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I am overweight and to manage that I go for jogging but I usually experience pain around my calf muscles and shin bone of left leg, which make me to stop after short intervals.
Mera beta 3 saal ka hai. Lekin wo theek se chal nahi pata. Ungali pakarkar cha lane m wo sirf panjo par chalata h. Main uski physiotherapy kara rha hu. But koi positive result nhi as rha h. Please advice me.
My height is 5'6 and the weight is 82 kg for quite some time. But i m not fat. There is a pain in my legs and other bones.
I am 30 years old I have a severe backache starts from neck shoulders till lower back. I had my c-sec an year back. Also, I am vit D deficient I have taken 60k units of Vit D3 once in a week for 3 months but the pain in my feet is still there.
A cat has bit on my right leg my leg is paining. I have tried many home remedies. But it doesn't work what to do please tell me.
Sir mere pairoo me kafi pain rhta h weekness feel hoti h any soultion yrr m job krta hu mkoo kafi prblm hoti h kafi weakness aa chuki h mjhme mko kya krma chahiye.
Joints are intersections between bones; they provide support to your body during movement. There are a host of conditions which might lead to joint pain; they are bursitis, osteoarthritis, rheumatoid arthritis and gout. The most common joint pain disorders are knee pain, hip pain and shoulder pain.
Ayurveda associates joint pain with loss of bone density in the joints. This problem is characterized by a feeling of discomfort and cracking sounds. If the condition is not treated, it might lead to immobilization of the joint. The condition of the bones tends to deteriorate as they do not receive enough nutrition.
The other cause that leads to joint pain is toxin accumulation in the joints. As the toxin accumulates, it leads to heavy and stiff joints. If preventive measures are not taken on time, continuous accumulation of toxins may lead to swollen joints.
The various Ayurvedic remedies for joint pain are:
- Diet: Focus on eating foods especially that are salty, sour and sweet in taste. Add healthy foods such as rye and quinoa along with ghee as they pacify the "vata" in your body. Focus on natural foods such as vegetables and fruits to your diet.
- Herbs: Certain herbs such as turmeric help to treat joint pain. It contains curcumin that has anti-inflammatory properties which help in reducing the pain. You may also consume fenugreek seeds for its antioxidant content and anti-inflammatory properties.
- Lifestyle Changes: Make sure you exercise on a daily basis, do basic bodyweight exercises such as push-ups and squats to improve your strength. You may also start with yoga workouts to build flexibility and mobility in your body.
- Smoking and Alcohol: Limit smoking and alcohol consumption to keep your body healthy, and free from free radical damage. Alcohol may also cause you to put on weight, thus leading to obesity. Smoking may cause various problems in the lungs that may lead to breathing disorders.

domain: health


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Period: Early / Mid Twentieth Century
Provenance: The Tony Haynes Collection
Canvas Height: 13 inches
Canvas Width: 11 inches
Painted in oils on board, depicting a small child, three quarter bust, blowing bubbles, presented in the original gilt frame, and signed lower right H van Meegeren.
A painterly picture, the cheerfully expressive style is not so typical of the artist's work, being a rather more joyous subject than most of his paintings, displaying flagrant use of colour, rather than the usual darker nineteenth century style. This piece would have been painted towards the end of his life and the technique is very competent, with the use of light particularly well rendered to the eyes and lone bubble, the overall balance of colours pleasing, the child looking curiously somewhere between apprehension and joy, perhaps waiting to break into a smile at any moment. We know van Meegeren painted in various styles and qualities, and experts at Bonhams, Christies and Sothebys have recently confirmed the picture as an original. This picture compares in style with, most notably, two of his other works, the first ‘Mother and Child’ and the second, ‘Die Ziegenhirtin’.
To the reverse of the painting are the remains of a South African label that reads; “P?.W. H. M?. erloo kunssentrum du Toit street 272 pretoria foon 3-7549”. From this we can deduce that the picture was framed (and probably painted) at least sixty years ago because the South African phone number on the label is only five digits long. Our investigations have led us to the Pretorian Art Museum along with several other galleries in and around Pretoria and South Africa and all signs of this mysterious ‘art centre’ seem to have vanished since, with 272 du Toit St. being close to the city centre, but almost downtown today. We therefore have no reason to believe there is any significance in the South African framer's label other than the strong links between the Dutch and the Afrikaans, thus giving the picture more credibility.
Born in 1889, the tale of Han Van Meegeren, the most notorious and celebrated forger of the 20th century, is an extraordinary one. Forging paintings of some of the world's most famous artists, including Frans Hals, Pieter de Hooch, Gerard ter Borch and Johannes Vermeer, his talent for drawing and painting was discovered at a young age. By 1913 Van Meegeren established himself as a painter in The Hague, where he won many commissions for portraits and his first forgeries date to 1923, being two portraits in the style of Frans Hals. Leaving for the South of France in the company of his then wife, Van Meegeren created his most famous forgery, a version of the Men of Emmaus, attributed to Vermeer. The sale of this and other forgeries brought him millions of guilders. In 1939 Van Meegeren returned to the Netherlands and in 1943 one of his forgeries was sold to Hitler’s right hand man Hermann Goering, giving Van Meegeren the title of ‘the man who swindled Goering’. After the war investigations into the sales of Dutch cultural heritage and thus illegal trade finally found leads to Van Meegeren. Considered a traitor, Van Meegeren decided to disclose the fact that he was the creator of this and many other paintings, to escape punishment, and remarkably, to prove his point Van Meegeren painted a 'Vermeer' from his jail cell. In November 1947 he was sentenced to one year in prison but suffered a heart attack soon after hearing the verdict and died in hospital, never serving his sentence.
This original work by a revered and multi talented artist, and one with a huge cult following, represents, in some way, the vanity, gullibility, artistic skill, greed, malice, and sense of fun, which encompasses all of his work. Van Meegeren still haunts the art world to this day, and make no mistake, he was a talented artist in his own right, but not only that, he made people stop and think what they value in a picture, and just why they do so.

domain: artistic


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Here is Ek Mini Katha actor Santosh Shoban next Anni Manchi Sakunamule Title & Motion Poster Out. Nandini Reddy- after delivering biggest hit of her career with Oh Baby directing this film. under Swapna Cinema productions.
The Anni Manchi Sakunamule title and motion poster have been released. Like the title, the poster too looks charming, as it showcases the exquisiteness of a hill station. Mickey J Meyer’s background score for the motion poster is cordial.
When successful people come together, we can expect an extraordinary film and going by the title and the setup, Anni Manchi Sakunamule is going to be a wonderful movie.
Malavika Nair is the leading lady of the movie. Priyanka Dutt is bankrolling the project under Swapna Cinema, wherein cinematography is handled by Sunny Kurapati. The film features prominent actors like Vennela Kishore, Rao Ramesh, Naresh, Rajendra Prasad, Gautami etc. in important roles.
Cast: Santosh Shoban, Malavika Nair, Vennela Kishore, Rao Ramesh, Naresh, Rajendra Prasad, Gautami and others.
Director: Nandini Reddy
Producer: Priyanka Dutt
Banners: Swapna Cinema and Mitra Vinda Movies
Music: Mickey J Meyer
DOP: Sunny Kurapati
Dialogue Writer: Lakshmi Bhupala
Costume Stylist: Pallavi Singh
Screenplay Writer: Dawood
Production Designer: Shivam Rao
PRO: Vamsi Shekar
Executive Producer: Divya Vijay


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- Store Name: Lisa Gargaro Sleep Co / Visit the store page →
- Vendor: Lisa Gargaro
- Address: Limassol
Have the new moments of the arrival of your little one captured forever with an in your home photography shot.
Various styles of photos are taken.
These are available individually &/or as a collage style photo as shown in the example.
Prices start from €50. * T&C apply
Book a 1-hour photography session and choose 1 photo which you can keep from the photographs taken. All additional photos will be available for you to also purchase.
For further information please contact me directly with any questions you may have.
*T & C – two portrait photos will be included in this price & additional shots are available for selections at an individual price after also.


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Tables | Seating | Storage | Receptions | Partitions | Lamps | Complements | Accessories | Ex Stock & Deals
Pedrali | Nolita family
Designed by Mandelli Pagliarulo
Pedrali | Nolita is a family of outdoor seatings which recalls the origins of a historic course, started by Mario Pedrali in 1963 with his first metal garden chairs. Chair with low backrest, completely made of steel and designed specifically for outdoor use. Stackable. A seat cushion is also available.

domain: design


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Parks Victoria / 100 Years of ANZAC
Script writing and editing, schools messaging and media communications and management, video direction and management.
At 12.45pm on Tuesday 5 August 2014, a single shot was fired on the Mornington Peninsula at Point Nepean to mark the centenary of a remarkable and defining moment in our nation’s history – the first shot fired in anger in the British Empire at the start of World War One.
A community campaign was required to invite the regional community, key stakeholders and VIPs to this historic events. I worked with Parks Victoria and the ANZAC 100 Years committee to coordinate communications with schools, dignitaries and broadcast media.
I also researched and wrote scripts for key interpretive materials. Actor William McInnes’s voice was used for historic VO work in the Pt Nepean tunnels, and we also directed video messages from key ANAZAC and Parks staff and dignitaries
- Media coverage on all national news
- Engagement with key communities and school children
- Legacy of in-situ script voice over sharing the history
- You tube video messages

