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It is interesting that they did the nr today. I don't know when they submitted but jesse sent me this undated full submission on July 12. Perhaps they couldn't announce until it completed the 30 day peer review stage, however the nr doesn't mention this.
Journal of Obesity
Volume 2015 (2015), Article ID 365604, 8 pages
http://dx.doi.org/10.1155/2015/365604
Clinical Study
Sustained Weight Loss with Vagal Nerve Blockade but Not with Sham: 18-Month Results of the ReCharge Trial
Scott A. Shikora,1,2 Bruce M. Wolfe,3 Caroline M. Apovian,4 Mehran Anvari,5 David B. Sarwer,6 Robert D. Gibbons,7 Sayeed Ikramuddin,8 Christopher J. Miller,9 Mark B. Knudson,2 Katherine S. Tweden,2 Michael G. Sarr,10 and Charles J. Billington11
1Division of General and Gastrointestinal Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
2EnteroMedics Inc., 2800 Patton Road, St. Paul, MN 55113, USA
3Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
4Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA
5Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S4L8
6Departments of Psychiatry and Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
7Departments of Medicine and Public Health Sciences, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
8Department of Surgery, University of Minnesota, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
93D Communications LLC, 8386 Six Forks Road, Raleigh, NC 27615, USA
10Department of Gastroenterologic and General Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA
11Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, Minnesota Veterans’ Administration Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA
Received 20 May 2015; Accepted 28 June 2015
Academic Editor: Francesco Saverio Papadia
Copyright © 2015 Scott A. Shikora et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Objectives. Vagal block therapy (vBloc) is effective for moderate to severe obesity at one year. Subjects/Methods. The ReCharge trial is a double-blind, randomized controlled clinical trial of 239 participants with body mass index (BMI) of 40 to 45?kg/m or 35 to 40?kg/m with one or more obesity-related conditions. Interventions were implantation of either vBloc or Sham devices and weight management counseling. Mixed models assessed percent excess weight loss (%EWL) and total weight loss (%TWL) in intent-to-treat analyses. At 18 months, 142 (88%) vBloc and 64 (83%) Sham patients remained enrolled in the study. Results. 18-month weight loss was 23% EWL (8.8% TWL) for vBloc and 10% EWL (3.8% TWL) for Sham (). vBloc patients largely maintained 12-month weight loss of 26% EWL (9.7% TWL). Sham regained over 40% of the 17% EWL (6.4% TWL) by 18 months. Most weight regain preceded unblinding. Common adverse events of vBloc through 18 months were heartburn/dyspepsia and abdominal pain; 98% of events were reported as mild or moderate and 79% had resolved. Conclusions. Weight loss with vBloc was sustained through 18 months, while Sham regained weight between 12 and 18 months. vBloc is effective with a low rate of serious complications.
1. Introduction
Vagal nerve blockade (vBloc) has been recently studied as a minimally invasive laparoscopic surgery for weight loss and improvement in weight-related conditions such as type 2 diabetes mellitus (DM2) [1–3]. The most frequently performed bariatric surgical procedures for weight loss, Roux-en-Y gastric bypass and sleeve gastrectomy, produce considerable weight loss but have potentially serious complications and require alterations of the gastrointestinal (GI) anatomy that are not acceptable to many patients [4]. The vBloc device was developed for patients with moderate to severe obesity, as an alternative to conventional weight loss surgery and does not require permanent anatomical alteration.
Two recent studies have examined the effect of vBloc on weight loss with a rechargeable device. The single-arm, prospective vBloc DM2 study showed that at one year subjects with DM2 and body mass index (BMI) between 30 and 40?kg/m2 achieved 25% excess weight loss (%EWL) [2]. In the double-blind, randomized ReCharge trial, using the last-observation-carried-forward (LOCF) analysis method, the vBloc arm achieved 24% EWL (9.2% total weight loss [%TWL]) at 12 months, which was significantly greater than the 16% EWL (6.0% TWL) achieved by subjects in the Sham arm implanted with a Sham neuroregulator [1]. Both studies showed that vBloc had a low rate of serious device-related complications in the first year. This report summarizes additional safety and efficacy data from the ReCharge trial beyond 12 months as patients were unblinded through 18 months of follow-up.
