text:
Baseline data of initial 1663 patients enrolled
Identification of new biosignatures for clinical outcomes in stable coronary artery disease - The study protocol and initial observations of a prospective follow-up study in Taiwan
Hsin-Bang Leu1, 2, 3,
Wei-Hsian Yin4,
Wei-Kung Tseng5, 6,
Yen-Wen Wu7,
Tsung-Hsien Lin8,
Hung-I Yeh9,
Kuan-Cheng Chang10, 11,
Ji-Hung Wang12,
Chau-Chung Wu13, 14 and
Jaw-Wen Chen1, 3, 15, 16Email author
BMC Cardiovascular DisordersBMC series – open, inclusive and trusted201717:42
https://doi.org/10.1186/s12872-017-0471-z
Received: 29 July 2016
Either classic or novel biomarkers have not been well investigated for clinical outcomes of coronary artery disease (CAD) in Asian people especially ethnic Chinese. We reported here a prospective national-based follow-up study that aims to elucidate the clinical profiles and to identify the new biosignatures (especially the non-lipid profile and inflammatory biomakers) for future clinical outcomes in a sizable cohort of stable CAD patients in Taiwan.
A total of 2500 CAD patients under stable condition after successful percutaneous coronary intervention will be enrolled for clinical data collection and blood/urine sampling in northern, southern, western, or eastern part of Taiwan between 2012 and 2017. They will be regularly followed up at least annually for 5 years to assess all cause deaths, hard clinical events (including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke), and total cardiovascular events (including hard events, unplanned revascularization procedures, unplanned hospitalization for refractory or unstable angina, and for other causes such as stroke, transient ischemic attack, heart failure, or peripheral arterial occlusive disease). The classic and newly defined biosignatures will be compared in patients with and without clinical events during follow-up. The novel biomarkers will be identified via metabolomics analyses. Additionally, psychological personality and lifestyle data will be incorporated to explore the new dimensional views of the complex mechanisms of the disease. Till December 2014, the initial 1663 patients have been successfully enrolled. Among them, 85.93% are male; 36.22% have type 2 diabetes; 64.82% have hypertension; 56.04% are smokers and 20.44% have a family history of CAD. Their lipid profiles are under contemporary medical control with a mean plasma total cholesterol level of 163.51 ± 36.99 mg/dL and a mean low-density lipoprotein cholesterol level of 95.21 ± 29.98 mg/dL.
This nationwide study has successfully started to update the contemporary information and to investigate the potential predictors for clinical outcomes of stable CAD patients in Taiwan. The identification of new biomarkers, lifestyle and psychological personality may help to elucidate the complex mechanisms and provide the novel rational to the individual treatment strategies in Asian especially ethnic Chinese patients with CAD.
Biosignaturs
Cardiovascular (CV) disease, a common disease in developed countries is associated with increased risk of mortality and morbidity, and is the leading cause of death worldwide. It has beensuggested that atherosclerosis plays a central role in CV disease. A chronic inflammatory process in the vessels leads to vascular damage, atheroma formation, vessel occlusion and even plaque rupture during the progression of atherosclerosis. Despite great efforts including the development of new medical devices, more aggressive revascularization therapies as well as progress in medication, the incidence of events associated with coronary artery disease (CAD) such as acute coronary syndrome (ACS), stroke, cardiac death, and revascularization persists, especially in high-risk CAD patients after coronary intervention. It has been shown that the severity of coronary arterial stenosis could not completely predict the risk of plaque rupture and the occurrence of subsequent thrombosis. A clinical risk score such as the Framingham risk score has been generated to predict cardiac risk, but it cannot reveal the whole disease risk for an Asian population and may lose its predictive value in a population with intermediate risk. The geographic heterogeneity, the genetic susceptibility, dietary habit and environmental risk exposure further increased the complexity of using same risk scoring to predict future risk for patients with CAD. It then becomes important to reassess the clinical profile and the diagnostic and treatment strategies in different cohorts, and to identify indicators for high-risk patients both in the general and the local clinical background.
Disease-specific biosignatures have a biological characteristic that can be measured and evaluated objectively as an indicator of normal biological process, pathogenic process, or pharmacological response to a therapeutic intervention [1]. Biomarkers, as a part of the biosignatures, can be used for a disease at different stages which may be associated with its onset, clinical course, or response to treatment [2–4]. For CV diseases, circulating biomarkers that have been incorporated into clinical practice are mainly used asprognostic markers, and have been shown to have value in addition to classic CV risk factors, which include N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) for heart failure [5], glycated haemoglobin (HbA1c) for glycaemic control in diabetes [6], high-sensitivity TroponinI [7], and high-sensitivity C-Reactive Protein (hs-CRP) for CV risk prediction [8]. Among them, inflammatory related biomarkers such as hs-CRP have been shown useful particularly for CAD patients with intermediate risk [8]. However, further data are still required to examine the specificity and efficacy of these new biomarkers for their clinical implication in different disease severity and in patients of different races in the world.
On the other hand, current treatment of CV disease adheres to tight guidelines. While classic risk factors such as blood pressure, sugar and lipid profile are treated accordingly, future adverse event rate remains high in some well-controlled patients, indicating the possibility of residual risks that need to be targeted, and which may also be related to the lack of more specific and powerful prognostic biomarkers to identify those patients at particular risk. For example, the interaction between personal factors, life styles, and classic risk factors may be complex. On the other hand, the identification of inflammatory biomarkers may be of value to follow the progression of vascular inflammation in atherosclerosis. Therefore, the role of clinical consortia and biospecimen banks is crucial for further investigations. Recent studies have also pointed to the potential of new strategies such as metabolomics or proteomics for novel biomarkers in the investigation of CV disease [9].
Finally, given the potential difference in diet, culture, and physical background between Western and Asian people, either classic or new biomarkers have not been well investigated for clinical outcomes in Asian patients especially ethnic Chinese with stable CAD. Therefore, we conduct a prospective follow-up study on a national basis to evaluate the demographic data, clinical profiles, and treatment strategies for future CV events in stable CAD patients under contemporary treatment in Taiwan. The collected data will be also used to stratify patients at particular future risk by identifying new biosignature profiles such as novel inflammatory biomarkers and the novel biomarkers via metabolomics approach. Here we present the study design/protocol together with the baseline data including demographic characteristics, clinical profiles, medical treatment, and so on in initial 1663 patients enrolled.
A consortium has been organized to conduct this study. Principle investigator meeting of consortium has been held every two months to discuss any queries about the protocol setting, IRB review process, and cases recruitment. In addition, Professor Ueng-Cheng Yang in National Yang-Ming University and Professor Wen-Harn Pan in Academia Sinica helped to build up the Clinical Informatics & Management System and sample collecting protocol for our consortium. Training courses for data collection were hold for four times. The objectives of the training sessions were not only to produce an instrument for this study but also to instruct the CAD in the principles of instrument design and to elaborate an instrument that could be standardized for use in later CAD research projects. All information will be recorded and blood/urine sample are stored in a central Laboratory in National Yang-Ming University, Taipei, Taiwan.
Patient enrollment
A series of stable CAD patients was initially evaluated in nine different medical centers located in Northern, Central, Southern, and Eastern Taiwan. The patients were initially evaluated if they had a history of significant CAD, as documented by coronary angiogram, a history of myocardial infarction as evidenced by 12-lead electrocardiography (ECG) or hospitalization, or a history of angina with ischemic ECG changes or positive response to stress test. The patients were enrolled only if (1) they had received successful percutaneous coronary intervention (PCI) with either coronary stenting or balloon angioplasty at least once previously, and (2) they had been stable on medical treatment for at least 1 month before enrollment.
Patients were excluded if (1) they had been hospitalized for unstable angina, acute coronary syndrome, acute myocardial infarction, acute cerebrovascular events, or other acute cardiovascular events within the 3 months prior to enrollment, (2) they planned to receive further coronary revascularization or interventional procedures for other CV diseases during the following one year period, (3) they had significant malignancy or tumor diseases requiring advanced medical or surgical therapy or both in the following one year, (4) they had other major systemic diseases requiring hospitalization or operation in the following one year, or (5) they were unable or unwilling to be followed up during the following one year period. Additionally, patients with life expectancy of <6 months (e.g., malignant metastatic neoplasm), and those receiving treatment with immunosuppressive agents were also excluded.
Clinical follow up for adverse cardiovascular events
According to the study protocol, each patient with initially stable conditions under medical treatment is prospectively and regularly followed up in the individual hospital clinics. After enrollment, follow-up data collection will be taken during outpatient clinic visit, if applicable, and approximately every 3 months for the first year and every 6 months starting from the second year after enrollment. Medication is prescribed for each patient individually at the discretion of the treating physician. During follow-up, the occurrence of adverse CV events will be recorded, including all cause deaths, cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, unplanned revascularization procedures, unplanned hospitalization for refractory or unstable angina, and for other causes including stroke, transient ischemic attack, heart failure, or peripheral arterial occlusive disease. Myocardial infarction is confirmed if ischemic symptoms presented with elevated serum cardiac enzyme levels and/or characteristic ECG changes. Coronary revascularization procedures with either PCI or coronary artery bypass grafting surgery are confirmed by medical record review. Stroke is confirmed if there is a new neurologic deficit lasting for at least 24 h with definite imaging evidence of cerebrovascular accident either by MRI or CT scan. The protocol for CV event follow-up is similar to that has been reported in our previous works [10, 11]. Besides, for the second track of long-term follow-up, the assessment of clinical events will be also conducted by some independent national data banks if the patients agree.
Baseline data collection
Personal and clinical profiles at enrollment
After enrollment, specially trained study nurses and qualified cardiologists collected all data prospectively whenever feasible. Baseline characteristics including risk factors such as history of hypertension, diabetes, smoking habit, as well as medications history were collected. Variable medications and dosage information were collected by chart review and structured questionnaire. Biochemical profiles including blood glucose, lipid profile and kidney function were recorded. In addition, healthy lifestyle factors were noted, including a healthy diet, abstinence from smoking, and regular exercise habit. A healthy diet was identified according to the Recommended Food Score, developed in 2000 by Kant et al. [12] which contains more fruits, vegetables, legumes, nuts, reduced-fat dairy products, whole grains, and fish. Abstinence from smoking applied to those whonever smoked, or had quit smoking for more than 6 months. Regular exercise denotes exercise episodeslasting for at least 30 min, more than five times a week.
In addition to baseline biochemical data and lifestyle information collected, all patients were asked to complete the Type D Scale for Taiwan (DS14-T) after enrollment. This version was translated from DS14 and has been validated for the Taiwanese population [9]. The reliability of Type D assessment in Taiwan is good, with Cronbach's α for negative affectivity and social inhibition of 0.86 and 0.79 respectively, [13] and adequate construct validity and can be considered equivalent to the Taiwanese version [13]. In short, this instrument is a measure of negative affectivity (e.g., "I often make a fuss about unimportant things" and "I take a gloomy view of things") and social inhibition (e.g., "I make contact easily when I meet people" and "I find it hard to start a conversation") with seven five-point Likert-scaled items ranging from 0 = false to 4 = true for each subscale and is regarded as the current standard for identifying the Type D pattern [14]. Patients scoring high on both subscales, according to a standardized cut-off score ≥ 10, are classified as having a Type D personality [15].
Blood and urine sampling
After enrollment, 20 mL of blood from peripheral vessels and 10 mL urine were collected. Sampling collection was at the time of enrollment, and every 3 months thereafter in 3-month intervals during outpatient clinic visits. These samples were stored in a −80 °C refrigerator until analysis for biomarkers and metabolomic study. Patients were excluded if they had ingested any drugs with antioxidant activity, vitamins, or food additives within the 4 weeks prior toblood/urine sampling.
Established and new BiomarkerMeasurement
Established biochemical markers for atherosclerotic cardiovascular disease
Biological markers provide quantitative information reflecting biological processes, disease state, or response to treatment in disease management. In the current study, we undertake to investigatea series of established biochemical markers, including but not limited to, the following: (1) high sensitivity C−Reactive Protein (hsCRP); (2) Adiponectin; (3) Matrix Metalloproteinase-3; (4) Matrix Metalloproteinase-9; (5) Interleukin-6; (6) Fibrinogen; (7) Lp-PLA2; (8) Tumor Necrosis Factor-α. Besides these established biochemical markers we attempted to validate another series ofnew potential bio-signature markers for cardiovascular disease.
New inflammatory biomarkers for cardiovascular disease
Biochemical marker spotentially associated with the atherosclerosis processwere selected, in particular those related to inflammation including but not limited to the following: (1) Fatty Acid Binding Protein; (2) soluble Vascular Cellular Adhesion Molecule-1; (3) soluble Intercellular Adhesion Molecule-1; (4) Carbohydrate Antigen 125; (5) Monocyte Chemotactic Protein-1; (6) Cardiac Troponin I; (7) CK-MB; (8) NT-proBNP; (9) C-type Natriuretic Peptide; (10) Fetal Heart Binding Protein; (11) Neutrophil Gelatinase-Associated Lipocalin; (12) Chemokine (C-X-C motif) ligand 6; (13) Chemokine (C-X-C motif) ligand 16; (14) Tumor Necrosis Factor ligand superfamily member 14; (15) Oncostatin M; and (16) Myeloperoxidase.
Both the above established and potentially newbiomarkers will be measured sequentially to determine any correlation with the development of future clinical events once the adequate clinical outcomes are identified in the next 5 years.
Metabolomic study for novel biomarkers
The plasma and urine samples will be frozen in liquid nitrogen immediately and stored at −80 °C to prevent any metabolic decay until further metabolomic analysis. Once more than 50 major cardiovascular events have been identified during follow-up, which may take around 2 years for the initially enrolled 1000 study patients, the metabolomic studies of the plasma and urine will be chronologically performed in the matched CAD cases with major cardiovascular events and those without events during the follow-up period. The biological pathways and clinical biomarkers valuable for predicting the major cardiovascular events of atherosclerotic vascular diseases will be investigated.
Qualitative and quantitative UHPLC -QTOF, GC-MS, LC-QQQ and GCXGC-TOF-MS analysis will be performed at the Metabolomics Core Laboratory. To confirm identified metabolite markers, we will develop a highly sensitive and specific isotope dilution GC-MS or LC-MS method for accurately quantifying the metabolite from biospecimens. Concentration of target markers will be accurately quantified.
A comparison will be drawn between subjects with existing CVD and those who newly develop cardiovascular events during the follow-up period. Quantitative variables will be expressed as mean and standard deviation in the presence of normal or median distribution, and interquartile range in the presence of asymmetric distribution. Qualitative variables will be presented in both absolute frequencies (number of patients) and relative frequencies (percentage). Comparisons of continuous variables between groups will beperformed by ANOVA test, while subgroup comparisons of categorical variables will be assessed by χ2 or Fisher's exact test. The primary, secondary, and tertiary outcomes will be described by an overall percentage, taking all centers into consideration, and the percentage described in each center. These will also be expressed by means of proportions and their confidence intervals of 95%. Where there is great variability in prescription, a weighted average variance at each center will be generated. For regression models, we will report the odds ratio (logistic regression) or hazard ratio (for the regression of Cox proportional hazards), the corresponding standard error, the confidence intervals of 95%, and p values. Additionally, we will report the p values up to three decimals; however, places with p values below 0.001 are reported as p < 0.001. In all the tests, we will use the two-tailed alpha significance level of 0.05.
Baseline patient characteristics
In this study, up to 2500 patients would be enrolled over 5 years according to the schedule. From September 2012 to December 2014, initial 1663 patients with a history of PCI have been successfully enrolled in the first 2.5 years. All patients gave written informed consent before participating in the study. Among them, 1429 (85.93%) were male, 602 (36.22%) had diabetes; 1078 (64.82%) had hypertension; 932 (56.04%) were smokers and 340 (20.44%) had a family history of HCVD. The baseline characteristics of the overall population are provided in Table 1.
Baseline demographic data of CAD patients enrolled till December 2014
Number of patients
Age at enrollment, yrs
63.49 ± 11.89
Male, n (%)
1429 (85.93)
Body mass index, (kg/m2)
26.58 ± 4.4
Waist, cm
93.68 ± 10
Buttocks, cm
99.45 ± 8.57
Waist/buttocks ratio
0.94 ± 0.08
Systolic blood pressure, mmHg
129.82 ± 17.2
Diastolic blood pressure, mmHg
Hypertension, n (%)
Diabetes, n (%)
602 (36.22)
Smoking, n (%)
Family history of CAD
Previous ischemic stroke, n (%)
Target lesion in coronary artery (n = 1114)
Left main artery, n (%)
Left anterior descending artery, n (%)
Left circumflex artery, n (%)
Right coronary artery, n (%)
Diameters and length of stents (n = 971)
Stent Diameters, mm
Mean ± SD
Median (IQR)
Stent length, mm
Left ventricular EF, % (n = 1014)
58.67 ± 21.7
CAD coronary artery disease, EF ejection fraction (calculated by echocardiography or ventriculography), mm minimeter, n patient number, SD standard deviation
As to the target lesion of coronary artery disease, 43.63% involved the left anterior descending artery, 27.29% the right coronary artery and 14.9% the left circumflex artery. Among the stent information collected, the mean stent diameter was 2.64 ± 0.68 mm with an average length of 21.99 ± 6.92 mm. An echocardiogram was performed in 1014 (61%) of the 1663 CAD patients and their mean left ventricular ejection fraction (58.67 ± 21.7%) was in the normal range.
Baseline biochemical profiles
Table 2 shows the baseline parameters and biochemical profiles of CAD patients enrolled in this cohort. Total cholesterol was 163.51 ± 36.99 mg/dL and low-density lipoprotein (LDL) cholesterol was 95.21 ± 29.98 mg/dL, showing these patients were treated well and the average LDL value achieved the ATP III/NCEP target of optimal LDL level (<100 mg/dL) [16, 17]. The values of serum high-density lipoprotein (HDL)- cholesterol and triglyceride were 41.63 ± 10.51 mg/dL and 139.76 ± 88.31 mg/dL, respectively.
Baseline blood biochemical profile at enrollment
Glucose, mg/dL
120.22 ± 42.96
Cholesterol, mg/dL
158 (137–185)
LDL-cholesterol, mg/dL
91 (74–112.2)
HDL-cholesterol, mg/dL
Triglyceride, mg/dL
Serum creatinine, mg/dL
1.02 (0.86–1.25)
75.66 (60.05–92.63)
White blood cells,/CUMM
7556.08 ± 2345.17
Hemoglobin, g/dL
13.9 (12.7–15)
Platelet,/CUMM
215254.96 ± 55152.1
211000 (176000–250000)
