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We also selected for you an interesting video about mobile app developing. Here you can see "How to Make an App – Secrets Top Developers Use to Gain Millions". We are sure that this video will bring you a lots of ideas how to make your own app. Let's enjoy!
To use the software, you will need an internet connection and a microphone and to be able to download their testing software. If you want to take mobile tests, you'll need an iPhone, an iPad, an Android phone or an Android tablet. You're paid via PayPal, which means you can live and use the service to make money as long as you live in a country where PayPal works.
Manual testing is a human input, analysis or evaluation. This approach is user centric focussing on explorative ways of monitoring, whether a mobile application meets user requirements and expectations. You should test your app for look & feel and for usability, making sure that it is user friendly. You should not be using manual testing for all your testing, but just for about 20% of them, for the rest you can use automated testing.
Another fun app that doesn't require a lot of time is Qriket. It is a free app that gives you real money, by simply watching an add, then spinning a wheel. For an extra free 25 spins use code 70045E when you sign up.
One part that really resonated with me was your description of usability testing. Qualitative analytics can help ensure your users are having a satisfactory experience.It adds an additional visual layer to your data and allows you to watch user session recordings and view touch heatmaps. You can see how users are interacting with your app. A tool that can help with this is Appsee.
UpWork is a perfect website for freelancers and provides opportunities for freelance testers to make money testing apps. All you need to do is set up your profile and check testing opportunity on this website. Payout starts from $5 for each test and can be up to $50.
However, this isn't horrible and many of the paid survey panels have ratings in the 2 to 4 star range even though they are legitimate. It's the context of the reviews that matter — people love this app, and the only ones complaining are those that don't pick up on new offers after going to local restaurants and Carter, Unlike most people who have great app ideas, I'm on the other end. I have the funds to develop/create an app but not an idea (how unfortunate) lol. I was wondering if you could direct me to someone who is looking to have his/her idea developed into an app but is in need of the funds so we could partner up OR i could buy his/her idea.
You can make extra money by selling your old laptop, and this app will let you do it. Simply select the type of device you wish to sell, add a description of the device, pack it up and ship it (free of charge), and get paid with a cheque or Paypal.
I also recommend FlexJobs. The company has an A+ rating with the Better Business Bureau, along with a money-back policy if you are unhappy with the website. FlexJobs guarantees that every single job is 100% legitimate.
Android is everywhere! In fact, over 80% of all smartphones in the world are controlled by that little green robot. Create your own Android app to run on all of them with Appmakr's Android app maker. You can develop Android apps, without hiring an Android developer or building your own coding skills. Easily add photos, videos, social feeds, maps and more. You can even publish it directly to the Google Play Market and make it available to all of your new fans around the world. Start building your Android App Now (it only takes 20 minutes)!
Besides design, being polished includes being technically solid. If you are developing the app yourself, you may want to consider bringing on a programmer who is well-versed in Objective-C to help you; though apps can be built using other programming languages, this version of C++ is the standard. You should also be sure to give your app the full battery of beta-testing it needs before you make your submission. An inexpensive way to test it is to distribute it among friends and solicit feedback. Just remember: Without smooth functionality, your app will be dead in the water.
Upwork is another freelancer platform where you bid on product testing jobs. If a client accepts your proposal, you get paid to test the product. By being a good reviewer, you will receive positive feedback that will help you receive invitations to interview with prospective clients instead of finding and pitching to clients yourself.
Note: The refer-a-friend promotion information applies to their offer running until the end of June 2017. They always have some type of great deal on the table though, so take a look when you sign up!
Additionally, wearable application testing is an interesting market. Bluetooth, GPS, Sensors, Wi-Fi are some of the core technologies at play in wearables.[4] A lot of importance is needed here for field testing, user focus, and looking at areas where hardware and software need to be tested in unison.
MoneySavingExpert.com is part of the MoneySupermarket Group, but is entirely editorially independent. Its stance of putting consumers first is protected and enshrined in the legally-binding MSE Editorial Code.
I had a quick question. I was looking for Feedback Army on Amazon Turk, but I cannot find it. I signed up, but cannot find where you look for user ability testing tasks. Where can I go to find that? Thank you
Rent out your home. Airbnb and other sites could help make you TENS of thousands of pounds from letting your home or spare room temporarily to holidaymakers – and some new tax breaks can really boost the gain. See Rent Out Your Home for a crash course in safely renting out your spare room or entire property for short periods.
YouGov acts more like a community than the other survey apps on this list. Once you complete a questionnaire, you instantly know how other people answered the same question. This gives you further insight as to what the general public thinks when it comes to political issues.
payment method oracle apps +mobile payment apps development
We also selected for you an interesting video about mobile app developing. Here you can see "How to Make an App – Secrets Top Developers Use to Gain Millions". We are sure that this video will bring you a lots of ideas how to make your own app. Let's enjoy!


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How to Write a College Education Essay
College instruction essay illustrations are among the writing styles at high school. Your school education essay should be unique, so you will want to obtain a lot of hints about the best way best to write college essays.
One of the situations which you ought to do is to work with an expert to create your college education essay. A professional writer can help you to get your essay. However, if you do not have the money to employ a professional to make your essay, you need to learn how to write an essay by yourself.
An important notice about faculty essays. Your essay's focus has to be about the topic. Topics are everything you are going to https://sites.google.com/site/essaydiscountcodes/evolution-writers-discount-code-10-off spend the bulk of your essay. If you're composing a college education article concerning'life's meaning,' this might be an interesting subject for your essay, but maybe not if it's the story of your life in college.
In order to construct your life's story, you have to first focus on a single topic. Furthermore, if you prefer to speak about a couple of distinct topics on your essay, you ought to select.
You can pay for a whole lot of subjects by having many different topics. As an instance, you can handle the only issue of your lifetime as well as a fascination with art or science. You'll be able to match many themes, by selecting a topic.
Because it is an easy way to tell a tale about your own life, life stories are rather well known in school essay examples. It's possible to tell the narrative in a fashion that is that has a bit more formality or casual.
You may wish to consider a subject before a college education composition is written by you in the event you do not write in a formal style. You might think. You will find that it helps you when you're writing your essay Should you do this.
Before you begin the writing process, try to select a topic for the college education essay. Doing so can help you . The better you can write, the better you will be able to relate.
You should keep in mind that your audience will need a certain style when you are learning how to write a college education essay. You must know about your audience's tastes, and then you will be able to make an essay which they will like.
Composing and editing are two procedures that you should exercise. These skills will become second nature, and you will be able to create essays.
Talk to folks about your own writing and you also have to get out. This will help you see how your writing sounds and looks. When you are speaking to individuals, you'll be able to discover the way to enhance your writing, as well as where you went wrong.
Writing a college education article is. You must understand that each idea you get for a subject might not work for everybody. Consequently, it's very important to keep on composing and editing as you proceed.

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Children's Favourites
An enchanting collection of favourite songs from the past. Included are I'm A Lonely Little Petunia, Sparky's Music Mix-up, I know an old lady, Popo the Puppet, The Kings's New Clothes, and many more, sung by such unique entertainers as Danny Kaye and Groucho Marx.
