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Consumers Right’s Day Open House
Basseterre, St. Kitts – Nevis
March 27, 2015 (SKNIS)
In celebration of World Consumer Right’s Day, a grand open house was held last Friday, March 20th and was hosted by the St. Kitts – Nevis Consumer Affairs Department, under the theme: Helping Consumers Choose Healthy Diets.
The observance took place at the Consumer Affairs Department on Church Street under the watch of Director of Consumer Affairs, Paul Queeley who stated that the main purpose of the event was to highlight the function of the department, how it protects the consumers in the marketplace and to give residents good tips on how to be wise consumers.
“World Consumer Rights Day started in 1983 by Consumer International, which is the global voice for consumers, and was set up to bring about discussions on legislation that will protect consumers. The topics of discussion can be anything from cost of cell phone usage to food consumption. This year the focus is on how we can make healthy food more affordable to the consumers,” commented Director, Queeley.
During the Open House, numerous persons visited the Consumer Affairs Department where healthy meals, drinks and pamphlets on consumer tips for the purchasing of healthy foods and other basic items were available for the spectators.
One visitor, Janice Kelley of Boyd’s Village, said “the Open Day event is a very important move by the Consumer Affairs Department in an effort, to give residents advice on purchasing healthy food choices.”
In addition to the Open Day event, other initiatives celebrating the week of activities from Sunday, March 15 to Friday, March 20th were: a church service held at the Antioch Baptist Church in Basseterre, a radio program on ZIZ radio, a consumer affairs appreciation service at Port Zante and a consumer information program and giveaway on WINN FM radio.
Every year, Consumer International chooses a theme and organizes various awareness activities in coordination with Government departments.
World Consumer Rights Day is held annually on March 15th to commemorate an historic address by former United States President, John F. Kennedy, which outlined the definition of consumer rights for the first time by a World leader.


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Depression after a heart attack raises your risk for more heart problems, but lifestyle changes can help. Here's how to beat depression after a heart attack.
You’ve probably heard of the well-known risks for heart disease, including high levels of cholesterol, hypertension, obesity, and being a couch potato. However, researchers have found another factor that can significantly raise the odds of heart problems and potentially make symptoms of existing cardiovascular disease worse — depression.
“Patients who are depressed after a heart attack have a two-fold risk of having another heart attack or dying compared to those who are not depressed," said David Nanchen, MD, who heads the prevention center in the University of Lausanne’s department of ambulatory care and community medicine in Switzerland.
However, there’s good news: Lifestyle strategies can help heart attack patients not only learn how to beat depression but also potentially lower their risk of future heart problems, according to a study by Nanchen and colleagues.
Nanchen’s team used information compiled on 1,164 patients enrolled in the Swiss Acute Coronary Syndromes study in Switzerland to zero in on depression in heart patients. The research participants were assessed at the beginning of the study, and a significant number had symptoms of clinical depression.
"More than one-quarter of patients in our study reported symptoms of depression after their heart attack, which shows this is a big issue," said Nanchen. "Some had chronic depression, which started before their heart attack, while others became depressed as an acute reaction to the hospitalization and the event."
Nanchen and colleagues investigated whether controlling blood pressure and high blood cholesterol, cutting back on alcohol (for those who drank more than 14 alcoholic beverages a week), stopping smoking, taking recommended medications, and getting more physical activity had an impact on whether the depressed heart patients felt better emotionally a year later.
The researchers found that about 27 percent of heart attack survivors were suffering from persistent or new depression at the end of the study. However, 11 percent of those who were initially depressed were better. There were two main factors found in the people who were experiencing less depression — they exercised and, if they had been smokers, they had given up cigarettes.
Smoking cessation was the factor most strongly associated with an improvement in depression symptoms. In all, those who quit smoking were 2.3 times more likely to be less depressed after a year than those who were still puffing away on cigarettes.
Depressed patients who were already exercising at the beginning of the study also experienced greater improvements in depression symptoms over the course of a year compared to the heart attack survivors who were sedentary.
"While our observational study was unable to find an impact of exercise after heart attack on depressive symptoms, we did show that patients who were already physically active were more able to improve their depression,” Nanchen said. “We believe that the benefits of exercise after heart attack would be shown in a randomized trial, but such a study is difficult to perform for ethical reasons."
If you’ve had a heart attack, Nanchen advises working with your doctor to stop smoking, if you haven’t been able to kick the nicotine habit, and to develop a safe plan for increasing regular physically active if aren’t exercising.
Depression after a heart attack can lead to poor health choices such as skipping medical appointments, eating an unhealthy diet, and social isolation, which may partly explain the worse outcomes for heart attack patients who remain depressed, according to psychiatrist Manuela Abreu, MD, of the University of Lisbon in Portugal. "Cardiac rehabilitation with aerobic exercise can reduce depressive symptoms and improve cardiovascular fitness," she said.
It’s also a risk factor for suicide.
The main factor protecting against depression among heart attack victims is strong social and family support. The National Institute of Mental Health provides more information on the link between depression and heart disease, including how to recognize symptoms of depression.
March 02, 2020
Christopher Nystuen, MD, MBA

domain: news


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D’Relle West is the Father of the International House of West, a dance teacher and choreographer for the Molly’s Masquerade.
Please be aware that this is an 6-week course and participation in all the sessions is very much encouraged.
300 years ago, London’s Molly Houses were the first cross-dressing gay clubs in Europe. A precursor to the 20th century ballroom scene, the Molly Houses were spaces where working class men could go to for sex, gin, fiddles and fun.
Tue 2nd Feb, Tue 9th Feb, Tue 23rd Feb
Tue 2nd March, Tue 16th March, Tue 23rd March
Sessions will be led through zoom. full details will be provided after booking
These workshops are a part of the Heritage Lottery and Arts Council England funded project ‘Molly’s Masquerade’ at St. Margaret’s House, Bethnal Green. In memory of our 18th century queer ancestors the sessions will work towards a sharing at the Molly’s Masquerade Spring Gathering on April 1st, and the Molly’s Masquerade ball in summer 2021

domain: artistic


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Jung Woo Seok (정우석) is the main rapper, vocalist, and maknae of the boy group Pentagon under Cube Entertainment. Wooseok often grabs attention for being the Tallest in the group, and for having a deep voice. Moreover, Wooseok has collaborated with many artists such as Soyeon of (G)I-DLE and Lai Kuanlin.
He debuted as the maknae of PENTAGON on October 10, 2016 with the mini album "PENTAGON".
On February 22, 2019, Cube Entertainment announced that Wooseok would be debuting in a new unit project alongside labelmate and former Wanna One member Lai Kuan-lin. The unit, Wooseok X Kuanlin, made their debut on March 11, 2019 with the title track "I'm A Star" and debut extended play, 9801.
In October, Wooseok was confirmed as a contestant on the rap competition program Show Me The Money 9. During the 60 Second Team Trials, he received one pass and three fails from the producers, and was subsequently eliminated from the show.

domain: entertainment


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The French film director, Eric Rohmer, one of the leaders of the "New Wave" movement which revitalised cinema in the 1960s, died yesterday at the age of 89.
Mr Rohmer, an intensely private, even secretive man, worked almost until the end and made his last movie in 2007. He will probably be best remembered for his blend of sentimentality and almost literary fussiness and erudition in films such as Ma Nuit chez Maude (1969) and L'Amour l'après-midi (Love in the Afternoon, 1972)
Like several of his "New Wave" colleagues such as Jean-Luc Godard and François Truffaut, Mr Rohmer began as a writer and cinema critic before making his first film in 1959.
"It's not a labour to make films, it's a passion like gambling or fishing," he once said. "I never had a disappointment in making a film, I don't think I ever made a bad one." Despite his reputation as an almost academic film-maker, he was a great admirer of the style of the classic Hollywood movies of the 1930s and 1940s. He often paid tribute to his debt to Alfred Hitchcock, whom he regarded as the greatest director of all time.
Despite continuing to make movies, Mr Rohmer became reclusive in the last decade of his life, rarely giving media interviews or attending the great cinema occasions. His reputation as a generous and warm-hearted man survived, however. Contacted a couple of years ago by a British student living in Paris, he gave her hours of his time over several days and helped her to gain a first in her Cambridge dissertation. The subject? The films of Eric Rohmer.
He was born Jean-Marie Maurice Scherer in Tulle in Corrèze in south western France in April, 1920. After working as a teacher and writing a novel, he became a cinema writer and critic. In 1950, he founded La Gazette du Cinéma with Godard, Truffaut and Jacques Rivette, all of whom went on to make films of their own.
Mr Rohmer later became the editor of the Cahiers du Cinéma, the highly intellectual journal of the "New Wave" movement. Although there was not a single style or technique, the overall ambition was to bring a more individual, improvised approach to direction and turn away from the shallower forms of commercial film-making.
Mr Rohmer created his own production company in 1959. He always wrote his own scripts, pioneering the French "auteur", or director-as-sole-artistic-controller approach, which influenced – without ever completely taking over – the fresher Hollywood approach of the 1970s and 1980s. In 50 years as a film-maker he made 25 full-length features, culminating in L es amours d'Astrée et de Celadon in 2007.
His most successful film late in life was probably L'Anglaise et le duc (The Englishwoman and the Duke) in 2000, an experimental film set during the Terror of the French Revolution.
As a disciple of Hitchcock – about whom he wrote a book with French director Claude Chabrol – Mr Rohmer said that the secret of successful movie-making was suspense. " I must have suspense in my films," he said. "I can't stand films that are boring."
The former French culture minister, Jack Lang, paid tribute to Mr Rohmer last night as a "master of French cinema" and "a man who discovered everything".Reuse content


