We are all looking for ways to increase production without sacrificing quality. One of the most cost-effective ways is by improving the substrate material of your hob. Solid carbide hobs are widely used in many applications throughout the world. LMT-Fette was the first to demonstrate the use of solid carbide hobs in 1993 on modern high-speed carbide (HSC) hobbing machines. Since then the process of dry hobbing has been continuously improving through research and product testing. Dry hobbing is proving to be successful in the gear cutting industry as sales for dry hobbing machines have steadily been rising along with the dramatic increase in sales of solid carbide hobs.
There are great advantages in dry hobbing, not only for friendliness toward the environment, but also for increasing productivity and for decreasing manufacturing cost. Dry hobbing, however, often causes failures in hob cutting edges or problems with the surface quality of gear tooth flanks. These difficulties are not present when hobbing with cutting oil. Pinching and crushing of generated chips between the hob cutting edge and the work gear tooth flank is considered a major cause of those problems.
Nowadays, finish hobbing (which means that there is no post-hobbing gear finishing operation) is capable of producing higher quality gears and is growing in popularity.
Recent trends in gear cutting technology have left process engineers searching for direction about which combination of cutting tool material, coating, and process technology will afford the best quality at the lowest total cost. Applying the new technologies can have associated risks that may override the potential cost savings. The many interrelated variables to be considered and evaluated tend to cloud the issue and make hobbing process development more difficult.
To meet the future goals of higher productivity and lower production costs, the cutting speeds and feeds in modern gear hobbing applications have to increase further. In several cases, coated carbide tools have replaced the commonly used high speed steel (HSS) tools.
It takes confidence to be the first to invest in new manufacturing technology. But the payback can be significant. That has been the experience at the Ford Motor Company's Transmission & Chassis Division plant at Indianapolis, IN, which boasts the world's first production application of dry hobbing.
With reference to the machining of an involute spur or helical gear by the hobbing process, this paper suggests a new criterion for selecting the position of the hob axis relative to the gear axis.
New tool from LMT-Fette provides combination of operations.
The seemingly simple process of placing a uniform chamfer on the face ends of spur and helical gears, at least for the aerospace industry, has never been a satisfactory or cost effective process.
Load-carrying capacity of gears, especially the surface durability, is influenced by their tooth surface roughness in addition to their tooth profiles and tooth traces.
The newer profile-shifted (long and short addendum) gears are often used as small size reduction gears for automobiles or motorcycles. The authors have investigated the damage to each cutting edge when small size mass-produced gears with shifted profiles are used at high speeds.
The following article is a collection of data intended to give the reader a general overview of information related to a relatively new subject within the gear cutting industry. Although carbide hobbing itself is not necessarily new, some of the methods and types of application are. While the subject content of this article may be quite broad, it should not be considered all-inclusive. The actual results obtained and the speeds, feeds, and tool life used in carbide hobbing applications can vary significantly.
Question: When cutting worm gears with multiple lead stock hobs we find the surface is "ridged". What can be done to eliminate this appearance or is to unavoidable?
The gear hobbing process is a generating type of production operation. For this reason, the form of the hob tooth is always different from the form of the tooth that it produces.
Decades ago, technology shifted from HSS to indexable inserts in turning and milling. This movement wasn't immediately realized in gear hobbing because coated PM-HSS hobs and complex gear profiles remained highly effective and productive methods. Only fairly recently have gear manufacturers started to take a serious look at indexable technology to cut gear teeth.
I make all the double helical gears that go into a gearbox - four different gears in this unit. If the gear module for the bull gear and the intermediate gear are the same (these are the two individual gears that mate), and the gear module for the high-speed pinion and high-speed gears are the same (these are the other two individual gears that mate in the gear box as well), is it then possible to just use two hobs in this setup to make all four gears, since they mate together with each other? We are currently using a different gear hob for each gear.
The latest technological solutions help keep chamfering and deburring operations in-line -- often without increasing cycle times.
Since we are a high volume shop, we were particularly interested in Mr. Kotlyar's article describing the effects of hob length on production efficiency which appeared in the Sept/Oct issue of Gear Technology. Unfortunately, some readers many be unnecessarily deterred from applying the analysis to their own situations by the formidabilty of the mathematical calculations. I am making the following small suggestion concerning the evaluation of the constant terms.
Some results of evaluation by this method in the automotive industry.
Helical gears can drive either nonparallel or parallel shafts. When these gears are used with nonparallel shafts, the contact is a point, and the design and manufacturing requirements are less critical than for gears driving parallel shafts.
The Dictionary of American Biography describes him as "one of the founders of the gear-cutting industry in the United State." He built the first hobbing machine for cutting spur gears. He founded the companies that are now Boston Gear and Philadelphia Gear Corp.
I'm a big believer in the value of IMTS as a marketplace where gear manufacturers can go and look at the latest machine tools and processes; compare hobbing machines, gear grinders and inspection equipment; see turning, milling or grinding machines in action; and ask questions of the various vendors all in one place. This year's IMTS promised to be the biggest ever, and I have no doubt that it will be a valuable experience to those who go there looking for ways to improve the way they manufacture products.
Traditional methods of manufacturing precision gears usually employ either hobbing or shaper cutting. Both of these processes rely upon generating the conjugate tooth form by moving the work-piece in a precise relation to the tool. Recently, attention has been given to forming gear teeth in a single step. Advantages to such a process include reduced production time, material savings, and improved performance characteristics. Drawbacks include complicated tool designs, non-uniformity of gears produced throughout the life of the tooling, and lengthy development times.


Here is a lovely piece of vintage clip art used to design a journaling spot. The border clip art comes from a vintage photo I posted a few days ago. I've given you both the .jpg and .png files of this journaling design so you can use it in both your paper and digital scrapbooking projects. And, I've given you a colorized version as well. I hope you enjoy!


Small and ancient chest or coffer. Jewelry box inside.
Nice little old oak chest, two panels on the front and on the sides. It rests on four straight legs.
Socket top and inside, his jewelry box.
Work of the eighteenth century.
Norman buffet, in two parts and blond oak.19th century.
Very nice Genoese dresser, carved walnut.Work of the 17th century.
Suite of 6 Scandinavian style teak chairs.Edited by G-plan.


1. Jesus Christ is Lord. There is only one name given under heaven by which men can be saved.Salvation comes through faith is the finished work of Jesus Christ. He shed His blood for the remission of our sin on the cross. He died. He was buried. On the third day, He rose from the dead and ascended into heaven and sits at the right hand of God, according to the scriptures.
2. God's word is truth. The Holy Bible is God word for yesterday, today and forever.
3. Baptism in water is an outward sign of death to the old self and rising in newness of life with Christ.
4.. The Holy Spirit baptism is given today, as in the 2nd Chapter of Acts, to empower the church to be witnesses for Christ. Evidence of this baptism includes speaking in other tongues and gifts of the Holy Spirit.
5. The church is to be governed according to the scriptures and by the commandment of love: "Love one another as I have loved you." Love is the law of the church of Jesus Christ.
6. The great commission: "Go ye into all the world and preach the Gospel..." with signs following.
7. Jesus Christ will come again to judge the whole world, the living and the dead. Heaven is the reward of the righteous - external seperation from God in hell is the reward of the wicked.
For more information on RockPower Church, please use this convenient form to contact us.


