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01 January 2020 IMMUNISATION SCHEDULE OF THE SPANISH ASSOCIATION OF PAEDIATRICS: 2020 RECOMMENDATIONS
Anales de Pediatría (English Edition)
The Spanish Association of Pediatrics has as one of its main objectives the dissemination of rigorous and updated scientific information on the different areas of pediatrics. Annals of Pediatrics is the Body of Scientific Expression of the Association and is the vehicle through which members communicate. Publishes original papers on clinical research in pediatrics from Spain and Latin American countries, as well as review articles prepared by the best professionals in each specialty communications and annual meeting minute books of the Association, and practice guidelines developed by the various Societies / Sections Specialized integrated into the Spanish Association of Pediatrics. The magazine, referring to the Spanish-speaking pediatric, indexed in major international databases: Index Medicus / Medline, EMBASE / Excerpta Medica and Spanish Medical Index.
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Vol. 92. Issue 1.
Pages 52.e1-52.e10 (01 January 2020)
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Vaccination against hepatitis b
Vaccination against diphtheria, tetanus, pertussis, poliomyelitis and haemophilus influenzae type b
Vaccination against pneumococcal disease
Vaccination against rotavirus
Vaccination against meningococcal disease
Vaccination against measles, mumps and rubella (mmr)
Vaccination against varicella
Vaccination against human papillomavirus (hpv)
Conflicts of interests (last 5 years)
Spanish Association of Paediatrics
DOI: 10.1016/j.anpede.2019.10.003
IMMUNISATION SCHEDULE OF THE SPANISH ASSOCIATION OF PAEDIATRICS: 2020 RECOMMENDATIONS
Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2020
Francisco José Álvarez Garcíaa,b,
pacoSalvarez1959@yahoo.es
Corresponding author.
, María José Cilleruelo Ortegac,d, Javier Álvarez Aldeáne, María Garcés-Sánchezf, Nuria García Sánchezg,h, Elisa Garrote Llanosi,j, Ángel Hernández Merinok, Antonio Iofrío de Arcel, Manuel Merino Moínam,n, Abián Montesdeoca Meliáno, María Luisa Navarro Gómezp,q, Jesús Ruiz-Contrerasr,s, en representación del Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP)
a Centro de Salud de Llanera, Severies, Asturias, Spain
b Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
c Servicio de Pediatría, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
d Departamento de Pediatría, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
e Servicio de Pediatría, Hospital Costa del Sol, Marbella, Málaga, Spain
f Centro de Salud Nazaret, Valencia, Spain
g Centro de Salud Delicias Sur, Zaragoza, Spain
h Departamento de Pediatría, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
i Sección de Infectología, Hospital Universitario Basurto, Bilbao, Spain
j Facultad de Medicina, Universidad del País Vasco UPV-EHU, Bilbao, Spain
k Centro de Salud La Rivota, Alcorcón, Madrid, Spain
l Centro de Salud El Ranero, Murcia, Spain
m Centro de Salud El Greco, Getafe, Madrid, Spain
n Facultad de Medicina, Universidad Europea, Madrid, Spain
o Centro de Salud de Guanarteme, Las Palmas de Gran Canaria, Spain
p Servicio de Pediatría, Hospital Universitario Gregorio Marañón, Madrid, Spain
q Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
r Servicio de Pediatría, Hospital Universitario 12 de octubre, Madrid, Spain
s Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
COMPOSITION AND PROFESSIONAL AFFILIATION OF THE MEMBERS OF THE ADVISORY COMMITTEE ON VACCINES OF THE SPANISH ASSOCIATION OF PEDIATRICS
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Table 1. Abbreviation, generic names and brand names of vaccines recommended for routine immunisation by the CAV-AEP currently available in Spain.
The CAV-AEP annually publishes the immunisation schedule considered optimal for children resident in Spain, taking into account the available evidence.
The 2+1 schedule is recommended (2, 4, and 11 months) with hexavalent vaccines (DTPa-VPI-Hib-HB) and with 13-valent pneumococcal conjugate.
A 6-year booster is recommended, preferably with DTPa (if available), with a dose of polio for those who received 2+1 schemes, as well as vaccination with Tdpa in adolescents and in each pregnancy, preferably between 27 and 32 weeks.
Rotavirus vaccine should be systematic for all infants.
Meningococcal B vaccine, with a 2+1 schedule, should be included in routine calendar.
In addition to the inclusion of the conjugated tetravalent meningococcal vaccine (MenACWY) at 12 years of age with catch up to 18 years, inclusive, the CAV recommends this vaccine to be also included at 12 months of age, replacing MenC. Likewise, it is recommended in those over 6 weeks of age with risk factors or who travel to countries with a high incidence of these serogroups.
Two-dose schedules for MMR (12 months and 3-4 years) and varicella (15 months and 3-4 years) will be used. The second dose could be applied as a tetraviral vaccine.
Universal systematic vaccination against HPV is recommended, both for girls and boys, preferably at 12 years, and greater effort should be made to improve coverage. The 9 genotype extends coverage for both genders.
Immunisation schedule
El CAV-AEP publica anualmente el calendario de vacunaciones que estima idóneo para los niños residentes en España, teniendo en cuenta la evidencia científica disponible.
Se mantiene el esquema 2+1 (2, 4 y 11 meses) con vacunas hexavalentes (DTPa-VPI-Hib-HB) y con antineumocócica conjugada 13-valente.
Se aconseja un refuerzo a los 6 años, preferentemente con DTPa (si está disponible), junto a una dosis de polio para aquellos que recibieron esquemas 2+1, así como vacunación con Tdpa en adolescentes y en cada embarazo, preferentemente entre las 27 y las 32 semanas.
La vacuna del rotavirus debería ser sistemática para todos los lactantes.
Se sigue proponiendo la incorporación en el calendario de la vacuna antimeningocócica B, con esquema 2+1 en lactantes.
Además de la inclusión de la vacuna antimeningocócica conjugada tetravalente (MenACWY) a los 12 años con rescate hasta los 18 años, inclusive, el CAV recomienda que esta vacuna sea introducida también a los 12 meses de edad, sustituyendo a MenC. Igualmente, se recomienda en los mayores de 6 semanas de edad con factores de riesgo o que viajen a países de elevada incidencia de estos serogrupos.
Se emplearán esquemas de 2dosis para triple vírica (12 meses y 3-4 años) y varicela (15 meses y 3-4 años). La segunda dosis se podría aplicar como vacuna tetravírica.
Se recomienda la vacunación sistemática universal frente al VPH, tanto a chicas como a chicos, preferentemente a los 12 años, debiendo realizar un mayor esfuerzo para mejorar las coberturas. La de 9 genotipos amplía la cobertura para ambos sexos.
Calendario de vacunación
Enfermedades inmunoprevenibles
Lactante
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates its recommendations for vaccination of children and adolescents compared to last year1 (Figure 1) taking into account the current scientific evidence on vaccine effectiveness, and vaccine safety, as well as the epidemiology of vaccine-preventable diseases in Spain.
Routine immunisation schedule of the Spanish Association of Pediatrics 2020.
(1) Hepatitis B vaccine (HB).- 3 doses of hexavalent vaccine at ages 2, 4 and 11 months. Children of HBsAg-positive mothers or mothers of unknown serologic status will also be given one dose of monovalent HB vaccine at birth, in addition to 0.5mL of hepatitis B immune globulin (HBIG) if maternal HBsAg-positive status is confirmed. Infants vaccinated at birth will adhere to the routine schedule for year 1 of life, and thus will receive 4 doses of HB vaccine. Unvaccinated children and adolescents should be given 3 doses of monovalent vaccine on a 0-, 1- and 6-months schedule.
(2) Diphtheria, tetanus and acellular pertussis vaccine (DTaP/Tdap).- 5 doses: primary vaccination with 2 doses, at 2 and 4 months, of DTaP (hexavalent) vaccine; booster at 11 months (third dose) with DTaP (hexavalent) vaccine; at 6 years (fourth dose) with the standard load vaccine (DTaP-IPV), preferable to the low diphtheria and pertussis antigen load vaccine (Tdap-IPV), and at 12-14 years (fifth dose) with Tdap.
(3) Inactivated poliovirus vaccine (IPV).- 4 doses: primary vaccination with 2 doses, at 2 and 4 months, and booster doses at 11 months (with hexavalent) and 6 years (with DTaP-IPV or Tdap-IPV).
(4) Haemophilus influenzae type b conjugate vaccine (Hib).- 3 doses: primary vaccination at 2 and 4 months and booster dose at 11 months (with hexavalent).
(5) Pneumococcal conjugate vaccine (PCV).- 3 doses: the first two at 2 and 4 months, with a booster dose starting at 11 months of age. The vaccine recommended in Spain by the CAV-AEP continues to be the PCV13.
(6) Rotavirus vaccine (RV).- 2 or 3 doses of rotavirus vaccine: at 2 and 3-4 months with the monovalent vaccine or at 2, 3 and 4 months or 2, 4 and 5-6 months with the pentavalent vaccine. It is very important to start vaccination between 6 and 12 weeks of life in order to minimise risks, and to complete it before 24 weeks for the monovalent vaccine or 32 weeks for the pentavalent vaccine. Doses must be given at least 4 weeks apart. Both doses may be given at the same time as any other vaccine.
(7) Meningococcal B vaccine (MenB).- 4CMenB. 3 doses: if vaccination starts at age 3 months, 2 doses at least 2 months apart with a booster starting at age 12 months and at least 6 months after the last dose in the primary vaccination series. If vaccination starts at 2 months, 4 doses are needed. Administration at least 15 days apart from other injectable inactivated vaccines is recommended up to age 18 months to minimise potential reactogenicity. The separation by a 15-day interval is not necessary for the varicella, MMR and rotavirus vaccines.
(8) Meningococcal C conjugate vaccine (MenC) and meningococcal ACWY conjugate vaccine (MenACWY).- 1 dose of conjugate MenC-TT at age 4 months. The CAV-AEP recommends 1 dose of the MenACWY conjugate vaccine at age 12-14 years, and a progressive catch-up vaccination schedule to be completed by age 18 years. If parents choose not to administer the MenACWY vaccine at age 12 months, the MenC-TT vaccine funded by the regional government must be administered instead. Administration of the MenACWY vaccine is still recommended in children and adolescents that are to live in countries where the vaccine is administered at this age (United States, Canada, Argentina, Austria, Greece, Netherlands, Italy, United Kingdom or Switzerland) and for children with risk factors for IMD: anatomic or functional asplenia, complement component deficiency, treatment with eculizumab, hematopoietic progenitor transplant recipients, HIV infection, prior episode of IMD caused by any serogroup, and contacts of an index case of IMD caused by serogroup A, W or Y in the context of an outbreak.
(9) Measles, mumps and rubella vaccine (MMR).- 2 doses of measles-mumps-rubella vaccine (MMR). The first at age 12 months and the second at age 3-4 years. The tetravalent MMRV vaccine may be administered for the second dose. Susceptible patients outside the specified ages will be vaccinated with 2 doses of MMR at least 1 month apart.
(10) Varicella vaccine (Var).- 2 doses: the first at age 15 months (age 12 months is also acceptable) and the second at age 3-4 years. The tetravalent vaccine (MMRV) may be used for the second dose. Susceptible patients outside the specified ages will be vaccinated with 2 doses of Var at least 1 month apart.
(11) Human papillomavirus vaccine (HPV).- Universal routine vaccination of all girls and boys, preferably at age 12 years, to prevent oncological diseases associated with this virus. All 3 HPV vaccines are authorised for use in male individuals, although there is little data on the use of the HPV2 vaccine in this sex. Administration of 2 doses at age 12 years. The vaccination schedule depends on the vaccine used: for the tetravalent vaccine, a 2-dose series (at 0 and 6 months) aged 9 to 13 years and a 3-dose series (at 0, 2 and 6 months) in those aged ≥14 years; for the 2-valent and 9-valent vaccines, a 2-dose series (at 0 and 6 months) aged 9 to 14 years and a 3-dose series (at 0, 1-2 [depending on the vaccine used] and 6 months) in those aged ≥ 15 years. The HPV vaccine may be administered at the same time as the MenC, MenACWY, hepatitis A and B and Tdap vaccines. There are no data on its coadministration with the varicella vaccine, although it should not cause any problems.
