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Post-incident research – gaining knowledge after the event
David Bruce, Communications Manager, Bushfire and Natural Hazards Cooperative Research Centre
Background and context
Research activities that follow major natural hazards are co-ordinated nationally by the Bushfire and Natural Hazards Cooperative Research Centre (BNHCRC) for emergency services organisations. This research has provided fundamental information for these organisations on what drives community behaviour during an emergency event, the policies that relate to the protection of lives and property, and the effectiveness of those policies.
Until now, bushfire has been the hazard in focus, but the scope is about to broaden to other natural hazards with a broader set of research possibilities.
In the aftermath of the 7 February 2009 Black Saturday fires in Victoria, the Bushfire Cooperative Research Centre assembled a large taskforce of researchers and fire and emergency services staff from across Australia and New Zealand. The taskforce gathered vital data from fire-affected areas related to fire behaviour, property loss, and community behaviour. This post-fire research provided information to the 2009 Victorian Bushfires Royal Commission. The Bushfire CRC used this research as a template for community surveying and research after major fire activity, and it now continues to be undertaken by the BNHCRC for emergency services organisations.
While traditionally the BNHCRC has facilitated post-event research activities following bushfires, these types of research activities are equally applicable to other natural hazards, including major storms, cyclones, floods and earthquakes. The same reasoning applies to the type of research undertaken. There has been a strong focus on community impact studies in the past, however there are a range of other areas where the CRC could provide research support following an event, including business impacts and effects on buildings and infrastructure.
Information collected in post-event studies such as those undertaken following Black Saturday and other significant fires, assists emergency services organisations to understand what drives community behaviour and the affects of certain policies and programs. This knowledge directly informs policies, programs and funding related to the protection of lives and property and enables these agencies to better monitor the effects of these policies.
Research teams at the Siding Spring Observatory in Coonabarabran, New South Wales after the summer fires of 2013. Image: David Bruce, Bushfire and Natural Hazards CRC.
Post-event research themes
The diversity of agencies and their needs for post-event research activities across all natural hazards has driven the CRC to develop a standardised approach to post-event research activities. A workshop in May 2015 with the Australasian Fire and Emergency Service Authorities Council Community Engagement Technical Group was a first key step to understanding client needs in this area.
High-level research themes identified at the May workshop include:
- drivers of community response
- impacts of community warnings and information
- economic impacts on the state
- effectiveness of interventions and mitigation measures
- the scale and nature of post event investment
- impacts on land-use planning and building regulations
- the role of emergency services organisations
- perceptions of risk and resilience
- effectiveness of partnerships
- impacts on Indigenous and rural communities.
These research themes could be adapted for all natural hazards in all jurisdictions and cover a range of issues, including and beyond community impacts.
Using the research
Every jurisdiction identified similar uses for the post-event research including:
- informing policies and altering the direction of programs
- driving evidence-based decision-making related to program design, budget allocation and training
- informing a sector-wide approach to continuous improvement in emergency management
- identifying priority areas of focus, ideas for further investigation or opportunities for trial programs.
The BNHCRC is now working on a range of suggestions that will streamline the post-incident research process and help agencies overcome challenges in study design and commissioning. These include:
- developing a pre-approved standing contract or panel type arrangement in order to respond quickly following an event
- developing a bank of pre-approved questions covering all research themes
- providing guidelines regarding what types of research projects will require ethics approval
- providing budget guidelines for cost ranges for different types of projects and different scopes
- facilitating inter-agency partnerships and sharing of resources
- producing a checklist of research requirements that can be gathered at the same time (e.g. data sets, maps)
- standardising governance frameworks.
Staff from across the emergency services sector move into the areas around Wandong hit by the Black Saturday fires in 2009. Image: David Bruce, Bushfire and Natural Hazards CRC.
Case study: community bushfire readiness 2009-2014
This case study illustrates the broad value of post-event research, and how it can challenge assumptions about community hazards education, and point to possible policy changes.
The case study describes the work of the BNHCRC and the Bushfire CRC researchers interviewing communities affected by destructive bushfires in Victoria, Western Australia, Tasmania and New South Wales from 2009–2014. Research was conducted at the request of fire agencies in those states and their purpose was to inform agencies about how residents understood bushfire risk, planned and prepared for a possible bushfire, and responded to a serious bushfire event.
The New South Wales Rural Fire Service worked with both CRCs after major fires in 2013, which was one of the most challenging and dangerous years for bushfires in NSW in more than a decade.
Anthony Clark, Group Manager of Corporate Communications at the New South Wales Rural Fire Service said the studies contributed to the national research agenda.
'These fires presented an opportunity to learn and refine our processes, particularly in relation to community preparedness and the delivery of information and warnings. The research has delivered benefits, influencing our approach to community engagement, as well as improving our understanding of how the public uses and responds to information and warnings, and the barriers that may prevent people responding,' he said.
The main researcher in all these studies was Dr Jim McLennan, an adjunct professor in the School of Psychology and Public Health at La Trobe University.
High-level findings from all studies include:
- A significant percentage of residents of the bushfire-affected communities had neither planned, nor prepared for, a possible bushfire.
- While many reported having 'a plan' as to what to do in the event of a bushfire, few (five per cent) had written plans.
- An appreciable percentage of residents (81 per cent) who had a bushfire plan undertook no or inadequate preparations to implement that plan—especially a plan to self-evacuate safely.
- Few people (two per cent) self-evacuated early on the basis of fire danger weather predictions before reports of a fire.
- Few (eight per cent) participated in organised community bushfire safety activities.
- About a third (27 per cent) reported reading agency material about bushfire safety.
- Less than ten per cent reported consulting material on fire agency websites before the fire.
Different motivations drove residents' choices of household bushfire planning. Residents who planned to leave indicated this was because of the perceived danger that would be posed by a bushfire, especially if the household included vulnerable members such as the elderly, the disabled or young children.
Most residents who planned to stay and defend did so in order to protect their valued property—of either financial or emotional value, or a combination of both. Staying and defending was seldom understood by residents as a bushfire survival plan, rather it was understood by most to be asset-protection involving some level of acceptable risk.
Residents who intended to wait and see what developed before making a final decision typically did this because:
- they perceived their bushfire risk to be low
- they believed that waiting would not add to their risk
- they viewed both leaving unnecessarily and having to defend against a serious fire as equally unappealing
- they intended to wait and hope for the best that the fire ultimately would not threaten their property.
Implications for agencies
The findings suggest that fire agencies have been only moderately successful in raising overall levels of bushfire preparedness in at-risk communities. Impressions reported by interviewers suggest that more residents understand the inherent dangers posed by bushfires than was the case before Black Saturday in 2009. More residents view staying and defending as a course of action that involves a degree of risk and is not a choice to be made lightly. However, the findings from six post-Black Saturday interview studies suggest that overall levels of bushfire threat readiness among residents in at-risk communities remain lower than desired by fire and emergency services agencies.
Future directions
Probably the most pressing need is for new approaches to increase the numbers of residents in at-risk communities who have planned and prepared appropriately to survive a future serious bushfire threat. Most agencies rely heavily on making detailed written information about bushfire safety available and exhorting householders to read this and act on it. Decades of research into health promotion and injury prevention demonstrate that education-based approaches alone result in limited improvements at best. Success stories such as lowering the road toll and reducing smoking rates involved costly mixes of innovative approaches to motivation and education, engineering solutions, legislation, sanctions, incentives and enforcement. There is no reason to believe that improving community bushfire safety will prove any easier. The BNHCRC research program is currently investigating new approaches to community warnings before, during and after hazard events.
Researchers inspect property damage at Marysville and Kinglake after the 2009 Black Saturday fires in Victoria. Images: David Bruce, Bushfire and Natural Hazards CRC.


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Help Support Aussie Homebrewer by donating:
We have implemented the ability to gift someone a Supporting Membership now! When you access the Upgrade page there is now a 'Gift' button. Once you click that you can enter a username to gift an account Upgrade to. Great way to help support this forum plus give some kudos to anyone who has helped you.Dismiss Notice
Sudden temp drop 24 hours after pitching US-05
Discussion in 'General Brewing Techniques' started by Piggy Smalls, 15/7/19.