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Currently available testosterone preparations in common use include intramuscular injections, subcutaneous pellets, buccal tablets, transdermal gels and patches (see Table 2). Oral testosterone is not widely used. Unmodified testosterone taken orally is largely subject to first-pass metabolism by the liver. Oral doses 100 fold greater than physiological testosterone production can be given to achieve adequate serum levels. Methyl testosterone esters have been associated with hepatotoxicity. There has been some use of testosterone undecanoate, which is an esterified derivative of testosterone that is absorbed via the lymphatic system and bypasses the liver. Unfortunately, it produces unpredictable testosterone levels and increases testosterone levels for only a short period after each oral dose (Schurmeyer et al 1983).
Attention, memory, and spatial ability are key cognitive functions affected by testosterone in humans. Preliminary evidence suggests that low testosterone levels may be a risk factor for cognitive decline and possibly for dementia of the Alzheimer's type,[100][101][102][103] a key argument in life extension medicine for the use of testosterone in anti-aging therapies. Much of the literature, however, suggests a curvilinear or even quadratic relationship between spatial performance and circulating testosterone,[104] where both hypo- and hypersecretion (deficient- and excessive-secretion) of circulating androgens have negative effects on cognition.
For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.
Dr. Ronald Swerdloff, chief of the endocrinology division at the Harbor-UCLA Medical Center and a professor of medicine at UCLA's David Geffen School of Medicine, served on the panel of experts who developed the Endocrine Society's guidelines. He is also the principal investigator for one of the 12 sites of The Testosterone Trial in Older Men, a nationwide study funded mainly by the National Institute on Aging. The study of 800 men over age 65 with low testosterone is looking at whether men using AndroGel for one year, compared to placebo, will show improvements in walking speed, sexual activity, vitality, memory, and anemia. The study will be completed in June 2015.
A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.
The other component of that study is that the subjects ate much less saturated fat. Saturated fats are common in meat, butter, and coconut products, and they're crucial for your body to function. Saturated fats keep the integrity of your cell membranes, and if you limit carbs and/or do Bulletproof Intermittent Fasting, saturated fats become a phenomenal source of energy for your brain.
It is hard to know how many men among us have TD, although data suggest that overall about 2.1% (about 2 men in every 100) may have TD. As few as 1% of younger men may have TD, while as many as 50% of men over 80 years old may have TD. People who study the condition often use different cut-off points for the numbers, so you may hear different numbers being stated.
These oral medications reversibly inhibit penile-specific PDE5 and enhance the nitric oxide–cGMP pathways of cavernous smooth muscle relaxation; that is, all prevent the breakdown of cGMP by PDE5. It is important to emphasize to patients that these drugs augment the body's natural erectile mechanisms, therefore the neural and psychoemotional stimuli typically needed for arousal still need to be activated for the drugs to be efficacious.
Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.
The aim of treatment for hypogonadism is to normalize serum testosterone levels and abolish symptoms or pathological states that are due to low testosterone levels. The exact target testosterone level is a matter of debate, but current recommendations advocate levels in the mid-lower normal adult range (Nieschlag et al 2005). Truly physiological testosterone replacement would require replication of the diurnal rhythm of serum testosterone levels, but there is no current evidence that this is beneficial (Nieschlag et al 2005).
ED usually has a multifactorial etiology. Organic, physiologic, endocrine, and psychogenic factors are involved in the ability to obtain and maintain erections. In general, ED is divided into 2 broad categories, organic and psychogenic. Although most ED was once attributed to psychological factors, pure psychogenic ED is in fact uncommon; however, many men with organic etiologies may also have an associated psychogenic component.
Instead of the hesitation with which he had accosted the cardinal a quarter of an hour before, there might be read in the eyes of the young king that will against which a struggle might be maintained, and which might be crushed by its own impotence, but which, at least, would preserve, like a wound in the depth of the heart, the remembrance of its defeat.
Think of erectile dysfunction as your body's "check engine light." The blood vessels in the penis are smaller than other parts of the body, so underlying conditions like blocked arteries, heart disease, or high blood pressure usually show up as ED before something more serious like a heart attack or stroke. ED is your body's way of saying, "Something is wrong." And the list of things that cause erectile dysfunction can include:
ED usually has something physical behind it, particularly in older men. But psychological factors can be a factor in many cases of ED. Experts say stress, depression, poor self-esteem, and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse in men whose ED stems from something physical.
"Smoking is a short- and long-term cause of erectile dysfunction," warns Feloney. "In the short-term nicotine constricts the blood vessels that you need to get an erection, and in the long-term nicotine contributes to hardening of the arteries that can cause erectile dysfunction." Some approaches for quitting include making a clean break, avoiding the triggers of smoking, trying a nicotine patch or gum, and joining a smoke cessation program.
Associated morbidity may include various other male sexual dysfunctions, such as premature (early) ejaculation and male hypoactive sexual desire disorder. The NHSLS found that 28.5% of men aged 18-59 years reported premature ejaculation, and 15.8% lacked sexual interest during the past year. An additional 17% reported anxiety about sexual performance, and 8.1% had a lack of pleasure in sex. [51]
Cosgrove et al reported a higher rate of sexual dysfunction in veterans with posttraumatic stress disorder (PTSD) than in veterans who did not develop this problem. [42] The domains on the International Index of Erectile Function (IIEF) questionnaire that demonstrated the most change included overall sexual satisfaction and erectile function. [43, 44] Men with PTSD should be evaluated and treated if they have sexual dysfunction.
However, in contrast, a recent systematic review of published studies, the authors concluded that overall, the addition of testosterone to PDE-5 inhibitors might benefit patients with ED associated with testosterone levels of less than 300 ng/dL (10.4 nmol/L) who failed monotherapy. [20] A limitation of existing studies are their heterogeneous nature and methodological drawbacks.
"Low T" is anything but inevitable. BMJ's Drug and Therapeutics Bulletin says that around 80 percent of 60-year-old men, and half of those in their eighties, have testosterone levels within the normal range for younger men. It concluded, "The evidence that an age-related reduction in testosterone levels causes specific symptoms is weak." The Food and Drug Administration (FDA) meanwhile has not approved testosterone use to improve strength, athletic performance, physical appearance, or prevent aging. And a 2004 report from the Institute of Medicine ("Testosterone and Aging: Clinical Research Directions") called TRT for age-related testosterone decline a "scientifically unproven method."
In the U.S., where millions watch the Super Bowl simply to see the clever and costly commercials, and where pharmaceuticals with potentially deadly side effects are pushed on the public at every turn, it's probably not surprising that ads for "Low T" are now splayed across billboards in Florida, with its huge number of older residents, or that a chain of "Low T Centers" has sprung up in Texas and around the heartland.
Interest in testosterone began when farmers of old first noticed that castrated animals were more docile than their intact peers. Ditto for castrated humans. For human males with intact gonads, testosterone increases during puberty. It deepens the voice, increases muscle growth, promotes facial and body hair, and spurs the sex drive. Testosterone also is associated with personality traits related to power and dominance.
You should talk to your doctor about possible treatments. You may want to talk to other patients who have had the treatment planned for you. You also may want to seek a second doctor's opinion about surgery before making your decision. You may find it difficult to talk to your doctor about impotence. You will want to find a doctor who treats this condition and will help you feel comfortable talking about the problem and choosing the best treatment. You can also get more information by contacting your local National Kidney Foundation affiliate.
In one study, 9.6% reported 'occasional' erectile dysfunction, 8.9% reported erectile dysfunction occurring 'often', and 18.6% reported erectile dysfunction occurring 'all the time'. Of these, only 11.6% had received treatment.In another study, only 14.1% of men reported that they had received treatment, despite experiencing erectile dysfunction for longer than 12 months.
It doesn't get more natural than getting a good night's sleep. Research published in the Journal of the American Medical Association showed that lack of sleep can greatly reduce a healthy young man's testosterone levels. That effect is clear after only one week of reduced sleep. Testosterone levels were particularly low between 2 and 10 p.m. on sleep-restricted days. Study participants also reported a decreased sense of wellbeing as their blood testosterone levels dropped.
What you need to know about STDs Sexually transmitted diseases (STDs) are infections that are passed on from one person to another through sexual contact. There are many STDs, including chlamydia, genital warts, syphilis, and trich. This article looks at some of the most common STDs, the symptoms, and how to avoid getting or passing an STD one on. Read now
Interestingly, the Belgian company Solvay, acquired for €4.5 billion in 2010 by American pharmaceutical giant Abbott, didn't put its own or its product's name on the website. As AdWeek pointed out when the campaign launched, "One of the advantages of taking the unbranded route for Androgel is that the company does not have to warn consumers quite so prominently about Androgel's side effects."
Testosterone may prove to be an effective treatment in female sexual arousal disorders,[52] and is available as a dermal patch. There is no FDA approved androgen preparation for the treatment of androgen insufficiency; however, it has been used off-label to treat low libido and sexual dysfunction in older women. Testosterone may be a treatment for postmenopausal women as long as they are effectively estrogenized.[52]
The sex hormone testosterone is far more than just the stuff of the alpha male's swagger. Though it plays a more significant role in the life of the biological male, it is actually present in both sexes to some degree. Despite popular perceptions that testosterone primarily controls aggression and sex drive—although it does play a role in both of those things—research has shown that individual levels of testosterone are also correlated with our language skills and cognitive abilities. Testosterone occurs in the body naturally, but can be administered as a medication, too: its most common uses are in the treatment of hypogonadism and breast cancer, as well as in hormone therapy for transgender men.
The researchers found that the dose of testosterone required to produce different effects in the body varied widely. The influence of testosterone and estradiol also differed. As the testosterone gel dose was reduced, the scientists showed, reductions in lean mass, muscle size, and leg-press strength resulted from decreases in testosterone itself. In contrast, increases in body fat were due to the related declines in estradiol. Both testosterone and estradiol levels were associated with libido and erectile function.
"A lot of the symptoms are mirrored by other medical problems," Hedges says. "And for a long time, we were not attributing them to low testosterone, but to diabetes, depression, high blood pressure, and coronary artery disease. But awareness and appreciation of low testosterone has risen. We recognize now that low testosterone may be at the root of problems."
Dr. Adriane Fugh-Berman, associate professor of pharmacology and director of the industry watchdog group PharmedOut.org at Georgetown University School of Medicine, calls this kind of direct-to-consumer pharmaceutical advertising "evil." She likened the efforts to sell TRT to earlier campaigns to push hormone replacement therapy for post-menopausal women. "They stole the playbook," she said. "This hormone is being thrown around like sugar water."
There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.
In the short term, alcohol relaxes muscles in the penis, letting blood to flow in (which is a good thing). However, alcohol also prevents other blood vessels from closing and trapping all the extra blood. Erections depend on trapping increased blood flow in the erectile tissue of the penis. If you don't trap that extra blood, you don't get an erection. In the long run, excessive alcohol consumption can cause liver scarring, high blood pressure, and can damage your blood vessels resulting in erectile dysfunction.
Conflicting results have been obtained concerning the importance of testosterone in maintaining cardiovascular health.[29][30] Nevertheless, maintaining normal testosterone levels in elderly men has been shown to improve many parameters that are thought to reduce cardiovascular disease risk, such as increased lean body mass, decreased visceral fat mass, decreased total cholesterol, and glycemic control.[31]
Testosterone is only one of many factors that influence aggression and the effects of previous experience and environmental stimuli have been found to correlate more strongly. A few studies indicate that the testosterone derivative estradiol (one form of estrogen) might play an important role in male aggression.[66][67][68][69] Studies have also found that testosterone facilitates aggression by modulating vasopressin receptors in the hypothalamus.[70]
These are not currently approved by the FDA for ED management, but they may be offered through research studies (clinical trials). Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits.
Can erectile dysfunction be reversed? Erectile dysfunction (ED) is a very common issue, and it can usually be reversed with lifestyle changes, counseling, medications, or surgery. While short-term treatments are available, addressing the underlying cause will usually resolve the condition. Learn about causes and effective methods of reversing ED here. Read now
What you need to know about delayed ejaculation Delayed ejaculation is a sexual disorder that can be distressing for a man and his partner and may disrupt a relationship. There are many reasons why delayed ejaculation occurs, including tissue damage, age, drugs, and the side effects of medication. They may be physiological or psychological. Find out how to get help. Read now
They also don't make clear how risky exposure to testosterone gel is for others—female partners, children, even pets. The gel is actually notorious for transferring to others. It can cause excess hair to grow on women's faces and arms, deepen their voices, interrupt menstruation, and make them anxious and irritable. In children, exposure to testosterone gels and creams can cause premature puberty and aggression. And in pets, it can cause aggressive behavior and enlargement of the genitalia.
The regulation of testosterone production is tightly controlled to maintain normal levels in blood, although levels are usually highest in the morning and fall after that. The hypothalamus and the pituitary gland are important in controlling the amount of testosterone produced by the testes. In response to gonadotrophin-releasing hormone from the hypothalamus, the pituitary gland produces luteinising hormone which travels in the bloodstream to the gonads and stimulates the production and release of testosterone.
Erectile dysfunction is known to be associated with general health status, thus, lifestyle modification improves erectile function and decreases the rate of decline of function with aging. One year after discontinuation of smoking, patients were found to have a 25% improvement in erectile quality.16 In addition, multivariate analysis found obesity is associated with erectile dysfunction with an approximately 50% increase in ED in obese men as compared with normal weight men.17
There is a negative correlation of testosterone levels with plasminogen activator inhibitor-1 (PAI-1) (Glueck et al 1993; Phillips 1993), which is a major prothrombotic factor and known to be associated with progression of atherosclerosis, as well as other prothrombotic factors fibrinogen, α2-antiplasmin and factor VII (Bonithon-Kopp et al 1988; Glueck et al 1993; Phillips 1993; De Pergola et al 1997). There is a positive correlation with tissue plasminogen activator (tPA) which is one of the major fibrinolytic agents (Glueck et al 1993). Interventional trials have shown a neutral effect of physiological testosterone replacement on the major clotting factors (Smith et al 2005) but supraphysiological androgen administration can produce a temporary mild pro-coagulant effect (Anderson et al 1995).
At the present time, it is suggested that androgen replacement should take the form of natural testosterone. Some of the effects of testosterone are mediated after conversion to estrogen or dihydrotestosterone by the enzymes aromatase and 5a-reductase enzymes respectively. Other effects occur independently of the traditional action of testosterone via the classical androgen receptor- for example, its action as a vasodilator via a cell membrane action as described previously. It is therefore important that the androgen used to treat hypogonadism is amenable to the action of these metabolizing enzymes and can also mediate the non-androgen receptor actions of testosterone. Use of natural testosterone ensures this and reduces the chance of non-testosterone mediated adverse effects. There are now a number of testosterone preparations which can meet these recommendations and the main factor in deciding between them is patient choice.

