Chronic migraine is a debilitating headache disorder that has significant impact on quality of life. Stimulation of peripheral nerves is increasingly being used to treat chronic refractory pain including headache disorders. This systematic review examines the effectiveness and adverse effects of occipital nerve stimulation (ONS) for chronic migraine.
Databases, including the Cochrane Library, MEDLINE, EMBASE, CINAHL and clinical trial registers were searched to September 2014. Randomized controlled trials (RCTs), other controlled and uncontrolled observational studies and case series (n≥ 10) were eligible. RCTs were assessed using the Cochrane risk of bias tool. Meta-analysis was carried out using a random-effects model. Findings are presented in summary tables and forest plots.
Five RCTs (total n=402) and seven case series (total n=115) met the inclusion criteria. Pooled results from three multicenter RCTs show that ONS was associated with a mean reduction of 2.59 days (95% CI 0.91 to 4.27, I2=0%) of prolonged, moderate to severe headache per month at 3 months compared with a sham control. Results for other outcomes generally favour ONS over sham controls but quantitative analysis was hampered by incomplete publication and reporting of trial data. Lead migration and infections are common and often require revision surgery. Open-label follow-up of RCTs and case series suggest long-term effectiveness can be maintained in some patients but evidence is limited.
While the effectiveness of ONS compared to sham control has been shown in multiple RCTs, the average effect size is modest and may be exaggerated by bias as achieving effective blinding remains a methodological challenge. Further measures to reduce the risk of adverse events and revision surgery are needed.
this systematic review is an update and expanded work of part of a broader review registered with PROSPERO. Registration No. CRD42012002633.
Data Availability: All relevant data are within the paper. All data used in the review was extracted from published articles that are listed in the references and, therefore, freely available. The methods section sets out how the reader can replicate the searches undertaken should they wish to repeat and update the analysis.
Funding: The original systematic review was commissioned by the UK National institute for Health and Care Excellence (NICE) to support the development of Interventional Procedures Guidance. This manuscript presents an update and expansion of part of the original systematic review as an independent academic output (not commissioned by NICE). We acknowledge NICE's input during our preparation of the original review and notify NICE of our submission of this manuscript. The authors have full control over the contents of the manuscript and the decision to publish it. The authors also received funding as salary or project grants not directly related to this review from the UK National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC), NIHR Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC), NIHR Health Technology Assessment Programme and UK Engineering and Physical Sciences Research Council Multidisciplinary Assessment of Technology Centre for Healthcare (EPSRC MATCH). The views expressed here are those of the authors and not necessarily those of the NICE, NIHR, SRMRC, the CLAHRC-BBC and the EPSRC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Migraine is a debilitating primary headache disorder that has been ranked as the eighth leading cause in terms of years lived with disability globally . While most people with migraine have 'episodic migraine' (defined as having <15 days of headache each month), each year about 2.5% of the sufferers have their headache 'transformed' into chronic migraine , which has even greater impact on the level of disability, social functioning and use of healthcare resources compared to episodic migraine .
Chronic migraine is defined as "headache occurring on 15 or more days per month for more than 3 months, which has the features of migraine headache on at least 8 days per month" in the latest International Classification of Headache Disorders, 3rd edition beta version (ICHD-III beta) . An alternative term 'transformed migraine' which emphasises the nature of headache that is developed from episodic migraine with increasing headache frequency but decreasing severity of migraine features has also been used in the literature . The diagnostic criteria and definitions for chronic migraine have been evolving over time with different requirements regarding the number and feature of headache days and varied exclusion criteria in relation to medication overuse headache . Medication overuse headache refers to chronic headache that is developed as a consequence of regular overuse of acute or symptomatic headache medication such as paracetamol, anti-inflammatory drugs, ergotamine, triptans and opioids . It occurs commonly among migraine sufferers and is a risk factor contributing to the development from episodic to chronic migraine. Medication withdrawal may revert chronic migraine back to episodic migraine . In ICHD-II, medication overuse needs to be absent for a diagnosis of chronic migraine to be made , but a concomitant diagnosis of chronic migraine and medication overuse headache is allowed in ICHD-III beta  and is indeed used in common practice. As controversies over the optimal definition of chronic migraine are yet to be resolved, we use the term 'chronic migraine' in the rest of this paper for consistency, but use it to include chronic or transformed migraine in its various manifestations.
Treatments for chronic migraine aim to reduce the frequency of migraine attacks and associated disability . Many drugs for the prophylaxis of episodic migraine have been used (often off-label) for chronic migraine . Only topiramate and botulinum toxin type A are supported by evidence from large randomised trials of patients with chronic migraine [3, 6, 8]. Despite the advances in the management of headache disorders, many patients with chronic migraine remain refractory to current treatments—a recent study in a tertiary headache centre in Spain showed that 15 of 20 patients with chronic migraine fulfilled the criteria for refractory chronic migraine . Novel treatments backed by good evidence are therefore in much need.
Electrical stimulation of peripheral nerves has been used to treat various painful conditions including headache disorders. Occipital nerve stimulation (ONS) is one of the invasive techniques that is gaining popularity for treating chronic migraine. Continuous stimulation of occipital nerves is achieved by the delivery of electrical impulses through cylindrical or paddle electrodes (leads) implanted subcutaneously. The procedure is usually done in two stages, involving an initial trial of stimulation of a few days to a couple weeks which, if successful, is followed by a permanent implant .
ONS may have a plausible biological basis  and has been shown to affect blood flow in brain structures thought to be important in the patho-physiology of migraine . Early case series in patients with chronic migraine were summarized in a systematic review and showed promising results . These were followed by randomized controlled trials (RCTs) reporting mixed findings [16–19]. As these RCTs were not included the previous review and further case series have been published, this systematic review aims to critically appraise this growing body of evidence and provide an overview to inform clinical and policy decisions.
This systematic review was initially conducted as part of a broad review of evidence on the use of invasive peripheral nerve stimulation for treating chronic refractory pain in support of the development of Interventional Procedures Guidance by the UK National Institute for Health and Care Excellence (NICE) . The protocol for the broad review was registered with PROSPERO (Registration No. CRD42012002633). This paper reports an updated review focusing on ONS for chronic migraine.
The ZETOC (Mimas) database, and Conference Proceedings Citation Index (ISI Web of Knowledge).
Current Controlled Trials metaRegister, NIHR Clinical Research Network Portfolio, WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov for ongoing studies.
Searches were conducted using index terms and key words relating to peripheral nerve stimulation, chronic pain, headache disorders, migraine and occipital nerve stimulation. No language restriction was applied. A sample search strategy can be found in Appendix A in S1 File. Relevant websites including the Medicines and Healthcare Products Regulatory Agency (MHRA) and Food and Drug Administration (FDA) were searched and reference lists of included studies were scanned. Studies highlighted during NICE's public consultation of relevant Interventional Procedures Guidance were also examined.
Recruited patients with chronic migraine, defined according to the International Classification of Headache Disorders, 2nd edition (ICHD-II) or its subsequent modification . Studies that adopted diagnostic criteria for transformed migraine suggested by Silberstein and colleagues prior to ICHD-II were also included .
Investigated the effect of stimulation of occipital nerves or areas innervated by them.
Was an RCT or non-randomized controlled study, or an uncontrolled case series with at least 10 patients.
Reported results for chronic migraine separately where various types of headache disorders were included.
We included studies in migraine patients where all participants were refractory to multiple prophylactic treatments but the proportion of patients with chronic migraine (as oppose to episodic migraine) was not clearly reported. Non-English studies or those published only as conference abstracts were excluded, with the exception of RCTs which were included irrespective of publication status. Studies that focused on the combined use of ONS with other forms of nerve stimulation were excluded.
Details on study design, trial participants, techniques of nerve stimulation, funding sources, effectiveness findings, and adverse events were extracted. For effectiveness, outcome measures recommended by the International Headache Society's guidelines were used .
The Cochrane Collaboration's Risk of Bias Tool was used to appraise RCTs . Information regarding the effectiveness of blinding and patients' expectation of treatment was also noted. Data extraction and assessment of risk of bias was carried out by one reviewer and quality assured by another. Any discrepancies in study selection, extraction and assessment were resolved through discussions. Case series were used to provide supplementary evidence on stimulation trials, adverse events and longer-term effectiveness. No separate risk of bias assessment was carried out for them. The overall quality of evidence for selected key outcomes was rated according to the GRADE framework .
Characteristics of included studies and the results of risk of bias assessment were tabulated. Assessment of effectiveness focused on evidence from RCTs. Where suitable data was available (see Appendix B in S1 File), meta-analyses of risk ratios (for binary outcomes) and mean differences (for continuous outcomes) were carried out in Review Manager 5.2 using a random-effects model. Statistical heterogeneity between studies was evaluated by visual inspection of forest plots and the I2 statistic. No statistical assessment of potential publication bias was carried out due to the relatively small number of included RCTs. Authors and sponsors of partially reported RCTs were contacted for unpublished data, although none were supplied.
As the majority of the adverse events were related to surgical procedures and implanted devices (rather than to the stimulation per se), data concerning adverse events from the active stimulation and sham control arms of the RCTs were combined (unless otherwise specified) and presented alongside additional data from case series. The proportion of patients who experienced specific adverse events were displayed in forest plots with 95% confidence interval calculated using the exact method . Meta-analysis was not carried out for adverse events given the varied methods of data collection, event classification and length of follow-up between studies.
