text: ArticleThe Importance of Early Treatment With Doxycycline in Human EhrlichiosisHamburg, Brian J. MD; Storch, Gregory A. MD; Micek, Scott T. PharmD, BCPS; Kollef, Marin H. MDAuthor Information From Division of Pulmonary and Critical Care Medicine (BJH, MHK) and Department of Pharmacy (STM), Barnes-Jewish Hospital, St. Louis; and Division of Infectious Diseases (GAS), Washington University School of Medicine, St. Louis, Missouri. Address reprint requests to: Marin H. Kollef, MD, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO 63110. Fax: 314-454-5571; e-mail: [email protected]. Medicine: March 2008 - Volume 87 - Issue 2 - p 53-60 doi: 10.1097/MD.0b013e318168da1d Free Metrics Abstract Human ehrlichiosis is a serious disease that can be fatal if not treated appropriately. We examined patients with a clinical presentation consistent with the syndrome of ehrlichiosis and a positive blood polymerase chain reaction (PCR) test for all known Ehrlichia species or Anaplasma phagocytophilum admitted to Barnes-Jewish Hospital in St. Louis, MO, from 1996 to 2006. Patients who had doxycycline initiated within the first 24 hours of admission to the hospital were compared with patients who did not have empiric doxycycline therapy. A total of 46 patients had a positive blood PCR test for Ehrlichia or Anaplasma phagocytophilum, and 28 (60.9%) had a delay in doxycycline therapy. At presentation, patients with a delay in therapy were more likely to present with an abnormal lung exam and altered mental status. None of the patients experiencing a delay in doxycycline treatment had the diagnosis of ehrlichiosis documented at the time of hospital admission, compared with 13 (72.2%) of the patients who were treated empirically (p < 0.001). Patients not started on doxycycline at hospital admission had a significantly increased rate of transfer to the intensive care unit (39.3% vs. 0%; p < 0.001) and requirement for mechanical ventilation (28.6% vs. 0%; p < 0.001). Patients with a treatment delay also had a longer hospital stay (12.3 ± 11 d vs. 3.9 ± 1.9 d, respectively; p < 0.001) and a longer length of illness (20.9 ± 14.2 d vs. 8.9 ± 2.7 d, respectively; p = 0.001). These data suggest that clinicians living in an area where Ehrlichia is endemic should have a high suspicion for ehrlichiosis, and a low threshold for instituting empiric antibiotic therapy with doxycycline. Abbreviations: ICU = intensive care unit, PCR = polymerase chain reaction. INTRODUCTION Human diseases attributed to ehrlichiosis have been described since 198618. Human monocytic ehrlichiosis, the most common form of ehrlichiosis in the United States, is caused by Ehrlichia chaffeensis, with 70% of the cases reported from 7 states (Arkansas, Georgia, Missouri, Maryland, North Carolina, Oklahoma, and Tennessee)23. Other causes of ehrlichiosis include Ehrlichia ewingii and Anaplasma phagocytophilum, which cause Ewingii ehrlichiosis and anaplasmosis (a disease with similar clinical features to ehrlichiosis), respectively. Ehrlichia species are obligate intracellular, coccobacillary Gram-negative bacteria that infect phagocytic bone marrow-derived cells6. Both of these infections are tick-borne illnesses with similar constitutional signs and symptoms including fever, headache, myalgia, and anorexia. A macular or papular rash has also been associated with some forms of ehrlichiosis, although this is less common (approximately 36% of patients in 1 study)7. Laboratory abnormalities include leukopenia, thrombocytopenia, and elevated liver function tests (alanine aminotransferase and aspartate aminotransferase levels)21. Most forms of ehrlichiosis readily respond to antimicrobial treatment. However reports of severe and fatal ehrlichiosis have been described, particularly in older and immunocompromised patients6. Complications observed include meningoencephalitis, adult respiratory distress syndrome, and sepsis-like syndrome6. The relationship of early appropriate antibiotic therapy to outcome has not been previously well described. We performed a study with 2 main goals. Our first goal was to describe the clinical presentations of patients hospitalized with ehrlichiosis at Barnes-Jewish Hospital. We also wanted to evaluate the relationship between the administration of early appropriate antibiotic treatment and clinical outcome. METHODS Study Location and Patients The study was conducted at a university-affiliated, urban teaching hospital: Barnes-Jewish Hospital in St. Louis, MO (1200 beds). During a 10-year period (January 1996 to December 2006), all patients with a positive blood polymerase chain reaction (PCR) test for Ehrlichia and a compatible clinical presentation were eligible for the investigation. This study was approved by the Washington University School of Medicine Human Studies Committee, and informed consent was waived. Study Design and Data Collection A retrospective cohort study design was employed assessing the administration of early appropriate antibiotic treatment with doxycycline. Additionally, we assessed secondary outcomes including the need for admission to the intensive care unit (ICU), hospital length of stay, complications, and hospital mortality. A computerized list of patients with ehrlichiosis was generated by the Medical Informatics Department through retrospective query of the Microbiology Laboratory database at Barnes-Jewish Hospital, which allowed identification of potential study patients. Patients could not be entered into the study more than once. Definitions All definitions were selected prospectively as part of the original study design. Appropriate antimicrobial treatment was defined as the administration of doxycycline within the first 24 hours of hospital admission to either Barnes-Jewish Hospital or another hospital before transfer to Barnes-Jewish Hospital. Patients were identified as being on chronic steroids if they were on prednisone at a dose of at least 10 mg/d (or an alternative steroid at an equivalent dose). Symptoms and findings on physical exam were determined by the notations made in the medical record from the treating physicians. Specifically, an abnormal neurologic exam was noted when the treating physician found a focal neurologic deficit during the initial physical exam. An abnormal chest radiograph was any chest radiograph with an infiltrate as read by the radiologist. Pulmonary complications that occurred during hospitalization included adult respiratory distress syndrome, pneumonia, and alveolar hemorrhage. Disseminated intravascular coagulation was determined based on laboratory studies, including elevated prothrombin time, elevated international normalized ratio, elevated partial thromboplastin time, and a decreased fibrinogen level. Acute renal failure was defined as renal failure significant enough to require dialysis. Duration of illness was based on the length of time from the onset of initial symptoms as noted in the medical record until hospital discharge. The term sepsis was defined based on the guidelines from the American College of Chest Physicians-Society of Critical Care Medicine (ACCP-SCCM) Consensus Conference on Sepsis and Organ Failure. PCR Assays The 16S ribosomal RNA gene (rrs) assay used has been previously described6,7. Patient samples were tested initially with a broad-range assay designed to amplify all known Ehrlichia species plus Anaplasma phagocytophilum. This assay employs primers ECA and HE3. Samples that were positive by the screening assay were subsequently tested using primer pairs HE1 and HE3, which are specific for Ehrlichia chaffeensis, and EWi and HE3, which are specific for Ehrlichia ewingii; Anaplasma phagocytophilum DNA was amplified using primers Ehr 521 and 747. For each patient, PCR assays were performed on lysates containing DNA from 105 leukocytes (1996-2002) or 10 μL of MagNA Pure (Roche, Indianapolis, IN)-extracted whole blood eluate (2002-2006). Reactions were performed in 100 μL samples with a DNA thermal cycler (model 480, Perkin-Elmer Cetus, Norwalk, CT). Final concentrations of reaction mixtures and cycling protocols for the broad-range assay, the Ehrlichia chaffeensis-specific assay, and the Ehrlichia ewingii-specific assay were performed according to previously reported procedures2,3. Statistical Analysis All comparisons were unpaired and all tests of significance were 2-tailed. SPSS version 11.0 for Windows (SPSS, Inc., Chicago, IL) was used for statistical analysis. Continuous variables were compared using the Student t-test for normally distributed variables and the Mann-Whitney U test for non-normally distributed variables. The chi-square or Fisher exact test was used to compare categorical variables. The primary data analysis compared patients with a delay in the administration of doxycycline for more than 24 hours from hospital admission with patients without a treatment delay. RESULTS Patients Over the time period 1996-2006, 46 patients with a clinical presentation consistent with Ehrlichia infection and a positive Ehrlichia PCR were admitted to Barnes-Jewish Hospital. Demographic characteristics of these patients are shown in Table 1. The mean age of the patients was 52 ± 16 years (range, 20-86 yr); 35 (76.1%) patients were men and 11 (23.9%) were woman. Twenty-eight (60.9%) patients had a delay in the institution of doxycycline therapy of greater than 24 hours from hospital admission. Twenty-three patients initially presented to a different hospital before being transferred to Barnes-Jewish Hospital. Of the patients with delayed administration of doxycycline therapy, 18 (64.3%) were initially admitted to a different hospital before being transferred to Barnes-Jewish Hospital, compared with 5 (27.8%) patients with no delay in administration of doxycycline (p = 0.016). There was no significant difference between the 2 groups in the average days from tick exposure to initial hospital admission, nor in the interval from onset of symptoms to hospital admission (at a different hospital or Barnes-Jewish Hospital) (see Table 1). The number of days ill to treatment with doxycycline was statistically different in the group of patients with a delay in doxycycline therapy compared with those patients with appropriate empiric treatment (see Table 1).TABLE 1: Patient Demographics at Hospital AdmissionPresenting Signs, Symptoms, and Physical Examination Findings No significant differences in symptoms at hospital presentation were identified between patients with and without a delay in the administration of doxycycline (Table 2). Patients with delayed administration of doxycycline were significantly more likely to have an abnormal lung examination and to have altered mental status at hospital presentation compared to patients without a delay in doxycycline therapy (Table 3).TABLE 2: Symptoms at PresentationTABLE 3: Findings on Physical Exam at Hospital AdmissionLaboratory and Radiographic Findings Patients with delayed administration of doxycycline had significantly greater total bilirubin values at hospital admission compared with patients without doxycycline treatment delays (Table 4). No patient had a diagnosis of ehrlichiosis suggested by initial evaluation of the blood smear. All abnormal findings on peripheral smear were nonspecific to ehrlichiosis. The presence of an abnormal chest radiograph was more common among patients with doxycycline treatment delays (see Table 4). Patients with a delay in doxycycline therapy were also significantly more likely to have more abnormal laboratory values for hemoglobin, total bilirubin, and aspartate aminotransferase during their hospitalization (Table 5).TABLE 4: Laboratory and Radiographic Abnormalities at Hospital Admission*TABLE 5: Most Abnormal Laboratory Studies During Hospitalization*Empiric Diagnosis of Ehrlichiosis and Treatment None of the patients with delayed administration of doxycycline had the diagnosis of ehrlichiosis suspected and documented in the medical record at the time of hospital admission, compared with 13 (72.2%) of the patients with no delay in doxycycline therapy (p < 0.001). The mean number of days between hospital admission and the administration of the first dose of any antibiotic was similar between patients with delayed administration of doxycycline treatment and those with no delay (1.9 ± 8.1 d vs. 0.3 ± 0.7 d; p = 0.422). Patients with delayed administration of doxycycline had an average time to the first dose of doxycycline of 4.6 ± 5.3 days. Consequences of a Delay in Appropriate Therapy Patients with a delay in the administration of doxycycline had significantly more complications during their hospitalization compared with patients with no delay in doxycycline therapy (Table 6). Pulmonary complications, admission to the ICU, mechanical ventilation, and the need for vasopressors were