subset: commoncrawl


text: Brad Fitzpatrick - June 21, 2019 Remington RM380 Executive Pistol Review Remington Arms Company celebrated its bicentennial in 2016, and that same year the company introduced the subcompact RM380 semiauto pistol. Affordably priced and easy to conceal, the RM380 was an ideal choice for the nation's growing number of concealed-carry permit holders, estimated at 13 million in 2015.Since the original RM380's release three years ago, the number of concealed-carry permits issued has risen by roughly 25 percent. To draw the attention of this rapidly growing segment of the firearms market, Remington is dressing up the pocket-size .380 semiauto. This year, Big Green unveiled the latest iteration of the RM380: the spiffed-up RM380 Executive.Functionally, it's the same as the previous model: a hammer-fired, double-action-only, single-stack .380 that's compact enough to conceal under the lightest clothing. And it retains the double-recoil-spring design, which helps reduce the force required to operate the slide—a major selling point for many people.Like the original RM380, the new Executive version shares the DNA of the Rohrbaugh R380/R9. Remington acquired Rohrbaugh in 2014 and, with the purchase, became the owners of one of the best compact pistol designs on the market. All Remington RM380s incorporate 416 stainless steel slides and a locked-breech, recoil-operated, tilt-barrel design with a flared muzzle bell to provide reliable and secure barrel-to-slide contact. A beefy external extractor lies flush in a machined channel on the right side of the slide. The frame is machined from 7075 aluminum, and that makes this pistol one of the few all-metal subcompact pistols available today. The 416 slide comes with a satin stainless finish, and the 2.75-inch, 1:16-twist match barrel features a matte stainless finish that contrasts nicely with the matte black anodized frame.The grips on the Executive are new for the platform—a Macassar laminate with large palm swell for added control.At first glance you might think the Executive's grip panels are wood, but closer inspection shows the grips are actually a high-pressure wood-grain Macassar laminate. They also feature a large palm swell, which helps fill the shooter's hand and provides better control of the gun when firing. The Executive's grip panels are replaceable and can be removed from the gun by loosening three small screws. It's worth noting this pistol's double-action, hammer-fired design has one advantage that striker-fired counterparts do not. In the rare event a shooter encounters a cartridge with a hard primer, hammer guns allow the shooter to continue striking the primer with additional pulls of the trigger.The hammer-fired DAO design offers a restrike capability, and the small beavertail allows a high grip while preventing slide bite.As I mentioned, the Executive is designed with concealment in mind. This end-use engineering is apparent in every aspect of the gun's design, from the beveled slide to the minimalist machined sights to the recessed controls. The rear portion of the slide is angled forward, and the spurless hammer rides flush against the back of the gun. A small beavertail prevents the shooter's hand from being bitten by the slide during cycling, and a small undercut on frontstrap checkering helps maintain control of this pistol when firing. The laminate grip panels are textured and feature a shallow recess on either side just aft of the trigger guard.As with most subcompacts, the Executive has minimal controls: a triangular magazine release tucked behind the trigger guard and a small slide stop.In terms of controls, there is no manual safety or takedown lever. An ambidextrous, triangular magazine release button is contoured to the grip profile, and the low-profile slide stop rides in a cutout on the left side of the grip. The trigger, extractor, slide stop and mag release are nickel-plated.Wide serrations machined into the rear of the slide makes for easy operation of the pistol even with gloved hands. Takedown is relatively simple. With an empty chamber and the magazine removed, pull the slide rearward until a round hole in the slide aligns with a longitudinal pin that can be pushed free. Every RM380 Executive ships with two six-round magazines, one that fits flush with the base of the frame for maximum concealment and another with a finger extension that provides more gripping surface when shooting at the range.Despite its all-metal construction, the RM380 Executive is very light. With an empty magazine in place, the pistol weighed exactly 14 ounces on my scale, and when fully loaded, it weighs right at a pound.Overall length is 5.3 inches, which compares favorably with other guns in this class—the Ruger LC380 (six inches), the Glock 42 (5.9 inches) and the Kahr CW380 (five inches). The slide measures 0.83 inch wide, exactly the same as the G42, and at the widest point on the grips, the RM380 Executive is just 1.1 inches wide. The Remington's overall height is 3.9 inches with the flush-fit magazine and 4.4 inches with the extended magazine. One of the primary complaints I hear from new CCW permit holders is that the slides on most compact and subcompact semiautos are heavy and difficult to manipulate. That's not the case with the RM380 Executive—again, thanks to the dual-spring design. The reduced slide weight means that most any shooter—even those who suffer from arthritis or who have weak hands—will be able to effectively operate this pistol.The slide serrations aren't overly aggressive, but they're deep enough and wide enough to allow plenty of purchase when operating the gun. There were no issues with the slide failing to close properly and chamber a cartridge, an important consideration when selecting a carry pistol. Initial accuracy testing took place at 15 yards from the bench, and at that distance the Remington's accuracy was as good or better than most guns in this class. The best groups of the day measured 2.1 inches at that range with Federal's Low Recoil HST load and 2.2 inches with Browning's BXP, but the other loads in the test produced at least one group under three inches. As you can see in the accompanying chart, average group sizes ranged from 2.5 to 3.4 inches, which is good for a pistol with a 2.75-inch barrel at that distance and particularly good when you consider the Remington's rudimentary sights. Because they feature the same satin stainless finish as the gun itself, I found the front sight to be difficult to see when I was firing groups from the bench.The reality is that subcompacts like the Executive are meant to be close-range weapons, and when firing the gun at point-and-shoot distances, the sights are less of an issue. And because they're machined directly into the slide, they're extremely robust and won't hang up when the gun is drawn.Most double-action-only guns that lack a safety have a long trigger pull to reduce the risk of an unintentional discharge. The RM380 Executive's trigger pull is quite long, even for a double action. I had to readjust my hand twice because I wasn't able to pull the trigger completely rearward with my normal shooting grip when shooting from the bench. But it's smooth and even until the hammer is almost completely rearward, and at 10.4 pounds it isn't particularly heavy for a double-action pistol.The undercut on the trigger guard is a worthwhile addition, and it certainly allows for more purchase on the grip. I do wish it was more pronounced, but space is at a premium with subcompact pistols, and Remington had to do the best it could with the minimal space allotted.Despite its small size and basic sights, the RM380 performed well at defensive ranges. These shots were taken offhand at ranges from five to 15 feet.After testing the pistol from the bench, I spent some time shooting the pistol from a standing position at ranges from five to 15 feet. At those distances the RM380 Executive performed quite well. The low-profile sights worked fine when drawing and firing the gun at defensive ranges, and it was easy to fire double-taps into the vital zone of a torso target.Recoil is somewhat stiff, but it's certainly not unmanageable, and I believe most shooters should be able to control the gun and shoot it comfortably with a bit of practice. The beavertail does a nice job of promoting a high handhold on the pistol while simultaneously preventing slide bite, and there's room on the frame for a thumbs-forward grip on the pistol without interfering with the action of the gun.Despite being tucked away in the frame, the magazine release is easy to find and use, but the very compact slide release requires concentration to release. It's much simpler to jam a fresh magazine into the gun with the slide locked open and pull the slide rearward to chamber a round.The extended magazine works great, especially for shooters with large hands, and there were few issues with cycling. The pistol jammed twice from the bench, both stovepipes, but during standing fire there weren't any malfunctions—although the slide failed to lock open after the last round was fired on four occasions. Remington includes metal magazines with a substantial yet manageable spring that makes loading this gun easier than some of its rivals. Carrying the RM380 is convenient and simple. The gun fits easily into pocket holsters, and when worn in a compact inside-the-waistband holster or belly band, it virtually vanishes under a light layer of clothing. This makes it suitable for year-round carry.It's also light enough and portable enough to be carried during outdoor exercise, like jogging or hiking, and its diminutive size and minimalist mass make it perfect for carry in a fanny pack or other small bag. It fits neatly in an ankle holster, keeping it out of sight when wearing dress pants or jeans, and it's an ideal backup gun for anyone who prefers to carry a second firearm. Additionally, the stainless slide, anodized frame and laminate grips mean this gun is able to withstand the abuses of daily carry, namely exposure to moisture.Engineering a carry pistol is an exercise in compromise. Remington decided to favor portability, but the RM380 remains a gun that's relatively easy to operate and use. I'd suspect most potential buyers will be looking for a really small, robust gun that's simple to carry and shoot, and the Executive fits the bill nicely.It offers improved ergonomics (and aesthetics) over the standard black RM380 thanks to the new grips, but the price is still within the budget for most shooters looking for a gun in this class. Suggested retail price is $405, which means street prices will likely be in the $300s, and that makes the RM380 Executive an American-made gun worth considering when you're in the market for a subcompact carry pistol.Notes: Accuracy results are averages of four five-shot groups at 15 yards from a fixed rest. Velocity figures are 10-shot averages recorded on a ProChrono digital chronograph placed 10 feet from the muzzle. Abbreviations: FMJ, full metal jacket; JHP, jacketed hollowpointREMINGTON RM380 EXECUTIVETYPE: DAO semiautoCALIBER: .380 ACPCAPACITY: 6BARREL: 2.75 in.OAL/HEIGHT/WIDTH: 5.3/3.9 (flush mag)/1.1 in.WEIGHT: 14 oz.CONSTRUCTION: black anodized 7075 aluminum frame; satin 416 stainless slideGRIPS: macassar laminateTRIGGER: 10.4 lb. pull (measured)SIGHTS: fixed; notch rear, post frontPRICE: $405MANUFACTURER: Remington Arms, remington.com GET THE NEWSLETTER Join the List and Never Miss a Thing. Sign Me Up


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Staging is an important part of selling your home. Buyers need to be able to imagine themselves living there. Owner of Upstaging Seattle Fernanda Bertrand is a professional stager who has advice that can make your home sell faster. Bertrand joins New Day Northwest to talk about the colors you should be using, removing personal memorabilia, and helping buyers visualize living in your house.