Five RCTs (reported in nine publications [17–19, 26–31]) and seven case series [32–38] met the inclusion criteria (Fig. 1). In addition, one unpublished  and one ongoing RCT  was identified. The unpublished RCT (the UK PRISM study) was terminated early (with only eight patients enrolled) based on interim data from another RCT  (PRISM study, included in this review) sponsored by the same manufacturer. A list of excluded studies with reasons for exclusion can be found in Appendix C in S1 File.
Fig 1. Flow diagram for study selection.
Of the five included RCTs (Table 1), three were industry-sponsored, multicentre, parallel-group trials (PRISM study—published only as a conference abstract , ONSTIM study , and Silberstein et al. 2012 ) and two were single-centre crossover trials (Serra and Marchioretto 2012 , Slotty et al. 2014 ). The sample size ranged from 67 to 157 in the multicentre RCTs and was eight and 30 for each of the two single centre RCTs respectively.
Table 1. Characteristics of included randomized controlled trials.
All three multicentre RCTs included an initial blinded phase of 12 weeks, during which patients received either active or sham stimulation.[16, 17, 19] The blinded phase was followed by an open label phase of 1–3 years during which all participants received active stimulation (results not yet published). The ONSTIM study also included a third arm of medication management group , which could be regarded as an open-label control group given that the patients were already refractory to medication management when entering the study. The single-centre crossover RCT by Serra and Marchioretto was designed as an open-label study with ONS switched on in one group and off in another group for a month. The two groups were then crossed over for another month . However, patients in the 'off' group could switch their stimulation on if they had ≥30% worsening in the number or severity of migraine attacks, and they did so after an average of just under five days. All patients had their ONS switched on after two months and continued to be followed up for ten further months. The other single-centre crossover RCT  compared suprathreshold stimulation (stimulation that was felt to be effective in reducing pain), subthreshold stimulation (stimulation with amplitude just below perception) and no stimulation. Patients received each of the stimulation options for one week in random order with no washout period between them. Patients and physicians were not aware of treatment allocation but suprathreshold stimulation cannot be effectively blinded.  The study included patients who had already had good response (>30% pain relief) to ONS for at least three months. It was set out to assess the significance of paresthesia and possible placebo effects of ONS rather than effectiveness and safety.
Stimulation trials were carried out in three RCTs [16, 18, 19]. Occipital nerve blocks and intraoperative testing were performed in the fourth . Successful trial stimulation or nerve block was a criterion for permanent implantation and study enrolment in all studies except the PRISM study. Trial stimulation was unsuccessful in between 3% to 11% of the patients screened in the trials [17–19]. Patients in all studies were refractory to at least two prophylactic medications. Those who experienced medication overuse were excluded in the ONSTIM study . Baseline migraine days per month were similar across the studies (between 20 to 23).
The seven case series included a total of 115 patients (Appendix D in S1 File) [32–36]. Duration of follow-up ranged from 1 to 79 months for individuals. Two of the case series included patients enrolled in RCTs described above [33, 34]. Stimulation parameters for all included studies are listed in Appendix E in S1 File.
The results of the risk of bias assessment for included RCTs are summarised in Table 2. The assessment for the PRISM study was hampered by the lack of full-text publication . Of the other two multicentre RCTs, the risk of bias was judged to be high for the ONSTIM study for incomplete outcome data (15% dropout excluded from analysis in the ONS group compared to 6% in the sham group and 0% in the medication management group) and selective outcome reporting (data were not reported for several statistically non-significant results) . The Silberstein et al. 2012 study was judged to be at low or unclear risk of bias , with the main uncertainty related to the effectiveness of blinding. Given that achieving paresthesia is considered a prerequisite for treatment effectiveness and a requirement before permanent implementation and trial enrolment in most studies, it is perceivable that a genuine sham control would be very difficult to attain. However, the success of blinding was not measured in any of the trials. The single-centre crossover RCT by Serra and Marchioretto was considered to be subject to high risk of bias in several domains due to lack of blinding, high level of contamination between groups and other issues related to crossover design . Finally the other single-centre crossover trial by Slotty and colleagues  was judged to be of low risk for potential biases related to blinding for the comparison between subthreshold stimulation and no stimulation but of high risk of bias for comparisons against suprathreshold stimulation. The selection of patients (who had already had good response to ONS), short treatment duration and lack of washout periods rendered it to be judged as unsuitable for the purpose of assessing the effectiveness and safety of ONS for treating chronic migraine. Consequently, its findings are used only to inform discussion concerning placebo effects.
Table 2. Risk of bias assessment of included randomized controlled trials.
Outcomes from RCTs were reported in different formats and were of various completeness (Appendix B in S1 File). Narrative and tabulated summaries are provided (see text below and Table 3). Meta-analyses were performed for two outcomes (Figs. 2 and 3).
Table 3. Additional short-term effectiveness results from randomized controlled trials.
Fig 2. Results of meta-analysis of RCT data for ONS compared with sham stimulation: days with prolonged (≥4 hours) moderate or severe headache.
Fig 3. Results of meta-analysis of RCT data for ONS compared with sham stimulation: response rate.
Days with prolonged (≥4 hours) moderate or severe headache.
This outcome was reported in three multi-centre RCTs [16, 17, 19]. Patients in the trials had between 19–22 days with prolonged, moderate or severe headache per month at baseline. Those receiving sham stimulation had a reduction of 2–4 days per month at three months compared to baseline. Meta-analysis shows that ONS was associated with an additional mean reduction of 2.59 days per month (95% CI 0.91 to 4.27, I2 = 0%) compared with sham control. The results were consistent across studies (Fig. 2).
Lipton et al. stated in their conference abstract that in a pre-specified subgroup analysis for this outcome, a trend in favour of patients without medication overuse (ONS vs. sham, reduction of 5.9 vs. 2.6 migraine days/month) was observed compared with patients with medication overuse (ONS vs. sham, reduction of 5.0 vs. 4.8 migraine days/month) . However, results for a formal test of interaction for the difference between subgroups were not presented.
The two studies that reported responder rates adopted a threshold of 50% improvement but defined the outcome differently (see Appendix B in S1 File) [17, 19]. The pooled result did not reach statistical significance and suggested a high level of heterogeneity between the studies (ONS vs. sham control at 3 months, relative risk 2.07, 95% CI 0.50 to 8.55, I2 = 51%; Fig. 3). Silberstein et al additionally conducted a continuous proportion responder analysis, which showed that the difference between groups became significant when the threshold of pain relief was reduced to 30% or lower (% responder 35% vs. 17% for ONS vs. sham control, p = 0.02 using 30% pain relief as the threshold) .
Results for the reduction in headache (migraine) days, headache intensity, Migraine Disability Assessment (MIDAS) scores and utilization of acute medications are summarized in Table 3. Additional data on quality of life, satisfaction of treatment and measures of physical and mental functions are described in Appendix F in S1 File. While the results are significantly better in the ONS group compared to the control group for the majority of outcomes, the reporting of results was incomplete and in some instances related to the lack of statistical significance of the findings . The observed sizes of effects also varied widely for some of the outcomes. For example the difference in mean reduction in headache days between ONS and sham control was approximately 5 days per month in the ONSTIM study , but a much larger difference was reported in the open-label trial (median headache day per week 2.1 vs. 6.3 for ONS vs. control respectively) .
One the three multicentre RCTs reported findings from long-term follow-up beyond the initial blinded phase . Additional long-term data (≥ one year) were available from the single centre RCT by Serra & Marchioretto  and six of the case series [32–34, 36–38]. As patients in the control groups of the RCTs also received ONS after the initial blinded phase, no long-term comparative data is available. The long-term effectiveness results are summarised in Appendix G in S1 File. Overall, more than 80% of patients continued to use ONS at 1 year across various studies, although the continuation rate seems to drop to around 50–60% in case series with longer follow-up of varied duration. The short-term effectiveness of ONS appears to be maintained in patients who stayed on the treatment.
Results from both RCTs and case series are presented here. Data from intervention and sham control arms are combined within each RCT unless otherwise specified.
Serious adverse events occurred in between 1% (2/157)  to 6% (3/56)  of patients in multicentre RCTs at 3 months. Forty of the 209 adverse events (19%) recorded at 1 year in the trial by Silberstein et al. were classified as serious adverse events, of which 58% (23/40) were not considered as treatment-related and 35% (14/40) were related to lack of efficacy or return of symptoms. Up to 20% (2/10)  of patients experienced serious adverse events in smaller case series of varied duration of follow-up. Six out of nine patients (67%) in the terminated UK PRISM trial experienced serious adverse events . The majority of treatment-related serious adverse events reported in these studies (except those related to lack of efficacy) were associated with infection, lead migration, post-operative symptoms and psychiatric complications (causality unclear). Further details are provided in Appendix F in S1 File.
Lead migration/dislodgement was common (Fig. 4). As expected higher rates were seen in case series with longer follow-up. One case series  suggests that using paddle-type leads rather than cylindrical leads can reduce the occurrence of lead migration. Measures were instigated during the ONSTIM trial to reduce lead migration , including the use of circular coils when placing the lead extension to create strain-relief loops, and choosing the abdomen in preference of the buttock as the implant location for the pulse generator. However, the impact of these measures was not formally assessed.
Fig 4. Adverse effects associated with implantation and/or use of occipital nerve stimulation: lead migrations.
Reported infection rates range from 4% to 30% with varied length of follow-up (Fig. 5). The exact infection rates were difficult to ascertain in some studies due to the different ways in which infections were described and classified (see footnote for Fig. 5).
Fig 5. Adverse effects associated with implantation and/or use of occipital nerve stimulation: infections.
