text:
We do not encourage or condone the use of this program if it is in violation of these laws. WinPcap is part of these download collections: Click to load comments. WinPcap was reviewed by Alexandru Pintilie. Install now to protect your privacy. Google Play Chrome Extension Free access your library of media from your browser.
|winpcap 4.1.2 gratuit
|Fichier D'archive
|Système d'exploitation:
|Windows, Mac, Android, iOS
|Usage Personnel Seulement
|45.7 MBytes
CONS The user will need to possess a fair amount of technical knowledge. Click here to see the download options for WinPcap Being the vital requirement to advanced networking monitor and analysis tools based on packet sniffing, WinPcap is a must-have for those of you that spend precious amounts of time working with this software category. This type of software are provided the facilities to capture raw packets that pass through available network adapters as well as the ones exchanged by other computers on shared media. This software is comprised of a driver and a built-in library. PROS An excellent way to expedite the transmission of packet data between two nodes. What do you like most about this program?
Brave blocks unwanted content by default and keeps count. Usual networking application require only basic operating system elements like sockets to access the data on the network.
WinPcap is an efficient, versatile program that has become the preferred filter engine and packet capture program 41.2 the most popular network applications available today, like protocol analysers, network monitors, network intrusion detection systems, sniffers, traffic generators, traffic analysers, etc. CONS The user will need to possess a fair amount of technical knowledge. It should also be mentioned that the Unix API is found within this library. WinRAR The king of compressed files.
No thanks, continue to download WinPcap.
WinPcap · Download
Some other tools included within WinPcap include Wireshark data graatuit control and the ability to work with User reviews about WinPcap.
Browse the web up to 8x faster than Chrome and Safari.
Don't leave without your download! This software is comprised of a driver and a built-in library.
Home Downloads Blog User Reviews. The ultimate goal of this bundle is to enhance end-user efficiency graruit interacting with a network. Download and installation help. Softonic review WinPcap is a tool that allows users to transfer packets of information within Windows operating systems by circumventing the protocol stack. Such a tool is often used by website developers, networking testing professionals and open-source software creators.
Google Play Chrome Extension Free access your library of media from your browser. This cannot be downloaded because my version of win 10 is not supported by WinPcap 4.
WinPcap Has Ceased Development
Your review for WinPcap. We do not encourage or condone the use of this sinpcap if it is in violation of these laws. WinPcap has some really valuable additional tools like core level packet filters, an engine for generating network statistics and support for remote packet capture.
WinPcap can be thought of as a virtual 'bridge' over traditional Windows protocol techniques. Click to load comments.
Free Download for Windows.
Most networking applications access the network through widely used operating system primitives such as sockets. Unlike traffic shapers, QoS Quality of Service schedulers or personal firewalls, WinPcap's main objective is to simply sniff the packets that transit the network wire.
WinPcap 4.1.2 free Download
The most recent updates of this system seem to have occurred in It is designed to be used with personal computers. Powerfully private No more data charges to download unwanted content. This type of software are provided the facilities to capture raw packets that pass through available network adapters as well as the ones exchanged by other computers on shared media. With this tool, you can capture-transmit network packets, manipulating the protocol grxtuit.
Of all the other virtual brige tool that I've experienced only WinPcap has the capability to provide super efficient data processing. WinPcap is the industry-standard tool for accessing connections between network layers connectivity and selection of routes between two host systemsunder the Windows operating system.
WinPcap was reviewed by Alexandru Pintilie.


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Change Your Water – Change Your Life
Water is the foundation of life on earth and the quality of the water consumed is of most importance. About 75% of the body is comprised of water – so yes, it's a big deal. Water is the basis for all fluids throughout the body and helps transport nutrients, remove wastes, cushions joints, supports digestion, transmits signals, transports hormones, and hydrates tissues. Water plays an incredibly important role in your health and the absence of it can lead to dehydration, a common cause for many health ailments. Adding to this, we live in environments where we are bombarded by chemicals, toxins and other harmful matter in our air, water and the foods we consume. Over time we absorb and can retain these foreign substances within our tissues often leading to chronic ailments and undesired symptoms of illness.
Common Signs of Dehydration
Digestive Disorders
High Blood Pressure
Respiratory Problems
Acid-Alkaline Imbalance
Weight Gain
Skin Problems
Detoxification Deficiencies
Joint Problems
Premature Aging
Does this realization make you want to reach for some water? Well, it's very important to understand that not all water is created equal. Water and other water-like substances can be found in many of the beverages consumed in our day to day lives, during social occasions, while we work and when we exercise. Many of these substances commonly consumed can actually have the opposite effect and lead to further dehydration. Bottled water may be convenient but isn't very special … it's often just tap water with a fancy name and label. Did you know that by changing the water you drink, you can bring about benefits beyond anything imagined? People all around the world are discovering the life changing power of Kangen Water.
Kangen Water (Electrolyzed Reduced Water) is produced using a technology that passes tap water through a carefully designed filter (removal of chlorine/impurities) and separates the hydrogen from the oxygen through a process called electrolysis. This electrolysis-treated water has been proven to neutralize free radicals, promote a healthy pH balance, combat acidity, remove wastes and toxins, and penetrate the tissues more effectively leading to superior cellular hydration. Have we caught your attention? Please contact us to attend a demonstration and learn how you can improve your health and change your life!

subset: commoncrawl


text:
Great Pacific
After USMCA Passes, Why Worry About A China Phase One Deal? // Forbes
Viz Hong Kong
Trade & Tech
Huawei will bring Harmony OS to more products next year, but not phones // CNET
Chinese library workers burn books seen as diverging from teachings of Xi Jinping // Independent
Hong Kong
Inside the Secret Network Helping Protesters Flee Hong Kong // YouTube @ The New York Times
Harshest opinion yet:
US Attorney Durham objects to IG findings on Russia probe origins in stunning statement // Fox News
Soc Media, Econ, Tech
For the first time in US history, a decade will pass without the country falling into a recession // Markets Insider
Chinese restaurant opened by white woman shuts down 8 months after controversy // NBC News
McDonald's black franchisees leave chain as disparity grows // CNBC
Last Week
Cadence editorial blog
Encore editorial blog
Great Pacific
This will fuel anti-China sentiment...
Trade & Tech
Huawei seeks to overturn FCC ban on the use of subsidy program // CNBC
China exports fall again as US trade war continues // BBC News
CNBCs Cramer says US can walk away from the table in China trade talks after jobs report // MarketWatch
Turn of the tide, whether in or out...
Huawei under fire in China over employee detained for eight months // Guardian
For the record...
Hong Kong
Hong Kong protests: Pro-democracy movement keeps up pressure with mass march // CNN
And "told" to sign "was voluntary"...
Hong Kong police to take 'flexible' approach to protests // NY Post
Hong Kong Protest Momentum Faces Test With Weekend Rally, Strike // Bloomberg
Investors 'cautious' about Hong Kong markets in 2020 as questions remain over how protests, trade war will be resolved // SCMP
Officer sitting on arrested student's head was using minimum necessary force, say Hong Kong police // HKFP
And sanctiond human rights groups!
Flagship airline...
Korean Peninsula
North Korea's UN ambassador says denuclearization is off the table in talks with US // CNN
North Korea: It's 'entirely up to the US what Christmas gift' it gets // CNBC
Westernizing his fashion...
Military Faceoff
In 1999, One Country Figured Out How to Kill U.S. Stealth Fighters // National Interest
With Sen. Kamala Harris' exit, Democrats can't avoid a tough conversation about diversity // NBC News
Can you figure out the point of this opinion piece?
Senate Republicans puncture House GOP dreams for impeachment trial // Politico
Nothingburger article, nothing new...
Top Republican urges against speculation after early leaks on FISA report findings // Fox News
Death & Taxes
US vows 100% tariffs on French Champagne, cheese over digital tax // CNBC
NATO Focus
Intelligence agencies have tracked Iranian short-range ballistic missiles into Iraq, US official says // CNN


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Why is he being so Inconsidarate twords me?