Watch New Day Northwest 11:00 weekdays on KING-TV Ch.5 or streaming live on KING5.com. Connect with New Day via Facebook, Twitter, Instagram.


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Looking for an inexpensive way to some color to your office, on your desk? The Checkomatic Blue Vinyl Top Stub Checkbook Cover is an excellent choice.
Certainly a best seller, this good looking Blue Vinyl reliable protection for your checks comes at the best price youll find online, only at Checkomatic!


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Krakatoa by Simon Winchester
Krakatoa by Simon Winchester, Viking/Penguin, £16.99, ISBN 0670911267 Reviewed by Roy Herbert
THE explosion that destroyed the volcanic island of Krakatoa near Java is still the biggest and most terrifying eruption ever recorded. Forty thousand people were killed and its effects were felt around the world. In Krakatoa, Simon Winchester goes as far as calling 27 August 1883 the day the world exploded, which is more Hollywood than fact.
When the eruption is reached, however, Winchester can make your hair stand on end, especially in describing the portents of coming disaster. It is a pity that his love of inconsequent …
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text:
F1 returns to Europe and Fernando Alonso returns to Spain as a race winner in 2018! We preview the Spanish GP on this edition and look back at the Supercars and WEC action from the previous week.
Show Notes
Follow us on Twitter @HitTheApexMedia
What is Hit The Apex Podcast?
Motorsports writer, photographer and all-round sports lover talks mostly F1.
But when he's not, there is plenty of other racing, sporting and sometimes random goodness that is discussed week-to-week.


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AdMob Banner Ads – Mobile Ads Garage #2
Related posts:
AdMob Banner Ads – Mobile Ads Garage #2
Hay Lam says:
Wilfred Mulenga says:
awesome stuff. didnt know it was that easy
Mathieu Magalhaes says:
A guide on how to protect our apps from adblockers/lucky patcher would be nice too
Amit Kalra says:
how do i contact them? my account was disabled and i don't know why…
Henry Escobar says:
Excelente, mi total admiración, Un cordial saludo.
Tim Haag says:
I really like the presentation where he is within the app. Makes it a bit easier to follow, I think 🙂 Instagram: timhaagdev
sadman samee tonmoy says:
When Native ads will be open for all?
Mikael says:
I followed every steps on this site https://firebase.google.com/docs/admob/android/quick-start#prerequisites
But since my computer doesn't support VT, I had to test it with a physical device, and thanks to that the app only closes at start up without giving me any error code.
The app and everything complied fine, and after 7 hours I've narrowed down to what might have caused the problem.
I've spent at least 5 hours searching for a solution, where people had a similar problem but they simply mistyped something etc.
Anyway, this section is what causes the problem for me:
AdView adView = (AdView)findViewById(R.id.adView);
AdRequest adRequest = new AdRequest.Builder().build();
As for my .xml
And build.gradle
dependencies {
compile fileTree(dir: 'libs', include: ['*.jar'])
testCompile 'junit:junit:4.12'
compile 'com.android.support:appcompat-v7:23.4.0'
compile 'com.google.firebase:firebase-ads:9.0.1'
compile 'com.google.android.gms:play-services-ads:9.0.1'
apply plugin: 'com.google.gms.google-services'
Would anyone be so kind to help me out? I'm really out of options at this point
OddNames Games says:
Thanks a lot, got it working in my game https://play.google.com/store/apps/details?id=com.OddNames.ArcadeDataEntry
Vignesh Raja says:
My log says this "Ad finished loading." But I can't see anything ! I've tested it on a Nexus 6P running Android 6.0.1
jahan babu says:
After following all steps now Ads are showing in test device in Debug
but after publishing in play store Ad is not showing.
Please suggest what should i do ?
Swornim Shah says:
How to do it if you are using an actual device? Should i ignore the addtest method??
Dariusz Pietrala says:
DON'T USE AdMob! After years of quite good numbers this happened few weeks ago: banner's match rate at 40%, fullscreen at 80%, ridiculous RPM and NO SUPPORT AT ALL!!!
eii dsljh says:
Thank you so much! I've been struggling for weeks on this and finally got it!!! One question that may sound noobie. Do I implement that code into my apps APK and generate a new APK to upload to the app store? Or do I leave the code into a new project? I always see people using ads in new projects so that's why I'm asking.
mukund code says:
@Andrew Brogdon, I have a question. Consider the following use case:
1) The user opens the app when he is not connected to the Internet(Hence, the banner ads are not displayed)
2) The user connects to the Internet (by switching on wifi or mobile data ) when he is using the app.
What I have noticed is that currently, banner ads are not automatically loaded when the user establishes an Internet connection during usage of the app. I did consider a workaround that included listening for the event of the user connecting to the Internet and then loading the banner ads(if they haven't already been loaded). However, I am not sure if this is the best approach for quite a few reasons.
One such reason is the following use case:
1) Steps 1 and 2 mentioned above happen
2) I implement the connection established listener and load a banner ad upon Internet connectivity establishment.The banner ad has a refresh rate of 50 seconds( which I set when configuring it in Admobs website).
3) The user now disconnects from the Internet when still using the app. But the banner ad that has been previously loaded is still visible and 20 seconds have ticked off the clock.
4) The user re connects to the Internet at time=30 seconds.
Now, should I reload the banner ad because the user just established an Internet connection for the second time(although it has been displayed to the user for just 30 seconds totally out of the configured 50 seconds) or should I leave the current banner ad stay as it is and would it refresh itself after the remaining 20 seconds?
The above use case is just one reason I could think of.
Could you please give me the best way to handle this situation?
P.S : I am asking this question in the context of Android applications. Not iOS. Although, I guess the approach will be more or less the same on both platforms.
Lee Fisher says:
For android do we need to modify the manifest? It wasn't mentioned.
A Shar says:
After implementing this exactly , I have been facing errors for the past 2 hours
This is a very incomplete tutorial
+1 dislike from me
Generic Intuition says:
Thank you for such nice tutorial videos.
Andrew, I have a question,…It is said that we should use a single AdUnit for a single activity, following AdMob Guidelines. So, how many "AdUnits" we can include in a single app?
Let's say I have 25 Android Activities in my app, and want to add Banner and Interstitial to 10 activities, so 10 AdUnits, right?So, is their any limit for number of Ad Units in an Android app, which is fine and acceptable by Google AdMob Guidelines?
N says:
so do we need to put the app id anywhere?
Kofoworola Sadique says:
Thank you for this amazing video!
I just started with Ads on my android project, and i'm experiencing a problem. When i used your "unitId" and "AppId" every thing works, but when i using my own created banner from my Admob account, I see nothing. So, my question is…
1. why am i not seeing ads with my own created ads?
2. Should i deploy my app before adding ads or what?
Khmer Timeline says:
need quick help from google developer, my banner ads appear on the top of the screen, both of them real device and emulator while testing. how can i fix that?
Kirill Karmazin says:
do we need to call adView.pause() on Activity's onPause() and adView.resume() in Activity's onResume() methods?
ticeland says:
Please i generate my apk with adobe flash. precisely which of all your videos will hell me to integrate admob
Moon Doggie says:
I've worked for years with PC's, setting up and installs, but not programming. You were very good in how you presented it all. Although, if a person doesn't understand the basics of where you even went to in order to do what you showed, let alone understanding the coding, how does one do this, when they have the need to integrate ads into a website build. Basically, a pre-beginners hand held walk-through of where to start, where to get the programming software, yada yada yada, and so forth.
Thanks much, Scott
Devesh Singh says:
You skipped having your app initializing Mobile Ads SDK by calling MobileAds.initialize().
Prof Herp says:
Why AdRequest.Builder().setLocation(location).build() not working anymore?? sory for my bad english
quasco kwasko says:
stop lieing; you confirmed to me that the adsense once disabled still we still be able to use the admob… YOU DISABLE EVEN MY ADMOB, ,,,,,,,,,m,, WHY ? answer please
Ilhami Yanmaz says:
MD.Jahangir Alam.01714829625. Parbes says:
Mark Chiu says:
this video is demo in objective-c, can you add new video to swift version.