2. Methods
2.1. Participants
The methods of the ReCharge trial have been described previously [1]. Briefly, participants were enrolled at 8 sites in the United States and 2 sites in Australia. Participants were eligible for inclusion if their BMI was between 35 and 40?kg/m2 with one or more obesity-related comorbidities (i.e., type 2 diabetes mellitus, hypertension, dyslipidemia, sleep apnea syndrome, or obesity-induced cardiomyopathy) or had a BMI between 40 and 45?kg/m2 regardless of comorbidities. Participants with DM2 were limited to 10% of total enrollment so that the weight loss-limiting impact of diabetes would not have an undue impact on study results.
2.2. Study Design
The ReCharge trial is a 5-year, double-blind, Sham-controlled trial comparing vBloc to an implanted Sham device. Participants were randomized at implant in a 2?:?1 ratio to vBloc and Sham control arms in permuted block sizes of 3 or 6 stratified by clinical site and type 2 diabetes mellitus status.
Participants, sponsor personnel, and follow-up staff were blinded. The surgeon and the surgery support team could not be blinded, so their interaction with participants after randomization was limited until the 12-month blinded period of the trial had elapsed for all participants.
Subjects were treated in accordance with the Helsinki Declaration of 1975.
2.3. Intervention
Implant of the vBloc device and electrodes requires standard laparoscopic surgery performed under general anesthesia [5]. Electrodes are placed around the anterior and posterior vagal nerve trunks near the gastroesophageal junction, secured with sutures and connected to a rechargeable neuroregulator placed in a subcutaneous pocket on the thoracic side wall. The neuroregulator is recharged transcutaneously with a transmit coil placed over the neuroregulator connected to a mobile charger.
Participants randomized to the Sham arm were implanted with a similar neuroregulator that dissipated charge at a rate similar to the active device into a resistor within the Sham neuroregulator. Electrodes were not implanted and the vagal nerve trunks were not manipulated. To support the blind, Sham patients had the same number of skin incisions to simulate a laparoscopic procedure, but without entering the abdominal cavity. Active and Sham neuroregulators were sized identically at 8.6?cm in diameter, 7.1?cm in width, and 1.6?cm thick.
The neuroregulators in both groups were programmed to deliver therapy for at least 12 hours per day (though no therapy was delivered in the Sham group). Therapy energy levels were increased over the first month to the desired amplitude of 6?mA, although the amplitude could be adjusted by the follow-up team if the participant felt uncomfortable therapy-related sensations at any time during the trial. All monthly visits were collected within a ±2 week window. All participants were asked to check their battery level daily and to recharge their battery approximately twice weekly.
Follow-up visits occurred weekly in the first month, biweekly through month 3, and monthly thereafter through the second year. All participants participated in a weight management program that coincided with clinic visits. The weight management program typically consisted of a 15-minute educational interaction discussing healthy food choices, physical fitness, and social support. No specific diet (e.g., portion-controlled meals) or exercise program was prescribed.
2.4. Study Objectives
The 12-month primary efficacy and safety endpoints of the study have been previously reported [1]. Efficacy and safety continue to be assessed for 5 years. This report focuses on efficacy and safety at 18 months. Related serious adverse events, as defined in the previous publication [1], through 18 months were classified according to the Clavien-Dindo classification of surgical complications [6].
2.5. Statistical Analysis
Analyses of weight loss data were conducted under the intention-to-treat (ITT) principle using mixed-effects regression models [7]. Data were analyzed using a linear mixed model with unstructured covariance matrix, treating time (study visits) as a categorical variable with time-specific contrasts. Under this model, data are treated assuming missingness at random.
Since participants were unblinded on a rolling basis after 12 months, two sensitivity analyses were performed to ensure that weight-related trends were not attributable to effects of unblinding. Firstly, a mixed-effects model was fit with a time-varying covariate for unblinding and its interaction with the treatment group to test whether the treatment effect was affected by unblinding of participants. Secondly, the mixed-model was fit to the subset of data for which participants were still blinded.
In this report, results are not reported using the last observation carried forward (LOCF) method, the primary imputation method for the 12-month results [1], due to the poor statistical properties of LOCF imputation [7]. All statistical analyses were performed using SAS version 9.3.
3. Results
3.1. Baseline Characteristics and Participant Disposition
The baseline characteristics of the ITT population are summarized in Table 1. A CONSORT diagram through 18 months is shown in Figure 1.
Table 1: Baseline characteristics by treatment group.
Figure 1: CONSORT diagram through 18 months.