2 CDs
Running Time: 2 h 16 m
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ISBN: 978-962-634-413-2 Digital ISBN: 978-962-954-444-7 Cat. no.: NA241312 Download size: 32 MB BISAC: JUV038000 Released: July 2006
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OSRAM Opto Semiconductors Expands LED Portfolio to Help Lighting Designers and Developers Meet ENERGY STAR Standards
OSRAM Opto Semiconductors, in their ongoing efforts to support energy savings initiatives, continues to broaden their product portfolio to offer LEDs that will help lighting designers and manufacturers meet or exceed ENERGY STAR standards for the solid state lighting (SSL) market. Read more »
Lamina Opens Product Showroom and Design Center in New York
Lamina Lighting Incorporated (Lamina), the world leader in the development and manufacturer of high-power LED light engines, today announced it has opened The Lamina Design Center, a product showroom and design studio at 336 West 37th Street in Manhattan. The Center is located in The Arts Building (www.theartsbuilding.com), also home to lighting designers, artists and other businesses in the creative field. Read more »
Lumileds Implements Lumiramic Phosphor Technology as Part of its Roadmap - Reduction of Warm White LUXEON Rebel Bins at First
The general lighting industry can look forward to dramatic improvements in the manufacture and supportability of color-consistent, white power LEDs under a new technology roadmap for Lumiramic phosphor technology. Read more »
Seoul Semiconductor's Acriche - Now UL Recognized, Another SSL World First
Seoul Semiconductor, one of the world's leading LED manufacturers announced today that its Acriche A2 and A3 series have been evaluated and found in compliance with the requirements and therefore is approved to bear the UL Component Recognition Mark. Read more »
Cree Announces Volume Shipments of LR4 Recessed LED Down Lights
Cree, Inc. (Nasdaq: CREE), a market leader in LED lighting, announces volume shipments in May of the LR4, a four-inch architectural recessed LED down light for new construction and renovation projects. The LR4 has been specified in a number of significant projects, including corporate campuses, full-service hotels, and global restaurant chains. Read more »
Carmanah and Beta Lighting Partner to Deliver BetaLED(tm) Solar-Powered Lighting Solution
Carmanah solar-powered area lights are now better and brighter than ever, thanks to a new partnership between Carmanah Technologies Corporation and Beta Lighting. Read more »
Intematix Adds Integration Capabilities with Solid State Lighting Technology Development Center
Intematix Corp. a leading innovator of advanced materials and merchant provider of patent-backed phosphor solutions for solid state lighting applications, today announced the launch of the Intematix Technology Center (ITC) in Yang Mei, Taiwan. With direct access to critical components, the center will provide LED packagers with the full compliment of materials necessary for rapid prototyping and deployment of any phosphor-based solid state lighting solution. In addition, ITC adds a full service integration and pilot production capability for a range of chip-on-board and integrated light engines/modules to support the needs of solid state lighting system providers. Read more »
Lamina Resource Center Offers Advanced Tools, Unique Expertise For Customer Product Development Needs
Lamina Lighting Incorporated (Lamina), an innovator of LED lighting systems and technologies, today announced it has launched the Lamina Resource Center, a unique service that allows customers and potential customers to utilize the company's specialized expertise and equipment for their own product development purposes. Read more »
Nexxus Lighting Closes Acquisition of Lumificient Corporation
Nexxus Lighting, Inc. (NASDAQ Capital Market: NEXS) today announced that it has closed the previously announced acquisition of solid-state LED lighting manufacturer, Lumificient Corporation. The newly acquired company will be operated as a wholly owned subsidiary of Nexxus Lighting and will continue to operate out of its manufacturing facility in Maple Grove, Minnesota. Read more »
Lighting Science Group Acquires Lighting Partner BV
Lighting Science Group Corporation (OTC Bulletin Board: LSCG) ("LSG"), a leading developer and integrator of intelligent and energy-efficient LED lighting solutions, announced today that it has completed the acquisition of Lighting Partner BV ("LPBV"), an innovative manufacturer providing a broad range of LED and High- intensity Discharge ("HID") lighting solutions for residential, commercial, and retail applications based in The Netherlands. Read more »
Cree Announces LED University Program to Promote and Deploy LED Lighting Technology
Cree Announces LED University Program with North Carolina State University, Marquette University, University of California at Santa Barbara, University of Arkansas and Tianjin Polytechnic University. Read more »
Lamina Announces CO2 Offset Certification for LED Products
Lamina Lighting Incorporated (Lamina), an innovator of LED lighting systems and technologies, has announced that the use of their new TitanTurbo TruColor LED product has been certified to avoid more than 3 tons of C02 emissions into the earth's atmosphere as compared to its incandescent equivalent. Read more »
Cree Expands Network of Solution Providers to Accelerate LED Adoption and Reduce Costs
Cree, Inc. (Nasdaq: CREE), a market leader in LED lighting, announces seven new value-added solution providers have joined the global Cree Solution Provider network. The program, created in November 2007, now includes 21 leading LED solution providers. Read more »
OSRAM Opto Semiconductors Opens New Asia Regional Headquarters in Hong Kong
OSRAM, a 100% Siemens subsidiary, today held an opening ceremony for the new Asia regional headquarters of its subsidiary, OSRAM Opto Semiconductors, a specialist in semiconductor technology for lighting, sensor and visualization applications. Read more »
Zumtobel Group acquires Italian LED company SpaceCannon
The Zumtobel Group has strengthened its position in preparation for the further expansion of its LED operations through the acquisition of the Italian LED company SpaceCannon. SpaceCannon, which was founded in 1988 near Alessandria in Piedmont, specialises in LED-based lighting scenarios for outdoor, façade and event lighting. Read more »


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Health Care Policy Expert Andy Slavitt On NYC's COVID-19 Battle, Ventilators, Mask Culture
This week, Colin talks with former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), and host of the…
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This research provides an analysis of the telecommunication services markets in Colombia, covering six main segments: local telephony, long distance telephony, mobile telephony, pay TV services, broadband and internet access and data communications. An analysis of the market size, drivers and restraints, a market forecast and a competitive analysis can be found. The study examines the current structure of the industry, analyses competitive factors and reviews major strategic opportunities for success in the market.
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It is now widely recognized that ours is a global age. One of the first to perceive and then describe this "happening" was the sociologist Martin Albrow, in his book with the title The Global Age.Since its appearance, in 1996 numerous studies have been published. Indeed, a critical bibliography would be a valuable tool, pointing to further research. This might be the opening project in carrying out an agenda that I am about to describe.[1]
In undertaking such a task, it would be well to establish what I will call regional globalization studies. Do these regional arrangements facilitate globalization? Work against it and in what ways? Examples immediately spring to mind. A major one, of course, is Globalization and China, perhaps the greatest challenge of our epoch. No less important is Globalization and Islam.[2] Of equal importance is the European situation, in which pulls toward a European and a Global identity may be in conflict. Other regional studies—the USA, Latin America, etc.–would also be subjects for further study.
I will now divide my proposed agenda into two parts. The first will focus on research projects, including those mentioned in the first two paragraphs, that appear promising. The second will concentrate on what I consider a most important offshoot from the globalization process itself—the concept of Humanity.
One of the most interesting problems for research is that concerning a possible emerging global identity. The literature on national identity has been growing apace. Most of it naturally has been attached to nationalism. The latter has been part of what historians identify as modernity. The national identity transcends earlier ones of family, clan, and tribe. In many parts of the world, the national has not emerged successfully, and tribal loyalties still reign supreme.
With the accelerated emergence of globalization after WW II, it is only natural that we must raise the issue of global identity, not as doing away with the earlier ties, but as adding to them, a new bond. Such inquiry has already begun. For example, Julia Docolas at Leipzig University, part of a group of graduate students there, has already done a study of what is clearly a self-selected group of about 145 students from different countries. Her thesis, called "Global Identity," is rich in both theoretical concern and empirical study.
Others now need to be undertaken. Additional comparative studies of different university settings would help greatly. So, too, similar studies of other groupings would be useful. For example, one would be of UN military forces. Has such service led to increased global awareness and identity? An anthropologist embedded in such units could further enlighten us. Even more ambitious would be research into international civil servants. We must not force them into a procrustean bed of global identity, but inquire into their orientations with an open mind.