domain: history


Efest Slim K4 Charger
EFEST Slim K4 Charger Compatible with Lithium IMR 3.6V/3.7V Batteries: 10440 / 14500 / 16340 / 17340 / 18350 / 18490 / 18500 / 18650 / 26500 / 26650 / 20700 / 21700 Cost effective and easy to use, the...
Nitecore - Intellicharger D4
NNITECORE D4 - 4 BAY DIGITAL BATTERY CHARGER The Nitecore D4 Digicharger is a universal smart charger compatible with almost all cylindrical rechargeable batteries. D4 comes four independent microcomputer-controlled charging channels and capable to monitor and charge up to four...
Nitecore - Intellicharger NEW i4
Nitecore NEW i4 Battery Charger It works with almost all types of rechargeable batteries, including 1.2V, 3.7V, 4.2V, and 4.35V batteries, eliminating the need to own several chargers.Designed and built upon the successful foundation laid by its predecessor, the NEW i4...
Gyrfalcon Professional Multi-Charger
Description Gyrfalcon All-88 Professional 8 Bay Battery Charger and Gyrfalcon All-44 Professional 4 Bay Charger 186502070021700 PRODUCT HIGHLIGHTS: 8 Bay Charger - Can fit 8 size 26650 batteries at the same time Multiple charging speeds - .1A, .25A, .5A, or...
Nitecore - Digicharger D2
Digicharger D2 Features: Capable of charging 2 batteries simultaneously Each of the two battery slots monitors and charges independently Compatible with and identifies Li-ion (26650, 22650, 18650, 17670, 18490, 17500, 18350, 16340(RCR123), 14500, 10440), Ni-MH and Ni-Cd (AA, AAA, AAAA,...
Efan NC2 2-Bay Charger
Efan NC2 2-Bay Charger Specifications: NC2 Dual Bay Charger Composed of Flame Retardant Materials Integrated Display Battery Power Charging Status Can Revive Dead Batteries Automatic Cutoff at 4.2V Maximum Charge Rate 1A Charging Compatible with Li-ion Batteries Auto Current Selection...
Efest MEGA USB Charger
Efest MEGA USB Charger PRODUCT HIGHLIGHTS: 2 Bay Battery Charger Multiple charging speeds - 1.0A for cell greater than 63mm / 0.5A or cell less than 63mm Monitors and charges each slot independently Can charge a li-ion and Ni-MH...
Nitecore - Intellicharger NEW i2
Nitecore NEW i2 Battery Charger The Nitecore NEW i2, an upgraded edition of the original i2 by Nitecore, is a charger with compatibility, efficiency, and intelligence.It works with almost all types of rechargeable batteries, including 1.2V, 3.7V, 4.2V, and 4.35V batteries,...
Imren K8 Intelligent Charger
Imren K8 Intelligent Charger The K8 intelligent charger by Imren is an 8 channel charger for compatible Li-ion batteries. The intelligent charger sports a digital LCD display that relays important information on the charging status of batteries in real time. The K8...
Efest Slim K2 Charger
EFEST Slim K2 Intelligent Charger Compatible with Lithium IMR 3.6V/3.7V Batteries: 10440 / 14500 / 16340 / 17340 / 18350 / 18490 / 18500 / 18650 / 26500 / 26650 / 20700 / 21700 Lightweight, practical, and fashionable, the Efest...


Chiba (千葉市; -shi) is the capital city of Chiba prefecture, Japan. It is east-southeast of Tokyo on Tokyo Bay, and connected to Tokyo by the Sobu Line, Keiyo Line, and Keisei Chiba Line.
Chiba City is one of the Kanto region's primary seaports. Much of the city is residential, although there are many factories and warehouses along the coast.
As of 2003, the city has an estimated population of 909,497 and a density of 3,342.76 persons per km². The total area is 272.08 km².
William Gibson used a futuristic Chiba as one of the main settings for his novel Neuromancer.
The city was founded on January 1, 1921.


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Drop Zone - GOLF Podcast
48 minutes | 12 hours ago
Drop Zone is BACK
All it took was a win from Bryson DeChambeau to bring the Drop Zone back onto your podcast airwaves. We discuss the event at Bay Hill, what hanging out with Bryson is really like, what he means for golf moving forward, etc. Also, it's Players Week! The biggest event thus far in 2021 kicks off Thursday, so we look back at the last 12 months of golf in the world of Covid-19. Dylan shares a reminder of what it was like on the ground at the 2020 Players and what to expect this week at TPC Sawgrass.
32 minutes | 2 months ago
Untold stories from 2020
We research plenty of stories — but we don't get a chance to tell all of them. What did it feel like at the final tournament before the pandemic? Who changed golf's conversation the most in 2020? And what was this year like for the PGA Tour's most accurate player? On this week's episode of the Drop Zone, we dig into our notebooks to revisit several key moments from the 2020 golf season and share the details behind the stories we never got to.
32 minutes | 3 months ago
Cameron Champ knows he has power
Cameron Champ has plenty of power on the course. So much that when asked about the race for distance, he said "I'm just gonna keep my mouth shut." He also has plenty of power OFF the course. After discussing his wacky and impressive 2020 season we talked with Cameron about his recent decision to fund two scholarships at an HBCU, Prairie View A&M, in the name of his Grandpa Mack. That alone impressed us at the Drop Zone, and so did the rest of his season, so we got into a lot of it in this week's episode.
31 minutes | 3 months ago
Golf's Biggest Winners of 2020
Who were the biggest winners of the strange, unprecedented 2020 golf season? Can Bryson DeChambeau crack the list? How 'bout Patrick Reed? Adidas? There's still a month's worth of rounds to be played, but let's beat the year-end rush with a celebration of those who made the most of it. This week's Drop Zone shouts out 10 big-time winners who grabbed an unusual year by the horns.
35 minutes | 4 months ago
Masters Recap: Everything we learned at the November Masters
What a week it was at Augusta National. Dustin Johnson is your Masters Champion after a record-setting performance. We break down the entire week by sharing what we learned about DJ, Tiger, Bryson, Rory, Augusta National, Augusta the town, distance in golf, and much more.
29 minutes | 4 months ago
The Ultimate Masters Preview
To break down this week's Masters, we interviewed six different experts to hone in on every aspect of golf's biggest tournament. From Bryson DeChambeau's game plan to Tiger Woods' title defense to the CBS broadcast to the best gambling picks to a potential equipment revolution, here's what to expect at Augusta National. Featuring Luke Kerr-Dineen, Jonathan Wall, James Colgan, Michael Bamberger, Alan Shipnuck and Josh Sens. Enjoy!
55 minutes | 4 months ago
Jack Nicklaus on the Masters, Augusta National and the evolution of golf
Jack Nicklaus, 6-time Masters Champion, for nearly an hour. Need we say more? Golf's greatest champion joins us for a long conversation about all things: the Masters, Augusta National, Bryson DeChambeau, changes to the golf course, Tiger and Phil. We hit on just about everything with Jack from the comforts of his compound down in southern Florida. Come for his memories of a Jack-proofed setup and stay for his first lesson at the hallowed grounds, courtesy of Arnold Palmer.
34 minutes | 4 months ago
Daniel Berger on Growing Up in Golf's Mecca and Re-finding his Game
While many of the best golfers in the world gravitate to southern Florida, Daniel Berger was raised in the middle of it. Raised on a golf course, picking the range and taking money off pros. It's all he's ever known, and it's a big part of the reason why he's so damn good. Berger sat down with us to talk about the iron-sharpens-iron aspect of Jupiter, Florida, his resurgence in 2020 and why he'd never dream of leaving the Sunshine State.
33 minutes | 5 months ago
How Bandon Dunes revolutionized golf
Bandon Dunes began as a pie-in-the-sky brainchild of a wannabe golf course developer and a wannabe Scottish golf course architect. Together, David McLay-Kidd and Mike Keiser built a golf course — but they had no idea they were spawning a revolution in the process. Bandon expanded and Cabot Links and Sand Valley followed in its footsteps; some dozen golf courses later, Bandon's lasting legacy is as an idea: That North America can have true links golf and that reimagine the idea of a remote golf course as a bucket-list destination. New locales have followed in Bandon's footsteps, like Cabot Links in Nova Scotia and Sand Valley in Wisconsin. Dream Golf has become a movement. But it sure didn't start that way. On this week's Drop Zone, here's how one course in nowhere, Oregon turned into an entire movement — all by accident.
29 minutes | 5 months ago
Collin Morikawa on becoming a prodigy
There's nobody quite like Collin Morikawa — even on the PGA Tour, where it feels like a new 'golden child' gets crowned every few weeks. Morikawa joins the Drop Zone to fill us in on his origin story, dive into the differences between 'good' and 'great,' tell us where he's been and where he's going.
29 minutes | 5 months ago
Xander Schauffele at Home
Whether or not he remembers it, Xander Schauffele was one of the first guests we ever had on the Drop Zone. That was years ago, and we've all come a long way since then. This week, he joined us again to dish on a bunch of stuff, including: - Watching Tiger Woods win at Torrey Pines in 2008 - Growing up in San Diego - Money games with Phil Mickelson - His rise to becoming a top 10 player - How he competes with the likes of Bryson, DJ, Rory and longer players
31 minutes | 5 months ago
Bryson DeChambeau on bringing Winged Foot to its knees, changing golf and tackling Augusta National
The U.S. Open champ is back for part 2 of our discussion. This time, we talk all about his victory at Winged Foot, why his game was so good that week and what it means for courses this fall ... like Augusta National. DeChambeau also responds to the claims that he might be "breaking" golf, and offers a retort for how his changing the game is actually great for golf.
32 minutes | 5 months ago
Bryson DeChambeau on growing up different, changing golf and winning the U.S. Open (part 1)
Golf's most recent major champion joins the Drop Zone for a lengthy discussion on all things Bryson: His upbringing, his transformation, some mind-blowing practice facts, how his game is perceived and what it was like demolishing Winged Foot. This is part 1 of 2 — the second half of the Bryson DeChambeau convo will go live Wednesday morning. Subscribe to make sure it lands in your podcast library!
30 minutes | 5 months ago
Watching Bryson win the U.S. Open (and celebrate afterward)
Our very own Dylan Dethier was on site at Winged Foot, and ALSO at the after party with Bryson DeChambeau as his team as they celebrated their biggest accomplishment ... yet. We recap the U.S. Open with behind-the-scenes detail you're not going to get anywhere else.
19 minutes | 6 months ago
Winged Foot insiders dish on winning secrets
Nobody knows more about winning at Winged Foot than the iconic club's very best players, so we assembled a roundtable of club champions to help preview this week's U.S. Open. What are the keys to winning a brutal test at Winged Foot? What will the best golfers in the world shoot? What kind of U.S. Open should we expect? All that — and more! — on this week's Drop Zone.
22 minutes | 6 months ago
The best short courses in the world
Sometimes, 18 holes is too much! For anyone who has ever thought that, GOLF Magazine is in your corner this week, launching a new ranking of the best 9-hole courses in the world, a list of the top par-3 courses and the best courses under 6,000 yards. Non-traditional golf at its very best. We talk with Ran Morrissett, the man behind the ranking, right here on the Drop Zone.
14 minutes | 6 months ago
Caddying with Tiger Woods
We’ve heard plenty of players describe the unforgettable sensation of playing golf alongside Tiger Woods for the first time. But what’s it like to caddie alongside him? For one man, it was the opportunity of a lifetime — and then it got a bit complicated. On this week's Drop Zone, we take a look at the fuller story behind Tiger Woods, world-famous caddie.
20 minutes | 7 months ago
Golf in the NBA Bubble
Basketball is the no. 1 sport being played in the NBA Bubble, but sport no. 2? It's golf. Players, coaches and staff members from every team have teed it up down in Orlando, and for some of them, golf is way more than a fun hobby. It's become a way of life down in Florida. We talked to a bunch of players about just how important golf is to them within the Disney bubble.
28 minutes | 7 months ago
Inside the PGA's Wild Finish with Alan Shipnuck
Our Alan Shipnuck was on site Sunday for the rollicking conclusion to the PGA Championship, and we dive in on how one golfer separated from the pack. What did Collin Morikawa's victory feel like at TPC Harding Park? What did we learn about Tiger Woods, Brooks Koepka, Dustin Johnson and more? What was it like covering the first COVID-era major championship? Shipnuck answers those questions and more on this week's Drop Zone.
40 minutes | 7 months ago
Golf Bettors' Biggest Myths, with DataGolf
When two Canadian brothers in their 20s launched DataGolf, they didn't realize just how many questions they'd be asking — and answering in the process. What are the biggest myths among golf fans? How do you pick a winner in a sport as random as golf? Even better, how do you create a model so powerful it can give you predictions and update in real time? Here's how DataGolf became one of the smartest voices in the game. Plus, some PGA Championship picks!
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Sale - Mardi Gras Jester Headband - SaleItem: 209-963
Top Off your Mardi Gras Party with Costume Hats
The Mardi Gras headband is the perfect way to top off the Mardi Gras festivities. Dress your Mardi Gras party guests in gold, green and purple with Mardi Gras costume hats like this.
- One size fits most.
- Flexible plastic headband covered in yellow nylon.
- Gold, green and purple fleur de lis plush design.
- Quantities Limited. Order now before they're gone forever!
- Sale items are non-returnable.
Make sure your guests are gold, green and purple from head to toe with great Mardi Gras costume accessories like this. Mardi Gras costume hats, boas, masks and accessories are the way to turn any Mardi Gras party into a wild celebration. These Mardi Gras accessories are a great way to get your guests ready for the Mardi Gras party of a lifetime!