significantly more common among patients with a delay in the administration of doxycycline (see Table 6). None of the patients who received appropriate empiric therapy with doxycycline at admission required admission to an ICU, while 11 (39.3%) of the patients with a delay in therapy required care in an ICU (p = 0.002). Of note, all patients who required ICU care were initially admitted to a regular medicine floor as opposed to being directly admitted to the ICU.TABLE 6: Patient Complications and OutcomesThe average length of illness was longer for patients with delayed administration of doxycycline than for patients who received doxycycline at admission (20.9 ± 14.1 d vs. 8.9 ± 2.7 d; p = 0.001) (Figure 1). Patients with a delay in doxycycline administration were also in the hospital longer than patients who received doxycycline at admission (12.3 ± 11 d vs. 3.9 ± 1.9 d; p < 0.001) (Figure 2).FIGURE 1: Length of illness for patients treated with doxycycline at admission versus patients treated with inappropriate antibiotics.FIGURE 2: Length of hospitalization for patients treated with doxycycline at admission versus patients treated with inappropriate antibiotics.DISCUSSION The findings of the current study demonstrate that delayed administration of doxycycline in patients admitted to the hospital with ehrlichiosis is associated with a statistically greater need for ICU admission and mechanical ventilation, and a prolonged length of hospitalization and illness. It is noteworthy that patients with more abnormalities at presentation, including an abnormal lung exam, abnormal neurologic exam, abnormal chest radiograph, and elevated bilirubin, were more likely to have a delay in appropriate antibiotic therapy. This finding suggests that clinicians may not recognize that ehrlichiosis is associated with severe illness at presentation, as these patients demonstrate. Thus, the patients who would most benefit from early antibiotic therapy with doxycycline are not receiving treatment, resulting in worse outcomes for these patients. Previous investigations have shown that antimicrobial regimens lacking activity against identified microorganisms causing serious infections (for example, hospital-acquired pneumonia, bloodstream infections) are associated with greater hospital mortality11,13,16,17,19. More recently, the same finding has been demonstrated for patients with severe sepsis5,9,10. Inappropriate antimicrobial treatment has been shown to be an important independent risk factor for mortality among hospitalized patients15. Additionally, the impact of inappropriate initial antimicrobial therapy on outcomes appears to be greater among patients with a lower predicted risk of mortality before the occurrence of the inappropriately treated infection4. Furthermore, the initial antibiotic regimen chosen must be broad enough to cover all possible offending pathogens. Waiting to change antimicrobial therapy to an appropriate regimen after susceptibility data become available has not been demonstrated to improve clinical outcomes1,14,17. Earlier studies have shown that early appropriate antibiotic treatment of ehrlichiosis is associated with better outcomes. Fishbein et al7 demonstrated that delay in treatment with tetracycline or chloramphenicol of greater than or equal to 8 or more days after the onset of illness was associated with increased risk for complications. The current study is unique in focusing on the clinical impact of early appropriate antimicrobial therapy in patients with ehrlichiosis. It further emphasizes the importance of early appropriate antimicrobial therapy, for an increased risk of complications was associated with a delay in treatment of just 24 hours after hospital admission. A delay in therapy in patients with ehrlichiosis might occur for many reasons. The signs and symptoms of ehrlichiosis are nonspecific, making the diagnosis difficult if the treating physician does not have ehrlichiosis in his or her differential diagnosis at all times during the appropriate season for infection. Furthermore, based on the current study it appears that physicians are overlooking the severity of illness that Ehrlichia can cause, and that it can affect multiple organ systems. This appears to lead clinicians to look for other causes of the patient's illness, and as a result the opportunity for early antibiotic therapy is missed. Studies evaluating other types of infections have suggested that the timing of appropriate antibiotic treatment is an important determinant of outcome. Iregui and coworkers12 showed that patients treated more than 12 hours after clinical suspicion of ventilator-associated pneumonia had a statistically greater risk of hospital mortality. Morrell et al20 and Garey et al8 have demonstrated that delayed appropriate treatment for Candida bloodstream infection is associated with increased hospital mortality. More recently, Schramm et al22 found that patients with delayed treatment for sterile site infections due to methicillin-resistant Staphylococcus aureus infections had significantly greater risk of hospital mortality. These investigations suggest that early accurate microbiologic diagnosis to guide specific treatment, or appropriate empiric treatment before culture results are available, may be necessary to improve the outcomes of serious infections. The current study has several important limitations. First, in this retrospective study we evaluated only patients with a positive PCR to establish the diagnosis of ehrlichiosis. It is possible that we may have excluded patients with PCR-negative cases due to other species of Ehrlichia not identified with our PCR assay. Second, we did not employ a severity of illness score in evaluating these patients. However, the assessment of vasopressor administration, mechanical ventilation, and the need for ICU admission provides similar stratification. Third, we examined only patients in a large, tertiary care teaching hospital in Missouri, where Ehrlichia infection is relatively common, which may lead to referral bias. Also, it is possible that the occurrence of delayed administration of doxycycline therapy would vary if hospitals from other regions were examined. Fourth, due to the observational nature of this investigation, we could not determine the specific rationale for the lack of Ehrlichia coverage in the antibiotic regimens selected by the treating physicians. Fifth, it was difficult to know whether the patients saw a primary care doctor before hospitalization. Thus, we cannot be certain whether the patients were treated with any antibiotics, including doxycycline, as outpatients before admission to the hospital. Another important cofounder could be that the longer length of illness and hospitalization in the delayed treatment group, as well as the increased rate of complications in this group, could be due to the fact that the patient presented to the hospital later in the course of their disease, and not to a delay in therapy. However, when reviewing the data it appears that the statistically significant difference in the number of days ill until treatment with doxycycline was not because of the length of illness before hospitalization (which was not statistically significant) but due to the delay in giving doxycycline (mean of 4.6 d, which essentially accounts for the difference seen between the delayed treatment group and the appropriately treated group). In addition, the syndrome ehrlichiosis is known to be caused by at least 3 distinct species of Ehrlichia or Anaplasma organisms. It is being assumed that the disease course and severity does not differ between organisms, as the PCR used to identify infection did not speciate the organism. Lastly, we had a relatively small number of patients in our analysis. Therefore, we may not have been able to identify all of the clinically important discriminators and outcomes between patients receiving early appropriate doxycycline therapy and those with delayed administration of doxycycline. In summary, we report that delayed administration of doxycycline is common among patients hospitalized with ehrlichiosis. These treatment delays were likely due to the lack of recognition of the diagnosis of Ehrlichia infection, as suggested by the administration of other antibiotics in these patients to cover more typical bacterial pathogens. Delayed treatment occurred despite all these patients residing in areas where Ehrlichia infection is endemic. This finding underscores the importance of providing early empiric treatment for Ehrlichia to patients presenting with serious organ dysfunction compatible with ehrlichiosis in appropriate clinical situations. ACKNOWLEDGMENT The authors thank Richard Buller, PhD, for his help with the methodology section of this paper.REFERENCES 1. Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. Intensive Care Med. 1996;22:387-394. Cited Here 2. Arens MQ, Liddell AM, Buening G, Gaudreault-Keener M, Sumner JW, Comer JA, Buller RS, Storch GA. Detection of Ehrlichia spp. in the blood of wild white-tailed deer in Missouri by PCR assay and serological analysis. J Clin Microbiol. 2003;41:1263-1265. Cited Here 3. Buller RS, Arens M, Hmiel SP, Paddock CD, Sumner JW, Rikihisa Y. Ehrlichia Ewingii, a newly recognized agent of human ehrlichiosis. N Engl J Med. 1999;341:148-155. Cited Here 4. Clec'h C, Timsit JF, De Lassence A, Azoulay E, Alberti, C, Garrouste-Orgeas M, Mourvilier B, Troche G, Tafflet M, Tuil O, Cohen Y. Efficacy of adequate early antibiotic therapy in ventilator-associated pneumonia: influence of disease severity. Intensive Care Med. 2004;30:1327-1333. Cited Here 5. Dhainaut JF, Laterre PF, LaRosa SP, Levy H, Garber GE, Heiselman D, Kinasewitz GT, Light RB, Morris P, Schein R, Sollet JP, Bates BM, Utterback BG, Maki D. The clinical evaluation committee in a large multicenter phase 3 trial of drotrecogin alfa (activated) in patients with severe sepsis (PROWESS): role, methodology, and results. Crit Care Med. 2003;31:2291-2301. Cited Here 6. Dumler JS. Human ehrlichioses: newly recognized infections transmitted by ticks. Annu Rev Med. 1998;49:201-213. Cited Here 7. Fishbein DB, Dawson JE, Robinson LE. Human ehrlichiosis in the United States, 1985 to 1990. Ann Intern Med. 1994;120:736-743. Cited Here 8. Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, Bearden DT. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43:25-31. Cited Here 9. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar AF, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empiric antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med. 2003;31:2742-2751. Cited Here 10. Harbarth S, Garbino J, Pugin J, Romand J, Ricou B, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med. 2003;115:529-535. Cited Here 11. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118:146-155. Cited Here 12. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262-268. Cited Here 13. Kollef MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis. 2000;31:S131-S138. Cited Here 14. Kollef MH, Morrow LE, Niederman MS, Leeper KV, Anzueto A, Benz-Scott L, Rodino FJ. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest. 2006;129:1210-1218. Cited Here 15. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115:462-474. Cited Here 16. Kollef MH, Ward S. The influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest. 1998;113:412-420. Cited Here 17. Luna CM, Vujacich P, Niederman MS, Vay C, Gherardi C, Matera J, Jolly EC. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997;111:676-685. Cited Here 18. Maeda K, Markowitz N, Hawley RC, Ristic M, Cox D, McDade JE. Human infection with Ehrlichia canis, a leukocytic rickettsia. N Engl J Med. 1987;316:853-856. Cited Here 19. Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH. Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrob Agents Chemother. 2005;49:1306-1311. Cited Here 20. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49:3640-3645. Cited Here 21. Paddock CD, Childs JE. Ehrlichia chaffeensis: a prototypical emerging pathogen. Clin Microbiol Rev. 2003;16:37-64. Cited Here 22. Schramm GE, Johnson JA, Doherty JA, Micek ST, Kollef MH. Methicillin-resistant Staphylococcus aureus sterile-site infection: the importance of appropriate initial antimicrobial treatment. Crit Care Med. 2006;34:2069-2074. Cited Here 23. Schutze GE. Ehrlichiosis. Pediatr Infect Dis J. 2006;25:71-72. Cited Here Cited By This article has been cited 1 time(s). Critical Care MedicineHospital-wide impact of a standardized order set for the management of bacteremic severe sepsis*Thiel, SW; Asghar, MF; Micek, ST; Reichley, RM; Doherty, JA; Kollef, MHCritical Care Medicine, 37(3): 819-824.10.1097/CCM.0b013e318196206b PDF (273) | CrossRef © 2008 Lippincott Williams & Wilkins, Inc.View full article text


