Da qualche mese mancava una segnalazion de un certo livello.
Finalmente xe rivada, e porta una firma importante. La sempre mitica moralizzatrice Franca C. Porfirio.
Bon però deve de far, no se pol lassarla sola nela produzion de segnalazioni de qualità ostregheta!
Niente, oggi non possiamo fare a meno di condividere questa importante short communication, che saria in pratica traducibile con "monadina", nella quale i muloni sottoelencati in calce (fa sempre 'ssai figo dirlo), dopo attente misurazioni, stabiliscono che le pulisi dei cani santa più dele pulisi dei gati.
Bon insomma dai lori risultati par che le pulisi dei gati saltino mediamente un metro e una neocibalgina (unità di misura degli anni '90 per indicare 20 cm), mentre le pulisi dei cani saltino mediamente un metro e una scoreza (30 cm), quindi di più.
Le generazioni future ci ringrazieranno.
Carte del frico, approfondimento culturale numero 14/82.
sono protettrici dell'acqua, dei pescatori e sono spiriti benevoli.
Nel gioco FRICO la carta Lis Aganis è una carta risurrezione: le armate perse nell'ultima battaglia, essendo spiriti, risorgono nel medesimo territorio e possono combattere nuovamente.
Siamo al 93% della raccolta, in pratica manca pochissimissimo.
E bon ah. Tuti assolti perchè gnanche pel cul dei, uacciuari.
It's ok to eat fish cause they don't have any feelings. Figurite i alberi.
On 24 March 2012 the Val Rosandra Natural Reserve has been spelachiated by a too much zelant brivez while neting the river. A lot of trees have been tirated down. Now, a lot of porconis are being tirated down by ecologists and people, that are asking themselves the reasons of this excessive action. We analyzed all the hypothesis and finally found the real evil hidden plan.
On 24 March 2012, the region Friul Venice Julie began an important series of netaments of the regional rivers. Most of the rivers were obviously in the Friul, like the Meduna or the Isonzo, that is the confin between Friul and Venice Julie. However, for par condicio, the region decided that also a triestin river was to be netated. Some proposed the Timavo, but they answered that it's sconted under the ground so it's difficult to netar it. Some proposed the Rio Ospo, but they answered that they don't want to go to Brazil. At the end the selected river was the Rosandra.
Some told them that Val Rosandra is a Natural Reserve, but they answered that there are no problem, if they will be in reserve, they will go to make benza in jugo that is vizin and cost less.
Some told them that Val Rosandra is a SIC, but they answered that there are no problem, SIC means SIChesepol, in contrast with the typical triestin Nosepol.
Some told them that Val Rosandra is a ZPS, but they answered "E che coioni!", and said that there are no problem because ZPS means Zona de Potatura Strong (Grignani, 1997).
During the operations, the brivezs were a little too imborezated and cut the Val Rosandra at scartazet (Fig. brivez). A lot of big and important trees like piopps, ontans and saleecees were tirated down with a great damage for the natural equilibrium of the Reserve. Also, this was made in a season very important for the reproduction of a lot of animalets of the Reserve, like usels and ampheebios (Vera, 2003). So now ecologists, "ambientalists of salott" (Cereeanee, 2012) and people in general are really incazated black and, between a porcon and another, want to know the reason of this spelachiament, that an Ordinary Professor of Botanic (i.e. "a person with a personal ambientalist salott in the University of Triest". Cereeanee, 2012) defined ambiental disaster (Nimis, 2012).
To understand what's happened, we use the first person scoionament reading method, a variant of the solit first person scoionament sampling method (Manna, 2009), that consist in reading a lot of things about Val Rosandra and then drinking a spritz to dimenticar the sadness of the spelachiated Reserve and then ligar yourself on the trees to boicottate future brivez actions.
As the assessor of ambient responsible of the operations, Ceereeanee, is furlan, a corrent of pensier thinks that this is the first phase of an evil lanfur plan to conquer Triest. The second phase will be to plant panoces in Val Rosandra. Panoces OGM, with the anti-triestin gene inplanted, that will trasform all the triestins in people who love work. Panic.
Another corrent of pensier is convinted that this disboscament is the first step for the realization of the TAV. Infact, as in Val di Susa there are still great problems, they have decided to build the TAV here because in this way they will recycle all the cartels that were za pront. They will only scanzielate "di Susa" and write "Rosandra", with a great risparm of bori.
Some believe that this is part of a biggest conspiratory plan in which there are involved aliens, chimic scies, 2012, the murders of JFK, Sauron, Tito and also the most terrible one: Quel mona che bate la porta (e chiude urlando) (BigFlies, 2012).
There are some interceptations of dialogues between vecionis that contain allarmant indizs. In particular, the vecionis exclaim a lot of time "una volta qua iera tuta campagna" and "no xe più la bora de una volta". Furthermore, the vecionis individuated in the trees the cause of the rallentament of the bora. So, to ristabilir the conditions of the tempi andai co se stava meo co se stava pezo, the vecionis have a great enemy: the trees.
This is a very interesting and realistic theory. The ailanto is an infesting tree with great capacity of diffusing itself. One of its best strategy is to take mental control of humans and obligate them to plant other ailanti in all the world. This human state of mind is called "il morbo di ailo" and it's very easy to recognize it, because the human with the "morbo di ailo" exclaim a lot of times during the day the word "Ailo!". It is evident that in Triest all the population have the morbo di ailo and are controlled by the ailanti. The second part of the ailanto plan is, obviously, to plant a lot of ailanti in Val Rosandra. Ailo!
Some people think that the above hypothesis are too complex and that all is instead very simple. This year there will be a great grigliata de pasqueta in Val Rosandra, and there were too many trees that were making ombre. Now there will be more sun and also it will be easier to ciapate some animals for the grigliate.
Peoples in blue and yellow who cutted the trees were really IKEA clones from Villesse and as we speak the piopps, ontans and noces are being transformed into furnitures by busy lanfurs for their secret Triangle of the Chair base beneath the rotonda of Manzàn (Tout, personal communication).
The last current of pensier thinks that this is the secret evil plan of Gas Intestinal to make its rigassificator without other rompiments of balls from triestins and ambientalists of salott. The rigassificator will be built in Val Rosandra and will use the water of the Rosandra river, so no one will scassar the maroons for the sea ecosystem. Another ambiental problem was the use of the cloro in the stabiliment. Nema problema: the water with the cloro coming out from the rigassificator will be put in a giant piscine, so all the triestin citizens will be happy for their new balnear stabiliment, in the middle of a Natural Reserve. Figada. Also, as the freshwater has a inferior density of the marine water, it will be easier to schizzar higher while clanfing and the future Clanfa Olympiads will be organized here. Some solit disfattists may say that the gasier ships will not rivar there. Gas Intestinal has yet thought about this, and will scavate the Rio Ospo in order to let it reach Val Rosandra. As these are very smart considerations, at least as smart as the plan of building it in the Zaule ploc', we think that this is the correct explanation of the Val Rosandra scartazet new look.
There are many hypothesis for the spelachiament of Val Rosandra, but we think that the most credible is that it is the first step of the construction of the Gas Intestinal rigassificator here. However, also the ailanto plan is really a convincent theory. Ailo!
We are sad for what's happened in Val Rosandra and we hope that in future these operations ask the parer of the ambientalists of salott that study these ecosystems from a life. We will thanks all people who will manifestate their empathy for nature without making casin in the Reserve and without planting plants in the Reserve, that is a tacon worst of the buso.
Grignani G. 1997. Ti raserò l'aiuola. Un disco de Grignani che desso no me ricordo dei.
Vera P. 2003. Primavera e usei nele zone umide. Wetlands kamasutra 23: 2-5.


The Serpentine Path now available!
I am pleased to announce that my book The Serpentine Path has now been e-published and is available at Smashwords.
The Serpentine Path is the first book of four in a series that I have written about my ancestors. It tells of the romance between Susan Kirke, the daughter of a gentleman, and John Dean, the gardener on her father's estate. Although these two characters were real people, my great-great-great-great-grandparents, I had to invent a great deal to embellish their story. This involved hours of fascinating research into life in England and Scotland in the eighteenth century.
I hope you will enjoy as much as I did learning about pleasure gardens, masquerades, impressment, Scottish wedding traditions, and many other details as John and Susan elope and set out together to start a new life of adventure that will lead them to four countries on two continents.
Book 4 in the series A Garden in the Wilderness is being published by Borealis Press in Ottawa and will be available at the end of March.