domain: entertainment


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Lizard Lick Towing will return to TLC on June 11. The show will be broadcast at 10PM EDT on Mondays.
Some critics of the show say it not a reality show, but instead is a fake reality show. They may be right, but it still shows a humorous side of repossessing vehicles and the lengths owners will go to so they can keep their vehicles from being repossessed. Former pro basketball star Charles Barkley is a fan of the show.
Ron Shirley and his wife Amy are the owners of Lizard Lick Towing and Recovery with Bobby Brantley assisting Ron in the repossessions. Ron and Bobby rarely can hook a vehicle up, without the owners knowing what is going on. Instead there is almost always a confrontation, with the owners before the vehicle is towed away.
Even Bobby Brantley has admitted some scenes are staged. If that is correct, then the show stops being realistic and instead is being manipulated by the producers, to make the viewers believe, that whatever is being shown really happened.
It is amazing how many times the lobby of the Lizard Lick Towing has been damaged by irate owners, returning to the office to pick up their vehicle. You would think that they wouldn’t bother to redecorate after the lobby has been trashed several times.
The show is a mixture of laughter and serious situations, where gunshots have been directed at Ronny before.
First show of the new season will be airing in only 11 days. Tune in June 11 to see the first show of the new season.

domain: news


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Spanish Posse, Episode 3: The Hunters and the Hunted
by Purple Hazel
This is the third installment in the thrilling Spanish Posse Wild West erotic romance serial, by author Purple Hazel.
In The Hunters and the Hunted, Caroline and Rex travel to Austin, Texas to hide out with Rex’s wealthy younger brother, Daniel, who’s been living there since right after the end of the Civil War.
Rex finally proposes to lovely Caroline; and though initially rebuffed by the hesitant young woman, she eventually agrees to marry him, pledging her undying love and affection. They are married in a beautiful, private ceremony on the front steps of Daniel’s massive Texas mansion.
Meanwhile, the despicable Carl Sunday is hot on their trail. He departs Dallas in headlong pursuit of them. Closing in, as the happy couple take their wedding vows and then pose for a family wedding photo, Carl manages to track them all the way to Daniel’s enormous cattle ranch…


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Man charged after crack cocaine and cannabis found
Main article content
A man has been charged after we found crack cocaine and cannabis in Stoke-on-Trent.
Andrew Kendall, 32, from Bradeley, is due to appear at North Staffordshire Justice Centre today (22 August) charged with being concerned in the supply of crack cocaine and possessing cannabis.
It comes after we searched an address in Stoke-on-Trent yesterday (21 August).
We've launched a major crackdown on serious and organised crime in a new operation to target those responsible and protect those who are most vulnerable – called Operation Target.
Officers from the Regional Organised Crime Unit (ROCU), which is made up of officers from Staffordshire, West Midlands, Warwickshire and West Mercia set about the crackdown on serious organised crime earlier this year.

domain: sociology


Duluth, Minn. man killed in crash at Cedar Lake Arena
Published 01/07/2013, New Richmond News
A Duluth, Minn. man was killed Friday after crashing his motorcycle at Cedar Lake Arena.Word count: 164
The full article is available to newspaper subscribers. If you are a subscriber please log in to continue reading.


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Title: Exploring the Potential of C-Met Library: Targeting C-Met in Cancer Therapy
Cancer is a complex and heterogeneous disease that often overexpresses and activates various signaling pathways. The c-Met signaling pathway is one such mechanism that plays a significant role in tumor growth, invasion, and metastasis. Targeting the c-Met pathway has emerged as a promising approach in cancer therapy. The development of C-Met libraries offers a plethora of opportunities to identify novel small molecules that can selectively modulate c-Met activity. In this blog, we will explore the significance of C-Met libraries in cancer research, discuss the key features of the c-Met pathway, and highlight their potential in developing novel therapeutic interventions.
- C-Met Pathway and Cancer:
The c-Met pathway is a critical signaling cascade that regulates cell proliferation, migration, and invasion. However, in cancer, the c-Met pathway becomes hyperactivated due to genetic mutations, amplification, or dysregulation of upstream signaling. This leads to enhanced tumor growth, resistance to therapy, and metastasis. Therefore, targeting the c-Met pathway has emerged as a promising approach to cancer treatment.
- C-Met Libraries:
C-Met libraries are collections of small molecules designed to selectively target c-Met activity or downstream signaling molecules. These libraries provide researchers with a vast resource to identify novel compounds that can effectively inhibit c-Met signaling. By blocking specific c-Met interactions, these libraries offer a potential avenue to counteract the aberrant activity of c-Met and its downstream effectors.
- Roles in Cancer Research:
C-Met libraries have revolutionized cancer research by facilitating targeted manipulation of the c-Met pathway. By selectively inhibiting c-Met activity or downstream signaling, researchers can explore the impact of blocking c-Met on cancer cell survival, resistance to treatment, and tumor progression. Furthermore, these libraries facilitate the investigation of synergistic effects with existing treatments, leading to the development of combination therapies.
- Precision Medicine Approach:
The diversity within C-Met libraries allows for personalized treatment strategies by identifying compounds that specifically target the dysregulated c-Met activity in individual patients. Through a precision medicine approach, researchers can tailor the treatment based on the specific c-Met mutations or expression levels in a given patient’s cancer. This approach may enhance treatment efficacy and minimize adverse effects.
- Overcoming Treatment Resistance:
The inhibition of the c-Met pathway holds promise in overcoming resistance mechanisms encountered in cancer therapy. By targeting the hyperactivated c-Met pathway, C-Met libraries can sensitize cancer cells to existing treatments or provide an alternative strategy for overcoming resistance mechanisms. By blocking the essential signaling cascade of c-Met, these small molecules can potentially re-sensitize cancer cells to the cytotoxic effects of chemotherapy or other targeted agents.
- Future Directions:
Continued research within C-Met libraries may lead to the discovery of more potent and specific inhibitors of c-Met and its downstream effectors, further expanding their therapeutic potential. Additionally, exploring the synergistic effects of combining c-Met inhibitors with other targeted therapies or immunotherapies may pave the way for innovative treatment regimens. The advancement of C-Met libraries promises to push the boundaries of cancer research and provide new therapeutic avenues for patients.
C-Met libraries have emerged as a critical resource in cancer research, providing a vast array of compounds to selectively target and modulate c-Met activity. By understanding and manipulating c-Met signaling, researchers can potentially develop innovative and effective therapies for cancer treatment. As research progresses, C-Met libraries hold tremendous promise for the development of personalized and effective interventions in cancer therapy, potentially overcoming treatment resistance and improving patient outcomes.

domain: medical


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How to recreate this jaw-dropping playroom at home (and on a budget!). @amytastley
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For the love of the game
At the end of a hall in this home is a 14x22-foot #playroom that includes an indoor jungle gym, rock climbing wall, rope swing and a door to the deck. #housetrends
How much fun would your kids' have with this full black chalkboard wall in a playroom? Looks super sleek and modern contrasting against the white too!
House Tour: A Colorful, Boho-Chic Cali Beach Cottage
Colorful contemporary art and energetic boys (and dogs) make this cozy Cali beach cottage vibrant. With a backyard art studio and the indoor climbable feature. it's all about fun.
Daydream Three Ways
Each sister got a different color of Daydream wallpaper for their ceiling which is just about the cutest thing ever! via HGTV Magazine. See the full house tour here!
32 Things That Belong In Your Child's Dream Room
Pottery Barn How great is this set up for your little girl. My daughter keeps telling me her kitchen needs an upgrade. (she's been listening to her father too much)
This gallery wall isn't quite finished but the wooden basketball hoop is such a fun addition to a kid's room and the pink pom poms add a fun girly twist. The pink heart chalkboard and cute little unicorn from HomeGoods add some whimsical touches to the space and the tufted daybed and desk chair can transition into a more grown up looking space as she gets older. (sponsored pin)
Kids playroom, large floral area rug, knit poufs, custom kids play house with white ladder | MaK Interiors
Lækker indretning til et børneværelse for børn fuld af krudt og energi. Hvem drømmer ikke om at have plads til sådan en væg?