(0.28MB).
We recommend reading the expanded version of these recommendations in the CAV-AEP website, which provides the detailed arguments that support the recommendations. In addition, the recommendations for special situations and risk groups can also be found in the Online Vaccine Manual of the AEP https://vacunasaep.org/documentos/manual/manual-de-vacunas. Table 1 presents a list with the vaccines currently included in the schedule.
Abbreviation, generic names and brand names of vaccines recommended for routine immunisation by the CAV-AEP currently available in Spain.
Abbreviation / type of vaccine
Brand name (manufacturer)
DTaP-IPV-Hib-HB Hexavalent (standard-load diphtheria, tetanus, standard-load acellular pertussis, inactivated poliovirus, Hib and hepatitis B vaccine) Hexyon (Sanofi Pasteur), Infanrix Hexa (GSK) and Vaxelis (MSD)
Tdap Tetanus, reduced diphtheria toxoid and reduced-load acellular pertussis Boostrix (GSK) and Triaxis (Sanofi Pasteur)
Tdap-IPV Tetanus, reduced diphtheria toxoid, reduced-load acellular pertussis and inactivated poliovirus Boostrix Polio (GSK)
PCV13 Pneumococcal 13-valent conjugate vaccine Prevenar 13 (Pfizer)
MenC-TT Meningococcal group C vaccine conjugated with tetanus toxoid NeisVac-C (Pfizer)
MenACWY Meningococcal A, C, W and Y vaccine conjugated with CRM Menveo (GSK)
Meningococcal A, C, W and Y vaccine conjugated with tetanus toxoid Nimenrix (Pfizer)
MenB 4CmenB Meningococcal group B vaccine Bexsero (GSK)
MenB-fHbp Meningococcal group B vaccine Trumenba (Pfizer)
MMR Measles, mumps, rubella vaccine MMRVaxPro (MSD) and Priorix (GSK)
MMRV Tetravalent vaccine (Measles, mumps, rubella and varicella) ProQuad (MSD)
Var Varicella Varilrix (GSK) and Varivax (MSD)
HPV HPV2 2-valent human papillomavirus vaccine Cervarix (GSK)
HPV4 4-valent human papillomavirus vaccine Gardasil (MSD)
HPV9 9-valent human papillomavirus vaccine Gardasil 9 (MSD)
RV RV1 Monovalent rotavirus vaccine Rotarix (GSK)
RV5 Pentavalent rotavirus vaccine RotaTeq (MSD)
These recommendations are aimed at paediatricians, family physicians, nurses, midwives, families and in general at anyone wishing to obtain updated information on paediatric immunisations.
Our objectives are to promote adherence with official immunisation schedules and offer health care providers options for catch-up vaccination in individuals with incomplete vaccination and to expand individual protection with the vaccines that are currently not included in official immunisation schedules.
We pursue the above objectives taking into account the local epidemiological circumstances and prioritising safety as a key component.
From the CAV-AEP, we once again emphasise the goal of promoting the establishment of a unified immunisation schedule to uphold the principle of equality in disease prevention and in the services offered by the public health systems of all the autonomous communities of Spain.
We need to structure systems for debate to advance in other important aspects, such as improving Primary Care as the cornerstone of the National Health System and the setting where vaccination is performed, gaps in vaccination coverage addressed in specific age groups, populations and geographical areas, considering approaches to the co-funding of vaccines that are not included in official immunisation schedules, establishing a system for compensation of adverse events that, while rare and unpredictable, may result from vaccination, and developing a platform with information on all aspects of vaccination.
As has been done in other countries, we need to promote a new technological and scientific infrastructure at the national level for providing evidence-based advice on policy issues related to vaccination, as recommended by the WHO, which would allow the synchronization of the various scientific, social and health administration perspectives at play.
The AEP is open and willing to participate and collaborate with the Ministry of Health, Consumption and Social Welfare of Spain, the governments of the different autonomous communities and any other parties involved in tasks and processes aimed at improving immunisation.
2020 recommendation:We recommend the vaccination of infants with 3 doses of hexavalent vaccine at 2, 4 and 11 months of age. Previously unvaccinated older children and adolescents will receive 3 doses of the monovalent vaccine in a 0-, 1- and 6-months schedule.
In Spain, the annual incidence of hepatitis B remains under 2 cases per 100 000 inhabitants. In 2016, a total of 530 cases were notified, corresponding to an incidence of 1.14 cases per 100 000 inhabitants.2
Since 2018, every autonomous community initiate the hepatitis B series at age 2 months with the hexavalent vaccine.
Newborns of mothers who are HBsAg-positive or of unknown serologic status should be vaccinated as early as possible regardless of birth weight and always with the monovalent vaccine. They should also be given hepatitis B immune globulin in the first 12hours post birth if the mother is HBsAg-positive. Newborns vaccinated at birth will adhere to the routine immunisation schedule for the first year of life, so they will receive a total of 4 doses of hepatitis B vaccine.
2020 recommendation: We recommend a 2+1 schedule with the hexavalent vaccine at 2, 4 and 11 months. Children that have received the 2+1 series should be given DTaP-IPV, preferably, or Tdap-IPV at age 6 years and Tdap at age 12-14 years. We recommend vaccination with Tdap of all pregnant women in each pregnancy, preferably between 27 and 32 weeks of gestation, as early as possible within this window. In case of known risk of preterm birth, vaccination could be given starting at 16 weeks.
The 2+1 schedule is sufficiently immunogenic and allows optimising the use of available doses. Earlier administration of the first dose at 6 weeks post birth is allowed.
The goal of vaccination during pregnancy is to prevent pertussis in infants aged less than 3 months and to reduce transmission. Vaccination of pregnant women with Tdap is the priority, without neglecting the primary vaccination series, booster doses and vaccination of health care staff employed in obstetrics and paediatrics settings.
Vaccination of pregnant women is effective, preventing disease (90%-93%) and death (95%) in infants aged less than 2 months.3 The vaccine is highly immunogenic, and some studies have found a higher immunogenicity when it is administered early at 13 to 25 weeks compared to after 26 weeks of gestation,4 but further research is required to confirm that the incidence of pertussis in infants aged less than 2 months does not increase with the former schedule. If vaccination is performed in the third trimester, a higher level of antibodies is achieved if performed between 27 and 30 weeks of gestation.5
Some authors recommend a 3+1 schedule in preterm infants, as studies in this subpopulation were carried out using this schedule, but it is unknown whether it is necessary. Many European countries maintain the 2+1,6 which facilitates adherence to the schedule, as vaccination may be delayed or incomplete in some of these children.
Children that received a 2+1 primary vaccination series with hexavalent vaccine should be given a booster dose at age 6 years, preferably with the DTaP-IPV vaccine.
Due to the increase in the incidence of poliomyelitis caused by wild poliovirus in Pakistan and Afghanistan, it is important to be careful in case of international travel.
2020 recommendation:Vaccination against pneumococcal disease is recommended for all children younger than 5 years and children that are at risk due to underlying disease at any age. A 2+1 series (at 2, 4 and 11 months) is recommended for routine vaccination of infants. The CAV-AEP continues to recommend the use of the 13-valent pneumococcal conjugate vaccine (PCV13) on account of the current epidemiology of pneumococcal infections in Spain prior to the introduction and use of this vaccine.
The impact of pneumococcal conjugate vaccines (decavalent [PCV10] and VNC13) on invasive pneumococcal disease (IPD) and non-invasive pneumococcal disease caused by vaccine serotypes has resulted in few cases of IPD being caused by these serotypes. Childhood vaccination is expected to achieve the near eradication (90% decrease) of IPD by vaccine serotypes within 10 years if high vaccination coverage rates are achieved. Therefore, the future impact of pneumococcal conjugate vaccines will depend on replacement by nonvaccine serotypes and the ability to maintain high vaccination coverage.
The increase in IPD caused by nonvaccine serotypes reflects changes in nasopharyngeal carriage, which aside from vaccination is determined by complex factors that are difficult to control, such as the invasiveness of specific serotypes.7 This explains the observed variability in replacement in different countries, even those using the same vaccine.
The increase in IPD by nonvaccine serotypes, which has been greater in the population aged more than 65 years, reduces, but does not nullify, the overall benefits of vaccination.7,8 Another factor at play is the phenomenon of serotype replacement, which can change the distribution of the different forms of IPD.
The United States is an exception in serotype replacement, as there has been no evidence of an increase in the incidence of IPD by nonvaccine serotypes in any age group.7,9 In Madrid, there has also been no increase in IPD by nonvaccine serotypes in individuals aged less than 15 years, but there has been an increase in other age groups in the incidence of IPD caused by serotypes 8, 3, 12F, 22F, 12B and 24F.
Although there has been a strong increase in the incidence of IPD by serotype 19A in countries using the PCV10, a study conducted in Kenya found that the incidence of IPD by this serotype did not change and did not detect replacement by other nonvaccine serotypes.10
Recently, it has been confirmed that the level of specific antibodies required to prevent nasopharyngeal colonization (which is key to achieve herd immunity) is greater compared to the level required to prevent IPD and different for each serotype.
2020 recommendation:Vaccination against rotavirus (RV) should be included in the routine immunisation schedule for al infants.
To date, more than 100 countries have introduced vaccination against RV in their immunisation schedules. The public health benefits of this intervention have been enormous, and in Europe vaccination programmes have led to reductions in the burden of disease of 60% to 90% both in terms of primary care visits and hospital admissions.11
In Spain, a review of studies published in the past 10 years reveals a high effectiveness, with a reduction of 83% to 96% in the number of hospital admissions due to RV.12
Vaccination also indirectly and positively affects the unvaccinated environment, which substantially enhances the impact and efficiency of this intervention. On account of their vulnerability, preterm infants deserve special attention, and they should receive the vaccine without delay, even if they are hospitalised, before 12 weeks post birth.13
The benefits of vaccination far exceed the risk of intussusception, the only severe adverse event associated with the RV vaccine, which is very rare (1 to 5 cases per 100 000 vaccinated children).14
2020 recommendation: Routine vaccination against meningococcus B is recommended in all infants starting at 3 months of age with a 2+1 schedule. For all other age groups, including adolescents, the decision whether to vaccinate should be made on a case-by-case basis.