text:
Families in Bedfordshire are being encouraged to talk to their school nurse or health visitor by text.
With more and more people using mobile phones, two secure text only numbers have been launched by Bedfordshire Community Health Services to provide another easy way to talk about health.
ChatHealth is for young people (aged 11-19) to confidentially ask for help about a range of issues, or make an appointment with a school nurse. They can also find out how to access other local services including emotional support or sexual health services. Simply text 07507 331450.
Glenda Hall, 0-19 service manager, said: "With young people increasingly using technology to access services we felt ChatHealth was ideal to encourage them to engage with us. It's really important that young people feel they have someone to contact to ask about their health and wellbeing, without fear of judgement or embarrassment. Our school nurses can support them on a wide range of issues.
Parentline is for parents and carers of those aged 0-19 and offers advice and support on a range of issues such as weaning, sleep and emotional health. They can also find out how to access other local services. Simply text 07507 331456.
Jacky Syme, service development manager children's services, said: "We are really pleased to be able to offer Parentline in the county, to compliment the support we provide to families. It will make accessing health services easier and less daunting."
ChatHealth and Parentline are available Monday-Friday from 9am - 4.30pm. Messages can be sent anonymously to the dedicated text numbers and are delivered to a secure website, and responded to by our team. Out of hours, anyone who texts the service receives a bounce back message explaining where to get help if their question is urgent, and when they can expect a response. Texts are usually replied to within one working day.
Fantastic artwork created by local children now lines the clinic corridors of Redgrave Gardens Children's Centre following the official unveiling by the Mayor of Luton Naseem Ayub recently.
Over the summer of 2018 local schools and children were invited to submit artwork to a competition, and more than 130 entries were received. Five winners were invited to attend the unveiling event to receive their certificates and prizes from the Mayor.
Charmaine Perry, Office Manager/Team Leader for the Cambridgeshire Community Services NHS Trust (CCS) Community Paediatrics team based at Redgrave Gardens Children's Centre has been the driving force behind this art project. She came up with the idea of running a competition with local children from Luton schools, and worked with local company 'TheBigArtProject' and also tied it in with the NHS 70th anniversary. The plan is to add interest and colour to the corridor leading to the clinic rooms, which is plain and grey and not very appealing to children.
Mayor of Luton Naseem Ayub said: "Well done to everyone who was involved in creating this fantastic display and making the environment more welcoming for all to enjoy. The centre's staff carry out an important and supportive role and everyone involved does a fantastic job to make it work."
Dr Catherine Kearney, Consultant Paediatrician for CCS at the centre was due to attend the unveiling, but unfortunately was not able to make it on the day, however, following the event, Catherine said: "I was so disappointed that I couldn't meet all the young people and their families that came to the unveiling to thank them personally for their beautiful works of art which have transformed our clinic space for all our current and future families. The Community Paediatric team looks forward to working with children and families in the future to make our centre more family friendly. Thank you all."
Currently there are around 40 artworks on display, and over the coming months there are plans to develop this even further with the remainder of the competition artwork that was submitted.
Check on the link for more photo's from the unveiling event: click here.
The Newborn Hearing Screening Programme team attended the relaunch of the midwifery- led Bedford Maternity Unit at Bedford Hospital recently along with 100 parents and other organisations.
Deborah Cheshire, National Hearing Screening Programme (NHSP) Manager for Luton Children's Services, Jasmine Box, Luton Screener and Janet Coleman, Bedford Screener were invited to the event.
NHSP created a display celebrating the achievements of a recent Public Health England Quality Assurance Success in achieving their Key Performance Indicators (KPIs) and data about the children found to have a confirmed congenital hearing loss. Visual aids such as a large model of the ear and a baby doll were used to demonstrate the screening process and engage families in all aspects of hearing as part of early development in child health. Fathers were particularly interested in the equipment and emissions of sound waves and were encouraged to be screened so they could hear exactly what the baby will hear.
It is hoped this Bedford event will take place twice a year clearly putting NHSP 'on the map' , promoting Cambridgeshire Community Services NHS Trust (who run Luton Children's Services) as a Trust, and giving the NHSP screeners the opportunity to take pride in the work they do each do to a recognised high standard.
It is important to state all the screeners work exceptionally hard especially when we face challenges of children not brought to clinic or logistic constraints and it would be remiss of me not to thank them all for their service across the board.
Luton Nurses who provide a fast and effective pathway for patients through hospital and back into the community have won two prestigious national awards.
The Luton Integrated Discharge and GP Liaison Team won one of the categories and were highly commended in another in the digital Leading Healthcare Awards recently.
They work with patients, mainly with highly complex needs, and the service is believed to be the only nurse-led one of its kind in the country.
The team was announced as the winner of the Staff and Patient Experience Category, and received a highly commended in the Improving Outcomes category.
Sally Shaw, Service Manager for the Team, said: "We are very excited and surprised to win, but I feel it's a true reflection of the positivity of the team in focussing at all times on the patient healthcare journey.
"Communication is fundamental to the success of the team, written and verbal, and the team can certainly talk; GP's, consultants, specialist nurses, receptionists, radiographers, A&E, families and patients etc. Continuity of communication is vital when caring for complex patients, and being able to share the information in a timely manner is essential for smooth, safe and appropriate discharge planning."
The team, which is based at the Luton and Dunstable Hospital, is part of Luton Adult Services run by Cambridgeshire Community Services NHS Trust. This service streamlines the way GPs refer patients for same day hospital assessment in Luton, and provide a fast, effective patient pathway through the hospital and back into the community. Before the service was launched GP referrals for same day acute medicine and general surgical assessments would go through the main hospital switchboard and were discussed and accepted by the hospital ward staff.
Matthew Winn, Chief Executive, said: "I am incredibly proud of the Luton GP Liaison Service who have been rightly recognised for their great work and won these awards. The nurse led team deserves full recognition for this ground breaking service and should be really proud of all they have achieved."
The Digital Healthcare Awards took place on Wednesday 6 March 2019. More information can be found here: www.leadinghealthcare.co.uk/2019/03/07/leading-healthcare-awards-winners-revealed
As part of World Hearing Day (Sunday 3rd March) Cambridgeshire Community Services NHS Trust, has showcased a new 'Hear Glue Ear' app designed for children aged 2-6 who are experiencing hearing loss due to glue ear.
The app was recently launched at the Trust's children's services hub at the Peacock Centre, Mill Road, Cambridge.
Funded and designed in partnership with the Cambridge Hearing Trust and Cambridge Digital Health, the app aims to reduce learning and development delays that can occur when children have hearing loss. Glue ear is caused by a build-up of fluid and mucous behind the ear drum which prevents sounds being transferred to the inner part of the hearing system.
Dr Tamsin Brown, Community Paediatrician, Cambridgeshire Community Services NHS Trust said: "We have worked closely with the Cambridge Hearing Trust Charity and Cambridge Digital Health to develop the app, which is available now free of charge to all families with glue ear from the Apple and Android App Stores.
"The app will help children diagnosed with glue ear to develop speech, language, auditory processing and listening skills at a critical time in their development through specially designed songs, games and audio books. As well as helping to ensure children do not fall behind with their language skills and work at school, the app also provides valuable information, resources and progress tracking for parents and carers."
Commenting on the app, Oriane Chausiaux, Managing Director, Cambridge Digital Health said: "We've really enjoyed having the opportunity to create something fun and useful for children and their families who are facing challenges due to Glue Ear.
"We're looking forward to working with Tamsin on additional features for the app to provide even more helpful tools and resources."
Ian Neville from Cambridge Hearing Trust said: "We were delighted to fund the Hear Glue Ear app and work with Dr Brown and Cambridge Digital Health to turn this into a reality. We are confident that the app will vastly improve outcomes for children with glue ear."
Dr Brown has also developed, in her own time, a bone conducting headset to support children with glue ear. She explains: "The headset takes sound and changes this into a vibration; routing it down the bone where the inner hearing system is and bypassing the problem area. These bone vibration headphones (similar to those worn by cyclists) can be synchronised to either the app or to a small microphone which a teacher or parent can attach to their lapel to improve the child's ability to hear. We hope the headsets will be available on the NHS next year."
Further information can be found at: https://hearglueear.wordpress.com/
Bedfordshire's Baby Friendly team, which supports new mothers with breastfeeding across the region, is taking an innovative step forward to increase the impact of their work. The team has worked with local entrepreneur Rosamund McFadden to rollout the Breastfeeding Hub mobile application for parents in Bedfordshire.
The app has two elements: an information hub, and an interactive map of breastfeeding friendly venues, which allows parents to rate and recommend particular venues for breastfeeding.
The information included is in line with the UNICEF Baby Friendly Initiative standards and includes photos, video clips and signposting to external articles and local and national breastfeeding support.
Practice Development Lead Sarah Pickford said: "This is a really exciting time for our Baby Friendly team. Whether on Facebook, our website or this fantastic new app, we're making sure that accurate information and details of how to get support are easy to find and available wherever mums might need it. It's an important part of doing our best to support parents to help their babies thrive."
This is just one strand of the Baby Friendly Team's ongoing efforts to improve their service and support breastfeeding across Bedfordshire. In December, the team received substantial positive feedback when it was revalidated by UNICEF's Baby Friendly initiative. Anne Woods, UNICEF assessor, said: "staff are commended for their work to maintain the standards established. It was clear to the assessment team that pregnant women and new mothers receive a very high standard of care."
Mothers' feedback has painted a similar picture, with an impressive 96% of mothers reporting they were very happy with the care provided. One happy mother even rated the service off the scale, saying: "I would give the service 11/10 and I am really hard to please!"
If you'd like to start using the breastfeeding hub app, it's available for download for Android here, or for iPhone here.
You can find out more about the Baby Friendly team's work here.
Artwork from children at the Orchards Church of England Academy in Wisbech is being used to promote services throughout Cambridgeshire that is provided to students moving up from primary to secondary school.
The School Nursing team from Cambridgeshire Community Services NHS Trust visited the school and discussed ideas with parents and teachers about how they could create a leaflet which would help the children in their transition to their new schools.
Tracey Bingham, Co-Production Lead for the Trust said: "Our school nursing team work closely with the Orchards Church of England Academy and after we visited the school, the teachers organised a chance for the children to express their thoughts about what they would like to be included in the leaflet by producing some artwork.
"16 children drew pictures and wrote about what they thought is needed in the leaflet which included topics such as bullying, stress, healthy eating, sleep and general concerns about moving to a new school. Their enthusiasm was inspirational."
From the ideas the children provided the Trust changed the entire format of their leaflet and made this into a simple flyer detailing all the information the children would need including the new 0-19 phone number where the team can be contacted directly. The Cambridgeshire 5-19 school nursing team offers advice on emotional wellbeing such as managing emotions, stress, eating concerns; healthy lifestyles including healthy eating, sleep, smoking; and help with puberty and growing up, focussing on healthy relationships, self-image and identity.
Families can call the duty desk number on 0300 029 50 50 where one of the team is able to provide help and advice or children aged 11-19 can text Chathealth confidentially on 07480 635 443.
Photo: Children from the Orchards Church of England Academy, Wisbech and Lisa Foulkes, Transition Co-ordinator and Pastoral Support Counsellor, being presented with their certificates and gifts for their artwork used to create the new transitions leaflet.
Today, the 2018 staff survey results are published – and yet again, thanks to the fabulous culture we have created at Cambridgeshire Community Services NHS Trust, the results are fantastic. However, these results don't happen by accident, they are the result of the passion and commitment of our wonderful staff and, as all the research shows, an engaged and valued workforce will deliver outstanding care.
Results summary
A whopping 60% (1444 individuals) responded to the survey, which is above the 53% average response rate compared to our 16 peer community trusts.
The chart below summarises our amazing results across the 10 overall themes (our results are the dark blue columns), compared to the 16 peer community trusts across the country. In eight themes we were the best performing community trust. We were 'above average' in the remaining two areas and had improved our scores in six of the 10 themes – outstanding results!
The following chart summarises whether staff would recommend our Trust as a place to work or receive treatment. Again, our results are the best in the country compared to our peer community trusts, and we think you'll agree there's no better commendation than whether our staff would be happy to entrust the care of their loved ones to our workforce!
There's always room for improvement! Results will now be analysed by division and we will then work together, with our staff side colleagues, to develop improvement plans for the Trust overall and for our different locality/service areas. From an initial analysis, our results indicate we need to respond to the following issues in our action plans:

