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Aluminium Wardrobe and Cabinate, Wood Grain Dress Table, Aluminium Good Quality Furniture manufacturer / supplier in China, offering Modern Metal Furniture Aluminum Profile Kitchen Cabinet, Powder Coating Sliding Door and Window Aluminium Profile, Glazing Unitized Anodizing and Powder Coating Glass Aluminum/ Profile Aluminium and so on.
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Furniture aluminium profile from Foshan Pailian Aluminium Profile Co., Ltd.. Search High Quality Furniture aluminium profile Manufacturing and Exporting supplier on Alibaba.


text:
Sikorsky SH-60 Seahawk är en variant av Sikorsky S-70, designad av Sikorsky för att spåra och sänka fientliga ubåtar.

Historia
1974 började USA:s flotta att leta efter en ersättare för Kaman SH-2 Seasprite att fylla fylla rollen som LAMPS-helikopter (Light Airborne Multi-Purpose System). Man följde med stort intresse USA:s armés UTTAS-program (Utility Tactical Transport Aircraft System). Flottan valde att kopiera upplägget i förhoppningen att en delvis gemensam helikopterplattform skulle minska kostnaderna. Sikorsky vann både arméns och flottans upphandling med sin modell S-70.

Den prototypen YSH-60B flög första gången 12 december 1979 och den första serieproducerade maskinen flög 11 februari 1983. Den togs officiellt i tjänst 1984. SH-60F började levereras i juni 1989.

Konstruktion
SH-60B har 83 % av sina delar gemensamma med UH-60A. Det som skiljer är främst landningsstället som har kraftigare stötdämpare och kortare hjulbas för att kunna landa säkert i grov sjögång och på små helikopterplattor. SH-60 är korrosionsbehandlad för att inte angripas av saltvatten och har kraftigare motorer för att bära upp all extra utrustning. Extrautrustningen består av den kraftfulla ytspaningsradarn AN/APS-124 som upptar nästan hela bredden under nosen, AN/ALQ-142 radarvarnare, AN/ARQ-44 datalänk och 25 avfyringstuber för totalt 125 sonarbojar. Avfyringstuberna syns bara på babords sida, men sträcker sig tvärs genom hela flygkroppen. På styrbords sida finns en räddningsvinsch framme vid kabindörren och längre bak ett fäste med kabeltrumma för en AN/ASQ-81 magnetometer. Magnetometern bogseras 20–50 meter bakom helikoptern för att inte störas av dess magnetfält.

Beväpningen består normalt av två ubåtsjakttorpeder, men helikoptern kan även bära sjunkbomber, sjömålsrobotar eller fälltankar. Sjömålsrobotar var ursprungligen två AGM-119 Penguin, men de håller på att fasas ut till förmån för AGM-114 Hellfire. Dessutom är helikoptrarna ofta utrustad med en medeltung eller tung kulspruta.

Varianter
SH-60B – Även kallad LAMPS III. Byggd för att ersätta Kaman SH-2 Seasprite som skeppshelikopter ombord på fregatter, jagare och kryssare. Huvuduppdragen är ubåtsjakt och ytmålsbekämpning. För detta är den utrustad med radar för att upptäcka ubåtars periskop eller ytfartyg, sonarbojar och magnetometer för ubåtsjakt och ESM-system för att upptäcka fientliga radarsignaler. Dessutom finns möjligheten att montera FLIR. Besättningen består av pilot, andrepilot/taktisk officer och ett underbefäl som fungerar som sensoroperatör.
SH-60J – SH-60B tillverkad på licens av Mitsubishi för Japans marina självförsvarsstyrkor.
SH-60K – SH-60J med 30 cm längre och 16 cm högre kabin, ny huvudrotor och ny elektronik.
SH-60F – Ibland kallad Oceanhawk. Byggd för att ersätta Sikorsky SH-3 Sea King som primär helikopter för ubåtsjakt och räddningsuppdrag ombord på hangarfartyg men kan utföra alla uppdrag som SH-60B klarar av. Saknar radar men är utrustad med ett ESM-system. Istället för SH-60B som använder sonarbojar som primär ubåtsjaktsensor har versionen en Bendix AN/AQS-13F dopphydrofon, tillsammans med förmågan att fälla sonarbojar. Detta eftersom SH-60F förväntades operera tillsammans med andra SH-60F helikoptrar, medan SH-60B förväntades arbeta som ensam helikopter i samarbete med fartyg. Den kan även böra en magnetometer. Beväpningen består av ubåtsjakttorpeder samt en medeltung eller tung kulspruta och den kan även utrustas med Hellfire ytmålsrobotar. Besättningen består av pilot, andrepilot/taktisk officer och två underbefäl som fungerar som sensoroperatör, varav den ena också är en fullt kvalificerad ytbärgare.
HH-60H – Ibland kallad Rescuehawk. Räddningshelikopter med transportkabin liknande den i Blackhawk. Förutom räddningsuppdrag används den även av specialförband. Saknar radar, sonarbojar och andra sensorsystem för ubåtsjakt och ytstrid, eftersom detta inte är en del av dess uppdrag. Då den förväntas genomföra räddningsuppdrag över fientlig mark är den utrustad med en extensiv motmedelssvit inkluderande robotvarningssystem, radar- och laservarare och fackel-/remsfällare och dessutom, mera ovanligt, infraröd störsändare. Beväpningen består framförallt av flera medeltunga eller tunga kulsprutor alternativt Minigun gatlingkulsprutor men den kan också bära Hellfire markmålsrobotar.
MH-60S – Även kallad Knighthawk eftersom den är byggd för att ersätta CH-46 Sea Knight. Den är egentligen närmare släkt med UH-60 Blackhawk eftersom den saknar marinhelikoptrarnas typiska korta hjulbas. Den är baserad på amfibiefartyg och trängfartyg och används för luftlandsättning respektive lasttransport.
MH-60R – En uppgraderad version tänkt att ersätta både SH-60B och SH-60F. Den har bland annat en modernare cockpit från MH-60S och samma FLIR som HH-60H.
S-70B – Sikorskys egen beteckning på SH-60B. Beteckningen används också på exportversionerna till Australien, Grekland, Spanien, Thailand och Turkiet.
S-70C – Sikorskys beteckning på SH-60F. Beteckningen används också på exportversionerna till Brunei och Taiwan.

Användare
 – 15 stycken S-70B i tjänst. Kommer att ersättas med 24 stycken MH-60R med början 2014.
 – Fyra S-70B levererade och ytterligare två beställda.
 – Nio styrken MH-60R levererade 2016-2018.
 – Åtta stycken S-70B.
 – 102 stycken SH-60J och SH-60K.
 – Tolv stycken S-70B levererade 2009 och ytterligare sex är beställda.
 – Sex stycken S-70B.
 – 19 stycken S-70C Thunderhawks levererade i november 2008.
 – Sex stycken S-70B i tjänst och sex stycken MH-60S beställda.
 – 25 stycken S-70B.
 – 129 stycken SH-60B, 60 stycken SH-60F, 52 stycken MH-60R och 154 stycken MH-60S.

