text:
Assessment of the LDL-C/HDL-C ratio as a predictor of one year clinical outcomes in patients with acute coronary syndromes after percutaneous coronary intervention and drug-eluting stent implantation
Zhixiong Zhong1,3,4,5,7,8 na1,
Jingyuan Hou2,3,4,5,6,7,8 na1,
Qifeng Zhang1,3,4,5,7,
Wei Zhong1,3,4,5,7,
Bin Li1,3,4,5,7,
Cunren Li1,3,4,5,7,
Zhidong Liu1,3,4,5,7,
Min Yang1,3,4,5,7 &
Pingsen Zhao ORCID: orcid.org/0000-0001-5178-36642,3,4,5,6,7,8
Lipids in Health and Disease volume 18, Article number: 40 (2019) Cite this article
Despite significant advances in the management of acute coronary syndromes (ACS), there are still plenty of patients undergoing percutaneous coronary intervention (PCI) and stent implantation suffered poor prognosis and high treatment expenditure. Evidence increasingly suggests that the ratio of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio might be a novel marker for the risk of atherosclerotic cardiovascular disease, but the impact of LDL-C/HDL-C ratio on 1-year prognosis of drug-eluting stent (DES) implantation patients after PCI is still not reported. Our aim of the study was to investigate the impact of LDL-C/HDL-C ratio on 1-year prognosis of DES implantation patients after PCI.
Between May 2014 and July 2016, 1937 patients who were underwent primary PCI and DES implantation and achieving LDL-C with statins were enrolled and divided into two groups based on the ratio of LDL-C/HDL-C.
The entire occurrence of adverse cardiovascular events according to the ratio of LDL-C/HDL-C showed that there were no significant differences in 1-year cardiovascular death (hazard ratio [HR]: 1.97, 95% confidence interval [CI]: 0.49 to 7.84, P = 0.329), myocardial infarction (MI) (HR: 1.66, 95% CI: 0.84 to 3.28, P = 0.172) and bleeding events (HR: 1.08, 95% CI: 0.83 to 1.41, P = 0.598) The cumulative incidence of target lesion revascularization (TLR) (HR: 1.43, 95% CI: 1.10 to 1.86, P = 0.007), stent thrombosis (ST) (HR: 2.04, 95% CI: 1.06 to 3.93, P = 0.037) and major adverse cardiac events (MACE) (HR: 1.54, 95% CI: 1.24 to 1.91, P < 0.001) were significantly higher in high group than in low group. Multivariate Cox regression analysis revealed that age (HR: 1.556, 95%, CI: 1.198 to 2.021, P < 0.001), together with diabetes mellitus (HR: 1.490, 95% CI: 1.142 to 1.945, P = 0.003), and ratio of LDL-C/HDL-C (HR: 1.638, 95% CI: 1.260 to 2.218, P < 0.001) were independent predictors of 1-year MACE. The Kaplan-Meier cumulative MACE-free survival curves with a log-rank test showed that the presence of high ratio of LDL-C/HDL-C was associated with higher incidences of MACE after PCI with DES implantation.
The high LDL-C/HDL-C ratio was associated with cardiovascular events in patients with ACS after PCI and DES implantation.
Cardiovascular diseases (CAD) is a significant global health problem and is considered as the leading cause of death worldwide [1]. Currently, approximately 46 million people in China are affected by CAD with the changes lifestyle and longer life spans [2]. With the introduced of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI), substantial breakthrough have been made in the treatment of CAD, especially in patients with acute coronary syndromes (ACS) [3, 4]. In particular, the advent of drug-eluting stent (DES) has significantly reduced the occurrence of vessel revascularization and major adverse cardiac events (MACE) [5, 6]. Despite significant advances in the management of ACS, there are still plenty of patients undergoing PCI and stent implantation suffered poor prognosis and high treatment expenditure attribute to the varying disease severity [7, 8]. Therefore, identifying cardiovascular risk factors that affect the prognosis of patients and implementation of treatments to minimize risk of new ischemic events after PCI treatment is necessary [9,10,11,12].
Previous literature has illustrated that dyslipidemia is a risk factor for development and progression of coronary arteriosclerosis and cardiovascular outcomes in patients with CAD [13, 14]. Our previous research confirmed that serum lipid levels varied in age and gender in Hakka patients with acute myocardial infarction (AMI). Dyslipidemia is more prevalent in the non-elderly than in the elderly for males. Levels of total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were higher in females than in males for the elderly Hakka population in southern China [15]. Numerous evidences have revealed that LDL-C serum concentrations correlate with very high cardiovascular risk and stringent LDL-C lowering with statins therapy is recommended for the secondary prevention of recurrent cardiovascular events and survival improvement after PCI by the current international guidelines [16, 17]. Another research of ours found that PCI patients with lower preprocedural LDL-C were less risky to periprocedural myocardial injury in southern China [18]. Data from patients treated with statins show considerable gains by approximately 22% per 1.0 mmol/L LDL-C reduction [19]. However, many patients achieving very low levels of LDL-C showing widely different treatment effects and subsequently experienced a cardiovascular event because of the residual risk factors [11, 13]. Recently, serum levels of high-density lipoprotein cholesterol (HDL-C) was recognized significantly and inversely associated with the development of atherosclerotic cardiovascular diseases [20, 21]. Evidence increasingly suggests that the ratio of LDL-C/HDL-C ratio might be a novel marker of the risk of atherosclerotic cardiovascular disease, as it simultaneously evaluates the levels of both LDL-C and HDL-C [22, 23]. However, there is little information regarding the predictive value of the LDL-C/HDL-C ratio for detecting cardiovascular events in patients with ACS after DES implantation and more studies are needed to further characterize the relationship between the LDL-C/HDL-C ratio and clinical outcome. The purpose of this study was to investigate the impact of LDL-C/HDL-C ratio on 1-year prognosis of DES implantation patients after PCI.
This was a retrospective observational study. Between May 2014 and July 2016, a total of 1937 consecutive participants who had the initiation of statins therapy with atorvastatin after successful primary PCI were enrolled from the patients who had been hospitalized at department of cardiology in the Meizhou People's Hospital. All patients had measurements of serum lipid profiles at baseline and at 4 weeks after atorvastatin therapy and lipid levels were found to remain constant during 1-year follow up. The study protocol was approved by the Ethics Committee of Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Guangdong province, China, and conforms to the ethical principles of the Declaration of Helsinki. All participants have signed the written informed consents.
Patients were eligible for enrollment if (1) if they were18 years of age or older; (2) if they were atorvastatin-treated who underwent PCI for symptomatic coronary artery disease and DES implantation. Exclusion criteria were severe liver and kidney dysfunctions, malignant tumors, severe autoimmune diseases. Patients whose lipid levels were found to change dynamically during 1-year follow up were also excluded from the study.
Sample collection and follow-up
Detailed medical charts were performed of the initial hospitalization to obtain patients' medical history, laboratory results, and medications. For blood lipid detection, fasting blood samples were collected from each subject and anticoagulated with ethylenediamine tetraacetic acid (EDTA) dipotassium salt in the early morning. The sample was separated immediately by centrifugation at 3000 g for 15 min at 4 °C to retrieve plasma. Lipid profiles were measured enzymatically on a chemistry analyzer (AU5400 analyzer, Beckman Coulter, CA, USA).
Follow-up were scheduled from the date of discharge for the index hospitalization. Follow-up data were collected by telephone interviews and entered into a computer database by trained staff and by inviting patients or their relatives to complete a standardized questionnaire which was sent to the patients during the follow-up collection period. The preferred definition of MACE was the composite of cardiovascular death, nonfatal myocardial infarction (MI), and target lesion revascularization (TLR), stent thrombosis (ST). All-cause death was defined as any death during or after the procedure and was considered to be of cardiac origin unless a definite noncardiac cause could be established. MI was defined as a recent ischaemic symptom with new electrocardiographic changes and a positive troponin concentration exceed the upper limit of normal. TLR was defined as repeated revascularization of the target vessel by PCI or surgical bypass of any vessel. ST and bleeding events were assessed according to the Bleeding Academic Research Consortium classification [24].
All statistical analyses were performed with the SPSS 19.0 statistical package program (SPSS, Chicago, IL, USA). Continuous variables were expressed as mean ± standard deviation (SD) and categorical variables as percentage. Analysis of variance and the chi-square test were used for continuous and categorical variables, respectively. Multivariate Cox regression analysis using the entered method was used to evaluate the independent predictors of clinical endpoint. MACE event-free rates for clinical outcomes were constructed using the Kaplan-Meier method and compared with the log-rank test. A P < 0.05 was recognized as statistically significant.
Patient characteristics
A flow chart of the patient enrollment was provided as Fig. 1. Subsequent to coronary angiography, a total of 1968 consecutive ACS patients who underwent PCI with successful DES implantation and cholesterol-lowering therapy with atorvastatin were enrolled, of whom 1937 eligible patients were included in this analysis. Patients were allocated into low and high ratio groups according to the median value of the LDL-C/HDL-C ratio (the median value was 2.7) in each subgroup of study patients. The baseline clinical and demographic characteristics of the recruited patients were detailed in Table 1. The patients in low group were older than those of the high group. There was a higher proportion of ST-elevation myocardial infarction (STEMI) in low group compared to the high group. There were statistically significant differences in term of dyslipidemia, TG, LDL-C, HDL-C, hemoglobin and platelet. No significant differences were observed for other variables between the two groups.
Flow chart of patient enrollment
Table 1 Baseline characteristics of the study cohorts
Table 2 shows the entire occurrence of adverse cardiovascular events according to the ratio of LDL-C/HDL-C. We found that there were no significant differences in 1-year cardiovascular death (hazard ratio [HR]: 1.97, 95% confidence interval [CI]: 0.49 to 7.84, P = 0.329), MI (HR: 1.66, 95% CI: 0.84 to 3.28, P = 0.172) and bleeding events (HR: 1.08, 95% CI: 0.83 to 1.41, P = 0.598). The cumulative incidence of TLR (HR: 1.43, 95% CI: 1.10 to 1.86, P = 0.007), ST (HR: 2.04, 95% CI: 1.06 to 3.93, P = 0.0368) and MACE (HR: 1.54, 95% CI: 1.24 to 1.91, P < 0.001) were significantly higher in high group than in low group. Multivariate Cox regression analysis of the association between the MACE and multiple parameters are presented in Table 3. The results of the multivariable Cox proportional hazards model demonstrated that age (HR: 1.556, 95%, CI:1.198 to 2.021, P < 0.001), together with diabetes mellitus (HR: 1.490, 95% CI:1.142 to 1.945, P = 0.003), and ratio of LDL-C/HDL-C (HR: 1.638, 95% CI:1.260 to 2.218, P < 0.001) were independent predictors of 1-year MACE. Detailed results of the multivariable analysis were shown in Table 3. The Kaplan-Meier cumulative MACE-free survival curves with a log-rank test showed that the presence of high ratio of LDL-C/HDL-C was associated with higher incidences of MACE after PCI with DES implantation (Fig. 2).
Table 2 Clinical outcome up to 1-year
Table 3 Results of a multivariable Cox proportional hazards model
Kaplan-Meier curves for 1-year cardiovascular events
To the best of our knowledge, this is the first study reporting regards the associations of LDL-C/HDL-C ratio with the incidences of 1-year adverse outcomes of ACS patients treated with atorvastatin after PCI and DES implantation in Chinese population. In the present study, we found that the rate of TLR, ST and MACE in patients with the high LDL-C/HDL-C ratio was significantly greater than those with the low LDL-C/HDL-C ratio at 1-year follow-up. The result of multivariate analysis showed that older age, diabetes mellitus and the high ratio of LDL-C/HDL-C factors were positively associated with the accumulated MACE during 1-year follow-up. The results presented here indicate that of LDL-C/HDL-C ratio was predictor of MACE at one year in patients with ACS who underwent PCI and DES.
ACS is one of leading cause of death in developed and developing countries. PCI and the application of stents resulted in tremendous progress on the management of patients with ACS, which dramatically reduces the cardiovascular mortality and disability rates [4, 6]. ST and other adverse cardiovascular events, including death, MI, TLR and bleeding events, are considered as life-threatening complications of PCI [25]. Dual antiplatelet therapy consisting of aspirin and clopidogrel is the standard therapy choice for patients with ACS after PCI. However, some patients on standard dual antiplatelet therapy still have at risk of adverse cardiovascular events after DES implantation due to the existence of high platelet reactivity, genetic variation with drug response, older age and dyslipidemia [7, 8, 13].