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- serves 0
5 lb(s) red apples, cored and cut into chunks (Spartan, McIntosh, Cortland)
1 cup sugar
¾ cup lemon juice
1. In a saucepan, combine all ingredients. Bring to a boil, reduce the heat to medium and simmer, stirring frequently, until the apples are soft, about 25 minutes.
2. Purée the mixture in a blender. Strain.

domain: food


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Interior Fabrics at Discounted Prices near Newton Abbott
A Day Out in Churchstow
Ultimate Fabrics is the leading independent discounted interior fabric retailer in the Southwest, making it the largest supplier for Newton Abbot fabric shoppers.
We offer thousands of metres of quality designer fabrics, both on the roll and as remnant pieces suitable for curtain making, upholstery and soft furnishing projects.
Located in the South Hams business park in Churchstow, we are only a short 20 mile journey from Newton Abbot. By visiting us, you will find popular materials in a wide range of colours, patterns & designs from the most well known designers including Sanderson, Clarke & Clarke, Prestigious Textiles and Harlequin, to name but a few.
Huge Range of Designer Fabric
We display all of our stock across two floors in our retail warehouse where customers are invited to browse fabric designs, see true colours and feel textures, helping them make the most appropriate choices. With an approved list of quality curtain makers and upholsterers located near Newton Abbot, we can also help you find the right help for your projects should you need it.
Everything on sale is discounted, often by more than 50% off the RRP and sometimes by up to 75% with the majority of prices being unbeatable elsewhere in the region surrounding Newton Abbot.
We are first choice for domestic customers and also supply professional curtain makers, upholsterers, interior designers, Hotel & B&B owners, and small fabric suppliers.
You will also find in stock, cotton towels in a variety of neutral shades, cushion covers & inners and a range of bed linens, again all offered at great discounts.
The true “Fabric Experience”
Please head on down to our fabric warehouse or call for further information


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Is ACTA the best thing ever to happen to the European Union?
For decades, committed pro-European politicians and academics have wished for a number of ingredients that would be necessary for the credibility of the European institutional framework. They wanted an effective, representative and democratic European Parliament. They wanted a European Parliament that was not just theoretically an equal player in the institutional framework in Brussels, but a Parliament that was a genuine counterweight to the Council (the Member States) and the European Commission. Finally, and most difficult to create, pro-European thinkers dreamed of the possibility of pan-European political campaigns driven by pan-European political movements.
Will ACTA be the issue that allows the European Parliament to assert a new democratic maturity? The reaction of the European Parliament to the avalanche of citizens’ protests, phone calls and e-mails in opposition to ACTA has, so far, been that of an institution that is open and attentive to the needs and concerns of citizens – much more even than some national parliaments. The Socialists and Democrats Group, the Alliance of Liberals and Democrats, the Greens and the Green United Left political groups all have taken a decision to oppose ACTA. Four parliamentary committees, albeit with varying degrees of conviction, have voted against ACTA.
Will ACTA be the issue that allows the European Parliament to assert a new, truly powerful and independent voice in the EU institutional framework? The European Commission was confident that the Parliament would back down in the end on ACTA. The Parliament backed down in relation to data retention, to the cost of citizens’ rights. It backed down in relation to export of passenger data to the US authorities, to the cost of citizens’ rights. It backed down in relation to export of financial data to the US authorities, to the cost of citizens’ rights. Why would it not back down in relation to a damaging intellectual property deal? This was the logic of the powerful European Commission in relation to ACTA. But this time things may be different. This time the European Parliament might finally have become a mature institution that is capable of its own decisions, capable of not just recognising the failures of the Commission’s policy, but having the confidence to say “STOP”! This time the Parliament may just assert a powerful and independent voice, for the good of European citizens.
Will ACTA be the issue that demonstrates that the European Union is capable of sustaining and respecting a democratic, pan-European citizens’ movement? ACTA has created hope in a generation of European citizens. It has created a pan-European movement, a pan-European movement of young citizens that have found a common voice and have faith that this voice will be heard and acted on. It has created exactly what pro-European thinkers have wished for and planned for and hoped for since the very start of the European project. It has created a sense of European citizenship, with shared values and goals.
Of course, the result could still be very different. If the Parliament fails to have the courage of its convictions, if it capitulates to the European Commission and industry misinformation, if it turns its back on a whole generation, it will be undermining itself as a democratic institution, it will be undermining itself as a European institution. If it capitulates, it will do damage to the credibility of the Union that goes far beyond any perceived benefit from an Agreement that the European Commission claims changes nothing in Europe. Even worse, a half-hearted “compromise” from the EU designed to outmanoeuvre its own citizens would generate a whole new level of political cynicism.
ACTA, whether adopted or rejected, will have a long-lasting effect on Europe. Let’s hope that ACTA becomes the best thing that ever happened to the European Union.


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The lime kilns
Old lime kilns were built in the second half of the 19th century, in Rudniki, in the „Rudniki” Chemical Plants premises. They are two brick items of the shaft kind, built on the circular plan with the cylindrical vents.
They were used to produce burnt lime obtained from lime stone and the coal, at the moment the kilns are out of order.
The stone pit and the Emerald Cave with the underground lake are located in close proximity
Is accessible to public?
How far it is?
How good lightning is
Has parking space

domain: geography


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Bellevue, Boys and Girls Clubs partner on Hidden Valley Park project
The Boys and Girls Clubs of Bellevue (BGCB) and the City of Bellevue will partner on the construction of new facilities planned for Hidden Valley Park.
The project includes a 24,655 square foot community center, with three basketball courts, office space and room enough for sports like pickle ball, volleyball, badminton, even batting cages. Thirty-seven parking spaces will be added and outdoor ballfields will be converted to synthetic turf.
To make room for the construction, three buildings will need to be demolished.
If approved, the city would lease land for the gym at a rate of $1 per year, and in exchange would be able to use the facilities when not in use by the BGCB. Early estimates projected a total cost of $9.6 million, $6.8 million of which would be funded by the BGCB for the construction of the new gymnasium, fields and other site projects. The remaining $2.8 million would be funded by the city. The city will continue to own and operate Hidden Valley Park.
The BGCB had earlier investigated using Surrey Downs Park for the new gymnasium, but with Rapid Transit planned for the neighborhood, construction did not seem feasible. Another location at Bellevue Way and Northeast 20th Street, was also vetoed because the space was found to be too small.
"This park needs improvements, and by partnering with the city [on something] the city couldn't do alone…It's an exciting venture," said Kathy Haggart, President and CEO of the BGCB.
If the project proceeds as planned, Haggart expects construction to be complete by the end of 2014.
"There is a shortage of gyms and fields [in Bellevue]," she added. "This will allow us to serve that many more kids. We're always competing for fields and gyms, and this will be a huge impact on what we can provide."
Three outreach meetings have already been conducted, but the public will have yet another opportunity to voice their opinion at a hearing scheduled for 7 p.m. Jan. 9 at Bellevue City Hall, 450 110th Ave. NE.