eGFR estimated glomerular fraction rate, HDL high density lipoprotein, LDL low density lipoprotein
Baseline medication profiles
Table 3 presents the medication used in thestudy cohort. Anti-platelet agents were prescribed in 93% of patients; anticoagulant in 15.88%; Beta-blocker in 64.86%; diuretics in 13.29%; dihydropyridine (DHP) calcium channel blockers in 32.79%; calcium-blockers (non-DHP) in 37.20%, and RAS blocking agents [angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in 62.56%. To our interest, although statin was suggested for all patients with coronary disease, only 73.67% of patients took statin during enrollment. Furthermore, proton pump inhibitors were prescribed in 5.25%. All data will be analyzed for drug interactions in the future.
Medication treatment at enrollment
Anti-platelet, n (%)
Anti-coagulant, n (%)
ACE-inhibitor, n (%)
ARB, n (%)
ACE inhibitor/ARB, n (%)
Beta-blockers, n (%)
Calcium-blocker, n (%)
Calcium-blocker (DHP), n (%)
Diuretics, n (%)
Oral nitrates, n (%)
Statin, n (%)
PPI, n (%)
ACE angiotensin-converting enzyme, ARB angiotensin receptor blocker, DHP dihydropyridine, PPI proton pump inhibitor
Baseline lifestyleand dietary supplementprofiles
To further investigate the effect of lifestyle modification strategies and physiological personality in mitigating future risk, exercise habit and whether diet control followed the ATP III guideline were recorded andare shown in Table 4. Of the study patients, 64.05% were on diet control following the recommendations of ATP III for CAD patients. Exercise frequency has been reported by 886 (51.74%) of enrolled patients, with 54.42% reporting more than 30 min of moderate-intensity exercise 5 days a week. Additional information regarding dietary supplements as well as Chinese medicinal herbs is also shown in Table 4. Dietary supplements were reported by557 (33.53%) study patients, with 446 (79.50%) taking cornmeal, 19.03% taking fish oil, 5.76% Anka, 5.40% Gingko; 5.92% Natto and 5.23% shark cartilage. The incidence of type D personality was 9.63% in the study patients.
Diet, life style, and personality information of study cohort
Diet control following NECP guidelines for patients with CAD, n (%)
Regular exercise habit, n (%)
Exercise frequency
< 1 times/week, n (%)
1–2 times/week, n (%)
> 5 times/week, n (%)
Use of Chinese medicinal herbs and dietary supplement, n (%)
Anka, n (%)
Fish oil, n (%)
Phytosterols or other stanols, n (%)
3 (0.54)
Cornmeal, n (%)
Gingko, n (%)
Natto, n (%)
Garlic essence, n (%)
Grape seed, n (%)
Grapefruit juice, n (%)
Shark cartilage, n (%)
Fur seal oil
Type D personality, n (%)
CAD coronary artery disease
In recent decades, atherosclerosis CV disease has become one of the leading causes of morbidity and mortality in the world. Despite great efforts to reduce risk including medical or primary prevention strategies, the risk remains high and new therapeutic strategies are still needed both in the western and the Asian patients. The current study aims to provide detailed information about long-term outcome in secondary prevention for stable patients with coronary intervention. Besides, it also aims to investigate possible new markers either independently or concomitantly pointing to the occurrence of adverse cardiovascular events. Findings from this study will not only provide new indicators of potential association between secondary prevention and future adverse events but also help to improve our understanding about the effective therapeutic targets as well as strategy to retard or prevent the progression of disease after revascularization.
Among the contemporary pharmacological therapeutic strategy, statins have been clearly shown to be potentially lifesaving medications and are widely used in patients with CV disease. Secondary and primary prevention trials have demonstrated that lipid lowering with statin can reduce morbidity and mortality of CV disease in both western and Asian (mainly Japanese) cohorts [18–20]. Further, a target of serum LDL level <70 mg/dL has been suggested for very high-risk patients according to the findings of some clinical trials mainly in western cohorts [21]. Recently, the 2013 ACC/AHA cholesterol guidelines further identified patients in the four statin benefit groups which included clinical atherosclerotic cardiovascular disease (ASCVD), diabetes, high LDL level (>190 mg/dL) and those with an ASCVD score ≥7.5%, [22] indicating the importance of statin therapy in CV protection. However, most of the above therapeutic strategy and targets are set mainly for western patients. Given the lack of adequate evidence, it is not known if these guidelines could be also feasible to the clinical implication in Asian especially ethnic Chinese cohorts. In this study, while 93% of the study patients received at least one antiplatelet including aspirin and others, there are 73% of the patients on regular statin treatment in this study. The baseline mean plasma LDL level is around 95 mg/dL either with or without statin treatment, which remains higher than the recommended target in patients with established CV disease (≤70 mg/dL). However, it is similar to the LDL values reported in the recently published European registry for secondary prevention study (CICD-PIOT), in which the LDL value is around 91.6 to 110.4 mg/dL, [23] revealing the LDL level for secondary prevention in the real world nowadays. Furthermore, a previous lipid registry for CV disease in Taiwan has reported the achieved mean LDL cholesterol level was 101.49 mg/dL in another secondary prevention CAD cohort during 2010 and 2011 [24]. In fact, the Taiwanese national insurance reimbursement policy have recommended to keep serum total cholesterol level <170 mg/dL and the serum LDL level <100 mg/dL for secondary prevention cohort since 2013. It is clearly demonstrated that the cholesterol control by statin use, as recommended by either global lipid guidelines or national insurance reimbursement policy, has much improved in Taiwan in the last 5 years. Similar findings of the trend of increasing statin use have also been observed in other cohort studies. Park et al. investigated the long-term outcome of left main coronary artery intervention classified by time periods: wave 1 (1995–1998), wave 2 (2003–2006), and wave 3 (2007–2010). The prescription rate of statins has progressively increased from 18.1% (wave 1), to 64.5% (wave 2) and 91.7% (wave3), [25], which confirmed the changing concept of stain use in CAD patients.
Renin-angiotensin system (RAS) is an important mediator of blood volume, arterial pressure, and cardiac and vascular function in CV system. RAS blocking agents (including ACE inhibitors and ARBs) can prevent CV disease by lowering blood pressure and by vascular protection. They have therefore been suggested as the first-line treatment for CV patients with target organ damage. The benefits of RAS blocking agents in the primary and secondary prevention of CAD have been well established [26]. In the current study, while the achieved systolic (130 mmHg) and diastolic blood pressure (75 mmHg) are quite acceptable, the use of renin-angiotensin system (RAS) blocking agents (ACE inhibitors and ARBs) and beta adrenergic blockers are above 60%. Besides, the higher prescription rate of ARBs than that of ACE inhibitors has been also observed in the Biosignature CAD cohort, which is probably due to the better tolerance of ARB use in the Asian population. Interestingly, the increasing use of ACE inhibitor/ARB was also observed in Park's 25 year-observation, with an increase from 11.9% (wave 1) to 26% (wave 3), supporting the importance of the use of RAS blocking agents in CAD patients [25]. The high prescription rate of ACE inhibitor/ARB in the Biosignature CAD cohort reflects the improvement of evidence-based treatment in CV disease, which is also essential to the improvement of long-term outcome in high-risk CAD patients.
Notably, while the classic risk factors such as lipid profile, blood pressure, and blood sugar have been adequately controlled, the risk of developing a future event may remain high especially in the high-risk CAD patients. Given the potential importance of inflammation in the development and progression of atherosclerosis CV disease, other non-classic risk factors such as lifestyle and environment exposure that might directly or indirectly lead to vascular inflammation/injury should be considered. There is no clear information for the role of lifestyle in secondary prevention for high-risk CAD patients after PCI. Thus, in this study, lifestyle data is collected, which will be investigated to evaluate the potential impact of healthy lifestyle factors including healthy diet, nonsmoking and active exercise on long-term clinical outcomes of the CAD patients. Given the popularity of healthy food not only in western world but also in Asian countries, we also incorporated patient data regarding the use of Chinese medicinal herbs and dietary supplements into the biosignature CAD cohort study. In contrast to the well-known nutrients, these supplements are complex and many potential mechanisms including antioxidant properties, regulation of the inflammatory response, and the proliferation/differentiation of immune cells have been proposed for them. To our interest, there have been few data about the CV benefits of Chinese medical herbs and supplements in CAD patients. In this cohort study, the use of Chinese medical herbs and supplements will be systemically evaluated to provide advanced clues for their potential impact on secondary prevention in CAD patients.
In addition to lifestyle factors, personality trait such as type D personality was included in this study. Personality traits, such as type A (high strung), type B (easy going), and type D (distressed type), have been reported to be variously associated with different CV diseases [27–29]. Recent evidence has pointed to closer connections of personality traits, especially type D personality, with CV diseases. Type D personality represents the effects of two personality traits: negative affectivity (NA, the tendency to experience negative emotions) and social inhibition (SI, the tendency to inhibit the expression of emotions [30]. It has been observed that type D personality might be associated with poor clinical outcomes in patients with congestive heart failure or peripheral arterial occlusive disease, after receiving open heart surgery and after receiving an implantable cardioverter-defibrillator [31]. Accordingly, type D personality may be considered an important risk factor that should be taken into account for risk stratification in some CV diseases. So far, the majority of the international studies on type D personality have indicated that the prevalence of type D personality is between 15 and 29% in CV patients [32, 33]. However, the prevalence of type D personality and its role in long-term outcome in an Asian population remains undetermined. According to the current baseline data, the prevalence of type D personality is around 9 ~ 10% in our study patients. Our study may provide important information on psychological issues in CAD patients.
Finally and most importantly, in this study, serial blood samples will be collected both at baseline and during regular follow-up to evaluate the baseline and the dynamic changes of inflammatory biomarkers for the development of clinical outcomes. The classic and well-established serum biomarkers including hs-CRP and others will be evaluated for both confirmation and comparison. On the other hand, serial new inflammatory biomarkers such as some cytokines, chemokines and inflammatory ligands that are less related to clinical atherosclerosis disease will be evaluated to identify their potential prognostic role for clinical outcomes in our CAD patients. The new biomarkers that could improve the prognostic value of well-established biomarkers such as hs-CRP will be further investigated. Once the clinical significance could be confirmed by replication, further new projects will be initiated with both in vitro and in vivo experiments to identify the potential mechanisms and new therapeutic targets. Besides, to further define the novel biosignatures as well as novel mechanisms, another line of metablomic study will be also done in selected cases in this study. Taken together, our study focused on secondary prevention to identify the new predictors and to investigate the potential mechanisms and novel therapeutic target in stable patients after PCI even when they are already under contemporary treatment.
Although the criteria for patient enrollment and the protocol for clinical follow-up have been clearly defined and all cases are recruited by well-train staffs in teaching hospitals, selection bias arising from clinical profile, investigator participation and treatment adherence by patients could not be completely excluded. Furthermore, according to the population distribution, the patients are extensively recruited throughout the whole country in order to represent the people living in Taiwan. However, this is a hospital-based rather than a community-based study. Further investigations may be required to elucidate and adjust the potential geographic variations in therapeutic principle, environmental exposure, patient behavior, and so on. Besides, given the long-term follow-up, a substantial portion of patients may be lost to follow up. Thus, the clinical outcomes of the patients will be also periodically assessed through some national data banks such as the national insurance policy data bank in Taiwan if indicated.
The biosignature CAD study is a nationwide prospective cohort study aiming to investigate new biosignatures to identify the CAD patients at very high risk in an Asian cohort. Given the comprehensive network in Taiwan, all the patients could be enrolled and closely followed up for 5 years to assess impacts of the classic and non-classic risk factors as well as the standard and novel biomarkers on future clinical events. As the study is ongoing, the baseline data revealed that the patients are in stable condition by standard contemporary treatment at enrollment. The investigation on new biosignatures including inflammatory markers, personality traits and environment factors will further improve our understandings of the complex atherosclerosis disease and advance the therapeutic strategies of stable CAD in Asian patients especially the ethnic Chinese in Taiwan.
ACE:
Angiotensin-converting enzyme
ARB:
Angiotensin receptor blocker
CAD:
DHP:
Dihydropyridine
EF:
eGFR:
Estimated glomerular filtration rate
HDL:
High density lipoprotein
hsCRP:
High sensitivity C-Reactive Protein
LDL:
Low density lipoprotein
PPI:
Proton pump inhibitor
RAS:
Renin–angiotensin system
The project of searching for biosignature for stable CAD patients is sponsored by Academia Sinica since 2012 (Project code: BM10501010039). The sponsor has no roll in study design, study conduction, data acquisition, data interpretation, and paper writing.
All data generated or analysed during this study are included in this published article.
A consortium has been organized to conduct this study. J-WC, H-BL, and C-CW contributed to study design. H-BL contributed to infrastructure design and technician training for this project. All investigators of this study (J-WC, H-BL, C-CW, W-HY, H-IY, K-CC, T-HL, Y-WW, J-HW and W-KT) are in charge of collecting clinical informatics and tissue sample in each hospital. J-WC, H-IY, and H-BL contributed to data analysis and data interpretation. J-WC, and H-BL contributed to paper writing. All the investigators approved the paper.
The study complied with the Declaration of Helsinki, which was approved by the appropriate Health Authorities, independent Ethics Committees, and Independent Review Boards in each hospital as well as the Joint IRB Ethics Committee Review Board in Taiwan. All patients should give their written inform consent before enrollment.
Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
Heath Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
Divison of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
Department of Cardiology, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien, Taiwan
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan, R.O.C.
Naylor S. Biomarkers: Current perspectives and future prospects. Expert Rev Mol Diagn. 2003;3(5):525–9.View ArticlePubMedGoogle Scholar
Mayeux R. Biomarkers: potential uses and limitations. Neuro Rx. 2004;1(2):182–8.View ArticleGoogle Scholar
Strimbu K, et al. What are biomarkers? Curr Opin HIV AIDS. 2010;5(6):463–6.View ArticlePubMedPubMed CentralGoogle Scholar
Ogino S, et al. Molecular pathological epidemiology of epigenetics: Emerging integrative science to analyze environment, host, and disease. Mod Pathol. 2013;26(4):465–84.View ArticlePubMedPubMed CentralGoogle Scholar
Weber M, et al. Role of B-typenatriureticpeptide (BNP) and NT-proBNP in clinical routine. Heart. 2006;92(6):843–9.View ArticlePubMedPubMed CentralGoogle Scholar
Gillett MJ. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327–34.View ArticleGoogle Scholar
Keller T, et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med. 2009;361(9):868–77.View ArticlePubMedGoogle Scholar
Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107(3):363–9.View ArticlePubMedGoogle Scholar
Cheng ML, et al. Metabolic disturbances identified in plasma are associated with outcomes in patients with heart failure: diagnostic and prognostic value of metabolomics. J Am CollCardiol. 2015;65(15):1509–20.View ArticleGoogle Scholar
Leu HB, et al. Risk stratification and prognostic implication of plasma biomarkers in nondiabetic patients with stable coronary artery disease: the role of high-sensitivity C-reactive protein. Chest. 2004;126(4):1032–9.View ArticlePubMedGoogle Scholar
Leu HB, et al. A novel SNP associated with nighttime pulse pressure in young-onset hypertension patients could be a genetic prognostic factor for cardiovascular events in a general cohort in Taiwan. PLoS One. 2014;9(6):e97919.View ArticlePubMedPubMed CentralGoogle Scholar
Kant AK, et al. A prospective study of diet quality and mortality in women. JAMA. 2000;283(16):2109–15.View ArticlePubMedGoogle Scholar
Weng CY, et al. The validity of the Type D construct and its assessment in Taiwan. BMC Psychiatry. 2013;13:46.View ArticlePubMedPubMed CentralGoogle Scholar
Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med. 2005;67(1):89–97.View ArticlePubMedGoogle Scholar
Meyer T, et al. Type D personality is unrelated to major adverse cardiovascular events in patients with coronary artery disease treated by intracoronary stenting. Ann Behav Med. 2014;48(2):156–62.View ArticlePubMedGoogle Scholar
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.Google Scholar
Smith Jr SC, AHA/ACC; National Heart, Lung, and Blood Institute, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006;113(19):2363–72.View ArticlePubMedGoogle Scholar
Serruys PW, Lescol Intervention Prevention Study (LIPS) Investigators, et al. Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002;287(24):3215–22.View ArticlePubMedGoogle Scholar
The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339(19):1349–57.Google Scholar
Sacks FM, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335(14):1001–9.View ArticlePubMedGoogle Scholar
Grundy SM, National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004;110(2):227–39.View ArticlePubMedGoogle Scholar
Stone NJ, American College of Cardiology/American Heart Association Task Force on Practice Guidelines, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1–45.View ArticlePubMedGoogle Scholar
Komajda M, et al. EURObservational Research Programme: the Chronic Ischaemic Cardiovascular Disease Registry: Pilot phase (CICD-PILOT). Eur Heart J. 2016;37(2):152–60.View ArticlePubMedGoogle Scholar
Ho LT, Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry Investigators, et al. Determinants for achieving the LDL-C target of lipid control for secondary prevention of cardiovascular events in Taiwan. PLoS One. 2015;10(3):e0116513.View ArticlePubMedPubMed CentralGoogle Scholar
Park SJ, et al. Temporal trends in revascularization strategy and outcomes in left main coronary artery stenosis: data from the ASAN Medical Center-Left MAIN Revascularization registry. Circ Cardiovasc Interv. 2015;8(5):e001846.View ArticlePubMedGoogle Scholar
Husain K, et al. Inflammation, oxidative stress and renin angiotensin system in atherosclerosis. World J Biol Chem. 2015;6(3):209–17.View ArticlePubMedPubMed CentralGoogle Scholar
Lemogne C, et al. Hostility may explain the association between depressive mood and mortality: evidence from the French GAZEL cohort study. Psychother Psychosom. 2010;79(3):164–71.View ArticlePubMedPubMed CentralGoogle Scholar
Eaker ED, et al. Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study. Circulation. 2004;109(10):1267–71.View ArticlePubMedGoogle Scholar
Grossarth-Maticek R, et al. Method of test administration as a factor in test validity: the use of a personality questionnaire in the prediction of cancer and coronary heart disease. Behav Res Ther. 1995;33(6):705–10.View ArticlePubMedGoogle Scholar
Denollet J, et al. Personality and mortality after myocardial infarction. Psychosom Med. 1995;57(6):582–91.View ArticlePubMedGoogle Scholar
Denollet J, et al. Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator. Int J Cardiol. 2013;167(6):2705–9.View ArticlePubMedGoogle Scholar
Kelpis TG, et al. Prevalence of "distressed" personality in patients with coronary artery disease and its correlation with morbidity after coronary surgery. Hellenic J Cardiol. 2013;54(5):362–7.PubMedGoogle Scholar
Spindler H, et al. Increased anxiety and depression in Danish cardiac patients with a type D personality: cross-validation of the Type D Scale (DS14). Int J Behav Med. 2009;16(2):98–107.View ArticlePubMedPubMed CentralGoogle Scholar


