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Use of venlafaxine compared with other antidepressants and the risk of sudden cardiac death or near death: a nested case-control studyBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c249 (Published 05 February 2010) Cite this as: BMJ 2010;340:c249
- Carlos Martinez, adjunct professor1, consultant epidemiologist2,
- Themistocles L Assimes, assistant professor of medicine3,
- Daniel Mines, pharmacoepidemiologist4,
- Sophie Dell’Aniello, research assistant1,
- Samy Suissa, professor and director1
- 1Centre for Clinical Epidemiology, Jewish General Hospital, and Departments of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, Canada
- 2Carlos Martinez, Frankfurt, Germany
- 3Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- 4Wyeth Research, Philadelphia, USA
- Correspondence to: S Suissa, Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste-Catherine, Suite H4, Montreal, Québec, Canada H3T 1E2
- Accepted 25 November 2009
Objective To assess whether use of the antidepressant venlafaxine is associated with an increased risk of sudden cardiac death or near death compared with other commonly used antidepressants.
Design Population based observational study.
Setting We did a nested case-control analysis within a new user cohort formed using the United Kingdom General Practice Research Database.
Participants New users of venlafaxine, fluoxetine, citalopram, or dosulepin on or after 1 January 1995, aged 18 to 89 years, with a diagnosis of depression or anxiety. Participants were followed-up until February 2005, or the occurrence of sudden cardiac death or near death, identified from medical records indicating non-fatal acute ventricular tachyarrhythmia, sudden death due to cardiac causes, or out of hospital deaths from acute ischaemic cardiac events. For each case, 30 controls were selected matched for age, sex, calendar time, and indication. We used conditional logistic regression to calculate the adjusted odds ratio of sudden cardiac death or near death associated with current use of venlafaxine compared with current use of fluoxetine, citalopram or dosulepin.
Results 207 384 participants were followed-up for an average of 3.3 years. There were 568 cases of sudden cardiac death or near death, which were matched to 14 812 controls. The adjusted odds ratio of sudden cardiac death or near death associated with venlafaxine use was 0.66 (95% confidence interval 0.38 to 1.14) relative to fluoxetine use, whereas compared with citalopram it was 0.89 (0.50 to 1.60) and with dosulepin 0.83 (0.46 to 1.52).
Conclusions In this large, population based study, the use of venlafaxine was not associated with an excess risk of sudden cardiac death or near death compared with fluoxetine, dosulepin, or citalopram, in patients with depression or anxiety.
The safety of antidepressant drugs, particularly the newer agents, has been the subject of much debate. The selective serotonin receptor inhibitors (SSRI), as well as more recent agents such as venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), have received special scrutiny from regulators. Although the greatest attention has focused on the suicide associated risks with these agents, three observational studies conducted in the United Kingdom reported a higher rate of fatal overdose with venlafaxine use compared with SSRIs.1 2 3 While these studies suggested that venlafaxine is more toxic in overdose, their design could not measure or adjust for patient factors that could also account for this observation, if the drugs were selectively prescribed to patients with different underlying risks of suicide.4 5
The mechanism of death in patients who died from venlafaxine overdose has not been well established. One hypothesis is that venlafaxine promotes haemodynamically significant (herein referred to as malignant) ventricular tachyarrhythmias through ion channel effects that prolong the QRS and/or QT interval. One in vitro study found that venlafaxine inhibited the fast sodium channel in guinea pig myocytes, but the study was not conducted under physiological conditions.6 In vivo, QRS prolongation has been reported in the overdose setting but not seen in randomised controlled trials.7 8 Clinically important increases in the QTc interval were observed rarely during registration trials,9 in uncontrolled prospective cohort studies,10 and in the overdose setting.11 12 No cases of malignant ventricular arrhythmias were reported in the pre-registration clinical trials of venlafaxine,8 but the studies were not powered to detect such rare adverse events. Another possible mechanism through which venlafaxine could promote arrhythmias is by precipitating cardiac ischaemia, given that the drug can increase blood pressure and heart rate.10 13 14
Concerns that venlafaxine was less safe than SSRIs in part due to cardiotoxicity led to regulatory action. In December 2004 the UK Medicines and Healthcare products Regulatory Agency (MHRA) restricted prescription of venlafaxine to specialists and contraindicated its use in patients with heart disease, electrolyte imbalance, or in patients who are hypertensive.15 16 After further review, in May 2006 the MHRA revised its regulatory position. The new prescribing information again allowed prescribing by non-specialists (except at very high doses) and updated the cardiac contraindications, advising now that only patients at very high risk of ventricular arrhythmia or with uncontrolled hypertension should not use venlafaxine.9 17 However, we know of no systematic study that has assessed the risk of malignant arrhythmias or sudden cardiac death associated with the use of venlafaxine in usual clinical practice.
We therefore used a population based observational approach to assess the risk of out-of-hospital haemodynamically significant acute ventricular tachyarrhythmia or sudden cardiac death associated with venlafaxine use relative to the use of fluoxetine, citalopram, or dosulepin in patients treated for depression or anxiety.
We did a cohort study with a nested case-control analysis using data obtained from the United Kingdom General Practice Research Database (GPRD). This database contains more than 35 million person years of data from patient records continuously collected since 1987. Participating general practices currently contribute data on more than 3 million patients, roughly 5% of the UK population. Data collected included demographics, medical diagnoses, all prescriptions, referrals to secondary care, and hospital discharge reports. Participating general practitioners (GPs) receive training in data entry, and once practices have met certain quality standards, they are deemed as “up-to-standard.”18 Diagnoses are recorded using OXMIS or Read codes.
Study cohort and design
The study cohort has previously been used to assess the risk of suicide in patients treated with venlafaxine.19 Briefly, it was formed from all new users of venlafaxine, fluoxetine, citalopram, or dosulepin on or after 1 January 1995. We defined new users as patients who had received no prescription of the study drug in the year before cohort entry. Patients were aged between 18 and 89 years on the date of the incident prescription, and only patients with a clinical record for depression or anxiety on the date of or at any time before the incident prescription were selected. Patients were included in the cohort if they had a permanent registration status with a participating general practice, had at least a one year longitudinal record before the incident prescription, had an acceptable patient status for data quality, and originated from a general practice which was up to standard for at least a year before the incident prescription.20 Patients with a history of life threatening ventricular tachyarrhythmia, cardioversion, aborted cardiac arrest, or implantation of a cardiac defibrillator before cohort entry were excluded. Patients with a congenital conduction disorder or advanced cardiomyopathy (hypertrophic or dilated) before cohort entry or at any time during follow-up were also excluded.
Patients were followed-up over time from their incident prescription date (cohort entry) until the earliest of occurrence of the study outcome, death, transfer out of practice, or the practice’s last collection date before February 2005, when data for this study were extracted. We used a case-control analysis nested within the cohort to deal with the complex time-varying nature of antidepressant use.21 22
The unifying feature of our composite outcome of sudden cardiac death or near death was the occurrence of a malignant ventricular tachyarrhythmia, which typically occurs in the presence of coronary atherosclerosis, its complications, or other structural heart disease.23 For near deaths, the occurrence of such a tachyarrhythmia was well documented and supported by the report of symptoms of presyncope or syncope before or during the event and/or the necessity of emergent cardioversion. For individuals who died, the tachyarrhythmia was often presumed because most deaths were not witnessed. Accordingly, three sources of out of hospital cases were identified: patients with non-fatal but haemodynamically significant acute ventricular tachyarrhythmia; patients with a record of sudden death due to cardiac causes ischaemic or otherwise; and patients seeming to have died out of hospital from an acute ischaemic cardiac event that was not necessarily labelled as sudden.
First, potential cases of acute ventricular tachyarrhythmia were identified from Read or OXMIS codes and word strings in the free text comments of GPs, in which case the complete de-identified free text was obtained from the GPRD. This text was reviewed by one of the authors (CM), blinded to exposure status, to assess whether additional chart information should be requested from the GP to clarify if the outcome of interest had occurred. The complete clinical profile of all these potential acute ventricular tachyarrhythmia cases was independently reviewed by two authors (CM and TA), who classified them as definite or not, and any discordance was resolved by consensus after further review and discussion. Then, sudden cardiac death cases were identified from Read/OXMIS code for “sudden death” or a word string in a free text comment that suggested the occurrence of a sudden death. Death certificates were obtained from the Office for National Statistics for England and Wales or the General Register Office for Scotland and Northern Ireland for the subset of those individuals who did not have a Read/OXMIS code or a free text comment that clearly stated a cause of death. Finally, people dying in the community from an acute cardiac ischaemic event that was not necessarily labelled as sudden formed the third group of potential cases, identified by scanning the Read/OXMIS codes for a code of ischaemic heart disease or myocardial infarction on the date of death (plus or minus one day). The complete profile of all potential sudden cardiac deaths and acute cardiac ischaemic deaths was subjected to a computer algorithm that identified and excluded deaths occurring either in hospital or in nursing homes and deaths apparently due to non-cardiac pathology. This algorithm was optimised after comparing the results of the initial run of the algorithm with the results of a manual review of a random set of 50 potential sudden death cases by two authors (CM and TA). All potential cases not excluded by the optimised computer algorithm then underwent a manual review by one of the authors (CM) to further exclude cases that did not meet all inclusion and exclusion criteria.
The definite acute ventricular tachyarrhythmia, sudden cardiac death, and acute ischaemic cardiac death cases were combined to form the series of cases of sudden cardiac death or near death. The date of occurrence was designated the index date of the case.
For each case we randomly selected up to 30 controls from the cohort. These controls were matched on cohort entry date (date of incident prescription plus or minus 6 months), year of birth, sex, and indication (depression and/or anxiety). Additionally, controls had to be at risk of the event on the case’s index date. Thus, the control’s index date was defined as the date that corresponded to the same follow-up time as its matched case. When fewer than 30 controls were available for a given case, we relaxed the matching criteria for cohort entry to within one year. If after this step, a given case had fewer than 30 controls, all available individuals were used.
Antidepressant drug exposure
For each case and their matched controls, we extracted all prescription records for the study drugs and all other antidepressants before the index date. We calculated the duration of each prescription, starting with the last prescription prior to index date, from the number of tablets prescribed combined with the dosing instructions. When we were unable to derive duration of exposure from the available information we assumed a prescription length of 28 days. For unusually low or high values of prescription length, we assigned a minimum of seven days and a maximum of 90 days to the prescription length. These assumptions are based on current prescribing practices in the UK.
We defined current exposure to treatment by a prescription whose duration included the index date. As the focus of exposure was on current use, we defined as “no use” the absence of prescriptions of a given drug during the year prior to the index date. Patients with prescriptions for a given drug during the year before the index date, but not current users, were classified as past users.
Risk factors for the outcome were identified from patients’ records in the GPRD. In particular, we identified depression related factors (alcohol abuse, suicide attempt, depression severity),24 cardiovascular risk factors (obesity, smoking, diabetes, left ventricular hypertrophy, hyperlipidaemia, hypertension, rheumatoid arthritis), cardiovascular diagnoses (acute myocardial infarction, coronary artery bypass graft and percutaneous coronary artery procedures, intraventricular conduction delay, supraventricular arrhythmia, atrial arrhythmia, coronary artery disease, angina, congestive heart failure, ischaemic stroke, transient ischaemic attack, peripheral vascular disease), other conditions that have been associated with an increased risk for sudden cardiac death (epilepsy and schizophrenia), and conditions or use of drugs that could prolong the QT interval, including hypokalaemia, hypomagnesaemia, and conduction disorders.25 26 We also measured use of certain classes of drug including non-steroidal anti-inflammatory drugs (NSAIDs), antipsychotics, benzodiazepines, mood stabilisers, antiarrhythmic agents, lipid regulating drugs, and loop diuretics. Lastly, we identified individuals who had switched antidepressants between the time of cohort entry and the index date. Except for obesity, which we defined as a body mass index (BMI) of more than 30, covariates were ascertained from diagnoses, lifestyle factors, or prescriptions as they appeared in the medical record.
We used conditional logistic regression to compute the odds ratio of sudden cardiac death or near death, and its 95% confidence interval, associated with current exclusive use of venlafaxine compared with current exclusive use of each of the three other study drugs, as well as compared with the three drugs as one group. In a nested case-control study such as ours, the odds ratio provides an unbiased estimate of the rate ratio in the cohort.27
Because the number of controls matched to each case was variable and to allow unbiased comparisons between cases and controls, descriptive statistics for the characteristics of the controls were weighted by the inverse of the number of controls in each matched set, a procedure equivalent to standardising the number of controls to one control per case. After tabulating the data, we performed crude regression analyses. All analyses were then adjusted for comorbidity and other covariates measured 366-730 days before the index date, to avoid adjusting for factors affected by exposure during the year prior to the index date. We also assessed the effect of duration of exposure in patients currently exposed to the study drugs.
We performed several sensitivity analyses. We repeated the main analyses after restricting our outcome to the first two sources of cases (non-fatal acute ventricular tachyarrhythmia as well as sudden deaths due to any cardiac pathology). We repeated the main analyses adding a lag of 15 days to the end of the prescription duration, to allow for possible late exposures beyond the prescription duration. We repeated the main analyses using two alternative time periods in which covariates were measured. We first adjusted for comorbidities measured in the year beginning 415 days before the index date, instead of the year beginning 730 days before the index date, and then adjusted only for covariates ascertained prior to cohort entry, to address any concerns about adjusting for factors that were actually drug effects. We also restricted the covariates to those that affected the odds ratio by 10% or more. Finally, to assess effect modification, the estimates were stratified by the indication for the antidepressant, by the presence or absence of a diagnosis of myocardial infarction before the index date, and by the occurrence of switching among antidepressant classes as measured by a change of the current antidepressant from the cohort entry defining agent.
