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HomeArteriosclerosis, Thrombosis, and Vascular BiologyVol. 25, No. 7Sensitivity and Specificity of the Ankle–Brachial Index to Predict Future Cardiovascular Outcomes
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Sensitivity and Specificity of the Ankle–Brachial Index to Predict Future Cardiovascular Outcomes
A Systematic Review
Anand V. Doobay
Sonia S. Anand
From the Department of Medicine and Population Health Research Institute, McMaster University, Hamilton Ontario, Canada.
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Originally published5 May 2005https://doi.org/10.1161/01.ATV.0000168911.78624.b7Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:1463–1469
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Objective— The ankle–brachial index is the ratio of the ankle and the brachial systolic blood pressure and is used to assess individuals with peripheral arterial disease. An ankle–brachial index <0.90 suggests the presence of peripheral arterial disease and is a marker of cardiovascular risk. The objective of this review is to determine the sensitivity and specificity of an ankle–brachial index <0.90 to predict future cardiovascular events, including coronary heart disease, stroke, and death.
Methods and Results— We conducted a systematic review of the literature and included studies that used an ankle–brachial index cutoff between 0.80 and 0.90 to classify patients with or without peripheral arterial disease, followed patients prospectively, and recorded cardiovascular outcomes (ie, myocardial infarction, stroke, or mortality). Data were combined using a random-effects model meta-analysis to determine the sensitivity, specificity, relative risks, and likelihood ratios of a low ankle–brachial index to predict future cardiovascular disease. A total of 22 studies were identified, 13 were excluded, and 9 studies were included in the meta-analysis. The sensitivity and specificity of a low ankle–brachial index to predict incident coronary heart diseases were 16.5% and 92.7%, for incident stroke were 16.0% and 92.2%, and for cardiovascular mortality were 41.0% and 87.9%, respectively. The corresponding positive likelihood ratios were 2.53 (95% CI, 1.45 to 4.40) for coronary heart disease, 2.45 (95% CI, 1.76 to 3.41) for stroke, and 5.61 (95% CI, 3.45 to 9.13) for cardiovascular death.
Conclusion— The specificity of a low ankle–brachial index to predict future cardiovascular outcomes is high, but its sensitivity is low. The ankle–brachial index should become part of the vascular risk assessment among selected individuals.
The ankle–brachial index (ABI) has been shown to be a marker of cardiovascular risk. This systematic review of the literature shows that the ABI does indeed have a high specificity for predicting cardiovascular events. This simple noninvasive test should be incorporated into cardiovascular risk assessment of certain patient populations.
Cardiovascular disease is the leading cause of death in North America and all developed nations.1,2 As the population ages, the burden of cardiovascular disease is expected to increase. Although the primary determinants of cardiovascular disease have been clearly established and are used to predict future cardiovascular risk, simple, noninvasive, and inexpensive tests that aid in vascular risk prediction are useful.
Individuals with peripheral arterial disease of the lower extremities are among the highest-risk vascular patients. The presence of peripheral arterial disease is an indicator of widespread atherosclerosis in other vascular territories such as the coronary, carotid, and cerebrovascular arteries.3–6 There is substantial evidence that peripheral arterial disease is a predictor of future cardiovascular outcomes such as myocardial infarction, stroke, and death.7–14
The ankle–brachial index (ABI) is the ratio of the ankle to brachial systolic blood pressure, and a value of <0.90 indicates the presence of flow-limiting arterial disease affecting the limb. The ABI is used in the diagnosis of peripheral arterial disease of the extremities in symptomatic patients and in the assessment of vascular risk in asymptomatic patients. The ABI is a simple and noninvasive test that can be performed in the office or clinic setting. The intraobserver variability of the test in trained observers is low at ≈7%.15,16 The validity of the ABI for detecting ≥50% stenosis in the leg arteries is high (90% sensitivity and 98% specificity).17,18
Although the ABI has been promoted as an adjunct to the office-based assessment of cardiovascular risk,19 to our knowledge, there have been no systematic reviews evaluating the sensitivity and specificity of the ABI used in this way. To determine the validity of a low ABI to predict future cardiovascular outcomes, we conducted a systematic review of all available studies in which the ABI was measured at baseline and the incidence of cardiovascular events was reported.
We attempted to identify all studies published before January 2004 by searching the MEDLINE database and reviewing reference lists. Computer searches used combinations of words related to ABI (or ankle–arm index, ankle arm pressure, or ankle brachial pressure) and words related to cardiovascular outcomes (myocardial infarction, stroke, transient ischemic attack [TIA], coronary artery disease, coronary heart disease [CHD], unstable angina, mortality, or atherosclerosis). Studies were included if they (1) measured ABI in all subjects at baseline, (2) used an ABI cutoff between 0.80 and 0.90 to categorize individuals, (3) excluded participants with previous myocardial infarction and stroke, and (4) collected data on ≥1 of CHD, stroke, or mortality. Studies were subclassified as population-based cohorts, defined as populations with no evidence of pre-existing peripheral arterial disease, or "high-risk" cohorts, defined as populations referred to a vascular laboratory for evaluation of peripheral arterial disease.
Outcome Definitions
The reported events of CHD, stroke, all-cause mortality, and cardiovascular mortality were extracted from the selected publications. CHD was defined as a report of incident ischemic or CHD, myocardial infarction, coronary angioplasty, or coronary artery bypass graft surgery. Stroke was defined as a report of incident stroke or stroke and TIA together. For mortality, all-cause mortality and cardiovascular mortality were distinguished from each other, and cardiovascular mortality included atherosclerotic causes of death such as fatal myocardial infarction or stroke but did not include thromboembolism or aneurysmal causes.
A meta-analysis was performed using a Mantel–Haenszel random-effects model, which incorporates within-study and between-study variation, generally provides wider CIs, and is preferred for analyses with significant heterogeneity.20,21 Sensitivity, specificity, and relative risks were calculated for each study outcome using standard formulas. The totals for sensitivity, specificity, and positive likelihood ratios shown are weighted estimates from the random-effects meta-analysis. The positive and negative predictive values for each outcome were derived from the cumulative event rates for each outcome. All analyses were performed using Comprehensive Meta-Analysis version 1.0.23.
We identified 22 reports6–13,22–35 that evaluated the relationship between the ABI and cardiovascular outcomes and excluded 136,9,22,24–27,29–32,34,35 studies. Seven studies were excluded because they measured only prevalent disease,6,22,24–27,35 2 studies were excluded because they did not collect any data specifically on CHD, stroke, or mortality,32,34 2 studies were excluded because they did not present data for CHD, stroke, or mortality in ABI categories,29,31 1 study was excluded because the ABI cutoff was not between 0.80 and 0.90,30 and 1 study was excluded because it included subjects with previous cardiovascular events.9 Of the 9 studies that were included,7,8,10–13,23,28,33 7 were population-based cohort studies of relatively healthy individuals,7,10–13,28,33 and 2 were cohort studies that included people with suspected peripheral arterial disease who were referred to a vascular laboratory.8,23
Demographics and Risk Factors
Combining data from 28 679 individuals from the 7 population-based cohort studies,7,10–13,28,33 the mean age was 68.1, 48.0% were women, 29.4% reported tobacco exposure, 10.8% had diabetes, and 32.1% had hypertension. A total of 7.7% of subjects (2214 of 28 679) had a low ABI, and the average duration of follow-up of the cohort was 6.2 years.
Combining data from 2674 individuals from the 2 high-risk cohort studies,8,23 the mean age was 68.4 years, 48.8% were women, 66.3% reported some exposure to tobacco, 30.5% had diabetes, and 48.1% had hypertension. A total of 72.3% individuals (1934 of 2674) had a low ABI at baseline, and the average duration of follow-up of the cohort was 10 years (Table 1).
TABLE 1. Demographic and Risk Factor Characteristics of All Subjects
Population-Based Cohort Studies (Range)7,10–13,28,33
High-Risk Cohort Studies (Range)8,23
Not all studies provided information on all the characteristics in Table 1.
One study did not provide information on hypertension or its average follow-up period.8
Two studies did not provide information on diabetes,28,33 and 1 of these studies provided no information on hypertension, tobacco exposure, or average age.28
*The overall prevalence of a low ABI <0.90 combining the population-based cohorts and the high-risk cohorts is 13.2% (4148 of 31 353).
No. of studies 7 2
No. of subjects 28 679 (366–14 306) 2674 (744–1930)
Average follow-up (years) 6.2 (4–10) 10 (10–10)
Average age 68.1 (61.4–77.8) 68.4 (66.2–69.2)
ABI <0.90* (%) 7.7 (2.9–25.5) 72.3 (64.8–75.2)
Women (%) 48.0 (0–100) 48.8 (46.8–54.0)
Tobacco exposure (%) 29.4 (10.1–59.6) 66.3 (63.2–67.6)
Diabetes mellitus (%) 10.8 (7.2–27.0) 30.5 (30.0–31.9)
Hypertension (%) 32.1 (15.2–100) 48.1 (48.1–48.1)
CHD and Stroke Incidence
Two of the 9 studies reported data on CHD incidence, and both were population-based studies (Table 2; n=7131).11,33 Three of the 9 studies reported stroke incidence, and all were population based (n=21 341).11–13
TABLE 2. Incident CHD and Stroke by ABI Category
Source, Year
No./Total (%) Subjects With ABI <0.90
No./Total (%) Subjects With ABI >0.90
Relative Risk (95% CI)
Adjusted Relative Risk (95% CI)
% Sensitivity of ABI (95% CI)
% Specificity of ABI (95% CI)
*This study used an ABI cutoff of 0.80; =for CHD incidence, positive predictive value was 10.9% (95% CI, 8.3–13.4), negative predictive value was 95.1% (95% CI, 94.5–95.6), and positive likelihood ratio was 2.53 (95% CI, 1.45–4.40); ¥for stroke incidence, positive predictive value was 6.4% (95% CI, 5.0–7.9), negative predictive value was 97.6% (95% CI, 97.9–97.7), and positive likelihood ratio was 2.45 (95% CI, 1.76–3.41); adjusted relative risk ratios are shown for studies that calculated the incremental effect of a low ABI on the risk of incident CHD or stroke after statistical adjustment for ≥1 cardiovascular risk factors including aage, bgender, crace, dsmoking, ediabetes, ftotal cholesterol, ghypertension, halcohol intake, ifibrinogen, jfasting glucose, kbody mass index, ldistance walked per day, and matrial fibrillation.
Population-based cohorts
Newman et al, 199911 33/409 (8.1) 169/3859 (4.4) 1.84 (1.29–2.64) 1.40abcdefijk (0.90–2.17) 16.3 (11.2–21.4) 90.8 (89.9–91.6)
Abbott et al, 2000*33 31/181 (17.1) 155/2682 (5.8) 2.96 (2.08–4.23) 2.7adefghikl (1.6–4.5) 16.7 (11.3–22.0) 94.4 (93.5–95.3)
Total CHD incidence=11,33 64/590 (10.8) 324/6541 (5.0) 2.34 (1.46–3.74) — 16.5 (12.8–20.2) 92.7 (92.1–93.3)
Abbott et al, 200112 20/322 (6.2) 71/2445 (2.9) 2.14 (1.32–3.47) 2.0adefgilm (1.1–3.5) 22.0 (13.5–30.5) 88.7 (87.5–89.9)
Tsai et al, 200113 19/419 (4.5) 187/13 887 (1.3) 3.34 (2.12–5.34) 1.93abcdefg (0.78–4.78) 9.2 (5.3–13.2) 97.2 (96.9–97.4)
Total stroke incidence¥11–13 74/1150 (6.4) 429/20 191 (2.1) 2.36 (1.69–3.30) — 16.0 (12.9–19.1) 92.2 (91.9–92.5)
For CHD incidence, the sensitivity of a low ABI was 16.5% (95% CI, 12.8 to 20.2), and the specificity was 92.7% (95% CI, 92.1 to 93.3). The positive likelihood ratio for CHD incidence was 2.53 (95% CI, 1.45 to 4.40). For stroke incidence, the sensitivity of a low ABI was 16.0% (95% CI, 12.9 to 19.1), the specificity was 92.2% (95% CI, 91.9 to 92.5), and the positive likelihood ratio was 2.45 (95% CI, 1.76 to 3.41).
All-Cause Mortality
Five studies reported information on all-cause mortality (n=8908),7,8,10,11,28 and 4 of these studies were population based (n=6978)7,10,11,28 (Table 3).
TABLE 3. All-Cause Mortality by ABI Category
Unadjusted Relative Risk (95% CI)
*This study used an ABI cutoff of 0.80; =for population-based cohorts, positive predictive value was 23.4 (95% CI, 20.5–26.3), negative predictive value was 92.3% (95% CI, 91.6–93.0), the positive likelihood ratio was 3.97 (95% CI, 3.17–4.96), and disease incidence was 9.5%; ¥for the high-risk cohort, positive predictive value was 39.7%; negative predictive value was 78.7%; positive likelihood ratio was 1.22 (95% CI, 1.16–1.28), and disease incidence was 35.2%; adjusted relative risk ratios are shown for studies that calculated the incremental effect of a low ABI on the risk of all-cause mortality after statistical adjustment for ≥1 cardiovascular risk factors including aage, bgender, crace, dsmoking, ediabetes, ftotal cholesterol, ghypertension, hfasting glucose, ibody mass index, jwaist-hip ratio, kfibrinogen, lphysical activity, history of mcoronary heart failure, namputation, oCHD, or pcardiovascular disease.
Criqui et al, 1992*28 22/50 (44.0) 46/366 (12.6) 3.50 (2.32–5.30) 3.1abcdfghi (1.8–5.3) 32.4 (21.2–43.5) 92.0 (89.1–94.8)
Vogt et al, 19937 11/51 (21.6) 40/976 (4.1) 5.26 (2.87–9.64) 3.1adefgijl (1.5–6.7) 21.6 (10.3–32.9) 95.9 (94.7–97.2)
Newman et al, 199710 52/298 (17.4) 53/969 (5.5) 3.19 (2.23–4.57) 2.79abcdefhik (1.88–4.13) 49.5 (40.0–59.1) 78.8 (76.5–81.2)
Newman et al, 199911 104/409 (25.4) 337/3859 (8.7) 2.91 (2.40–3.54) 1.62abcdefhik (1.24–2.12) 23.6 (19.6–27.5) 92.0 (91.2–92.9)
Total (population-based)=7,10,11,28 189/808 (23.4) 476/6170 (7.7) 3.23 (2.68–3.88) — 31.2 (27.8–34.6) 88.9 (88.2–89.6)
High-risk cohorts
Vogt et al, 1993¥8 577/1452 (39.7) 102/478 (21.3) 1.86 (1.55–2.24) — 85.0 (82.1–87.5) 30.1 (27.6–32.7)
Combining data from the population-based studies for all-cause mortality, the sensitivity of a low ABI was 31.2% (95% CI, 27.8 to 34.6), and the specificity was 88.9% (95% CI, 88.2 to 89.6). The likelihood ratio of a low ABI predicting all-cause mortality was 3.97 (95% CI, 3.17 to 4.96). Among 1 high-risk cohort, the sensitivity of a low ABI for all-cause mortality was 85.0% (95% CI, 82.1 to 87.5), the specificity was 30.1% (95% CI, 27.6 to 32.7), and the positive likelihood ratio was 1.22 (95% CI, 1.16 to 1.28).
Cardiovascular Mortality
Five studies collected data on mortality from cardiovascular causes such as myocardial infarction or stroke (n=7722)7,10,11,23,28 (Table 4). Four of these studies were population based (n=6978).7,10,11,28
TABLE 4. Cardiovascular Mortality by ABI Category
No./Total Subjects With ABI >0.90