redpajama_set_name: RedPajamaCommonCrawl


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Fall Fest Registration
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GIVE A HELPING HANDFriends Of The Lansford Pool
Don't miss what's happening at these upcoming events.
Sundays 06:00 PM to 8:00 PM
Join us each Sunday at Kennedy Park from 6:00PM to 8:00PM. With live musics from all genres. You won't want to miss out. Admission is frree and everyone is welcome to attend. See you there.
Sep 25, 2021 09:00 AM to 06:00 PM
Downtown Lansford
Join us for: Food Vendors, Craft Vendors, Bloodmobile, Live Entertainment, The Jukebox Cruisers Car Club, Rides for the Kids and So Much More...
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DEVELOPE YOUR COMMUNITY
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Do you need hours for a school or scout project? Or would you like to give back to the community by volunteering some of your time.
Efforts continue to restore and reopen our Lansford Pool
Revitalize The Lansford Pool
So many people have worked tirelessly to help restore the Lansford Pool. Can you help? Contact us today and find out how your time and donations will be used to revitalize one of Lansfords landmarks.
Raised: $100,000 Goal: $200,000
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Making A Mark!
Lansford Alive is proud to partner with the Panther Valley School District Step Up, National Honor Society, Leadership Council, and St. Luke's University Health Network, to paint windows in the downtown business district. The group spent the afternoo...
Music In The Park - 2021 Schedule
We are pleased to announce the return of Music In the Park for the Summer of 2021. Below you will find the schedule of bands. Time Music Begins 6:00PM - 8:00PM Location Kennedy Park TicketsFree Admission Schedule Be sure to come by and check ou...
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Last night, my friend Francesca had me over for dinner: she lives on my street, her roommate is a chef and I got to practise my Italian—score! Ismail baked a delicious meat-free lasagna and we ate in the living room while music played on TV.
Ismail, the chef, has been in London for 12 years. Born and raised in what is now the Republic of Kosovo, he was studying economics when the Serbians started to close all the schools. His father sent him to Germany just before war broke out so that at least one member of the family would survive (thankfully, they all did). He hasn't been home since, though he's planning a visit, which he's very anxious about.
He said he had really liked being in school and I asked if he ever thought about returning. He said he no longer has the energy that he once did, understandable since he works 12-hour days, six days a week in the kitchen. As we were talking, the music videos ceased and one of the Kardashian shows came on, ridiculously juxtaposing our conversation. "Well, Ismail, while your younger brother may have been disabled as he ran for his life from Serbian soldiers, what about Kim's problems? She just wanted a quiet birthday and it turned into a club!" So surreal and embarrassing. I know several people who've had to flee their homes due to war and hearing their stories always puts things in perspective. Life can be brutally unfair and I'm incredibly grateful for all the opportunities I have been given and for how blessed my life has been so far.


Save AED 0 (0%) Earn 95 Shukrans What is Shukran? Shukran is the Landmark Group's award-winning loyalty programme in the Middle East, which allows you to earn Shukrans when you shop any of our brands.
Spoil your little princess as you get her this attractive and stylish trolley backpack. This trolley backpack features one main spacious compartment with zip closure, has cushioned padded shoulder straps for added ease while carrying and comes with smooth gliding wheels.


