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Prevalence of Stroke Risk Factors and Their Distribution Based on Stroke Subtypes in Gorgan: A Retrospective Hospital-Based Study—2015-2016
Background. Stroke is a leading cause of death and disability worldwide. According to the Iranian Ministry of Medical Health and Education, out of 100,000 stroke incidents in the country, 25,000 lead to death. Thus, identifying risk factors of stroke can help healthcare providers to establish prevention strategies. This study was conducted to investigate the prevalence of stroke risk factors and their distribution based on stroke subtypes in Sayad Shirazi Hospital, Gorgan, Northeastern Iran. Material and Methods. A retrospective hospital-based study was conducted at Sayad Shirazi Hospital in Gorgan, the only referral university hospital for stroke patients in Gorgan city. All medical records with a diagnosis of stroke were identified based on the International Classification of Diseases, Revision 10, from August 23, 2015, to August 22, 2016. A valid and reliable data gathering form was used to capture data about demographics, diagnostics, lifestyle, risk factors, and medical history. Results. Out of 375 cases, two-thirds were marked with ischemic stroke with mean ages (standard deviation) of 66.4 (14.2) for men and 64.6 (14.2) for women. The relationship between stroke subtypes and age groups (P=0.008) and hospital outcome (P=0.0001) was significant. Multiple regression analysis showed that hypertension (Exp. (B) =1.755, P=0.037), diabetes mellitus (Exp. (B) =0.532, P=0.021), and dyslipidemia (Exp. (B) =2.325, P=0.004) significantly increased the risk of ischemic stroke. Conclusion. Overall, hypertension, diabetes mellitus, and dyslipidemia were the major risk factors of stroke in Gorgan. Establishment of stroke registry (population- or hospital-based) for the province is recommended.
1. Introduction
Stroke is the second leading cause of death, accounting for 11.13 % of total deaths, and the main cause of disability worldwide. The major type of stroke is ischemic, which occurs in about 87% of all stroke cases [1]. According to Global Burden of Disease (GBD) study in 2010, more than 11 million ischemic strokes occurred while 63% of them were in low- and middle-income countries. Also, near 3 million deaths occurred due to ischemic stroke [2]. About 13% of stroke is of a hemorrhagic type [1]. According to GBD study in 2010, there were about 5.3 million hemorrhagic stroke cases, out of which about 80% occurred in low- and middle-income countries. Over 3 million deaths occurred from hemorrhagic stroke [3]. The range of incident rates of stroke in Iran varies [4]. According to the Mashhad Stroke Incidence Study, conducted during 2006-2007, the age-adjusted incidence rate of stroke was 203 per 100,000 individuals per year (95 % CI: 175-231) and this rate could be divided based on the stroke subtype into 113 (95% CI: 142-192), 26 (95 % CI 16-36), and 4 (95 %CI 0-8) per 100000 per year for ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage stroke, respectively [5].
The incidence rate of stroke in middle east countries is variable [6] and it is progressively becoming a main problem in the region [7]. This rate in Iranian population is increasing dramatically [6, 8, 9]. For example, in Isfahan Cohort Study (ICS) [9], which prospectively followed up 6504 individuals (32893 person-years of follow-up) between 2003 and 2010, 91 new stroke cases (43 men and 48 women) were confirmed. The age-adjusted incidence rate was 260 (95% CI: 179-341), 295 (95% CI: 205-384), and 280 (95% CI: 219-341) per 100,000 person-years for men, women, and total, respectively. The stroke mortality rate was 49 (95% CI: 13-85), 68 (95% CI: 20-116), and 59 (95% CI: 29-89) per 100,000 person-years, for men, women, and total, respectively. There were significant differences in stroke rates among women (P value= 0.020), when compared to the incidence rates nine years later. The authors concluded that the urgent consideration by health policy makers is essential for this high incident rate of all cardiovascular diseases, especially stroke and its mortality.
Stroke has different risk factors, which can be grouped into modifiable and nonmodifiable risk factors. Major risk factors for stroke include age, history of cerebrovascular event, smoking, alcohol consumption, physical inactivity, hypertension, dyslipidemia, diabetes mellitus, cardiovascular diseases, obesity, metabolic syndrome, diet, nutrition, and genetic risk factors [10–12]. In Iran, many hospital-based studies have investigated the stroke risk factors. Hypertension, diabetes mellitus, ischemic heart diseases, male gender, and age >=65 years are main reported stroke risk factors in Iran [7, 13]. To our knowledge, there is only one study reporting on stroke risk factors in Gorgan, the capital of Golestan province, northeastern Iran, but it lacks details on distribution of risk factors over the stroke subtypes [14]. According to this study, which was accomplished in 2001, the major risk factors were hypertension (64%), hyperglycemia (29.3 %), cigarette smoking (22.7 %), and heart diseases (22%).
The aim of the present study was to investigate the stroke subtypes and risk factors in patients admitted to Sayad Shirazi Hospital affiliated to Golestan University of Medical Sciences (GoUMS) in Gorgan. The Sayad Shirazi Hospital is the only referral university hospital for stroke patients in Gorgan city.
2. Materials and Methods
Medical records of all patients who were admitted to the Sayad Shirazi Hospital, affiliated to GoUMS, between August 23, 2015, and August 22, 2016, were manually screened for a confirmed discharge diagnosis of stroke (International Classification of Diseases, Revision 10 (ICD 10) codes in the categories of I60, I61, I62, I63, and I64). Diagnosis was mainly based on physician's opinion, clinical features, and Magnetic Resonance Imaging (MRI) or Computed Tomography (CT scan) reports. Medical records with a diagnosis of unspecified stroke (code I64 of ICD 10) were rechecked with a specialist coder to assign a correct code based on MRI or CT scan reports or after consulting with the attending physician or a neurologist.
A valid and reliable data collection form was used to capture data contained in the medical records. In this form, the following criteria and clinical parameters were considered: patient demographic data (age, gender, ethnicity, and residence area), diagnostic data, type of stroke (hemorrhagic or ischemic), history of diseases (such as hypertension, ischemic heart disease, nonischemic heart disease, diabetes, hyperlipidemia, previous stroke, or Transient Ischemic Attack), and lifestyle data (such as cigarette smoking and opium addict).
The chi-square test and Mann–Whitney U test were used to analyze the categorical and continuous data, respectively. The relationship between risk factors and stroke subtypes were examined by logistic regression and chi-square test. Statistical significant was P value<0.05. All statistical analyses were performed by SPSS software, version 20 (IBM SPSS Statistics).
This study was approved by the ethical committee and the institutional review boards of the GoUMS (code: IR.GOUMS.REC.1395.205). The permission to collect data from medical records was provided by the Sayad Shirazi Hospital administration.
3. Results
In the study period, the medical records of 25422 patients were surveyed for stroke diagnostic code based on ICD 10. Our screening protocol identified 415 stroke records, out of which 40 cases (9.6 %) were unspecified stroke. Of 375 specified stroke cases, 70.7% described an ischemic incidence and 29.3 % reported a hemorrhagic incidence. Analysis of demographic attributes over this dataset showed that 218 (58.1%) men and 157 (41.9%) women with mean ages (standard deviation) of 66.4 (14.2) and 64.6 (14.2), respectively, were admitted with stroke diagnosis, irrespective of stroke type. Further analysis indicated that both ischemic and hemorrhagic stroke subtypes had high prevalence in age >=70 years (Table 1). The relationship between age group and stroke subtype was significant (P<0.05) but there was no significant association between ethnicity and stroke subtypes (P value =0.335). The majority of ethnicity was Fars.
Chi-square test showed that the hospital outcome differs based on stroke subtypes (p<0.05). Analysis of the mortality rate in this population based on the stroke subtype indicated that the mortality rate in patients hit by hemorrhagic stroke is higher than those with ischemic attack. Furthermore, there was no significant difference between stroke subtypes, on one hand, and gender and residence, on the other hand (Table 2).
Analysis of possible relations between comorbid risk factors and stroke subtypes using chi-square test showed that, compared to other comorbid risk factors, diabetes mellitus (P value=0.003) and dyslipidemia (P value=0.001) were significantly prevalent among ischemic and hemorrhagic stroke patients. There was no significant difference between ischemic and hemorrhagic stroke with regard to other risk factors [Table 3].
The regression model of comorbid risk factors indicated that the risk of ischemic stroke in patients with dyslipidemia and hypertension is 2.325 and 1.755 higher than patients suffering from hemorrhagic stroke, respectively. Also, the risk of ischemic stroke is 47% higher than hemorrhagic stroke in diabetic patients [Table 4].
4. Discussion
According to the global stroke belt report in 2015, Iran ranks 187 among other countries, representing one of the highest stroke incidence rates in the world [15]. The Iranian Stroke Society reports that this rate continues to increase so that 300 stroke patients are admitted to hospitals every day and the average age of stroke onset in Iran is getting 10 years younger than the global average age (https://goo.gl/pEDZZW). This alarming situation calls for identification of stroke risk factors among the Iranian patient population so that prevention strategies can be defined and risk factors can be managed properly.
The existing risk factor studies on the Iranian stroke patients are relatively old [4, 16] but our results are in line with their reports. For instance, Ahangar et al. (2005) reported that the incidence of stroke among female patients in Babol was relatively higher than male patients and the average age of stroke incidence was 68 [17] whereas our study in Gorgan not only shows a reverse gender distribution but also confirms the fact that the average age of stroke incidence among stroke patients is declining to younger ages. Another finding in this patient population was the higher mortality rate among patients hit by the hemorrhagic stroke, which indicates that this group of patients is exposed to fatal aneurysmal ruptures in the brain and such incidences might be prevented by early diagnosis and screening for unruptured aneurysms [18]. Moreover, the observed higher rates of ischemic stroke incidence suggests that ischemic stroke patients have a great exposure to modifiable risk factors whose control through lifestyle modifications can prevent a large proportion of such incidences [19]. Interestingly, those patients who were resident in urban districts were more than 1.5 times at higher risk of developing stroke compared with residents of rural areas, which can be probably attributed to the unhealthy lifestyle practices with regard to lack of physical activity and unhealthy diet [20].
In general, a strong relationship between some risk factors (such as hypertension, diabetes mellitus, dyslipidemia, smoking, and age) and the incidence of stroke has been reported in the literature [21]. It is now established that hypertension is a major risk factor for stroke, both ischemic and hemorrhagic [22]. In our study, although the most frequent risk factor in both ischemic (30.6 %) and hemorrhagic (26.3 %) stroke subtypes is hypertension, the chi-square test showed that these results were not statistically significant (P>0.05). Instead, the regression model of all risk factors showed that the prevalence of hypertension in ischemic stroke patients is 1.755 times higher than hemorrhagic stroke patients. According to Malekzadeh et al. (2013), the WHO age-standardized prevalence of hypertension in Golestan province was 41.8% (95%CI: 38.3%–45.2%) [23]. In the study of Hosaini and colleague (2001) [14], 64% of stroke patients in Gorgan—regardless of the stroke type—had hypertension, which is similar to our study (66.9 %). Recently, a prospective study of 50,000 adults in the Golestan Cohort by Sepanlou and colleagues (2016) [24] showed a positive association between hypertension and stroke mortality: they found that the stroke mortality rate was 147.1 (95%CI: 133.9-160.1) per 100,000 person-years, although they did not consider stroke subtypes. With regard to the stroke subtype, our finding that prevalence of hypertension was higher among ischemic stroke patients is consistent with findings of Bilic et al. (2009) [25] and Zhang et al. (2011) [26] who reported similar results in Croatian and Chinese stroke populations, respectively. The role of hypertension in pathogenesis of stroke has been well documented in other studies, which include the initiation of vasculopathy, promotion of microatheroma, lipohyalinosis, and atherosclerotic diseases, and blood-brain barrier disruption [27]. According to a meta-analysis study of clinical trials by Law et al. (2009), the incidence rate of stroke was dropped by 41% when both systolic and diastolic blood pressure were reduced [28]. It seems that antihypertensive therapy and lifestyle modification can reduce the risk of stroke and its recurrence. Since hypertension develops by aging, lowering hypertension risk profile through lifestyle changes starting in middle age can prevent cardiovascular events in older ages [29]. Indeed, the CARDIA (Coronary Artery Risk Development in Young Adults) study demonstrates that, beside physical activity, diet is the most prevalent risk factor for cardiovascular diseases [30]. This study recommends that clinicians should adopt dietary approaches to stop hypertension during young adulthood to middle age as healthier diet significantly contributes to lower risk of developing hypertension and consequently cardiovascular events such as stroke in the elderly.