So since last month my boyfriend been treating me like this hell claim that he's "busy" with work and school and i understand that but every time I turn around he always end up posteing something on fb but never has time to text me all week and atleast say hi or when i text him he's already hanging with his friends and He hasn't spent time with me in Hela long.I'm always the 1 that initiates contact and I'm always the 1 that ask him if he wants to hangout,so i ended up going 5 days without calling or texting him to see if hell atleast put in some efort (he didnt) so on the 5the day I finnally text him and told him how I felt (my 2 time doing this) and I said Wasup with you?? You don't contact me or barely see me what kinda **** is that???
and he says Idk just busy!!! Me:..action speak louder than words,you could say that you miss me and want to be with me but if you ain't puting In that effort to atleast say hi than all that's comeing out your mouth is bullshit,the same phone that you us to get on fb is the same thing you can use to say hi to me...yea I was pretty pissed!!
A couple of days later didn't really hear nothing from him so I texted him and asked him hows his day going and he said its goin koo I just got back from great America..,now im thinking like wow you couldn't even asked me if I wanted to go??? He took his sister and his cuzn and didn't even invite me wich seemed really unfair and Inconsidarate obviously he's not that busy if he could hangout with friends,go to the club,hop on fb and twitter,go to great America but when it comes to me he's always "busy" idk what to do anymore I'm tired of crying I just need some really good advice???
1 Answer
- ...Lv 48 years agoFavorite Answer
Some good advice will be to leave him. Why do you still want to be in a relationship like this? If he is not even making a still effort to communicate with you why should you? He's doing other things to get away from you, like seeing his friends, going to other places all without you so the best thing to do will be to get over him and find someone who is worth your time.


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GET INVOLVED!! All members are welcome to attend Colorado SPJ Pro Board Meetings. The next session is Saturday, Oct. 19, at 9:30 a.m. at Metropolitan State University of Denver, Room C119.
Come volunteer for a committee (Top of the Rockies contest, Scholarships, Programs, and more), or to simply offer your thoughts. Journalism needs you now more than ever.


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Ralph Waldo Emerson
Famous American poet, essayist and philosopher.
Marilyn Monroe
Famous American actress, model and singer.
Albert Einstein
German-born mathematician and theoretical physicist.
Family Quotes
Showing: 31 - 40 Family Quotes of 83
Parenthood remains the greatest single preserve of the amateur.
Good family life is never an accident but always an achievement by those who share it.
The family is the nucleus of civilization.
To an old father, nothing is more sweet Than a daughter. Boys are more spirited, but their ways Are not so tender.
A large family, quick help.
Cruel is the strife of brothers.
I think the family is the place where the most ridiculous and least respectable things in the world go on.
As states subsist in part by keeping their weaknesses from being known, so is it the quiet of families to have their chancery and their parliament within doors, and to compose and determine all emergent differences there.
Father raised his glass one last time and we repeated after him: "Next year in Jerusalem." None of us could know that this was our last Passover meal as a family.
I'm sure Hitler was great with his family.
Life Quote
Life can only be understood backwards; but it must be lived forwards.
Wise Quote
It is better to remain silent and be thought a fool than to open one's mouth and remove all doubt.
Life Quote
To live is the rarest thing in the world. Most people exist, that is all.
Relationship Quote
A relationship is what happens between two people who are waiting for something better to come along.
Friendship Quote
The friendship that can come to an end, never really began.
All quotations on this website are the property and copyright of their respective authors. All quotations are provided for educational and informational purposes only.
Copyright © 2011 LifeQuotesLib.com. All Rights Reserved.


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Big kudos to @Funk! Many thanks for sharing your! His 2019 code remains unused. Up for grabs!
Any spare code, please ?👻 TIA
Any kind soul would PM his/her unused code ? I purchased a few months ago but somehow didn't get my email. Contacted Teddy, just in case
PA Halloween Sale is on!
Enrique Cutillas replied to cclarry's topic in DealsDespite of turning on a monthly PA-Sub model... what's is still cool on PA webshop besides vouchers? They warned me on a repeat when purchasing! "You already own or are making installment payments on 1 of the products in your cart. Please review your cart below before continuing with your order" Good guy PA!
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My Latest Deal
Enrique Cutillas replied to cclarry's topic in Dealssweet story behind a sweeter dig! well deserved Larry
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Enrique Cutillas replied to cclarry's topic in DealsI'll take any PA spare voucher also, thanks in advance
FREE Sonarworks E Book
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10 freebies @ 6000!
Is there a glitch or is IK going to extend the GB up to 9 freebies?⁉
I jumped twice on this GB. Have just got me AT Fender Collection 2 from JRR. Now is time to decide what else I should choose/skip besides all 4 Tape Machines and both Leslies. I'll be using TR/AT mostly on keys. Happy to keep reading your suggestions in this thread. Also, would be ARC System software only bonus (with no mic) of any use?
Early this month, Reverb gave away their Roland TR-808 Sample Pack. Now their Roland TR-808 +50 drum machines https://reverb.com/software/samples-and-loops/reverb/3514-reverb-drum-machines-the-complete-collection
Free Sonex Audio "Steinway D Piano"
Enrique Cutillas posted a topic in DealsSonex Audio has released a free 6.3GB Steinway Grand Piano Size 6.31 GB / 2805 Samples / Kontakt 5.6 required https://www.sonex.store/en/index.php?route=product/product&path=72&product_id=58 https://sonex.store/files/Sonex_PA_Steinway_D.zip
Thanks. I'm in!
Do I have to purchase from IK webstore to join the group buy ? Could I become part of it registering the license bought from usual official resellers?


text:
Scott Asher
MHN Solutions Showcase: Q&A with RentPath
Throughout the year MHN will showcase companies that provide solutions to the apartment industry. From finance, legal, construction and design to technology, operations, marketing and communications, gain new insights into the companies that solve problems and add value.National 19 November 2015 12:03
RentPath Reveals 2015 Apartment Demand is Breaking Records
The start of 2015 came in hot as demand for apartment housing reached a peak. Despite some slow down, demand in Q2 remained strong.Atlanta 20 July 2015 13:56
Breaking Down the Rental Decision
Study finds that strangers are more influential than friends and family.National 07 May 2015 19:14
Disruptive Technologies
Apartment marketing makes use of new consumer-driven capabilities.National 05 June 2014 20:13
Analyze This!
Savvy multifamily firms monitor multiple metrics to track the impact of marketing. This year, centralized data collection, leading to more efficient reporting and better-than-ever analysis capabilities, is likely to be a definitive trend.National 24 February 2014 04:00
Apartment Guide Survey Suggests Home Sales Will Drive Improvements at Apartment Communities Next Year
A national survey conducted by Apartment Guide suggests that the rising number of new and existing homes will spur investment into apartment community improvements by property managers.National 19 December 2013 19:11
You May Also Like
Tampa-Area Value-Add Community Sells for $18M
The 143-unit multifamily asset traded for almost double the price it sold in 2012. The new owner intends to upgrade and reposition the Class B property.12 August 2019 14:05
A Closer Look at CA Ventures' Expansion Plans
Steve Boyack, recently named CEO of CA Management Services, explains how a management company should adapt its strategies in order to retain tenants and become more sustainable.24 June 2019 07:25
Landmark Properties Opens 9 Student Housing Communities
The assets are located in North Carolina, Arizona, Alabama, Texas, Illinois, Florida and Pennsylvania.10 September 2019 17:11
Access Device Provides Key-Free Exits
Available in touchscreen or pushbutton models, the product from ASSA ABLOY offers greater building control for multifamily property owners.14 November 2019 15:42
FPA Pays $34M for Los Angeles-Area Community
The 108-unit property was 95.4 percent occupied as of October, per Yardi Matrix data.26 November 2019 15:48


text:
A.P Dillon on Social Media
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- #WCPSS Updates: War on Charters, Revisionist History, a threat and an injured student
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#NCED Updates: NCAE hides membership again, a Renewal School District Explainer, General Assembly updates & more
This installment of NCED updates covers the NCAE hiding their membership numbers again, legislative updates and renewal school district explainer video. Also included are a few national headlines and a Quiet Epidemic update. Continue reading
Guilford County Teacher charged with rape of student; held on $2.5M bond
A Guilford County Public Schools high teacher has been arrested on charges that he raped a student. Continue reading
Posted in CRIME, EDUCATION, LL1885, Quiet Epidemic Tagged Daniel Webster Smith Jr., Guilford County Schools, Quiet Epidemic 1 Comment
Durham teacher charged with attempting to kill husband with a knife
A Durham Public School System teacher has been arrested after allegedly attempting to kill her husband with a knife. Continue reading
Posted in EDUCATION, LL1885, Quiet Epidemic Tagged Durham Public Schools, Quiet Epidemic, Trenise Yaisa Wright 1 Comment
Elizabeth Warren called out by #SchoolChoice Parents at Rally
Democratic presidential candidate Sen. Elizabeth Warren (D-MA) was called out for her attacks on charter schools and her anti-school choice stance by a group of minority moms and dads at a recent campaign stop. Continue reading
Posted in EDUCATION, LL1885, School Choice Tagged Elizabeth Warren, Powerful Parent Network, School Choice 1 Comment
Cleveland County special education teacher charged with indecent liberties
A special education teacher in the Cleveland County public school system has been arrested and charged with taking indecent liberties with a student. Continue reading
Posted in CRIME, EDUCATION, LL1885, Quiet Epidemic Tagged Cleveland County Public Schools, Quiet Epidemic, Whitney Fite Baker 1 Comment
#WCPSS Updates: The BIMAS-2 pricetag for experimenting on our kids
This week's WCPSS updates will cover one topic, the BIMAS-2. Also included are a few related headlines and the arrest of an assistant principal. Continue reading
Posted in Big Ed Complex, EDUCATION, LL1885, Parental Rights, Wake County School Board Tagged BIMAS-2 5 Comments
#NCED Updates: Per Pupil Spending, Whiplash and Higher Ed news
This installment of NC Ed updates includes the lastest per-pupil spending figures in North Carolina as well as the whiplash induced by Tom Campbell's education articles and some higher Ed news and general headlines. Continue reading
Posted in EDUCATION, LL1885, NC Ed Updates Tagged Mark Johnson, Per Pupil Spending, Tom Campbell Leave a comment


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Going with the grain: Mother with 12-year food allergy survives on diet of just RICE
A former caterer who developed wide-ranging food allergies more than ten years ago has been forced to survive on a daily diet of rice.