*This study used an ABI cutoff of 0.80; £this study used an ABI cut-off of 0.85; ≠for population-based cohorts, positive predictive value was 8.0% (95% CI, 6.2–9.9), negative predictive value was 98.3% (95% CI, 98.0–98.6), positive likelihood ratio was 5.61 (95% CI, 3.45–9.13), and disease incidence was 2.5%; ¥for the high-risk cohort, positive predictive value was 17.8%, negative predictive value was 94.3%, positive likelihood ratio was 1.38 (1.25–1.53), and disease incidence was 13.6%; adjusted relative risk ratios are shown for studies that calculated the incremental effect of a low ABI on the risk of all-cause mortality after statistical adjustment for ≥1 cardiovascular risk factors including aage, bgender, crace, dsmoking, ediabetes, ftotal cholesterol, ghypertension, hfasting glucose, ibody mass index, jwaist-hip ratio, kfibrinogen, lphysical activity, history of mcoronary heart failure, namputation, oCHD, or pcardiovascular disease.
Criqui et al, 1992*28 12/50 (24.0) 15/366 (4.1) 5.86 (2.91–11.8) 6.3abcdfghi (2.6–15.0) 44.4 (25.7–63.2) 90.2 (87.3–93.2)
Vogt et al, 19937 6/51 (11.8) 9/976 (1.0) 12.76 (4.72–34.5) 4.5adefgijl (1.5–6.7) 40.0 (15.2–64.8) 95.6 (94.3–96.8)
Newman et al, 199710 19/298 (6.4) 16/969 (1.7) 3.86 (2.01–7.41) 3.29abcdefhik (1.67–6.49) 54.3 (37.8–70.8) 77.4 (75.0–79.7)
Newman et al, 199911 28/409 (6.8) 67/3859 (1.7) 3.94 (2.57–6.06) 2.03abcdefhik (1.22–3.37) 29.5 (20.3–38.6) 90.9 (90.0–91.7)
Total (population-based)≠7,10,11,28 65/808 (8.0) 107/6170 (1.7) 5.09 (3.30–7.88) — 41.0 (33.8–48.2) 87.9 (87.2–88.6)
McKenna et al, 1991££23 86/482 (17.8) 15/262 (5.7) 3.12 (1.84–5.28) 2.02a-egmnop (1.34–3.02) 85.2 (76.9–90.8) 38.4 (34.7–42.2)
Combining data from the population-based studies, for cardiovascular mortality, the sensitivity of a low ABI was 41.0% (95% CI, 33.8 to 48.2), the specificity was 87.9% (95% CI, 87.2 to 88.6), and the positive likelihood ratio was 5.61 (95% CI, 3.45 to 9.13). Using data from 1 high-risk cohort, the sensitivity was 85.2% (95% CI, 76.9 to 90.8), the specificity was 38.4% (95% CI, 34.7 to 42.2), and the positive likelihood ratio was 1.38 (95% CI, 1.25 to 1.53) for predicting cardiovascular mortality.
The ABI is a simple, noninvasive, and inexpensive test that can be used to identify individuals who are at high risk of developing cardiovascular disease (Table 5). Among population-based cohorts, the ABI is highly specific but not sensitive for predicting cardiovascular disease. In other words, a low ABI helps to "rule in" a high-risk patient, but a normal ABI does not "rule out" a high-risk patient.
TABLE 5. Summary Table of Population-Based Studies
Sensitivity of Low ABI (95% CI)
Specificity of Low ABI (95% CI)
Positive Likelihood Ratio (95% CI)
CHD11,33 16.5 (12.8–20.2) 92.7 (92.1–93.3) 2.53 (1.45–4.40)
Stroke11–13 16.0 (12.9–19.1) 92.2 (91.9–92.5) 2.45 (1.76–3.41)
All-cause mortality7,10,11,28 31.2 (27.8–34.6) 88.9 (88.2–89.6) 3.97 (3.17–4.96)
Cardiovascular mortality7,10,11,28 41.0 (33.8–48.2) 87.9 (87.2–88.6) 5.61 (3.45–9.13)
Ideally, screening tests that are highly sensitive can "rule out" disease if the test is normal (eg, serum ferritin for iron deficiency anemia). Therefore, if the sensitivity of a test is high, it can be applied broadly in the population. However, if the sensitivity is low, a normal test cannot "rule out" the disease, and if the pretest probability is high, further testing is needed. Because of its low sensitivity (yet high specificity), the ABI cannot be used as a generic screening test. Rather, it must be used in a focused manner, choosing individuals for whom the yield of the test is expected to be higher.
When applying the results of a diagnostic test practically, using likelihood ratios is superior to using the specificity and sensitivity because likelihood ratios are less likely to change with the prevalence of the disorder. They can be calculated for several levels of the symptom/sign or test, they can be used to combine the results of multiple diagnostic tests, and they can be used to calculate post-test probability for a target disorder.36 This effect is reflected when comparing the diagnostic test properties of the population-based cohort to the high-risk cohort in our study (Tables 3 and 4). The high-risk cohort consists of individuals who are older, have more cardiovascular risk factors, and in whom the follow-up time is longer (ie, 10 years versus 6.8 years) compared with the population-based cohorts. As a result, the incidence of CHD, stroke, and mortality occur at a much higher rate in the high-risk compared with the population-based cohorts (35.2% versus 9.5% for all-cause mortality). The sensitivity of a low ABI to predict all-cause mortality is much higher in the high-risk cohorts compared with the population-based cohorts (85.0% versus 31.2%), and the reverse is true for the specificity (30.1% versus 88.9%). The likelihood ratios for all-cause mortality are also different between the groups (1.22 versus 3.97) and indicate that among patients who have multiple risk factors or established vascular disease, the finding of a low ABI does not add significant additional information in determining their future risk of death (eg, pretest to post-test probability changes from 35.2% to 38.5%), whereas among lower-risk patients, the finding of a low ABI does provide important prognostic information because its associated with a significantly increased risk of mortality (eg, pretest to post-test probability changes from 9.5% to 28.0%).
It is important to determine whether a low ABI provides additional risk information over and above the assessment of conventional cardiovascular risk factors. The finding of a low ABI indicates the presence of flow-limiting atherosclerosis in a peripheral artery and likely reflects the presence of generalized atherosclerosis. Furthermore, the ABI should be used as an adjunct to a global risk assessment, which considers conventional cardiovascular risk factors as being additive in their predictive power. This is in contrast to the use of single risk factors to assess vascular prognosis (ie, low-density lipoprotein cholesterol) because on their own, they have poor predictive accuracy.37 A low ABI is more prevalent in patients with cardiovascular risk factors such as smoking, diabetes, and hypertension and is inversely correlated with other measures of vascular disease, including microalbuminuria38 and carotid intimal-medial thickness.22,39 Several studies have demonstrated that after adjusting for conventional cardiovascular risk factors, a low ABI is an independent predictor of cardiovascular risk.7,10–12,23,27–29,33,40 Murabito et al, using the Framingham data set, demonstrated that CHD prevalence remains associated with a low ABI after adjusting for conventional risk factors, indicating that there is some incremental value of a low ABI in this setting.27 Using the likelihood ratio of a low ABI for predicting incident CHD derived in our analysis (2.53), together with the pretest probability that a patient will experience future CHD, can assist a clinician in determining the post-test probability of future CHD. For example, a 55-year-old male smoker on an antihypertensive medication with a high-density lipoprotein cholesterol of 38.5 mg/dL is at a 20% risk of developing clinical CHD in the next 10 years by conventional risk assessment. If his ABI is <0.90, the likelihood ratio of 2.53 increases his post-test probability of developing CHD to 42%. This information will help inform the clinician that the patient is at much higher risk than that derived from standard risk assessments and may influence his/her choice of diagnostic and therapeutic strategies for this patient.
The American Heart Association (AHA) Prevention Conference V described the ABI as a strong and independent risk factor for cardiovascular mortality and recommended it be used to detect subclinical disease in the prevention of cardiovascular mortality and stroke.19,40 AHA recommended that the ABI might be a useful addition to the assessment of CHD risk in selected populations, especially among people ≥50 years of age or among those who appear to be at intermediate or higher risk for cardiovascular disease on the basis of traditional risk factor assessment, such as cigarette smokers or individuals with diabetes mellitus. Their recommendation takes into account that the prevalence of a low ABI increases significantly with age and is 4 to 5× higher among individuals >70 years of age compared with those <50 years of age.41 In our analysis, the mean age of individuals was 68 years, and the prevalence of a low ABI was ≈13%; accepting that the prevalence of a low ABI is ≈4× lower among individuals aged 50, this is consistent with an expected prevalence of 3% in this age group. Although the prevalence of a low ABI may be lower in a younger population, the relative impact of this finding on their cardiovascular prognosis would be expected to be quantitatively similar. This suggests that although identifying younger individuals is important, advocating routine screening of all adults with the ABI is beyond the scope of primary care practice. Thus, the AHA recommendation to streamline the use of the ABI by age or the presence of cardiovascular risk factors is reasonable.
This model was tested in the Partners Program42 involving 350 primary care practices across the United States in which ABI screening was performed if subjects were ≥70 years of age or if they were 50 to 69 years of age and had a history of smoking or diabetes. After exclusion of individuals with established diagnosis of peripheral arterial disease or previous cardiovascular disease, a low ABI was identified in 13.1% of individuals screened. In primary care settings, it seems reasonable to expand the Partners approach to screen people >70 years of age or among those aged 50 to 69 years who have ≥1 cardiovascular risk factor (ie, elevated serum cholesterol, hypertension, dysglycemia, tobacco exposure, or a family history of atherosclerotic vascular disease; Figure). Among patients with established vascular disease, there is clear evidence that supports aggressive risk factor control and treatment with antiplatelet agents,43–45 statins,46–48 and angiotensin-converting enzyme (ACE) inhibition,49,50 and routine screening with the ABI would not alter drug treatment. However, the ABI may be useful in identifying certain high-risk patients before their first event. Many of these patients would normally not receive treatment with antiplatelets, statins, and ACE inhibitors because most clinical trials have focused on patients with previous cardiovascular events. Future prospective studies are needed to determine the cost and effectiveness of a screening program using the ABI, followed by early aggressive medical treatment among individuals with a low ABI to determine whether such an approach significantly improves cardiovascular prognosis.
Algorithm for using ABI as a screening method in a primary care setting. CVD indicates cardiovascular disease; CV, cardiovascular.
The major limitation of the present analysis is our inability to determine the exact incremental value of the ABI over and above conventional risk factors because individual data were not available to us. Therefore, our weighted estimates of sensitivity, specificity, relative risk, and positive likelihood ratios are unadjusted for conventional risk factors such as age, gender, hyperlipidemia, hypertension, smoking, and diabetes. However, many of the included studies, but not all, showed an increased relative risk of CHD, stroke, and mortality in subjects with a low ABI even after adjustment of these risk factors (Tables 2 through 4). Therefore, an essential contribution to the current understanding of ABI and cardiovascular risk prediction would be a large-scale study adequately powered to assess the predictability of ABI after adjusting for all conventional risk factors such as diabetes, hypertension, smoking, and hyperlipidemia. Conducting such a study is the only reliable way to show conclusively that low ABI has an incremental predictive value over traditional methods of risk assessment. A second limitation is the variation in measurement technique of the ABI across studies. Some investigators used the average ABI of the 2 lower extremities, some used the lower of the 2 measured values, whereas others used the lowest pressure found among multiple points in the leg. However, despite variations in measurement technique between studies, no systematic bias in the classification of low versus normal ABI would have occurred.
A low ABI is highly specific but not sensitive for predicting future vascular risk. Given that it is simple to perform, noninvasive, and inexpensive, among selected individuals, the ABI is a useful vascular risk prediction tool.
A.D. is a medical student at the University of Alberta, and S.A. is a recipient of a Canadian Institutes of Health Research clinician–scientist phase-2 award.
Correspondence to Sonia S. Anand, MD, PhD, FRCPc, Hamilton General Hospital, McMaster Clinic, 237 Barton St E, Hamilton, ON, Canada L8L 2X2. E-mail [email protected]
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Fox C, Golden S, Anderson C, Bray G, Burke L, de Boer I, Deedwania P, Eckel R, Ershow A, Fradkin J, Inzucchi S, Kosiborod M, Nelson R, Patel M, Pignone M, Quinn L, Schauer P, Selvin E and Vafiadis D (2015) Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence, Circulation, 132:8, (691-718), Online publication date: 25-Aug-2015.
Vemulapalli S, Greiner M, Jones W, Patel M, Hernandez A and Curtis L (2014) Peripheral Arterial Testing Before Lower Extremity Amputation Among Medicare Beneficiaries, 2000 to 2010, Circulation: Cardiovascular Quality and Outcomes, 7:1, (142-150), Online publication date: 1-Jan-2014.
Vu T, Stamler J, Liu K, McDermott M, Lloyd‐Jones D, Pirzada A, Garside D and Daviglus M (2012) Prospective Relationship of Low Cardiovascular Risk Factor Profile at Younger Ages to Ankle‐Brachial Index: 39‐Year Follow‐Up—The Chicago Healthy Aging Study, Journal of the American Heart Association, 1:6, Online publication date: 29-Nov-2012.
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(2008) Oral Buflomedil in the Prevention of Cardiovascular Events in Patients With Peripheral Arterial Obstructive Disease, Circulation, 117:6, (816-822), Online publication date: 12-Feb-2008.
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Vol 25, Issue 7
Download: 955
https://doi.org/10.1161/01.ATV.0000168911.78624.b7
Manuscript receivedJanuary 5, 2005
Manuscript acceptedApril 22, 2005
Originally publishedMay 5, 2005
ankle–brachial index
diagnostic test
Arteriosclerosis, Thrombosis, and Vascular Biology
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Ever since I had my scuba diving certification last year, I promised myself that I would at least dive once a month. Scuba diving, for me, is relaxing and releases all my stress away. If you haven't done scuba diving before, well it's about darn time you should try.
Wow. It's been almost two and a half months since my last post and this blog is almost dying. It's not that I don't have anything to post but it's just that I've been reaaaaally lazy lately. Whew.
Okay, now that that's out of the way, let me share our most recent adventure.