Another important finding in our study was positive and significant association between diabetes mellitus and incidence of stroke, particularly the ischemic subtype. According to our finding, 36% of all stroke patients were diabetic and this is in agreement with Hosaini and colleagues' [14] findings, which showed 29.3% of all stroke patients had hyperglycemia. The prevalence of diabetes in ischemic stroke patients was 47% higher than that in patients with hemorrhagic stroke. Based on the Golestan Cohort Study between 2004 and 2007, it appeared that a crude prevalence of diabetes mellitus in Golestan province was about 6.9 % (95%CI: 6.7-7.1), which was positively associated with obesity at all ages [31]. Diabetes causes several metabolic and pathologic changes that lead to stroke, including arterial stiffness, systematic inflammation, endothelial dysfunction, and heart failure [32, 33]. By these changes, stroke in a diabetic patient increases hospital mortality [34] as reflected in our results (odds ratio: 7.341 with 95% CI: 3.637-14.817). Controlling diabetes can prevent both primary and secondary stroke and may decrease the mortality as well. Clinical studies suggest that improvements in nutrition and dietary pattern, beside weight management, in diabetic patients lower cardiovascular disease incidence significantly [35]. Thus, dietary components and nutritional patterns should be incorporated into any prevention strategy at the national level [36].
In the current study, we also found that dyslipidemia was strongly associated with the incidence of total stroke (P<0.05), which was consistent with previous findings reported by Tziomalos et al. [37] and Sarti et al. [38]. As expected, prevalence of dyslipidemia in ischemic stroke patients was almost double the hemorrhagic stroke cases. Atherosclerosis is the major mechanism of dyslipidemia, which leads to stroke [39]. It seems that reducing lipid profile can reduce atherosclerotic plaques, which results in the decreased risk of stroke. Very recently, the Strong Heart Study (2017) revealed that low density lipoprotein cholesterol levels equal to or greater than 130 mg/dl confer higher risk of ischemic stroke, but interestingly individuals with high triglycerides and low high density lipoprotein levels who were also suffering from diabetes showed more than 2 times higher incidence of ischemic stroke [40]. As previously reported, there is a significant association between dyslipidemia and diabetes. This observation implies that coincidence of two risk factors, namely, diabetes and dyslipidemia, already doubles the risk of ischemic stroke incidence and such at-risk population should be given priority in prevention programs.
This study confirms that age >=70 is associated with stroke risk (p<0.05), which was similar to other studies in Iranian population [7]. However, the observation that more than half of all stroke cases were below 69 years (57%) and nearly half of hemorrhagic cases (47.4%) were younger than 59 years confirms the trend of excessive stroke incidence among Iranians at younger ages [5]. This trend can be attributed to a shift in prevalence of vascular risk factors towards younger adults; a meta-analysis of ischemic stroke data from three large studies showed a sharp increase in the prevalence of hypertension followed by hypercholesterolaemia over the age of 35 years and interestingly a striking increase in the number of risk factors per patient over 35 years of age [41].
5. Conclusion
The present study was designed based on hospital medical records to determine the prevalence of stroke subtypes and their relations to risk factors in Gorgan, Northeastern Iran. Since analysis of medical record data for evidence-based medicine becomes an indispensable part of prevention and treatment strategies, the quality of these records in hospitals is of high importance. In the studied population of stroke patients at Gorgan, the prevalence of stroke incidence and rates of mortality were significantly related to known comorbid risk factors such as hypertension, diabetes, and dyslipidemia but no significant association was found with ethnicity. Moreover, a relatively high prevalence of stroke incidence in younger age groups was alarming and in agreement with recent trends. These findings may be indicative of a stronger role for environmental risk factors than genetic ones in incidence of stroke subtypes in the studied population.
Limitations and Recommendation
The current study was limited by the quality of medical records documentation due to incompleteness of some parameters such as weight, height, exercise, and occupation. In the case of accuracy, diagnoses were not documented accurately by the physician. To correct this, we had to consider all reports and sometimes refer to attending physician, particularly for medical records with a diagnosis of unspecified stroke type (ICD 10 code of I64). An implication of these findings is that these risk factors should be taken into account for decision making at GoUMS when developing preventive strategies. The observation that the risk of ischemic stroke in patients with hypertension, dyslipidemia, and diabetes mellitus was higher than hemorrhagic stroke calls for a prevention plan at the regional level with focus on major lifestyle factors, namely, diet, exercise, smoking, and body mass index. Control and treatment of hypertension and dyslipidemia through lifestyle modifications and medical management should be given high priority in the studied patient population. We foresee a need for implementation of a cohort- or population-based study of stroke in the region. There is, therefore, a definite need for the establishment of hospital- or population-based stroke registry at regional or national levels.
Data Availability
The data used to support the findings of this study are available from the corresponding author upon request.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
The authors would like to acknowledge Golestan University of Medical Sciences and the Clinical Research Development Unit (CRDU) of Sayad Shirazi Hospital for their support.
D. Mozaffarian, E. J. Benjamin, A. S. Go, D. K. Arnett, M. J. Blaha, M. Cushman et al., "Heart disease and stroke statistics--2015 update: a report from the American Heart Association," Circulation, vol. 131, no. 4, pp. e29–e322, 2015.View at: Google Scholar
D. A. Bennett, R. V. Krishnamurthi, S. Barker-Collo et al., "The global burden of ischemic stroke: Findings of the GBD 2010 study," Global Heart, vol. 9, no. 1, pp. 107–112, 2014.View at: Publisher Site | Google Scholar
R. V. Krishnamurthi, A. E. Moran, M. H. Forouzanfar et al., "The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study," Global Heart, vol. 9, no. 1, pp. 101–106, 2014.View at: Publisher Site | Google Scholar
A. A. Hosseini, D. Sobhani-Rad, K. Ghandehari, and H. T. S. Benamer, "Frequency and clinical patterns of stroke in Iran - Systematic and critical review," BMC Neurology, vol. 10, p. 72, 2010.View at: Publisher Site | Google Scholar
M. R. Azarpazhooh, M. M. Etemadi, G. A. Donnan et al., "Excessive incidence of stroke in iran: Evidence from the mashhad stroke incidence study (MSIS), a population-based study of stroke in the middle east," Stroke, vol. 41, no. 1, pp. e3–e10, 2010.View at: Publisher Site | Google Scholar
N. Sarrafzadegan, M. Gharipour, M. Sadeghi et al., "Metabolic Syndrome and the Risk of Ischemic Stroke," Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, vol. 26, no. 2, pp. 286–294, 2017.View at: Publisher Site | Google Scholar
N. Fahimfar, D. Khalili, R. Mohebi, F. Azizi, and F. Hadaegh, "Risk factors for ischemic stroke; results from 9 years of follow-up in a population based cohort of Iran," BMC Neurology, vol. 12, article no. 117, 2012.View at: Publisher Site | Google Scholar
M. Ghayour-Mobarhan, M. Moohebati, H. Esmaily et al., "Mashhad stroke and heart atherosclerotic disorder (MASHAD) study: design, baseline characteristics and 10-year cardiovascular risk estimation," International Journal of Public Health, vol. 60, no. 5, pp. 561–572, 2015.View at: Publisher Site | Google Scholar
M. Talaei, N. Sarrafzadegan, M. Sadeghi et al., "Incidence of cardiovascular diseases in an Iranian population: the Isfahan cohort study," Archives of Iranian Medicine, vol. 16, no. 3, pp. 138–144, 2013.View at: Google Scholar
O. Y. Bang, B. Ovbiagele, and J. S. Kim, "Nontraditional risk factors for ischemic stroke: An update," Stroke, vol. 46, no. 12, pp. 3571–3578, 2015.View at: Publisher Site | Google Scholar
J. C. Hopewell and R. Clarke, "Emerging Risk Factors for Stroke: What Have We Learned from Mendelian Randomization Studies?" Stroke, vol. 47, no. 6, pp. 1673–1678, 2016.View at: Publisher Site | Google Scholar
B. von Sarnowski, J. Putaala, U. Grittner et al., "Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the stroke in young fabry patients study," Stroke, vol. 44, no. 1, pp. 119–125, 2013.View at: Publisher Site | Google Scholar
M. Togha and K. Bakhtavar, "Factors associated with in-hospital mortality following intracerebral hemorrhage: A three-year study in Tehran, Iran," BMC Neurology, vol. 4, article no. 9, 2004.View at: Publisher Site | Google Scholar
S. A. Hosaini and H. Bazrafshan, "A statistical study on the role of high-risk factors in the incidence of CVA," Journal of Gorgan University of Medical Sciences, vol. 3, no. 2, pp. 76–80, 2001.View at: Google Scholar
A. S. Kim, E. Cahill, and N. T. Cheng, "Global stroke belt: geographic variation in stroke burden worldwide," Stroke, vol. 46, no. 12, pp. 3564–3570, 2015.View at: Publisher Site | Google Scholar
A. Delbari, R. Salman Roghani, S. S. Tabatabaei, M. Rahgozar, and J. Lokk, "Stroke epidemiology and one-month fatality among an urban population in Iran," International journal of stroke : official journal of the International Stroke Society, vol. 6, no. 3, pp. 195–200, 2011.View at: Publisher Site | Google Scholar
A. A. Ahangar, S. B. A. Vaghefi, and M. Ramaezani, "Epidemiological evaluation of stroke in Babol, Northern Iran (2001-2003)," European Neurology, vol. 54, no. 2, pp. 93–97, 2005.View at: Publisher Site | Google Scholar
L. N. Williams and R. D. Brown, "Management of unruptured intracranial aneurysms," Neurology: Clinical Practice, vol. 3, no. 2, pp. 99–108, 2013.View at: Publisher Site | Google Scholar
C. L. Allen and U. Bayraktutan, "Risk factors for ischaemic stroke," International journal of stroke : official journal of the International Stroke Society, vol. 3, no. 2, pp. 105–116, 2008.View at: Publisher Site | Google Scholar
K. Teo, S. Lear, S. Islam et al., "Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study," Journal of the American Medical Association, vol. 309, no. 15, pp. 1613–1621, 2013.View at: Publisher Site | Google Scholar
M. J. O'Donnell, X. Denis, L. Liu et al., "Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study," The Lancet, vol. 376, no. 9735, pp. 112–123, 2010.View at: Publisher Site | Google Scholar
W. S. Aronow, "Hypertension-related stroke prevention in the elderly," Current Hypertension Reports, vol. 15, no. 6, pp. 582–589, 2013.View at: Publisher Site | Google Scholar
M. M. Malekzadeh, A. Etemadi, F. Kamangar et al., "Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population," Journal of Hypertension, vol. 31, no. 7, pp. 1364–1371, 2013.View at: Publisher Site | Google Scholar
S. G. Sepanlou, M. Sharafkhah, H. Poustchi et al., "Hypertension and mortality in the Golestan Cohort Study: A prospective study of 50 000 adults in Iran," Journal of Human Hypertension, vol. 30, no. 4, pp. 260–267, 2016.View at: Publisher Site | Google Scholar
I. Bilic, G. Dzamonja, I. Lusic, M. Matijaca, and K. Caljkusic, "Risk factors and outcome differences between ischemic and hemorrhagic stroke," Acta Clinica Croatica, vol. 48, no. 4, pp. 399–403, 2009.View at: Google Scholar
J. Zhang, Y. Wang, G. N. Wang, H. Sun, T. Sun, J. Q. Shi et al., "Clinical factors in patients with ischemic versus hemorrhagic stroke in East China," World journal of emergency medicine, vol. 2, no. 1, pp. 18–23, 2011.View at: Google Scholar
N. F. Hisham and U. Bayraktutan, "Epidemiology, pathophysiology, and treatment of hypertension in ischaemic stroke patients," Journal of Stroke and Cerebrovascular Diseases, vol. 22, no. 7, pp. e4–e14, 2013.View at: Publisher Site | Google Scholar
M. R. Law, J. K. Morris, and N. J. Wald, "Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies," British Medical Journal, vol. 338, Article ID b1665, 2009.View at: Publisher Site | Google Scholar
E. Pinto, "Blood pressure and ageing," Postgraduate Medical Journal, vol. 83, no. 976, pp. 109–114, 2007.View at: Publisher Site | Google Scholar
K. Liu, M. L. Daviglus, C. M. Loria et al., "Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: The Coronary Artery Risk Development in (Young) Adults (CARDIA) study," Circulation, vol. 125, no. 8, pp. 996–1004, 2012.View at: Publisher Site | Google Scholar
A. Golozar, H. Khademi, F. Kamangar et al., "Diabetes mellitus and its correlates in an iranian adult population," PLoS ONE, vol. 6, no. 10, Article ID e26725, 2011.View at: Publisher Site | Google Scholar
R. Chen, B. Ovbiagele, and W. Feng, "Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes," The American Journal of the Medical Sciences, vol. 351, no. 4, pp. 380–386, 2016.View at: Publisher Site | Google Scholar
T. J. Quinn, J. Dawson, and M. R. Walters, "Sugar and stroke: Cerebrovascular disease and blood glucose control," Cardiovascular Therapeutics, vol. 29, no. 6, pp. e31–e42, 2011.View at: Publisher Site | Google Scholar
A. Arboix, A. Rivas, L. García-Eroles, L. de Marcos, J. Massons, and M. Oliveres, "Cerebral infarction in diabetes: Clinical pattern, stroke subtypes, and predictors of in-hospital mortality," BMC Neurology, vol. 5, no. 1, p. 9, 2005.View at: Publisher Site | Google Scholar
C. S. Fox, S. H. Golden, C. Anderson et al., "Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American Heart Association and the American Diabetes Association," Circulation, vol. 132, no. 8, pp. 691–718, 2015.View at: Publisher Site | Google Scholar
S. H. Ley, O. Hamdy, V. Mohan, and F. B. Hu, "Prevention and management of type 2 diabetes: dietary components and nutritional strategies," The Lancet, vol. 383, no. 9933, pp. 1999–2007, 2014.View at: Publisher Site | Google Scholar
K. Tziomalos, V. G. Athyros, A. Karagiannis, and D. P. Mikhailidis, "Dyslipidemia as a risk factor for ischemic stroke," Current Topics in Medicinal Chemistry, vol. 9, no. 14, pp. 1291–1297, 2009.View at: Publisher Site | Google Scholar
C. Sarti, M. Kaarisalo, and J. Tuomilehto, "The relationship between cholesterol and stroke. Implications for antihyperlipidaemic therapy in older patients," Drugs & Aging, vol. 17, no. 1, pp. 33–51, 2000.View at: Publisher Site | Google Scholar
B. J. Ansell, "Cholesterol, stroke risk, and stroke prevention," Current Atherosclerosis Reports, vol. 2, no. 2, pp. 92–96, 2000.View at: Publisher Site | Google Scholar
J. S. Lee, P.-Y. Chang, Y. Zhang, J. R. Kizer, L. G. Best, and B. V. Howard, "Triglyceride and HDL-C dyslipidemia and risks of coronary heart disease and ischemic stroke by glycemic dysregulation status: The strong heart study," Diabetes Care, vol. 40, no. 4, pp. 529–537, 2017.View at: Publisher Site | Google Scholar
N. A. M. M. Maaijwee, L. C. A. Rutten-Jacobs, P. Schaapsmeerders, E. J. van Dijk, and F.-E. de Leeuw, "Ischaemic stroke in young adults: risk factors and long-term consequences," Nature Reviews Neurology, vol. 10, pp. 315–325, 2014.View at: Publisher Site | Google Scholar