subset: commoncrawl


text:
I'll try but honestly it's hard to see unless it's spinning on a tire balancer.Can we get the pic of the bend?
im kinda interested, been looking for a set of at tires/wheel combo.
you should edit that and remove your number..I'm interested; i can possibly pick up this weekend, if available. Please text me at xx.
This is for 5 rims and 4 tires, there is one rim that does NOT have a tire mounted on itThis is a set of 4 or 5?


text:
Fall Dudes 3D
Clearly inspired by Fall Guys, this online multiplayer game is in public beta, but you can easily download it from Google Play. Trials, obstacles, many players and nice graphics for a game that promises. The levels are very much inspired by Fall Guys, including the colorful scenes.
Oopstacles – Games similar to Fall Guys
Of considerably lower quality, although with a style very similar to Fall Guys. More than a thousand levels, multiplayer or Versus mode, although coins are needed to activate it, and even a scream mode to control the character yelling at the phone, a very curious detail but which is still a humorous and friendly aspect of the game.
Run Royale 3D
It's one of the most downloaded alternatives since Fall Guys has become so popular. It is a similar game in which you must manage a character and go through tests of all kinds. Some of the tests of this game have been copied directly from the original game, so they will sound like you. Graphically they are the same, although the avatars do not imitate them by heart.
Knockout Race – Games similar to Fall Guys
Some of the tests are identical to the original game, although with less quality when developing them. The only thing that is not equal is the number of players. In order to have a stable connection and a fast game this game has reduced the total number of players. Of course, the elimination and tests continue with the same dynamics.
Run Guys: Knockout Royale
Perhaps it is one of the games most similar to Fall Guys, since even the cute dolls are almost identical as the Mediatonic title. The negative point is that customization elements such as skins cost a real outrage, not to mention that we constantly face bots, not real players.
Party Royale: Guys do not fall
It is a game that, although the avatars do not resemble Fall Guys too much, the catalog of levels it offers does have a lot of similarity. Not really to say that they are the same, since many elements and obstacles are identical, although we play in the way we play, everything will be against bots and without the possibility of playing with real rivals.
Ragdoll royale
It is developed by the creators of Roblox to include many of the already recognizable elements of Fall Guys. But nevertheless, not to be confused with a copy or with an attempted copy, because it is far from that. The reason is that, despite the strong inspiration that is taken from the Mediatonic title, it includes its own traits to differentiate itself.
Epic Race 3D – Games similar to Fall Guys
It is one of the games that least resembles Fall Guys, but we find similes. It is on this list because it has the same dynamics and gameplay, but with different graphics and own tests. It's a good alternative if you want to try something different on Android until the original game is developed and available.
Race 3D – Cool Relaxing endless running
A endless runner It contains infinite levels to overcome. Obstacle races like a good copy of Fall Guys in which we compete with other dolls in a gameplay so simple that even 3-year-olds can play. In short, a game that promises a lot of fun with its intrepid obstacles and its colorful 3D graphics.
Bombergrounds: Battle Royale
This multiplayer title is a competition to see who is the last without receiving a bombshell (the graphic style is very mythical Bomberman). You must dodge the rest of the players, move through the maze and place bombs in order to win first place.


text:
Serviços Personalizados
- Citado por SciELO
- Acessos
Links relacionados
- Similares em SciELO
Enfermería Actual de Costa Rica
versão On-line ISSN 1409-4568versão impressa ISSN 1409-4568
CARVALHO, Lorena Rodrigues de et al. Fatores associados ao conhecimento de pessoas leigas sobre suporte básico de vida. Enfermería Actual de Costa Rica [online]. 2020, n.38, pp.163-178. ISSN 1409-4568. http://dx.doi.org/10.15517/revenf.v0i38.39087.
To analyze the factors associated with the knowledge of lay people about basic life support. This is a descriptive cross-sectional epidemiological study, conducted with 65 employees from a Campus at the State University of Bahia. Data were collected in February and March 2019 and tabulated in IBM SPSS version 21.0 software. The analysis was performed using descriptive frequencies, Pearson's chi-square test and Fisher's exact test, adopting a significance level of 95% and p value <0.05. It was observed that 67.7% of participants do not know what is basic life support, 61.5% do not feel prepared to act in emergency, 58.5% would not know how to facilitate the breathing of a victim, 64.7% do not know the amount of compressions performed per minute and 86.2% do not know the function of the automatic external defibrillator. Regarding associated factors, knowledge about basic support is associated with being a teacher (p = 0.005), feeling prepared to act in emergency situations (p = 0.001), knowing how to facilitate the victim's breathing (p = 0.001). = 0.000), know the location of the chest compressions (p = 0.013). The study raises the need for greater training of lay people about basic life support so that they can adequately assist victims of cardiac arrest in an out-of-hospital setting.
Palavras-chave : Cardiopulmonary-Arrest; Cardiopulmonary-Resuscitation; Health-Education.