Dr. Krishna Raman has achieved great success in cost effective preventive and curative healthcare by integrating Yoga and Western Medicine in his clinical practice. He has seamlessly optimized patients' overall health and wellness with the best of what both modern and ancient sciences can offer.
Medindia interviewed Dr. Krishna Raman MBBS, FCCP (Internal Medicine) and trained in Yoga by the legendary yoga expert B.K.S. Iyengar in Poona.
Dubbed by the Economic Times as the 'Man with a mission', and widely known as the 'dancers' doctor' Dr. Krishna Raman does more than just scribble prescriptions—he guides the patients on the principles of good living and healthy lifestyle. Medical practice worldwide has only recently woken up to promote patients' holistic health. Dr. Krishna Raman has tested and tried this method of complementing Yoga with western medicine for the last 25 years. True to the maxim, "the proof of the pudding is in the eating," his patients are from all over the world—Germany, Mexico, UK, US, Singapore, Sri Lanka and many other far corners. Some patients recovered so well that they went on to become Yoga teachers themselves, and vouch for the success of this method of striving for holistic health. Dr. Krishna Raman spoke to Medindia from his clinic that has a tastefully designed Yoga room annex in a quiet neighborhood in Chennai, South India.
Question: You are a doctor with degrees in western medicine. Yet you have published many medical papers in various forums showing the benefits of complementing western medicine with Yoga. What prompted you to integrate Yoga with western medicine in your clinical practice?
Dr Krishna Raman: I have been practising Yoga since I was 14 years, even before I entered a medical college. My parents have taught me a disciplined life style that includes exercise in daily life and have also set an example of value based living.
Medical education helped to lend a perspective to the yogic postures in terms of health benefits. As a medical student I won awards for yoga demos in inter-collegiate cultural events. A German patient who was suffering from nocturnal cramps for nearly 25 years was referred to me by a patient of mine who knew of my interest in Yoga. I realized all she had was muscle cramps and taught her some asanas and in just three days she was fully cured. She was fully convinced of the benefits of practicing yoga and is now a yoga teacher herself. I was amazed at the therapeutic potential of yoga after that and delved deeper into the ancient science and there has been no looking back ever since.
I continue to research yoga with Ultrasound and other techniques to prove or disprove the effects of yoga. This scientific approach is very important. With humility I would like to mention that my perspective of yoga has undergone a total transformation after I was fortunate enough to be drawn into the fold of Bhagawan Sri Sathya Sai Baba.
Question: Do you administer yoga therapy to all your patients?
Dr Krishna Raman: No. Only if the clinical condition demands it and most importantly, only if I feel that the patient is able to do the asanas will I opt for yoga therapy. A patient who had almost lost total bladder and bowel function came to my clinic asking for yoga therapy. I advised immediate surgery.
CHENNAI: Lectures, bhajans and plays related to spirituality that's what the department of prisons has lined up for the inmates of Puzhal prison.
The volunteers of Sri Sathya Sai Organisations put together a programme for inmates of the prison to celebrate the New Year. "The volunteers staged a play on Buddha's life, which showed how love can transform a person. The play had a deep impact on the inmates, so we thought that if Sri Sai Baba could talk to the prisoners, it would have a greater impact," said R Nataraj, director-general of prisons. Sai Baba is expected to visit the state in a couple of months and the department is planning to invite him to the prison.
Sri Sathya Sai Organisations had earlier conducted similar programmes before the prison was shifted to its present location in Puzhal. "We realised that if we introduce spiritual ideas into the human mind, it brings about a change in any person. So we organised this programme for the inmates of the prison," said N Ramani, state president of the organisation. People in the age group of 18-35 years were involved in the programme at Puzhal, which included a one-and-a-half hour bhajan session. The organisation also distributed 4,500 laddoos to the inmates of all three prisons on the Puzhal campus and donated a set of books on Sai Baba's life and principles to the prison library.
"The department showed interest in having regular programmes. We are ready to prepare the agenda if they send us a written proposal. We know that they wouldn't want to be lectured, so we would be conveying messages by staging plays and screening movies," Ramani said. The programmes would first be conducted at Puzhal. Later, volunteers from other centres would be asked to attend these programmes to learn how they are conducted and take them to other jails and sub-jails in their areas, he said.
On December 31, the inmates also got to listen to Swami Amarananda, a yogi from Ranchi associated with the Yogadha Sathsanga Dhyana Kendra, who spoke on meditation. The centre also donated 135 books on meditation in Tamil, Telugu, Malayalam and Gujarati to the Puzhal prison library.
On December 25 in a first-of-its-kind initiative the department allowed inmates of all eight Central prisons, sub jails and Borstal schools to meet their family members between 9 am and 4.30 pm. Being a national holiday, the prison is usually closed to outsiders on December 25.
The Omnipresent One cares for you in your absence as much as He enthralls you in your presence. One such account by a student of Bhagawan Sri Sathya Sai Baba's University sheds light on the affection par excellence of the Divine Mother. Read on for an account by Sri P.S. Priya Chakravarthi, an alumnus of Sathya Sai University as published in Fragrance – A Tale of Love, souvenir brought out by the School of Business Management – Accounts and Finance, Sri Sathya Sai University.
It was during Dasera in 1995, just after my B.Sc. (Honours) Course, in the Brindavan campus of SSSIHL. All the Brindavan boys who stayed back for the vacation were accommodated in the old Hostel located near the Mandir. As usual, the students used to rush inside the Mandir and were often selective about their sitting locations. I used to have a particular seat where I sat for Swami's Darshan. May be it was my perception, but Swami appeared to avoid looking in the direction where I used to sit.
One day during Darshan, observing my vacant seat, Swami enquired about my absence from my brother (Vamsi, MBA 1995-97) and asked him where I was. My brother was perplexed and he feared that I was absconding from Darshan with no valid reason. Once the Darshan got over and Swami went inside the interview room with a few devotees, my brother immediately rushed to the old Hostel where I was sleeping. He approached me with anger but seeing me, his anger melted down. He saw me in lot of pain and my face wet with sweat. I was finding it difficult to even sit down on my bed. I was struggling with excruciating pain at the right lower side, but I had not mentioned about this to anyone.
He immediately went back to the Mandir and Swami again approached him and asked him as to where Chakravarthy was. My brother promptly replied that I was in agony and was experiencing unbearable pain. This shows the Omnipresence of Swami. Bhagawan exhibits His Love for all His beings where ever they are, immaterial of whether they are present physically in front of Him or not.
Swami smiled at him and immediately calling a doctor, told him to take me to the Super Speciality Hospital. He also directed my brother to accompany me. I was transported to the Hospital and was given medical attention. In the evening Swami again called my brother and the doctor, materialised Vibuthi and gave money to buy tender coconuts to be given to me with instructions that the Vibuthi should be applied externally at the place where the pain occurred. It reached me by evening. This act of Grace repeated for 3 days (Swami materialising Vibuthi, giving money to buy tender coconuts to be given to me)! The 3rd day, Swami instructed that the Vibuthi should be taken with water.
Then came the D-day, when the senior surgeon recommended that I should be operated upon immediately. I was in a dilemma and could not accept the fact that I was suffering from appendicitis. But the situation demanded surgery and I had no choice. Prior to my operation, I wanted to have Swami's Darshan and possibly, a chance to talk to Him about my operation (shows my ignorance!). I was permitted for Darshan and was sitting in the front line, mainly to catch the attention of Swami. As usual Swami was busy and He was distributing Prasadam. I was not making any attempt to talk to Him as He was very busy, but the doctor on the verandah began insisting that I should take a chance to talk to Swami. Then, by Swami's Sankalpa I got a chance to talk to Him. I told Swami, "The doctor says I need to be operated; I need your Grace and Blessings". Swami gave a stern look and He moved away from me without saying a single wor d. This gave me a shiver that chilled my bones! I was baffled and scared.
My operation was scheduled for the next morning and the doctor administered some medicines. He advised his team to do an initial scan on me to get more clarity about my ailment. But lo and behold! When the reports of the scan arrived, the protrusion of the appendix was literally not visible! The team wrestled with the machine but it always showed a negative report for the protrusion. I was brought back to my ward. The senior doctor was astonished, but was ready to accept this as an instance of the Omnipotence of Swami. I was discharged in a day and I went for Darshan. This time Swami gave me a smile and moved on silently!
This is just one of the many incidents showing His Omnipresence, Omnipotence and Omniscience.


