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Cindy Au's usual ride is a Camry, but look for her in something a little more high tech when the Shell Eco-Marathon comes to town later this month.
Au is a member of one of four teams the University of Houston will field for this year's competition, which challenges students to design, build and drive energy efficient cars. It will be held April 25-27 at Discovery Green (1500 McKinney St.).
The cars themselves look like futuristic Formula 1 racing cars, even though top speed might be 20 mph. Some will be powered by old-fashioned gasoline, but others will be fueled by sunlight, electricity, natural gas or hydrogen.
Au, a senior mechanical engineering student, will serve as driver for the three-wheeled, ultra-light electric car designed and built by Team Primer. She also is in the group working on safety, braking and steering issues.
The UH teams, two from the Cullen College of Engineering and two from the College of Technology, began working on the cars in September. In some cases, the work began even earlier.
The Shell Eco-Marathon is an international competition run by the energy company; the North American competition has been held in Houston for the past few years.
Split into two classes – a prototype class, focused on maximum efficiency, and an urban concept class that encourages more practical designs – the competition allows students to enter cars in one of seven categories: gasoline, diesel, biofuel, fuel made from natural gas, hydrogen, solar or electric.
Contestants travel as far as possible on the equivalent of one liter of fuel, driving at a set speed.
The cars serve as senior projects for both the 10-member Team Primer and the Dream Team, a three-member group of mechanical engineering technology students.
"You can implement almost everything you've learned," said Ryan Haire, a mechanical engineering technology senior and a member of the Dream Team, which is building a car that will run on a gas-to-liquid fuel provided by Shell. Made from natural gas, the fuel has fewer greenhouse gas emissions than gasoline or diesel.
All four teams have spent thousands of hours on the projects, and they aren't quite finished.
"They're learning 'real' engineering, specifying and buying parts … and they're putting everything together," said Richard Bannerot, a professor of mechanical engineering and advisor for Team Primer.
It hasn't been easy.
"None of us have previous car experience," Haire said of the Dream Team. "This is a new experience altogether."
The Dream Team predicts their car will get 120 mpg, thanks partly to a driving strategy that involves accelerating through turns, then killing the engine and rolling. Top speed will be about 20 mph.
Team Primer's car – a plug-in battery will power a motor fitted into the single rear wheel – is rated for 50 mph but will be go considerably slower for safety reasons, said team leader Ryan Hannemann, who was named the Cullen College of Engineering's Outstanding Senior student this year.
He said the battery will be able to go further than 100 miles on a charge.
The Team Primer car and one powered by a hydrogen fuel cell will be on display in the Engineering 1 building Wednesday morning, April 9.
The Dream Team will have their car on display during the city's Earth Day celebration Saturday, April 12, team leader Alexus Romero said.


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Mother's Day Hats
In honor of the special day where we get to celebrate our mothers for all their hard work, love, and compassion they've given us, we've put together a special list of some of our best selling hats not only from our website but from all of our physical stores as well. most of the hats below are perfect for the spring and summer seasons as well and consist of straw hats, visors, some lite wool felt hats, and fabrics. All of these hats are guaranteed to be a great styles that your mom or wife will love!

subset: commoncrawl


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[Pub.22Mmu] Download :
Lady Ce'cil PDF
by Carol Goodnight : Lady Ce'cil
ISBN : #0997152826 | Date : 2017-05-11
Description :
PDF-30e66 | A short story inspired by A Kiss in Darkness from the Carolyn Wingate Novella Series…. Lady Ce'cil
Download eBook Lady Ce'cil by Carol Goodnight across multiple file-formats including EPUB, DOC, and PDF.
PDF: Lady Ce'cil
ePub: Lady Ce'cil
Doc: Lady Ce'cil
Follow these steps to enable get access Lady Ce'cil:
[Pub.20pIQ] Lady Ce'cil PDF | by Carol Goodnight
Lady Ce'cil by by Carol Goodnight
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Your Extension Anywhere
Deskphone, Smartphone, or Computer - your system extension can be wherever you are.
Whether you operate a local office, have teleworkers, or manage a call center or hotel, we have budget concious solutions to meet your needs.
About 3CX
3CX is an open-standard, software based phone system with feature-rich Unified Communications functionality included.
Unified Communications Built-in
3CX's integrated web conferencing solution allows users to host web meetings from anywhere.
3CX easily converts voicemail to email and sends inbound faxes directly to your inbox all without having to purchase additional software.
Control your extension and manage your call flow using 3CX's powerful Webclient. View the status and interact with your colleagues using 3CX's presence and text chat functionality. 3CX's award winning platform is feature rich - see more.
CRM Integrations
3CX integrates with many popular CRM & office applications and includes a scripting interface to connect others.
Launch calls from your CRM or get screen-pops from inbound callers and much more!
Hotel Centric Features
3CX integrates with many PMS systems to make guest interactions seamless and professional.
Display guest names on reception, room server, and management phones. Provide wake up calls, check in/out or set DND. Allow housekeeping to set room status right from the phone and more.
Call Center Features & Management
3CX Pro & Enterprise editions include powerful call center management features such as wallboard, call queuing, in-depth reporting and more!
Monitor and manage your agents with barge, listen, and whisper functionality. Track in real-time and review reports on critical call statistics such as queue length, SLA, Callbacks, agent performance metrics and much more.
Why IronLogix?
There are many 3CX partners but IronLogix knows that your phone system should be the gateway to a great customer service experience. We offer complete turn-key and fully customized implementations that will exceed your expectations.
Our experienced, certified, staff has the knowledge and expertise to deliver efficient and productive interactions so that your callers don't experience endless loops of automated options when all they want to do is talk to someone.
The IronLogix ongoing support experience is unparalleled. Whether you are looking for a new phone system or just need someone to support your existing 3CX system, talk to us.


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How to Achieve Maximum Success with Businesses
What You Need to Know About an Asphalt Roof
Whenever it is a budget-friendly option that you will choose to have that you also have to see to it that you will be choosing an asphalt roofing. Due to the affordability that it has that it is also one of the main options that builders and homeowners have. A durable and an easy to repair material is what you will get once you will choose this one and this is also reason why many people choose it. It can also be a great option whenever you will choose this material especially when planning to have a roof replacement.
Whenever you are able to choose an asphalt roof that it is also the one that can match any types of homes. For the roof that you have that it is you that will be able to choose different colors and styles of design. Whenever it is you that will have a high-end roofing project that there are also high-end shingles that you will be able to choose in the market today. It is this one that can match the look that you want to achieve. Different features and look is what one can also have when choosing to have an asphalt shingles making it easier for you to achieve the overall look that you want in your home. There are also asphalt shingles that have designs similar to that of a wooden or metallic roof.
It is important to take note that despite the affordability and accessibility that you can have with these materials that they still can come with quality. Depending on the conditions that you have that these materials can last for up to ten years. It is the weather and wind that will be the basis for its longevity. You have to remember that whenever there are strong winds that these materials can get damaged. Whenever heavy rains are also common in your area that these materials that can get damaged for that as well. Whenever these damages are what you will have that it is the one that can be covered by it. Replacing the roof that you have by the insurance policy that you got is what will commonly happen especially when you are hit by a major storm.
Despite the fact that these materials have already been damaged that it is still possible to repair it by sections. A much better option is what you will get with this one instead of replacing the whole thing. Being nailed into the roof by rows is how these asphalt shingles are installed. It is only the rows that have been damaged that will be removed and replaced. It is the rest of the roof that will remain intact once this is done.
It is this one that is the best choice that you can have in the market whenever you are looking for a great bargain.
How to Achieve Maximum Success with Businesses


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We've seen a lot of projects that let you control all of your devices from a smartphone. But this universal web-based remote control system looks like the most versatile we've seen yet. The project is called Webmote as the controls are served up as a web interface so that you're not limited to say an Android device. The UI can be customized by choosing what buttons you will use and where to place them on the display. You can get a good feel for this by viewing this G+ album. Setup is made a bit easier thanks to an add-on system that has predefined layouts for common things like controlling XBMC.
The hardware seen above is the business end of Webmote. It's an Arduino with an IR receiver, IR LED, and an XBee module. For your common home entertainment devices you can teach the system your codes using the IR receiver. The IR LED is used to transmit those codes back, and the Xbee gives you the ability to control X10 (home automation) devices. Right now the setup requires the hardware be connected to a server via USB, but it shouldn't be hard to set up some type of wireless alternative.


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"The redeemed have all their objective good in God. God himself is the great good which they are brought to the possession and enjoyment of by redemption. He is the highest good, and the sum of all that good which Christ purchased. God is the inheritance of the saints; he is the portion of their souls. God is their wealth and treasure, their food, their life, their dwelling place, their ornament and diadem, and their everlasting honor and glory. They have none in heaven but God; he is the great good which the redeemed are received to at death, and which they are to rise to at the end of the world. The Lord God, he is the light of the heavenly Jerusalem; and is the 'river of the water of life' that runs, and the tree of life that grows, 'in the midst of the paradise of God'. The glorious excellencies and beauty of God will be what will forever entertain the minds of the saints, and the love of God will be their everlasting feast. The redeemed will indeed enjoy other things; they will enjoy the angels, and will enjoy one another: but that which they shall enjoy in the angels, or each other, or in anything else whatsoever, that will yield then delight and happiness, will be what will be seen of God in them."
–Jonathan Edwards, The Sermons of Jonathan Edwards: A Reader. (New Haven: Yale University Press, 1999), pp. 74-75.


