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Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies
Daniel E. Weiner, Hocine Tighiouart, Manish G. Amin, Paul C. Stark, Bonnie MacLeod, John L. Griffith, Deeb N. Salem, Andrew S. Levey and Mark J. Sarnak
JASN May 2004, 15 (5) 1307-1315; DOI: https://doi.org/10.1097/01.ASN.0000123691.46138.E2
Daniel E. Weiner
Hocine Tighiouart
Manish G. Amin
Paul C. Stark
Bonnie MacLeod
John L. Griffith
Deeb N. Salem
Andrew S. Levey
Mark J. Sarnak
ABSTRACT. Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four publicly available, community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were indirectly calibrated across studies. CKD was defined by a GFR between 15 and 60 ml/min per 1.73 m2. A composite of myocardial infarction, fatal coronary heart disease, stroke, and death was the primary study outcome. Cox proportional hazards models were used to adjust for study, demographic variables, educational status, and other cardiovascular risk factors. The total population included 22,634 subjects; 18.4% of the population was black, and 7.4% had CKD. There were 3262 events. In adjusted analyses, CKD was an independent risk factor for the composite study outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07–1.32), and there was a significant interaction between kidney function and race. Black individuals with CKD had an adjusted HR of 1.76 (95% CI, 1.35–2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02–1.26). CKD is a risk factor for the composite outcome of all-cause mortality and cardiovascular disease in the general population and a more pronounced risk factor in blacks than in whites. It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals.
Chronic kidney disease (CKD) is a major public health problem. On the basis of clinical practice guidelines established by the National Kidney Foundation, ∼20 million adults in the United States have CKD, with 8 million of these classified as having moderate or severe kidney disease (1).
In dialysis patients, cardiovascular disease (CVD) mortality rates are 10 to 30 times higher than in the general population (2). In high-risk patients, defined by the presence of either CVD or cardiovascular risk factors, less severe kidney disease is also an independent risk factor for CVD outcomes (3–12⇓⇓⇓⇓⇓⇓⇓⇓⇓). However, in more representative community-based populations that were not selected for being at increased risk for CVD, there have been less consistent findings. Data from some studies suggest the absence of an independent association between the presence of CKD and CVD (13,14⇓), whereas other data suggest that CKD is an independent risk factor for CVD outcomes (15–18⇓⇓⇓). Previous studies may have been limited by insufficient power to examine subgroup relationships, in particular race, which may have caused discrepancies in these results.
The purpose of the present study was to pool the findings from several large community-based cohort studies to evaluate more systematically whether CKD, as quantified by estimated GFR, is a risk factor for CVD. This large and diverse database provides sufficient power to investigate the effect of moderate and severe CKD on outcomes in subjects without CVD at baseline. In addition, it provides the opportunity to identify high-risk subgroups. We were particularly interested in differences between black and white subjects, as a previous analysis by our group revealed a trend toward a differing impact of CKD depending on whether subjects were black or white (18).
This study is a secondary evaluation of four community-based, longitudinal public-use data sets to ascertain the relationship between baseline kidney function and long-term risk of CVD and all-cause mortality. The cohorts used were the Atherosclerosis Risk in Communities Study (ARIC), the Cardiovascular Health Study (CHS), the Framingham Heart Study (FHS), and the Framingham Offspring Study (Offspring). Importantly, these four studies all have meticulous ascertainment of CVD events during their follow-up periods.
Between 1987 and 1989, ARIC enrolled 15,792 participants aged 45 to 64 yr from Jackson, Mississippi; Forsyth County, North Carolina; the northwestern suburbs of Minneapolis, Minnesota; and Washington County, Maryland. The Mississippi cohort is entirely black and composes >80% of the black individuals in ARIC. CHS is a population-based study of 5201 subjects 65 yr and older randomly selected from Medicare eligibility files during 1989 and 1990 from four different communities: Sacramento County, California; Washington County, Maryland; Forsyth County, North Carolina; and Pittsburgh, Pennsylvania. An additional 687 blacks were recruited in 1992 and 1993. FHS began in 1948 with 5209 residents of Framingham, Massachusetts, aged 28 to 62 yr. Serum creatinine levels were initially assessed at the 15th biennial examination (1977–1979; n = 2632) in FHS. Offspring recruited 5124 of the children and the spouses of children of FHS participants in 1971, and serum creatinine was assessed at the second examination (1979–1983; n = 3863). Therefore, the 15th examination in FHS and the second examination in Offspring were considered to be the baseline period for our current analysis. Details of recruitment and procedures for all studies have been described elsewhere (19–22⇓⇓⇓).
Ascertainment of Level of Kidney Function
ARIC assessed baseline creatinine in 15,582 (99%) subjects at baseline using the modified kinetic Jaffé method (alkaline picrate). Serum creatinine in CHS was assessed at baseline by the Kodak Ektachem 700 Analyzer, in 5716 (97%) subjects. FHS and Offspring assessed creatinine using either an autoanalyzer technique or the creatinine amidohydrolase assay in 2536 (96%) and 3703 (96%) subjects, respectively.
The Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR were derived by comparing GFR assessed by kidney clearance of iothalamate with demographic characteristics and laboratory values (23). Serum creatinine in the MDRD study and subsequently in a subset of individuals included in the Third National Health and Nutrition Examination Survey (NHANES III) both were analyzed at the Cleveland Clinic laboratory (24). Because creatinine values vary across clinical laboratories, serum creatinine data in our current study were calibrated to the Cleveland Clinic laboratory indirectly by using NHANES III data. Because both NHANES III and the studies used for the pooled sample were designed as population samples and NHANES III data have been compared directly to the MDRD study samples, it was assumed that the mean serum creatinine in the four original studies for a given age, race, and gender should be comparable to NHANES III. A linear regression of data combining each study individually with NHANES III showed that serum creatinine values were 0.24 mg/dl higher in ARIC, 0.11 mg/dl higher in CHS, 0.04 mg/dl higher in the CHS black cohort, 0.22 mg/dl higher in FHS, and 0.32 mg/dl higher in Offspring than among NHANES III participants. Similar calibration corrections have been made by the CHS investigators to pool the two CHS cohorts and the Framingham investigators to pool data from the FHS and Offspring (25). These values were then subtracted from measured creatinine levels before use in the current study.
GFR was estimated using the four-variable MDRD formula as follows: GFR = 186.3 × (serum creatinine−1.154) × (age−0.203) × 1.212 (if black) × 0.742 (if female). Serum creatinine is measured in mg/dl, age is in years, and GFR is expressed in ml/min per 1.73 m2 (23,26⇓).
GFR was subsequently dichotomized, and subjects were classified as having CKD when their GFR values were <60 ml/min per 1.73 m2. Subjects with a GFR of <15 ml/min per 1.73 m2 were excluded from the study to avoid confounding by imminent dialysis.
Baseline Variables
Baseline characteristics included demographics (age, gender, race, and education level), lifestyle (smoking and alcohol intake), medical history (baseline CVD, diabetes, and hypertension), medication use (antihypertensive agents, lipid-lowering agents, and diabetes medications), physical examination findings (height, weight, body mass index [BMI], systolic and diastolic BP, and left ventricular hypertrophy [LVH] by electrocardiogram), and laboratory variables (total cholesterol, HDL cholesterol, creatinine, and glucose). The methods used for collection of baseline data by each of these studies have been described previously.
Age in CHS was provided in 2-yr groups. Subjects were assigned the mean age for that group to create a continuous variable comparable with the other studies. Race was defined as white or black. The Framingham cohorts were assumed to be entirely white (27). Education level was dichotomized according to whether the subject graduated from high school. Cigarette smoking and alcohol use were dichotomized as current users and nonusers. For ARIC, CHS, and Offspring, diabetes was defined as the use of insulin or oral hypoglycemic medications or a fasting glucose level ≥126 mg/dl. Although the measurement of serum glucose in FHS was based on a casual measurement with respect to fasting, for the primary analysis diabetes was also defined by use of diabetes medications or serum glucose level ≥126 mg/dl. Hypertension was defined as systolic BP ≥140 mmHg, diastolic ≥90 mmHg, or use of an antihypertensive medication.
BMI was calculated using the formula weight (kg)/height2 (m). Total cholesterol and HDL cholesterol were measured in all studies. Urinalysis results were not available for all studies; therefore, proteinuria was not included as a variable. LVH was derived from electrocardiographic criteria.