text:
Gabriel Michau
According to our database1, Gabriel Michau authored at least 14 papers between 2015 and 2021.
Collaborative distances:
Collaborative distances:
Legend:Book In proceedings Article PhD thesis Other
On csauthors.net:
IEEE Trans. Ind. Electron., 2021
Improving Generalization of Deep Fault Detection Models in the Presence of Mislabeled Data.
CoRR, 2020
Interpretable Partial Discharge Detection with Temporal Convolution and Pulse Activation Maps: An application to Power Lines.
CoRR, 2020
Anomaly Detection And Classification In Time Series With Kervolutional Neural Networks.
CoRR, 2020
Time Series to Images: Monitoring the Condition of Industrial Assets with Deep Learning Image Processing Algorithms.
CoRR, 2020
CoRR, 2020
Fully Unsupervised Feature Alignment for Critical System Health Monitoring with Varied Operating Conditions.
CoRR, 2019
Proceedings of the 2019 IEEE International Conference on Prognostics and Health Management, 2019
Feature Learning for Fault Detection in High-Dimensional Condition-Monitoring Signals.
CoRR, 2018
IEEE Trans. Signal Inf. Process. over Networks, 2017
IEEE Trans. Intell. Transp. Syst., 2017
Estimating link-dependent Origin-Destination matrices from sample trajectories and traffic counts.
Proceedings of the 2015 IEEE International Conference on Acoustics, 2015


text:
Sphere: Related Content Dear friends, sorry for this long period of silence.
We got very busy over the past few weeks and could not post here. Please expect our post to be more frequent from here. Thanks and remain blessed!
Tuesday, 29 April 2008
Sorry for the long period of silence
Posted by Evergreenword at 17:15 0 comments Links to this post
Labels: Back
Subscribe to: Posts (Atom)


text:
WHEN LILLIE Carroll Jackson took over Baltimore's branch of the NAACP in the 1930s, it barely had a pulse. Ms. Jackson gave it a transplant of energy and passionate commitment to justice.
Her work helped to put the state and the nation on the road to many civil rights victories. The monumental Brown vs. Board of Education decision started, many believe, with a Maryland case pushed by Ms. Jackson.
"God opened my mouth," she said, "and no man can close it."
At a time when too few people, black or white, were willing to stand up for an end to discrimination, Ms. Jackson became a one-woman barrier-busting force. She registered voters, hectored politicians, badgered judges and recruited 20,000 new NAACP branch members. There had been only a handful when The Afro-American newspaper's publisher, Carl Murphy, recruited her to be the organization's leader.
Today, 40 years after the Voting Rights act of 1964, the venerable Baltimore branch has another leader, Marvin "Doc" Cheatham, president-elect of the second-oldest NAACP branch in the nation. Like Ms. Jackson, Mr. Cheatham faces a chore of reinvigoration. Membership is in the range of 1,500, he says. Less than half that number voted in the recent NAACP election that encountered enough irregularities to be taken over by the group's national organization.
The new president arrives during a time of transition nationally as well as in Baltimore. Kweisi Mfume recently announced he was stepping down from the national presidency. He had helped the organization erase a debt of several million dollars. At the same time, leaders such as comedian Bill Cosby are calling for a new commitment to the problems of black young people.
Mr. Cheatham says he's ready to tackle both issues and others. The financial health of the branch may need a tonic. It also needs another new dose of energy to pursue old and new problems. In too many arenas of concern, he said, the NAACP has been virtually silent.
"We have a total crisis in our educational system. We have neglected our children," he said. He wants to make Baltimore a national model for NAACP advocacy.
The civil rights organizations of today need to recognize the perils of progress, he says. Black men and women are in the positions of authority that Ms. Jackson envisioned, but they can't get too comfortable with officialdom, he said.
"There has to be a separation between the mayor and the council and us," he said. "The mayor has a responsibility to run the city, and we have a responsibility to make sure he does. We haven't held him accountable. The relationship the NAACP has had with him has been an embarrassment."
Health, he said, must become an NAACP priority. Epidemic drug use continues to demand attention. Diabetes, heart disease and AIDS must be addressed vigorously, he said.
And he wants the NAACP to get involved in this century's voting rights challenge: black men and women disenfranchised because of their criminal records. Until now, he says, the Baltimore branch has done too little to restore the voting rights of what he says are the 60,000 ex-offenders in Baltimore who need help reclaiming these rights.
Maryland, he points out, has not had an admirable history in the area of voting rights. Its legislature declined to ratify the 15th Amendment, which granted voting rights to blacks after the Civil War. Other, even more reprehensible efforts were mounted to deny black Americans the vote.
Formerly a member of the city's Board of Elections, Mr. Cheatham has worked on voter registration campaigns for more than 25 years. He's the founder of the Maryland Voting Rights Restoration Coalition. He wants the NAACP to champion a legislative effort to bring ex-offenders back into the process.
Ms. Jackson, midwife to the earlier civil rights movement, would likely applaud her successor's objectives. Then she would hold his feet to the flames.
C. Fraser Smith is news director for WYPR-FM. His column generally appears Sundays.


text:
Brian's 80th birthday
My next door neighbour Brian is 80 on the 10th December. He is going through a sad time as he recently had to have his companion put down, his beloved dog. Let's make his birthday special.
DonationsSee top
- Dawn Kenny
- Jaime Burgess
- Gemma Unwin
- Helen Moir
- Anonymous
Jaime Burgess
Birmingham, West Midlands, United Kingdom
#1 fundraising platform
People have raised more money on GoFundMe than anywhere else. Learn more
GoFundMe Guarantee
In the rare case that something isn't right, we will refund your donation. Learn more
Expert advice, 24/7
Contact us with your questions and we'll answer, day or night. Learn more


text:
Job Seekers, Welcome to Mississippi State College of Veterinary Medicine Career Center
The job you tried to view is no longer active.
See similar jobs below or perform a new job search.
See similar jobs below or perform a new job search.
Sort By
3,438 'full OR time OR veterinarian OR needed OR greenville OR sc OR area OR STATECODE:"SC"' Jobs
Dubuque, Iowa
PetMed Animal Health Center
3 Weeks Ago
Amsterdam, New York
Amsterdam Animal Hospital
1 Week Ago
Absecon, New Jersey
Absecon Veterinary Hospital
1 Week Ago
Bellefonte, Pennsylvania
Straley LA Veterinary Services
3 Weeks Ago
Chandler, Arizona
Ocotillo Animal Clinic and Pet Resort
2 Weeks Ago
Smith Animal Hospital
1 Week Ago
Harrisburg, Pennsylvania
Shores Veterinary Emergency Center
1 Month Ago
Hobart , Indiana
Hobart Animal Clinic/Crossroads Animal Hospital
2 Months Ago
WAUPACA, Wisconsin
Countryside Animal Hospital
1 Month Ago


text:
Brighten the Face of a Child
Christmas Committee, Inc - Toys for Joy
Two Turkey Bingos
Ham Lake Area Chamber of Commerce
Andover Football Association
Cooperative Living Designed for Members 62+
The American Cooperative of Anoka
Special Leaf Drop-Off
Spring Lake Park
Feel Fabulous in Anoka!
Discover Anoka
Virtual Open House
Four Seasons Toastmasters Club
Pumpkin Patch
Riverdale Crossing
Check the Anoka Halloween Website for Events and QCTV Coverage
Anoka Halloween Inc
FREE Pumpkins & Treats
Thank You, Fridley City Council!
City of Fridley
Fall Recycling Event
City of Anoka


text:
Applies to: All Visual Studio 2015 Update 3 editions except Isolated and Integrated Shells, Build Tools, Remote Tools, and Express for Web
In November 2020, the content of this article was updated to clarify the affected products, prerequisites, and restart requirements. Additionally, the update metadata in WSUS was revised to fix a Microsoft System Center Configuration Manager reporting bug.
A remote code execution vulnerability exists in Microsoft Visual Studio 2015 when it incorrectly handles objects in memory.
To learn more about the vulnerability, see CVE-2020-16874 and CVE-2020-16856.
How to obtain and install the update
Visual Studio 2015 Update 3
Method 1: Microsoft Download
The following file is available for download:
Download the hotfix package now.
Method 2: Microsoft Update Catalog
To get the standalone package for this update, go to the Microsoft Update Catalog website.
More information
To apply this security update, you must have both Visual Studio 2015 Update 3 and the subsequent Cumulative Servicing Release KB 3165756 installed. Typically, KB 3165756 is installed automatically when you install Visual Studio 2015 Update 3. However, in some cases, you have to install the two packages separately.
Restart requirement
We recommend that you close Visual Studio 2015 before you install this security update. Otherwise, you may have to restart the computer after you apply this security update if a file that is being updated is open or in use by Visual Studio.
Security update replacement information
This security update doesn't replace other security updates.
File hash information
|File name
|SHA1 hash
|SHA256 hash
Installation verification
To verify that this security update is applied correctly, follow these steps:
- Open the Visual Studio 2015 program folder.
- Locate the Dxtex.dll file in the Microsoft Visual Studio 14.0\Common7\IDE\Extensions\Microsoft\VsGraphics folder.
- Verify that the file version is equal to or greater than 14.0.27543.0.
If you elected to install the optional component (Windows 8.1 and Windows Phone 8.0/8.1 Tools), follow these additional steps:
- Locate the Dxtex.dll file in the Microsoft Visual Studio 12.0\Common7\IDE\Extensions\Microsoft\VsGraphics folder.
- Verify that the file version is equal to or greater than 12.0.40689.0.
- Locate the Dxtex.dll file in the Microsoft Visual Studio 11.0\Common7\IDE\Extensions\Microsoft\VsGraphics folder.
- Verify that the file version is equal to or greater than 11.0.61246.400.
Information about protection, security, and support
- Protect yourself online: Windows Security support
- Learn how we guard against cyber threats: Microsoft Security
- Obtain localized support per your country: International Support
- Get more information about the Visual Studio support policy: Visual Studio Product Lifecycle and Servicing.