Micaela Stafford, 53, used to love fried breakfasts and roast dinners but her body now rejects any food that include dairy, gluten, wheat, sugars, oils and fats.
The mother-of-two suffers violent physical reactions if she eats any normal meals - forcing her to only eat boiled plain white rice for breakfast, lunch and dinner.
No pain with grain: Micaela Stafford, 53, used to survive on a daily diet of rice because she was allergic to almost all other foods
Medical experts fear she could suffer serious health problems as the illness, which has never been, diagnosed, prevents her from getting nutrients.
Micaela, from Loughborough, Leicestershire, said: 'If I have something I shouldn't, I have to go to bed for a week. My body shuts down.
'Sometimes I feel like I don't have the energy to fight it any more. I just want to give up.
'I just want my life back. I do not want to live like this.
'I would do anything to be able to taste a curry again. And I miss ice cream and desserts so much.
'I just want something with flavour. It is getting harder and harder for me.'
Dieticians, gastroenterologists and even neurologists have been baffled by Micaela's condition, which began in 1999 when she started getting headaches from dairy food.
As the years passed, the foods she could no longer eat increased - to the point where only rice remains.
If she eats something she shouldn't Micaela suffers prolonged migraines, horrendous sickness and diarrhoea and joint pains all over her body.
Renowned Harley Street nutritionist Carolyn Leigh said: 'Not getting any protein into the body is extremely dangerous.
Treat: Micaela used to enjoy curry but can no longer eat the dish
'There is a real imbalance in the body and I do not want to think about what the long-term effects could be.
'She is getting hardly any vitamins, minerals and antioxidants. I think she is heading for a major disease.
'I have never treated anyone with an intolerance to foods this bad.'
Micaela has been forced to stop eating meals out at restaurants because almost all restaurants use oils in their cooking - even when making rice. She used to enjoy curries but even they include sugars and fats.
She takes a gas cooker, pots, pans and rice with her on days out so she can cook food on the move.
She added: 'I have to take a cooker around with me wherever I go. If I forget it that is it - I can't eat for the day. It is my survival kit.'
Micaela says the condition has ruined her life. She suffers from a constant lack of energy so much so that she had to give up her job in catering ten years ago.
She is now practically housebound.
Micaela, who can only drink fennel tea or water, said: 'It has taken more than ten years to get to the point where mentally I can even begin to cope with it.
'I am tired all the time and rarely go out - I have no social life any more and I can't do the things I love like doing the garden.
'I can't make my husband's dinner any more. He has a ready meal every night because he gets in so late.
'I have to use a wheelchair sometimes because I also suffer with scoliosis but I feel more disabled not being able to be myself and eat what I want.
'I want someone to see my story and come forward to help me. I want this nightmare to end.
'I keep thinking there must be more people out there who have this. It is a silent illness.'
Husband Philip, 62, a worker at British Waterways, said: 'I'm not a massive food person but this is ruining both our lives.
'We just want to find a way we can fix her and live normally again.'
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Jordon is the President/CEO of HITECH. He is a business minded security professional who has a passion for people and small business. Some of his certifications include: CISSP, CSSA, MCPS, MCNPS, MS, SA
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Siberian researchers contribute to global monitoring of the Earth's Green Lungs
(Siberian Federal University) Researchers of Siberian Federal University took part in a global project to collect, systematize and universalize data on the composition of forests in all climatic zones and on all continents of the planet.
New tool to predict the global spread of dengue
Researchers have developed a new tool to predict the global spread of human infectious diseases, like dengue, and track them to their source.
Why copper is so good at killing super bugs (and regular bacteria, too)
Copper's health benefits have been known for ages — literally. One of the oldest medical books in the world, the 5,000-year-old Smith Papyrus, details how copper was used in ancient Egypt to sterilize both water and directly treat injuries. Thousands…
The health benefits of green tea
Tea is one of the most popular beverages in the world, with some reports stating that tea is second only to water in worldwide beverage consumption. Tea is embedded in culture: the British have tea time, and Asian communities still…
Purdue apple innovator elected fellow of National Academy of Inventors
(Purdue University) Jules Janick, a distinguished horticulture professor in Purdue University's College of Agriculture, has been elected a fellow of the National Academy of Inventors.
1940s blood samples reveal historical spread of malaria
DNA from 75-year old eradicated European malaria parasites uncovers the historical spread of one of the two most common forms of the disease, Plasmodium vivax, from Europe to the Americas during the colonial period, finds a new study.
Science snapshots from Berkeley Lab
(DOE/Lawrence Berkeley National Laboratory) An experiment shows undersea fiber optic cable can act as earthquake detectors, a new tool will enable important insights into the microbial communities in the environment and inside our bodies, and an infrared technique at Berkeley Lab's Advanced Light Source probes active chemistry at the solid-liquid interface.
A better way to convert dog years to human years
Researchers collected DNA samples from 104 Labrador retrievers over a 16-year period. They compared changes in their DNA samples against DNA previously collected from humans. The result? A better sense of what a "dog year" really means.
Global heating driving spread of mosquito-borne dengue fever
Rising temperatures across Asia and the Americas have contributed to multiple severe outbreaks of dengue fever globally over the past six months, making 2019 the worst year on record for the disease. In 1970 only nine countries faced severe dengue…
Once Numbering Less Than 400, Majestic Bukhara Deer Return To The Wilds Of Kazakhstan
In a bid to reestablish tigers in the area, five Bukhara deer have stepped foot onto central Kazakhstan soil, where they've been absent for 100 years.
The post Once Numbering Less Than 400, Majestic Bukhara Deer Return To The Wilds Of Kazakhstan appeared first on Good News Network.


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Conan is a late-night talk show airing each Monday through Thursday on TBS in the United States. The hourlong show premiered on November 8, 2010, and is hosted by writer, comedian and performer Conan OBrien. The programs host previously starred on NBCs Late Night with Conan OBrien for 16 years, then presented The Tonight Show for seven months until Jay Lenos return to his version of The Tonight Show due to the 2010 Tonight Show conflict. Describing itself as a traditional late-night talk show, Conan draws its comedy from recent news stories, political figures and prominent celebrities, as well as aspects of the show itself. The show typically opens with a monologue from Conan OBrien relating to recent headlines and frequently features exchanges with his sidekick, Andy Richter, and members of the audience. The next segment is devoted to a celebrity interview, with guests ranging from actors and musicians to media personalities and political figures. The show then closes with either a musical or comedy performance. In January 2010, after The Tonight Show with Conan OBrien had been on the air for seven months, it was announced that NBC intended to move Jay Leno from primetime back to his original timeslot, with OBriens show starting shortly after midnight. Following a brief conflict, NBC announced that they had paid $45 million to buy out OBriens contract, ending his relationship with the network. Months after his official leave, OBrien went on a comedy tour called The Legally Prohibited from Being Funny on Television Tour, which was largely inspired by the outpouring of support for OBrien on the Internet during the conflict. It was announced on the first day of the tour that OBrien would be joining TBS in November.