Another major project is to think hard and long about transnational and international history, and their relation to globalization. Overcoming eurocentrism, transnational history, outstandingly as practiced by Akira Iriye, has shown the way. What now needs to be done is to analyze the relationship of the transnational and the global more carefully. Are they similar processes?And what is the relationship of transnational and international history?
Then there is the vexed issue of world, global, and new global history. All emphasize interconnectivity. World historians tend to study the way civilizations have interacted with one another. William McNeill has been primus inter pares. World and global history have often been used as synonyms. A supposed difference is that global historians focus more on the totality of interactions and interdependency in the course of the past. Then there is new global history, focused on post-WWII developments. This is the time when interconnectivity increases exponentially, owing to the use of artificial satellites and personal computers. One must also remember that this is the epoch when the term "globalization" comes into currency and thus inspires a look along these lines at the past. A leader in global and new global history is Raymond Grew, probing the field sceptically while sympathetically. Needless to say, inquiries in one direction are not necessarily at the expense of inquiries in other directions.[3]
The concept of Humanity has been brought down from the skies of 18th century philosophers such as Immanuel Kant by the processes set in place by post WW II developments. First is the widespread effect of the bomb dropped on Hiroshima. It made dramatically obvious that human civilization could easily be destroyed—by humanity's own self-destructive impulses.
Next was the Nuremberg Trials and their epochal effect. Overshadowed by other aspects was the declaration that war was a crime. Before 1945-46, war crimes had been denounced. Now it was aggressive war itself which was declared a crime. It was as if a new step in human evolution had been taken.
Better known, and with a longer history, crimes against humanity were recognized and excoriated. At first linked with Christendom, it was detached from that religious tie because of it being offensive to Moslems, and then made to stand independently. In 1945-46 at the Trials it took on irrevocable life. Followed by the Yugoslav and Rwanda Trials, the movement has culminated for the moment in the International Criminal Court. Though judgments have not always been effectively carried out, and individuals have escaped the net of justice, the flame has been lit and the beacon of criminal responsibility casts its beams globally. As I have remarked elsewhere, a "Judicial Revolution" has taken place.[4]
Let us now return to the concept of Humanity. Aided by globalization and the computer revolution, it has put people in touch with one another in an immediate and unprecedented manner. In the Middle East especially, it has sparked or at least facilitated what has been called "The Arab Spring." More people now recognize their "togetherness." It may remain only in terms of a religious, ethnic,or national state, but to these is now added the possibility of a transcending tie, to Humanity.
When the Nuremberg Trials spoke of "crimes against humanity," the question naturally arose: what is this humanity? One answer came from the moon landing, where the astronauts could look back at planet Earth and see it as one abode. Logos endorsed this view. Buckminster Fuller popularized the notion. It will not be achieved in a moment. It will be very much helped by what the Canadian philosopher Ian Hacking has called dynamic nominalism. By this he means that once a category has been created—in his case he instances "homosexuality"–people are prepared to rush in and fill it. Such, gradually will be the case with Humanity.
What measures can be taken to aid this process? As we know there is an Earth Day. Why not a Humanity Day to make us pause and think? Such a day could also be celebrated with rituals, ceremonies, speeches, and parades, all over the world. Statues and monuments to Humanity could also be commissioned by global organizations. It is a task to which our imaginations must be brought.
In sum, I have tried to suggest an agenda for future efforts at dealing with globalization. Some of it has involved research projects. Others civic endeavors. Many hands will be needed. The challenge is before us. Now we must meet it.
[1] Martin Albrow, The Global Age (Stanford 1996). Aiif Dirlik, Global Modernity: Modernity in the Age of Global Capitalism (Boulder, CO: Paradigm Books, 2006).David Held et al, Global Transformations. Politics, Economics and Culture (Stanford, 1999). Global History, ed. A.G. Hopkins (Palgrave, 2006). Bruce Mazlish, The Idea of Humanity in a Global Era (Palgrave Macmillan, 2009). Bruce Mazlish, "Social Bonding, Globalization, and Humanity,"New Global Studies (electronic journal), Ms. 1148, 2011. Abstract + 1-8. Roland Robertson, Globalization, Social Theory and Global Culture (Sage, 1992). From sociology of religion to globalization. World Histories, ed. Marnie Hughes-Warrington (Palgrave Macmillan, 2005). Chapter 2, "Terms." These are some of the works worth consulting.
[2] Outstanding in the effort to understand this subject is the French scholar, Olivier Roy.
[3] An important book in this regard is World Histories, ed. Marnie Hughes-Warrington (Palgrave Macmillan, 2005). Chapter 2, "Terms." is my contribution.
[4] Bruce Mazlish, The Idea of Humanity in a Global Era (Palgrave Macmilan, 2009), Chapter 4. On crimes against humanity, see further Eric D. Weitz, A Century of Genocide. Utopias of Race and Nation (Princeton, 2003), and Sévane Garibian, "Géoncide arménien et conceptualisation du crime contre l'humanité. De l'intervention pour cause d'humanité à la intervention pour violation des lois de l'humanité", Revue d'Histoire de la Shoah, no 177-178, 2003, pp. 274-294.


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COVID 19- How to live in uncertain times (10 - Flood)
See part 1 of this series here.
Okay friends, my hope today is just to share a little something from a parable of Jesus this morning, that's been going around my head since I woke up, and it seems at the moment like we're very much in the quiet, or the calm, before the storm.
So I know friends and the health service services saying that that it feels like we're in the calm before the storm. So I just want to ask really whether you have in place the right thing to cope with the storm.
In Luke chapter 6, verse 46 and following there's the story of the wise and foolish builder, and we mustn't reduce that to a story just for children, it's a story for situations like this. You probably know it well, I won't read it, but I'll just explain it. There's the man that builds his house on a good foundation, and when the floods come it stands; and there's the man who builds his house without a foundation, we often say on the sand and rather than the rock; and it doesn't stand, his house doesn't stand when the flood comes.
And really what I want to ask is: do you have the right foundation in place, do you have the foundation of Christ and His Word in place, because that's the point of the story, before the flood comes. And that holds for any situation in life really, not just this current season that we're in. We know horrendous things come along in life and it's at that point that the foundation we have, or don't have, is exposed and Christ tells this story because he wants us to have this foundation. "Everyone who comes to me and hears my words and puts them into practice, I will show you what they are like, they are like the person with the strong foundation", Christ says.
So we're praying for our country at the moment, we're praying for workers in the health service and things, but friends whether you're religious or not, I guess that there could be someone listening in who's just happened to click on this, wouldn't say they're religious, wouldn't say they're a follower of the Lord Jesus. Please just make sure you've got the right foundation in place for life.
See part 11 of this series here.
During these strange and testing times, we hope to post encouragement for you here each day. As ever, if you would like to speak with a Minister, please get in touch through our contact us page.


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BACKGROUND: Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization. METHODS AND RESULTS: We identified Medicare fee-for-service beneficiaries who were CR eligible in 2016, and assessed CR participation (≥1 CR session attended), timely initiation (participation within 21 days of event), and completion (≥36 sessions attended) through 2017. Measures were assessed overall, by beneficiary characteristics and geography, and by primary CR-qualifying event type (acute myocardial infarction hospitalization; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant). Among 366 103 CR-eligible beneficiaries, 89 327 (24.4%) participated in CR, of whom 24.3% initiated within 21 days and 26.9% completed CR. Eligibility was highest in the East South Central Census Division (14.8 per 1000). Participation decreased with increasing age, was lower among women (18.9%) compared with men (28.6%; adjusted prevalence ratio: 0.91 [95% CI, 0.90-0.93]) was lower among Hispanics (13.2%) and non-Hispanic blacks (13.6%) compared with non-Hispanic whites (25.8%; adjusted prevalence ratio: 0.63 [0.61-0.66] and 0.70 [0.67-0.72], respectively), and varied by hospital referral region and Census Division (range: 18.6% [East South Central] to 39.1% [West North Central]) and by qualifying event type (range: 7.1% [acute myocardial infarction without procedure] to 55.3% [coronary artery bypass surgery only]). Timely initiation varied by geography and qualifying event type; completion varied by geography. CONCLUSIONS: Only 1 in 4 CR-eligible Medicare beneficiaries participated in CR and marked disparities were observed. Reinforcement of current effective strategies and development of new strategies will be critical to address the noted disparities and achieve the 70% participation goal.