Baseline CVD included a history of both recognized and silent myocardial infarction (MI), angina, stroke, transient ischemic attack, and intermittent claudication as defined by consensus committees for the respective studies. In addition, baseline CVD included a history of congestive heart failure in CHS, FHS, and Offspring (not coded in ARIC) and a history of angioplasty and coronary bypass procedures in ARIC and CHS (not available in the Framingham cohorts). The methods used for definitions of CVD outcomes by each of these studies have been described extensively elsewhere (19–22⇓⇓⇓).
Study Sample
We excluded 575 subjects who had data missing on age, race, gender, or creatinine or were of nonwhite/nonblack race; 36 subjects with GFR <15 ml/min per 1.73 m2; 93 subjects who did not provide permission to release data; three subjects without follow-up data; 556 subjects with missing baseline CVD data; and 4278 subjects with preexisting CVD. After these exclusions, the final study population consisted of 22,634 subjects. A total of 602 subjects had missing single data points, such as systolic BP and total cholesterol; for these subjects, single imputation was performed on the basis of age, gender, and race stratified means. Analyses were performed using both the imputed and nonimputed data. Final models are based on the imputed results.
Follow-up Time and Outcomes
Because only the Framingham cohorts had >10 yr of follow-up data, we censored all subjects at 10 yr for follow-up times to be similar among the studies. The primary study outcome was a composite of MI, fatal coronary heart disease (FCHD), all-cause mortality, and fatal and nonfatal stroke. MI was defined by both clinically recognized and silent infarctions. Secondary outcomes included individual analyses of three outcomes: cardiac events (MI and FCHD), stroke, and all-cause mortality.
Data were stratified by CKD status on the basis of GFR of 60 ml/min per 1.73 m2. χ2 tests and ANOVA were used to compare baseline data between subjects with and without CKD as well as between whites and blacks.
Kaplan-Meier survival analysis was used to compare survival times among patients with CKD versus those without CKD. The log-rank statistic was used to test for differences among groups. Cox proportional-hazards regression was used to examine the differences in the principal study end points between the respective comparison groups while adjusting for various covariates. All models included traditional CVD risk factors described in the Framingham population, namely age, gender, smoking status, systolic BP, total cholesterol, HDL cholesterol, diabetes, and history of hypertension. Additional candidate covariates included LVH, alcohol use, BMI, and education status; these were retained when P < 0.05 in the multivariate model. Terms for original study were included in the models to test that studies were not inherently different. We also tested for interactions between CKD status and the major CVD risk factors (including race) defined above. The proportional hazards assumption was tested using a time-varying coefficient model testing for global and individual covariates.
Graphical analysis of racial differences was performed using data from the fully adjusted model with an interaction term for race and GFR. With the use of a cubic spline function, GFR was plotted as a continuous variable (with levels >150 ml/min per 1.73 m2 truncated to this level) versus the probability of developing the composite outcome over a 10-yr period.
Two sensitivity analyses were performed to account for potential differences among the original studies: (1) analyzing two other definitions of diabetes in FHS, the first defining diabetes as serum glucose ≥200 mg/dl or use of antihyperglycemic medications at Visit 15 and the second defining diabetes as any serum glucose ≥200 mg/dl or any use antihyperglycemic medications at or before visit 15 and (2) Examining for an interaction between study and CKD in the subset of exclusively white patients to ascertain whether study differences have an impact on the effect of CKD on CVD and mortality outcomes in a racially homogeneous group. In addition, other sensitivity analyses (1) compared the model with imputed data with that without imputed data; (2) removed LVH and systolic BP from the model to investigate for overcorrection for factors that may be in the pathway between CKD and CVD; (3) evaluated the effect of CKD on outcomes after additional adjustment for medication usage at baseline; and (4) assessed the effect of anemia on the composite outcome, as previous studies have suggested that anemia may be a risk factor for outcomes in the general population (28) and may modify the impact of CKD (29). Anemia was defined as hematocrit <36% in women and <39% in men. Finally, in a fully adjusted model including anemia, we tested for an interaction between the presence of anemia and CKD.
Secondary analyses were performed for the individual outcomes of all-cause mortality, MI/FCHD, and stroke adjusting for covariates that were significant in the fully adjusted model for the composite outcome with an interaction term for race and CKD. Data were analyzed using SAS Version 8.2.
The baseline characteristics of 22,634 subjects are displayed in Tables 1 and 2⇓. Blacks composed 18.4% of the study population. The mean serum creatinine for both whites and blacks was 0.9 mg/dl. The mean estimated GFR was 88.6 ml/min per 1.73 m2 for whites and 99.9 ml/min per 1.73 m2 for blacks. CKD was present in 1664 subjects. The CKD group was composed of 1505 (8.1%) white and 159 (3.8%) black subjects; 19% of patients with CKD were from ARIC, 47% were from CHS, 25% were from FHS, and 9% were from Offspring. In patients with CKD, the mean estimated GFR was 51.9 ml/min per 1.73 m2 for whites and 49.6 ml/min per 1.73 m2 for blacks. Because of the large study sample, all study variables were significantly different between the white and black subgroups.
Table 1. Baseline characteristics by original study and CKD groupa
Table 2. Baseline characteristics and outcomes by race and level of kidney functiona
The prevalence of traditional CVD risk factors was higher in patients with CKD as compared with those without CKD. Patients with CKD were older and more likely to include those with a history of hypertension and diabetes.
The average duration of follow-up was 99 mo for the pooled database, with average follow-up of 98 mo for ARIC, 81 for CHS, 108 for FHS, and 118 for Offspring. There were 2076 total deaths (9.2%), 1279 (5.7%) cardiac events, and 712 (3.1%) strokes. The composite study outcome was reached in 3262 (14.4%) subjects. When compared with subjects without CKD, a higher percentage of subjects with CKD developed each of the study outcomes (Table 3).
Table 3. Outcomes by level of kidney function
Composite Outcome
Subjects with CKD were at significantly greater risk for the composite study outcome (30.1% versus 13.2%) than patients without CKD (Table 3). Our unadjusted analysis showed a hazard ratio (HR) of 2.60 (95% confidence interval [CI], 2.36–2.86) for the composite outcome in subjects with CKD (Figure 1). The fully adjusted HR was significantly higher for patients with CKD as compared with those without CKD (HR, 1.19; 95% CI, 1.07–1.32; Table 4). A higher percentage of blacks (38.4%) than whites (29.2%) with CKD reached the composite end point. There was a significant interaction between CKD and race with the composite outcome (P = 0.002), whereas interactions between CKD and other major CVD risk factors were not statistically significant. The term for the original study was not significant in the final model. On the basis of the interaction model, blacks with CKD had an adjusted HR of 1.76 (95% CI, 1.35–2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02–1.26). Figure 2 shows significantly worse 10-yr probability of survival without reaching a composite study end point in blacks with CKD when compared with whites with CKD.
Figure 1. Kaplan-Meier survival analysis for the composite outcome stratified by the presence of chronic kidney disease. Bars represent 95% confidence intervals.
Table 4. Hazard ratio for outcomes in patients with CKD in the fully adjusted modela
Figure 2. Racial differences in the adjusted 10-yr probability of survival to the composite outcome based on level of GFR. Dashed lines represent 95% confidence intervals.
In adjusted analyses, patients with CKD had an increased risk of all-cause mortality (HR, 1.36; 95% CI, 1.21–1.53) as compared with those without CKD but no increased risk of MI/FCHD or stroke (Table 4). All-cause mortality was higher in blacks (HR, 1.83; 95% CI, 1.33–2.52) versus whites (HR, 1.31; 95% CI, 1.16–1.49). Blacks with CKD were also at higher risk of cardiac outcomes (HR, 2.09; 95% CI, 1.33–3.26) than whites with CKD (HR, 1.01; 95% CI, 0.84–1.21). Race, however, did not seem to influence the risk of stroke in patients with CKD.
Sensitivity Analyses
Using more liberal definitions of serum glucose in the FHS reduced the number of individuals with diabetes in the Framingham population. There were no differences in hazards among models using the three definitions of diabetes. In addition, we found no significant interaction between study and CKD in exclusively white subjects. We also compared the model with imputed data with that without imputed data and found no significant differences. Models that excluded LVH and systolic BP showed no significant differences from the fully adjusted model. The effect of CKD on outcomes was not changed by inclusion of medication variables in the model. In the fully adjusted model, anemia was noted to be an independent risk factor for the composite outcome (HR, 1.37; 95% CI, 1.21–1.56). The HR for blacks and whites with CKD were essentially unchanged (HR, 1.64; 95% CI, 1.25–2.15; and HR, 1.12; 95% CI, 1.01–1.25, respectively). The interaction term for CKD and anemia did not achieve statistical significance (P > 0.05).
