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We are so sorry to hear about Judy!She was the sweetest gal ever-so glad we got to catch up awhile back!Lots of memories from back in the day!Thinking of you all!!!
~ Denise Queen (Lober) - April 10, 2023
I have fond memories of Judy while coaching her son in baseball. She was always so friendly and generous. I feel honored to know her. Condolences to the Ike and the family. May God grant you some comfort.
~ Jim Powell - March 25, 2023
Dear Ike and Family:Sally and I always so much enjoyed the times that you and Judy came to visit us in Salina. Judy was a bundle of joy, laughter and sweetness and we loved her and are so sorry she is gone. Please know that our hearts are heavy for you and your family, and we hope that the loving memories you have of Judy will sustain you in your grief. We send our love to you all.Jim & Sally Agin
~ Jim & Sally Agin - March 19, 2023
Much of my childhood was spent in the Eikleberry home or car. I do not recall a harsh word ever from Judy (Mrs. Eikleberry.) Even when we broke her window, or stole her cigarettes, or were all around annoying. Even during her own difficult times of life, she could laugh about anything. I always knew she was rooting for the very best for not only her kids, but us extras. That encouragement never stopped, even as we became adults. Much love to you all during this sad heavy time.
~ Kim Perkins - March 17, 2023
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There are 9 NRICH Mathematical resources connected to Energy, you may find related items under Mechanics.Broad Topics > Mechanics > Energy
Show that even a very powerful spaceship would eventually run out of overtaking power
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A ball whooshes down a slide and hits another ball which flies off the slide horizontally as a projectile. How far does it go?
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NORVIT indicates Norwegian Vitamin Trial; WENBIT, Western Norway B Vitamin Intervention Trial.
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Ebbing M, Bønaa KH, Nygård O, et al. Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12. JAMA. 2009;302(19):2119–2126. doi:10.1001/jama.2009.1622
© 2023
Author Affiliations: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (Drs Ebbing, Nygård, and Nordrehaug); Department of Heart Disease, University Hospital of North Norway, Tromsø (Drs Bønaa and Rasmussen); Departments of Community Medicine (Drs Bønaa, Arnesen, and Njølstad) and Clinical Medicine (Dr Rasmussen), University of Tromsø, Tromsø, Norway; Institute of Medicine, University of Bergen and Haukeland University Hospital, Bergen, Norway (Drs Nygård, Ueland, Nordrehaug, and Nilsen); Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway (Dr Refsum); Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, England (Dr Refsum); Department of Cardiology, Stavanger University Hospital, Stavanger, Norway (Dr Nilsen); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (Drs Tverdal and Vollset); Bevital AS, Bergen, Norway (Dr Meyer); and Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway (Dr Vollset).
Context Recently, concern has been raised about the safety of folic acid, particularly in relation to cancer risk.
Objective To evaluate effects of treatment with B vitamins on cancer outcomes and all-cause mortality in 2 randomized controlled trials.
Design, Setting, and Participants Combined analysis and extended follow-up of participants from 2 randomized, double-blind, placebo-controlled clinical trials (Norwegian Vitamin Trial and Western Norway B Vitamin Intervention Trial). A total of 6837 patients with ischemic heart disease were treated with B vitamins or placebo between 1998 and 2005, and were followed up through December 31, 2007.
Interventions Oral treatment with folic acid (0.8 mg/d) plus vitamin B12 (0.4 mg/d) and vitamin B6 (40 mg/d) (n = 1708); folic acid (0.8 mg/d) plus vitamin B12 (0.4 mg/d) (n = 1703); vitamin B6 alone (40 mg/d) (n = 1705); or placebo (n = 1721).
Main Outcome Measures Cancer incidence, cancer mortality, and all-cause mortality.
Results During study treatment, median serum folate concentration increased more than 6-fold among participants given folic acid. After a median 39 months of treatment and an additional 38 months of posttrial observational follow-up, 341 participants (10.0%) who received folic acid plus vitamin B12 vs 288 participants (8.4%) who did not receive such treatment were diagnosed with cancer (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). A total of 136 (4.0%) who received folic acid plus vitamin B12 vs 100 (2.9%) who did not receive such treatment died from cancer (HR, 1.38; 95% CI, 1.07-1.79; P = .01). A total of 548 patients (16.1%) who received folic acid plus vitamin B12 vs 473 (13.8%) who did not receive such treatment died from any cause (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Results were mainly driven by increased lung cancer incidence in participants who received folic acid plus vitamin B12. Vitamin B6 treatment was not associated with any significant effects.
Conclusion Treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods.
Trial Registration clinicaltrials.gov Identifier: NCT00671346
Folate is a B vitamin essential for nucleotide biosynthesis, DNA replication, and methyl group supply, and thus for cell growth and repair.1 Folic acid is the synthetic form of folate used in vitamin supplements and in fortified foods. Most epidemiological studies have found inverse associations between folate intake and risk of colorectal cancer,2 although such associations have been inconsistent or absent for other cancers.3-8 Experimental evidence suggests that folate deficiency may promote initial stages of carcinogenesis, whereas high doses of folic acid may enhance growth of cancer cells.9,10
Since 1998, many countries, including the United States, have implemented mandatory folic acid fortification of flour and grain products to reduce the risk of neural-tube birth defects.11 In the US population, fortification has resulted in substantial increase in circulating folate12 and unmetabolized folic acid13 concentrations. Recently, concerns have emerged about the safety of folic acid, in particular with respect to cancer risk.1
Folic acid has been used alone or in combination with other B vitamins in a series of homocysteine-lowering trials initiated in patients with cardiovascular disease to assess whether this treatment may reduce cardiovascular outcomes.14 So far, none of the larger trials has reported beneficial effects on primary outcomes.14
In 2 Norwegian homocysteine-lowering trials among patients with ischemic heart disease, there was a statistically nonsignificant increase in cancer incidence in the groups assigned to folic acid treatment.15,16 Our study was performed to explore whether folic acid treatment was associated with cancer outcomes and all-cause mortality after extended follow-up. Because there is no folic acid fortification of foods in Norway, this study population was well suited for such an investigation.
This is a combined analysis of data from 2 randomized, double-blind, placebo-controlled clinical trials (Norwegian Vitamin [NORVIT] trial15 and Western Norway B Vitamin Intervention Trial [WENBIT]16) conducted between 1998 and 2005, and an observational posttrial follow-up through December 31, 2007, with respect to cancer outcomes and all-cause mortality. Details and the primary results of the 2 trials have been reported previously.15,16 The pooling of data is justified by the fact that the 2 trials included similar patients, had identical study design and treatment regimen, had similar follow-up routines, and used the same central laboratory for study-related blood analyses.
The objective of both trials was to assess whether homocysteine-lowering treatment with folic acid and vitamin B12 could improve cardiovascular morbidity and mortality in patients with ischemic heart disease. Patients with known active cancer were excluded, whereas patients with a history of cured cancer were not excluded. All participants gave written informed consent. Participants were randomly assigned to receive a capsule with 1 of the following 4 compositions: (1) folic acid (0.8 mg/d) plus vitamin B12 (cyanocobalamin; 0.4 mg/d) and vitamin B6 (pyridoxine hydrochloride; 40 mg/d); (2) folic acid (0.8 mg/d) plus vitamin B12 (0.4 mg/d); (3) vitamin B6 alone (40 mg/d); or (4) placebo. They were concomitantly requested to abstain from taking over-the-counter supplements containing B vitamins.
Clinical information and blood samples were obtained at baseline, 1 to 2 months after randomization, and at a final study visit in both trials. Adherence was judged by capsule counts and interviews. Analyses of circulating B vitamins, homocysteine and cotinine, and genotyping of the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene (NCBI Entrez Gene 4524) 677C>T single-nucleotide polymorphism were performed at the laboratory of Bevital AS, Bergen, Norway, by published methods.17-20
The NORVIT trial was terminated in March 2004 and the WENBIT in October 2005. When trial results were available, participants were informed by letter that there was no apparent health benefit from the B vitamin intervention.