text:
DeVry University Kansas City Downtown
1100 Main St Kansas CityMO64105
devry.edu
The DeVry University KC Downtown Center offers undergraduate degree programs in some of today's fastest-growing career fields.
by facebook on August 23, 2014 from facebook
The DeVry University Kansas City Downtown Center is conveniently located in City Center Square, at the corner of 11th and Main Streets in the Central Business and Financial Districts of Downtown Kansas City near the KC Public Library's Central Branch and other downtown amenities. We're in the heart of a city that is home to numerous Fortune 500 companies, agricultural companies, and one of the...
Why DeVry University? This is the place you can find success. It isn't always easy to succeed in your education or in reaching your career goals. It takes a lot of work, energy, and dedication. But we believe you can do it. Because for over 80 years we've been helping students within this University do just that, by providing an accredited university education that truly works. An education...
by superpages on June 30, 2014 from superpages
For over 80 years we've been helping students earn the bachelor's or master's degrees they need to find success in today's and tomorrow's careers.
by foursquare on April 30, 2014 from foursquare
& Master's Degree Programs Within 5 Colleges Business & Management
Online or On Campus Classes
DeVry University Operates As Devry College of New York; Keller Graduate School of Management
Professional Development Information
DeVry University Makes IT Easy to Find A Location Near Where You Live or Work. Plus
and Media Arts & Technology....
by yasabe on April 07, 2014 from yasabe
college College & University Colleges And Universities education educational Educational Organizations Health Sciences keller graduate school of management Online Classes university