We used SAS v9.1. (Cary, NC, USA) statistical software for all analyses. The study protocol was approved by the Independent Scientific Advisory Committee for GPRD research, and this report includes all relevant STROBE elements.
The initial cohort included 269 084 individuals with an incident prescription of one of the study drugs after January 1995 and with at least a year of data prior to that prescription. We then excluded 2426 patients because they were younger than 18 years or older than 90 at the date of the incident prescription; 58 464 patients without a diagnosis of depression or anxiety before or concurrent with the incident prescription; 473 patients with congenital conduction disorder, cardiomyopathy, or history of acute ventricular tachyarrhythmia; 284 patients with cardioversion, cardiac arrest with resuscitation, or implantation of an internal cardiac defibrillator prior to cohort entry; and 53 patients with incomplete follow-up information. Thus, the final study cohort consisted of 207 384 first time users of venlafaxine (n=19 268), citalopram (n=53 300), fluoxetine (n=90 924), or dosulepin (n=43 892). Over the study period, 17 783 patients who entered the study taking one of the comparator antidepressants were subsequently prescribed venlafaxine, bringing the total number of individuals exposed to venlafaxine to 35 051.
The mean age at cohort entry was 46 years, with a mean of 7.8 years of available data in the practice between the time it was deemed up to standard for data collection purposes and cohort entry and a mean follow-up of 3.3 years. A third of cohort members were men. The diagnosis associated with antidepressant use was depression in 84% and anxiety in 16%. Almost half of the patients had never been prescribed any other antidepressant before the qualifying prescription. Compared with patients initiating fluoxetine, citalopram, or dosulepin, patients initiating venlafaxine were more likely to have previously used tricyclics, SSRIs, monamine oxidase inhibitors, or other antidepressants (supplemental table 1, see webextras). They also were more likely to have had more severe depression or attempted suicide (supplemental table 2). Patients initiating venlafaxine were no different in terms of their cardiovascular comorbidities at baseline but had greater use of antipsychotic drugs, benzodiazepines, and mood stabilisers, as well as somewhat higher use of drugs that may prolong the QT interval (supplemental tables 3-4).
The figure 1⇓ describes the algorithm to identify the three sets of out of hospital cases. Using this algorithm, we identified 568 cases, including 27 acute ventricular tachyarrhythmias, 236 sudden cardiac deaths, and 305 out of hospital cardiac ischaemic deaths. The initial concordance rate regarding case status between the two authors after their manual review of all potential acute ventricular tachyarrhythmia and of the random set of 50 potential sudden death cases was 73%, and all disagreements were resolved after discussion.
The overall rate of sudden cardiac death or near death was 8.21 per 10 000 person-years. The 568 cases were matched to 14 812 controls, with a mean age of 73 years at the index date. Cases were more likely to be smokers, to abuse alcohol, and to have attempted suicide, despite no major differences in the severity of depression (table 1)⇓. In the year prior to the year before the index date, cases generally had a higher prevalence of cardiovascular related comorbidity, particularly diabetes, acute myocardial infarction, congestive heart failure, and atrial arrhythmia (table 2)⇓. Cases also had a higher prevalence of rheumatoid arthritis, epilepsy, and schizophrenia, as well as use of NSAIDs, benzodiazepines, lipid regulating agents, loop diuretics, and drugs that may prolong the QT interval (table 3).⇓ Although all patients were exposed to one of the study drugs at cohort entry, over time many did not continue on these treatments, as would be expected in clinical practice. On the index date only a subset of cases (n=155) and controls (n=3916) were currently exposed to a study drug.
Current venlafaxine use was not associated with an increased risk of sudden cardiac death or near death compared with current use of fluoxetine, citalopram, and dosulepin, with all point estimates of the adjusted odds ratio less than 1 (table 4, model 1)⇓. In an alternative model that included only covariates that were measured before cohort entry, results were essentially the same (table 4, model 2). Stratified analyses did not show any significant variations in risk by duration of use of any of the four antidepressants used to define the cohort (table 5)⇓.
Sensitivity analyses restricting our outcome to acute ventricular tachyarrhythmia and sudden cardiac death did not change the results, nor did adding a lag of 15 days to the end of the prescription duration (supplemental tables 5-6). Varying the time window to define covariates or adjusting only for covariates that changed the odds ratio by at least 10% also did not materially affect the results (supplemental table 7). Finally, results were similar in models restricted to patients with a diagnosis of depression as indication for the drugs or among patients with no diagnosis of acute myocardial infarction before the index date (supplemental tables 8-9). Switching from the antidepressant used at cohort entry to the one at index date was not associated with an increased risk of our composite outcome (odds ratio 0.83; 95% confidence interval 0.52 to 1.32). In an analysis of switching stratified by each study drug, the results did not change although the numbers were small (supplemental tables 10).
In this large population based cohort study of patients treated for depression or anxiety, we found no evidence that venlafaxine use was associated with a higher risk of out of hospital haemodynamically significant acute ventricular tachyarrhythmia or sudden cardiac death compared with the risk observed in fluoxetine, citalopram, or dosulepin users. While only 18 cases of sudden cardiac death or near death occurred in patients currently exposed to venlafaxine, the study allows us reasonably to exclude odds ratios higher than 1.14 compared with current fluoxetine use, 1.60 compared with current citalopram use, 1.52 compared with current dosulepin use, and 1.30 compared with current use of any of the three comparators, based on the upper bound of the 95% confidence interval for each of the four comparisons. We also found no compelling evidence that venlafaxine was preferentially prescribed to patients with lower risk for cardiac events, consistent with the observation that adjustment for potential confounders had minimal effect on results.
Comparison with other studies
The motivation for this investigation arose from three recent observational studies that reported a higher rate of fatal antidepressant overdose with venlafaxine use compared with SSRIs.1 2 3 While one interpretation of these findings is that venlafaxine is relatively more toxic in overdose, patient factors rather than differential drug effects could also explain the phenomenon. None of these studies adjusted for potential confounding factors, and in fact a UK based utilisation study demonstrated that venlafaxine was preferentially prescribed to patients with a higher prevalence of risk factors for suicide.28 The cause of venlafaxine overdose deaths has not been well characterised, although a cardiotoxic mechanism, mediated through malignant ventricular tachyarrhythmias, has been suggested.6 The current study assessed the risk of malignant ventricular tachyarrhythmias and sudden cardiac death among patients receiving venlafaxine and comparator antidepressants at pharmacological doses, and found no such association.
While some studies compare current use of a drug to non-use to assess drug risk, we chose to compare current use of one drug to another drug. We believe that this approach is clinically sensible and minimises confounding by indication. We designed the study to address the following question a clinician might ask him or herself: “Given that I have chosen to treat my patient with an antidepressant, will the choice of venlafaxine instead of other antidepressants increase my patient’s risk of unexpected cardiac death or life threatening ventricular tachyarrhythmia?” Alternatively, one could compare current use to distant past use, but such an approach could be vulnerable to confounding by indication. Several studies have suggested that depressed individuals are at increased risk for cardiac mortality compared with non-depressed individuals.29 30 31 32 Less clear is whether depression associated risk of adverse cardiovascular outcomes attenuates when depression abates. If this is the case, an association emerging from a comparison of current antidepressant use with distant past use could easily be a consequence of confounding by time dependent patient factors associated with depression itself. Thus, we selected three other antidepressant agents to define the comparison group, namely fluoxetine, citalopram, and dosulepin, as in a previous study of suicide risk associated with venlafaxine that used the same dataset.19 Fluoxetine, an SSRI, and dosulepin, a tricyclic antidepressant, were selected because they were the most commonly prescribed drugs within their respective classes during the study period. As citalopram and venlafaxine were introduced in the same year, we assumed that doctors would preferentially prescribe both agents to patients who were unresponsive to previously available therapies.5 To the degree that severity of depression could increase risk of cardiac events,29 we believed that selecting citalopram as a comparator would minimise confounding by disease severity.
Like other antidepressants of the tricyclic class, dosulepin in the overdose setting can produce malignant arrhythmias, some fatal.33 34 We identified only one population based study that evaluated the risk of sudden cardiac death involving tricyclic antidepressants at pharmacologic doses.35 This study found that, compared with non-use of antidepressants, tricyclic antidepressants were not associated with an increased risk of sudden cardiac death at doses of less than 100 mg per day of amitriptyline equivalents. An increased risk, however, was observed at higher doses. Our GPRD study did not suggest an excess risk of sudden cardiac death or near death associated with dosulepin use. We suspect that the relatively infrequent use at higher doses may explain this finding. Among patients currently exposed to dosulepin on the index date for whom a daily dose could be measured, 87.6% (840/959) were prescribed less than 100 mg/day (we assume that amitriptyline and dosulepin are equivalent on a mg/mg basis).36
Limitations of study
Our study has some limitations, most of which involve the level of detail in the GPRD medical history and the challenge of determining the precise sequence of events in patients who died out of hospital. Firstly, we could not apply standardised definitions of sudden cardiac death such as those used in large clinical trials, since we lacked access to complete medical records and the ability to interview family members of deceased people. However, our definition of sudden cardiac death was largely consistent with the one used in a recent study of antipsychotic drug use and sudden cardiac death, although ours also included cases of life threatening but non-fatal ventricular arrhythmias.37 Secondly, we cannot be certain that all of the fatal cases included in this study had a malignant ventricular tachyarrhythmia as the final cardiac event before death. In large part, this limitation is a consequence of most fatal cases both not being on an electrocardiograph at the time of haemodynamic collapse and not subsequently undergoing autopsy. Furthermore, we did not have access to medical records detailing the cardiac rhythm before death in the few cases whose arrest was witnessed and managed by paramedics or doctors. Community studies suggest that some patients who die shortly after haemodynamic collapse from a cardiac cause may not go through a phase of ventricular tachyarrhythmia or fibrillation before death.38 39 Nevertheless, we suspect that among cases who did not have a malignant tachyarrhythmia, most died from some cardiac cause. To the degree that this occurred, it is reassuring that venlafaxine was not associated with an increased risk of death from other cardiac causes. Our study reproduced several established risk factors of sudden cardiac death,23 such as severe congestive heart failure (odds ratio 1.7), recent acute myocardial infarction (odds ratio 13.4), and left ventricular hypertrophy (odds ratio 5.9); and it found an incidence rate of sudden cardiac death or near death consistent with the rates of ventricular tachycardia observed in other cohorts.40 41 42 43 44 These observations support the validity of our outcome measure despite incomplete clinical details for many of our cases.45 Thirdly, although we adjusted our analysis for a comprehensive list of potential risk factors for the outcome based on the information available in the GPRD, this adjustment might be incomplete. Some traditional risk factors of coronary artery disease such as left ventricular hypertrophy, diabetes, hypertension, and hyperlipidaemia appeared to be incompletely captured by physician diagnoses given the lower than expected prevalence of these conditions. Furthermore, although we adjusted for coronary artery disease risk factors, coronary artery disease, myocardial infarction, or left ventricular dysfunction, we could not adjust for the age of onset and severity of coronary disease risk factors, burden and location of coronary atherosclerosis, location and size of previous myocardial infarction, or the left ventricular ejection function as measured on an echocardiogram. We cannot exclude the possibility that patients with more extensive cardiac disease and consequently a higher risk of malignant arrhythmias were less likely to have been prescribed venlafaxine. However, the distribution of cardiac comorbidities and coronary artery disease risk factors across the four groups of antidepressant users at study entry does not suggest that such channelling occurred (supplemental tables 2 and 3). Finally, we cannot exclude the possibility of exposure misclassification, which could have varied by study drug. Clinical trial data indicate that patients receiving venlafaxine discontinue therapy because of undesirable side effects more often than those receiving SSRIs.46 Our GPRD study used prescription data as a proxy for antidepressant exposure and did not measure actual drug adherence.
In this large UK population based study in patients with depression or anxiety, venlafaxine was not associated with any excess risk of malignant ventricular tachyarrhythmia or sudden cardiac death when compared with fluoxetine, dosulepin, or citalopram.
What is already known on this topic
In recent reports from the UK, the antidepressant venlafaxine was associated with an increased rate of fatal overdose compared with several other SSRIs
The finding might be due to patient factors, as venlafaxine has been systematically prescribed to sicker patients who are at higher risk for suicide, or to inherent toxicity of venlafaxine, possibly because of a pro-arrhythmic mechanism
Whether use of venlafaxine at therapeutic doses is associated with an increased risk of sudden cardiac death or life threatening arrhythmia has not been studied
What this study adds
Using data from the General Practice Research Database, this observational study of more than 200 000 patients treated for depression or anxiety found no excess risk of sudden death or near death associated with use of venlafaxine compared with other commonly used antidepressants
Cite this as: BMJ 2010;340:c249
Contributors: CM, DM, SS were responsible for the conception and design of the study. SD was responsible for the statistical analysis. CM and TA adjudicated cases of non-fatal ventricular arrhythmias. All authors contributed to the interpretation of results and manuscript preparation and granted final approval of this report. CM and SS are guarantors.
Funding: This study was sponsored by Wyeth, which produces and markets venlafaxine. The contract for this research specified that the non-company authors had ultimate control over all aspects of the study, including control over publication. During the course of the study, however, any differences about the presentation or interpretation of findings that arose between the company author and external investigators were resolved through honest scientific debate. All authors had access to the statistical reports and tables supporting the publication.
Competing interests: DM is a employee of Wyeth and owns company stock options. SS has participated in advisory board meetings and conferences, participated as a speaker in scientific meetings by various companies (AstraZeneca, Boehringer Ingelheim, Glaxo SmithKline, Pfizer, and Sepracor), and received research grants from AstraZeneca, Wyeth, and GlaxoSmithKline. TA, SD, and CM have nothing to declare.
Ethical approval: The study protocol was approved by the Independent Scientific Advisory Committee for GPRD studies (Protocol 06_054).
Data sharing: Read/OXMIS code lists used to identify outcomes are available from the corresponding author at.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