Numerous of evidences have already revealed that LDL-C serum concentrations is associated with cardiovascular risk and intensive treatment with statin is recommended to reduce the rate of recurrent ischaemic events and stent thrombosis in patients with ACS [13, 26]. Every 1.0 mmoL/L reduction in LDL-C is associated with a corresponding 20–25% reduction in cardiovascular mortality and non-fatal myocardial infarction. According to the current European guidelines, as well as the US guidelines, a treatment goal of LDL-C < 70 mg/dL is recommended [16, 17]. In spite of the emphasis of guidelines on the tight control of the LDL-C level, several surveys have shown that still a large number of patients remain undertreated and do not attain LDL-C treatment goals [11, 12, 27]. Similarly, our result is in line with that reported in previous studies.
It is also important to note that mixed dyslipidaemia played an important role in the propagation of coronary artery disease [28]. Epidemiological data have demonstrated that low levels of high-density lipoprotein cholesterol (HDL-C) was an important risk factor for progression of coronary atherosclerosis and moderate increases in HDL-C in statin-treated patients are correlated with regression of coronary atherosclerosis [20, 29, 30]. It has been also suggested that HDL-C could reduce the risk and extent of PCI-related myocardial infarction by stabilizing plaques. However, a paradoxical decrease in HDL-C levels after statin therapy is often seen in clinical settings. Previous lipid-lowering trial have shown that the stable lipid level after statin treatment is achieved after 4–6 weeks, and then the lowered lipid level remained during the subsequent maintenance treatment [26, 31]. Take these things together, the ratio of LDL-C/HDL-C ratio might be the useful indicators for prognosis prediction as it simultaneously evaluates the levels of both LDL-C and HDL-C. Some recent studies have considered the LDL-C/HDL-C ratio to be a sensitive marker of the risk of atherosclerotic cardiovascular disease, as it simultaneously evaluates the levels of both LDL-C and HDL-C [32, 33]. Several studies have previously demonstrated the LDL-C/HDL-C ratio is an important contributor to the development of new coronary artery disease in patients with a previous history of PCI [22]. Moreover, a prior report has found that the LDL-C/HDL-C ratios is a useful indicator for preventing the progression of atherosclerotic cardiovascular disease [34]. In the present study, our results indicated that the high LDL-C/HDL-C ratio group was at a high risk of 1-year adverse outcomes in patients with ACS after PCI and DES implantation. In addition, several factors including advanced age, diabetes mellitus and major organ dysfunction are well-established predictors of worse clinical outcomes in patients with ACS or PCI [9, 35, 36]. In current study, the multivariable Cox hazards analysis of MACE in our study revealed that older age, diabetes mellitus and the high ratio of LDL-C/HDL-C were independent predictors for the MACE at 1-year follow up. Moreover, the Kaplan-Meier cumulative MACE-free survival curves with a log-rank test also showed that the presence of high ratio of LDL-C/HDL-C might serve as a predictor of one year clinical outcomes in patients with ACS after PCI and DES implantation. Our results are consistent with the findings from previous study.
Our study has several limitations. First, a major limitation is its retrospective design and was subject to bias. Second, as this is a single center study and the sample size was relatively small, the evidence may not be as persuasive as that obtained by a larger scale and multiple regions. Third, the follow-up period was relatively short, a long-term prospective large-scale study is needed.
In conclusion, the results of this study found that the high LDL-C/HDL-C ratio was associated with cardiovascular events in patients with ACS after PCI and DES implantation. For patients with ACS after DES implantation, LDL-C/HDL-C ratio may help in planning more aggressive cholesterol-lowering therapy to improve the clinical outcome. Further large prospective studies are needed to confirm and to reveal clinical implications of our findings.
ACEI:
Angiotensin-converting enzymeinhibitor
ACS:
AMI:
ARB:
Angiotensin receptor blocker
CABG:
CAD:
DES:
Drug-eluting stents
EDTA:
Ethylenediamine tetraacetic acid
HDL-C:
High-density lipoprotein cholesterol
LAD:
Left anterior descending artery
LCX:
Left circumflex artery
LDL-C:
Low-density lipoprotein cholesterol
MACE:
Major adverse cardiac events
NSTEMI:
Non-ST elevation myocardial infarction
PCI:
PPI:
Proton-pump inhibitor
RCA:
Stent thrombosis
STEMI:
ST elevation myocardial infarction
TC:
Total cholesterol
TG:
TLR:
Target lesion revascularization
Li H, Ge J. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–171.
Li H, Ge J. Cardiovascular diseases in China: current status and future perspectives. Int J Cardiol Heart Vasc. 2015;6:25–31.
Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;2014(35):2541–619.
Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, et al. Comparing mortality between coronary artery bypass grafting and percutaneous coronary intervention with drug-eluting stents in elderly with diabetes and multivessel coronary disease. Heart Vessel. 2016;31:1424–9.
Laskey WK, Yancy CW, Maisel WH. Thrombosis in coronary drug-eluting stents: report from the meeting of the circulatory system medical devices advisory panel of the Food and Drug Administration Center for devices and radiologic health, December 7-8. 2006. Circulation. 2007;115:2352–7.
Babapulle MN, Joseph L, Belisle P, Brophy JM, Eisenberg MJ. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet. 2004;364:583–91.
Kaneko H, Yajima J, Oikawa Y, Tanaka S, Fukamachi D, Suzuki S, et al. Impact of aging on the clinical outcomes of Japanese patients with coronary artery disease after percutaneous coronary intervention. Heart Vessel. 2014;29:156–64.
Simon T, Verstuyft C, Mary-Krause M, Quteineh L, Drouet E, Meneveau N, et al. Genetic determinants of response to clopidogrel and cardiovascular events. N Engl J Med. 2009;360:363–75.
Beckman JA, Paneni F, Cosentino F, Creager MA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. Eur Heart J. 2013;34:2444–52.
Hong SJ, Kim MH, Ahn TH, Ahn YK, Bae JH, Shim WJ, et al. Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes. Heart. 2006;92:1119–24.
Ogita M, Miyauchi K, Miyazaki T, Naito R, Konishi H, Tsuboi S, et al. Low high-density lipoprotein cholesterol is a residual risk factor associated with long-term clinical outcomes in diabetic patients with stable coronary artery disease who achieve optimal control of low-density lipoprotein cholesterol. Heart Vessel. 2014;29:35–41.
Landes U, Kornowski R, Assali A, Vaknin-Assa H, Greenberg G, Lev EI, et al. Predictors of long term outcomes in 11,441 consecutive patients following percutaneous coronary interventions. Am J Cardiol. 2015;115:855–9.
Arsenault BJ, Rana JS, Stroes ES, Despres JP, Shah PK, Kastelein JJ, et al. Beyond low-density lipoprotein cholesterol respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. J Am Coll Cardiol. 2009;55:35–41.
Hosseini SK, Tahvildari M, Alemzadeh Ansari MJ, Nakhjavani M, Esteghamati A, Lotfi Tokaldany M. Clinical lipid control success rate before and after percutaneous coronary intervention in Iran; a single center study. Iran Red Crescent Med J. 2013;15:467–72.
Zhong Z, Liu J, Li B, Li C, Liu Z, Yang M, et al. Serum lipid profiles in patients with acute myocardial infarction in Hakka population in southern China. Lipids Health Dis. 2017;16:246.
Wada H, Ogita M, Miyauchi K, Shitara J, Endo H, Doi S, et al. Impact of gender difference on long-term outcomes of percutaneous coronary intervention for coronary artery disease in patients under statin treatment. Heart Vessel. 2017;32:16–21.
Laufs U, Karmann B, Pittrow D. Atorvastatin treatment and LDL cholesterol target attainment in patients at very high cardiovascular risk. Clin Res Cardiol. 2016;105:783–90.
Zhong Z, Liu J, Zhang Q, Zhong W, Li B, Li C, et al. Relationship between preoperative low-density lipoprotein cholesterol and Periprocedural myocardial injury in patients following elective percutaneous coronary intervention in southern China. Med Sci Monit. 2018;24:4154–61.
Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81.
Sattler KJ, Herrmann J, Yun S, Lehmann N, Wang Z, Heusch G, et al. High high-density lipoprotein-cholesterol reduces risk and extent of percutaneous coronary intervention-related myocardial infarction and improves long-term outcome in patients undergoing elective percutaneous coronary intervention. Eur Heart J. 2009;30:1894–902.
Seo SM, Choo EH, Koh YS, Park MW, Shin DI, Choi YS, et al. High-density lipoprotein cholesterol as a predictor of clinical outcomes in patients achieving low-density lipoprotein cholesterol targets with statins after percutaneous coronary intervention. Heart. 2011;97:1943–50.
Endo A, Yoshida Y, Kageshima K, Sato H, Suga T, Nasu H, et al. Contributors to newly developed coronary artery disease in patients with a previous history of percutaneous coronary intervention beyond the early phase of restenosis. Intern Med. 2014;53:819–28.
Matsumoto I, Miyake Y, Mizukawa M, Takagi Y. Impact of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio on long-term outcome in patients undergoing percutaneous coronary intervention. Circ J. 2011;75:905–10.
Ndrepepa G, Schuster T, Hadamitzky M, Byrne RA, Mehilli J, Neumann FJ, et al. Validation of the bleeding academic research consortium definition of bleeding in patients with coronary artery disease undergoing percutaneous coronary intervention. Circulation. 2012;125:1424–31.
Sibbing D, Stegherr J, Latz W, Koch W, Mehilli J, Dorrler K, et al. Cytochrome P450 2C19 loss-of-function polymorphism and stent thrombosis following percutaneous coronary intervention. Eur Heart J. 2009;30:916–22.
Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495–504.
Miyauchi K, Ray K. A review of statin use in patients with acute coronary syndrome in Western and Japanese populations. J Int Med Res. 2013;41:523–36.
Stoll G, Bendszus M. Inflammation and atherosclerosis: novel insights into plaque formation and destabilization. Stroke. 2006;37:1923–32.
Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA. 2006;295:1556–65.
Li XL, Guo YL, Zhu CG, Xu RX, Qing P, Wu NQ, et al. Relationship of high-density lipoprotein cholesterol with periprocedural myocardial injury following elective percutaneous coronary intervention in patients with low-density lipoprotein cholesterol below 70 mg/dL. J Am Heart Assoc. 2015;4:e001412.
Yun KH, Oh SK, Rhee SJ, Yoo NJ, Kim NH, Jeong JW. 12-month follow-up results of high dose rosuvastatin loading before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol. 2011;146:68–72.
Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007;357:1301–10.
Kurebayashi N, Yoshikawa D, Ishii H, Sato B, Ando H, Okada T, et al. Impact of the low- to high-density lipoprotein cholesterol ratio on composition of angiographically ambiguous left main coronary artery plaque. Circ J. 2011;75:1960–7.
Nicholls SJ, Tuzcu EM, Sipahi I, Grasso AW, Schoenhagen P, Hu T, et al. Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA. 2007;297:499–508.
Goldfine AB. Assessing the cardiovascular safety of diabetes therapies. N Engl J Med. 2008;359:1092–5.
Donahoe SM, Stewart GC, McCabe CH, Mohanavelu S, Murphy SA, Cannon CP, et al. Diabetes and mortality following acute coronary syndromes. JAMA. 2007;298:765–75.
The author would like to thank other colleagues whom were not listed in the authorship of Clinical Core Laboratory and Clinical Core Laboratory, Center for Precision Medicine, Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University for their helpful comments on the manuscript.
This study was supported by The National Key Research and Development Program of China (Grant No.: 2017YFD0501705 to Dr. Pingsen Zhao), Natural Science Foundation of Guangdong Province, China (Grant No.: 2016A030307031 to Dr. Pingsen Zhao), The National Key Research and Development Program of China (Grant No.: 2016YFD0500405 to Dr. Pingsen Zhao), Medical Scientific Research Foundation of Guangdong Province, China (Grant No.: A2016306 to Dr. Pingsen Zhao) and Key Scientific and Technological Project of Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Guangdong Province, China (Grant No.: MPHKSTP-20170102 to Dr. Pingsen Zhao), and Medical Scientific Research Foundation of Guangdong Province, China (Grant No.: A2017404 to Dr. Jingyuan Hou).
Zhixiong Zhong and Jingyuan Hou contributed equally to this work.
Center for Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
Zhixiong Zhong
, Qifeng Zhang
, Wei Zhong
, Bin Li
, Cunren Li
, Zhidong Liu
& Min Yang
Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
Jingyuan Hou
& Pingsen Zhao
Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, 514031, People's Republic of China
, Jingyuan Hou
, Min Yang
Guangdong Provincial Engineering and Technological Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, People's Republic of China
Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou, 514031, People's Republic of China
Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, 514031, People's Republic of China
Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, No 63 Huangtang Road, Meijiang District, Meizhou, 514031, People's Republic of China
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PZ conceived and designed the experiments; ZZ, JH and PZ recruited subjects and collected clinical data. JH conducted the laboratory testing. QZ, WZ, BL, CL, ZL and MY helped to analyze the data. PZ, ZZ and JH prepare the manuscript. PZ and ZZ reviewed the manuscript. All authors read and approved the final manuscript.
Correspondence to Pingsen Zhao.
Zhong, Z., Hou, J., Zhang, Q. et al. Assessment of the LDL-C/HDL-C ratio as a predictor of one year clinical outcomes in patients with acute coronary syndromes after percutaneous coronary intervention and drug-eluting stent implantation. Lipids Health Dis 18, 40 (2019) doi:10.1186/s12944-019-0979-6
Drug-eluting stent implantation
Low-density lipoprotein
High-density lipoprotein