By the 18-month visit, 20 participants (12.3%) in the vBloc group and 13 participants (16.9%) in the Sham group had withdrawn from the study. Five withdrawals in the vBloc group and 1 in the Sham group occurred at implant and have been previously discussed [1]. After implant in the vBloc group, 2 participants were lost to follow-up, 3 participants withdrew for an adverse event (pain at the neuroregulator site, heartburn, and pain with therapy, resp.), and 10 withdrew for subject decision. In the Sham group, 6 withdrawals were for adverse events (2 for pain at the neuroregulator site, rotator cuff pain, irritable bowel syndrome, anxiety, and breast cancer, resp.) and 6 for subject decision.
The 18-month visit completion rates were 72% in the vBloc group and 55% in the Sham group; however, approximately 80% of participants in the ITT population in both groups had weight measurements within 2 months of the 18-month visit, which were incorporated in the statistical analysis of 18-month results. Eleven participants in the vBloc group and 19 in the Sham group who did not attend the 18-month visit had attended either their 16- or 17-month visit.
In addition to the revision procedures reported in the first 12 months [1], there were an additional 3 revisions in the vBloc group between 12 and 18 months. Two were for adverse events and one for a device malfunction. The revision procedures were uncomplicated and the patients were released within a day of the procedure.
3.2. Blinding
All participants and blinded study personnel remained blinded to randomization assignments until all participants had completed their 12-month visit and the 12-month study database was locked and verified. Since the study was enrolled over approximately 7 months, the majority of participants were not unblinded until their 16-month visit. At 15 months, 85% of subjects in the vBloc group and 90% of subjects in the Sham group remained blinded. At the 18-month visit, 27% of vBloc participants and 25% of Sham participants were still blinded.
3.3. Weight Loss
Weight loss as both %EWL and %TWL over time is shown in Table 2 and Figure 2. For the ITT population at 12 months, the estimated mean %EWL was 26% in the vBloc group and 17% in the Sham group (). At 15 months, where 86% of subjects remained under the study blind, the estimated mean %EWL was 24% for the vBloc group versus 13% for the Sham group (). At 18 months, the estimated mean %EWL was 24% for vBloc and 10% EWL for Sham (). The corresponding treatment difference between groups increased from 9 percentage points at 12 months (95% CI, 4–14) to 13 percentage points (95% CI, 8–18) at 18 months.
Table 2: Mean %EWL and %TWL at 12, 15, and 18 months in ITT population.
Figure 2
Sensitivity analyses showed that unblinding did not significantly influence the larger treatment effect with vBloc over time as the Sham group regained weight ( for the unblinding by treatment interaction). Similarly, when the analysis was restricted to patients who remained blinded throughout 18 months, the estimated mean %EWLs were similar to that of the overall sample. At 15 months, the estimated mean %EWL was 26% in vBloc and 13% in Sham (); at 18 months, the estimated mean %EWL was 21% in vBloc and 8% in Sham ().
Among the patients completing the 18-month visit (without imputation), the mean %EWL was 25% in the vBloc group and 12% in the Sham group (treatment difference, 13 percentage points; 95% CI, 6–21). At 18 months, 54% of vBloc patients achieved at least 20% EWL compared to 26% in the Sham group (); 41% vBloc patients achieved at least 25% EWL compared to 17% in the Sham group ().
3.4. Safety
The safety profile of vBloc remained favorable at 18 months. The adverse event (AE) profiles of both treatment groups were similar to that reported at 12 months [1]. All related AEs are shown in Table 3. The most commonly reported related AEs were heartburn and dyspepsia, abdominal pain, another pain, eructation/belching, and dysphagia. Ninety-eight percent of all AEs in the trial were reported as mild or moderate in severity (versus only 2% reported as severe) and 79% of events had resolved at 18 months. Most of the related events were transient side effects of therapy and resolved either spontaneously with no intervention or with an alteration of the therapy algorithm.
Table 3: Cumulative adverse events related to device, procedure, or therapy through 18 months.
One additional surgical complication occurred between 12 and 18 months in the vBloc group. One patient had a gastric perforation at the gastroesophageal junction during explant of the device following the participant’s decision to discontinue in the study. Following repair of the perforation, the patient improved postoperatively and fully recovered.