Each week celebrity guests join Irish comedian Graham Norton to discuss what's being going on around the world that week. The guests poke fun and share their opinions on the main news stories. Graham is often joined by a band or artist to play the show out.
TV Show Star Rating : 6.6 Read More
After Jay Leno's second retirement from the program, Jimmy Fallon stepped in as his permanent replacement. After 42 years in Los Angeles the program was brought back to New York.
TV Show Star Rating : 6 Read More
Wogan is a British television chat show that was broadcast on BBC1 from 1982 until 1992, presented by Terry Wogan. It followed the format of a series broadcast in 1980 entitled What's On Wogan?, which failed to gather viewers. The Wogan show was initially broadcast on Tuesday evenings on BBC1 in 1981. From 1982 to 1984, it moved into the Parkinson slot on Saturday nights.
From Monday 18 February 1985 it was moved to weekday evenings at 7:00pm, where it remained, three nights per week, from 1985 to 1992, as part of the new look BBC one schedule. The show was generally broadcast live from BBC Television Theatre in Shepherd's Bush, London until 1991. It was then broadcast from the BBC Television Centre. Some shows were pre-recorded, but broadcast unedited, 'as live'. It was replaced by the soap opera Eldorado.
TV Show Star Rating : 7 Read More
Some of this year's most talked about talent open up about the challenges and triumphs of creating critically acclaimed series and performances.
TV Show Star Rating : 8 Read More
What to expect: interviews, musical performances, a fierce band, surprising stories and most of all, guests who are more than happy to play along and follow Éric Salvail on his beautifully crazy tangents!
TV Show Star Rating : 0 Read More
Jimmy Kimmel Live! is an American late-night talk show, created and hosted by Jimmy Kimmel and broadcast on ABC.
TV Show Star Rating : 5.9 Read More
Skavlan is a Norwegian-Swedish television talk show hosted by Norwegian journalist Fredrik Skavlan. It premiered in Sweden on Sveriges Television in January 2009, and the first guests to appear on the show were former Prime Minister of Sweden Göran Persson and his wife Anitra Steen. On 8 May 2009, it was announced that Skavlan had been renewed for a second season. It was also announced that the show would no longer only be produced by SVT in Sweden; Skavlan would now be partly produced in Norway by the Norwegian Broadcasting Corporation. The first twelve episodes of Skavlan's second season were produced by SVT in Sweden, and the remaining twelve by NRK in Norway.
Skavlan speaks Norwegian and his dialog is therefore subtitled in Swedish in Sweden, even though the two languages are quite similar and mutually intelligible. If the persons being interviewed by Skavlan are Swedish, he often tells them to let him know if they do not understand what he is saying. Swedish novelist Jan Guillou has criticized SVT for subtitling the program, stating "there is no need for that. If the host had been Danish, subtitling would have been necessary, but with a Norwegian host it does not make any sense."
TV Show Star Rating : 5.3 Read More
Each week Bill Maher surrounds himself with a panel of guests which include politicians, actors, comedians, musicians and the like to discuss what's going on in the world.
TV Show Star Rating : 6.2 Read More
Late Show with David Letterman is an American late-night talk show hosted by David Letterman on CBS. The show debuted on August 30, 1993, and is produced by Letterman's production company, Worldwide Pants Incorporated and CBS Television Studios. The show's music director and band-leader of the house band, the CBS Orchestra, is Paul Shaffer. The head writer is Matt Roberts and the announcer is Alan Kalter. Of the major U.S. late-night programs, Late Show ranks second in cumulative average viewers over time and third in number of episodes over time. The show leads other late night shows in ad revenue with $271 million in 2009.
In most U.S. markets the show airs at 11:35 p.m. Eastern/Pacific time, but is recorded Monday through Wednesday at 4:30 p.m., and Thursdays at 3:30 p.m and 6:00 p.m. The second Thursday episode usually airs on Friday of that week.
In 2002, Late Show with David Letterman was ranked No. 7 on TV Guide's 50 Greatest TV Shows of All Time. CBS has a contract with Worldwide Pants to continue the show through 2014; by then, Letterman will surpass Johnny Carson as the longest tenured late-night talk show host.
TV Show Star Rating : 6.9 Read More
Furie 2019 - Foreign Bluray 720p (Dec 15th)
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Rosewood meaning in Urdu is Khushbodar lakri خُوشبُودار لَکڑی, where Rosewood synonym is and also find here definition and translation of Rosewood.
The word
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Rosewood Meaning in Urdu - In the age of digital communication, it is better for any person to learn and understand multiple languages for the better communication. In the modern world, there is a dire need of people who can communicate in different languages. However, a person feels better to communicate if he/she has a sufficient vocabulary. The Rosewood meaning in Urdu will improve your knowledge about Rosewood. By visiting this page you will get Rosewood of different words and you can easily improve your English and Urdu vocabulary.
Searching meanings in Urdu can be beneficial for understanding the context in an efficient manner. You can get more than one meaning for one word in Urdu. You have searched the English word "Rosewood" which means "خُوشبُودار لَکڑی" Khushbodar lakri in Urdu. Rosewood meaning in Urdu has been searched 310 (three hundred and ten) times till Dec 16, 2019. You can find translation in Urdu and Roman Urdu that is Khushbodar lakri - for the word Rosewood. The definitions of the word Rosewood has been described here with maximum details, and also fined different synonyms for the word Rosewood, like . You can listen to the pronunciation of the word Rosewood in clear voice from this page online through our voice dictionary a unique facility for dedicated users. You can find words like Rosewood from Hamariweb.com dictionary in multiple languages like Urdu, Arabic, Hindi, Spanish, French and other languages. Hamariweb.com dictionary is not only popular among students but also popular among professionals; it is one of the best online dictionaries in Pakistan and Worldwide especially in "English to Urdu Meaning" & "Urdu to English Meaning" of thousands of daily use and typical words.


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The Boeing Co. recently announced that two Missouri S&T graduates — Carl Vorst, EE'68, and Talion Edwards, ME'97 — have received the Boeing Special Invention Award. The award recognizes outstanding contributions to aerospace. Boeing officials said Vorst and Edwards are among the company's leading scientists.
Boeing recognizes leading scientists
Around the Puck
"Forged in Gold: Missouri S&T's First 150 Years"
In the 1870s, Rolla seemed an unlikely location for a new college. There were only about 1,400 residents in a community with more saloons than houses of worship. There were no paved streets, sewers or water mains. To visitors, there seemed to be as many dogs, hogs, horses, ducks and geese as humans walking the dusty streets.[Read More...]
Bringing clean water to South America
Assessing water quality, surveying mountaintop locations and building systems to catch rainwater — that's how members of S&T's chapter of Engineers Without Borders spent their summer break.[Read More...]
Geothermal goals exceeded
After five years of operation, Missouri S&T's geothermal energy system continues to outperform expectations. S&T facilities operations staff originally predicted the geothermal system would reduce campus water usage by over 10% — roughly 10 million gallons per year. The system, which went online in May 2014, cut actual water usage by 18 million to 20 […][Read More...]
What happens in Vegas…may appear in print
In his latest volume of Las Vegas lore, historian Larry Gragg says it was deliberate publicity strategies that changed the perception of Sin City from a regional tourist destination where one could legally gamble and access legalized prostitution just outside the city limits, to a family vacation spot filled with entertainment options and surrounded by […][Read More...]


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Cocktail Dresses Style Guide For Men and Women
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Since their inception in the early 20th century, cocktail parties have become fashionable. If you are invited to one and the invite specifies the appropriate cocktail dress code there is no need to worry or get into a dither as to how to dress. Be it for your anniversary party or for your official events, if you want to follow the cocktail dress code then you can wear the suit with matching trousers and tie. When you choose the dress for your party, you can consult with your dress designers and you can also talk to the retail outlet personnel. They will assist you to choose the best cocktail dress and they will also provide you with the best dresses which will especially be customized for you.