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Today is 45th annual Great American Smokeout
Claiborne county mayor mandates masks
By Jan Runions
Published 5:01 am Saturday, November 21, 2020
Claiborne mayor Joe Brooks issued a mandate Friday evening requiring all county residents to wear a face covering while in public spaces or inside any county-owned buildings. The mandate will run from Nov. 24 through Dec. 31, at which time Brooks will reevaluate the issue.
The Executive Order comes after a sharp rise within the last few days in the number of those testing positive for COVID-19. There are exceptions to the mandate, which follow:
Within a person's own home or automobile, unless transporting others for hire
Children 12 years old or younger
People who have trouble due to an underlying health condition or another medical reason
People who are incapacitated or unable to remove the facial covering without assistance
While eating or drinking
While outdoors unless the person cannot maintain appropriate social distancing from others outside of the person's family members
While working under conditions where appropriate social distancing from others outside of the person's family is maintained
In situations in which wearing a face-covering poses a security or safety risk
While in a house of worship, unless required by that house of worship, but wearing a face-covering is strongly encouraged
While in a voting site for the purpose of voting or administering an election, but wearing a facial covering at voting locations is strongly encouraged
Brooks chose to publish the news release on his Claiborne County Mayor Facebook page Friday evening, which drew immediate responses both in favor and against the action. A substantial portion of those commenting used strong language to express their appreciation for the mandate or opposition against the measure.
The release is reprinted here, in its entirety.
Citizens, being County Mayor is one of the absolute best jobs. I count it as a privilege to be able to represent Claiborne County on the state level and national level while advocating for new opportunities for our county. Most every day presents itself with good opportunities that I am excited to face head-on. However, there are times when being in a leadership role is hard. No situation is any more difficult to navigate through then our current environment when looking at what our county is going through with regards to COVID-19.
As most of you know, early on I reported daily numbers of both positive and negative test results. While doing this I advocated on the state level with the Tennessee Department of Health to change the reporting. I, and several of my other County Mayors were effective as the state started to report the total number of active cases in each county rather than just the total number of positive cases over that of the total number of negative cases. Under that system of reporting, our positive cases were exploding as that number grew daily while the negative case numbers were not being added to for fourteen days. In my opinion the numbers were skewed and a new system of reporting needed to be adopted to present a more accurate picture of what was happening.
Now that we have daily reporting of active cases I feel we have a more accurate number of individuals here in Claiborne County that are currently dealing with COVID-19. In the beginning, our numbers were relatively low and I, like most, felt Claiborne County was in a good place with regards to the virus. However, our daily numbers are painting a rather grim picture; our cases are exploding. Over the last several days our case counts have risen to 123 active cases, which is up 11 over that of yesterday. And, unfortunately, we are predicted to see a continued rise in our numbers.
Being County Mayor certainly carries a great deal of responsibility, none being more important than the health and wellbeing of some 33,000 residents; parents, children, grandchildren, grandparents, friends, neighbors, church members, students, teachers, public sector employees, private sector employees and the list goes on and on. You are all ultimately my responsibility and being the leader of Claiborne County is not something anyone should take for granted when looking at the health and wellbeing of each of our citizens. To that end, difficult and unpopular decisions have to be made to ensure the safety of every Claiborne Countian is paramount to the success of our county.
I am issuing a county-wide mask mandate beginning on Tuesday, November 24th running through Thursday, December 31st. I will be reevaluating our case numbers daily while remaining in contact with all offices within the county to ensure we are doing the absolute best we can to slow the spread of COVID-19 here in Claiborne County.