text:
LA Dodgers Found Negligent: Beaten Giants Fan Bryan Stow Awarded Almost $18 Million
bryan stow LA Dodgers SF Giants by Bay City News | July 9, 2014 3:11 pm | in In Court | 5
4:42 PM: A San Francisco Giants fan was awarded almost $18 million in damages today in a civil lawsuit against the Los Angeles Dodgers and two men who attacked him outside of Dodger Stadium in Los Angeles three years ago, leaving him with permanent brain damage.
Bryan Stow, 45, was brutally beaten in a stadium parking lot following the season opener between the Giants and the Dodgers on March 31, 2011. He was in a coma for months following the attack.
Stow's family sued the Dodgers, former team owner Frank McCourt and his two assailants for damages in Los Angeles County Superior Court. The lawsuit alleged that the team did not provide adequate security during the heated baseball rivalry.
The civil trial began on May 29 with the family seeking the reimbursement of Stow's medical bills, legal fees, reimbursement of donors to Stow's recovery and other unspecified damages.
Today the jury awarded them nearly $18 million. The Dodgers are responsible for about $15 million of the damages and each of the two attackers—identified as 31-year-old Louie Sanchez and 33-year-old Marvin Norwood—are responsible for about $3 million, according to the family's attorney, Thomas Girardi.
Sanchez pleaded guilty to one count of mayhem earlier this year and was sentenced to eight years in prison. Norwood pleaded guilty to one count of assault and was sentenced to four years, according to the Los Angeles County District Attorney's Office.
The case was held up for years as the Dodgers went through bankruptcy proceedings and was transferred to new ownership.
The Dodgers were found to have been negligent in preventing the attack but former owner Frank McCourt was absolved of liability. The former ownership group will have to pay 100 percent of the medical expenses and loss of past and future earnings as well as 25 percent for Stow's pain and suffering, Girardi said.
Norwood and Sanchez each owe 37.5 percent of the $5 million pain and suffering award, but as they are serving prison terms, Girardi said, "I won't hold my breath for a payment from Sanchez and Norwood."
"I'm very, very happy for this family," Girardi said in a phone interview today. "This money is going to go a long way to help the family enormously. It is going to give a little bit of rest to a mom and dad who have been getting out of bed every night to walk him to the restroom."
He said that the Dodgers current ownership, which includes former NBA star Earvin "Magic" Johnson, has already corrected many of the problems that he argued led to Stow's assault, like improving the lighting and adding security patrols.
The suit alleged that Stow, a former paramedic, and his friends were taunted throughout the game because they were Giants fans and that Dodgers team security failed to intervene. Stow sent a text message to his family at about 7 p.m. while the game was still going on expressing concern for his safety.
He left the game after the Dodgers' 2-1 victory and the threats continued outside. The lawsuit alleged that the taxi stand where Stow was standing was dimly lit with no security present. He was attacked and hit in the head multiple times.
It took 10 to 15 minutes for Dodgers security personnel to arrive at the scene, according to the suit.
The Dodgers, "with full knowledge of these dangerous conditions, carelessly cut funds for security forces at Dodger Stadium," the lawsuit said.
Girardi said that he does not know whether the Dodgers will attempt to appeal the verdict, saying that he has not been able to predict what they would do through the process, including that they took the case to trial in the first place.
"Why didn't they do the right thing a long time ago?" he said.
Attorneys for the defendants were not immediately available for comment today.
Scott Morris, Bay City News
Today the jury awarded them nearly $18 million. The Dodgers are responsible for 25 percent of the damages and each of the two attackers—identified as 31-year-old Louie Sanchez and 33-year-old Marvin Norwood—are responsible for 37.5 percent.
The Dodgers were found to have been negligent in preventing the attack but former owner McCourt was absolved of responsibility.
The case took years to get to trial as the Dodgers went through bankruptcy proceedings and were sold to new owners.