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pumpkin images
Shutterbug Saturday: Halloween Local 4.0
The mood of our country isn't really conducive to decorating or celebrating. There are a few highlights, here but, our town isn't showing a lot of Halloween spirit. It's a complete shame but, I managed to get a few shots. ~Vic
Halloween Local 3.0


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Fenix el Despertar de Joe Hillson
Unete a Joe Hillson en una aventura por Londres para salvar al mundo de Kent, un cientifico [...] See book
We present you the books of Fantasy in e-book tagged in amistad-y-amor that match your search. In Bubok we have thousands of books that you can not find anywhere else, books by new authors that enrich your books with our works and that we offer you to enjoy.
Do you want to lear more on how to publish your work? Leave us your phone and we call you without obligation.


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Press Release
Akumin to Host Third Quarter 2020 Financial Results Call on November 12, 2020
News Provided by Akumin Inc. / Nov 2, 2020. 7:16am ET
November 2, 2020 – Plantation, FL – Akumin Inc. (NASDAQ/TSX: AKU) ("Akumin" or the "Company") will host a conference call at 8:30 a.m. Eastern Time, November 12, 2020, to discuss its third quarter 2020 financial results.
To access the conference call, dial toll-free in the U.S. or Canada 888-231-8191 or, for international callers, 647-427-7450. Participants are asked to connect at least 10 minutes prior to the beginning of the call to ensure participation. There will also be simultaneous and archived webcasts available at https://akum.in/Q3-2020-Results. The webcast archive will be available for 90 days. A replay of the conference call will also be available until Thursday, November 19, 2020 by calling 416-849-0833 or toll-free 1-855-859-2056, using passcode number 5482562.
About Akumin
Akumin is a leading provider of freestanding, fixed-site outpatient diagnostic imaging services in the United States with a network of owned and/or operated imaging centers located in Florida, Texas, Pennsylvania, Delaware, Illinois, Kansas and Georgia. By combining our clinical expertise with the latest advances in technology and information systems, our centers provide physicians with imaging capabilities to facilitate the diagnosis and treatment of diseases and disorders and may reduce unnecessary invasive procedures, minimizing the cost and amount of care for patients. Our imaging procedures include MRI, CT, positron emission tomography (PET), ultrasound, diagnostic radiology (X-ray), mammography, and other interventional procedures.
Forward-Looking Information
Certain information in this press release constitutes forward-looking information. In some cases, but not necessarily in all cases, forward-looking information can be identified by the use of forward-looking terminology such as "plans", "targets", "expects" or "does not expect", "is expected", "an opportunity exists", "is positioned", "estimates", "intends", "assumes", "anticipates" or "does not anticipate" or "believes", or variations of such words and phrases or state that certain actions, events or results "may", "could", "would", "might", "will" or "will be taken", "occur" or "be achieved". In addition, any statements that refer to expectations, projections or other characterizations of future events or circumstances contain forward-looking information. Statements containing forward-looking information are not historical facts but instead represent management's expectations, estimates and projections regarding future events.
Forward-looking information is necessarily based on a number of opinions, assumptions and estimates that, while considered reasonable by Akumin as of the date of this press release, are subject to known and unknown risks, uncertainties, assumptions and other factors that may cause the actual results, level of activity, performance or achievements to be materially different from those expressed or implied by such forward-looking information, including but not limited to the factors described in greater detail in the "Risk Factors" section of our Annual Information Form dated March 31, 2020, which is available at www.sedar.com. These factors are not intended to represent a complete list of the factors that could affect Akumin; however, these factors should be considered carefully. There can be no assurance that such estimates and assumptions will prove to be correct. The forward-looking statements contained in this press release are made as of the date of this press release, and Akumin expressly disclaims any obligation to update or alter statements containing any forward-looking information, or the factors or assumptions underlying them, whether as a result of new information, future events or otherwise, except as required by law.
For further information:
R. Jeffrey White
Investor Relations


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Baseball Era Universal Hawaiian Shirt
Frequently Bought Together:
Baseball Era Universal Hawaiian Shirt
SIZE: Available in sizes S – 5XL
CARE INSTRUCTIONS: Hand wash or machine wash on a gentle cycle in cold water. Hang dry or tumble dry on low heat. Do not bleach or iron directly on the design.
PACKAGING: Packaged in a protective plastic bag to ensure that the shirt arrives in perfect condition.
CUSTOMER SERVICE: If you have any issues with your shirt, please contact our customer service team for assistance. We are dedicated to ensuring that you are completely satisfied with your purchase.
AVAILABILITY: Available for purchase online.
Overall, this Baseball Era Universal Hawaiian Shirt is a perfect choice for those looking for a comfortable, stylish, and customizable shirt that is suitable for a variety of occasions. Made of 100% Kate Silk, this shirt is breathable and of good quality. It is designed with a regular fit and casual button-down style that is customizable and flexible. The shirt is available in a range of sizes, and comes with easy care instructions. Packaged in a protective plastic bag, this shirt is available for purchase online only. If you have any issues with your purchase, our customer service team is dedicated to ensuring your satisfaction. Don't wait, order yours today!


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XP loses ground to Windows 7 but still top OS
The 10-year-old operating system saw its market share drop in February but it still commands a leading 45 percent.
Windows XP lost more users to Windows 7 last month, but the decade-old platform continues to hold on as the most popular operating system
Looking at OS stats for February, NetApplications found that XP's share of the market dipped to 45 percent from 47 percent in January. At the same time, Windows 7 grabbed 38 percent of all users, up from 36 percent the prior month.
The latest numbers show a trend in which XP has gradually lost share over time, while Windows 7 has picked up more customers. In February 2011, XP owned more than half of the market at 57 percent, while Windows 7 had just a 24 percent share. And though XP climbed slightly in January, it now seems on the decline once again.
Over the past year Windows 7 has been winning an extra percentage point or two most months and has risen steadily each month since its debut more than two years ago. The punching bag of operating systems--Windows Vista--has kept losing more of its audience, now resting with just 8 percent of the market.
Microsoft continues to convince people to move away from XP toward Windows 7.
The company has reminded consumers and especially companies that support for XP runs out in April 2014, at which time security patches, bug fixes, or other updates will no longer be available.
And despite its considerable effort in creating Windows 8, Microsoft has advised businesses still on XP not to wait for the new OS and instead migrate to Windows 7 now. The software giant unveiled its new Windows 8 beta, or Consumer Preview, yesterday at the Mobile World Congress in Barcelona, Spain.
The Windows 8 Developer Preview, which launched in September, accounted for just 0.3 percent of the market in February, according to NetApplications. It'll be interesting to see how much of a share the Consumer Preview is able to carve off for March when the research firm releases its next report.


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Long recognized as producing the purest, most realistic simulator of on-water rowing, WaterRower has been dedicated to handcrafting rowing machines of exceptional quality and design since 1988.
Benefits of the WaterRower
The Ultimate Cross Trainer
Includes Series 4 performance monitor
Award Winning Design - The WaterRower has been designed to set it apart from other fitness equipment, featuring an attention to detail unseen in other exercise equipment (learn more about award winning design)
Refined Design - The WaterRower has been designed to set it apart from other fitness equipment, featuring an attention to design refinement unseen in other exercise equipment.
Hand Crafting - WaterRower's wooden models are handcrafted from a selection of the world's finest hard woods (Ash, Cherry, Walnut, Beech and Oak).. Each model is hand finished and coated with Danish oil giving it a deep penetrating Lustre (Learn more about Handcrafting)
Sustainably Eco-Friendly - all our wooden models are crafted from the finest Appalachian hardwoods sourced ONLY from replenishable forests (learn more about Appalachian forests)
Styled to Compliment your Environment - There is a WaterRower model to compliment any environment, Home, Office or Gym. Soothingly Silent The WaterRower's silent operation means it may be used anywhere, at any time without imposition on those around you. (view all Waterrower models) or click a model in the showcase above for details, specifications, and a 360 degree view.
Functional Fitness Furniture - Fitness is not a workout, it is a series of workouts spread conveniently throughout the weeks, months and years.
Stores with Ease - Good looks and a compact frame the WaterRower stores conveniently on end simply and easily when not in use. (Learn more about Ease of Storage)
Silent and Unintrusive - The WaterRower has been designed to be silent, with all but the soothing sound of moving water.
Perfect Exercise - Rowing has long been recognized as the perfect aerobic pursuit; working 84% of your muscle mass, Spreading the work evenly over all major muscle groups, the WaterRower is unrivalled in its replication of the real thing.(read more on the Perfect Exercise)
Self-Regulating Resistance - WaterRower's patented WaterFlywheel's varies resistance proportional to the users intensity of exercise, according to the Rule of Cubes, allowing any user of any age and fitness level to use the machine with no adjustment (read more on the Rule of Cubes)
Suitable for ANY User - Suiting the requirement of any user, young or old, fit or unfit, male or female, even a short workout will burn calories, tone your body, and leave you feeling enriched.
Row Anytime - The WaterRower is silent but for the soothing sound of flowing water making it available to use at any time and in almost any place
Workout Monitoring - There are currently three different monitors; The A1, the IndoRow and the S4 Monitor (read more about WaterRower monitors)
IndoRow Monitor
A1 Montor
S4 Monitor
Monitor Comparisons
We-Row - WaterRowers unique community based training program allows you to train with others using the convenience of the internet. You will never train alone again! (requires S2 monitor of higher) (read more on We-Row)
Other Software - WaterRower's open source software philosophy has encouraged development of a wide variety of software over the years. The most notable is Netathlon VR (read more on Netathlon)