Background and Purpose- Recent national and state-level trends show a stalling or reversal of previously declining stroke death rates. These national trends may mask local geographic variation and changes in stroke mortality. We assessed county-level trends in stroke mortality among adults aged 35 to 64 and ≥65 years. Methods- We used data from National Vital Statistics Systems and a Bayesian multivariate space-time conditional autoregressive model to estimate age-standardized annual stroke death rates for 2010 through 2016 among middle-aged adults (35-64 years) and older adults (≥65 years) in US counties. We used log-linear regression models to estimate average annual and total percent change in stroke mortality during the period. Results- Nationally, the annual percent change in stroke mortality from 2010 to 2016 was -0.7% (95% CI, -4.2% to 3.0%) among middle-aged adults and -3.5% (95% CI, -10.7% to 4.3%) among older adults, resulting in 2016 rates of 15.0 per 100 000 and 259.8 per 100 000, respectively. Increasing county-level stroke mortality was more prevalent among middle-aged adults (56.6% of counties) compared with among older adults (26.1% of counties). About half (48.3%) of middle-aged adults, representing 60.2 million individuals, lived in counties in which stroke mortality increased. Conclusions- County-level increases in stroke mortality clarify previously reported national and state-level trends, particularly among middle-aged adults. Roughly 3×as many counties experienced increases in stroke death rates for middle-aged adults compared with older adults. This highlights a need to address stroke prevention and treatment for middle-aged adults while continuing efforts to reduce stroke mortality among the more highly burdened older adults. Efforts to reverse these troubling local trends will likely require joint public health and clinical efforts to develop innovative and integrated approaches for stroke prevention and care, with a focus on community-level characteristics that support stroke-free living for all.
PROBLEM/CONDITION: A 2017 report quantified the higher percentage of potentially excess (or preventable) deaths in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas. In that report, CDC compared national, regional, and state estimates of potentially excess deaths among the five leading causes of death in nonmetropolitan and metropolitan counties for 2010 and 2014. This report enhances the geographic detail by using the six levels of the 2013 National Center for Health Statistics (NCHS) urban-rural classification scheme for counties and extending estimates of potentially excess deaths by annual percent change (APC) and for additional years (2010-2017). Trends were tested both with linear and quadratic terms. PERIOD COVERED: 2010-2017. DESCRIPTION OF SYSTEM: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate potentially excess deaths from the five leading causes of death among persons aged <80 years. CDC's NCHS urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Potentially excess deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Potentially excess deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and District of Columbia. RESULTS: The number of potentially excess deaths among persons aged <80 years in the United States increased during 2010-2017 for unintentional injuries (APC: 11.2%), decreased for cancer (APC: -9.1%), and remained stable for heart disease (APC: 1.1%), chronic lower respiratory disease (CLRD) (APC: 1.7%), and stroke (APC: 0.3). Across the United States, percentages of potentially excess deaths from the five leading causes were higher in nonmetropolitan counties in all years during 2010-2017. When assessed by the six urban-rural county classifications, percentages of potentially excess deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan) for the study period. Potentially excess deaths from heart disease increased most in micropolitan counties (APC: 2.5%) and decreased most in large fringe metropolitan counties (APC: -1.1%). Potentially excess deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan (APC: -16.1%) and large fringe metropolitan (APC: -15.1%) counties. In all county categories, potentially excess deaths from the five leading causes increased, with the largest increases occurring in large central metropolitan (APC: 18.3%), large fringe metropolitan (APC: 17.1%), and medium metropolitan (APC: 11.1%) counties. Potentially excess deaths from CLRD decreased most in large central metropolitan counties (APC: -5.6%) and increased most in micropolitan (APC: 3.7%) and noncore (APC: 3.6%) counties. In all county categories, potentially excess deaths from stroke exhibited a quadratic trend (i.e., decreased then increased), except in micropolitan counties, where no change occurred. Percentages of potentially excess deaths also differed among and within public health regions and across states by urban-rural county classification during 2010-2017. INTERPRETATION: Nonmetropolitan counties had higher percentages of potentially excess deaths from the five leading causes than metropolitan counties during 2010-2017 nationwide, across public health regions, and in the majority of states. The gap between the most rural and most urban counties for potentially excess deaths increased during 2010-2017 for three causes of death (cancer, heart disease, and CLRD), decreased for unintentional injury, and remained relatively stable for stroke. Urban and suburban counties (large central metropolitan and large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in potentially excess deaths from unintentional injury during 2010-2017, leading to a narrower gap between the already high (approximately 55%) percentage of excess deaths in noncore and micropolitan counties. PUBLIC HEALTH ACTION: Routine tracking of potentially excess deaths by urban-rural county classification might help public health departments and decision-makers identify and monitor public health problems and focus interventions to reduce potentially excess deaths in these areas.
Accurate and precise estimates of local-level epidemiologic measures are critical to informing policy and program decisions, but they often require advanced statistical knowledge, programming/coding skills, and extensive computing power. In response, we developed the Rate Stabilizing Tool (RST), an ArcGIS-based tool that enables users to input their own record-level data to generate more reliable age-standardized measures of chronic disease (eg, prevalence rates, mortality rates) or other population health outcomes at the county or census tract levels. The RST uses 2 forms of empirical Bayesian modeling (nonspatial and spatial) to estimate age-standardized rates and 95% credible intervals for user-specified geographic units. The RST also provides indicators of the reliability of point estimates. In addition to reviewing the RST's statistical techniques, we present results from a simulation study that illustrates the key benefit of smoothing. We demonstrate the dramatic reduction in root mean-squared error (rMSE), indicating a better compromise between accuracy and stability for both smoothing approaches relative to the unsmoothed estimates. Finally, we provide an example of the RST's use. This example uses heart disease mortality data for North Carolina census tracts to map the RST output, including reliability of estimates, and demonstrates a subsequent statistical test.