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By Robert Coover
A satirical delusion with a rootless and helpless accountant because the protagonist. by myself in his residence, he spends all his nights and weekends taking part in an complicated three-hitter of his personal invention. the writer has gained the William Faulkner Award and an American Academy of Arts and Letters Award.
By Travis Sawchik
New York instances Bestseller
After twenty consecutive wasting seasons for the Pittsburgh Pirates, staff morale used to be low, the club’s payroll ranked close to the ground of the game, video game attendance was once down, and town used to be changing into more and more disappointed with its crew. Big information Baseball is the tale of ways the 2013 Pirates, mired within the longest wasting streak in North American seasoned activities historical past, followed drastic big-data recommendations to finish the drought, make the playoffs, and switch round the franchise’s fortunes.
Big information Baseball is Moneyball for a brand new new release. Award-winning journalist Travis Sawchik takes you behind the curtain to expertly weave jointly the tales of the foremost figures who replaced the way in which the Pirates performed the sport, revealing how a tradition of collaboration and creativity flourished as whiz-kid analysts labored along graybeard coaches to revolutionize the game and discover groundbreaking insights for a way to win extra video games at no cost. From pitch framing to on-field shifts, this exciting and enlightening underdog tale heavily examines baseball’s burgeoning substantial info stream and demonstrates how the thousands of knowledge issues which aren’t instantly noticeable to gamers and spectators, are the little bit of magic that led the Pirates to complete the 2013 season in moment position and taken an finish to a twenty-year wasting streak.
By Art Davie
On November 12, 1993, a wholly new recreation was once unleashed on an unsuspecting viewing public--one that was once in contrast to the other, and person who could come to redefine wrestle and motion activities for a brand new iteration. the game used to be combined martial arts (MMA)--although it hadn't been named that yet--and the development used to be the last word combating Championship. The production of advert guy and serial entrepreneur paintings Davie, the UFC entered approximately 90,000 families via pay consistent with view tv with an explosion...an explosion of blood--as Dutch karate champion Gerard Gordeau kicked fallen Sumo wrestler Teila Tuli correct within the face in the course of the first minute of the hole struggle. This stunning scene used to be just a prelude of what was once to return that autumn evening in Denver, and all over the world over the following twenty years. Now, for the 1st time, the genuine tale of the way the UFC and the game of MMA got here into life should be informed via the guy who all started all of it. artwork Davie is the Dr. James Naismith and Abner Doubleday (with a slightly of PT Barnum) of MMA, but his identify is essentially unknown. that's, in the past. during this shiny and fast-moving, first-person account, Davie tells the tale of his production, which has flourished into the billion-dollar behemoth final combating Championship. Davie's is a story of perseverance and against-all-odds selection, as he labored tirelessly for 4 years to determine his suggestion come to brutal fruition, assembly resistance at each flip. it is also a mash-up of martial arts, star and company tradition, concerning a hugely inconceivable solid of characters, starting from Academy Award nominee John Milius, NFL corridor of status working again Jim Brown, motion celebrity Chuck Norris, Brazilian Jiu-Jitusu godfather Rorion Gracie and pay consistent with view pioneer Bob Meyrowitz. Davie's tale of ways he created the last word battling Championship, and hence invented the recent recreation combined martial arts, is one for not only struggle fanatics, yet for enthusiasts of mavericks in company and existence, who cease at not anything to meet their desires. even if you are a hardcore supporter of MMA, or have by no means watched a bout on your existence, you can be enthralled through Davie's tale of final triumph tempered by way of consistent near-disaster. Davie created the game of the twenty first Century, which arrived twenty years early and with nearly no fanfare or caution. He began a revolution, and his revolution was once televised.
By Daniel Paisner
During this New York Times bestselling memoir, Ray Lewis—legendary Baltimore Ravens linebacker and one of many maximum protective avid gamers of his generation—holds not anything again at the country of soccer in addition to his stricken early life, his upward thrust to athletic greatness, the hurricane that threatened to damage his NFL occupation, and the devastating damage that almost expense him a last second of glory.
Ray Lewis is undeniably one of many largest names in football—not just for his seventeen years within the NFL, but in addition for the dramatic occasions that almost introduced his occupation to a halt in 2000. In his memoir, Lewis stocks sincere money owed of his tricky formative years and delves into the discomfort and controversy that he discovered clear of the sport. yet those heartbreaks gave him the braveness to belief in God and proceed his dream to play for the NFL and win the great Bowl.
From a rookie participant to a soccer veteran, Lewis has skilled every thing that you can imagine in the course of his soccer profession, and has turn into the most effective protective avid gamers within the heritage of the NFL. I believe Like Going On is the tale of his terrific trip, and a honest examine the preferred activity in the United States from considered one of football’s such a lot respected gamers.
Download E-books We Might As Well Win: On the Road to Success with the Mastermind Behind Eight Tour de FranceVictories PDF
By Johan Bruyneel, Bill Strickland
Johan Bruyneel is familiar with what it takes to win. In 1998, this calculating Belgian and previous expert bicycle owner appeared Lance Armstrong within the eye and stated, "Look, if we're going to experience the travel, we'd besides win." In that robust word a dynasty used to be born.We may perhaps AsWellWin takes readers behind the curtain and contained in the staff automobile, as Bruyneel unearths the making plans, education, technique, and strategies that resulted in a list seven journey de France victories with Armstrong and an 8th with Alberto Contador. via exciting tales of his personal racing profession and people of the cyclists he has guided in the course of his awesome profession, Bruyneel unearths the keys to victory either in biking and in life.
This paperback version features a new afterword at the 2008 season, with Bruyneel's reflections on his list 11th grand travel victory on the Giro d'Italia and the exclusion of his group Astana from the 2008 travel de France.
By John Feinstein
It's the event that separates champions from mortals. it's the place to begin for the careers of destiny legends and will be the ultimate cease at the down escalator for fading stars. the yearly PGA journey Qualifying event is likely one of the so much grueling competitions in any game. each fall, veterans and gifted hopefuls sweat via six rounds of hell at Q university, because the event is universally recognized, to get a shot on the PGA journey, vying for the 30 slots on hand. the bleak truth: should you are not making it via Q tuition, you are not at the PGA journey. you are out. and those that make it to the six day finals are the fortunate ones: thousands extra gamers fail to get during the both grueling first phases of the development. John Feinstein tells the tale of the gamers who compete for those coveted positions within the 2005 Q university as in basic terms he can. With arresting bills from the avid gamers, verified winners, emerging stars, the defeated and the without end hopeful, America's favourite sportswriter finds the interior tale in the back of the PGA Tour's brutal all-or-nothing festival.
What greater strategy to increase your tennis--and to achieve a brand new appreciation for the sport--than by way of researching the secrets and techniques of the world's maximum gamers and coaches? learn this ebook to enhance your online game with inside of tips from the tennis elite, together with those that have received Grand Slam titles and held the area no 1 ranking.
Game, Set and Match is an unparalleled choice of guidance from the sport's superstars, together with Maria Sharapova, Andy Murray, Grigor Dimitrov, Venus and Serena Williams, Eugenie Bouchard, Kei Nishikori, Pete Sampras, Steffi Graf, Boris Becker, Stefan Edberg, Milos Raonic, Caroline Wozniacki, Stan Wawrinka, Jo-Wilfried Tsonga, Bob and Mike Bryan, Martina Navratilova, Gael Monfils, Petra Kvitova, Ana Ivanovic and Marin Cilic.
There can also be suggestion from Roger Federer's mom, Lynette, on tennis parenting and suggestions from Rafa Nadal's uncle and trainer, Toni, in addition to different prime coaches corresponding to Patrick Mouratoglou, Nick Bollettieri, Paul Annacone, Marian Vajda, Judy Murray, Darren Cahill, Roger Rasheed and Robert Lansdorp, and from health specialists equivalent to Andre Agassi's former coach, Gil Reyes.
Top tips from the professionals include:
"How to hide your serve" through Pete Sampras
"How to stick healthy all yr" by way of Caroline Wozniacki
"How to assault together with your one-handed backhand" by means of Stan Wawrinka
"How to include your superstitions" via Goran Ivanisevic
By Brian Oliver
How good are you aware the pleasant video games? activities journalist Brian Oliver brings the Commonwealth video games to existence with riveting tales of the athletes who've competed through the years. He delves into the easiest stories of the previous and interviews the foremost protagonists to unveil the highs and lows of this idiosyncratic carrying competition.
There is the vintage contest among Roger Bannister and John Landy simply months after either had finally damaged the four-minute mile, and the lesser-known struggles of 1 of Australia's maximum swimmers, sunrise Fraser, opposed to the petty-minded and all-male 'silver spoon mob' who ran beginner activity. learn the sorrowful story of Emmanuel Ifeajuna, the 1st ever black African to win a gold medal, in any game in any overseas occasion. He received excessive bounce gold in 1954 and have become a countrywide hero in Nigeria, yet after staging a coup used to be arrested for treachery and shot by means of firing squad.
Find out why the 1974 video games in Christchurch, New Zealand have been often called the 'Emigration Games', and the tale at the back of the sour Eighties swimming pool competition among England's Adrian Moorhouse and Victor Davis of Canada. there are various extra, from that of 4-foot 10-inch weightlifter necessary McKenzie – who rose via brutal abuse and discrimination to record-breaking good fortune and a dance with the Princess Royal – to the penniless and boycotted 1986 video games in Edinburgh that have been 'saved' through Robert Maxwell and a bucket of fried chicken.
The Commonwealth video games is an interesting perception into human stories of endeavour, luck and failure.
By Lucas Mann
An unforgettable chronicle of a yr of minor-league baseball in a small Iowa city that follows not just the travails of the gamers of the Clinton LumberKings yet also the lives in their committed enthusiasts and of the city itself.
Award-winning essayist Lucas Mann supplies a robust debut in his telling of the tale of the 2010 season of the Clinton LumberKings. alongside the Mississippi River, in a Depression-era stadium, younger clients from around the globe compete for an opportunity to maneuver up during the baseball ranks to the main leagues. Their coaches, a few of whom have spent approximately part a century within the video game, watch from the dugout. within the bleachers, neighborhood lovers name out from an identical seats they’ve occupied 12 months after 12 months. And within the distance, smoke rises from the most important ultimate manufacturing unit in a city that after had extra millionaires according to capita than the other in America.
Mann turns his eye at the avid gamers, the coaches, the enthusiasts, the radio announcer, town, and eventually on himself, a tender guy raised on baseball, pushed to grasp what nonetheless attracts him to the stadium. His voice is as clean and humorous because it is poignant, illuminating either the small triumphs and the cruel realities of minor-league ball. half activities tale, half cultural exploration, half memoir, Class A is a relocating and exact learn of why we play, why we watch, and why we remember.
By Charles Parrish
Two prime activities gurus discover the tradition of football world wide, contemplating the game as a method to raised comprehend a society's previous, current, and destiny.
• contains either men's and women's soccer
• positive aspects lists of winners of global Cups, nearby confederations cups, and Olympic video games
• offers sidebars of fascinating proof and pictures to complement the text
• bargains a multi-disciplinary viewpoint from throughout geography, social reviews, international cultures, and anthropology