Participants residing in Norway at the time of their final study visit were included in the posttrial follow-up, which did not imply any continued study treatment, further blood sampling, or personal contact. Our study was approved by the Regional Committee for Medical and Health Research Ethics, the Data Inspectorate, and the Norwegian Directorate of Health.
The primary end points were cancer incidence, cancer mortality, and all-cause mortality through 2007. Data were obtained by linking the unique personal identification numbers to the Cancer Registry of Norway21 and to the Cause of Death Registry at Statistics Norway.22 Malignant neoplasms except nonmelanoma skin cancers were considered, and only the first of new primary cancers after randomization was included. A person was regarded deceased from cancer if the underlying cause of death was coded as International Statistical Classification of Diseases, 10th Revision (ICD-10) codes C00 to C97.
Analyses were conducted among all individuals who participated in the trials. Differences between groups were tested with χ2 test for categorical variables and 1-way analysis of variance, Kruskal-Wallis, or Mann-Whitney U test were used for continuous variables.
We computed the expected numbers of total incident cancers and incidence of the major cancer subtypes in the study population by applying age (5-year age groups) and sex-specific annual national cancer incidence rates for the actual calendar years from the Cancer Registry of Norway.23 The 95% confidence intervals (CIs) for the observed vs expected incidence ratios were computed, assuming that cancer incidence had a Poisson distribution.
Cancer and mortality outcomes were analyzed for groups assigned to folic acid plus vitamin B12 treatment (folic acid groups) vs no folic acid plus vitamin B12 treatment (non–folic acid groups), and for groups assigned to vitamin B6 treatment (vitamin B6 groups) vs no vitamin B6 treatment (non–vitamin B6 groups), according to the 2×2 factorial design. There were no interaction effects between folic acid plus vitamin B12 treatment and vitamin B6 treatment on the primary end points (all P for interaction ≥ .63).
Neither of the 2 trials was originally designed to address cancer risk. By pooling the data and extending the follow-up of both trial populations, we had a statistical power of 61% to detect the observed difference in cancer incidence between the folic acid and non–folic acid groups at a 2-sided statistical significance level of .05.
Person-time was calculated from the date of randomization to the date of event, date of emigration, or December 31, 2007, whichever occurred first. Participants who declined posttrial follow-up were censored at the date of their final study visit.
Survival curves were constructed using the Kaplan-Meier method and differences in survival between groups were analyzed using the log-rank test. Estimates of hazard ratios (HRs) with 95% CIs were obtained by using Cox proportional hazards regression models stratified by trial. Proportional hazards assumptions were tested by Stata's estat phtest based on Schoenfeld residuals,24 and evidence of nonproportionality was not found.
For the 3 closely associated primary end points and for noncancer mortality, we obtained HRs with 95% CIs. A 2-sided statistical significance level of .05 was applied throughout and reported P values were not adjusted for multiple comparisons.
Because our study was not preplanned, and we performed several outcome analyses, there was an increased risk of type I error. However, to guard against this, for incidence and mortality of cancer subtypes, we reported HRs with 99% CIs.
Effect modifications of folic acid plus vitamin B12 treatment by subgroup indicators were assessed by including the relevant interaction terms in the main effects model. Six predefined participant characteristics were examined for the 3 primary end points across folic acid plus vitamin B12 treatment. Of the resulting 18 comparisons, there was a 60.3% probability that one or several statistically significant P values would appear on the basis of chance alone. No subgroup analyses were performed with respect to vitamin B6 treatment.
To assess separate effects of folic acid treatment and vitamin B12 treatment, we stratified the study population by quartiles of serum folate and serum cobalamin (vitamin B12) measured during study treatment, and estimated HRs for the primary end points across these strata, independently of the random treatment assignment.
We used the statistical software packages SPSS version 15.0 (SPSS Inc, Chicago, Illinois), SAS version 9.2 (SAS Institute, Cary, North Carolina), Stata version 10 (StataCorp LP, College Station, Texas), and S-Plus version 8.0 (TIBCO Software Inc, Palo Alto, California).
The numbers of participants through in-trial and posttrial follow-up are shown in the Figure. A total of 6837 individuals were included in the combined analyses, of whom 6261 (91.6%) participated in posttrial follow-up. Median (interquartile range) duration of extended follow-up through December 31, 2007, was 78 (61-90) months, including median (interquartile range) in-trial follow-up of 39 (31-42) months.
Patient baseline characteristics, risk factor levels, and use of concomitant medications are shown in Table 1. Mean (SD) age was 62.3 (11.0) years and 23.5% of participants were women. The percentage of current smokers (total 39%) was lower in the folic acid groups (38%) than in the non–folic acid groups (41%) (P = .01). Among current smokers, plasma levels of cotinine, a marker of tobacco exposure,19 did not differ across the intervention groups. A total of 297 participants (4.3%) had been registered with cancer before trial entry. The prevalence of TT homozygotes of the MTHFR 677C>T polymorphism was 8.2%, similar to that found in a large sample from the general Norwegian population.25
Adherence, defined as taking at least 80% of the study capsules throughout in-trial follow-up, was 84.7%. eTable 1 shows circulating B vitamin levels at baseline and during study treatment. In the folic acid groups, median serum folate increased from 3.9 to 27.5 ng/mL (to convert to nmol/L, multiply by 2.266) and serum cobalamin from 477 to 761 pg/mL (to convert to pmol/L, multiply by 0.7378) during the intervention. In the vitamin B6 groups, median plasma pyridoxal 5′ phosphate (the active form of vitamin B6) increased from 8.2 to 75.4 ng/mL (to convert to nmol/L, multiply by 4.046).
Individuals with the TT genotype of the MTHFR 677C>T polymorphism had lower median serum folate concentration than those individuals with the CC or CT genotype, both at baseline (17.7% lower; P < .001) and during study treatment (11.7% lower in the folic acid groups and 10.4% lower in the non–folic acid groups, P < .001 and P = .001, respectively).
A total of 629 participants (9.2%) were diagnosed with new cancers during (n = 292) or after (n = 337) the trials. Diagnoses were based on histological, cytological, or other diagnostic examinations in 90.5%, 4.9%, and 4.1% of the incident cases, respectively. Three cases of cancer were based on information from death certificates only.
The total cancer incidence and cancer pattern in the study population were similar to what was expected in the general Norwegian population, except for a 25% higher lung cancer incidence (HR, 1.25; 95% CI, 1.01-1.53) in the study population vs the general population. A total of 496 participants (7.3%) died during the trials and 525 (8.4%) died during posttrial follow-up. Of the total 1021 deaths through December 31, 2007, 236 (23.1%) were classified as cancer deaths and 75 of 236 (31.8%) were lung cancer deaths.
Table 2 shows cancer and mortality outcomes in the 4 intervention groups and the HRs and CIs for the comparisons between folic acid vs non–folic acid groups and between vitamin B6 vs non–vitamin B6 groups. Treatment with folic acid and vitamin B12 was associated with a statistically significant increase in cancer incidence during extended follow-up of both trial populations through December 31, 2007 (folic acid vs non–folic acid groups: HR, 1.21; 95% CI, 1.03-1.41; P = .02). This treatment was also associated with a statistically significant increase in cancer mortality (HR, 1.38; 95% CI, 1.07-1.79; P = .01) and all-cause mortality (HR, 1.18; 95% CI, 1.04-1.33; P = .01).
The cumulative incidence and mortality curves in the eFigure indicate that the increase in cancer incidence, cancer mortality, and all-cause mortality associated with folic acid plus vitamin B12 treatment emerged after approximately 1, 2, or 3 years of follow-up, respectively. Treatment with vitamin B6 was not associated with the primary end points (Table 2 and eFigure).