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Margherita Margiotti reviews Henrietta L. Moore's The Subject of Anthropology: Gender, Symbolism and Psychoanalysis for the LSE Review of Books.
In this excellent and compelling modern classic, Henrietta Moore invites the forging of new alliances between anthropology and psychoanalysis in their common concerns for culture, representation and the nature of symbols. Anthropologists are encouraged to work toward a theory of imagery, fantasy, and the pre-oedipal to shed new light to the classic Durkheimian question of the relation between the social and the individual. Reviewed by Margherita Margiotti.
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Dementia Friendly


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Investment accounts
Authorised and regulated by the UK's FCA to provide investment accounts, we are bound by CASS rules to segregate and protect client assets.
This week, Head of Investment Portfolios, James Gutman, Credit Analyst, Geoff Wan and Senior Portfolio Manager Adrian van den Bok look at the credit market and, in particular, ask, should you own anything other than high yield if the Fed is buying the market?
Welcome to our Q2 2020 investment outlook. As usual, it lays out the latest views, analysis and thematic ideas from our Investment Management team. What's different this quarter is that, although we have traditionally published this as one standalone – typically printed – document, this time, because of the restrictions we face as a result of coronavirus, we are publishing it as website pages.
Watch our investment management team present a quarterly portfolio update, a global macroeconomic overview and outlook for the next months, as well as our positioning in light of the rapid developments we are seeing on global financial markets.
Investors and analysts are carefully examining economic tea leaves for signs of what is to come but confusion still reigns. Here, Head of Investment Portfolios, James Gutman, provides a macro update.
Dolfin's investment accounts safeguard securities and cash, while ensuring you or your clients can take full advantage of multi-asset, multi-currency, and multi-strategy investments.Learn more
Founded as a London-based wealth boutique in 2013, today we're a diversified financial services firm with an international presence and our own bespoke technology platform.Learn more
We pride ourselves on our ability to help. Please get in touch.Contact us


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West Indies Cricket: CWI President Slams Over-Rate Ban On Jason Holder
Cricket West Indies president David Cameron has marked Jason Holder's suspension for a slow over-rate to be quite "punitive".
Having anchored a 10-wicket pounding in the second match in Antigua, West Indies captain Jason Holder guided the Windies to a radiant Test series prevail upon England with one match to play.
Notwithstanding, having been sanctioned by the ICC, Jason Holder would not be a part of the series finale against Joe Root's men in St Lucia, for the 3rd and final test.
Women Blind Cricket – Pak Vs Nepal – 5th T20: Consecutive 10 Wicket Victory; Nepal Win Series
Holder was handed a one-match ban, along with a forty percent match fee, after Windies were found just 2 overs shy of their over-rate target.
CWI's President David Cameron said:
"We will, of course, abide by the ICC ruling, but we have to wonder if such punitive action at a pivotal stage of the series is good for cricket. What a shame if the series is remembered not for the sparkling play of the reinvigorated West Indies players but for a crippling decision made by a rule that ought to be modified,"
He further added:
Jason now has the opportunity to benefit from resting his body over the period of the next test and be well prepared for the upcoming ODI series against England which begins on February 20," Cameron continued."
Be that as it may, Cameron trusts the punishment gave to Holder, who was discovered blameworthy of a minor over-rate offense amid the Barbados Test against Sri Lanka a year ago, conveys the wrong message.
At present, Jason Holder has taken 7 wickets in the series and also made 229 runs which includes an unbeaten double century in the 1st Test.
Totally agree with this piece. If slow over rate affected the game,then the ban was justified,but how can you ban a player if the game finished in less than 4 days? This rule needs to change
"Miller: Jason Holder slow-over ban is just ICC killjoys at work" https://t.co/7J5cJIPV1G
— Farooq Yousaf (@faruqyusaf) February 5, 2019
This ban is a travesty. Clearly with four fast bowlers with longer run ups the over rate will be slower. Last time the #Windies were beating all comers new regulations restricted bouncers. Sport – England in West Indies: Jason Holder banned for third Test https://t.co/dr6cVIpHY5
— Joe Aldred (@joealdred) February 3, 2019
For more updates keep visiting allsportspk