Externa länkar

Referenser

Tryckta källor

Webbkällor

Ubåtsjakthelikoptrar
SH-60

redpajama_set_name: RedPajamaWikipedia


Dr. Bruce L. Rothschild, DDS, has become a top alternative for a family dentist near Pearl River NY or the rest of the local area as a result of providing high quality dental treatment within an environment that's caring and inviting. Practicing for over twenty five years and providing some of the most comprehensive services, Dr. Rothschild, together with our friendly and proficient team supply high quality dental care to suit your requirements. Dr. Rothschild is a great alternative if you're looking for family and cosmetic dentistry in Pearl River NY thanks to the gentle care, experience, integrity and humor he brings.
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text:
Fry's Customer Service Number
Category : Computers & Electronics
Address 4000 Air Park Cove, Memphis, TN 38118
Calling Hours 9 AM - 1 AM Monday - Sunday
Email service@cs.frys.com
Website https://www.frys.com
Fry's customer service number is important for customers and retailers who purchase products from the electronic retail chain. The customer service team is available daily during designated hours over the phone, and you can always email them or send them traditional mail. Their social media pages are another great resource to get in touch with Fry's. To learn more about the company and how to get in touch with corporate or a specific store then check out the rest of this article!
Fry's offers customer service over the phone daily from 9:00 a.m. to 1:00 a.m. EST (except for major holidays). You can reach a customer service representative by phone at 408-350-1484 or by fax at 408-487-4700.
Fry's Email/Contact Form
If you would like to email Fry's customer service team, you can reach them directly at service@cs.frys.com. You can also fill out a customer service email form here:
https://www.frys.com/template/feedback/email/.
Fry's Mailing Address
If you would like to get in touch with Fry's through the postal service there are two specific mailing addresses:
Mailing address for RETURNS:
(You must obtain a Return Authorization number, RMA#, from the Customer Service department before a return will be accepted)
Frys.com/Returns
4000 Air Park Cove
Corporate mailing address:
(Do not send returns to this address.)
Fry's Electronics
600 East Brokaw
Fry's Live Chat
Unfortunately, there is no live chat on the Fry's customer service website. There are numerous other ways to get in touch with them online or over the phone.
Fry's Customer Support Website
The customer service page on Fry's website is an excellent source of information on price matching, weekly ads, email specials, and your account. Other topics include in-store pickup details, order tracking, payment methods, returns, order tracking, and more. Check out the customer service page on Fry's website here: https://www.frys.com/ac/customerservice/?site=csfooter_A
There is also a contact page on the Fry's website for sales and customer service phone numbers and emails. It also shows customer service hours and mailing addresses for corporate and for returns. You can find the contact page here: https://www.frys.com/template/help/index/FE30/Service3/Assistance/Left_Topics/A12ContactUs.
If you would like to leave a specific comment for Fry's you can do so on the feedback form here: https://www.frys.com/template/isp/index/Frys/isp/Middle_Topics/G2%20Store%20Feedback/?site=csfooter_D
Fry's Social Media Accounts
If you haven't followed Fry's on social media, you are missing out on a lot of education on electronics. The YouTube page has tons of great videos of drones, software and hardware compatibility, gaming videos, and information on computers, phones, and other electronics. The Facebook and Twitter page showcase sales and posts high-quality photos of products. To visit the Fry's social media pages and follow them then check out the link below:
Fry's Facebook: https://www.facebook.com/fryselectronics
Fry's Twitter: https://twitter.com/fryselectronics
Fry's Instagram: https://www.instagram.com/fryselectronics/
Fry's YouTube: https://www.youtube.com/fryselectronics
Fry's Google+: https://plus.google.com/+FrysElectronics
About Fry's
Fry's is an American retailer that sells consumer electronics, computer hardware and software, and other household appliances. The company is headquartered in Silicon Valley, one of the largest tech areas in the United States. The store started with one location in Sunnyvale, California but now has over 30 locations.
Charles Fry sold Fry's Supermarkets in the early 1970s, and his sons joined together with other partners to open Fry's Electronics in 1985. All of the owners are actively involved in daily operations of the stores. The purpose of the store is to provide one-stop shopping for high tech professionals. There are over 50,000 electronic items in each store as well as even more products on the Fry's website. All of the Fry's stores sell, service and support computer products and accessories as well as video, audio, and appliances.
Fry's has stores in Northern California, Southern California, Texas, Arizona, Georgia, Illinois, Nevada, Indiana, Oregon, and Washington. Each store location carries its own unique theme. For example, in Northern California the Roseville location honors the railroad, San Jose pays tribute to astronomers, and Sunnyvale showcases the history of Silicon Valley. Additionally, stores like South Houston, TX honor pioneer heritage, Phoenix, AZ reflects ancient Aztec temples, and Fishers, Indian pays tribute to the Indy Speedway.
Fry's Headquarters Location Map

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text:
KMRE-LP (102,3 LP FM) je rozhlasová stanice vysílající historické, vzdělávací a kulturní pořady. Vlastní ji Americké muzeum rádia a elektřiny v Bellinghamu, v americkém státě Washington. Odtud pochází také její zkratka Muzeum Rádia a Elektřiny.

Stanice se soustředí na předvádění Amerického muzea a elektřiny a vysílá hudbu od prvních nahraných kousků z devatenáctého století až po konec čtyřicátých let dvacátého století, čímž zachycuje zlatou éru rozhlasového vysílání a vysílá hudbu, která jen tak jinde k slyšení není. Také chce kultivovat místní pořady přidáním jejich vzdělávací hodnoty. Dále uvítá podporu kohokoli z komunity a svým zaměstnancům nabízí svobodu kreativity.

Federální komunikační komise dala rozhlasu licenci v červenci 2006.

Reference

Rozhlasové stanice v Bellinghamu


text:
What's Your Plan?: School Library Instruction and Programming in the Age of COVID-19
162 registrants
MASL Member
The webinar registration fee includes membership to MASL for 2020/2021.
As schools in Maine prepare to reopen, it's crucial that school library staff plan for library instruction and programming that meet the needs of students and teachers. MASL invites you to attend a panel discussion about school library programs during the COVID-19 crisis. School librarians, Tina Berumen, Anita Cellucci, Amanda Jones and Matthew Winner will share ideas for library programming, instruction, collaboration and leadership. The webinar will also highlight information from AASL's document, "School Librarian Role in Pandemic Learning Conditions."
This webinar is free to MASL members. Non-members may register for $25. The $25 webinar registration fee includes one year of MASL membership and access to other MASL webinars during the membership year.
Tina Berumen is the coordinator of library services for Coppell ISD in Coppell, Texas. Tina has been a STEM School Librarian and has presented on STEM in the Library, Makerspaces, Global Connections, E-Books and Digital Resources. She is an active member of the Texas Library Association, Texas Computer Library Association and an advisory board member for the Mackin Educational Resources Transform Your School Library movement.
Anita Cellucci is a teacher librarian at Westborough High School in Westborough, MA, and she teaches courses at Plymouth State University in New Hampshire. Anita was named a Library Journal Mover & Shaker in 2019, and she was a School Library Journal School Librarian of the Year Award Finalist in 2016. Anita has been recognized for her work with social emotional learning in schools and in the school library. Anita is Director at Large for the AASL Board. She worked with the AASL committee that wrote the framework, School Librarian Role in Pandemic Learning Conditions.
Amanda Jones is the school librarian at Live Oak Middle School Library in Watson, Louisiana. Amanda is currently 2nd Vice President/1st Chair Elect of the Louisiana Association of School Librarians, and her library was the winner of the 2019 LLA James O Modisette Award for middle school library programming. She is the 2020 Louisiana School Librarian of the Year, the 2019 LACUE Middle/Junior Teacher of the Year, and the 2019 Social Media Superstar Program Pioneer for the American Association of School Librarians. Amanda recently hosted the webinar: Navigating School Library Programming in the Face of COVID-19.
Matthew Winner is the lead Lower School Librarian at McDonogh School in Owings Mills, Maryland. He is the host of The Children's Book Podcast, and he co-hosts Kidlit These Days, a Book Riot podcast pairing the best of children's literature with what's going on in the world today. In 2013 Matthew was named a Library Journal Mover & Shaker and was invited to the White House as part of the Champions of Change program. In June, Matthew published the Demco article, "Ways School Librarians Can Serve Students in Fall 2020."


text:
Q: Where can I obtain the latest clang static analyzer? On Ubuntu I can install scan-build from the clang-tools package. But for mac computer, there's no formula in homebrew and all I found online is this one: https://clang-analyzer.llvm.org/downloads/
The last build is from 2016, where can I find the latest one?

redpajama_set_name: RedPajamaStackExchange


Directly from you – for example: through the login authorisation form which allows us to determine the level of access you have on the site, and online forms and service requests which allows us to process your query or order.
We take our protection of our user's information seriously, this website takes every reasonable step to ensure that any personal details submitted are protected both online and off-line. Our developers utilise the latest technologies to ensure that your information is kept secure and confidential. Our management team and developers are authorised to handle your information and we will retain your data on file no longer than is required by us. By law we are required to keep on file your login information for seven years after the login is cancelled, however some information may be deleted earlier than that depending on our legal requirements.


text:
Eine Boygroup oder Boyband (englisch boy band) ist eine Popgruppe mit ausschließlich männlichen Mitgliedern im Teenager- und Twen-Alter, die oft auch synchron zum Gesang tanzen. Nicht unter diesen Begriff fallen für gewöhnlich rein männliche Bands, deren Mitglieder Instrumente spielen.