Surfaces must be sound, clean, dry and free from all defective or poorly adhering material, dirt, grease or wax. Remove all loose or defective paint or powdery residues by thorough brushing and scraping, using a stiff fiber brush and high pressure water jet. Treat any areas affected mould, lichens, algae and moss with Dulux Fungicidal Wash. Make good minor defects with a suitable exterior grade Filler. Surfaces that remain powdery, friable or chalky after thorough preparation should be sealed with one coat of an appropriate Primer (see below). It should not be applied on areas where moisture reading (as measured by Protimeter) exceeds 17%. These wall should be left to dry further. Note: Do not apply Dulux Weathershield Powerflexx during wet weather.


A Radnor Oak pavilion is made for outdoor living; the perfect space to enable you to enjoy the outdoors whilst offering shelter from the elements.
Impressive oak trusses and chunky oak posts are hand-crafted in our workshop in Wales using quality materials to create a strong, durable and beautiful structure.
Generally, our oak pavilions will not require planning permission or building regulation approval however it is advisable to check with your local authority.


text:
Mr P Feels For The Poor And Expose Why They Retain Their Status
PSquare twin Peter Okoye aka Mr P, a Nigerian singer has decried the increasing rate of poverty and bitterly revealed why the poor remain poor.
He lamented that the number of the poor is overwhelmingly higher than the rich. Consequently, the growing influence of the rich is manipulated to keep the poor in perpetual poverty.
He exposed that the poor are retaining their status primarily because they are not willing to fight for freedom and also eager to unite
His words read partly: "We only have two Tribes in Nigeria, THE POOR and THE RICH. The poor are higher in number while the rich are fewer but the rich managed to keep the poor in perpetual slavery because the poor have refused to unite and fight for their freedom. 2023 election Vote Wisely"

redpajama_set_name: RedPajamaCommonCrawl


Solid & Straight with Upgrading & detached Garage nestled on a deep, fenced Lot.
Just under 800 sq. feet of Living Area above the full Basement and originally built in 1961.
Cute curb appeal with attractive Stone Façade and newer Roof Shingles, Fascia & Soffits (2010).
Main Floor boasts mostly PVC Triple Paned Windows (2010). Newer Front and Side Exterior Doors.
Beautifully Refinished Hardwood Flooring on Main Floor including Hallways and Bedrooms. Dark, rich stain tone used on the Wood Flooring was completed in 2016!
Large L-shaped Living Room with huge picture Window and adjacent Dining Room features Hardwood Flooring, deluxe Ceiling Fan and large PVC Window with Air-Conditioner Unit.
Dining Room Furniture might be included.
Eat-In Kitchen with newer Vinyl Flooring (2016) and original wood Cabinetry, double stainless steel Sink and Exhaust Fan.
The remodelled 4pc Bathroom in 2011 with Ceramic Tile Flooring, Tile to half Wall and Tiled Tub Surround.
Master Bedroom provides Hardwood Flooring and a large PVC Window.
Bedroom Suite/Furniture might be included.
Unspoiled Full Basement is ready for development.
Shingles, Stucco Exterior and Garage Door.
Super Starter in great convenient location near neighbourhood parks, schools and shopping centres!


The big thing is to make the subject relax the uses of Disney music helps alot everyone will start signing along and put them in a good mood. also have a drink with them and just talk let them get to know you. This will help them relax being around you as a photographer.
Five year old Bella Vandeventer was the flower girl at a friends wedding. When I shoot a wedding I try to get photos of the Flower girl in their dress. I uselessly take them away from people/parents and have them relax and tell me a story. This was at Alpine Ponds in Meridian, Idaho. Use what you have Nikon D5000 50mm 1.4 lens, F1.4 1/200 ISO200 at 4:31 pm using natural lighting. I try to photograph children by getting down to their eye level and see the world though their eyes. The rest is just luck.
After looking on Pintest website for ideas I came across the idea for trashing the dress photos in the river. I was able to talk the model into taking some photos in the river. Why not take a dip in the Boise river on a hot August 18th at 7:09 pm. After taking photos of the model in Julia Davis Park in Boise why not cross the bridge and take a dip in the river in a dress. I had the Model just start blowing bubbles in the river and this is what I came out with. Using what I have Nikon D5000 18-55 F3.5-5.6 Kit lens Camera settings of F5.6 1/100 ISO 200 and my on camera flash fired, plus a little luck.