Adjusting for age (continuous), sex, baseline smoking status, and use of acetylsalicylic acid, or for baseline smoking status alone, did not essentially alter the results. Excluding the 297 participants with registered cancer before trial entry, of whom 23 (7.7%) also had new cancer diagnosis after randomization, or excluding those participants with diagnosed new cancer within 1 year after randomization (n = 97), gave similar results.
When restricting analyses to participants who took study capsules for more than 6 months following randomization (n = 6218, 90.9% of all), HRs for cancer incidence, cancer mortality, and all-cause mortality in the folic acid vs non–folic acid groups increased to 1.27, 1.43, and 1.24, respectively.
Results for the 4 most common cancer subtypes in the study population are shown in Table 2. Estimated HRs for colorectal cancer incidence and colorectal cancer mortality in the folic acid vs non–folic acid groups were close to 1. For the other cancer subtypes, estimated HRs for folic acid vs non–folic acid groups were more than 1, but 99% CIs included the value of 1.
There were 56 cases of lung cancer in the folic acid groups compared with 36 cases in the non–folic acid groups (HR, 1.59; 99% CI, 0.92-2.75). Of all patients diagnosed with lung cancer, 64 (69.6%) were current smokers, 22 (23.9%) were former smokers, and 6 (6.5%) were never smokers at trial entry. After removal of the lung cancer cases, HR for cancer incidence in folic acid vs non–folic acid groups was 1.16 (95% CI, 0.98-1.37).
Table 3 shows the primary end points for folic acid vs non–folic acid groups across patient characteristics. Results were consistent in both trial populations, among patients aged younger than or older than the median (62.5 years), in both sexes, among never and ever smokers, and among patients with baseline serum folate levels of less than or more than the median (3.9 ng/mL) (all P for interaction ≥ .06). HRs for folic acid vs non–folic acid groups were higher among individuals with TT genotype than among those with CC or CT genotypes of the MTHFR 677C>T polymorphism. For cancer mortality, we observed a statistically significant interaction between TT vs CC or CT genotypes and folic acid plus vitamin B12 treatment (P = .03).
eTable 2 shows the primary end points across strata defined by serum folate and serum cobalamin levels measured during study treatment. Participants in the second serum folate quartile (range, 3.81-10.56 ng/mL) or in the second cobalamin quartile (range, 456.4-595.9 pg/mL) had the lowest cancer incidence, cancer mortality, and all-cause mortality through extended follow-up; therefore, quartile 2 was used as the reference category. HRs were statistically significantly higher for participants in the fourth serum folate quartile (>27.66 ng/mL) compared with those in the second folate quartile. There were no such differences across quartiles of serum cobalamin.
We investigated cancer and mortality outcomes after extended follow-up of 6837 individuals who participated in 2 similar randomized B vitamin trials. Study treatment with 0.8 mg/d of folic acid and 0.4 mg/d of vitamin B12 during a median of 39 months was associated with increased cancer incidence and cancer mortality after an additional median of 38 months of posttrial follow-up. These findings were mainly driven by increased lung cancer incidence. Furthermore, folic acid plus vitamin B12 treatment was associated with higher all-cause mortality. The latter finding was driven by the higher cancer mortality, but also by statistically nonsignificant higher noncancer mortality.
Our study is the first to our knowledge to report results from extended follow-up of trial participants after years of treatment with folic acid and other B vitamins. In this large well-described population, adherence was high and corroborated by substantial increase in B vitamin concentrations during study treatment. Loss to follow-up was minimal (1.3%) and ascertainment of outcomes close to complete by linkage to the population-based Cancer Registry23 and Cause of Death Registry.22
Because use of vitamin supplements was modest (23%) at trial entry and there is no folic acid fortification in foods in Norway, baseline serum folate levels were lower than in populations from areas where use of vitamin supplements is more widespread26 and fortification is voluntary27,28 or mandatory.12 The intervention dose of 0.8 mg/d of folic acid was 4 to 6 times higher than the average dose delivered by the mandatory fortification in the United States29 and twice the recommended daily allowance.30 Still, the intervention dose was below the tolerable upper intake level of 1 mg/d as set by the US Institute of Medicine.30 Our findings are therefore relevant across folic acid intake readily obtained from consumption of fortified foods and dietary supplements.
This study has several limitations. First, we do not have data on participants' family history of cancer or on occupational or environmental exposure to cancer-promoting factors. However, due to the large sample size, we expected that these risk factors were evenly distributed across the randomly assigned treatment groups. Second, we do not have information on the use of B vitamin supplements during posttrial follow-up. Because patients were discouraged from such supplement use when trial results were available, we assumed that this was moderate with similar proportions of posttrial B vitamin users across initial treatment groups. Third, the study design implied that all patients assigned to folic acid treatment also received vitamin B12. However, the observed associations between the primary end points and vitamin concentration measured during study treatment were confined to serum folate, suggesting that the adverse effects were mediated by folic acid.
Experimental findings suggest that excess folic acid may stimulate the growth of established neoplasms (ie, the so-called acceleration phenomenon).9,10 There is also the question of potential adverse effects of circulating unmetabolized folic acid.13,31 A recent cross-sectional study32 reported reduced natural killer cell cytotoxicity associated with folic acid in plasma. Thus, folic acid may impair cancer immune defense.32
Epidemiological evidence suggests that large relative increase in the incidence of solid cancers in humans over a short period by chemical causes is unlikely.33 However, it is plausible that folic acid given for a median of 39 months may have influenced growth in cancers that were silent at baseline or during trials,9,10 leading to excess subsequent clinical surfacing and diagnosis in the folic acid groups during extended follow-up.
The observed risk modification by the MTHFR 677C>T polymorphism may reflect its pronounced effect on the metabolic distribution of folate species. In individuals with the TT genotype, more of the intracellular folate is retained as 5,10-methylenetetrahydrofolate needed for nucleotide biosynthesis.34,35 Folic acid treatment may further expand the 5,10-methylenetetrahydrofolate pool and thereby enhance DNA replication and neoplastic growth in these individuals.
The high lung cancer incidence in the study population could readily be explained by the high percentage of former and current smokers. However, the higher incidence observed in the folic acid groups cannot be explained by imbalance in baseline smoking habits, because there were fewer smokers in these groups but no difference in baseline cotinine levels among smokers across the groups. Epidemiological studies have demonstrated no associations between intakes of folate or folic acid and lung cancer risk3,4; therefore, our findings need confirmation in other populations.
Lack of association between folic acid treatment and colorectal cancer outcomes in this study is noteworthy and may reflect the postulated dual effects of folate/folic acid on colorectal carcinogenesis.9,10 For prostate cancer outcomes, estimated HRs were more than 1 for the folic acid vs non–folic acid groups, but although we observed 5 times as many prostate cancer cases (n = 165) as in the Aspirin/Folate Polyp Prevention Study36 (n = 33), we found no statistically significant association between folic acid treatment and these outcomes.
Reports on cancer outcomes from other homocysteine-lowering B vitamin trials do not support our findings.37,38 Notably, these trials used larger folic acid doses and had longer in-trial follow-up than the NORVIT and WENBIT trials. However, 72% of participants in the Heart Outcomes Preventive Evaluation (HOPE) 2 study37 and all participants in the Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS)38 resided in North America where fortification had been implemented before trial entry. Therefore, these participants had considerably higher circulating folate concentrations at baseline,37,38 which may have obscured effects from the intervention. Moreover, the HOPE 2 and WAFACS populations had fewer smokers (11.5 and 11.9%, respectively)37,38 than the NORVIT and WENBIT populations did (39.0%). Also, the prevalence of smokers in the general adult US population (approximately 20.9% in 2005)39 is lower than in our study population.
In conclusion, combined analyses and extended follow-up of 2 vitamin B intervention trials among patients with ischemic heart disease in Norway, where there is no folic acid fortification, suggest that treatment with 0.8 mg/d of folic acid was associated with increased cancer incidence, cancer mortality, and all-cause mortality. Our results need confirmation in other populations and underline the call for safety monitoring following the widespread consumption of folic acid from dietary supplements and fortified foods.1,13,40
Corresponding Author: Marta Ebbing, MD, Department of Heart Disease, Haukeland University Hospital, Jonas Liesvei 65, Bergen, Norway 5021 (firstname.lastname@example.com).