Broad definition of cocktail dresses:
If you receive an invite then common sense will tell you that it is a formal occasion and the host will expect you to blend in by wearing "appropriate" attire. To explain it in the simplest terms, cocktail dress means almost the same type of dress you would wear to formal events like weddings, birthday celebrations and anniversaries. This narrows down the choice of cocktail apparel for men and cocktail dresses for women to select styles.
The dress code that must be avoided for your cocktail parties:
- If you are doubtful as to what is implied by the cocktail dress code then ask your host and follow his instructions. If he goofs and says jeans are acceptable you certainly will not be blamed.
- Do not wear the most stylish and haute couture dress that will upstage your host or the guest of honour, especially when it is an event like weddings.
- Men: Do not wear gaudy, neon or light colors.
- Women: Do not wear flat heeled footwear, go for heels. Else you can also try out the ugg sheepskin boots and footwear for your parties.
What would be your best cocktail dress?
For men the rules are relatively simple. Consider the weather and the season and accordingly pick your cocktail dress. You can wear a tux if you like but something less formal like trousers and a coat or jacket. Just wear dark colours and also try to wear some leather footwear or shoes with the suit. Choose a plain coloured shirt and make sure the collars and cuffs are not floppy. There are little things to which you can pay attention for big results. If you think no one is going to look at your shoes, think again. Pick calf length socks to match the trousers, preferably dark coloured. Lastly, you need to wear some attractive accessories like you can wear some gold chain wristwatch with your formal dress code, and if you wear a T-shirt then you can wear the leather band wrist watch.
For women:
Women have more latitude when it comes to picking dresses for cocktail events. The first thing to do is pick a dress to suit the body shape otherwise it will never look good. Pear shaped bodies look good in waistline dresses and A-line skirts to draw attention away from the body's lower half. Wear an upper garment preferably with shoulder pads. Straight bodied females can wear a dress that clings to the top and has a flowing bottom or a suit with a peplum jacket. Women with fuller bodies will benefit by wearing more accessories, a low décolleté and empire waistline dress. Generously endowed women can look good in slightly loose fitting clothes instead of body hugging dresses.
Accessories are indispensable for women from a simple embellishment in the hair to earrings, a simple necklace, and a bracelet and, of course, a neat and dandy clutch instead of a shoulder bag.
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Joe Burrow arrasa votación y gana el Trofeo Heisman
NUEVA YORK (AP) — El quarterback Joe Burrow, de LSU, conquistó el sábado el Trofeo Heisman, al acaparar proporciones sin precedentes de los votos.
Joe Burrow Wins the 2019 Heisman Trophy
- 14 Diciembre 2019
- Fuente: USA Today
NEW YORK — LSU quarterback Joe Burrow has won the 2019 Heisman Trophy, cementing his place in program and SEC lore after one of the most impressive seasons by a passer in the history of the sport.
Perry rushes for 304 yards, leads No. 21 Navy past Army
PHILADELPHIA (AP) Navy used a trick play to help reverse a rare losing streak against Army and Malcolm Perry ran for a career-high 304 yards and two touchdowns in front of President Donald Trump in the No. 21 Mids' 31-7 victory Saturday at Lincoln Financial Field.
AP Player of the Year: QB Joe Burrow, first winner from LSU
What figures to be an award-winning week for LSU quarterback Joe Burrow is underway.
LSU Quarterback Joe Burrow Overwhelming Favorite for 2019 Heisman Trophy
- 14 Diciembre 2019
- Fuente: si.com
The question going into Saturday night's Heisman Trophy ceremony isn't whether LSU quarterback Joe Burrow can become the second Tiger player to take home college football's most prestigious award. No, the question is how much Burrow will win by.
Jackson, Ravens beat Jets 42-21 to clinch AFC North title
- 12 Diciembre 2019
- Fuente: AP
BALTIMORE (AP) Lamar Jackson threw five touchdown passes, scurried into the NFL record book and guided the Baltimore Ravens to their second straight AFC North title and 10th consecutive victory, 42-21 over the New York Jets on Thursday night.
Army aims for fourth straight win over No. 23 Navy
- 12 Diciembre 2019
- Fuente: AP
The 120th installment of the Army-Navy Game on Saturday comes with some added incentive for the No. 23 Midshipmen.
Heisman Trophy finalists: How to rank the three primary contenders for the 2019 award
- 11 Diciembre 2019
- Fuente: cbssports.com
The official Heisman Trophy ballot only allows voters to list three players. Seems kind of limiting considering there are 130 schools, half of them in the Power Five, and scores of skill players populating them.
International players to compete for a spot in the NFL international player pathway program
- 11 Diciembre 2019
- Fuente: NFL
Nine athletes from eight countries will compete for a spot in the 2020 International Player Pathway Program, the NFL announced today.
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- Burrow completes Heisman coronation, LSU routs Georgia 37-10
- Gibson, No. 16 Memphis top No. 21 Cincinnati for AAC title


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Edoxaban Versus Warfarin in Latin American Patients With Atrial FibrillationThe ENGAGE AF-TIMI 48 Trial
Author + information
- Received April 24, 2018
- Revision received June 28, 2018
- Accepted July 2, 2018
- Published online September 17, 2018.
Author Information
- Ramón Corbalán, MDa,∗ (corbalan{at}med.puc.cl), @BrighamWomens,
- José Carlos Nicolau, MDb,
- José López-Sendon, MDc,
- Armando Garcia-Castillo, MDd,
- Rodrigo Botero, MDe,
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- Manuel Horna, MDg,
- Christian T. Ruff, MD, MPHh,
- Rose A. Hamershock, MAh,
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- Eugene Braunwald, MDh and
- Robert P. Giugliano, MD, SMh@rgiugliano
- aDivisión Cardiovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- bInstituto do Coracao, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- cHospital Universitario La Paz, IdiPaz, Madrid, Spain
- dCardiolink Clinical Trials S.C., Monterrey, Mexico
- eClinica Medellin, Medellin, Colombia
- fEdificio Clinicas Medicas, Ciudad de Guatemala, Guatemala
- gInstituto Médico Miraflores, Lima, Perú
- hTIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Ramón Corbalán, Department Cardiovascular Diseases, P. Catholic University of Chile, Marcoleta 367, Piso 7, Santiago, Chile, CP 8330024.
Central Illustration
Background There is limited information about the use of antithrombotic therapies and outcomes of Latin American (LatAm) subjects with atrial fibrillation. The global ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation Atrial Fibrillation–Thrombolysis In Myocardial Infarction 48) trial compared the efficacy and safety of edoxaban versus warfarin over a median follow-up of 2.8 years.
Objectives The authors aimed to compare adjusted outcomes in Latin America versus outside Latin America and to compare outcomes stratified by anticoagulant treatment and region.
Methods The authors analyzed clinical characteristics and outcomes, adjusted for baseline characteristics, the Human Development Index, and randomized treatment of 2,661 LatAm versus 18,444 non–Latin American subjects (nLAS).
Results When compared with nLAS, LatAm subjects had a similar overall risk for stroke. After multivariate adjustment, the risks of stroke/systemic embolism (hazard ratio [HR]: 1.19; 95% confidence interval (CI): 0.96 to 1.47; p = 0.11) and major bleeding (HR: 1.10; 95% CI: 0.89 to 1.36; p = 0.39) were similar in LatAm and nLAS. LatAm subjects were at higher adjusted risk of death (HR: 1.48; 95% CI: 1.30 to 1.69; p < 0.001) and intracranial hemorrhage (ICH) (HR: 1.55; 95% CI: 1.00 to 2.41; p = 0.049). In both regions, when compared with warfarin, edoxaban reduced stroke/systemic embolism (HR: 0.64 and 0.91 in LatAm and nLAS, respectively), major bleeding (HR: 0.71 and 0.82), and cardiovascular death (HR: 0.78 and 0.88), without evidence of regional heterogeneity (pint = 0.41, 0.50, and 0.70, respectively). There was a greater reduction in hemorrhagic stroke with edoxaban in LatAm (HR: 0.16) than in nLAS (HR: 0.64; pint = 0.037).
Conclusions After multivariable adjustment, LatAm subjects with atrial fibrillation had higher rates of intracranial hemorrhage and death than nLAS. Outcomes with higher-dose edoxaban versus warfarin were at least as favorable in LatAm subjects as in nLAS, with an even greater reduction in hemorrhagic stroke seen in LatAm.