text:
Invited Commentaries
JCRP Review Articles
AACVPR Statements
Tutorial for Reviewers
Peer Reviewer Training Course
Thought you might appreciate this item(s) I saw at Journal of Cardiopulmonary Rehabilitation and Prevention.
Invited Commentary
Update on RFA Increasing Use of Cardiac and Pulmonary Rehabilitation in Traditional and Community Settings NIH-Funded Trials
ADDRESSING CLINICAL TRIAL CHALLENGES PRESENTED BY THE COVID-19 PANDEMIC
Shero, Susan T. BSN, MS; Benzo, Roberto MD, MS; Cooper, Lawton S. MD, MPH; Finkelstein, Joseph MD, PhD; Forman, Daniel E. MD; Gaalema, Diann E. PhD; Joseph, Lyndon PhD; Keteyian, Steven J. PhD; Peterson, Pamela N. MD, MSPH; Punturieri, Antonello MD, PhD; Zieman, Susan MD, PhD; Fleg, Jerome L. MD
National Heart, Lung, and Blood Institute, Bethesda, Maryland (Ms Shero and Drs Cooper, Punturieri, and Fleg); Mayo Clinic, Rochester, Minnesota (Dr Benzo); Icahn School of Medicine at Mount Sinai, New York, New York (Dr Finkelstein); University of Pittsburgh and VA Pittsburgh Healthcare Systems, Pittsburgh, Pennsylvania (Dr Forman); University of Vermont, Burlington (Dr Gaalema); National Institute on Aging, Bethesda, Maryland (Drs Joseph and Zieman); Henry Ford Hospital, Detroit, Michigan (Dr Keteyian); Denver Health Medical Center, Denver, Colorado, and University of Colorado Anschutz Medical Center, Aurora (Dr Peterson).
Correspondence: Jerome L. Fleg, MD, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 6705 Rockledge Dr, Room 309-K2, Bethesda, MD 20892 ([email protected]).
The contents of this article are solely the responsibility of the authors and do not necessarily represent official views of the National Heart, Lung, and Blood Institute, the National Institute on Aging, the National Institutes of Health, or the United States Department of Health and Human Services.
Journal of Cardiopulmonary Rehabilitation and Prevention: January 2022 - Volume 42 - Issue 1 - p 10-14
doi: 10.1097/HCR.0000000000000635
We previously described the design of six NIH-funded clinical trials designed to increase uptake and reduce disparities in the use of cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) based on age, gender, race/ethnicity, and socioeconomic status. The onset of the COVID-19 global pandemic necessitated signifi cant revisions to the trials to ensure the safety of participants and research staff. This article described necessary modifi cations for assessments, interventions, and data collection to support a no-contact approach centered on the use of virtual/remote techniques that maintain both safety and the original intent and integrity of the trials. The general shift from site-based to home-based interventions and hybrid models of CR and PR will be increasingly important in a post-COVID world.
We previously reported on an initiative to increase the uptake of cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) in traditional and community settings funded by the National Heart, Lung, and Blood Institute (and the National Institute on Aging [NIA]).1 The overall objectives of the initiative and those reflected in the funded research projects are to (1) test strategies that will lead to increased use of CR and PR in the US population who are eligible based on current clinical guidelines; (2) test strategies to reduce disparities in the use of CR and PR based on age, gender, race/ethnicity, and socioeconomic status; and (3) test whether increased use of CR and PR, whether administered by traditional center-based or new models, is accompanied by improvements in relevant clinical and patient-centered outcomes. The NIA funding opportunity announcement addressed one or more specific age-related factors.
At the time of our previous report, the six funded projects (four CR and two PR) had successfully met milestones for the initial grant year and had transitioned into the second year, most having begun participant recruitment. At the initial investigator meeting in October 2019, principal investigators from all six trials presented their progress and exchanged valuable feedback. Summaries of the respective research projects published in 2020 highlight the features of the research studies.1 The October 2020 investigator meeting focused on the effects of the novel coronavirus (COVID-19) pandemic on the projects, trial adaptations to address related challenges, lessons learned, and potential paths forward.
On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic.2 Most hospitals and clinics suspended nonemergent procedures, surgical procedures, and appointments, including center-based CR and PR sessions. Other overarching factors affected the conduct and progression of clinical research, including fear of contracting COVID-19 among potential study participants and researchers, stay-at-home orders issued by local governments, and the need for clinician researchers to shift their responsibilities solely to the inpatient clinical setting, notably pulmonary and critical care medicine. In most areas of the US, the temporary suspension of in-person clinical services was in place from March to May 2020, with gradual partial reopenings beginning in May.3
At the onset of the pandemic, the National Institutes of Health issued guidance outlining flexibilities for studies impacted by the COVID-19 public health emergency. Grant recipients were encouraged to consult with their institutional review boards and institutions about potential measures to protect participants and research staff. Concurrently, the Centers for Medicare & Medicaid Services expanded access to telehealth visits for Medicare beneficiaries and to many behavioral health and education services delivered via telehealth and audio-only communications.3,4
For this CR/PR initiative, the COVID-19-related shutdowns and suspension of services required the study teams to quickly submit revised protocols to ensure the safety of participants and research staff. Sites modified interventions, assessments, and data collection to minimize direct participant contact (Table). Psotka and colleagues5 discuss these types of changes in end point collection, functional and exercise measures, and statistical analysis in expert consensus recommendations for clinical trials in the COVID-19 age. The specific approaches taken to address the COVID-19-related challenges for each funded trial are summarized next.
Table - COVID-19-Related Study Changes in This CR/PR Collaborative Initiative
CR/PR Project
Primary End Point(s)
Secondary End Point(s)
Statistical Analysis Plan
Recruitment Status at Time of Suspension of Services
iATTEND Number of sessions attended, percentage of patients completing 36 visits (hybrid vs traditional). 26 participants affected by suspension Included data from the 26 patients affected by trial suspension For primary end point, DSMB considering how to include data from the 26 participants impacted by trial suspension 78 patients enrolled, with 26 participants actively participating in CR randomized before suspension. No recruitment mid-March to mid-May. Enrollment resumed in June Revised during suspension. In-person sessions temporarily changed to synchronized telehealth visits and phone calls. CR hybrid-program telehealth model enhanced from a one-on-one patient-to-staff encounter to a WebEx platform, allowing for simultaneous virtual engagement of three to five patients during a 45-min period
HeLP Attendance at CR. Data collected for remote sessions during suspension No change anticipated 65 participants recruited and 15 still participating in CR. No recruitment between March 16, 2020, and June 7, 2020 In-person interventions changed to remote (phone, e-mail, postal mail) Anticipate need for 4-mo extension
ERA Nudge Participation in CR. Will count logging exercise into app and phone calls as participation during suspension Exercise capacity originally assessed by METs on treadmill. Changed to 6MWT No change anticipated 112 patients enrolled, 21 were active in center-based program and 10 active in home-based program March to May. Center-based CR changed to fully remote March to May. Some outdoor in-person sessions began in May. Added messaging for all patients regarding precautions for COVID-19. During inclement weather, limited use of gym for in-person sessions.
MACRO Changed from SPPB that requires direct supervision to self-reported AM-PAC-CAT Basic Mobility Domain Accelerometry elevated into a more prioritized end point and integrated with the AM-PAC-CAT as a complementary performance measure No change anticipated 43 enrolled prior to suspension. Stopped by the DSMB on March 16, 2020, and resumed (with protocol changes approved by the IRB) on September 21, 2020 Significantly revised to facilitate remote processes. Changes approved on July 10, 2020. Sample size reduced from 480 to 374. Overall shift from site-vs-home-based CR to home- and hybrid-based models.
Increasing Adherence to PR After COPD-Related Hospitalizations Percentage of patients that initiate and complete PR after a COPD-related hospitalization—unchanged Patient choice of home-based vs on-site PR—unchanged Original intent-to-treat analyses retained. Two secondary analyses added. Recruitment deferred during suspension. Sample size increased to 240 (from 150) as it is now noninferiority study. Revised to have no contact enrollment The study transitioned to allow the individuals referred to the PR center to have the choice of either on-site PR or telehealth home-based PR program.
CHIEF-PR Completion rate of PR after acute COPD exacerbation—unchanged To assess exercise capacity at patient homes, 6MWT replaced by 1-min sit-to-stand test. Surveys and questionnaires collected remotely using NIH Toolbox for PROs. No change anticipated Recruitment postponed until mid-June; no participants affected by suspension. Increased enrollment rates after June—currently on track Revised to Online Patient Enrollment Network The study transitioned to a remote assessment of exercise capacity at patient homes.
Abbreviations: AM-PAC-CAT, Activity Measure for Post-Acute Care with Computerized Adaptive Testing; COPD, chronic obstructive pulmonary disease; CR, cardiac rehabilitation; DSMB, Data and Safety Monitoring Board; IRB, institutional review board; MET, metabolic equivalent; NIH, National Institutes of Health; PR, pulmonary rehabilitation; PRO, patient-reported outcome; 6MWT, 6-min walk test; SPPB, Short Physical Performance Battery.
Project Title:Improving ATTENDance to Cardiac Rehabilitation (iATTEND). Principal Investigator: Steven J. Keteyian, PhD, Henry Ford Hospital, Detroit, MI (HL 143099).