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New Russian manufacture Novosibirsk 7.62x54R.148grn full bi-metal jacket bullet, bi-metal steel case, and NON-CORROSIVE berdan primer. Packaged 20rds to a box. Affordable NON-CORROSIVE ammo for your Mosin-Nagants 91/30, m38, m44 and Dragunovs. Imported by Wolf.
Please Click Here to View our List of Restricted States, Cities, Counties, and Locations Prior to Ordering Ammo, Guns, & MagazinesFirearms (Rifles, Handguns, Shotguns and Receivers) and Ammunition cannot be shipped in the same package as per UPS, FEDEX and USPS. For accurate shipping charges please place one order for Firearms and another for the Ammunition separately. Orders placed for Firearms and Ammunition together will not reflect the current shipping charges, and will require additional shipping charges and a delay when the orders are shipped.


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Gujarat Gaun Seva Pasandgi Mandal (GSSSB) Mechanic, Economic Investigator & Laboratory Assistant Exam Postponed Notification 2020
GSSSB Exam Postponed 2020| GSSSB Mechanic Exam Postponed | GSSSB Economic Investigator Exam Postponed |GSSSB Lab. Assistant Exam Postponed 2020 | Gujarat Gaun Seva Pasandgi Mandal (GSSSB) published Upcoming Exam Postponed Notification for the post of Mechanic, Economic Investigator and Laboratory Assistant at OJAS gsssb.gujarat.gov.in at given below details.
Posts Name:
• Mechanic
• Economic Investigator
• Laboratory Assistant
Postponed Notification: Click Here
More Details: Click Here


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444 North Winchester Blvd.
Santa Clara, CA 95050
(408) 249-5121
Business Hours:
Mon-Tuesday: 8:00 am -5:15 pm
Wed-Fri: 7:00 am -5:15 pm
Saturday: 8:20 am - 1pm
Breast Feeding Issues:
Tongue Tie / Lip Tie
Play above video for more information Breastfeeding issues and treatment
Tongue-Tie /Lip-Tie Symptoms
Does your child...
Have difficulty Latching or Breastfeeding pain for mother
Have difficulty pronouncing L's and R's (speech issues)
Snore or Mouth-breadth, Restricted Airway
Have a high palate, v-shaped, nasal speech
Large space between the two front teeth
Chewing or swallowing problems
Difficulty brushing upper teeth/cavities along the gumline of upper teeth
If so, your child can be suffering from a Tethered Oral Tissues (TOTs). TOTs are also known as frenum ties of the lip or tongue.
Normally, Tethered Oral Tissues undergo apoptosis (normal programmed cell death) while the child is in the womb (similar to how webbing of fingers and toes is removed before birth).
However, in about 5-10% of children, this process does not occur properly and we are left with tongue and lip ties.
Treatment and Release
The treatment for tongue / lip tie is relatively simple. Our dentists simply release the tied tissue with a laser to allow the tongue and lip to move freely. Since the tissue is released with a laser, the resulting tissue has minimal bleeding and pain. In most instances, breastfeeding improvement can be seen immediately.
Since the condition is so prevalent, you probably know someone – a family member, friend, colleague or acquaintance – that could benefit from tongue tie treatment for their child. One of the most common questions from parents of children with this condition is: "Where can I find a dentist specializing in tongue tie treatment near me?"
At Silicon Valley Pediatric Dentistry we have the expertise and tools needed to help treat patients that suffer with tongue tie or lip tie.
Patient Testimonial
Tongue and Lip Tie release
Tongue Tie
Immobile or limited mobility of tongue associated with snoring, sleep apnea, speech delay
Tongue Tie Released
(1 minute after procedure)
Fibrous tissue removed and immediate increased mobility of tongue
Tongue Tie Released
(1 week later)
Tissues is healed and symptoms relieved
Lip Tie
Heavy Tension on Upper Lip creating gap between central incisors
Lip Tie Released
(1 minute after procedure)
Fibrous tissue removed and
tension is alleviated
Lip Tie Released
(1 week later)
Tissues is healed and ready for orthodontics for space closure
External Resource:
Healthy Horizons Breastfeeding Centers - Baby Boutique, Lactation Consultants, Classes, Breast Pump Rentals, and Workplace Lactation Rooms https://www.healthyhorizons.com/


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- Discover the Great Pyramids of Giza
- Visit one of Egypt's largest surviving temples during a Nile River cruise
- Sail along the Nile River to Aswan and Philae Temple
- Wander along rose-colored architecture in the ancient city Petra
- Float in the salty waters of the Dead Sea
Brief Itinerary
|Day 1
|Arrive in Cairo
|Day 2
|The Egyptian Museum - Great Pyramids Of Giza
|Day 3
|Cruise in Luxor
|Day 4
|Nile Cruise - Valley of the Kings
|Day 5
|Edfu and Kom Ombo Temples
|Kom Ombo
|Day 6
|Sail to Aswan - Philae Temple
|Day 7
|Return to Cairo
|Day 8
|Arrive in Amman
|Day 9
|Amman City Tour - Jerash
|Umm Qais
|Day 10
|Transfer to Petra
|Day 11
|Wadi Rum – Dead Sea
|The Dead Sea
|Day 12
|Depart Amman
Detailed Itinerary
Day 1: Arrive in Cairo
After arriving in Cairo—one of the largest cities in Africa and in the Middle East—your tour coordinator will transfer you to your hotel.
After check-in, you will be free to relax and catch up with rest in time for a busy day of exploring tomorrow. If you feel well-rested, you may get an early start to exploring the city and venture out to try some authentic Egyptian local cuisine.
Day 2: The Egyptian Museum - Great Pyramids Of Giza
After breakfast, you will meet your Egyptologist who will accompany you on your day exploring the city and its sites.
Today's activities include:
- The Egyptian Museum: You will visit the Museum of Antiquities, commonly known as the Egyptian Museum in Cairo, which has a substantial collection of ancient treasures such as the tomb of King Tut and his funerary mask.
- The Pyramids of Giza: First you'll travel to Giza outside of Cairo where you will see the three major pyramids at its necropolis complex. Your Egyptologist will explain the history of their construction, which spanned nearly three generations starting from the Great Pyramid of Giza, Cheops, followed by the smaller Chepren, and Mykerinos.
Day 3: Cruise in Luxor
After breakfast, your tour coordinator help transfer you in time for your short flight to Luxor. This small city in the Nile Valley is located 420 miles (676 km) south of Cairo. Once you arrive in Luxor, you will make your way to your cruise ship. This unforgettable cruise includes visiting many of the major sights in Luxor.
Today's sightseeing includes:
- Karnak Temple: One of Egypt's largest surviving temples which was founded in the Middle Kingdom, and was once a key religious center.
- Luxor Temple: A large temple complex located on the east bank of the Nile River. It was founded during the New Kingdom around 1400 BC.
Day 4: Nile Cruise - Valley of the Kings
Today, you'll continue your Nile cruise which includes sightseeing on the river's west bank. Your guide will lead you through this tour.
Activities might include visiting:
- Valley of the Kings: The location of rock-cut tombs for kings and powerful nobles (including Tutankhamun) for nearly 500 years from the 16th to 11th century BCE.
- Colossi of Memnon: Visit the ruins of Amenhotep's memorial temple. What remains are two imposing statues of Pharaoh Amenhotep III, which were erected to guard the temple's entrance.
- Hatshepsut Temple: The Mortuary Temple of Queen Hatshepsut is the focal point of Deir el-Bahri, a complex of mortuary temples and tombs.
After your tour, you will make your way back to your cruise ship where you can relax on board as you sail to Esna.
Chat with a local specialist who can help organize your trip.
Day 5: Edfu and Kom Ombo Temples
The next stop on your Nile cruise will be to see the temples at Edfu and Kom Ombo.
Your guide will explain the significance of these temples in further detail:
- Temple of Horus at Edfu: The Ptolemaic Temple of Horus was constructed between 57 BCE and 237 BCE. It is one of the best-preserved shrines in Egypt and inside you can still make out many of its inscriptions.
- Temple of Sobek and Haroeris at Kom Ombo: This temple is dedicated to the crocodile god (Sobek) and falcon god (Haroeris). It was built during the Ptolemaic era. Many of the walls of its courts, halls, sanctuaries, and rooms are still intact along with wall carvings and some statues.
Day 6: Sail to Aswan - Philae Temple
Your adventure continues as you set sail for Aswan. In Aswan, you will have a chance to get off the ship and explore more sights along with your guide.
Today's sightseeing includes:
- Aswan High Dam: Built in the 1960s and completed in 1970. Aswan Dam was formally inaugurated in 1971 and was an engineering marvel at the time due to it changing the landscape of Egypt by increasing cultivable land by 30 percent and doubling its electricity supply.
- Philae Temple: There were once temples at Philae (construction began in 690 BC) dedicated to the goddess Isis. The complex was moved from its original location on Philae Island to Agilkia Island due to the construction of Aswan High Dam. You'll board a small boat to learn more about the temple here.
- The Botanical Garden: You'll have time to explore the grounds of Kitchener's Island—also known as the Botanical Garden—a 16-acre island in the Aswan archipelago located between Elephantine Island and The Nile's west bank.
Day 7: Return to Cairo
From Aswan, your tour coordinator will transfer you to the airport in time for your flight back to Cairo.
After checking into your hotel, you can spend the rest of the afternoon or evening exploring Cairo, indulging in local cuisine or taking in some last-minute sightseeing—before departing for Jordan tomorrow.
Day 8: Arrive in Amman
After breakfast, your tour coordinator will transfer you to the airport in time for your flight to Amman. A driver will be waiting for you to take you to your hotel in Amman.
Depending on your time of arrival, you may have some time to explore this bustling capital city.
Suggested activities include:
- Walk around in Jabal Weibdeh, which is the oldest neighborhood in Amman. There are lots of small side streets, shops offering local goods and produce to be explored, as well as many cafés and restaurants.
- Close to Jabal Weibdeh is also the King Abdullah II Mosque which welcomes visitors.
- Explore the Citadel with the Temple of Hercules which offers a 360-degree view over Amman. It's best to be there during prayer time, as you'll hear the calls to prayers from the various mosques, creating a surreal echo.
- Continue to the Roman Theater, and then head through the bustling downtown souks.
- Head to Rainbow Street in Jabal Amman, which is lined with shops, restaurants, and shisha cafés. You can explore the side roads, and you'll have great views over the surrounding "white hills".
- Visit the Jordan Museum, where some of the Dead Sea Scrolls are on display.
Day 9: Amman City Tour - Jerash
After breakfast, a driver will pick you up for your city tour of Amman. The capital city was called Rabbath Ammon or Rabat Amon by the Ammonites. It was later conquered by the Assyrians, followed by the Persians, and then the Greek Macedonians. Ptolemy II Philadelphus, the Macedonian ruler of Egypt, renamed it Philadelphia.
The city tour includes visiting:
- The Citadel and its Archeological Museum. It's best to be there during prayer time, as you'll hear the calls to prayers from the various mosques, creating a surreal echo.
- Visit the Roman Theater, which is located in downtown Amman. As you walk up the stairs, you'll notice that it is much steeper than it looks from afar.
- You will then continue to downtown Amman, to stroll through the bustling markets. Here, everything from fruits and vegetables, to clothing and animals, are offered.
- A panoramic tour of the modern parts of Amman.
After your city tour of Amman, you will set off my car to Jerash. Here, you'll discover the marvel of the ruins of the Greco-Roman city of Gerasa, also known as "Antioch on the Golden River". Sites you'll visit in Jerash include The Corinthian Column, Hadrian's Arch, The Circus-Hippodrome, The Two Large Temples (dedicated to Zeus and Artemis), the nearly unique oval forum that's surrounded by a fine colonnade, the long colonnaded street or cardo, the South Theater and the North Theater, two baths as well as a scattering of smaller temples.
You'll return to your hotel in Amman in time for dinner.
Day 10: Transfer to Petra
After breakfast, you'll depart Amman for a three and a half-hour drive to Petra.
Petra is a historical and archaeological city famous for its rock-cut architecture and water conduit system. Petra, which is also known as the Rose City due to the color of the stone out of which it is carved, is the capital city of the Nabateans and seen as a famous symbol of Jordan. UNESCO has described it as one of the most precious cultural properties of man's heritage.
You can walk through the mystic Siq ("the shaft"), a natural geological feature formed from a deep split in the sandstone rocks and serving as a waterway flowing into Wadi Musa. After walking through Siq, you should reach the famous Treasury (also known as Al-Khazneh). There is also a viewpoint opposite it which you can climb up for a view from above. Then, you can visit the Street of Facades and walk through the Roman area, where you can climb up to the High Place of Sacrifice and follow the path to the Garden Temple Complex.
If you have the energy then climb the 800 steps up to the Monastery, Petra's largest Temple.
Day 11: Wadi Rum – Dead Sea
After breakfast, you'll check out of your hotel and transfer to Wadi Rum.
You'll travel for two hours in a Jeep through the magnificent desert of Wadi Rum which is also known as "the Valley of the Moon". This valley has been inhabited by humans since prehistoric times with a significant cultural history including the Nabateans who have left their mark in the form of rock paintings, graffiti, and temples. Starting from Rum Village, you'll visit the best places of the Wadi Rum Protected Area including red sand dunes, canyons, Nabatean inscriptions, bizarre rock formations, and huge rock bridges.
In the afternoon, you'll head the lowest point on earth: the Dead Sea. Here, you have a free afternoon to float in the salty waters, go for a full-body mud treatment or relax in the sun. In the evening, you can enjoy the sun going down over the mountains on the other side.
You'll spend the night at a hotel at the Dead Sea.
Day 12: Depart Amman
Depending on the time of your flight, you may be able to spend the morning swimming in the Dead Sea or exploring this picturesque area.
Your driver will then transfer you to the airport in Amman in time for your international flight. Safe travels!


