA said in a short statement on its website: “Southampton’s Charlie Austin has been charged following the game against Manchester City on Sunday [30 December 2018].“It is alleged that Mr Austin’s gesture in or around the 68th minute of the fixture was abusive and/or insulting.” shining Berahino hits back at b******t Johnson criticism – ‘I was in a dark place at Stoke’ Forbes list reveals how much Mayweather, Ronaldo and Messi earned this decade RANKED REPLY Ronaldo warned Lukaku how hard scoring goals in Serie A would be before Inter move Top nine Premier League free transfers of the decade Premier League Team of the Season so far, including Liverpool and Leicester stars huge blow Where Ancelotti ranks with every Premier League boss for trophies won center_img REVEALED REVEALED Which teams do the best on Boxing Day in the Premier League era? Austin was withdraw with just over 20 minutes of the match remaining Latest Football News no dice Son ban confirmed as Tottenham fail with appeal to overturn red card Austin, who has scored only twice in the Premier League this season, was booked 10 minutes before his substitution and appeared to be jeered by some supporters as he made his way off the pitch.The 29-year-old has until 6pm on January 7 to respond to the FA’s charge.Austin did not start Southampton’s next match after the defeat by City, though he came off the bench in the dying stages of Wednesday’s 0-0 draw at Chelsea. MONEY Oxlade-Chamberlain suffers another setback as Klopp confirms serious injury Every time Ally McCoist lost it on air in 2019, including funny XI reactions BEST OF last_img read more

December 22, 2019 | | Post a Comment

first_imgEnlow suffered only minor injuries and was treated and released at the scene.  Ciotti was transported by ground, then airlifted to University of Louisville Hospital, where she was listed in critical condition.  Assisting agencies at the scene included the Crawford County Sheriff’s Department, English Fire Department, Crawford County EMS, and Air Methods Helicopter.    Just before 8:30 p.m., Indiana Conservation Officers responded along with the Crawford County Sheriff’s Department, and Ciotti was found unresponsive and badly injured in a Polaris Ranger side-by-side ORV.Enlow’s full-size Dodge Ram pickup truck had crashed into a nearby tree after striking Ciotti’s ORV broadside.  Indiana Conservation Officers are investigating an Off Road Vehicle (ORV) accident that occurred in Crawford County Saturday evening. Stacy Ciotti, 45, of Taswell, suffered serious injuries after colliding with a pickup truck driven by Ronald Enlow, 40, of English, near the 7400 block of Overhead Bridge Road near Taswell.    Ciotti was not wearing a helmet or utilizing the ORV’s safety restraints at the time of the collision.  Indiana Conservation Officers strongly encourage riders to always wear a helmet and utilize necessary safety equipment when operating an ORV.last_img read more

December 21, 2019 | | Post a Comment

first_imgJim Witter and his remarkable band return to the Western Carolina University Bardo Arts Center on September 16 at 3pm for the Friends of the Arts annual Friend-Raising concert.Jim Witter’s “Time in a Bottle” will take you on a journey back to the ’60s and ’70s. Immerse yourself in the sights and sounds of the social and cultural revolution that catapulted folk artists such as Jim Croce, Cat Stevens, James Taylor, Harry Chapin and Bob Dylan to the forefront of the musical landscape. You may not be able to save “Time in a Bottle,” but experiencing one of Jim Witter’s signature musical and lyrical voyages sure comes close!This Friend-Raising concert from the WCU Friends of the Arts is the keynote of their “Friend” drive, generating support for the newly named David Orr Belcher College of Fine and Performing Arts. Individuals who donate to Friends of the Arts can purchase tickets for only $10 to the Jim Witter concert on September 16. Tickets are $25 for the general public.Learn more about the concert and purchase tickets by visiting foa.wcu.edu. You may also purchase tickets at the Bardo Arts Center box office located at 199 Centennial Drive, Cullowhee, NC or over the phone at 828.227.ARTS. To purchase the exclusive $10 Friends of the Arts tickets, please visit or call the Bardo Arts Center Box Office.last_img read more