Geschichte
Die Bezeichnung wird erst seit den 1990er-Jahren verwendet, auch wenn das Konzept der analog zu Girlgroups meist von Managern oder in einem Casting zusammengestellten Gruppen bereits früher erfolgreich war. Beispiele in den 1960ern waren die Monkees, in den 1970ern die Bay City Rollers und die New Kids on the Block in den 1980ern.

Erst mit dem zunehmenden Aufkommen nahezu identisch konzipierter Gruppen wie Take That, East 17, Worlds Apart und Caught in the Act Mitte der 1990er-Jahre wurde der Begriff Boygroup im deutschen Sprachraum geläufig. Mit über 100 Millionen verkauften Tonträgern ist die von Lou Pearlman gegründete Gruppe Backstreet Boys die bislang erfolgreichste ihres Genres. Pearlman war außerdem für die ähnlich erfolgreiche Boygroup *NSYNC verantwortlich. In der ersten Hälfte der 2010er Jahre war One Direction international erfolgreich, in der zweiten Hälfte war vor allem die südkoreanische Gruppe BTS populär.

Kennzeichnend für Boygroups ist ihr kommerzieller Charakter, da sie auf eine der wichtigsten Zielgruppen des Musikmarktes, die weiblichen Teenager ausgerichtet sind. Die Musik folgt aktuellen Trends, Satzgesang ist typisch. Ein Musikproduzent überwacht üblicherweise das Gesamtkonzept von der Musik über die Choreografien bis zum Image. Oft lösen sich Boygroups nach einigen Jahren wieder auf, wenn ihre Fans das Teenager-Alter verlassen haben oder eine neue Gruppe vermarktet werden soll, wobei aber einzelne Mitglieder durchaus auch Solo-Karrieren durchlaufen und sich dauerhaft etablieren können.

Literatur

Belege

Musikgruppen-Typ


text:
Balthasar Münter (* 24. März 1735 in Lübeck; † 5. Oktober 1793 in Kopenhagen (Dänemark)) war evangelischer Pfarrer, Aufklärer, Hofprediger in Gotha und Kopenhagen und Kirchenlieddichter.

Leben
Münters Vater war in Lübeck ein angesehener Kaufmann, Münter besuchte das Katharineum zu Lübeck unter Rektor Johann Daniel Overbeck und studierte dann ab 1754 in Jena Theologie. 1757 habilitierte er sich hier als Privatdozent und war im folgenden Jahre Adjunkt der philosophischen Fakultät. Außer einigen akademischen Dissertationen schrieb er über die Allgemeine Redekunst. Er hielt beachtete Reden in der Freimaurerloge zur Hoffnung, die in fünf Sammlungen von je fünf Reden in den Jahren 1759 bis 1762 gedruckt wurden.

Bald darauf erhielt er einen Ruf des Herzogs zu Gotha, der ihm eine Stellung als Hofdiakon und Waisenhausprediger in die Residenzstadt gab. 1763 wurde er auf seinen Wunsch als Superintendent nach Tonna versetzt, wobei er die Bedingung akzeptierte, monatlich einmal vor der herzoglichen Familie in Gotha zu predigen.

1765 wurde er, infolge einer in seiner Vaterstadt Lübeck gehaltenen Gastpredigt, zum Hauptprediger an der deutschen St. Petrikirche in Kopenhagen berufen. 1769 wurde er Mitglied der dänischen Königlichen Akademie der Wissenschaften. In dieser Stellung blieb er bis an sein Lebensende.

Münter hat nicht nur als Kanzelredner eine große Wirksamkeit gehabt, sondern hat sich zugleich um das Schul- und Armenwesen seiner Gemeinde im Sinne der Aufklärung große Verdienste erworben.

Andererseits war Münter schon zu seinen Lebzeiten auch umstritten. So erhielt er 1772 den Auftrag, den Geheimen Kabinettsminister des dänischen Königreiches Johann Friedrich Struensee als Seelsorger und Beichtvater vor dessen Hinrichtung geistlich vorzubereiten, obwohl er als erklärter Gegner Struensees in die Umsturzpläne gegen diesen einbezogen war. Vom 1. März bis 28. April hielt Münter insgesamt 38 Unterredungen mit dem inhaftierten Grafen, die beweisen sollten, dass der Atheist Struensee zum Christentum zurückgekehrt sei. Die kurz darauf veröffentlichten Gespräche, die den Eindruck einer sorgfältigen Vorbereitung und einer gewissenhaften Niederschrift vermittelten, wurden ein Bestseller und in viele europäische Sprachen übersetzt. Zeitgenössische Denker in Deutschland wie Johann Wolfgang Goethe, Gotthold Ephraim Lessing und auch Matthias Claudius zweifelten allerdings schon damals die Echtheit dieser Bekehrung an. Grundlage der Zweifel waren die Umstände, dass es außer Münter keine weiteren Zeugen für die referierten Gespräche gab und dass die zitierten schriftlichen Bekundungen Struensees über seine Bekehrung und sein Schuldbewusstsein nur durch Münters Buch bekannt wurden. Andere in Struensees Handschrift verfasste schriftliche Quellen, die Münters Aussagen stützen würden, sind nicht überliefert. Außerdem weicht Struensees angeblich eigenhändige Schilderung seiner Bekehrung erheblich vom Stil der von Struensee nachweisbar eigenhändig verfassten Verteidigungsschriften, die er etwa gleichzeitig der gegen ihn eingesetzten Untersuchungskommission vorgelegt hatte, ab. Zuletzt enthalten die Gespräche auch einige Anmerkungen zur Verbreitung von Krankheiten, die sich mit Struensees zuvor veröffentlichten wissenschaftlichen Ansichten nicht vereinbaren lassen.

Das umfangreiche Einkommen aus seinen Schriften nutzte Münter, um in Anteile der Dänisch-Westindischen Handelskompanie zu investieren, die im atlantischen Dreieckshandel und damit im Sklavenhandel stark engagiert war. Sein Aktionärsbrief, der von Heinrich Carl von Schimmelmann unterschrieben wurde, ist erhalten.

Familie
Münter war verheiratet mit Magdalena Ernestina Sophia Friederika, geborene Wangenheim. Ihr gemeinsamer Sohn war Friedrich Münter (1761–1830) der ebenfalls evangelischer Theologe in Kopenhagen und Bischof in dänischen Diensten war, ihre Tochter war die Schriftstellerin Friederike (1765–1835). Sie heiratete den Kaufmann Constantin Brun.

Werke
 Balthasar Münter: Bekehrungsgeschichte des vormaligen Grafen und Königlichen Dänischen Geheimen Cabinetsministers Johann Friederich Struensee. Rothens Erben und Prost, Kopenhagen 1772. ();
 Seine in Gotha gehaltenen Predigten erschienen zwischen 1760 und 1765 unter dem Titel Heilige Reden in 7 Theilen. Von 1766 an gab er in Kopenhagen jährlich den Inhalt seiner Predigten heraus.
 Die größte Nachwirkung war seiner Sammlung geistlicher Lieder von 1773 (2. Folge 1774) beschieden, zu denen Carl Philipp Emanuel Bach eine Reihe Sätze beisteuerte. Carl Loewe vertonte später daraus Unsere Auferstehung durch Christum. Viele der Lieder Münters erfreuten sich bis in Kirchengesangbücher des 20. Jahrhunderts großer Popularität, sind aber nicht mehr im Evangelischen Gesangbuch vertreten. Im katholischen Gotteslob (2013) findet sich unter Nr. 435 die 1. Strophe seines Herr, ich bin dein Eigentum (kombiniert mit drei Strophen aus dem 20. Jahrhundert).
 Ferner erschienen von ihm 1775 Unterhaltungen eines nachdenkenden Christen mit sich selbst über die Wahrheit und Göttlichkeit seines Glaubens aus inneren Gründen in zwei Teilen.