Asunto(s)Disparidades en el Estado de Salud , Modelos Estadísticos , Análisis Espacial , Factores de Edad , Teorema de Bayes , Enfermedad Crónica/epidemiología , Sistemas de Información Geográfica , Cardiopatías/mortalidad , Humanos , North Carolina/epidemiología , Reproducibilidad de los Resultados
A holistic view of racial and gender disparities that simultaneously compares multiple groups can suggest associated underlying contextual factors. Therefore, to more comprehensively understand temporal changes in combined racial and gender disparities, we examine variations in the orders of county-level race-gender specific heart disease death rates by age group from 1973-2015. We estimated county-level heart disease death rates by race, gender, and age group (35-44, 45-54, 55-64, 65-74, 75-84, ≥ 85, and ≥ 35) from the National Vital Statistics System of the National Center for Health Statistics from 1973-2015. We then ordered these rates from lowest to highest for each county and year. The predominant national rate order (i.e., white women (WW) < black women (BW) < white men (WM) < black men (BM)) was most common in younger age groups. Inverted rates for black women and white men (WW
One hypothesized explanation for the recent slowing of declines in heart disease death rates is the generational shift in the timing and accumulation of risk factors. However, directly testing this hypothesis requires historical age-group-specific risk factor data that do not exist. Using national death records, we compared spatiotemporal patterns of heart disease death rates by age group, time period, and birth cohort to provide insight into possible drivers of trends. To do this, we calculated county-level percent change for five time periods (1973-1980, 1980-1990, 1990-2000, 2000-2010, 2010-2015) for four age groups (35-44, 45-54, 55-64, 65-74), resulting in eight birth cohorts for each decade from the 1900s through the 1970s. From 1973 through 1990, few counties experienced increased heart disease death rates. In 1990-2000, 49.0% of counties for ages 35-44 were increasing, while all other age groups continued to decrease. In 2000-2010, heart disease death rates for ages 45-54 increased in 30.4% of counties. In 2010-2015, all four age groups showed widespread increasing county-level heart disease death rates. Likewise, birth cohorts from the 1900s through the 1930s experienced consistently decreasing heart disease death rates in almost all counties. Similarly, with the exception of 2010-2015, most counties experienced decreases for the 1940s birth cohort. For birth cohorts in the 1950s, 1960s, and 1970s, increases were common and geographically widespread for all age groups and calendar years. This analysis revealed variation in trends across age groups and across counties. However, trends in heart disease death rates tended to be generally decreasing and increasing for early and late birth cohorts, respectively. These findings are consistent with the hypothesis that recent increases in heart disease mortality stem from the beginnings of the obesity and diabetes epidemics. However, the common geographic patterns within the earliest and latest time periods support the importance of place-based macro-level factors.
Asunto(s)Cardiopatías/epidemiología , Cardiopatías/mortalidad , Adulto , Distribución por Edad , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Factores de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología
PROBLEM/CONDITION: Heart disease is the leading cause of death in the United States. In 2015, heart disease accounted for approximately 630,000 deaths, representing one in four deaths in the United States. Although heart disease death rates decreased 68% for the total population from 1968 to 2015, marked disparities in decreases exist by race and state. PERIOD COVERED: 1968-2015. DESCRIPTION OF SYSTEM: The National Vital Statistics System (NVSS) data on deaths in the United States were abstracted for heart disease using diagnosis codes from the eighth, ninth, and tenth revisions of the International Classification of Diseases (ICD-8, ICD-9, and ICD-10) for 1968-2015. Population estimates were obtained from NVSS files. National and state-specific heart disease death rates for the total population and by race for adults aged ≥35 years were calculated for 1968-2015. National and state-specific black-white heart disease mortality ratios also were calculated. Death rates were age standardized to the 2000 U.S. standard population. Joinpoint regression was used to perform time trend analyses. RESULTS: From 1968 to 2015, heart disease death rates decreased for the total U.S. population among adults aged ≥35 years, from 1,034.5 to 327.2 per 100,000 population, respectively, with variations in the magnitude of decreases by race and state. Rates decreased for the total population an average of 2.4% per year, with greater average decreases among whites (2.4% per year) than blacks (2.2% per year). At the national level, heart disease death rates for blacks and whites were similar at the start of the study period (1968) but began to diverge in the late 1970s, when rates for blacks plateaued while rates for whites continued to decrease. Heart disease death rates among blacks remained higher than among whites for the remainder of the study period. Nationwide, the black-white ratio of heart disease death rates increased from 1.04 in 1968 to 1.21 in 2015, with large increases occurring during the 1970s and 1980s followed by small but steady increases until approximately 2005. Since 2005, modest decreases have occurred in the black-white ratio of heart disease death rates at the national level. The majority of states had increases in black-white mortality ratios from 1968 to 2015. The number of states with black-white mortality ratios >1 increased from 16 (40%) to 27 (67.5%). INTERPRETATION: Although heart disease death rates decreased both for blacks and whites from 1968 to 2015, substantial differences in decreases were found by race and state. At the national level and in most states, blacks experienced smaller decreases in heart disease death rates than whites for the majority of the period. Overall, the black-white disparity in heart disease death rates increased from 1968 to 2005, with a modest decrease from 2005 to 2015. PUBLIC HEALTH ACTION: Since 1968, substantial increases have occurred in black-white disparities of heart disease death rates in the United States at the national level and in many states. These increases appear to be due to faster decreases in heart disease death rates for whites than blacks, particularly from the late 1970s until the mid-2000s. Despite modest decreases in black-white disparities at the national level since 2005, in 2015, heart disease death rates were 21% higher among blacks than among whites. This study demonstrates the use of NVSS data to conduct surveillance of heart disease death rates by race and of black-white disparities in heart disease death rates. Continued surveillance of temporal trends in heart disease death rates by race can provide valuable information to policy makers and public health practitioners working to reduce heart disease death rates both for blacks and whites and disparities between blacks and whites.
Asunto(s)Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Disparidades en el Estado de Salud , Cardiopatías/etnología , Cardiopatías/mortalidad , Adulto , Causas de Muerte , Femenino , Humanos , Masculino , Estados Unidos/epidemiología
INTRODUCTION: The prominent decline in U.S. stroke death rates observed for more than 4 decades has slowed in recent years. CDC examined trends and patterns in recent stroke death rates among U.S. adults aged ≥35 years by age, sex, race/ethnicity, state, and census region. METHODS: Trends in the rates of stroke as the underlying cause of death during 2000-2015 were analyzed using data from the National Vital Statistics System. Joinpoint software was used to identify trends in stroke death rates, and the excess number of stroke deaths resulting from unfavorable changes in trends was estimated. RESULTS: Among adults aged ≥35 years, age-standardized stroke death rates declined 38%, from 118.4 per 100,000 persons in 2000 to 73.3 per 100,000 persons in 2015. The annual percent change (APC) in stroke death rates changed from 2000 to 2015, from a 3.4% decrease per year during 2000-2003, to a 6.6% decrease per year during 2003-2006, a 3.1% decrease per year during 2006-2013, and a 2.5% (nonsignificant) increase per year during 2013-2015. The last trend segment indicated a reversal from a decrease to a statistically significant increase among Hispanics (APC = 5.8%) and among persons in the South Census Region (APC = 4.2%). Declines in stroke death rates failed to continue in 38 states, and during 2013-2015, an estimated 32,593 excess stroke deaths might not have occurred if the previous rate of decline could have been sustained. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Prior declines in stroke death rates have not continued in recent years, and substantial variations exist in timing and magnitude of change by demographic and geographic characteristics. These findings suggest the importance of strategically identifying opportunities for prevention and intervening in vulnerable populations, especially because effective and underused interventions to prevent stroke incidence and death are known to exist.
Asunto(s)Accidente Cerebrovascular/mortalidad , Estadísticas Vitales , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Estados Unidos/epidemiología
INTRODUCTION: Nonadherence to taking prescribed antihypertensive medication (antihypertensive) regimens has been identified as a leading cause of poor blood pressure control among persons with hypertension and an important risk factor for adverse cardiovascular disease outcomes. CDC and the Centers for Medicare and Medicaid Services analyzed geographic, racial-ethnic, and other disparities in nonadherence to antihypertensives among Medicare Part D beneficiaries in 2014. METHODS: Antihypertensive nonadherence, defined as a proportion of days a beneficiary was covered with antihypertensives of <80%, was assessed using prescription drug claims data among Medicare Advantage or Medicare fee-for-service beneficiaries aged ≥65 years with Medicare Part D coverage during 2014 (N = 18.5 million). Analyses were stratified by antihypertensive class, beneficiaries' state and county of residence, type of prescription drug plan, and treatment and demographic characteristics. RESULTS: Overall, 26.3% (4.9 million) of Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen. Nonadherence differed by multiple factors, including medication class (range: 16.9% for angiotensin II receptor blockers to 28.9% for diuretics); race-ethnicity (24.3% for non-Hispanic whites, 26.3% for Asian/Pacific Islanders, 33.8% for Hispanics, 35.7% for blacks, and 38.8% for American Indians/Alaska Natives); and state of residence (range 18.7% for North Dakota to 33.7% for the District of Columbia). Considerable county-level variation in nonadherence was found; the highest nonadherence tended to occur in the southern United States (U.S. Census region nonadherence = 28.9% [South], 26.7% [West], 24.1% [Northeast], and 22.8% [Midwest]) CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes.