We also recommend administration of the MenC-TT vaccine at age 4 months and replacing the MenC dose at age 12 months by a dose of MenACWY. It is essential that, should a child not be given the latter vaccine, the dose of MenC is administered without fail. We continue to recommend administration of the MenACWY vaccine to adolescents, and catch-up vaccination is recommended up to age 18 years.
In Spain, 2 vaccines are available for prevention of invasive meningococcal disease (IMD) due to group B meningococcus: the 4CMenB vaccine (from age 2 months) and the MenB-fHbp vaccine (authorised in Europe for use from age 10 years), both of which contain subcapsular protein antigens.
Since IMD by serogroup B is rare, conventional cost-benefit analyses of this vaccine are unfavourable. However, the CAV-AEP considers that it should be included in the routine immunisation schedule for 2 reasons:
IMD is a devastating disease and the most frequent serogroup isolated in infants aged less than 12 months in Spain is group B.15
It is an effective vaccine, as demonstrated by its impact after the introduction in the vaccination schedule in England in 2015, with a 2+1 series given in infancy.
The outcomes after the first 10 months of the programme showed an effectiveness of 83% against all group B strains and a reduction of 50% in the number of cases in the target population.16 Three years after its introduction, there is evidence of an overall adjusted effectiveness of 58.9% (95% confidence interval [CI], -31.5%-87.1%), and an effectiveness of 70.5% against strains theoretically covered by the vaccine. Since 2015, 277 cases of IMD due to group B meningococcus have been prevented, and the annual incidence observed in the 3 vaccinated cohorts has been lower than predicted,17 with no evidence of safety concerns. It is possible that the 4CMenB vaccine may offer cross-protection against other serotypes.
Assuming the degree of uncertainty that is to be expected in relation to any recently developed vaccine, the CAV-AEP considers that there are sufficient data on its impact and safety to recommend administration of the 4CMenB vaccine to all infants, the age group with the highest incidence of IMD, with a 2+1 series starting at age 3 months. Two autonomous communities in Spain (Castilla y Leon and the Canary Islands) have already included the 4CMenB vaccine in their routine childhood immunisation schedules.
The CAV-AEP recommends vaccination against group B meningococcus in all adolescents to improve individual protection, but not as a routine measure, as these vaccines do not reduce the prevalence of nasopharyngeal carriage or generate herd immunity.18
There is ample evidence of the effectiveness of the monovalent vaccine against group C meningococcus. The incidence rate of IMD due to serogroup C in Spain remained very low in the 2017-2018 season (0.08 cases/100 000 inhabitants).14
Starting in 2000, there has been a marked increase in the incidence of IMD by serogroups W and Y in Europe,19 leading many countries to change their vaccination policy against IMD by replacing the dose of MenC by a dose of MenACWY at age 2 years and/or in adolescence. Some countries in America, such as the United States, Canada, Chile and Argentina, have also included the MenACWY vaccine in their immunisation schedules.20
In Spain, from the 2014-15 season, there has been an increase in the annual incidence of IMD, a trend that has been sustained year after year due to the increase in the incidence of IMD by groups W and Y. The latest data from the Centro Nacional de Epidemiología (National Epidemiology Centre), corresponding to week 32 of 2019, reflect a clear increase: 77 cases of IMD by group W (incidence, 0.16/100 000) and 48 by group Y (incidence, 0.10/100 000).15
With these data, the Comisión de Salud Pública (Public Health Committee) published a document in 2019 with recommendations on vaccination against IMD. When it came to the MenACWY vaccine, the committee considered vaccination of adolescents and young adults a priority, replacing the MenC dose at 12 years by a dose of MenACWY and planning catch-up vaccination of adolescents aged 13 to 18 years in the span of 2 to 3 years to achieve an epidemiologically significant impact as soon as possible.21 Meanwhile, the government of Castilla y León has included the MenACWY vaccine in the official immunisation schedule at ages 12 months and 12 years. Andalusia will add it to its routine schedule in 2020.
The CAV-AEP supports the replacement of the dose of MenC by a dose of MenACWY in adolescence, but also at age 12 months, given the increasing trend in the incidence of IMD by groups W and Y in children aged less than 5 years. In case the MenACWY vaccine is not given at 12 months, it is important to ensure administration of a dose of MenC to prevent a drop in vaccination coverage.
2020 recommendation: We recommend the administration of a first dose of MMR vaccine at 12 months of age, with a second dose given between 3 and 4 years of age. The tetravalent vaccine (MMRV) may be used for the second dose.
Due to suboptimal vaccination coverage in some countries, the prevalence of measles has exhibited a sustained increase in the past 6 years in 6 World Health Organization (WHO) regions. In the European Region, in the first semester of 2019, the incidence doubled compared to the same period in 2018,22 and 4 countries have lost their measles-free status (not including Spain). There are still outbreaks of mumps, while rubella stays stable.23 Maintaining vaccination coverage rates above 95% for the 2 doses and strict epidemiological surveillance are of the essence to eradicate these diseases.
Some studies have detected an increased risk of suffering convulsive seizures when the MMRV vaccine is used for the first dose given to children aged less than 2 years, so for the time being we recommend giving these 2 vaccines separately (MMR and varicella) in this age group.24
2020 recommendation:We recommend vaccination of all children against varicella with 2 doses administered at ages 15 months and 3–4 years (the MMRV vaccine may be used for the second dose). We also recommend catch-up vaccination with a 2-dose series (or completion of the 2-dose series when applicable) for all children and adolescents that have not had the disease.
Since 2016, vaccination against varicella has been included in the immunisation schedule of every autonomous community with a 2-dose series (at 15 months and 3–4 years).25 There are two monovalent and two tetravalent vaccines with evidence of a high effectiveness (92%–97.3%).26
In 2019, 9 autonomous communities in Spain introduced the use of the MMRV vaccine for the second dose, facilitating adherence to the immunisation schedule.
The strategy of universal vaccination against varicella has proven cost-effective.27 After 20 years of use in the United States, there is evidence of an overall decline in the incidence of disease28 and in the incidence of herpes zoster in the paediatric population.29 There is no evidence of shift toward older ages or of an increase in the incidence of herpes zoster in the overall population.30
2020 recommendation:Routine vaccination against HPV is recommended in both girls and boys, preferably at age 12 years, as a means to prevent oncological diseases associated with this virus.
The optimal age for vaccination is 12 years, with administration of a 2-dose series, with the aim of maximizing immunogenicity and its possible benefits prior to sexual debut and pursuing the broadest possible vaccination coverage. The recommendation also extends to older ages if vaccination has been delayed, as well as to at-risk groups, given the benefits that it may continue to provide.
In girls, the evidence on the efficacy and effectiveness of this vaccine in preventing persistent HPV infection, genital warts and precancerous cervical lesions continues to grow, with a reduction of up to 85% in the incidence of high-grade dysplasias, even 10 years after vaccination.31,32
In male individuals, the efficacy of the vaccine in preventing HPV-related cancer is greater in those that receive it prior to their sexual debut.33
These vaccines are extremely safe and have a very favourable risk-benefit ratio.31 The only adverse events described are anaphylaxis, which may occur with administration of any vaccine, and syncope.34 In spite of this, the coverage in Spain continues to be considerably low compared to all other vaccines in the routine immunisation schedule.35
Vaccination of male individuals is already included in the schedules of 29 countries, with the recent addition of Germany and the United Kingdom.34,36 There are relevant data on the role of HPV in the aetiology of certain types of cancer affecting both sexes but with a higher incidence in males, such as rectal cancer and head and neck cancer.37 The immunogenicity achieved is comparable to the one achieved in girls.38 For all the above reasons, the CAV-AEP also recommends vaccination of male adolescents.
In Spain, 3 HPV vaccines are currently available: the 9-valent vaccine (HPV9), the 4-valent vaccine and the 2-valent vaccine.39,40 All 3 confer protection against cervical cancer and precancerous lesions, although the first 2 also protect against genital warts. The HPV9 vaccine offers the widest direct coverage against cervical malignancies (90%) and potential prevention of HPV-related vulvar, vaginal and anal cancers (85%-95%).41 All 3 are authorised for use in individuals of both sexes. In case vaccination against HPV is publicly funded, we recommend using the HPV vaccine that has been selected by each autonomous community.
The development of these recommendations (analysis of the published data, debate, consensus and publication) has not been supported by any funding source outside of the logistic support provided by the AEP.
FJAG has collaborated in educational activities funded by GlaxoSmithKline, Novartis, Pfizer, Sanofi Pasteur and MSD and as a consultant in GlaxoSmithKline, Novartis, Pfizer, Sanofi Pasteur and MSD advisory boards.
MJCO has collaborated in educational activities funded by GlaxoSmithKline, Novartis, Pfizer, Sanofi Pasteur and MSD, as a researcher in clinical trials for GlaxoSmithKline and Pfizer, and as a consultant in GlaxoSmithKline, Novartis, Pfizer, Sanofi Pasteur and MSD advisory boards.
JAA has collaborated in educational activities funded by Astra, GlaxoSmithKline, Pfizer and Sanofi Pasteur MSD, as a researcher in clinical trials for GlaxoSmithKline and Sanofi Pasteur and as a consultant in GlaxoSmithKline, MSD, Sanofi Pasteur and Pfizer advisory boards.
MGS has collaborated in educational activities funded by Astra, GlaxoSmithKline, Pfizer y Sanofi Pasteur MSD, as a researcher in clinical trials for GlaxoSmithKline, Janssen and Sanofi Pasteur MSD and as a consultant in GlaxoSmithKline and Novartis advisory boards.
NGS has collaborated in educational activities funded by Sanofi Pasteur and MSD and attended educational activities funded by Novartis y Pfizer.
EGL has received funding to attend domestic educational activities, and has participated in educational activities funded by GlaxoSmithKline, Pfizer and Sanofi Pasteur MSD, collaborated as a researcher in clinical trials for GlaxoSmithKline and as a consultant in GlaxoSmithKline advisory boards.
AHM has received funding to attend domestic educational activities and has participated in educational activities funded by Pfizer.
AIA has collaborated in educational activities funded by GSK, Pfizer and Sanofi-Pasteur-MSD, has received funding from Pfizer to attend domestic educational activities, and has participated in educational activities funded by GSK, MSD and Pfizer.
MMM has collaborated in educational activities funded by GlaxoSmithKline, Pfizer, Sanofi Pasteur and MSD, as a researcher in clinical trials for GlaxoSmithKline, Pfizer, Sanofi Pasteur and MSD and as a consultant in Novartis advisory boards.
AMM has received funding from Pfizer to attend educational activities in Spain and abroad, but stopped accepting any type of sponsoring from any pharmaceutical laboratories for any type of activity (as an educator or as a learner) since becoming a member of the CAV-AEP.