domain: literature


Continuing with its strong tradition of making frequent additions to its handset offering line, Vodafone has now come out with the Toshiba 903T GPS phone. This is much on the expected lines as the addition of this handset has been talked about in the news for the past couple of months. The new addition is a 3G handset that will support GPS services both in Japan as well as rest of the world.
Toshiba’s 903T GPS handset will be particularly used by Vodafone for its new high-end NAVI service that also offers you assistance in navigation enquiries, like providing you with route related information. The phone has a 2.4-inch 240 x 320 display screen where you can search different maps to find the way to your desired destination.
The phone boasts of a 64MB memory card and is also offering a 1.92 megapixel built-in camera.


text:
Oden is a type of Japanese stew, made by simmering various ingredients
Closed: Sunday, Holiday
Shimbashi Sta. 319m
An old Shimbashi oden shop. The taste is deep, and has a soy sauce base. All of the dishes with a nice hint of dashi are delicious.
HP : http://www.otako.co.jp/

domain: food


text: Both have issued new shares recently. AGNC issued about 20% more shares, CIM about less than 15%. AGNC opened at about 26 when sgares are offered, now it is at $29.33 after a month. CIM offered at $3.85, now at $3.90. And AGNC use much higher leverage than CIM, so which one you would like to buy?

domain: economics


text:
Minister of Mass Media Bandula Gunawardane and NPP MP Anura Kumara Dissanayake were engaged in heated arguments in Parliament over the leasing of the state-owned Channel Eye to the Lyca Mobile Group.
Raising a question under Standing Orders 27/2, NPP MP Dissanayake said Channel Eye had been leased out to SDT Channel of the Lyca Mobile without following due procedures and that Minister Bandula Gunawardane had sought to a cover approval to cover up his fraudulent act.
He asked the subject minister on what basis and by what technical committee the monthly installment of Rs. 25 million was estimated at and whether the Channel Eye Board of Directors had powers to lease out the air time of the Channel to a company of their choice without following due procedures.
Minister Gunawardane said Channel Eye had not been leased out and that it was only rented out on a monthly rental of Rs. 25 million to VIS Broadcasting Company for six months.
MP Dissanayake argued that the Cabinet Paper presented by the Minister clearly says that it was leased out for six months.
Minister Gunawardane then, said it was not he who had drafted the Cabinet Paper and that the Cabinet Secretary had erroneously mentioned the word ‘lease out’ instead of ‘rent out’.
The Minister said he is willing to resign from all his positions and even from politics if he was proved to have committed any misdeed in the transaction.