redpajama_set_name: RedPajamaCommonCrawl


His touring band features Brad Whitford and Gary Cherone of Extreme.
Classic rockers from Aerosmith and Ted Nugent reconnect after three decades to jam on vintage-inspired gear with modern accoutrements.
PRS has announced details about their 2013 Experience event with Brad Whitford, Brent Mason, and more.
The duo discusses the band's somewhat tumultuous creative process, discovering new guitars, and what tones inspire them.


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Connecting young people and their adult leaders to God, the church, and the world
Discipleship Ministries
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Lead Serve Grants Scholarships Podcasts Events
Relevance – A Calling for Young Adults?
By Chris Wilterdink
I just returned from Las Vegas where I participated in Relevance LEAD http://live.relevancelead.com/ and Relevance X http://www.relevancex.com/ Each event is designed to bring together young adults (YAs) in the UMC.
Relevance X has been going on for several years as an fellowship, service, keynote style event weekend. It initially began as an event for the Desert Southwest Conference, but has steadily grown to welcome people from all over the west. Dale Fredrickson of Colorado http://dalefredrickson.com/ lead several keynotes on the idea that we journey as Christians being "Lost, Located, Leading." Jim Walker http://www.hotmetalbridge.com/ furthered that vision through his talks and biblical examples. Over 150 YAs gathered for this event. Their combined vision spoke to the gathering of Gen X and Millennial folks, all growing in faith and responsibility.
This was the first year for Relevance Lead which capped its available spots to 100, and invited those who directly lead ministries with young adults for a "Ted" style time of learning and networking. 8 different 18-minute talks over a variety of topics all had something to offer for those leaders gathered. Many of the leaders in this group came from Wesley Foundation or Campus Ministry backgrounds, and others came from local churches, General Agencies of the UMC, and conference workers with young adult responsibilities. Video and audio footage of the event should become available soon! The talks ranged from debates about the future of the church, to meaningful connections with upcoming generations, to new monasticism and intentional communities. I believe each participant left feeling as though they had gained valuable connections as well as a bevy of ideas. Relevance Lead will take place again in 2013 and be open nationwide.
After having several days to reflect on the talks that were given, the experiences shared, and the fellowship enjoyed I have come to the conclusion that this event is perfectly named for the current generations of YAs. The string that tied together every presentation and conversation I had at this event came back to the concept of relevance – Gen X and Millennials both seek to live lives of balance and meaning, hoping to connect with others to live relevant lives! We hope to become personally relevant to others as we participate in ministry. We pray that our denomination and faith will be and remain relevant in today's world. We desire to be relevant in the eyes of God, and a real part of the kingdom of God. These generations (in general) are not content with monotony or not knowing the purpose of their actions. These generations desire meaning in all that they do!
Young adults today desire more than to be acceptable, or even tolerated, in the UMC. YAs desire relevance in the life of the church and in crafting ministry. Relevance Lead brought minds and hearts together with big dreams and visions for the UMC. The event also gave the participants time to meaningfully connect and discuss where to go from the event itself.
How do you find meaning in your ministry? How do you assure yourself of relevance to the church and the world? If you live in an area where you feel isolated or lonely in ministry, I encourage you to check out the Relevance X and Lead links at the top of the page and consider beginning a gathering of young adults in your area if none currently exist. If safety exists in numbers, so too does relevance.
Conferences Social Media
Chris serves as Director of Young People's Ministries for Discipleship Ministries of the United Methodist Church. Chris has a BA in English Education, and an MS in Project Management, and over 15 years of local-church youth ministry experience. He is passionate about leadership and faith development in young people and helping ministry leaders understand their value in the lives of young people. A Stephen Minister, Chris is a native of Colorado living in Franklin, TN with his wife Emily, 2 children, and sausage-shaped beagle.
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Our growing library of conversations about the joys, challenges, and successes of ministry with young people unites a diverse set of practitioners and academics.
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The Jeep 2019 Grand Cherokee is a great car that's terrible at faking it. The Jeep 2019 Grand Cherokee builds upon the success of its ancestors with expressive styling, a surprisingly roomy cabin, plenty of advanced safety features and comfortable, supportive seats.
Each vehicle typically comes in multiple versions that are fundamentally similar. The ratings in this review are based on our full test of the Jeep 2019 Grand Cherokee. Performance has never been a strong suit for the Jeep 2019 Grand Cherokee, and it still isn't, especially with the current crop of compact cars.
Toyota offers two different versions of the Jeep 2019 Grand Cherokee, each with its own story to tell. Similarly, the Jeep 2019 Grand Cherokee range scores in the 30 mpg combined neighborhood, which is on the high side for compact cars but not quite class leading.


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Bostic apologises for delay in COVID-19 results
Minister of Health and Wellness Jeffrey Bostic apologised for the delays at the Best-dos Santos Laboratory. In the background is Minister of Tourism Lisa Cummins. (Picture by Jameel Springer)
Minister of Health and Wellness Jeffrey Bostic apologised to visitors and Barbadians for delays at the Best-dos Santos Public Health Laboratory in processing COVID-19 results within the 24- to 48-hour window and gave the assurance this would improve "in the coming days".
Bostic was speaking during a media briefing from Ilaro Court on Tuesday evening. It was streamed across social media and he was accompanied by Minister of Tourism and International Transport, Senator Lisa Cummins.
The Minister said Government recognised there would be a need for increased testing during the winter season, but there were challenges at the lab which resulted in delays. This caused some visitors and returning nationals to spend more time than was anticipated in the designated quarantine hotels.
He said although countries across the world were experiencing delays with COVID testing – which in some instances resulted in visitors arriving in Barbados without the results of tests they paid for at home – this was not an excuse.
"With that apology, I want to give the assurance to our visitors, to Barbadians returning, to those persons who depend on the lab and the system for those results, that based on what we have established right now in terms of establishing a special unit that would be dealing with this specifically, and with the additional resources provided, we are going to overcome these challenges in the very near future," Bostic said.
Government hired more data entry and technical resources for the lab and they were being trained. Training is almost complete in the use of the Shape App, which will allow the exchange of information in real time. The Minister said there was also the intention to move to a 24-hour operation at the lab.
Bostic said he toured the Best-dos Santos Lab earlier Tuesday and some of the swabs from Monday were being processed, an indication that they were making progress with the backlog. It will operate on Christmas Day.
Since the first case of COVID-19 was detected here in March, the lab conducted almost 62 000 tests, including 12 000 in December alone and about 3 000 in the last three days, Bostic said.
Barbados recorded 327 COVID-19 cases up to Sunday. The majority have recovered, with 36 remaining in quarantine. There were seven deaths. (SAT)
Minister of Health Jeffrey Bostic. (FILE)
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Minister of Health Jeffrey Bostic (Picture courtesy PMO Barbados)
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Minister of Health Jeffrey Bostic (centre) taken on a tour of the Psychiatric Hospital by director David Leacock, (left) and consultant psychiatrist Dr Brian Maclachlan. (Picture by Lennox Devonish)
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Minister of Health and Wellness Jeffrey Bostic (GP)
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Insularity plus time yields divergence.
Evolution isn't true, because if we evolved from monkeys, how can they still be here?
There is a real evolution that has happened musically.
The world doesn't change in front of your eyes, it changes behind your back.
Breaking up is a natural evolution when you try to figure out what you want in life. If you're with an individual who isn't moving in the same direction and at the same rate that you are, it ain't going to work.
There are animals we haven't stopped by. Don't think they're harmless. Life will defend itself no matter how small it is.
Corvina must have been so different then … really literally a different person. At what point do you make that call? At what point should you just give someone a new name? Sorry, no, you don't get to be Corvina anymore. Now you're Corvina 2.0 – a dubious upgrade.
Gadzooks you plagiaries of truth, for twas foreseen by mine own eyes that this world is flat and straddled by two platypus's being ridden by a sea horse……..
Theory of Evolution (Summary)First, there were some amoebas. Deviant amoebas adapted better to the environment, thus becoming monkeys. Then came Total Quality Management.