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Medicare is a complex health insurance program. This suite of courses from VTR Learning builds a solid foundation for professionals who deal with Medicare issues in the workplace.
This introductory course teaches learners the basics of Medicare Parts A, B and C, as well as other options such as Medigap coverage. It is pre-approved for SHRM, HRCI and NASBA credit. The course also includes supplemental fact sheets that are downloadable to most devices.
Medicare is health insurance for people age 65 or older. Some people who are younger can also qualify if they receive disability benefits from the Social Security Administration or Railroad Retirement Board and have been receiving them for 24 months, have End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant), or have Amyotrophic Lateral Sclerosis (ALS).
There are four parts of Medicare: Part A, Part B, Part C and Part D. These cover hospital care, doctor visits, prescriptions and more. Medicare Advantage plans offer additional coverage options, like vision and hearing aids. There are also special programs that help pay the cost of premiums and co-pays for those who need it. Not only that, it’s imperative that you know the existence of the CA Medigap birthday rule.
To qualify for Medicare, a person must be 65 or older and have paid into the system through payroll taxes for a certain amount of time. For most, this means paying into Medicare for at least 10 years. However, some people can also get Medicare if they:
Once someone meets the above criteria, they can sign up during their Initial Enrollment Period for Parts A and B. The IEP is the three months before, the month of and the three months after a person turns 65. People can also enroll during a Special Enrollment Period (SEP) for Parts B and C. If they were covered by a group health plan during that time, the SEP begins the month their employment ends or their current employer’s group health plan coverage ends, whichever comes first. They can also enroll during the Annual Election Period from October 15 to December 7 for coverage that starts on January 1 of the following year. This is a good opportunity to compare Medicare Advantage and Supplement plans that best fit their needs. eHealth provides comprehensive, accurate and up-to-date information about Medicare coverage. Our content is compliant with CMS regulations, ensuring you’re getting the right information to make the best Medicare decisions for your lifestyle and budget. Learn more about our Medicare Compliance Program. We’re here to help you navigate the complex world of Medicare.
Medicare Options & Coverage Rules
There are many different Medicare options, including Medicare Advantage plans (private insurance alternatives to Original Medicare), and Medigap supplemental insurance policies that pay for costs not covered by Medicare Parts A and B. Generally, you must be enrolled in both parts of Original Medicare to enroll in either of these options. You can enroll during your seven-month Initial Coverage Election Period, which starts three months before you turn 65, includes the month of your birthday and continues for three months afterward. You can also sign up during the General Enrollment Period, which occurs from January through March each year.
During this enrollment period, you can choose your Medicare Advantage or Medigap plan for the following year. If you don’t choose a plan during this time, you can still enroll in a new Medicare Advantage or Medigap plan during the Annual Enrollment Period, which happens each fall from October 15 to December 7.
You can also use an exception to the General Enrollment Period to get Medicare, if you have a special circumstance. This can include if you’re an active member of the military or Foreign Service employee, an individual with certain health conditions, or if your employer or union has group Medicare coverage. Individuals whose Medicaid eligibility terminated because of an incarceration may also enroll during this time. They can choose a coverage start date up to six months earlier than their release date from jail or prison and will be responsible for paying all prior premiums.
In addition to deciding what type of Medicare you want, you will need to decide how it interacts with any other health insurance that you have or will have. You can find a lot of information on this online, and it’s important to understand how your choices will affect each other.
Typically, you will need to have minimum essential health coverage in order to avoid penalty fees from the federal government for not having it. You can find more information on what counts as this coverage, as well as how it interacts with Medicare, on our Medicare & Other Coverage page.
Medicare: Appeals & Penalties
Depending on the situation, you may be able to appeal Medicare’s decision to deny coverage or add costs. There are five levels of Medicare appeals. It’s important to keep records and documentation as you move through the process, and to follow any instructions or deadlines that you receive.
There are several reasons that you might want to file an appeal, including:
You’re being discharged from a hospital sooner than you think is medically appropriate. You’re being denied a service you think you need, such as an MRI. You’re being charged a late enrollment penalty for Part D that you think is inaccurate. You have a Medicare Advantage plan and you think that your insurer is wrong about the cost of a service or item that you’ve received from another provider.
If you don’t agree with the decision at level 1 of the appeals process, you can move on to level 2. At this point, you’ll request a reconsideration hearing with an ALJ, or administrative law judge. You’ll submit new documentation to support your case and provide more information that you didn’t include in your original appeal.
In some cases, your doctor’s billing privileges may be revoked by CMS if they don’t meet certain requirements. If you have Medicare Advantage, your plan may be able to take on the responsibility for paying your claims, but if you have traditional Medicare, you can’t.
The next step in the appeals process is to request a review of the ALJ’s decision at level 3. At this stage, you can ask for a hearing with the Departmental Appeals Board (DAB). At this level, you can also seek judicial review, which means filing a civil lawsuit in federal court.
In some situations, you may be able to appeal a decision that’s been made by CMS or your Medicare Advantage plan. For example, you can use a Medicare appeals form to file an appeal if you’ve been charged a late enrollment penalty because you didn’t enroll in a Part D prescription drug plan during your initial enrollment period. This form is available here.
Medicare: Other Insurance and Assistance Programs
Medicare plays a vital role in the health and financial security of 60 million Americans. It pays for many basic health services, such as hospital stays, physician services and prescription drugs. However, it doesn’t cover everything. That’s why millions of people choose to enroll in private Medicare Advantage plans, also known as Part C, which offer an array of health plan options including HMOs and PPOs, or buy Medigap supplemental insurance policies.
The Centers for Medicare & Medicaid Services (CMS) administers Medicare, which is funded in part by Social Security and Medicare payroll taxes and part through premiums paid by those enrolled. Medicare is free for most people ages 65 and older, or under age 65 with certain disabilities or end-stage renal disease that requires dialysis or a kidney transplant. It’s a federal program, and the individual states provide assistance with the cost of the Medicare Part A premiums and co-payments for some beneficiaries.
People who are newly eligible for Medicare receive a General Enrollment Period between January 1 and March 31 of the year they turn 65. They can choose either Premium Part A or Medicare Advantage. If they choose Medicare Advantage, the plan they join must limit their out-of-pocket spending in certain ways, but they can still enroll in a stand-alone Part D plan.
In addition, some Medicare beneficiaries may qualify for help paying their premiums and out-of-pocket costs through the Medicaid program administered by each state. Some beneficiaries with limited income and resources can even get both Medicare and Medicaid benefits.
Unlike Original Medicare, which includes both parts A and B, some private Medicare Advantage plans are required to limit the amount of money beneficiaries pay out-of-pocket for medically necessary services, such as doctor visits or hospital stays. Medicare Advantage plans can also cover a wider variety of services, including dental and vision care.
In 2019, there are a growing number of proposals calling for “Medicare for All,” or universal health coverage that would replace private Medicare with a single government-funded program. While there are many variations on the proposal, all versions call for nearly all American citizens to have access to basic health coverage.


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Richard Reeves is a writer, commentator and speaker. His latest book is John Stuart Mill â€“ Victorian Firebrand, an intellectual biography of the British liberal philosopher and politician. Richardâ€™s other principal areas of current interest are the economics and politics of wellbeing; trends in British politics; and the future of the workplace.
Richard is an essayist for the New Statesman magazine and editor-at-large and columnist for Management Today, for which he writes a monthly column. He is also a regular contributor to The Guardian, Observer and Prospect magazine as well as a range of national radio and television programmes. In 2005, he was a presenter of the four-part BBC2 series, Making Slough Happy.
Published to commemorate the 50th anniversary of John F. Kennedy's election as 35th President of the United States, this book tells the story of the thousand days that Kennedy served as captured by the lens his official White House photographer, Cecil Stoughton, and in the words of bestselling author Richard Reeves. A captain in the United States Army Signal Corps, Stoughton was assigned to photograph Kennedy's inauguration. Kennedy was pleased with the images and requested that Stoughton be made his official photographer. Over the 34 months Kennedy was in office, Stoughton, JFK, and Jackie developed a close rapport, working together to carefully construct the image of the presidency and the first family they wanted to project to the world. Stoughton was given unequaled access to the family both at official functions and private moments, in the White House, and on the family's boat in Hyannisport or at holidays. Together the photographs reveal the behind-the-scenes story of the president, the presidential family, and the careful construction of Camelot. Acclaimed author Richard Reeves provides an introduction to the photographs and captions that provide history and context for the images. He tells not only the story of JFK's presidency but also probes the close collaboration that resulted in images that captivated a nation. Harvey Sawler, who interviewed Stoughton extensively before his death in 2008, contributes a biographical piece on the photographer. The book will also include a DVD of rarely seen and intimate film footage of the first family.
The power and status of the press in America reached new heights after spectacular reporting triumphs in the segregated South, in Vietnam, and in Washington during the Watergate years. Then new technologies created instantaneous global reporting which left the government unable to control the flow of information ot the nation. The press thus became a formidable rival in critical struggles to control what the people know and when they know it. But that was, according to Richard Reeves, more power than the press could handle - and journalism crashed towards new lows in public esteem and public purpose. The dazzling new technologies, profit-driven owners, and celebrated editors, reporters, and broadcasters made it possible to bypass older values and standards of journalism. Journalists revelled in lusty pursuit after the power of politics, the profits of entertainment and trespass into privacy. Richard Reeves was there at the rise and the fall, beginning as a small-town editor, becoming the chief political correspondent of the New York Times , and then a best-selling author and award-winning documentary film-maker. From the Pony Express to the Internet, Reeves chronicles what happened to the press as America accelerated into uncertainty, arguing that to survive, the press must go back to doing what it was hired to do a long time ago - stand as outsiders watching government and politics on behalf of a free people busy with their own affairs.

domain: library


Swipe the Navigation Bar to Switch Tabs in Chrome
Android (5.0+): In Lollipop, Google introduced a new style of tab management that treats individual Chrome tabs as separate apps. If you have on-screen buttons, you can switch between the corresponding tabs by swiping your finger across the navigation bar.
As Android Police shows above, Chrome creates “sibling tabs” when browsing, which are grouped in a task switch menu. You can switch between these tabs by pressing the Back or Multitasking button on the on-screen navigation bar and swiping to the other side. It’s a bit unintuitive and only works on those sibling tabs (so you can’t go back to old tabs or other apps), but it’s a nice quick way to move between tabs in the same browsing session.