Anmerkungen

Literatur

Einzelnachweise

Weblinks

Autor
Literatur (Deutsch)
Literatur (18. Jahrhundert)
Kirchenlieddichter
Lutherischer Theologe (18. Jahrhundert)
Hauptpastor (Kopenhagen)
Aufklärer
Illuminat
Freimaurer (18. Jahrhundert)
Freimaurer (Deutschland)
Person (Lübecker Geschichte)
Deutscher
Geboren 1735
Gestorben 1793
Mann


text:
Q: how to store html code in mysql? I want to store some html codes in mysql database , I did not  do this ever before , what is the correct way to store html in db?
$html_code='

hello world

';

// database table
part_name | html_code
hello | ??

A: My recommend is use htmlpurifier to do it for you , sanitize input and remove all malicious code
otherwise you have to write a function like remove_special_chars($string) for removing special chars like < > " and replacing them with something like <,>,"... and save to your db.
And after reading data from db use a function like add_special_chars($string) for vice versa action to show the content. which are not easy and still non reliable


text:
College of Liberal Arts and Sciences | English
We Want Our Bodies Back!
February 25, 2020 | 12:30 p.m. - 2:00 p.m.
Location: Undergraduate Library, David Adamany Bernath Auditorium | Map
5155 Gullen Mall
Calendars: Main Events Calendar, Get Involved, Gender, Sexuality and Women's Studies, English, College of Liberal Arts and Sciences, Black History Month, African American Studies
Join us as we welcome internationally renowned poet, playwright, performance artist and producer jessica Care moore to the WSU campus. She will present on the topic "We Want Our Bodies Back!"
moore is a Detroit native and the CEO of Moore Black Press, Executive Producer of Black WOMEN Rock!, and founder of the Jess Care Moore Foundation. Some of her publications include The Words Don't Fit in My Mouth, The Alphabet Verses The Ghetto, God is Not an American, Sunlight Through Bullet Holes, and Love is Not The Enemy.
https://jessicacaremoore.com/
For more information about this event, please contact Douglass at Davis or ap3621@wayne.edu.
85086 english


So after watching two episodes of Fist of the North Star and a peanut butter twix; I decided to shave the beard I grew while watching the manliest anime and make some Cookies.
First of, when you've got all of your ingredients and utensils out, smack that oven on for 190C. Then you can start with the dough/mix. Get your flour and give it a cheeky sieving into the bowl; making sure all, or at least most of it, gets into your bowl or giant cup or bath tub. It all depends on how big/how many you're making or what you have at hand when you make these.
Measure your sugar out, sugar. And, honestly, chuck it right on in there. Right on top of that flour, flour…what? Anyway…NEXT STEP!
Butter should be at room temperature…it just makes it easier. Get that 100G and cube it; for no other reason other than it makes the whole process easier, which is what you if you just want to make biscuits. Chuck it in with the flour and sugar; have to mix it together so it almost resembles bread crumbs (If the bread was quadruple the size of the average loaf (this may be exaggerated)). Wondering now if I could have used a potato masher, what do you guys think?
Once all that is done. Crack an egg into whatever you can crack an egg into. Beat it up nice and lightly and add it, a bit at a time, to mix the mega crumbs together into a stiff-ish dough. You want to be adding enough egg into the mix to that it actually combines (that's why it says '1-2 eggs' just in case 1 isn't enough).
You can do whatever you want with the doughy mix after that, but, would be advisable to start shaping them. To make some dough balls, you should get your hand a little moist and pass them about between the palms of your hands. Them, once they're ball shaped get them on the tray and press them down into something along the lines of a disc. Your ball discs don't have to be perfect, but if you want them perfect; get a cookie cutter ring, put the ball in the middle and press on it till it forms the same shape as the cutter.
Once you do get them into disc-like-balls; get your thumb or end of the wooded spoon you didn't see till things were already mixed together and give your discs a little indent in the middle. When you've finished your indenting it's time to bring out the jam. Get which ever sized spoon you want, (depends on the size, I guess), and spoon in some of your jam into the middle of the biscuit/cookies. After that, apologize to your oven, explain that you didn't forget about him/her/Mildred, get the tray with the biscuit/cookies on and slide them in for about 15-25 minutes.
Once they're done and the jam has stopped bubbling, take them off the tray and ever so gently place them on a wire rack to cool. Once they've cooled, you can them eat them all…or share them around; that works too.
Hope you enjoyed my little recipe thing (which is strange, considering this started as a review site (which it still is)). I will cook again sometime soon and the recipe will go up for people who actually read my Blog or the people who just want to dabble in deliciousness. Like, Comment, Follow. and I shall see you next time. Byee Byee :D.