December 18, 2019 | | Post a Comment

first_imgWhen considering new job opportunities or career moves, there are lots of factors that come into play. Of course people think about salary, benefits, and potential for growth. Many employees also focus on their “fit” [1] with an organization’s culture. But where does that culture come from? The Attraction-Selection-Attrition (ASA) Model [2] was developed to explain how cultures form, how they are reinforced, and why they sometimes need to be forcibly changed.Attraction: Job seekers are attracted to certain companies more than others. Maybe this is because of the company’s brand recognition, its mission, or because candidates have friends/family who work at the company and perceive a good fit. If I like my friend and she likes her employer, then I would probably like working for that company too. Organizations make a strong effort to be attractive employers. Many of my conversations with Chief HR Officers included discussions of “employer brand” and how to be known as a great place to work. One reason for using employee engagement surveys is to ensure that current employees enjoy where they work, which will make them good “brand ambassadors” who help spread the word about why their company is attractive. External candidates who perceive a good fit with the company are more likely to feel that attraction and apply for a job. Attraction is a huge help in recruiting top talent.Selection: During the interview and hiring process, managers tend to pick people who fit the company’s culture. There are inherent biases that play into this process, and candidates who are more similar to the people already working for the company are more likely to be hired. Although there are laws protecting against certain types of discrimination during hiring, managers still have a lot of leeway to determine if candidates fit the company culture. And they use it.Attrition: People who do not fit the company culture tend to leave. Sometimes, people are hired and get into the job and then realize they don’t fit. Other times the company goes through an organizational change and doesn’t feel the same to veteran employees. Sometimes employees perceive social cues from their coworkers that they don’t fit in, and feel pressured to leave. Whatever the reason, when people feel a lack of fit, they usually move on. As a result, the people who remain are the ones who like the culture and want to perpetuate it. They are also the ones who continue being brand ambassadors and hiring managers, so they reinforce this cycle by attracting and selecting the next round of similar candidates.Attraction – Selection – Attrition.The result of this cyclical process is a company with a strong culture of like-minded individuals. While that can be energizing and really powerful, it can also lead to some troubling outcomes. One issue is it drives the company toward homogeneity. Employees who all fit a strong culture tend to think and act similarly to one another, which can lead to groupthink, tunnel vision, and a lack of creativity. Most people today understand that diversity is an imperative, both socially and also for strong financial performance. The ASA model can dissolve diversity unless companies actively fight against the homogenizing process. To that end, diversity and inclusion need to be strongly mandated as core features of the culture so ASA can work in the company’s favor. Companies that are known for being inclusive attract a much wider range of job seekers, are willing to select many unique kinds of candidates, and allow employees to feel good fit even if they are different from some of their immediate coworkers.By actively fighting homogeneity, inclusive companies actively fight failure.last_img read more

December 12, 2019 | | Post a Comment

first_imgJEFFERSON CITY, Mo. (AP) – Republican Sen. Josh Hawley of Missouri is doubling down on efforts to rein in big-tech companies by proposing that they be required to prove they’re not using political bias to filter content.Hawley filed the bill Wednesday. It would require companies to prove to the Federal Trade Commission that their algorithms and other ways they filter content are not biased against a party or candidate.If companies don’t do that, they would lose current legal protections that shield them from being sued over posts on their sites made by users.President Donald Trump and other Republicans have repeatedly claimed anti-conservative bias by tech companies, which tech companies have denied.Big tech has said Hawley’s bill would discourage companies from self-policing hate speech and extremist views by opening websites up to lawsuits.last_img read more