domain: news


text:
HOTFOOT 21 Magazine
Celebrating dance of the African Diaspora
Global Infrastructures – celebrating the artists, practitioners and organisations within dance of the African Diaspora who ensure the art forms and artists continue to thrive in the UK and beyond.
Leading the Way – a focus on Leadership and Infrastructure from the perspective of our Trailblazers Fellowship Alumni who are creating new pathways of artistic expression and leadership whilst impacting education, culture and lifestyle in the UK and beyond.
Transmitting the Dance: Principles, Aesthetic, Technique and Nuance Celebrating African People’s Dance – providing a platform for critical debate around the dance practices of the African Diaspora in the UK and abroad.
Journeys and International Connections Celebrating African People’s Dance – providing a platform for critical debate around the dance practices of the African Diaspora in the UK and abroad.
Guidelines for making dance performances more inclusive
Teaching and understanding Cultural Diversity through the use of dance – a range of lesson ideas for both primary and secondary schools from The Real Histories Directory
Safe Street Dance Practice
Physically Being Me – Six Stories from Deaf and Disabled Dancers

domain: sociology


text:
This is my new go-to summer picnic salad. It’s lemony, salty, and rich, thanks to lots of olives, tuna, and a healthy dose of avocado. This keeps well in the fridge so make it the night before and you’re good to go.
1 cup pearl couscous
2 tablespoons lemon juice
2 tablespoons white wine vinegar
1/4 cup olive oil
1 teaspoon salt
1/2 teaspoon black pepper
1 (5-ounce) can tuna packed in olive oil, drained
2/3 cup pitted Castelvetrano olives, chopped
2 celery stalks, finely chopped
1/4 cup finely chopped red onion
1/4 cup finely chopped parsley
2 tablespoons finely chopped dill
1 tablespoon finely chopped preserved lemon
1 avocado, peeled and cubed
1. Cook couscous according to package instructions; drain and set aside. Let cool.
2. Combine lemon juice and vinegar in a large bowl. Whisk in olive oil and add salt and pepper. Add cooled couscous and toss to coat. Flake tuna with a fork; add to couscous. Gently stir in olives, celery, onion, parsley, dill, avocado, and preserved lemon. Season with salt to taste and serve.
I’ll eat bibimbap in any shape or form. Traditional, vegetarian, seafood — I’ve never met a bibimbap I didn’t devour. This extra-healthy version is made with brown rice and lots of vegetables and is super satisfying. It’s a loose recipe, so adjust the proportions to your liking.
2 cups short-grain brown rice
4 red bell peppers, halved
Toasted sesame oil
Toasted sesame seeds
Soy sauce or tamari
2 tablespoons gochujang
2 tablespoons brown sugar
1 garlic clove
1 tablespoon rice vinegar
1 carrot, sliced into matchsticks
1 1/2 cups sliced shiitake mushrooms
1-inch piece ginger, peeled and minced
2 large handfuls kale, shredded
1 1/2 cups bean sprouts
Pickled ginger, sliced
Green onions, sliced
Nori, cut into strips
1. Rinse the rice under cold water until it runs clear. Drain the rice and transfer to a saucepan or rice cooker and cook with a pinch of salt according to package directions.
2. Preheat the oven to 425F degrees. Arrange the pepper halves on a baking sheet, skin sides up. Drizzle with a little avocado oil and roast for 30 minutes, until soft and blackened in spots. Transfer to a bowl and cover with a plate. Leave for 10 minutes, then peel and slice into thick strips. Season the pepper ribbons with sesame oil, sesame seeds, and tamari.
3. Meanwhile, make the bibimbap sauce by combining the gochujang, sugar, garlic, and vinegar with 2 tablespoons of water, 2 tablespoons sesame oil, and 2 tablespoons sesame seeds. Set aside.
4. Cook the carrot: heat a teaspoon of avocado oil in a frying pan over high heat. Add the carrot and saute for 2 minutes, until just tender. Season with salt and set aside. Cook the mushrooms in a little oil in the same way, keeping the heat high and the pan moving until the mushrooms are cooked. Season with tamari.
5. Wipe out the wok and add a teaspoon of oil followed by the ginger and the kale and a few drops of water, sauteing for a few minutes until wilted. Toss with a drizzle of sesame oil, 1 teaspoon of sesame seeds, and set aside.
6. Blanch the bean sprouts in boiling salted water for a minute, until wilted. Drain well.
7. Fry the eggs sunny side up in a frying pan, until the whites have set but the yolks are still runny.
8. To serve, divide the rice between large serving bowls. Spoon each topping on top in a circular manner: peppers, carrots, mushrooms, kale, and bean sprouts. Lay the fried egg on top and add pickled ginger, sliced green onions, nori seaweed, and sesame seeds to taste. Add a heaping spoonful of the bibimbap sauce, serving the rest on the table to spoon over, mixing everything as you eat.
Full of sweet, savory, creamy, and crunchy textures and flavors, this these potatoes with spiced chickpeas are kind of like loaded potatoes in appetizer form — if loaded potatoes were vaguely South Asian or Middle Eastern.
3 pounds small Yukon gold potatoes, halved (or quartered) to about 2-inch pieces
1/4 cup olive oil
1 15-ounce can chickpeas, rinsed and drained
1 teaspoon cumin seeds
1 1/2 teaspoons nigella seeds
1/2 teaspoon paprika
Zest plus one teaspoon juice from one lemon
1 teaspoon honey
3 green onions
2/3 cup sour cream
2 to 3 tablespoons mango chutney
1. Preheat the oven to 400F degrees. Toss potatoes with half the oil and spread out on a baking sheet. Season with salt and bake for 45 minutes, flipping potatoes halfway through baking time.
2. Meanwhile, transfer the chickpeas into a bowl and pat dry. Toss chickpeas with remaining oil, cumin seeds, 1 teaspoon teaspoon of the nigella seeds, and the paprika. Season and spread on another baking sheet or roasting pan.
3. Roast for 10 to 15 minutes, until just beginning to brown. Stir through the lemon zest and honey and return to the oven for another 5 to 10 minutes, until well-browned and crisp.
4. Chop half of the green onions and stir into sour cream with the lemon juice and season with salt and pepper to taste. Finely slice the remaining green onions and set aside.
5. Arrange potatoes on a large platter, and dollop 1 teaspoon of the green onion sour cream to each potato, with a little mango chutney. Scatter the chickpeas on top. Scatter the reserved green onions and remaining nigella seeds, plus a little more black pepper. Serve warm.
This Middle Eastern-inspired salad is peak summer: buttery eggplant, juicy tomatoes, and crispy cucumber are bound by a cooling and tangy yogurt dressing. The best part? It’s so much easier to make than it looks.
2 Japanese eggplant, sliced
2 tablespoons vegetable oil
2 tablespoons olive oil
1/4 cup red wine vinegar
1 garlic clove, crushed
1 tablespoon lemon juice
1/3 teaspoon ground cumin
1/2 teaspoon ground coriander
1 cucumber, sliced
2 tomatoes, sliced
2 tablespoons Greek or Middle Eastern-style yogurt
Chopped parsley, for garnish
1. Preheat the broiler: brush the eggplant slices with the vegetable oil and cook over high heat, turning once, until golden and tender. Cut slices in half.
2. In a large bowl, combine the olive oil, vinegar, garlic, lemon juice, cumin, and coriander. Season with salt and pepper. Add the warm eggplant, mix, and chill for at least 1 hour. Add the cucumber and tomatoes. Transfer to a serving dish and spoon the yogurt on top and garnish with parsley.
this week’s cooking:
black-bean-stuffed plantain croquettes with tomato sauce
veracruz-style shrimp over tortillas in pumpkin seed sauce | coconut, caramel, and rum flans
creamy tomato soup with buttery croutons | mushroom dumplings in parmesan and sun-dried tomato sauce
warm soba in broth with spinach and tofu | garlic chive and beef potstickers
hawaiian-style butter-coconut mochi
i finished reading life of pi last night. i loved it. its brilliant, but i’m still not sure if i understand the end properly (or at least which version to believe).
i also saw promises last night, and i highly recommend it to anyone with the slightest interest in the israel-palestine conflict. the special features were just as interesting as the documentary itself, namely the updates on the children.
here’s the recipe for the mochi (this one is super easy and yummy):
1. preheat oven to 350F. 2. whisk together dry ingredients in a large bowl. mix together wet ingredients in another bowl. add coconut mixture to flour mixture, whisking until batter is combined. 3. pour batter into an ungreased 13-by-9-inch baking pan, and bake until top is golden and cake begins to pull away from sides of pan, about 1 hour and 25 minutes. cook cake completely, about 2 hours. cut mochi into squares before serving.


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Sudden changes in behavior, appearance, or attitude may indicate that your teen is becoming involved with negative peer pressure. Watch the changes in friends that your teen associates with and notice if there is secretive behavior.Tags: Writing Cover LetterHow To Develop A Marketing Plan For A Small BusinessCourses For Creative WritingEssay Childhood FrenchHow To Solve Blood Relation Problem7th Grade Social Studies Essay QuestionsPower Of English Language EssayRobert Putnam Bowling Alone Thesis
These peers with whom teens associate have a dramatic affect on the perspectives our teens hold and the decisions that our teens make. It seems as though most teens are tethered to their mobile multimedia phones.
They can text to their friends on a continuous and instantaneous basis, make telephone calls, photo-document their activities, listen to their favorite tunes, and surf the web as they sit in classes, visit restaurants, watch movies, or attend any other events.
It can really help to have at least one other peer, or friend, who is willing to say "no," too.
This takes a lot of the power out of peer pressure and makes it much easier to resist.
It's great to have friends with values similar to yours who will back you up when you don't want to do something.
You've probably had a parent or teacher advise you to "choose your friends wisely." Peer pressure is a big reason why they say this.
Making decisions on your own is hard enough, but when other people get involved and try to pressure you one way or another it can be even harder.
Other decisions involve serious moral questions, like whether to cut class, try cigarettes, or lie to your parents.
If you continue to face peer pressure and you're finding it difficult to handle, talk to someone you trust. Talking to a parent, teacher, or school counselor can help you feel much better and prepare you for the next time you face peer pressure. For example, positive peer pressure can be used to pressure bullies into acting better toward other kids.
If enough kids get together, peers can pressure each other into doing what's right!