Optimism about peace between Israel and the Palestinians has always been a matter of religious faith rather than rational analysis. Every new proof that the process begun in 1993 with the Oslo Accords was based on false premises must be dismissed or ignored simply because believers in peace insist it is possible and because they wish it be so. While the Atlantic’s Jeffrey Goldberg has not generally been among the most dogged optimists about peace, he was still willing to co-author a 2,200-word essay with Hussein Ibish of the American Task Force on Palestine published on today’s New York Times op-ed page that argues that despite the evidence of our lying eyes, there is still plenty of room for belief that the process can be revived.
Their thesis rests on the idea that changes in the political cultures of both Israel and the Palestinians make progress inevitable. It is true that there is an overwhelming consensus within Israel in favor of a two-state solution and that even the supposedly intransigent right-wing government of the country has made it clear it is ready to accept a Palestinian state. It is also true that the Palestinian Authority under the leadership of Mahmoud Abbas and Salam Fayyad has made great strides toward making the territories a better place for its inhabitants, though Goldberg and Ibish overestimate the PA’s abandonment of anti-Semitic incitement and the language of delegitimization of Israel. The PA has also created a security apparatus that has been allowed greater scope by the Israelis, and Abbas and Fayyad understand it is in their interest to clamp down on terrorism.
These are factors that theoretically ought to allow the two sides to come to an agreement and finally make peace. But that hasn’t happened. The reason is that the less-hopeful developments of the past few years are still far more important in determining whether the conflict can be brought to an end.
The chief of these is the power of Hamas. Optimists like Goldberg acknowledge the fact that Gaza is a Hamas state and that no peace can be signed without its agreement. Unacknowledged in the Goldberg-Ibish piece is the fact that Abbas’s hold on the West Bank rests not on his legitimacy or the strength of his forces but on Israel’s unwillingness to allow it to fall into the hands of Hamas, as happened in Gaza in 2006. After all, Netanyahu’s predecessor Ehud Olmert offered Abbas a state in the West Bank, Gaza, and a share of Jerusalem in 2008 and was turned down flat. President Obama’s foolish insistence on an Israeli settlement freeze even in those areas (as the recently released Al Jazeera documents show) the PA had already agreed would stay in Israeli hands has made it impossible for those talks to be renewed. But even if Abbas were to return to the table, he would be faced with the same dilemma he had before. Were he to accept the legitimacy of a Jewish state, no matter where its borders were drawn, he would face the wrath of his own people (as the reaction from the released documents proves), and even Israel’s support might not be enough to keep him in power, or alive.
Goldberg and Ibish conclude their lengthy article by calling for both Netanyahu and Abbas to visit the other side and acknowledge their antagonists’ respective rights and pain much in the way that Anwar Sadat and King Hussein of Jordan once did. But they forget that the original Oslo Accords were just such an acknowledgment, and that while Israelis swooned over such gestures (even though Yasir Arafat’s credibility was very much doubtful), Palestinians merely took Israel’s willingness to make concessions as a sign of weakness and lack of faith in the rightness of their cause. Moreover, Abbas doesn’t dare do more. In a region where both Israel and the PA are faced with the growing influence of Iran and its allies Hezbollah (which is moving toward control of Lebanon) and Hamas, the tide of extremism is more than a match for Fayyad’s pragmatism. Under such circumstances, optimism about peace requires the sort of tunnel vision that comes only with blind faith.


What you need to know:
- A forensic analysis of 400 videos shows, among others, that shooters of people on Kampala Road spotted military and field force police uniforms and rode on the back of 999 police patrol vehicle, registration UP 5564
Some of the armed men who shot at and killed alleged rioters on Kampala’s streets last November drove in police patrol pick-up and other state vehicles and brandished AK-47 assault rifles, according to new evidence.
A BBC Africa Eye investigation titled, Three Killings in Kampala, which airs this morning, reveals that the men who allegedly targeted and shot civilians dead on Kampala Road, wore military police and field force police uniforms.
They were captured in multiple videos analysed by the British public broadcaster to have sat on the left back-side of a patrol police pickup, registration UP5564, and emblazoned with number 17 on the sides.
The videos shot by well-wishers from different directions and angles show the patrol car speeding from Bombo Road side, with security personnel on its back shooting indiscriminately as city dwellers scampered for safety.
Among them was Kamuyat Nangobi, 28, a waitress and mother of four. Dressed in a black top and red skirt, a bullet caught her on the back of her head as she sprinted to deliver food to her grandfather, Mr Muslim Musimami, based at E-Towers on Kampala Road.
She fell face-down and the plates she was carrying crushed on the hot bitumen surface and her mobile phone handset fell close to her frontally outstretched arm.
Kamuyat became a poster-child of the November bloodletting, which the state says in total claimed 54 lives over two days, when a picture of her body lying in a pool of blood by the roadside widely circulated on social media on day one of the madness.
The riots were ignited by the arrest of then National Unity Platform (NUP) presidential candidate Robert Kyagulanyi, alias Bobi Wine, while on a campaign trail in eastern Uganda.
The BBC Africa Eye carried out forensic analysis of 400 videos shot on mobile phone handsets and spoke to 30 witnesses who, the broadcaster, reported corroborated accounts that some of the victims were killed in cold-blood.
A leaked copy of the government’s investigations report on the killings, which it produced and exclusively circulated to western donor countries, and whose findings this newspaper partially published a fortnight ago, showed only 13 of the 54 victims had anything to do with the violent protests.
The government told BBC Africa Eye investigators that the inquiry into the killings was complete and that findings had been submitted to Parliament.
In the aftermath of the admission, Uganda Law Society as well as human rights defenders categorised the lives lost last November as acts of “extra-judicial killings” and demanded the government name and prosecute the perpetrators.
The government is yet to publicly identify the shooters, if it ever will, and both the army and police continue to point at each other for answers on accountability over the killings amid claims investigations into the matter are ongoing even after CID Director Grace Akullo signed off the report of the official inquiries way back in December.
The videos analysed by BBC Eye suggest that the person who shot Kamuyat was one of four armed men seated on the left side of the police pickup truck. That crew was linked to the shooting of seven other people within the shot stretch from E-Tower to the turn off Kampala Road to CPS.
The images show that two people were shot at Little Bee Restaurant, but they survived after Uganda Red Cross and other volunteers evacuated them into an ambulance and onwards to Mulago National Referral Hospital.
John Amera, 31, a father of two who worked at a phone shop near Shell Capital, was fatally shot in the chest as he hid in a shop.
23-year-old Abbas Kalule, an electronics shop attendant across the street from Amera, was shot in the upper left leg and reportedly died at hospital after four days.
Septuagenarian and former academic John Kittobbe, who was reportedly in the city centre to exchange money, was shot in the neck at the door of Mabirizi Complex facing Kampala Road.
Another passer-by took a bullet on the lower back at the eastern entrance to Mabirizi Complex, suggesting he was shot at after the police patrol pick-up turned to head to CPS.
According to the BBC Africa Eye investigation, the videos show no link between the people shot and the riots, suggesting that they were killed in cold blood.
Similar drive-by shootings happened about 7 kilometres away, in Banda, on the Jinja highway.
According to videos analysed by the BBC, the shooters were driving at a high speed in government vehicles including a Prado.
Shakira Nyemera, who had a two-weeks-old baby at the time, and her neighbour Shamim Nabirye, pregnant with triplets were shot at by the roadside, but survived.
Ms Nyemera who was returning from a shop had joined other onlookers when a bullet hit her and Ms Nabirye, who was standing close to her.
Ms Nyemera said her wounds appear to have healed from the outside, but she still feels pangs inside her body.
The third shooting incident happened at Cornerstone Plaza, near Usafi Taxi Park. Arnold Ssegawa, a 15-year-old student of Lubiri High School (Buloba Campus), was shot in the mouth by soldiers, whom witnesses said targeted civilians as a game.
These security forces were reportedly on a military pick-up they had descended from Mengo, the hill on the western side of Kampala Central Business District.
His mother, Hajjarah Nakitto, is the only one of the various families who lost their loved ones, who is pursuing justice in the courts of law.
“They were aiming directly at the people and shooting at them. It was the military that killed my son. The car drove off, still shooting. They have killed innocent people like my child, and I am here suffering,” she says in the video.
Daily Monitor published the first substantive account of the November killings witnesses and the circumstances in an incisive series titled: November riots: The lives we lost.
The BBC Africa Eye Investigation, which came four months after this newspaper’s ground breaking investigations, builds on the findings and sheds new light in attempting to pinpoint the actual killers.


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The film nagar is buzz that talks have reached the final version for remaking the hit film ‘Rangasthalam’ in Tamil. It is evident that Ram Charan and Sukumar have collaborated for the film ‘Rangasthalam’. The film did great business at the Box Office and gave good identity to Ram Charan as an actor among South Indian stars and Sukumar’s work is even appreciated in this film in this village period drama.
Now the latest update about this iconic film getting remade in Tamil is sulking the mega fans! Director-Choreographer Raghava Lawrence is acting as the lead in this Tamil remake which the mega fans feel as a bad choice and Nikki Galrani reprising Samantha’s role is far worst and thus the mega fans are totally worried!
All the mega fans want the film to be dubbed in other Indian languages so that Ram Charan gets a good identity nationwide rather than these cheap remake plans is what they say!
Ram Charan who is busy with RRR would be idle for quite some time and thus is banking big on RRR and is said to be focusing on his future projects as well in this break time.


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Mercedes-Benz GLA45 AMG: interior and red stripe design
The Mercedes-Benz GLA is a subcompact luxury crossover SUV manufactured and marketed by Mercedes-Benz over two generations. It is essentially the SUV equivalent of the A-Class, and the smallest SUV marketed by the brand. The production version was revealed in August 2013 ahead of the 2013 Frankfurt Auto Show in September 2013.
The GLA is powered by a range of petrol and diesel 4-cylinder engines, and comes in either front-wheel drive or all-wheel drive, the latter marketed by Mercedes as 4Matic.
The GLA nameplate aligns with Mercedes SUV nomenclature, where GL stands for Geländewagen (German for off-road vehicle) and the A designates its overall place in the Mercedes range, in this class, the smallest or A-Class.
Concept GLA 45 AMG (2013)
The Concept GLA 45 AMG concept car was unveiled at the 2013 Los Angeles Auto Show, as a high-performance version of the GLA with an AMG 2.0-litre four-cylinder twin-scroll turbocharged petrol engine rated 360 PS (265 kW; 355 hp) and 450 N⋅m (332 lbf⋅ft), 4Matic all wheel drive, AMG Speedshift DCT 7-speed transmission with paddle shifters, and fitted with various AMG-badged accoutrements and an AMG sports exhaust system with an electronically controlled variable vane system to modulate the exhaust note.