The FHS advanced clinical medicine by identifying significant risk factors for the development of CVD (30,31⇓). Our study examines kidney function as an additional risk factor for the development of CVD and mortality in a relatively healthy community-based population.
In subjects without a history of CVD, we demonstrated that a lower level of kidney function was associated with an increased risk of the composite outcome of all-cause mortality and CVD. When considering the components of the composite outcome, we noted that the presence of CKD was an independent risk factor for both all-cause mortality and CVD in blacks but only for all-cause mortality in whites. Blacks with CKD were at significantly higher risk than whites with CKD for the composite outcome as well as the components MI/FCHD and all-cause mortality.
Previous studies of patients with preexisting CVD or at high risk for CVD have consistently shown an association between decreased kidney function and increased risk of CVD outcomes (4–9,32⇓⇓⇓⇓⇓⇓). Community studies of lower risk patients, however, have been less conclusive. In NHANES I, subjects with moderately elevated serum creatinine levels were not at increased risk for dying compared with those with lower creatinine levels after adjusting for age and underlying CVD. Race-specific findings were not described (13). An examination of members of the FHS and Offspring cohorts, comparing subjects with kidney disease (serum creatinine 1.5–3.0 mg/dl and 1.4–3.0 mg/dl in men and women, respectively) with those without kidney disease also found no significant relationship between the presence of kidney disease and CVD events after adjustment for traditional CVD risk factors. Men with kidney disease, however, were at slightly increased risk of all-cause mortality (14).
In contrast, an examination of data from NHANES II using GFR calculated from the MDRD study equation found that risk for all-cause mortality and CVD-related mortality was significantly increased in subjects with GFR <70 ml/min per 1.73 m2 when compared with those ≥90 ml/min per 1.73 m2(16). Examination of the ARIC cohort found an increased risk of CVD events and a trend toward an interaction between GFR and race in patients with CKD (18). Finally, evaluation of CHS also demonstrated that reduced kidney function was an independent risk factor for CVD outcomes (17).
We used the MDRD equation to estimate GFR. The MDRD equation was derived and validated in a biracial population with CKD where the majority of GFR values were between 20 and 80 ml/min per 1.73 m2 (32). The race variable in the MDRD equation reflects that blacks have a higher GFR than whites for the same level of creatinine. Recently, in an exclusively black population, a similar relationship between creatinine and GFR was noted (33). We defined CKD as GFR <60 ml/min per 1.73 m2 for several reasons: (1) the current clinical guidelines have adopted this GFR as the cut point for defining CKD; (2) the MDRD equation for estimating GFR was derived in a population that allows reliable estimates about this level; and (3) a GFR <60 ml/min per 1.73 m2 is abnormal in any population, including the elderly.
In our study, we noted that a higher percentage of whites had CKD than blacks. A similar relationship was recently noted for moderate CKD in NHANES III (34). Another analysis of the NHANES III data demonstrated that the most striking racial difference was not the prevalence of moderate and severe CKD but rather the more frequent progression to kidney failure among blacks (35).
Multiple explanations exist as to why the level of kidney function may be associated with an increased risk for CVD outcomes. A decrease in kidney function may be associated with an increase in other nontraditional risk factors that were not included in the current analysis, including hyperhomocysteinemia, inflammation, and oxidative stress (36). In addition, reduced kidney function may be a marker for both duration and severity of other causes of cardiovascular disease, such as hypertension, and thereby reflect residual confounding from these risk factors. Furthermore, patients with kidney disease likely receive less aggressive therapy for risk-factor modification (7,8,37⇓⇓). Last, reduced kidney function may serve to exacerbate the effects of other CVD risk factors; for example, CKD may potentiate the effect of hypertension and anemia on cardiomyopathy.
We noted that the risk associated with CKD seemed to be higher in blacks than in whites. We believe that differences in the study populations are not the primary explanation for this finding as the study term was not significant in the final model. Furthermore, we did not find any interaction between CKD and study with regard to outcomes when we considered a pooled cohort of exclusively white subjects. We acknowledge, however, that we cannot completely rule out that differences in studies may be playing a role, particularly given that many of the black subjects are from one center within the ARIC study.
There are several theoretical explanations for why the level of kidney function may affect blacks differently than whites. First, it is possible that the severity of hypertension and diabetes in many blacks is of a magnitude greater than that seen in whites. Blacks are more likely to have hypertension at an earlier age and at any given age have higher systolic and diastolic BP than whites (38). As hypertension is a common cause of moderate CKD, it follows that reduction in kidney function may represent a greater severity of hypertension and end-organ damage secondary to hypertension. This would not be fully accounted for in our regression models. Second, the discrepancy may also be a reflection of socioeconomic disparities in access and utilization of health care, where diagnosis and treatment of risk factors such as hypertension and diabetes may be delayed in the black population.
We also noted that the effect of CKD on outcomes was different in blacks and whites. In particular, in the fully adjusted analysis in whites, CKD was only a risk factor for all-cause mortality but not CVD outcomes. Although this issue clearly needs further investigation in future studies, we suggest caution in the overinterpretation of this result. One reason is that fatal CHD may not necessarily include all cardiovascular deaths (e.g., death as a result of heart failure) and therefore our definition of a "CVD" event, although well accepted, may be subject to misclassification, especially when definitions from different studies are combined. Because of this factor and also because of the issue of competing risk between a CVD event and non-CVD mortality, we believe that the composite outcome provides the best representation of the results.
Our study has several limitations. Because the public-use database does not provide center information in ARIC and CHS because of confidentiality concerns, we are unable to adjust for differences or clustering of outcomes as a result of center effects in these two studies. We endeavored to control for this by including several socioeconomic variables: education, race, smoking, and alcohol use. Our definition of CKD is based on a single assessment of serum creatinine; although this may introduce misclassification bias, these studies all evaluated subjects when they were at their baseline and presumably free of acute illnesses that may affect serum creatinine. In addition, by stratifying on the basis of level of GFR, we endeavored to minimize misclassification. Although we had a large study population, we had relatively few blacks with CKD. Despite this, the relationship between blacks with CKD and adverse outcomes was highly significant. We also lack data on several more recently identified risk factors for CVD that may be especially prominent in patients with kidney disease, including C-reactive protein (39), homocysteine (40), and albuminuria (41). Finally, we were not able to adjust for changes in medication use during follow-up or to assess the impact that several newer therapies, such as statins and renin-angiotensin-aldosterone system blockade, may have had on CVD outcomes as the initiation of the four studies predated extensive use of these now commonly prescribed medications. However, even without this information, our study adjusts for all of the major history, physical examination, and laboratory items that are checked in a routine patient visit and are used in the Framingham risk equations, making the results applicable to clinical practice.
The current study also has several strengths, most significant of which may be the very large sample size that allows us to examine subgroup associations in subjects with moderate and severe CKD. In addition, our pooled cohort is likely generalizable as the individuals are drawn from multiple communities with a broad age range. Last, we calibrated serum creatinine results across all studies to the central laboratory that processed the specimens used to derive the MDRD equation for estimating GFR. This allowed us to standardize creatinine values from several different cohorts.