Saper 2011—the number shown was infections at site for lead/extension tract. There were additionally four 'complications at incision sites'. Silberstein et al. 2012—there were additionally 'wound site complications' (four at 3 months; five at 1 year). Lipton et al. described infections being the most frequent device-related adverse events but did not report the numbers in their published abstract. The three cases described by Kiss and colleagues were 'inflammation at surgical sites' (3/10, 30%) that were treated with intravenous and oral antibiotics. They stated that 'neither blood nor wound cultures identified bacterial growth'.
Seventy-one percent (111/157) of patients experienced one or more adverse events over one year in the RCT by Silberstein and colleagues. Of a total of 209 adverse events recorded, 56 (27%) were hardware-related (e.g. battery failure, device malfunction or disconnection etc.), 82 (39%) were 'biological' events (e.g. infection, skin erosion, pain, numbness or swelling, allergic reaction, hematoma etc.), 45 (22%) were stimulation-related (e.g. unintended change in headache severity or stimulation, lack of efficacy, muscle spasms/cramping, nausea/vomiting etc.) and the remaining 26 (12%) were not considered treatment-related. Eighteen (9%) of the adverse events required hospitalization and 85 (41%) resulted in an additional surgery. Similar types of adverse events were reported in other RCTs and case series.
Long-term complications or potential nerve damage.
Two trials reported that there was no evidence of adverse device effects leading to long-term complications or potential nerve damage (at three months  and one year  respectively). A case of subcutaneous tissue change at implant site and another case of reduction or loss of musculoskeletal control were reported in Silberstein et al .
This systematic review examines current evidence for using ONS for chronic migraine. Comprehensive literature search was performed, which identified five RCTs and seven case series that met the inclusion criteria. Findings from the RCTs suggest that at 3-month follow-up ONS reduces the number of days with prolonged moderate/severe headache by approximately 2.5 days per month compared to sham stimulation (which in itself brings about a reduction of 2–4 days per month compared to baseline). Responder analysis at 3 months using a threshold of 50% reduction in headache days and/or pain intensity favoured ONS but did not reach statistical significance in either individual trials or pooled results. ONS was shown to be more effective than sham control for other outcome measures, but results were often reported incompletely and in different formats, hindering the analysis of evidence across studies. Overall the level of evidence is considered moderate to low according to the GRADE framework  (see Appendix H in S1 File for Summary of Findings Table).
The short-term results indicate that the effect of ONS is, on average, modest among patients with chronic refractory migraine although the observed effects may still be clinically important given the refractory nature of the condition. Some individual patients experienced significant improvement that lasted for years in case series but the data is limited. On the other hand, adverse events associated with the devices and surgical procedures including lead migration and infections remain relatively common. These findings suggest that while ONS may be a valuable option when patients have exhausted other non-invasive treatments, further improvement in both efficacy and safety may be needed before it can firmly be established within the treatment pathway. Further large reductions in pain are desired by patients and associated with improvements in other outcomes including improved quality of life [40, 41]. To date the proportion of patients who achieved a response (albeit short of "no worse than mild pain") in the larger trials has not been very high even at three months.
The definition of chronic migraine has evolved over time and this is reflected in the varied inclusion criteria for the RCTs included in our review. Whether the overall effectiveness of ONS can be improved by refining diagnostic and patient selection criteria remains to be seen. Limited evidence suggested that response to occipital nerve block may not be a useful predictor for response to ONS treatment. While a subgroup analysis from the PRISM trial  and a small case series  suggested that ONS is more effective in patients without medication overuse, the observed effectiveness was similar between the ONSTIM trial (which excluded patients with medication overuse) and the other trials which allowed patients with medication overuse, including the crossover trial by Serra and Marchioretto in which 85% of the patients with chronic migraine also met the criteria for medication overuse .
A previous systematic review published in 2008 included only case series . The identification in the current review of five completed and an ongoing RCT  and registry  is encouraging. In particular, three of the completed RCTs were industry-sponsored multicentre trials, which incorporated a sham control group with some attempts of blinding. The successful completion of these trials exemplifies that assessment of interventional procedures need not rely upon case series only. Despite this, the incomplete publication and reporting of results from ONS trials is an ongoing concern, the existence of which goes against the current movement of making all trial results available .
This systematic review has some limitations. Firstly, while the comprehensive search also attempted to retrieve unpublished data, none was made available and therefore the review findings are based upon published data only. Given the consistency in findings in the key outcome (reduction in prolonged, moderate/severe headache) reported in the three larger RCTs, the potential publication and reporting bias is likely to influence the estimation of effect sizes for other incompletely reported outcomes rather than change the direction of effect. Secondly, despite the existence of published guidelines for chronic migraine trials , the synthesis of evidence was hindered by the different ways in which outcomes were selected and reported in individual studies. Moreover, long-term data is limited. Apart from the one year results of the RCT by Silberstein and colleagues, evidence is available from predominantly single-centre case series, which could only provide imprecise estimations with uncertain generalizability.
An area of uncertainty for the RCT findings relates to how effective the blinding was in each of the trials, and how much this influenced the observed results. Patients with refractory migraine who are willing to try an invasive intervention are likely to have high expectations of the efficacy of the intervention , and there is some evidence that differential expectation due to presence or absence of blinding could impact upon observed clinical effects . Apart from attempts to directly measure the success of blinding, future trials also need to pay attention to potential unblinding through patients' sharing of experiences in social media as highlighted by Goadsby .
Slotty and colleagues compared suprathreshold stimulation, subthreshold stimulation (stimulation just below perception) and no stimulation in a small double-blind, crossover trial of ONS responders . Although the issue of blinding remains for the suprathreshod stimulation, the observed differences in the reduction in pain intensity between each of the groups (see Appendix F in S1 File) suggests that while paresthesia contributes to the analgesia, the effect of ONS seems to go beyond merely a placebo effect induced by paresthesia.
In conclusion, currently evidence on the effectiveness and safety of ONS is still limited in quantity and remains inconclusive given the challenges in trial methodology and patient selection. Further development of ONS and other similar techniques and validation of their efficacy require both continuous accumulation of clinical evidence (for which multicentre, prospective registries may have an important role to play) and further studies on the pathophysiology of migraine and its responses to various forms of neuromodulation. In the interim, the use of ONS may be best guided by individual patient preference, affordability, treatment response and contribution to the accumulation of the evidence base through RCTs or prospective registries .
We thank Melita Shirley and Peter Chilton for their administrative support. We are grateful to Koh Jun Ong and Hannah Patrick for their help during the preparation of our technical report for NICE, and to the trial investigators who answered our queries.
Wrote the paper: Y-FC GU DH-C JD DM SB CC RL GB. Main reviewer and was involved in all processes of the preparation of the review: Y-FC. Conducted study selection, data extraction and assessment of risk of bias for RCTs and case series: GB. Assessed the risk of bias for RCTs, checked data from case series: GU. Involved in study selection and advised on review methodology: JD DM. Provided clinical advice and feedback on report drafts: DH-C. Carried out searches of electronic databases and the internet: SB. Provided senior advice and support throughout the review process: CC RL. Contributed drafts of the manuscript and approved the submitted final version: Y-FC GU DH-C JD DM SB CC RL GB.
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Colon Hydrotherapy is an alternative therapy used to cleanse, maintain and restore optimum colon health. As the body is empowered to properly eliminate toxins, this non-habit forming treatment the first step towards optimum health. Colon Hydrotherapy (colonic) at Bradley Chiropractic Center, LLC is a healing experience facilitated by our Certified Colon Hydrotherapists.
What can I expect to experience during my colon hydrotherapy treatment?
The client inserts a disposable speculum which is connected to a long disposable plastic hose connected to the colon hydrotherapy unit.
Warm, filtered water is slowly released into the colon. The water causes the muscles of the colon to contract and "pushes" feces out through the hose to be disposed in a closed waste system. The session will last approximately 45 minutes.
After a colonic it is helpful to take probiotic supplements which contain friendly colon bacteria.
A simple colon cleansing program is one of the most important, positive steps you can take to establish and maintain an optimal level of health and energy. Many people report feeling a sensation of lightness and well being after as many as just one colonic. Other benefits of Colon Hydrotherapy include hydration of the body, improved levels of energy, heightened mental clarity, increased absorption of vitamins & minerals from food and supplements, improved complexion and weight loss.
A single colon hydrotherapy session can produce the same results as having numerous regular bowel movements. Eliminations during following sessions can be even more significant as older, putrefied feces are eliminated from the colon walls. To achieve optimal cleansing benefits it is recommended that you have a series of three sessions. Your therapist will make recommendations based on the results of your treatment.
No, colon hydrotherapy retrains the muscle of the bowel to regain its strength. We do not use chemicals-only clean purified water!
Very little preparation is necessary. We do suggest however, that you refrain from eating a 2 hours prior to your appointment. Drinking plenty of water is always a great idea.
Absolutely not. Your body remains covered throughout the session. The waste tube is connected directly to the pluming for a closed session which exposes nothing (smell or sound) to the client or therapist.
There will be no pain at all. You may experience a feeling of fullness in the abdominal and possibly slight cramping created by the water. Gentle water flowing through your colon may give you an unusual sensation. The inserting of the small speculum takes only a few seconds and is not painful. After a minute or so you will not even feel that it is there. Most clients find the treatment to be relaxing.
Yes it is. We always use a brand new disposable speculum and hose, both of which are disposed after each use.
Existing and new client coming for maintenance treatments after 6 sessions on regular bases (every 6-10 weeks) $55.