December 1, 2019 | | Post a Comment

first_img Trials of impotence drug to help poorly growing fetuses are halted after infant deaths AMSTERDAM—When gynecologist Wessel Ganzevoort received a request for an urgent meeting from the independent committee watching over his clinical trial last week, he thought it might be good news.Ganzevoort leads a study to find out whether sildenafil could help poorly growing fetuses if given to their pregnant mothers; the drug dilates blood vessels and in theory could bring fetuses more oxygen and nutrients. A data and safety monitoring committee, however, had looked at the unblinded evidence halfway through the study and wanted to talk. Ganzevoort, who’s at the Amsterdam University Medical Center (AUMC), knew that probably meant one of two things: Either the drug worked so well that continuing to give a placebo to half of the mothers in the trial would be unethical, or the study had to be stopped because sildenafil was causing serious complications. Because previous studies had not shown any major side effects, Ganzevoort expected the former.He was wrong. At the 19 July meeting, the committee told him that a very specific complication, persistent pulmonary hypertension—in which blood vessels in the baby’s lungs fail to open after birth—had occurred 17 times in the sildenafil-treated group, leading to 11 deaths. There were only three cases of the condition in the placebo group and no deaths. (In total, there were 19 deaths in the treatment group versus nine in the placebo group—the latter not being a surprise given all the fetuses were at high risk because of their poor growth.) “It took us very little time to make the decision to halt the study,” Ganzevoort says. That same day, he and his colleagues began to call the women who participated in the study, including several who are still pregnant or whose babies are in the hospital.Sign up for our daily newsletterGet more great content like this delivered right to you!Country *AfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of theCook IslandsCosta RicaCote D’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinianPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussian FederationRWANDASaint Barthélemy Saint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofVietnamVirgin Islands, BritishWallis and FutunaWestern SaharaYemenZambiaZimbabweI also wish to receive emails from AAAS/Science and Science advertisers, including information on products, services and special offers which may include but are not limited to news, careers information & upcoming events.Required fields are included by an asterisk(*) By Jop de VriezeJul. 25, 2018 , 12:40 PM Cavan Social/Alamy Stock Photo center_img Impaired fetal growth can lead to stillbirth or neonatal death, and babies that survive are still at higher risk of infections and long-term problems. Researchers at the University of British Columbia in Vancouver, Canada, have stopped a similar study, pending an in-depth investigation of what happened in the Netherlands. But the sudden halt likely means the end of the road for what many thought was a promising therapeutic approach, says AUMC gynecologist Ben Willem Mol, who co-initiated the study.“Fetal growth restriction” is caused by a lack of blood flow from the placenta to the unborn child, resulting in undernourishment and stunted growth and development. It can lead to stillbirth or neonatal death, and babies that survive are still at higher risk for infections and often suffer from long-term problems such as obesity and cardiovascular disease. Growth restriction is diagnosed using ultrasound, but now the only medical treatment is closely monitoring the pregnancy and inducing birth when the risk of stillbirth is deemed high. That poses a difficult dilemma for doctors: Inducing birth too early increases the risk of complications, but waiting too long could lead to developmental anomalies or stillbirth.Increasing placental blood flow could spur fetal growth, which is why a growing number of doctors around the world are prescribing sildenafil to pregnant women whose fetuses suffer from impaired growth. The drug is known to dilate some blood vessels, including those in the penis—which is how it became a blockbuster drug for erectile dysfunction—and a number of animal studies and small human trials suggested the drug might benefit unborn children. Yet it is not approved for such use in pregnant women by any regulatory body, so physicians have been using it in a so-called off-label manner.Ganzevoort and a number of other experts in obstetrics wanted to firm up the evidence on the issue. In 2012, they started an initiative to conduct five separate but very similar trials that would culminate in a meta-analysis.The studies began in 2015, and even before last week’s dramatic decision, the results so far had been disappointing. A study by a team in the United Kingdom, published online in The Lancet Child & Adolescent Health in December 2017, found sildenafil didn’t improve the duration of pregnancy, birth weight, or fetal and neonatal survival. The team did not observe any negative effects of the drug, except for a decrease in the blood flow from placenta to fetus through a shunt between the placenta and fetus called the ductus venosus. “This was an unexpected result and it was the first evidence for a potential adverse effect of the treatment,” says Gordon Smith of the University of Cambridge in the United Kingdom, who was not involved in the study.A joint Australian–New Zealand team whose results from a similar trial were presented at a recent meeting didn’t find any benefits either, but also didn’t see complications, says study leader Katie Groom of the University of Auckland in New Zealand. A trial in Ireland has yet to start enrollment; researchers in that study did not respond to emails today, but Mol expects it will be canceled.The Dutch team held out hope for a more positive result, until the call last week. “There were no signs of serious harm, so we continued with our plan,” Ganzevoort says.The news was devastating to some study participants. “We were at peace with the death of our daughter, but now we no longer are,” one mother said on Dutch public television. It also raised questions about the information parents received about the study’s risks. The informed consent form they were asked to sign does not mention any potential negative effects for the child. “We did state that sildenafil normally is not prescribed during pregnancy, and that no strange things had been observed in this indication, which is a fact,” Ganzevoort says, “but we could have stated more specifically that we don’t know what we don’t know, as I did during all the counseling I did myself.” How the drug could have caused the complications is unclear. The Dutch team plans to investigate all of the cases of lung hypertension and the neonatal deaths it caused to check whether the diagnosis was correct and whether there were other specific characteristics among this group. One possible explanation is a “rebound effect,” Groom says. Some of the drug probably reached the fetus before birth, where it may have put dilating forces on the lung vessels, she says; that might have led to an increase of constricting signals from the fetus itself to prevent them from opening prematurely. “After birth, the child stopped receiving the dilating drug, potentially causing a constriction of the lung vessels,” Groom speculates.It’s also unclear why the deaths happened only in the Dutch trial. Study inclusion criteria in the United Kingdom, Australia, New Zealand, and the Netherlands differed slightly, but not enough to explain the varying outcomes, Groom says. Researchers in the two other trials plan to check whether they may have missed cases of lung hypertension in the newborns.Given the small numbers of deaths, it’s also possible that the outcome in the Netherlands is entirely due to chance, although Ganzevoort says the odds of that are lower than 5%. “Combining our results with those of the other trials and zooming in on subgroups might give more clarity,” he says.The decision to halt the trial is a blow to the field, Mol says. “There were good reasons to believe this drug would work and it was responsible to run this trial,” he says. “I get emotional talking about it because we now have 11 grieving families and it does not help those people.”There is always a risk in clinical trials, however, says Indira van der Zande, who recently finished her Ph.D. thesis on pregnant women in clinical research at the University Medical Center Utrecht in the Netherlands. “But we should always keep in mind that by not conducting this study, there would have been a risk as well. Doctors might have prescribed this drug for years off-label, assuming it was safe and effective.”last_img read more