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Dreaming Up an Active Retirement
When you retire, how will you treat your next chapter?
Have A Question About This Topic?
Understanding how capital gains are taxed may help you refine your investment strategies.
When your child has income, there’s a good chance that he or she will need to report it and pay taxes.
65 or older? It may be time to enroll in Medicare. Read to learn if you’re eligible.

domain: economics


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About the property
- House1200 sqft
- Half Baths0
- Minimum Stay2 - 4 nights
2 Bedroom, 2 Bath, Cozy And Clean And Close To Everything
Salida STR 0288 STX-ID-03505718-0001 Comfortable and convenient, Dunwell Cottage is a darling house in the heart of Salida. Walk out the door to Riverside Park and downtown cafes, galleries and shops. Feel right at home in this well-appointed cottage. It's a wonderful way to experience downtown Salida!
This home offers:
~A mix of original charm and sophisticated remodeling with brand new kitchen and baths.
~A bright interior with comfortable furnishings.
~Two comfy bedrooms; both with queen sized beds.
~Sleeper sofa in the living room allows for a total of 6 guests.
~The all-natural snow at Monarch Mountain ski area is 25 minutes away, or bike the first class trails on Tenderfoot Mountain - just blocks away. The best of Colorado's seasons surrounds you!
This home is "vacation ready" with a fully appointed kitchen, towels and linens. Hand, dish and shower soaps are provided as well as TP, trash bags and coffee filters. Bring your own laundry detergent, napkins and toiletries.
Manager provides live in-home guest support from 8:30am-10pm and Accidental Damage Protection coverage up to $1500 per reservation for accidental damage to the property.
~Max of two pets at $15 per pet per night; acceptance of the terms of the Pet Policy is required.
~Discover, Visa or MC accepted for payments.
~Acceptance of the terms of the Rental Agreement and all Rental Policies is required at the time of reservation.
~Cleaning Fee is $85.
*Send us an email if you have questions, we would be happy to hear from you!
**This home is rented for personal vacation use only, any other use including large gatherings or parties is not allowed. Renters must abide by all rental terms and policies, as well as all local applicable property covenants, restrictions, regulations and laws. Any evidence of smoking, use of firearms, driving ATV's other than in the driveway as access only, unapproved over-occupancy or pets, unauthorized use of property grounds, damage resulting from violation of rental policies, and/or excessive mess may result in charges up to $1000.00 to the Guest's credit card on file, as authorized by Guest's approval of the terms of the Rental Agreement. Reservations may be cancelled more than 30 days prior to check-in with full refund minus a $125 cancellation fee. No refunds will be issued after this cut-off date for any reason. No refunds will be issued due to weather conditions.**
Salida STR #0288
What our guests have to say about Dunwell Cottage:
"Thanks so much for sharing your wonderful cottage. It is so perfectly restored. We had a great time!" O'Malea Family
"Thank you for letting us stay here. It was perfect for our family. We had never experienced downtown Salida & found it to be a delight. We love this area & will definitely be back, maybe in the Summer!" Farmer Family
"Perfect Cottage! Thank you- we love the location and it is very cozy!" Fitgerald Family
Pinon Vacation Rentals
- Response rate:
- Response time:
- within one hour
- Calendar last updated:
- Apr 22, 2018
Why Pinon Vacation Rentals chose Salida
This house is old, or it used to be... We have a picture of of Salida 1888 and it's not there, but it shows up in one dated 1892. It was lived in for 80 years by one of the local families. When we bought it we hoped a coat of paint would put it right, however, we ended up tearing the whole back half off! A long year later it was all put back together and is now a thoroughly enjoyable and cute house. With all that updating it is to all intents and purposes a newly built home. In fact it's where Mom and Dad Tanner stay when they come from England to visit us every year, and I always wonder if they will be able to go back. The reason we bought the place was it's location. It is in the perfect spot. Close enough to walk down to F street where everything is happening, right next to Riverside park and the Arkansas river. The house is easy to find, easy to leave your car and take a walk, easy to hunker down and have some fun with friends. It's really a great place.
Sports & Adventure Activities
Dunwell Done Well!
Perfect little house for a family wishing to enjoy Salida. Easy walk to downtown and convenient drive to all else. Would rent again.
Right next to park.
Sweet house, great location
We could tell that the home had been recently remodeled and is extremely well done! Large kitchen, everything that you could need to cook up a feast. Great location, easy walking distance to everything downtown. Nice living room, dining room, 2 nice sized bedrooms, and patio in the back with a BBQ, spotlessly clean. We really enjoyed our stay in Salida!
This a great rental. The home is very very clean, great location and a very comfortable stay. We will return for sure.
My only complaint and this may be the case with all VRBO rentals is after I made my reservation I received TEN emails which was annoying.
Fantastic Location and property
Everything we needed at our fingertips both inside the house as well as being SO close to everything downtown. We could get to the park area to walk the dog in less than 1 minute! Downtown shopping was also within a couple minutes.
The house was very clean and cozy. It has recently been redone to make it current. The bedrooms were nice sized and the beds comfortable.
It really was the perfect way to spend our Thanksgiving break in the coolest town.
Clean and spacious cottage
We really enjoyed ourselves at Dunwell Cottage over the weekend. The cottage is very well kept and supplied. It also is so much more spacious than we expected. The location to downtown and numerous restaurants, bars, art galleries and sporting activities is great. We will definately be back. Thanks.
Located in Salida, in the heart of the Rockies. There are gorgeous mountain views from anywhere in the city. The house is located a few hundred feet from the Arkansas river, and just across the street from Riverside Park which host lots of festivities throughout the year. Hiking or Mnt. Biking can start right at the door step. Park the car and walk to the downtown area where all the bars and restaurants and shops are located. Close to the night life, but quiet at the same time.
Additional information about rental rates
$165-$185 per night
$165-$185 per night
Cleaning Fee $85
Pet Fee $15/night per pet
Local Sales and Lodging taxes apply
Full Payment Due 30 Days before your stay

domain: travel


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Embroidery mounted directly over a vinyl record sleeve.
12x12x2 inches, framed in acrylic.
Edition of 8, plus one artist's proof.
Hands down this has been the hardest piece in the series so far. This is the Talking Heads' second album released in 1978 and contained the hit “Take me to the River.” The art for the album consists of a stylized painting of the band members that is then cut into about 500 little squares and placed back together. I digitized each of the squares using very small embroidery stitches and over 50 colors of thread. Each square was then cut out individually and mounted to the album. This may not sound that difficult but it truly was a process that took at least triple the amount of time a regular album would take. Keeping the pieces organized and placing them perfectly was a long process. The finished piece was amazing once it was complete, the individual tiles truly give the piece a unique look and style.


Surbhi Dewan was a film student at Rochester Institute of Technology, New York, when she met Mara Ahmed, who was taking a part-time course at the university, in 2008. They had what most South Asian students would have in common, the Partition. “Both our families came from the other side of the border,” says Dewan. Her family is from Lyallpur (now Faisalabad); they moved to New Delhi in 1947.
Ahmed’s mother’s family is from Haryana and they immigrated to Pakistan after Partition. “We both grew up with the same legacy of loss and displacement, yet our perspectives were slightly different. We felt that we were meant to make a film together, one that is shot on both sides of the border,” says Ahmed, the director of the film; Dewan is the co-producer.
This is how Partition Stories was conceptualised. Meant to be an intimate take on the effect of the Partition, they were clear that they wanted to make a personal film. This sentiment is palpable within the first 30 seconds of the trailer. We see Ahmed’s mother flipping through an old photo album filled with portrait shots of her friends.
“We were studying at Government College in Lahore during its centenary celebrations. Many people came from India, including actors, bureaucrats and generals. In their speeches, they spoke of how Lahore is like Paris to them. They loved the city so much,” says Ahmed’s mother, teary-eyed.
Apart from family stories about the journeys, Ahmed and Dewan were interested in their lives before the Partition. “Hindus and Muslims were part of the same community. In fact, a grand-aunt of mine told me that when she was growing up, she had so many Muslim friends in her school, she started calling her mother ammi. She continued to call her ammi for the rest of her life. There was a cultural exchange, and it was all very organic,” says Dewan.
By 2011, the duo were done with interviews in Lahore, Delhi and Rochester. They interspersed the narrative with dream-like illustrations by fellow student, Moscow-based artist and animator, Gayane Bagdasaryan. “Rather than use archival footage and black-and-white photographs which preserve the story of Partition as a monochromatic historical episode, we chose to use artwork, poetry and music to recreate a bygone era with the lush colours of the present. Dream-like visual sequences and stream of consciousness are important stylistic elements of the film,” says Ahmed.
Partition Stories also includes words by British poet John Siddique and Pakistani writer Uzma Aslam Khan, music by Brooklyn-based folk musician Sunny Zaman and piano performances by Ruth Demaree Peck, all of whom have some connection with India or Pakistan. “It will also include the vivid paintings of Pakistani artist and humanitarian Jimmy Engineer, famous for his Partition series,” she says.
Dewan and Ahmed put up a campaign of the film on the crowdfunding platform, Indiegogo, to raise money for the edit. In six weeks, their page was visited by 3,000 people from almost 40 countries, and celebrities like Nandita Das tweeted about, and contributed to, the film.
Partition historian Vazira Zamindar consented to be interviewed and Urvashi Butalia, who has written The Other Side of Silence: Voices From the Partition of India, agreed to let Ahmed quote her work in the documentary. They are currently working on a rough cut of the film, and are looking to release it early next year.