NEW ORLEANS (AP) - Crews lost control of a natural gas well being drilled off the Louisiana coast Thursday, but officials said no injuries or pollution have been reported and efforts are underway to stop the flow of gas.
NEW ORLEANS (AP) � Crews lost control of a natural gas well being drilled off the Louisiana coast Thursday, but officials said no injuries or pollution have been reported and efforts are underway to stop the flow of gas.
EnVen Chief Operating Officer Jonathan Garrett said gas, water and sand are flowing, but no pollution has reached the Gulf of Mexico. He says gas is being vented off the rig while crews work to kill the well.
Coast Guard Chief Petty Officer Bobby Nash said no sheen was sighted when a Coast Guard crew flew over the site Thursday.
A natural gas blowout off Louisiana's coast in July 2013 ended one day later. Authorities believed the well had been clogged by sand and sediment.
The rig, operated by Hercules Offshore Inc., blew out and later caught fire. Part of the rig collapsed before the well apparently plugged itself.


text:
describe("user controller", () => {
  it(`visits /user/1`, () => {
    cy.visit(`/user/1`);
  });

  it("is not authenticated and visits /user/1/edit", () => {
    cy.visit("/user/1/edit");
    // it should redirect to participedia.auth0.com/login
    cy.url().should("include", "https://participedia.auth0.com/login");
  });

  // this needs to be in it's own test becuase you can only visit one domain per test
  it("goes to /", () => {
    cy.visit("/");
  });

  it(`authenticates`, () => {
    cy.visit("/login");
    cy.login();
  });

  it("visits their own profile page and edit page", () => {
    cy.get(".js-profile-dropdown-button-trigger").click();
    cy.get(".js-profile-dropdown-button-items")
      .contains("Profile")
      .click();

    // click edit button and goto /user/id/edit
    cy.get(".user-view-edit-profile-button").click();

    // /user/id/edit has a submit button
    cy.get("button[type='submit']").should("be.visible");

    // it edits the name field
    const newName = "Jane Smith";
    cy.get('input[name="name"]')
      .clear()
      .type(newName);

    // it submits the form
    cy.get("button[type='submit']").click();

    // the name field is updated with new name
    cy.get(".user-view-name")
      .should("exist")
      .and("contain", newName);
  });

  it("visits someone else's profile page", () => {
    // if it's not their profile page, they should be
    // redirected to the view and not allowed to edit
    cy.visit("/user/1/edit");
    cy.url().should("include", "/user/1");
  });
});

redpajama_set_name: RedPajamaGithub


The inspiring image is other parts of hello my name is dog tags for pets hello my name is id4pet has dimension 640 x 480 pixel. You can download and obtain the hello my name is dog tags for pets hello my name is id4pet images by click the download button below to get multiple high resolutionversions. Here is fundamental information about All Tags. We have the resource more image about All Tags. Check it out for yourself! You can get hello my name is dog tags for pets hello my name is id4pet and see the Hello My Name Is Dog Tags For Pets in here.


Job after 12th with Physics, Maths, Biology and Chemistry?
What kind of career i can make after 12th as i am good in Chemistry and Biology subjects?
Eligibility conditions for doing B.Sc. in Agricultual field?
Am i eligible for BCA course with no Maths/Biology in class 12th?
Can i do B.Tech in either Civil or Chemical Engineering after completing Diploma in Ceramic Technology?
Career options after 12th for candidates suffering from Colour Blindness?
Syllabus of Written Examination for Merchant Navy jobs?
Which site should i choose after passing 10th with 55% marks?
Please guide me about becoming Doctor? Should i take PCMB or PCBC after 10th?
Jobs for 12th passed students with Biology, Chemistry and Physics subjects?
Re: Job after 12th with Physics, Maths, Biology and Chemistry?
There are many governments jobs are available after completing 12th.
** Bank clerck jobs( SBI Bank).
Can i join CBI after 12th science? Provide details about procedure and how to apply for it?
Can i join CBI after 12th science? What are the requirements and procedure to follow up?
Will i be eligible for government jobs after doing Graduation in B.Sc. from CMJ university?
What is the scope of Diploma (ECE) course in Navy for girl candidates?


text:
Ein Klick (auch Klicklaut, Schnalz(laut), Injektiv) ist ein velar-ingressiver Verschlusslaut, der durch zwei Verschlussbildungen im Vokaltrakt (Ansatzrohr) gebildet wird.
Die Geräuschbildung dieser Laute entsteht durch das Öffnen des primären Verschlusses der entstandenen oralen Luftkammer, in welche die umgebende Luft infolgedessen schnell hineinströmt, um den Unterdruck auszugleichen.

Die Klicks werden auf verschiedene Weise durch Schnalzen mit der Zunge gebildet. Um die Klicks zu erzeugen, muss die Zunge eine saugende Bewegung ausführen. Die Stellung der Zunge und die Art des Atemholens bringt ganz verschiedene Klicks hervor.

Bei der Verwendung in Wörtern ist es für Nichtmuttersprachler recht schwierig, sie mit umgebenden Konsonanten und Vokalen zu verbinden.

Vorkommen

Schnalzen kommt in vielen Sprachen vor, beispielsweise als Ausdruck des Missfallens oder zur Erregung von Aufmerksamkeit. Die einzigen lebenden Sprachen jedoch, in denen Klicklaute als reguläre Sprachlaute (bzw. Phoneme) verwendet werden, sind die afrikanischen Khoisan-Sprachen (beispielsweise Khoekhoegowab, eine der Nationalsprachen Namibias) sowie benachbarte Sprachen der Bantu-Sprachgruppe (z. B. Zulu, Xhosa, Süd-Sotho und Yeyi) und die kuschitische Sprache Dahalo, die solche Laute höchstwahrscheinlich von den Khoisan übernommen haben. In allen drei Sprachgruppen zusammen sind es etwa 80 Sprachen. Einige der Khoisan-Sprachen, wie etwa das , haben über 80 verschiedene Klicklaute in ihrem Phoneminventar.

Die einzige nichtafrikanische Sprache, von der man weiß, dass Klicks regulär benutzt wurden, ist Demiin, eine alternative Sprachkodierung, die von Sprechern des Lardil, einer australischen Sprache, in einer Art Sprachspiel verwendet wurde. Die Sprache ist mittlerweile allerdings ausgestorben.

In der Musik wird Schnalzen als Element der Vocal Percussion verwendet. Ein prominentes Beispiel ist der 2004 erschienene Nummer-eins-Hit Drop It Like It's Hot von Snoop Dogg feat. Pharrell.

Schreibung

Die Orthografien verschiedener Sprachen des südlichen Afrikas, beispielsweise Khoekhoegowab, verwenden spezielle Klicklautbuchstaben zur Schreibung der Klicks, wie sie auch im Internationalen Phonetischen Alphabet verwendet werden. Diese Buchstaben kommen dann auch in geografischen Namen, Personennamen und Namen mythologischer Gestalten vor (wie beispielsweise aus der Mythologie der Juǀ'hoansi die Namensgeberin für den Zwergplanetenkandidaten (229762) Gǃkúnǁ'hòmdímà). Andere Sprachen (beispielsweise isiXhosa) verwenden Buchstaben des lateinischen Grundalphabets für Klicks.

IPA
Die International Phonetic Association (IPA) differenziert in ihren Publikationen zwischen fünf Clicks und ordnet diesen entsprechende Zeichen zu (Internationales Phonetisches Alphabet):
 Bilabial : Ähnlich einem Luftkuss mit ungerundeten Lippen.
 Dental : Die Zungenspitze wird an die Vorderzähne gebracht. Diesen Laut verwendet man im Deutschen manchmal, um Tadel oder Enttäuschung auszudrücken.
 (Post)alveolar : Die Zungenspitze wird möglichst weit nach oben an die Decke der Mundhöhle gebracht.
 Palatoalveolar : Die Zungenspitze wird an die Vorderseite des harten Gaumens angepresst und dann so rasch wie möglich zurückgezogen. Das klingt etwa wie ein knallender Korken.
 Alveolar lateral : Die Zunge wird seitwärts an die Backenzähne gebracht.

Übersicht der im IPA darstellbaren Klicklaute im Zusammenhang mit anderen nichtpulmonaren Konsonanten:

Siehe auch
 Liste der IPA-Zeichen#Sonstige

Literatur
 Otto von Essen: Allgemeine und angewandte Phonetik. 5., neubearbeitete und erweiterte Auflage. Akademie-Verlag, Berlin 1979, S. 27f., 115 (über Schnalzlaute/Klicklaute).