Table 4 shows the serious adverse events (SAEs) that occurred through 18 months classified according to the Clavien-Dindo Scale. This analysis demonstrates that 56% of the SAEs were grade I in severity, 6% were grade II (and this patient was not implanted but needed a transfusion due to bleeding from biopsy of a cirrhotic liver), 31% were grade III, and 6% was grade IV. Importantly, all patients had a full recovery without sequelae.
Table 4: Serious adverse events graded as surgical complications according to the Clavien-Dindo Scale through 18 months in the vBloc group.
4. Discussion
Results of the ReCharge trial at the 18-month time point provide important context for weighing the benefits and risks of vBloc therapy. First, the trial continues to demonstrate sustained weight loss with vBloc therapy. Second, vBloc appears to have a favorable safety profile with a low risk of serious complications (0.6% of patients had a grade IV complication), and nonserious complications were typically mild or moderate sensations of the therapy that were resolved with little to no intervention. Interestingly, weight loss in the Sham group was considerably diminished within 6 months of the 12-month endpoint, despite continued blinding of the study past the 12-month visit and ongoing weight management counseling. These 18-month data were the topic of a meeting of the FDA Gastroenterology and Urology Devices Panel in June 2014 to consider US regulatory approval of the Maestro Rechargeable System to deliver vBloc therapy. The independent panel voted that the benefits of vBloc therapy outweighed the risks, and FDA subsequently granted approval to the Maestro Rechargeable System in January 2015.
Given that a large proportion of persons with moderate to severe obesity do not present for traditional bariatric surgical procedures secondary to the concerns for serious complications and permanent alteration of their gastrointestinal anatomy [4, 8], access to additional less-invasive options will be attractive to these individuals. While longer-term efficacy data are needed, the continued durability of weight loss with vBloc through 18 months provides additional support that vagal block may be considered an effective alternative to conventional weight loss surgery.
Weight loss in the Sham group was thought to result from a combination of Sham surgery including a Sham device, self-monitoring due to daily interaction with the Sham device to recharge the battery, and the weight management program [1]. Weight loss in the Sham group was more than expected, since participants were not prescribed a diet (e.g., portion-controlled meals) or physical activity, and as such, the primary 12-month objectives of the trial were not met. Sham surgeries in other contexts have also produced large effects [9–11], but these effects would be expected to be transient since no active treatment is being delivered. Surprisingly, weight loss in the Sham group of the ReCharge trial was relatively stable between 6 months and 12 months but deteriorated considerably thereafter. We suspect that this prolonged Sham effect may have resulted from enhanced self-monitoring due to the daily interaction with the Sham device.
Statistical modeling of the 18 month results suggest that unblinding of participants did not have a significant impact on the weight trajectories of either group and that weight regain in the Sham group occurred regardless of whether or not participants remained blinded. This 50% relative increase in the treatment effect of vBloc therapy through 18 months compared to 12 months indicates more substantial efficacy than that previously reported with vBloc compared to a rigorous Sham control.
Several limitations of the present report should be noted. First, frequency of missing data was appreciable at 18 months. However, nearly 80% of randomized participants in both groups had a visit within 2 months of the 18-month time point and all analyses were conducted on the ITT sample using all available longitudinal data, so inference can be made to the entire cohort at 18 months. Second, statistical analysis of the ReCharge study was not prespecified after 12 months. This limitation is offset by the continued analysis of the ITT cohort rather than a convenience sample as well as sensitivity analyses that concurred with the overall analysis. Finally, all participants were not blinded through 18 months and were unblinded on a rolling basis, making interpretation more difficult. However, nearly 90% of participants were still blinded through the 15-month visit, at which point much of the weight regain in the Sham group had already taken place. Additional analyses also suggest that unblinding did not impact weight regain in the Sham group.
5. Conclusions
Follow-up through 18 months of the ReCharge study showed sustained weight loss with intermittent vagal nerve block but not with a Sham surgery and device intervention. vBloc therapy continued to be safe and well tolerated. Additional long-term data and continued follow-up of the ReCharge study are needed to further characterize the safety and effectiveness profile of vBloc therapy.