Dev Suhad says:
device 'emulator-5558' not found !!
Walt Williams says:
What about iOS Swift code.
Pepito Torres says:
Todo lo dejo en manos de Dios si yo me equivoque el peso que caiga sobre mi
Pepito Torres says:
Eres es humano no somo perfectos
Pepito Torres says:
Mis hijos que los cuide mi dios
hari setiawan says:
Zeeshan Ali says:
I'm Getting this error.
WARNING: Configuration 'compile' is obsolete and has been replaced with 'implementation' and 'api'.
Zeeshan Ali says:
plz help
Zeeshan Ali says:
Plz help me sir
Zeeshan Ali says:
Zeeshan Ali says:
Can you solve this problem.?
Sugeng Sutandi says:
Actually how much cheapest banner CPM? my new app CPM on play store can go low more than U$0.01, is this normal?
Rockin Ronnie says:
This video instruction is good, but Xcode has since been updated. And using the code from this video in your project now will return errors. What is the new code for the latest Xcode version?
weshuiz13 says:
i rather skip this video it contains adds
shakeel khan says:
how to add banner ad in cordinator layout
Daniel C says:
Thanks guys, useful video… appreciate the humor too! 🙂
Let's Learn Computer Programs says:
I have four app then I have use the multiple ads unit for multiple app
ashik wome says:
i can't install admob in my project. Whenever i am doing it it is showing a error in my dependencies @ app:compact activity version 28.0.0
Yo Apps says:
WOW! if every google product had clean tutorials like this… coding would be so much more fun! I also have a Question: I cant seem to find the difference in money earned between a regular banner sized Ad and a large banner sized Ad?
Sunny Kumar says:
I added all the codes and when app call to load ad it not loaded and in admob i able to it as request and imp 0 and match rate is also 0 plz help me
TECH PATHAK says:
My apps crash when in implement "com.google.android.gms:play-services-ads:17.1.1" while my compileSdkVersion is 28
Khurkham Langkhur says:
Why aren't my Admob ads showing?
Daniel da Silva says:
Do I need to be inside one RelativeLayout or can it be another?
hunaza shabbir says:
My app is crashing why so?
universal apps says:
thanks that is useful
Amiine Xp says:
My admob account terminated with balance of +8500$ i didn't receive any email for the reason of termination, i don't know if i'll get my monthly revenue or not, if anyone still working with admob i think it's the best time to switch to another trustable ad network …
Gaurav meghanathi says:
while implement of banner it will loaded but not show as per google guild line as well as google git hub sample code.. ? even if not error it just Add was loaded on add listener.. so can you explain why this kind of issues occur while implementing of banner ads. i have put both side add unit on my java as well as XML files.
rahul patil says:
admob plugin give an error in xcode googlemonbileads.h not found
why it is give an error i m download the plugin official website ?? i m trying last 3 to 4days
Extinction says:
Ducking admob!! I keep getting account disabled due to duplicate account!! Ffs! I don't have a duplicate
Islamic Apps 2018 says:
How to create a shared admob banner ad? Create it in appdelegate and add it to any view that i want?
moses apeabu says:
How do I navigate to android studio from my admob account?


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The Peloponnesian War Has Begun An Army Of Merciless Spartan Invaders Have Arrived At The Gates Of Plataea, Bent On Obliterating The Independent City State And Its Inhabitants Plataea S Oldest Allies, The Athenians, Are Spread Too Thin In Their Own Campaigns To Send Help Cut Off And Alone, The Plataeans Have Dug In Behind Their High Walls For The Coming Attack, While The Tyrannical Spartans Prepare To Lay Siege.On A Rugged Mountain Road, A Young Plataean Warrior Named Nikias Rides To Athens On An Urgent Quest He Carries With Him A Bag Of Ill Gotten Gold, Hoping To Raise An Army Of Mercenaries To Help Defend His Citadel From The Spartan Assault But In The Sprawling Stronghold Of Athens, Nikias Encounters Perils That Prove To Be Dangerous Than Those He Has Faced On The Battlefield.Noble Smith S Spartans At The Gates Transports Us To The Dawn Of One Of History S Most Famous Wars A Fight That Would Tear Apart The Great Powers Of Ancient Greece.
Is a well-known author, some of his books are a fascination for readers like in the Spartans at the Gates (The Warrior Trilogy, #2) book, this is one of the most wanted Noble Smith author readers around the world.
- Hardcover
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- Spartans at the Gates (The Warrior Trilogy, #2)
- Noble Smith
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- 20 March 2019 Noble Smith
- 1250025583


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Annual Conference of the Lebanese Society of Family Medicine Antoine Sarkis, MD Associate Professor of Cardiology Hotel Dieu de France Hospital
Guidelines ESC HFSA NYHA Classification CCS ACC/AHA
2005 NYHA Classification 2006 2006 Four stage classification 2005
A B C D Stages in the Evolution of Heart Failure.
Clinical Characteristics Hypertension Diabetes, Hyperchol. Family Hx Cardiotoxins A B Heart disease (any) Asymptomatic LV dysfunction Systolic / Diastolic C Dyspnea, Fatigue Reduced exercise Tolerance (current or past) D Marked symptoms at rest despite max. therapy AHA / ACC HF guidelines 2001 4
Classification of Recommendation
Class I: General agreement or evidence that a therapy is beneficial ►(therapy is recommended) Class II: Conflicting evidence IIa: evidence in favor of efficacy ►( therapy should be considered) IIb: evidence less well established ►( therapy may be considered) Class III: Not recommended, may be harmful
Level of evidence Level A: multiple randomized clinical trials or meta-analysis Level B: single randomized trial, or non randomized studies Level C: Consensus opinion of experts
Treatment Objectives Mainly decrease symptoms and prolong life
But also: Decrease morbidity (hospital admissions, embolism…) Increase exercise capacity and improve quality of life Control neurohormonal changes Retard progression of CHF Treatment of Heart Failure. Objectives The objectives of treatment of the patient with heart failure are many, but they may be summarized in two principles: decrease symptoms and prolong life. In daily practice, the first priority is symptom control and the best plan is to adjust to the individual patient's particular circumstances over the course of therapy. Nevertheless, the rest of the listed objectives should not be forgotten, as medical therapy now has the potential for decreasing morbidity (hospital admissions, embolism, etc.), increasing exercise capacity (all of the usually prescribed drugs), improve the quality of life, control neurohormonal changes (ACE-I, beta blockers), retard progression (ACEI) and prolong life.
Treatment of CHF All Control of risk factors Life style
Treat etiologic cause / aggravating factors Drug therapy Revascularization ICD (Implantable Cardiac Defibrillator) Ventricular resynchronization (CRT) Ventricular assist devices Heart transplant Artificial heart Neoangiogenesis, Gene therapy All Selected patients
Correction of reversible causes
Ischaemia Valvular heart disease Thyrotoxicosis and other high output status Shunts Arrhythmia Atrial fibrillation, flutter, Medications Ca channel blockers, some antiarrhythmics
Pharmacologic Therapy
Diuretics ACE inhibitors Beta Blockers ARBs Digitalis Spironolactone Other Treatment of Heart Failure. Drugs This is a simple and pragmatic classification of the vast numbers and types of medications in the pharmacopoeia for the treatment of heart failure.
Diuretics. Indications
Symptomatic HF, with fluid retention Peripheral edema Dyspnea/ Pulmonary edema (Xray) Jugular distension Hepatomegaly AHA / ACC HF guidelines 2005 ESC HF guidelines 2005 11
Adverse Effects of Diuretics.
K+, Mg+ ( %) (sudden death ???) Na+ Hyperuricemia ( %) Stimulation of neurohormonal activity Hypotension. Pre-renal azotemia, Ototoxicity, Gastrointestinal, Metabolic Alkalosis. Skin rashes, Neutropenia, Thrombocytopenia
Inhibitors of renin-angiotensin- aldosterone system
Renin-angiotensin-aldosterone system is activated early in the course of heart failure and plays an important role in the progression of the syndrome
Angiotensin Converting Enzyme Inhibitors Angiotensin Receptor Blockers
RAAS Blockade Angiotensin Converting Enzyme Inhibitors (ACE-I) Angiotensin Receptor Blockers (ARB)
ACE-I. Clinical Effects in CHF
Improve symptoms Reduce remodeling / progression Reduce hospitalization Improve survival Treatment of Heart Failure. Angiotensin Converting-Enzyme Inhibitors (ACEI): Mechanisms of action ACE-inhibitors cause arteriovenous vasodilatation. Venodilation is accompanied by reduction in PAD, PCWP, and LVEDP. Arterial vasodilatation decreases SVR and MAP and increases cardiac output, ejection fraction, and exercise tolerance. Heart rate and contractility do not change, and, thus, double product and myocardial oxygen demand are decreased. These effects are more noticeable in patients with low sodium levels, in whom there is an increased plasma renin activity. Vasodilatation is seen in various vascular territories: renal, coronary, cerebral, and musculoskeletal (increasing exercise capacity). Additionally, ACE-inhibitors cause diuretic and natriuretic effects that are a consequence of the inhibition of angiotensin II and aldosterone synthesis, as well as the increase in cardiac output and renal perfusion. It is now known that the magnitude and duration of blood pressure reduction correlates better with the activity of ACE in certain tissues (heart, vessels, kidney, adrenal, etc.) than with its plasma levels, which indicates that ACE-inhibitors act by inhibiting local tissue production of angiotensin II. Plasma levels of ACE are not good predictors of the magnitude of hemodynamic effects of ACE-inhibition.