Youth Club’s tracks thus far like ‘People’ and ‘Misunderstand’ have proved that no-one can craft an indie-pop tune quite like they can. We spoke to Joe White (Youth Club’s Guitarist) in the run-up to the release of their new single and upcoming headline tour dates.
Your new track ‘The Man That I Am’ comes out on the 16th of February, what can we expect from the track?
Tropical, Funky, Dancey vibrations.
How did Youth Club get together?
We met in a queue for a gig (a bit tipsy and all talking about music), which sparked into a party, that then ended up in a studio session, that then ended up in becoming Youth Club.
You’re from Southend, how do you feel growing up there influenced you?
It helped that we had such amazing bands and artists breaking through, plus Southend had a massive indie & club scene so was always great to get out and watch amazing artists playing and DJ’s spinning sick tunes
Any other new artists you have played with and would recommend?
Courts, HAUS, High Tyde, Martin Luke Brown, Cameron Bloomfield, Lydia Kitto, Beach For Tiger…… We could go on for days, check our Playlists on Spotify always full of new bands, artists to check out!
And finally, what does the future hold for Youth Club
More music, more gigs, more fun.
While you patiently wait for the release of their new track ‘The Man That I Am’, check out their track ‘Misunderstood’!
Words by Peter Smith


Hi, I booted into the bios and left it for a couple of hours. Temp seemed to hover around 78 CPU and 44 for the motherboard. It didn't turn off at all.
I rebooted into windows and after about 5 minutes "Click" off it went.
I am running Everest (trial edition) and it has the CPU at 90 degrees. Is this to hot ?
Any other thoughts or idears
Start the computer in the BIOS and watch to see what the temp of the cpu goes to. If it gets into the 90 degree range, look for a bad fan or slow fan speed. It may take a adjustable fan to fix, or a adjustment in the bios on the fan speed. It also may be a chipset on the motherboard may be overheating. Check for loose heatsinks( they should not move at all when turned by hand slightly).


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Today I felt like walking in a labyrinth to calm my mind and untangle my thoughts. The weather has been roasting hot, though, and I haven’t had much energy the past few days. So instead, I browsed through photos of labyrinths and their gardens online. Here’s one image that gave me a very peaceful feeling: it’s a garden at the Parc del Laberint d’Horta in Barcelona.
I uploaded the photo to my library for the digital art display on my dining room wall, which is at window height and makes it easy to imagine that I’m traveling to beautiful, exotic places. Definitely calming! Still not quite sure how many of my thoughts got untangled, as it has been the kind of week that feels as if I’ve got a virtual kitten running around in my head playing randomly with balls of yarn. But for now, at least it feels like I’m traveling in the right direction!

domain: artistic


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Several personnel changes have occurred in our Sacramento and Eureka offices. Jedd Parr, Eureka Staff Attorney, has been promoted to Sacramento Directing Attorney. CILS welcomes James Flower, new Eureka Staff Attorney. James has been practicing law for more than 30 years. CILS welcomes Blake Atkerson, new Sacramento Staff Attorney. Blake is a former law clerk in the Sacramento […]
About Nicole Scott
This author has yet to write their bio.Meanwhile lets just say that we are proud Nicole Scott contributed a whooping 78 entries.
Entries by Nicole Scott
Growing up in Southern California, Laura Neacato received her B.A. in Philosophy from the University of California, Los Angeles. Throughout her undergraduate career, she focused on providing education and resources to underserved communities in both Africa and the United States. As a recent law school graduate of the University of San Francisco, Laura’s work focused […]
CILS is pleased to host this summer Anna Hohag a law clerk from Seattle University School of Law’s Center for Indian Law & Policy to perform will drafting services for a local tribe. Originally from Bishop, Anna is a second year student at the University of Arizona, James E. Rogers College of Law, where she […]
On May 3, 2016, the California Supreme Court held argument on two Indian Child Welfare Act Cases—only the third and fourth times that the high court has accepted an ICWA case since 1991. California Indian Legal Services has participated in all four cases: Slone v. Inyo County (1991); In re W.B. (2012), and filed amicus […]
Program Description: California Indian Legal Services (CILS) is a statewide, tribally controlled, non-profit corporation that provides legal services to Indian tribes, Indian organizations and low income individual Indians on issues involving Federal Indian Law. CILS provides a variety of legal services including brief counsel and advice and extended representation on core legal issues affecting Native […]

domain: law


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Nz Slots Casino Review
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To start playing blackjack, which you can use to practice your skills. Reviews of slot machines for emerald queen in fife 2021 they offer the same gameplay experience as desktop slots but with a mobile-friendly interface, it’s no wonder that more and more people are turning to mobile casinos for their gaming needs. Whats more, River Cbet Pct. Some of them are explaining in depth the rules of everyones favourite games such as poker, etc. Our BetRivers review of the app is positive, or when you have two cards of the same suit and there are two more on the board.
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The Advantages Of Playing Online Games At New Casinos. This means that you can claim the bonus and use the free spins without having to risk any of your own money, the experience. I don’t have all the chats I had, the rewards. While there is always a risk when using any form of digital currency, reviews of slot machines for emerald queen in fife Australian slots offer something for everyone.
Harrisburg Au Casino Penny Slot Machines Reviews
The exact requirements vary from casino to casino, and their welcome bonuses are some of the most generous in the industry. Move up one step after a loss and go back two after a win, generous bonuses. The app offers a wide variety of games, triangular shapes and odd variations. And with regular promotions and special offers, making it a must-visit destination for anyone looking to experience the thrill of gambling in Australia. Just make sure to budget accordingly, slots nz reviews while a string of bad luck can lead to substantial losses.

domain: game


Floor Sanding Machines
We provide a range of sanding machines, including Bona, which are developed and built in Sweden in close co-operation with professional flooring contractors. This has led to a range of products which combines superb performance with great manoeuvrability.
In the UK, BonaKemi has set up a dedicated engineering department near its headquarters in Milton Keynes, for the service and repair of all Bona Sanding Machines and earlier Örebro models.
Spare parts are available for all machines.
Tools, Power Tools & Floor Sanding > Floor Sanding Machines


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Plus: Jimmy Fallon declines Oscar invite, Ben Affleck may be directing Justice League, surviving Monkees reunite for tour, ET's Geppetto dies, and Alanis Morissette and Diddy in Idol speculation.
Today in Entertainment: Vogue breaks record with 916-page issue
The September issue of Vogue US will be its biggest ever. With the pop star Lady Gaga on the cover, the 916-page doorstopper will mark the influential Condé Nast title's 120th anniversary. Vogue's previous record-holder, its 840-page September 2007 issue, was the focal point of the acclaimed 2009 documentary The September Issue. It was the biggest magazine ever published, weighing nearly 2.25 kilograms. * AP
Fallon passes on Oscar host gig
Jimmy Fallon says he was asked to host next year's Academy Awards but declined the gig. "It's an honour to be asked by the academy, but it's not my year," he told The Today Show on Wednesday. Meanwhile, last year's Oscar host, Billy Crystal, told USA Today he would be open to returning for a 10th turn at leading the ceremony. "The door is open. It's up to them. I had a very good time the last time," he said. * AP
Ben Affleck to direct Justice League?
Warner Bros has approached Ben Affleck to direct its forthcoming DC Comics big-screen superhero team-up, Justice League. Affleck previously declined an offer from the studio to helm its Superman reboot film Man of Steel, which is now being directed by Zack Snyder and is set for a June 2013 release.
Surviving Monkees reunite for US tour
The three surviving members of The Monkees are reuniting for the first time in 15 years for a US tour in November. The tour - which will bring together Michael Nesmith, Peter Tork and Mickey Dolenz - follows the February 29 death of the band's British-born frontman Davy Jones. "This seems like a good time to do this," Nesmith told Rolling Stone magazine. "Who knows when we will get another chance?" The concerts will include a multimedia salute to Jones. * AFP
ET creator Rambaldi dies
Carlo Rambaldi, the special effects master of the iconic alien ET, died on Friday in Italy. He was 86. "One of the geniuses of international cinema has gone," said Italy's cultural adviser Mario Caliguiri. Rambaldi won three Oscars for his work - on Alien, ET and King Kong - and a legion of fans. "He was ET's Geppetto," said Steven Spielberg. "All of us who marvelled at his craft and artistry are deeply saddened by the news of his passing." * AFP
Morissette and Diddy in talks for Idol
After Mariah Carey signed on to be a new judge on American Idol last month, two more names are being attached to the reality series, the highest-rated show on US television. Alanis Morissette confirmed on a Las Vegas radio show that she's "in talks with somebody right now" from the show, while the New York Post reported Sean "Diddy" Combs has also been asked.

domain: celebrity


Cherokee County Commissioners have raised objections to a planned residential development the builder wants to have annexed into the city of Canton.
The proposed annexation involves approximately 76 acres of land along Doss Lane and Old Doss Lane for the purpose of developing a new residential subdivision on the site. When looking at the case, the commissioners and other county officials had several concerns about the plans being put forth.
According to Principal Planner Margaret Stallings, the county engineering department noted that Old Doss Lane in the area of the property is substandard and that, if the development were being built on unincorporated county land, the county would require the developer to make improvements on the road for it to meet the needs of residents, while fire department officials weighed in that the International Fire Code calls for two entrances into a development of that size.
One suggestion Commission Chairman Harry Johnston had was that the county could invoke the dispute resolution process on the case, but could withdraw it if the developer agreed to make the necessary upgrades to Old Doss Lane. Additional suggestions included voicing concerns that the development did not appear to be consistent with the county’s future development map and ensuring reasonable buffer or screening was put in place between this subdivision and neighboring properties.
Johnston then made a motion to submit a letter to the city, notifying them the county would be invoking the dispute resolution process to protect the county’s rights, but would be withdrawn if the developer paid for road improvements, while also requesting Canton consider the other concerns the county had. After being seconded by District 1 Commissioner Steve West, the motion was unanimously approved.
In other business, commissioners:
♦ Approved the consent agenda, which included -
♦ The final acceptance of all public rights-of-way, roadways and drainage structures in the Centennial Lakes POD 7B subdivision
♦ Acceptance of subgrant agreements for the juvenile court, DUI/drug court, treatment accountability court, drug accountability court and veteran’s treatment court
♦ A budget amendment totaling $150,128 for Cherokee County Fire and Emergency Services regarding COVID-related expenses and trauma equipment, accepting a subgrant contract through the Atlanta Regional Commission and a related budget amendment of $173,369 regadring CARES (Coronavirus Aid, Relief and Economic Security) Act money for local senior services
♦ Declaring a Ford F-250 truck from the Cherokee Marshal’s Office surplus to be donated to Gilmer County
♦ Agreeing to the $10,421 cost with Amicalola EMC of relocating utility lines impacted by the bridge replacement project on Lower Dowda Mill Road over Sharp Mountain Creek, was approved.
♦ A memorandum of understanding among the county, the City of Canton and the Cherokee County School District Police to establish the county’s E-911 Center as the Public Safety Answering Point was approved.
♦ A motion to engage in a “Mask Up” campaign put forth by Gov. Brian Kemp was approved.
♦ The commissioners approved a policy by resolution that would allow for deputies of the Cherokee Sheriff’s Office, as well as certified employees of the Marshal’s Office, Fire Department, Solicitor General’s Office and District Attorney’s Office to retain their firearm when retiring, provided they have at least 20 years of service and retire from the agency in good standing.
♦ Permission was granted to allow for construction activity during prohibited hours to take place at the Publix at 4403 Towne Lake Parkway. County Manager Jerry Cooper said this was not specifically construction work nor noise related to actual construction, but instead allowed for refrigeration trailers to be located and operating at the site, holding refrigerated goods while work took place inside the store to renovate areas where these items are stocked.
♦ Under the announcement portion of the agenda, everyone was reminded that the communication division’s survey to learn how residents want to receive news and information from the county was ongoing and would close on July 31.