redpajama_set_name: RedPajamaCommonCrawl


On behalf of Mark A. Di Carlo, PLLC Attorney at Law posted in Personal Injury on Monday, October 1, 2018.
A growing number of Texas car buyers are choosing vehicles equipped with advanced systems designed to anticipate and prevent accidents. However, this technology may not be as effective as they believe. This was the conclusion reached by researchers from the American Automobile Association's Foundation for Traffic Safety after they polled 1,200 owners of 2016 and 2017 passenger vehicles equipped with advanced driver assistance systems.
The AAA researchers say they were concerned by how little the motorists responding to their poll knew about the key limitations of advanced safety technology like blind-spot monitoring, emergency braking systems and adaptive cruise control. They say that their findings suggest that American drivers may not yet be ready to adapt to vehicles with even more sophisticated autonomous technology.
Eight out of 10 of the respondents did not know that blind-spot monitoring systems often struggle to cope with fast-moving objects, and an alarming 29 percent admitted to engaging in activities other than driving when their adaptive cruise control systems were engaged. Only 40 percent of the motorists polled knew that emergency forward-collision warning systems did not automatically apply their brakes.
The researchers insisted that this kind of technology does have the potential to save many lives. Therefore, AAA says carmakers and legislators should do a better job of explaining its merits and limitations to consumers.
Technology designed to avoid and prevent accidents also collects vast amounts of data. This electronic evidence could help a personal injury attorney establish recklessness and liability in a car accident lawsuit. For example, tech could reveal that posted speed limits were being exceeded at the time of a crash or brakes were applied late or not at all.