Weblinks

Einzelnachweise

Phonetik

redpajama_set_name: RedPajamaWikipedia


This Crystal Spike Stainless Steel Pendant is beautifully detailed. It is meticulously handcrafted using high quality, durable stainless steel and stunning metallic Swarovski crystals. This Alyce n Maille Original design is sure to attract many compliments. It is a unique necklace that is gorgeous and fashionable. It is the perfect accessory to add a unique sparkle to your look.
This Crystal Spike Stainless Steel Pendant is absolutely stunning! It is an Alyce n Maille Original design that is sure to get you noticed. It is beautifully detailed with silver metallic Swarovski crystals and stainless steel beads. Each saw cut ring is meticulously handwoven using high quality stainless steel and finished with a gorgeous Swarovski crystal spike. Stainless steel necklaces are the perfect accessory that do not require a ton of maintenance. Unlike sterling silver, stainless steel will never tarnish. Not only is this pendant necklace unique and fashionable, it has a nice weight to it and is extremely durable. This Crystal Spike Stainless Steel Pendant is a unique must have necklace to add to your wardrobe.


text:
Tracking Progress - One Reform at a Time
ReformVerdict
Grants for young Georgian farmers 2017-09-19
In the framework of the program, it will be allocated from 15 thousand to 100 thousand small and medium-sized grants for young entrepreneurs.
As Deputy Agriculture Minister Nodar Kereselidze states at Business Course, at this stage the Georgian side agrees to funding criteria with donor organization. According to Kereselidze, the process will last until the end of the month, after which the project will be implemented.
"This is a grant program for young farmers and today we are negotiating with other donors about other criterias, for example what fields will be covered, other than agriculture. We will consult with the donor and at the end of September and we will have the conditions and start implementation of the project by then, "- said Nodar Kereselidze
Reform: Agricultural Development Source View All News
ReforMeter
This application is made possible by the support of the American People through the United States Agency for International Development (USAID). The contents of this application are the responsibility of International School of Economics at Tbilisi State University (ISET) Policy Institute and do not necessarily reflect the views of USAID or the United States Government.

redpajama_set_name: RedPajamaCommonCrawl


Samsung Galaxy A6 and A6+ are one of top all-screen smartphones available at budget. Samsung from year to year produces luxury flagships. As for middle and lower price smartphones, they usually cost exorbitant money. It's easy to explain. On a wave of success of top models the gullible and not very knowledgeable user offer ostensibly "a little simplified" variant of the flagship. Quite a bit, if you believe advertising, that's only in fact the buyer gets too expensive for the very modest characteristics of the phone. Smartphone Galaxy A6, the news about which passed on editorials sites last week, is a wonderful illustration. If you believe the representatives of the company, here you and Infinity Display, and a lot of flagship functions, and elite design, and whatnot, only much cheaper than in Galaxy S9 and S9 +. In principle, fans of the brand can believe all this, especially if the horror want to buy a cool smartphone for funny money. That's just money is not funny-the price of Galaxy A6 will be in the area of 300 euros, and cool this smartphone is not exactly name. We offer six facts about the Galaxy A6, which you should pay attention to if you suddenly thought about buying a Korean device with a loud name and (relatively) low price.
The official sources had to mention the flagship design, in particular, the placement of the camera module and the fingerprint scanner is exactly the same as in the Galaxy S9. In reality, the exterior of the smartphone Samsung Galaxy A6 is closer to the J-series. By the way, the characteristics of it is closer to her. On the heel terrible strips for antennas, and as for the location of the camera and scanner... Here, of course, all like the flagship. Of course, there is no protection against dust and moisture. No USB Type-C, only good old MicroUSB. Another common feature with flagships-a weak battery at 3000 mAh, with which you will be doomed to permanent recharge. By the way, only charging from the socket is supported, and the wireless is not. If you dream of an "endless display", in the direction of Samsung Galaxy A6 is not exactly worth watching. Not only that there is an ordinary sensor with impressive frames, and the resolution of it only 720 by 1480 pixels. (which gives us the "flagship" aspect ratio of 18.5:9). Pixel density 294 ppi, diagonal 5.6 inches.
The computing center is built around a very good chipset Exynos 7870. Not bad, if there is some 2014 in the yard, and you do not have a huge selection of mobile phones on much more steep platforms. 8-the nuclear chip somehow cope with the work in multitasking mode, although the clock frequency of 1.6 GHz strongly limits the already outstanding ability of the Cortex-A53 architecture. There can be no question of how to implement the flagship functions on such a preflood gland. What to say at all, if among these "functions" is a fingerprint scanner and reminders Bixby. There is a "reminder" in your phone. If you don't know how to use it, ask your grandchildren. Graphic accelerator-ridiculous for laughter. Yes, that's right, and no other way. Mali-t830 MP1 is a video card with one core, which it is time to forget, at least when it comes to smartphones of the middle price range. In the game will not play, unless only in Tetris.
There is an Always-On-Display function.
Promising cameras with 16 MP and Aperture F/1.6 (main) and F/1.9 (front).
Dedicated slot for MicroSD memory card up to 256 GB.
Multimedia Super AMOLED screen with the resolution of the sides 18.5:9.
Weak chipset Exynos 7870 with a graphics adapter Mali-t830 MP1.
Low resolution, 720 to 1480 pixels.
Not the most attractive design, MicroUSB.


Pressure Cleaning Hawthorn East is the highest rated, professional pressure cleaning & exterior home washing company in Hawthorn East. We service all suburban areas across Melbourne and Mornington Peninsula.
It is suggested for many paths, swimming pools & outdoor patio areas, pavers, tennis courts & keeping walls. For roofings, we have a special treatment to prevent tile deterioration and to minimise the risk of water damage.
Roofings can become extremely unpleasant due to organic growths like moss and lichen. Roofings are likewise regularly discoloured and stained by a common bacteria called gloecapsa magma. Roofing associations and producers do not recommend high pressure washing to clean roofs. It may remove moss from the roofing, but the aggressive jets of water might also damage tiles, ridge capping and other roofing system fittings as well as increase the risk of flooding. There is likewise a great chance that the moss will grow back. Cleaning with the manufacturers preferred detergent is suggested. This is what we do! Softwash roof washing is by far the most effective way to clear moss or other bacterial developments from the roofing system, whenever they are at risk of ending up being a major problem.
We clean up, paint and seal driveways, paths and concrete utilizing our innovative cleaning and sealing products. A clean driveway will greatly enhance the look, value and street appeal of your home or business. This is achieved by giving a new look to old and tired surfaces.
Don't let beginners practice on your biggest investment. Our expert group of specialists has more than 20 years worth of experience, so we know what we are doing. For your comfort we ensure all of our work, and even much better, we have very competitive rates. Our service is insured and we're fully licensed to work on your property.
No task is too big. We have the equipment needed for big storage facilities, sports surfaces, school grounds, shopping centers, body corporate complexes and big car parks.
We works with businesses throughout Hawthorn East, offering environmentally compliant, high pressure steam cleaning and water blasting services that enable organisations to meet hygiene compliance policies and provide personnel and visitors with a pleasant environment.
Our certified, licensed and totally insured staff clean both indoor and outdoor areas around your company. Our dependable staff are available to work after hours to prevent any disruptions to your company. We are also certified and licensed to work at height as our service frequently involves tall buildings, which might need abseiling or elevated work platforms.
Our company has a strong reputation amongst its clients for dependability and workmanship. No two jobs are alike, so call us to discuss your Bluestone high pressure cleaning Hawthorn East requirements, whether you require a one-off pressure clean or a regular contracted service.


text:
Q: Identifying NFC tag ID I am trying to identify the unique identifier of NFC tag on android using the following code:
@SuppressLint("NewApi")
@Override
protected void onCreate(Bundle savedInstanceState) {
 super.onCreate(savedInstanceState);
 setContentView(R.layout.activity_main);
 Tag myTag = (Tag) getIntent().getParcelableExtra(NfcAdapter.EXTRA_TAG);
 String nFCID = myTag.getId().toString();
 Toast.makeText(getApplicationContext(), "NFC id is: "+ nFCID, Toast.LENGTH_SHORT).show();
}

Unfortunately, when I deploy the app to a real device and scan an NFC tag, my app will crash stating "Unfortunately xyz has to stop...".
I know getID() will return byte array and I have to parse it to String. But at least I expect this code to return some values rather than crashing the app. Any ideas how to fix it?
Edited: LogCat outputs:
W/dalvikvm(25548): threadid=1: thread exiting with uncaught exception group=0x41b652a0)
E/AndroidRuntime(25548): FATAL EXCEPTION: main
E/AndroidRuntime(25548): java.lang.RuntimeException:
Unable to start activity ComponentInfo{com.xyz.nfcid/com.xyz.nfcid.MainActivity}:
at android.app.ActivityThread.performLaunchActivity(ActivityThread.java:2100)

A: I'm pretty sure, that your tag is null. You should check the action String first
String action = intent.getAction();
if (NfcAdapter.ACTION_NDEF_DISCOVERED.equals(action)) {
    //... do something
}

I've written a complete tutorial, which should help you.