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Straight Boy Brendan Patrick Gets Fucked By Hairy Muscle Hunk Jaxton Wheeler
Any video with Jaxton Wheeler in it, almost makes me squirt my load as soon as I see that fucking hot hairy muscle hunk. This new video from Icon Male features Jaxton Wheeler fucking straight boy Brendan Patrick. Jaxton met Brendan at a bar down the street from his house. Brendan wasn't one of the regulars so Jaxton struck up a conversation with him and found out that Brendan just broke up with his girlfriend and she kicked him out of their apartment. After the two guys talk some more, Jaxton invites Brendan over to his condo so he doesn't have to sleep on the streets. Brendan at first isn't sure about staying with a stranger but after a few more drinks, he agrees and they are off to Jaxton's condo. At the condo, Jaxton shows Brendan to the guest bedroom. Alone, he takes his clothes off and strips down to his underwear and gets in the bed. A few seconds later, Jaxton walks in and starts unbuttoning his shirt. Brendan is confused and asks Jaxton if he is in the wrong room. Jaxton just gets in the bed and says there is room for both of them. Brendan turns over and closes his eyes. Jaxton puts his hand on Brendan's arm and starts kissing his back. Brendan turns around, but before he can say anything, Jaxton is kissing him. As the two guys make out, Jaxton starts rubbing Brendan's crotch and the straight boys cock grows rock hard. They both take their underwear off, and Brendan decides to take it farther and starts sucking on Jaxton's thick hairy cock. Jaxton's cock grows hard and he flips Brendan over and starts fucking Brendan's virgin ass. Once he works his thick cock inside of the straight boy ass, he gives him a hard pounding. Brendan moans in pleasure as he is getting fucked by the hairy muscle hunk. The two spend hours fucking in several positions until they are both ready to cum. As they lay next to each other, they stroke their big cocks until Brendan shoots his jizz all over Jaxton's hairy body. Fucking hot!
Click here to watch this full length hairy muscle hunk fucking a straight guy gay porn video and hundreds more amateur gay porn videos at Icon Male.


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Here at GeekTech, we cover a lot of advanced robots, but what we really want to see is progress in the exoskeleton front (think Iron Man suit). Meet Vaudeville (sometimes called Kuratasu), a 12-foot-tall, five-ton mech that you can get inside of and control like a real Mobile Suit.
Vaudeville is a creation of Suidobashi Heavy Industry, a Japanese mecha building enthusiast group made up of a Kogoro Kurata, Wataru Yoshizaki and Yuke Kitani. Vaudeville looks something straight out of a Japanese anime with a bulking body, tiny head, and a crazy looking mobile platform. But it really works, and you can jump into its torso to control it. The whole thing carts around on four-legs with wheels (like a Tachikoma from Ghost in the Shell), and it's powered by a diesel engine that's also located in its torso.
It might seem like you would incredible number of button, switches, and levers just to turn it on–but to the contrary it is really quite simple. The control interface uses a smartphone running V-SIDO software and uses a set of joysticks to control the arms. It also uses Microsoft Kinect head-tracking to rotate the torso and cockpit.
As for the mech's weapon systems, it won't be carrying anything lethal. The only things that Vaudeville will have on board are a water gun and a fully articulated five-finger hand that can easily crush cardboard boxes.
Suidobashi Heavy Industry expects to finish Vaudeville sometime later this year, after which the builders plan to sell it on the open mech market.
[Suidobashi Heavy Industry and Kogoro Kurata via Tested]
Like this? You might also enjoy…
- Cellphone Glove Brings Us One Step Closer to Being Iron Man
- This DIY Tesla Gun Must Be The Deadliest Weapon Ever
- Electric Motorcycle Hits 200 MPH; Breaks Record, Burns Rubber
Get more GeekTech: Twitter – Facebook – RSS | Tip us off | Follow Kevin Lee


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Both 401(k)s and individual retirement arrangements (IRAs) are investment vehicles that allow you to save for retirement. The beauty of these retirement savings accounts is that your contributions are pre-tax, meaning those funds aren't subject to federal income taxes before they're withdrawn in retirement.
Whereas 401(k)s and IRAs serve the same purpose, they have significant differences that can influence which one is right for you. Here are five comparisons that can help illuminate which one best serves your situation and financial needs:
1. Initiation
401(k): An employer (company, nonprofit organization, governmental agency) or a sole proprietor of a small business can establish these plans. In other words, individuals can't start these on their own. If your employer offers such a plan and you participate in it, your employer will routinely withhold from your earnings and contribute to your account the amount you determine, with limitations (see below). As far as the work required on your part, it's usually minimal.
IRA: An individual sets this up with a bank, insurance company or other financial institution, and then adds money to the account as desired, though there are limitations here too (see below). With an IRA, you're responsible for the account set-up and arranging your contributions.
2. Matching
401(k): Some employers offer to match part or all of what their employees contribute to their accounts. Experts recommend that if your employer provides this, you should take full advantage, as an employer match can greatly increase your retirement account's value. However, annual contribution limits, which the Internal Revenue Service sets each year, exist. This applies collectively to all 401(k) accounts you might have in a given year. There's also a limit to the combined contribution of the employee and employer.
IRA: Because an IRA isn't employer-sponsored, matching contributions aren't an option.
3. Contribution limits
401(k): The IRS limits contributions to traditional 401(k)s to $18,000 in 2017, though participants age 50 or older at the end of the calendar year can make catch-up contributions of up to $6,000 above the base restriction. The limit for the combined contribution to these accounts (employer and employee) is either 100 percent of the employee's compensation or $54,000, whichever is less. The latter number jumps to $60,000 if the participant is eligible for catch-up contributions.
IRA: For 2017, the IRS limits IRA contributions to $5,500 — $6,500 if you're 50 or older — or your taxable income for the year. But you should note that some of those contributions may not be tax-deductible, depending on your income or if you or your spouse participates in a workplace-based retirement program, such as a 401(k).
4. Beneficiaries
401(k): According to the terms of the federal Employee Retirement Income Security Act, if you're married, your spouse automatically becomes your 401(k)'s beneficiary upon your death, regardless of whom you listed as the beneficiary. The one exception is if your spouse previously consented in writing to your naming someone else the beneficiary. If you are single, upon your death the individual you named on your beneficiary form becomes the beneficiary.
IRA: Whomever you designate as the beneficiary will, in fact, become the beneficiary upon your passing. This designation doesn't require spousal consent.
5. Loans
401(k): You may be able to take out a hardship loan against your 401(k) depending on the plan and if you're still employed by the employer that established it, says the IRS. Loans must be for less than half of the account balance or, at the most, $50,000. If the plan allows for loans, you generally may take out a five-year loan without penalty — provided you pay it back on time.
IRA: You can't take out a loan against your IRA, but may access money from your account for a 60-day period via a tax-free rollover. In other words, you may withdraw money from your IRA free of taxes and penalties if you return it to the same or a different IRA within 60 days. Should you fail to do so, the withdrawal is subject to income taxes and a 10 percent penalty if you're under age 59 and a half.
Determining whether a 401(k) or IRA is best for you may feel overwhelming at first, but knowing a bit more about their major differences can help make the process much easier.


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We love libraries, and so do our authors! Not only are libraries a place where you have stories and information at your fingertips (for free!), but they are also places of comfort, refuge, and joy.
In this special edition of This is the Author, to celebrate Library Card Sign-up Month, listen to authors Mayim Bialik, Heather Turgeon, Allison Pataki, Grant Wahl, Nathalie Nino, Camas Davis, and Mark & Angel Chernoff share why libraries are so special to them.


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Taiwan's Industrial Technology Research Institute (ITRI), one of the world's largest R&D organizations, has developed e-paper technology which it expects to be used mainly as easily updated signage and posters in shops and other public areas.
ITRI demonstrated prototypes of the e-paper that it aims to commercialize in two years.
The e-paper has the ability to print red, green, and blue in different parts of the paper and a roll-to-roll printing process that is similar to the technology used on a conventional newspaper press that helps cut production cost, ITRI said. The colors cannot however be mixed.
One example of an application for the product that ITRI demonstrated was an e-paper clock that refreshes electronically with each second. Other possibilities include e-wallpaper and e-tickets that can be recycled and reprinted for hundreds of events.
"This is a killer application," said Frank Shiu, deputy division director of ITRI's Display Technology Center.
Commercialized e-paper products could take a bite out of the multi-billion dollar market for conventional paper printing that's dominated by companies such as Hewlett-Packard and Canon, according to ITRI. The flexible display market is expected to surge from US$280 million in 2010 to $5.9 billion in 2015, according to market research firm Displaybank. One of HP's most profitable products is toner cartridges for the printers it makes.
ITRI's e-paper can be printed in a number of ways including with thermal, electrical and physical technology. With small modifications, thermal printers in fax machines can be used to print on the e-paper, Shiu said.
ITRI is working with nine companies in Taiwan to commercialize the technology. It may choose to spin off an e-paper startup company if it can find venture capitalists to provide financing. An alternative would be to do a "spin-in" partnership with a large company, according to Shiu.
The e-paper can be thermally reprinted 260 times, and ITRI aims to increase that number to 500 times during the next year or two.
When ITRI acquired the technology from Kodak in 2007, it could be used to print only monochrome at a resolution of 6 dpi (dots per inch). After three years of development, ITRI has added the ability to print red, green and blue at a resolution of 300 dpi.
Part of the inspiration behind ITRI's development work was the aim to develop products that save energy and reduce carbon emissions, Shiu said. ITRI said that when used in a shop over a 24-hour period, a piece of e-paper measuring five inches diagonally consumes 0.54 watts of power, compared with a five-inch LCD with an LED backlight that consumes 1.2 watts during the same 24-hour period.