domain: library


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Fullerton California Westin Hotel
The La Quinta Inn in Buena Park is pet friendly, and the Fullerton California West Hotel in Fullerton, California, just outside Fullerville, CA, is also pet friendly. The Fullnerton California East Hotel in Fullerton, Calabasas, Los Angeles County, California is dog and behave friendly, as well as cat and cat friendly!
Pet trash bags are available and four-legged guests can get treats at the reception. The hotel has a designated pet area and a dog beach within walking distance. There is no residential area where dogs can walk, and there is no pet maintenance area in front of the property, but there are dog beaches within walking distance of the properties, as well as dog parks.
Dogs and cats are allowed, but well-behaved pets may be left unattended in the room and may not be left outside the room. When making a reservation, there is a "Guest" field where you can enter your pets, so you can enter a fee for pets. Dogs and pets are allowed in all rooms, except in the guest rooms and private rooms with at least two pets per guest. Well - pets cannot cause any problems in your room, although they can cause trouble for guests and they may have been left unattended in the guest's room or left outside the room.
If applicable, the fees are usually displayed on-site in the "Owner's Fees" section of the checkout. Contact your host or contact the owner or read the house rules in the listing to learn more about the rules and regulations of your Airbnb property. If applicable, contact the host and read their rules or regulations as set by the host and Airbnb accommodation.
Dogs and cats are allowed, but well-behaved pets may be left unattended in the room. Guests are allowed to pet their pets during quiet hours from 10 pm and until midnight on weekends and holidays.
The old Starwood system seems to be being badly affected at the moment, as many hotels are reflagging to rival brands, which is not unexpected. In other recent reflags, where members were not warned in advance, they had only 12 months. When contracts expire and changes occur, owners are allowed to reassess what is their best course of action, and Marriott seems to be behind many of them. The hotel chain has adopted an asset-light management strategy, but still owns the properties that carry its flag.
I was in Sydney earlier this week and I walked past a Hilton that was about 100 metres from my hotel. I only went to the hotel once in 2012 and I was checking my paperwork, so I only went past it once last year.
The Marriott Fullerton Anaheim welcomes two pets up to 15 lbs for an additional $100 per stay. Suites welcome two pets of any size, and they are priced at $15 / lb for 15 lb or $20 / lb if they are larger.
The Anaheim Majestic Garden Hotel welcomes two pets of any size for an additional fee of $115 per stay. Staybridge Suites Resort Anaheim offers up to two pets weighing 80 lbs as part of the resort's pet policy. Two pets over 75 lbs are welcome for the same fee as the other hotels in the Fullerton area, but not as much as in other parts of the state. Hilton Long Beach welcomes two pets over 75 lb for a fee of $100 per day or $150 per night for two dogs or two cats.
Inn in Long Beach Downtown welcomes two pets of any size for an additional fee of $100 per stay. Hilton Irvine Orange County Airport receives up to two dogs over 70 pounds for the same fee as other hotels in the Fullerton area, but not as much as in other parts of the state. The Hilton Huntington Beach Hotel and Spa in Huntington Park welcomes three pets over 75 lbs or two cats and two pets over 50 lbs, with a $50 per day or $150 per night pet policy surcharge. The Inns of Long beach Downtown and Hilton Long Island City Center Hotel in Newport Beach welcome two pets of all sizes for an additional fee of over $200 per week for two or more pets and $500 per month for three dogs or four pets for any length of time.
A two-bedroom apartment in Fullerton allows two pets of any size for an additional fee of over $200 per week for two or more pets and $500 per month for three dogs or four pets for any time. A three-bedroom apartment in Fullerton allows up to three pets over 75 lbs or two cats and two dogs over 50 lbs, with a $50 per day or $150 per night surcharge for pets, and a four-bedroom apartment in Fullerton does not allow dogs in the same way as the Hilton Huntington Beach Hotel and Spa in Huntington Park or the Hilton Long Island City Center Hotel in Newport Beach, but it does allow a dog of all sizes in a two-bed room for a maximum of four people.

domain: pet


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The first unmanned station in St Petersburg and in the whole of Russia was opened in June. The station is located in the Kalinin district by Rustaveli street. The Kalinin district has
a population of about a half a million. Another two Neste A-24 stations are planned to be opened during this year.
The station located by Rustaveli street has two card-note automats and meters for two gasoline grades and diesel. Payment may be effected with Neste card and cash. Later in this
autumn, it will be possible to use international credit cards as well. Extremely strict safety and environmental requirements have been applied in the building of this station, as there is no experience of unmanned stations in Russia. To make sure that the operations will begin smoothly, the station has personnel to guide customers in refuelling.
Vladimir Yakovlev, Governor of St Petersburg, together with Vice President Veli-Pekka
Helander, opened the new station in the presence of Vice-Governor Juri Antonov, high
officials of the city and Fortum’s local representatives. In his opening speech,
Governor Yakovlev mentioned that Neste is pioneering in the service station business and
a good example to other companies. He hoped that in the 300th anniversary of St Petersburg in 2003 there will be several other unmanned Neste stations in the city.
The first Neste station in St Petersburg was opened in 1991, and today there are 21 Neste stations in the city. The opened station complements these services, as the other stations provide other services in addition to fuel sale.
Veli-Pekka Helander, Vice President, Fortum Oil Retail, Baltic Rim,
tel. +358 10 45 28226


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Reality Check on Immune Globulin
Market access for IVIG treatments reveals differences in payer coverage across each major channel, as well as specific trends in the drug landscape.
To help make sense of this new research, MMIT's team of experts has analyzed the data for you and summarized the key findings:
- Payer Insights: A complex market landscape across pharmacy and medical benefits, with an increase in restrictions on payer-controlled pharmacy benefit formularies
- Class Trends: How the IVIG landscape will develop in 2018, with significant M&A activity expected
- Key Findings: How developing treatments could impact market access and coverage across pharmacy and medical benefits
What can pharma do to curb this trend and overcome these challenges?
Get the data behind this change and how it could impact your market access plans from MMIT's team. Their clinical and policy backgrounds provide a unique and expert perspective to help expand your knowledge in the class and guide your decision-making process.
Download the full Reality Check now.