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August 22, 2018 by -30- Forensic Engineering
TORONTO, ON August 22, 2018/insPRESS/ – 30 Forensic Engineering, Canada's leading and fully-independent multi-disciplinary forensics firm, is pleased to announce the appointment of Heather Aitken, E.I.T., B.Sc., B.Eng. as Associate within our Collision Reconstruction Group.
Heather holds a Bachelor of Engineering with a focus in Mechanical Engineering, and an Honours Bachelor of Science in Human Kinetics. In her role at 30 Forensic Engineering, Heather will analyze collisions involving different types of vehicles, including automobiles, trucks, light rail vehicles, bicycles, motorcycles, and other types of heavy machinery.
Prior to starting her career in Forensic Engineering, Heather worked in transportation with a focus on the design and testing of Light Rail Vehicles. She has also worked in the aerospace and health care sectors. Heather currently serves as Director for the non-profit WTS (Women's Transportation Seminar) Canadian Education Foundation and is active in promoting women's advancement in Engineering fields.
"Heather's commitment to learning and ability to see the big picture will make her a success at handling the types of complex, multi-disciplinary investigations that we at 30 Forensic Engineering excel at. We know Heather will be a great resource for our valued clients going forward." Stated Mark Fabbroni, Vice President & Practice Lead, Collision Reconstruction & Trucking.
About 30 Forensic Engineering
30 Forensic Engineering is one of Canada's largest and most respected multi-disciplinary forensic firms. Our core team of 65 Professional Investigators, Engineering Technicians and support staff is enhanced through relationships with some of the top scientists, standard-makers and specialized consultants in North America serving a wide variety of industries including: Insurance, Manufacturing, Legal, Construction, Health Care, Commercial and Residential Property, Financial, Government, Hospitality, Mining, Renewable Energy and Transportation.
We provide world-class engineering and consulting expertise in:
Civil/Structural Failure
Building and Fire Code
Geotechnical and Mining
Biomechanics Personal Injury
Human Factors
Collision Reconstruction
Transportation Safety
Renewable Energy
Environmental Health & Safety
Multi-disciplinary Remediation
Materials & Product Failure / Piping & HVAC
Fire / Electrical & Explosion investigations
The Canadian Lawyer Magazine readership acknowledged 30 Forensic Engineering as their top choice in both forensic engineering categories:
For further information, please contact:
Paul Aquino, Director, Marketing
For confidential inquiries on becoming a member of the -30- Forensic Engineering team, please contact:
Stephanie d'Obrenan, Senior Manager, People and Culture
30 Forensic Engineering In the News:
30 Forensic Engineering Appoints Robert Sparling as Senior Vice President & Practice Lead, Materials Failure
30 Forensic Engineering Strengthens Senior Management with the Appointment of Greg MacLeod as Chief Financial Officer
30 Forensic Engineering Appoints Jamie Catania to President
30 Forensic Engineering Strengthens Fire Investigation Group with the Senior Appointment of Brandon Northrup
2018 Forensic Investigation Forum: Ottawa
30 Forensic Engineering Announces New Ownership
2018 Forensic Investigation Forum: Current Perspective on Property & Casualty Claims and Risk Mitigation
Be Prepared – "Be Emergency Ready"
JLT Canada Presents 2018 Municipal Risk Management & Professional Development Conference
30 Forensic Engineering Names Jeff Reitsma Principal for Remediation Practice
30 Forensic Engineering and Blouin Dunn LLP Host The 12th Annual Big Mingle
30 Forensic Engineering Strengthens Civil/Structural Group with the Senior Appointment of Derek Gibson
30 Forensic Engineering Expands Human Factors Group with the Appointment of Fabian Erazo
30 Forensic Engineering Strengthens Geotechnical Group with the Appointment of Dr. Ahmed Fahmy
30 Forensic Engineering and Blouin Dunn Proudly Announce the 2018 Big Mingle Sponsorship Partners
2017 Forensic Investigation Forum: Current Perspective on Property & Casualty Claims and Risk Mitigation
JLT Canada Public Sector Summit 2017 – A Shift in Focus for Canadian Municipalities
30 Forensic Engineering Announces Senior Level Appointments
2017 Forensic Investigation Forum: Property & Casualty Claims and Risk Mitigation
30 Forensic Engineering's Dr. Adam Campbell Presented at the 2017 Human Factors and Ergonomics Society International Meeting
30 Forensic Engineering Joins JLT Canada to Bring Together Municipal Leaders at the Inaugural Public Sector Summit 2017
30 Forensic Engineering Recognized as Top Experts by Canada's Legal Community
ASM International & 30 Forensic Engineering host Steel Image Workshop on Decoding Metallurgical Failure
British Columbia Wildfire Catastrophe: 30 Forensic Engineering Onsite & Ready to Assist
30 Forensic Engineering Announces New Website Launch
30 Forensic Engineering Transportation Safety Group to Host Road Safety and Risk Management Workshop for Bicycle Facilities
30 Forensic Engineering Celebrates International Women in Engineering Day
30 Forensic Engineering Transportation Safety Group to Present at the Human Environments Analysis Laboratory Symposium
30 Forensic Engineering Strengthens Geotechnical and Mining Group with the Appointment of Xiangyu Li
30 Forensic Engineering Strengthens Construction Services Group with the Senior Appointment of Jiwan Thapar
30 Forensic Engineering's Jiwan Thapar Presents Advanced Construction Claims Management Course at Toronto Construction Association
30 Forensic Engineering Strengthens Fire and Electrical Investigations Group with the Appointment of Joshua Campbell
30 Forensic Engineering Strengthens Remediation Group with the Appointment of Chris Ciasnocha
30 Forensic Engineering Transportation Safety Group to Host a Pedestrian Safety and Risk Management Workshop
30 Forensic Engineering Construction Services – Claims, Risk and Advisory
30 Forensic Engineering Strengthens Civil/Structural Group with the Appointment of Karen Lin
Plan. Prepare. Be Aware. It's Emergency Preparedness Week
Renewable Energy Group at 30 Forensic Engineering Offers Pre-Loss Inspection and Risk Management Services
30 Forensic Engineering's Multidisciplinary Approach Provides a 360° View of Slip & Fall Assessments
30 Forensic Engineering Expert Jeff Reitsma Delivers Breakout Session at PLRB Claims Conference in Boston
The Society of Automotive Engineers International Publishes 30 Forensic Engineering Research Paper
–30- Forensic Engineering Proudly Announces Retitled Transportation Safety Group
Construction Claims Team at -30- Forensic Engineering Offers Productivity Loss Assessment Services
-30- Forensic Engineering's Jiwan Thapar Presents Full Day Course at Toronto Construction Association on Feb 28, 2017
-30- Forensic Engineering's Pierre Maheux to Present at the 2017 Ontario Bar Association Institute
-30- Forensic Engineering Strengthens Road Safety Group with the Appointment of Shahram Almasi
Blouin Dunn LLP and -30- Forensic Engineering's Big Mingle, January 30, 2017
Blouin Dunn & -30- Forensic Engineering Thank 2017 Big Mingle Sponsors
-30- Forensic Engineering Launches Fixed-Fee Fire Investigation Service
-30- Forensic Engineering Promotes Pablo Robalino to Senior Associate within Civil/Structural Group
-30- Forensic Engineering Strengthens Civil/Structural Group with the Appointment of Paul Reinis
-30- Forensic Engineering Forms Integrated Fire and Electrical Investigations Division
-30- Forensic Engineering Strengthens its Collision Reconstruction Group with the Appointment of Brad Muir
-30- Forensic Engineering Retained to Complete Rail Crossing Safety Reviews for Ontario Municipalities
–30- Forensic Engineering's Alex Nolet to Present at the Association Quebecoise des Transports (AQTR) Symposium
-30- Forensic Engineering Brand Launch Event, October 5, 2016