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KILLINGTON, Vt. — Swollen rivers began falling Wednesday in much of the Northeast, allowing relief crews to reach the last of the tiny Vermont towns that had been entirely cut off from help by Hurricane Irene's fast-moving floodwaters.
The receding water eased the flooding that had paralyzed parts of the region and revealed more damage to homes, farms and businesses across the flood-scarred landscape. Repair estimates indicated that the storm would almost certainly rank among the nation's costliest natural disasters, despite packing a lighter punch than initially feared.
Of the 11 towns that had been severed from the outside world, the final one to be reached by rescuers was tiny Wardsboro, a village of 850 in the Green Mountains. The community is little more than a post office and some houses standing along Route 100, a highway popular in the fall with tourists searching out autumn colors.
The National Guard continued to ferry supplies to mountain towns that had no electricity, no telephone service and limited transportation in or out. Eight helicopters were expected to arrive Wednesday with food, blankets, tarps and drinking water.
In the ski resort town of Killington, residents came to the elementary school for free hot dogs and corn-on-the-cob. Jason and Angela Heaslip picked up a bag filled with peanut butter, cereal and toilet paper for their three children and three others visiting from Long Island.
"Right now, they're getting little portions because we're trying to make the food last," said Jason Heaslip, who only has a dollar in his bank account because the storm has kept him from getting paid by the resort where he works.
Don Fielder, a house painter in Gaysville, said the White River roared through his house, tearing the first floor off the foundation and filling a bathroom tub with mud. He was upbeat as he showed a visitor the damage, but said he's reluctant to go into town for fear he will cry when people ask about the home he built himself 16 years ago.
Other losses include a 1957 Baldwin piano and a collection of 300 Beanie Babies amassed by his daughter, who does not live with him but has a bedroom at his house.
"I bet that's in the river," he said.
Irene has been blamed for at least 45 deaths in the continental U.S., plus one in Puerto Rico and seven more in the Dominican Republic and Haiti.
If that death toll stands, it would be comparable to 1999's Hurricane Floyd, which caused 57 deaths in the U.S. and the Bahamas when moved through the Caribbean and charged up the East Coast into New England. At the time, it was the deadliest U.S. hurricane in nearly 40 years but was later dwarfed by the 1,800 deaths caused by Katrina in 2005.
An estimate released immediately after Irene by the Kinetic Analysis Corp., a consulting firm that uses computer models to project storm losses, put the damage at $7.2 billion in eight states and Washington, D.C.
That would eclipse damage from Hurricane Bob, which caused $1 billion in damage in New England in 1991 or the equivalent of about $1.7 billion today, and Hurricane Gloria, which swept through the region in 1985 and left $900 million, or the equivalent of $1.9 billion today, according to the Insurance Information Institute.
Even as rivers finally stopped rising in Vermont, New Jersey and Connecticut, many communities and farm areas remained flooded, and officials said complete damage figures were nowhere in sight.
Some New Jersey towns resembled large, soggy yard sales as residents dragged flood-damaged belongings out onto lawns and into streets still muddied with floodwaters.
Large sections of Wallington, N.J. remained underwater after a cruel one-two punch: The Passaic River flooded the heart-shaped hamlet Sunday and then receded, only to rise again late Tuesday, forcing a new round of evacuations.
"Sunday morning, the water was only up to here," said Kevin O'Reilly, gesturing to where his front lawn used to meet the sidewalk. "My daughter and I took a walk around the block. We figured everything would be fine."
Only hours later, waves were bouncing off the house, and the basement windows were shattered.
"It sounded like Niagara Falls," O'Reilly said. "It just filled up immediately, and this is what we've been dealing with since then."
The town is accustomed to moderate flooding because it sits atop a network of underground streams that form a water table already saturated by record August rainfall.
Neighbors had started mucking out flooded basements and piling water-logged furniture and ruined possessions on the sidewalks when the river rose again. The town rushed to place garbage bins on higher ground so debris wouldn't be floating in the high water.
President Barack Obama planned to travel to the northern New Jersey town of Paterson on Sunday to survey damage.
New York Gov. Andrew Cuomo estimated the damage to his state alone at $1 billion during a visit to Prattsville, a Catskills community where 600 homes were damaged by heavy rains and floods that also shredded roads and washed out bridges.
"Upstate New York paid a terrible, terrible price for this storm," Cuomo said.
Downstream from Vermont's devastating floods, the Connecticut River hit levels not seen in 24 years, but Middletown Mayor Sebastian Giuliano said the situation was not much worse than annual spring floods caused by snowmelt.
In Simsbury, Conn., several farm fields were flooded along the Farmington River. Pumpkins and other produce could be seen floating away.
"Farmers lost a good amount of crops," said First Selectwoman Mary Glassman.
After floods in 1955, New England states installed flood-control dams and basins that helped prevent a catastrophe along the lower Connecticut River, said Denise Ruzicka, director of inland water resources for Connecticut's Department of Energy and Environmental Protection.
Power outages persisted across the region, with some of the largest in Connecticut, where more than 360,000 homes and businesses were still in the dark, and Virginia, where 242,000 customers had no lights.
In Killington, residents were volunteering to use their lawn tractors to help remove mud and debris. People with electricity were letting neighbors without water use their showers. One question was whether the camaraderie would wear thin before things returned to normal.
Karen Dalury, who did not have power at her home, said she had been eating vegetables from her garden and storing some in a neighbor's freezer.
"For now it's fine," she said. "But who knows how long this is going to continue."
In North Carolina, where Irene blew ashore along the Outer Banks on Saturday before heading for New York and New England, Gov. Beverly Perdue said the hurricane destroyed more than 1,100 homes and caused at least $70 million in damage.
With Irene gone, scientists turned their attention to the open Atlantic Ocean, where Tropical Storm Katia was gaining strength and forecast to become a hurricane by early next week. Meteorologists said it was too soon to determine where it might go.


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Good Morning, Happy Saturday!
Today I would like to introduce you to Stephanie of Infinite Life Fitness.
She guest posted two weeks ago, showing us how to make our own 100 calorie snacks!
Well, she is going to become a regular contributor of Agape Love Designs.
Well, she is going to become a regular contributor of Agape Love Designs.
With her knowledge on fitness and living a healthy lifestyle I thought she'd make a wonderful
addition to go along side my own posts on my weight loss journey.
Today she is sharing with us FITNESS 101!
Much Love & Hugs,
Today I would like to go over some commonly asked fitness related questions. These questions are usually questions that I get form people who are starting out with a new health and fitness routine.
Much Love & Hugs,
Fitness 101
Today I would like to go over some commonly asked fitness related questions. These questions are usually questions that I get form people who are starting out with a new health and fitness routine.
- How often should I work out?
It is suggested that AT THE MINIMUM 20 minute workout at least 3 times a week. This does NOT include your warm up and stretching routine. For beginners this is a great place to start and as you get used to working out and get a little stronger add time to your workout. You should maintain a moderate intensity level during the WHOLE 20 minutes. An example of this is that you are slightly out of breath but you are still able to talk/communicate during the workout. You are not exhausted but you can still keep up and maintain that exercise for the duration of the workout. Any beginner at a new health and fitness routine needs to take it easy so you do not hurt yourself and so you can build your body up to be prepared to do more intense workouts.
- How many calories can I burn walking/running/jogging a mile?
For every 100 pounds of body weight, you can lose an estimated 62 calories per mile of your workout. So if you weigh 200 pounds, you can estimate to lose about 124 calories per mile of exercise…if you weigh 300 pounds you can estimate to lose about 186 calories per mile of exercise. You can increase the amount you lose per mile if you add weights to your walk/jog/run or incorporate other intense moves during that workout.
- How many calories does it take to burn one pound of fat?
3,500 calories equals one pound. So if you burn 3,500 calories you can estimate to lose one pound, and if you eat 3,500 you can estimate to gain one pound. For example: Let's say you want to lose one pound per week. You can do this by decreasing your calorie intake by about 500 calories each day. The easiest way to do this is by decreasing your diet for one day by 250 calories and burning the other 250 calories with physical activities or with your workout for that day.
- What abdominal exercises can I do to get rid of belly fat?
To be perfectly honest, there is not just one routine or a series of routines that will allow you to get rid of just your belly fat. When it comes to body fat there is no way to fix just one area of your body. You have to have a good cardio workout along with other exercises to help burn those extra calories which in the end will start to burn fat stored all over your body.
- What are some of the health benefits exercising can have for people?
Having a regular fitness routine will allow you to decrease your chances of getting diseases or illnesses that are brought on by obesity. It will lower your cholesterol levels, lower your blood pressure, and allow you to be more physically active. Exercise and decrease you risks for getting heart diseases and also help lower your stress levels during the day. Studies have shown that exercise helps lessen or eliminate depression symptoms, and allow for you to sleep better at night. Working out can help you improve you self-image and allow you to look younger and healthy!
- Other than a healthy diet what else should I be doing to help me with my weight loss?
Getting an adequate amount of sleep each night and drinking plenty of waters. These are two staples things that are needed to help your body when you want to shed some extra weight.
- I started working out with my boyfriend/husband. Why is he losing weight faster than me? Am I not doing something right?
No you are fine. When it comes to weight loss men just have an advantage that women do not have. Traditionally men have more muscle than females. This allows for their metabolism to be slightly higher which in return allows them to burn those unwanted calories a little faster than women. But do not focus on your partners results! Focus on your goals and what you are doing to reach your goals.
- Making home meals for me is not always an option for me. If I have to eat out a lot, what is the best way to eat healthy while I eat at food establishments?
The best thing to do is do some research. You can find almost ANY restaurants nutritional information online. If not, call the company and they should be able to send you something. Find the healthiest options they offer and stick to those options when you go out to eat. Try to stay away from condiments. Ask for your salad dressings on the side (so you can drizzle it on your salad instead of drowning your lettuce in it) and try to stick to soups that are broth based. Vegetables and lean meats are always a good choice. And always remember to try to stick to correct portion sizes so you are not overeating. Try to have water (not coke or sweet tea) with your meal. You do not want to consume half of the calories during the day with the beverages you have with your meals. The best snacks to have are things like string cheese, yogurt, hard boiled eggs, nuts, turkey breast. Try to stay away from processed foods!
I hope that these are some common questions that some of you had and I hope that I helped to answer some of them! Please feel free to check out my website infinitelifefitness.com for more health and fitness related articles.
Dont forget to check out this weeks In Post Sponsor:
Interested in sponsoring "In Post"? Check out my sponsor options {here}!