The primary aim of the iATTEND trial is to assess the efficacy of hybrid CR (HYCR) on attendance. The primary hypothesis is that patients randomized to HYCR will complete significantly more CR sessions than patients randomized to clinic-based CR alone. Secondary aims are to assess the effect of HYCR on exercise capacity and quality of life. In mid-March 2020, all outpatient clinical and research activities were suspended at Henry Ford Hospital. This policy impacted 26 patients actively engaged in either the standard CR (S-CR) or hybrid CR (combined clinic- and home-based using video synchronized telehealth) arms of the trial. Regardless of study group assignment, for these 26 patients, the number of CR sessions attended at the time CR operations were suspended was used as their total number of sessions completed for the trial (Table). The COVID-19-related suspension directly impacted assessment of the primary trial end points, and the Data and Safety Monitoring Board (DSMB) is evaluating how to include the data from these 26 patients in the statistical analysis. For example, one trial whose primary end point was impacted by COVID-19 excluded all affected participant-related data from their primary analysis but included such data in secondary analyses.6 In June 2020, new patient enrollment resumed using COVID-19-specific procedures (eg, wearing a mask during CR, individual vs group education).
Due to COVID-19, the findings from iATTEND take on increasing importance because the trial evaluates the delivery of CR outside the facility-based setting.7 Additionally, because of COVID-19, health systems are now better prepared to assist CR programs by adding telehealth-based HYCR programs to their services. To leverage these system-level advances within Henry Ford Health System, in February 2021, the CR hybrid program switched its telehealth model from a one-on-one patient-to-staff encounter8,9 to a WebEx platform (Cisco) that allows simultaneous and virtual engagement of three to five patients in a real-time manner during a 45-min period, with the goal of at least 30 min of supervised exercise for each person. The autumn 2020 surge in COVID cases in Michigan did not necessitate appreciable alterations in trial operations.
Project Title:Improving Participation in Cardiac Rehabilitation Among Lower-Socioeconomic Status Patients: Efficacy of Early Case Management and Financial Incentives. The Healthy Lifestyle Program (HeLP) Study. Principal Investigator: Diann Gaalema, PhD, University of Vermont, Burlington, VT (HL 143305).
The goal of the HeLP trial is to test the impact of two interventions: case management and incentives on participation in CR among Medicaid enrollees of low socioeconomic status.1,10 On March 16, 2020, trial recruitment was suspended, and the CR facility ceased normal operations due to the COVID-19 outbreak. At this time point, the study had recruited 65 participants, of whom 15 were still participating in CR.
The CR program transitioned from in-person visits to weekly telehealth phone calls for currently enrolled patients. Accordingly, the study pivoted to encouraging remote attendance. To maintain a consistent target of encouraging or incentivizing 2-3 visits/wk, at-home exercise sessions were included. For each of these sessions, CR staff set a patient-specific step goal, and objective measures of step counts were obtained with pedometers (Omron).11,12 Study interventions switched to completely remote delivery, with case management conducted by phone and incentives delivered by email or mail, to encourage participation in weekly telehealth visits and complete step goals. The trial continued to operate fully remotely for 8 wk before the CR program began a phased reopening in May. While COVID-19 surges have occurred in late 2020 to early 2021, infection rates have remained low in Vermont, and the clinic has not been required to reduce operations.
The main outcome for this trial is attendance at CR. As the team was able to continue data collection and CR sessions remotely, investigators anticipate using data from this time and do not foresee a need for changes to the statistical plan. However, to account for the cessation of recruitment for 11 wk due to research restrictions, they may need to extend trial recruitment by 4 mo.
Project Title:Enhancing Cardiac Rehabilitation Adherence Through Home-Based Rehabilitation and Behavioral Nudges (ERA Nudge). Principal Investigator: Pamela Peterson, MD, MSPH, Denver Health Medical Center, Denver, CO, and University of Colorado Anschutz Medical Campus, Aurora, CO (HL 143324).
The goal of ERA Nudge is to increase adherence to and completion of CR in a diverse, low socioeconomic status population. The study is testing the choice of home versus hospital-based rehabilitation and behavioral nudge messages.13,14 All patients receive an application (app) on their smartphone that allows them to access information, chat with staff, and receive educational information.15,16 On March 13, 2020, all in-person research activities were suspended due to COVID-19, and the in-person clinical CR program was closed. At that time, 112 patients had been enrolled, 21 were active in the center-based program, and 10 were active in the home-based program.
In response to this situation, the team moved to a fully remote program, with patients who were enrolled in center-based CR receiving phone calls on the days of their previously scheduled classes. Participants received teaching and exercise coaching. Those who were enrolled in the home-based program continued to receive one phone call/wk as per the protocol. The collection of survey data was by phone, and assessment of exercise capacity was delayed. The team continued to deliver nudge messaging with added messages for all participants regarding precautions for COVID-19. For example, the messages encouraged them to use mail pharmacies, prescription delivery, or have friends or family members pick up medication refills to avoid exposure to COVID-19. Recruitment was suspended for approximately 6 wk. In early May, the investigators were able to reopen center-based classes and resume enrollment, with approval from the hospital to hold classes in the park next to the hospital, with an option for indoor sessions with two to three participants/class on inclement weather days. This outdoor model was developed based on experience in Toronto.17
The primary outcome of the trial remains CR participation. When no in-person visits were allowed, participation was counted as logging exercise into the app and participating in phone calls. No changes are anticipated in the statistical analysis. Exercise capacity is a secondary outcome, which was originally assessed as metabolic equivalents (METs) on the treadmill but switched to 6-min walk test (6MWT) due to COVID-19 (Table).
Project Title:Modified Application of Cardiac Rehabilitation for Older Adults (MACRO). Principal Investigator: Daniel E. Forman, MD, University of Pittsburgh, Pittsburgh, PA (AG 060499).
Modified Application of Cardiac Rehabilitation for Older Adults (MACRO) is a randomized controlled multisite trial in which precepts of cardiology and geriatrics are merged. A coaching intervention is employed by MACRO that aims to increase function in older adults hospitalized with cardiac disease by increasing their participation in CR. The MACRO coaches use behavioral prompts to better motivate patient interests in CR programs and facilitate options for site-based, home-based, and hybrid (site-based transitioning to home-based) formats of CR to best match circumstances and preferences for each patient. The pre-COVID-19 MACRO protocol relied heavily on face-to-face assessments. The pre-COVID-19 primary end point was the Short Physical Performance Battery,18 a performance measure of gait, balance, and strength that requires direct supervision to maintain safety and fidelity.
When the COVID-19 pandemic was declared, the trial was suspended by the DSMB, as the direct engagements required by the protocol were no longer feasible. The 43 pre-COVID-19 enrollees were released from the trial and their data removed from the analysis. The study team had to extensively revise the protocol to achieve practical, sensitive, and safe methods without face-to-face encounters. The primary end point was changed to the Activity Measure for Post-Acute Care with Computerized Adaptive Testing Basic Mobility Domain,19 a self-reported measure of physical function that can be administered by phone. The sample size was reduced from 480 to 374.
In addition to the Activity Measure for Post-Acute Care with Computerized Adaptive Testing, remotely facilitated accelerometry was prioritized as a complementary performance measure.20 Despite these significant changes, great efforts were made to preserve the original primary goal (ie, improving functional capacity by facilitating CR).
The MACRO study was initially designed to study trade-offs between site-based and home-based CR. However, as a pragmatic trial, it has shifted focus since the pandemic to home-based and hybrid CR models because these have become more common options of care. As a pragmatic trial, MACRO will be able to track the utility of these novel approaches to CR, which may better serve older, complex, and/or frail patients who could not easily attend site-based programs even before COVID was a concern.
Project Title:Increasing Adherence to Pulmonary Rehabilitation After COPD-Related Hospitalizations. Principal Investigator: Roberto Benzo MD, MS, Mayo Clinic, Rochester, MN (HL 142933).
The goal of this clinical trial is to compare adherence to PR after referral to either a centralized home-based PR program21 or a center-based program that offers on-site PR after a chronic obstructive pulmonary disease (COPD)-related hospitalization. Centralized home-based PR involves delivery of all home PR program materials virtually and/or remotely. The center can take referrals from any provider, and provide home PR to any patient in the country, facilitating use by small hospitals, rural hospitals, or hospitals with low resources to deliver home PR. The randomized trial was slated to start in March 2020, but was delayed because of the COVID-19 pandemic.
In response to the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services added PR services to the Medicare telehealth reimbursement list. Due to this change, PR centers can now offer telehealth PR. Thus, the study transitioned to allow the individuals referred to the PR center to choose either on-site PR or the telehealth home-based PR program. The changes made in the context of a public health emergency will provide the study with generalizable and practical results while respecting the original goals as funded:
The investigators will still learn the percentage of patients who initiate and complete PR after a COPD-related hospitalization to compare to the current dismal <2% PR initiation in the same setting22 found in a large study of Medicare beneficiaries.
The team will learn about patient choice of home-based versus on-site PR after a COPD hospitalization.