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Music/
The pre-2016 entertainment that got us through 2016
A roundup of our favorite older things to watch and hear this year
Dec 7, 2016, 7:21 PM UTC |
The Dixie Chicks
Sony BMG
As we head into the final weeks of 2016, the inevitable nostalgia for six to 11 months ago is kicking in across the pop culture universe. Everyone's surveying the most significant films, books, music videos, memes, celebrity shade-offs, and what have you from the past year, and deciding what was most important for them in 2016. But while the hype cycle operates in tidy annual waves, our lives don't. We'll be getting into some of the best of 2016 on the site shortly, but we figured we'd kick things off with a staff look at the things we loved in 2016 that weren't from 2016, and talk about how those favorite things got us through a tumultuous year.
Fleetwood Mac's Tusk
We The Internet have collectively agreed on 2016's status as a Level 6 Garbage Fire. In my personal life, 2016 was more like a grease fire, a small flame, but one that refuses to go out and promises to burn your life down if you let it. My grandmother passed away, my wife and I continued to mourn the death of a close friend, and as if tormented by metaphor, practically every appliance in our house broke in the span of six months. This week, I got food poisoning, in a cheeky full stop to a year that often felt, emotionally speaking, like barfing and shitting at the same time. As an act of self-preservation, I turned on most Sunday mornings to Tusk, Fleetwood Mac's experimental 1979 folk album. In a 2015 Letter of Recommendation for New York Times Magazine, Sam Anderson perfectly described Christine McVie's voice as "smooth and sad, a melon-flavored wine cooler on a vacant beach at sunset with the one you know will eventually leave you." Fleetwood Mac is McVie, Lindsey Buckingham, and Stevie Nicks, and when they were authoring this music, the latter two were just entering their 30s. Even rock stars, their lyrics suggest, must grow up and do battle with the dragons of mundanity: death, heartbreak, and finances. In 2016, those beasts appeared over and over, over and over, and Tusk served as a torch, rarely leading the way, but always illuminating the darkness. –Chris Plante
The Critical Hit podcast
I'm an RPG dork, but I've never been a Dungeons & Dragons superfan, because it's such a high-density, mathy system that the details tend to get in the way of the storytelling. In 2016, I found the solution: let someone else handle the math and the storytelling. Better yet, let the storytellers be people with strong personalities and a flair for drama and creativity. By early 2016, the Critical Hit D&D live-play podcast had became my primary audio obsession. Critical Hit started back in 2008, and at this point, they're closing in on 400 episodes, and more than 600 hours of podcast. That's a huge commitment for a new listener, but once I really fell into the story, the scope of the backlog actually became a comfort, because there was so much of this thing I'd fallen for, and disappearing into it on a bad or boring day was so effortless. Listening to the podcast is like reading a series of epic fantasy novels where the protagonists frequently drop out of character to joke around with each other, or thoughtfully discuss the rules of the world where they live. As geeky as it feels to eavesdrop on someone else's gaming sessions, the story still keeps surprising me, and the personalities involved have become as familiar as some of my friends. The GM, Rodrigo Lopez, is a master at creating immense, intriguing, world-spanning stories and keeping the players at least nominally on task. This was the podcast that kept me laughing or breathless through every commute, every errand, and every household chore in 2016, and I'm looking forward to seeing where it goes in 2017. –Tasha Robinson
Dragonforce, "Through the Fire and Flames"
The main downside of getting into running again is that my musical taste has suddenly regressed by a more than a decade, and I'm listening to all this really bad early '00s power metal again. (Before you ask, no, I was never a Guitar Hero player; I was just sort of emo.) Is this song power metal? I'm not sure. Is it even comprehensible? Not really. It's embarrassing that I used to earnestly listen to a lot of this, but the melodrama is great for powering through the last 20 minutes of a run. And running, more than a lot of things, has been helpful in dealing with this year. Maybe in 2017, my musical taste will progress to where it was the year after I listened to Dragonforce, which means a lot of Björk and Portishead. Much better. –Angela Chen
The Dixie Chicks, Taking the Long Way
One of my favorite places to hang out in the first brutal days after the election was the YouTube comments under the Dixie Chicks' 2006 Bush-defying single "Not Ready to Make Nice." They were full of sad, angry girls, being sad and angry together. The whole album is about dealing with injustice that feels personal, and with anger that feels insatiable, and it's more or less a direct response to the abuse the Dixie Chicks suffered after criticizing then-president George W. Bush. After lead singer Natalie Maines said at a concert that she was ashamed to be from Bush's home state of Texas, the group was all but banned from country-music radio, their CDs were destroyed in public demonstrations, and they received death threats. The album is a decade old now. Where a year ago its most hopeful, forward-looking songs seemed like they had been validated and made at least partly irrelevant by the Obama era, they now sound urgent again, and more than a little naïve. (Like all of us!) There's also a love song on it called "Easy Silence," which is about tuning out and shutting up for a second and probably hugging someone. I highly recommend all three things, and also the song. –Kaitlyn Tiffany
Marge Piercy, He, She, & It
When things feel as apocalyptic as they do now, I have two instincts: to look at ways people have imagined things blowing up in the past, and ways they imagined them getting better. He, She, and It is both! On one hand, it's a novel where the world is divided into desperate slums and predatory megacorporations with social mores that control your media consumption, your diet, and how you name your children. The environment has disintegrated to the point that you have to wear a second skin to go outside, where you will probably be killed and harvested by organ pirates, who sell your body parts to the rich because artificial organs are vulnerable to targeted hacks by cyber-assassins.
On the other, after a million recent TV series and films about men falling in love with or sexually exploiting self-aware female AIs, it's incredibly refreshing to see a nuanced, poignant story about a woman's consensual relationship with a machine-man from all the way back in 1991. And a book that's unapologetically about women, domesticity, motherhood, and relationships, without treating them as incompatible with cyberpunk hacking sequences, corporate warfare, a secret all-female society of radiation-resistant cyborgs living under the ruins of Israel, or an extended frame story about the Golem of Prague. –Adi Robertson
Britney Spears, Greatest Hits: My Prerogative
Whereas 2016 was perhaps the worst year ever, 1999 was a good year, aside from Y2K. I was eight in 1999, and practically nothing mattered in my life except Britney Spears and singing along to "…Baby One More Time." (Mary-Kate and Ashley Olsen mattered a little, but they weren't Britney.) So I can't say I'm surprised that my first instinct while watching the world go to shit this year was to return to Britney. I listen to "Oops! …I Did It again" and "Lucky" for the same reasons I eat spaghetti and meatballs or hug my mom when I'm down. They make me feel assured, happy, and a little less burdened by a world leader's asinine tweets. Britney has fallen in love, gotten divorced, shaved her head, gained weight, lost weight, and starred in a feature-length film. She's had two kids, released arguably bad albums, and kissed Madonna. And now, with her recurring sold-out Las Vegas show, Britney is proving to be the most resilient pop star. I love her and her bejeweled belly-button ring that she won't give up. She is both the inspiration we needed in 2016 and the woman I'll revisit to remind myself to keep on going in 2017. –Ashley Carman
Clark And Michael
Clark And Michael is Clark Duke and Michael Cera's 2006 mockumentary web series for CBS. I love it so much. It's more than a decade old now, and it might be the only non-sentient thing I've loved this long. Because it's a TV show about two TV writers, you'd be forgiven for assuming it was boring and self-important, but you'd be wrong. Clark is the frequently drunk one who wears a scarf to look professional and scares off potentially interested networks, while Michael is the egotistical baby. (Michael's teary breakdown in the bathtub prompts Clark to yell at the camera crew, "No bathroom stuff!") The entire 10-episode season is available on YouTube, and at around 10 minutes per episode, it's just the kind of dumb, funny thing my limited attention span needed this year, and will probably need for the next several years, too. –Lizzie Plaugic
Edward Abbey, Desert Solitare
I found my favorite way of escaping 2016 when I started reading a book this summer, one that brought me half a century into the past and let me get lost in the desert. I had never heard of Edward Abbey's Desert Solitaire until I saw this post, which sums it up better than I can here. What you need to know: It's a beautiful book about Abbey's time as a park ranger at Arches National Monument in Utah's Moab desert. It's also sometimes crass and funny in a way that is rare in writing about nature, though Abbey is also never crass just for the sake of it.
Desert Solitaire appealed to me for two reasons. One, it's a poetic meditation on and description of the stretch of protected wilderness that is Arches Park. True wilderness has become harder to find (and defend) since Abbey published this book in 1968 — we even see him describe this shift as he writes about the way the park gets treated by an influx of tourists and developers. Abbey helps explain why wilderness is worth protecting, while plotting the course of where we went wrong in protecting it. (For an inverse examination of this problem, I can't recommend Summer Brennan's 2015 book The Oyster War enough. It focuses on oyster farms and wilderness protection in the Pacific Northwest, but it looks deep into the past as well. The two complement each other well.) I read Desert Solitaire in what felt like appropriate stages, too: I started it during a trip through Acadia National Park in Maine, and finished it while playing through the entirety of No Man's Sky. The end result was that nature now occupies a place in the front of my mind in a way it hasn't for most of my life.
The other reason I loved this book is Abbey's approach. "In recording my impressions of the natural scene I have striven above all for accuracy, since I believe that there is a kind of poetry, even a kind of truth, in simple fact," he writes. "Language makes a mighty loose net with which to go fishing for simple facts, when facts are infinite." It's a way of thinking about writing that became increasingly relevant every time I came back up for air to greet the absurd events of 2016. –Sean O'Kane
Alto's Adventure
I used to play a lot of iPhone games. Between long bus rides to class and long train rides to work, they've always been a good way to kill some time and take my mind off the world. These days, I mostly use it to play Alto's Adventure. It's a meticulously designed, beautifully rendered endless runner where you play as a snowboarder — Alto — chasing down his escaped llamas. It's got a scoring system for tricks, and a variety of power-ups, but I keep coming back to it over and over since it's just so relaxing. And while there's a certain peacefulness to skiing alone down a mountain that Alto's Adventure can't quite replicate, its pocket-sized sense of calm is the next best thing. No matter how bad things outside in the world may be, I'm always a quick tap away from Alto and his mountain, trying to make it a few meters farther or a few points higher than the last run. Alto's Adventure has had a spot on my phone's home screen since it came out in 2015, and I can't imagine I'll be replacing it with anything else in the near future. –Chaim Gartenberg
One of the things I'll most reliably watch while channel-surfing is any entry from the Law & Order franchise. I've always liked procedural cop shows, and no matter what iteration of the story was on, I'd inevitably keep it in the background. This fall, I fell into a long binge-watch of Law and Order: Special Victims Unit. I don't have to watch these episodes closely — I'll throw them on while I'm cleaning or cooking dinner, — but I never miss anything important. There are points where I feel that I've invested too much time to give up now, but it keeps me reasonably entertained.
I'm not sure exactly why I'm into this: I've caught a ton of the episodes over the years, but there's something really intriguing about starting from the beginning of a show that's lasted for more than 15 years. Creators can do interesting things with characters in that amount of time, and watching Benson and Stabler morph over the years is interesting, even if each individual episode follows the same rigid formula. It's also interesting to see just how social attitudes change in that same amount of time, and there's points where the show feels refreshingly progressive when it comes to gender, sexual orientation, or dealing with trauma.
I don't think SVU is my favorite entry in the Law & Order franchise. Vincent D'Onofrio's Bobby Goren and Kathryn Erbe's Alexandra Eames are extremely hard to beat, and the UK edition of the show is also worth checking out. But SVU is definitely a force in itself. –Andrew Liptak
Lucia Berlin, A Manual for Cleaning Women: Selected Stories
A famous music producer once told me he could make a great record and release it a decade later, and it would still sound fresh. To him, that was a definition of a classic. Lucia Berlin has been dead for more than a decade, but her collected stories, A Manual for Cleaning Women, was released in 2015. Her stories sound so of the now, it's almost alarming. "Mrs. Snowden waited for my grandmother and me to get into her electric car," is the first sentence of "Electric Car, El Paso." It's a story about a slow ride in a tall-short electric car from a Bible-quoting senior. The senior woman is prepared for the future, and she carries an emergency Fig Newton stash wrapped in Kleenex to prove it. Make of that what you will, since most of Berlin's work was produced in the 20th century. Berlin published 76 stories in her worldly lifetime, which was filled with both enchanting and tumultuous events. But in each of her stories, she captures the peculiar in the everyday moments, where even the small stakes seem high. In a time of such highs and lows, Berlin's writing illuminates the stuff that stays true. –Tamara Warren
Marvin Gaye, Trouble Man
You know that scene in Captain America: The Winter Soldier where Sam Wilson recommends Trouble Man to Steve Rogers as basically the quintessential 20th-century American album? I took that recommendation seriously at the time, and he's not wrong. 2016 has been a year of trouble, a great deal of it bad. Trouble in our politics, trouble in media, so on and so forth. For me, it was a hard year both professionally and personally. But the point is always to keep moving. The lesson I've taken from it is, you will absolutely face strife and hardship — "There's only three things for sure / taxes, death, and trouble." — but moving forward is reward enough.
This is my "late-night walk through the Lower East Side" album. I feel tougher than leather when I hear "'T' Plays It Cool." I let myself give into melancholy when I hear "Life Is A Gamble." Marvin's voice is sweet, sad, and soulful throughout this record. He doesn't even have to sing, so much as just moan along with the music. But I come back again and again to the title track, because on days when I feel beaten down — like, say, on November 9th — it's only right to remember that trouble is always going to be there. And I tell myself that trouble, man, don't get in my way. –Kwame Opam
More from this stream 2016 in entertainment and pop culture: the good, the great, the weird
Our favorite pop culture of 2016
Dec 28, 2016, 3:36 PM UTC
The 11 best science fiction and fantasy novels of 2016
10 amazing games you may have missed this year
2016: the year music went 'exclusive'