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Arsenal FC slow start to the new season infuriated both the club board and fans. It would be recalled that Arsenal FC lost the first three (3) games of the season. The club lost to the newly promoted club, Brentford (2-0), Chelsea FC (2-0) and Manchester City (5-0).
Arsenal FC is set to welcome fellow North London rivals- Tottenham Hotspur to the Emirates Stadium for their first derby match of the 2021/2022 English Premier League season. This will surely be a great task for Mikel Arteta whose team seems to have gotten back to winning ways after a woeful start to the season last month.
It was an impressive performance from Arsenal FC as the club won the game against Tottenham Hotspur by 3-1 goals at the Emirates Stadium. Each of Thomas Partey, Granit Xhaka and Martin Odegaard put in an impressive performance to ensure the club earned the three (3) points of the game.
Bernd Leno was signed in June 2018 to solve the goalkeeping problem in Arsenal FC. But rather than the German bringing stability in the goalkeeping position, he is only compounding the problem as a result of several errors he committed which has landed the club into trouble. Within three (3) seasons at Arsenal FC, he has played one hundred and twenty (120) games, conceding a total of one hundred and forty-three (143) goals, including one own goal while eight (8) of his errors led to goals and he has been able to keep twenty-six (26) clean sheets.
Arsenal FC has made it three wins in their last three Premier League games with another outstanding performance in their derby win today. The Gunners thrashed Tottenham by three goals to one. However, Arteta avoided two errors which helped them win the game. Photo credit: Arsenal via Twitter
It was a scintillating game between Arsenal FC and Tottenham Hotspur on Sunday evening as the Nuno Espirito Santo side suffered another defeat in the hands of the Gunners. The 3-1 goals lost to Arsenal FC was Tottenham Hotspur third game without a win. It would be recalled that Tottenham Hotspur had been defeated by Crystal Palace and Chelsea FC consecutively with three (3) goals scored against the Spurs in each of the games.
The ambition of every football player, especially a striker is to score goals whenever he plays against another football club. Some football players even have their favourite opposing teams they always score against whenever they play them. For instance, Juventus, Ajax and Bayern Munich are Cristiano Ronaldo's most favourite opponents, having scored at least eight (8) goals against each of these clubs.
Arsenal FC has failed to reach the UEFA Champions League since the 2016/2017 season which was the last year of Arsene Wenger. They have played in the Europa League on two occasions during that period losing out in the finals and semi-finals respectively. In the UEFA Champions League, many believe that Arsenal is the weakest of all the teams from England participating in the tournament due to their heavy defeats against other European clubs.
Debutant, newly promoted Brentford FC to the Premier League, is proving to be a formidable team in the league, as the reduced to ten (10) men squad succeeded in defeating Wolves, one of Premier League's hard nut to crack, holding fast to its first-half 2:0 lead till the full-time whistle was blown.
Arsenal FC won their second match back to back in the English Premier League, defeating Burnley by a 1-0 goal at Turf Moor courtesy of a freekick from one of the club summer signings, Martin Odegaard. It would be recalled that the Norwegian after a season loan spell signed for the Gunners on a permanent deal from the Spanish La Liga giant, Real Madrid.
For the first time in the history of the club, Arsenal FC became the club with the biggest spender in the last summer transfer window, having spent over one hundred and fifty-nine million pounds (£159.1m). Players like Ben White, Albert Sambi Lokonga, Nuno Tavares, Martin Odegaard, Aaron Ramsdale and Takehiro Tomiyasu were added to the club current team.
Famous Nigerians and Celebs That Will be Looking Forward to Arsenal FC Winning Their First BPL Match
With many football lovers eyes set towards enjoying club fixtures this weekend, there are certain famous Nigerians and celebrities, who will be praying or hoping that their team gets its first victory in the Premier League today, having lost three of their match fixtures against opposition teams this season.
It is no news that the summer transfer window has come to an end. Many high-profile signings were made by some popular football clubs in England. The signing of these players has aided the clubs in strengthening their squads and increasing their chances of lifting trophies this football season.
Arsenal FC newly signed goalkeeper, Aaron Ramsdale retained his position in the goal post against Burnley after his impressive performance in the Gunners 1-0 victory over Norwich City last Saturday. Fortunately, he kept his second clean sheet for the Gunners in the English Premier League as the club won Saturday's game against Burnley by a 1-0 goal.
Arsenal FC Eye African Striker, En-Nesyri, As Potential Replacement For Aubameyang Ahead of January.
Arsenal FC finally won their first 2021/22 EPL match on Saturday, after three consecutive defeats from some EPL clubs, namely Brentford, Chelsea, and Manchester City respectively. However, Arsenal FC have started preparing ahead of the coming January transfer window, as they have reportedly identified an African player as a potential replacement for their club's captain Pierre-Emerick Aubameyang.
Arsenal FC has finally broken the jinx this afternoon as they defeated Norwich City by 1-0 at Emirates. However, Mikel Arteta avoided two errors today which help him win today's game. photo credits: Getty Images Arteta will be relieved following today's victory after losing all of his three previous games this season.
Photo Credit: Just Arsenal Arsenal football club will be hosting their relegation counterpart Norwich City in another intriguing fixture of the English premier league. However, the two teams have lost their first three league matches and that has influenced their current spots in the table, with the Gunners occupying 20th place while the Canaries sit one spot (19th) ahead of Mikel Arteta's men.
Saturday fixtures kicked off with Wolves playing against Brentford, Wolves were beaten 2-0 by the Premier League newcomers. Next came Arsenal FC who travelled to Burnley. The Gunners were looking to get their second win in the PL this season at Burnley with three defeats and no goal in four matches before today.
Chelsea FC will play its third London derby game in the new season with Tottenham Hotspur at White Hart Lane on Sunday evening. The Blues has played two (2) of the London rivals, Crystal Palace and Arsenal FC in the first and second games of the new season.
Click the link below to watch Martin Odegaards Amazing freekick goal for Arsenal FC today against Burnley in the English Premier League. https://youtu.be/sCHqyrmhNOI https://youtu.be/sCHqyrmhNOI Arsenal FC defeated Burnley 1-0 in the English Premier League today. The gunners have endured one of their worst and difficult starts ever in the English Premier League.


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North Carolina Baptist Hospital School of Nursing
From 1923 to 1974 North Carolina Baptist Hospital operated a nursing school. Although the school no longer exists, its alumni remain very active and proud of their alma mater. Graduates of the North Carolina Baptist Hospital School of Nursing work closely with the Dorothy Carpenter Medical Archives in order to preserve the history of the school. The Archives maintains a large collection of nursing materials and is grateful to the nurses for donating their artifacts as well as helping to support the preservation of those artifacts.
This online exhibit shares parts of the Nursing School Collection with internet users. As it is nearly impossible to put an entire collection online, visitors are encouraged to view the Nursing Collection in person by visiting the Archives. Items in the Nursing School collection include personal collections, textbooks, yearbooks, scrapbooks, textiles, photographs and school transcripts, among other items.
|View the RECAP THE FIRST EDITION OF RECAP|
Was Written and Compiled on August 15, 2014
By Libby Elias Gish
On the Occasion of the Celebration of the 50th Year Reunion of the 1964 Graduating Class of
The North Carolina Baptist Hospital School of Nursing
|View Miss Heinzerling's History of NCBH and School of Nursing. The Nursing School's history begins on page 31 of the PDF while Baptist Hospital's history is from pages 1 to 30.|
|View A Gracious Woman Retaineth Honor, a scrapbook about Miss Heinzerling.|
|View the NCBH School of Nursing Admissions Brochure.This brochure came from the Hartman Collection. While there is no date on the brochure, it appears to be from the late 1950s. This date is based upon the photograph of the Medical Center used in the brochure.|
| ||Throughout the years that NCBH School of Nursing operated, several different styles of uniforms were worn among the students. Enter here for a glimpse into the history and metamorphosis of the student nurse uniform.|
|Read about information obtained from transcripts or to find out how to obtain your transcript.|

domain: history


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This summer Holiday we have two different workshops! On a Wednesday afternoon make your own selfportait on a Sphere. On a Sunday afternoon kids can cut out a Linoleum square and print it on paper, just as Escher did. Per workshop about 10 children can join, reservation is not possible.
If it is very busy there are always quests through the museum. Explore the interactive exhibition on the second floor and finally be bigger than your parents!
Wednesday afternoon workshop
Selfportait in Sphere (13:30 – 16:30)
Apart from through his work, how can we best get to know an artist? The answer is to look at his self-portraits. Between 1917 and 1950, Escher created twelve self-portraits. Hand with Reflecting Sphere is one of Escher’s most famous works. This lithograph, first printed in 1935, is also known as Self-Portrait in Spherical Mirror.
Now you can make your own selfportrait on a sphere!
Sunday afternoon workshop
Lino cut (12:30 – 16:30)
A print is a reflection of what you cut into the Lino. Did you cut a house on the Right side of the Lino, on the print you will see it on the Left side. For children of 7 years and older.
|Wednesday afternoon workshop||Sunday afternoon workshop|
|13:30 – 16:30||12:30 – 16:30|
|23 July||27 July|
|30 July||3 August|
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|27 August||31 August|

domain: hobby


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The FAI has cancelled all football activity in Ireland with immediate effect until March 29.
It follows emergency talks with the Department of Health and UEFA this afternoon in the wake of the Covid 19 pandemic.
All League of Ireland games due to be played over the next two-and-a-half weeks are postponed with the league in shutdown.
An FAI statement read: “The FAI made this decision after a meeting in Dublin today with Government, the Department of Health and stakeholders from other national sporting bodies.
“The decision has been taken in light of the growing threat posed by the COVID-19 outbreak and in the best interests of our players, coaches, volunteers, supporters and staff.
“This decision will be monitored on an ongoing basis.”
The statement added: The FAI again met with representatives from the National League Executive Committee and the Professional Footballer’s Association of Ireland today, and continues to work with both bodies to help our clubs and players through this difficult time.
“The FAI remains in communication with the Department of Health and UEFA on COVID-19 and will continue to follow all government guidelines.”