Conflict of Interests
EnteroMedics Inc., funder/sponsor, was involved in the design and conduct of the study, site selection, and database management. The sponsor provided funding to the clinical sites for patient enrollment, core laboratory analyses, clinical events adjudications, and database entry. The sponsor provided fees to NAMSA (Mr. Christopher J. Miller for independent statistical analyses). The sponsor provided fees to Drs. Caroline M. Apovian, Bruce M. Wolfe, David B. Sarwer, and Robert D. Gibbons for assistance in preparing and presenting theses data at an independent FDA advisory committee meeting. Dr. Sayeed Ikramuddin receives consulting income from EnteroMedics. This relationship has been reviewed and managed by the University of Minnesota in accordance with its conflict of interests polices. Dr. Scott A. Shikora received fees as the sponor’s chief medical officer. Two sponsor representatives (Mark B. Knudson and Katherine S. Tweden) were allowed to review and participate in the critical revision of the paper prior to submission.
Acknowledgments
National primary investigators are Michael G. Sarr, M.D., and Charles J. Billington, M.D. Site principal investigators and surgeons are Sayeed Ikramuddin, M.D., and Daniel B. Leslie, M.D. (Department of Surgery, University of Minnesota, Minneapolis); Robin P. Blackstone, M.D., and James Swain, M.D. (Scottsdale Bariatric Center, Scottsdale); Anthony Brancatisano, M.D., Ph.D., and Roy Brancatisano, M.D. (Institute of Weight Control, Sydney, Australia); James Toouli, M.D., Ph.D., and Lilian Kow, M.D., Ph.D. (Adelaide Bariatric Centre, Adelaide, Australia); Sajani N. Shah, M.D. (Department of Surgery, Tufts Medical Center, Boston); Bruce M. Wolfe, M.D., and Clifford Deveney (Oregon Health & Science University, Portland); Ken Fujioka, M.D., and Mark Takata, M.D. (Scripps Clinic, San Diego); James W. Maher, M.D. (Division of General Surgery, Virginia Commonwealth University, Richmond); Florencia Que, M.D. (Mayo Clinic, Rochester); John M. Morton, M.D. (Division of General Surgery, Stanford University School of Medicine, Stanford); and Robert W. O’Rourke, M.D. (Department of Surgery, University of Michigan and Ann Arbor VA Hospital). Study and weight management coordinators are as follows: University of Minnesota: Bridget Slusarek, Elsie Waddick, Shannon Johnson, and Nikolaus Rasmus; Scottsdale Bariatric Center: Melisa Celaya, Heather Lane, Samantha Easterly, Cassie Truran, Arrin Larson, Dorrie Wilson, Katherine Emershad, Jennifer Childress, and Angelia Seitz; Institute of Weight Control, Sydney: Radhika Butala, Gretel Young, Ruth Hutchinson, Kerry McCurley, and Geane Sharman; Adelaide Bariatric Centre, Adelaide: Jane Collins and Fiona McDonald; Tufts Medical Center: Ann Marie Melanson, Meghan Ariagno, Danielle DeMarco, and Jillian Regan; OHSU: Wencesly Paez, Chad Sorenson, Shannon Rentz, Gloria Scalzo, and Tracy Severson; Scripps Clinic: Jennifer Wagner, Mary Collard, Sandy Grad, Cindy Galm, and Melissa Susaki; VCU: Donna Neatrour, Jill Meador, Sakita Sistrun, Melanie Wiggins, Carly Sopko, and Leah Loomis; Mayo Clinic: Amy Reynolds, Joe Hockert, Sue Starkson, Margaret Gall, and Debbie Dixon; and Stanford: Dana Schroeder and Kristine Birge. Data Safety Monitoring Board and Clinical Events Committee members are James Freston, M.D., (chair) Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut; Daniel Bessesen, M.D., Division of Endocrinology, University of Colorado Denver, Denver, Colorado; Miguel Herrera, M.D., Division of General Surgery, Universidad Nacional Autónoma de México at Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico; Melissa Martinson, Ph.D., Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota; and Frank Moody, M.D., Department of Surgery, University of Texas Health Science Center, San Antonio, Texas.
References
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They can cover in a few days trading if they haven't already. Short reports come out so late they are not of use to tell if shorts have covered - 35M shares traded since the last report so easy to slip in there and close the short position.
What are you going to do if the 8M shorts have covered - make up a story that temporary 8M share artificial buying couldn't lift the sp so we are doomed? All you can do is guess - a baseless guess is worth nothing.
There are many applications of the tech, and computers maybe down the road, but they don't have the resources to pursue every opportunity now. They would be nuts to fly off in every direction when they don't even have any revenue yet.