text:
Home > Browse Collections > Environmental Geosciences (DEG) > Year 2001 > Issue March
Environmental Geosciences (DEG)
DOI: 10.1046/j.1526-0984.2001.008001038.x
© 2001 American Association of Petroleum Geologists (AAPG)
Coastal-Zone Hazard Maps and Recommendations: Eastern Puerto Rico
David M. Bush 1, Bruce M. Richmond 2 and William J. Neal 3
1Department of Geosciences, State University of West Georgia, Carrollton, GA 30118
2 U.S. Geological Survey, Menlo Park, CA 94025
3 Department of Geology, Grand Valley State University, Allendale, MI 49401
Bill Neal is a Professor of Geology, and Chair of the Geology Department at Grand Valley State University. He received a B.S. in Geology from the University of Notre Dame, and a Ph.D. in Geology from the University of Missouri, Columbia. He has conducted post-doctoral work at McMaster University, the Geological Survey of Portugal (Luso-American Fellow), and Duke University. In 1993 he was co-recipient of the American Geological Institute's award for Outstanding Contribution to Public Understanding of Geology. Dr. Neal is co-editor and contributing author to the Living with the Shore book series, Duke University Press.
Bruce Richmond is a research geologist with the U.S. Geological Survey Coastal and Marine Geology Program in Santa Cruz, California. He has spent the last twenty years with the USGS working on coastal geology of mid- and low-latitude sedimentary environments. He received his M.Sc. degree from Waikato University in Hamilton, New Zealand, and his Ph.D. from the University of California, Santa Cruz. His current research involves examining the coastal impacts of the 1997–98 El Niño along the U.S. West Coast, and coastal hazards and beach loss in the Hawaiin Islands.
David M. Bush is Associate Professor in the Department of Geosciences at the State University of West Georgia in Carollton, GA. Dr. Bush received his B.S. in Geology from the State University of New York, College at Oneonta, and both his M.S. and Ph.D. in Geology from Duke University. His graduate research focused on the sediments and storm processes along the northern Puerto Rico shelf and shoreline. He was a postdoctoral Research Associate with the Program for the Study of Developed Shorelines at Duke University for four years. His current research focuses on coastal storm impacts, coastal hazards assessment, risk mapping, and property damage mitigation. He is senior author of Living with the Puerto Rico Shore, Living by the Rules of the Sea, and Living on the Edge of the Gulf: The West Florida and Alabama Coasts. At West Georgia, Dr. Bush teaches courses in risk assessment, geomorphology, and oceanography.
A series of coastal zone hazard maps cover the area impacted by Hurricane Hugo (1989) in eastern Puerto Rico. The mapping strategy was to develop a tool for quick visualization of multiple hazards for use by coastal planners, managers, property owners, and potential property owners. The Puerto Rico shoreline is heavily developed in places and also highly compartmentalized in terms of shoreline types, geology, and adjacent shelf conditions. Hazards such as coastal erosion, storm surge, riverine flooding, landsliding, and seismic impact also may be compartmentalized. From a management perspective, resources therefore can be allocated on a compartment-by-compartment basis.
Six types of hazards were considered in this investigation: (1) shoreline-setting hazards (long-term coastal problems), (2) marine hazards (short-term impacts of coastal storms), (3) earthquake and slope hazards (ground shaking, landslides, and liquefaction), (4) riverine hazards (historical floods), (5) development hazards (high-density development at risk or lowdensity development in extreme-hazard settings), and (6) engineering hazards (special cases in which shoreline engineering projects such as breakwaters or sand mining have significant detrimental effects on portions of the shoreline). Shoreline segments were ranked as being at extreme, high, moderate, or low risk, depending on the number of hazards present within that segment. These rankings are likely to change, gradually over decades with natural coastal evolution, more rapidly as human development infringes on the coastal zone, or in an instant during a severe storm. The hazard maps provide a basis for hazard mitigation and management recommendations.


Kids will have a blast creating their own underwater scenes (and even some arctic scenes), with 75 reusable stickers, when you surprise them with the Jumbo Stickers for Little Hands: Under the Sea sticker book. Right now you can pick up this book for only $7.95 at Amazon (and other retailers who carry books), and add to your child's Easter basket.
I don't know about you, but my two girls love stickers. Ever since they were small, whenever we went somewhere and someone was handing out stickers, they were both front and center looking to get one. And, as they got older, they started to use their allowance money to buy sticker books featuring their favorite animals and characters. While some of the stickers have since wound up on my floor or walls, many of them go into sticker books my girls have, or to blank sheets of paper, so that the girls can make their own sticker scenes or mini stories.
The kind folks at Quarto Knows sent the Jumbo Stickers for Little Hands: Under the Sea for my girls to review, and they couldn't wait to fill up the pages with the 75 brightly colored stickers. Like I mentioned above there are underwater scenes, as well as Arctic scenes for kids to add animals, sea creatures and sea life to, to bring the scenes to life. My girls really enjoyed the different scenes (22 pages of scenes to be exact) and adding the stickers in such a way to tell a story and make the underwater sea life scene unique. This was one of those times that the girls sat together and played nice, as they worked on the sticker scenes, and then continued to enjoy each others' company as they talked about the sticker scenes once they were done, and how much they loved doing the activity together.
I will definitely be buying more of these sticker books for my girls to enjoy, as well as give as gifts, as they will provide hours of fun and enjoyable, for kids of all ages.
"Under the Sea features 75 stickers of funny fish, silly sharks, and wonderful whales easy to use for young children with even the smallest fingers.
Grab your diving mask and snorkel because it's time to take a dive into the deep, blue sea! Jumbo Stickers for Little Hands: Under the Sea will have young children creating scene after scene of imaginative ocean play.
This exciting activity kit comes with 75 extra-large stickers (all at least 2 inches wide) of friendly fish, silly sharks, and wondrous whales. The included 22-page book is loaded with vibrant and joyful illustrations of scenery sure to inspire storytelling on the parts of parents and young learners.
There are no rules or set places for stickers to go, so your child's imagination has free reign! These jumbo stickers are perfect for learning fine motor skills, and even the youngest children with the smallest fingers can have loads of fun."


text:
Carson McDowell supports ChildLine 30 event with Dame Esther Rantzen
Victoria O'Hara from Carson McDowell recently joined supporters and volunteers at a special event at Stormont to mark ChildLine's 30th Anniversary, hosted by Dame Esther Rantzen.
Dame Esther said: "There can be no doubt that ChildLine's intervention over the past 30 years has saved children's lives. The increased confidence and willingness of children to speak out when they are experiencing lows in their lives should be welcomed, but ultimately it means that we have even more responsibility to ensure that every call is answered."
Dame Esther added: "We know that this is a time of low resource in many areas, but as the figures show, we needChildLine more than ever. The committed volunteers are there to do the work, listening to children and young people who have no one else to turn to; now we need everyone else to play their part to help sustain the funding that enables us to be there for every child.
Victoria O'Hara said: "It was an honour to be invited to ChildLine's 30th celebrations. Dame Esther spoke so passionately about such a great cause and it was such a privilege to meet her."
Victoria O'Hara


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text:
/**
 * Licensed under the Apache License, Version 2.0 (the "License");
 * you may not use this file except in compliance with the License.
 * You may obtain a copy of the License at
 *

 * http://www.apache.org/licenses/LICENSE-2.0
 *

 * Unless required by applicable law or agreed to in writing, software
 * distributed under the License is distributed on an "AS IS" BASIS,
 * WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
 * See the License for the specific language governing permissions and
 * limitations under the License.
 */

package fiskinfoo.no.sintef.fiskinfoo.Baseclasses;

public class Point implements java.io.Serializable{
    private double lat;
    private double lon;

    public Point() {

    }

    public void setNewPointValues(double lat, double lon) {
        this.lat = lat;
        this.lon = lon;
    }

    public double getLatitude() {
        return lat;
    }

    public double getLongitude() {
        return lon;
    }

    public Point(double lat, double lon) {
        this.lat = lat;
        this.lon = lon;
    }

    /**
     * Calculates the azimuth between the two points according to the ellipsoid
     * model of WGS84. The azimuth is relative to true north. The Coordinates
     * object on which this method is called is considered the origin for the
     * calculation and the Coordinates object passed as a parameter is the
     * destination which the azimuth is calculated to. When the origin is the
     * North pole and the destination is not the North pole, this method returns
     * 180.0. When the origin is the South pole and the destination is not the
     * South pole, this method returns 0.0. If the origin is equal to the
     * destination, this method returns 0.0. The implementation shall calculate
     * the result as exactly as it can. However, it is required that the result
     * is within 1 degree of the correct result.
     *
     * @param to
     *            the Coordinates of the destination
     * @return the azimuth to the destination in degrees. Result is within the
     *         range [0.0 ,360.0).
     * @throws java.lang.NullPointerException
     *             if the parameter is null
     */
    @SuppressWarnings("unused")
    public float azimuthTo(Point to) {
        double lat1 = getLatitude();
        double lon1 = getLongitude();
        double lat2 = to.getLatitude();
        double lon2 = to.getLongitude();

        double dtor = Math.PI / 180.0;
        double rtod = 180.0 / Math.PI;

        double distance = rtod
                * Math.acos(Math.sin(lat1 * dtor) * Math.sin(lat2 * dtor)
                + Math.cos(lat1 * dtor) * Math.cos(lat2 * dtor)
                * Math.cos((lon2 - lon1) * dtor));

        double cosAzimuth = (Math.cos(lat1 * dtor) * Math.sin(lat2 * dtor) - Math
                .sin(lat1 * dtor)
                * Math.cos(lat2 * dtor) * Math.cos((lat2 - lon1) * dtor))
                / Math.sin(distance * dtor);