The primary outcome of this study, completion of the 3-mo PR program, will continue to be based on intention-to-treat analysis, wherein comparisons will be made between the two randomization groups: referral to centralized home-based PR versus referral to a PR center. Because of the COVID-19-related changes, two secondary analyses also will be performed: a per-protocol analysis combining participants in the centralized home-based PR arm with those in the PR center arm that chose home-based telehealth versus hospital-based PR, and an analysis comparing three participant arms: those randomized to home-based PR, those randomized to hospital PR who chose home-based telehealth PR, and those randomized to hospital PR who chose on-site PR. The sample size will increase from 150 to 240 patients, and the design will change to a noninferiority study.
Project Title:Comprehensive Health Informatics Engagement Framework for Pulmonary Rehabilitation (CHIEF-PR). Principal Investigator: Joseph Finkelstein, MD, PhD, Icahn School of Medicine at Mount Sinai, New York, NY (HL 143317).
The Comprehensive Health Informatics Engagement Framework for Pulmonary Rehabilitation (CHIEF-PR) aims to facilitate PR referrals, initial assessments, completion rates, and maintenance using an innovative multipronged approach. The goal of this trial is to demonstrate that the CHIEF-PR is effective in increasing the use of PR in patients after an acute exacerbation of COPD, and improving clinical and patient-reported outcomes as compared with routine clinical care. The CHIEF-PR is a multipronged integrated trial, which addresses barriers for PR uptake and completion using integrated multilevel information technology solutions at the health care, provider, and patient levels. Recruitment into the clinical trial was supposed to commence in March 2020 but was postponed until mid-June due to the COVID-19 pandemic. Thus, the study participants were not affected by the clinical trial shutdown.
During the trial shutdown, the investigators refined their enrollment and follow-up procedures to ensure sufficient social distancing and participant protection from COVID-19 risks. Initial patient contact is now carried out by hospital staff providing interested patients with access to an electronic consenting platform via their smartphone or tablet.23 The entire study is conducted at participant homes after discharge from a hospital. An individualized exercise program is prescribed after remote assessment of exercise capacity using a validated telehealth system.24 To assess exercise capacity at participant homes, the team replaced the 6MWT with a 1-min sit-to-stand test, which was previously demonstrated to be a reliable alternative to the 6MWT.25 As originally planned, participants in the intervention group follow their exercise plan daily using a home-based telerehabilitation system. In comparison, those in the control group receive only printed materials provided after the initial assessment. Physical activity assessment was planned using Fitbit devices. However, the team found that Fitbit accuracy depended on pace and sensor location,26 which may bias estimates in older adults. Additionally, the number of steps may be affected by social isolation during a lockdown. These considerations resulted in using the Physical Functioning Scale of the Short-Form 36, whose internal consistency and validity in older adults have been well established27 (Table).
The sample size and primary outcome of the CHIEF-PR trial, and the completion rate of PR after acute COPD exacerbation, have not changed. The team has increased patient enrollment rates to address the initial delay in the trial commencement, and the current CHIEF-PR accrual to date has reached initially planned milestones.
SUMMARY AND FUTURE DIRECTIONS
The overall objectives of this CR/PR initiative include using new models to increase the uptake of CR/PR in both traditional and community settings. Thus, several of the research projects already employed virtual and/or remote components as part of their original protocols before the COVID-19 pandemic. With the onset of this public health emergency, a rapid shift to new and more extensive uses of telehealth, remote monitoring and assessment, and virtual oversight/supervision approaches were initiated to ensure patient and research staff safety and maintain study integrity to the extent possible (Table). Central to the investigator ability to address trial shutdown challenges was ongoing supportive guidance by the National Institutes of Health staff.
The research questions addressed by these projects have become more critical in light of the pandemic. It is crucial to understand whether safe, effective, and efficient CR/PR programs can be delivered remotely and/or virtually in home-based and hybrid settings. In a post-COVID world, hospitals and clinics may add or enhance remote and/or virtual components to their CR/PR programs to establish safe, effective hybrid programs. Overall, the research projects underwent numerous adaptations and revisions to address the considerable challenges posed by COVID-19. Despite these challenges, the trials may provide even more valuable, generalizable, and practical results in a post-COVID-19 world in which innovative approaches are likely to remain at the forefront of CR/PR delivery. Study adaptations, including early contingency planning and risk management protocols, are needed for the future to address potential public health emergencies, natural disasters, travel or communication disruptions, policy changes, and social and demographic factors in target populations.
1. Fleg JL, Keteyian SJ, Peterson PN, et al. Increasing use of cardiac and pulmonary rehabilitation in traditional and community settings: opportunities to reduce health care disparities. J Cardiopulm Rehabil Prev. 2020;40(6):350–355.
2. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157–160. doi:10.23750/abm.v91i1.9397.
3. Van Iterson EH, Laffin LJ, Crawford M, Mc Mahan D, Cho L, Khot U. Cardiac rehabilitation is essential in the COVID-19 era: delivering uninterrupted heart care based on the Cleveland Clinic experience. J Cardiopulm Rehabil Prev. 2021;41(2):88–92.
4. Centers for Medicare & Medicaid Services. COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. Baltimore, MD: Centers for Medicare & Medicaid Services;2020.
5. Psotka MA, Abraham WT, Fiuzat M, et al. Conduct of clinical trials in the era of COVID-19: JACC Scientific Expert Panel. J Am Coll Cardiol. 2020;76(20):268–2378.
6. Mann DL, Greene SJ, Givertz MM, et al. LIFE Investigators. Sacubitril/valsartan in advanced heart failure with reduced ejection fraction: rationale and design of the LIFE trial. JACC Heart Fail. 2020t;8(10):789–799.
7. Scherrenberg M, Wilhelm M, Hansen D, et al. The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology [published online ahead of print July 2, 2020]. Eur J Prev Cardiol. doi:10.1177/2047487320939671.
8. Berry R, Brawner CA, Kipa SG, Stevens C, Bloom C, Keteyian SJ. Telemedicine home-based cardiac rehabilitation: a case series. J Cardiopulm Rehabil Prev. 2020;40(4):245–248.
9. Keteyian SJ, Grimshaw C, Brawner CA, et al. A comparison of exercise intensity in hybrid versus standard phase two cardiac rehabilitation. J Cardiopulm Rehabil. Prev. 2021;41(1):19–22.
10. Gaalema DE, Elliott RJ, Savage PD, et al. Financial incentives to increase cardiac rehabilitation participation among low-socioeconomic status patients: a randomized clinical trial. JACC Heart Fail. 2019;7(7):537–546.
11. Basset DR, John D. Use of pedometers and accelerometers in clinical populations: validity and reliability issues. Phys Ther Rev. 2013;15(3):135–142.
12. Hasson RE, Haller J, Pober DM, Staudenmayer J, Freedson PS. Validity of the Omron HJ-112 pedometer during treadmill walking. Med Sci Sports Exerc. 2009;41(4):805–809.
13. Thaler R, Sunstein C. Nudge: Improving Decisions About Health, Wealth, and Happiness. Revised & Expanded. New York, NY: Penguin Books; 2009:312.
14. Kahneman D. Thinking, Fast and Slow. New York, NY: Farrar, Strauss and Giroux; 2015.
15. Pfaeffli DL, Dobson R, Whittaker R, Maddison R. The effectiveness of mobile-health behaviour change interventions for cardiovascular disease self-management: a systematic review. Eur J Prev Cardiol. 2016;23(8):801–817.
16. Chow CK, Redfern J, Hillis GS, et al. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial. JAMA. 2015;314(12):1255–1263.
17. Health e-University. Our Program. https://www.healtheuniversity.ca/EN/CardiacCollege/About.
18. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–M94.
19. Jette AM, Haley SM, Tao W, et al. Prospective evaluation of the AM-PAC-CAT in outpatient rehabilitation settings. Phys Ther. 2007;87(4):385–98. Erratum in: Phys Ther. 2007;87(5):617.
20. Urbanek JK, Zipunnikov V, Harris T, Crainiceanu C, Harezlak J, Glynn NW. Characteristics extracted from raw accelerometry during walking against measures of physical function, mobility, fatigability, and fitness. J Gerontol A Biol Sci Med Sci. 2018;73(5):676–681.
21. Benzo RP, Kramer KM, Hoult JP, Anderson PM, Begue IM, Seifert SJ. Development and feasibility of a home pulmonary rehabilitation program with health coaching. Respir Care. 2018;63(2):131–40.
22. Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA. 2020;323(18):1813–1823.
23. Robins D, Brody R, Jeong IC, Parvanova I, Liu J, Finkelstein J. Towards a highly usable, mobile electronic platform for patient recruitment and consent management. Stud Health Technol Inform. 2020;270:1066–1070.
24. Finkelstein J, Jeong IC, Doerstling M, Shen Y, Wei C, Karpatkin H. Usability of remote assessment of exercise capacity for pulmonary telerehabilitation program. Stud Health Technol Inform. 2020;275:72–76.
25. Ozalevli S, Ozden A, Itil O, Akkoclu A. Comparison of the sit-to-stand test with 6 min walk test in patients with chronic obstructive pulmonary disease. Respir Med. 2007;101(2):286–293.
26. Wei C, Robins D, Finkelstein J. Fitbit accuracy depends on activity pace and placement location. Stud Health Technol Inform. 2020;272:310–313.
27. Bohannon RW, DePasquale L. Physical functioning scale of the Short-Form 36: internal consistency and validity with older adults. J Geriatr Phys Ther. 2010;33(1):16–18.
© 2021 Wolters Kluwer Health, Inc. All rights reserved.
Update on RFA Increasing Use of Cardiac and Pulmonary Rehabilitation in Traditional and Community Settings NIH-Funded Trials: ADDRESSING CLINICAL TRIAL CHALLENGES PRESENTED BY THE COVID-19...
Journal of Cardiopulmonary Rehabilitation and Prevention42(1):10-14, January 2022.
Articles in PubMed by Susan T. Shero, BSN, MS
Articles in Google Scholar by Susan T. Shero, BSN, MS
Other articles in this journal by Susan T. Shero, BSN, MS
Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals: 2010 Update: Position Statement of the American Association of Cardiovascular and Pulmonary Rehabilitation
Seasonal Variations Affect Physical Activity and Pulmonary Rehabilitation Outcomes
Measuring Behavioral Outcomes in Cardiopulmonary Rehabilitation: AN AACVPR STATEMENT
The Talk Test as a Marker of Exercise Training Intensity
Core Components of Cardiac Rehabilitation/Secondary Prevention Programs: 2007 Update: A Scientific Statement From the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation


Sorry no videos found for your query Drechseln Aus Hepoxidharz Schale. Please try with another query. If you are seeing this more often and think it's an internal problem, please contact the site administrator.


The Cambridgeshire to which we aspire will have healthy communities in healthy environments. We will pioneer initiatives to ensure that green space and access to nature help people to enjoy and appreciate the nature around them, leading to healthier and happier lives.
What do Brighton and Lewes Downs, Galloway & south Ayrshire, the Isle of Man, north Devon, Wester Ross and the Dyfi valley have in common? They have all been granted designated Biosphere Reserve status by UNESCO.


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Q: How to remove the top bar from a resizable form on Windows 10? I am trying to remove title-bar of a form while keeping the border to have a resizable form. I set the BorderStyle to bsNone and override the CreateParams procedure:
procedure TMainForm.CreateParams(var Params: TCreateParams);
begin
  inherited;
  Params.Style := Params.Style or  WS_BORDER or WS_THICKFRAME;
end;

The only issue I am facing is a white bar on top edge of the form (in win 10):

How can I get rid of this white bar?

A: Going the win API way will consume a lot of time and can prove to be so hard. If you are willing to go that way I strongly recommend it. But for the current time here is a quick work around to your problem.
Use the VCL Styles by changing the style of the title bar like this
go to Tools-> Bitmap Style Manager and reopen the Windows 10 style (since you want this in windows 10)
Go to Objects-> form->title and change the height to 5.
in your IDE's object inspector uncheck the border Icons and set the caption to ' '.
The result will be a form with a title bar that is so thin, it is a border.

You can further modify the look of the title bar so it looks exactly like the borders.
and see this Vcl.Forms.TFormStyleHook.PaintNC to know exactly how this is done using style Hooks.

A: In Delphi 11, and possibly earlier, you can create a resizable form without a title bar by using the form's CustomTitleBar property:
Enabled=true
Height=0
ShowCaption=false
ShowIcon=false
SystemButtons=false
SystemColors=false
SystemHeight=false

Form.BorderStyle=bsSizeable

A: It is not handled by Delphi on Windows 10!
You must use a tweak tool to control the border size inside windows.
I used winaero (www.winaero.com) and reduce the window border to 1
and padding to zero.

A: for firemonkey (fmx) users: You can do this via styles.

redpajama_set_name: RedPajamaStackExchange


Commercial property owners are looking to accomplish several things with their property. They are looking for profitability, business progress, and protection. The first two are accomplished through good business practices and acumen. The last however, that depends upon wisely choosing the products and services of others. Many businesses employ the services of alarm and security systems to protect their investments. These services are essential to safeguarding an investment property, but while you are looking for those security services don't forget the basics: commercial quality exterior steel doors.
Security. Energy Efficiency. Long-lasting. These three qualities make steel doors a top priority consideration for not only commercial property owners but residential homeowners as well.
Steel doors are not easily knocked off their hinges or broken through. The thick steel can be an effective deterrent for petty thieves as well as more experienced robbers. The heaviness of steel doors can also support the weight of a heavier door lock, allowing for greater protection.
Steel doors typically have either a hollow core or a high-density polyurethane foam core. Both help to provide greater energy efficiency to the building they are placed in. Steel doors are also hung in their frames with extreme precision which provides a greater barrier to drafts and moisture.
Steel doors are by far the longest lasting of commercially available doors. They don't require the same care as wood and they are not as easily dented or damaged as fiberglass. While commercial exterior steel doors from UberDoors come with a 5 year warranty, these high quality doors can last for many, many years beyond that time frame.
Restroom doors- This is an area where customers are looking for security and quality. In restaurant, store, or business settings the decision to get a quality door can save an owner years of headaches.
Hotel room doors- Vacationers like to feel as safe in their hotel rooms as they do in their own homes. A heavy steel door can provide that sense of security and peace of mind.
Apartment doors- Most apartment doors are located in an interior space but renters are just as desirous of that sense of security as a traditional home owner. Commercial quality exterior steel doors can provide that security.
Office doors- With many business offices housing sensitive information, the protection of that information is a top priority. Office doors made of steel can provide peace of mind.
The perceived downside of steel doors is the lack of style choices. Many people believe that by choosing a steel door they are limited to one or two shades of gray as a color choice. The truth is that steel doors are completely paintable and can easily be painted to match any design scheme. Steel doors have often been used specifically in areas that are painted with full-wall murals. With their strength and stability they have been utilized in zoos, theaters, and schools where they provide the perfect secure canvas for creative interior design.
If you are pursuing a new construction, updating an existing property, or even looking for your own home, steel doors are the secure and lasting option.


Build configuration Contains all the information you need to compile the sources into binaries. Different build configurations allow you to quickly build the project for different purposes. By default, Qt Creator creates debug build and release build configurations for each kit defined for your project. A debug build contains additional debug symbols that you need for debugging the application but that you can leave out from the release version. Generally, you use the debug configuration for testing and the release configuration for creating the final installation file.
Build step A command that Qt Creator executes to accomplish a basic step in a complex task such as cleaning, building, or deploying a project. Qt Creator executes build steps in sequence to complete the task. The number and type of necessary build steps depends on the project type and the build system you use. For example, projects that are based on qmake specify build steps to use qmake and make.
Component An instantiable QML definition, typically contained in a .qml file. For instance, a Button component may be defined in Button.qml. The QML runtime may instantiate this Button component to create Button objects. Alternatively, a component may be defined inside a Component QML type.
Deploy configuration Handles the packaging and copying of the necessary files to a location you want to run the executable at. The files can be copied to a location in the file system of the development PC or a device.
Device An embedded device or a mobile device. For more information, see Target Platforms.
Kit Qt Creator groups build and run specific settings as kits to make cross-platform development easier. Each kit consists of a set of values that define one environment, such as a device, tool chain, Qt version, and debugger command to use. Configure kits at Tools > Options > Kits.
Mode Adapts the Qt Creator user interface to the different application development tasks at hand. Each mode has its own view that shows only the information required for performing a particular task, and provides only the most relevant features and functions related to it. As a result, the majority of the Qt Creator window area is always dedicated to actual application development tasks.
Project Groups together a set of source files, forms, and resource files that you can build for, as well as deploy and run on different desktop and device platforms, as specified by a build configuration, deploy configuration, and run configuration.
Qt version Qt Creator allows you to have multiple versions of Qt installed on your development PC and use different versions to build your projects for different purposes.
Run configuration Starts the application in the location where it was copied by the deploy configuration. By default, when you run a project, Qt Creator builds it, deploys it to the device specified in the selected kit, and runs it there. However, if you have not made any changes to the project since you last built and deployed it, Qt Creator simply runs it again.
Shadow build Shadow building means building a project in a separate directory, the build directory. The build directory is different from the source directory. One of the benefits of shadow building is that it keeps your source directory clean, which makes it faster to switch between build configurations. Therefore, shadow building is the best practice if you need many build configurations for a single set of source files.


When you have an itchy rash you often don't want to go out or socialize, especially if it extremely itchy and causes discomfort. Also you may not even know you have nummular eczema. When I had a severe rash two years ago I was told initially that it was scabies. That didn't seem right, but I did the pesticide cream treatment and lived in a lot of anxiety that it may have been passed on to other people. When it persisted, I received a second opinion from a dermatologist who thought it was erythema multiforme minor. This was treated with oral steroids and a cortisone cream. Though the initial rash did improve during the course of the oral steroids, it returned as soon as the twelve day dosage was completed. It wasn't till I sought a third opinion from a dermatologist that I was properly diagnosed with nummular eczema.
This dermatitis consists of red circles on the body and they can range in size. There can also be small bumps that appear to be pimples as well as the classical patches of dermatitis. The rash is often on the trunk of the body as well as arms and legs. Though kids have atopic eczema on their faces, many other forms of dermatitis do not strike the facial areas. It is important to not dry the skin out too much. Hot baths are not advised and I made a number of mistakes such as using water that was too hot for body washing.
It is a good idea to use moisturizers like bath oils, and moisturizing creams after any bathing. This was emphasized by the third dermatologist I saw and was very helpful for skin improvement. There are natural moisturizers that contain coconut oil and olive oil. Local drug stores have dermatologist approved lotions. The benefit of a good moisturizer is that it relieves the itching and dryness associated with the rash. My doctor still advised using a cortisone ointment twice a day, but stated that moisturizing twice a day was also essential.
If there is any weeping, leaking or scabbing of the eczema, you may be prescribed antibiotics. When you take an antibiotic for a skin condition, you need to finish the dosage like you would if you have a respiratory infection such as bronchitis. Antihistamines are taken to reduce the itchiness that is associated with the rash. Though I was initially resistant to this, it was important for sleep management and to focus at my job. Because the evening antihistamines have a sedating effect, it is better to only use this at night. You may be itchy at work using a milder antihistamine, but it is necessary to focus and drive.
Treatments with ultraviolet light have helped some people with chronic nummular eczema when used a few times a week. However, there are some cases where it is not advised and your physician will help you determine if you are a candidate.
It is important to research how you can control nummular eczema because it is more difficult to clear up than atopic dermatitis. It also tends to come back after treatment has stopped so consult with your dermatologist or general practitioner to come up with long term treatments for this skin condition. Taking supplements for skin care, boosting your immune system and staying hydrated are also very important for making progress.


Sfera is the perfect all year round jacket. This tracksuit jacket is suitable to use both in your free time and as part of your team uniform: the perfect jacket to wear before and after your most important games. This jacket provides an outstanding wearability. Sfera is a unisex jacket perfect for both boys and girls.