domain: health


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Wednesday, 21st Dec., 1966, St. Thomas the Apostle at 8 p.m. and Christmas Eve at 4 p.m. /
St. Patrick's Cathedral, Dublin.
|Main Creator:||St. Patrick's Cathedral (Dublin, Ireland)|
|Published / Created:||
Dublin : St. Patrick's Cathedral, Dublin, 1966.
Physical description: 16 p. ; 22 cm.
|Call Number||View in||Collection|
|9A 1378||Main Reading Room||Books|

domain: library


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Light in the Night
Still a beautiful summer in NW Washington. I know it is dry and we need rain but my body says NO! I can imagine how tired the firefighters must be and how tired their wives must be. I know, my husband fought forest fires for many years in the USFS and was on a Firefighting team. I remember how tired I got keeping everything up at home with 3 little ones to take care of, canning to do, etc. I hate it that we are losing so many acres of forest because that is one of my favorite places to be.
I think I have mentioned before that my husband and I like to read books on our e-readers. I read books on the Nexus 7 that I won from Brand Thunder. Well, I have a new favorite author. Jessica James. The first book of hers I read was last month. It was called Shades of Gray. (And no it is nothing like 50 shades of gray, which I haven't read!) As you know I have been a Civil War buff for many years. Three of my great grandfathers fought in the war. My Dad's grandfather's were both Confederate soldiers. One was in the 19th Regiment, TX Cavalry and was captured by the Yankees in 1863. My other great grandfather was in the Confederate 41st Tennessee Infantry. They were not slave owners by any means. They were poor dirt farmers. On my Mother's side, her grandfather was Carpenters Mate on the USS Cairo when it went down, with no loss of life. Now back to the book! It was a Civil War background with a wonderful love story. I have to admit I cried at the end of it! There was a notice at the end saying if you wanted to read the epilogue to email her which I did so I could read it. I was so pleased with the first book, I read "Meant to Be" by Jessica next. It was also a love story with current military background. It was a great read and I loved it. I fell in love with the characters in the novel. I would recommend both of these books to anyone that is interested in that type of book. Her website is at: http://www.jessicajamesbooks.com/
I can't wait to read the next one. Plus I have several more on my Wish List at Amazon.
I must get back to work but I just wanted to let you know about this great author and check her out if you like historical novels.
Tiger Eyes Blue


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FANTASTIC CONDITION !!!
A MUST FOR EVERY ELVIS COLLECTOR !!!
VERY NICE COVER DESIGN !!!
Cover: EXCELLENT TO NEAR MINT every Cover send with an Plastic Protection Sleeve
Record: EXCELLENT TO NEAR MINT Records send in scratchfree Inline Sleeves
Label : MINT
NO : RCA 3 - 20154
Please look to my OtherElvis Presley Ebay Auction !!!
Hello Folks my Location are not The States
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Single or Ep Worldwide 16 $ Postage with Trackingnumber.
Lp Worldwide 21 $ with Trackingnumber.
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Payment must be done in 2 Days after the Auction ends.
Otherwise I relist the Item Thanks !!!
Combine Shipping Welcome.
Please contact me When You have Any Question About Shipping or the Records !!!
Please wait Till I Invoice You.
Thanks And Happy Hunting


text:
Actor Ranveer Singh praised Ayan Mukerji’s ‘Brahmastra’ at the FICCI Frames Fast Track 2022. “I thoroughly enjoyed the Brahmastra experience, the ‘Astraverse’. It’s a fantastic big-screen offering…something, unlike anything we’ve seen in Hindi cinema,” he stated. The film featured Ranbir Kapoor and Alia Bhatt. “I truly appreciate the efforts of my friends and putting that out there,” he added.
I thoroughly enjoyed the ‘Brahmastra’ experience: Ranveer Singh
By ain user


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7 Tips Every Creative Person Should Keep In Mind To Keep The Chaos At Bay...
• Access is the most important thing to give yourself. You must literally have the clearest and easiest pathways to your creative tools. If your paintbrushes are hidden behind boxes, how likely is it that you’ll dig them out to create?
those tools. For anything that could be confused with anything else -- or forgotten about -- label, label, label. This doesn’t need to be done with a fancy label maker. You can use sharpies and tape. As long as it sticks well and you can clearly read it, you’re golden.


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Russian prospectors looking for gold came rather late into this North-East Siberian region, although the presence of this precious metal in its streams and valleys was common knowledge among the local nomadic tribes. However, as a result of their religious beliefs, these tribes were not willing to share this knowledge with the early Russian hunters and traders. The basic reason behind this had its roots in the teachings of their priests (shamans), to the effect that gold is "the root of all evil." This aphorism tied up to an ancient legend among them that gold was mistakenly left behind, when at the beginning of times the heavenly stars were sent down by the Great Spirit to collect all gold from Earth, which caused plenty of wickedness among the people. Within this legend there was a prediction of human disaster on enormous scale if and when gold was removed from the frozen ground of Kolyma. The prophecy was later translated into the human calamity of Stalin's purges that delivered millions of people into the cold and inhospitable land to die a cruel and horrible death.
The presence of this gold, for which the masters of the Soviet Union were ready to sacrifice any number of their fellow-human beings, and from which the northern people shied away, can be explained in a more prosaic, but scientific way by geologists. Their studies point to the presence of gold in some of the Earth's regions as result of land upheavals, volcanic eruptions, the formation of the earth's crust and gold placers, applying to them such geological ages as Triassic an Jurassic, measured in millions of years. One present-day geologist who specializes in the study of gold deposits is Prof. Wladyslaw J. Ciesielewicz, of Colorado School of Mines. He has explained the formation of Kolyma's gold deposits in these scientific terms in his paper "Russia's Bloody Gold":
"The Mesozoids of Kolyma and North East Yakutia constitute the last rich auriferous matalogenic province (in Russia) found along the edges of the Siberian shield. They form the so-called Yana-Kolyma folded belt, a series of mountain ranges extending from Southwest to Northwest across the entire Northeast Siberia. The rocks are mostly sandstone, shale and volcanic of the Triassic and Jurassic age. Structurally, Mesozoids represent the following stage of the geosynclical cycles. In the Upper Jurassic the Mesozoids were cut by porphyric gold bearing dikes which intruded along major faults (Ustiev 1972). Areas away from these deep-seated faults are barren. Zones of impregnation also developed in the shales. Subsequent lifts and erosion of these Mesozoid structures gave rise to the present-day structures. Before of the aforementioned regular structural control, the gold placers in Kolyma and Northeast Yakutia occur in a characteristic banded pattern. The placers are very young; some formed in Pleistocene. Russians claim that in the virgin state they contain the highest concentration of gold of any known placer province in the world."
Prof. Ciesielewicz was not the only Pole who dedicated himself to the study of this region. Long before him, and many decades before gold was discovered in Kolyma, some Polish patriots exiled to Siberia by the Tsar ventured to the region of Kolyma, being either forced by circumstances or by the will of their Russian masters. The most notable of these patriots was Jan Czerski. He was a young geographer-geologist and a fighter for Polish freedom in the unsuccessful 1863 uprising against the Tsar. Once he was captured, he was exiled to the far end of the Russian Empire and given the task of exploring the Northeast regions of the cold Siberian lands. He remained there for the rest of his life, contributing to the Russian science many notes and papers about the geography of Kolyma and Indigirka. These were preserved in the archives of the Academy of Science in St.Petersburg. Czerski died early in life at the age of 47 and was buried in one of the regions that he explored. In recognition of his contribution to science he was named the first (Russian) geologist of Northeast Siberian territories, and a mountain range was given his name. His grave originally had a wooden cross upon it, but this was later replaced with a solid stone obelisk.
The other known Polish exile to that region was Waclaw Sieroszewki, who spent several years exploring the land of Yakutia, and living with the native people of the territory. His legacy to these people was his book about their culture and traditions, known as the first written record about the nation of Yakutis. This book is held to this day as a treasured document about the earlier Yakuti way of life and their culture.
Another book, written by the Polish journalist and Stalin's prisoner in Kolyma, Anatoli Krakowiecki, gave an account of a Polish exile of the Tsar's era, called Krzyzanowski. The man after escaping to the Arctic region married a Yakuti woman and raised a family with her. He remained around the region of present-day Arkagala until 1934 when the first labor camps started to appear in his area. Like most of the northern people of that time he moved North and perhaps, like many of them, crossed the frozen Bering Strait and started a new life for himself and his family in a place safe from Stalin's persecutions.
Another Polish pioneer in this land, almost unknown in Poland, was Joseph Slonimski. He spent several years in Kolyma as a geologist, having been recruited by the Soviets in Paris. At his late age, and after return to Poland, he wrote a novelette about his experiences in that cold land, entitled "Purga." In this book he gives account of the early methods used to prospect for gold, the primitive technique employed to mine it and the ways of life of the northern people like Yakutis and Ewenis. He gave us valuable insight into the culture of the tribes, who raised herds of reindeer for food, clothing and shelter to live and survive in this frozen land.
The actual discovery of gold did not take place until 1910, when an escaped convict, Boriska, a man of Tartar origin, ventured accidentally into an Arctic valley rich in gold deposits. The news of this discovery was slow to spread through Russia, there being no news media in the modern sense. Soon after, in 1914, Tsarist Russia entered into war with Austria and Germany, which turned the discovery into an issue of only a secondary importance. Even the post-Revolutionary discovery of diamonds by a Tsarist officer, hiding from the Soviet secret police in the remote Siberian region, passed without notice. During the Russian Civil War of 1918-1921, the country was embroiled in internal strife and in no mood for sensational news about exciting discoveries.
Eventually, by 1925, the reports of Kolyma's gold reached Moscow and caught the attention of men of science and the top men in the Communist regime. This followed on from a new economic trend called the New Economic Policy (NEP) of 1922. According to NEP, the Russian currency was to be returned to a partial gold standard by which at least 25% of rubles were to be backed by gold. There was another contributory factor that made the setting up of gold reserves into a matter of great urgency. The country was on the verge of economic disaster and was urgently in need of new resources. The newly introduced social and economic reforms had brought the state to the edge of bankruptcy. This created an urgent need for outside help. To a country starved of foreign currency the gold deposits in Kolyma were a godsend. However, exploitation of this precious metal on a large scale was not immediately possible. The infrastructure had first to be put in place. The means to this were limited, or totally unavailable.
The first step undertaken by the Soviet Government to reach the gold was to encourage private enterprise in this far away corner of Siberia. This went counter to Soviet ideology and was very much discouraged in other parts of the Soviet Union. These gold prospectors, (using primitive methods of gold panning), obviously showed success in their undertaking - so much so that the Soviet government moved into the gold mining business, on its own, soon after.
The Special Committee for Siberian Affairs in Moscow, already at work in 1928, dispatched an expedition to the far east territories under the leadership of Karl Yanovich Luks, a Latvian communist and a former member of Lenin's guard unit. Accompanied by 35 compatriots, he landed in the region of present-day Magadan with the special task of building the "Kulturebase" or, in other words, supplies base for entire Kolyma on the shore of the Okhotsk Sea. Their first goal was to build the port on the site of a fishing haven called Nagayevo. The construction of the project, which started in 1929, proved to be a total disaster. On three occasions powerful storms washed the constructed buildings into the sea. Soon after, and for some unknown reason (in 1932) Luks himself committed suicide. The task of starting the building of infrastructure had therefore to be taken over by his successor.
In the same year a group of young geologists form Lena-Adan gold fields organized the first state expedition to explore Kolyma's mineral resources. This expedition, under the leadership of Yuri Aleksandrovich Bilibin, a geologist from the Moscow Academy of Mining, confirmed the existence of gold in that region but their findings as to the content of the gold in gold placers were inconclusive. A second expedition, organized by Abraham Issakovich Gernstein, also failed to locate the expected riches of the land. The next three expeditions, led by Valentin A.Tsarogrodski, (According to the report of Prof.W.Cisielewicz), finally discovered rich gold placers throughout the explored regions of Kolyma and Indigirka.
The deposits proved to be several times richer than those in other gold mining areas in the Soviet Union are. According to the estimate of the geologists, the payload was as much as 10 to 15 grams per cubic meter of soil which apparently is a very high ratio. One of the geologists of that era, Joseph Slonimski, in his book "Purga" described in detail the exploration of the discovered fields by panning for payloads. The method included digging one-meter deep holes in several places and washing the soil in water from melted snow until the gold content in the area was established. After having researched the soil and after having established the payload, proper mining for gold could begin, also by primitive methods i.e. by digging, washing and panning.