Author Contributions: Drs Ebbing and Arnesen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Ebbing, Bønaa, Nygård, Arnesen, Ueland, Nordrehaug, Rasmussen, Refsum, Nilsen, Vollset.
Acquisition of data: Ebbing, Bønaa, Nygård, Arnesen, Ueland, Rasmussen, Njølstad, Nilsen, Tverdal, Meyer, Vollset.
Analysis and interpretation of data: Ebbing, Bønaa, Nygård, Arnesen, Ueland, Nordrehaug, Rasmussen, Njølstad, Refsum, Tverdal, Meyer, Vollset.
Drafting of the manuscript: Ebbing.
Critical revision of the manuscript for important intellectual content: Ebbing, Bønaa, Nygård, Arnesen, Ueland, Nordrehaug, Rasmussen, Njølstad, Refsum, Nilsen, Tverdal, Meyer, Vollset.
Statistical analysis: Ebbing, Arnesen, Tverdal, Vollset.
Obtained funding: Bønaa, Nygård, Ueland, Nordrehaug, Rasmussen, Refsum, Nilsen, Vollset.
Administrative, technical, or material support: Ebbing, Bønaa, Nygård, Arnesen, Ueland, Nordrehaug, Rasmussen, Refsum, Nilsen, Vollset.
Study supervision: Bønaa, Nygård, Arnesen, Ueland, Nordrehaug, Rasmussen, Nilsen, Vollset.
Financial Disclosures: Dr Meyer is employed at the laboratory of Bevital AS, Bergen, Norway. No other authors reported any conflicts of interest or financial disclosures.
NORVIT Steering Committee: Knut Rasmussen, MD, PhD (chair), Kaare Harald Bønaa, MD, PhD (principal investigator), Egil Arnesen, MD, Inger Njølstad, MD, PhD, Aage Tverdal, PhD, Jan Erik Nordrehaug, MD, PhD, Per Magne Ueland, MD, PhD.
WENBIT Steering Committee: Ottar Nygård MD, PhD (chair), Per Magne Ueland, MD, PhD, Jan Erik Nordrehaug, MD, PhD, Helga Refsum, Dennis W. Nilsen, MD, PhD, Stein Emil Vollset, MD, DrPH.
Funding/Support: The NORVIT and WENBIT trials were funded by the Advanced Research Program and Research Council of Norway; the Norwegian Foundation for Health and Rehabilitation; The Norwegian Council on Cardiovascular Disease; the Norwegian Heart and Lung Patient Organization; the Norwegian Red Cross; the Northern Norway Regional Health Authority; the Western Norway Regional Health Authority; the Norwegian Ministry of Health and Care Services; the University of Tromsø, Tromsø, Norway; the University of Bergen, Bergen, Norway; Department of Heart Disease at Haukeland University Hospital, Bergen, Norway; the Foundation to Promote Research Into Functional Vitamin B12 Deficiency, Bergen, Norway; by an unrestricted private donation; and by Alpharma Inc, Copenhagen, Denmark, who provided study medication. The posttrial follow-up was supported by the Norwegian Foundation for Health and Rehabilitation; Department of Heart Disease at Haukeland University Hospital, Bergen, Norway; the University of Tromsø, Tromsø, Norway; and by the University of Bergen, Bergen, Norway.
Role of the Sponsors: The main sponsors were nonprofit organizations with no participating role in the trials. Alpharma Inc provided the study capsules, generated the randomization sequence and concealed the randomization code, free of charge, and rendered a limited grant to finance the initial phase of the trials. However, the company had no role in the design and conduct of the trials or the current study; or in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Dr Ebbing had full access to all data at the end of the study and had the final responsibility for the decision to submit for publication.
Disclaimer: Some of the data in this article are from the Cancer Registry of Norway. The Cancer Registry of Norway is not responsible for the analysis or interpretation of the data presented.
Additional Contributions: We thank the recruiting physicians, the study nurses, laboratory personnel, and other coworkers. In addition, we thank all 6837 participants for their time and motivation.


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Filter By:
- Parts & Accessories (58)
- Cargo Trailers (6)
- Child Trailers (12)
- Trailer Bikes (2)
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Thule's Axle Mount ezHitch enables you to attach any Thule bicycle trailer or bicycle compatible child carrier (sold separately) to the rear axle of your bike.
Thule's Bicycle Trailer Kit easily converts your Thule Chariot carrier (sold separately) into a stable, sturdy bike trailer. With Thule's Axle Mount ezHitch system, attachment and removal are quick and easy. You even get a tall flag and reflector kit for enhanced visibility.
Whether your day includes a quick trip downtown or a longer bicycle-based adventure, Thule's Cadence is a great way to amp up your family's taste for the open road. Boasting Thule's super-stable ezHitch bicycle attachment for confidence and ease of use, the Cadence comfortably seats two children in padded seats with five-point harnesses. You also get extra storage space for accessories, as well as a visibility-increasing safety flag. When your trip is over, the Coaster folds down quickly and easily for transport and storage.
- Bicycle Trailer Kit included - Secure attachment to bike using Thule ezHitch axle mount - Extra storage space for hauling around cargo - Easy folding for storage and transporting - Comfortably seats two children - Compatible with a range of accessories - Meets international safety standards
Convert your Thule Chariot into a high-performance jogging stroller. - Simple installation by clicking the kit into Thule VersaWing - Convenient tracking adjustment to make sure the carrier tracks straight - Includes pocket for easy storage of the jogging wheel when not in use
Thule Coaster is a durable bicycle trailer that provides a safe, comfortable ride and easily transforms to a stroller once you reach your destination. - Bicycle Trailer Kit and Stroller Kit included - Easy conversion from cycling to strolling - Secure attachment to bike using Thule's patented ezHitch - On-board storage of strolling wheel - Comfortably seats two children - HeightRight adjustable handlebar for parents comfort - Compatible with a range of accessories - Easy folding for storage and transporting - Extra storage space for hauling around cargo - Meets international safety standards Technical specifications - Children: 1 or 2 - Meets safety standards: Yes - 5-point child safety harness: Yes - Shoulder width: 23 in - Weight capacity: 100 lb - Weight: 24.2 lb - Sitting height: 23.6 in - Pass through: 31.5 in - Folded dimensions (LxWxH): 37 in x 30 in x 9 in - Dimensions (LxWxH): 54 in x 30 in x 40.5 in
- Bicycle Trailer Kit and Stroller Kit included. - Easy conversion from cycling to strolling. - Secure attachment to bike using Thule ezHitch axle mount - On-board storage of strolling wheel. - Comfortably seats two children - Adjustable handlebar—ergonomic, adjustable handlebar for maximum parent comfort - Compatible with a range of accessories - Easy folding for storage and transporting - Extra storage space for hauling around cargo - Meets international safety standards
Thule's Infant Sling fits inside Thule Chariot carriers (sold separately) providing a comfortable, secure way to carry your little one. It offers lateral support for excellent stability and is easy to install and remove. When used in a 2-passenger carrier, there's still plenty of room for a second child. Recommended for 1- to 10-month-old children, this handy accessory is ideal for strolling, jogging, and hiking.
Thule's Internal Hub Hitch Adapter enables you to attach a bicycle trailer conversion kit (sold separately) to bicycles with an internally geared hub.
Thule's Thru-Axle Hitch Adapter enables you to attach a bicycle trailer conversion kit (sold separately) to bicycles with a rear thru-axle.
Surly's Bill Trailer is brilliantly engineered to carry almost everything! This seriously stout workhorse is built from chromoly with stainless-steel hardware for excellent durability and it rolls on quality 16-inch wheels and tires. There are even fenders. The trailer sits perfectly level as you ride, so even heavy and bulky items stay secure. You can tote up to 300 pounds of whatever on this bad boy! So go ahead, run all your errands by bike — you'll be smiling when you get back home. Please note that the required Surly hitch for this trailer is sold separately.