The other day I was at the department store when I saw a fan on sale. I contemplated purchasing it for myself since the warmer weather will be coming soon, but then I suddenly had the thought that I should purchase it for my brother-in-law instead. My brother-in-law hates to be hot. I knew he would use it and this one was really nice. It has multiple settings, six speeds, the ability to set it to automatically turn on and off at pre-determined intervals and a remote control. It's just a fan, but as fans go, it's a pretty cool one.
I was nervous about giving it to him because we have a very strained relationship and we never exchange gifts. He is an atheist and limits the exposure his children have to me because he doesn't want me influencing them. He assumes all Christians are unintelligent and hypocritical. More than that, he holds a lot of bitterness and anger towards Christians. I can understand his feelings because he was hurt very badly as a child when his father became a "Christian" and walked out on the family, never to support him again. The only contact he had with his father after that was the occasional phone call where his father would tell him repeatedly that he is going to hell. When this is your experience of Christianity, it is natural to distrust Christians.
This simple text i s incredibly touching to me and it is a gift for which I am very grateful. My brother-in-law went out of his way to thank me and show appreciation. He even expressed brotherly love. I stand amazed at the goodness of God! I see the door opening a little. I hope to be able to show him that not all Christians are like his father. Although we make mistakes, most of us are genuinely trying to live for Christ and to show His love. It is my prayer that one day he will be converted and model Christ in a way that his father never did.
Wow! How touching! The LORD truly was at work, in both of your lives. May the LORD of the Harvest continue to use you to plant the seeds of love!
Yes, it was awesome to see that he accepted and appreciated it. I was afraid that he would reject it or say something hurtful. It just goes to show you that we should keep reaching out to people even when we think they've already written us, or our God off. I pray one day he will come to know the Lord as He truly is!
I prayed for him. That he would see Truth and love in you, my friend.
Thank you so much for your prayers!! It's so sad that so many people have these misconceptions about God and about Christianity because of past hurts. I believe that God is able to show him the Truth!!
Amen. All of our hope is in God. I pray one day my brother-in-law is able to see the Truth of His love!


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At first glance, employing the services of The neighborhood handyman may appear like an ideal alternative to get your gutters cleaned. They will get the job done for you, and they will generally do it for less than what a trained professional rain gutter and downspout cleaning company would charge you. Seems like a great deal, right? Regrettably, if this is what you were believing, then you would be mistaken. Is it possible that if you hire a community handyman to clean your rain gutters and everything goes according to plan? Sure, but, it's likewise possible that something will wind up going wrong, and if it does you might be in for some major issues.
The most crucial reason that employing the services of a local handyman should not be a choice is the fact that they are not licensed, certified, bonded, and guaranteed. Why is this so important? It is essential due to the fact that rain gutter cleaning can be quite dangerous. While a qualified professional gutter cleaner isn't prone to suffer an accidental injury while working on your property, you can't presume that a local handyman that you employ has the training, skills and experience necessary to complete the job in safety.
What occurs if an uninsured local area handyman has a personal injury while working on your property? Well, believe it or not, you might actually be liable for their injuries which would make you responsible for their medical bills. That thought alone should suffice for you to recognize that employing an area handyman rather than a trained professional rain gutter cleaning service is never an excellent idea.
If the thought of having to pay medical expenses isn't sufficient to frighten you off, what about the prospect of them hurting your home and refusing to pay for the damages they created? If a local area handyman damages your house, and even takes your cash and never shows up, you do not have very many legal choices at hand that you can utilize to try to hold them accountable.
When you employ a licensed, bonded, and insured experienced professional for gutter clearing, and cleaning you get a great deal of advantages. First of all, an experienced professional rain gutter and downspout cleaning company will almost certainly do a much better job than you could ever do yourself, or that a local area handyman might do for you. Trained professional gutter cleaners have the training, tools, and equipment required to accomplish the job the way it really should be done.
On top of that, a professional gutter and downspout cleaning company is likely to do a better job since they know that their track record is at stake. They know that their future earning power is directly connected to their track record. Pleased customers mean not only just repeat customers, but also recommendations which can result in more income in the future. So, employing the services of a trained professional rain gutter cleaning company will always cause a more comprehensive job and better service.
But what occurs if things don't go according to prepare when a trained professional is cleaning your rain gutter and downspout? Well, if they have a mishap and suffer an injury then they have insurance coverage that will cover those medical costs. What happens if they harm your property? In many cases, a reliable contractor will simply make things right with you and cover the cost of repairs. They do not desire any ill will from you, and they don't desire an accident to damage their credibility. However if they do not make things right and fix the damage they triggered, you can always sue against them to recover your money. In short, employing the services of an experienced professional gutter and downspout cleaning company will protect you from any monetary liability.
There are numerous aspects you should consider when selecting a gutter and downspout cleaning company. Rain gutter cleaning cost must certainly be one of those factors, however it should not be the main driving force behind any option that you make. You need to absolutely do your due diligence and look at prices so you can be sure that you aren't being overcharged by the company you choose to deal with.
The more important factors in your decision though need to focus on the experience and reputation of the contractor you are going to pick. You desire a rain gutter cleaning contractor that has been in business for a while so that you understand that they know what they are doing. You likewise desire a rain gutter and downspout cleaning company with an excellent reputation. It's easier than ever to learn a lot of details about any company browsing the web and doing some research. So, ensure that you do your homework to guarantee that the company you choose is trusted, with a fantastic history of client service.
While it is very important to pick the ideal gutter and downspout cleaning company, the simple fact that you have actually noticed that this is the best approach is definitely a step in the right direction. Far too many American homeowners make the error of trying to clean their own gutter and downspout, or even worse they neglect them and let them fall into a state of disrepair. The gutters and downspouts on your home are there for a reason, and if you desire them to be able to do what they are there for, you need to look after them. Employing the services of a qualified professional, reputable, rain gutter and downspout cleaning contractor is the best method to do this.


The number of new homes registered to be built by the UK's housebuilders in 2018 was in line with 2017 figures, according to NHBC's annual new homes statistics for last year. Overall, developers registered 159,617 new homes with the organisation over the year, a 0.5% decrease on 2017. Completions for the year were also stable, up 1% on 2017 at 149,480 in 2018. The NHBC covers about 80% of the market.
However, while the NHBC figures suggest a level market year-on-year, according to Deloitte's latest survey, confidence among developers is strong across the UK's regional cities. The Deloitte Real Estate Crane Survey series monitor construction activity in Belfast, Birmingham, Leeds and Manchester as well as Dublin. In 2018 each city saw a sustained or increased level of development across a range of sectors including offices, residential, hotels, retail, education and student housing.
The construction industry experienced a mixed quarter for sales, output and new orders in the final three months of 2018, according to the Construction Products Association's Construction Trade Survey for 2018 Q4. It shows that during the quarter, sales of construction products rose according to 55% of heavy side manufacturers and 21% of light side manufacturers, whilst 25% of SME builders reported an increase in workloads.
However, HMRC's recently released Stamp Duty Land Tax (SDLT) statistics, indicate that Tax receipts for 2018 in England, Wales and Northern Ireland are down 8.5% on 2017, according to analysis by residential property advisor LCP. It notes that transactions in England, Wales and Northern Ireland fell 2.6% from 2017 and now stand at 1,083,970.
Naomi Heaton, CEO of LCP commented: "The 2.6% fall in transactions reported in HMRC's 2018 SDLT report reinforces the surfeit of statistics, showing buyers now holding back. The febrile political climate around the UK's departure from the EU and stagnating prices, have brought ever growing uncertainty to the residential market, following several years of increased taxation".


St Kitts, famous for its collection of diverse beach bars on Frigate Bay, has a new beach bar to boast about: SALT Plage.
The bar has officially debuted at the Christophe Harbour development on the country's southwest peninsula.
According to the company, the bar gets its name from the onetime estate of Dr Arthur Wilkin, who ran a salt export business on the same site in the 1940s.
The bar on St Kitts' Whitehouse Bay was designed by Christophe Harbour's John Denton Haley.
It includes an 82-foot pier and 1,450 square feet to dock tenders.
The major Christophe Harbour project includes several projects in development, including a planned Park Hyatt hotel.