text:
Heart attack victim dies at Snowmass
An Australian man suffered a heart attack on the slopes of the Snowmass ski area Monday and died, according to Rose Abello of the Aspen Skiing Co.'s communications department.
The man, who's name was unavailable, was in his 50s and was believed to be a visitor to
the Roaring Fork Valley, Abello said.
He apparently stopped skiing on Gunner's View trail in the Elk Camp area at Snowmass and went into cardiac arrest, according to Abello.
The ski patrollers initiated CPR when they arrived at the scene, Abello said. They continued performing life-saving measures on the man as he was transported by toboggan to the Snowmass Clinic, she said.
The man was pronounced dead at the clinic, Abello said.
Support Local Journalism
Support Local Journalism
Readers around Aspen and Snowmass Village make the Aspen Times' work possible. Your financial contribution supports our efforts to deliver quality, locally relevant journalism.
Now more than ever, your support is critical to help us keep our community informed about the evolving coronavirus pandemic and the impact it is having locally. Every contribution, however large or small, will make a difference.
Each donation will be used exclusively for the development and creation of increased news coverage.
Start a dialogue, stay on topic and be civil.
If you don't follow the rules, your comment may be deleted.
User Legend: Moderator Trusted User
Aspen Music Fest still planning in-person concerts for summer 2021
Amid the pre-Thanksgiving gloom of grim pandemic news here in Aspen, across Colorado and the mountain west came a small but significant dose of hope in the unlikely form of an Aspen Music Festival and School announcement.


text:
Dirks Offers Insect Pest Control and other Pest and Wildlife Control in Elkins Park 19027
Dirks pest control provides proven services for Insect Control in Elkins Park Pa, as a 2nd generation family owned pest control company, we care about our clients in Elkins Park; we work and live in the same community. At Dirks, we offer an integrated Insect pest management strategy that is Guaranteed.
Our pest control company offers environmentally friendly Insect options that provide long term Insect management solutions.
All Insect inspections are performed by experienced technicians that have been certified in Montgomery County by the State of PA. By choosing Dirks Pest Control, our trained exterminators will be able to professionally treat your Insect situation.
Call DirksPMS or to handle your Insect control situation in Elkins Park Pa 19027.
Keep in mind that many of our technicians live in the Elkins Park area, so getting your Insect concerns solved will be handled promptly. At Dirks Pest Control, we go the extra mile. Our experienced, certified pest Control specialists can confidently design a treatment to solve your Insect situation. Dirks is a local family owned company, our technicians live locally to Elkins Park, which means servicing your location will be convenient to schedule – Just give us a call.
Get to know the Dirks Pest Management Specialist Family for your Insect needs in Elkins Park, Montgomery County.


text:
- How do dentists treat small cavities?
- How do you rebuild enamel?
- Do all cavities need to be filled?
- How do you fix cavities?
- What do small cavities look like?
- How can I fill a hole in my tooth at home?
- What toothpaste is best for cavities?
- How long does it take to reverse a cavity?
- Are cavities painful?
- Can you reverse a cavity?
- How can you get rid of a cavity without going to the dentist?
- Why do I keep getting cavities?
- Can you remove cavities at home?
- Can MI Paste reverse cavities?
- How do you heal cavities naturally?
- How do you stop cavities from growing?
- Can small cavities go away?
- What happens if you don't fill cavities?
- How do you know when a cavity is really bad?
How do dentists treat small cavities?
Cavity-Specific Treatment Options Pit and Fissure Cavity Treatment – If your dentist catches a small pit and fissure cavity early, a prescription fluoride toothpaste may be the only treatment recommended.
But, if your small cavity reaches your tooth's dentin, your dentist will recommend a tooth filling or composite..
How do you rebuild enamel?
These simple steps can help ensure your enamel remains strong:Brush twice a day with a fluoride toothpaste such as dCrest Gum & Enamel Repair.Brush for the dentist-recommended two minutes.Try brushing in between meals when possible.Floss at least once a day.Rinse with a fluoride-infused, remineralizing mouthwash.More items…
Do all cavities need to be filled?
In short, the answer is no. Dental fillings are used to treat cavities because a dentist tends to want to remove the decayed part (the cavity) and fill it to stop any further damage from occurring. While there aren't ways to remove a cavity without using a filling, there are ways almost to reverse the decay.
How do you fix cavities?
Treatment options include:Fluoride treatments. If your cavity just started, a fluoride treatment may help restore your tooth's enamel and can sometimes reverse a cavity in the very early stages. … Fillings. … Crowns. … Root canals. … Tooth extractions.
What do small cavities look like?
What Does a Cavity Look Like? Some cavities start with a whitish or chalky appearance on the enamel of your tooth. More serious cases can have a discolored brown or black color. However, most often there are no distinguishable red alerts.
How can I fill a hole in my tooth at home?
Keep adding glass ionomer until the cavity is over-filled. Put extra glass ionomer in any other pits on the surface of the tooth near the cavity. Rub petroleum jelly on your finger and press down firmly onto the filling for a few seconds, rolling your finger from side to side. This will make the filling smooth.
What toothpaste is best for cavities?
Research-backed toothpastes3M Clinpro 5000 1.1% Sodium Fluoride Anti-Cavity Toothpaste. You and your dentist may decide that a prescription toothpaste such as 3M Clinpro 5000, which contains more fluoride than traditional toothpaste brands, may be the best choice for you. … Sensodyne Pronamel. … Crest Pro-Health Advanced.
How long does it take to reverse a cavity?
Every Cavity Is Different. The time it takes for a cavity to form varies. It can, on average, take anywhere from six months to four or five years before a cavity requires treatment.
Are cavities painful?
Cavities usually do not hurt, unless they grow very large and affect nerves or cause a tooth fracture. An untreated cavity can lead to an infection in the tooth called a tooth abscess. Untreated tooth decay also destroys the inside of the tooth (pulp).
Can you reverse a cavity?
Tooth decay can be stopped or reversed at this point. Enamel can repair itself by using minerals from saliva, and fluoride from toothpaste or other sources. But if the tooth decay process continues, more minerals are lost.
How can you get rid of a cavity without going to the dentist?
Some of these remedies include:Oil pulling. Oil pulling originated in an ancient system of alternative medicine called Ayurveda. … Aloe vera. Aloe vera tooth gel may help to fight off bacteria that cause cavities. … Avoid phytic acid. … Vitamin D. … Avoid sugary foods and drinks. … Eat licorice root. … Sugar-free gum.
Why do I keep getting cavities?
If you brush and floss regularly but still miss these areas, a cavity can easily form. Gum Recession – When the gums recede, the root of the tooth is exposed, which isn't covered with protective enamel like the rest of the tooth. This exposed area is much softer and can easily develop a cavity.
Can you remove cavities at home?
Vitamin D, oil pulling, licorice lollipops, chewing gum, and other home remedies won't get rid of existing cavities on their own. But these methods may keep cavities from getting bigger and prevent new ones from coming.
Can MI Paste reverse cavities?
It's balanced. Every time you eat or drink, acid is introduced into your mouth and your pH level becomes more acidic, or imbalanced from a pH standpoint." Using MI paste after eating restores oral balance and protects teeth from acid damage. The application is simple.
How do you heal cavities naturally?
Tips for healing cavities naturallyConsume plenty of vitamin D3, C, and K2.Get enough calcium, magnesium, and phosphorus.Consider other supplements and oils that support healthy teeth.Reduce sugar intake.Reduce phytic acid consumption.Use a natural remineralizing toothpaste.Don't brush too hard.
How do you stop cavities from growing?
Here is what you can do in the meantime to help prevent the cavity from worsening.Brush the Tooth With Care. Brushing is essential for tooth and gum health. … Hydration Will Help Prevent Additional Cavities. … Fluoride Treatment. … Saltwater Rinses Might Help. … Xylitol Gum. … Avoid Refined Sugar.
Can small cavities go away?
Fact: Once a Cavity Starts, There's No Turning Back But once bacteria and decay get through that enamel, the damage is done. "Once that bacteria gets so far into the tooth that you can't brush it away, it's not going to get better, Harms says. "Cavities don't go away once they start.
What happens if you don't fill cavities?
However, as time goes forward, the hole becomes larger and larger if it stays untreated. You can experience a severe toothache with an untreated cavity. It can become infected and eventually lead to tooth loss.
How do you know when a cavity is really bad?
Some of the most common signs of a cavity include:Visible Discoloration or Dark Spots. When a cavity begins to develop, it can cause dark spots on the tooth's surface. … Sensitivity to Hot or Cold. … Holes or Craters on Teeth. … Bad Breath and Unpleasant Taste. … Pain and Discomfort. … Swelling or Bleeding Gums. … No Symptoms At All.