MLNG has collaborated in educational activities funded by Gilead, GlaxoSmithKline, Janssen, Pfizer, MSD and ViiV, as a consultant for Abbott, Astra Zeneca, Novartis and ViiV advisory boards and as a researcher in clinical trials sponsored by GlaxoSmithKline, Pfizer, Roche and Sanofi Pasteur.
JRC has collaborated in educational activities funded by GlaxoSmithKline, Pfizer, Sanofi Pasteur and MSD and as a researcher in clinical trials for GlaxoSmithKline and Pfizer.
We thank Javier Arístegui, José María Corretger and Luis Ortigosa for their inhouse advice in the development and writing of these recommendations.
Francisco José Álvarez García. Paediatrician, Centro de Salud de Llanera, Asturias. Associate Professor in Health Sciences, Department of Medicine, Universidad de Oviedo.
María José Cilleruelo Ortega. Department of Paediatrics, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid. Department of Paediatrics, School of Medicine, Universidad Autónoma de Madrid.
Javier Álvarez Aldeán. Paediatrician, Chief of Paediatrics, Hospital Costa del Sol, Marbella. Malaga.
María Garcés-Sánchez. Paediatrician, Centro de Salud Nazaret, Valencia. Researcher affiliated to the Section on Vaccines, FISABIO, Valencia.
Nuria García Sánchez. Paediatrician, Centro de Salud Delicias Sur, Zaragoza. Associate Professor in Health Sciences, Department of Paediatrics, School of Medicine, Universidad de Zaragoza.
Elisa Garrote Llanos. Paediatrician, Department of Infectious Diseases, Hospital Universitario Basurto, Bilbao. Associate professor, School of Medicine, Universidad del País Vasco, UPV-EHU.
Ángel Hernández Merino. Paediatrician, Centro de Salud La Rivota, Alcorcón, Madrid.
Antonio Iofrío de Arce. Paediatrician, Centro de Salud El Ranero, Murcia.
Manuel Merino Moína. Paediatrician, Centro de Salud El Greco, Getafe, Madrid.
Abián Montesdeoca Melián. Paediatrician, Centro de Salud de Guanarteme, Las Palmas de Gran Canaria.
María Luisa Navarro Gómez. Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid. Associate professor, Department of Paediatrics, School of Medicine, Universidad Complutense de Madrid.
Jesús Ruiz-Contreras. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Chair of the Department of Paediatrics. School of Medicine. Universidad Complutense de Madrid.
D. Moreno-Pérez, F.J. Álvarez García, J. Álvarez Aldeán, M.J. Cilleruelo Ortega, M. Garcés Sánchez, N. García Sánchez, et al.
Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2019.
An Pediatr (Barc)., 90 (2019), pp. e1-9
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H. Campbell, S. Gupta, G.P. Dolan, S.J. Kapadia, A. Kumar Singh, N. Andrews, et al.
Review of vaccination in pregnancy to prevent pertussis in early infancy.
J Med Microbiol., 67 (2018), pp. 1426-1456
http://dx.doi.org/10.1099/jmm.0.000829 | Medline
C.S. Eberhardt, G. Blanchard-Rohner, B. Lemaître, M. Boukrid, C. Combescure, V. Othenin-Girard, et al.
Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis.
Clin Infect Dis., 62 (2016), pp. 829-836
http://dx.doi.org/10.1093/cid/ciw027 | Medline
C.M. Healy, M.A. Rench, L.S. Swaim, E.O. Smith, H. Sangi-Haghpeykar, M.H. Mathis, et al.
Association between third-trimester Tdap immunization and neonatal pertussis antibody concentration.
JAMA., 320 (2018), pp. 1464-1470
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E. Chiappini, C. Petrolini, E. Sandini, A. Licari, L. Pugni, F.A. Mosca, et al.
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Expert Rev Vaccines., 18 (2019), pp. 523-545
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J.A. Lewnard, W.P. Hanage.
Making sense of differences in pneumococcal serotype replacement.
Lancet Infect Dis., 19 (2019), pp. e213-e220
http://dx.doi.org/10.1016/S1473-3099(18)30660-1 | Medline
S.N. Ladhani, S. Collins, A. Djennad, C.L. Sheppard, R. Borrow, N.K. Fry, et al.
Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000-17: A prospective national observational cohort study.
Lancet Infect Dis., 18 (2018), pp. 441-451
Centers for Disease Control and Prevention. Active bacterialcore surveillance (ABCs). Streptococcus pneumoniae. Trendsby serotype group [accessed 30 Sep 2019]. Available from: https://www.cdc.gov/abcs/reports-findings/survreports/spneu-types.html.
L.L. Hammitt, A.O. Etyang, S.C. Morpeth, J. Ojal, A. Mutuku, N. Mturi, et al.
Effect of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya: A longitudinal surveillance study.
Lancet., 393 (2019), pp. 2146-2154
M.L.A. De Hoog, T. Vesikari, C. Giaquinto, H. Huppertz, F. Martinon-Torres, P. Bruijning-Verhagen.
Report of the 5th European expert meeting on rotavirus vaccination (EEROVAC).
Hum Vaccin Immunother., 14 (2018), pp. 1027-1034
J. Díez-Domingo, M. Garcés-Sánchez, F. Giménez-Sánchez, J. Colomina-Rodríguez, F. Martinón-Torres.
¿Qué hemos aprendido sobre rotavirus en España en los últimos 10 años?.
An Pediatr (Barc)., 91 (2019), pp. 166-179
http://dx.doi.org/10.1016/j.anpedi.2019.01.024 | Medline
J. Alvarez-Aldeán, S. Ares-Segura, C. Díaz-González, A. Montesdeoca-Melián, R. García-Sánchez, H. Boix-Alonso, et al.
Recomendaciones para la vacunación frente a ROTAvirus de los recién nacidos PREMaturos (ROTAPREM).
An Pediatr (Barc)., 91 (2019), pp. 205
J.E. Tate, C. Yen, C.A. Steiner, M.M. Cortese, U.D. Parashar.
Intussusception rates before and after the introduction of rotavirus vaccine.
Pediatrics., (2016), pp. 138
http://dx.doi.org/10.1186/s12887-019-1515-6 | Medline
Centro Nacional de Vigilancia Epidemiológica. Instituto de Salud Carlos III. Boletín Epidemiológico Semanal en Red. Enfermedad meningocócica [accessed 30 Sep 2019]. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Boletines/Paginas/BoletinSemanalEnRed.aspx.
S.R. Parikh, N.J. Andrews, K. Beebeejaun, H. Campbell, S. Ribeiro, C. Ward, et al.
Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine against group B meningococcal disease in England: A national observational cohort study.
S. Ladhani.
Meningococcal protein vaccines – where next? Prevention of meningococcal disease – The way forward ESPID Symposium, May 9.
37th Annual Meeting of the European Society for Pediatric Infectious Diseases., May 6-11 (2019),
H. Marshall.
What has the South Australia Carriage Study taught us? Prevention of meningococcal disease – The way forward ESPID Symposium, May 9.
M. Krone, S. Gray, R. Abad, A. Skoczyńska, P. Stefanelli, A. van der Ende, et al.
Increase of invasive meningococcal serogroup W disease in Europe, 2013 to 2017.
Euro Surveill., 24 (2019),
R. Borrow, P. Alarcón, J. Carlos, D.A. Caugant, H. Christensen, R. Debbag, et al.
The Global Meningococcal Initiative: Global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection.
Grupo de Trabajo de Vacunación frente a EMI de la Ponencia de Programa y Registro de Vacunaciones. Recomendaciones de vacunación frente a enfermedad meningocócica invasiva. Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud. Ministerio de Sanidad, Consumo y Bienestar Social, Mar 2019 [accessed 30 Sep 2019]. Available from: https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/Recomendaciones_Vacunacion_Meningococo.pdf.
World Health Organization (WHO). WHO EpiData, August 2019 [accessed 30 Sep 2019]. Available from: https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/.
European Centre for Disease Prevention and Control. Monthly measles and rubella monitoring reports. En: European Centre for Disease Prevention and Control (ECDC) [online] [accessed 30 Sep 2019]. Available from: https://www.ecdc.europa.eu/sites/portal/files/documents/measles-monthly-report-august-2019.pdf.
K. Macartney, H.F. Gidding, L. Trinh, H. Wang, A. Dey, B. Hull, et al.
Evaluation of combination measles-mumps-rubella-varicella vaccine introduction in Australia.
JAMA Pediatr., 171 (2017), pp. 992-998
http://dx.doi.org/10.1001/jamapediatrics.2017.1965 | Medline
Calendario común de vacunación a lo largo de toda la vida. Consejo Interterritorial del Sistema Nacional de Salud; 2019 [accessed 30 Sep 2019]. Available from: http://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/docs/CalendarioVacunacion_Todalavida.pdf.
M. Marin, M. Marti, A. Kambhampati, S.M. Jeram, J.F. Seward.
Global varicella vaccine effectiveness: A meta-analysis.
Pediatrics., 137 (2016), pp. e20153741
http://dx.doi.org/10.1542/peds.2015-3741 | Medline
V. Spoulou, S. Alain, G. Gabutti, C. Giaquinto, J. Liese, F. Martinon-Torres, et al.
Implementing universal varicella vaccination in Europe: The path forward.
Pediatr Infect Dis J., 38 (2019), pp. 181-188
http://dx.doi.org/10.1097/INF.0000000000002233 | Medline
A.S. Lopez, J. Zhang, M. Marin.
Epidemiology of varicella during the 2-dose varicella vaccination program - United States, 2005-2014.
MMWR Morb Mortal Wkly Rep., 65 (2016), pp. 902-905
http://dx.doi.org/10.15585/mmwr.mm6534a4 | Medline
R. Civen, M. Marin, J. Zhang, A. Abraham, R. Harpaz, L. Mascola, et al.
Update on incidence of herpes zoster among children and adolescents after implementation of varicella vaccination, Antelope Valley, CA, 2000 to 2010.
Pediatr Infect Dis J., 35 (2016), pp. 1132-1136
R. Harpaz.
Do varicella vaccination programs change the epidemiology of herpes zoster? A comprehensive review, with focus on the United States.
World Health Organization (WHO). Human papillomavirus vaccines: WHO position paper, May 2017. Weekly Epidemiol Record. 2017;92:241-68.
M. Drolet, É. Bénard, N. Pérez, M. Brisson.
Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: Updated systematic review and meta-analysis.
Lancet., 394 (2019), pp. 497-509
E. Joura, M. Kyrgiou, F.X. Bosch, V. Kesic, P. Niemenen, C.W. Redman, et al.
Human papillomavirus vaccination: The ESGO-EFC position paper of the European society of Gynaecologic Oncology and the European Federation for colposcopy.
Eur J Cancer., 116 (2019), pp. 21-26
http://dx.doi.org/10.1016/j.ejca.2019.04.032 | Medline
A. Takla, M. Wiese-Posselt, T. Harder, J.J. Meerpohl, M. Röbl-Mathieu, M. Terhardt, et al.
Background paper for the recommendation of HPV vaccination for boys in Germany.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz., 61 (2018), pp. 1170-1186
Ministerio de Sanidad, Consumo y Bienestar Social, Gobierno de España. Coberturas de vacunación. Datos estadísticos [accessed 30 Sep 2019]. Available from: https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/coberturas.htm.
JCVI recommends extending HPV vaccination to boys. Drug Ther Bull. 2019;57:85.
T. Harder, O. Wichmann, S.J. Klug, M.A.B. van der Sande, M. Wiese-Posselt.
Efficacy, effectiveness and safety of vaccination against human papillomavirus in males: A systematic review.
BMC Med., 16 (2018), pp. 11
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Infect Agent Cancer., 13 (2018), pp. 15
Please cite this article as: Álvarez García FJ, Cilleruelo Ortega MJ, Álvarez Aldeán J, Garcés-Sánchez M, García Sánchez N, Garrote Llanos E, et al.; en representación del Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP). Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2020. An Pediatr (Barc). 2020;92:52.
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If you didn't jingle all the way over to Madison Square Garden on Friday, Dec. 8, 2017, for Z100's Jingle Ball, you missed performances by Ed Sheeran, Demi Lovato, Halsey and other top artists.
Liam Payne performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 in New York City.
Liam Payne performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Camila Cabello performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Logic performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Demi Lovato performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Fall Out Boy performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Pete Wentz of Fall Out Boy performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Ed Sheeran performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Lauren Jauregui and Halsey perform at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Halsey performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.
Sam Smith performs at Z100's Jingle Ball 2017 on Dec. 8, 2017 at Madison Square Garden in Manhattan.