The results of our study suggest that the presence of CKD is an independent risk factor for adverse outcomes in a large, pooled, community-based cohort of patients without CVD. The risk associated with CKD seems to be stronger in blacks than in whites. Our study provides further evidence that patients with CKD should be considered at high risk for CVD and mortality outcomes and identifies patients with CKD as potential candidates for aggressive risk factor reduction.
This study was supported by grants K23 NIDDK 02904 and T32DK007777 and by Amgen (Thousand Oaks, CA). The study sponsor was not involved in data analysis or interpretation of findings.
This work was presented in part at the Annual Meeting of the American Society of Nephrology, 2003, San Diego, CA.
The ARIC, CHS, FHS, Offspring studies are conducted and supported by the National Heart, Lung and Blood Institute (NHLBI) in collaboration with the individual study investigators. This manuscript was not prepared in collaboration with the study investigators and does not necessarily reflect the opinions or views of the study investigators or the NHLBI.
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G: National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 139: 137–147, 2003
US Renal Data System. USRDS 2002 Annual Data Report, Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2002
Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S: Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: The HOPE randomized trial. Ann Intern Med 134: 629–636, 2001
Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW: The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 35: 681–689, 2000
Best PJ, Lennon R, Ting HH, Bell MR, Rihal CS, Holmes DR, Berger PB: The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 39: 1113–1119, 2002
Szczech LA, Best PJ, Crowley E, Brooks MM, Berger PB, Bittner V, Gersh BJ, Jones R, Califf RM, Ting HH, Whitlow PJ, Detre KM, Holmes D: Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. Circulation 105: 2253–2258, 2002
Wright RS, Reeder GS, Herzog CA, Albright RC, Williams BA, Dvorak DL, Miller WL, Murphy JG, Kopecky SL, Jaffe AS: Acute myocardial infarction and renal dysfunction: A high-risk combination. Ann Intern Med 137: 563–570, 2002
Shlipak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan MB: Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med 137: 555–562, 2002
Shlipak MG, Simon JA, Grady D, Lin F, Wenger NK, Furberg CD: Renal insufficiency and cardiovascular events in postmenopausal women with coronary heart disease. J Am Coll Cardiol 38: 705–711, 2001
McCullough PA, Soman SS, Shah SS, Smith ST, Marks KR, Yee J, Borzak S: Risks associated with renal dysfunction in patients in the coronary care unit. J Am Coll Cardiol 36: 679–684, 2000
McClellan WM, Flanders WD, Langston RD, Jurkovitz C, Presley R: Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: A population-based study. J Am Soc Nephrol 13: 1928–1936, 2002
Walsh CR, O'Donnell CJ, Camargo CA Jr, Giugliano RP, Lloyd-Jones DM: Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction. Am Heart J 144: 1003–1011, 2002
Garg AX, Clark WF, Haynes RB, House AA: Moderate renal insufficiency and the risk of cardiovascular mortality: Results from the NHANES I. Kidney Int 61: 1486–1494, 2002
Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, Levy D: Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 56: 2214–2219, 1999
Henry RM, Kostense PJ, Bos G, Dekker JM, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD: Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study. Kidney Int 62: 1402–1407, 2002
Muntner P, He J, Hamm L, Loria C, Whelton PK: Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 13: 745–753, 2002
Manjunath G, Tighiouart H, Coresh J, Macleod B, Salem DN, Griffith JL, Levey AS, Sarnak MJ: Level of kidney function as a risk factor for cardiovascular outcomes in the elderly. Kidney Int 63: 1121–1129, 2003
Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, Coresh J, Levey AS, Sarnak MJ: Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 41: 47–55, 2003
Fried LP, Borhani NO, Enright P, Furberg CD, Gardin JM, Kronmal RA, Kuller LH, Manolio TA, Mittelmark MB, Newman A, et al.: The Cardiovascular Health Study: design and rationale. Ann Epidemiol 1: 263–276, 1991
The Atherosclerosis Risk in Communities (ARIC) Study: Design and objectives. The ARIC investigators. Am J Epidemiol 129: 687–702, 1989
Kannel WB, Feinleib M, McNamara PM, Garrison RJ, Castelli WP: An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol 110: 281–290, 1979
Dawber TR, Kannel WB: An epidemiologic study of heart disease: The Framingham study. Nutr Rev 16: 1–4, 1958
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130: 461–470, 1999
Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, Levey AS: Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 39: 920–929, 2002
Culleton BF, Larson MG, Evans JC, Wilson PW, Barrett BJ, Parfrey PS, Levy D: Prevalence and correlates of elevated serum creatinine levels: The Framingham Heart Study. Arch Intern Med 159: 1785–1790, 1999
Levey AS GT, Kusek JW, Beck GJ: A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol 11: 155A, 2000
D'Agostino RB Sr, Grundy S, Sullivan LM, Wilson P: Validation of the Framingham coronary heart disease prediction scores: Results of a multiple ethnic groups investigation. JAMA 286: 180–187, 2001
Sarnak MJ, Tighiouart H, Manjunath G, MacLeod B, Griffith J, Salem D, Levey AS: Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol 40: 27–33, 2002
Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM: Association of high serum creatinine and anemia increases the risk of coronary events: Results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol 14: 2919–2925, 2003
Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation 97: 1837–1847, 1998
Wilson PW, Castelli WP, Kannel WB: Coronary risk prediction in adults (the Framingham Heart Study). Am J Cardiol 59: 91G–94G, 1987
Beattie JN, Soman SS, Sandberg KR, Yee J, Borzak S, Garg M, McCullough PA: Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction. Am J Kidney Dis 37: 1191–1200, 2001
Lewis J, Agodoa L, Cheek D, Greene T, Middleton J, O'Connor D, Ojo A, Phillips R, Sika M, Wright J Jr: Comparison of cross-sectional renal function measurements in African Americans with hypertensive nephrosclerosis and of primary formulas to estimate glomerular filtration rate. Am J Kidney Dis 38: 744–753, 2001
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS: Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 41: 1–12, 2003
Hsu CY, Lin F, Vittinghoff E, Shlipak MG: Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol 14: 2902–2917, 2003
Sarnak MJ, Levey AS: Cardiovascular disease and chronic renal disease: A new paradigm. Am J Kidney Dis 35: S117–S131, 2000
Tonelli M, Bohm C, Pandeya S, Gill J, Levin A, Kiberd BA: Cardiac risk factors and the use of cardioprotective medications in patients with chronic renal insufficiency. Am J Kidney Dis 37: 484–489, 2001
Rahman M, Douglas JG, Wright JT Jr: Pathophysiology and treatment implications of hypertension in the African-American population. Endocrinol Metab Clin North Am 26: 125–144, 1997
Ridker PM, Rifai N, Rose L, Buring JE, Cook NR: Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 347: 1557–1565, 2002
Homocysteine and risk of ischemic heart disease and stroke: A meta-analysis. JAMA 288: 2015–2022, 2002
Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S: Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 286: 421–426, 2001
Thank you for your help in sharing the high-quality science in JASN.
You are going to email the following Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies
Daniel E. Weiner, Hocine Tighiouart, Manish G. Amin, Paul C. Stark, Bonnie MacLeod, John L. Griffith, Deeb N. Salem, Andrew S. Levey, Mark J. Sarnak
JASN May 2004, 15 (5) 1307-1315; DOI: 10.1097/01.ASN.0000123691.46138.E2
Survival among Patients with Kidney Failure in Jalisco, Mexico
A Population-Based, Prospective Study of Blood Pressure and Risk for End-Stage Renal Disease in China
Hepatitis C Virus and Death Risk in Hemodialysis Patients
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Genetic overlap and causal inferences between kidney function and cerebrovascular disease
Disentangling the multiple links between renal dysfunction and cerebrovascular disease
In reply: Is diabetes still a compelling indication for renin-angiotensin-aldosterone system inhibitors?
American Association of Clinical Endocrinologists/American College of Endocrinology Management of Dyslipidemia and Prevention of Cardiovascular Disease Clinical Practice Guidelines
BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD
Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association
MicroRNA-92a Mediates Endothelial Dysfunction in CKD
Association of QT-Prolonging Medication Use in CKD with Electrocardiographic Manifestations
eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study
APOL1 Risk Variants and Cardiovascular Disease: Results From the AASK (African American Study of Kidney Disease and Hypertension)
APOL1 and Cardiovascular Disease: A Story in Evolution
Carbamylated Low-Density Lipoproteins Induce a Prothrombotic State Via LOX-1: Impact on Arterial Thrombus Formation In Vivo
Silent Cerebral Microbleeds and Longitudinal Risk of Renal and Cardiovascular Events in Patients with CKD
What drives quality improvement in chronic kidney disease (CKD) in primary care: process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) trial
Chronic Renal Insufficiency Cohort Study (CRIC): Overview and Summary of Selected Findings
Cause-Specific Deaths in Non-Dialysis-Dependent CKD
Change in Multiple Filtration Markers and Subsequent Risk of Cardiovascular Disease and Mortality
Added Value of Screening for CKD among the Elderly or Persons with Low Socioeconomic Status