text:
Mr. Chow Celebrates Its 30th Anniversary With Brooke Shields, Hamish Bowles and Other Fashion Folk
The adjective most often attached to Mr. Chow is "classic," although it's more accurate to say the upscale Chinese restaurant in midtown Manhattan is a time capsule. It's impossible to walk into the space, with its sunken dining area, mirrored walls and black leather banquettes and not be transported back to the days of Studio 54 and coke spoons. Not that there's anything wrong with that. In fact, Mr. Chow has become a classic for its ability to evoke a feeling of '70s urban glamor.
That was the vibe last night as the restaurant...
To Read the Full Story
Continue reading your article with
View Membership Options
a WSJ membership
Sponsored Offers
American Eagle Outfitters:
Get a 20% American Eagle coupon with your new AEO Connected credit card
Foot Locker:
Spend $49 & get 20% off + free shipping - Foot Locker coupons
Macy's coupon - Sign up to get 25% off next order
Download the mobile App for free Nordstrom coupons
Saks Fifth Avenue:
$20 off $200 - Saks Fifth Avenue coupon
Forever 21:
20% off sitewide with Forever 21 coupon


text:
Newly remodeled 4 bedroom 3 bath home with screened in pool on a corner lot. Located in The city of Atlantis. The home features a new tile roof, impact windows, tile floors, remodeled bathrooms, open floor plan. One of the bedrooms is a separate guest quarters with its own bathroom. Your new home is ready and waiting.
Clubhouse, Golf Course, Park, Playground
Cable, 3-Phase Electric, Public Sewer, Public Water
Entry Lvl Lvng Area, Split Bedroom, W/D Hookup
Auto Garage Open, Dishwasher, Range - Electric, Refrigerator, Smoke Detector, Water Heater - Elec, Washer/Dryer Hookup
Perfect Properties of the Palm Beaches
|Status Changed from New to Active
All listings featuring the BMLS logo are provided by Beaches MLS Inc. Copyright 2020 Beaches MLS. This information is not verified for authenticity or accuracy and is not guaranteed.
© 2020 Beaches Multiple Listing Service, Inc. All rights reserved.
Listing information last updated on December 1st, 2020 at 3:30am EST.


text:
Eclipse IDE
1478 Solutions and counting.
The Eclipse 4 Application Platform now uses CSS for theming Eclipse-based applications. The Lightweight CSS Editor provides support for editing and tweaking the active CSS theme for active applica...
This plug-in is an attempt to provide language-independent editor keyboard-macro record/play support. You can build or record macros and save them. Macros can be edited. Macros can be imported/e...
RDF Persistence for EMF Models.
emftriple lets you store and load EMF models from RDF data sources. It supports various RDF stores, including Jena TDB, SDB, Joseki, Sesame, sparql endpoints ...
The Synopsys® Code Sight™ plug-in identifies security bugs and vulnerabilities in your software while you code. It scans automatically, and highlights issues in the development environmen...
The Intents Registry Eclipse Plug-in allows developers to browse an online intents registry provided by OpenIntents and insert a code block corresponding to the selected intents directly into their...
JRipples helps programmers during software change. JRipples is based on the philosophy of "intelligent assistance", which requires close cooperation between the programmer and the tool. The tool an...
ConExt is a tool for extraction of concept hierarchies between a certain number of terms refering to concepts relevant for a specific domain. It is based on the Formal Concept Analysis (FCA) approa...
New innovative GrokClipse plug-in for developers using OpenGrok portal. GrokClipse is plug-in for Eclipse integrated programming environment. The main aim is to integrate with OpenGrok – the portal...
COLA Tests m2e connector - No longer required (see details)
JUnit + BDD = COLA Tests
COLA Tests is a BDD framework built on top of JUnit.
It is easy to use, setup and above all, DOES NOT r...
Testing, IDE, Team Development, Tools, Collaboration
Last Updated on Monday, February 4, 2019 - 13:54 by Bruno Santos
Prolog Development Tools (ProDT) is a Prolog Integrated Development Environment (IDE) aiming to be as rich in functionality as the Eclipse's java IDE, giving the developer a single environment...
Languages, IDE, Editor
Last Updated on Monday, February 4, 2019 - 13:53 by Claudio Mising name
Smarter Mocking: Eclipse IDE with Service Virtualization
When developing apps, developers want to have all the dependencies, like virtual services, to be available/accessible from within their&n...
Last Updated on Tuesday, November 24, 2020 - 02:51 by Sankar Subramaniam
A powerful development library that allows easy integration of any 3-D Secure 2.2, 2.1 or 1.0.2 program, including Visa 3-D Secure, American Express SafeKey, Discover ProtectBuy, MasterCard Identif...
Application Development Frameworks
Last Updated on Friday, May 8, 2020 - 10:33 by Irida Haznedari
Next ABAP extension for ADT Tools. Split from ABAP Favorites in order to keep clean and to keep the core functionality of Favorites alone, giving the users a choice if they want to install this fea...
Tools, Application Development Frameworks, Application Management
Last Updated on Wednesday, September 9, 2020 - 14:37 by Lukasz Pegiel
ABAP Code Insight is an Open Source Plugin which enabled inline code information for ABAP code in Eclipse. The only prerequisite to use this plugin for developing with ABAP is an ABAP Developm...
IDE, Programming Languages
Last Updated on Wednesday, September 9, 2020 - 14:35 by Andreas Gautsch
ABAP Search and Analysis Tools is an Open Source plugin which provides tools for searching and analyzing ABAP objects.
The main purpose of the plugin is to provide advanced search and analysis too...
Application Development Frameworks, Tools, Search
Last Updated on Wednesday, September 9, 2020 - 14:39 by Ludwig Stockbauer-Muhr
ABAP Tags is an Open Source Plugin which provides tools for adding arbitrary tags to ADT objects.
The main features of this plugin are:
View to manage ABAP Tags
Wizard to assign Tag...
Tools, Application Development Frameworks
Last Updated on Wednesday, September 9, 2020 - 14:38 by Ludwig Stockbauer-Muhr
AcceCite provides a graphical solution to design accessible e-services.
AcceCite complies with the W3C WAI standard (WCAG AA level) including W3C CSS and XHTML standards.
AcceCite is part of ...
Web, Modeling Tools, IDE, UI
Last Updated on Tuesday, December 13, 2011 - 10:35 by Olivier Mising name
Acceleo is a pragmatic implementation of the Object Management Group (OMG) MOF Model to Text Language (MTL) standard. You do not need to be an expert to start using the plug-ins and create your fir...
Languages, UML, Modeling Tools, IDE
Last Updated on Wednesday, September 9, 2020 - 14:34 by Obeo Mising name
The AccessModifer Plug-in for Eclipse allows the user to change the visibility (public, protected, default, private) and other modifiers (final, static, synchronized) of Java classes, interfaces, e...
IDE, Programming Languages, Tools, Code Management, Editor
Last Updated on Monday, February 4, 2019 - 13:51 by Nils Winkler
An Eclipse plugin which generates Javadoc for getters and setters of a Java class. The generated Javadocs are based on those of fields corresponding to the getters or setters.
How to use
Tools, Documentation
Last Updated on Saturday, March 2, 2019 - 11:12 by recyclebin5385 Doe
This plugin has been tested to work with AccuRev 6.0 or higher. This plugin is free to use with our AccuRev customers and evaluators. It is fully supported and documented.
You can fi...
SCM, Team Development, Tools
Last Updated on Monday, September 9, 2019 - 02:53 by Vignesh Murugan
Actifsource is a code generator plug-in for the Eclipse IDE. Code generation is driven by models which are created according to user-defined meta-models. UML-like graphic editor assists modeling. G...
IDE, Tools, Modeling Tools, Modeling, Editor
Last Updated on Wednesday, October 7, 2020 - 04:57 by Micha Riser
ADA Plugin lets you generate single pages and module template structure for the ADA Platform by Lynx Srl.
Once installed, select File -> New -> Other -> ADA Wizards
From there, select one of ...
Tools, Editor, Application Development Frameworks
Last Updated on Wednesday, April 6, 2016 - 09:13 by Giorgio Consorti
Eclipse plug-in to remote adb to an android device.
Mobile and Device Development
Last Updated on Friday, September 23, 2011 - 12:18 by Dev PPareit
Awarded Best RCP Application in the Eclipse Conference awards!
Download it here http://www.justinmind.com/downloads/wireframe_tool . Define web and mobile applications with Rich Interactive...
Graphics, Editor, Application Management, Documentation, IDE
Last Updated on Tuesday, May 24, 2016 - 14:34 by Victor Conesa
The AEM Developer Tools for Eclipse is a Eclipse plugin based on the Eclipse plugin for Apache Sling released under the Apache License 2.
Instructions: http://docs.adobe.com/docs/en/dev-tools...
Web, XML, Java EE and OSGi Enterprise Development
Last Updated on Wednesday, September 9, 2020 - 14:35 by Robert Munteanu
Envision - Agile Pseudocode Development Tool (APDT) speeds up planning and application modeling. The tool helps decrease the gap between developers and non-technical guys on a project, so you can m...
Modeling Tools, Editor, Application Development Frameworks, Code Management
Last Updated on Thursday, March 15, 2012 - 15:32 by Giorgio Natili
Anyone inheriting someone else's Java code will be familiar with the problem of understanding how it's been put together, how well structured it is and how best to take it forwards. Stepping throug...
Languages, Modeling, General Purpose Tools, Code Management, Documentation
Last Updated on Monday, February 4, 2019 - 13:55 by Paul Wells