Some of you people just can't get enough hauling done with your Big Dummy or your Surly trailer. Well, nutball cargo haulers, here is your solution: The Big Dumb Trailer Hitch. This handy piece replaces the wheel yoke of your Surly Bill or Ted trailer and inserts into the horizontal tubes on the non-drive side of your Surly Big Dummy cargo bike, thereby making it possible to haul your trailer using your cargo bike. Wow. I'm not really sure what to say here. Good for you, I guess? I hope your hemorrhoid surgery goes really well. Note: Big Dummy Hitch is not compatible with the Big Fat Dummy
This is our Excellent Adventure Thru-Axle. It upgrades your bike's rear end for hauling cargo trailers, should you feel like taking Rufus along on your errands. Extensive product testing with our Bill and Ted Trailers provided an "awesome experience," but time travel remains a risky endeavor. Designed for use with slotted horizontal or vertical single-position dropouts, the Excellent Adventure Axle is compatible only with 12 x 148mm hubs. Compatible Surly models include Skid Loader, our compact electric cargo bike, as well as Karate Monkey, Krampus, Grappler, Ogre, Lowside, ECR, and Troll. Once again, the 12 x 148mm hub requirement cannot be overstated. Visit your local Surly dealer to discuss other scenarios you may have in mind. - 12 x 148mm hub compatibility only - Designed for use only with Surly's Bill and Ted Trailers - Works with slotted horizontal or vertical single-position dropouts
Surly Trailer Parts - Attaches with proprietary mounting skewer (included) or proprietary mounting nuts for compatible frames (i.e. Surly Troll, Ogre, etc.)
Surly's Ted Trailer is brilliantly engineered to carry almost everything! This seriously stout workhorse is built from chromoly with stainless-steel hardware for excellent durability and it rolls on quality 16-inch wheels and tires. There are even fenders. The trailer sits perfectly level as you ride, so you can haul longer items that extend off the back. You can tote up to 300 pounds of whatever on this bad boy! So go ahead, run all your errands by bike — you'll be smiling when you get back home. Please note that the required Surly hitch for this trailer is sold separately.
Surly Trailer Parts - These hitch mounts are for connecting Surly Bill and Ted trailers to any 10x1mm solid axle; they replace standard locknuts - They also include threaded stubs for direct mount to Surly Troll and Ogre frames; these frames have eyelets drilled into the dropouts specifically for these mounts
Surly Trailer Parts
Surly Trailer Parts
$62.00 - $65.00
Yes! A 12mm thru-axle adapter for BOB Trailers. These Robert Axles for BOB Trailers are specifically engineered to attach the proven BOB Trailer to your thru-axle-equipped bike. Take full advantage of your modern bike with 12mm thru-axles and harness the rigidity of the thru-axle to haul your BOB Trailer. Set out on any adventure, big or small. Great for off-road tours, trail building, hauling cargo, and more! - The axle shaft and axle end are precision CNC-machined. - The axle shaft is 7075 aluminum and hard black-anodized for rugged durability. - The axle ends are stainless steel which allows for mounting of the BOB Trailer bobbins. - No special tools required. The design allows for wheel installation or removal using your standard 5mm hex wrench. - Please note: This axle does not come with the BOB Trailer bobbins (those are available separately). Or, you can reuse your bobbins from the stock BOB Trailer Quick Release that came with your trailer. - Designed, built, and quality tested in the USA. Proven around the world.
$58.00 - $65.00
Purchase our Kid Trailer axle for your bike, and share your stoke for cycling with your kids. Simplify your life by allowing quick and secure attachment of your trailer to your best and favorite bike. Enjoy the adventure. Robert Axles for Kid Trailers are designed specifically to fit your 12mm thru-axle bike and allow attachment of any hitch-mounted trailer. These fit any trailer that has two wheels and a single point of attachment to the axle. This includes all the two-wheeled child, pet, and cargo trailers such as Thule, Chariot, Burley, Instep, Carry Freedom, and many more. - The axle shaft and axle end are precision CNC-machined. - The axle shaft is 7075 aluminum and hard black-anodized for rugged durability. - The stainless steel axle end allows for mounting of the hitch provided with your trailer. - Hardware for attachment of the hitch is included; the hitch, itself, is not. - No special tools required. Design allows for wheel installation and removal using your standard 5mm hex wrench. - Designed, built, and quality tested in the USA. Proven around the world.
These bobbins are made by the Robert Axle Project and are identical to the bobbins that came with your original BOB skewer. Slide them on your axle ends to complete your Robert Axle thru axle for BOB Trailer. - Sold in pairs - Manufactured from 303 Stainless Steel - Includes stainless steel hardware for attaching to axle
Don't let your adventures be limited to the pavement. The 16+ Wheel Kit improves handling over snow, sand and gravel. The kit includes two 16x3" push button wheels with a knobby tread. A wide range of acceptable tire pressures let you adjust the stiffness to your liking. Let a little air out and the tires soak up the bumps for your passengers. Say goodbye to the sidewalk. Constructed with aluminum rim/hub and stainless steel spokes.
Take your Burley all over town with the 2-Wheel Stroller Kit. The wheels connect directly to the frame for a compact footprint to turn on a dime in tight spots. Leveling springs keep the stroller grounded on uneven terrain. Get out and explore with added versatility. - Easy conversion from biking to strolling - Fully pivoting wheels provide optimal maneuverability - Wheels easily slide into the trailer mounts - Includes: 8-inch Stroller Wheels (2) & Wrist Tether - Compatible with: 2019 – D'Lite X, 2019 – D'Lite Single, 2019 – Cub X, 2019 – Encore X, 2007-Current – D'Lite, 2007-Current – Encore, 2007-2018 – Solo, & 2010-2018 – Cub
Keep your little one safe and cozy while strolling or jogging with the Baby Snuggler.
A Burley Ballz Thru Axle is required for any bike with a 12mm rear thru axle to use the Coho XC (stock thru axles are not able to accommodate any sort of axle mounted hitch system). The Burley Ballz Thru Axle is not compatible with all carbon fiber bike frames (consult manual). - Official Burley Ballz adapter for bikes with 12mm rear thru axles - Includes both the thru axle and Ballz hitch mounts - Quick and easy installation - Specially designed for use with the Coho XC
The Bark Ranger™ pet bike trailer and stroller is ready to go anywhere, anytime—just like your favorite four-legged friend. Designed for ultimate pet comfort, this dog stroller and bike trailer combo offers a roomy interior, exterior pockets to store leashes and treats, mesh windows for breezy ventilation, and a large rear tailgate with low clearance for easy loading and unloading. For additional pet comfort, add our plush Pet Bed insert for some serious R&R on the go. Equipped with multiple roll-up zippered panels and an integrated parking brake for stability, you'll feel at ease knowing your best pal is fully secured. The Bark Ranger holds pets up to 75 pounds and allows you to pack for a full day of adventures with the additional storage options of the Pet Trailer Pouch and Bark Ranger™ Bag. When your outing is done, remove the trailer floor for easy clean up, or fold the Bark Ranger down for compact storage until your next adventure. You'll Love – - 2-in-1 bike trailer and stroller with included 1-Wheel Stroller Kit and adjustable handlebar - Zippered panels roll up to accommodate optimal pet riding positions - Mesh windows offer maximum ventilation - Lower center of gravity provides a smoother ride for you and your pet - Integrated parking brake for added security and stability while stopped - Contains recycled polyester and BLUESIGN® certified sustainable materials Additional Features – - Sturdy, removable floor for easy cleaning - Ability to quickly convert to a kennel for training - Pet-safe interior free of hooks, snags, and sharp edges - Large rear tailgate with low clearance for seamless loading and unloading - Easily folds down for compact storage and transportation - Drum-tight fabric keeps pet secure while riding - Spacious interior for ultimate pet comfort - Push-button wheels for quick removal - Sturdy aluminum frame - Expandable storage options with attachment points for use with the available Pet Trailer Pouch and Bark Ranger™ Bag - Flex Connector allows the bike to lay flat while trailer remains upright
Keep extra treats, leashes, and other essentials handy with the Bark Ranger™ Bag. Attachment points along the top of the Bark Ranger™ and Bark Ranger™ XL let you quickly and securely increase your trailer's cargo capacity. Large and small zippered pockets provide multiple storage options for you and your pet's gear while on the go.