text:
ESIA profile
SEA profile
Updated to: 27 June 2011
SEA background
Legal framework for SEA
Institutional setting for SEA
SEA procedure
SEA practice
SEA links
Country contact on SEA
Ministry of Natural Resources and the Environment
100 m south of the National Stadium
Tegucigalpa M.D.C., Honduras
Central America.
E-mail: oss@serna.gob.hn, webmaster@serna.gob.hn
History of SEA
The principle of the SEA in Honduras, was not introduced in the General Environment Law (Decree No. 104-93) nor in the Regulation of the SINEIA (published in La Gaceta No. 27.291 on March 5, 1994), which was the first time that the EIA procedure was developed. It was not until 2009, that Honduras adopted legislation regarding the SEA, when a new regulation of SINEIA was enacted (Ministerial Agreement No. 189-2009 published in the official journal on 31 December 2009).
Framework/Enabling law
The legal framework of SEA in Honduras is the SINEIA Regulation (Ministerial Agreement No. 189-2009 published in the official newspaper on 31 December 2009).
Approving authority of enabling law
The authority which adopted SINEIA Regulation (Ministerial Agreement No. 189-2009 published in the official journal on 31 December 2009) with legislation related to SEA was the constitutional President of the Republic.
First national detailed SEA regulation
General SEA procedures are described in the SINEIA Regulation (Ministerial Agreement No. 189-2009 published in the official newspaper on 31 December 2009).
Article 94 (Decree 189-2009), shows methodological guidelines defined by the SERNA for integrating the environmental variable in the plans and programs of land use planning with the Manual of Environmental Assessment and Control of SINEIA.
Also, article 93 (Decree 189-2009), points out guidelines on the drafting and review of the SEA procedure laid down in the same Handbook mentioned (Manual of Environmental Assessment and Control).
Recent updates and additions to the SEA legislation
It has not been reformed, as it is a very recent regulation.
Sector specific procedures/regulations
Specific sectorial regulations do not exist yet.
Guidelines on Strategic Environmental Assessment for Central America. (CCAD-UICN, 2007.)
Objective SEA
To introduce the environmental dimension in strategic planning and decision-making for the development of a region or country. As well as to facilitate decision-making, within a framework of transparency, participation and information, to be used as a adjuvant planning instrument (article 4.17 Decreto 189-2009).
To systematize and expedite the resolution and the environmental authorization of projects that make up an SEA (article 92 of the Decreto 189-2009).
Scope of SEA application
SEA is a process that applies to strategic decision and policy making used for the planning and programming of land use development in the different sectors as well as for megaprojects qualified by the SERNA as strategic for the country
According to article 97 of Decree 189-2009, the SEA has precedence for project execution, in hydrographic basins or sub-basins, or in geographical areas where development has been poorly organized and planned without taking into account human activities and those that are not yet using SEA as a way to assess its environmental situation and the corrective plan and environmental mitigation that may arise from it. SERNA, with the support of institutions that they deem necessary, may establish a national prioritization plan or program for carrying out such assessments.
Exemptions from SEA application
It does not indicate exemptions.
SEA approach
The methodology of EAE is different from the EIA.
SEA tiering with EIA
Article 92 (Decreto 189-2009), points out that an SEA can serve as a mechanism to systematize and expedite the resolution and the environmental authorization of projects that are located in areas where the SEA was developed. Article 94 (Decreto 189-2009) also mentions that the land-use plans and programs that are developed, must integrate the environmental variable into these processes. The SERNA, once revising the land use planning already done can make adjustments to their Categorization Table in order to simplify and expedite the processing of EIA in projects, construction work or activities only if they are located in territories which have already undergone such land use planning. These adjustments to the Categorization Table should be published as part of a document which formalizes the land use plan or program in question, with the participation of the SERNA.
Central SEA authority
As described in the SINEIA Regulation (Decree 189-2009), the DECA of SERNA is the competent authority in SEA. This is also the case for the Environmental Management Units (EMU) in the public administration institutions which also can deal with SEA issues (4.46 article of Decree 189-2009).
Mandate for exemption of SEA obligation
(De)centralisation of SEA mandates
Initiator of the SEA
Establishing context
Screening requirement and authority
Timeline Screening
Identification of stakeholders
Setting SEA objectives
Establishing SEA objectives is considered part of the first main step in conducting an SEA (article 93, Decree 189-2009), as stated in the following first step: Context to realize an SEA, objectives and scope definition.
Implementing the SEA
Scoping process
The scope of an SEA is considered a part of the first main step in conducting an SEA (article 93, Decree 189-2009), being the first step the following: Context of the realization of an SEA, objectives and scope definition.
In addition, to help to define the scope, as an input, is the second main step in the realization of an SEA, which is: Identifying the links between related plans and programs, consistency analysis.
As fourth main step in conducting an SEA is: Environmental scope of the assessment object.
Participation in scoping
According to article 93 (Decree 189-2009), the procedure for preparation of an SEA will be carried out within a framework of transparency, participation and information. In addition, as part of the seventh and last main step in conducting an SEA, participation and information is a transversal element (93 article, Decree 189-2009).
Outcome of scoping
The results of scoping are the following: consistency analysis, evaluation and comparison of alternatives and the definition of monitoring indicators
Baseline data
The alternatives are a part of the third main step in the realization of an SEA (article 93, Decree 189-2009), stated as follows: Recognition of alternatives, assessment and comparison, including the no implementation of the proposed assessment object.
Assessment/mitigation of effects
Assessment and mitigation of impacts is taken into account in the fifth main step in conducting an SEA (article 93, Decree 189-2009), as the fifth step states the following: Definition of strategic environmental actions to implement and of the monitoring indicators.
Institutional analysis
Content of SEA report
The SEA is documented in a final report as the sixth main step in conducting an SEA (93 article, Decree 189-2009).
SEA review
DECA of SERNA is the competent authority on SEA, it is the one that has the mandate to review the SEA report with the support of the Environmental Management Units (EMU) in public administration institutions (article 4.46 Decree 189 - 2009).
Participation in review
For the revision of the final report of an SEA, DECA has the support of the Environmental Management Units (EMU) in the public administration institutions (article 4.46 Decree 189 - 2009).
Timeline review
Informing and influencing decision-making
SEA and planning decision-making
Article 92 (Decreto 189-2009), suggests that findings of an SEA can be used in decision-making strategy, policies, plans and programs for super sectors and sector development and land use planning, as well as for mega projects.
Article 94 (Decreto 189-2009) also indicates that land-use plans and programs that are developed, must integrate the environmental variable as a way to ensure a healthy and ecologically balanced environment.
Recommendations for decision-making
Justification of decision
Monitoring requirement
As a fifth main step in conducting anSEA the monitoring indicators must be defined (article 93, Decree 189-2009).
Evaluation requirement
Annual no. of SEAs
Central SEA database
SEA information is not accessible to the public, since it is not on the website of the SERNA.
Practice reviews
GTZ and IUCN provided technical support in the period from 2008 to 2010 for a pilot SEA of 10 strategic plans for Municipal Development.
A pilot SEA of 10 Strategic plans for Municipal Development.
Staff of the EIA project for Central America, a tool for sustainable development from IUCN and CCAD.
From 2006 onwards officials have been receiving training through the EIA Project in Central America provided by IUCN.
Non-governmental SEA guidance
Guidelines on Strategic Environmental Assessment for Central America. (CCAD-UICN, 2007)
Links to laws/regulation
Other relevant links on SEA
EIA project for Central America, a tool for sustainable development from IUCN and CCAD:
http://www.ccad.ws:8080
Guidelines on Strategic Environmental Assessment for Central America. (CCAD-UICN, 2007):
http://www.ccad.ws:8080/eia/documentos.php?cat=1
Ineke Steinhauer


Two new screenprints at great prices. Designed and hand screenprinted by Ryan Quickfall himself.
Would make a great Xmas present.
Posted rolled in a heavy duty mailing tube with old posters, flyers and stickers we have lying around. Frame not included.
Just ordered and soon in France. Thank you and ryan quickfall.
Since I have been subscribing to Sideburn, I have seen an explosion of interest in flat track and street versions of flat trackers. Now my tele is awash in reports about rollerball! Well done, keep on keeping on. Support the independents and free spirits.


+<svg version="1.1" id="Feather" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px"
+              Apache Unomi is an effort undergoing incubation at The Apache Software Foundation (ASF), sponsored by the Apache Incubator PMC. Incubation is required of all newly accepted projects until a further review indicates that the infrastructure, communications, and decision making process have stabilized in a manner consistent with other successful ASF projects. While incubation status is not necessarily a reflection of the completeness or stability of the code, it does indicate that the project has yet to be fully endorsed by the ASF.


How can I operation occasionally on a background thread, but reschedule it if something happens to delay it?
There are a lot of reasons you might want to reschedule a background operation. For example, you want to re-parse a file 3 seconds after the user stops typing, so you can show errors. But at 2 seconds she starts typing again. You don't want that task to run a second from now anymore. You can either cancel the task, or even simpler, call task.schedule(3000) every time a key is pressed. If it was already scheduled, it will be rescheduled for 3 seconds from now again.
Or imagine you have the situation described in the FAQ about RequestProcessor.getDefault() - a node for a file needs to read the file after it is created to mark itself if the file has errors. RequestProcessor.Task makes this sort of thing easy.


The Plano Haiti Family Discipleship Trip is February 15-20, 2018. This family trip is for two family members or more, including couples or parents with kids 3rd grade or older. For more details and to apply, visit [watermark.org/international-trips](http://www.watermark.org/plano/ministries/international/international-discipleship-trips/) .