domain: health


December 11, 2011
Lewis stands tall at Hoops Festival
The featured game between Oak Hill and Grace Prep at the National High School Hoops Festival lived up to expectations, and Tyler Lewis helped lead the way for Oak Hill.
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A 59-year-old patient of the coronavirus disease (Covid-19 ) died in Madhya Pradesh’s Bhopal after he was left unattended for more than an hour in a parking lot of a private hospital on Monday evening, his family members alleged.
The man’s son said his father, who was suffering from a kidney ailment, was admitted to Peoples General Hospital on June 23 after he complained of breathing problem and low sugar level.
“On Sunday, the hospital administration got a Covid test done. The report came on Monday that suggested my father suffering from Covid-19. The Peoples Hospital called Chirayu Hospital, a Covid-19 designated private medical college’s hospital, for an ambulance to shift him there,” he said.
“The ambulance came at around 5pm and took my father. I also left the place but later in the evening, I came to know that my father was abandoned by Chirayu Hospital ambulance back at People’s hospital. The carelessness of staff of both the hospitals led to the death of my father. I want strict action against them,” he said.
Relatives of Covid-19 patients are not allowed to accompany them, he said.
The administration of Peoples General hospital, where the patient was allegedly abandoned, blamed Chirayu Medical College and Hospital for the death.
“The patient has been visiting the hospital for his dialysis for the past five years. He was referred to Chirayu Hospital after completing all the discharge formalities in an ambulance. After 20 minutes of discharge, the ambulance attendant called us that they are coming back and we should get ready to provide the man treatment at ICU,” Udayshankar Dixit, the Peoples Hospital’s manager said
“I asked him not to come back as we had already sealed our ICU as he was the first Covid-19 patient detected in our hospital for the safety of other patients. But instead of listening to us, they left the patient on a stretcher in the parking area. We arranged a PPE kit and provided the patient oxygen but he died,” said Dixit.
When contacted, Chirayu Hospital’s director Dr Ajay Goenka denied the allegations as “baseless to say that patient was left abandoned in parking”. He said the man was in a critical condition due to renal failure and was also suffering from a heart ailment.
“When a doctor from Peoples Hospital called us, our team of doctors inquired about the condition of the patient to send the ambulance accordingly but the doctor over the phone didn’t explain the condition. When the ambulance driver was taking the patient to Chirayu Hospital, he found that he was very critical and needed ventilator support,” Goenka said.
He said the ambulance driver called the Peoples Hospital and asked them to attend to the man as Chirayu Hospital was 45 minutes away.
“The ambulance driver urged the People’s Hospital to manage the patient for just 20 minutes till another ambulance from Chirayu equipped with a ventilator could reach there. First, the administration of Peoples Hospital refused to take the patient back. Later, it provided oxygen and CPR. When our second ambulance reached there the patient was found dead,” Goenka said.
As the photo and video of the man lying in the parking area went viral on social media, Zameel Khan, a sub-divisional magistrate (SDM), reached the hospital and shifted the body to a morgue.
SDM Khan said tough action will be taken against whoever is found responsible for the man’s death.


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By Kate Hesseldenz, Curator
One of my favorite items in the collection is a commonplace book owned by Margaretta Mason Brown (1772-1838). The book contains 52 poems. Margaretta wrote many of the poems in the book, but she also copied some of them from magazines and newspapers. They are arranged chronologically, and she titled the book “Fugitive Pieces, or, Juvenile Essays.” Margaretta began writing and copying poems into the book in 1785, when she was just 13 years old and lived in New York City. The last poem in the book is dated 1807.
Two of the poems in the book celebrate American independence and the Fourth of July. She copied both from New York periodicals. To make the distinction, Margaretta wrote the initials of the newspaper or magazine by the poem when she was copying them into her book. “On the 4th of July” is dated 1786 and is from The Daily advertiser, political, historical, and commercial, an early New York magazine that included poetry.[i] This poem was written only three years after America gained its independence from England in the Revolutionary War. The first four lines proudly recount America’s defeat over the British.
Hail glorious day! Forever to be known,
When first Columbia’s rising glories shone;
When first she humbled haughty Britain’s pride,
And quelled of Tyranny through flowing tide.
The word Columbia is a poetic term for the national personification of America. It refers to Christopher Columbus and was first used in the 18th century. [ii]
The second poem from 1794 is titled “Independence or The fourth of July.” This poem appeared in New-York Magazine; or, Literary Repository, a magazine published in New York City from 1790-1797.[iii]
The first lines from this poem demonstrate a new nation’s jubilant triumph.
Yes, let the ecstatic voice of joy
With glad vibrations rend the air,
Let Music all her powers employ
To banish each intrusive care,
For lo, from yon enamored sky
Springs the young Dawn of Liberty.
Margaretta admired these poems enough to copy them into her book. In 1776 when the British began their seven-year occupation of New York City, Margaretta was 4 years old. The constant presence of British soldiers during her childhood probably made an impression on her and her family.
The classical style of poetry written in the 18th century seems formal compared to today’s poems. But these early patriotic poems, written so soon after the Revolutionary War ended and admired by a young Margaretta Mason, express the triumph, joy, and anticipation for a newly created United States.
Have a happy and safe Fourth of July!
To view the whole poetry book, click here.
[i] Wells, Colin, Poetry Wars: Verse and Politics in the American Revolution and Early Republic (2018): University of Pennsylvania Press, Philadelphia.
[ii] Steele, Thomas J., “The Figure of Columbia: Phillis Wheatley plus George Washington,” The New England Quarterly, vol. 54, no. 2 (1981), page 264-266.
[iii] New-York Magazine, or Literary Repository, vol. 5 (1794): Thomas and James Swords: New York. University of Chicago Libraries.


What happens internally when ESP8266 goes to deep sleep mode. Is there any official documentation explaining that?
You can see this document https://www.losant.com/blog/making-the-esp8266-low-powered-with-deep-sleep
In summary, ESP8266 supports 3 sleep modes:
Modem-sleep mode is enabled only when ESP8266 connects to a router in station mode, via DTIM beacom mechanism. Within this mode, ESP8266 would wake up periodically, automatically, to handle arriving Beacon.
CPU and system are still on. Hence program that does not require constant network access could still run.
System clock is off and CPU is suspended. No program could run. ESP8266 could be woken up via external GPIO level triggers.
System clock and CPU are off.
ESP8266 could be woken up via
a) a low-level pulse generated on the EXT-RSTB pin via an external IO.
b) timer which is managed by the RTC