Asunto(s)Antihipertensivos/uso terapéutico , Disparidades en el Estado de Salud , Hipertensión/tratamiento farmacológico , Medicare Part D/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Geografía , Humanos , Hipertensión/etnología , Masculino , Cumplimiento de la Medicación/etnología , Estados Unidos
OBJECTIVE: Many cardiovascular deaths can be avoided through primary prevention to address cardiovascular disease (CVD) risk factors or better access to quality medical care. In this cross-sectional study, we examined the relationship between four county-level health factors and rates of avoidable death from CVD during 2006-2010. METHODS: We defined avoidable deaths from CVD as deaths among U.S. residents younger than 75 years of age caused by the following underlying conditions, using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes: ischemic heart disease (I20-I25), chronic rheumatic heart disease (I05-I09), hypertensive disease (I10-I15), or cerebrovascular disease (I60-I69). We stratified county-level death rates by race (non-Hispanic white or non-Hispanic black) and age-standardized them to the 2000 U.S. standard population. We used County Health Rankings data to rank county-level z scores corresponding to four health factors: health behavior, clinical care, social and economic factors, and physical environment. We used Poisson rate ratios (RRs) and 95% confidence intervals (CIs) to compare rates of avoidable death from CVD by health-factor quartile. RESULTS: In a comparison of worst-ranked and best-ranked counties, social and economic factors had the strongest association with rates of avoidable death per 100,000 population from CVD for the total population (RR=1.49; 95% CI 1.39, 1.60) and for each racial/ethnic group (non-Hispanic white: RR=1.37; 95% CI 1.29, 1.45; non-Hispanic black: RR=1.54; 95% CI 1.42, 1.67). Among the non-Hispanic white population, health behaviors had the next strongest association, followed by clinical care. Among the non-Hispanic black population, we observed a significant association with clinical care and physical environment in a comparison of worst-ranked and best-ranked counties. CONCLUSION: Social and economic factors have the strongest association with rates of avoidable death from CVD by county, which reinforces the importance of social and economic interventions to address geographic disparities in avoidable deaths from CVD.
Asunto(s)Enfermedades Cardiovasculares/mortalidad , Gobierno Local , Mortalidad Prematura/tendencias , Adulto , Anciano , Estudios Transversales , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Distribución de Poisson , Estados Unidos/epidemiología
BACKGROUND: Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. METHODS AND RESULTS: Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. CONCLUSIONS: The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality.
Asunto(s)Cardiopatías/mortalidad , Adulto , Anciano , Teorema de Bayes , Femenino , Geografía Médica , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Mortalidad/tendencias , Vigilancia de la Población , Factores Socioeconómicos , Estados Unidos/epidemiología
Asunto(s)Certificación , Programas Médicos Regionales , Accidente Cerebrovascular/epidemiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Servicios Médicos de Urgencia , Humanos , Medicare , Grupos de Población , Atención Primaria de Salud , Mejoramiento de la Calidad , Programas Informáticos , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Análisis de Supervivencia , Estados Unidos
Excess sodium intake correlates positively with high blood pressure. Blood pressure varies by region, but whether sodium content of foods sold varies across regions is unknown. We combined nutrition and sales data from 2009 to assess the regional variation of sodium in packaged food products sold in 3 of the 9 US census divisions. Although sodium density and concentration differed little by region, fewer than half of selected food products met Food and Drug Administration sodium-per-serving conditions for labeling as "healthy." Regional differences in hypertension were not reflected in differences in the sodium content of packaged foods from grocery stores.
Asunto(s)Análisis de los Alimentos/estadística & datos numéricos , Etiquetado de Alimentos/estadística & datos numéricos , Embalaje de Alimentos , Valor Nutritivo , Sodio en la Dieta/análisis , Censos , Comercio , Bases de Datos Factuales , Dieta/normas , Alimentos/clasificación , Etiquetado de Alimentos/normas , Embalaje de Alimentos/estadística & datos numéricos , Abastecimiento de Alimentos/economía , Abastecimiento de Alimentos/estadística & datos numéricos , Humanos , Hipertensión/prevención & control , Política Nutricional , Factores de Riesgo , Sodio en la Dieta/efectos adversos , Estados Unidos
PURPOSE: To demonstrate the implications of choosing analytical methods for quantifying spatiotemporal trends, we compare the assumptions, implementation, and outcomes of popular methods using county-level heart disease mortality in the United States between 1973 and 2010. METHODS: We applied four regression-based approaches (joinpoint regression, both aspatial and spatial generalized linear mixed models, and Bayesian space-time model) and compared resulting inferences for geographic patterns of local estimates of annual percent change and associated uncertainty. RESULTS: The average local percent change in heart disease mortality from each method was -4.5%, with the Bayesian model having the smallest range of values. The associated uncertainty in percent change differed markedly across the methods, with the Bayesian space-time model producing the narrowest range of variance (0.0-0.8). The geographic pattern of percent change was consistent across methods with smaller declines in the South Central United States and larger declines in the Northeast and Midwest. However, the geographic patterns of uncertainty differed markedly between methods. CONCLUSIONS: The similarity of results, including geographic patterns, for magnitude of percent change across these methods validates the underlying spatial pattern of declines in heart disease mortality. However, marked differences in degree of uncertainty indicate that Bayesian modeling offers substantially more precise estimates.
Asunto(s)Causas de Muerte , Geografía , Cardiopatías/mortalidad , Análisis Espacial , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Teorema de Bayes , Ambiente , Métodos Epidemiológicos , Femenino , Cardiopatías/diagnóstico , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Análisis Espacio-Temporal , Análisis de Supervivencia , Estados Unidos
INTRODUCTION: High sodium intake and low potassium intake, which can contribute to hypertension and risk of cardiovascular disease, may be related to the availability of healthful food in neighborhood stores. Despite evidence linking food environment with diet quality, this relationship has not been evaluated in the United States. The modified retail food environment index (mRFEI) provides a composite measure of the retail food environment and represents the percentage of healthful-food vendors within a 0.5 mile buffer of a census tract. METHODS: We analyzed data from 8,779 participants in the National Health and Nutrition Examination Survey, 2005-2008. By using linear regression, we assessed the relationship between mRFEI and sodium intake, potassium intake, and the sodium-potassium ratio. Models were stratified by region (South and non-South) and included participant and neighborhood characteristics. RESULTS: In the non-South region, higher mRFEI scores (indicating a more healthful food environment) were not associated with sodium intake, were positively associated with potassium intake (P [trend] = .005), and were negatively associated with the sodium-potassium ratio (P [trend] = .02); these associations diminished when neighborhood characteristics were included, but remained close to statistical significance for potassium intake (P [trend] = .05) and sodium-potassium ratio (P [trend] = .07). In the South, mRFEI scores were not associated with sodium intake, were negatively associated with potassium intake (P [trend] = < .001), and were positively associated with sodium-potassium ratio (P [trend] = .01). These associations also diminished after controlling for neighborhood characteristics for both potassium intake (P [trend] = .03) and sodium-potassium ratio (P [trend] = .40). CONCLUSION: We found no association between mRFEI and sodium intake. The association between mRFEI and potassium intake and the sodium-potassium ratio varied by region. National strategies to reduce sodium in the food supply may be most effective to reduce sodium intake. Strategies aimed at the local level should consider regional context and neighborhood characteristics.