Ensure your pet's trailer stays level during mid-ride breaks or pauses with The Bark Ranger™ Kickstands. Your dog will feel secure and comfortable with the added stability of these convenient kickstands. Biking or strolling, the Bark Ranger™ Kickstand helps your dog's trailer stay level and steady when not in motion. Easy to fold and unfold, the kickstand can be installed on the front or back of the trailer to allow for stable loading and unloading. When you pause for a mid-ride water break or stop to talk to a friend during a stroll, the kickstand provides added stability to keep your pet feeling secure and comfortable. Pro tip: use the kickstand while training to stabilize the trailer during loading and unloading to help make your pet feel more at ease! You'll Love – - Compatible with Bark Ranger™ and Bark Ranger™ XL pet trailer - Easily deploy to activate or fold to stow - Mounts to front or back of the trailer for stable loading and unloading of your furry friends Specifications: - Size L x W x H (in) 11.2 x 0.9 x 3 - Size L x W x H (cm) 28.5 x 2.3 x 7.5
Ensure your pet's trailer stays level during mid-ride breaks or pauses with The Bark Ranger™ XL Kickstand. Your dog will feel secure and comfortable with the added stability of these convenient kickstands. Designed to support bigger dogs in the Bark Ranger™ XL, the Bark Ranger™ XL Kickstand provides added stability for your dog's trailer. The kickstand attaches to the front or rear of the trailer and helps your dog feel secure by keeping the trailer level during mid-ride pauses or when loading and unloading. When it's time to head out, simply fold up the kickstand and you're ready to roll. Pro tip: use the kickstand while training to stabilize the trailer during loading and unloading to help make your pet feel more at ease! You'll Love – - Compatible with Bark Ranger™ and Bark Ranger™ XL pet trailer - Easily deploy to activate or fold to stow - Mounts to front or back of the trailer for stable loading and unloading of your furry friends Specifications: - Dimensions L x W x H (in) 15.2 x 0.9 x 3 - Dimensions L x W x H (cm) 38.5 x 2.3 x 7.5
The fun doesn't stop when the rain starts. Keep your canine copilot warm and dry with the Bark Ranger Rain Cover. When it's raining cats and dogs, keep your pup dry and cozy with the Bark Ranger™ Rain Cover. Water-repellent and wind-resistant, the rain cover fits snugly over your trailer to keep the elements out. When the rain stops, the cover stows easily in the attached storage bag. Simply attach the rain cover storage bag to the accessory loops on the top of the trailer and you're ready for any surprise rain shower. You'll Love – - Water-repellent and wind-resistant - Easily attaches to Bark Ranger™ accessory loops for use whenever the weather changes - Reflective accents provide added visibility for your trailer on cloudy days and in low light - Adjustable elastic cable keeps the cover snug against the trailer - Stows easily in attached storage bag Specifications: - Coated 70D ripstop nylon - Weight 0.5 lb / 0.25 kg
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Skype #Leicestershire
Find Skype #Leicestershire Usernames
Find Skype user profiles tagged with #Leicestershire hashtag. Find the best Skype #Leicestershire usernames for 2023. Explore Skype user photo gallery and discover their stories. Discover interesting people on Skype and gain new friends and followers.
About Skype #Leicestershire
Skype #Leicestershire is a hashtag directory listing for Skype. This is a dynamic curation of Skype usernames to help you find like-minded people to follow.
How to Add My Username to Skype #Leicestershire?
Login to Dizkover and add your Skype username to your messaging accounts. Then like #Leicestershire hashtag in People Discovery Engine.
More about Skype #Leicestershire:
The #Leicestershire hashtag is a topic or interest by Skype users. Users who liked #Leicestershire hashtag in People Discovery Engine will be listed in this page. If you don't want to appear in Skype #Leicestershire, remove the hashtag in your People Discovery Engine settings. In Twitter, hashtag is a word or phrase used to identify messages on specific topic. Here at Dizkover, hashtag is used to group people in specific topic to help users discover like-minded people.


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NovemberReign99: I'm looking for a man in there 60 years and older.
This section compares your answers vs. their answers based on Relationship, Dating Compatibility and Personality Test Questions that you both answered. When you are logged in and both users have answered questions, a match percentage for both users will be displayed here! This user has answered 15 popular questions - click the button below to browse through their answers and details.Click For User's Question & Answer Details
More Details:
About Me:
My Ideal Match:
Mail Requirements:
Sender must be Male.
Sender must be from the following country: United States.
Sender must have a profile picture.
Sender must be older than 60 years old and younger than 70 years old.
Sender must be located within 20 miles of this user.


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P0354 is a generic OBD2 code that indicates that ignition coil "D" has an issue with the primary or secondary wiring circuits. If your Chevy Tahoe has thrown this code, it may be accompanied by P0304. P0354 is a relatively straightforward diagnosis and is typically caused by a bad coil pack or wiring harness issue, although there can be caused by other factors.
P0354 Ignition Coil "D" Primary/Secondary Circuit → Malfunction
Primary or Secondary Wiring?
It's important to determine if it is the primary or secondary circuit that has thrown the code. Luckily, it's easy to determine which one is at fault.
The primary wiring is the wiring harness leading from your Tahoe's ECM/PCM to the ignition system itself. A short, open, or poorly ground wiring harness is almost always what causes P0354 when it is the primary wiring side that has thrown the code.
The secondary side of the equation is the spark side. Which means that plugs, plug wires (if so equipped) or the spark plug itself is causing your Tahoe to throw P0354. Ignition Coil "D" indicates the problem is in the fourth cylinder. You'll need to look up which cylinder is number four on your engine. Different manufacturers use different methods. Here's a pretty good explanation of how how to locate the fourth cylinder.
There is a really easy test to determine if it is the primary or secondary wiring that has thrown this code in your Tahoe. Move the ignition components (coil pack, plug wire, plug) from cylinder D/4 to another and clear the codes. If the code "moves" from the fourth cylinder, you now know that it's a secondary issue. If it stays, it's a primary. We go into this in greater detail below (go straight there).
P0354 Symptoms: Chevy Tahoe
- Check Engine Light– The check engine light may be all that you notice when you have this code, particularly if it is caused by an intermittent wiring issue with your Tahoe.
- Misfiring– P0354 might be accompanied by P0304. P0304 indicates a misfire in the fourth cylinder. Resolving P0354 will typically clear P0304 as well. Misfiring can lead to a lack of power, and/or engine hesitation. It can also really mess up the catalytic converter.
- Rough Idle– You vehicle may idle rough if the fourth cylinder isn't getting enough spark. You very well may smell raw fuel as your Tahoe's engine runs as well.
P0354 Causes: Chevy Tahoe
These are the most common problems that cause P0354:
- Wiring Issues (short, open, or bad ground)
- Bad Coil Pack
- Loose Connection at the coil
- Bad PCM
Diagnosing P0354
The first goal of diagnosing P0354 is determining if you are dealing with a primary or secondary wiring problem in your Tahoe. If you do that, you've eliminated half of the variables.
Voltage Test (Optional, but time saving)
The first place that you would want to start looking for what could be causing P0354 in your Tahoe would be the wiring harness. You can use a digital voltmeter to check if the coil pack is getting the proper signal. You would want to set it for A/C hertz and check to see if it is between 5-20hz.