ACE-I Placebo Probability of Death Enalapril CONSENSUS 253 patients
N Engl J Med 1987;316:1429 ACE-I 0.8 0.7 Placebo 0.6 Probability of Death p< 0.001 0.5 0.4 p< 0.002 0.3 Enalapril Treatment of Heart Failure. Angiotensin Converting-Enzyme Inhibitors (ACEI): Survival CONSENSUS. Prolonged administration of ACE-inhibitors reduces mortality in symptomatic heart failure. The first study to demonstrate this effect was CONSENSUS I. This graph shows the cumulative mortality curves of the treatment and placebo group in this randomized, double-blind trial. The study analyzed the effect of enalapril on prognosis of 253 patients with class IV heart failure, who also received digitalis, diuretics, and conventional vasodilators. At the end of 6 months of treatment, there was a clear-cut improvement in functional class, a reduction in the need for medications, and a 40% reduction in mortality (p<0.002). After 12 months the mortality reduction was 31% (p<0.001). Nonetheless, there were no differences in the incidence of sudden death between the two groups, or in the sub-group that received other conventional vasodilators. Another characteristic of this study was variability of the dose that was used for each patient (adjusted for tolerance and symptoms): mg/day. This aspect shows the importance of individualized treatment for heart failure patients. The CONSENSUS Trial Study Group. N Engl J Med 1987;316:1429. 253 patients NYHA IV 0.2 31 % 0.1 1 2 3 4 5 6 7 8 9 10 11 12 Months
ACE-I % Mortality SOLVD (Treatment) N Engl J M 1991;325:293 Placebo
50 40 30 20 10 p = Placebo n=1284 % Mortality Enalapril n=1285 Treatment of Heart Failure Angiotensin Converting-Enzyme Inhibitors (ACEI) : Survival SOLVD study-symptomatic heart failure. Mortality curves in patients with clinical heart failure in the SOLVD treatment study. In this study, 2589 symptomatic heart failure patients with EFs<35% (90% in functional class II – III) were randomized to receive enalapril or placebo. Mortality over a 41 month follow-up period was 39.7% in the enalapril arm and 35.2% in the placebo arm (p<0.004). The mortality reduction was chiefly mediated through less progression of heart failure; deaths due to arrhythmia were not reduced. Additionally, the enalapril group required fewer hospitalizations for heart failure. The SOLVD Investigators. N Engl J Med 1991;325:293 N = 2589 CHF - NYHA II-III - EF < 35 % 6 12 18 24 30 36 42 48 Months
ACE-I Mortality % Years SAVE 30 Placebo 20 Captopril 10 1 2 3 4
N Engl J Med 1992;327:669 ACE-I 30 Asymptomatic ventricular dysfunction post MI Placebo n=1116 Mortality % 20 Captopril n=1115 Treatment of Heart Failure Angiotensin Converting-Enzyme Inhibitors (ACEI): Survival SAVE (Survival and Ventricular Enlargement). Mortality curves in the SAVE study in patients with varying degrees of post-infarct ventricular dysfunction. In this study, 2231 patients with EF < 40% were randomized to receive captopril or placebo between 3 to 16 days after experiencing a transmural infarct. After 42 months, the captopril group had a significant reduction in overall mortality (-19%), number of reinfarctions (-25%), hospitalizations (-22%), and in the number of patients who developed clinical congestive heart failure. The mortality reduction appeared after 1 year of treatment. Pfeffer MA et al. Survival and Ventricular Enlargement (SAVE) Study. NEngl J Med 1992;327:669. 10 N = 2231 days post AMI EF < 40 % mg / day ² -19% p=0.019 1 2 3 4 Years
ACE-I AIRE Mortality % Placebo Ramipril p = 0.002 Months N = 2006
Lancet 1993;342:821 ACE-I Placebo 30 Mortality % 20 Ramipril 10 p = 0.002 N = 2006 HF after AMI 6 12 18 24 30 Months
ACE-I Indications Symptomatic heart failure (stage C)
Asymptomatic ventricular dysfunction LVEF <35-40 % (stage B) Patients with recent or remote history of MI regardless of EF or presence of HF (stage B) Class I recommendation Level of evidence A AHA / ACC HF guidelines ESC HF guidelines
ACE-I. Practical Use Start with very low dose
Renal function & serum K+ after 1-2 w In the absence of fluid retention, ACE-I should be given first / In the presence of fluid retention together with diuretics Dose NOT determined by symptoms. ACE-I should be up-titrated to dosages shown to be effective in clinical trials
ACE-I. Adverse Effects Hypotension (1st dose effect)
Worsening renal function, Hyperkalemia Cough Angioedema Rash, ageusia, neutropenia, … Pregnancy is a contra indication Treatment of Heart Failure. Angiotensin Converting-Enzyme Inhibitors (ACEI) : Undesirable Effects These can be classified into two groups. One group includes those effects that are inherent to its mechanism of action, and therefore are common to all ACE-inhibitors. The other includes those effects that are related to the specific chemical structure of the drug. In this case, substitution of one ACE-inhibitor for another could possibly reduce the intensity of the adverse reaction (e.g. choosing an ACE-inhibitor without a sulfhydryl moiety).
Substitute or adjunctive therapy to ACE inhibitors ?
Angiotensin Receptor Blockers (ARBs) in Heart Failure Substitute or adjunctive therapy to ACE inhibitors ?