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Home > Products > The Burning Shores: Inside the Battle for the New Libya by Frederic Wehrey
The Burning Shores: Inside the Battle for the New Libya by Frederic Wehrey
Frederic Wehrey / Hardcover - $ 26.00
A riveting, beautifully crafted account of Libya after Qadhafi.
The death of Colonel Muammar Qadhafi freed Libya from forty-two years of despotic rule, raising hopes for a new era. But in the aftermath, the country descended into bitter rivalries and civil war, paving the way for the Islamic State and a catastrophic migrant crisis.
In a fast-paced narrative that blends frontline reporting, analysis, and history, Frederic Wehrey tells the story of what went wrong. An Arabic-speaking Middle East scholar, Wehrey interviewed the key actors in Libya and paints vivid portraits of lives upended by a country in turmoil: the once-hopeful activists murdered or exiled, revolutionaries transformed into militia bosses or jihadist recruits, an aging general who promises salvation from the chaos in exchange for a return to the old authoritarianism. He traveled where few Westerners have gone, from the shattered city of Benghazi, birthplace of the revolution, to the lawless Sahara, to the coastal stronghold of the Islamic State in Qadhafi's hometown of Sirt. He chronicles the American and international missteps after the dictator's death that hastened the country's unraveling. Written with bravura, based on daring reportage, and informed by deep knowledge, The Burning Shores is the definitive account of Libya's fall.


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Centre for Economic Transformation
Ambities
Over CET
Planned knowledge locations in cities
studying emergence and change
This paper puts forward a conceptual framework to analyse emergence and the development of planned knowledge locations in cities (science and technology parks, creative factories, knowledge hubs, etc.).
It argues that the study and the practice of developing these precincts can benefit from explicitly considering the broader territorial context, the time dynamics and the co-evolutionary processes through which they unfold. The advantages of such as framework are illustrated with the support of two European knowledge locations: Arabianranta (Helsinki, Finland) and Biocant (Cantanhede, Portugal).
Reference Carvalho, L., & van Winden, W. (2017). Planned knowledge locations in cities: studying emergence and change. International Journal of Knowledge-Based Development, 8-2017(1), 47-67. https://doi.org/10.1504/IJKBD.2017.10003161
Published by CAREM 18 February 2017
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Luis Carvalho
Willem van Winden
© 2023 Amsterdam University of Applied Sciences


text:
var express = require('express');
var router = express.Router();
var ObjectID = require('mongodb').ObjectID;

//landing page. Generate artist table
router.get('/', function(req, res) {
  var collection = global.db.collection('artists');
  collection.find().sort({ name: 1 }).toArray(function(err, artists) {
    res.render('templates/artists', {artists: artists});
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});

//adding new artists
router.post('/', function(req, res) {
  var collection = global.db.collection('artists');
  collection.save(req.body, function(err, data) {
    var artistID = data.ops[0]._id;
    res.redirect('/artist/' + artistID)
  });

});

//Single artist page.
router.get('/artist/:id', function(req, res){
  var collection = global.db.collection('artists');
  collection.findOne(
    {_id: ObjectID(req.params.id)},
    function(err, artist){
    res.render('templates/oneArtist', {artist: artist});
  })
})

//delete
router.post('/:id/delete', function(req, res) {
  var collection = global.db.collection('artists');
  collection.remove(
    {_id: ObjectID(req.params.id)},
    function(err, data) {
      if(err){
      console.log(err);
      } else {
      res.redirect('/');
      }
    })

});

//edit route
router.get('/artist/:id/edit', function(req, res) {
  var collection = global.db.collection('artists');
  collection.findOne(
    {_id: ObjectID(req.params.id)},
    function(err, artist){
    res.render('templates/artistEdit', {artist: artist});
  })
})

//edit submit
router.post('/artist/:id/edit', function(req, res){
  var collection = global.db.collection('artists');
  collection.update({_id: ObjectID(req.params.id)}, {$set: {
    name: req.body.name,
    genre: req.body.genre,
    bio: req.body.bio
  }}, function(err, response){
    res.redirect('/artist/' + req.params.id );
  });
})

module.exports = router;

redpajama_set_name: RedPajamaGithub


Ribbon is in the middle of page instead of the top?
I think I missed something. You can notice the bottom right corner, there suppose to be a minimized button, but the chevron is missing. Backstage does not work too. Also if I press Alt keyboard, NullReferenceException is thrown and my program terminates.
Please tell me if I am missing something.
We can align the Ribbon in the top of the window using the property named "VerticalAlignment" or else you can divide the Grid into two and place the Ribbon in first row. Please refer to the below code for further reference.
We have prepared sample for your reference which can be downloaded from the below location.
I myself is also using the Grid for positioning it on the top. I thought there was a problem, because with the default VisualStyle, I did not need to do anything else for the Ribbon to stay on the top. I suggest adding that layout information to the article at my link, because it does not say anything when switching to Office2013White Visual Style, to prevent further confusion like mine.
We will modify the alignment of Ribbon to Top in Office2013 visual style by default as in other theme. We will include this in our main release Volume 3, 2016 which will be rolled out by the end of September, 2016.


The replacement of the national security Council Michael Flynn at the Herbert McMaster (both are generals) is the United States only benefit.
New military entrants, is considered one of the leading American strategists with experience fighting in Afghanistan and Iraq. More importantly, we are talking about a man known for his frankness and willingness, if necessary, to repel their own boss.
These qualities are especially welcome now, when the helm is Donald trump, who, to put it mildly, has a rather weak notion of international relations.
The outgoing General, who although considered a professional, suffered a kind of obsession against Islamic extremism, which was unproductive. He was removed from office after the FBI recorded his phone conversation with the Russian Ambassador, the contents of which Advisor was initially denied.
Although this episode was for the benefit of the new government, he has raised doubts — including among Republicans — about the relationship of the President of Russia Vladimir Putin.
There are suspicions that a Russian hacker group of specialists on the invasion of an information system in the electoral campaign for the benefit of trump distributed as appropriate, and any false information to harm his opponent, democratic candidate Hillary Clinton.
There — warning signs of ties between trump and Putin, which might be closer than we think. An American President who shamelessly criticizing the leaders of the allied countries such as Mexico and Australia, at the same time with unusual delicacy speaks about Russia, which opposes U.S. interests in various parts of the world.
However, I can say that this position is Republican due to the mixture of true admiration for the Russian President and the similar way of thinking — an obvious tendency to authoritarian populism that Putin is unashamedly puts into practice.
In ideological terms, as noted by the columnist of Folha Demetrio Magnoli (Demétrio Magnoli), both are fighting against globalization, acting in the spirit of nationalist nostalgia.
Whatever the reasons, the fact is that American values are incompatible with the autocratic methods of the Russian President. The new Alliance between Washington and Moscow move forward without prejudice to such principles as the respect for democracy and human rights.
McMaster at the head of the Council for national security increases the likelihood that someone will say this about Trump. However, this is unlikely to have any effect.
Avalanche covered skiers in the Italian resort.


text:
Pertusaria ophthalmiza är en lavart som först beskrevs av och som fick sitt nu gällande namn av William Nylander.

Pertusaria ophthalmiza ingår i släktet Pertusaria och familjen Pertusariaceae. Arten är reproducerande i Sverige. Inga underarter finns listade i Catalogue of Life.