Asunto(s)Comercio , Conducta Alimentaria , Potasio , Sodio , Adulto , Anciano , Estudios Transversales , Ambiente , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Características de la Residencia , Adulto Joven
OBJECTIVES: We evaluated trends and disparities in stroke death rates for American Indians and Alaska Natives (AI/ANs) and White people by Indian Health Service region. METHODS: We identified stroke deaths among AI/AN persons and Whites (adults aged 35 years or older) using National Vital Statistics System data for 1990 to 2009. We used linkages with Indian Health Service patient registration data to adjust for misclassification of race for AI/AN persons. Analyses excluded Hispanics and focused on Contract Health Service Delivery Area (CHSDA) counties. RESULTS: Stroke death rates among AI/AN individuals were higher than among Whites for both men and women in CHSDA counties and were highest in the youngest age groups. Rates and AI/AN:White rate ratios varied by region, with the highest in Alaska and the lowest in the Southwest. Stroke death rates among AI/AN persons decreased in all regions beginning in 2001. CONCLUSIONS: Although stroke death rates among AI/AN populations have decreased over time, rates are still higher for AI/AN persons than for Whites. Interventions that address reducing stroke risk factors, increasing awareness of stroke symptoms, and increasing access to specialty care for stroke may be more successful at reducing disparities in stroke death rates.
Asunto(s)Indios Norteamericanos/estadística & datos numéricos , Inuits/estadística & datos numéricos , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Alaska/epidemiología , Alaska/etnología , Certificado de Defunción , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos/epidemiología
Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities.
Asunto(s)Predicción , Hipertensión Pulmonar/epidemiología , Vigilancia de la Población/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiología
OBJECTIVES: We evaluated heart disease death rates among American Indians and Alaska Natives (AI/ANs) and Whites after improving identification of AI/AN populations. METHODS: Indian Health Service (IHS) registration data were linked to the National Death Index for 1990 to 2009 to identify deaths among AI/AN persons aged 35 years and older with heart disease listed as the underlying cause of death (UCOD) or 1 of multiple causes of death (MCOD). We restricted analyses to IHS Contract Health Service Delivery Areas and to non-Hispanic populations. RESULTS: Heart disease death rates were higher among AI/AN persons than Whites from 1999 to 2009 (1.21 times for UCOD, 1.30 times for MCOD). Disparities were highest in younger age groups and in the Northern Plains, but lowest in the East and Southwest. In AI/AN persons, MCOD rates were 84% higher than UCOD rates. From 1990 to 2009, UCOD rates declined among Whites, but only declined significantly among AI/AN persons after 2003. CONCLUSIONS: Analysis with improved race identification indicated that AI/AN populations experienced higher heart disease death rates than Whites. Better prevention and more effective care of heart disease is needed for AI/AN populations.
Asunto(s)Cardiopatías/etnología , Cardiopatías/mortalidad , Indios Norteamericanos/estadística & datos numéricos , Inuits/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Alaska/epidemiología , Causas de Muerte , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología
OBJECTIVES: Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race. METHODS: We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004-2009 using technical specifications published by the Agency for Healthcare Research and Quality. Rates per 100,000 beneficiaries were age- and sex-standardized to 2000 U.S. Census data. We mapped county-level rates by race and identified clusters of counties with extreme rates. RESULTS: Black people had higher crude rates of these hospitalizations than white people for every year studied, and the test for an increasing linear time trend for the standardized rates was significant for both black and white people; that is, the gap between the races increased over time. For both races, clusters of high-rate counties occurred primarily in parts of Oklahoma, Texas, Southern Alabama, and Louisiana. High rates for white people were also found in parts of Appalachia. Large differences in rates among black and white people were found in a number of large urban areas and in parts of Florida and Alabama. CONCLUSIONS: Racial disparities in preventable hospitalizations for hypertension persisted through 2009. The gap between black and white people is increasing, and these inequities exist unevenly across the country. Although this study was intended to be purely descriptive, future studies should use multivariate analyses to examine reasons for these unequal distributions.
Asunto(s)Hospitalización/estadística & datos numéricos , Hipertensión/epidemiología , Afroamericanos/estadística & datos numéricos , Anciano , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Geografía Médica , Humanos , Hipertensión/etnología , Masculino , Medicare , Estados Unidos/epidemiología
Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants' experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments.


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The Uganda Law Society has blasted Makerere University Vice Chancellor Prof.Barnabas Nawangwe for recommending that the Law School at the university should be closed.
Early this week, Prof.Nawangwe in a report the University Council, said the school of law has continued to be defiant by refusing to resume lectures recommending for its closure.
However, in a statement on Thursday afternoon, the Uganda Law Society president Simon Peter Kinobe has said it wrong for the university leadership to close the Law School which he said has contributed the development of the country by training a number of lawyers.
"In addition to training the largest number of lawyers in Uganda, the School of Law has trained and influenced the legal profession in Africa. Some of the scholars at this great institution have world-wide recognition in their chosen fields of specialty,"Kinobe said in his statement.
"The School of Law has made an immeasurable contribution to fostering the rule of in Uganda. It would be both illegal and high-handed to shut it down because members exercised their rights in law and offered guidance in a time of crisis."
In his report to the University Council, Prof.Nawangwe said despite other schools resuming with lectures, the School of Law has not heeded to the call, adding that they are making the university ungovernable for him.
He recommended that they should be asked to handover the university property for failure to return to work.
However in response, the Uganda Law Society president said members of staff at Makerere have a right to do whatever they feel good without being forced including not returning to class.
"Members of staff at Makerere enjoy various rights to engage in industrial action under both the Constitution of the Republic of Uganda and the labor laws of this country,"Kinobe said.
"In addition, to conferring the above rights, the Constitution of the Republic of Uganda enjoins each member of staff, as a citizen of Uganda, to both promote democracy and the rule of law; and to engage in gainful employment for the good of that citizen, the family and the common good."
Kinobe also applauded members of the Law School for stepping up to offer guidance to the university administration in regards legal issues surrounding the impasse at Makerere University.
He however asked that the impasse be resolved because it has occasioned loss to students who are not having lectures.
"We will continue to monitor the situation and remain available to offer any support to the University should the same be required. Highlighting the right of the students to timely education, we require that the impasse be resolved immediately to avoid continuous loss to the affected University students and the financially strained parents that pay tuition."
The impasse was caused by the suspension of Makerere University staff leaders by the university council led by Prof.Nawangwe prompting the staff members to lay down tools until the suspensions of their leaders are lifted, a thing that has not happened up to now.


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Can you put any yeast in the mixture? And if you did, would it help it rise more in addition to tasing more "yeasty"? I have been making (with great results) a browner, wheat colored bread from a recipe called Diedre's For Real Low Carb Bread. It uses yeast and only has one rise after kneading with my dough hook attachment on my mixer. I would like to try some white bread.
Because of the golden brown color on this chicken dish, it looks so yummy before you even try it! Then when you cut into it and are greeted with mouthfuls of tender meat with soft and flavorsome stuffing, you will put this recipe down in your favorites section! If you don't have a meat mallet you can use a rolling pin or even a pan to pound the chicken flat ready for rolling.
Louise holds a Bachelors and Masters in Natural Sciences from Cambridge University (UK). She attended Columbia University for her JD and practiced law at Debevoise & Plimpton before co-founding Louise's Foods, Paleo Living Magazine, Nourishing Brands, & CoBionic. Louise has considerable research experience but enjoys creating products and articles that help move people just a little bit closer toward a healthy life they love. You can find her on Facebook or LinkedIn.