redpajama_set_name: RedPajamaCommonCrawl


text:
Barbara Neßler (* 2. März 1991 in Dornbirn) ist eine österreichische Politikerin (Die Grünen). Sie ist Bezirkssprecherin der Grünen Innsbruck, sitzt seit 2018 im Innsbrucker Gemeinderat und seit 2019 im Nationalrat. Neßler war die Spitzenkandidatin der Tiroler Grünen bei der Nationalratswahl 2019.

Ausbildung
Barbara Neßler wuchs im elterlichen Gasthaus Sonne in Alberschwende-Müselbach auf. Sie besuchte von 2005 bis 2008 die Fachschule für wirtschaftliche Berufe in Marienberg. Von 2009 bis 2010 absolvierte Neßler ein Freiwilliges Soziales Jahr in einer Flüchtlingsunterkunft der Caritas in Bregenz. Zwischen 2009 und 2013 besuchte sie den Aufbaulehrgang Kultur, Wirtschaft und Soziales an der HLW Marienberg und schloss diesen 2013 mit der Matura ab. Seit 2013 studiert sie die Lehramtsfächer Deutsch, Geschichte, Sozialkunde und Politische Bildung an der Universität Innsbruck. Während ihrer Ausbildung war Neßler im Gastronomiegewerbe tätig.

Politische Laufbahn
Als Motivation für ihr politisches Engagement gibt Neßler eine lebensbedrohliche Erkrankung während ihrer Schulzeit an. Diese Erfahrung habe sie dazu bewogen, etwas "Positives bewirken" zu wollen. Für die Grünen habe sie sich nach eigener Aussage entschieden, weil diese die einzige Partei sei, welche sich für "eine echte Verbesserung für Menschen und Natur" einsetzen würde.

Von 2009 bis 2012 war Barbara Neßler stellvertretende Schulsprecherin an der HLW Marienberg und saß dort im Schulgemeinschaftsausschuss.

Während ihrer Studienzeit startete Neßler in der Politik mit einer E-Mail an die politische Studierendenvereinigung Grüne & Alternative Student innen im Dezember 2016, in der sie kundtat, dass sie sich politisch einbringen möchte. Einen Monat später wurde sie Spitzenkandidatin für die Wahl der Universitätsvertretung an der Universität Innsbruck und ist seit Jänner 2017 Mandatarin der Universitätsvertretung Innsbruck.

Seit der Gemeinderats- und Bürgermeisterwahl in Innsbruck 2018 sitzt Neßler für die Innsbrucker Grünen im Gemeinderat und ist dort Mitglied des Ausschusses für Arbeit, Tourismus und Wirtschaft sowie des Kulturausschusses und Ersatzmitglied der Ausschüsse für Finanzen, Subventionen und Beteiligungen sowie Stadtentwicklung, Wohnbau und Projekte. Seit November 2018 ist Barbara Neßler Bezirkssprecherin der Grünen Bezirksgruppe Innsbruck und damit "Parteichefin der Bürgermeister- und stärksten Gemeinderatsfraktion". Seit 2018 ist sie auch Delegierte zum Bundeskongress der Grünen.

Bei der Vorwahl der Landesliste für die Nationalratswahl am 29. Juni 2019 setzte sich Neßler in einer Kampfabstimmung mit 51,2 % der 130 Delegiertenstimmen gegen die Quereinsteigerin Stefanie Gartlacher durch und wurde damit zur Spitzenkandidatin der Grünen im Bundesland Tirol. Zuvor zog Ex-Landtagsvizepräsident Hermann Weratschnig seine Kandidatur für Platz eins zurück und kündigte an, nur auf Platz zwei zu kandidieren, auf dem er sich im ersten Durchgang gegen vier andere Bewerber mit 61,3 % durchsetzte. Durch den Wiedereinzug ihrer Partei in den Nationalrat und das Erreichen der Voraussetzungen für ein Landesmandat zog Neßler in den Nationalrat ein.