Gen 2 is the highest priority now - it will bring in billions of royalties per year with no expenses which would make the stock worth hundreds of dollars. Why set the whole thing back by burning up their cash on other projects that might take years to complete?
There are many applications of the tech, and computers maybe down the road, but they don't have the resources to pursue every opportunity now. They would be nuts to fly off in every direction when they don't even have any revenue yet.
Gen 2 is the highest priority now - it will bring in billions of royalties per year with no expenses which would make the stock worth hundreds of dollars. Why set the whole thing back by burning up their cash on other projects that might take years to complete?
You are right that there were a lot of shorts at June 30, but they could have closed since June 30. It is almost the same amount for the last year.
http://www.nasdaq.com/article/lessons-from-a-dozen-years-of-short-selling-cm449311
Item 5 is N/A but hilarious.
Items 9, 10, 11 show why no one would short etrm ever. There is not enough info out there to analyze at this stage of its life.
Also, your broker has to have the shares for you to borrow against. I shorted a sure thing (the bankrupt Air Canada) with a market cap of $500M 10 years ago, because on their website they said the stock was worthless and they were planning a 10,000 for 1 consolidation to refinance. Problem is, the world is full of dopes who think every big company has value (K-Mart bankruptcy is another example of massive market cap in the face of nr stating there was no value) so it maintained its market cap for a year until the court arrangement for bankruptcy went through. My brokerage called me within 2 weeks of my short and said all shorts had to be cleared out because they ran short of stock to borrow - they did this to every short and gave us until the end of the day to buy back and end our shorts.
So anyone who posts there is heavy shorting without any proof is playing with your mind - or worse someone plays with his.
Have you ever shorted a stock and felt the danger to your money that exists if the stock goes up on you? I didn't think so. Shorts don't play tiny biotechs where the sky is the limit of their losses if an unexpected breakthrough occurs so that is the only thing that is clear.
Instead this one is purely about chartists, paranoids and the aftershocks of the financing - a drop happens with every financing but not usually to this extent but it seems like the perfect storm of the 3 forces I mentioned.
No man is stronger than the markets, so value always emerges triumphant after a sp meltdown on a company that is cashed up - only question is how much value there is, not how many momentum guys are trading the stock today.
Yeah, nxt for one dated it when they produced a Gen 1 cell with reduced silver but almost as efficient as the best today. mich must think nxt is pretty stupid to make Gen 2 when Google is available for all your science planning.
Or mich could find someone to interpret the nr here and ask yourself why would the competition try for a long time, if you know better? "completely eliminate high-cost silver from mass-manufactured silicon solar cells – an achievement that has been a long-time goal of solar science."
Mitcheroo has no brains because he can't interpret the nr. Don't waste your time going to his link article which has nothing to do with what NXT has already done for one thing by removing some of the silver and already having power around what the best do today - and will finish off by removing all the silver with Gen 2.
He is obviously also coin's dumb brother.
Bad move for anyone who sold based on these stupid witch doctor charts yesterday for this stock. I guess the chart guys like to forget about those days.
Bad move for anyone who sold based on these stupid witch doctor charts yesterday for this stock. I guess the chart guys like to forget about those days.
I wonder how accurate that report is? There are only 5 analysts listed on etrm site, yet the article says "many analysts" then lists 5, however Canaccord hasn't updated yet because of 1 day blackout. I wonder if they are referring to 1/4 page newsletter writers who copy/paste nr, but call themselves analysts.
Never mind if people can't get it today. It is almost as good as the best and cheaper because of no furnaces and with less silver - manufacturers can use it immediately.
Second generation has no silver and way better efficiency than competition. It would be nice if Chuck could make a forward statement about when Gen2 is projected to come out - perhaps because it is science it can't be predicted - perhaps even BULLear will understand there was a purpose for those scientists getting stock options, and realize what he calls stupid is most accurately examined with a mirror.
You are leaving out important points. Etrm expects to succeed because its product is shut off 8 hours a day - unlike the others like surgery dealing with the vagus nerve- so the brain won't be able to figure out a pattern of starvation.
Your claim that the market just happened to figure out problems with the product starting last Tuesday when the financing was announced (the financing stated closing in 5 days so obviously the funds had their money ready since they pre-evaluated it at $.87 as a good buy) and discovered new negative product knowledge to further drive it down exactly when the second financing was announced is not accepting reality.