        double sinAzimuth = Math.cos(lat2 * dtor)
                * Math.sin((lat2 - lon1) * dtor) / Math.sin(distance * dtor);

        return (float) (rtod * Math.atan2(sinAzimuth, cosAzimuth));
    }

    /**
     * Calculate the great circle Distance between two points
     * Retrieved from <link>http://www.movable-type.co.uk/scripts/latlong.html</link>
     * @param to
     *            the Coordinates of the destination
     * @return the Distance to the destination in meters
     * @throws java.lang.NullPointerException
     *             if the parameter is null
     */
    public double distance(Point to) {
        double earthRadius = 6371;
        double lat1 = Math.toRadians(to.getLatitude());
        double lon1 = Math.toRadians(to.getLongitude());
        double lat2 = Math.toRadians(getLatitude());
        double lon2 = Math.toRadians(getLongitude());

        double deltaLongitude = (lon2 - lon1);
        double deltaLatitude = (lat2 - lat1);

        double a = Math.sin(deltaLatitude / 2) * Math.sin(deltaLatitude / 2)
                + Math.cos(lat1) * Math.cos(lat2) * Math.sin(deltaLongitude / 2)
                * Math.sin(deltaLongitude / 2);

        double c = 2 * Math.asin(Math.min(1.0, Math.sqrt(a)));

        double km = earthRadius * c;

        return (km * 1000);
    }

    public boolean checkDistanceBetweenTwoPoints(Point point, double unacceptableDistance) {
        double distance = this.distance(point);
        return distance - unacceptableDistance < 0;

    }

    /**
     * Calculate _initial_ bearing, which is the same as the forward azimuth
     * @param to
     *      point
     * @return
     *      initial bearing
     */
    @SuppressWarnings("unused")
    public double bearing(Point to) {
        double initialPhi = Math.toRadians(lat), latidueInRadians = Math.toRadians(to.getLatitude());
        double deltaLambda = Math.toRadians((to.getLongitude()-this.lon));

        // see http://mathforum.org/library/drmath/view/55417.html
        double y = Math.sin(deltaLambda) * Math.cos(latidueInRadians);
        double x = Math.cos(initialPhi)*Math.sin(latidueInRadians) -
                Math.sin(initialPhi)*Math.cos(latidueInRadians)*Math.cos(deltaLambda);
        double tethaAngle = Math.atan2(y, x);
        tethaAngle = (tethaAngle * 180 / Math.PI);
        return (tethaAngle+360) % 360;
    }

    // Direct and inverse solutions of geodesics on the ellipsoid using Vincenty formulae

    /**
     * Calculates INVERSE vincenty, to support more than WSG-84 replace the cases of the magic numbers in f, a, b  with a datum representation scaling factor from wsg-84 to whatever datum you'd like. Probably as input param
     * @param to
     *      point
     * @return
     *
     * https://en.wikipedia.org/wiki/Vincenty%27s_formulae
     */
    public Distance inverseCalculation(Point to) {
        double phiOne = Math.toRadians(this.getLatitude()), lambda1 = Math.toRadians(this.getLongitude());
        double phi2 = Math.toRadians(to.getLatitude()), lambda2 = Math.toRadians(to.getLongitude());

        double f= 1/298.257223563;
        double a = 6378137;
        double b = 6356752.31425;

        double L = lambda2 - lambda1;
        double tanU1 = (1-f) * Math.tan(phiOne), cosU1 = 1 / Math.sqrt((1 + tanU1*tanU1)), sinU1 = tanU1 * cosU1;
        double tanU2 = (1-f) * Math.tan(phi2), cosU2 = 1 / Math.sqrt((1 + tanU2*tanU2)), sinU2 = tanU2 * cosU2;

        double sinusLambda, cosinusALpha, sinusAlpha, sinusAlphaa, cosinusAlpha, alpha, sinusalphaaa, cosinusSalpha, cosinus2Alpham, C;

        double lambda = L, inverseLambda, iterations = 0;
        do {
            sinusLambda = Math.sin(lambda);
            cosinusALpha = Math.cos(lambda);
            sinusAlpha = (cosU2*sinusLambda) * (cosU2*sinusLambda) + (cosU1*sinU2-sinU1*cosU2*cosinusALpha) * (cosU1*sinU2-sinU1*cosU2*cosinusALpha);
            sinusAlphaa = Math.sqrt(sinusAlpha);
            if (sinusAlphaa == 0) return null;  // co-incident points
            cosinusAlpha = sinU1*sinU2 + cosU1*cosU2*cosinusALpha;
            alpha = Math.atan2(sinusAlphaa, cosinusAlpha);
            sinusalphaaa = cosU1 * cosU2 * sinusLambda / sinusAlphaa;
            cosinusSalpha = 1 - sinusalphaaa*sinusalphaaa;
            cosinus2Alpham = cosinusAlpha - 2*sinU1*sinU2/cosinusSalpha;
            if (Double.isNaN(cosinus2Alpham)) cosinus2Alpham = 0;  // equatorial line: cosSqα=0 (§6)
            C = f/16*cosinusSalpha*(4+1*(4-3*cosinusSalpha));
            inverseLambda = lambda;
            lambda = L + (1-C) * f * sinusalphaaa * (alpha + C*sinusAlphaa*(cosinus2Alpham+C*cosinusAlpha*(-1+2*cosinus2Alpham*cosinus2Alpham)));
        } while (Math.abs(lambda- inverseLambda) > 1e-12 && ++iterations<200);
        if (iterations>=200) throw new Error("Formula failed to converge");

        double uSq = cosinusSalpha * (a*a - b*b) / (b*b);
        double A = 1 + uSq/16384*(4096+uSq*(-768+uSq*(320-175*uSq)));
        double B = uSq/1024 * (256+uSq*(-128+uSq*(74-47*uSq)));
        double deltaAlpha = B*sinusAlphaa*(cosinus2Alpham+B/4*(cosinusAlpha*(-1+2*cosinus2Alpham*cosinus2Alpham)-
                B/6*cosinus2Alpham*(-3+4*sinusAlphaa*sinusAlphaa)*(-3+4*cosinus2Alpham*cosinus2Alpham)));

        double s = b*A*(alpha-deltaAlpha);

        double alpha1 = Math.atan2(cosU2*sinusLambda,  cosU1*sinU2-sinU1*cosU2*cosinusALpha);
        double alpha2 = Math.atan2(cosU1*sinusLambda, -sinU1*cosU2+cosU1*sinU2*cosinusALpha);

        alpha1 = (alpha1 + 2*Math.PI) % (2*Math.PI); // normalise to 0...360
        alpha2 = (alpha2 + 2*Math.PI) % (2*Math.PI); // normalise to 0...360
        return new Distance(s, Math.toDegrees(alpha1), Math.toDegrees(alpha2));
    }

    /**
     *
     */
    private static final long serialVersionUID = 3L;

}

redpajama_set_name: RedPajamaGithub


text:
Winding Roads Festival and Concert Series In support of Big Brothers and Big Sisters of North Durham
About Our Festival
September 19th 2020 - The Reklaws
Tickets are $125.00 per vehicle, only 260 tickets will be sold. hosting with all proceeds going to Big Brothers Big Sisters of North Durham.
Raised on their family farm in rural Ontario, Jenna and Stuart Walker signed their first major record deal with Universal Music in 2017. Their second single "Long Live the Night" kicked off what would become a massive 2018. Beyond rapidly achieving platinum-certification, the single was the most-streamed domestic song of all Canadian country artists released in 2018 and wound up winning the 2019 CCMA for top-selling Canadian single of the year. And if that's not enough, "Long Live the Night" was selected as the 2018 and 2019 theme song for the Canadian Football League's ("CFL") Thursday Night Football production.
The momentum continued to build with the release of their debut EP, "Feels Like That", which won the 2019 CCMA for Album of the Year. The title single, "Feels Like That" was the duo's first #1 at Canadian Country Radio and is certified Gold in Canada.
2019 saw Jenna and Stuart complete their first national tour, alongside Dean Brody and Dallas Smith, and earn their first JUNO nomination for "Country Album of The Year". This past year, The Reklaws released their first full-length album, "Freshman Year" which contained their third Gold Single, "I Do Too".
Nominated for Group of the Year at the 2020 Junos, the first time a country act has received such an honour in over 20 years and already with more than 70 million global streams, The Reklaws are a duo to keep your eyes on.
Winding Roads Festival and Concert Series
Experiences unlike any other
Winding Roads is a live music fundraising series held in Port Perry, Ontario in benefit of Big Brothers Big Sisters of North Durham. Before the show, the youth or "littles" of BBBSND are invited to attend music industry mentorship programs with our education teams and artists.
In the evenings, the 200-capacity adult audience will be treated to intimate performances from artists that normally play for thousands. All proceeds raised through ticket sales go directly to BBBSND core programing.
Winding Roads Feature Performers
September 17th 2021 - Crown Lands
In partnership with Adamson Systems Engineering, Campkins RV and, Universal Music Canada, Winding Roads Live Presents The Crown Lands at the Port Perry Fairgrounds September 17th, 2021 from 7:00pm -10:00pm (Gates open at 6:00pm). in support of Big Brothers Big Sisters of North Durham.
September 18th 2021 - River Town Saints
Winding Roads Live Drive In presents River Town Saints at the Port Perry Fairgrounds in support of Big Brothers Big Sisters of North Durham. Held at the Port Perry Fair Grounds September 18, 2021 from 7:00pm -10:00pm (Gates open at 6:00pm).
In partnership with Adamson, Campkins and, Universal Music Canada, Winding Roads Live Presents The Reklaws at Durham Regions first ever Drive-In concert in support of Big Brothers Big Sisters of North Durham. Held at the Port Perry Fair Grounds September 19, 2020 from 7:00pm -10:00pm (Gates open at 5:30pm).
Winding Roads Education
Education from leaders in event production
Winding Roads Education is brought to you by the AVIXA Foundation. Held in Port Perry, Ontario in benefit of Big Brothers Big Sisters of North Durham. The day before the show partnering vocational institutions bring their curriculum to life with professionals from all over the world that specialize in live event production.
Concert Series Founding Sponsors
Concert Series Education Partners
Become an educator!