Barbara Neßler sieht sich selbst nicht als politisch links, sondern "menschlich". Ihre Ziele sieht sie vor allem im Klimaschutz, beim Thema leistbares Wohnen und im Bildungsbereich.

Weblinks

 Barbara Neßler auf der Website der Innsbrucker Grünen
Barbara Neßler auf der Website des Innsbrucker Gemeinderates

 Barbara Neßler auf www.meineabgeordneten.at

Einzelnachweise

Abgeordneter zum Nationalrat (Österreich)
Politiker (Innsbruck)
Die-Grünen-Mitglied (Österreich)
Österreicher
Politiker (21. Jahrhundert)
Geboren 1991
Frau
Absolvent der Universität Innsbruck

redpajama_set_name: RedPajamaWikipedia


text:
Q: How to stretch a div vertically and horizontally to occupy all the space? This is a two part question, I believe, with a third and fourth, bonus twist.

*

*What am I doing wrong to get the height of the purple set to 100% to be a little bit too high?

*How can I set the width of the purple so that it goes 100% of the remaining space?

*Is the only way to get rid of the spacing between the yellow and the purple to alter the HTML code by putting everything on the same line?

*How can I remove the margin that the green border holds between self and the outer component?
jsfiddle.net/jL8e5/1/
div.faqticleList {
  background: #ffdd00;   /* yellow */
  display: inline-block;
  padding: 3px;
  width: 200px;
  height: 150px;
}
div.faqticlePreview {
  background: #bb88ff;   /* purple */
  display: inline-block;
  padding: 3px;
  width: auto;
  height: 100%;
}

A: I'm not sure if I completely understand your goals. I assumed:

*

*Fixed width left

*Variable width right

http://jsfiddle.net/wXme4/
CSS
body{
    margin: 0;
    padding: 0;
    width: 100%;
}

div.faqticleList {
  background: #ffdd00;
  width: 200px;
  height: 100%;
  float: left;
}
div.faqticlePreview {
  background: #bb88ff;

  width: 100%;
  height: 100%;
  margin-left: -203px;
  padding-left: 203px;
}

div.container {
  border: solid 1px #007700;
  margin: 0px;
  height: 100px;
  //overflow: hidden;
  //overflow: auto;
}

div.faqticleList div, div.faqticlePreview div {
    padding: 3px;
}

Script
document.getElementById("faqticleList").innerHTML = "
faqticleList
";
document.getElementById("faqticlePreview").innerHTML = "
faqticlePreview
";

A: Updated Demo
Float the left column, and make the right column a regular block element with overflow: hidden. That might be the simplest way to do it.
CSS
div.faqticleList {
  /* display: inline-block; */
  float: left;
  ...
}
div.faqticlePreview {
  /* display: inline-block; */
  /* width: auto; */
  overflow: hidden;
  ...
}

A: This will do what you want, but I would recommend you set your height to fixed, or it wont work,
div.faqticleList {
   background: #ffdd00;
   display: inline-block;
   width: 30%;
   height: 150px;
}
div.faqticlePreview {
   background: #bb88ff;
   display: inline-block;
   width: 69%;
   height: 100%;
   clear: both;
}

div.container {
  border: solid 1px #007700;
  margin: 0px;
  height: 100%;
  //overflow: hidden;
  //overflow: auto;
   display: block;
   clear: both;
}

A: You can use jquery to dynamically find the width.
JS:
 document.getElementById("faqticleList").innerHTML = "faqticleList";
 document.getElementById("faqticlePreview").innerHTML = "faqticlePreview";
 var difWidth = $('.container').width() - 212;
 $('#faqticlePreview').css( "width", difWidth )

Then, in your CSS, remove the width from faqticlePreview and float the other div left:
div.faqticleList {
  background: #ffdd00;
  display: inline-block;
  padding: 3px;
  width: 200px;
  height: 150px;
  float: left;
}
div.faqticlePreview {
  background: #bb88ff;
  display: inline-block;
  padding: 3px;
  height: 100%;
}

Updated jsfiddle:
http://jsfiddle.net/a2Run/
Note: The width you are subtracting needs to be 212.  200px width from the first div, plus 3px of padding on each side of both divs 200+(3x4)=212

redpajama_set_name: RedPajamaStackExchange


First off, I would like to make everyone aware that I am a Leaf Salesman in the Texas market. This is considered to be in Nissan's Central Region. Next, I would like to thank everyone on this site for educating Leaf consumers and making my job much easier by sharing their experience among the community. (And lastly, I would like to apologize if this is posted in the wrong place, as I am new to the site).
That all being said, I want to make sure that one other thing is clear: I love my job. We all do. Anyone who sells the Leaf willingly has a love and admiration for the car and knows that it is the future of our industry and is proud to be on the front lines selling these things.
However, I would like to give everyone here an idea of what it is like to be a Leaf Salesman.
For the most part, Leaf Salesmen are the same people that handle internet traffic for any given Nissan dealership. At my particular dealership we have 4 certified Leaf Salesmen, for example. In order to be Leaf certified, we must have a Leaf Sales Staff, a Leaf Service Adviser, a Leaf Technician, and a Leaf-Certified General Manager. As well, the dealerships have spent a lot of money in order to carry the brand and be provided with the latest models and certifications necessary to sell and service the car.
All in all, the process is pretty straightforward. At least at my dealership, the majority of Leaf traffic is internet-based, meaning that we receive an inquiry that reads similarly to "I am interested in a Leaf, please quote me on stock number ABCDE12345." This is where the process begins. A vast majority of these "leads" come in with no phone number and therefore we are forced to correspond via email. Now, there are two sides to that coin -- yes, we cannot "bug" you with phone calls for days and days -- but we also cannot do our job in the most efficient manner if you are truly interested in making a purchase. A reason that many people think that the buying process on these cars is tedious is simply because we are unable to do our jobs -- for the most part I can answer all of your questions about the Leaf in a 10 minute phone call rather than in 30 emails back and forth. We legitimately just want to help.
MSRP -- this is the price that we would like to sell every car for in order to make a good amount of money. It is what Nissan suggests we sell the car for - "the sticker".
Invoice -- this is the cost that Nissan shows the dealer to own the car for.
Holdback -- this is the difference between invoice and what the dealer actually owns the car for (usually about $500). A salesperson does not generally get paid on this.
Now, as a salesperson, if you have a buyer, the email we send out at $750 below invoice elicits a response at some point within the next 24 hours. To be honest with you, this response is normally "I've found a lower price elsewhere. Thanks." (or something along these lines). Which puts us in a tough position -- we do not want to be annoying, but we need to sell cars to make a living. So we persist and proceed to play the haggling game with you over the course of 10-15 emails.
Over these emails we field questions from range on the Leaf to the reason for disposition fees, from mileage caps on a Leaf to exact pricing on an in-home charger. Now, while this is our job and we happily do it, you must understand that this is not the norm with a non-Leaf customer. Normal cars illicit a response like, "Okay, when can I come in and test drive this ________?"
After many hours of explaining and negotiating -- if we are lucky -- we will schedule an appointment to test drive with about 10% of our Leaf "leads". Of those, about half will show up for their appointments. Of those, less than half will buy the car. So for example, if we receive 50 leads per month for Leafs, about 10 will respond to any form of communication we try. Of those 10, we MIGHT get an appointment with 5, and 2-3 will actually show up, leaving 1-2 to buy the car. That is a 2% closing rate. An Altima/Pathfinder/Sentra/etc. lead will close at about 15-20%.
So before you even walk in the door to a dealership a Leaf Salesman has spent three times as much time trying to earn your business as he would on any other car.
Now, once you arrive, it is generally our job and good customer service to have the car fully charged, detailed, and ready for you to drive and maybe purchase. A standard test drive is about 15-20 minutes -- a Leaf test drive is about 35-45 after we have explained every bell and whistle and eased your concern about going fully electric.
So, if all goes well, you are ready to buy. If I have done my job correctly, you have driven the exact Leaf you want to own, already have an idea of exact pricing due to our emails and you are ready to pull the trigger.
This is where it gets hairy.
After all our our previously mentioned negotiation and deliberation via email, we bring you all of your numbers to sign off on. That is our job. To get you to sign the dotted line. Remember, by this point, the dealer has lost all of our holdback and is generally losing money to get that $199/mo lease payment you asked for and said that Joe's Nissan can do down the street.
Now, let's say you are one of the select customers that signs up at whatever payment, term, etc and you agree to buy. My job, though I have already spent several hours on this deal, has just begun.
-Contact an Electric Charger Provider (like eVgo) in order to set up your home charger evaluation and get any promotional keyfobs, chargecards, etc activated.
-If you bought a Leaf equipped with Carwings, contact Nissan and active that telematics system for you.
All of this must be completed in a manner that is accurate, but also quickly. Because your part is done. You've won. You got the deal you wanted. Which is absolutely 100% your right as a consumer, but naturally, your first instinct is to hurry up and get in your new Leaf and go home. This is where I have to create a perception that I am going to complete all of this in a timely fashion, which leads me to my next point.
Literally one of the only reason selling cars for Nissan is worth it.
Though I won't dive into grand detail, Nissan surveys all new car customers. On anything from the salesperson to the variety of a dealer's inventory. No matter what it asks, the dealer isn't penalized for your answers, but the salesman is. Anything less than a perfect score can cost us THOUSANDS of dollars. Not the dealer. The individual salesperson. We are paid directly on these survey scores and have to maintain a very high customer satisfaction score in lieu of being paid a TON of money on cars like salespeople were WAY back in the day.
Imagine getting a paycheck on Friday, tearing open the envelope and expecting $5,000 to get all your bills paid and your family to live for the next month and to your shock and panic, it is only $1,500 because Leaf Customer X gave you an "excellent" (6) rating on a survey where 10 is "Truly Exceptional".
So for those of you that have bought a Leaf recently... did you cross paths with a dealer that after an hour of negotiation decided they would NOT sell you a car -- that is the reason.
So after this paperwork is complete, you go to finance. And we take a deep breath, sit down, take a coffee break, throw your temporary license plates on the back of the vehicle and deliver the car to you hoping that everything is "clean and problem free." We have done all that we can do, your livelihood is in our hands. We wave goodbye to you and watch you drive away with our commission, our survey, and our time.
So, in total, we are looking at making $300-$500 on every single Leaf deal we close, sometimes a little more. Now, you may be saying to yourself, "$300 for just selling a car???? That's awesome. Easy work!". Wrong. Because while that $300 is nice, it comes right back out of our pocket when your survey gets back and we lose $1200-$2250 that month. (Leaf surveys are almost GUARANTEED to come back with a lower score) Plus, a normal Leaf sale takes at least 2-3 full shifts. In that time, an average salesman can sell 4-5 cars and make $1,000-$2,000. In the time it takes to sell ONE Leaf.
I love the Leaf. I love Leaf customers. I really do. But in the same way you all educate each other about the car, the pricing, and the deals; I want to educate you on our side of the desk and how hard it is to do this job and try to help any way that we can with very little to look forward to. I write all this so that the next time someone from this forum tries to beat up a Leaf salesman at their local dealer for less than $10/month, please try to remember that we are on your side. The next time a survey comes to your inbox, maybe you'll just check all 10's and use the comments' box to vent anything else for the sake of the salesman. We want to help -- but we need help in return.
This is the car of the future. We understand that just like you do. We are just disappointed that this car has gone from having value and loyal customers that understood that you NEVER NEED TO PAY FOR GAS/MAINTENANCE AGAIN and the government gives you $7,500-$8,250 to buy it to having customers who will only drive it if they can get it for $199 or $149 or $99 or whatever the newest "best deal" is. Everyone wants the best deal -- me included, but not at the expense or the livelihood of a salesman.
I can appreciate your desire to share your side of the transaction. And you definitely put a lot into writing that post up. I have worked in retail though not commission based retail. I feel for you that the system is screwed up but that is just it. It is the system, the dealers and the car makers that make it that way not the customers. As a customer I would rather not have to deal with all the back and forth and hours of wasted time. From my experience your finance guys are the ones screwing over most sales guys. They quite honestly are the low of the low. I ripped the Hyundai dealership finance guy a new one in the survey we received after purchasing the wife's vehicle there. Did the sales guy get punished and not the finance guy? Probably but that is something sales guys/gals should be doing something about. I as the customer am asked a question and I am going to answer it truthfully.
I wish you luck and hope things improve as the market for these vehicles grows.
Thanks for your reply. You would be right, that sales guy was punished for that survey.
Finance guys are our "managers", as in, it is a promotion to be in finance. They are above a salesman's wrath unfortunately. And finance managers do not really give two craps about that survey. Doesn't make a difference to them. They hardly read them.
You're right. It's the system that is broken. There's nothing WE can do about it but hope and pray. I just want you guys to know how it works. It probably makes no difference to the average consumer, but just one would be nice.
Thanks very much for a look inside that side of the business.
It truly is the car of the future. Shame the business model is 50 years old.
That's why the Leaf is going to fail. Unfortunately. If you lose money on every one you sell, why keep selling them?
Tesla might not sell nearly as many... but they've got the right idea.
Thank you for the information and education, megger.
I think that much of what you describe points to why the dealership model may have its days numbered. It also exposes yet another disincentive for Nissan -- primarily an ICE manufacturer -- to talk up and sell EVs, in spite of knowing how much better they are, and how much you and we love them.
And I guess the above facts can be considered part of the broken system.
Thanks! That was actually quite interesting and informative... I do have to agree with the others that it does sound like a terribly broken and dysfunctional system, however... And, unfortunately, you guys take the brunt of it.
Thanks for the effort and patience it took to describe Leaf sales. I didn't know those surveys were that skewed. Maybe that is why a great local salesman moved on or was pushed out. Kind of extreme (sick) to require such high ratings and for all the fallout of that extreme to fall on one part of the dealerships.