Metabolically Healthy Obesity and Risk of Incident CKD
Cardiac Myocyte-Derived Follistatin-Like 1 Prevents Renal Injury in a Subtotal Nephrectomy Model
ESRD and Death after Heart Failure in CKD
Intradialytic Hypotension and Risk of Cardiovascular Disease
Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease
The Impact of Acute Kidney Injury on the Long-term Risk of Stroke
Proposal for a Functional Classification System of Heart Failure in Patients With End-Stage Renal Disease: Proceedings of the Acute Dialysis Quality Initiative (ADQI) XI Workgroup
Increased Burden of Cardiovascular Disease in Carriers of APOL1 Genetic Variants
Fibroblast Growth Factor-23 and the Long-Term Risk of Hospital-Associated AKI among Community-Dwelling Older Individuals
Recognition of CKD After the Introduction of Automated Reporting of Estimated GFR in the Veterans Health Administration
Impact of Chronic Kidney Disease on Carotid Atherosclerosis According to Blood Pressure Category: The Suita Study
Prognostic Value of LA Volumes Assessed by Transthoracic 3D Echocardiography: Comparison With 2D Echocardiography
Impact on cardiovascular risk follow-up from a shift to the CKD-EPI formula for eGFR reporting: a cross-sectional population-based primary care study
Elevated Galectin-3 Precedes the Development of CKD
Kindlin-2: A New Player in Renal Fibrogenesis
Galectin-3 and New-Onset CKD: Marker or Mediator?
Disentangling the Ultrafiltration Rate-Mortality Association: The Respective Roles of Session Length and Weight Gain
Serum {beta}-2 microglobulin predicts mortality in people with diabetes
A Piece of the Puzzle in the Cardiorenal Conundrum
Identification of chromosome 3q28 and ALPK1 as susceptibility loci for chronic kidney disease in Japanese individuals by a genome-wide association study
Renal Impairment and Ischemic Stroke Risk Assessment in Patients With Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project
Cardiorenal Syndrome: The Emerging Role of Protein-Bound Uremic Toxins
Racial differences in albuminuria, kidney function, and risk of stroke
Electrocardiogram Abnormalities and Cardiovascular Mortality in Elderly Patients with CKD
Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease
Chronic Kidney Disease and Risk for Presenting With Acute Myocardial Infarction Versus Stable Exertional Angina in Adults With Coronary Heart Disease
Effects of Beta-Adrenergic Antagonists in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis
Screening for Proteinuria: A Tool for Predicting Rapid Declines in Kidney Function?
Cardiovascular Disease Among Hispanics and Non-Hispanics in the Chronic Renal Insufficiency Cohort (CRIC) Study
Racial and Ethnic Differences in Mortality among Individuals with Chronic Kidney Disease: Results from the Kidney Early Evaluation Program (KEEP)
GFR Decline and Mortality Risk among Patients with Chronic Kidney Disease
Chronic Kidney Disease in Octogenarians
Chronic Kidney Disease as a Coronary Disease Equivalent--A Comparison with Diabetes over a Decade
Associations among Estimated Glomerular Filtration Rate, Proteinuria, and Adverse Cardiovascular Outcomes
Longitudinal Association of Depressive Symptoms with Rapid Kidney Function Decline and Adverse Clinical Renal Disease Outcomes
Association of Decreased Glomerular Filtration Rate with Racial Differences in Survival after Acute Myocardial Infarction
The Increasing Prevalence of Atrial Fibrillation among Hemodialysis Patients
Cystatin C Identifies Chronic Kidney Disease Patients at Higher Risk for Complications
A Multi-Marker Approach to Predict Incident CKD and Microalbuminuria
Low Socioeconomic Status Associates with Higher Serum Phosphate Irrespective of Race
Fibroblast Growth Factor 23 and Fetuin A are Independent Predictors for the Coronary Artery Disease Extent in Mild Chronic Kidney Disease
Low glomerular filtration rate and risk of stroke: meta-analysis
Rate of ESRD Exceeds Mortality among African Americans with Hypertensive Nephrosclerosis
Chronic Kidney Disease as a Potent Risk Modifier for CAD in Diabetics
Renal Function and Risk Stratification of Diabetic and Nondiabetic Patients Undergoing Evaluation for Coronary Artery Disease
Mobilized Human Hematopoietic Stem/Progenitor Cells Promote Kidney Repair After Ischemia/Reperfusion Injury
Serum Creatinine and Glomerular Filtration Rate: Perception and Reality
Uromodulin Levels Associate with a Common UMOD Variant and Risk for Incident CKD
Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis
Change in Estimated GFR Associates with Coronary Heart Disease and Mortality
Rapid Decline of Kidney Function Increases Cardiovascular Risk in the Elderly
CKD Associates with Cognitive Decline
Association of Dialysis Modality and Cardiovascular Mortality in Incident Dialysis Patients
Increased Risk of Acute Myocardial Infarction for Patients With Panic Disorder: A Nationwide Population-Based Study
Relationship Between Blood Pressure Category and Incidence of Stroke and Myocardial Infarction in an Urban Japanese Population With and Without Chronic Kidney Disease: The Suita Study
Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study
Kidney function and the risk of cardiovascular disease
Outcomes Associated with Race in Males with Nondialysis-Dependent Chronic Kidney Disease
Association of Genetic Variants with Chronic Kidney Disease in Japanese Individuals
Cystatin C Associates with Arterial Stiffness in Older Adults
Impact of Proteinuria and Glomerular Filtration Rate on Risk of Thromboembolism in Atrial Fibrillation: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study
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text:
Here are the UX upgrades that Samsung is bringing with the newest iteration of TouchWiz
T-Mobile AT&T Verizon Sprint Samsung Android
Updated: Aug 13, 2015, 10:06 AM
Paul K.
Well, folks, Samsung has finally unveiled the Galaxy S6 edge+ and its Note5 – the next iteration of its leading phablet line. Along with these super-hot phones, the company will also be updating its UI with an array of features and upgrades to improve user experience.
We've had a chance to get a close-up demo of said features – that includes the new and improved Smart Connect, live YouTube streaming, the new S Pen functions, and Samsung Pay. Check out the details below!
Connect to other devices
Samsung's SideSync has been present on its smartphones for a while now, but it it has, together with the Samsung PC companion software, received another rehash in order to make connections easier, and more seamless. As you can see in the video below, you can now wirelessly connect your phone to your laptop and use Sammy's proprietary program to mirror the handset's screen on your PC display, get notifications, and transfer files with ease.
SideSync 4.0 isn't limited to computers, though – it can basically link to any "smart" device – like a smart TV, as shown below.
The S Pen is what sets the Note line apart from any other tablets and Samsung, naturally, continues to improve it with every new iteration. This year, we are treated to a stylus that is closest in appearance to an actual pen than ever before. It's not all in the looks, of course – the way S Pen works has been tweaked as well.
For starters, the new Air Command menu is now a persistent tool that constantly floats on top of the screen – kind of like a Facebook chat head. It can be dismissed at any time by flicking it to the top of the screen. Should you need to recall it, a simple swipe with the S Pen's tip over the screen will do that. Tapping on Air Command's persistent bubble will open the full menu of functions.
The improved uses for the S Pen include an upgraded screen capture – one that allows you to capture many pages in succession, ending up with a large, automatically glued-up screenshot of a document that is otherwise larger than the phone's screen. Additionally, the S Pen can now write directly on top of .pdf files – great for signing documents. The Scrapbook also got an upgrade in terms of being able to categorize your scraps for easier reference later on.
Last, but not least, it will now be easier to take Action Memos directly on the lock screen, as the user can pull out the pen and start typing on the screen while it's in an "off" state. The pen will leave white traces on the black background, saving both battery and time.
Broadcast to YouTube
The new Camera app will allow users to broadcast to YouTube directly from their top-shelf Galaxy smartphones. The max resolution this mode would support is Full HD – 1920 x 1080 pixels. As with any regular YouTube stream, you can schedule the broadcast, you can choose it to be saved on YouTube's servers, and you can control the stream from a PC by visiting the website while still streaming from the phone.
Samsung Pay was also demoed, as it approaches its own launch. There is pretty much nothing vital that we don't already know about the system. It employs your phone's NFC and MST connectivity, so a payment is done by bringing the phone near a terminal and holding your thumb over the fingerprint scanner. Something really cool we can see in this video is a shortcut to bring up Samsung Pay's credit cards.
Even if your phone is off, all you need to do is swipe up from the very bottom of the screen. This will automatically bring up the last card you used, but swiping left or right will flip through all the ones that you have registered. From then on, it's simply a matter of authorizing the payment. Besides a physical receipt from the retailer, you will also get a digital copy of it stored in the Samsung Pay app. This is all shown in the video below.