If it was between 5-20hz, it's highly likely that the coil pack has gone bad. Although, it could also be a bad plug or plug wire as well. If it has no signal, it's time to look at the wiring harness. If you don't have a voltmeter, you can use the parts swap method to help you determine if it's the primary or secondary side causing your problems. See directly below ↓.
Parts Swap
A great way to determine if it is an ignition related component, and not a wiring issue, is to reset the trouble code and swap the coil, plug, and plug wire (if equipped) with another cylinder. If the misfire "jumps" to the cylinder that you've just swapped your Tahoe's ignition components into, then you know that you are looking at is a coil, plug wire, or (most likely) coil pack failure.
If the misfire did move cylinders, you can go ahead and replace the plug, plug wire, and coil pack. If you are on a tight budget, you can keep resetting the code and swap the ignition parts back one at a time until the misfire returns to cylinder 4. Start with the coil pack.
This method is only as difficult as the fourth cylinder is to get to.
If the misfire failed to move from the fourth cylinder, then you know that you most likely have an issue with the wiring harness going from the coil pack to the Tahoe's PCM/ECM. Take a look at where the harness plugs into the coil pack. Is it damaged or loose feeling in relation to the other cylinder's connections? If so it may need to be replaced.
If the misfire is intermittent, go ahead and jiggle the wiring harness and see if it has an impact on the way the engine is running. If it does start or stop misfiring, you know you've found your problem. Look anywhere that the harness bends or touches anything sharp. Look to see if it looks burnt anywhere. Check for damage and repair the wiring accordingly.
Make sure that it has a solid ground.
If you still can't find the problem, it's time to take a look at the PCM. This is the least likely answer, and an area where it may be time to call in the pro's.
Wrapping Up: P0354 Chevy Tahoe
P0354 is usually pretty easy to diagnose through the swap test, even if you don't have any specialty diagnostic tools. If there is anything you can add, please leave a comment below. Good luck fixing your Tahoe!


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6304 Fleet Ave, Cleveland, OH 44105
Local: 216-341-4758 Fax: 216-341-7654Email Us
- 6304 Fleet Ave, Cleveland, OH 44105
Arrangement of PlantsIntercat-1005
This basket includes a mix of green and blooming plants. Orchids have limited availability and may be substituted with another orchid type.
All items featured on this site represent the types of arrangements we offer and may vary depending upon availability in certain regions. Substitution Policy


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Travel Nurse RN - CVICU - $1,918 per week
Company: OneStaff Medical
Location: Chillicothe
Posted on: November 19, 2023
Job Description:
OneStaff Medical is seeking a travel nurse RN CVICU for a travel
nursing job in Chillicothe, Ohio.Job Description & Requirements
Your team at OneStaff is dedicated to finding the perfect assignments (for you), negotiate the best rates and handles any issues that may arise while you are on assignment. We take great pride in building relationships with our traveling professionals and we enjoy hearing about your experiences. Whatever the need, we are here to help along the journey.
We understand you are the heart and soul of what we are. Whether it is housing, payroll, travel, benefits, or just a friendly voice to talk to, we are there every step of the way. The company you choose is the most important decision you will make in your traveling career. We get that, so we're committed to you 24 hours-a-day, 7 days-a-week. We're your "one" solution in travel assignments and here to assist whether helping with accelerating your trajectory towards your career goals or meeting your travel requirements.Benefits
OneStaff Medical is seeking a travel nurse RN CVICU for a travel nursing job in Chillicothe, Ohio.Job Description & Requirements
Keywords: OneStaff Medical, Columbus , Travel Nurse RN - CVICU - $1,918 per week, Healthcare , Chillicothe, Ohio
here to apply!


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It's sometimes said that the limitations of a house are what help make it a home. For many, however, it is a point of pride to accept only the finest in their new residence. How can you find the balance between cultivating a lived-in home with personality and quirks versus a house with cutting-edge amenities that improve quality of life? To get to the bottom of that, we gathered a list of the six keys to consider when selecting and developing the home of your dreams:
The neighborhood
Surprisingly, one of the biggest factors in choosing a new home isn?t the property itself, but rather the surrounding neighborhood. While new homes occasionally spring up in established communities, most are built in new developments. The settings are quite different, each with their own unique benefits.
Older neighborhoods often feature tree-lined streets; larger property lots; a wide array of architectural styles; easy walking access to mass transportation, restaurants and local shops; and more established relationships among neighbors.
New developments are better known for wider streets and quiet cul-de-sacs; controlled development; fewer aboveground utilities; more parks; and often newer public facilities (schools, libraries, pools, etc.). There are typically more children in newer communities, as well.
Consider your daily work commute, too. While not always true, older neighborhoods tend to be closer to major employment centers, mass transportation and multiple car routes (neighborhood arterials, highways and freeways).
Design and layout
If you like Victorian, Craftsman or Cape Cod style homes, it used to be that you would have to buy an older home from the appropriate era. But with new-home builders now offering modern takes on those classic designs, that?s no longer the case. There are even modern log homes available.
Have you given much thought to your floor plans? If you have your heart set on a family room, an entertainment kitchen, a home office and walk-in closets, you?ll likely want to buy a newer home?or plan to do some heavy remodeling of an older home. Unless they?ve already been remodeled, most older homes feature more basic layouts.
If you have a specific home-d?cor style in mind, you?ll want to take that into consideration, as well. Professional designers say it?s best if the style and era of your furnishings match the style and era of your house. But if you are willing to adapt, then the options are wide open.
Materials and craftsmanship
Homes built before material and labor costs spiked in the late 1950s have a reputation for higher-grade lumber and old-world craftsmanship (hardwood floors, old-growth timber supports, ornate siding, artistic molding, etc.).
However, newer homes have the benefit of modern materials and more advanced building codes (copper or polyurethane plumbing, better insulation, double-pane windows, modern electrical wiring, earthquake/ windstorm supports, etc.).
Current condition
The condition of a home for sale is always a top consideration for any buyer. However, age is a factor here, as well. For example, if the exterior of a newer home needs repainting, it?s a relatively easy task to determine the cost. But if it?s a home built before the 1970s, you have to also consider the fact that the underlying paint is most likely lead0based, and that the wood siding may have rot or other structural issues that need to be addressed before it can be recoated.
On the flip side, the mechanicals in older homes (lights, heating systems, sump pump, etc.) tend to be better built and last longer.
Outdoor space
One of the great things about older homes is that they usually come with mature trees and bushes already in place. Buyers of new homes may have to wait years for ornamental trees, fruit trees, roses, ferns, cacti and other long-term vegetation to fill in a yard, create shade, provide privacy, and develop into an inviting outdoor space. However, maybe you?re one of the many homeowners who prefer the wide-open, low-maintenance benefits of a lightly planted yard.
Car considerations
Like it or not, most of us are extremely dependent on our cars for daily transportation. And here again, you?ll find a big difference between newer and older homes. Newer homes almost always feature ample off-street parking: usually a two-car garage and a wide driveway. An older home, depending on just how old it is, may not offer a garage?and if it does, there?s often only enough space for one car. For people who don?t feel comfortable leaving their car on the street, this alone can be a determining factor.
Finalizing your decision
While the differences between older and newer homes are striking, there?s certainly no right or wrong answer. It is a matter of personal taste, and what is available in your desired area. To quickly determine which direction your taste trends, use the information above to make a list of your most desired features, then categorize those according to the type of house in which they?re most likely to be found. The results can often be telling.
This article was originally printed on windermere.com


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Detective movie lovers should really come on board this is about Prima ballerina Dominika Egorova faces a bleak and uncertain future after she suffers an injury that ends her career. She soon turns to Sparrow School, a secret intelligence service that trains exceptional young people to use their minds and bodies as weapons. Egorova emerges as the most dangerous Sparrow after completing the sadistic training process. As she comes to terms with her new abilities, Dominika meets a CIA agent who tries to convince her that he is the only person she can trust.