text:
package br.ufsc.lehmann.classifier;

import br.ufsc.core.IMeasureDistance;
import br.ufsc.core.trajectory.SemanticTrajectory;
import br.ufsc.lehmann.EnumProblem;
import br.ufsc.lehmann.method.MSTPTest;
import br.ufsc.lehmann.msm.artigo.Problem;

public class MSTPClassifierTest extends AbstractClassifierTest implements MSTPTest {

	public MSTPClassifierTest(EnumProblem problemDescriptor) {
		super(problemDescriptor);
	}

	@Override
	public IMeasureDistance<SemanticTrajectory> measurer(Problem problem) {
		return MSTPTest.super.measurer(problem);
	}

}

redpajama_set_name: RedPajamaGithub


If you haven't heard of this site and have kids you might want to click over there right now and start feeling the love. If access to all that advise and retail-therapy aren't motivation enough then maybe the opportunity to win our YouthfulNest Consultation + Room Registry (value of $225) will be the right incentive. Plus, their is a readers' perk just for being as curious and enthusiastic as we are about good design.
We are usually spreading news of our favorite designer products or DIY projects, but we wanted to give a shout out to the website that inspired me when I was designing my son's nursery. Project Nursery is the ultimate children's design resource for baby nursery ideas. For those who haven't heard of the site, I explain it as HOUZZ.com, but focused on baby and kids rooms. Genius right?!
Like myself with YouthfulNest, the initial idea for this company stemmed from the co-founders', Melisa Fluhr and Pam Ginocchio, efforts designing their own nurseries. Since then, they have expanded into a retail shop and given birth to a site Project Jr. dedicated to the "big kids" – toddlers through tweens. While Project Jr. offers similar information as it's older sister, Project Nursery, has it's own set of offerings like DIY CRAFTS, STYLE & COOL STUFF!
This site is super user friendly and choc-full of all the stuff you are looking for when putting together a nursery or child's room. From advise on all things kids & moms to inspirational imagery to boutique shopping.
When looking for inspirational imagery via the Photo Gallery you will notice as a Houzz user, that projects are searchable by various filters, but drop down menus include unique categories including "Celebration" (baby showers birthday parties) and "Activity" (cooking & Do-It-Yourself).


The entire experience of publishing a book is non-stop learning. Some things are fun to learn and some are disappointing.
However, there is one part that I love and that is the unbelievable support from complete strangers! It's fantastic! It's proof to me that humans genuinely care for each other and support each other.
Happy Thanksgiving to every single wonderful human out there!


text:
Abbey Hill är en civil parish i Milton Keynes i Buckinghamshire i England. Orten har 4 215 invånare (2011).

Referenser

Civil parishes i Buckinghamshire
Milton Keynes

redpajama_set_name: RedPajamaWikipedia


text:
Plastic Soda is the second studio album by the Brazilian musician Jupiter Apple, released on September 1, 1999 by independent label Trama. Unlike its predecessor, it is fully sung in English and mixes more elements of jazz and traditional Brazilian genres such as samba and bossa nova amid the psychedelia Jupiter Apple is known for. Marcelo Birck, who previously collaborated with the musician in A Sétima Efervescência, returns for this release. Future Cachorro Grande guitarist Marcelo Gross was also a guest musician, providing drums.

The title of the track "Bridges of Redemption Park" is a reference to the Farroupilha Park (also known as Redemption Park) in Porto Alegre, Jupiter Apple's hometown.

Track listing

Personnel
 Jupiter Apple – lead vocals, electric guitar, bass guitar, keyboards, percussion, production, cover art
 Marcelo Birck – electric guitar, arrangements (track 5)
 Julio Cascaes – bass guitar
 Marcelo Gross – drums
 Gustavo Dreher – flute

References

1999 albums


These low carb dinner rolls are amazing! Using several staples of low carb baking, this recipe is gluten-free, dairy-free and can be made in nearly any size/shape. Just 10 minutes to prep and 20-25 to bake, these are perfect to whip up on food prep days and can be frozen to last you all week.


text:
Зинаида Сергеевна Иванова (литературный псевдоним — Н. Мирович; 1865, Сычёвский уезд, Смоленская губерния — 24 августа 1913, Владыкино, Московская губерния) — русская писательница, публицистка, критик, переводчица, историк, педагог. Видная деятельница женского движения конца XIX — начала XX века в России.

Биография
Родилась в семье деятельного участника крестьянской реформы 1861 года С. С. Иванова. Окончила пансион Дюмушель. Позже — выпускница Высших женских курсов Герье в Москве.

Деятельница женского движения в России. Была одной из активисток «Всероссийского союза равноправия женщин».

Автор многих книжек, изданных в Санкт-Петербурге и Москве. Напечатала ряд статей об эпохе французской революции (в «Пантеоне Литературы», «Историческом обозрении» и др. изданиях), критический этюд о Генрихе Ибсене и ряд педагогических и публицистических работ. Сотрудничала с журналами: «Образование», «Женское дело» (1900), «Русская мысль» (1906), «Нижегородский сборник» (СПб.,1905), «Вестник воспитания».

В своем творчество использовала псевдонимы Ив., З.; И—ва, З.; М—ч, Н.; Мирович, З. С., но чаще Н. Мирович. В списке авторов Энциклопедического словаря Гранат значится как З. С. Мирович.

Избранные публикации
 Библиографическое и историко-литературное исследование о богогласнике (Вильно, 1876);
 Госпожа Ролан: Историко-литературный этюд. СПб., 1890;
 Генрих Ибсен: Биографическмй очерк. СПб., 1892;
 Страница из истории Великой французской революции. (Г — жа Ролан). М.: издательство «С. Дороватовского и А. Чарушникова», 1905, тираж — 2400.
 Передвижная школа для взрослых. 1905;
 Очерки из истории Великой французской революции. Т. 1—3. М., 1906;
 Сен-Жюст. 1906;
 Победа женского движения в Финляндии. 1907;
 Женское движение в Европе и Америке. М., 1907;
 Из истории женского движения в России. М., 1908;
 Жан Масе;
 Из истории женского образования в России;
 Университетские поселения в Англии;
 Национальный союз домашнего чтения в Англии;
 Демократизация образования во Франции;
 Два конгресса женской фронды: (из воспоминаний) (Сборник на помощь учащимся женщинам, составленный исключительно из произведений женщин-писательниц… М., 1901) и др.

Перевела с английского «В доме сумасшедших: Драматическая картина» (1900); «Лицемеры: Драма» (1900), «Послание австралийских гражданок к женщинам других стран, собравшимся на конгресс в Копенгагене» 1906; в 1905 перевела книгу Джона Стюарта Милля «Избирательные права женщин».