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Little Simz delivers a ruthless verse. More »
The electronic producer isn't finished being on the road just yet. More »
The perfect combination. More »
We recently chatted with the flame-haired singer at SXSW 2016 about all things music. More »
The 25 singer took the moment to announce her support for troubled pop peer Kesha. More »
Little Mix, OMI and Ellie Goulding also performed. More »
British critics and industry figures predict the Next Big Thing. More »
We spoke to British singer/songwriter/producer Jack Garratt about his new EP Synesthesiac and touring America. Read more after the jump. More »


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Restaurant Listings in Bullhead South DakotaTry your search for: Bars | Restaurants | Casinos |
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Approaches to treating patients with unresectable melanoma after failure from anti–PD-1 single-agent treatment vary greatly, but using the combination of ipilimumab and nivolumab may result in best outcomes, suggest data presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago Illinois.
Moreover, some clinicians still use chemotherapy in such patients even though this approach yields poor outcomes, according to the findings.
In the study, investigators looked at 200 patients in Germany with unresectable metastatic cutaneous or mucosal melanoma who had failed treatment with single agent anti–PD-1 antibody. The researchers examined what treatments the participants received after anti PD-1 failure and what outcomes those treatments yielded. Some of these outcomes were the rate of objective remissions, disease control, and survival.
The researchers found that 47 patients received ipilimumab single agent, 77 patients received the combination of ipilimumab and nivolumab, 18 received BRAF/MEK inhibitors, and 58 received other regimens such as chemotherapy and talimogene laherparepvec (TVEC). The combination of ipilimumab and nivolumab resulted in a higher rate of objective remissions of 19.5% compared with 4.2% for ipilimumab alone (P =.02). Among patients who received BRAF/MEK inhibitor rechallenge, the rate of objective remissions was 22.2%.
Overall survival was highest among patients who received the combination of ipilimumab and nivolumab — at 15.6 months compared with 9.2 months among patients who received ipilimumab single agent, 11.7 months among patients who received BRAF/MEK inhibitors, and 10.1 months among patients who received other regimens.
Progression-free survival was also higher among patients who received the combination of ipilimumab and nivolumab (3.4 months) compared with those who received nivolumab single agent (2.6 months).
The researchers also found that conventional chemotherapy was still used quite often; dacarbazine was used in 33 patients and other chemotherapy regimens were used in 17 patients, but the rate of objective remissions was low, at 6%. In addition, 2 out of 4 patients who received talimogene laherparepvec achieved remission.
"Conventional chemotherapy is still in use, though only giving poor results," said lead study author Michael Weichenthal, MD, a professor of dermatology at the University of Kiel, Germany.
Weichenthal M, Ugurel S, Leiter UM, et al. Salvage therapy after failure from anti-PD-1 single agent treatment: A Study by the German ADOReg melanoma registry. Presented at: 2019 American Society of Clinical Oncology (ASCO) Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract 9505.
This article originally appeared on Cancer Therapy Advisor


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Paul Kelley, 89, of New Paltz, NY, passed away on Tuesday, August 27, 2019, at Woodland Pond in New Paltz. Born July 7, 1930, in Port Byron, NY, he was the son of the late Irvin and May (Morris) Kelley. Paul married Edythe Oteri on December 26, 1958, at Winter Park, Colorado. They spent 44 years together before her death on December 6, 2002.
Paul proudly served his country in the Army during the Korean War. He was awarded various medals including Sharp Shooter, Korean Service Medal with Bronze Service Star, National Defense Service Medal, and the United Nations Service Medal.
Paul earned two Master's Degrees in both Education and Geology. He was a Technology and Industrial Arts teacher at New Paltz Middle School in New Paltz, NY. He retired in 1992.
Paul and his wife Edythe had a wonderful partnership. An energetic person, Paul couldn't sit still for a moment; however, Edythe had an incredible calming effect on him. Edythe and Paul enjoyed renovating their stone house, raising their children, and many wonderful vacations. After Paul retired from teaching, he and Edythe opened a successful bed and breakfast where they shared their warm and welcoming home with a myriad of interesting guests for over 10 years.
Paul was an infinitely curious person, an extraordinary athlete, and a tremendous lover of the outdoors. His father, Irvin, was a farmer and minister, so Paul spent his early life moving around Tennessee and upstate New York. However, his heart was always in upstate New York, as he adored the fresh air and wide-open spaces. In exploring other places, he bicycled all over Europe, including the Austrian and Bavarian Alps, Ireland, Germany and England. He would be disappointed in himself if he failed to log in 100 miles a day on his bike and was occasionally known to have done 200. He was an avid mountain climber and a "46er," having scaled the 46 high peaks of the Adirondacks, as well as Mt. Fuji in Japan and Gannett Peak in Wyoming. At home, he swam in his pond every morning until he couldn't break the ice with his forearms. He was then forced to put his swims on hold till the spring thaw, so he turned to daily sledding.
Paul was a multiple medium artist, sketching, painting, and working with wood to make furniture and carvings. He was also an excellent mason, making beautiful fireplaces from stone. A lover of music, his favorites included classical as well as folk.
Paul was also a political activist and felt very passionate about his beloved Hudson River. The family suggests that in lieu of flowers, donations in Paul's name be made to Clearwater Hudson River Revival, Anne Todd Osborn, Clearwater Board President.
Paul was preceded in death by his wife, Edythe; his twin brother, Peter; and his older siblings Robert, Louise, and Lovina.
Survivors include his children, Steven LeConte Kelley and his wife, Debra of Clintondale, NY; Ellen Kelley Scalzi and her husband Christopher of Rensselaer, NY; and Laurel Lei Kelley and her husband David Johnson of West Sand Lake, NY; his brother, Porter Kelley of Tacoma, WA; his grandchildren, Jaclyn Kelley-Widmer and her husband David Kelley-Widmer of Ithaca, NY; Travis Paul Kelley and his husband Paulo Murta of Boston, MA; Alexander Scalzi of Troy, NY; Elgin Scalzi of Rensselaer, NY; Liam Blake Johnson of West Sand Lake, NY; and Ava Kelley Johnson of West Sand Lake, NY; and his great grandchildren, Wendell Kelley-Widmer and Conrad Kelley-Widmer of Ithaca, NY.
Calling hours will be held on Saturday, September 21, 2019, from 1-3 p.m. at Copeland Funeral Home, 162 South Putt Corners Road, New Paltz, NY. This will be followed by a memorial service at 3 p.m.


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Please read the handbook in its entirety, it contains a plethora of helpful information. Included are forms that are important for all students to review. Please complete & submit all forms as instructed.
Follow the link for the NEMCI&A policy manual. The manual includes a comprehensive explanation of all policies and procedures.
The Athenian Leadership Society is an advanced IIMC Leadership Development Program.
The premise of this program is the idea that clerks are leaders in very profound yet subtle ways.
This scholarship program has been designed to assist with the costs of attending an IIMC approved Institute or Academy program for those working toward IIMC's professional designations.
2023 IIMC Scholarship Application