The market (of who knows what calibre of people are selling) is the best judge per you at $.35 when funds paid $.50 today? lol - Why does anything go up if it is always instantly priced correctly?
Reality you don't understand is the sp is down because of the uncertainty from financing drove it there - just like always happens during a financing - so because they have a good product available today, the sp will rebound after a while - just like it always does after a good product gets financed. In the meantime, and hopefully a short meantime, the chart guys and know-nothings figure the product can't be good enough like you just claimed - funny thing they gave it an $84M market cap a few weeks ago but you suddenly decide that it is worth $26M today ($40M less $16M in cash they didn't have last week.)
ETRM's real market is insurance/healthcare because not enough private individuals (which is etrm are forced to go to while waiting for approvals) can come up with this much money - like you said, so you got that part right.
It can take 2 years for approvals per Canaccord, which is why the sales are estimated to pick up in 3 years and full value will be obvious to all market participants.
I guess you missed the significance of the "if" part of my quote which makes your conclusion and hindsight comments irrelevant to my idea.
Anyway it is closed at $.50 so anyone like me who bought it today to average down is pretty safe - Canaccord predicts $63M in sales in 3 years with a 120% quarter over quarter growth, so a 10 multiple at that point will be reasonable. They will downgrade the sp target tomorrow because no one dreamed of a $.50 financing dilution and just as importantly there is no purpose maintaining $4 target on a $.35 stock when a $1.25 target or less will get the same message across that this is a screaming buy - whether or not the market crashes, the obese people don't go with it so the only connection is whether some can't afford it or if insurance/healthcare coverage is not in place by then.
Admit you are too dumb to be investing. Here is an update to the company that your simple brother coin8300, described in typical one word analysis as "dumb." Reality is it will only be dumb tech if NXT succeeds, which so far hasn't - and never will if anyone listens to your idea that new employees shouldn't be hired because they get incentive stock options.
https://howardgroupinc.com/2015/07/sun-shines-aurora-solar-joins-forces-industry-leader-h-l-m-elektronik-heels-oversubscribed-private-placement/
Admit you are too dumb to be investing. Here is an update to the company that your simple brother coin8300, described in typical one word analysis as "dumb." Reality is it will only be dumb tech if NXT succeeds, which so far hasn't - and never will if anyone listens to your idea that new employees shouldn't be hired because they get incentive stock options.
https://howardgroupinc.com/2015/07/sun-shines-aurora-solar-joins-forces-industry-leader-h-l-m-elektronik-heels-oversubscribed-private-placement/
Bankruptcy? Every biotech is BK if financing is your definition.
I am bored with this logic - all the points are out there for investors to ponder. See you late Wednesday.
What is a BK?
To confirm, you are out of etrm now that you proclaimed it a loser?
1. Free market doesn't offer warrants. Small prize when they knew yesterday it would trade lower today, but maybe that is how they play the game - hold $.50 until warrants go in the money then take profits.
2. I am betting Canaccord told them not to welch this time so I got even more at $.386 now - I take my chances based on the hope that ETRM told the funds that this is our last price offer and if you want in on the remaining $19M next year then you have to accept it.
If not, then management are just science guys who have no interest in the shareholders and take whatever happens with a shrug (and a secret smirk) that they tried - hopefully I don't learn more lessons tomorrow afternoon!
I think I read mgmt doesn't own much paper? If so, that increases the risk they are just science guys.
You forgot my question already in your haste to switch topics. Why are funds buying today at $.50?
You have unusual ideas that won't happen. Reality is the only proper course of action for investors.
You have unusual ideas that won't happen. Reality is the only proper course of action for investors.
No idea what your point is selling at a big loss. Funds are buying today at $.50 - connect the dots.
Shareholders with cash have nothing to complain about - they can load up and make 25% before the funds break even. If you are out of cash you need to find a corner to cry in.
That is not true unless you are referring to ST pricing - the future sp has nothing to do with today's. The company has to execute its business plan and the sp will find its proper level - in the meantime sp can go anywhere depending on perception. The funds aren't stupid and stuck it to this management team - must have been just a verbal agreement that they welched on.
By the way, someone inboxed me saying he gave me a follow and wants me to reciprocate - I don't operate that way - every post has to stand on its own and I could care less what rating occurs - obviously with people like him "follow" is a garbage event but since I don't have pm privilege I have to let him know here.