text:
Study protocol
Effectiveness of an intervention designed to optimize statins use: a primary prevention randomized clinical trial
Mireia Fàbregas1,2,
Irene Berges3,
Francesc Fina4,
Eduardo Hermosilla2,
Ermengol Coma4,
Leonardo Méndez4,
Manuel Medina4,
Sebastià Calero5,
Elena Serrano6,
Rosa Morros2,7,
Mònica Monteagudo2,7 &
Bonaventura Bolíbar2,7
Although hypercholesterolemia is considered a cardiovascular risk factor, in isolation it is not necessarily sufficient cause for a cardiovascular event. To improve event prediction, cardiovascular risk calculators have been developed; the REGICOR calculator has been validated for use in our population. The objective of this project is to develop an intervention with general practitioners (GPs) and evaluate its impact on prescription adequacy of cholesterol-lowering drugs in primary prevention of cardiovascular disease and in controlling the costs associated with this disease.
This nonblinded, cluster-randomized clinical trial analyzes data from primary care electronic medical records (ECAP) and other databases. Inclusion criteria are patients aged 35 to 74 years with no known cardiovascular disease and a new prescription for cholesterol-lowering drugs during the 2-year study period. Dependent variables include the following: RETIRA, defined as new cholesterol-lowering drugs initiated during the year preceding the intervention, considered inadequate, and withdrawn during the study period; EVITA, defined as new cholesterol-lowering drugs initiated during the study period and considered inadequate; COST, defined as the total cost of inadequate new treatments prescribed; and REGISTER, defined as the recording of cardiovascular risk factors. Independent variables include the GP's quality-of-care indicators and randomly assigned study group (intervention vs control), patient demographics, and clinical variables. Aggregated descriptive analysis will be done at the GP level and multilevel analysis will be performed to estimate the intervention effect, adjusted for individual and GP variables.
The study objective is to generate evidence about the effectiveness of implementing feedback information programs directed to GPs in the context of Primary Care. The goal is to improve the prescription adequacy of lipid-lowering therapies for primary prevention.
Trial registration
ClinicalTrials.gov Identifier: NCT01997671. November 28, 2013.
Primary care medicine has included a focus on prevention for decades, but the possible side effects of preventive treatments were unknown or underemphasized. More recently, these possible risks have taken on greater importance in clinical practice [1, 2], making the population aware of the potential harms associated with prevention efforts.
Hypercholesterolemia as a risk factor
The treatment of hypercholesterolemia, a risk factor for cardiovascular disease, is a well-established preventive action; its association with increased incidence of ischemic heart disease has been described together with smoking, hypertension, and diabetes as cardiovascular risk factors (CVRF). In the Seven Country Study [3], total cholesterol of 200 mg/dl was associated with a cardiovascular mortality rate of 15% in the northern countries of Europe, compared to 3% in the south (results adjusted for age and other CVRF). This implies that, in isolation, the role of hypercholesterolemia in the incidence of cardiovascular events is neither essential (cardiovascular events occur in the absence of hypercholesterolemia) nor sufficient (most patients with high cholesterol do not have cardiovascular events) [4].
For this reason, the various models of cardiovascular risk calculation incorporate the presence of other risk factors and are not based exclusively on hypercholesterolemia [5]. Therefore, the calculation of cardiovascular risk is a tool for classifying patients according to their risk and contributes to decisions on hypercholesterolemia treatment, focusing on decreasing the incidence and mortality rates associated with cardiovascular disease rather than the potential benefits of intermediate outcomes such as lower levels of low-density lipoproteins (LDL) and total cholesterol [6].
Repercussions of inadequate use of cholesterol-lowering drugs in primary prevention
Pharmacological treatment of hypercholesterolemia is indicated in two different groups of patients: those with and without cardiovascular disease (primary and secondary prevention, respectively). At present, there is no question about the indications and benefits of this therapy in secondary prevention [7]. Achieving cholesterol reduction objectives is usually included in evaluations of clinical management. In our context, indicators of LDL cholesterol control in patients with cerebrovascular disease and ischemic heart disease are available dating back to 2007, when the electronic medical records system was implemented. Data include monthly monitoring and feedback and asynchronous reminders to all primary care centers (PCC) within the Catalan Institute of Health (ICS: Institut Català de Salut) system. Since January 2009, secondary prevention results (adequate LDL control) have improved 21.87% for cerebrovascular disease and 15.97% for ischemic heart disease.
In primary prevention, on the other hand, drug therapies continue to be debated for two main reasons. First, no benefit has been demonstrated in women, elderly, and low-risk patients [8]. Second, differences between the criteria established in various guidelines and consensus documents result in a variable clinical impact with respect to the number of patients for whom treatment is indicated [9]. In contrast to secondary prevention, clinical assessments in primary prevention do not include a monitoring of treatment adequacy, despite the possible "medicalizing" impact associated with assigning a label and treatment and the potential consequences for the patient's quality of life.
It is also unclear whether primary prevention drains resources that could be directed to other clinical areas. The increased prescription of cholesterol-lowering drugs in national health systems [10] has had a major impact on pharmaceutical expenditures; the greatest cost is for statins, as a group. Few studies have analyzed the distribution of this increased cost [11–13], but inadequate prescription of cholesterol-lowering drugs has been reported both as underutilization in high-risk patients and overutilization in low-risk patients [14].
Improvement in prescription adequacy requires that we address multiple factors, because this does not depend exclusively on improved adherence to clinical recommendations [15]. Of the factors to be considered, we would highlight two: the general practitioner (GP) faces challenges in interpreting results and recommendations from trials with methodological biases and marginal population-level benefit [8], and the influence of the pharmaceutical and food products industries is evident in the presentation of clinical trial results that emphasizes relative risk [16], with messages about the need to measure cholesterol levels and lower them with drug therapies that can prevent premature death in the healthy general population [17, 18].
Interventions to improve prescription adequacy
Several different types of intervention studies have been conducted in an effort to improve prescription adequacy in clinical practice. These can be grouped into three major types of intervention: 1) feedback or audits [19], in which information about clinical practice is a posteriori; 2) alerts or reminders [20], which suggest an action such as preventive care at the time of the patient visit or a priori; and 3) clinical decision support systems (CDSS) [21], which are more complex systems that guide practitioners and provide recommendations on clinical decisions to be made, based on information added to the clinical record.
In a 2010 review of literature on interventions designed to improve clinical practice, Cochrane concluded that feedback leads to slight or moderate improvement [20]. A recent clinical trial, better adapted to the characteristics of our environment [22], demonstrates major variations in carrying out preventive activities such as vaccinations, comparing usual practice with message alerts and alerts plus feedback. The progressive computerization of our primary care system creates a unique opportunity to develop interventions: the electronic medical records system is fully implemented in all health centers administered by the ICS and information systems are available that support the use of quality indicators and provide feedback to health care professionals –with or without economic incentives. Although these may have a moderate impact, their low cost and the possibility of adapting them to provide personalized information, whether in real time or asynchronously, offer enormous intervention potential.
For all these reasons, given the concerns generated by current statins prescription as a primary prevention strategy and the opportunity offered by information systems based on electronic medical records, this clinical trial is designed to evaluate the effectiveness of an intervention intended to improve the pharmacological approach to hypercholesterolemia in primary prevention.
Research hypotheses
Inadequate prescription of cholesterol-lowering drugs in patients with no history of cardiovascular disease may have negative repercussions for the patient as well as for the health care system.
Implementation of an intervention designed for GPs in primary care and based on informational feedback concerning the adequacy of prescribed cholesterol-lowering drugs could strengthen their competency, their adherence to clinical practice guidelines (CPG), and overall efforts to contain health care costs.
To evaluate the effectiveness of an intervention directed to primary care GPs, based on providing informational feedback about the adequacy of using cholesterol-lowering drugs in primary prevention, and designed to improve prescription practices according to the recommendations in clinical practice guidelines and to reduce health care costs, compared to current practice.
Secondary objectives
To describe demographic and clinical characteristics of patients receiving new prescriptions for cholesterol-lowering drugs.
To determine the degree of adequate prescription of cholesterol-lowering drugs in patients treated for primary prevention (i.e., without previous history of cardiovascular disease).
To identify the factors associated with adequate prescription of cholesterol-lowering drugs in primary prevention.
To analyze the degree to which cardiovascular risk is recorded in electronic medical records after the intervention.
To determine the economic impact of the cholesterol-lowering drugs prescribed for primary prevention during the study period.
The design is a multicenter, controlled, cluster-randomized, nonblinded clinical trial to evaluate the effectiveness of an intervention related to the prescription of cholesterol-lowering drugs in primary prevention, compared to usual clinical practice.
All individuals attended in 283 primary care center (PCC) managed by the ICS, which cover a population of 5.8 million urban, semi-urban, and rural residents of Catalonia.
Twelve PCC are excluded because their current participation in a different intervention could invalidate the results of this study. The research team will identify all patients aged 35 to 74 years who received a new prescription for cholesterol-lowering drugs from the remaining 271 PCC during the study period (October 1, 2011-September 30, 2013), as recorded in the electronic medical records system, known as ECAP. Exclusion criteria are any history of cardiovascular disease (ischemic heart disease, cerebrovascular accident, or peripheral artery disease) recorded in ECAP and patients for whom pharmacy records showed receipt of a cholesterol-lowering prescription drug during the 12 months preceding their inclusion in the study.
The unit of randomization is the PCC. This avoids a possible contamination effect if different health professionals from the same PCC were randomized to different study groups. Cluster randomization will be done by random-sized blocs of PCCs (i.e., 2,4,6,8,10), stratified in quartiles by a synthetic PCC quality care indicator, "EQA" [23]. This method will ensure that each study group has the same number of PCCs and GPs and that there is a balanced distribution of the EQA covariate between the two groups [24, 25].
Due to the nature of the intervention, GPs in the intervention group cannot be blinded to their group assignment. However, the researcher responsible for data analysis will be blinded to study group assignments.
Intervention design