Less than two weeks before the release of their re-recorded greatest hits album "Nucleus", Japan's leading traditional heavy metal band ANTHEM have unveiled a new live-video for the song 'Cryin Heart' featuring guest drummer Mad Ohuchi.
The band also announced their first ever European festival appearance.
On April 26th-27th 2019, ANTHEM will play at the Keep It True festival in Germany!
Mixing and mastering of "Nucleus" was done by established producer and engineer Jens Bogren, known for his work with a multitude of big name artists.
Jens' work is based on elaborate theories and an abundance of knowledge, which has helped guide the careers of many bands, ANTHEM's case is no exception.
This album which features Jens' fat sound with rich low-end is more than up to par with the worldwide heavy metal standard.
A remarkable point worth noting about this release is that all of the songs except 'Venom Strike' were written after their reunion in 2001 – proving that ANTHEM have always has been a 'current band' that does not have to rely on their past.
ENTERFIRE – single "A thousand voices" from album "Slave of time".


text:
Mavericks owner Mark Cuban donates $10 million after hostile workplace investigation
DALLAS - Dallas Mavericks owner Mark Cuban announced Wednesday he will contribute $10 million to help further the cause of women in sports and raise awareness about domestic violence after an investigation substantiated numerous incidents of sexual harassment and improper workplace conduct within the franchise going back more than 20 years.
The investigation faulted the Mavericks for allowing an environment where workplace misconduct was rampant.
"The findings of the independent investigation are disturbing and heartbreaking and no employee in the NBA, or any workplace for that matter, should be subject to the type of working environment described in the report," Commissioner Adam Silver said. "While nothing will undo the harm caused by a select few former employees of the Mavericks, the workplace reforms and the $10 million that Mark has agreed to contribute are important steps toward rectifying this past behavior and shining a light on a pervasive societal failing."
The NBA also said it would require staffing, reporting and policy changes for the Mavericks seven months after a Sports Illustrated report detailed years of examples of a hostile workplace for women on the business side of the team. There were also allegations of sexual misconduct against former team President Terdemy Ussery, who worked for Cuban for 15 years and was investigated by the Mavericks over similar allegations in 1998, two years before Cuban bought the team.
Soon after the SI report, Cuban hired former AT&T executive Cynthia Marshall as CEO. The NBA made note of that and other staffing changes the Mavericks had already implemented.
Independent investigators hired by Cuban interviewed 215 current and former Mavericks employees and reviewed 1.6 million documents, including emails and other electronic documents.
The NBA largely deferred to the investigation, which determined there was no evidence Cuban was aware one of the probe's key findings that expanded on the SI report: Ussery allegedly engaging in improper workplace conduct with 15 female employees, including touching and forcible kissing.
According to the report, a former ticket sales employee viewed and shared pornographic images and videos at work and made unwanted sexual advances toward co-workers.
The Mavericks made a "significant error in judgment" in allowing former team website writer Earl Sneed to keep his job despite his involvement in two domestic violence cases, the report said. Sneed was fired after the SI report.
An advisory group that will include Cuban, Marshall and representatives from the NBA will determine where the $10 million will go. It is earmarked for groups committed the leadership and development of women in the sports industry and combating domestic violence. By rule, the maximum fine allowed by the NBA is $2.5 million.
When the SI report came out, Ussery was three years removed from his time with the Mavericks. He had previously served as commissioner of the old Continental Basketball Association and was praised by former NBA Commissioner David Stern. Ussery left the Mavericks for the sports shoes and clothing company Under Armour but was gone from that job in less than six months. He denied the allegations when the SI report came out.


A bed is a major investment and beds are expensive. When you are looking for a new bed you want to try to get a deal because you will save money this way and end up with beds that are a better deal. It can be a challenge trying to find the best times to get those deals on your new bed so are going to want to take your time and look around for deals that are going to help you save the most money. If you shop smart, you will never have to pay full price for your bed and you will be happy with your purchase because you saved so much money.
One way to get deals is to wait for the beds to go on sale so you can get a discount. Most furniture stores have sales several times a year. Black Friday sales often give you the best deals and you can sometimes save 50 to 75 percent. You can keep an eye on sales and when the price goes low enough you can buy your bed. You will also find a variety of other sales during the year that you can keep your eye on.
Another way to look for deals is to use a price savings app that will track the price of the bed you are interested in and alert you to when it gets to its lowest price. These sites are easy to use and they can help you keep track of things, especially if you are interested in multiple beds. You never have to pay full price for a bed if you try to track savings and use these apps.
You can also look for coupon codes and other discounts for your bed so you end up with the right bed for your needs. Trying to find the right bed can be a challenge which is why it is important to use coupon codes and other types of offers. You want to make sure that you look for the best deals so you can save money and so you don't have to spend more on your bed than you really need to.


text:
Bugwolf is proud to have taken part in the Go Girl Go for IT event this year in Melbourne. We participated along with our partners the National Australian Bank, IBM and K-Mart. The Go Girl Go for IT program exists to help educate young women on the many digital technology careers available.
"It is about highlighting to girls, between 13 and 17, the joys and opportunities of a career in IT because often they don't know about it, or they are not given the opportunity to know more and decide. So we're not about making them going into IT. We are giving them the opportunity to choose," event leader Fi Slaven explained to CIO Australia.
The Go Girl Go program originally hosted a themed conference every two years to assist young women to understand the opportunities available in IT careers. This year's event was so successful that it has now turned into an ongoing endeavor with newsletters, competitions and programs. As Fi Slaven said, "We are the only program of its kind in Australia - and we are the biggest this year. We had a goal of 1,500 girls and we had 2,300 register from over 85 schools."
Bugwolf created a challenge where teenage girls would use their own phones, or supplied devices, to test NAB's website and give feedback on what they found using Bugwolf's state of the art software testing platform. Over 273 girls participated by reporting feedback about NAB's website.
The ever-increasing level of technology means that, in the next few decades, the demand for knowledge of digital technology and other skills such as engineering and mathematics won't simply be in demand, they'll be prerequisites for the majority of jobs. This is a big change since coding, and other aspects of IT, originally developed in a rather esoteric and isolated atmosphere. Consequently, there are many young people whose main influencers know little or nothing about IT and its many career opportunities.
The Go Girl Go program is there to say that you don't have to be a "geek" to be a part of IT. There are career opportunities that anyone can take advantage of. And not everything is coding, there are many creative ways to engage with digital technology.
Bugwolf is proud to take part in inspiring young women to be the innovators, entrepreneurs and inventors who will take on the challenges of building the next generation of digital technology.


text:
Перде и завеса са два вида свободно висящ текстил, закачен в горния край на различни устройства, осигуряващи движение встрани по корниз или спускане и вдигане. Предназначени са да закриват прозорци, ниши, помещения, сцени и др.

Съществуват различни техники, механизми и корнизи, осигуряващи движението на пердетата и завесите. Когато платът е захванат и в долния край, т.е. не е свободно падащ, тогава устройството се нарича щора.

Перде
Пердето се прави от прозрачен или полупрозрачен плат, който пропуска светлина и служи за декоративно покриване на прозорците.

Пердетата са с изключително разнообразие на цветове, форми и декоративни елементи.

Завеса

Завесата е от по-плътен плат, непропускащ светлина. Функцията ѝ освен декоративна е да затъмнява, както и частична шумо- и топлоизолация, осигурявайки комфорт в помещението.

Театралните завеси се изработват обикновено от тежък плътен червен плат, често със златисти ресни покрая.

Завеса от изкуствена водоустойчива материя се ползва в баните, за да не се мокри помещението при ползване на душа.

Балдахин

Балдахинът () е вид вътрешна декорация от плат, който се слага около и над легло или трон. Балдахинът може да е от всякакъв плат (подобен на перде или завеса), а закрепването може да подвижно или фиксирано. При леглата служи и за предпазване от комари, поради което често се поставя на детски легла.

Аксесоари
 Корниз
 Кукички
 Перделък – лента, на която се закачат кукичките, които свързват пердето или завесата с корниза. Пришива се в горния край на плата.
 Тежести
 Декоративни елементи

Вижте също
 Параван
 Щора

Източници

Обзавеждане

redpajama_set_name: RedPajamaWikipedia


Get the Best Deals for you in Holiday Packages.
Life is an adventure that needs to be lived to the utmost. Travel far and wide not to escape life but to live it in all its glory…Travel is more than sightseeing. It is a transformation that goes deep and permanent in your very ideas of life!
We aim to our customers a large variety of custom travel deal with promise of outstanding customer service.
Make yourself always feel like home, discover the charm and luxury of our hotels, made to escape hustles and bustles of everyday.
Longing for a vacation and have no idea of where to go? Skygo travels brings you the best opportunity to enjoy holiday at different destinations across the world, With its amazing tour packages, your trip can be really exciting.
If you are unable to choose a place in your budget, then call our travel experts to get your tour customized and have memorable travel experiences with family or with your loved once by customizing your tour packages with us.