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12:00pm • October 15
Free on Zoom
This event will take place live on the Zoom platform. Once you register, you will receive an email confirmation, including a link to download a .pdf document with Zoom invitation information for your selected event(s). Please note, for security reasons, you will be required to have a free Zoom account to enter the event. If you have any technical questions, please email email@example.com for information.


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"Mutation" means changing one or more amino acids or nucleotides in a protein or nucleic acid chain. Mutation of a 3D model is modeling, and hence not within the capabilities of Protein Explorer. However, it is quite easy to "mutate" a protein 3D model (PDB file) using DeepView (also called SwissPDB-Viewer), and then explore the resulting mutation structure in Protein Explorer.
To download and install DeepView, look in the DeepView section of the World Index of Molecular Visualization Resources (molvisindex.org).
The following instructions were written for Windows DeepView version 3.7-beta2. If you are using a different version, or a Macintosh, some details may vary.


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Om is not usually a gossip, and his sources are usually very accurate, so his report about SunRocket may be very credible.
I've never been a fan of SunRocket. Don't ask me why, but it came from my gut. Maybe it was the too good to be true pricing model. Maybe it was their "we're better" attitude. Maybe it was affirmed when their very good PR person, Brian Lustig "left" a few months ago. In VOIP he blew away what Vonage had/still has to speak for them and was right up with Earthlink's Carla Shaw who is always helpful to me.
UPDATE-What's sad is SunRocket's new product team was very sharp, Rob Chandhok and Jeremy James, are ex-Qualcomm guys, and my friends at Q said amazing things about the duo, so I had hoped they were not caught up in this. A source updated me overnight and said that "Chandhok was cut as Chief Product Officer for being an ineffective leader" and that "James had left in the last month or so."
This inside source also tells me via a private email that "Om is right on: forty-plus (25% of the staff) were laid off from SunRocket yesterday (Friday). The CTO, CIO, CFO, and CPO were axed too. As far as I know, the only C-levels still there are CEO and CMO. The whole San Diego product team was cut."
I sense that the "airpocket" Om describes is likely more to do with VC's not seeing the value in VoIP due to Vonage's failings.
So the big question I have is if SR goes sideways, or worse, and you ported your phone number to them, how do you get it back..
To me this looks like one more win for the "cable guys" if they, Sun Rocket, end up down and out.
Analysis/Speculation--This was done on the Friday that is leading up to the July 4th holiday. In PR the rule of thumb is you put out bad news on a Friday and hope it will get lost. With the blogosphere, it doesn't. The news is out, thanks to Om.
Second, the impact of this could be due to a pending sale of the company, and that many of the jobs were viewed as duplicated by the new suitors who may already have the same staff on hand-CTO, CIO, CFO, CPO, and others in the product and management group. So by chopping this group before the acquisition, the buyer doesn't have to pay their salaries of later, terminate them and have it impact things like unemployment taxes. The possibility of a pending sales or merger comes to mind because a company like SunRocket can't function without those level executives for too long, so either the new money said "can them" or in order to attract new money and CEO Lisa Hook had to bite the bullet by taking some drastic action to keep the company running in order for what's next to possibly come SunRocket's way. Losing 25 percent of a staff is hard. Cutting the high cost part of the budget helps reduce burn, but who is there to keep things running?


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Is preserving the general environmental conditions that allowed civilization to flourish—a moderate climate, a rich array of species, rivers that reach the sea—necessary to ensure humanity endures? Or is minimizing alterations to the global environment introduced by human activity—rising levels of CO2 from fossil-fuel burning, widespread extinction, dams that impound water—more important to our success? Choosing the right approach is vital as the scale of human impact on the planet becomes so large that scientists are calling this new epoch in Earth's history the Anthropocene (when human activity alters global climate and ecosystems).
One bid for preservation initiated in 2009 by 29 scientists from around the world focused on the concept of planetary boundaries. They identified 10 environmental limits we might not want to transgress in the Anthropocene: aerosol pollution; biodiversity loss; chemical pollution; climate change; freshwater use; changes in land use (forests to fields, for example); nitrogen and phosphorus cycles; ocean acidity; and the ozone hole. That meme has now spread to the United Nations, and is driving ongoing global talks to address environmental problems, including the much-anticipated Rio+20 summit meeting that begins next week in Rio de Janeiro.
But a new analysis from environmental policy think tank the Breakthrough Institute released June 12 argues that such a focus on environmental restoration is actually counterproductive when it comes to overall human welfare. "The planetary boundaries framework is not a useful guide for policy or environmental management in any concrete sense, as it does not capture the challenges involved in most of the environmental problems it lists," argues geographer Linus Blomqvist, policy associate at the institute's Conservation Program and co-author of the review. "They should be discarded."
Specifically, Blomqvist and his colleagues argue that six of the 10 boundaries—land use, biodiversity, nitrogen cycle, freshwater use, aerosol and chemical pollution—do not have a hard limit at planet-scale physical thresholds that, if transgressed, would tip them into functioning differently. For example, managing a given watershed may make more sense than managing the amount of global freshwater consumption to stay below an arbitrary, sustainable "limit" of 4,000 cubic kilometers per year.
Further, breaking any of these boundaries might not have any negative impact on humanity. Indeed, cutting back on, say, nitrogen fertilizer could significantly set back human welfare given that more than half of the people on the planet are fed by food grown with synthetic fertilizer. A pristine rainforest, after all, provides less direct benefit to humanity than additional food production. Instead, society should focus on environmental trade-offs, the review argues. "The real limitations for sustainability are rather our ability to grow enough food, maintain a healthy climate and so on," Blomqvist says, although the analysis fails to offer its own limits or policy suggestions other than focusing more on climate change.
Reducing the emissions of the greenhouse gases that cause global warming makes the most sense in the context of planetary boundaries, and many of the other thresholds collapse into it, Blomqvist and his colleagues note. That makes climate change the defining boundary of the Anthropocene. "Arguably, the single most important measure to ensure climate stability is reform of our energy and transport systems," Blomqvist says. "There is every reason to regard the Holocene climate as desirable." (The Holocene epoch extends from about 12,000 years ago to the present.)
Although the 2009 study's authors also noted no thresholds exist for some of their planetary boundaries they proposed limits on land-use change, freshwater, nutrients and biodiversity based on two criteria. First, they help determine the resilience of ecosystems on land and at sea, which in turn impact whether larger boundaries, such as climate change, are transgressed. Second, they are associated with tipping points at the local scale. After all, when a large enough number of local ecosystems transform, a global shift occurs, notes Johan Rockström, one of the authors of the planetary boundaries concept and a natural resource management professor at Stockholm University.
"It would be good to define planetary boundaries at multiple scales—local, regional and global," adds ecologist Jonathan Foley, director of the Institute on the Environment at the University of Minnesota and a co-author of the planetary boundaries concept. But "if there are major changes in the global environment, beyond what we have experienced in the Holocene, then this could represent a serious disruption to our civilization."
Many of the criticisms offered by the Breakthrough Institute were raised in the original paper that presented the planetary boundaries concept, published in Nature on September 24, 2009. (Scientific American is part of Nature Publishing Group.) Blomqvist concedes that point, yet he says: "Given the sometimes naive reception of the [planetary boundaries] concept, we thought it was worthwhile pointing out."
Other scientists have criticized the planetary boundaries as too generous (for example, allowing too much human appropriation of freshwater flows) or employing the wrong metric (atmospheric concentrations of CO2 rather than cumulative emissions of greenhouse gases).
At the same time any effort to identify a safe operating space for humanity must grapple with the fact that humans, on the whole, have never been better off—whether the metric be population, wealth or some other measure. Any ecological degradation has not led to a collapse in human welfare.
The point of the planetary boundaries, according to its authors, is to enable an enduring human prosperity that doesn't destroy the planet's natural resources in the process—ultimately undercutting that good fortune. After all, the present wealth and attendant short-term boost in population, consumption and technological growth may be largely founded on longer-term deterioration of the planet, including declining fish populations, acidifying oceans, degrading soils, remnant forests, polluting watersheds and a transforming climate. "Future generations will pay the price for this," Foley argues, unless human activity is redirected. "I'm still hopeful that we can do this, but it will represent a massive shift from our current way of running the world."
Blomqvist agrees: "We must not destroy the ability of future generations to enjoy a healthy, good life by depleting resources for short-term gain." In addition, he says, "humans everywhere want food as well as beautiful landscapes and a rich biological heritage."
The difference in approach comes down to how best to manage the Anthropocene: through planetary boundaries suggested by the environmental systems that allowed the epoch to come about or through local or regional efforts aimed at weighing the complex trade-offs among human resource use, ecological needs and a global push to combat climate change. "Arbitrary boundaries are not helpful and, if anything, can be dangerously misleading on local and regional levels," Blomqvist maintains. And "critical transitions" or "tipping points" as suggested by the planetary boundaries concept may not exist for many of the cases because those shifts, if they exist, have already happened. "Earth has already been fundamentally and thoroughly transformed by humans," Blomqvist notes. "Saying that land-use change has a tipping point in this respect is like saying that there's a tipping point for methane-farting cows."
But now that planetary management is no longer a luxury but a necessity, many policymakers, including some of the nations gathering in Rio this month, have adopted the 10 boundaries as their negotiating framework. That suggests that such planetary lines in the sand are of at least some utility, although researchers will continue to revise them in a bid to help create an enduring home for humanity. "I see it as a useful framework for dealing with the complexities of managing the planet," Foley says. "We will see how the ideas are useful—or not—in the coming weeks and months."