Initial release: February 28, 2018 (Indonesia)
Director: Francis Lawrence
Box office: $142.8 million
Budget: 69 million USD
Screenplay: Eric Singer, Justin Haythe


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GAME TIME STICKER - GAMER / Planner Sticker / Hand drawn stickers | Gs005
- Hand drawn by Sena
- In stock, ready to ship
- Inventory on the way
Hand drawn stickers game stickers to decorate your planner or notebooks!
Cute gamer girl stickers!
**Skin-tone + hair options Now available! Choose from light, medium, and dark skin tones!**
-Sticker sheet size: 3.5x4.5 inches
-Printed on matte white sticker paper
*Please take note that the colors may differ from screen to screen (may be darker/lighter)*
*All artwork for the items I have presented in my shop is drawn by myself and are copyright ©nerdypaperco. All images and products are for personal use only.
Follow me on my social media outlets for daily updates on new drawings and so much more!
☁ Facebook group
☁ Instagram || @nerdypaperco
Processing time :
All orders are made to order by yours truly, I'm a one nerd operation! Orders are sent out to their nerdy destinations within:
- Current processing time is 7-12 business days*, unless otherwise noted under the product listing. *Please note: during sale periods, such as the Black Friday or Group Sales, the processing period is extended to 10-15 business days.
Shipping :
I ship all orders through USPS, unless noted otherwise.
Domestic via USPS First Class Mail
International via USPS First Class Mail
Please double, triple, quadruple check your shipping address! I ship to the address provided by you. If the incorrect shipping address is provided, and your package is delivered to that address, it is unfortunately out of my hands and responsibility.
International Shipping + Customs and Duty Charges
Please be mindful that transit times vary! Packages occasionally do get held at customs, and however long they get held there is out of my control as they are now in the hands of your country's customs officials.
Buyers are responsible for any customs and import taxes that may apply. Note, that I have NO control over a country's customs and duty charges. Some countries will charge duty for international packages and others will not, and all at different rates!


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Internal Medicine Job In Grapevine, Texas
TX Facility Is Seeking a Temp to Perm Internal Medicine Physician CPH# JOB-2893818Next Steps... Apply Now Register Now
- Must have active state license
- BC required
- Weekdays, Days, No call
- 17 - 18 patients per day
- Credentialing not needed
- DEA needed
- We negotiate better pay and deposit it weekly
- We arrange complimentary housing and travel and comprehensive malpractice coverage
- We simplify the credentialing and privileging process
- Access to online portal for assignment details and time entry
- Your specialized recruiter takes care of every detail
CompHealth started in 1979 with the idea of connecting top healthcare providers to the communities who need them and has since become the industry leader in healthcare staffing. Connecting with each person's unique story in order to find them the right job for their lifestyle is what makes us different. And with 1,000 employees in offices across the nation, we have the team in place to ensure that every provider and facility staff recruiter receives the excellent customer service we've offered for nearly forty years. Learn more at comphealth.com so we can find the job that's just right for you.


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Our privacy policy is simple…
We do not share any personal information we collect on you with any other organisations or individuals.
- We keep all information you provide to us, no matter how or why you provide it, completely confidential.
- Only those employees and contractors we specifically employ with relevant business duties may access personal information, and only to perform their duties. They are strictly prohibited from any other use.
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In order to improve the overall experience of visiting our website, we use a server-based log to collect anonymous information about our website visitors. This data is only used to generate statistical charts and will not be used in any other way.
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If you feel that this site is not following its stated information policy, you may contact us by phone, email or post.
Changes to this policy
We will post any changes to this policy on our website. Those changes will then apply to any future use by you of our website.


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AC Milan Away Replica shorts for the 2022/23 season.
. Material using DRYCELL technology: performing and comfortable, it wicks humidity off skin to keep it dry
. A stretch fabric made using recycled materials to reduce waste in the name of a sustainable future
. Official AC Milan patch logo applied to the right leg with a small embroidered star
. Embroidered Puma logo on the left leg
. Elastic waist with internal drawstring
. Regular fit
. The model is 1.87 m tall and is wearing a size M
. Outer material: 100% recycled polyester
. Always follow the instructions on caring for this garment on the inner label.
Order process times and shipping will depend upon the product types you have purchased.
For orders containing non customized items, we aim to process within 1 business day before shipment. Delivery from our courier will then take on average an additional 2-3 business days.
For orders containing at least one customized item, we aim to process between 1-3 business days before shipment. Delivery from our courier will then take on average an additional 2-3 business days.
Place your order by the following dates to receive your items by Christmas:
Italy and Central Europe (France, Spain, Germany, Austria, Holland, Belgium)
Personalized Order: December 17
Non-Personalized Order: Dec. 18
Eastern Europe, Scandinavia, United Kingdom, Switzerland
Personalized Order: December 16
Non-Personalized Order: Dec. 18
United States, Canada, Middle East
Personalized Order: December 16
Non-Personalized Order: December 17
Asia, South America
Personalized Order: December 15
Non-Personalized Order: December 16
Personalized Order: December 13
Non-Personalized Order: December 14
You will receive a shipping notification with tracking number as soon as the package is shipped.
Customized products include team jerseys featuring the names and numbers of players on the roster, or simply customized with patches chosen by the customer (e.g., jerseys with or without UCL, wefox,Fondazione Milan patches, etc.). Please remember that customized products have specific production timelines and return policies which differ from non customized products.
If you place an order for a"standard" product (e.g., a scarf) and a customized item (e.g a playerjersey with name/patch), your order will follow the shipping and delivery timelines established for a customized product, as both items will be shipped together.
Products are shipped using the following shipping services:
- SDA in Italy
- UPS internationally
Both shipping services offer a package tracking service. SDA delivers from Monday to Friday, mornings and afternoons. Recipients may not request deliveries at precise times of day or on specific days. If the recipient is absent, the shipping service will leave a notice of attempted delivery in the form of a sticker attached on the recipient's front door. Two delivery attempts will be made; if both are unsuccessful, the shipping service will try to contact the recipient. It is important to provide a phone number (landline or mobile) when placing an order to facilitate deliveries. It is important to provide a delivery address where someone is present to receive the goods. It is also important to always indicate the last name as it appears on the buzzer at the front door. Milan Entertainment srl will not be liable for any malfunctioning of the shipping on the part of the shipping service.
UPS delivers from Monday to Friday, mornings and afternoons. Saturday deliveries are possible depending on the city of shipment, and can only be made in the morning. If the recipient is absent, the shipping service will leave a notice of attempted delivery in the form of a sticker attached on the recipient's front door. Two delivery attempts will be made; if both are unsuccessful, the shipping service will try to contact the recipient. It is important to provide a phone number (landline or mobile) when placing an order to facilitate deliveries. The shipping service notifies the customer via email regarding the shipment's status.
This service is
automatically activated if the email address field has been filled in
correctly.We ask that you not enter a PO Box in the address field, as the
shipping service cannot deliver any goods purchased to such an address.
Therefore, you must enter a physical delivery address. For deliveries made to reception services
(with a signature in acceptance by the receptionist), store.acmilan.com will
not be liable for any subsequent failure to deliver the package to the end
recipient.If a destination country does not appear among those listed, this
means that products cannot currently be delivered to that country.
Payment on delivery: 10.00€
Advance payment of your order (credit card or PayPal):
- Standard: 7.50€
Shipping costs vary according to the destination country and the
package's weight and volume. Customers may visualize the online cost upon
completing their order and before confirming it.


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Use of JCP site is subject to the JCP Terms of Use and the Oracle Privacy Policy
Community Summary | Community Files
JSR #396 JavaTM SE 21
Community Summary
The materials on this page are provided by the Spec Lead of this JSR for evaluation and feedback.
These materials are not final, and are subject to change as the JSR progresses through the process.
Please see the EG's home page for further information: https://openjdk.org/projects/jdk/21/spec/.