Like what use was or is that video to predict today's news or what will happen after they price and size the new financing?
Stock will be down tomorrow since they terminated the offering and have to start over.
Anyone know the fastest way to get etrm news? In Canada where I am from, almost all companies use Marketwire or CNW to disseminate their info and those companies have free sign-up email service to anyone who wants to follow their stocks news via email at the same moment it is broadcast to the media/securities commission. That doesn't seem to happen with my US stocks but maybe etrm is different? I emailed them about getting info, preferably via email at the time of news release but haven't heard back yet.
Anyone know the fastest way to get etrm news? In Canada where I am from, almost all companies use Marketwire or CNW to diseminate their info and those companies have free email service to anyone who wants to follow their stocks news via email at the same moment it is broadcast to the media/securities commission. That doesn't seem to happen with my US stocks but maybe etrm is different? I emailed them about getting info, preferably via email at the time of news release but haven't heard back yet.
If it is fully financed it obviously should be much higher than $.87, otherwise the funds who committed on Tuesday are idiots - which they aren't.
I have never seen a financing attempt to close in less than a week - the only one that tried to do one in one week ended up taking 3, so there must be only a few financing players in this one in order to have set such a quick close. Sounds like 100% institutional or some high net worth guy.
I have followed mzei for years, but just bought in last week and didn't read the prospectus to see what the intended use of the $35M is, which is sometimes illuminating and should be done. Sounds like no one else here did either.
Anything less than full funding means something in the game plan isn't going to be able to happen, so we will have to see what their adjusted plan is. Either way the die is cast and I expect news tomorrow and a Canaccord report by Wed. to spell it out for me.
I don't know why my posts are coming out in duplicate, but it is not intentional.
I just looked up the prospectus use of proceeds "Unless otherwise indicated in the prospectus supplement, we intend to use the net proceeds from the sale of securities and exercise of warrants under this prospectus to continue work toward regulatory approval of our product in the United States, for commercialization efforts in the United States and internationally, to expand our operations and grow our research and development, product development and administrative operations and for other working capital and general corporate purposes. The prospectus supplement relating to a particular offering of securities by us will identify the use of proceeds for that offering."
That makes no sense that the sp has "adjusted" for the dilution. Do you think every financing involves a bunch of dopes with $35M in their pocket who pay $.87 for something worth $.52 immediately afterwards because the financiers were so stupid that they forgot there would be more shares?
Argex also tried to finance $35M at $.37 on June 1 but that was to close on June 17, however the sp also dived immediately and they had to withdraw the filing on June 10 - likely the buyers welched or Argex overestimated the market's appetite for a financing.
Difference from Argex is the etrm deal is supposed to close only 4 biz days after pricing was announced and etrm doesn't involve building a plant that will need $300M of debt that no one knows if they will ever get, so much higher probability Canaccord got the money in hand for etrm last Tuesday and the financing will happen.
Unfortunately sometimes probabilities don't work out like I think they should, so we will find out sometime tomorrow.
No, the financing is just news to you. Any realistic investor knew from the beginning that etrm would need big dough with associated shares to get the marketing rolling and priced that into their expectations, but perhaps the size of it dismayed some traders last week - who knows but news about closing is tomorrow.
No one knows what "initial beneficial ownership limitation " means, for one thing. I will wait for Canaccord to spell it out next week - depending on whether this is taken up in a large way, or course.
No one knows what "initial beneficial ownership limitation " means, for one hting. I will wait for Canaccord to spell it out next week - depending on whether this is taken up in a large way, or course.
It is best to stop wasting time trying to be the first to guess a non-event, and you will be more at peace. Who cares, who knows who is trading shares? - it has nothing to do with etrm and everything to do with people who don't work at etrm.
I said before, this financing closes tomorrow which means it was totally spoken for previously - I have done lots of pp and know you don't get in on a bought deal at the last minute or nothing would ever get financed because of all the guys dumping over and over every time you priced the issue like etrm did yesterday - the guy dumping could be the one buying to get the warrants.
Actually the nr says closing is July 6 but my broker in Canada who isn't in on the deal said July 2 - maybe timing difference for international money deal, I don't know since I have never done one of those. If he is right it could be an early closing because the money is all there. Hopefully it really does go through tomorrow. Now that is an important event we should focus on instead.
How did they do, and did they learn anything or repeat the process?
How did they do, and did they repeat the process?