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Online Registration (Search by Course #) Opens a New Window.
Come try out one of the fastest growing paddle sports in the USA. Pickleball is a cross between badminton, tennis and ping-pong. This is a great opportunity to keep physically fit and have fun. Rules and basic fundamentals will be covered in a kid friendly environment. Players will get the chance to work with adult pickleball enthusiasts and play other kids in various games throughout the season! No previous experience is required. All players will receive a paddle and ball to keep, along with practice instructions.


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Top Items:
Loïc Le Meur / Loic Le Meur Blog:
Twitter: We Need Search By Authority — There were more than 7000 tweets posted during the two days of LeWeb, no way anyone can read them quickly. We need filtering and search by authority. We're not equal on Twitter, as we're not equal on blogs and on the web.
Robert Scoble / Scobleizer: Mike and Loic are wrong about Twitter search
Dave Winer / Scripting News: Social search, not authority-based
Warner Crocker / Life On the Wicked Stage: Twitter and A Little Brief Search Authority
Zennie Abraham / Zennie62: Loic Le Meur's Call For Twitter "Search By Authority" Is Misguided and Self-Serving
Sam Harrelson / CostPerNews: Fallacy of Twitter Authority Based on Followers
Daniel Tunkelang / The Noisy Channel: Loic Le Meur Misses the Point of Twitter
Frederic / The Last Podcast: We Don't Need Authority on Twitter
MG Siegler / ParisLemon:
Bitchmeme: On Twitter You Will Respect My Authori-tay — I'm so glad Bitchmeme is back, because it gives me the opportunity to weigh in on what is an awful idea. Authority search in Twitter. — Now let me be clear, the most basic form of the idea isn't an awful one …
Michael Arrington / TechCrunch:
Should Twitter Add Authority-based Search? — Loic Le Meur is asking Twitter to add an authority filter to their search (he also goes on a rant about Sprint, but ignore that). He wants to sort through Twitter messages based on how many followers the person writing has, so he'll know the relative importance of what's being said.
Newest Videos:
The "I'm Linux" Video Contest — If you've been alive and aware of mass media over the last twelve months, you've probably seen television commercials from Apple and Microsoft touting their operating system. From Apple's ubiquitous "I'm a Mac" to Jerry Seinfeld to Microsoft's "I'm a PC" …
Lee Mathews / Download Squad:
Windows 7 Beta ISO leaked on torrent trackers — Apparently you won't even have to wait until January to get your hands on the Windows 7 Beta release as I mentioned in a previous post. That's right, there's already been an ISO file leaked to several torrent trackers.
Julio Franco / TechSpot: Windows 7 Beta 1 is ready, leaked
Robert Winnett / Telegraph:
Internet sites could be given 'cinemastyle age ratings' Culture Secretary says — Internet sites could be given cinema-style age ratings as part of a Government crackdown on offensive and harmful online activity to be launched in the New Year, the Culture Secretary says.
Discussion: Guardian, Guardian and Press Association
Charles Arthur / Guardian: Oh, Mr Burnham, must you learn about the internet the hard way?
Gavin Cordon / Press Association: Age-ratings plan for websites
Associated Press:
UK Minister: Internet age ratings may be needed
UK Minister: Internet age ratings may be needed
Discussion: p2pnet
Timothy / Slashdot:
Fairpoint Pledges To Violate Net Neutrality — Fairpoint Communications, which has taken over Verizon's landline business in Maine, New Hampshire and Vermont, has announced that on February 6 'AOL, Yahoo! and MSN subscribers will continue to have access to content but will no longer be able …
Discussion: Rutland Herald
Michael Arrington / TechCrunch:
F**ked Company/Adbrite Founder Philip Kaplan To Launch Kaplan Index — People are urging Philip Kaplan to restart his F**kedCompany site that gathered so much attention earlier this decade. Clone sites are popping up to fill the void during this down market, and people sort of see the world …
Discussion: Gawker
Owen Thomas / Gawker: F**kedCompany Founder to Launch "Kaplan Index" Site
Tim O'Reilly / O'Reilly Radar:
Google, WalMart, and MyBarackObama.com: The Power of the Real Time Enterprise — What do Google, WalMart, and MyBarackObama.com have in common, besides their extraordinary success? They are organizations that are infused with IT in such a way that it leads to a qualitative change in their entire business.
Robin Wauters / TechCrunch:
Cuil Fail: Traffic Nearly Hits Rock Bottom — Remember the ill-fated Google-killer Cuil? Named 'Cuill' and very much in stealth mode for the first part of the year, they finally emerged end of July 2008 with a 'massive' search engine that would rival the most popular search engines …
Discussion: Communications …
Alana Semuels / L.A. Times Tech Blog:
Lalawag hopes to get tongues wagging about L.A. technology — It might be the final sign that the L.A. tech scene is something to be reckoned with. Months after Gawker Media laid off much of the staff of Silicon Valley news and gossip site Valleywag, an independent news and gossip site …
Discussion: Sean Percival's Blog
Sean Percival / Sean Percival's Blog: lalawag in the LA Times
Keith J. Kelly / New York Post:
IT COULD GET CONDé NASTY — WEB, DOMINO, DETAILS COULD BE 'JANUARY SURPRISE' VICTIMS — Condé Nast Chairman S.I. Newhouse Jr. is slated to return from his extended annual European vacation next week and already insiders are growing nervous ahead of his "January surprise."
Discussion: Silicon Alley Insider and Gawker
Henry Blodget / Silicon Alley Insider: Conde Nast May Whack Some More
Owen Thomas / Gawker: The Media Depression Arrives