Примечания

Ссылки

 Мирович Н. (Иванова Зинаида Сергеевна)

Деятели феминизма Российской империи
Русские писатели XIX века
Русские писатели XX века
Выпускницы Московских высших женских курсов
Авторы Энциклопедического словаря Гранат


Zinc Oxide [ZnO] Sputter Target used for Magnetron Sputtering Physical Vapour Deposition.
Available in pre-bonded assemblies with OFHC Cu backing plate and indium bonding. Please note that the Cu backing plate will add another 1/8" (3mm) to the target thickness.


text:
GET READY TO RUN
I just heard our completed production of WILLIAM F. NOLAN'S LOGAN RUN - LAST DAY this afternoon. This is one exciting show! The script by Paul J. Salamoff is fantastic and without question this is one of our fastest moving productions, with the average scene lasting about 3 minutes. It's a roller coaster ride. For those who are not familiar with the story,
It's the 23rd Century — at age 21 your life is over.
Logan-6 has been trained to kill. Born and bred from conception to be the best of the best. His time is short, but before his life ends he's got one final mission — find and destroy Sanctuary, a fabled haven for those who chose to defy the system.
When Logan meets and falls in love with Jessica, he begins to question the very system he has sworn to protect. Soon they are both running for their lives.
It's a great book by William F. Nolan and George Clayton Johnson CHECK IT OUT ON WIKIPEDIA.
Paul Salamoff wrote the script that we used, which is also the script used to create the comic book released by Bluewater Productions. Bluewater and CRT partnered on this audio presentation.
The cast is headed by Tom Berry as Logan 6, Kate DeSisto as Jessica 6, and J.T. Turner as Ballard. Joe Caliendo Jr. co-stars as Francis 7, Deniz Cordell is Gant 5, and in supporting roles you'll hear Joseph Zamparelli as The Warden, yours truly as Whale, Mark Thurner as Titus-9, and Isaac Bean as Charming Billy. Also in the cast are Kerry Donovan, Justin O'Brien, Catherine Benjamin, Amy Sheridan, Andrew Monroe, Noah Greenstein, Lucas Callahan, Heather Colter, and David Smith.
Jeffrey Gage composed the score, and the production was masterfully produced by Seth Adam Sher (Zorro and the Pirate Raiders, Zorro Rides Again, The Martian Chronicles).
LOGAN'S RUN - LAST DAY is based on the original book, Logan's Run, by William F. Nolan and George Clayton Johnson, and also Logan's World and Logan's Search, by William F. Nolan.
Everyone at CRT is very excited about this production! It will be released on CD and Audio Download by Brilliance Audio on Tue. July 5th. You can pre-order it HERE

redpajama_set_name: RedPajamaCommonCrawl


Jan 24, 2009 To test this software I will convert a Dvd video into an Avi(Divx codec) a 2 hour 7 minute film into 700mb file and the quality remained great. After googling the internet for a few days i purchased DVD Converter Ultimate 2.1 1.25 yesterday. Over the years I have come many films on the. В борьбе за независимость народа Джон пытается спасти принцессу Торис. Фильм очень увлекательный, приключение захватывает, есть отважные.


Successive British governments have consistently ignored Scottish ministers on major issues during two decades of devolution, key players in cross-party administrations have revealed.
Newly published interviews reveal the tensions, from the "dysfunctional relationship" between Tony Blair and Gordon Brown taking up too much bandwidth, to the Conservative-led government leaving the SNP on the "naughty step".
That feeling of being sidelined has been heightened after the Brexit referendum, according to a new report, Ministers Reflect on Devolution, by the Institute for Government.
Lord Wallace of Tankerness, the Liberal Democrat who was Scotland's first deputy first minister, and advocate-general in the Conservative-led coalition, said he did not believe British ministers were living up to promises made at the start of Brexit to engage meaningfully with devolved governments.


text:
'Breastfeeding bullies' keep up campaign that 'breast is best'
Breastfeeding versus formula feeding has long been a hot-button issue that can pit mom against mom. The recent death of a B.C. woman who suffered from postpartum depression is drawing new attention to the debate after her husband penned a letter saying she had anxiety over breastfeeding.
Decades-old stigma still being felt by mothers who choose formula over breastfeeding
Kas Roussy · CBC News · Posted: Feb 28, 2017 5:00 AM ET | Last Updated: March 1, 2017
Toronto mother Trish Bentley had difficulty breastfeeding, so she formula-fed her three sons. Not being able to breastfeed made her feel like a failure, she says. (CBC News)
Being a mom to three boys is not a job Trish Bentley takes lightly – and neither was the choice over whether to bottle-feed or breastfeed them.
Bentley kept trying, with little success, to breastfeed after each of her babies was born: Olly, now seven, Eddie who's five and her youngest Ben, who is 19 months old.
"I felt like a failure," she says. "I thought, here is the biggest job on the planet, and here in my first month, I am failing miserably."
Feeling guilty and depressed, she eventually felt she had to switch to pumping and supplementing with formula.
Seven-year-old Olly Hopkins helps at feeding time, giving his baby brother Ben a bottle of formula. (Trish Bentley)
But soon after, at a gathering with friends, she says she was brought back to some of those negative emotions, saying she felt disapproval and judgment after the topic of feeding came up.
"They all said, 'Oh, just bring the baby in here, just put him back on your breast. Try again, come on,'" she recalls, the episode still clearly riling her up. "And I'm like, 'You don't think that I haven't tried that? For three babies now?'"
Changing the message
So-called "breastfeeding bullies" have been shaming moms on social media for years. It's easy to find their comments online, on message boards or on parenting blogs.
"Formula-feeding is selfish," reads one. "Moms who formula-feed are lazy," says another.
The death of a B.C. woman suffering from postpartum depression is drawing more attention to the issue after her husband recently posted a statement on Facebook about her depression — and her anxiety over breastfeeding.
'You are not a bad mother': Husband pens letter after losing wife
'Really unkind:' Lack of support for moms with breastfeeding difficulties
The message of "breast is best" has long been touted in doctors' offices, medical literature and parenting groups for decades, intended to be a positive movement aimed at promoting breastfeeding and its benefits.
But in this highly charged debate, another campaign has emerged: It's called "fed is best" and promotes the idea that a fed baby is a happy one. The goal of the campaign, started by a U.S. non-profit, is to make sure new mothers don't feel inferior if they are unable to, or choose not to, breastfeed for reasons including low milk supply, difficulty with breastfeeding technique, a medical condition or the decision to return to work.
A campaign advocating 'fed is best' aims to dispel some of the issues facing moms who can't breastfeed. Instead, it supports the concept that a fed baby is a happy one. (fedisbest.org)
"Mothers don't just breastfeed anymore — they believe in breastfeeding. They preach breastfeeding," says Courtney Jung, the author of Lactivism, a book that explores the pressure to breastfeed, and the bullying that sometimes goes along with it.
"They really believe mothers who don't breastfeed are doing damage to their children," Jung says.
Women pushing back
Jung has nothing against breastfeeding; she breastfed her two children. But she says it's the "smugness" and the "moral self-righteousness" of breastfeeding advocates that gets to her.
"My experience has been that women are pushing back against the established dogmas around breastfeeding and insisting on their own right to choose now," she says.
Last year, the American Congress of Obstetricians and Gynecologists tweaked its policy on breastfeeding, saying while it "strongly encourages" women to breastfeed, it also recognizes that a mother "is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding or formula feeding is optimal for her and her infant."
The Society of Obstetricians and Gynecologists of Canada isn't planning to follow suit, sticking with its guidelines of exclusive breastfeeding for the first six months of a baby's life and continued breastfeeding up to two years of age or beyond.
Jennifer Levy has some quiet time breastfeeding her one-year-old daughter Olive at a breastfeeding clinic at Toronto's Michael Garron Hospital. (Kas Roussy)
At Toronto's Michael Garron Hospital, moms who have trouble breastfeeding can get help.
Jennifer Levy started visiting the hospital's breastfeeding clinic after she gave birth to her daughter Olive, who's now one. Levy had difficulty getting the baby to latch onto her breast but was able to succeed with guidance from a lactation consultant.
"I knew that breastfeeding at first could be challenging," she says. "But I did know, if I stuck with it, and was able to access support and get help, I maintained the faith that it would work out."
There are many benefits to breastfeeding, says Toronto family physician Danielle Martin, including improved immunity, lower rates of infections and better cognitive development.
But having said that, she says "lots of healthy kids" have been formula-fed.
"There's no need to lay it on so thick with women that we make them feel that they are inadequate moms if they can't, or don't wish to, breastfeed."
Mothers who choose formula over breastfeeding, either because they can't or don't want to, face stigma for their decision. 2:39
Kas Roussy
Kas Roussy is a senior reporter with the Health unit at CBC News. In her more than 30 years with CBC, Kas's reporting has taken her around the globe to cover news in countries including Pakistan and Afghanistan, Chile, Haiti and China, where she was the bureau producer.
'You are not a bad mother': Husband pens letter to moms with postpartum depression after losing wife
Lack of support for moms with breastfeeding difficulties 'really unkind'
Remembering Mother Florence Leung


Compiling your own Linux kernel is useful if you need to enable or disable certain kernel features that are not available in Linode-supplied or distribution-supplied kernels. For example, some users desire SELinux support, which is not enabled in stock Linode kernels, and may not be enabled in some distribution-supplied kernels.
If you'd rather run a distribution-supplied kernel instead, please follow our guide for Running a Distribution-Supplied Kernel.
Prior to these instructions, follow the steps outlined in our Getting Started guide. Then, log in to your Linode as the root user.
When installing GRUB, you'll be asked which disk images you'd like GRUB to configure. Unless you're planning on using the Direct Disk option in the Linode Configuration Manager, this is not required.
make oldconfig prompts the user to answer any new configuration options not present in the old configuration file.
Once your configuration options are set, exit the configuration interface and answer "y" for yes when asked whether you would like to save the new kernel configuration.
In the Linode Dashboard, click Edit next to your Configuration Profile (usually named after the version of Linux installed).
Click Save Changes. You can now reboot the Linode. We suggest opening a LISH or GLISH session first, so you can monitor the boot process and troubleshoot if necessary.
You may need to run cp /boot/grub/unicode.pf2 /boot/grub/fonts/ for the boot menu to properly display in GLISH. Your Linode will still boot, assuming there are no configuration issues, without this command.
Congratulations, you've booted your Linode using a custom-compiled kernel!