Based on the list of patients with inclusion and exclusion criteria, the research team will analyze the adequacy of new prescriptions for cholesterol-lowering drugs, based on the recommendations contained in ICS clinical practice guidelines on cholesterol and coronary risk [26]. The flow chart for this analysis is included as Additional file 1.
All GPs assigned to the intervention group will receive informational feedback about the adequacy of cholesterol-lowering drugs prescribed for their patients. Feedback is provided as part of the ECAP system capabilities. The preparation and dissemination of intervention-related feedback will be monthly, beginning in the second year of the study (October 1, 2012-September 30, 2013). This information, available to the GPs at their convenience, will be presented in two distinct and complementary formats and updated throughout 12 consecutive months:
Asynchronous information (patient not present)
a) Quantitative information about the percentage of the GP's assigned patients who have started primary cardiovascular prevention therapy with cholesterol-lowering drugs and that is considered correctly indicated according to the criteria established in the corresponding ICS clinical practice guidelines [26].
b) List of names of patients who have started primary cardiovascular prevention therapy with cholesterol-lowering drugs but do not meet the guidelines criteria.
Real-time information (patient present when information is presented to GP).
In each GP's daily schedule, an alert symbol will indicate appointments with patients who have started statins therapy for primary cardiovascular prevention without meeting the established indications criteria. In addition, a message will be included in the ECAP system of clinical advisories. This screen, used during the patient visit, shows all active clinical advisories and alerts for that specific patient. This may include EQA information, medication safety considerations, notice of availability of test results, etc.
The GPs assigned to the control group will not receive the project's ECAP feedback. The study algorithm is diagrammed in Additional file 2.
The research team will carry out the analysis of prescription adequacy. Implementation of ECAP feedback will be the responsibility of the SISAP team (Sistema de Informació dels Serveis d'Atenció Primària), the ICS unit that provides clinical practice information to ICS primary care professionals and administrators [26].
A pilot study was conducted with GPs selected from two primary care centers. This study ensured that data extraction and information alerts worked correctly. Data for these GPs will be excluded from the final results.
New treatment with cholesterol-lowering drugs is defined as a prescription given to a patient who has not collected any such prescription from a pharmacy during the 12 months preceding study inclusion, according to national health system records.
Primary prevention is considered the absence of cardiovascular disease (ischemic heart disease, cerebrovascular accident, peripheral artery disease).
The ICS clinical practice guidelines on cholesterol and coronary risk are applied to determine prescription adequacy when cholesterol-lowering drugs are prescribed for primary prevention [26]. To operationalize the algorithm, adequate treatment is defined as meeting one or both of the following criteria:
At least 10% cardiovascular risk, according to REGICOR 10-year risk calculated within 12 months of treatment initiation. The REGICOR risk function has been calibrated and adapted to local incidence and distribution of risk factors in Catalonia [27]. It stratifies cardiovascular risk into 4 classifications: low (<5%), moderate (5%–9.9%), high (10%-14.9%), and very high (>15%). The ICS clinical practice guidelines recommend the use of REGICOR tables to calculate coronary risk and consider individuals with at least 10% risk of a 10-year coronary event to be candidates for more intensive interventions, which may include cholesterol-lowering drugs. Additional file 3 contains the REGICOR risk tables, adapted from the Framingham risk calculation.
At least 240 mg/dl LDL cholesterol recorded during the 12 months preceding treatment initiation.
Primary outcomes
The primary study variable is improved prescription adequacy in the use of cholesterol-lowering drugs for primary prevention of cardiovascular disease according to the recommendations of ICS clinical practice guidelines, comparing the intervention group to usual clinical practice.
Two dependent variables will be analyzed to address the primary objective:
RETIRA, defined as new cholesterol-lowering drugs initiated during the year preceding the intervention, considered inadequate, and no longer prescribed after the GP receives feedback information. This variable is directly affected by the intervention because patient records included in the calculation of this variable will be precisely those that triggered the intervention feedback.
EVITA, defined as new cholesterol-lowering drugs initiated during the 12 months follow-up period and considered inadequate.
Improved prescription adequacy is defined as an increase in the RETIRA variable and decrease in the EVITA variable.
Secondary outcomes
To assess the recording of cardiovascular risk in electronic medical records, the REGISTER variable will be calculated: number of patients with no history of cardiovascular disease (primary prevention) treated with statins without having any record of a cardiovascular risk calculation.
To assess the economic impact of prescriptions, the COST variable will be calculated: the total cost of all prescriptions for new cholesterol-lowering drugs in primary prevention reimbursed by the national health system that are considered inadequate during the study period.
The intervention is designed to produce an increase in the REGISTER variable and a decrease in the COST variable.
Other variables
The primary independent variable is the GP's assigned study group (intervention or control group).
Patient variables: age, sex, new statin prescription picked up from a pharmacy, cardiovascular risk (calculated using the REGICOR formula and recorded in ECAP), cholesterol (total, LDL and HDL), systolic and diastolic blood pressure, smoking habit, treatment group from the catalog of statins (Anatomic, Therapeutic, Chemical [ATC] code), and diagnosed cardiovascular disease, diabetes mellitus, or hypertension, according to International Classification of Diseases (ICD-10 codes), listed below:
Myocardial infarction: I21 and subtypes, I22 and subtypes, I23 and subtypes, I25.2
Ictus: I60 and subtypes, I62 and subtypes, I63 and subtypes I64
Peripheral artery disease: I73, I73.8, I73.9
Tobacco use: F17 and subtypes F17.1 – F17.9
Diabetes Mellitus: E11 and subtypes, E12 and subtypes, E13 and subtypes, E14 and subtypes
Arterial hypertension: I10, I15, I15.1, I15.2, I15.8, I15.9.
General practitioner variables
EQR: SIDIAP has developed this synthetic index showing the quality standard of each GP's data recording in the ECAP system.
EQPF: This ICS synthetic indicator reflects the quality (adequacy) of drug prescription for each GP.
EQA: This ICS synthetic indicator reflects the overall quality of care provided by each GP, based on established ICS standards.
Use of the intervention: SISAP provides a monthly summary of the number of time each GP accesses the information provided in ECAP.
Teaching responsibilities: This variable reflects whether or not the GP works with a resident physician.
The patient and GP variables analyzed also allow a description of the use of cholesterol-lowering drugs for primary prevention and the associated factors that are relevant to the secondary objectives.
Data collection and follow-up
Most of the study variables will be obtained from the population-based SIDIAP database (Sistema d'Informació pel Desenvolupament d'Investigació en Atenció Primària) [28], which is similar to other European databases such as Clinical Practice Research Database (CPRD), Quality database for ethical research (QRESEARCH), Out-Patient Pharmacy Database (PHARMO), or The Health Improvement Network (THIN). The SIDIAP database contains anonymized data from 5.8 million individual patients in the ICS electronic medical records system and from complementary sources that provide valid, reliable information for research about primary care. This database is representative of Catalonia as a whole (http://www.sidiap.org) and includes the following information:
ECAP data on sociodemographic variables, primary care visits, diagnoses (ICD-10 codes), clinical variables, prescriptions, immunizations, and background. ECAP implementation began in 1998 and has been used in routine practice since 2005 in all PCC managed by ICS.
Pharmacy records:
Pharmacy records: Information on medication dispensed in community pharmacies since 2005, including the associated cost.
Laboratory tests: Results are available for all tests since 2006.
Finally, to complete the identification of patients with a history of cardiovascular disease, hospital discharge data are available for all public hospitals in Catalonia (Minimum Basic DataSet).
The preliminary study conducted by the research team showed the availability of a sample size of approximately 60,000 new statin treatments prescribed each year. Assuming 90% strength, 5% alpha error, a 1:1 ratio of control to intervention participants, corrected by the cluster design and assuming 10% loss to follow-up, our study could detect a difference of 1% (according to the medical criteria applied by the experts on the research team) at a 90% confidence interval. Even with this strength level, a clinically relevant difference of 10% can be established.
Initially, descriptive analysis will be completed for all study variables: mean (standard deviation) for continuous variables with a normal distribution, median (interquartile ranges) in the case of non-normal distribution and the frequency (percentage) of categorical variables. Differences between the intervention and control groups will be assessed using the χ2 or Fisher exact test for categorical variables and Student t for continuous variables with normal distribution, or nonparametric Mann–Whitney U test, as appropriate. Differences between means, medians, or ratios at the beginning and end of the two-year follow-up period (pre- and post-intervention) will be compared using the McNemar test, Student t for paired tests, or Wilcoxon test, as appropriate.
The percent change with respect to baseline value is used as a measure of the pre- and post-intervention change in categorical variables, calculated as the final percentage minus the initial percentage × 100.
The intervention effect after one year of follow-up will be evaluated using the decrease in the EVITA variable and increase in the RETIRA variable. To assess the effect of the intervention model, a multilevel logistic regression analysis will be performed, considering intervention vs control group as the independent variable. The analysis will be adjusted for potential predictive independent variables and, for those considered clinically relevant, for baseline values.
To determine the economic impact of new prescriptions of cholesterol-lowering drugs in primary prevention prescribed during the study period, a descriptive analysis of costs and resource use will be completed for each study group and the groups will be compared (discount rate: 3%). The incremental cost-effectiveness ratio will be calculated as the difference between the cost average for the 2 study groups, divided by the difference between the effects for both groups. Acceptance curves will be calculated to determine the cost-effectiveness of the intervention compared to usual practice.
Significance will be established at the 5% level. All analysis will be done using Stata/SE, version 10.1 (StataCorp).
The study will follow the national and international norms defined in the Declarations of Helsinki and Tokyo, as well as the recommendations of the Clinical Research Ethics Committee (CEIC) of our research institute, the Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol. Confidentiality of personal data is guaranteed for all participants in accordance with Spanish Law (LOPD: Ley Orgánica de Protección de Datos de Carácter Personal 15/1999, 13 December).
The data included in the SIDIAP database are anonymized and identified only by an internal code, created when the record is created; personal identification of patients by the research team is impossible. All PCC will be informed about the study outcomes.