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A Chicago man who became a professor of astronomy at Northwestern University coined the term "close encounters."
Dr. J. Allen Hynek was a highly respected scientist for decades before he received a credit as a technical adviser on Steven Spielberg's 1977 movie "Close Encounters of the Third Kind." Hynek died in 1986, but his life and legacy are explored in a new biography by Mark O'Connell called "The Close Encounters Man: How One Man Made the World Believe in UFOs."
O'Connell, who teaches screenwriting at DePaul University, wrote several episodes of "Star Trek: The Next Generation" and "Star Trek: Deep Space Nine" (including the fan favorite "Who Mourns for Morn?").
Below, an edited Q&A with the author.
Chicago Tonight: Has this been a lifelong interest for you?
O'Connell: Absolutely. My first conscious memory is from when I was about 3 years old, 1963, and for some reason my mom tuned in this new TV show call "The Outer Limits" and I remember being scared to death by the space aliens in the premiere episode, and that sort of set the theme for my entire life.
Also, my mom was a librarian at our village library [in Big Bend, Wisconsin] and she would take me in with her a lot of times. When she worked I always gravitated toward the UFO bookshelf.
Did Hynek's feud with Carl Sagan lead Hynek to create the Center for UFO Studies [CUFOS]?
It's hard to draw a direct line between the two, but I think it was definitely a factor, because Dr. Hynek's first public announcement about the formation of CUFOS took place on national TV on "The Dick Cavett Show" right after Carl Sagan had just finished ridiculing all the UFO witnesses on the panel, and he [Hynek] basically waits for a quiet moment toward the end of the show and says "Well, I'm starting a research foundation," which probably meant nothing to the people watching the Cavett show but it meant a lot to Sagan, because it indicated that Hynek had scientific support for his work.
Video: "Wild Chicago" visits the Center for UFO Studies in October 1990.
CUFOS is no longer in a storefront on Peterson Avenue in Chicago. Where is Hynek's research currently?
Hynek's career as a UFO researcher is in a bunch of beat-up old file cabinets scattered around between two basements and an attic in Chicago and Skokie. So it's kind of a sad state of affairs. The people who are taking care of the files are very dedicated and sincere people but there's only so much they can do, because there's no money.
Were his inquiries into UFO research met with controversy in the academic circles of Northwestern University and elsewhere?
He was a superstar professor at Northwestern because in his heyday, during the '70s especially, he was just on TV constantly – he was on Tom Snyder's "Tomorrow Show," "The Tonight Show," Dick Cavett. So Northwestern loved the attention that he brought to the university, but they didn't always love being attached to the idea of UFOs. It was a complicated relationship.
Below, an excerpt from "The Close Encounters Man."
THE INTOXICATING MIX OF FEAR AND FASCINATION that defined the public's infatuation with science and with Earth's heavenly neighbors reached a crescendo with the approach of Halley's Comet in the spring of 1910. Here was a scientific phenomenon that nearly every human being on Earth could see with his or her own eyes in the night sky—the ultimate shared experience— and that a great many human beings feared. For while the exact time and location of a comet's appearance could, by 1910, be accurately predicted by science, its actual nature and purpose was still clouded in myth and superstition.
It was established fact that Halley's Comet appeared in our skies about every seventy-six years and established lore that its appearance—the appearance of any comet, for that matter— brought about certain calamity and suffering. In 1066, most famously, Halley's Comet foretold the Battle of Hastings and the violent struggle for the British throne that ensued, and after that even Shakespeare submitted that the comet was a bad sign for a sitting monarch. This proved to be the case again in May 1910, when King Edward VII succumbed to failing health and passed away only days before the comet's nearest approach.
Even worse, scientists discovered that all humanity was at risk of following Edward to his doom. Not only was it determined that Earth would be passing directly through the comet's tail for a six-hour period on the night of May 18–19, but astronomers at the Yerkes Observatory in Williams Bay, Wisconsin, utilizing the new technique of spectroscopy to determine the temperature and chemical composition of a luminous body by analyzing the spectrum of light it emits or reflects, found the tail to contain a deadly substance: poisonous cyanogen gas. French astronomer Camille Flammarion was distressed enough by the Yerkes findings to declare that "the cyanogen gas would impregnate the atmosphere and possibly snuff out all life on the planet."
Finding themselves stalled out and stranded on a celestial railroad crossing with an express freight hurtling toward them, the people of Earth gave way to fear and prepared for the end. "Some people took precautions by sealing the chimneys, windows, and doors of their houses. Others confessed to crimes they had committed because they did not expect to survive the night, and a few panic-stricken people actually committed suicide," reported science writers Gunter Faure and Teresa Mensing.
The most gullible bought "comet pills," "comet umbrellas," and gas masks, while the most faithful gathered nervously in houses of worship, prepared to meet their maker. Some, intent on going against the grain, were gripped by an inexplicable end-of- the-world euphoria: "A strangely frivolous mood caused thousands of people to gather in restaurants, coffee houses, parks, and on the rooftops of apartment buildings to await their doom in the company of fellow humans."
One of those rooftops was in Chicago, Illinois, although its viewing party took place almost two weeks ahead of the global deathwatch of the eighteenth, and the guest list was rather small. On the night of May 5, Joseph and Bertha Hynek took their five-day-old son, Josef, to the roof of their West Side home to bask in the light of the comet. What the mood was on that rooftop, one can scarcely guess, but it must have come as some relief to Joseph and Bertha that they and their newborn son survived the fallout of the comet's tail thirteen nights later. Nonetheless, little Josef, who was to be their only child, may have gotten a sprinkling of comet dust that night, because for the rest of his life, his path would be marked, and sometimes defined, by the appearance and movements of unusual heavenly bodies.
Destined to become a trusted spokesman for the space race, a paradigm-shifting pioneer in astronomical imaging, an authority on the study of UFOs, both lauded and reviled, and an unexpected cultural touchstone in the world of science fiction, Josef Allen Hynek could not help but spend much of his life and career out on a limb, reaching for the lights in the night sky. Born into a world where cunning and intelligent Martians built thousand-mile canals and spied on us through giant eyes, where scientific destruction could rain down on us from the skies without warning, where impossible flying ships could crisscross the skies with impunity, and where a spaceman was laid to rest in a small cemetery in north Texas after crashing his flying ship into a windmill, Hynek would, fittingly, grow up to embody the contradictory nature of scientific inquiry and investigation in the twentieth century, with its simultaneous dependence on and rejection of imagination and wonder.
It wasn't just a boy who was born on May 1, 1910, to Joseph and Bertha Hynek. He was a spaceman.
Excerpt reprinted with permission. Dey Street Books, an Imprint of William Morrow.
Related stories:
Adler Planetarium Offering Free Admission for Aug. 21 Solar Eclipse
July 12: Are you ready to party like it's 1925? That's the last year Chicago experienced a solar eclipse like it will next month. To celebrate, the Adler Planetarium is hosting a daylong block party, and you're invited.
Chicago Astronomer to Create Plan for Human Exploration of Mars
July 12: Adler Planetarium astronomer Lucianne Walkowicz will spend the next year figuring out how humans can get along while exploring one of the more curious planets in our solar system: Mars.
Neil deGrasse Tyson on Making Science Fun, Understandable
March 9: Neil deGrasse Tyson joins Chicago Tonight's Eddie Arruza for an extended conversation about science and our place in the cosmos.


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I found this video over at SurfThereNow.com, it shows Tyler Bradt kayaking over the 186-foot-high Palouse Falls. He broke the old waterfall world record of 127 feet.
Technorati Tags: kayaking, extreme kayaking, i'm a crazy son of a gun, tyler bradt
« Song For Saturday. [Video] | Main | Hola Miguel. »


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Busty redhead actress Maitland Ward See Through shows off her hot body in red lace lingerie – Instagram, Snapchat, 01/08/2018
Maitland Ward (born Ashley Maitland Welkos; February 3, 1977) is an American actress. She is known for playing Rachel McGuire on the ABC original series, Boy Meets World, and Jessica Forrester on The Bold and the Beautiful.
Ward starred as Jessica Forrester on The Bold and the Beautiful, where she appeared from 1994 to 1996. She landed that role, which was her first ever acting role when she was 17 and still a junior in high school. Ward had guest-starring roles on USA High and the seventh season of ABC's Home Improvement; and co-starred with Jay Thomas and Mario Lopez in the dramatic movie, Killing Mr. Griffin.
Her character of Rachel McGuire was added to Boy Meets World in 1998, at the beginning of the sixth season, as a main cast member. This role lasted until the series ended in 2000. After Ward's stint on Boy Meets World, she appeared in the independent film, Dish Dogs, a romantic comedy in which she co-stars with Brian Dennehy, Matthew Lillard and Sean Astin. Later, she appeared in the 2004 comedy film White Chicks with Shawn and Marlon Wayans.


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These days, wireless headsets are aplenty. It's great that we have choices, but that also means we need to be extra selective. Wireless headphone designs vary quite a bit, and they can work better for specific uses than others. For instance, we have a list just for the best Bluetooth headphones built for working out. You can also read our review on the MPOW 059 Bluetooth headphones.
One of the headphones on that list was the LG TONE Active. But if you care more about quality than active use, LG still has you covered, in the form of the LG TONE Platinum. It ups the TONE line with premium looks and high-def wireless audio, in conjunction with renowned audio manufacturer Harman Kardon. Let's check out what LG's latest headset brings in our LG TONE Platinum headphone review. And speaking of checking out, also check out the best headphones around.
Price: $169 on Amazon
Available: Now
Model: HBS-1100
WHY IT'S A TOP PICK: Thought-out ergonomics, comfortable fit, and high-quality Bluetooth audio.
What We Liked:
- The whole unit is lightweight, and compact earpieces fit well
- Loads of features: vibration, built-in equalizer, and call functions
- Crisp and detailed HD audio through Bluetooth
What We Didn't:
- The around-the-neck wear may not be for everyone
- The thin cables can cause microphonic noise
- Slight hiss in the audio
LG TONE Platinum Specs
|Frequency Range
|Bluetooth Standard
|Version 4.1, aptX HD (24-bit audio)
|Bluetooth Range
|33 feet
|Battery Life
|10 hours of playback
|Charge Time
|less than 2 hours
|58 grams
|Rechargeable Battery
|Carrying Case
|Eartip Sizes
LG takes a different approach to the Bluetooth headset. Typically, manufacturers bridge earpieces with a slender cable, but instead, the LG TONE design makes the headphone a one-piece circular band. The idea behind this approach is that the unit rests around your neck, and the earpieces extend from the open ends via very thin, retractable wires. If a neckpiece doesn't sound comfortable, you'll want to check out our Optoma BE Free8 review instead.
The entire band appears to be one material, but there's a section on the back that's rubbery and flexible. This allows the band to open up to don and change shape for different neck sizes. The "Platinum" version of the LG TONE can be thought of as a higher-end, premium version. Most of the chassis is constructed from smooth hard plastic, but there's brushed metal accents lined on the open ends (with a nice shiny chamfer) and around the sides. This touch certainly gives the headset an elegant feel.
Related: If you like these headphones, you might be interested in our Logitech UE 4000 On-Ear Headphones review.
There is a slew of controls along the metal lining. On the right side is a play/pause button and a switch to go to the next/previous tracks. You'll also find the charging port nearby; it's protected by a flap and takes a microUSB connector. On the left, we have a call answer/end/reject button (the headset has a microphone to answer phone calls) and a volume switch.
The inner lining of the band is nicely textured (we appreciate the attention to detail). You'll also find the same button on both sides. These are simply to retract the earpieces.
I'm not sure why LG didn't use the same mechanism as on the TONE Active, where you gently pull on the earpieces when they're fully extended and they retract automatically. I prefer that method, but pressing a button isn't that much more work. Near the button on the right side is an on/off switch for the unit.
A benefit of LG's wireless headphone design is that the earpieces can be compact (since they don't have to house all the wireless-enabling electronics). Their shape is simple, but the housing also has a nice metal touch. They're also really light.
The packaging includes a standard set of silicone ear tips – small, medium, or large pairs.
As expected, LG thought out the fit of the TONE Platinum. It contours around the neck naturally and due to its lightweight, barely feels like anything is there. Comfort is no concern whatsoever. The small, capsule design of the earpieces means that they slip into the ear canal with ease and fit snugly. Once donned, they stay in place despite movement. And because the cables are super thin, you barely notice them. They extend out by just over 9″, so there's plenty of slack. But with that said, it's possible that they rub on the unit or your face when you move and pick up some microphonic noise.
Pairing the headset for the first time is as easy it comes. As soon as you turn the device on, it's in discover-able mode. You simply go into the Bluetooth settings of your mobile device and select the TONE Platinum. A comforting voice tells you the status of the headset (in this case, that it's paired and ready to go).
Related: Also check out our Jabra Elite 75T review.
The functions have a slight learning curve. Particularly, you have to try to remember which direction of the switches means next/previous track or volume up/down. What's nice is that there are additional actions when you hold the switches. Holding down the track button rewinds or fast forwards through the song. Holding down the volume switch moves through the volume range more quickly.
Similarly, if you hold the play/pause button, it stops the track. LG baked in an equalizer into the TONE Platinum as well. Double pressing on the play/pause button switch between bass boost, treble boost, or neutral settings. Pressing the call button (when not in a call) activates the phone's voice command. On Android, it brings up Google Now and on iOS, it toggles Siri. If a call comes in, the headset will vibrate (LG built-in a vibration motor). With the call button, you either answer/end with a press, activate Call Waiting with a press and hold for 1 second, or reject an incoming call with a press and hold for 2 seconds.
LG also makes sure that the TONE Platinum is competent from a technological perspective. The Bluetooth range is a decent 33 feet, and the battery lasts up to 10 hours of music playback (depending on volume level). Additionally, this "premium" model also ups audio capability. It packs Qualcomm's newest Bluetooth streaming standard – aptX HD. This codec allows for HiFi playback over Bluetooth (24-bit audio quality), which is impressive. The quality of audio through Bluetooth has trailed behind wired setups, so we were excited to test this out. Newer smartphones, like the LG G5 we reviewed, pack aptX HD capability.
By default, the sound profile of the LG TONE Platinum is set on bass boost. That raises a question mark, as I'd figure you'd want to start neutral. But I think LG is acknowledging that most people care about bass, suggesting that its headset is targeted more at the general consumer than audiophiles. Fortunately, audiophiles get thrown a bone with 24-bit Bluetooth audio streaming (thanks to aptX HD technology). But is the boosted audio quality discernible?
I think so. I was fortunate to have tried the TONE Active, which has the standard aptX (non-HD), and I think this Platinum version ups the detail. But then again, the driver technology is different between the Active and Platinum, so it's not necessarily apples-to-apples. Whereas the Active uses LG's quad-layered dynamic driver, the Platinum moves to Balanced Armature driver technology.
Regardless, what I hear from the TONE Platinum is clear and crisp audio. This is definitely one of the best Bluetooth headphones that I've heard. Particularly, the bass definition and treble detail are reproduced very well. Additionally, the sound signature is engaging, as the sounds appear to fill a 3D space around your head. I wouldn't say that the mid-range frequencies are as defined as the bass and treble (they get slightly overshadowed), but they're still good.
A drawback that plagues wireless headsets is hiss, and the TONE Platinum isn't an exception. It's noticeable. You have to get to a medium volume level to drown it out with the music. Don't get me wrong though, it's not loud or disruptive. Most listeners should be able to tune it out.
Final Thoughts
In our opinion, the LG TONE Platinum is one of the better Bluetooth headphone offerings out there. LG does both design and sound so well. The around-the-neck band may not be for everyone, but we suggest considering it. The ergonomics of the TONE series just work. Additionally, aptX HD support makes the Platinum variant even more attractive. You'll be getting one of the best Bluetooth audio experiences. Couple that with excellent battery life and a multitude of functions, and we have a winner.