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An electronic system containing high frequency RF components reduces failure rates.
A study determined the value of Field Programmable Gate Arrays (FPGAs) for high-performance computing (HPC) applications.
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The "RadCNT" program use carbon-based transistors to study the interactions between ionizing and non-ionizing radiation.
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One particular semiconductor, gallium arsenide (GaAs), has received considerable attention due to its potential electronic applications.
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When designing electro-mechanically actuated systems, there are several electrical design requirements that must be determined.
Integrating different types of devices and materials could increase their functional density, improving the performance of electro-optic systems for sensor applications.
Inductive eddy current technology is an extremely versatile non-contact method for measuring an object's position, distance, or vibration.
Artillery in the wrong hands pose an increased risk to the safety of U.S. service members, allies and civilians.
B-21 Raider Passes First Loads Calibration Test
Collins Aerospace Completes Preliminary Design of 1MW Electric Motor
A New Approach to Counter-UAS Technology - Mobility Engineering Technology
Air Force and Lockheed Martin Complete ARRW Hypersonic Boosted Test Flight
Oscillating Heat Pipes Tested for Use in Space - Mobility Engineering Technology
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Ahhlree amedels SHE HAS BECOME ONE OF THE MOST INFLUENTIAL WOMEN OF HER GENERATION. AMY SCHUMER TELLS HANNAH JAMES HOW IT FEELS TO LEAD A NEW REVOLUTION
It’s a rite of passage for any foreign celebrity reflecting on their time spent in Australia: the mandatory gushing over how much they enjoyed their visit. But when the celebrity is Amy Schumer – who is due to tour here nationally with her one-woman show in December – there’s good reason to expect she might be a little more restrained.
Last year the actor and comedian came to Australia on a publicity blitz for Trainwreck, the largely autobiographical movie that she both wrote and starred in. Her back-to-back schedule resulted in several headline-making awkward exchanges with the media, including a polite but painfully stilted appearance on The Weekly With Charlie Pickering and a terse encounter with Kiis FM presenter Matt Tilley, who suggested her character in the film was “skanky”.
“I think the media had the idea that she would be funny all the time,” says Caroline Overington, associate editor of The Australian, who interviewed Schumer prior to the tour and believes many local journalists held unrealistic expectations of what a conversation with her would entail.
“They were trying to get her to play one gag after another,” is Overington’s theory. “The mistake, I think, was to underestimate her sublime intelligence and the seriousness with which she takes her craft, and the many years of hard yards she’s done, and just assume she’s going to be the class clown.”
By the time the PR trip wrapped up, Schumer flew out of the country with a reputation for being “hard work”. But if she holds a grudge over being misunderstood, she’s not letting on, and is quick to brush off any lingering concerns when Stellar asks about her seemingly bumpy time here. “I love Australia and I love Australians,” she declares enthusiastically. “You guys are the best at brunch anywhere I’ve ever been in my whole life.”
IN THE 12 MONTHS that have passed since then, her public persona largely remains intact. She’s still a brassy Long Island blonde who jokes about her sex life on stage and drinks from a wineglass the size of a bucket on her sketch show, Inside Amy Schumer, which began in 2013.
Yet her most recent project, a book of personal essays titled The Girl With The Lower Back Tattoo, reveals a hitherto hidden complexity. Fans have now learnt that Schumer, 35, is actually an introvert, has survived both rape and an abusive relationship, is an active campaigner for gun safety and enjoys being a devoted girlfriend.
Hers is the latest in a long line of autobiographies by comedians and actors – Tina Fey, Mindy Kaling, Lena Dunham, Chelsea Handler. And despite Schumer’s stated belief her career hasn’t been hampered by being a female in the male-dominated world of comedy (“I’ve only heard that from journalists. I worry it’s being kept alive by that”), it’s hard not to notice they’re all women.
If there’s something in our culture that requires soul-baring honesty from famous females, Schumer’s happy to oblige. Her book includes stories that cast not only herself, but also her family, friends and lovers, in an unflattering light. She details two occasions on which her father loses control of his bowels when out in public with her, due to his multiple sclerosis. She also reveals how her mother, “manipulated me in unhealthy ways”. In person, she is blunter: “She brainwashed me. My brother and sister knew it for years.”
Yet even in her searing honesty, she’s taken care to burn no bridges. “Anyone who is mentioned by their real name in the book, it was cleared with them and they read every word about them,” she tells Stellar. “Had either of them [her parents] said, ‘I don’t want that in there,’ I would have understood. But they know it’s part of what made me who I am, and they were down to share that.” So the book hasn’t caused any family rifts? “It’s brought us closer.”
Her parents, Sandy, a teacher for the deaf, and Gordon, a former furniture shop owner, gave Schumer, by her account, a rocky childhood. Comfortable circumstances in her early youth were followed by bankruptcy, her dad’s MS diagnosis and her mother’s affair with a family friend. Her mum’s attempts to reassure Schumer, her brother Jason and sister Kim, that none of this had negative effects on the family led to Schumer’s belief she was “brainwashed”. “I wish she could have just been honest with us. And with herself,” she writes.
Schumer’s own career has been based on radical honesty. She occupies a unique place in pop culture, thanks to her onstage and TV sketches taking aim at everything from yeast infections to
sexism. (Her “Last F*ckable Day” sketch, in which Julia Louis-dreyfus, Tina Fey, and Patricia Arquette celebrate the last day an ageing Louis-dreyfus can be considered attractive in Hollywood, has racked up 5.5 million views on Youtube.) Yet the revelations in her book, much of which were drawn from her teenage diaries, are more personal – and painful – than anything she’s shared before.
Two chapters she found particularly harrowing to write were the ones recounting an abusive relationship from her early 20s, which led to her boyfriend chasing her with a knife, and the loss of her virginity by rape. Shockingly, she says she had almost forgotten about the second event. “That was one of the things in my journal that I really hadn’t thought about in a long time. I revisited it thinking, ‘Wow, I had that so buried.’ There’s no way it didn’t have an effect on me.” Her abusive relationship was just as scarring: “That was so much pain and damage I didn’t realise was still a part of my nervous system. Revisiting that was really hard – and it isn’t over for me. I still think I have stuff to deal with from having been in that relationship,” she says.
So why dredge it all up? Why not write the light, bright, funny book her fans, not to mention her publishers, doubtless anticipated? “That’s a direction I’ve been pushed before when I’ve been thinking of writing a book,” she admits. “But it actually would have been harder for me to write a shiny package of a book: that’s not in me. Some of it was painful, but I don’t shy away from that.”
In fact, the pain was partly the point: “It was totally therapeutic and cathartic. It was a labour of love, and a lot of work. I came out of it feeling changed and better – about my relationships and myself and what my contribution is to people. I’m so glad I did it.”
Her contribution to society is something Schumer has been mulling over of late. Despite a mock-stern warning that her book contains “NO SELF-HELP INFO OR ADVICE”, she’s mindful of the impact her words can have. After describing her rape, she writes, “I’m opening up about my ‘first time’ because I don’t want it to happen to your daughter or sister or friend some day. I want to use my voice to tell people to make sure they have consent before they have sex with someone.”
And that’s not the only message she’s keen to get out. In July 2015, a gunman shot dead two women at a Trainwreck screening in the US. He had documented mental-health problems and a history of violence, yet still legally bought a gun. Profoundly shocked, Schumer began campaigning with her second cousin once removed, Senator Chuck Schumer, for improved gun-safety laws. Her book ends with statistics about gun crime.
It’s all a long way from talking about her sex life onstage. “I’m learning more and more the influence I have,” says Schumer of becoming a public figure. “I think of how I’ve been influenced by people in the media, and I’ve come to terms with the fact that I’m one of those people now.” Does the responsibility of being a role model unnerve her? “I think people are in really good hands with me, because my intentions are good and hopefully egoless. I just like for people to feel better – I know that I felt so much better and supported when other women have shared their struggles.”
When Schumer herself shares, the world listens. Despite the perception her promotion of Trainwreck here lived up to its name, thousands of fans lined up outside cinemas for the chance to see the comic in the flesh. “At the time Amy had a small Australian fan base for her TV


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OKLAHOMA CITY (CelebrityAccess MediaWire) — Officials at the Oklahoma City Community College are investigating a tent collapse at Arts Festival Oklahoma that left 8 people injured.
According to the Oklahoman, the tent collapsed at approximately 3pm during a magic performance at the festival. Witnesses reported that the tent appeared to billow upwards shortly before collapsing on more than 80 people.
Four adults were reportedly treated at the scene with an additional four victims being transported to hospitals in the region with non life-threatening injuries.
After the collapse, continued gusty winds at the festival site prompted organizers to shut the event down one hour early.
The tents had all been inspected by fire marshals several days prior to the collapse and had all been rented from a local supply company, the Oklahoman said.
In a statement, OCCC President Paul Sechrist expressed his regrets about the collapse and hopes that the injured would recover quickly.
"I guess I brought the house down," Jim Green, the magician who was performing at the time of the collapse was quoted as saying. – CelebrityAccess Staff Writers


Manuel “Mar” Roxas 2nd, who in 2009 set his Malacañang ambitions aside to give way to then Sen. Benigno Aquino 3rd whose popularity soared after the death of his mother, continues to reap the “goodwill” he sowed.
Despite an almost stagnant performance in popularity surveys, Roxas remains on top of President Aquino’s shortlist on who he had in mind to succeed him when he bows out of office in 2016.
Speaking to reporters on Monday, Aquino said he was “surprised” to read reports that it is as if Roxas was not being considered to be the administration party’s standard-bearer in 2016.
The President went on to describe his Interior secretary as a “valuable member” of the Cabinet who has shown “quite a wide range of expertise” in different assignments.
“He has been a staunch leader of the party even during the days that we were in the opposition,” Aquino said.
He added that Roxas has also shown his “ability to sacrifice” when he agreed to slide down as Aquino’s running mate in the 2010 elections.
Roxas lost to Binay by a close margin. Binay got 14.6 million or 41.65 percent of the total number of votes cast as against Roxas who got 13.9 million or 39.58 percent. A far third was Sen. Loren Legarda who got 4.2 million votes.
The President said the Liberal Party will hold “consultations” to reach a “consensus” on who to field in next year’s polls.
He added that the announcement of his choice of possible successor will be made after the State of the Nation Address (SONA) in late July.