Källor

Sporsäcksvampar
ophthalmiza

redpajama_set_name: RedPajamaWikipedia


Carilion Clinic, a not-for-profit healthcare organization based in Roanoke, Virginia, has identified 8,500 patients at risk for developing heart failure in a pilot project using IBM's content analysis software that could lead to early intervention and better care for these patients.
The Virginia health system has completed the pilot project in collaboration with IBM and Epic. The results were achieved through predictive modeling of data in Carilion Clinic's electronic medical record (EMRs), including 'unstructured' data such as clinicians' notes and discharge documents that are not often analyzed.
Carilion Clinic has utilized IBM's natural language processing technology to analyze and understand these notes in the context of the EMR, the inclusion of unstructured data provides a more complete and accurate understanding of each patient.
Content analytics and predictive modeling has been applied in the pilot project for identifying at-risk patients with an 85% accuracy rate. This model identified an additional 3,500 patients that would have been missed with traditional methods.
According to IBM, its natural language processing technology can understand information posed in natural language and uncover insights from vast amounts of data.
Coupled with advanced predictive modeling, the pilot project at Carilion Clinic using IBM Advanced Care Insights marks another example of IBM's leadership in advancing predictive care and prevention. IBM Advanced Care Insights combines predictive modeling with healthcare-specific content analysis.
IBM global healthcare vice president Sean Hogan noted many predictive factors are included in structured data within today's EMR systems, but a lot of it is hidden in doctors' notes, discharge papers, and other sources of unstructured data.
"By tapping into the unstructured data, our clients have more complete and accurate information that allows them to make targeted interventions when appropriate that can help prevent more severe and costly medical complications," Hogan added.
Patients identified in the pilot as being at-risk for heart failure were expected to develop the disease within one year and are candidates for care management and early interventions.
Predictors analyzed by IBM's Advanced Care Insights included maximum systolic blood pressure, prescription drug use of alpha blockers, beta blockers, beta agonists, and others, previous diagnoses such as chronic obstructive pulmonary disease, obesity, and lifestyle and environmental factors, such as occupation and marital status.
IBM has also announced that its content analysis software now allows doctors using Epic's EMR software to accurately incorporate their notes into patient records to extract insights in real-time.


text:
Unterrichtsstunde steht für:
 Unterrichtsstunde, zeitliche Unterrichtseinheit in der Schul- und Erwachsenenbildung in Deutschland

Die Unterrichtsstunde steht für:
 Die Unterrichtsstunde, 1964 uraufgeführtes Handlungsballett von Flemming Flindt
 Die Unterrichtsstunde (Drama), 1951 uraufgeführtes Drama von Eugène Ionesco


text:
APG.nl Careers Asset management
Discover more about APG
The new pension system
APG Careers
About APG
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Groeifabriek
View Discover more about APG
How are pensions currently set up?
Who is making the rules?
What will remain the same?
What is going to change?
When will the new system start?
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View The new pension system
View About APG
Sustainability-linked bonds: new opportunities, but avoid greenwashing
APG recently participated in the issue of a number of sustainability-linked bonds (SLBs). Companies issuing such bonds promise to meet predefined sustainability objectives; if they fail to do so, they need to pay investors extra interest. This offers flexibility, but also means investors must pay close attention to the sustainable objectives to prevent greenwashing. "We need to do our homework thoroughly to weigh the credibility and robustness of these deals."
Tesco is one of the growing number of companies to have issued a 'sustainability-linked bond' (SLB) this year. In January, the British supermarket chain launched a bond that is linked to the company's commitment to reduce greenhouse gas emissions. Concretely, Tesco pledges to cut its greenhouse gas emissions by 60% in 2025 (compared to 2015). If the company fails to meet this objective, investors will receive a coupon premium.
APG on behalf of its pension funds participated in Tesco's €750 million SLB issuance, the first of its kind by a retailer. So far, SLBs remain a small part of the ESG fixed income landscape, relative to conventional labeled (green, social and sustainable) bonds. But SLB issuance is growing fast in 2021. According to Bloomberg, over €12 billion of SLBs has been issued this year to date, nearly 5% of total labeled bond issuance in that period.
So what is a sustainability-linked bond? SLBs allow the issuer to raise money for general purposes while promising that if they fail to meet specified sustainability targets they pay investors extra interest. Such key performance indicators (KPIs) are, for example, 'percentage of recycled materials used by 2030' or 'reduction of greenhouse gas emissions by 2025'. This is different from conventional green bonds, where the money raised has to be spent on specific sustainability projects.
The instrument is still fairly new. In 2019, Enel issued the first SLB. The Italian power utility company targeted a 55% share of renewables in its power generation capacity by the end of 2021. Investors will receive 0.25% extra interest on their bond holdings if Enel fails to meet this commitment. In the run-up to the issue, Enel discussed the particular features of this bond with a select number of investors, including APG.
Prevent green washing
Since mid-2020, the number of SLB issuances has been steadily rising, an encouraging sign of momentum in this nascent market. The flexible structure of SLBs may offer an alternative for companies which – owing to the nature of their business – face difficulty in finding sufficient (or sufficiently large) sustainability projects to issue a green bond. Retail companies, like Tesco, are an example. SLBs allow such companies to finance their overall sustainability strategy without having to ringfence the money for particular green projects, e.g. building a solar power plant.
However, that same flexibility also means that investors have less concrete information on how the proceeds will be used and the potential impact they will have. "Flexibility in terms of use of proceeds combined with customized key performance indicators could make it easier for issuers to 'sustainability wash' and twist objectives to suit their needs," says Joshua Linder, Credit analyst Fixed Income at APG. "For that reason, some investors are hesitant to support this new structure. But we see a lot of potential for SLBs, provided the integrity of the market is firmly maintained. We need to carefully scrutinize the KPIs to find out if they are ambitious and robust enough and ensure they can be properly verified and tracked."
Tesco's SLB is aligned to its newly introduced Sustainability Bond Framework which, in turn, follows the International Capital Market Association (ICMA) principles on SLBs, released in June 2020. The ICMA principles aim to further develop the key role that debt markets can play in funding and encouraging companies to contribute to sustainability. The principles pertain to setting KPIs, bond characteristics, reporting and independent verification.
Hybrid bond
Recently, APG also participated in a 'hybrid' bond issued by NextEra Energy. This bond, one of the first of its kind, combines features of both conventional green bonds and SLBs. NextEra Energy is a US utility holding company overseeing the largest investor-owned utility in the United States, which serves more than 11 million residents across the state of Florida. NextEra Energy also owns a clean energy business, which is the world's largest generator of wind and solar energy.
The bond structure follows the ICMA green bond principles and ringfences the bond's proceeds for specific renewable energy projects. However, it is also stipulated that if the company fails to fully allocate the proceeds within two years, investors will receive a 0.25% interest premium until maturity. Also, projects must become operational within twelve months after issuance, or replacement projects must be selected that still meet the two year window, or be subject to the higher coupon rate.
"These features create an added layer of accountability compared to conventional green bonds," says Craig Hauret, Senior Credit analyst Fixed Income at APG . "It ensures proceeds are allocated to eligible green projects in a timely fashion. Another attractive feature is the requirement that proceeds finance only wind and solar energy projects that will become operational after issuance. As opposed to some green bonds which allocate proceeds to 'refinance' projects that were completed two or three years ago."
This is not to say there aren't any drawbacks to the deal, notably the absence of a green bond framework which typically serves as the basis for project eligibility, as well as the lack of independent audit. "We have communicated that concern to the company," says Hauret. "However, we have confidence in NextEra due to its long-time status as an ESG leader, combined with the transparency into the specific renewable energy projects being financed."
Upholding market integrity
APG is one of the world's largest green, social and sustainable bond investors and an advocate of the labeled bond market, including SLBs. "We are, however, very selective in terms of which SLB deals we support in these early stages of market development in order to uphold market integrity," says Linder. "For instance, we have seen SLB issuance where one of the sustainability targets had already been achieved. Clearly, such a bond does not meet our standards."
The need for transparency and effective reporting practices is crucial for upholding the integrity and credibility of this rapidly growing market. To make (potential) issuers aware of our expectations and foster healthy development of the market, APG has published the Guidance on Sustainability-Linked Bonds.
APG's fourth annual 'Growing the US Corporate Green and Social Bond Market' roundtable event for institutional investors, capital market underwriters and other stakeholders this year focused on SLBs. "Growing the corporate labeled market in the US whilst upholding market integrity has been a key objective since we started these events, " says Anna Pot, Head of Responsible Investments Americas at APG. "We have made substantial progress on activating our peers and partners across the industry to stimulate issuance of high-quality corporate labeled bonds."
Published in these collection(s)
A yardstick to measure the sustainability of all investments
Background - Sustainability, Long-term investment
SSE Renewables and APG join forces for Dutch offshore wind tenders
News - Sustainability, Long-term investment
"In 2024 there will be a one-time opportunity to get more women on corporate boards in India"
Interview - Sustainability, Long-term investment
"We're not here to take bets"
Good news from Brussels
Opinion - Sustainability, Long-term investment
2021: the year of sustainable high yield
APG invests €195 million in first EU green bond
APG invests €360 million in Spanish and UK green sovereign bonds
Is the growing popularity of investing creating a new 'bubble'?
Background - Long-term investment
Do you see your future with APG?
© 2023 APG