Potential advantages of ARBs
ARBs more effective than ACE-I due to: - Better RAAS Blockade - Absence of angiotensin II escape - Placebo like side effects
ELITE II: Endpoint Results
1.0 0.8 All-cause mortality Probability of Survival 0.6 Losartan 0.4 P = .16 Captopril 0.2 0.0 1.0 0.8 Event-free Probability 0.6 Sudden death or resuscitated arrest P = .08 0.4 0.2 1.0 The recommended treatment of HF due to left ventricular systolic dysfunction (ejection fraction, <0.35 to 0.40) ranges from monotherapy with ACEIs in patients with the mildest manifestations to the use of a combination of ACEI, digoxin, diuretic(s), and hydralazine HCl or isosorbide dinitrate for patients with severe HF.35 The efficacy of ACEIs in the treatment of HF is well established. However, some physicians do not prescribe these agents due to safety concerns surrounding the accumulation of bradykinin associated with these agents.36 Therefore, clinical studies with ARBs in HF were initiated in an effort to find out if similar efficacy was observed with better tolerability. In 1997, the results of a 48-week study in HF patients demonstrated a 46% risk reduction in mortality with losartan therapy (an ARB) compared to captopril (an ACEI).36 However, these results were analyzed with caution because mortality was a secondary endpoint of the study and the number of events in this initial trial were small.36 Therefore, a larger study, including over 3,000 patients with HF, randomized patients to losartan or captopril and evaluated death from any cause as the primary endpoint.36 After a median follow-up period of 1.5 years, no differences in all-cause mortality, sudden death or resuscitated arrest, or all-cause mortality or hospital admission were observed between the two treatment groups.36 Interestingly, losartan therapy was associated with significantly fewer discontinuations due to adverse events attributed to study drug or due to cough compared to captopril (P<.001).36 Worsening HF was reported in 25% of patients in each group and the frequency of discontinuations did not differ for worsening of HF.36 Slide Reference Pitt B, Poole-Wilson PA, Segal R, et al, on behalf of the ELITE II investigators. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomized trial–the Losartan Heart Failure Survival Study ELITE II. Lancet. 2000;355: 0.8 Event-free Probability 0.6 P = .18 0.4 All-cause mortality or hospital admission 0.2 100 200 300 400 500 600 700 Follow-up (days) (Reprinted with permission from Pitt B, et al. Lancet. 2000)
Val-HeFT: Study Design and Inclusion Criteria
5010 patients EF < 40%; NYHA II - IV Receiving background therapy ACEIs (93%), diuretics (86%), digoxin (67%), beta-blockers (35%) Over 5,000 patients with chronic heart failure defined as NYHA class II (62%), III (36%), and IV (2%) with an ejection fraction of <40% and left ventricular diastolic transverse diameter (LVIDD) >2.0 cm/m2 were randomized to receive valsartan 40 mg twice daily titrated to 160 mg twice daily or placebo.38 At the time of randomization, 93% of patients were receiving an ACEI, 86% a diuretic, 67% digoxin, and 35% were receiving a beta-blocker.38 Slide Reference Cohn JN, Tognoni G, for the Val-HeFT Investigators. A randomized trial of the angiotensin receptor blocker valsartan in chronic heart failure. N Engl J Med. 2001;345: Randomized to Valsartan 40 mg bid titrated to 160 mg bid Placebo (Cohn JN, et al. N Engl J Med. 2001)
Time since randomisation (months)
Effect of Valsartan on Combined Mortality and Morbidity End Point* in Overall Population All-cause mortality and morbidity All-cause mortality 1.0 1.0 0.9 0.8 0.7 Time since randomisation (months) p = 0.80 Survival probability (%) 3 6 9 12 21 18 15 24 27 Valsartan 0.9 0.8 Event-free probability Placebo 0.7 In the overall population, Val-HeFT showed a significant benefit on the primary endpoint combined morbidity and mortality, which was reduced by 13.2% (p=0.009), but a neutral effect on all-cause mortality. 13% risk reduction p= 0.009 0.6 3 6 9 12 15 18 21 24 27 Time since randomisation (months) Cohn et al. NEJM 2001;345:1667
CHARM Program 3 component trials comparing Candesartan
to placebo in patients with symptomatic heart failure CHARM Alternative CHARM Added CHARM Preserved n=2028 LVEF £40% ACE inhibitor intolerant n=2548 LVEF £40% ACE inhibitor treated n=3025 LVEF >40% ACE inhibitor treated/not treated
CHARM Program Mortality and morbidity
CV Death or CHF Hospitalisation All Cause Mortality 0.77 Alternative p=0.0004 0.85 Added p=0.011 0.89 Preserved p=0.118 0.91 0.84 Overall p=0.055 p<0.0001 0.7 0.8 0.9 1.0 1.1 1.2 0.6 0.7 0.8 0.9 1.0 1.1 1.2 Hazard ratio Hazard ratio p heterogeneity=0.37 p heterogeneity=0.43
ARB Indications in CHF Patients intolerant to ACE-Inhibitors:
(Class I recommendation in stage C) On top of ACE I and B Blockers in patients who remain symptomatic: optional (discrepancy in guidelines): Class I (ESC, CCS), IIa (HFSA), and IIb (ACC/AHA) Use of ARB instead of ACE-I is a Class IIa recommendation (reasonable, should be considered) in stage C heart failure
Spironolactone Survival RALES Aldactone N = 1663 NYHA III-IV
NEJM 1999;341:709 Spironolactone 1.0 0.9 0.8 0.7 0.6 0.5 Annual Mortality Aldactone 18%; Placebo 23% Survival Aldactone N = 1663 NYHA III-IV Mean follow-up 2 y Mortality curves in the RALES study. (probably already shown by previous speaker). I will coment on the progressive increase in benefit and will made a comparation with the CIBIS-II results. p < months Placebo 6 12 18 24 30 36
Spironolactone. Indications
Moderate-severe symptoms/advanced heart failure Class I recommendation, level of evidence B Routine combination of ACE-I, ARB and aldosterone antagonist is not recommended (Class III)
Spironolactone. Practical use
Do not use if hyperkalemia, renal insuficieny Monitor serum K+ at "frequent intervals" Start ACE-i first Start with 25 mg / 24h
ß-Blockers Has been traditionally contraindicated in pts with CHF
Now they are a corner stone in treatment of CHF
ß-Adrenergic Blockers Mechanism of action
Density of ß1 receptors Inhibit cardiotoxicity of catecholamines Neurohormonal activation HR Anti-ischemic Anti-hypertensive Anti-arrhythmic Treatment of congestive heart failure. Possible benefits of beta adrenergic blockers .
ß-Adrenergic Blockers Clinical Effects in CHF
Improve symptoms (only long term) Reduce remodeling / progression Reduce hospitalization Reduce sudden death Improve survival
ß-Adrenergic Blockers
US Carvedilol HF NEJM 1996; 334: ß-Adrenergic Blockers 1.0 1.0 Carvedilol (n=696) 0.9 0.9 Survival % p<0.001 Placebo (n=398) 0.8 0.8 0.7 0.7 Risk reduction = 65% I-II NYHA HF 0.6 50 100 150 200 250 300 350 400 Days
ß-Adrenergic Blockers
CIBIS-II Lancet 1999;353:9 ß-Adrenergic Blockers 1 Bisoprolol 11.8% 0.9 0.8 P< Survival Placebo 17.3% 0.7 NYHA III-IV n=2647 0.6 Annual Mortality: bisoprolol=8.2%; placebo=12% Mean Follow-up 1.4 years 0.5 200 400 600 800 Days
ß-Adrenergic Blockers
MERIT-HF Lancet 1999; 353: 2001 ß-Adrenergic Blockers Placebo 15 p=0.0062 Mortality % Metoprolol 10 5 Risk Reduction 34% NYHA II-IV N=3991 3 6 9 12 15 18 21 Months
ß-Adrenergic Blockers
COPERNICUS NEJM 2001;344:1651 ß-Adrenergic Blockers 100 90 80 Survival% Carvedilol 70 p= 35% RR 60 Placebo N = 2289 III-IV NYHA 50 4 8 12 16 20 24 28 Months
ß-Adrenergic Blockers
CAPRICORN Lancet 2001;357:1385 ß-Adrenergic Blockers 1 HR 0.77 ( ) p<0.031 0.95 0.9 Carvedilol 116 / 975 (12%) Survival 0.85 0.8 LVD / HF Post AMI Placebo 151 / 984 (15%) 0.75 0.7 0.5 1 1.5 2 2.5 Years
ß-Adrenergic Blockers Indications
Symptomatic heart failure (stage C) Asymptomatic ventricular dysfunction - LVEF < % (stage B) After AMI Class I recommendation AHA / ACC HF guidelines 2005 ESC HF guidelines 2005
ß-Adrenergic Blockers When to start ?
Patient stable No physical evidence of fluid retention No need for I.V. inotropic drugs Start ACE-I / diuretic first Start Low, Increase Slowly Increase the dose every weeks
ß-Adrenergic Blockers Drugs and Dose (mg)
Initial Target Bisoprolol / 24h 10 / 24h Carvedilol / 12h 25 / 12h Metoprolol succinnate 12,5-25 / 24h 200 / 24h Nebivolol (ESC, elderly) /24h mg/24h 25
ß-Adrenergic Blockers Adverse Effects
Hypotension Fluid retention / worsening heart failure Fatigue Bradycardia / heart block Review treatment (+/-diuretics, other drugs) Reduce dose Consider cardiac pacing Discontinue beta blocker only in severe cases
Digitalis Glycosides The role of digitalis has declined somewhat because of safety concern Recent studies have shown that digitals does not affect mortality in CHF patients but causes significant Reduction in hospitalization Reduction in symptoms of HF
Digitalis DIG Mortality % 50 40 30 20 10 Placebo N=6800 NYHA II-III
N Engl J Med 1997;336:525 50 40 30 20 10 Mortality % Placebo n=3403 p = 0.8 N=6800 NYHA II-III Treatment of heart failure. Digoxin: Effect on survival The results obtained from 3 controlled studies which included patients at low risk (The German and Austrian Xamoterol Study Group, 1988; The Captopril-Digoxin Multicenter Research Group, 1988; DiBianco et al., 1989) indicate that the mortality was similar in the group of patients with placebo. The results of the Digitalis Investigator Group-DIG study, which included 7788 patients with heart failure in sinus rhythm, functional class II-III and LVEF < 45%. The patients were treated with digoxin or placebo, in addition to conventional therapy over a mean of 37 months ( months). No differences in mortality were observed between the two treatment groups. Am Coll Cardiol 1996 Digoxin n=3397 12 24 36 48 Months
Digitalis. Indications
• Sinus rythm: When no adequate response to ACE-i + diuretics + beta-blockers • Atrial Fibrillation: to slow AV conduction Dose to mg / day Narrow therapeutic to toxic ratio !!