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Sada Williams raced to a new national record in the women’s 400 metres at the World Athletics Championships in Budapest, Hungary, as she booked her spot in Wednesday’s final.
Running out of lane seven in the third of three semis earlier today, Williams ran a quick 250 metres, but appeared to turn off the burners on the home stretch, easing across the line in 49.58 seconds behind Poland’s Natalia Kaczmarek.
The old national record of 49.75 seconds was set in July last year in the World Championships finals in Eugene, Oregon, when she won a bronze medal behind Bahamian Shaunae Miller-Uibo and Marileidy Paulino of the Dominica Republic.
The former did not make it out of the first round, while Paulino qualified from the first heat with 49.54.
Williams enters the final with the third fastest time overall. The race is shaping up to be a fight among her, Paulino and Kaczmarek, who won the final heat in 49.50 seconds. (SAT)

domain: sports


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Author + information
- Received June 18, 2009
- Accepted July 25, 2009
- Published online October 1, 2009.
- Yuri B. Pride, MD⁎,
- John G. Canto, MD, MSPH‡,
- Paul D. Frederick, MPH, MBA§,
- C. Michael Gibson, MS, MD†,⁎ (, )
- NRMI Investigators
- ↵⁎Reprint requests and correspondence:
Dr. C. Michael Gibson, 350 Longwood Avenue, 1st Floor, Boston Massachusetts 02115
Objectives The goals of this analysis were: 1) to evaluate outcomes among non–ST-segment elevation myocardial infarction (NSTEMI) patients presenting to hospitals with on-site cardiac surgery (OHS hospitals) and without on-site cardiac surgery (No-OHS hospitals); and 2) to specifically examine outcomes among the subset of NSTEMI patients undergoing percutaneous coronary intervention (PCI).
Background Whether backup cardiac surgery improves outcomes among NSTEMI patients or is simply a marker of better adherence to guideline recommendations is unknown.
Methods The NRMI (National Registry of Myocardial Infarction) enrolled 100,071 NSTEMI patients from 2004 to 2006. Outcomes were evaluated in the population as a whole and in propensity-matched analyses in the entire population and in the subset of patients undergoing PCI.
Results In-hospital mortality was significantly lower at OHS hospitals (5.0% vs. 8.8%, p < 0.001). Patients presenting to OHS hospitals were significantly more likely to receive aspirin, beta-blockers, and statins (p < 0.05 for all) and to undergo PCI (38.4% vs. 14.1%, p < 0.001). In the propensity-matched model, the difference in mortality remained significant (5.9% vs. 8.5%, p < 0.001). After adjusting for differences in medications administered within 24 h of arrival and hospital characteristics, the difference in mortality was nearly attenuated (hazard ratio: 0.89, 95% confidence interval: 0.79 to 1.00, p = 0.050). When the propensity-matched model was restricted to patients undergoing PCI, there was no significant difference in mortality (1.3% vs. 1.0%, p = 0.51).
Conclusions NSTEMI patients presenting to No-OHS hospitals have significantly higher mortality. This appears to be due to both modifiable (lower use of guideline-recommended medications) and nonmodifiable factors (hospital size, myocardial infarction volume). In a propensity-matched analysis of patients undergoing PCI for NSTEMI, there was no significant difference in mortality.
- percutaneous coronary intervention
- non–ST-segment elevation myocardial infarction
- backup cardiac surgery
Among patients with non–ST-segment elevation myocardial infarction (NSTEMI), early angiography and, if warranted, percutaneous coronary intervention (PCI) have been associated with improved outcomes (1,2). An early invasive strategy is therefore recommended among most patients with NSTEMI (3). As a result, cardiac catheterization in NSTEMI patients is becoming more prevalent (4).
Emergent cardiac surgery is sometimes required after complications from cardiac catheterization and PCI (5). While there is evidence that PCI performed among NSTEMI patients at hospitals without on-site cardiac surgery (No-OHS hospitals) is safe (6), other studies have reported higher mortality among patients undergoing PCI at No-OHS hospitals (7). Elective PCI is currently not recommended at sites without surgical backup in the American College of Cardiology/American Heart Association guidelines (3,8).
Surgical backup may improve outcomes because of its use after complications of PCI. Alternatively, it may simply be a marker of quality of care and better adherence to guideline recommendations. There were 2 goals of this analysis: 1) to compare outcomes, the use of PCI, and the use of guideline-recommended medications among NSTEMI patients presenting to OHS and No-OHS hospitals; and 2) to compare outcomes and the use of guideline-recommended medications among the subset of NSTEMI patients undergoing PCI at hospitals with and without backup cardiac surgery. In order to evaluate these objectives, we utilized phase 5 of the NRMI (National Registry of Myocardial Infarction), which collected data from over 450 hospitals from 2004 to 2006.
NRMI is an industry-sponsored observational study whose methods have previously been described (9,10). To be included in the registry, patients must have had an acute myocardial infarction (MI) documented according to local hospital criteria, usually including a history suggestive of acute MI and corroborated by cardiac enzymes, 12-lead electrocardiogram (ECG), coronary angiography, or International Statistical Classification of Diseases-9 diagnostic code of MI. NSTEMI was defined as all patients enrolled who did not have ST-segment elevation or left bundle branch block (old/new/unknown) on first/subsequent 12-lead ECG.
A registry coordinator at each participating hospital recorded data from each patient, including demographic information. In-hospital mortality was available among patients who were not transferred to another facility.
To ensure quality control of registry data, registry coordinators were trained in data entry utilizing a standardized manual of instructions and definitions. Case report forms were required to pass systematic range and internal consistency checking. Hospitals obtained approval of the registry data collection process as dictated by local investigational review boards.
Only hospitals with PCI capabilities were included in the analysis. In-hospital mortality, as well as the incidence of other adverse clinical outcomes, was assessed only among patients who were not transferred as the outcome of patients transferred to other acute care hospitals was not known.
All statistical analyses were performed using a commercially available statistical package (SAS 9.1.3 Service Pack 2, SAS Institute, Cary, North Carolina). Continuous variable values are reported as the mean plus or minus the standard deviation or the median and interquartile range. Model-based approaches were used to analyze unmatched and matched data. To account for clustering of patients within hospitals, model-based group comparisons of binary, continuous, and ordinal data were implemented using a generalized estimating equations approach or generalized linear mixed models. To estimate group differences in survival, Cox proportional hazard regression models for left-truncated and right-censored unmatched data were constructed, with and without adjustment for propensity score (as a continuous variable) and covariates. Treating the transfer-in patient as the truncating event and transfer-out, death, or discharge events as the censoring event, Cox regression analysis was applied to adjust for differences in the administration of guideline-recommended medications (aspirin, clopidogrel, statins, beta-blockers, and glycoprotein [GP] IIb/IIIa inhibitors) within 24 h, and hospital characteristics (region in U.S., hospital type, hospital size, and MI volume).
In the propensity-matched analysis, cases (patients presenting to No-OHS hospitals) were matched to control subjects (patients presenting to OHS hospitals) using the propensity score generated from a nonparsimonious logistic regression model. No interactions between the predictor variables were used in this model. In both total and PCI patient populations, the C-statistic, or area under the receiver-operator characteristic curve, was 0.68, indicating fair discriminatory ability in predicting no-OHS. The events per variable statistic exceeded 10. A greedy matching algorithm was used to match patients based on 8→1 digit matching. Cases were matched to control subjects using the following set of independent variables: transferred-in status; sex; age; hypertension; diabetes mellitus; hyperlipidemia; stroke; peripheral vascular disease; previous MI; congestive heart failure (CHF); smoking status; and aspirin, clopidogrel, beta-blocker, and statin received within 24 h before arrival. Patients grouped into control subjects were randomly selected without replacement, and 97.5% of pairs had exactly matching covariates. All p values used 2-tailed tests, and p values <0.05 were considered significant.
There were 186,267 patients enrolled at 456 hospitals in the NRMI 5 registry from April 2004 to December 2006. Of these, 158,892 patients presented to 266 hospitals with PCI capabilities. There were 100,071 NSTEMI patients: 9,189 (9.2%) who presented to 52 No-OHS hospitals and 90,872 (90.8%) who presented to 214 OHS hospitals. Baseline characteristics among the entire group are shown in Table 1 (left). Patients presenting to OHS hospitals were slightly younger, more likely to be male, to have hyperlipidemia, to present with Killip class II, and to be receiving aspirin and less likely to have diabetes mellitus, hypertension, and a history of heart failure. The most substantial difference between the groups was that patients presenting to OHS hospitals were far more likely to have been transferred from another hospital (34.8% vs. 5.8%, p < 0.001).
Patients presenting to OHS hospitals were significantly more likely to receive aspirin (87.8% vs. 84.0%, p < 0.001), beta-blockers (78.6% vs. 74.7%, p = 0.014), and statins (44.3% vs. 38.0%, p = 0.002) within 24 h after arrival (Table 2, left).
Patients presenting to OHS hospitals were more likely to undergo angiography (68.3% vs. 40.2%, p < 0.001) and PCI (38.4% vs. 14.1%, p < 0.001) (Table 3, left).
Patients who presented to No-OHS hospitals were much more likely to be transferred to another short-term general hospital (35.3% vs. 2.2%, p < 0.001). Baseline characteristics among patients who were transferred out from No-OHS and those transferred in to OHS hospitals were similar, except that patients transferred out from No-OHS hospitals had a slightly higher median body mass index (28.8 vs. 28.3, p = 0.023), were less likely Caucasian (81.8% vs. 87.9%, p = 0.017), and have angina pectoris (8.9% vs. 15.0%, p = 0.006), had a higher median pulse (84 vs. 80, p < 0.001), systolic blood pressure (148 vs. 142, p < 0.001), and diastolic blood pressure (83 vs. 80, p < 0.001).