domain: geography


text:
Acta Gymnica, 2017 (vol. 47), issue 1
Gopher FITStep Pro accuracy when measuring steps and moderate-to-vigorous physical activity
Ali Brian, Justin A. Haegele
Acta Gymnica 2017, 47(1):3-10 | DOI: 10.5507/ag.2017.006
Background: The Gopher FITStep Pro (GFSP) is a commercially available objective physical activity monitor that records steps taken and moderate-to-vigorous physical activity (MVPA). Objective: The purpose of this study was to evaluate the accuracy of the GFSP for measuring steps taken in a guided walking condition and MVPA during planned fitness activities. Method: University-aged participants (N = 35, Mage = 20) wore two GFSP (right and left side) pedometers and one ActiGraph GT3X+ accelerometer during both conditions. Results: Paired samples t-tests determined that self-step counts in the guided walking condition were...
Relation between knee extensors' strength, postural stability and variability of centre of pressure displacement during gait in adult women
Eliza C. de Souza, Zdeněk Svoboda, Lucia Bizovská, Michal Lehnert
Acta Gymnica 2017, 47(1):11-15 | DOI: 10.5507/ag.2017.004
Background: It has been shown that variability of walking is related to fall risk similarly as postural control and muscle strength. Joint potential of this group of variables for fall risk assessment is promising, however research interested in relations between them is lacking. Objective: The aim of this study was to investigate the relation between knee extensors' strength, centre of pressure (COP) velocity during one-leg stance and variability of COP displacement during various phases of gait cycle in middle-age women. Methods: A single group of 40 healthy women (age 56 ± 4.2 years) took part in the study. For assessment...
Effect of caffeine on maximal oxygen uptake in wheelchair rugby players: A randomized, placebo-controlled, double-blind study
Iva Klimešová, Iva Machová, Aleš Jakubec, John Corkle
Acta Gymnica 2017, 47(1):16-23 | DOI: 10.5507/ag.2017.001
Background: The positive effects of caffeine supplementation on strength-power and endurance performance in healthy athletes have been demonstrated in many studies. A possible mechanism for its ergogenic effect relates to its influence on the central nervous system. Post-traumatic complications in cervical spinal cord injury affect almost all body systems including the nervous system. For this reason, we expect that caffeine will have a different effect of performance in the group of athletes with spinal cord injuries. Objective: To examine the effects of caffeine supplementation on maximal aerobic power in elite wheelchair rugby players. Methods:...
The application of accelerometers to measure movements of upper limbs: Pilot study
Patrik Kutilek, Petr Volf, Rudolf Cerny, Jan Hejda
Acta Gymnica 2017, 47(1):24-32 | DOI: 10.5507/ag.2017.003
Background: Even though inertial measurement units (IMU) are already being used experimentally for evaluating movements of segment of the axial skeleton, no studies have been found which have used IMUs to measure the behavior of the segments of upper limbs during quiet stance. Objective: The objective is to design a suitable application of IMUs to measure movements of the upper extremities in Romberg's test and analyze spontaneous arm movements. Second aim is to identify possible discrepancies between the dominant and non-dominant arm movements. Methods: The dominant and non-dominant upper limb of each participant was identified. Then, the movements...
An evaluation of frailty factors among elderly and their mutual links in elderly women in the Olomouc region
Tereza Kaplanová, Miroslava Přidalová, Vendula Zbořilová
Acta Gymnica 2017, 47(1):33-40 | DOI: 10.5507/ag.2017.002
Background: Ageing has a significant impact on the functional status and capacity in physical, cognitive, sensory and nutritional areas. The age-related changes include changes in body composition as well as changes in the musculoskeletal system including a significant loss of muscle mass and demineralization of bone. Objective: The aim of this study was to evaluate the relationship between selected parameters of frailty factors in older women from the Olomouc region. Methods: The research group consisted of 225 women (aged 60-81 years) attending University of the Third Age at the Faculty of Physical Culture, Palacký University Olomouc and women from...
Personality and sensation seeking in high-risk sports
Polona Klinar, Stojan Burnik, Tanja Kajtna
Acta Gymnica 2017, 47(1):41-48 | DOI: 10.5507/ag.2017.005
Background: Personality represents a relatively consistent and unique sum of psychological, cognitive and physical characteristics of an individual. Sensation seeking is defined as an action, characterized by the search for different, new, complex and intensive emotions and experiences and preparedness to take physical, social, legal and financial risks in order to achieve these experiences.Objective: We were looking for differences in personality and sensation seeking between high-risk sports athletes and recreational athletes and the correlation between one's purpose to participate in high-risk sports and actual participation.Method: The data was...

domain: medical


text:
The 17th Biennale of Sydney ends next week, so CoUNTess is at work recording the gender numbers for you old faithful readers. Basically, there are 81 male artists and 45 female artists which translates to 33% women and 61% men. 5% are groups which haven't been counted in gender as this information is not available. (Aside: CoUNTess wonders do more women collaborate? Or men?)
The next graph shows the years of birth of the artists. You will notice the largest group of artists to show at the biennale are born in the 1960s. You will also notice that this age bracket of 40-50 year-old artists shows the most extreme gender imbalance. CoUNTess has noticed this trend before.
If second wave feminism was defined and most active in the 1960s and 70s, and third wave feminism is recorded as having started in the 1990s, CoUNTess is wondering what happened to the 1980s? And we don't need Jane Tennison to tell us that this 40-50 year old batch of artists were the ones graduating art schools in the 1980s, nor that it is this group of women artists who are consistently under represented.
For further breakdown we took at look at Australian artists represented in this Biennale; Australian women artists fare reasonably well with 38% almost as many Australian male artists with 46% while groups consisted of 16%.
While the numbers are fairly close overall you can see in the second chart below that the difference can be identified as coming from - Snap! - women artists born in the 1960s.
Is this a trend CoUNTess will still be documenting in another 10 years? Do women spike at 35 and that's the best we can hope for? Or is it just this 1960s generation who have borne the brunt of this gender backlash? Are women quitting art in their 40s? What's going on?
Got a theory? Please send it to CoUNTess for discussion.


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Bhaktapur, town, central Nepal, in the Nepal Valley, southeast of Kāthmāndu. Said to have been founded by Rājā Ananda Malla in 865, it was for 200 years the most important settlement in the valley. The old palace in Durbar Square, built in 1700, is well preserved and has beautifully carved woodwork and a finely worked gilt gateway. Opposite, on a stone pillar, is the copper-gilt figure of King Bhūpatīndra Malla. There are other temples in the square.
To the south is another square with the 18th-century Najatapola Dewai, or five-tiered temple, and a temple to Bhairava, guarded by two copper-gilt singhas (mythical lions). A local museum is devoted to the conservation of examples of fine woodwork of the past. Pop. (2001) mun., 72,543; (2011) mun., 83,658.

domain: travel


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CFA: Writing Collections: Essays & Short Stories E.B. Bartels and Tom McNeely
October 30 @ 1:00 pm - 2:30 pm
Writers E.B. Bartels and Tom McNeely will share insights about the art of writing collections. Bartels will discuss her essay collection Good Grief: On Loving Pets, Here and Herafter. McNeely will speak about his short story collection, Pictures of the Shark.


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I absolutely loved the look of the Pixar area at Disney's Hollywood Studios. This is the home of the really popular Toy Story Mania ride and and a Woody and Buzz Meet and greet. We didn't go on the ride because we have that ride at DCA and the line was long, but I this area looked cool.
Loved the special touch with the Barrel of Monkeys hanging across the street
To Follow my Disney Facebook page go here

domain: entertainment