This month's newsletter follows up on some developments in the FACTA credit card receipt class action suits that InfoSecCompliance LLC ("ISC") explored in its April and June 2007 newsletters (What You Don't Know Just Might Hurt You. - April 2007; FACTA Privacy Class Action Lawsuit Developments - Bad News and Good News for Merchants). Recently plaintiffs have filed lawsuits against companies displaying credit card receipts on the consumer's computer screen (not printed on a paper receipt), and at least one court has denied a merchant's motion to dismiss a case based on online credit card receipts. In other words, the FACTA credit card receipt prohibitions may not be limited to paper receipts.
Except as otherwise provided in this subsection, no person that accepts credit cards or debit cards for the transaction of business shall print more than the last 5 digits of the card number or the expiration date upon any receipt provided to the cardholder at the point of the sale or transaction. *** (2) LIMITATION.--This subsection shall apply only to receipts that are electronically printed, and shall not apply to transactions in which the sole means of recording a credit card or debit card account number is by handwriting or by an imprint or copy of the card.
15 U.S.C. 1681c(g) (emphasis supplied). A single willful violation of FACTA could result in damages ranging from $100 to $1,000 without the plaintiff having to establish that he or she suffered actual harm. Class plaintiffs are alleging hundreds of millions of dollars in statutory damages against such household names as Urban Outfitters, IKEA, Cost Plus and Toys-R-Us.
In a complaint filed August 8, 2007 in the U.S. District Court for the Southern District of Florida, plaintiffs alleged that after they purchased iPods and other electronic equipment from Apple Computer Inc. online, the company provided receipts that included the full credit or debit card number used to make the purchase (Maria v. Apple Computer Inc., S.D. Fla., 1:07-cv-22040-AJ, complaint filed 8/8/07). In addition, in a complaint filed in the U.S. District Court for the Southern District of Illinois, plaintiffs alleged they received receipts with their full payment card number information after they paid for hotel reservations and services online through a subsidiary of Expedia Inc. (Sutton v. Expedia Inc., S.D. Ill., No. 3:07-cv-00547-GPM-DGW, complaint filed 7/31/07). These lawsuits may have been initiated because of a recent ruling against Stubhub Inc. in a FACTA lawsuit.
Stubhub Ruling: On-Screen Credit Card Receipt Qualifies as "Printed"
Stubhub, Inc., an online ticket broker, was sued for a violation of FACTA based on an electronically generated credit card receipt, and the plaintiff in that case survived a motion to dismiss the case. In July 2007, the U.S. District Court for the Central District of California ruled that a credit card expiration date appearing on an electronically generated receipt qualifies as "printed" for purposes of FACTA (Vasquez-Torres v. Stubhub Inc., C.D. Cal., No. CV 07-1328, motion to dismiss denied 7/2/07). Since the term "print" was not defined in FACTA, Stubhub and the court looked to common dictionary usage for guidance on the definition. Stubhub cited Webster's Third New International Dictionary, which defines "print" in part as "to make an impression in or upon." The court held that even under Stubhub's definition, Stubhub had "made an impression upon" a computer screen when it displayed the credit card expiration date. The court also cited Merriam-Webster's Collegiate Dictionary (10th ed. 2002, p. 924), which defined "print" as "to display on a surface (as a computer screen) for viewing." In addition, the court held that its ruling was consistent with the purposes of FACTA: to prevent identity theft in all its forms. The court reasoned that a narrow interpretation limited to paper-printed records did not comport with the broad goals of FACTA in combating identity theft. The court stated that if Congress intended to exclude receipts printed on a computer screen, it could have explicitly done so as it did for the exclusion of "transactions in which the sole means of recording a credit card or debit card account number is by handwriting or by an imprint or copy of the card."
While some of the recent rulings on class certification may have slowed down the FACTA lawsuits for plaintiffs, the potential for lawsuits with respect to online credit card receipts poses considerable challenges to organizations. Just getting sued and having to incur substantial fees to defend the suit could be an expensive and distracting proposition. Companies, working with attorneys and IT professionals, should conduct an inventory of their online consumer systems to determine whether any of their websites or portals displays credit card confirmations or receipts with expiration dates or credit card numbers in excess of the last five digits. If such information is displayed, organizations should seek to technologically disable that display. In addition, service providers (e.g. ecommerce payment processors, hosters, application service providers) that may be working with companies displaying credit card information using the service provider's systems, should consider informing their customers of FACTA and adding contract terms to protect themselves from FACTA liability.