redpajama_set_name: RedPajamaCommonCrawl


I saw my first Swallow-tailed Kite two summers ago. It was way up in the sky and of course, flying away from me. The tail was unmistakable, though. The S-t Kite's wings are long and slender, making it's job in nature (snatching large insects from the air and small lizards from trees) effortless.
I had no idea it was so big. When comparing it's size with other raptors, I discovered it's larger than a Red-tailed hawk by a couple of inches in both length and wingspan! L 22", WS 51", Weight 15 oz. But, the Red-tailed Hawk weighs 2.4 lbs.!
I love form and function in nature..... for everything there is a reason.


text:
Mistrató es un municipio localizado en el departamento de Risaralda, Colombia

Se encuentra a 86 km al noroccidente de Pereira; sus territorios son montañosos en su mayoría y se encuentran hidratados por las aguas de los ríos Risaralda, San Juan, Mistrató y Chamí y las de algunas corrientes de menor caudal.

Las actividades económicas más significativas son: la agricultura, ganadería, explotación forestal y minería.

Mistrató fue fundado el 18 de marzo de 1925 por poblaciones provenientes de los departamentos de Caldas, Antioquia y Quindío.
Posee dos corregimientos: Puerto de Oro y San Antonio del Chamí.

Referencias

Enlaces externos
 Página oficial de Mistrató
 Sitio no oficial del municipio de Mistrató

Municipios de Risaralda

redpajama_set_name: RedPajamaWikipedia


Think that this experience could not be topped? Well, think again! You also have access to any restaurant at Walt Disney World Resort with -wait for it – no reservation required! The tour is tailored to your specific requests so the possibilities are endless! You even receive FastPasses for all the rides.
So how does one go about booking this amazing tour? The tour must be booked at least 1 week in advance so all of your amazing opportunities can be arranged. If you would like guaranteed seating at any restaurant you desire, you must book this tour starting at 180 days out. The World of Dreams Tour costs $12,000 and can be scheduled for up to six guests. If you would like to add on an additional day, you may do so for an additional $10,000.
Don't have $12,000 to spend on the World of Dreams VIP tour? There are other VIP tours that you should check out that may be more within your budget. I, on the other hand, am going to be right back. I have to go buy myself a lottery ticket and hope that I win so I can take part in this once in a lifetime experience!
Would you like to visit Walt Disney World Resort? I would love to assist in planning your trip! I am a travel planner with Key to the World Travel – the Official Travel Partner of Chip & Co. I specialize in Disney Destinations and am certified in Universal Orlando Resort as well as Sandals & Beaches Resorts. My planning services are FREE when you book with me! Contact me today at 908-773-0930. You can also email me at n.newgas@keytotheworldtravel.com, follow me on Facebook or fill out the form below.


At 25%, women's enrolment at McGill's Faculty of Engineering ranks near the top of Canadian engineering schools. That figure, however, includes a very high percentage of female students at the School of Architecture. So Vanessa Jones (BEng'17) tells us how POWE (Promoting Opportunities for Women in Engineering) is leveling the playing field at the Faculty even more.
Is engineering still a man's world?
Vanessa Jones: Today the numbers are still low, and that's why POWE is so active: because we really want to change this. Engineering should be as diverse as possible, but for some reason it's still mostly men that go into it. POWE believes that it shouldn't just be half of the population that is designing, building stuff and solving problems. We think that diversity in engineering is not just important, it's necessary—because everyone has different backgrounds and different ways of thinking.
Why don't women choose engineering?
Jones: I think it starts really young. Once you decide in high school that you don't want to do math, it's over. I think women today still think like they are imposters. They feel they're not good enough. If they do bad on a test, women tend to take it harder. They say, 'Oh, I am not good in math, I am not good in physics…' And for some reason, girls don't know about engineering in high school. I didn't know about it; my friends didn't know about it. Young girls get drawn away from engineering because there is still a societal misconception that applied sciences are for men and social sciences and biology are for women.
POWE was voted "Best Club of the Year" this year; you are co-hosting the Conference on Diversity in Engineering in 2016; you have a successful speakers series; you do field trips to industries; you run the Conference for Future Engineers; you recruit in junior colleges and high schools. You're incredibly active.
Jones: We're changing the mentality; we're changing the community. We also have a mentorship program for first and second year students. They're paired with a senior student who acts as a mentor. I think some people need that community. POWE is there for them. We have 'Shadow Days' where junior-college girls come and experience the life of an engineering student. This year a girl named Ilana came from a junior college and shadowed me. A month later she sent me a text that said: "Vanessa, I got accepted in software engineering at McGill!" I just helped her make her schedule last week. It's really fun to see that what we do actually has an impact.
Click here to download the Engineering eBulletin in PDF format.


You may already know that Drupal 8 Media entity has a nice feature that applies to the File field type: the possibility to specify the folder where those files will be saved (that prevents from having tons of files all stacked into the public files folder).
Furthermore, that setting supports tokens, as you can see in the above example, which makes the feature even more handy.
But those of you that want to handle media entities and file storage programmatically may wonder how to take advantage of this capability.
If your directory setting is not tokenized, then you're probably all set.
But since I mentioned that, I feel like I'm beholden to you, so here is how you can deal with a datetime token.
Say what? Where can we get Drupal date?
From datetime service, of course. Let's get that as well.


text:
by Rachel Hahn
Pop/R&B
Listen to the track below
Smerz
"Oh my my"
The Norwegian duo Smerz (comprised of Henriette Motzfeldt and Catharina Stoltenberg) cite Jessy Lanza and the late DJ Rashad as influences, and indeed, their strange electronic songs shares a lineage with both of those artists. Their tracks are replete with unrelenting drums, woozy synths, and soft R&B vocals. Yet, Motzfeldt and Stoltenberg, who control just about every facet of their output, from songwriting, production, programming, to directing all of their music videos, render moments of intimacy and humor in ways unlike either of those artists.
"Oh my my," Motzfeldt and Stolenberg's debut recording for XL, strikes a balance between homemade, DIY-pop and disorienting techno. Glassy synths and a stuttering beat and rough drum machine give the song a warm, but barely-there pulse, and their in-unison singing and elongated phrasing is unsettling. Motzfeldt and Stoltenberg sing about "basic bitch problems," and a boy that's too faded and doesn't really know what he wants, but lots of their lyrics are muffled by cloudy production and fuzzy R&B groove. They punctuate every couple of bars with a "oh my my," as if to feign surprise at the end of each observation. Throughout, they're droll, funny, and disaffected, but blessed with dulcet voices. "Oh my my," like Smerz, is sometimes indecipherable, but it's not inscrutable, and when they reveal themselves to the listener, the reward is worth it.