1.1 Reception cart shall at times collect information relating to Your use of the website. Such information may either be classified as "personal" or "non-personal". Your personal information includes Your name, address, telephone number, email address etc ("Personal Information"), and Reception Cart may collect Personal Information for purposes such as Registration on the Website and for other purposes including but not limited to purchase and sale of Goods on the Website.
i. to enable You to use the Website and to exchange information with Receptioncart; ii.to personalize your Website experience; iii.for the administration and efficient functioning of the Website; iv.in response to any request by an appropriate investigative authority under order from an appropriate judicial authority or under direct order from an appropriate judicial or quasi-judicial authority.
1.3 You also understand that your own personal information disseminated by You on the public forums of the Website shall be at your own risk and peril and that Reception Cart shall not be responsible for the any consequences that may flow from your having shared such information.
1.4 You also understand that while Reception Cart takes all necessary steps to protect your information, security hazards and risks cannot be fully ruled out or eliminated and that your use of the Website still carries risk of this nature with it.
1.5 Other than the Personal Information Reception Cart may also collect anonymous information about your usage of the website and other websites ("Non-Personal Information"). Such Non-Personal information may be collected by us through cookies stored on your hard drive. You can choose to disable cookies on your web browser, however this will negatively affect your browsing experience on the Website. Such Non-Personal Information may be shared by Reception Cart with third-parties such as advertisers, sponsors etc., and may be used to improve Reception Cart business model and customer needs. Such information will never identify You personally and will be collected and stored on a completely anonymous basis.
2.1 Reception Cart will use best practices to ensure that your Personal Information is secure and not open to third-party access. Reception Cart puts in places physical measures to ensure such protection. We shall continue not be responsible for any breach of security in respect of the Personal Information in case of events outside Reception Cart controls such as, but not limited to, earthquake, cyclone, tsunami and such natural disasters, as well as riots, acts of war, acts of terror, unauthorised computer attacks, system crashes, software or hardware defects etc., the events are collectively classified as force majeure events.
2.2 Reception Cart shall not be responsible for any breach of security or any other consequence owing to Your having clicked on any third-party advertiser or other links that appear on Reception Cart website.
3.1 Reception Cart shall preserve and store all communication made with You on any subject. These communications may be used, amongst other things, as evidence during legal investigations initiated by competent legal authorities, for the protection of Reception Cart interests in the case of dispute and for any other purpose stated here regarding the use of Personal Information.
3.2 You agree that the use of the Website authorises the transfer of Your Personal Information across international borders and permit Reception Cart to store and process such information in any country around the world.
3.3 These conditions may be changed without notice by Reception Cart from time to time. Reception Cart will not require your consent to change these conditions and your continuing to access the Website will constitute as You having given consent to such new terms of this policy.
3.4 All disputes in respect of this policy will be interpreted in accordance with the laws in force in India. The courts at Bangalore, Karnataka shall have exclusive jurisdiction.


text:
Art, Culture, Photography
Photography Adventures with Asher Svidensky
by Anna Durbanova
Asher Svidensky is a freelance photographer, who is working with diverse and beautiful cultures from around the world and presenting them with wonderfully-built storytelling and photography. His works have been featured in such magazines as BBC, National Geographic, The Guardian,
Anna Durbanova, Asher Svidensky, documentary photography, Impakter Magazine, Kazakh Eagle Hunters, Mongolia, thingser, travel, Travel Photography
Art, Culture, Design, Society, Style
Language, time and image in the Alicia Eggert's Art
Alicia Eggert, is an American interdisciplinary conceptual artist, whose artworks in the form of kinetic, electronic, interactive sculpture and installations focus on the relationship between language, time and image. Alicia's artworks have been exhibited at different local and international museums in Beijing,
Alicia Eggert, Anna Durbanova, art, Conceptual art, Impakter Magazine, thingser, TIME
Environment, Science, Society
Building a Culture of Sustainability with MyGreenLab
MyGreenLab, a non-profit organization, is building a culture of sustainability in the scientific community and brings awareness about the hazardous environmental impact that laboratories usually bring. Impakter Magazine had an exciting conversation with the Executive Director of My Green Lab, Allison
Allison Paradise, Anna Durbanova, Impakter Magazine, My Green Lab, neuroscience, Sustainability, thingser
Art, Design, Science
Jeweler's Art Meets Neuroscience
The Society for Neuroscience (SfN) annual conference in Washington, D.C., impressed me with the variety of seminars, workshops, symposiums and amazing people from around the globe with impactful ideas and projects in the neuroscience field. Running from one lecture to another one, I sensed a beauty and inspiration in the
Anna Durbanova, Design, Impakter Magazine, jewelry, Kathleen Childress, neuroscience, thingser
Knowledge makes Humanity stronger: Interview with 15×4 Munich
In 2017 Munich has suddenly became excited about 15x4 community. Four talks for 15 minutes, about almost everything, including science and technology, were presented in the most accessible and interactive way. The team of volunteers creates a buzz for knowledge
15x4, Anna Durbanova, community, Education, Impakter Magazine, Munich, Science, thingser
Lifestyle, Society
We Need to Talk – Interview with Celeste Headlee
Imagine the situation: you are having a conversation with a friend, but he is not really listening to you; instead, he endeavors to show his attention by mumbling "supportive" words like "Uh huh," "Mm-hmm" and nodding a lot. Familiar, isn't
Anna Durbanova, Celeste Headlee, communication, conversations, Impakter Magazine, thingser, we need to talk
Art, Culture
Magical Watercolor Architecture with Sunga Park
Sunga Park is a Korean artist, graphic designer and illustrator. She is a "self-taught" artist, who is not following the realistic colors in her watercolor architecture. Sunga challenges viewers to finalize her artwork with their imagination. Impakter Magazine: Sunga, tell us, when
Anna Durbanova, architecture, art, Impakter, Sunga Park, thingsert, watercolor
Lifestyle, Style
Zero Waste Lifestyle: Interview with Bea Johnson
Bea Johnson is a California-based French native, a guru of the Zero Waste lifestyle movement. She is an advocate for improving humanity through waste reduction; she often speaks at universities, presenting at conferences, and publishing a bestselling book translated into
Anna Durbanova, Bea Johnson, Impakter Magazine, thingser, zero waste, zero waste lifestyle
Culture, Equal Rights, Photography
Conversation about conflicts and human rights with Marcus Bleasdale
Marcus Bleasdale is a photographer who has been documenting some of the world's most brutal wars over the past eighteen years. Marcus covered the wars in Sierra Leone, Liberia, The Democratic Republic of Congo, Central African Republic, Somalia, Chad and
Anna Durbanova, Conflict, documentary photography, Human rights, Impakter Magazine, Marcus Bleasdale, thingser
Luminous Journey with David Lazar
David Lazar is an Australian travel photographer and musician, who captures the beauty of the world, moments of life and culture. He travels to the countries with a rich cultural background, traditions, and history. David is a contributor to photography, travel and
Anna Durbanova, David Lazar, Impakter, Impakter Magazine, Luminous Journey, Myanmar, photography, thingser
Art, Culture, Uncategorized
Magical World with Adam S. Doyle
Adam S. Doyle is an illustrator and designer based in New York. In this article, Adam shares his story, discusses the importance of color in the storytelling, gives pieces of advice for those artists who feel frustrated in front of the
Adam S Doyle, Anna Durbanova, art, Impakter Magazine, thingser
Culture, Foodscape
Pastry World: Interview with David Lebovitz
David Lebovitz is an American pastry chef and the author of the cookbooks "Room for dessert," "Ripe for Dessert," "The Great Book of Chocolate", "The Perfect Scoop," "The Sweet Life in Paris," "Ready for Dessert" and "My Paris Kitchen." His last
Anna Durbanova, David Lebovitz, Impakter, Pastry, thingser