Need a Commercial Dumpster Service in Anawalt, WV?
Commercial Dumpster Service are available* in Anawalt.
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These along with issues may influence the process of Commercial Dumpster Service in Anawalt, WV, regardless of the mother nature of the task. Ask challenging questions, need clear advice, knowing that there are many choices when it comes to renting roll off containers.
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If you live inside Virginia, Dc or Annapolis than you live in a wonderful area and also you want to make it beautiful. Your neighborhood is happy with the beauty which surrounds these and you many want to maintenance it. Regardless of where you live you desire your home in addition to neighborhood kept clean and beautiful.
To produce things a whole lot easier, make sure you rent a compact dumpster that holds up to two a lot of debris. It could be wise to rent some sort of dumpster that is upon wheels in the event you need to go it in one area of your driveway to another area of your driveway. It is possible to request in the company which rents out of the dumpsters to send skids combined to protect your driveway. This gives you a feeling of relief knowing that your flat driveway won't have any deterioration done to the idea.
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I designed and built the external elements for this playhouse with a team from Orchard Supply Hardware. This is our entry in a fun competition with other local businesses raising money for Habitat for Humanity. It is held annually at San Jose California's "Christmas in the Park". Last year we created a minature OSH store Playhouse with oversized Candy decorations shown in another Instructable.
This year we chose a Star Wars theme and picked the unique Tie Fighter because it was best suited to become a cool and fun playhouse for kids. It is built on a standard wood Playhouse kit that CITP provides with few restrictions on how it can be modified or decorated. You can build or purchase a standard Playhouse kit so I'm just describing how it was transformed into a "Tie Fighter". I chose most of the materials from our stores. The entry side of the Playhouse features the sweetness of "Join us in the Dark Chocolate Side" and "We have Cookies" theme which is why it is painted a chocolate color with drips. The two primary Tie Fighter features are the Octagonal (8 sides) Port Window or Pilot Canopy and the Hexagonal (5 sides) Wings. There is also an Octagonal light fixture with an LED rotating "Party Light" and a white large metal ring to represent the round shape of the original Tie Fighter.


An unpleasant mood disorder and feeling that is triggered by an often unidentifiable stimulus which then results in uneasiness, apprehension, fear or worry.
Anxiety is a fear-based response that is triggered when we feel confronted with situations in life that appear overwhelming.
When anxiety is not addressed it can begin to take hold of your life and can begin to impact on your family, friends and work relationships.
It is at this point that anxiety can turn into personal distress and can become a problem for you functioning as you once were. Feelings of unhappiness and of life not being fulfilled can be a serious start of an anxiety disorder, one that is frequently underestimated.
Anxiety is the flip side of the beliefs behind depression and the sufferer believes they can create outcomes by surveillance and control.
Anxiety is often a future-oriented mood state in which a person is ready or prepared to attempt to cope with upcoming negative events or tasks. When anxiety becomes excessive, it may fall under the classification of an acute anxiety disorder.
Timely help can make a huge difference and our natural anti-anxiety holistic programs are designed for just that.
How can a program from The Fountainhead Retreat help my anxiety?
Clients suffering from anxiety make up the second largest group attending our programs.
Help with anxiety is our specialty. Our qualified and experienced Therapists are experts in helping you pinpoint the beliefs that trigger your anxiety.
This anxiety-reducing process begins by learning techniques for observing emotions resulting after anxiety is activated. We teach that trying to stop a painful emotion, at best, only achieves a temporary fix. You might get through the moment or even the hour.
However, when you are in a similar situation again, the same beliefs will be activated again and the same emotional responses will occur. The evidence based educational techniques teach you simple ways to halt, alter and even reverse this pattern.
It is important to note, changing the belief that causes anxiety driven emotions such as anger or blame, does not mean you will never experience these again. What it will change however is the time you spend in that painful emotion. Your emotions are teaching you that there is more to learn. Our unique approach teaches you what to do with this new found knowledge in ways that can make your anxiety disappear.
This technique has existed and been treating anxiety for millennia but has only been explained scientifically in the last twenty years.
Help with anxiety is our specialty and we can teach you how to beat your anxiety.
When it comes to how you interpret your life and your anxiety, you only ever confirm or change what you know by gathering new information from life experiences and events. It is how you interpret that information and what you learn (or do not learn in most cases) that exacerbates, aggravates and elevates your anxiety.
During your program, we guide you through a unique learning from the collection, evaluation, and interpretation of information and beliefs you have gathered throughout your lifetime and the current information inflaming your anxiety. In a sense, you become a student, an inquisitive learner reflecting and researching yourself, objectively and accurately. Ultimately, you take control of your anxiety by taking control of your personal development.
Within our peaceful and relaxing surroundings, we work with you day by day, teaching you how to initiate a new way of thinking. This approach is accompanied by nutritious organic meals cooked by our passionate chefs and body work facilitated by our professional personal trainers and qualified therapists.
We are the most established holistic Retreat in Australia and our intense programs are led by dedicated, highly trained staff and qualified therapists to ensure your program is giving you maximum chance of success.


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Home » Celebrity News » Wizkid Grabs Best African Music Act Win at #MOBOAwards 2021
Ubiquitous on Dec 5, 2021
Wizkid Grabs Best African Music Act Win at #MOBOAwards 2021
Nigerian superstar, Wizkid has been named the winner of the Best African Music Act award at the 2021 MOBO Awards held just now in the United Kingdom.
At the just concluded MOBO Awards 2021 show, Wizkid was named as the winner of the Best African Music Act category which also included heavyweight names like Davido and Burna Boy. The show was held on Sunday, the 5th of December 2021.
The MOBO Awards is an annual British awards ceremony that celebrates achievements in "music of black origin". The show honors the best of the best in Hip-Hop, Grime, R&B, Soul, Reggae, Jazz, Gospel, and African Music. The 2021 edition of the MOBO Awards was held at Coventry's CBS Arena on Sunday, the 5th of December 2021.
READ ALSO: Wizkid Set to Feature on The Tonight Show With Jimmy Fallon | SEE DETAILS
Wizkid was announced as the Best African Music Act of the year at the MOBO Awards 2021 from a category that also included the likes of Davido and Burna Boy. Other nominees for the same category include CKay, Tiwa Savage, Rema, Tems, NSG, King Promise, and Ayra Starr. The show also saw Tiwa Savage present an award while Tems also performed on stage.
Celebrity News Celebrity News
Watch How Wizkid Was Recognized By O2 Arena for Three Sold Out Nights
Kizz Daniel Hits New Milestone On Audiomack With New Project 'Barnabas' | SEE DETAILS
Davido to Celebrate 10 Year Anniversary with Lagos Concert | SEE DETAILS


Jinzu Gin is a popular Craft Gin available from Amazon.co.uk in 70cl to buy online. Visit Amazon.co.uk for the best price for 70cl of Jinzu Gin or compare prices on our other Craft Gin products. Jinzu is a top-award-winning blend of Gin and Sake, created by British bartender Dee Davies. It's smooth and creamy and slightly sweet, says Dee, who was inspired to create Jinzu Gin by her hometown of Bristol and her love of Japan.
Where to buy Jinzu Gin ?
Jinzu Gin Supermarkets & Stockists.
You can buy Jinzu Gin online in most retailers and find it in the Craft Gin aisle in supermarkets but we found the best deals online for Jinzu Gin in Amazon.co.uk, 31dover.com, TheDrinkShop, DrinkSupermarket.com, and others. Compare the current price of Jinzu Gin in 70cl size in the table of offers below. Simply click on the button to order Jinzu Gin online now.


The ShapeShift platform gives you an API to quickly swap between assets in a seamless, safe, and secure environment.
No information at time of writing, keep an eye on the ShapeShift blog for updates.
To use the ShapeShift API you need to create ann account first. You can find full instructions in the API docs.
If you run into problems ShapeShift have an FAQ section and a help center.


The gender stall is dead. Last week a Council on Contemporary Families online symposium provided new data suggesting that the stall in progress on gender egalitarian attitudes and behaviors has ended. Evidence has accumulated, and a stall in attitudes that started around 1994 may have turned around after 2004.
From Cotter, Hermsen, and Vanneman's CCF brief using a composite of gender attitudes from the GSS.
Long live the gender stall. Here's what gets me. The change in attitudes is not due to men and women becoming more similar in their attitudes. Under gender egalitarianism (ideally) you wouldn't be able to predict someone's views based on their gender. But… in the graphs here, there's no hint of gender convergence. The figure on the left from Cotter et al., shows that people are at a higher level of approving of gender egalitarianism. But, men and women are the same distance apart. For young people, in Joanna Pepin's figure (right) on youth attitudes, the same pattern appears.
Pepper Schwartz and I have written about this abiding gender gap when we talk about the moving target of the sexual double standard.
Youth stalled too? Younger generations—millenials in particular—are at a much higher level of egalitarian attitudes than others. But… in the Cotter analysis, younger generations' support for gender equality isn't increasing—they just started at a higher level. The trend is flat. Like there's a ceiling or something.
Joanna Pepin, at Representations of Romantic Relationships, wondered about the younger generation, and analyzed similar attitudinal questions in the Monitoring the Future survey of high school seniors from 1976 until 2012. (Her column is cross-posted here at Girlw/Pen, too!) She finds that high school seniors mostly have high levels of the egalitarian attitudes Cotter focused on.