Among patients who were not transferred (n = 94,817), in-hospital mortality was significantly lower among patients presenting to OHS hospitals (5.0% vs. 8.8%, p < 0.001) (Table 4, left). The incidence of recurrent MI was similar at the 2 hospital types (1.0% vs. 0.9%, p = 0.64), but the incidence of the composite of death and MI (5.8% vs. 9.5%, p < 0.001) and the composite of death, recurrent MI, CHF, and cardiogenic shock (21.9% vs. 26.8%, p = 0.043) was significantly lower among patients presenting to OHS hospitals.
Among patients who lived and were not transferred, there were significant differences favoring OHS hospitals in the use of guideline-recommended discharge medications, including aspirin (89.6% vs. 81.2%, p < 0.001), clopidogrel (55.9% vs. 46.9%, p = 0.005), beta-blockers (86.3% vs. 80.5%, p < 0.001), and statins (76.9% vs. 61.6%, p < 0.001) (Table 5, left).
Patients presenting to No-OHS hospitals were matched 1:1 in a propensity-matched model with patients presenting to OHS hospitals based on the following baseline characteristics: transfer-in status; sex; age; hypertension; diabetes mellitus; hyperlipidemia; stroke; peripheral vascular disease; previous MI; CHF; smoking status; and aspirin, clopidogrel, beta-blocker, and statin received within 24 h before arrival.
There were 9,049 patients in each group. Baseline characteristics were similar between the groups and cross-strata comparisons of covariates used in the propensity score models were nonsignificant (Table 1, center).
The differences in the administration of guideline-recommended medications favoring OHS hospitals was mildly attenuated in the propensity-matched analysis (Table 2, center), although patients presenting to OHS hospitals remained significantly more likely to receive aspirin (87.5% vs. 84.2%, p < 0.001), beta-blockers (78.5% vs. 75.1%, p = 0.034), and statins (42.6% vs. 38.2%, p = 0.038) in the first 24 h. The use of GP IIb/IIIa inhibitors and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was similar. OHS hospitals were less likely to administer a heparin product during stay (70.9% vs. 74.0%, p = 0.041).
More patients presenting to OHS hospitals underwent angiography (60.2% vs. 40.5%, p < 0.001) and PCI (33.2% vs. 14.2%, p < 0.001), and 10.6% of patients presenting to OHS hospitals in the propensity-matched analysis underwent coronary artery bypass grafting (Table 3, center).
There remained a large disparity in that patients presenting to OHS hospitals were far less likely to be transferred to another acute care hospital (2.7% vs. 35.4%, p < 0.001). Among patients who were not transferred, patients presenting to OHS hospitals had significantly lower in-hospital mortality (5.9% vs. 8.5%, p < 0.001) and had a lower incidence of the composite of death or MI (6.7% vs. 9.1%, p < 0.001) (Table 4, center). The rates of recurrent MI, CHF, and cardiogenic shock were not significantly different between the 2 hospital types.
Among patients who lived and were not transferred, patients discharged from OHS hospitals were significantly more likely to be prescribed aspirin (87.6% vs. 81.3%, p < 0.001), beta-blockers (85.5% vs. 80.6%, p < 0.001), and statins (72.6% vs. 61.8%, p < 0.001) (Table 5, center).
When this propensity-matched population was further adjusted for differences in the administration of aspirin, clopidogrel, beta-blockers, statins, and GP IIb/IIIa inhibitors within the first 24 h, and hospital region, type, size, and MI volume, the difference in mortality was largely attenuated (hazard ratio: 0.89, 95% confidence interval: 0.79 to 1.00, p = 0.050) (Table 6).
Propensity-matched analysis, PCI patients
The propensity matching was then restricted to patients who underwent PCI (n = 1,282 in each group). Baseline characteristics, medication use, and presenting characteristics were well matched between the groups (Table 1, right). Patients undergoing PCI were substantially younger, more likely to be men, less likely to have diabetes mellitus, hypertension, prior coronary artery bypass grafting, stroke, chronic kidney disease, atrial fibrillation, CHF, or chronic obstructive pulmonary disease and were more likely to have hyperlipidemia or be smokers than either the unmatched population or entire propensity-matched population. They were also more likely to have been transferred in and generally had a lower Killip class.
No-OHS hospitals were significantly more likely to administer clopidogrel (58.7% vs. 66.4%, p < 0.001) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (37.8% vs. 44.5%, p < 0.001) within the first 24 h (Table 2, right). The administration of aspirin, GP IIb/IIIa inhibitors, beta-blockers, heparin products, and statins within the first 24 h was similar at the 2 hospital types.
In-hospital mortality (1.3% vs. 1.0%, p = 0.49); the composite of death and recurrent MI (2.0% vs. 1.1%, p = 0.088); and the composite of death, recurrent MI, cardiogenic shock, and CHF (9.4% vs. 8.6%, p = 0.52) among patients undergoing PCI at OHS and No-OHS hospitals was similar. Patients presenting to OHS hospitals who underwent PCI had a significantly higher incidence of recurrent MI (0.8% vs. 0.2%, p = 0.041).
Patients with NSTEMI presenting to hospitals without on-site cardiac surgery have significantly higher in-hospital mortality than those presenting to hospitals with on-site cardiac surgery. This difference was observed in both unadjusted and propensity-matched models. However, the difference in mortality was of marginal significance after adjusting for both modifiable characteristics, such as the administration of guideline-recommended medications within 24 h, as well as nonmodifiable characteristics, such as hospital size, region, type, and MI volume. Furthermore, in patients who underwent PCI at No-OHS hospitals, who were generally of better health than the population as a whole, there was no increase in mortality when compared with similar patients undergoing PCI at OHS hospitals.
In addition to the difference in in-hospital outcomes between No-OHS and OHS hospitals, patients discharged from No-OHS hospitals were less likely to receive guideline-recommended medications such as aspirin, beta-blockers, and statins. Given the incremental possible benefit derived from each of these medications (11–13), post-discharge adverse event rates may very well be increased among patients discharged from No-OHS hospitals.
This is the first study to specifically evaluate outcomes among patients with NSTEMI presenting to OHS and No-OHS hospitals. Current guidelines recommend against elective PCI at hospitals without surgical backup (8). This recommendation is based largely on a review of Medicare data by Wennberg et al. (7), who reported a 38% relative increase in mortality among patients undergoing nonprimary/rescue PCI at No-OHS hospitals after adjusting for differences in baseline characteristics.
Other studies suggest that PCI in the setting of non–ST-segment elevation acute coronary syndrome at hospitals without surgical backup is safe and effective. In the Swedish Coronary Angiography and Angioplasty registry, 16,245 patients with NSTEMI or unstable angina underwent PCI at hospitals with (n = 12,073) and without (n = 4,172) backup cardiac surgery (14). The 30-day mortality (1.0% vs. 1.2%) was not significantly different between the groups. In a study of patients presenting to a single No-OHS and OHS hospital, there were no deaths or recurrent MIs at either hospital type among the 104 patients who had NSTEMI (6).
The findings presented here suggest that efforts aimed at increasing adherence to guideline recommendations at No-OHS hospitals appear to be warranted and may help close the gap in mortality between the 2 hospital types. Such improvements in adherence are not only within reach, but, when achieved at No-OHS hospitals, are associated with improved outcomes. As noted in the propensity-matched analysis, among low-risk PCI patients, No-OHS hospitals utilized guidelines-based therapies more often, and, in turn, this was associated with a significantly lower incidence of recurrent MI.
Larger hospital size and higher volume have been associated with improved outcomes among patients undergoing PCI (15–17). Many of these studies did not discriminate between truly elective PCI and PCI in the setting of NSTEMI or unstable angina. The findings in the current analysis provide further evidence that hospital characteristics play a significant role in outcomes among patients with NSTEMI, and that outcomes at smaller hospitals with lower MI volumes are significantly worse.
There are several limitations to the current study. While many hospitals participated in the NRMI registry, these hospitals may not be representative of all health care facilities, and they likely reflect larger, more procedure-oriented centers. There was no independent validation of data forms. The outcomes of patients who were transferred to other hospitals are unknown. Long-term outcomes are not known. The American College of Cardiology/American Heart Association guidelines for the management of patients with NSTEMI were updated in 2007. Although all of the medications listed in the current analysis had class I indications in the 2004 guidelines, it is possible that the re-emphasis of an update to the guidelines has increased the use of these medications at hospitals without backup cardiac surgery. Medication treatment may be a function of living long enough to receive medications, rather than the therapies alone. In addition, the added model components may simply reflect the hospital type, such that the significance of hospital type drops as the new variables are added.
Patients with NSTEMI presenting to hospitals without backup cardiac surgery have significantly higher in-hospital mortality, even after adjusting for differences in baseline patient characteristics. The difference in mortality appears to be the result of both modifiable and nonmodifiable factors, suggesting that efforts to increase adherence to guideline recommendations are warranted. Among the relatively healthy cohort of patients who underwent PCI at hospitals without on-site cardiac surgery, there was no increase in mortality compared with similar patients at hospitals with backup cardiac surgery.
The National Registry of Myocardial Infarction is supported by Genentech, Inc., San Francisco, California.
- Abbreviations and Acronyms
- congestive heart failure
- myocardial infarction
- hospitals without on-site open heart surgery
- non–ST-segment elevation myocardial infarction
- hospitals with on-site open heart surgery
- percutaneous coronary intervention
- Received June 18, 2009.
- Accepted July 25, 2009.
- American College of Cardiology Foundation
- Bavry A.A.,
- Kumbhani D.J.,
- Rassi A.N.,
- Bhatt D.L.,
- Askari A.T.
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- et al.
- Smith S.C. Jr..,
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- Collaborative overview of randomised trials of antiplatelet therapy—I
- Carlsson J.,
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- Wu C.,
- Walford G.,
- et al.