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Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort studyBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f521 (Published 14 February 2013) Cite this as: BMJ 2013;346:f521
- Peter K Lindenauer, associate professor of medicine123,
- Tara Lagu, assistant professor of medicine123,
- Michael B Rothberg, associate professor of medicine123,
- Jill Avrunin, statistician1,
- Penelope S Pekow, senior statistician14,
- Yongfei Wang, lecturer in medicine, senior statistician56,
- Harlan M Krumholz, Harold J Hines Jr professor of medicine567
- 1Center for Quality of Care Research, Baystate Medical Center, Springfield, MA 01199, USA
- 2Division of General Internal Medicine, Baystate Medical Center, Springfield, MA, USA
- 3Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
- 4Division of Biostatistics and Epidemiology, Department of Public Health, University of Massachusetts-Amherst, Amherst, MA, USA
- 5Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- 6Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- 7Section of Health Policy and Administration, Yale School of Public Health, Yale University, New Haven, CT, USA
- Correspondence to: P K Lindenauer peter.lindenauer{at}bhs.org
- Accepted 11 December 2012
Objectives To examine the association between income inequality and the risk of mortality and readmission within 30 days of hospitalization.
Design Retrospective cohort study of Medicare beneficiaries in the United States. Hierarchical, logistic regression models were developed to estimate the association between income inequality (measured at the US state level) and a patient's risk of mortality and readmission, while sequentially controlling for patient, hospital, other state, and patient socioeconomic characteristics. We considered a 0.05 unit increase in the Gini coefficient as a measure of income inequality.
Setting US acute care hospitals.
Participants Patients aged 65 years and older, and hospitalized in 2006-08 with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia.
Main outcome measures Risk of death within 30 days of admission or rehospitalization for any cause within 30 days of discharge. The potential number of excess deaths and readmissions associated with higher levels of inequality in US states in the three highest quarters of income inequality were compared with corresponding data in US states in the lowest quarter.
Results Mortality analyses included 555 962 admissions (4348 hospitals) for acute myocardial infarction, 1 092 285 (4484) for heart failure, and 1 146 414 (4520); readmission analyses included 553 037 (4262), 1 345 909 (4494), and 1 345 909 (4524) admissions, respectively. In 2006-08, income inequality in US states (as measured by the average Gini coefficient over three years) varied from 0.41 in Utah to 0.50 in New York. Multilevel models showed no significant association between income inequality and mortality within 30 days of admission for patients with acute myocardial infarction, heart failure, or pneumonia. By contrast, income inequality was associated with rehospitalization (acute myocardial infarction, risk ratio 1.09 (95% confidence interval 1.03 to 1.15), heart failure 1.07 (1.01 to 1.12), pneumonia 1.09 (1.03 to 1.15)). Further adjustment for individual income and educational achievement did not significantly attenuate these findings. Over the three year period, we estimate an excess of 7153 (2297 to 11 733) readmissions for acute myocardial infarction, 17 991 (3410 to 31 772) for heart failure, and 14 127 (4617 to 23 115) for pneumonia, that are associated with inequality levels in US states in the three highest quarters of income inequality, compared with US states in the lowest quarter.
Conclusions Among patients hospitalized with acute myocardial infarction, heart failure, and pneumonia, exposure to higher levels of income inequality was associated with increased risk of readmission but not mortality. In view of the observational design of the study, these findings could be biased, owing to residual confounding.
Income inequality, or the degree to which income is unevenly distributed within a society, peaked in the United States in the late 1920s, declined sharply after the second world war, and has risen steadily since the early 1980s.1 2 3 Many studies, conducted in the US and elsewhere, have documented an association between increased levels of inequality and worsened self reported health status, raised mortality rates, and reduced life expectancy.4 5 6 7 8
Two mechanisms have been posited to explain these associations.4 9 A "compositional" explanation suggests that the poor health outcomes can be attributed to the increased rates of poverty typically found in highly unequal societies. A complementary "contextual" explanation posits that a high level of inequality has corrosive effects on society, independent of its relation to individual income. For example, large differences in income can result in spatial concentrations of poverty, leading to diminished levels of social cohesion and social capital.10 11
Acute myocardial infarction, heart failure, and pneumonia are among the most common causes of hospitalization among Medicare beneficiaries. In recent years, the outcomes associated with hospital care for these conditions have come under increasing scrutiny. Hospital outcomes are now made available to the public on government and privately run websites, and are the subject of pay for performance programs. Although many of the clinical factors associated with short term mortality and readmission have been defined,12 13 14 15 16 17 the effects of environmental factors—such as income distribution—on communities and individuals are poorly understood, and could help explain geographic variation in patient outcomes.18 19 20 We therefore examined the association between income inequality and risk of mortality and readmission among patients hospitalized for acute myocardial infarction, heart failure, and pneumonia. Using multilevel modeling techniques, we sought to distinguish contextual health effects of inequality from those effects of individual income and other factors.
Design, setting, and patients
We conducted a retrospective cohort study using Medicare claims to examine the association between exposure to income inequality and a patient's risk of death and readmission after admission to an acute care hospital. We included patients aged 65 years or older and hospitalized between 1 January 2006 and 31 December 2008 with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia. Web appendix 1 lists the codes used from ICD-9-CM (international classification of diseases, 9th revision, clinical modification).
Using methods described previously,12 13 14 15 16 17 we excluded patients from the mortality analyses if they were enrolled in the Medicare hospice program during the year before admission (because survival is not typically a priority for such patients), if they were discharged alive but had a length of stay of at least one day (because of concerns about the accuracy of the principal diagnosis), or if they were discharged against medical advice. To avoid survival bias, we randomly selected one admission per year for patients with more than one admission for the same diagnosis during any study year.
For the readmission analyses, we excluded patients if they died during the hospitalization or if they did not have a complete claims history during the 30 days after discharge. For both the mortality and readmission analyses, we excluded patients who did not have 12 months of continuous enrolment in a Medicare fee-for-service plan before hospitalization (to obtain complete data for coexisting conditions), or who were admitted to hospitals that could not be matched to data from the American Hospital Association Annual Survey or that were outside of the 50 states. Patients who were transferred between hospitals for management of the same problem were assigned to the initial admitting hospital for the mortality analyses and the discharging hospital for the readmission analyses.
Information about patient comorbidities was derived from diagnosis codes recorded in the year before the index hospitalization, or during the index hospitalization as found in Medicare inpatient, outpatient, and physician claims files. Comorbidities were identified using the Condition Categories of the Hierarchical Condition Category grouper,21 and selected on the basis of existing risk adjustment models used by the Centers for Medicare and Medicaid Services (CMS) to support federal public reporting programs.12 13 14 15 16 17 In addition to age, sex, and comorbidities, we approximated each patient's socioeconomic status. This status included median annual income, probability of living in poverty, and the likelihood of having graduated from high school, taken from data at the zip code level as reported in the US Census Current Population Survey.
Income inequality and other state characteristics
Information concerning income inequality at the state level was obtained from the US Census Bureau's annual American Community Survey for 2006, 2007, and 2008. The information was averaged across the three years for each state. We measured inequality using the Gini coefficient, defined as a half of the relative mean difference of all pre-tax household income pairs within a population. The Gini coefficient ranges from 0 to 1, where 0 indicates perfect equality (that is, all incomes are the same) and 1 indicates perfect inequality (that is, one person receives all of the income).
State level estimates of median family income, standardized to inflation adjusted US dollars in 2009, were taken from the US Census Bureau's Current Population Survey.22 The percentage of the population with incomes below the poverty threshold, and of adults aged 25 years or older with a high school education or less, were obtained from the US Census Bureau's annual American Community Survey.23 24 Three year averages were computed to correspond to the study period.
We obtained additional state level characteristics from statehealthfacts.org, a website maintained by the Henry J Kaiser Family Foundation.25 These state level characteristics included the number of hospital and certified nursing home beds per 1000 people, the number of physicians in patient care per 10 000 civilian population, the percentage of the population living in an area with a shortage of health professionals (HPSA) providing primary care, and the annual number of hospital admissions per 1000 people. For each of these factors, we computed three year averages for 2006-08, apart from data for the number of physicians in patient care and the estimated underserved population living in primary care HPSAs, which were available for 2008 only.
Hospital characteristics
We examined a diverse set of hospital characteristics that we hypothesized might serve to confound the relation between inequality and the outcomes. We obtained information on characteristics of the participating hospitals from the American Hospital Association Annual Survey.26 These hospital characteristics included the number of beds, teaching status, location (urban or rural), ownership, safety net status (a designation given to hospitals that disproportionately serve the poor and other vulnerable populations), and whether the hospital maintained a cardiac catheterization laboratory and performed coronary bypass surgery.
We assessed each patient's vital status at 30 days after admission using the CMS Enrolment database. Readmissions within 30 days of discharge, for any cause, were identified using the National Claims History File. One exception was that planned admissions were not counted as readmissions for the analysis of acute myocardial infarctions. Instead, planned admissions were defined as a hospitalization in which the patient had percutaneous coronary intervention or coronary bypass surgery but without myocardial infarction, heart failure, unstable angina, cardiac arrest, or arrhythmia.
For each condition, we fit a series of three level, hierarchical, logistic regression models that incorporated patient, hospital, and state effects. In each of these models, the Gini coefficient—measured at the state level—served as the primary predictor, with mortality or readmission as the outcome (web appendices 2-7). The initial model was unadjusted; the second model adjusted for patient age, sex, and comorbidities; the third included hospital characteristics; and the fourth added other state level characteristics such as population level measures of income and education, as well as the supply of healthcare resources. Because the risk of readmission is associated with the general tendency to hospitalize patients,27 the readmission models with state level characteristics included the number of hospital admissions per 1000 patients as an additional covariate.
Finally, to better distinguish between contextual effects (from relative differences in outcome) and compositional effects (from absolute levels of income), we fit a final model that added measures of socioeconomic status at the patient level, estimated from data based on zip codes. Because readmission rates ranged from nearly 18% to 25%, we converted model adjusted odds ratios to risk ratios to simplify direct interpretation.28 Using the effect estimates developed from the final models, we estimated the potential number of excess deaths and readmissions associated with the higher levels of inequality found in US states in the three highest quarters of income inequality, compared with US states in the lowest quarter.
All analyses were conducted with the use of SAS software, version 9.1.3 (SAS Institute) and HLM software, version 6.0 (Scientific Software International). All statistical tests were two tailed and used a type I error rate of 0.05.
From 2006 to 2008, we identified 555 962 hospitalizations in 4348 hospitals for acute myocardial infarction that met criteria for the mortality analysis, 1 092 285 hospitalizations in 4484 hospitals for heart failure, and 1 146 414 hospitalizations in 4520 hospitals for pneumonia. The readmission analysis included 553 037 hospitalizations in 4262 hospitals for acute myocardial infarction, 1 345 909 hospitalizations in 4494 hospitals for heart failure, and 1 345 909 hospitalizations in 4524 hospitals for pneumonia.
Income inequality and other state characteristics