text:
She now meets guys at do-it-yourself crafting meet-ups and her rock-climbing gym. But when it comes to the algorithms of love, many say they are losing faith. They wonder whether the valley has proven too vexing for even its own dating apps. Melissa Hobley, an executive at the dating app OkCupid, hears the complaints about the apps regularly and thinks they get a bad rap. One thing distinguishes the Silicon Valley dating pool: The men-to-women ratio for employed, young singles in the San Jose metro area is higher here than any other major area. There were men for every women, compared to about to nationwide, of never-married young people between 25 and 34 in San Jose, U. Census data from show. Men make up about 70 percent of the workforces of Apple, Facebook, and Google parent Alphabet, company filings show. The companies are also so big that different departments, with differing gender balances, barely mix.
For better or much, much worse, dating in SF is not like dating in any other city. It just isn't. Whether it's because we're sometimes too laid back or because we have the best date hikes in the entire world , you won't find another place like it to try to find your lobster.
Loads of the worlds largest dating scene in san francisco singles, so you. Get it: dating site to know in san francisco just that the u. Free online.
No one seems to really want a relationship or is already in a relationship. No one seems to really want kids. I'm from the area and don't plan on leaving, but I'm not sure how many other people want to settle down here. It seems popular to say you aren't really looking for a relationship or you're just seeing what's out there. Maybe it's just a millennial thing but it can get really annoying at times.
Everyone is always coming or going at some point, and I feel like everyone I connect with eventually ends up moving, or they've been here too short of a time to get serious with someone. There is a real elitist attitude here now, one that wasn't as prevalent when I was growing up in the city. If I wasn't over six feet and in great shape, I think I would be totally f—ed as far as dating here. I don't like having the guy pay for everything I think it's because of the dense nature of this city and the technological rise that people feel they're not accountable or held to their actions in any way.
Online dating makes this worse because now your dates are treated in some ways more like a commodity then an emotional connection. That's where all the cool people went! My options over the past five years were 1 Engineers at startups or Salesforce, or Google with lots of money but no personality.
Jump to navigation. There may be places in America where online dating still carries stigma but the Bay Area is definitely not one of them! In fact, with so many people in San Francisco dating online, singles are spoiled for choice and can afford to pick and choose the site that most suits their priorities. But how do you know which is right for you?
Are the san francisco. Personals sf. Imo the bar scene in san francisco, you ignite on one thing about dating. Asian dating with a guy wondering how straight.
Russian dating san francisco bay area Russian dating san francisco bay area This posting. Sign up now at sea. Are the san francisco. Personals sf. Imo the bar scene in san francisco, you ignite on one thing about dating. Asian dating with a guy wondering how straight women in california. She came west with more singles.
There are more than any other russians and found has members.
Dating in San Francisco sucks. I said it. Or, until I meet someone I like enough to stop reflecting on this issue. So, please, do share your own perspective in the comments—but first: six reasons why dating in SF totally sucks… and a conclusion that you may or may not like.
Automating Tinder date-hunting with chatbots. 'Homeless' camping dates. Techies are putting their stamp on San Francisco's dating scene.
This is especially true considering the fact that San Francisco has a higher ratio of males to females, not to mention there are over 20, more single men than women in the Bay Area. In my opinion, there seems to be an overall attitude and lifestyle in San Francisco that has made it almost impossible to date anyone in this city. It means you have the chance to go on a date with someone once or twice, but your travel calendar always keeps you busy.
No one has time to focus on a new relationship when he or she is building a company. Entrepreneurs are more afraid of failing when it comes to relationships than when it comes to building a company. CEOs and co-founders also seem to be a bit more afraid of failure when it comes to relationships or even talking to the opposite sex. For instance, I will go out every so often with a group of young, single, smart and attractive girlfriends.
After going on one or two dates, most people tend to just fall off the face of the earth without any explanation whatsoever. The dating app addiction has gotten so severe, people who are in relationships are also on dating apps just for the thrill of swiping.
Culture Trip stands with Black Lives Matter. Contrary to much belief, San Francisco has many eligible singles looking for a real relationship. The trick is knowing where to find them. San Francisco is the land where its inhabitants are better at creating the thing they want instead of searching for it.
Dating is tough, especially when you live in a busy city like San Francisco. Check out our list of completely true San Francisco dating woes.
Go to company page Microsoft. I heard both are pretty rough for straight guys. I'm considering a move to San Francisco and I'm casually wondering if I'm going to die alone. How bad is SF dating compared to Seattle? Go to company page Nordstrom Eng. Go to company page Facebook. Go to company page Google.
By Nadia Ibanez. While I was trying to get out of a bad relationship, I was offered a job in San Francisco. But in addition to starting an exciting new job, I moved here with the intention of finding a new man. Little did I know that the dating scene in San Francisco is a little different from that of the rest of the state.
Singles with relations. We match people looking for san francisco singles? Pinoy sites san jose, bryant st. More singles? Elite dating portal. Fall in san francisco singles starts here. Pal, featuring the best website for business or personals site with live interviews. More and free and looking for: filipino dating for singles with relations. Fall in san francisco online who naturalized as dating in san francisco can hear their match.
What's happening behind the best filipino singles in san francisco – philippines dating site. San francisco speed dating scene can be a lot of the city at idating4you.
I can speak about this with some confidence because as soon as I moved to the East Coast my dating life became almost the opposite of the above, especially when it comes to starting and maintaining relationships. They are not. Being "millionaire serial founder" will induce specific personality traits, and now it is up to you which type of women you prefer.
San francisco dating scene. Things in french dating section – start by walter biller, los angeles or in nyc women. Bathroom-Blowjob. Favorite this was my social.
Dating in san francisco blog There is dead martian civilization. Maybe just like never before buying. How does dating therapist on the most dating blog – what could go? Find yourself? Actually constitutes a decade. Looking for dating personalized matchmaking experts at it's just lunch share dating blog. Hello fellow humans and more solidly drawn. Or create your own fierce love journey.
Two great cities of us are 10 differences between norcal socal? In the calendar and connect with singles – join the science of the bay area dating in short name as of sept. When you are you have each of music, followers. Find a date. Two years wiser and cynical about singles in sf vs los angeles.


text:
MINNEAPOLIS – The Minnesota Vikings will be short-handed in the secondary for Sunday's playoff game at New Orleans against the Saints and their potent passing attack.
Cornerback Mackensie Alexander was ruled out with a knee injury, and cornerback Mike Hughes was placed on injured reserve with a neck injury. Alexander has served as the slot man in the nickel defense.
Hughes has taken turns at the outside spots for starters Xavier Rhodes and Trae Waynes down the stretch. He's also been the primary punt returner.
Also on Friday, Vikings President Mark Wilf has issued a statement of confidence in general manager Rick Spielman and head coach Mike Zimmer. Wilf says the team has "every intent" of bringing back both of them for 2020 "and beyond."
Spielman and Zimmer each have one season left on their contracts. Speculation about their future has swirled recently. The Vikings play at New Orleans on Sunday, their third trip to the postseason in six years under Zimmer.
They have only one postseason victory since reaching the NFC championship game after the 2009 season.


text:
Covid-19 in Italy: a provincial modelling using an adjusted time-dependent SIRD model and a wavelet and cross-correlation data analysis in Lombardy region.
In this talk we will present a predictive model for the spread of COVID-19 infection at a provincial (i.e. EU NUTS-3) level in Italy by using official data from the Italian Ministry of Health integrated with data extracted from daily official press conferences of regional authorities and from local newspaper websites. An adjusted time-dependent SIRD model is used to predict the behaviour of the epidemic, specifically the number of susceptible, infected, deceased and recovered people. Predictive model performance is evaluated using comparison with real data. Furthermore a special attention to Lombardy region, the one most affected by the epidemics in Italy, will be payed, and a wavelet and cross-correlation study of the predictive power of Twitter messages and of emergency calls to the rescue service will be presented, as possible tools to anticipate the peaks of new infections or to evaluate the effects of national policies for restriction measures.
1. Luisa Ferrari, Giuseppe Gerardi, Giancarlo Manzi, Alessandra Micheletti, Federica Nicolussi, Elia Biganzoli, Silvia Salini, Modelling provincial Covid-19 epidemic data in Italy using an adjusted time-dependent SIRD model, preprint, 2020 , arXiv:2005.12170
2. Luisa Ferrari, Giuseppe Gerardi, Giancarlo Manzi, Alessandra Micheletti, Federica Nicolussi, Silvia Salini, COVID-Pro in Italy: a dashboard for a province-based analysis, preprint, 2020, arXiv:2004.12779
3. B.A.Rivieccio, A. Micheletti, M. Maffeo, M. Zignani, A.Comunian, F.Nicolussi, S.Salini, G.Manzi, F.Auxilia, M. Giudici, G.Naldi, S. Gaito, S. Castaldi, E. Biganzoli, CoViD-19, learning from the past: A wavelet and cross-correlation analysis of the epidemic dynamics looking to emergency calls and Twitter trends in Italian Lombardy region, medRxiv preprint, 2020. doi: https://doi.org/10.1101/2020.10.14.20212415
Biography: Alessandra Micheletti is Associate Professor of Probability and Mathematical Statistics at the Dept. of Environmental Science and Policy, Università degli Studi di Milano. She was awarded her PhD in computational mathematics and is a member of the council of the European Consortium for Mathematics in Industry, of the Data Science Research Center of University of Milan and coordinator of the H2020 MSCA project BIGMATH- "Big data challenges for Mathematics". She is then managing editor of the Journal of Mathematics in Industry and guest editor of a special issue entitled "Mathematical models of the spread and consequences of the SARS-CoV-2 pandemics. Effects on health, society, industry, economics and technology." Her main research interests are in the field of Statistics and Topological Data Analysis applied to industrial and life sciences problems.