Just made this and as a normal bread lover, I am very impressed! But do have a question. Can you over cook this? Mine seems a bit light inside, like a teenie bit mooshy, and can't see it holding up in a sandwich. The temp was at 200 inside but I had already had it in for like 50 minutes longer than the posted time and I could still hear a little squish but didn't want to over cook.
Thankfully, it's not as much of a head-scratcher as you might think. Thanks to a ton of keto-friendly ingredients on the market these days, you can enjoy a piece of cake or a fudgy brownie just as easily as any other sweet fiend out there—you've just got to make it yourself! So grab your keto-friendly dark chocolate, your favorite alternative sweeteners, your nut flours, and of course, your butter. It's time to master keto desserts.
The best part about this recipe is that it's simple, and once you have it down, you can replicate this keto friendly bread any time you want. I've been making a low carb loaf every Sunday for the past few weeks and would recommend that to anyone. It's so nice to have a loaf of bread at your disposal when you're on a low carb diet. It almost feels like cheating. Check out this recipe and start making the best keto bread you've ever tried today!
What carbs should I avoid to lose belly fat
Tuna is another fish, like salmon, which is packed with omega 3 and healthy fats, and in a dish like this one, can give you a filling and nutritious lunch that you can even take to work. Roasting cauliflower and broccoli gives them a mellower flavor so they do not overpower the taste of the fish and with a simple seasoning of salt and lemon, the whole meal can be enjoyed anytime.
I made it tonight and use a mini loaf pan. It came out delicious. I used the http://www.tasteofhome.com/article/how-to-cut-down-recipes/ link to adjust the recipe measurements using the one third column. I used 2 egg whites. The slices will be small but it was delicious with melted butter. Keto bread recipes and I have tried quite a few have not turned out well for me. I do not like to waste expensive ingredients that is why I will usually do a small amount first. This recipe has been the exception. It is good simple and delicious. I will make it again using the recipe as written. Note: I whipped the egg whites for 10 minutes to get the right consistency. I hope this helps and thank You Maya for finally for me making a bread that tastes great and is easy to make.


text: Potato Harvest Postponed In Aberdeen School District September 16, 2015 Sydney B. Jensen Featured, Local News ABERDEEN – Potato harvest has been postponed in the Aberdeen School District. Because of weather, farmers asked the district to change the dates. It will now be September 21 through October 6. Aberdeen School Districtpostponedpotato harvestSeptember 21 through October 6


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How to Achieve the Best Negotiation Training
Becoming an ultimate negotiator can be a career. Nowadays everybody is wishing if they had the skills to negotiation. It gets to a point that you need to negotiate with someone about something could be a business or other topic. A good negotiator will always have the advantage of being able to persuade others. Training on negotiation skills is offered by several training intstitutions. At times, it can be difficult choosing the right institution that will offer you the best negotiation training. They all claim to be the best in training but there are some tips to consider to get the best negotiation training.
People who offer the best negotiation training ought to have a good reputation in the field. When getting training from individuals, it is good to consider people who can prove their professionalism. It is also right to consider an institution that is legit and has negotiation training approved to be offered there. Best negotiation training should have the trainers who consider personal abilities. Session is the best method to offer negotiation skills hence it is important to consider how the trainer is doing it. To get best negotiation training you need to do a lot of practice too. You can also get the best training from attending to negotiations involving professionals.
professionals who have had successful negotiations could give you the best negotiation training. Involving you in real negotiations in the field is what good negotiation training should involve. To get the best negotiation skills; this should help. To get experience, negotiation seminars ought to be involved in the training. Public speaking also, is a good negotiation training. Sales and marketing is involved in a lot of negotiating and persuasions which is good negotiation training. short practical courses are also offered on the internet by reputable trainers. Getting involved in public relations also can give you exposure to negotiation skills. A good negotiator ought to have the ability to hide emotions hence the training should involve learning how to deal with emotions. To be taken into consideration too, is good listening skills. ethics should be involved in good negotiation training as the negotiator is expected to hold their end of the bargain. An ultimate negotiator has good communication skills hence to become one you need to have training on that.
Accept making mistakes since they are part of good negotiation training. Understanding several people, is essential since you come across different kinds of people. Since a successful negotiation involves a lot of time, patience is a key thing that you need to be trained on. Understanding the purpose of the negotiation is essential too not to lose it in the bargain.
The 4 Most Unanswered Questions about


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The new rules are an improvement, but proper implementation is vital, writes Murray Hunter and Cherese Thakur.
Showers early. Partly cloudy. Cool.
South Africa's rural areas are buckling – and some have already fallen over – as corrupt officials suck the life out of municipal service delivery. This needs to stop.
Opposition parties in the KZN legislature have welcomed the ANC's decision to relieve Zandile Gumede of her mayoral duties in eThekwini and to redeploy her.
National Treasury has raised the alarm over officials who abuse the public procurement system through deviations from tender processes, saying the practice is rife and there is little accountability.
The DA is demanding answers from SAA and Finance Minister Malusi Gigaba about what it terms an apparently fraudulent contract of R1bn to the airline's subsidiary SA Airways Technical.
Gauteng intends to make the open tender system compulsory by law to ensure procurement processes are free from corruption, says Finance MEC Barbara Creecy.
A prospective shareholder in one of Denel's companies is being probed by the Special Investigating Unit for alleged tender fraud.
The story of how Hitachi bought political influence to win a massive $5.6bn contract questions the very integrity of the government and sends all the wrong messages.
The Competition Tribunal has confirmed settlement agreements ranging from R150 000 to R4m for six furniture removal companies.
The awarding of tenders for Pilgrim's Rest shop leases was unlawful and characterised by irregularities and maladministration, says Public Protector Thuli Madonsela.
New evidence shows that the EFF leader scored a R1m Merc, tyres for his luxury German sedan, a chartered jet, holidays in Zimbali and even legal fees from a Limpopo tender company.
Two officials at a KwaZulu-Natal FET college have been sentenced to three years imprisonment each after manipulating tender processes.
Three companies who ferry passengers to and from the Robben Island Museum have entered into settlement agreements on charges of price fixing and collusive tendering.
Former Prasa CEO Lucky Montana claims the behaviour of the entity's board under the leadership of Popo Molefe can be likened to the "mafia".
Since the procurement office was set up in 2013, Kenneth Brown and his team of 93 have led a Treasury drive to contain spending and renegotiate business deals.
A former Western Cape government official has been arrested for allegedly rigging tenders to the value of R35m, the Hawks say.
Gauteng's former chief financial officer who was suspended last year following alleged tender irregularities has been appointed chief financial officer of the KZN health department.
The Special Investigating Unit will probe the validity of a tender awarded by the department of communications, according to the presidency.
The UN says corruption is the greatest threat to global economic and social development, with 5% of global GDP being lost to bribes and corruption each year.
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In preparation of lots of Gundam building over the coming year, i've spruced up the 'Current Gunplas' widget on the sidebar to something alot more visual at a glance, comments welcome! Will be writing a 2009 stash post later today.
Thanks for reading! Here are some of my other posts you might like
Gundam 00 Caramelldansen
Gunpla Project NEXT
1/100 GAT-X105 Aile Strike Gundam - Progress 2
Announcing the launch of Gundamfactory.com!
Bandai Hobby Center Shizuoka, the home of Gunpla
1/48 Mega Size Gundam AGE-1 Normal - Progress!
2 Responses to Ooo, Shiny Meters!
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Jamaipanese on 3 January, 2010 at (16:21)
looking good I like 'em and looking forward to the building updates.
What plugin or resource are you using for the meters?


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