The prevalence of atrial fibrillation (AF) increases with aging and is associated with a higher risk of ischemic stroke, heart failure, and all-cause mortality (1–3). The international ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation Atrial Fibrillation–Thrombolysis In Myocardial Infarction 48) trial evaluated, in a double-blind fashion, 2 different dose regimens of edoxaban, an oral anti–factor Xa inhibitor, compared with warfarin in 21,105 subjects with AF who were at moderate to high risk of stroke. Both edoxaban dose regimens were noninferior to warfarin in stroke prevention and significantly reduced rates of major and intracranial bleeding and cardiovascular (CV) death (4).
Data regarding baseline characteristics and outcomes of Latin American (LatAm) subjects with AF are limited. There is considerable variability in the available data from LatAm, depending on the design of global registries and numbers of centers and countries involved (5–7). Although the rate of prescription of vitamin K antagonists (VKAs) in LatAm is similar to that reported in North American and European surveys, there is scarce information about the efficacy and safety of antithrombotic therapies in this population (8).
In this paper, we analyzed baseline characteristics and outcomes with edoxaban versus warfarin in subjects with AF enrolled in the ENGAGE AF-TIMI 48 trial in LatAm compared with non–Latin American subjects (nLAS).
Study design
The design of ENGAGE AF-TIMI 48 has been described (9). This international trial randomized subjects with documented AF in a double-blind manner to 3 treatment arms: higher-dose edoxaban (HDE) (60 mg daily), lower-dose edoxaban (LDE) (30 mg daily), and warfarin with dose adjustment to achieve an international normalized ratio (INR) 2.0 to 3.0. The doses of edoxaban were reduced by 50% in both edoxaban treatment arms in cases with a creatinine clearance ≤50 ml/min, low body weight (≤60 kg), or concomitant drug therapy with a strong P-glycoprotein inhibitor. Median follow-up was 2.8 years (8). For this analysis, we focused on HDE because this is the regimen approved for use.
Subjects enrolled
Eligible subjects were age 21 years or older with a documented episode of AF within the prior 12 months and a CHADS2 score ≥2, who required permanent oral anticoagulation. Exclusion criteria included a history of AF secondary to a reversible disorder, creatinine clearance below 30 ml/min at the end of screening, moderate to severe mitral stenosis, previous implantation of mechanical valves, need for dual antiplatelet therapy, high risk of bleeding, coronary revascularization, or stroke within the previous 30 days.
The primary efficacy outcome was the time to first stroke (ischemic or hemorrhagic) or systemic embolic event (SEE). The secondary efficacy outcome was the composite of stroke, SEE, or death from CV causes (including bleeding). Major adverse cardiovascular events (MACE) were stroke, SEE, myocardial infarction (MI), or death from any cause. Additional efficacy endpoints were death from any cause, MI, and the individual elements described in the previous text.
The principal safety outcome was major bleeding as defined by the International Society of Thrombosis and Haemostasis. Key secondary safety outcomes included fatal, life-threatening, intracranial, and clinically relevant nonmajor bleeding. The primary net clinical outcome was a composite of stroke, SEE, and major bleeding.
Differences in baseline characteristics and outcomes between regions (LatAm vs. nLAS) were compared first in the whole population (collapsing across all 3 randomized treatment groups). This was followed by comparisons of outcomes by region within the warfarin arm only. Finally, outcomes were compared by randomized treatment (edoxaban vs. warfarin), stratified by region.
Adjudication of all events was performed by an independent clinical endpoint committee that was unaware of study drug assignment. The relevant ethics committee at each center reviewed and approved the protocol and amendments, and all patients provided written informed consent.
Statistical analysis
Baseline characteristics and concomitant medications at randomization were summarized as counts and percentages or means with SDs. These were compared between subjects enrolled in LatAm versus nLAS with a chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. Event rates were expressed per 100 patient-years. Mortality was reported using a Kaplan-Meier curve stratified by treatment arm and region. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated with Cox proportional hazards models.
Because subjects were enrolled from different parts of the world, the patterns of comorbidities, sociocultural levels, incomes, and access to health care facilities might differ. Therefore, all proportional hazards analyses comparing LatAm subjects to nLAS were adjusted for age; sex; body mass index; history of hypertension, dyslipidemia, diabetes, stroke or transient ischemic attack (TIA), congestive heart failure (CHF), coronary artery disease (CAD), hepatic disease, and bleeding (excluding intracranial hemorrhage); smoking status; increased risk of falling; risk of neuropsychiatric disease; race; creatinine; pattern of atrial fibrillation; alcohol intake; medication predisposing to bleeding; as well as the randomized treatment and the Human Development Index (HDI). The HDI was created to emphasize that people and their capabilities should be the ultimate criteria for assessing the development of a country, not economic gross national index alone (10). In 2010, the HDI was available for 169 countries, which were grouped in quartiles as very high (HDI >0.788), high (0.677 to 0.784), medium (0.488 to 0.669), or low (0.300 to 0.470). Proportional hazards derived from Cox models comparing edoxaban and warfarin treatment were adjusted for the 2 randomization stratification factors as described in the ENGAGE AF-TIMI 48 protocol—need for dose reduction, and CHADS2 score at randomization. The proportional hazards assumption was confirmed with Schoenfeld residuals and by plotting the log negative-log of the survival function by log of time.
Analyses for efficacy events were calculated using the intention-to-treat principle, which included data from subjects who underwent randomization, and included all events whether occurring on or off study drug during the treatment period. Analyses for bleeding events were performed during the on-treatment period, defined as the time between the first study drug dose and either the end of the planned treatment period or 3 days after the last dose of study drug if it was discontinued early, with interval censoring of events during study drug interruptions that lasted >3 days. Analyses were done using SAS version 9.4 (SAS Institute, Cary, North Carolina). This trial is registered with ClinicalTrials.gov (NCT00781391).
Patient characteristics
The ENGAGE AF-TIMI 48 trial recruited 21,105 subjects worldwide, including 2,661 subjects from 7 LatAm countries: Argentina (n = 1,060), Brazil (n = 707), Chile (n = 254), Colombia (n = 141), Guatemala (n = 136), Mexico (n = 190), and Peru (n = 173). Baseline characteristics of LatAm subjects compared with nLAS are shown in Table 1. LatAm subjects had higher proportions of permanent AF, elderly subjects, higher proportions of pre-existing hypertension, CHF, left ventricular ejection fraction <40%, and lower mean creatinine clearance and body weight (Table 1). On the other hand, LatAm subjects had a lower incidence of prior MI, diabetes and peripheral artery disease (PAD). Both the mean CHA2DS2-VASc score and Charlson Comorbidity Index were slightly (0.1 points), yet significantly, lower in LatAm subjects (Table 1). Meanwhile, the mean HDI and Gross National Index in LatAm were 8% and 55% lower, respectively, compared with the other countries combined. LatAm subjects were less likely to have received VKAs prior to randomization and to be treated at baseline with beta-blockers, statin, and calcium-channel blockers, but were more frequently treated with amiodarone, digitalis, diuretic agents, and renin-angiotensin-aldosterone inhibitors (p < 0.01 for each).
Study drug management
A total of 10 LatAm subjects (0.4%) and 69 nLAS (0.4%) never took study drug and thus were not included in the safety population. The study drug was interrupted for >3 days less frequently in LatAm subjects than nLAS (47.9% vs. 52.2%; p < 0.001) during the median 2.8 years of follow-up. The median time in therapeutic range (TTR) in patients randomized to warfarin was significantly lower in LatAm subjects (66% vs. 69%; p < 0.001).
Outcomes in the total population
The primary efficacy endpoint of stroke/SEE occurred in 135 of 2,661 patients enrolled in LatAm compared with 881 of 18,444 nLAS (2.08%/year vs. 1.77%/year in LatAm vs. nLAS, respectively; adjusted HR: 1.19; 95% CI: 0.96 to 1.47; p = 0.11) (Table 2, Figure 1). There were no regional differences in the adjusted risk of all stroke or stroke subtypes, myocardial infarction, or hospitalization for CV causes (Table 2).
The adjusted risk of major bleeding was also similar in LatAm versus nLAS (2.67%/year vs. 2.58%/year; adjusted HR: 1.10; 95% CI: 0.89 to 1.36; p = 0.39) (Table 2, Figure 1). However, the adjusted risks of intracranial hemorrhage (ICH) (adjusted HR: 1.55; 95% CI: 1.00 to 2.41; p = 0.049), major or clinically relevant nonmajor bleeding (adjusted HR: 1.22; 95% CI: 1.09 to 1.37; p < 0.001), and all bleeding (adjusted HR: 1.26; 95% CI: 1.14 to 1.40; p < 0.001) were significantly increased in LatAm.