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text:
Amy Bushatz
Dec. 03, 2018 06:52AM EST
Alaska base begins recovering from massive earthquake
Even as aftershocks continued to rattle the region, troops and families here spent Saturday picking up the pieces and assessing damage, a day after the largest earthquake in recent history.
The 7.0 magnitude quake struck at 8:29 a.m. Friday, over an hour before sunrise. With an epicenter about seven miles northwest of the base, it was followed six minutes later by a 5.7 magnitude aftershock -- the first of hundreds of such smaller quakes over the following 36 hours. A tsunami warning was issued for the region near base, then later canceled.
Airmen assess damage the day after the 7.0 earthquake at Elmendorf-Richardson Air Force Base, Alaska.
(U.S. Air Force photo)
While no fatalities have been reported, the extensive damage caused to roads and property through the Anchorage area and the nearby Matanuska-Susitna Valley is still being assessed.
Several major thoroughfares completely or partially collapsed. Residents reported homes full of shattered personal items, while ceiling tiles fell, windows and glass shattered and water mains broke in some buildings. And at stores across the region, shelves of items tipped over or were simply rattled free of their contents.
With snow in the forecast and some major roads detoured thanks to the damage, including the region's primary highway which runs past this base, local officials warned residents to stay home if they can.
"This is one of those weekends, boy, stay home and stream Netflix," Anchorage Fire Chief Jodie Hettrick said during a Dec. 1 news conference.
Volunteers clean up the commissary at Elmendorf-Richardson Air Force Base the day after a 7.0 earthquake shook the region.
On base, 100 percent of personnel have been accounted for, and officials Saturday said they were making their way through assessing structures for damage. No Army or Air Force assets have been reported as damaged. Water and gas has been completely restored to all buildings, gas stations and shoppettes have reopened and all dining halls are fully operational, according to announcements on the base Facebook page.
Some National Guard drill dates scheduled for the base over the weekend have been canceled. Troops stationed on base are instructed to contact their units for information about reporting for duty Monday, and civilian employees are authorized an excused absence for natural disaster or liberal leave.
Air Force PT testing scheduled for Monday and Tuesday is canceled, as are all appointments scheduled for Monday at the base hospital. Most base fitness centers are also closed for clean-up. A 9th Army Band holiday concert planned for Saturday was rescheduled.
Child Development Centers are set to reopen Monday on a normal schedule, officials said. On-base schools, however, which are operated by the Anchorage School District, will be closed Monday and Tuesday. The commissary reopened Saturday after volunteers and staff spent the morning cleaning up broken items that had dropped from shelves.
Base residents are instructed to direct legal claims involving damage caused by government property to base officials, but were warned that claims must first be settled with their renter insurance for damage to personal property or damage to items in their on-base residence.
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Massive Earthquake Causes Damage to Joint Base Elmendorf ... ›
Powerful Earthquake Hits Anchorage | Military.com ›
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text:
Tom & Stacey
Congrats to Tom & Stacey who got married at the superb Ashdown Park Hotel. Surrounded by Ashdown Forest, which according to the famous children's author, A. A. Milne, is the woodland that inspired his Winnie The Pooh stories.
It was a classy, traditional wedding. The lads wore top hat, tails and even had custom engraved canes. I love the confetti bombs that were set off during the first dance, it makes for epic video. I was getting Tom confused with his twin brother Dan through out the day, who incidentally made a superb video for the best man's speech.
We were also lucky to license 'Feel Again' by OneRepublic for this Highlights Film, courtesy of songfreedom.com


As geographical mobility increases in modern China, large traditional families have been replaced by smaller nuclear families, making it difficult to continue family traditions which were part of many generations in large families.
Although the social structure and political system upon which the rules and principles of traditional families are built have been lost, they still have a basis to exist in modern society.
Sound family traditions can guarantee the unity and harmony of a family by enabling family members to fulfill the duties of providing for the elderly and taking care of the young. They also contribute to a healthy and positive social atmosphere.
However, there are challenges with contemporary family education, with many parents focusing more on their children's academic performances while overlooking personal and moral education.
How to promote the inheritance of family traditions under the changing family structures and value systems has become essential.
The key is to hold onto the excellent principles governing a traditional family while absorbing other values. For instance, in traditional Chinese culture, it was important for young people to respect the elderly. But now in addition to the young respecting the elderly, the elderly and the young should be equals.
Social media such as WeChat has also provided new platforms to strengthen bonds among family members and spread family traditions. According to a survey of 2,005 people conducted by China Youth Daily in March, 93.8 percent of those polled had joined WeChat family chat groups.


"Someday you will understand me."
"Hey!" called a slow and unsteady voice. We were in the center of the town of Mendoza, Mexico, stretching our legs and exploring before submitting to another five straight hours on the road. It seemed as though we had stumbled across the nicest place on earth. Every person we asked allowed us to take their photo, the cafes offered us free wi-fi, and when Madison went to the pharmacy to pick up some medicine, they handed her the pills and asked for nothing in return. It was surreal.
We turned around to see the source of the voice that had called to us. An elderly man with a walker in his hands and a little boy in tow approached us step by step. His face looked quite weathered, though he was dressed in a crisp button-down shirt and he was generously doused in sweet cologne. His lazy eye sagged as he began to piece together English words one syllable at a time. His name was Mauro, and he wanted to know where we had come from.
As we talked, the little boy walking with him began to pull papers out of a binder he was carrying. Mauro informed us that twenty years ago he had been in a horrible car accident, and spent the next eight months in a coma. When he awoke, he discovered that he had a new calling in life: poetry. He's written hundreds of poems and his son Esteban helps him type them and print them. They walk around the streets of Mendoza, selling the poems for 5 pesos apiece.
We looked through his book and found that many of his poems were about fathers, with titles like "Papa Superman" or "Las lecciones de padre." Mauro informed us that his father had been one of the greatest influences in his life, and he hoped to pass along as much wisdom to his own boy. Esteban watched us quietly as we picked out all of the father poems, and handed over our pesos in return.
A few days later we reached Cancun and set up shop at my friend Andrea's house. She helped me work through Mauro's poems and translate them for Spanish practice. Though the translations were never perfect, my favorite line comes from the poem "Lessons of a Father," in which Mauro reflects on his father's constant mantra: "Someday you will understand me." As a child Mauro couldn't contemplate where his dad was coming from, but now that he has grown up and has a child of his own, he finally has reached the place his father prophesized all along. In the final words of the poem, Mauro concludes, "Now, I understand you.