To further guarantee confidentiality, SIDIAP has a protocol for linking records with external databases such as the CMBD-AH, and information provided by SISAP does not contain patient-identifying data. The procedure used consistently by SISAP is that anonymized codes are assigned, which the ECAP system decodes when information is provided to professionals responsible for that patient's care.
The results of this trial will provide new evidence of the effectiveness of an intervention based on clinical advice and feedback to primary care professionals via electronic medical records information. Extensive computerization of PCC records allows the creation of mechanisms and instruments to help the professional improve his or her approach to particular health problems and adherence to current clinical practice guidelines.
There are major problems with pharmacological treatment for the primary prevention of hypercholesterolemia, including a high percentage of patients being treated inappropriately under established guidelines. It is a priority to address these problems within PCCs, in order to avoid negative consequences for patients as well as for the health care system.
This trial will be conducted in a broad population of more than 5 million patients, which results in sufficient strength to obtain significant results. In addition, evaluation of the intervention will be based on an information system that has been widely studied and validated, the SIDIAP.
In any case, the study has several limitations, which we have attempted to address. One assumes that all databases (such as SIDIAP) have a certain level of underreporting on variables of interest, although this should not differ between the two randomized study groups. In our case, data recording in the electronic medical records should be reliable: most of the study variables form part of the quality indicators that are incentivized by the ICS payment systems. In addition, one of the study variables, EQR, is the level of professional quality, which allows a sub-analysis of the quality of the services provided. To avoid the loss of recorded diagnoses, any diagnosis of cardiovascular disease recorded in the electronic medical record will be complemented with hospital discharge diagnostic data. With respect to the treatment variables, the records are reliable because the data are taken from the pharmacies' invoicing system for national health system reimbursement for the prescriptions they filled for patients.
The fact that the groups are not blinded is a limitation of the intervention, and the possibility of contamination between groups could limit the study conclusions. Nonetheless, we attempt to evaluate the effectiveness of an intervention in a real-life context linked to normal clinical practice, where this type of situation is quite frequent. Randomization by PCC rather than by individual GP reduces the probability of contamination between the study groups.
In conclusion, this study contributes new knowledge about interventions that can improve the prescription of cholesterol-lowering drugs by following the recommendations in clinical practice guidelines, and can help to reduce health care costs. We consider this study very valuable for informing health care professionals about changes that can be made, based on the information received in PCC.
The study provides an idea of usual clinical practice by primary care professionals related to the adequacy of cholesterol-lowering drug prescriptions for primary prevention. At the same time, it allows us to evaluate possible changes that could occur naturally after an intervention related to the proper prescription of cholesterol-lowering drugs. This study could have special relevance because of the enormous potential offered by the low cost of the intervention and the possibility of adapting the electronic medical records system to provide personalized information, whether in real time or asynchronously.
CDSS:
Clinical Decision Support System
CEIC:
CMBD-AH:
Minimum Basic Dataset of Admissions to Hospital
CPRD:
Clinical Practice Research Database
CVRF:
Cardiovascular risk factor
ECAP:
Electronic health record system of the Institut Català de la Salut in primary care, estació Clínica d'Atenció Primària
EQA:
Quality Care Indicator
EQPF:
Prescription Quality Indicator
EQR:
Quality of data recording
GP:
HDL:
High-density lipids
ICD:
International Classification of Diseases
ICS:
Institut Català de la Salut
IDIAP:
Institut Universitari d'Investigació en Atenció Primària
LDL:
Low-density lipids
PCC:
PHARMO:
Out-Patient Pharmacy Database
QRESEARCH:
Quality database for ethical research
REGICOR:
Registre Gironí del Cor
SIDIAP:
Information system for research on primary care: Sistema de Informació pel Desenvolupament d'Investigació en Atenció Primària
SISAP:
Primary care database: Sistema d'Informació dels Serveis d'Atenció Primària
THIN:
The Health Improvement Network.
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Verschuren WMM, Jacobs DR, Bloemberg BPM, Kromhout D, Menotti A, Aravanis C, Blackburn H, Buzina R, Dontas AS, Fidanza F, Karvonen MJ, Nedelijković S, Nissinen A, Toshima H: Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA. 1995, 274: 131-136.
Gil M, Martí H, Elosua R, Grau M, Sala J, Masiá R, Pérez G, Roset P, Bielsa O, Vila J, Marrugat J: Análisis de la tendencia en la letalidad, incidencia y mortalidad por infarto de miocardio en Girona entre 1990 y 1999. Rev Esp Cardiol. 2007, 60: 349-356.
Comín E, Solanas P, Cabezas C, Subirana I, Ramos R, Gené-Badía J, Cordón F, Grau M, Cabré-Vila JJ, Marrugat J: Rendimiento de la estimación del riesgo cardiovascular en España mediante la utilización de distintas funciones. Rev Esp Cardiol. 2007, 60: 693-702.
Grundy SM: Promise of low-density lipoprotein-lowering therapy for primary and secondary prevention. Circulation. 2008, 117: 569-573.
Law MR, Wald NJ, Rudnicka AR: Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003, 326: 1407-1408.
Do statins have a role in primary prevention? An update. Therapeutics. Letter Issue 77/ Mar - Apr 2010. Disponibe en: http://ti.ubc.ca/letter77
Miguel F, Merino A, Montero MJ: La prevención según el CEIP para la prevención cardiovascular: una valoración crítica. Rev Esp Salud Pública. 2010, 84 (2): 104-107.
Walley T, Folino-Gallo P, Stephens P, Van Ganse E: Trends in prescribing and utilization of statins and other lípid lowering drug across Europe 1997–2003. Br J Clin Pharmacol. 2005, 59 (5): 564-573.
Peiró S, Sanfelix Gimeno G, Ridao López M, Cervera CP: Revisión sistemática de evaluaciones económicas de las estatinas comercializadas en España. 2005, Valencia: Fundación Instituto de Investigación en Servicios de Salud
Brody H, Light DW: The inverse benefit law: how drug marketing undermines patient safety and public health. Am J Public Health. 2011, 101 (3): 399-404.
Hayward RA, Krumholz HM, Zulman DM, Timbie JW, Vijan S: Optimizing statin treatment for primary prevention of coronary artery disease. Ann Intern Med. 2010, 152: 69-77.
Baena-Díez JM, Félix FJ, Grau M, Cabrera de León A, Sanz H, Leal M, Elosua R, Rodríguez-Pérez Mdel C, Guembe MJ, Torán P, Vega-Alonso T, Ortiz H, Pérez-Castán JF, Frontera-Juan G, Lapetra J, Tormo MJ, Segura A, Fernández-Bergés D, Marrugat J, DARIOS: Risk factor treatment and control in relation to coronary disease risk in the Spanish population of the DARIOS Study. Rev Esp Cardiol. 2011, 64 (9): 766-773.
Smith MA, Cox E, Bartell JM: Overprescribing in lipid lowering agents. Quality and Safety in H. Care. 2006, 15: 251-257.
Brugts JJ, Yetgin T, Hoeks SE, Gotto AM, Shepherd J, Westendorp RG, de Craen AJ, Knopp RH, Nakamura H, Ridker P, van Domburg R, Deckers JW: The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ. 2009, 338: b2376-
Mintzes B: Disease mongering in drug promotion: Do governments have a regulatory role?. PLoS Med. 2006, 3 (4): e198-
Hooper L, Thompson RL, Harrison RA, Summerbell CD, Ness AR, Moore HJ, Worthington HV, Durrington PN, Higgins JP, Capps NE, Riemersma RA, Ebrahim SB, Davey Smith G: Risks and benefits of omega3 fats for mortality, cardiovascular disease and cancer: a systematic review. BMJ. 2006, 332: 752-755.
Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD: Audit and Feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006, 2, CD000259
Shojania KG, Jennings A, Mayhew A, Ramsay C, Eccles M, Grimshaw J: Effect of point-of-care computer reminders on physician behaviour: a systematic review. CMAJ. 2010, 182 (5): E216-E225.
Kawamoto K, Houlihan CA, Balas EA, Lobach DF: Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005, 330 (7494): 765-
Loo TS, Davis RB, Lipsitz LA, Irish J, Bates CK, Agarwal K, Markson L, Hamel MB: Electronic medical record reminders and panel management to improve primary care of elderly patients. Arch Intern Med. 2011, 171 (17): 1552-1558.
Iglesias Pérez B, Cortés Pérez P, Fina Avilés F, Méndez Boo L, Ferran Mercadé M, Medina Peralta M, Serrano Carro B, Casajuana Brunet J, Calero Muñoz S, Morros Pedrós R, Amat Camats G: Indicador sintètic de qualitat assistencial (EQA) dels equips d'atenció primària 2008 [En línea] Barcelona: Institut Català de la Salut. 2008, Disponible en: http://www.gencat.net/ics/professionals/pdf/EQA_2008.pdf
García-Gil Mdel M, Hermosilla E, Prieto-Alhambra D, Fina F, Rosell M, Ramos R, Rodriguez J, Williams T, Van Staa T, Bolíbar B: Construction and validation of ascoring system for the selection of high-quality data in a Spanish populationprimary care database (SIDIAP). Inform Prim Care. 2011, 19 (3): 135-145.
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Bolíbar B, Fina F, Morros R, Garcia-Gil M, Hermosilla E, Ramos R, Rosell M, Rodriguez J, Medina M, Calero S, Prieto-Alhambra D: SIDIAP database: electronic clinical records in Primary Care as a source of information for epidemiologic research. Med Clin. 2012, 138 (14): 617-621.
To Joan Camús and Albert Mercadé for technology expertise without which this study would not have been possible.
To the Institut Català de la Salut and all of its professional staff for the support provided to carry out this study.
To Elaine Lilly for assistance with manuscript preparation and English language revision.
This work was made possible by competitively awarded grants in support of independent clinical research from Spain's Ministry of Health, Social Services, and Equality (EC11-342).
ABS La Marina, SAP Esquerra, Institut Català de la Salut, Barcelona, Spain
Mireia Fàbregas
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
Mireia Fàbregas, Eduardo Hermosilla, Rosa Morros, Mònica Monteagudo & Bonaventura Bolíbar
Hospital Parc Taulí, Sabadell, Spain
Irene Berges
Sistemes d'Informació d'Atenció Primària (SISAP) – Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP), Institut Català de la Salut, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
Francesc Fina, Ermengol Coma, Leonardo Méndez & Manuel Medina
Àrea de Desenvolupament Clínic, Direcció Adjunta d'Afers Assistencials, Institut Català de la Salut, Institut Universitari d'investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
Sebastià Calero
Centre d'Atenció Primària Baix a Mar, Consell comarcal del Garraf, Vilanova i la Geltrú, Barcelona, Spain
Elena Serrano
Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
Rosa Morros, Mònica Monteagudo & Bonaventura Bolíbar
Francesc Fina
Eduardo Hermosilla
Ermengol Coma
Leonardo Méndez
Manuel Medina
Rosa Morros
Mònica Monteagudo
Bonaventura Bolíbar
Correspondence to Bonaventura Bolíbar.
This manuscript contains no information on medical devices. The authors neither received, nor will receive, individual financing of their work. The authors declare that there are no competing interests.
BB is the principal investigator and coordinator of the project. The study was designed by BB, MF, IN, and FF. These authors, with the help of EH, MM, SC, RM and ES, designed the intervention. EH, FF, RM were responsible for database creation and management. The intervention was implemented by FF, EH, EC, LM, SC and MM. EH performed the statistical analyses. All the authors have read and revised the various versions of the manuscript and have approved this final version.
Catalan Institute of Health Clinical Guidelines for Primary Prevention of Cardiovascular Disease
Additional file 1: [26].(DOCX 210 KB)
Additional file 2: Study algorithm.(DOCX 35 KB)
12875_2014_1108_MOESM3_ESM.docx
Additional file 3: Framingham-REGICOR adapted risk charts, simplified into four risk categories based on event concentration data and the 10-year risk cutoff values proposed by experts from various autonomous communities in Spain.(DOCX 650 KB)
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Fàbregas, M., Berges, I., Fina, F. et al. Effectiveness of an intervention designed to optimize statins use: a primary prevention randomized clinical trial. BMC Fam Pract 15, 135 (2014). https://doi.org/10.1186/1471-2296-15-135
Lipid-lowering therapy
Prescription adequacy