redpajama_set_name: RedPajamaStackExchange


text:
Clinton Outspends Trump 4 to 1 in Florida, But Race is Tightening
Democratic nominee Hillary Clinton and her allies have outspent Donald Trump handily across the nation, and especially in Florida. Nevertheless, polls show the race tightening to a statistical tie.
A full 95 percent of all campaign television ad spending scheduled between now and Election Day comes from Clinton's team, according to an ABC News analysis of CMAG/Kantar Media data. Clinton's campaign and her allies have reserved $143.2 million in television ads for the final stretch, while Trump's team has only spent $6.8 million.
Florida presents a particularly stark example. Clinton is spending $36.6 million in that state, while Trump's numbers reach a mere $700,000 — that's 53 times more money for Clinton than for Trump. Florida is the largest of four crucial states for Trump's campaign. If he wins Florida, Ohio, Pennsylvania, and North Carolina, he will likely take the White House. If he loses just one, however, Clinton is almost a shoe-in. This year has proven bogus for most conventional wisdom, but Electoral College math does not lie, and neither do campaign ledgers.
Clinton's TV ad spending also dwarfs that of Trump in the other key states. In Ohio, Clinton's spending $20.9 million to Trump's $1.8 million. In Pennsylvania, she has $18.8 million to his $1.5 million. In North Carolina, her numbers add up to $14.3 million to his $1.3 million.
The Democratic candidate leads by a mere 1.9 percent nationally, according to the RealClearPolitics average. In Florida, the race is at an exact tie, with both Trump and Clinton at 45.0 percent. A recent Monmouth University poll, released Tuesday, shows Clinton five points ahead, with key support coming from minorities.
Florida's presidential races usually come down to the I-4 corridor, a region between Tampa and Orlando which is highly contested politically. The state's northern third usually goes to the Republican, while the heavily Latino south often favors the Democrat. While generalizations always break down on some level, the usual trend among the Latino community is that Cubans often favor Republicans, while Puerto Ricans side with Democrats.
Nevertheless, Clinton's low favorability has even the Puerto Ricans in the I-4 hesitant to pull the Democratic lever. The Associated Press's Steve Peoples reported Wednesday that Clinton's allies concede she has work to do among the Puerto Rican community.
"Hillary no sirve," declared Kissimmee resident Heriberto Ferrer. This means "Hillary is useless" in Spanish. Ferrer is no fan of Trump — he flatly told a Republican volunteer, "I don't want Trump to win. Period." — but he certainly doesn't sound "Ready for Hillary." He said he can't rule out voting for Trump, as he dislikes her so much.
Ferrer's neighbor, Amparo Vargas, had a similar negative opinion of both candidates. "She's a liar," he said in Spanish. "I have no trust in Hillary. And I think Trump is a crazy man."
This unpopularity might be one of the reasons Clinton's campaign and her allies have invested more political advertising along the I-4 corridor than any other media market in the nation. Since June 28, her team spent a combined $28 million on advertising in the Tampa and Orlando areas, according to Kantar Media's political ad tracker. Trump's team, by contrast, has only invested slightly more than $5 million.
Manipulating U.S. Elections: 10 Ways Voting Is Being Hacked by the Left
Next Page: Will Hillary's micro-targeting pay off?
Clinton has adopted very sophisticated micro-targeting to reach the Puerto Rican community. Her Orlando radio ads not only feature Spanish language, but employ Spanish speakers with Puerto Rican accents. Trump has not aired any Spanish ads, much less micro-targeted to specific communities. The Census Bureau has reported that an estimated 1.6 million Florida residents speak English "less than very well."
Worse, half of Trump's campaign offices sat empty last weekend. While the Republican National Committee (RNC) said they had a paid staff of 200 on the ground, the Trump campaign told the AP the number was closer to 120, including both RNC staff and campaign staff.
"This is a campaign that is not necessarily built on the traditional bricks and mortar campaigning," Susie Wiles, Trump's top Florida operative, told the AP. She said she had been on the job for only about a week. Nevertheless, the campaign is signing up hundreds of new volunteers at every rally, Wiles added. She said the team keeps in touch with them by text message. Even so, the campaign relies on the RNC to do the grunt work of door knocking and phone calls.
As usual, the RNC sent volunteers into Puerto Rican neighborhoods last weekend. A handful of Spanish speakers reached out to voters in their native language. RNC Field Director Francheska Markus grew up in a Puerto Rican family, and used that connection ask the Spanish speakers to "have an open mind."
During the same weekend, the Clinton campaign hosted 72 individual events in the Orlando area, including nearly 20 phone banks, 40 registration events, and a dozen door-knocking teams. State Senator Darren Soto, a Democrat who would be Florida's first Puerto Rican member of Congress, argued that Trump has "stoked racism," pushing his community toward Clinton. Even he admitted that the Democrat nominee needs to work hard for the support of Hispanics in Florida.
The Monmouth poll gave Clinton an overwhelming advantage among Hispanic, black, and Asian voters, who make up about one third of the electorate. Sixty-nine percent of these three groups backed Clinton, while only 16 percent said they favor Trump. Fifty-three percent of white voters backed the Republican nominee, while only 35 percent supported the Democrat.
An estimated 1,000 Puerto Rican families are moving to Florida from the U.S. territory every month. Unlike other immigrants, they arrive as American citizens and become eligible to vote almost immediately. Immigrant groups like this are considered the Democrats' "blue wall," but what if the wall starts showing cracks? If Puerto Ricans dislike Her Majesty, the Dowager Empress of Chappaqua, might they end up breaking for Trump? Hillary's massive spending in the I-4 suggests she's terrified, and perhaps for good reason.
Forget What You've Heard: Republicans Have the Demographic Edge for 2016
https://pjmedia.com/election/2016/09/22/clinton-outspends-trump-4-to-1-in-florida-but-race-is-tightening/
Related: 2016 presidential election, Donald Trump, Florida, hillary clinton, Race


text:
in: 1945 births, Canadian ice hockey players, Montreal Canadiens players,
California Golden Seals players
Boston Bruins players
New York Rangers players
New Jersey Devils players
Stanley Cup champions
NHL assistant coaches
Carol Vadnais
Born September 25, 1945(1945-09-25)
Died August 31, 2014(2014-08-31) (aged 68)
Position Defence
Played for Montreal Canadiens
Carol Vadnais (born Carol Marcel Vadnais on September 25, 1945) was a Canadian professional ice hockey defenceman who played seventeen seasons in the National Hockey League (NHL) from 1966–67 until 1982–83.
He won two Stanley Cups during his career: in 1968 with the Montreal Canadiens and in 1972 with the Boston Bruins.
2 Coaching Career
3 Post-Playing Career\Death
Originally a forward, Carol was shifted to defence in his final year of junior hockey with the Montreal Jr. Canadiens.
In his first NHL training camp, he made the Montreal Canadiens lineup for the 1966-67 season.
While the Canadiens were initially successful in not exposing Carol to the 1967 NHL Expansion Draft, he was left unprotected after the 1967-68 season and would be claimed by the expansion Oakland Seals in the June 1968 intra-league draft.
He became the Seals' captain at the beginning of the 1971-72 season but was traded mid-season.
On February 23, 1972, Carol was acquired by the Boston Bruins in an attempt to bolster their blueline for a Stanley Cup run.
The Bruins outbid Vadnais' old club, the Canadiens, to secure his services. The move paid off and Carol headed the Bruins' second defence pairing behind Bobby Orr's first unit which helped the Bruins capture the 1972 Stanley Cup.
In his best statistical season (in the 1974–75 season), he scored 18 goals and set career highs with 56 assists and 74 points.
Carol was one of the players involved in the November 7, 1975 blockbuster trade that sent him along with star forward Phil Esposito to the New York Rangers.
He went on to play seven seasons for the Rangers and one for the New Jersey Devils before retiring in 1983.
During his career, Carol played in 1,087 career NHL games, scoring 169 goals and 418 assists for 587 points as well as adding 1,813 penalty minutes.
Coaching Career[]
Carol joined the Rangers' coaching staff as an assistant for the 1983-84 and 1984-85 seasons.
This was followed by one season as the head coach of the Quebec Major Junior Hockey League's Verdun Junior Canadiens after which he left hockey for good.
Post-Playing Career\Death[]
After his hockey career, Carol worked as a real estate agent in the Montreal area. His wife, Raymonde, died of cancer in 2004; they had one daughter.
On August 31, 2014, he died from cancer in Laval, Quebec, Canada at the age of 68.
Stanley Cup champion (1968, 1972)
Selected to the NHL All-Star Game (1969, 1970, 1972, 1975, 1976, 1978)
Ranked at #52 on the all-time list of New York Rangers in the book "100 Ranger Greats" (John Wiley & Sons, 2009).
Montreal Canadiens players


Off-site catering means that Loveless Events Catering will come to your table! Whether you are hosting a party in your home or a business dinner across town, we can provide custom menus, licensed bartenders and professional staff.
Learn more about Loveless Events services, menus and more!