In the 21st century, literacy has evolved beyond its basic definition of knowing how to read and write. Everyone is required to know how to process, deliver and receive information in today's highly digitalised world. It is inevitable then that the new definition of literacy includes components of digital literacy, which emphasises the ability to use digital technology, communication tools and networks to locate, evaluate, use and create information.
According to the US Digital Literacy website, a digitally literate person can perform tasks in a digital environment, read and interpret media, reproduce data and images through digital manipulation, and evaluate and apply new knowledge gained from digital environments.
Clearly, being digitally literate is more than sending a Whatsapp message or watching a music video on youtube. It is much more – if you are digitally literate, you possess the knowledge and skills needed to use a range of digital tools for a variety of purposes. You can: use technology strategically to find and evaluate information, connect and collaborate with others, produce and share original content, and use the internet and technology as tools to achieve academic, professional, and personal goals.
At CIS, we ensure our students learn how to: think critically and ethically as they harness technology in their learning; behave safely and appropriately online; identify what information is important online; and use technology as a tool to showcase their skills and talents. They learn to be strategic in their approach to the use of technology – as they connect and collaborate with others.
Digital literacy is taught through our One to World Programme, where we apply best practice models and standards adopted from the International Society for Technology in Education (ISTE), Common Sense Education, and the IB Programme. Parents can also visit the Digital Literacy page in My.CIS where they can find useful resources and tips to support their children's digital life inside and outside CIS.
Our dynamic and changing world requires new comprehension and communication skills, as well as evolving codes of conduct, to ensure that these powerful media and technologies are used responsibly and ethically. Much of the interaction in this digital world happens at a distance, making it difficult for children to understand the consequences of their actions, as much of their digital life takes place under the cloak of anonymity. We endeavour to highlight to our students that although it might seem easy to participate in unethical and even illegal behaviors online, it is not right.
Digital Citizenship means that children appreciate their responsibility for their content as well as their actions when using the Internet, mobile devices, and other digital media. All of us need to develop and practice safe, legal, and ethical behaviors in the digital media age.
and we have adopted their Scope & Sequence: K-12 Digital Citizenship Curriculum. This comprehensive curriculum is designed to empower students to think critically, behave safely, and participate responsibly in our digital world. From lesson plans, videos, student interactives, and assessments, to professional learning and family outreach materials, their turnkey curriculum provides schools with everything they need to take a whole-community approach to digital citizenship.


In the past, if you wanted a cool, custom side mount license plate you paid through the nose. Our product brings the price down to reality without compromising style & function. Choose your plate then get the correct Mounting Clamps. Sized to fit 4" x 7" plates only.
Note: Not intended for use with saddlebags. Please check local laws regarding side mount license plates before ordering.
Note: Mounts are motorcycle specific & designed to work with Kuryakyn Side Mount License Plate Holders - Sold separately.


text:
5g compatible computers
This is especially true considering that 5G Wi-Fi routers are just slightly more expensive than a high-end N dual-band router. Qualcomm showed off its Project Limitless 5G laptop with Lenovo using the Snapdragon 8cx processor and Snapdragon X55 5G modem in May with a planned launch sometime in 2020, but nothing's available for consumers yet. The advantage of low-band is that it can travel long distances and penetrate buildings. Look for the "Radio types supported" section. https://www.cnet.com/news/5g-laptops-coming-this-year-first-batch-ces-2020 Thank you for signing up to Laptop Mag. HP only announced its ultralight Elite Dragonfly business two-in-one back in September, but it's already moved on to its second-gen version, the Elite Dragonfly G2. Currently active in 13 cities and some NFL stadiums, Verizon is looking to match T-Mobile and AT&T by the end of the year with 30 total cities on its 5G network. Within the Advanced tab, click 802.11n mode. AT&T is exclusively using mmWave currently and will be upgrading those nodes in the next year to boost their performance while also rolling out some low-band 5G to extend coverage. Devices with built-in adapters expected by the end of 2012. It's a beautiful device, meant for the traveling businessperson who's looking to take their work on the go. It will be faster and able to handle more connected devices than the existing 4G … 5G is next generation wireless network technology that's expected to change the way people live and work. Finally, Intelligent Audio ensures a better sound experience during calls — the Latitude laptop features two top-firing speakers and four noise-canceling microphones. And on a more fun note, online gaming or game streaming services should be flawless on a 5G connection. Currently active in 21 cities, AT&T has been fastest out of the gate with its 5G network and it projects that it will deploy in 30 cities by the end of 2019, however access is still limited to select business customers. When continuously used in the same duration, an N client and a 5G WiFi client would require about the same amount of juice, however. Sprint is also using Massive MIMO (Multiple Input Multiple Output) transceivers and beamforming to further boost its 5G coverage, putting 64 transmitters and 64 receivers on a single array which can then track devices to direct a signal more precisely at them. But, more interestingly, Dell also announced a totally different laptop with one major new feature. While regular consumers can certainly benefit from 5G availability on laptops, professionals whose work depends on being productive anywhere at anytime will get the most from it right now. Best Black Friday 2020 deals: Big savings on TVs, headphones, Apple Watch, Roku, Fitbit, Chromebooks, more, Amazon Black Friday 2020 deals: $100 Amazfit GTS, $130 Fitbit Versa 2, $65 Echo Show 8, more, Wanna buy a PS5 by Black Friday? Copyright ©2020 Designtechnica Corporation. * With 802.11n, its capability is unknown, and in order to find out you must attempt to connect to a 5GHz connection. launch in 1983, this was voice-only and only became known as 1G following the release of its successor. Read more about the Lenovo ThinkPad X1 Fold. Receive news and offers from our other brands? All Rights Reserved. Because of that, it's not exactly a surprise that the models announced at CES were mostly aimed at business users. The computer MAY OR MAY NOT have 2.4 GHz and 5GHz network capability and be Dual-Band Compatible. * With 802.11n, its capability is unknown, and in order to find out you must attempt to connect to a 5GHz … So technically, 5G Wi-Fi is the first wireless standard that breaks the gigabit barrier. Currently active in six cities, T-Mobile is also targeting 30 total cities for its 5G network by the end of 2019. The device features a "5G-ready design," which means we're looking at 5G antennas that are fit into the speakers of the laptop. The high-speed, always-connected future for laptops is just around the corner. Currently active in nine cities, Sprint is also going to be the slowest rollout this year as it isn't projecting any additional 5G cities by the end of the year. The more streams, the more bandwidth a device can handle. 5G is the next-generation wireless technology, 10 to 100 times speedier than your typical cellular connection and with low latency, so things like streaming video or downloads start almost instantaneously. The laptop learns what apps you use most and launches them faster (ExpressResponse), and adapts battery life based on your charging patterns and typical power usage (ExpressCharge) — the laptop can charge up to 35% in 20 minutes thanks to the ExpressCharge Boost tech. Dell on Thursday unveiled a few new products ahead of CES 2020, including the 2020 version of its XPS 13 2-in-1 — the upgraded device has a bigger screen than ever before and will hit stores in select markets next week. But what exactly is 5G and how is it going to impact you in 2019 and beyond? The laptop is also light, at 3.2 pounds, but in spite of that, it's supposed to support up to 30 hours of battery life. Similar to Wireless-N, 802.11ac, for now, comes in three tiers, based on the number of streams. Additional 5G smartphones currently available include the LG V50 ThinQ, the OnePlus 7 Pro 5G, the Samsung Galaxy Note 10 Plus 5G and the Moto Z4/Z3/Z2 Force with a 5G … In many ways, mid-band seems like the ideal solution for nationwide 5G as it still offers a reasonable range while also delivering much of the speed that 5G promises. This is where we are presently seeing the amazing speed tests with download speeds topping 1Gbps under the right conditions. Louisiana State University ALL RIGHTS RESERVED. Receive mail from us on behalf of our trusted partners or sponsors? Live-translation during video calls, one of Qualcomm's own examples, could be achieved using the on-board AI of the Snapdragon 8cx along with 5G. In order to access the speeds and capabilities of a 5G network, your phone must have radio technology that is compatible with 5G. In our limited time with the laptop, we were impressed with its design — including the leather folio material that services as the back of the laptop and moves as the display is folded and unfolded without bunching up along the spine. However, the new standard is especially good for high-def streaming within a local network. MORE: Verizon 5G Rollout: Locations, Phones, Price and More | Tom's Guide. Naturally, everyone is advertising the blazing-fast speeds and telling us that 5G is going to change everything. Discussion threads can be closed at any time at our discretion. Lenovo has also hinted that the ThinkPad X1 Fold will also receive 5G connectivity at some point in the near future. It'll be known as the Flex 5G in US. That said there's no dis-benefits in getting one even you currently don't have any hardware at home that supports 5G WiFi. It will be available in both clamshell and 360-degree convertible 2-in-1 formats, and it's the latter that will first get 5G support in July 2020 via its Qualcomm X55 5G modem. PCMag had a look at one of the routers Verizon … AT&T is out to an early lead, but by year's end only Sprint will be lagging behind if everyone manages to hit their stated goals. There's an onscreen keyboard for quick text entry, but if you prefer a physical keyboard for typing, there's a Bluetooth keyboard that can be used separately or magnetically attached to half the display. While the "ac" designation definitely does not mean "air conditioning," I can say for sure that 802.11ac is cool. ALL RIGHTS RESERVED. Lenovo was the first to announce a 5G laptop with its Flex 5G (as it's known in North America, and the Yoga 5G everywhere else), a brand new device powered by Qualcomm's Snapdragon 8cx 5G Compute Platform. MORE: Apple Will Release Two 5G iPhones in 2020, Analyst Says. The Flex 5G is a 360-degree convertible 2-in-1 with support for the Lenovo active pen, which combined with its power-saving features and always-connected 5G internet means it could be an excellent laptop for both productive and creative work anywhere and anytime. For now, the majority of always-connected laptops still sport 4G LTE connections, and it will take some time for the majority of laptops to make use of the latest in 5G goodness. That's 5G cellular technology, and it's just now starting to roll out to laptops. This is not to be confused with AT&T's 5G Evolution (5GE) that started showed up on some AT&T devices at the end of 2018. A great example is the Dell Latitude 9510, which will be available in March 2020. If you have a 4G phone, you'll be limited to 4G networks until you upgrade when 5G … This is the same area in which LTE operates in the U.S., below 1GHz frequencies. Discuss: 5G Wi-Fi (802.11ac) explained: It's cool, Always dual-band (with N on the 2.4Ghz band), Now, with more in coming weeks. It has to do with the hardware manufacturer, because they do not specify on 802.11n whether they have included the additional parts needed in the chip to connect to 5GHz. Read more about the Dell Latitude 9510. In arecent demo, Netgear showed that it could instantly play back four different 1080p movies wirelessly to four HDTVs using 802.11ac connections, something not possible with Wireless-N. 802.11ac clients are also supposed to offer much better battery life than N clients.
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text:
categoryTermID2172----CategoryParentID1530------
500-bed Cant Hospital to be functional soon: RCB
by Staff Report , (Last Updated July 30, 2018)
RAWALPINDI: Rawalpindi Cantonment Board (RCB) Chief Executive Officer (CEO) Sibtain Raza has said that the Cantonment General Hospital (CGH) is being made a state-of-the-art health facility which will soon be made a fully functional 500 bed hospital.
Talking to media, he said that the latest machinery was being procured for the hospital to cater needs of the residents. He said that it was 80-bed hospital in the past and due to hectic efforts of former CEO Dr Saima Shah, its up-gradation project was started.
Qualified and experienced doctors have been appointed purely on merit and the hospital will soon serve as a teaching hospital of the Raheel Sharif Medical and Dental College. The Cantonment Hospital has become number one health facility in Cantt hospitals of the country.
He said that it would be a gift for the residents from RCB. To a question, he said that there was no change in the service structure of doctors and paramedics of the hospital and they would be provided all possible facilities. He said that a group of doctors and paramedics who have vested interest were propagating against the project.
They are trying to create problems to foil the efforts being made for a fully function health facility, he said. He said that no one would be allowed to take law into their hands and play with the interest of the residents and the patients. RCB is undertaking number of initiatives to improve healthcare delivery system in the area.
All out efforts are being made to provide the quality emergency, diagnostics and therapeutic Health services to people of the area. In the last fiscal year, the RCB spent Rs180 million on the improvement of the structure, sewerage lines and elevators.
The RCB has prepared a plan to activate 14 departments in the hospital, including medicines, ear, nose and throat (ENT), eye, gynae, cardiology, emergency. Under the plan, the RCB would install electric incinerators in the hospital to dispose of medical waste.
Pakistan's Tyrion Lannister wants to work in movies, meet Peter Dinklage
2 booked for violating marriage laws
Sindh brace for Pakistan Cup challenge under Umar Gul