All-cause mortality was significantly higher in LatAm (6.56%/year vs. 3.72%/year; adjusted HR: 1.48; 95% CI: 1.30 to 1.69; p < 0.001), with an excess risk in both deaths due to CV (4.68%/year vs. 2.64%/year; adjusted HR: 1.43; 95% CI: 1.22 to 1.67) and non-CV causes (1.88%/year vs. 1.08%/year; adjusted HR: 1.76; 95% CI: 1.37 to 2.26]); p < 0.001 for each (Table 2, Figure 1). A similar pattern was observed for major adverse CV events and the 3 net clinical outcomes that combined death, CV events, and bleeding.
There was variation in event rates between the countries in LatAm, but, because of the small sample size in several countries, it is not possible to determine whether these were play of chance or not. When analyzing causes of CV deaths, we found that sudden cardiac death (adjusted HR: 1.48; 95% CI: 1.18 to 1.86) and death due to heart failure or shock (adjusted HR: 2.20; 95% CI: 1.64 to 2.95) were significantly more frequent in LatAm subjects (each p ≤ 0.001). Among non-CV deaths, fatal infections/sepsis were significantly more common (adjusted HR: 3.09; 95% CI: 2.13 to 4.48; p < 0.001) in LatAm subjects. There were no other significant differences among other causes of CV and non-CV deaths between regions.
There was evidence for a significant interaction between the use of baseline lipid therapy and CV mortality between the regions. Among patients treated with lipid-lowering drugs, the CV mortality was similar in LatAm versus nLAS (adjusted HR: 1.14; 95% CI: 0.88 to 1.48), whereas among patients who were not on lipid-lowering therapy at baseline, CV mortality was significantly higher in LatAm subjects (adjusted HR: 1.56; 95% CI: 1.30 to 1.86; pint = 0.033). No other significant interactions between regions or other therapies, including the prior use of VKAs or baseline use of beta-blockers, calcium-channel blockers, digitalis, or amiodarone, were present for the endpoint of CV death (pint >0.10 for each).
Efficacy and safety outcomes in 7,036 subjects randomized to warfarin
In the warfarin arm, the rates of stroke/SEE were 2.50%/year in the 888 LatAm subjects versus 1.71%/year in the 6,148 nLAS (adjusted HR: 1.45; 95% CI: 1.01 to 2.09; p = 0.042), while all-cause mortality rates were 7.34%/year versus 3.97%/year (adjusted HR: 1.49; 95% CI: 1.19 to 1.85; p < 0.001) (Online Table 1). In the warfarin arm, there was no difference in major bleeding (adjusted HR: 1.15; 95% CI: 0.84 to 1.58; p = 0.38) by region, although LatAm subjects did have higher adjusted risks of ICH (adjusted HR: 2.07; 95% CI: 1.18 to 3.65; p = 0.011) and life-threatening or fatal bleed (adjusted HR: 1.83; 95% CI: 1.13 to 2.96; p = 0.014) (Online Table 1).
Efficacy and safety in 14,071 subjects randomized to HDE versus warfarin by region
The annualized rates of stroke/SEE in the 1,774 LatAm subjects and in the 12,297 nLAS were both lower with HDE compared with warfarin (LatAm: HDE 1.61% vs. warfarin 2.50%; HR: 0.64; 95% CI: 0.42 to 0.99; nLAS: HDE 1.56% vs. warfarin 1.71%; HR: 0.91; 95% CI: 0.77 to 1.08) with no statistical evidence of heterogeneity by region (pint = 0.14) (Table 3, Online Table 2, Central Illustration). There was a larger absolute reduction in the Kaplan-Meier rate of stroke/SEE at 3.5 years with HDE compared to warfarin in LatAm subjects (5.37%) than in nLAS (0.35%) (Figure 2). Annualized rates for LatAm of all-cause mortality were 7.34% versus 6.47% for nLAS, HR: 0.88 (95% CI: 0.70 to 1.10, pint = 0.27). HDE significantly reduced hemorrhagic stroke compared with warfarin in both regions, but there was evidence of significant effect modification by region (pint = 0.037), with a greater benefit observed in LatAm subjects (HR: 0.16; 95% CI: 0.05 to 0.55) compared with nLAS (HR: 0.64; 95% CI: 0.44 to 0.92). In both regions, HDE tended to reduce the rates of MACE and CV mortality compared with warfarin (Table 3, Central Illustration) without significant regional heterogeneity.
Reductions in major bleeding with HDE compared with warfarin were observed in both regions (LatAm: HDE 2.65% vs. warfarin 3.74%; HR: 0.71; 95% CI: 0.49 to 1.03; nLAS: HDE 2.76% vs. warfarin 3.39%; HR: 0.82; 95% CI: 0.71 to 0.94) with no statistical evidence of heterogeneity by region (pint = 0.50) (Table 3, Central Illustration). The incidence of life-threatening or fatal bleeding, ICH, major or clinically relevant nonmajor bleeding, and all bleeding were significantly lower in the HDE arm compared with warfarin by a similar degree in both regions (each pint >0.10) (Table 3). Rates of major gastrointestinal bleeding were increased with HDE versus warfarin to a similar degree in LatAm subjects (HR: 1.33; 95% CI: 0.78 to 2.25) and nLAS (HR: 1.22; 95% CI: 0.99 to 1.50; pint = 0.77). The primary net outcome was significantly reduced with HDE versus warfarin in both regions (HR: 0.82; 95% CI: 0.68 to 1.00, and HR: 0.91; 95% CI: 0.84 to 0.98 for LatAm subjects and nLAS, respectively; pint = 0.36) (Online Table 2).
Outcomes with LDE versus warfarin
When compared with warfarin, patients randomized to LDE had higher rates of ischemic stroke, but lower rates of hemorrhagic stroke and all-cause mortality (Online Tables 3 and 4).
We conducted analyses stratified by use of antiplatelet therapy at baseline (92% of which was aspirin) and we did not find any interaction between antiplatelet therapies and oral anticoagulants.
In this analysis comparing 2,661 subjects enrolled in LatAm centers to 18,444 enrolled elsewhere in the ENGAGE AF-TIMI 48 trial of subjects with moderate-to high-risk AF randomized to edoxaban or warfarin, we report 3 major findings:
1. There were numerous differences in patient characteristics, treatments, and socioeconomic factors between regions that only partially explained higher mortality in LatAm.
2. Patients in LatAm treated with warfarin had higher rates of bleeding (particularly ICH) despite a median TTR of 66% (vs. 69% in nLAS).
3. The approved edoxaban regimen (60/30 mg once daily) significantly reduced stroke/SEE, ICH, MACE, and net outcomes compared with warfarin in LatAm, with an even greater reduction in hemorrhagic stroke in LatAm compared with areas outside of LatAm.
Differences in risk profiles, treatments, and mortality outcomes
We found significantly higher mortality rates, including both CV and non-CV death, among LatAm subjects. Although many regional differences in risk factors were present, these were not unidirectional, the absolute difference in risk scores (CHADS2, CHA2DS2-VASc, Charlson Comorbidity Index) were small, and the higher mortality rates in LatAm persisted despite multivariate adjustment for baseline characteristics. There was a >2-fold difference in mean gross national index between regions that may have influenced access to care, and this contributed to the modestly lower HDI in LatAm. An exploration of the potential effect of baseline therapies revealed that nonuse of lipid-lowering drugs in LatAm was associated with an increase in CV mortality, although we cannot definitively establish a causal relationship given the lack of randomization to nonanticoagulant therapies and the possibility that lipid therapy prescription was confounded by other unmeasured factors.
Sudden death and death due to heart failure were the most frequent causes of CV deaths in the ENGAGE AF-TIMI 48 trial (11), an observation that was also reported in the GARFIELD (Global Anticoagulant Registry in the Field) AF registry of 17,116 subjects enrolled in 35 countries (12). Older subjects and those with a history of permanent AF, previous CHF, lower left ventricular ejection fraction, and reduced creatinine clearance were more likely to die of sudden death or heart failure; each of these characteristics was significantly more prevalent among LatAm subjects. As previously reported in an observational study of urban LatAm populations (13), patients enrolled in Latin American centers in ENGAGE AF-TIMI 48 were treated less frequently with evidence-based therapies (e.g., beta-blockers, lipid-lowering therapy), while several medications not associated with mortality reduction (e.g., digoxin, amiodarone) were administered more often. Each of these factors may have contributed to the higher rate of CV death in LatAm. These findings are consistent with a recent report of the ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation), where it was also observed that LatAm AF patients had higher mortality rates (14).