There's nothing more relaxing than having a drink on the deck at Bald Mountain Camps while watching the sun set over Mooselookmeguntic Lake. BMC serves up some of the best food in the region, from fried lobster legs and fish tacos to their famous Sunday Bloody Mary bar.
This historic Maine sporting camp has been a favorite destination of boaters, snowmobilers, hunters, anglers, seaplanes, and outdoor enthusiasts since it opened in the 1800s.


text:
15 Books on Art Deco
Fifteen books on Art Deco—the predominately European and American decorative arts style of the 1920s and '30s that took its name from the 1925 Exposition Internationale des Arts Décoratifs et Industriels Modernes held in Paris.
Paul T. Frankl, Vanity Stool. Photo: courtesy of Doppelhouse Press
Art Deco Norbert Wolf
From the Publisher. This sumptuous volume salutes everything Art Deco—from historically significant art and design through to the present day. The Art Deco style is so recognizable and widespread that its original influence on the culture in which it emerged has been all but lost in the clutter of imitation. This book draws our attention back to the birth of Art Deco—a period between two devastating world wars when industrialization was flourishing, interest in archaeology was peaking, and movements such as Cubism, Constructivism, Futurism, and Modernism were turning the art world on its head. Brilliantly designed to reflect the style it celebrates, Art Deco is filled with hundreds of examples of painting, architecture, interiors, jewelry, crafts, furniture, and fashion. Author Norbert Wolf traces the chronology of the Art Deco style by looking at the politics and culture of Europe in the 1920s and early 1930s, and the artistic movements that paralleled its popularity. He follows Art Deco's influence in Europe and its immigration to the Americas and Asia. Most importantly, this wide-ranging volume looks beyond the era of Art Deco's origination to the present day. Pointing to the numerous revivals and contemporary echoes in painting and even literature, this beautiful volume demonstrates that Art Deco is alive and well today—often in forms where we least expect it.
Art Deco Jewelry Sylvie Raulet
From the Publisher. The creations of the Art Deco period's haute joaillerie (jewelers such as Cartier and Van Cleef & Arpels) and of the avant-garde designers, including Jean Fouquet, Raymond Templier, Gerard Sandoz, Jean Durand, and Paul Brandt—to whom we owe some of the most daring and brilliant jewels of the period. There is also an exquisite range of accessories: dainty vanity cases fashioned with the maximum of detail in the minimum of space, boxes and cigarette cases, and a spectacular array of clocks. With the addition of succinct biographies of the most innovative and influential jewelers of the day, a select bibliography, and a glossary, this book serves as an essential reference for anyone interested in the period or in superb examples of the jeweler's art. (Out of print)
The Art Deco Murals of Hildreth Meière Catherine Coleman Brawer
Kathleen Murphy Skolnik
Foreword by Richard Guy Wilson
Photographs by Hildreth Meière Dunn
From the Publisher. An unsung heroine of Art Deco art and architecture, Hildreth Meière is the artist behind many of the most spectacular murals of the first half of the twentieth century. The dynamic roundels of Dance, Drama, and Song at Radio City Music Hall, the shimmering glass mosaics in the narthex of St. Bartholomew's Church, and the rich iconographic designs at the Nebraska State Capitol, the National Academy of Sciences, and elsewhere—all are the work of Meière, a central figure in American decorative art. The first monograph on the artist, The Art Deco Murals of Hildreth Meière examines her distinctive designs within the context of American art and architecture.
Art Nouveau and Art Deco Bookbinding Alastair Duncan
Georges De Bartha
Sumptuous study of art bookbinding that includes a detailed biography and bibliography of every binder included, such as Rose Adler, Georges Crette, Genevieve de Leotard, Rene Wiener, and others. (Out of print)
Art Deco Poster William W. Crouse
From the Publisher. Posters of the Art Deco period, which once graced billboards and walls to advertise every variety of product, service, entertainment, or political cause, are today prized for the richness of their design and ingenuity; they offer inspiration for graphic designers and are highly collectible. Now, William Crouse, a long-time poster aficionado and collector, has selected more than 300 of the most sought-after examples of poster art created between the World Wars to include in this definitive volume. Organized thematically (aviation, communication, fashion, etc.), The Art Deco Poster presents a jaunty cavalcade of international poster design, and includes rare and unique examples by masters of the art form, including Nizzoli, Cassandre, and Beall. Each poster—superbly photographed under carefully controlled conditions—is accompanied by an informative caption that addresses the aesthetic, sociological, economic, and/or political context of the image. The book includes an introduction by well-known Art Deco specialist Alastair Duncan.
Edgar Brandt: Art Deco Ironwork Joan Kahr
From the Publisher. A premier metalsmith in the early 20th-century in France, Edgar Brandt (1880-1960) designed and fabricated some of the most beautiful architectural and decorative ironwork of his age. This elegant book recounts his life and work with scholarly text and photographs. Lyrical gates, doors, and tables, including his most famous screen, L'Oasis, appeared at the seminal 1925 Exposition des Arts Décoratifs, in Paris, which gave the name Art Deco to the new style of designs. Combining motifs from ancient Egypt and classical Greek sources, floral and animals forms, and machine-inspired geometric designs, Brandt created items that became synonymous with the most lavish designs of the time. His workshop and showroom in Paris, along with a gallery that featured works by other contemporary artist-craftsmen, produced luxury goods and private commissions. Grilles, fire screens, doors, tables, andirons, vessels and lighting devices were exquisitely executed, and appear here to be studied and compared. Historians and art collectors interested in this fascinating period will find this book an invaluable reference.
A. M. Cassandre Henri Mouron
From Publisher's Weekly. For Cassandre, designing a poster meant telling a story. He would take an objectthe Normandie ocean liner, a locomotive, a record, a wine bottle, or whateverand make it the center of attraction through bold geometry and witty pictorial drama. Aside from their strong nostalgic appeal, his famous posters of the 1920s and 1930s are memorable for their innovative graphic solutions and their frequent references to such painters as Ernst, de Chirico and Picasso. Cassandre, whose real name was Adolphe Mouron, was a highly influential commercial artist. This oddly impersonal biography by his son shows us the frustrated but prolific easel artist, successful theatrical designer, and creator of elegant typefaces and magazine art.
Eileen Gray: Objects and Furniture Design Introduction by Carmen Espegel
Sandra Dachs Editor
From the Publisher. Neglected in her lifetime, Eileen Gray (1878-1976) is now regarded as one of the most important furniture designers and architects of the early twentieth century. She first worked as a lacquer artist, then as a furniture designer and finally as an architect. At a time when other leading designers were almost exclusively male and adherents to one movement or another, Gray remained stalwartly independent. Her design style was as distinctive as her way of working; Gray developed an opulent, luxuriant take on the geometric forms and industrially produced materials used by International Style designers such as Le Corbusier, Charlotte Perriand, and Mies van der Rohe. Her voluptuous leather and steel Bibendum Chair and chic E-1027 glass and tubular steel table are now familiar icons of modernity. Part of the By Architects series, Eileen Gray highlights the work of this singular designer-architect.
Exposition Internationale des Arts Décoratifs et Industriels Modernes Fernand David
Paul Léon
The official illustrated "general reports" from the time of the 1925 International Exposition of Modern Decorative and Industrial Arts (Exposition Internationale des Arts Décoratifs et Industriels Modernes) in Paris.
Italian Art Deco Steven Heller
From the Publisher. Survey of Italian commercial graphic design during a period of both creative artistic vitality and extreme political turmoil. The first English-language book to showcase the bold typography and streamlined imagery of modern Italian design motifs on comercial products of the day, this fascinating and important resource for designers, history buffs, and collectors includes a discussion of the Futurist influence on the Italian Art Deco style and the success of such individualized expression despite a ruthless Fascist regime.
Jean-Michel Frank Adolphe Chanaux
Léopold Diego Sanchez
Monograph on the work of Jean-Michel Frank by Frank's former studio assistant Adolphe Chanaux—the first comprehensive survey of the furniture and interiors by the renowned Parisian master of Art Deco. Designed by Andrée Putman, and with new color photographic documentation by Jacques Boulay.
Joseph Urban John Loring
From the Publisher. Joseph Urban is a lavish celebration of this prolific artist, architect, and designer, whose accomplishments include magnificent Art Deco buildings, spectacular Ziegfeld Follies productions, and dramatic sets for the Metropolitan Opera. Joseph Urban (1872–1933) began his career as an architect and artist in Vienna before moving to America in 1911. In 1914 he moved to New York, where he ultimately signed on as set designer of the Metropolitan Opera. He also became immersed in an astonishing array of outside projects, designing nightclubs, hotel lounges, skyscrapers, theaters, stage and film sets, and even children's books. Though his creative output was immense, little remains of his work except the Mar-a-Lago in Palm Beach, and the New School and the base of the Hearst Tower in New York.
Paul T. Frankl: Autobiography Paul T. Frankl
Viennese émigré Paul T. Frankl (1886-1958) was one of the pioneers of early modern design in the United States known for his "Skyscraper" furniture of the 1920s, his work for New York trend-setters and the Hollywood élite in the 1930s and early 1940s, as well as his many original pieces in rattan and work for the Johnson Furniture Company. A prolific and influential writer about design, Frankl was the author of five books, including Form and Re-Form (1930) and Machine-Made Leisure (1932). When Frankl died of cancer in 1958, he left his nearly complete autobiography. This never-before published work, written at the end of Frankl's long career in a captivating style, is a vivid account of his early life, his rise in the profession, and his many travels in search of ideas and forms. Accompanying Frankl's text are eighty-five photographs and drawings, many of which have never previously been published. The book also includes an introduction by the noted design scholar Christopher Long and a remembrance written by his daughter Paulette Frankl.
Popular Art Deco Robert Heide
John Gilman
From the Publisher. Production-line objects from the 1920s and '30s are increasingly sought after as icons from a crucial era in American industrial design. The ornate style promoted by the 1925 Paris exposition dramatically affected design down to the most utilitarian level, ranging from dime store rouge pots to kitchen utensils, from advertising graphics to book and fabric design, from wallpaper to furniture. This richly illustrated volume, with its comprehensive survey of the style that revolutionized mass marketing, will appeal not only to collectors, designers, and decorators but also to the general reader who seeks guidance to the increasingly important Art Deco marketplace.
Ruhlmann: Master of Art Deco Florence Camard
#1 Most Popular Design Seller at Modernism 101 (November 2013). From Modernism 101. This is still the major reference work on the renowned French modernist architect and interior designer Jacques-Emile Ruhlmann. Known as "The Master of Art Deco," Ruhlmann created opulent, exquisitely designed furniture, homes and showrooms for the Parisian beau monde in the twenties and thirties.
Eileen Gray Turns 135
King of Fashion: The Autobiography of Paul Poiret Paul Poiret