domain: medical


text:
DPRK: The Land of Whispers
North Korea, officially the DPRK (Democratic People’s Republic of Korea), has been called the land of whispers for a long time and it’s because people just don’t say things in public. In other words, nobody says anything out in the open. They kind of whisper to each other and then quickly walk away. Not only is it one of the most secretive countries on earth, it’s also one of the most isolated.
Visitors are never shown the full story, only blurry shadows that don’t give the whole picture. Maybe there’s some truth and honesty in what a tourist experiences but it’s probably mostly fear and lies. There’s not a lot online about North Korea either. A lot of what has been published seems one-sided and unreal.
Every year, the amount of foreigners allowed to visit the DPRK is limited to about 1,000 to 2,000. Most visitors go for the Arirang Games and so they don’t get to experience much more than that. Unfortunately, the only feasible way to enter North Korea is to travel in a group with tour guides. This means that all your time and activities while there are controlled. Walking down the street or exploring alone is prohibited for foreigners.
A river separates China from Korea at a place called Dandong. On the Chinese side there are tall buildings, businesses, and advertising. On the Korean side there’s just people wandering along the river and not much else.
There are a strict set of rules that visitors must follow once they are in the DPRK. Pictures and videos of the local people are not allowed, for instance. If a newspaper contains a picture of the political leaders, one is not allowed to fold that newspaper in half or crumble it. Another rule is that when photographing monuments and statues, they have to be shot from a lower angle and the entire structure has to be included in the shot.
Many things and places have been named after the leaders; not only parks and buildings but also mountains, trees, and flowers. However, visitors are never given or allowed to have the local experience. The mandatory tour guides make sure to only speak what they are allowed to say, which is all propaganda.
The ideology of the regime is hard to understand even for the people of North Korea, although none of them would admit that out loud. Watch this fascinating film now.

domain: geography


text:
Trial of Rapid On-Site Evaluation of Transbronchial Needle Aspirate (TBNA)
Purpose: Previous studies suggested an increased diagnostic yield for bronchoscopic (FB) transbronchial needle aspirate (TBNA) specimens from mediastinal lymph nodes when using rapid on-site evaluation by cytopathology (ROSE) but were limited by lack of randomization. The investigators performed the first randomized-prospective trial comparing ROSE(R) to no on-site cytopathology assessment (NR).
Methods: All patients referred were eligible. 78 patients were randomized to R or NR groups. For R procedures, further specimens were deferred until results were available from the on-site cytopathologist. Diagnoses made by all procedures were recorded. The primary end-points were specimen adequacy and diagnostic yield.
|Study Design:||Primary Purpose: Diagnostic|
|Official Title:||A Randomized Prospective Trial of Rapid On-Site Evaluation of Transbronchial Needle Aspirate Specimens|
- diagnostic yield
|Study Start Date:||November 2004|
|Study Completion Date:||December 2007|
|Primary Completion Date:||November 2007 (Final data collection date for primary outcome measure)|
|Experimental: ROSE for TBNA||
rapid on-site evaluation by cytopathology
No Intervention: NR
no on-site cytopathology assessment (NR)


text:
Real Estate Solicitor/Head of Department - Path To Partnership
Real Estate Solicitor - Head of Department - Path to Partnership
A leading Legal 500 listed full-service practice is keen to appoint a Real Estate Solicitor to a Head of Department position and to be responsible for the firms' Property Department and be based predominantly at the firms' flagship office in Coventry.
This practice is one of the largest within both Coventry and Warwickshire and has a network of offices throughout the area. It offers the full range of legal services to both individuals and commercial entities and is renowned for providing high calibre, expert advice. The firm continuously invests in technology to tailor its approach to the needs of its long-standing clients and it is particularly focused on continuous investment in all of its members to ensure constant professional development to aide progression opportunities whilst maintaining an exceptional level of client service.
As a consequence of growth and, vitally, with very specific consideration being given to strategic succession planning, the firm is keen to hear from an experienced commercial property solicitor with a minimum of 5 years' PQE who has a desire to make significant progress in their career. This is a unique opportunity as not only is there the very real opportunity of attaining partner status swiftly, there is also no requirement for you to have a following. The firm already has a well-established and extensive client base so there are already instructions to attend to.
This is the perfect opportunity for somebody who is keen to take on a new and exciting challenge and who wants to get involved in continuing to build the department and increasing the practices' standing in the market, so this is not just a purely fee earning role and has a lot of variety allowing you to really make your mark.
This role would suit a current partner who is perhaps disillusioned in their existing firm and who is seeking a new challenge without having to deal with the complexities of bringing a client base with them. Alternatively, those who able describe themselves as a "frustrated number two/three" who are tired of promises of promotion in their current firm yet again failing to materialise and who are keen to take the step up.
On offer is a very competitive salary and benefits package which includes health and dental insurance and also the opportunity to participate in a number of social outings organised by the firm. The practice provides a supportive and collaborative environment and there is a very good work/life balance philosophy in operation, so this is a firm that is very much aware of the importance of employee engagement.
For more information on this Real Estate Solicitor - Head of Department role please contact Matt Robinson at QED Legal.

domain: law


text:
Another recent work in acrylic on MDF board.
From a figure drawing class that I took part in a few months back.
Working on MDF board with oils, dremel tools, grinders, sand paper and everything else lying around in the studio.
A piece from a few months ago.
Two pieces I did for a charity auction. “Nichinan Sunset” and “Miyakonojo Sunset”

domain: design


text:
This panoramic image presents the awe-inspiring Horseshoe Falls at night, with its powerful cascade of water reflecting vibrant, colorful illumination. The mist rising from the falls adds a mesmerizing quality to the scene, heightening its allure.
The city lights in the background create a striking contrast between the urban landscape and the natural wonder of the falls. The dazzling light show casts rainbow hues on the rushing waters, captivating viewers with the mesmerizing spectacle.
Horseshoe Falls serves as a prominent symbol of hydroelectric power, showcasing the potential of harnessing nature's resources for clean energy. The image highlights the falls' status as a beloved tourist destination and a site for thrilling adventure.
This night photograph of Horseshoe Falls offers a picturesque view of an extraordinary natural wonder, encapsulating its majesty, vibrancy, and spectacular beauty, which leaves an indelible impression on all who experience it.
- Duncan Rawlinson
- Image Size
- 29680x7420 / 253.9MB
6qmc9aZevLGknzdSceebcaa1LMuaHrqY2mQPZVsjUPfA, American Falls, Bridal Veil Falls, Crowd, Duncan Rawlinson Photo, Duncan Rawlinson Photography, Duncan.co, Horseshoe Falls, Hydroelectric power, Hydroelectricity, IQ250, Landscape, Light show, New York, New York State, Niagara Falls, Niagara Falls New York United States Of America, Niagara Gorge, Niagara River, Phase One, Phase One IQ250, Photo by Duncan Rawlinson, Popular, Shot With A Phase One IQ250, Skyline, The Magnificent Niagara Falls at Night, Thrilling, Tourist destination, adventure, bc1q4ryjw6era7jklj0gjftdtpzwkmpgassyhvvdeh, city lights, colorful, exploration, https://Duncan.co, https://Duncan.co/the-magnificent-niagara-falls-at-night, iconic, illuminated, illumination, landmark, long exposure, majestic, mist, natural wonder, night photography, north america, panorama, rainbow, scenic view, spectacular, tourism, tourist attraction, travel, vacation, vibrant, waterfall
- Contained in galleries
- Panorama, Niagara Falls