text:
THE SECRET THAT THE TNA DOESN'T WANT EXPOSED
It is reported that R. Sampanthan is to lead a TNA delegation to meet the Mahanayakes ('TNA Delegation to meet Mahanayakes,' Sunday Times, 9th July 2017.) On 4th July 2017, the Mahanayakes issued a formal statement where they totally rejected the idea of a new Constitution. No doubt Sampanthan and his cohorts are trying to get the monks to soften their stance.
Sampanthan and his cohorts cannot deny that they were once the political arm of the LTTE. However, after the defeat of the LTTE, their story has been that they have given up separatism – the demand for Eelam – that they are now fully committed to the idea of an 'Eksath' (Undivided) Sri Lanka, and that all they want is sufficient autonomy in their areas, i.e. the North and East, to live in dignity and self-respect.
The difficulty in refuting the above claim of TNA members has always been the difficulty in proving their intention. When one accuses Sampanthan or his cohorts of continuing to harbor separatist intentions, they retort, 'How do you know? Can you get inside our minds?' Needless to say it is a slippery but effective reply.
In the course of my research for a case, I uncovered a certain fact that can overcome the aforesaid difficulty, and establish beyond a reasonable doubt that Sampanthan and his cohorts have never stopped being separatists. I shall discuss it briefly because it is of particular relevance in these trying times.
In case no. SC/SPL/03/2014 (H. K. D. Chandrasoma v. Mervai Senathirajah, Secretary of the Ilangai Tamil Arasu Kadchi) the court ordered an English translation be produced of the Constitution of the Ilangai Tamil Arasu Kadchi. All TNA MP's presently in Parliament or in Provincial Councils contested elections under the ITAK banner, so the ITAK Constitution is the official and definitive statement of their aims and objectives.
Interestingly, the ITAK Constitution on file at the Elections Commission is in Tamil, without accompanying Sinhala or English translations. So, court ordered that, for the purposes of the case, an English translation be produced by the Government Translator. (To the best of my knowledge, it is the first time such a translation has been produced. It is now a public document and can be accessed by any member of the public.)
There are actually two documents: the original Constitution, and an Amendment brought in 2008. I am interested in clause 17(D) of this latter Amendment, which is as follows:
'17(D): The General Committee of the Ilangai Tamil Arasu Kadchi dcided on 24.04.08 and 03.08.08 to approve all resolutions and actions taken by the Tamil United Liberation Front and the Ilankai Tamil Arasu Kadchi from 14th May 1976.'
What is the significance of the date, 14th May 1976? Anyone familiar with the history of Tamil separatism in Sri Lanka knows that the Vaddukoddai Declaration – the seminal document of the Separatist Movement – was signed on 14th May 1976. All the Tamil political parties and factions at the time came together as the 'Tamil United Liberation Front' (TULF) and signed the document.
For those who don't know anything about the Vaddukoddai Declaration is, here is its penultimate section, which is self-explanatory:
'This convention resolves that restoration and reconstitution of the Free, Sovereign, Secular, Socialist State of TAMIL EELAM based on the right of self determination inherent to every nation has become inevitable in order to safeguard the very existence of the Tamil nation in this Country….And this convention calls upon the Tamil Nation in general and the Tamil youth in particular to come forward to throw themselves fully into the sacred fight for freedom and to flinch not till the goal of a sovereign socialist state of TAMIL EELAM is reached'[1]
So, what is the significance of clause 17(D) of the Amendment? The ITAK has deliberately endorsed all resolutions and acts of the TULF going back specifically to 14th May 1976. That necessarily means that the ITAK has deliberately endorsed and embraced the Vaddukoddai Declaration, including the clear and unambiguous separatist sentiments expressed in the words quoted above.
To pass an Amendment to a Constitution is an act, not just to make or issue a statement. Meanwhile, it is well-recognized in the law that, a person's intention can be inferred from his actions.
Therefore, the deliberate act of the ITAK in amending its Constitution to endorse all resolutions and acts of the TULF and the ITAK going back specifically to 14th May 1976, is objective proof of the existence in ITAK members of the intention to carry on the separatist struggle.
I take as self-evident that to discuss reconciliation, particularly any concessions involving devolution of power, with committed separatists is suicidal. Therefore, the first thing that has to be done before discussing constitutional changes to facilitate devolution is to ask Sampanthan and his cohorts to clarify their position with regard to clause 17(D) of their Constitution.
[1] Power-sharing in Sri Lanka: Constitutional and Political Documents 1926-2008, Rohan Edirisignhe, Marco Gomez, et al (eds.) Colombo, Centre for Policy Alternatives, 2008
12 Responses to "THE SECRET THAT THE TNA DOESN'T WANT EXPOSED"
Dilrook Says:
Good work by Dharshan in unearthing ITAK's constitution.
Maha Sangha must be educated about TNA's obvious intentions but I'm sure they are fully aware of it.
However, this position of ITAK/TNA/TULF doesn't land them in legal trouble. Tamils are entitled to pursue self determination. This is what they exploit to keep separatist fires burning. It is a very cunning approach as these documents were drafted by the best Tamil legal luminaries. The only way to disrupt their plans is to stop all devolution of power and have alternative power sharing arrangements. The north and the east are different provinces with different majorities. Whatever Tamils get in the north must be given to Muslims in the east and Sinhalese in the rest.
Indian Colonial Parasites.
ranjit Says:
Maha Sanga or anybody in this country should not trust TNA or Indians or any other Tamil groups because they have forgotten what Sinhalese have done to them and all those groups did to our country for thirty long years. Even war times Sinhala government fed them and helped them but these Tamil hypocrites never appreciated what we did and still want to destroy our peaceful buddhist land with their cunning treacherous actions. Never trust Tamils or Indian parasites.
Fran Diaz Says:
Dharshan,
Thank you so very much !
As always, you bring out the legal angles of truth & justice for Sri Lanka.
Suggestions to combat Tamil Leaders Separatism :
Remove the ILLEGAL 13-A.
The rest of the Others in Sri Lanka are also entitled to follow Self Determination by Removing the dangerous 13-A.
There are other things to be done too, all in the name of Self Determination of the rest of Lanka.
Question : Why has the 6-A NEVER been activated ?
The Cold War is over. It is time to activate the 6-A.
The REAL Tamil Problem is always in Tamil Nadu, INDIA.
It is the 3,000 yr old CASTE SYSTEM.
CASTE is stated in the birth certificates there.
There are over 15 Million Tamil folk who are classified as Dalits.
INDIA does the Census based on CASTE.
Any Tamil Eelam formed in Lanka will come under INDIA.
INDIA will impose the CASTE system on Eelam and rest of Lanka, won't they ?
Alternately, Eelam will come under neo-Colonial 'protection' ?
What we need in Lanka is PATRIOTISM.
We invite the Tamil Leaders & the Tamil People of Sri Lanka, to join the rest of us in PATRIOTISM.
Tamil people : Please become PATRIOTS OF LANKA !
Ancient Sinhalaya Says:
These Tamil Nadu Alliance aka TNA are crafty, untrustworthy, ungrateful lot. Their aim is somehow get their
drealam while keeping Colombo and other areas to themselves as well. Tamils' problem is they are
never happy
can never have enough
want to live separately wherever they are in the world
never Sri Lankan
never loyal.
So there is no point trying to please them. They know they were brought here by the dutch and the british to work
in tobacco farms and tea farms. Still they keep chanting the mantra they had kings, kingdoms etc. This is an absurd
claim since they don't have an ancient tamil brick to substantiate it. No Anurdhapuras, no Polonnaruwas, etc. If they have been the followers of a true religion which says lying is a sin, they wouldn't carry on living this lie. But their religions of convenience say it is ok. So the lie goes on. Maha Sanga should never trust these liberation of tamil drealam's proxies. Just look at these guys' eyes tell the whole story. You can see hatred in them. Just like ayatollas!
SA Kumar Says:
THE SECRET THAT THE TNA DOESN'T WANT EXPOSED- No Secret We-ALL Tamil want TE nothing else Include DD/Karuna/Sampanthan/ CM Viggie .
Why can not achieve TE because Indian want us to settled with 13A so not much We-Tamil can not do at this present time.
So We-Tamil settled with fully committed to the idea of an 'Eksath' (Undivided) Sri Lanka, and that all they want is sufficient autonomy in their areas, i.e. the North and East, to live in dignity and self-respect.
Why Time is correct ( Indian possition to Train/arms us) We-Demila start our Eelam war V ( Oyatha Allakal; vi, Thavala pachchal V, Jeya sukura Muruyadippu 2 , etc….) than that will end up in Nanthi kaddal 2 . We-All Mother Lanka knows.
So why this kolaveri machang ????
fully implement 6A & 13A together (not half or quater) We all can live United mother Lanka until We-Tamil mess up by declare UD of TE.
Sampanthan and his cohorts cannot deny that they were once the political arm of VP& co- Not only TN We-All Demila are kodiya no secret .
One & Only Our ( Self declared) Thesiya Thalavar VP !
Long live to 'Eksath' (Undivided) Sri Lanka
It is reported that R. Sampanthan is to lead a TNA delegation to meet the Mahanayakes – At last We-Thamil Sakkiliyar understood that nothing can be change in Chignkela Theevu with out Mahanayakes (Biggus) approval .
Ratanapala Says:
Many thanks to Dharshan for exposing the real nature of these vipers in disguise. The sheer lunacy of not bringing these former LTTE agents to book immediately after the end of the Tamil Tiger Terrorist war is the reason for them making these unreasonable demands. They now want the introduction of a Vice Presidential position too to the constitution.
For myopic political reasons privy to only themselves, the Rajapakse Administration failed the nation on this score.
The fact that the ITAK document with its references to the infamous Vadukkodai Declaration has not been translated into Sinhala and English alone shows the depth ignorance in the South and the derelection of duty by the Sri Lankan Government institutions in not dessiminating information relevant to the national dialogue.
TNA must for ever be treated only as the unrepentant remnants of the LTTE, responsible for tens of thousands of war dead as well as destruction of property and infrastructure. They must be brought to book if there is to be any realistic national reconciliation in Sri Lanka.
Kumar,
TE is in Tamil Nadu.
The rest of the People of Lanka do not TE in Lanka.
That is the Self Determination of the rest of Lanka.
Develop and bring CASTE peace to Tamil Nadu. Then TN will become TE. You guys can do it. If there is a Will, there is a Way !
There are far more life supportive activity for Tamil People to do than waste time on TE.
The rising sea levels due to Climate Change > Global Warming will result in rising sea levels, up to 15 ft or more, the experts say.
Right now, a large slice of the Antarctic has broken off recently and will slowly melt into the sea, raising sea levels.
Imagine what a rise in sea levels up to and above 15 ft would do to the coastlines of Lanka and INDIA, and the rest of the world !!
Tamil People of Lanka and elsewhere have a part to play in containing such an event.
Tamil People ought to concentrate on what has to be done for SURVIVAL of all. Petty infighting of old days must be put aside.
Join us to fight for Survival !
Tamil People ought not to waste time re TE. In any case, TE is in Tamil Nadu, not elsewhere.
Global Warming from Climate Change is resulting in rising sea levels – up to 15 ft or more, the experts say !
Imagine what such a rise in sea levels would do to the coastline of Lanka and INDIA, and the rest of the world !
Already a large slice of the Antarctic ice shelf has broken off just a few days ago. This will slowly melt as it drifts into warmer waters.
Tamil People in Lanka & elsewhere should join us the rest of us to fight Climate Change.
Fight the worthy fight with the rest of us !
This entry was posted on Tuesday, July 11th, 2017. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response.