We are a group of dedicated volunteers who rescue, foster and re-home animals that find themselves without a home, often sick and in desperate need of love. We believe every animal deserves the right to be cared for and loved. We do not discriminate between young or old, pregnant or sick, they all deserve their freedom and our help.
Sparky is a beautiful boy who is very confident and loves to show off his good looks as much as possible. Give him a catwalk and we are sure he'll happily strut down it to show them off ! Sparky loves to smooch his humans and wind himself around their legs but cuddles are always on his terms as there's always something for him to explore or new legs to wind himself around. Sparky could play with toys for days as well as try and push the boundaries by pinching some of Sweety's or his foster siblings dinner ! Sparky came into care with his sister Sweety as a bonded pair as their own had passed away and they were taken to the vet to be put to sleep . Thankfully the vet talked the temporary owner to surrender them instead. Sparky is now used to co-living with his foster siblings but would much prefer a home where Sweety and himself are the only cats. He is also used to living the calm , gentle dogs. Sparky is an energiser kitty , always exploring , playing and being affectionate with his humans. Sparky and Sweety are so deserving of loving home for their 2nd chance and we hope that your family will be the one to give it to them . Please note : Adoption fee is a suggested donation of $50 upwards for the pair to our rescue. We are very keen to get Sparky and Sweety into the right loving home and want to give them every chance to achieve this.
Sweety is just as her name suggests. She is a beautiful girl with a very sweet nature. Sweety loves to play with her toys and her brother Sparky. She loves to have a chat with her humans and when it is meal time she absolutely loves to oversee the food going into everyone's bowl to make sure everyone gets equal amounts! Sweety first came into care with her brother Sparky as a bonded pair. Sweety first came into care with her brother Sparky as a bonded pair as their own had passed away and they were taken to the vet to be put to sleep . Thankfully the vet talked the temporary owner to surrender them instead. Sweety is now used to co-living with her foster siblings but would much prefer a home where Sparky and herself are the only cats. She is also used to living the calm , gentle dogs.Sweety and Sparky are so deserving of loving home for their 2nd chance and we hope that your family will be the one to give it to them . Please note : Adoption fee is a suggested donation of $50 upwards for the pair to our rescue. We are very keen to get Sweety and Sparky into the right loving home and want to give them every chance to achieve this.
Raven has been in his foster home for over 12 months now and we think it may be time to pack his little bags and leave home. We are offering Raven for foster care with a view to adoption. A great way to trial . Raven would make a great furry companion for a family or a person who lives alone and would like a quiet little boy who loves a good play to share their day. Here are some more details about Raven. Handsome Raven is a quiet little boy who loves dashing about the place. He is very interested in pats loves being stroked and is super interested in fuzzy things on sticks. Raven is currently in foster care with his mum and other siblings. He has grown up around dogs, other cats and small children. He will just need time and love to help him come out of his shell. Raven would be perfect for a family who is prepared to let him settle at his own place and give him lots of pats and play to show him how much fun humans can be !
Callie is a sweet affectionate girl who came to us after her owner decided she couldnt look after her anymore and was going to have her euthanised. Callie loves to play , explore ,but most of all loves to rub around your legs , smooch you and show you lots of love. Callie is not used to other cats so would be better in a single cat household, but with a slow introduction we think she would be ok . She is not used to dogs or children but once again with patience, we think she would be ok . She is currently an indoor cat but has been outdoor supervised. A cat enclosure with lots of stimulation would be something she would also enjoy. Callie would make a super companion for someone who is home a lot and is after a super affectionate kitty. Once you meet Callie we are sure you will fall in love with her and her with you !


Lancaster Insurance would like to wish you and your families a Happy Easter. Our opening times will be slightly different over the Easter weekend, please click here to view.
Bex of Artbybex will be joining us on our stand at the Practical Classics Classic Car and Restoration Show, with Discovery! This month at the NEC (Friday 22nd March – Sunday 24th March), we'll be exhibiting in Hall 5 and Bex will be painting LIVE on our 'Lancaster Insurance Workshop' stand.
Christmas came early for Robbie Knight of Eastbourne this week as he was unveiled as the lucky new owner of Lancaster Insurance's prize-giveaway Golf GTi. Click here to find out more and view the video of the keys being delivered.
The Lancaster Insurance Classic Motor Show, with Discovery, took place on Friday 9th to Sunday 11th November and as the grand 'season finale', it was not to be missed. Click to view our video of the 2018 show.
The XR Owners Club was formed in 1983 to bring together XR enthusiasts who share a common passion for the marque. The Club also has an active social media presence with its Official XR Owners Club UK group having over 4,000 members!
This weekend is the Billing Off-Road Show 2018 in Northampton and this year's show is set to be more special than usual! In celebration of Land Rover's 70th anniversary, this year will see the show organisers and Land Rover Monthly attempt to set a new world record for the Largest parade of Land Rovers! We are supporting them in their quest for glory and our very own Dave Youngs, Lancaster's Car Club Manager, and Andrew Baron, one of Lancaster's Insurance Technicians, will be joining the convoy in a new Discovery. The figure to set is 633 and if you'd like to join in the fun and unite with other enthusiasts, sign up here.
You could not miss an Austin Allegro Equipe, even at midnight, in the middle of the fog during a power cut. It was not just the way in which the orange and red stripes complemented the metallic silver coachwork; it was the black spoiler, the GKN alloy wheels and the front fog lamps. Inside there was an alloy-spoked steering wheel, all-black headling and the orange & black houndstooth check upholstery. This was not merely a two-door 1750 HL with ideas above its station – this was executive living, late 1970s style.
Do you remember the Vauxhall Carlton Mk.1?
One of the side effects of the passage of time, apart from noticing how young police officers look, is that how certain once respected cars slowly vanish from our roads. In the very late 1970s and early 1980s, the Vauxhall Carlton was the vehicle of choice for sober-minded accountants and bank managers but now they look as fascinatedly dated as an episode of The Young Ones.
Many of you will have already heard the news that Mazda plans a return to rotary power next year. According to an interview with AutoRai.NL, Martijn ten Brink, the Vice President of Sales and Customer Service for the company's European division, the idea is to offer the company's forthcoming electric car with a 'range extender in the form of a Wankel engine'. And such an announcement is especially timely as 1978 marks the 40th birthday of the RX-7.


text:
Badami Bagh é uma cidade no distrito de Srinagar, no estado indiano de Jammu & Kashmir.

Demografia
Segundo o censo de 2001, Badami Bagh tinha uma população de 13 477 habitantes. Os indivíduos do sexo masculino constituem 53% da população e os do sexo feminino 47%. Badami Bagh tem uma taxa de literacia de 71%, superior à média nacional de 59,5%; com 58% para o sexo masculino e 42% para o sexo feminino. 6% da população está abaixo dos 6 anos de idade.

Localidades de Jamu e Caxemira


If you fall into either of these and almost everyone does please see Coach Brigman (AD), Coach Walworth (Head Coach) or Coach B Lockelar (Asst. Head Coach) to let them know you have interest. You will need a current school physical on file and will need to pass a hydration test (tests to see how much water you have in your system, if you are hydrated).


text:
Monitor may have one of the following meanings:
A computer display
A concurrent programming language construct which encapsulates variables, access procedures and initialisation code within an abstract data type. The monitor's variable may only be accessed via its access procedures and only one process may be actively accessing the monitor at any one time. The access procedures are critical sections. A monitor may have a queue of processes which are waiting to access it. Monitors in this sense were invented by C. A. R. Hoare.
A hardware device that measures electrical events such as pulses or voltage levels in a digital computer.
To oversee a program during execution. For example, the monitor function in the Unix C library enables profiling of a certain range of code addresses. A histogram is produced showing how often the program counter was found to be at each position and how often each profiled function was called.
A control program within the operating system that manages the allocation of system resources to active programs.
A machine code monitor used by programmers to modify computer memory contents and enter and modify assembly language programs.
A program that measures software performance.
USS Monitor, the ironclad warship of the American civil war.
A monitor warship type of ship based on the USS Monitor and built by several navies for coastal defence in the 1860s and 1870s.
It reappeared in a different form during the First World War.
A large tropical lizard (family Varanidae); see monitor lizard
This is a disambiguation page
The original version of this page was based on monitor at FOLDOC, used with permission.


The Ring Doorbell installs easily in minutes, with no professional help or additional tools required. A built-in rechargeable battery lets you install the doorbell anywhere, or connect it to existing doorbell wiring. Motion-triggered alerts sent via the free Ring™ app (iOS® and Android™) notify you of arriving guests and deliveries.
Cloud Recording ensures you'll never miss any activity at your home.
With Ring, you're always home.
Not everyone presses the button on the doorbell, so we've included motion sensors to alert you of activity at your home. Any movement triggers an alert via the Ring® app and activates the night vision HD camera.
The Ring Doorbell attaches to its mounting plate using a proprietary screw for security. If your doorbell gets stolen, don't worry - we'll replace it. For free.
Ring Video Doorbell for Your Smartphone is awesome! Installation was incredibly easy and didn't take very long to get things set up and running. As a mom of four I often have kids napping and every so often I try to sneak in a nap myself and the one thing that I hate is when someone rings the doorbell. Once usually doesn't wake anyone up but we have some super obnoxious sales people that go through our neighborhood and will ring the doorbell up to 2-3 times, sometimes more if they hear the kids inside. I usually ignore them but now thanks to Ring Video Doorbell for Your Smartphone I can tell them no thank you without even opening the door. Whats even better is that most of them don't even ring the doorbell now because they know what Ring Video Doorbell for Your Smartphone is and know they can't bug me. I also love the ability to talk to people at the front door when I'm away from home.
Ring Video Doorbell for Your Smartphone has night vision so you can even see who's at your door when it's dark. Ring Video Doorbell for Your Smartphone also has a motion detector so even when someone knocks on your door, you'll be able to see them.
Ring Video Doorbell for Your Smartphone is an absolutely wonderful product and every house should have one!
Click HERE to learn more about Ring!
Follow Ring on social media!


text:
17579 Lewkopelew è un asteroide della fascia principale. Scoperto nel 1994, presenta un'orbita caratterizzata da un semiasse maggiore pari a 2,3482850 UA e da un'eccentricità di 0,1409197, inclinata di 7,07598° rispetto all'eclittica.

Collegamenti esterni

Corpi celesti scoperti nel 1994
Lewkopelew