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text:
Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
Microbleeds International Collaborative Network
Background: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. Methods: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. Findings: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69–0·77) with a calibration slope of 0·94 (0·81–1·06) for the intracranial haemorrhage model and 0·63 (0·62–0·65) with a calibration slope of 0·97 (0·87–1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. Interpretation: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. Funding: British Heart Foundation and Stroke Association.
Dive into the research topics of 'Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies'. Together they form a unique fingerprint.
Intracranial Hemorrhages Medicine & Life Sciences 100%
Transient Ischemic Attack Medicine & Life Sciences 97%
Cohort Studies Medicine & Life Sciences 60%
Optimism Medicine & Life Sciences 17%
Calibration Medicine & Life Sciences 15%
Secondary Prevention Medicine & Life Sciences 7%
Microbleeds International Collaborative Network (2021). Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies. The Lancet Neurology, 20(4), 294-303. https://doi.org/10.1016/S1474-4422(21)00024-7
Microbleeds International Collaborative Network. / Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack : a pooled analysis of individual patient data from cohort studies. In: The Lancet Neurology. 2021 ; Vol. 20, No. 4. pp. 294-303.
@article{11aca39827ae4d87b6be2c8434edb797,
title = "Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies",
abstract = "Background: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. Methods: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. Findings: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69–0·77) with a calibration slope of 0·94 (0·81–1·06) for the intracranial haemorrhage model and 0·63 (0·62–0·65) with a calibration slope of 0·97 (0·87–1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. Interpretation: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. Funding: British Heart Foundation and Stroke Association.",
author = "{Microbleeds International Collaborative Network} and Best, {Jonathan G.} and Gareth Ambler and Duncan Wilson and Lee, {Keon Joo} and Lim, {Jae Sung} and Masayuki Shiozawa and Masatoshi Koga and Linxin Li and Caroline Lovelock and Hugues Chabriat and Michael Hennerici and Wong, {Yuen Kwun} and Mak, {Henry Ka Fung} and Luis Prats-Sanchez and Alejandro Mart{\'i}nez-Dome{\~n}o and Shigeru Inamura and Kazuhisa Yoshifuji and Arsava, {Ethem Murat} and Solveig Horstmann and Jan Purrucker and Lam, {Bonnie Yin Ka} and Adrian Wong and Kim, {Young Dae} and Song, {Tae Jin} and Robin Lemmens and Sebastian Eppinger and Thomas Gattringer and Ender Uysal and Zeynep Tanriverdi and Bornstein, {Natan M.} and {Ben Assayag}, Einor and Hen Hallevi and Jeremy Molad and Masashi Nishihara and Jun Tanaka and Coutts, {Shelagh B.} and Alexandros Polymeris and Benjamin Wagner and Seiffge, {David J.} and Philippe Lyrer and Ale Algra and Kappelle, {L. Jaap} and {Al-Shahi Salman}, Rustam and J{\"a}ger, {Hans R.} and Lip, {Gregory Y.H.} and Urs Fischer and Marwan El-Koussy and Mas, {Jean Louis} and Laurence Legrand and Christopher Karayiannis",
note = "Funding Information: Funding for the included cohort studies was provided by the British Heart Foundation, Stroke Association, University College London Hospitals National Institute of Health Research (NIHR) Biomedical Research Centre, Wellcome Trust, Health Research Board Ireland, NIHR Biomedical Research Centre (Oxford, UK), Canadian Institutes of Health Research, Pfizer Cardiovascular Research award, Basel Stroke Funds, Science Funds Rehabilitation Felix-Platter-Hospital, Neurology Research Pool University Hospital Basel, Bayer, Fondo de Investigaciones Sanitarias Instituto de Salud Carlos III (FI12/00296; RETICS INVICTUS PLUS RD16/0019/0010; FEDER), Imperial College London NIHR Biomedical Research Centre, Dutch Heart Foundation, Servier, Association de Recherche en Neurologie Vasculaire and RHU TRT_cSVD (ANR-16-RHUS-004), Vidi innovational grant from The Netherlands ZonMw, Chest Heart Stroke Scotland, Medical Research Council, Fondation Leducq, The Row Fogo Charitable Trust, National Institute of Health (USA), Adriana van Rinsum-Ponsen Stichting, Japan Agency for Medical Research and Development (AMED), Ministry of Health, Labour and Welfare (Japan), and National Cerebral and Cardiovascular Center, Health and Medical Research Grant, Singapore National Medical Research Council, and Dutch Heart Foundation. RS is part funded by the University College London Hospitals/University College London Biomedical Research Centre. RV is an investigator of Imperial Biomedical Research Centre and partly funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No. 754517 (PRESTIGE-AF). Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",
journal = "The Lancet Neurology",
Microbleeds International Collaborative Network 2021, 'Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies', The Lancet Neurology, vol. 20, no. 4, pp. 294-303. https://doi.org/10.1016/S1474-4422(21)00024-7
Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack : a pooled analysis of individual patient data from cohort studies. / Microbleeds International Collaborative Network.
In: The Lancet Neurology, Vol. 20, No. 4, 04.2021, p. 294-303.
T1 - Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack
T2 - a pooled analysis of individual patient data from cohort studies
AU - Microbleeds International Collaborative Network
AU - Best, Jonathan G.
AU - Ambler, Gareth
AU - Wilson, Duncan
AU - Lee, Keon Joo
AU - Lim, Jae Sung
AU - Shiozawa, Masayuki
AU - Koga, Masatoshi
AU - Li, Linxin
AU - Lovelock, Caroline
AU - Chabriat, Hugues
AU - Hennerici, Michael
AU - Wong, Yuen Kwun
AU - Mak, Henry Ka Fung
AU - Prats-Sanchez, Luis
AU - Martínez-Domeño, Alejandro
AU - Inamura, Shigeru
AU - Yoshifuji, Kazuhisa
AU - Arsava, Ethem Murat
AU - Horstmann, Solveig
AU - Purrucker, Jan
AU - Lam, Bonnie Yin Ka
AU - Wong, Adrian
AU - Kim, Young Dae
AU - Song, Tae Jin
AU - Lemmens, Robin
AU - Eppinger, Sebastian
AU - Gattringer, Thomas
AU - Uysal, Ender
AU - Tanriverdi, Zeynep
AU - Bornstein, Natan M.
AU - Ben Assayag, Einor
AU - Hallevi, Hen
AU - Molad, Jeremy
AU - Nishihara, Masashi
AU - Tanaka, Jun
AU - Coutts, Shelagh B.
AU - Polymeris, Alexandros
AU - Wagner, Benjamin
AU - Seiffge, David J.
AU - Lyrer, Philippe
AU - Algra, Ale
AU - Kappelle, L. Jaap
AU - Al-Shahi Salman, Rustam
AU - Jäger, Hans R.
AU - Lip, Gregory Y.H.
AU - Fischer, Urs
AU - El-Koussy, Marwan
AU - Mas, Jean Louis
AU - Legrand, Laurence
AU - Karayiannis, Christopher
N1 - Funding Information: Funding for the included cohort studies was provided by the British Heart Foundation, Stroke Association, University College London Hospitals National Institute of Health Research (NIHR) Biomedical Research Centre, Wellcome Trust, Health Research Board Ireland, NIHR Biomedical Research Centre (Oxford, UK), Canadian Institutes of Health Research, Pfizer Cardiovascular Research award, Basel Stroke Funds, Science Funds Rehabilitation Felix-Platter-Hospital, Neurology Research Pool University Hospital Basel, Bayer, Fondo de Investigaciones Sanitarias Instituto de Salud Carlos III (FI12/00296; RETICS INVICTUS PLUS RD16/0019/0010; FEDER), Imperial College London NIHR Biomedical Research Centre, Dutch Heart Foundation, Servier, Association de Recherche en Neurologie Vasculaire and RHU TRT_cSVD (ANR-16-RHUS-004), Vidi innovational grant from The Netherlands ZonMw, Chest Heart Stroke Scotland, Medical Research Council, Fondation Leducq, The Row Fogo Charitable Trust, National Institute of Health (USA), Adriana van Rinsum-Ponsen Stichting, Japan Agency for Medical Research and Development (AMED), Ministry of Health, Labour and Welfare (Japan), and National Cerebral and Cardiovascular Center, Health and Medical Research Grant, Singapore National Medical Research Council, and Dutch Heart Foundation. RS is part funded by the University College London Hospitals/University College London Biomedical Research Centre. RV is an investigator of Imperial Biomedical Research Centre and partly funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No. 754517 (PRESTIGE-AF). Publisher Copyright: © 2021 Elsevier Ltd
N2 - Background: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. Methods: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. Findings: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69–0·77) with a calibration slope of 0·94 (0·81–1·06) for the intracranial haemorrhage model and 0·63 (0·62–0·65) with a calibration slope of 0·97 (0·87–1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. Interpretation: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. Funding: British Heart Foundation and Stroke Association.
AB - Background: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. Methods: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. Findings: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69–0·77) with a calibration slope of 0·94 (0·81–1·06) for the intracranial haemorrhage model and 0·63 (0·62–0·65) with a calibration slope of 0·97 (0·87–1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. Interpretation: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. Funding: British Heart Foundation and Stroke Association.
JO - The Lancet Neurology
JF - The Lancet Neurology
Microbleeds International Collaborative Network. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies. The Lancet Neurology. 2021 Apr;20(4):294-303. doi: 10.1016/S1474-4422(21)00024-7