text:
Q: sapply() returns 'logical(0)' when x value is 0 in R I am trying to make a small script to get rid of extreme values in a large dataset, but when my value is "0" my function returns "logical(0)" instead of NA.
#Getting rid of extreme values
test=NULL
test$value<-runif(200,13.90,14.10)
test$date<-seq(1,200,1)
test$value[125]<-15
test$value[175]<-0

plot(test$date, test$value)

averagei=NULL
averagetot=NULL
for (i in 1:length(test$value)) {
  averagei<-mean(test$value[i-15:i+15])
  averagetot=c(averagetot,averagei)

}

t<-sapply(test$value, function(x) ifelse(x - averagetot[x]>0.5, "NA", x))
t[175]
[[1]]
logical(0)

Why does this happen? I can of course get rid of the 0 before but it drives me crazy that I cannot understand why this happens or fix it.
EDIT: Thanks to Marius comment I fixed it using a for loop, might not be the most efficient but it does the job. Someone has a solution in a sapply loop but I could not make it work in my case: Row/column counter in 'apply' functions
test=NULL
test$value<-runif(200,13.90,14.10)
test$date<-seq(1,200,1)
test$value[125]<-15
test$value[175]<-0

plot(test$date, test$value)

a=NULL
atot=NULL
for (i in 1:length(test$value)){
  a<-ifelse(abs(test$value[i] - averagetot[i])>0.5, "NA", test$value[i])
  atot=c(atot,as.numeric(a))
    }

atot[175]
length(atot)

A: The problem seems to be in the
averagei<-mean(test$value[i-15:i+15])

It should be
averagei<-mean(test$value[(i-15):(i+15)])


Beautifully well maintained six-plex. Easy care brick and vinyl. New roof. 100% occupied. Plenty of upside on rents.
4-2 bedroom, 1 bath and 2-1 bedroom, 1 bath. 78 additional units available.
100% Occupied. 4-2 bd, 1 ba & 2-1 bd, 1 ba. Under market rents; plenty of upside. Well taken care of. 2012 Appraisal at $336,000. 2 bedrooms are 762 SF and 1 bedrooms are 576 SF. Interiors shown with pre-approval letter & Sales Contract during due diligence. Please call for rent roll & operating expenses. Large complex that is being split up. May be difficult to separate numbers. Buy one building or buy them all. Additional info in Remarks.


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Having been educated in the field of maths and science, I did not pick up a pencil/pen to "draw art" until the age of 25. So I am basically self taught. In order to improve my techniques and learn new skills, I spent 2 years full-time/4 years part-time at TAFE Colleges in Perth and Cairns studying courses in Fine Art, Design and Printmaking.
My style, techniques and media used are varied and each has their own personality, quality and influences - from the fine, detailed precision of line and image of pencil drawings and printmaking to the more expressive, colourful, spontaneous imagery of the oil and mixed media paintings I hope that my artwork will touch people's emotions, psyche, social values, visual faculties and thus make them experience a reaction to what they are seeing.
- "OTHER SCHOOLS OF THOUGHT"
- "EXPOSE OF THE MYTH"
- "NO PARTICULAR PLACE TO GO"
JUNE 1991 MIDLAND (WA) COUNCIL OF COMMERCE AWARD FOR ART.
DEC 1993 BOLTON INPRINT AWARD FOR ART.
PIER MARKET-PLACE, CAIRNS 1992 -2000 .


I went into two different West Elm stores and asked patient employees what they thought of the Peggy and if they would recommend it to somebody. ... In both cases, I asked what the expected lifespan is for a West Elm couch like the Peggy. Both store employees told me that between one and three years was normal for a couch with light use.
We're thinking a lot about our own couches here. The couch and big chair that we bought when we moved into this house are ten years old, and the dog has loved being on them for nine and a half of those years; not to mention the three kids when they came along, the two of us, and countless visitors. There have been many pillow forts. And yet I'm dismayed and disappointed that the covers are getting threadbare and are suffering lots of little holes (and a couple gigantic ones). And our other couch? My parents got that one when I was a baby. Sure, it's been reupholstered once and has a slipcover on it now, but it's still hanging on.
Talking to some other folks about my reaction to the West Elm article, I was gratified to hear that they too thought one to three years was unreasonable—but I think the majority view even among sensible people of my acquaintance is that you shouldn't expect much more than five. I just don't know what to do with that. I was thinking about furniture a while ago (just after we started our epic, house-wide furniture-moving project—still in its middle stages today) and it occurred to me that couches are a pretty new invention, relatively speaking. At least for the common folks, a couple chairs around the stove would be all you could look for by way of relaxing seating. Maybe a rocker. Wooden chairs last longer than five years, I believe.
Generally, I admit I'm too ready to believe that, since I obtained a thing once, I should be free from having to do so again. Shoes, for example, need to be replaced with some regularity, it turns out. Jeans. Socks. But I don't think it's unreasonable of me to expect twenty years out of my couches. The money is bad enough—even worse is the trouble and effort of actually managing the replacement! And what happens to the old couches? Landfill? They're not getting sold on Craigslist, if they're breaking down after one to three years!
Clearly, many people are still making solid, reputable couches, so I shouldn't overreact to this one failure of common sense. But West Elm also sold a lot of Peggys, so. Modern culture is weird.


text:
Sadie Silk Dress
A$ 260,00 A$ 575,00
Color: Yellow Pink
Hobbs Size 6 8 10 12 14 16 18 20
Bust Size 81.5 84 89 94 99 104 109 114
Waist 63.5 66 71 76 81 86 91 96
Full Hip 89 91.5 96.5 101.5 106.5 112 117 123
Bust Size 32 33 35 37 39 41 43 45
Full Hip 35 36 38 40 42 44 46 48
See all charts
Email me when available Email me
link.addtowishlist
Yellow Pink
Enter a Town, Postcode or City
Or find your local store
Product Code: 0219-5138-3793L00
Fabric Composition: 100% silk
Length: 117cm/46 inches
Care: Specalist Dry Clean
Fastening Type: Back Zip
Model is 175cm/5'9'' and is wearing a size UK 8
Designed to make a statement. Part of our limited edition By Invitation collection, the yellow-hued Sadie dress needs little else to make an impression at the races, weddings or garden parties this season. Cut from pure silk, it showcases a beautiful print of echinaceas in full bloom throughout its elegant fit and flare silhouette. A tie detail flatters the waist, while the flared midi skirt offers plenty of swoosh on the dancefloor. Model is 175cm/5'9'' and is wearing a size UK 8.
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The hem is not sewn properly and hanging down. It is much too big in the neck


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Using APIs and data exchange tools, we can develop custom interfaces to enable data transfer to and from other data sources. Most interfaces can be automated through the use of APIs and PowerShell scripts. Your EnergyCAP project manager will work with you to develop specifications for each interface developed for you by EnergyCAP, Inc.


There's no doubting that January can be a tough time for us with everything going on – the highs of the festive period are a distant memory, you've already failed your New Year's resolutions, and you're broke, fat and struggling to get up in the morning. It's no surprise then that January is home to the most depressing, lonely, and sad day of the year – Blue Monday. But there are ways to beat it.
Accept it – life is a journey and there will be ups and downs along the way. You know there's going to be a blue period and accept that this happens. It's normal to be down and it's normal to be blue. Stop giving all your energy to fearing blue Monday and accept that these down moments will pass.
You've got choice – once you've come to accept Blue Monday, you can then exercise choice and control over how you are going to deal with it. What is it that makes you happy? Is it nourishing food? A friend? Spending time in nature? Plan your day around the things that make you happy and you will be able to change the colour of the day to whatever one you want.
Turn it around – you know this down moment might come, so get into the headspace of, "what am I going to do about it?" What have you done in the past that has worked for you? List these things down and energise these positive thoughts into actions. You need to emotionally move into a positive mindset and take charge of Blue Monday turning it into blue skys.
Have a clear out – we're all guilty of being hoarders and everyone has stuff that they need to get rid of. Whether it's too many Internet tabs or stacks of files, have a clean-up and a clear out and get rid of the impending shadows that linger over you. Use Blue Monday to expand your horizons rather than be fearful and hide behind your backlogs.
Pass it on – whatever it is you wish to feel, pass it onto to other people. If you wish to feel appreciated; go and appreciate someone. If you want to feel loved; show someone some love. Putting these positive energies out into the world will make you feel great and the world will naturally return the favour.