Other Drugs. (only in selected patients)
Inotropics: refractory HF Nitrates: ischemia, angina, pulmonary congestion Antiarrhythmics: (only amiodarone) H risk arrhyth. Anticoagulants: High risk of embolism e.g Atrial Fibr. Ca channel blockers (only amlodipine): ischemia, hypertension 28
Devices Cardiac Resynchronization Therapy (CRT)
Implantable Cardiac Defibrillator (ICD)
Cardiac Resynchronization Therapy for Heart Failure (CRT)
Ventricular Dysynchrony Electrical: Inter- or Intraventricular conduction delays typically manifested as left bundle branch block Mechanical: Regional wall motion abnormalities compromising ventricular mechanics Cardiac Resynchronization Modification of interventricular, intraventricular, and atrio-ventricular activation sequences Introduces "new" terms used in this slide series. Ventricular dysynchrony is defined as the effect caused by intra- and inter-ventricular conduction defects or bundle branch block. Read Dr. Tavazzi's editorial referenced here for a summary of the three potential causes of ventricular dysynchrony. Cardiac resynchronization is defined as the therapeutic intent of atrial synchronized biventricular pacing for patients with heart failure and ventricular dysynchrony. The intent of the therapy is to resynchronize the ventricular activation sequence, and to better coordinate atrial-ventricular timing to improve pumping efficiency. Cardiac resynchronization therapy is currently indicated for the reduction of symptoms of moderate to severe heart failure (NYHA Function Class III or IV) in those patients who remain symptomatic despite stable, optimal medical therapy, and have a left ventricular ejection fraction 35% and a QRS duration 130 ms. An ICD is also available for patients with a standard ICD indication who also meet the above listed criteria. Using atrial-synchronized biventricular pacing in combination with optimal drug therapy has been shown to significantly improve a patient's symptoms. Tavazzi L. Eur Heart J 2000;21:
Primary and secondary outcomes in CARE-HF: 409 CRT-treated patients as compared with 404 control patients Outcomes Hazard ratio (95% CI) p All-cause mortality 0.64 ( ) 0.0019 All-cause mortality/HF hospitalization 0.54 ( ) <0.0001 Cleland JG. NEJM 2005; 352:
Cardiac Resynchronization Therapy (CRT)
NYHA class III or IV, LVEF < 0.35 and dyssynchrony (QRS >= 120 ms) Class I recommendation, Level A
Intra Cardiac Defibrillator. Indications in Secondary Prevention
Patients with sustained VT or SCD → ICD
Intracardiac Defibrillator Mortality outcomes over five years in SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) Parameter ICD, n=829 Amiodarone, n=845 Placebo, n=847 All-cause mortality (%) 22 28 29 Mortality risk vs placebo, HR (97.5% CI) 0.77 ( ), p=0.007 1.06 ( ), p=0.53 — * randomized 2521 patients with NYHA class 2-3 HF and an LVEF <35% Bardy GH et al. N Engl J Med 2005; 352:
ICD indications Primary prevention
NYHA class II or III and LVEF <= 30 % With a reasonable life expectancy > 1 year Class I recommendation However may be indicated even in stage B (NYHA class I) especially in ischemic aetiology
Heart Transplant. Indications
Refractory cardiogenic shock Documented dependence on IV inotropic support Severe symptoms of ischemia not amenable to revascularization Recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities
Stages in the Evolution
of Heart Failure. Treatment Treat risk factors. ACE-I (or ARB) in appropriate pts for vascular disease or diabetes A AHA / ACC HF guidelines 2005 ACE-I, ARB, -Blockers in appropriate pts. ICD in selected pts. B (Asymptomatic LV Systolic Dysfunction) C (Symptomatic LV Systolic Dysfunction) Routine: ACE-I, blockers, Diuretics In selected pts: aldost antag, ARB, Digitalis, nitrates ICD, CRT D (Refractory End-Stage HF) CRT Mech. Assist device Heart Transplant 4
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There are various corporations who present dwelling pc repair companies. If there isn't any operating system, or if the operating system just isn't accurately installed, then you may need to take into account probably formatting the arduous drive, doing a recent clear install of the operating system and then trying once more. Many laptop technicians will travel to your house or workplace to prognosis, estimate and full upgrades and repairs. The Pc is an electronic system that requires restore and maintenance time to time. The primary part is limiting the amount of personal data that you simply place in computer service supplier's possession while you give them your pc to repair.
Your pc will possible require repair in some unspecified time in the future in time. The computers are susceptible to many issues like virus assault, disk corruption, FAT errors, DVD ROM error, invalid media error, partition error, data loss and so on. With most on-line laptop restore firms they provide a fix it or free policy. Once all inventoried hardware is checked and passes, control is passed to the arduous drive controller and looks for what is known as the boot sector of the hard drive and the operating system is loaded into ram which results with the logo which we've all see on the display. Clearly, in case you have a Mac, you do not need LAPTOP restore software program on it. You will have to look for something that matches your working system. The first component is limiting the quantity of non-public information that you place in pc service supplier's possession once you give them your pc to restore. Their assist services embody working system assist, virus removal support, internet arrange help, PC pace up assist, and lots of more. Most individuals do not think about it, and a few take it as a right, but really how safe is your private data whenever you take your computer in for repair.
Most "flat price" quotes are based on what a tech would have charged by the hour for a similar service and in this case in case your restore takes much less time your stuck paying more the you would have within the first place. Most of these Los Angeles pc restore firms provide free decide-up and supply companies of the computer. There are many corporations who provide dwelling laptop restore companies. A complete new breed of technicians has sprung into existence to help customers get maximum profit from both hardware and software program. Typically by reinstalling Windows drivers, you can also restore your computer points yourself. If you're under the impression that you simply computer points are hardware related, you'll have encountered corrupted drivers. Huntsville laptop repairs can give you the right kind of restore service at your premise at the most competitive pricing. Computer networking problems can manifest themselves in a number of methods comparable to Community delays, denial of service, community safety and unavailability of sure network services and might be set proper by Pc repairs in Huntsville AL.
Computer Repair Centers one zero one
With the excessive tech world of at the moment, Online Computer repair is rapidly taking maintain. COMPUTER Restore software is probably the most suitable choice when you've gotten error messages on the display screen that you don't know easy methods to fix. But then again, there's a bit of an edge that cellular pc restore providers acquire over laptop facilities. If there is no such thing as a working system, or if the working system is just not accurately installed, then it's possible you'll need to think about probably formatting the hard drive, doing a fresh clean install of the operating system and then making an attempt again. In a business, members of the technical support employees arrange computer systems, reply questions about using them, and see that they are well-maintained. The layer of core applications that act as intermediaries between primary laptop hardware and excessive-level computing applications, controlling the allocation of computing sources, are collectively labeled to be the operating system of a computer. A hardware drawback could lead to software program injury, but unlikely the other approach round. Extremely educated laptop technicians carry out all of those services.
Different Varieties Of Pc Repair Companies
Getting your pc mounted has come a good distance from the days when you needed to disconnect your exhausting drive from the opposite peripherals and bodily carry it to the repair shop. The Laptop is an digital gadget that requires repair and upkeep time to time. With an excellent workforce of technicians, a lot of the service and upkeep shops present clients the very best in terms of know-how and efficiency for nearly all makes of laptops including IBM, Sony, Compaq, Dell, Toshiba, Apple, Asus, Acer, Panasonic, Packard Bell, Siemens, HP, Gateway, Fujitsu, Lenovo, NEC, Alienware, Introduction and many others. If you are at residence, you may choose to bring the pc to your office, the place they can decide it up. Keep in mind that a Craigslist technician at all times wants a background verify of some type; ask for references, and call them up. Perform a search on their phone number, title, and be completely certain they are somebody you possibly can belief; if you have any doubt, transfer on to a restore store with a strong repute, on your security's sake, and your knowledge's sake. When your community gets setup by a network repair solutions professional it is possible for you to to get your laptop and desktop pc communicating in your network, sharing files and way more.
This really only works when the problem is NOT along with your arduous drive, resembling in knowledge corruption, attainable failure, or infection by virus, malware or spyware and adware. Thanks to the Web, there are many great tutorials that may walk you thru the process of installing a brand new exhausting drive or creating a house entertainment system accessible by way of your laptop is possible with these tutorials. Because the Pc Restore Franchise is a service oriented business venture, the flexibility to seek out and find repeat business is vital to success. Previous to working on hardware problem, do swap off all energy supply to the PC. If you're engaged on a software program downside, bear in mind to back up all your essential knowledge and information (at any time when attainable). If it is a damaged hard drive, have a cost estimate by doing online analysis. Discover out how you can get pc restore companies and troubleshooting. In truth, if left unattended, many simple repairs can turn into main expenses and lead all the way as much as the necessity to replace your complete arduous drive.


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DUBUQUE, Iowa (KCRG-TV9) - Cancelled flights are causing problems for some Dubuque families trying to make it to the Rose Bowl.
But some fans from Dubuque said they were going to make it to the game, no matter what.
As thousands of Hawkeye fans crowded The Eastern Iowa Airport ready to watch their beloved Hawkeyes try their luck against Stanford, some travelers from Dubuque weren't so lucky.