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The perfect gift for an Outlaw Surf & Turf spice lover! The Bootleg Outlaw Bundle includes the Outlaw Surf & Turf 5 LB bulk bag PLUS a limited edition, Bootleg - Handcrafted in Minnesota stainless steel steak knife with hammered handle. Comes in a black decorative case. Hurry, limited quantity available!
BOOTLEG - Handcrafted in Minnesota is a family-owned business.


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What and why Vagrant
Vagrant is computer software for creating and configuring virtual development environments. It can be seen as a wrapper around virtualization software such as VirtualBox, KVM, VMware and around configuration management software such as Ansible, Chef, Salt or Puppet.
Vagrant provides easy to configure, reproducible, and portable work environments built on top of industry-standard technology and controlled by a single consistent workflow to help maximize the productivity and flexibility of you and your team.
Vagrant Official Website www.vagrantup.com
After install Vagrant and VirtualBox, we can create a Vagrant development environment such as Ubuntu 14.04 LTS 64bit by this command
vagrant init ubuntu/trusty64, will be generate a Vagrantfile in current directory.
If you wanna ro moving VirtualBox and Vagrant to another directory, first move
~/.vagrant.d to the another directory,
$ sudo mv ~/.vagrant.d /Volumes/SAMSUNG/.vagrant.d
VAGRANT_HOME to new path in
$ export VAGRANT_HOME="/Volumes/SAMSUNG/.vagrant.d"
Open the VirtualBox, in Preferences set its Default Machine Folder to new path, then quit VirtualBox, move
VirtualBox VMs folder to the new directory. Reopen VirtualBox. will see VMs are listed as
inaccessible. Remove them from the list. For each VM in your
VirtualBox VMs folder on the external drive, browse to its folder in Finder and double-click the .vbox file to restore it to the VirtualBox Manager. Finally, move any existing Vagrant directories you've made with vagrant init (these are the directories with a Vagrantfile in each) to the external drive. Since these directories only store metadata you could leave them on your main drive, but it's nice to keep everything together so you could fairly easily plug the whole drive into another machine and start your VMs from there.
The Vagrantfile
The primary configuration location for any Vagrant development environment is a file called Vagrantfile which you need to place in your project's folder.
The configuration syntax of this Vagrantfile is Ruby, but you do not need to be a Ruby programmer or have any knowledge of the programming language to write this configuration file. You'll mostly do basic variable assignment in the configuration.
Every configuration option you will need you can place inside this file.
About provisioning
The primary purpose of Vagrant is to have a base virtual machine and to give you the framework for creating automatic software installations and configurations in the virtual machine.
By letting Vagrant handle the provisioning of software, it also gives you the flexibility in configuration and more importantly, makes this process repeatable and automatic.
Vagrant doesn't care how you provision the virtual machine, it offers multiple options ranging from basic shell scripts to software automation managers such as Puppet, Chef or Ansible. You can even configure it to use multiple provisioners at the same time.
Of course there's always the possibility to vagrant ssh into the base virtual machine and install your required software manually, but that defeats the purpose of Vagrant and all the flexibility it offers when provisioning a box.
Shell Script Provisioning
The easiest way to provision a base box is to use basic shell script commands which then run inside the virtual machine. This also removes the need for learning or installing Puppet, Ansible and similar tools – even though they can sometimes be more effective provisioners. We'll deal with them in future articles.
We need to define the provisioning type, which in our case is called shell. Let's write that inside this block in the configuration file
config.vm.provision "shell" do |s| s.path "provision/setup.sh" end
Vagrant has two types of shell provisioning, inline and external. With inline you can write shell commands in the Vagrantfile itself, but let's focus on external provisioning, which simply means to load and run a shell script from a file (relative to Vagrantfile) or even from a URL.
In our case we want to load
provision/setup.sh file, let's create it and write the following in this file
#!/bin/bash echo "Provisioning virtual machine..."
Now, run vagrant up and it will output
Provisioning virtual machine... on the screen. Note that Vagrant will provision the virtual machine only once on the first run, any subsequent provisioning must be executed with the
--provision flag either vagrant up
--provision or
vagrant reload --provision. The provisioning will re-run also if you destroy the VM and rebuild it with vagrant destroy and
vagrant up.
Update and Upgrade
echo "Update and Upgrade..." sudo apt-get update && sudo apt-get upgrade
Vagrant.configure(2) do |config| # Specifying the base box config.vm.box = "ubuntu/trusty64" # Shell provisioning config.vm.provision "shell" do |s| s.path = "provision/setup.sh" end end
#!/bin/bash echo "Provisioning virtual machine..." echo "Update and Upgrade..." sudo apt-get update && sudo apt-get upgrade
vagrant up to set up virtual machine. This article reference Moving VirtualBox and Vagrant to an external drive and Vagrantfile Explained: Setting Up and Provisioning with Shell.


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The fracturing of the Democratic Party is actually fascinating to watch as the field narrows to a choice between an oligarch billionaire and a socialist millionaire. Check out just how much money is being poured into this race!
Tucker: Bloomberg is trying to buy the election
by Angela Eckhardt | Feb 18, 2020 | Tucker Carlson | 0 comments


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This is the official "Quick Payments" plugin for Razorpay merchants. This allows
you to do the following:
- Add a few custom variables and some markup to a page.
- Specify the amount, name, description and other custom details as page metadata.
- Write [RZP] wherever you want on the post and the button to show up.
- The plugin takes over and completes the payment.
This makes use of the Razorpay Orders API, and the flow is the follows:
- The plugin parses the page before it is rendered
- Inserts its javascript/css/html if it finds the relevant data and markup
- A click on the button creates an "order" using Ajax/Razorpay API
- The order ID is passed to checkout with auto-capture enabled
- The payment is completed there itself and the customer is informed
For this plugin to work correctly, please mention the following items as page metadata (using Screen Options for >4.8) -> Custom Fields:
- 'name' of the product.
- 'description' of the product.
- 'amount' with a minimum of 1 rupee.
26 augustus 2021
3 augustus 2021
I raised a bug via Razorpay support and they engaged the tech team quickly to turn around a fix.
5 december 2018
lack of support
3 maart 2018
pl help in getting this worked as i activated this plugin but this is not working because when i put a short code on a page it does not make any priview of payment gateway ... pl help
18 mei 2017
Razorpay is only plugin who is providing All in one indian wallet payment gateway.
Bijdragers & ontwikkelaars
"Razorpay Quick Payments" is open source software. De volgende personen hebben bijgedragen aan deze plugin.Bijdragers
Vertaal "Razorpay Quick Payments" naar jouw taal.
Interesse in ontwikkeling?
Bekijk de code, haal de SVN repository op, of abonneer je op het ontwikkellog via RSS.
- Updated Razorpay SDK
- Tested up to WordPress 6.1.1
- Bug fix for script.
- Bug fix for payment pop up in WordPress 6.0.
- Bug fix response data.
- Bug fix
- Bug fix
- Tested upto WordPress 5.5
- Added Callback Url support for in app browser
- Tested upto WordPress 5.4.2
- Added metadata information.
- Updates Razorpay SDK
- Tested upto WordPress 5.3.2