text:
import '../modules/index.js';
import './seed.js';
import './callbacks.js';


text:
Q: "row" in CSS Bootstrap is very high, can I make it of the same height as its embedded div? I have a simple website, with Bootstrap CSS.
<!DOCTYPE html>

        <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap@4.3.1/dist/css/bootstrap.min.css" integrity="sha384-ggOyR0iXCbMQv3Xipma34MD+dH/1fQ784/j6cY/iJTQUOhcWr7x9JvoRxT2MZw1T" crossorigin="anonymous">

        <meta name="viewport" content="width=device-width, initial-scale=1"/>

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                © 2022.

When it renders on a desktop monitor,
 element gets really high, respectively, pushing this property to all its children elements (cols).
If you'll open this website, you'll notice, that height of the scrollablediv element is not that high, but its container row element is really high. I want to have a wrapper row of the same size as its children cols.
How would I do that?

A: Hope it's work for you !!!
you need to add class align-items-start in main row, and also set height of scrollable div in px instead of %

/* width */
                ::-webkit-scrollbar {
                    width: 5px;
                }

                /* Scrollbar background */
                ::-webkit-scrollbar-track {
                    background: rgb(244, 244, 244);
                }

                /* Scrollbar handle */
                ::-webkit-scrollbar-thumb {
                    background: rgba(200, 200, 200, 12);
                }

                /* Scrollbar handle on hover */
                ::-webkit-scrollbar-thumb:hover {
                    background: rgb(80, 20, 160);
                }

                p, ul {
                    font-family:Consolas;
                    padding:1%;
                    font-size:12px
                }

                footer {
                    text-align:center;
                    font-size:10px;
                }

                #scrollablediv {
                    overflow-y: scroll;
                    height:300px;
                }

                /* Making images black-and-white and colourful when hovered. */
                img {
                    -webkit-filter: grayscale(100%);
                    -moz-filter: grayscale(100%);
                    filter: grayscale(100%);
                    transition: all .5s ease;
                }
                img:hover {
                    -webkit-filter: grayscale(0%);
                    -moz-filter: grayscale(0%);
                    filter: grayscale(0%);
                }

Header here!

Title1

                        TL;DR: Some text..

                        TS;WM: Some text..

Title2

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                            Some text..

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Title6

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                            Some text..

                © 2022.

redpajama_set_name: RedPajamaStackExchange


Our lifestyles today, including both our personal and professional activities, demand good health in order for us to enjoy success and fulfillment. There is no doubt that we are moving at a faster pace than people did just a generation ago and participating in a much wider range of activities.
On one hand, much of what we do is sedentary. But at the same time, we have a passion for pursuing demanding sports and other outdoor activities. Because our lives are so deeply invested in such divergent ventures, the value of maintaining our health and wellness is at a premium. Preventing the injuries and illnesses that interrupt our lives is critical.
I'm glad that more and more people as well as our institutions are recognizing the vital role of prevention in health care, but even then, we're spending some 20 percent of all our money on combating disease and that number is expected to go up to 25 percent in the coming years!
Since the first days of chiropractic, its emphasis has been on promoting good health and preventing disease. And at Ramer Chiropractic, we are dedicated to prevention and elevating the wellness of our patients. We know that when the body is in balance, it has a tremendous capacity to maintain good health and fight disease, and that the spine can affect the overall health of a person.
When your neuromusculoskeletal system is functioning properly, it enables and empowers your body's natural healing power. When there are misalignments in your spine, it puts you on a path to both pain and disease.
A healthy spine combined with a healthy lifestyle adds up to optimum wellness, and that's the holistic approach we take with our patients from all around the Santa Monica area. New patients often come to us for help with a physical problem or illness that they are dealing with and we start a custom treatment program that resolves their problem.
However, we know that implementing a prevention program is far more valuable than addressing one acute health problem after another, so we recommend a schedule of preventative chiropractic visits as well as offer lifestyle and nutritional guidance to achieve an optimum level of wellness.
At Ramer Chiropractic we are highly trained and experienced in diagnosis and we can often detect problems even before our patients feel any pain or discomfort. Using advanced methods of treatment – including gentle, low-force instrument adjusting and activator adjusting methods – we are able to correct misalignments early and prevent the major problems that would have occurred had they gone unnoticed until pain or illness set in.
This approach to prevention goes further than many appreciate. By maintaining good spinal and nervous system health, your body's immune system is able to operate at its optimum level. This prevents disease and keeps your other systems healthy as well. When you put all of these benefits together, they allow our patients to maintain their active lifestyles without interruption, greatly benefiting their personal lives, family life and even careers.
Further, because we recognize the value in taking a holistic approach to wellness, Ramer Chiropractic is also able to give sound dietary advice and help our patients establish individualized exercise routines to improve their overall strength, flexibility and physical wellbeing.
Statistics prove that we spend most of our health care dollars fighting disease and illnesses that are preventable. We urge you to consider the full scope of health and wellness in your life and make prevention a habit. It will serve you well all throughout your life.


A fatal truck accident occurred in which a sports utility vehicle entered the highway on the exit ramp, causing the driver to drive into oncoming traffic. The car struck the back of a truck and then the SUV went into the air and struck another semi-truck. The driver of the SUV was ejected from the car and was pronounced dead immediately. There is currently no information as to why the driver entered the highway going the wrong way and toxicology reports are still pending. Neither truck driver involved in the truck accident were injured. For more information on this fatal accident, click here.


It is not clear if the Commissioners ever took responsibility for Belgrave Square. When High School purchased the Square in 1897 the vendor was John Holmes. Deirdre Kelly in her book "Four Roads to Dublin" states that the Commissioners and the speculators had several disputes about paying the cost of railing the Square. Eventually railings were erected on the northern two thirds of the Square but not on the southern part, the area which was originally leased from the Earl of Meath, although Hugh Morrison was the leaseholder from the mid 1850's.


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Order Online (West End)
An interview with Table 26 owner
Horizontal Timeline
ta26admin
We spoke recently with the owner and founder
of Table 26 to find out a bit about the new cafe…
Q: How long have you been in the cafe business?
Amit: We currently own and run the West End Park Cafe on Montague Road and we've had that business since 2003.
Q: Where is the new cafe?
Amit: In fact, it's located just around the corner from the West End Park Cafe, on the corner of Rogers Street and Duncan Street, in the Gardens Riverside West End complex, which is made up of
multiple residential buildings including – Arbor, Parc, View and Rise. We'll be right next to a Night Owl convenience store on the ground floor level of Gardens Riverside.
Q: What will the new cafe be called?
Amit: We're calling the cafe Table 26.
Q: Tell us the story behind the name.
Amit: Well, when we first got into the West End Park Cafe in 2003 I was working with my father. We had always planned to run the business together and it was such a shock when we found out that he had lung cancer. Unfortunately, he passed away a few years ago, in 2009, and so the new cafe is named in memory of him – his birthday was on 26th. At the new cafe, we will have a corner table permanently reserved for my father. He was great with the customers and was always welcoming and friendly, and we'd like to keep a permanent reminder of him in the new cafe.
Q: What can we expect to see at Table 26?
Amit: Table 26 will first and foremost be a 'local' venue – we'll be able to seat 70 people both inside and undercover outside and we're planning to be open seven days a week for breakfast and lunch, and dinner Thursday to Saturday.
Q: Can you tell us what will be on the menu?
Amit: We're still refining the menu at the moment, but I can tell you that we'll have some interesting options, especially for breakfast – we'll have sandcrab omelette, breakfast sundaes and a breakfast pizza for example. And we're pretty certain we'll have some items that you just won't find anywhere else! We'll be sourcing as much of the food as possible locally and serving an eclectic mix, with some menu items inspired by my pop's favourite dishes.
Q: And the big question – when do you expect to open
Amit: The fitout is underway as we speak, and so we're hoping to be able to open Table 26 in late October. Anyone wanting to be kept up-to- date can check out our new website, www.table26.com.au, and sign up to our update there.
Q: Have you got anything special planned for the opening?
Amit: Yes we have, and we're planning on revealing what that is very soon. Again – we can keep everyone up to date on our website and via our Table 26 email.
We look forward to seeing the new cafe – sounds great!
Pull up a seat at West End's charming new eatery Table 26
West End Carindale