"Our flight was scheduled out of Dubuque to Chicago, then Chicago to LAX. We planned to leave on the 30th. But we got a call on the 29th at 11 p.m. The call said our flight from Chicago to LAX has been cancelled due to no crew for the plane," Jennifer Webber said.
The Webber family scrambled to find other flights, but with no luck, they decided to hop in their car and make the 27 hour drive from Dubuque, all the way to Pasadena.
"Yes it will be worth it. It will be worth it to be part of history. You know being back there, 25 years later," Webber said.
That same cancelled flight put Hawkeye fans Mike and Shannon Giese in a bind.
"I got a call from American Airlines saying that they were cancelling our flight and re-booked us on a Friday flight, which wasn't going to work because the game is Friday," Mike Giese said.
Instead the Gieses drove from Dubuque to Chicago O'Hare in the middle of the night. They found another flight to Phoenix, then finally to LA.
"At the time I was like, 'That's crap! No, they can't do that. Illegal! There should be some sort of government investigation so I can get to Pasadena for the Rose Bowl," Giese joked.
Both families say they were willing to do whatever they had to do to make it to the game.
"You've got go to the Rose Bowl. It's been 25 years!" Giese said.


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On 13th September Cat Hase and I ran a Street Wisdom for September's Learn > Connect > Do event, and welcomed an inquisitive bunch of wanderers to the PKF Cooper Parry offices up here in the East Mids. You can *see some of them there in the photo 😉 (*courtesy of Cat's creative skills and in the absence of us thinking to take photos!) Thanks to these wonderful people buying tickets to find wisdom in the streets, we've now upped our total donated to Twenty:Twenty to £325 so far this year – more than last year's total already! We're delighted!!
You're good enough as you are – but here's some feedback
The other day I wrote this piece about how we are all absolutely OK. We just forgot it.
This has been a new realisation for me thanks to learning about the Three Principles with Piers Thurston and this particular realisation has helped to settle a paradox that I used to just accept I had to hold both ends of.
Don't believe the hype
Everyone. Every. Single. One of us. Has hang ups, neuroses, insecurities.
They show up in different ways. Some masked by confidence, others shaking with fear, others pursuing, driving and achieving to compensate for the empty space and the belief that they're not good enough.
But we've been sold hype all our lives and this is how it plays out.
Self Care for People Professionals @ Learn > Connect > Do
Today's post is brought to you by Janice Keyes. Janice is a wonderful, dedicated HR professional and coach who's bringing her self care expertise (learned through her own challenges with bringing balance to life!) to Learn > Connect > Do next Thursday (15th March). All profits from these events go to Twenty:Twenty and when you join us you
My experience of flotation!
This is my experience of a flotation pod at Calm Water Flotation, Nottingham who (despite how you'll see my thought flowed) were very helpful at explaining how everything worked and how we might feel in the pod. Giving floating a try was for our Aligning Teams Christmas Do and on the back of Mark Gilroy's experience – we decided that the usual meal and drinks wasn't for us and instead we plan to try a different therapy or experience each year……
Break the habit of busy
I'm seeing it everywhere I go.
No time to stop. No time to think. Just get on and do, do, do! And make sure others are doing the same.
In this place your brain is in action mode (distinct from reflection mode). You become more concerned about yourself than others. You lose perspective. It's hard to see the bigger picture. You don't think with full capacity because you're verging on threat state and some parts of your brain aren't deemed important enough for good blood flow when you're in that place. More things become a competition than necessary. Frustrations are everywhere. And you're more likely tip from the edge of "healthy pressure" into unhealthy stress and unhelpful reactions. When that happens you damage relationships, often with those you're relying on to get your "doing" done.
Confessions of a recovering Type A
I'm a recovering Type A, maybe with a bit of Type C chucked in!
Like alcoholics, I'm not sure my treatment will ever be entirely complete, but I'm on the right track.
I've always strived to achieve. To achieve with the hope of being 'good enough' for the parental figures in my life – be they at home or work. Having always found good grades fairly easy to come by at school I expected the trend to continue in work, sometimes sorely disappointed by the different type of race being run there with politics and relationships suddenly part of the game – not just working hard to deliver 'the work'.
When did you last check under your carpet?
It's not that unusual for people to cry when they work with me. Stopping the daily busy-ness and task-focused activities to pause, reflect and to think well can often bring things to the surface that people hadn't noticed were there. Our always-on and busy lives lead us to sweep things under the carpet and carry on with an "it's all fine" and "I'm fine" face on. Sometimes a client's upset is "normal level" upset, sometimes it's a symptom of medically-recognisable anxiety for which they need different help than I can provide. And when I say anxiety, don't picture "jibbering mess, barely able to function". Instead picture the reality which is genuinely what's in front of me – capable, confident leaders who are very skilled at what they do and who are able to hide their anxious turmoil REALLY well.
Learn > Connect > Do : Wellbeing and the Thinking Environment
A week ago on 9th March was the latest Learn > Connect > Do : an event held quarterly in Leicester which is for people professionals who care about making work better through doing great people stuff. These are also people who care about giving back while they learn and I'm delighted that we raised a fantastic £130 for Twenty:Twenty through ticket sales. This will enable a young person to get support with transport costs to get to their local centre to learn, or to go for a day out to celebrate their learning successes! And even more than that, with the professional backgrounds we have there are so many other ways delegates can get involved and support these young people into jobs they might never have considered an option before.
The Soulless Hotel Room
For this post I'm delighted to be hosting a piece from Andrew Page. I worked with Andrew and a number of his fellow leaders alongside Lane 4 as part of their leadership development programme at Loughborough Uni, and I subsequently went on to work with more of the Anglian team at one of their main UK locations.


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Storytelling is an art form that has been passed down through generations, centuries, and even millennia. The only differing part between the ages is how it has evolved. Different mediums offer different insight on how perspective is taken on a single story. Take a look into my medium; a different perspective of storytelling.
Michael D. Arteaga // COG Cinemas
I'm a songwriter, as well as a musician. A storyteller, as well as a performer. The arts have changed my life by showing me the endless possibilities of the creative mind. Whether you're marketing an idea, visualizing a concept, or creating a project, your only limit is you. I hope to share my passion with others, inspiring them in the same way that I've been inspired by others before me. It's said that true progress can only be made from outside of your comfort zone, so let's push the boundaries and seek discomfort.
Having recently graduated from Cal Poly Pomona as a Double Major in Marketing Management and Music Industry Studies, I seek to further understand the connection between the creative and business industries. With such a diverse personal background as a musician and filmmaker, it's my goal to continue to inspire others by doing what I love and finding new ways to excite others in what they do.
Let's Create
IG @cogcinemas // @__dcmbr__
Wedding Films
There's always something new to witness with every couple that every story always turns out differently. From the high school sweethearts to the lovers who met randomly because of a name mix up, we continue to love the couples who entrust us with their big day and capturing some of their most intimate moments. With each story we continue to tell, they then become a part of our own bigger picture.
Social Media Films
Connecting with an audience can be a challenge in itself, but capturing them is another ball game. With only seconds to deliver something worthwhile to eager eyes, I strive to make each as impactful as the last with either something visually appealing or thoughtfully remembered. With brands like Creamistry, Yes Theory, Spinitar, Churned, LogicLink, and more, I've used the social media platform to an advantage in order to captivate new and loyal audiences alike.
Adventure Films
It's been known that stepping outside your comfort zone is where you'll grow the most. Here you'll find my captured moments from past travels to inspiring visuals including music videos, vlogs, and short form films. COG Cinemas knows no bounds when it comes to storytelling, which means we'll roam the world until each story is told!
Business Films
Clients have chosen COG Cinemas to promote a product, tell their startup story, or to just capture the essence of what they do on camera. Working with fellow business owners and entrepreneurs is one of the greater honors we have as we continue to build our network of motivated and talented individuals.
I currently serve as Director of COG Cinemas. Having established COG Cinemas in 2013, I've used it as an avenue to inspire others through my work, while encouraging creativity and collaboration. In 2014, I joined with Creamistry to create engaging video content for digital marketing across their social media platforms for national and international franchise locations. Additionally, I've worked with other companies to showcase their products such as Cryptopreneur, one of the first franchise-model crypto-mining startups; Yes Theory, an entrepreneurial brand of thrill seekers who seek to challenge society's comfort zone; Churned Creamery, Spinitar, LogicLink, and more.
COG Cinemas aims to know you and your mission, striving to serve and tell your tale. Because it all matters in the greater scheme of things. We're all just COGs, part of a Greater Machine.
COG Cinemas aims to know you and your mission, striving to serve and tell your tale. Because it all matters in the greater scheme of things. We're all just COGs, part of a Greater Machine.


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