Oral anticoagulants and outcomes
In the warfarin arm, we observed higher adjusted risks of stroke/SEE, ICH, and life-threatening or fatal bleeding in LatAm subjects in addition to higher mortality rates. A limited number of studies have addressed the efficacy and safety of VKAs in LatAm subjects; these have shown high rates of stroke in association with poor INR control (15–17). Although the median TTR was lower in LatAm than nLAS, and LatAm subjects spent a greater proportion of time with an INR >3.0 (13% vs. 11%), the median TTR of 66% in LatAm was at least as high as that reported in other contemporary AF trials, and the difference between regions was small (3%); thus, differences in warfarin management do not appear to fully explain these results. Furthermore, interruption rates of study anticoagulant were significantly lower among LatAm subjects. The role of other unmeasured factors (e.g., use of complementary medical therapies affecting the response to warfarin, access, and quality of care during hospitalizations) were not ascertained in this study.
In this context of higher rates of CV and non-CV mortality observed in LatAm subjects, the use of higher-dose edoxaban, when compared to warfarin, was associated with significantly lower rates of stroke/SEE, ICH, the net primary outcome, and a 22% reduction in MACE in LatAm. The benefit of HDE relative to warfarin in reducing hemorrhagic stroke was even greater in LatAm than in nLAS; this may have been related in part to the high rate of hemorrhagic stroke among LatAm subjects treated with warfarin.
The incidences of major bleeding events, ICH, and the composite of life-threatening or fatal bleeding events were also less frequent in the HDE arm compared to warfarin. Similar results also were reported by Yamashita et al. (18) in East Asian subjects in whom edoxaban significantly reduced major bleeding compared with warfarin. In the ARISTOTLE (Apixaban for Reduction of Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial with apixaban, it was found that ICH was more frequent among Asian and Latin American patients, which is consistent with our findings (19). Giugliano et al. (20) reported that the reduction of mortality observed with edoxaban in the ENGAGE AF-TIMI 48 trial was largely due to the significant reduction of serious bleeding events. Although LDE reduced bleeding even further, this occurs at a loss of efficacy (primarily an increase in ischemic stroke compared to warfarin); hence, clinicians are strongly advised to use 60 mg edoxaban unless 1 of the 3 specified criteria for dose reduction are present, in which case 30 mg is the recommended dose.
Thus, in Latin America, where bleeding and mortality rates were high in patients treated with warfarin, HDE represents an attractive alternative anticoagulant for patients with AF to reduce morbidity and mortality. This study confirms the benefits observed with edoxaban and the other direct oral anticoagulants (DOACs) in AF patients. This is particularly relevant in the Latin American population, where there is evidence of difficulties in achieving adequate INR control with VKAs (15). This has moved different authors to advocate for better stroke prevention strategies with DOACs in LatAm, which is also justified by cost-effectiveness studies that compared DOACs with VKAs (21–23).
Study limitations
The ENGAGE AF-TIMI 48 trial was not designed or powered to explore regional differences or other subgroups. Accordingly, the data can only be considered as exploratory and hypothesis-generating. The differences in regional outcomes may be attributed to residual confounding related to differences in risk factors, warfarin management, or other unmeasured factors. Other limitations include the small sample of subjects in some countries and low event rates, which may result in type II error. Finally, results from subjects enrolled in selected centers participating in a randomized clinical trial may be different from general practice or be representative of hospitals in any 1 country or region.
LatAm subjects with AF had higher rates of intracranial hemorrhage and death than nLAS after multivariable adjustment. Although event rates were higher in LatAm, outcomes with higher-dose edoxaban versus warfarin were at least as favorable in LatAm subjects as in nLAS, with an even greater reduction in hemorrhagic stroke seen in LatAm. Edoxaban represents an attractive alternative to warfarin in LatAm patients with AF to prevent major morbidity and mortality related to arterial thromboembolism and anticoagulant-related bleeding.
COMPETENCY IN PATIENT CARE AND PROCEDURAL SKILLS: Regional variation in patient outcomes is multifactorial and related to demographics, comorbidities, treatment patterns, socioeconomics, and culture. In a large, international randomized trial, patients in Latin America with AF had higher rates of ICH and death than those in other regions. Compared with warfarin, treatment with edoxaban was associated with an even greater reduction in hemorrhagic stroke in Latin America than in the global trial population.
TRANSLATIONAL OUTLOOK: Additional studies of newer anticoagulants are needed to define optimal therapy for high-risk patients with AF in various settings of care.
Dr. Nicolau has received grants and personal fees from Novartis, Sanofi, Boehringer Ingelheim, AstraZeneca, and Bayer. Dr. López-Sendon has received grants from Portola Pharmaceuticals, Merck/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, GlaxoSmithKline, and Bayer; and has received grants and personal fees from Merck, AstraZeneca, Menarini, Merck Sharp & Dohme, and Sanofi. Dr. Ruff has received consulting fees from Daiichi-Sankyo, Bayer, Janssen, Portola, Bristol-Myers Squibb, and Boehringer Ingelheim; and has received grant support from Boehringer Ingelheim and through his institution from Daiichi-Sankyo. Ms. Hamershock, Ms. Grip, and Dr. Antman have received grant support through their institution from Daiichi-Sankyo. Dr. Braunwald has received consulting fees from The Medicines Company and Theravance; has received lecture fees from Medscape; has received grant support through his institution from Daiichi-Sankyo, AstraZeneca, GlaxoSmithKline, Merck, Duke University, and Novartis; and has served as an unpaid consultant and lecturer for Merck and Novartis. Dr. Giugliano has received consulting fees from Daiichi-Sankyo, Janssen Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Portola, and Merck; has received lecture fees from Daiichi-Sankyo, Merck, and Servier; and has received grant support through his institution from Daiichi-Sankyo, Merck, Johnson & Johnson, Sanofi, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.
- Abbreviations and Acronyms
- atrial fibrillation
- higher-dose edoxaban
- intracranial hemorrhage
- International Normalized Ratio
- LatAm
- Latin American
- lower-dose edoxaban
- nLAS
- non–Latin American subjects
- systemic embolism
- time in therapeutic range
- vitamin K antagonists
- Received April 24, 2018.
- Revision received June 28, 2018.
- Accepted July 2, 2018.
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text:
Cubs Interest In Japanese Outfielder Shogo Akiyama Would Solve Two Roster Holes
Since centerfielder and leadoff man extraordinaire Dexter Fowler left the Cubs after the 2016 season, they've sorely lacked production from that spot in the lineup, both from their leadoff hitters and their centerfielders. That's why the rumors linking them to Japanese centerfielder Shogo Akiyama should be encouraging. If the Cubs are able to sign Akiyama, he would address two club needs by himself. According to The Athletic's Patrick Mooney, the Cubs are at least checking in on the Japanese star, who will be 32 at the start of the 2020 season. Akiyama has played for the Saitama Seibu Lions since 2011; he filed for free agency on October 30 in hopes of signing with a major league club in the
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text:
School estate inspections update
Published on 14 April 2016
As we stated on Monday, as well as ongoing routine surveys of our school estate, further inspections began in March 2016.
No major structural issues identified
This was in response to the situation in Edinburgh where, you will be aware, structural defects have been identified in some buildings.
Our inspections are now complete and no major structural issues have been identified. As would be anticipated, routine maintenance repairs were highlighted and these will be carried out as quickly as possible.
Further selective tests for re-assurance
In light of the further information coming from the Edinburgh schools situation, a phase of selective tests and surveys will take place in the coming weeks in some of our buildings to provide further re-assurance. These findings will also be shared with you.
The safety of our pupils, staff and building users are our highest priority.
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text: Assalamu Alaikum, fellow TMVers! The latest issue of The Muslim Voice Magazine is now available! In this issue, we challenge negative stereotypes and shine some light on the voices which foster positive change in our perceptions and practices of being a Muslim. You can download the magazine by clicking on the link below or you can pick up a hard-copy … Read More