text:
Revolution in a comic strip: Gasparazzo and the identity of southern migrants in Turin, 1969-1975
Pizzolato, Nicola (2007) Revolution in a comic strip: Gasparazzo and the identity of southern migrants in Turin, 1969-1975. International Review of Social History, 52 (S15) . pp. 59-75. ISSN 0020-8590 (doi:10.1017/S0020859007003124)
PDF - Published version (with publisher's formatting)
Official URL: http://dx.doi.org/10.1017/S0020859007003124
Between 1969 and 1975, in Turin, a social movement with migrants from southern Italy as its protagonists addressed the issues of working conditions in the automobile plants, and housing and living standards in the city's overcrowded working-class neighbourhoods. Southern migrants, from different regions and speaking sometimes mutually incomprehensible dialects, forged a collective identity as Meridionali – "southerners" – and claimed recognition as fully fledged citizens of Turin's industrial society. This identity-building was captured in the making through the satirical cartoons featuring Gasparazzo, the character of a southern worker at FIAT who struggled daily with the alienation of work, the arrogance of supervisors, the repression enforced by the police, and, back in the south, the backwardness of the social system. Although the publication of Gasparazzo ended abruptly in 1972 the qualities of the cartoon character continued to resonate in succeeding years. As militancy waned and the social movement started to crumble, Gasparazzo came to symbolize the nostalgic model of a working-class hero rather than any actual southerner in the plant.
A. > Work and Learning Research Centre
Notes on copyright:
Middlesex University Expert Profile
Nico Pizzolato
https://eprints.mdx.ac.uk/id/eprint/14459
Full text downloads (NB count will be zero if no full text documents are attached to the record)
Downloads per month over the past year


text:
from django.conf.urls import url
from . views import NoteList

urlpatterns = [
    url(r'^$', NoteList.as_view(), name="index"),
    ]

redpajama_set_name: RedPajamaGithub


text:
*Gaurav Pawar – Inspiring story of a fitness Coach that has clocked crores in revenue within 3 years*
Updated At: Dec 30, 2021 10:49 AM (IST)
Living a healthy, active lifestyle has never been more fashionable, thanks in part to the development of the fitness Coach. Gaurav Pawar, a well-known celebrity fitness Coach from Pune, rather than making people feel awful about their bodies, encourages them to live a healthy lifestyle and teach them new skills. Whether you want to enhance your mobility, learn ballet, or start weight lifting for the first time, Gaurav Pawar, a fitness coach, is always willing to assist you to achieve your fitness objectives. His seminars are the only nutrition, training, and attitude program in India.
Gaurav has successfully trained Babita Wallach of Tarak Mehta ka Ulta chashma renown for the previous two months, and it was one of the biggest triumphs of Gaurav's life as a trainer and fitness coach. Gaurav has risen to the top in just three years as a Fitness Coach, earning over one crore in the current financial year. His fitness empire began with just three members, and he now has a tribe of 25 people.
Gaurav is based in Pune, where he manages his fitness business, which includes training regimens and nutrition plans, as well as an Instagram follower base of over 35000. He is allowing the television industry's stars and superstars to become in terrific condition. Gaurav, as a gym fit person and fitness trainer, is an unsung hero who works behind the scenes and helps others get in great condition without taking any credit. Gaurav Pawar, a Fitness Coach, and trainer have transformed over 2500 customers in his three years as a fitness instructor. The more individuals he assisted in losing weight, the better his fortunes were.
Without a doubt, with the Pandemic spreading over the globe, fitness businesses of all types flocked. Gaurav not only saw an increase in followers, but he also maintained a positive relationship with his clientele. Gaurav has been all over the fitness teaching and influencing movement, employing inventive new business methods to transform his passion for fitness into a thriving company with yearly income in the billions of rupees. He had developed his fitness business from the bottom up, without the help of a large crew at first. Now he credits his success to his team as he says "I went strong because of my team and it was the best thing that happened in my business"
"With the appropriate mentality, intention, and sincere devotion," he argues, "nothing is impossible." His passion for fitness, a healthy physique, and all aspects of exercise propelled him to success as a professional fitness trainer with a global clientele. Gaurav's transformation of his passion for exercise into a job as a fitness trainer demonstrated that anything is possible when you love what you do.
Gaurav's fitness coaching will help you take charge of your fitness. Gaurav is on Instagram and would love to hear from you. Contact Gaurav to see how he can help you alter your life.
Gaurav Pawar's Instagram - https://instagram.com/itsallaboutjourney?utm_medium=copy_link


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©2018 BAM Brands USA
B A M BrandsUSA
LINDSAY M. EBBIN
Lindsay is the co-founder of BAM Brands USA. He is an accomplished leader with over 25 years of experience in beauty, cosmetics, and spa services. His deep-rooted passion for makeup and cutting-edge looks has led to his being recognized as a prominent influencer in the cosmetics industry. Lindsay is known as an innovative makeup expert and spa-salon retail training leader. He was instrumental in driving Elizabeth Arden Red Door Spas growth from 3 to 31 award-winning spas and salons across North America.
Partner & Board Member
Sheila Johnson is an entrepreneur and philanthropist whose accomplishments span the areas of hospitality, sports, TV/film, the arts, education, women's empowerment and community development. She is the Founder and CEO of Salamander Hotels & Resorts which have been recognized as one of the country's finest properties. As Vice Chairman of Monumental Sports & Entertainment, Ms. Johnson is the only African-American woman to have ownership in three professional sports teams. She also serves on the Executive Committee of the United States Golf Association. In 2015 Ms. Johnson was named on Forbes Magazine's Top 50 America's Richest Self Made Women.
Ms. Johnson has long been a powerful influence in the entertainment industry, starting with her work as the founding partner of Black Entertainment Television. A fervent supporter of education and the arts, Ms. Johnson serves on the Board of Governors of Parsons The New School of Design in New York and is a member of the Leadership Council at Harvard Kennedy School's Center for Public Leadership. In recognition of her humanitarian efforts, she was honored with the Eleanor Roosevelt Val-Kill Medal in 2012. Ms. Johnson received her Bachelor of Arts in music from the University of Illinois, as well as honorary degrees from numerous institutions.
LISA HANES
Lisa is a Vice President of T. Rowe Price Group, Inc and T. Rowe Price Trust Company and is on the Board of Directors for T. Rowe Price Canada, Inc. She is the head of Non-'40 Act Funds Product Management for T.Rowe Price and focuses on managing product related strategies and business activities. She sits on the Diversity and Inclusion Operating Council and is the acting co-chair of the firms multi-cultural business resource group. Lisa also serves on the Board of Directors for Chimes International Limited. Lisa earned her MBA from Loyola University of Maryland.
Dr. LISA SAVOIE
Dr. Lisa Savoie is the Medical Director of Digestive Health Services at WellSpan Health. She provides day-to-day medical leadership and serves as the system leader for strategic planning and facilitating system integration within WellSpan Digestive Health Services. Before joining WellSpan Health, Dr. Savoie was recruited by Med Star Health to grow minimally invasive surgery through the use of robotics. Dr. Savoie has a career record of accomplishments as a surgeon, teacher, and trainer to residents. She was recognized with 2 hospital teaching awards, as well as the Golden Stethoscope Award and the Golden Scalpel Award. Dr. Savoie has been voted Top Doctor by Baltimore Magazine for three consecutive years.
Dr. Savoie graduated summa cum laude with a BS in Biology from York College, earned her Medical Degree from the Medical College of PA, earned her MBA from Loyola University of Maryland and is board certified in Colon and Rectal Surgery.
Kevin was there from the start when ideas were written on sticky notes at the bar. He is a talented leader with a deep understanding of sales strategy and execution with an eye for identifying and achieving operational efficiencies. Kevin spent 10 years as a leader with Alcon Surgical as a National Surgical Consultant. Kevin earned his Masters degree from Loyola University of Maryland, MBA, 2016 and his Bachelors degree from the University of South Carolina, BS, 2001.