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oreide Law Group is Investigating Claims of Investors Who Were Recommended Windstream Holdings, Inc. Bonds or Stock By Their Investment Advisors
Windstream Bond victims call 888-760-6552 to start the recovery process now.
Windstream Holdings, Inc. has filed for bankruptcy because a court ruled it violated its bond covenants. Windstream Bonds that were 6.375% senior notes maturing in 2023 were put into default. The CEO of Windstream, Tony Thomas, said it was a “necessary step” to file voluntarily to address the impact on consumers and businesses. It will renegotiate its debt with creditors and does not anticipate any material impact to its operations.
The reorganization plan put forth in court April 1st says it will attempt to reduce the company’s debt and try to emerge from restructuring quickly. The initial chapter 11 reorganization filing was with the southern District of New York on Feb 25, 2019 and the business operated as normal since.
This leaves a significant impact on bond and equity holders. Bond and equity holders were sold the Windstream securities by stock brokers touting high yield and safety. However, this proved not to be the case and some brokers may have overconcentrated investors in these and other risky investments. Some of the related bond CUSIP numbers for Windstream Holdings, Inc. Bonds are:
97382A101 97382A909 97382AOLD 97382A951 97382A950 97382A959 097382A10 97382A900 97381W104 097382A20 97382A309 97382A901
Windstream as of May 8th is attempting to exit bankruptcy and Judge Robert Drain has approved an equity backstop agreement that could help it exit. Low ranking creditors apposed this recent deal and say related rights offerings isn’t necessary. The underlying stock of Windstream Holdings, Inc. is symbol WINMQ and has fallen from about $75 per share to $.16 which has obviously hurt investors badly. Many brokers failed to limit losses in the decline and do their fiduciary duty to their clients by advising them to hold the entire way down.
If you or a loved one were sold Windstream bonds or related stock (symbol WINMQ) please call Soreide Law Group today to speak to an attorney to discuss your possible recovery 1-888-760-6552. Soreide Law Group files claims against brokerage firms nationwide through the FINRA forum. There is no fee unless we are successful in recovering your investment losses. Soreide Law handles claims nationwide and is available to meet with clients via zoom or phone conference anywhere in the world. If you feel that Windstream was not an appropriate recommendation from your financial advisor call us today to discuss your legal rights to recover.


text:
Rustoleum American Accents Antique Gold Kit
Rustoleum American Accents Anqique Gold Kit
Rust-Oleum American Accents Decorative finishes capture the look of antiqued metal finishes in convenient, all-inclusive two-part kits. Kit includes base coat, top coat, sanding pad, gloves, paint brush, and idea book.
-Two part easy to use kit
-Use on Wood, metal, masonry and unglazed ceramic
-Indoor and Outdoor usage
Orders containing this item MUST go via UPS ground
They CANNOT go via first class mail
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domain: hobby


text:
Stormzy has asked that diversity is not used as a "buzzword" or "a box to tick" while accepting an award acknowledging his work to improve diversity in music.
The British rapper has been honoured with the diversity champion award by the Association of Independent Music (AIM) Awards, which took place in London on Wednesday.
Speaking in a pre-recorded acceptance speech, Stormzy said: "I encourage everyone in the room today to not just use diversity as a buzzword, but for you lot, whatever position you’re in, whatever role you play, to really be a driving factor for it and not just see it as a quota or as a box to tick.
"Really see the worth and the value in being diverse. Thank you to the AIM Awards and God be the glory."
The 29-year-old grime artist has used his platform to try to level the playing field in the music industry and beyond through his charity #Merky Foundation and #Merky Books, a collaboration with publisher Penguin Random House.
Elsewhere on the night, fellow grime artist and rapper Lethal Bizzle scooped the outstanding contribution to music award and also performed during the ceremony at London’s Roundhouse.
Increasingly popular indie rock duo Wet Leg – compromising of Rhian Teasdale and Hester Chambers – were awarded the gong for UK independent breakthrough, while Nova Twins – made up of Amy Love and Georgia South – secured the award for best independent track for Antagonist after a similar upward trajectory in 2022.
The Libertines received special recognition for their highly successful career and influence on guitar music – and the band’s record label Rough Trade Records was also recognised, receiving the award for best independent label.
British singer-songwriter Cleo Sol took home best independent album for her second studio album Mother, and Nilufer Yanya won the award for best second album for her release Painless.
The 2022 AIM awards also saw the introduction of two new categories, best independent EP/mixtape and music entrepreneur of the year, with Scottish producer TAAHLIAH's Angelica and Corey Johnson winning respectively.
Johnson was recognised for his work founding The Digital Holdings studio to create a safe space in the UK rap scene.
Nia Archives was named this year’s one to watch, which has previously been won by the likes of Arlo Parks and British rapper Enny.
American rapper and songwriter Blxst was awarded the international breakthrough award after the success of his recent debut album Before You Go and his appearance on Kendrick Lamar’s latest album Mr Morale & the Big Steppers.
With over 29,000 votes cast by fans across the category, Japanese-American singer-songwriter Mitski emerged victorious as the best live performer and British DJ D.O.D claimed the award for most played new independent artist.
There were also wins for Jeshi, who claimed the best independent video award for his song 3210, while Champion’s reimagining of Ibeyi’s Lavender & Red Roses ft Jorja Smith was named as best independent remix.
Canadian musician and artist Maylee Todd secured the award for best creative campaign for her album Maloo. Meanwhile, after celebrating their 10th anniversary this year, Local Action won best boutique label.
Source: Press Association

domain: celebrity


text: Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Error: Please enter a valid sender email address. Example: email@example.com CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Error: Please enter your name Error: Please enter your email address Error: Please enter a valid recipient email address. Example:firstname.lastname@example.org Thank you! Your email has been sent to: The recipient(s) will receive an email message that includes a link to the selected article. Recipients may need to check their spam filters or confirm that the address is safe. Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@email.mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy. AMA Citation Bier, MD B, Lala-Trindade, MD A. Bier, MD B, & Lala-Trindade, MD A Bier, MD, Benjamin, and Anu Lala-Trindade, MD. Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. Hurst's the Heart Updates, 16 October 2019. McGraw-Hill, 2019. AccessCardiology. https://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=506586§ionid=229608436APA Citation Bier, MD B, Lala-Trindade, MD A. Bier, MD B, & Lala-Trindade, MD A Bier, MD, Benjamin, and Anu Lala-Trindade, MD. (2019). Angiotensin–neprilysin inhibition in heart failure with preserved ejection fraction. Fuster V. Fuster V Fuster, Valentin. Hurst's the heart updates. McGraw-Hill. https://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=506586§ionid=229608436.MLA Citation Bier, MD B, Lala-Trindade, MD A. Bier, MD B, & Lala-Trindade, MD A Bier, MD, Benjamin, and Anu Lala-Trindade, MD. "Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction." Hurst's the Heart Updates Fuster V. Fuster V Fuster, Valentin. McGraw-Hill, 2019, https://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=506586§ionid=229608436. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction by Benjamin Bier, MD, Anu Lala-Trindade, MD Listen + +Update to Chapter 70: The Diagnosis and Management of Chronic Heart Failure Summary + +The angiotensin receptor–neprilysin inhibitor sacubitril-valsartan has been shown to reduce risk of hospitalization for heart failure or death from cardiovascular causes among patients with heart failure with reduced ejection fraction (HFrEF) compared to ACE inhibitors and angiotensin receptor blockers, however its effect on patients with heart failure with preserved ejection fraction (HFpEF) is unclear. This study randomly assigned patients with ejection fraction of 45% or higher and NYHA class II to IV heart failure symptoms to receive sacubitril—valsartan versus valsartan alone. The primary outcome was a composite of hospitalizations for heart failure and death from cardiovascular causes, and patients on sacubitril-valsartan did not experience a statistically significant reduction in this composite compared to patients on valsartan HR 0.87 (95% confidence interval [CI], 0.75 to 1.01; P = 0.06). +Prespecified secondary outcomes included the individual components of the composite, QOL as assessed by KCCQ, improvement in NYHA Class, a renal composite outcome (renal death, ESRD, reduction in 50% of GFR) and all cause death) there was improvement in NYHA class; 15% in the sacubitril—valsartan group versus 12.6% in the valsartan group (odds ratio, 1.45; 95% CI, 1.13 to 1.86) and reduction in renal outcomes but not in quality of life or all cause death. In addition, of the 12 prespecified subgroups, 2 showed a possible treatment effect, with a suggestion of benefit in patients with an ejection fraction in the lower part (45 to 57%) of the range studied, and in women, who represent a high proportion of patients with heart failure with preserved ejection fraction. They made up 51.6% of the patients in this trial. In regard to the safety profile, patients in the sacubitril–valsartan group were more likely to have hypotension, however less likely to have increases in the creatinine/potassium levels than those in the valsartan group. In addition, angioedema occurred in 14 patients in the sacubitril–valsartan group and in 4 patients in the valsartan group after randomization had occurred. +Overall, Sacubitril–valsartan did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes among patients with heart failure and an ejection fraction of 45% or higher. However, there is a trend towards benefit observed by a non-significant reduction in hospitalizations from heart failure, and an improvement of NYHA class in the sacubitril—valsartan group as compared to the valsartan group. Commentary + Study Strengths + +The study was a randomized multicenter double-blind trial. It has a Clear definition of HFpEF – (50 years or older with signs and symptoms of heart failure, NYHA class II to IV, an ejection fraction of 45% or higher within the previous 6 months, elevated level of natriuretic peptides,evidence of structural heart disease and on diuretic therapy). This was an Important population – HFpEF comprises 50% of heart failure in the world today and has high rates of morbidity and mortality. To date no pharmacotherapy has shown improvement in HFpEF clinical outcomes. Inclusions of the patient reported outcome of quality of life using KCCQ which is a well validated tool. Women represented 51% of the study. Study Weaknesses + +The study patient population had a very low proportion of African American patients (2% in both groups) and therefore the extrapolation of data to this subset of patients is limited. Sacubitril–valsartan was tested against an active comparator, valsartan, since most patients were receiving a renin–angiotensin system inhibitor before enrollment. The potential benefit of angiotensin-receptor blockers in patients with heart failure with preserved ejection fraction (as suggested in prior trials) may have contributed to the smaller-than-anticipated treatment difference between groups. Interesting they did not use enalapril like PARADIGM-HF. Irbesartan and candesartan have been studied with some suggestion of benefit. More patients in the valsartan group were on spironolactone which may have biased towards the null hypothesis. Next Steps/Clinical Perspective + +This was a difficult population to study given number of comorbid conditions and heterogeneity among patients. Given these results it is possible that the guidelines for sacubitril-valsartan use should extend for patients with intermediate EF of 40-50%, where there is currently a lack of guidance to direct our therapies. The trend towards benefit seen in women indicates the need for further evaluation.