The school runs a daily Breakfast Club which is free to all pupils. Breakfast Club is open from 8.am—8.45am and is held in the school hall. Pupils are offered a variety of healthy breakfast foods and drinks, thus strengthening the Healthy School Status Ysgol Llanybydder is accredited with. Parents should enrol their child to the Breakfast Club. Enrolment forms are available from Breakfast Club staff. Pupils must arrive at the school before 8.35am to allow sufficient time for breakfast to be eaten.
On Monday Llanllwni school holds Urdd Club for the members of the Urdd. In the club members have the opportunity to take part in a variety of activites such as: cooking, art and crafts, sports, bingo, quiz and paracute games.


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When South Dakota Ice Fishing Becomes Unsafe
Danny V Published: January 24, 2023
Photo by Danny V, Townsquare Media
For the most part, ice fishing has been great from December and most of January. But a recent trip to Lake Vermillion just west of Sioux Falls was challenging, to say the least. The snow cover and slush on the lake made it very difficult to pull the gear sled.
Driving out on the lake with my SUV was not even an option. Even ATVs and 4-wheelers were getting stuck. My sons often reminds me that we need a snowmobile but that's for another post.
But a few news stories really hit a chord in the last few days that should be a yellow caution flag for area ice fishermen.
1. Catfish Bay has canceled this weekend's Ice Fish Fest due to uncertain ice. The lake has a nice layer of snow on it but under that snow lies a lot of water and slush, according to Jim Bruns, owner of Catfish Bay. The official announcement says the rain and warm weather the area received several days ago and the insulating layer of old and new snow cause a safety risk, according to Dakota News Now.
2. Earlier this week, six vehicles went through the ice on a Minnesota Lake for parking too close to one another. The ice on Lake Pepin, south of Minneapolis, couldn't take the combined weight after land parking filled to capacity. Experts say that you should park at least 50 feet apart on a frozen lake to reduce the risk of going through. The adage "you're walking on thin ice, mister" sometimes takes a literal meaning.
It can also create a real headache dealing with your insurance company if your vehicle goes through the ice. I'm not sure many policies cover that. You may want to check with your agent but I wouldn't hold out hope.
A good rule of thumb comes from the Minnesota Department of Natural Resources (DNR) which has these recommendations:
You need at least 4" of ice for ice fishing on foot.
You need at least 5" of ice for snowmobile or ATV.
You need at least 8-12" of ice for small cars and small pickups.
You need at least 12 - 15" of ice for a medium sized truck or SUV.
There are still some great opportunities to hook some walleye, crappie, and perch on area lakes. But it may take some patience until we can get a good cold snap.
I snapped the pic below when ice fishing on Lake Vermillion. It was a fun day but the water and slush made it a bit of a challenge.
LOOK: The states with the most UFO sightings
For each state, we've also included details of famous UFO sightings in that state. Of note is that almost three-quarters of all UFO sighting reports in the United States occur between 4 p.m. and midnight, and tend to peak between 9 and 10 p.m. Food for thought next time you're out scoping for alien life. Keep reading to see which states have had the most UFO sightings.
Source: When South Dakota Ice Fishing Becomes Unsafe
Filed Under: South Dakota, Minnesota, fishing, Ice Fishing
Remembering The Mall Of America Incident With NSYNC From The 90s
Minnesotans Win the World Snow Sculpting Championship Over the Weekend
Minnesota Neighborhood Is Currently Being Terrorized By Wild Turkey
Nickelback Bringing Get Rollin' Tour To Minnesota With Country Rocker Brantley Gilbert


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Diese Liste enthält Lieder der internationalen Pop-Boygroup US5. Aufgeführt sind alle Lieder ihrer Alben Here We Go (2005), In Control (2006), Around the World (2008) und Back Again (2009). Verschiedene Remixe oder Versionen ihrer Lieder sind ausgenommen.

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Choose your license based on your development needs. All licenses come with full source code. They are not limited to a set number of developers, but they are limited based on the number of sites you want to build. A "site" is one web application served from one domain, such as example.com.
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David Howard Harrison (* 1. Juni 1843 in London, Oberkanada; † 8. September 1905 in Vancouver) war ein kanadischer Politiker. Er war Premierminister der Provinz Manitoba und regierte vom 26. Dezember 1887 bis zum 19. Januar 1888. Seine Regierungszeit von 24 Tagen ist die mit Abstand kürzeste dieser Provinz.

Biografie
Harrison studierte Medizin an der University of Toronto und an der McGill University. 1864 eröffnete er eine Praxis im Ort St. Marys, wo er aufgewachsen war, später wurde er Gerichtsmediziner von Perth County. 1882 beschloss er, nach Manitoba zu ziehen und eine Ranch aufzubauen. Im darauf folgenden Jahr kandidierte er für einen Sitz in der Legislativversammlung von Manitoba und wurde im Wahlbezirk Minnedosa gewählt. Bald freundete er sich mit Premierminister John Norquay an. Dieser ernannte Harrison im August 1886 zum Minister für Landwirtschaft, Statistik und Gesundheit. Drei Monate später gelang ihm die Wiederwahl im neuen Wahlbezirk Minnedosa West.

Als Norquay die Unterstützung des kanadischen Premierministers John Macdonald verlor, weil er das Monopol der Canadian Pacific Railway nicht länger unterstützen wollte, brach die Provinzregierung auseinander. Harrison wurde am 26. Dezember 1887 zum neuen Premierminister von Manitoba ernannt. Doch wenige Tage später verloren die regierenden Konservativen zwei Nachwahlen, woraufhin er nach nur 24 Tagen im Amt zurücktrat und Thomas Greenway, der Vorsitzende der Liberalen, den Auftrag zur Regierungsbildung erhielt.

Nach dieser Niederlage kandidierte Harrison bei den Wahlen im Jahr 1888 nicht mehr. Er führte erfolgreich eine Bank in Neepawa und ließ sich 1900 in der Provinz British Columbia nieder.

Weblinks

 Biografie auf der Website der Manitoba Historical Society

Premierminister (Manitoba)
Abgeordneter der Legislativversammlung von Manitoba
Mediziner (19. Jahrhundert)
Kanadier
Geboren 1843
Gestorben 1905
Mann


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BIOLAND ENERGY GROUP
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The Eptagon Group of companies is a dynamic Cypriot registered company operating all over the world. The Eptagon Group is comprised across an array of business and economic sectors which include the renewable energy sector as well as the finance, retail, imports, medical, software and construction sectors.
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NEW DELHI, September 12: All 16 members of the Indian team, which competed in the Olympic Games in London earlier this year, are among the 90 domestic players who have signed up for the Hockey India League Players Auction to be held next month in the run up to the prestigious six-team Hockey India League in January 2013.
Author: ""; Last updated on February 27, 2013 02:27 .
NEW DELHI, September 9, 2012: The vastly experienced Sohail Abbas is among 14 Pakistan hockey stars who have signed up for the inaugural Hockey India League to be held from January 5 to February 3 next year. Rated among the world's best drag-flick exponents, Sohail Abbas has scored the most international goals in the history of hockey with 349 goals.
NEW DELHI, August 1: Hockey India today announced Jaiprakash Associates Ltd (JAL) as one of the six franchises who will compete in the inaugural Hockey India League (HIL) from January 5 to February 13 2013. Jaiprakash Associates will be the owner of the Punjab-based team.
Hockey India signs multi-year broadcast deal with ESPN STAR Sports for the soon to be launched Hockey India League (HIL).
New Delhi- Hockey India entered into a multi-year broadcast agreement with leading sports broadcaster ESPN STAR Sports to exclusively broadcast the soon to be launched Hockey India League (HIL). ESPN STAR Sports will also cover all international matches to be played in India for the next 5 years.
Author: ""; Last updated on February 27, 2013 02:30 .
Minister of State for Parliamentary Affairs Rajeev Shukla, Leader of the Opposition in Rajya Sabha Arun Jaitley and media personality Rajat Sharma have been named members of the Board of the high-profile Hockey India League (HIL) that will be held in January-February 2013.
Hockey India Secretary-General and HIL Chairman Dr. Narinder Batra said the appointments of these personalities from outside hockey circles would enhance the profile of the League. "We are honoured that Mr Rajeev Shukla, Mr. Arun Jaitley and Mr. Rajat Sharma have accepted our invitation to be on the Board," he said.
28 Indian Players including the top stars from the current national team have signed on to play in the inaugural session of cash rich Hockey India League. Initial 28 contracts were signed between Hockey India and players in Pune on Thursday 7 June 2012.
In the list of 28 players who have signed on to play in the league includes Indian forward Shivendra Singh, Tushar Khandker ,Yuvraj Walmiki and others.


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