text:
Stand up straight and smile, S.A. — this is our NFL moment
Roy Bragg, Sports Columnist
1of4Raiders quarterback Derek Carr (4) huddles against the San Diego Chargers in Oakland, Calif., on Dec. 24, 2015.Jeff Chiu /Associated PressShow MoreShow Less
2of4Raiders quarterback Derek Carr drops back to pass during a game against the Green Bay Packers at O.co Coliseum in Oakland, Calif., on Dec. 20, 2015.John Cordes /Associated PressShow MoreShow Less
3of4Fans hold up a sign for the Raiders to stay in Oakland before the home game against San Diego Chargers on Dec. 24, 2015.Jeff Chiu /Associated PressShow MoreShow Less
4of4John Lupo from Santa Clara, Calif., hands out signs for the Raiders to stay in Oakland as they enter the stadium before the game against the San Diego Chargers at O.Co Coliseum on Dec. 24, 2015.Carlos Avila Gonzalez /San Francisco ChronicleShow MoreShow Less
The idea of the NFL in San Antonio is no longer a plaintive call for attention from the desperate wallflower of the sports business world.
As of today, we've met a nice boy who wants to be with us, or at the very least, is OK being stuck with us.
Stadium politics, as I wrote Wednesday, are cruel. Begging for a team is like high school dating — it's demeaning, and it can scar people for life.
But things have changed since Tuesday night. We've got a chance to come out of it with our self-esteem intact and/or a date for next weekend.
We're the last girl standing alone at the high school dance. The Los Angeles sisters had been with us most of the evening, but then Charger and Ram came over and asked them to dance a few minutes ago.
Now, it's just us and a kid with a blonde bowl cut and a black-and-silver leisure suit. He's spent the evening at the nacho table, enjoying the cheese fountain. Now, as the DJ spins the last song of the evening, he's making his way toward you.
And so it goes at the NFL "Relocation Under the Sea" dance, held every year to help antsy billionaires escape the tyranny of tight-fisted city councils.
Bowl Cut's real name is Mark Davis, owner of the Oakland Raiders, who got left out in the cold when the Rams were given permission Tuesday to move to L.A. and the Chargers the option to join them.
That means San Antonio, which has long wanted to join the NFL club, is closer today than it has ever been. Everything that's happened — or which has been revealed — in the last few days points to San Antonio's best chance ever to land an NFL team.
Davis doesn't want to return to Oakland, nor does he want to go to San Diego. He scouted San Antonio in 2014 to gauge local interest.
And now, Bleacher Report says, Davis has access to land along the I-35 corridor, close to Austin. The state capital offers another million potential customers and a lot of high-tech corporate wealth. In a decade, there could be a rail line running through the area, or at the very least, new toll roads connecting I-35 to Texas 130.
Officials in the two cities have pledged to work together on big ticket, long-term, mutually beneficial projects, District 9 City Councilman Joe Krier says.
A new stadium between the cities would fit that description.
But I've got better ideas. They're way cheaper than buying a few hundred acres of the most expensive land in the state, then dropping $1 billion to build on it.
I talked about a couple of them with Krier on Thursday.
Davis has said he wants free land and will line up investors to pay for a stadium. San Antonio, on the other hand, wants downtown venues.
The fix to both sits underneath the Alamodome. Literally.
Most don't believe the dome to be NFL-worthy. But the land — downtown and already owned by the city, next to a freeway — is a perfect location.
I suggest we tear it down.
Texas A&M recently rebuilt its stadium in a pair of nine-month windows. San Antonio, which wouldn't have to stop for a football season, could demolish the dome for less than $25 million, hand the land to Davis and let him build on it.
Krier countered the dome is still serviceable. Drop $75 million on widening concourses and updating amenities, and it becomes a top-flight venue.
With either use of public money — $25 million to tear down or $75 million to fix up — Krier would want to go to the voters. He believes it would pass because, well, it's football.
However it goes, Krier said, San Antonio has to act before Bowl Cut has second thoughts.
"My father told me, when I was much younger," Krier said, "that you can't catch any fish if your line isn't in the water."
He's right. This might be the best chance the city ever gets.
When Bowl Cut comes calling, understand that he's desperate. We won't have to debase ourselves to be with him. And who knows? We might end up liking him.
rbragg@express-news.net
Twitter: @roybragg
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Roy Bragg
Reach Roy on
Roy Bragg is a former San Antonio Express-News columnist.
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Ángel Hernández was arrested in Madrid on homicide charges after he helped his terminally-ill wife to end her life.
It has reignited the euthanasia debate in Spain and taken the election campaign by storm ahead of voting on April 28.
Hernández spent the night at a police station but was released once he gave his statement to the court the next day.
His wife, Maria José Carrasco, was diagnosed with multiple sclerosis when she was just 31. For thirty years her husband has been by her side, taking care of the 61-year-old until the end.
He is now being investigated over collaborating with a suicide and a possible charge of gender violence.
The 69-year-old told Euronews of the last minutes he spent with his wife and the day he helped her die with a lethal dose of sodium pentobarbital.
"We waited for half an hour," said Ángel. "She was so quiet. I had the liquids there, and I had water, and the substance.
"I asked her, do you want to do it? She said yes. Then I offered the glass to her. I gave her some eye drops. She said 'my eyes are crying'. I caressed her and I said goodbye to her."
Ángel filmed himself offering his wife a glass with the drug to provide proof of her consent.
"I knew I could face prison," he said. "This is what I assumed. What I am more worried about is that they portray me as gender-violent rather than how many years I can spend in jail.
"But this thing of diverting the issue and now it's gender violence? Let's talk about euthanasia, that's the important thing.
Spain's election could provide an opportunity for those that want to decide how to end their lives. The final decision is in the hands of the MPs elected at the end of this month.
Read more: Where in Europe is assisted dying legal?


Our Jerri white temple dress exudes tasteful beauty. Featuring delicate pleats over the bust line that gather into a high empire waist with simple trim detailing, this chiffon temple dress provides an easy, comfortable fit for every female temple-goer.
These dress have a Hollow to Hem of 55"


When the Hogwarts management knows that there are children with magical abilities, they are either sent a letter or special messengers are sent.
In the case of Muggle parents, special messengers are sent to explain everything to them. But don't forget that they will have noticed that there's something strange about their child for the previous ten years, so it won't come as a complete bolt from the blue.
We can see that Hagrid paid a visit to Harry Potter, Dumbledore paid a visit to Tom Riddle and Remus Lupin.
But how do they identify that there are children with wizarding capabilities in Muggle born and Muggle raised families? What is the process? Are there spies or similar organizations?
In a small locked tower, never visited by any student at Hogwarts, sits an ancient book that has not been touched by human hands since the four founders placed it there on completion of the castle. Beside the book, which is bound in peeling black dragon-hide, stands a small silver inkpot and from this protrudes a long, faded quill. These are the Quill of Acceptance and the Book of Admittance and they constitute the only process by which students are selected for Hogwarts School of Witchcraft and Wizardry.
If anybody understands what powerful and long-lasting magic causes this book and quill to behave as they do, nobody has ever confessed to it, doubtless because (as Albus Dumbledore once sighed) it saves the staff tedious explanations to parents who are furious that their children have not been selected for Hogwarts. The Book and Quill's decision is final and no child has ever been admitted whose name has not first been inscribed on the book's yellowing pages.
At the precise moment that a child first exhibits signs of magic, the Quill, which is believed to have been taken from an Augurey, floats up out of its inkpot and attempts to inscribe the name of that child upon the pages of the Book (Augurey feathers are known to repel ink and the inkpot is empty; nobody has ever managed to analyse precisely what the silvery fluid flowing from the enchanted Quill is).
How did Dumbledore first find out about Tom Riddle?
Are Muggle-born Wizards automatically subject to Wizarding Laws?
Are there any known muggle-born wizards/witches who have a magical sibling?
Were Muggle-born wizards free to talk about their experiences?
How do muggle-born students have enough money to go to Hogwarts?


Almost six months after defaulting on a $300-million loan for his stalled River East project, real estate developer Daniel E. McLean is expected to give up a piece of the massive mixed-use development in Streeterville as part of a refinancing package.
Mr. McLean's Chicago-based development firm, MCL Cos., has agreed to a "deed in lieu of foreclosure," a move that allows Mr. McLean to avoid a formal--and possibly messy--foreclosure proceeding in court, sources say.
Under the agreement, Tokyo-based Mitsui Sumitomo Insurance Ltd., which reinsured the $300-million loan, would take over River East Center I, part of the project that includes a 455-room Embassy Suites Hotel, a 21-screen movie complex and a 620-unit condo tower, says one source familiar with the agreement.
MCL may keep a small equity stake in 2.1-million-square-foot River East Center I as part of the deal, but Mitsui is expected to put the property up for sale, the source says.
Yet Mr. McLean, MCL's founder and president, would keep control of other parts of the sprawling River East development and receive financing to resume construction of RiverView II, a 32-story, 148-unit condominium tower alongside the Chicago River that has been stalled for more than a year. In a March 7 letter to buyers of units in the tower, Mr. McLean said he expected to restart construction on the building this week.
Mr. McLean, who declined to comment, has been scrambling to refinance River East for the past several months. Edinburgh, Scotland-based Royal Bank of Scotland provided the $300-million construction loan in 1999, and MCL has been in default since the loan matured last September.
Yet the bad loan isn't Royal Bank's problem because the bank bought insurance to guarantee the loan from London-based Royal & SunAlliance Group. Mitsui, in turn, has stepped into Royal & SunAlliance's shoes because the Japanese firm reinsured the loan.
It's unclear, however, whether Mitsui or another company will provide additional financing for the project, and how much funding MCL will receive. It's also unclear whether the refinancing package will cover more than RiverView II, enabling Mr. McLean to develop other River East parcels.
A Royal & SunAlliance spokesman didn't return phone calls for comment, and an attorney for Royal Bank and Mitsui declined to comment.
As part of the deal, Mr. McLean is buying out his equity investors in River East, a group including racetrack investor Richard Duchossois, Aon Corp. Chairman Patrick Ryan, attorney Peer Pedersen, Blockbuster Video co-founder John Melk and Waste Management Inc. founder Dean Buntrock. It's not known how much, if anything, they'll receive for their equity. The investors either didn't return phone calls or were unavailable for comment.
River East has struggled amid a depressed travel market, construction overruns and an overbuilt condo market.
At River East Center's 620-unit condo tower, 231 units were unsold at the end of 2002, according to Appraisal Research Associates Ltd., a Chicago-based consulting firm. Forty-nine of the 148 units at RiverView II were unsold at yearend.
The uncertainty surrounding River East has hurt sales at RiverView II, but they should pick up once construction of the tower resumes, says Appraisal Research Vice-president Gail Lissner.
"There's a lot more competition at the upper end of the market (than there was in 1999, when MCL started marketing the units), but his price point is still pretty attractive," she says. Asking prices range from $436,000 to more than $1 million.


Europe & Central Asia had a total export of 6,838,476,171.56 in thousands of US$ and total imports of 6,674,150,525.67 in thousands of US$ leading to a positive trade balance of 164,325,645.89 in thousands of US$ The Effectively Applied Tariff Weighted Average (customs duty) for Europe & Central Asia is 2.71% and the Most Favored Nation (MFN) Weighted Average tariff is 4.35%. GDP of Europe & Central Asia is 21,444,091,703,392.50 in current US$. Europe & Central Asia services export is 2,625,863,940,821.16 in BoP, current US$ and services import is 2,254,138,966,333.85 in Bop, current US$.Europe & Central Asia exports of goods and services as percentage of GDP is 43.14% and imports of goods and services as percentage of GDP is 39.82%.


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