The average Gini coefficient, over the three years and at the US state level, varied from 0.41 in Utah to 0.50 in New York. States in the lowest quarter of inequality had a mean Gini coefficient of 0.425 (standard deviation 0.008), whereas those in the highest quarter had a mean Gini coefficient of 0.473 (0.010; table 1⇓). As anticipated, income inequality was associated with other state characteristics and with the supply of healthcare resources. Compared with states in the lowest quarter of inequality (that is, quarter 1), states in the highest quarter (that is, quarter 4) had a lower median income ($48 749 (£30 900; €36 120) v $54 621), a higher percentage of the population living below the poverty line (14.5% v 10.5%), and a greater percentage having a high school education or less (47.4% v 42.2%). Additionally, states in the highest quarter of inequality had more hospital beds per 1000 population (3.0 v 2.7), nursing home beds per 1000 people (5.9 v 5.5), physicians in patient care per 10 000 (25.4 v 23.5), annual hospital admissions per 1000 people (127 v 100), and percentage of people living within health professional shortage areas (15.6 v 9.0).
Patient characteristics
More than 66% of patients for each condition were cared for at hospitals in US states in the two highest quarters of inequality (table 2⇓). Compared with patients in states in the lowest quarter of inequality (quarter 1), those receiving care in high inequality states (quarters 2-4) were less likely to have graduated from high school or college, and more likely to live below the poverty level. This pattern held true for each of the three diagnoses and for both the readmission and mortality outcomes. Among patients with acute myocardial infarction and pneumonia, observed rates of mortality at 30 days were similar between the high and low inequality quarters (table 2), while in heart failure the risk of mortality in the highest inequality states (10.9%) was lower than in states in the lowest quarter (12.4%). By contrast, observed readmission rates, for each of the diagnoses, increased with higher levels of inequality (table 2).
Hospital characteristics
Income inequality was also associated with a number of hospital characteristics (table 3⇓). For example, compared with hospitals in the lowest quarter of inequality (quarter 1), those in the highest quarter (quarter 4) had more beds, and were more likely to be teaching hospitals and to have the ability to perform cardiac surgery. Conversely, hospitals in low inequality states were more likely to be located in rural areas, and to be considered a safety net institution.
Association between income inequality and outcomes in multivariable analyses
Income inequality, as measured by the Gini coefficient, was not associated with 30 day mortality for patients with acute myocardial infarction or pneumonia, in either unadjusted or fully adjusted models (fig 1⇓). For patients with heart failure, a 0.05 increase in the Gini coefficient (representing the difference in the mean Gini coefficient observed between upper and lower quarters) was associated with a lower risk of mortality in an unadjusted model (risk ratio 0.88, 95% confidence interval 0.82 to 0.94). This effect persisted with adjustment for patient and hospital characteristics. However, in models that adjusted for other state level factors and estimated patient income and education, the association was tempered and was no longer significant (0.93, 0.86 to 1.01).
In unadjusted models, a 0.05 increase in the Gini coefficient was associated with an increased risk of hospital readmission within 30 days of discharge for patients with all three conditions, with the largest effect seen in acute myocardial infarction (risk ratio 1.27, 95% confidence interval 1.19 to 1.35; fig 2⇓). Additional models that adjusted for patient factors, then hospital factors, and then state level factors (including the number of admissions per 1000 people) attenuated this association; however, the results remained significant.
Our final models, which adjusted for patient level estimates of socioeconomic status, continued to show a significant association between income inequality and readmission for acute myocardial infarction (risk ratio 1.09, 95% confidence interval 1.03 to 1.15), heart failure (1.07, 1.01 to 1.12), and pneumonia (1.09, 1.03 to 1.15). This effect would translate to an increase in the risk of readmission of 1.5% in acute myocardial infarction, 1.5% in heart failure, and 1.4% in pneumonia per 0.05 unit increase in Gini coefficient (that is, the difference between means of the highest and lowest quarters observed across the US). Over the three year period, we estimate an excess of 17 991 (95% confidence interval 3410 to 31 772) readmissions in heart failure, 7153 (2297 to 11 733) in acute myocardial infarction, and 14 127 (4617 to 23 115) in pneumonia. These estimates were associated with the higher inequality levels found in US states in three highest quarters of income inequality, as compared with the lowest quarter.
In this study of US Medicare beneficiaries hospitalized with acute myocardial infarction, heart failure, and pneumonia, exposure to higher levels of income inequality was associated with increased risk of readmission within 30 days of discharge. The effect was similar in magnitude to the risk associated with major comorbidity. Supporting both compositional and contextual explanations, these associations were attenuated by—but remained significant after—adjustment for numerous state, hospital, and patient characteristics, including patient level estimates of income and education.
Comparison with other studies
Our analysis builds on a large number of prior studies that have examined the association between income inequality and a diverse set of health outcomes, including infant mortality, death rates from cardiovascular disease and cancer, life expectancy, and self reported health status.4 5 7 8 Similar to the most robust studies, we used multilevel modeling methods that accounted for estimates of patient income and education in addition to analyzing state level characteristics. Such techniques are needed to distinguish compositional from contextual factors.
In a meta-analysis of nine multilevel longitudinal studies that used mortality as outcomes, involving nearly 60 million participants in the US and elsewhere, Kondo and colleagues reported a cohort relative risk of 1.08 (95% confidence interval 1.06 to 1.10) per 0.05 unit increase in Gini coefficient.7 In a departure from those longitudinal studies, we focused on the outcomes of patients in the 30 days after an acute care hospitalization, rather than on survival over many years among the general population.
Through what pathways might income inequality have contributed to the increased risk of hospital readmission? A patient's risk of readmission is probably influenced by factors such as the strength of their social networks and support systems and by their capacity for managing their own care, including obtaining follow-up care, adhering to complex medication regimens, or complying with other instructions after discharge. Prior research has suggested that income inequality results in reduced levels of social capital and social cohesion.10 11 29 30 31 32 Thus, to the extent that higher levels of income inequality erode a community's underlying social fabric, it might also be associated with higher risk of readmission. In this context, one can view successful programs aimed at preventing rehospitalization—such as the Care Transitions Program, and the Transitional Care Model—as attempts to strengthen the support systems and the self care capacity of patients at greatest risk.33 34
Many of the same factors that can be hypothesized to influence the risk of readmission might also be expected to have an effect on survival itself. Therefore, it is less clear why we found no consistent association between income inequality and mortality, and in the case of heart failure, a suggestion that inequality might have in fact been associated with improved short term survival. One explanation might simply be that over the span of 30 days, readmission is more sensitive to social conditions than is mortality, and that an effect on mortality might have been observed had we extended the period of observation to one year. In addition, among patients whose disease is advanced enough to require hospitalization, the marginal effect of income inequality on mortality might be inconsequential.
Policy implications
Differentiating compositional from contextual effects of income inequality has important policy implications. We observed strong associations between income inequality and readmission risk, particularly in unadjusted models, and those models that accounted for patient comorbidities. If these associations had been "adjusted away" by patient income and other socioeconomic characteristics, it would have suggested that economic policies that focused on reducing poverty would be sufficient to prevent readmission. However, we found that relative differences in income remained independently associated with readmission, even after adjustment for these patient level factors. This finding suggests that, in addition to reducing poverty, policies intended to reduce income disparity might have additional benefits. In the meantime, the adverse outcomes associated with higher levels of inequality may be mitigated through the re-engineering of processes and programs in hospital transitional care.
Strengths and limitations of study
Our analysis has several strengths. Firstly, this is the first study that we are aware of to examine the association between income inequality and hospital readmission, which is especially important in view of the incomplete understanding of the risk factors at the patient and community level for readmission and the unexplained geographic variation in outcomes. Secondly, our models included demographic characteristics and patient comorbidities. As a result, we have produced an estimate of the effect of income inequality on outcomes above and beyond the effect mediated through comorbidity burden.
Thirdly, our analyses considered multiple supply factors, such as the number of hospital beds and practicing physicians per capita, which were highly associated with the Gini coefficient in each US state. Fourthly, we took care not to overstate our findings, by reporting adjusted risk ratios because modeled odds ratios would have overestimated the relative risk by up to 14%.28 Finally, because we studied the outcomes of Medicare beneficiaries, the increased risk of readmission cannot be attributed to a lack of health insurance.
Our results should be interpreted in the light of their limitations. Firstly, our analysis included only Medicare beneficiaries with three conditions. Age, diagnosis, and insurance status could modify the relation between inequality and outcome, and our findings should be generalized with caution. Secondly, our regression models controlled for several important variables that might serve as potential confounders of the association between inequality and health outcomes. However, the number of possible sources of unmeasured confounding is large, and our results may reflect residual bias. Additionally, some of the factors that we treated as confounders could, in fact, lie on the causal pathway between inequality and the outcomes we investigated. To the extent that a patient's comorbidities—or the number of hospital beds or physicians in a community—represent such mediators, our analysis could have underestimated the actual effect of inequality on readmission.
Thirdly, like many prior studies, we measured levels of inequality and outcomes during the same period of time, and attempted to account for a lag between a person's exposure to inequality and outcome.35 Fourthly, we estimated patient income and education on the basis of zip code, which could have led to considerable misclassification. Fifthly, we chose to measure and analyze the effects of inequality at the level of the state, which has been the most common unit of analysis in US studies; however, levels of inequality vary within states, and alternative levels of geographic aggregation could have led us to different conclusions.
Sixthly, because hierarchical survival models are not computationally feasible with particularly large datasets, our readmission analyses did not account for the competing risk of death. Nevertheless, the lack of association between inequality and mortality suggests that this competing risk is unlikely to have biased our results. Finally, although we evaluated outcomes at 30 days, an extended period of follow-up may have yielded different results.
What is already known on this topic
Income inequality is associated with a variety of adverse health outcomes, including higher infant mortality, reduced life expectancy, and poorer self reported health status
Little is known about the association between income inequality and the outcomes following admission to acute care hospitals
What this study adds
Income inequality was not associated with an increased risk of death within 30 days of admission for patients with acute myocardial infarction, heart failure, or pneumonia
But for all three conditions, patients exposed to higher levels of inequality had increased risk of readmission within 30 days of discharge
Additional research is required to elucidate the mechanisms underlying these observations
Cite this as: BMJ 2013;346:f521
Contributors: PKL devised the study concept and design; analyzed, and interpreted the data; drafted the paper; and supervised the study. He is the guarantor. TCL, MBR, JSA, PSP, YW, and HMK analyzed and interpreted the data and critically revised the paper. HMK acquired the data and obtained funding. PKL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding: HMK is supported by grant U01 HL105270-02 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the National Heart, Lung, and Blood Institute for the submitted work; PKL, TCL, MBR, JSA, and PSP have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; HMK is the recipient of a research grant from Medtronic, through Yale University and is chair of a cardiac scientific advisory board for UnitedHealth; PKL, TCL, MBR, JA, PSP, and YW have no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The institutional review board at Yale University approved the protocol.
Data sharing: No additional data available.
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