text:
Clifton Suspension Bridge
Revision as of 12:36, 31 July 2018 by JohnD (talk | contribs)
Looking south to the Leigh tower
Looking north towards Clifton
Wrought iron lattice girders serve as parapets. Photo also shows the wrought iron cross girders and cast iron stanchions
Top of north tower. The capping is assembled from cast iron sections, bolted internally. The longer pins in the chain links comprise pairs of tapered cotters. The black castings within the towers are roller-mounted saddles, bearing the maker's name, Barrett, Exall and Andrewes of Reading
South tower
Close view of saddle in north tower, during refurbishment in 2015
The towers' flared caps scarcely attract attention from below, but they are assembled from relatively thin iron castings and represent a fine example of the ironfounder's art. We are indebted to David Anderson, Bridge Master, for providing access to the tower during refurbishment in 2015
Photograph of drawing displayed at the Visitor Centre. The drawing was traced for Howard Humphreys & Sons in 1903 from drawings used by the contractors during completion of the bridge in the 1860s. See enlarged details below
Access to the south abutment's chambers was recently made by core drilling through the east wall
This is the first chamber to be entered by visitors on 'Hard Hat Tours'. The small hole near the top is a manhole at road level
Second chamber
Second chamber, showing one of the holes communicating with the eastern upper chamber. Also note cottered tie bars and wooden bearing plates
Exhibit in the new bridge visitor centre. Explanatory note below
The longitudinal lines are typical features of wrought iron, representing rolled-in slag inclusions. The horizontal features are fracture surfaces, the flatter ones being due to metal fatigue, which presumably started at the RHS above the end of the screw thread.
The Clifton Suspension Bridge spans the Avon Gorge, and linking Clifton in Bristol to Leigh Woods in North Somerset, England.
Bridge Road, Leigh Woods, Bristol, BS8 3PA. Clifton Suspension Bridge Website.
An excellent Visitor Centre was opened in 2015 on the south side of the bridge.
2 Saddles
4 Sources of Information
The idea of building a bridge across the Avon Gorge originated in 1753, with a bequest in the will of Bristolian merchant William Vick, who left £1,000 invested with instructions that when the interest had accumulated to £10,000, it should be used for the purpose of building a stone bridge between Clifton Down (which was in Gloucestershire, outside the City of Bristol, until the 1830s) and Leigh Woods (then in Somerset).
By 1829, Vick's bequest had reached £8,000, but it was estimated that a stone bridge would cost over ten times that amount. An Act of Parliament was passed to allow a wrought iron suspension bridge to be built instead, and tolls levied to recoup the cost.
A competition was held to find a design for the bridge; the judge, Thomas Telford, rejected all designs, and tried to insist on a design of his own, a suspension bridge supported on tall Gothic towers. Telford claimed that no suspension bridge could exceed the 600 feet span of his own Menai Bridge.
1831 A second competition, held with new judges, was won by the design of Isambard Kingdom Brunel on 16 March, for a suspension bridge with fashionably Egyptian-influenced towers.
An attempt to build Brunel's design in 1831 was stopped by the Bristol Riots, which severely dented commercial confidence in Bristol.
1836 Work was not started again until 1836, and thereafter the capital from Vick's bequest and subsequent investment proved woefully inadequate.
By 1843, the towers had been built in unfinished stone, but funds were exhausted.
In 1851, the ironwork was sold and used to build the Brunel-designed Royal Albert Bridge on the railway between Plymouth and Saltash.
Brunel died in 1859, without seeing the completion of the bridge. Brunel's colleagues in the Institution of Civil Engineers felt that completion of the Bridge would be a fitting memorial, and started to raise new funds.
In 1860, Brunel's Hungerford Suspension Bridge, over the Thames in London, was demolished to make way for a new railway bridge to Charing Cross railway station, and its chains were purchased for use at Clifton. A slightly revised design was made by William Henry Barlow and John Hawkshaw; it has a wider, higher and sturdier deck than Brunel intended, triple chains instead of double, and the towers were left as rough stone rather than being finished in Egyptian style.
Work on the bridge was restarted in 1862, and was complete by 1864.
Towers: Although similar in size, the bridge towers are by no means identical in design. Leigh (south) tower has chamfered corners. The Clifton tower has square corners, and has openings in the sides. The arches above the road have different shapes on the two towers. Brunel's original plan proposed the towers be topped with fashionable sphinxes, but the ornaments were never constructed.
Abutments: The 85 ft tall Leigh Woods tower stands atop a 110 ft red sandstone clad abutment. In 2002 it was discovered that this was not a solid structure but contained 12 vaulted chambers up to 35 ft high, linked by shafts and tunnels. It is now possible to visit two of these chambers on guided 'Hard Hat Tours'.
Saddles: Roller mounted "saddles" at the top of each tower allow movement of the chains when loads pass over the bridge. Though their total travel is miniscule, their ability to absorb forces created by chain deflection prevents damage to both tower and chain.
Chains, Hangers, and Deck: The bridge has three independent wrought iron chains per side, from which the bridge deck is suspended by eighty-one matching vertical wrought-iron rods ranging from 65 ft at the ends to 3 ft in the centre. Composed of numerous parallel rows of eyebars connected by bolts, the chains are anchored in tunnels in the rocks 60 ft below ground level at the sides of the gorge. The deck was originally laid with wooden planking, later covered with asphalt, which has been renewed in 2009.
The weight of the bridge, including chains, rods, girders and deck is approximately 1,500 tons.
The above information is largely drawn from Wikipedia[1]
The change in direction of the chains in passing over the top of the towers is accommodated by iron saddles which incorporate rollers. The rollers facilitate changes in catenary due to load or temperature changes, and also minimise the transmission of longitudinal forces form the chains to towers.
The main span chains and the anchor chains are connected, not directly to each other, but through the medium of 13 vertical iron plates, arranged 'toast rack' fashion - see drawing. The plates are sandwiched between a pair of 'stirrup'-shaped iron castings. The required gap between each plate (for the 12 chain links) is established by plate washers, the whole 'sandwich' being held together by six long bolts passing through the plates and the castings.
Each 'stirrup' casting has two feet which sit on a large cast iron plate. The plate can be seen in the drawing, distinguished by chamfered edges. The feet of the stirrup castings are bolted to this plate.
The chamfered plate sits on 50 rollers, and these in turn run on the planed surfaces of a rectangular iron plate. This plate is supported by four large fish-bellied cast iron beams, which bear the name Barrett, Exall and Andrewes. The beams are supported on the tower's masonry. The whole assembly is set at a slight angle to the horizontal, sloping down towards the 'land' side.
It is recorded that the saddles were previously used on the Hungerford Bridge in London. However, at Hungerford the chains on each side were two-high, compared with three-high at Clifton. We will now examine how the extra chain was accommodated at Clifton, and consider the extent to which old and new saddle components were used.
The extra chains were accommodated by adding an 'auxiliary saddle' on top of the Hungerford saddle. Specifically, this was a stack of 13 iron plates, bored for the two pins of the centre and main span chains. This stack sits on top of the original Hungerford stack, and is clamped together and united to the main stack by means of the pair of 'stirrup' castings. It therefore appears that the only new (1860s) parts are the auxiliary saddle components, the stirrup castings, and various fasteners.
It is reasonable to suppose that efforts were made to ensure that the bottom edges of the plates of the main (ex-Hungerford) 'toast rack' were all well-seated on the base casting. This was presumably achieved by temporarily bolting the stack of 13 plates together to bore the four holes and to plane the base of the plates. For the 'auxiliary saddle', the drawing implies that its plates are unsupported at the bottom, but it seems more likely that there is a plate inserted in the gap.
Several photographs of one of the saddles are available here[2]. One photo shows that one set of links is perforated by a rectangular slot, whose function is not clear.
↑ [1] Wikipedia
↑ [2] 'Celebrating an engineering marvel: Spectacular photos offer rare view from INSIDE Brunel's 150-year-old Clifton Suspension Bridge' – Daily Mail online
Retrieved from "https://www.gracesguide.co.uk/index.php?title=Clifton_Suspension_Bridge&oldid=1043178"
Town - Bristol
Things to do - Bristol
Bridges of Bristol
Suspension Bridges
Suspension Bridges - Chain Type


text:
Lushnjë este un oraș din regiunea Fier, Albania.

Orașe din Albania


text:
Tennis: Tsonga shines on gloomy day at French Open
31 May 2015 | 8:17 pm
Jo-Wilfried Tsonga beat fourth seed Tomas Berdych at a weather-hit Roland Garros on Sunday, winning their fourth round tie 6-3, 6-2, 6-7 (5/7), 6-3 on a day of mixed fortunes for French hopes.
Jo-Wilfried Tsonga Doha
The 14th seed's emphatic win was followed by a loss for Gilles Simon, who went down 6-1, 6-4, 6-2 to eighth seeded Swiss Stan Wawrinka.
Then Gael Monfils saw his contest with Roger Federer suspended due to poor light with the score level at one set all. It will resume Monday afternoon with the winner going up against Wawrinka.
In the other match completed, Japan's fifth-seeded Kei Nishikori comfortably saw off the challenge of Russia's Teymuraz Gabashvili and he will be the next opponent for Tsonga.
Berdych looked out of sorts from the start against Tsonga in the cold, damp conditions that marked the tournament's second Sunday, allowing the French favourite to dominate rally after rally with his powerful serve and shot-making.
The Czech player rallied briefly in the third set as Tsonga's level dropped, but after a brief scare at the start of the fourth set, Tsonga won five games in a row to move through.
The 14th seeded Frenchman will take on Nishikori with the prospect of reaching what would be just his second appearance in a French Open semi-final.
"It was not easy because I played really well during three sets. And when it was time to finish I played a little bit differently and because he's a good player, he came back in the match," Tsonga said.
"Then I started to miss a little bit more. But I had a good reaction in the fourth, and finally I won it. So it's good for me. I'm happy to beat a guy like this — one of the best at the moment."
Tsonga was one of five French players into the last 16, equalling the best home showing at Roland Garros in the Open-era since 1968.
But on the two previous occasions that happened, only one man reached the quarter-finals.
His win briefly raised French hopes, but they were soon let down when current French number one Simon was thrashed by Wawrinka, the 2014 Australian Open winner who is perfectly at home on clay, having grown up playing on the surface in Lausanne.
"It was perfect and I am happy to have won the match. I had been expecting a tough match against Gilles, but I played very well, aggressive, as the conditions were slow," Wawrinka said.
The Monfils-Federer match always looked likely to be unfinished at the end of the day as darkness started to fall to add to the gloomy conditions as they took to the court.
Second seed and 2009 champion Federer dominated the opening set, with Monfils looking exasperated at times with the wind and the cold.
But as ever, the French showman dug deep and found some fresh reserves to level the set scores before the match referee called both men to the net and they all agreed to sleep on it.
The two other Frenchmen into the last 16 — Richard Gasquet and Jeremy Chardy — were down to play their ties on Monday with Gasquet against top see Novak Djokovic and Chardy facing third seed Andy Murray.
No Frenchman has won at Roland Garros since Yannick Noah in 1983 and prior to that it was Marcel Bernard in 1946.
Nishikori's win made him the first Japanese man in 82 years to reach the French Open quarter-finals.
Jiro Satoh was the last Japanese man to enjoy such a run in Paris when he went on to the semi-finals in 1931 and 1933.
Nishikori hadn't played since Wednesday after scheduled third round opponent Benjamin Becker withdrew with an injury.
Asked about his thoughts about taking on Tsonga in the last eight, Asia's top player, who reached the final of the US Open last September, said he expected it to be a "fun match."
"We haven't played for a long time, maybe couple of years," he said.
"But, you know, he was injured and he came back now and he's coming back very strong. You know, he has a big serve, big forehand. He's always a dangerous player."
Monster iceberg released 'billions of tonnes' of fresh water into ocean
A giant iceberg that detached from Antarctica in 2017 released the equivalent of 61 million Olympic-sized swimming pools of fresh water as it melted, according to research published Thursday, raising questions over the impact on the marine ecosystem.
Napoli may stop Osimhen from 2022 African Cup of Nations
Super Eagles Striker, Victor Osimhen's hopes of playing in Nigeria's opening game at the Cameroon 2022 African Cup of Nations against Egypt is hanging on the balance as his club's doctors...
Djokovic withdraws from ATP Cup, deepening Australian Open doubts
Novak Djokovic has pulled out of this week's ATP Cup in Sydney, organisers said on Wednesday, heightening doubts over whether he will defend his Australian Open title.
Eguavoen needs 'intelligent players' to succeed in Cameroon, says Adelabu
Former Green Eagles winger, Adegoke Adelabu, has given Coach Austin Eguavoen tips on how to build a winning squad at the African Nations Cup in Cameroun.
NFF finally names Jose Peseiro as Super Eagles coach
Nigeria Football Federation (NFF), yesterday, ended the speculations on who becomes Super Eagles head coach when it named Portugal's Jose Peseiro as the senior national team's new manager.
Remove your tattoos, Beijing tells Chinese football players
Footballers playing in China's national team should remove any existing tattoos and are "strictly prohibited" from getting any new ones, the country's sports administration body has said.
APO Press Releases
NRM is for affordable universal education
Download logoPresident Yoweri Museveni has commissioned Keihangara Seed Secondary School, the first of its kind in the country in Ibanda district under the fund of World Bank and Government of Uganda. 'I came here to use the opportunity of commissioning the school as a symbol to remind Ugandans that the government is moving on the…