Revival a Go-Go Loves Vintage Dresses!
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The Respect Demand, Or, How To Refute Yourself Without Realizing It For The Sake of Appearing Non-Partisan
by Kaiter Enless July 2, 2017 July 2, 2017
Consider this most common of political responses.
"I don't agree with your argument, but I respect your opinion."
Scarcely has there been a more popular and simultaneously ridiculous statement made in the whole history of modern American discourse than this one. Yet, it is one that you, whoever and wherever you are, have doubtless heard a thousand times over. It is a tempering tactic utilized primarily by political Centrists (or those who are aping as such), and may also be heard a great deal by the acolytes of individuals who proclaim themselves to be "Freethinkers," or, "Rationalists" (which usually do not use the word to denote the philosophical school). But it is wholly wrongheaded, given some contingencies, for if the opinion which one respects is inexorably tied to the argument that one disagrees with, and one does not respect the argument then by parsimony, one cannot, also, respect the opinion. If, however, the opinion is suitably disconnected from the aforementioned argument than the equation swiftly changes.
That is to say, if A [the argument] is not equal [congruent] to R [your respect/admiration] but IS equal to O [the opinion informing A] and A = O then so R MUST also = A. And yet it fundamentally cannot because, though A = O, R cannot equal A, and thus one reaches a inescapable logical impasse. The equation is self-refuting.
There are also other linguistic formulations very similar to the aforementioned such as, "I respect your opinion but I disagree." This presents a slightly different problem and thus a slightly different solution but the core of the issue is still quite the same which is that in the effort to appear polite, one dons a mask of fawning adoration and pretends of the man or woman who stands in starkest opposition before him as if they were some esteemed colleague when in reality nothing of the sort could possibly be any further from the truth. If one disagree wholeheartedly with a position then one clearly has no respect for it and if that same position informs a suitably portion of the personality of the person who is holding it then that same person is also, not worthy of respect. What people mean, if they were being truly honest with themselves, is that they do not respect opinions they disagree with but rather that they respect the rights of others to have them. This too is a vexed question, for "rights" in any objective sense do not exist. All rights are merely those with the ability to crush you restraining themselves and their like cohorts from doing so. Accepting this, one should have no respect for rights, either, but rather, one should have respect for the powerful whom are cognizantly self restrained.
Uncategorizedcognizance consistency disagree disagreement distinction Freethinker honesty human inter-personal relations interaction language linguistic logic logical non-partisan parsimony partisan personal personality polemical Politics position power Rationalism Rationlist respect semantic speech thought truth


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The Unusuals
Prince Michael's Chronicles
King Ferdinand's Infidelities
20 September 2016 - 2 mins
Ferdinand I, King of the Two Sicilies, had a poor reputation. Nicknamed the Nose King, owing to his formidable nasal appendage, he was seen as an ultra-conservative, and both cruel and stupid. He wasn't properly educated by his private tutor the Duke of San Nicandro, as such he only spoke the Neapolitan dialect. He also loved to bring his hunting and fishing catches to the market of Naples and sell them himself, greatly insulting the Neapolitan people. And yet, he was not entirely stupid for having invented the Three Fs Formula, making him a rather popular king: Farine, Feste, Forche. Which means bread, feasts, and gallows for public executions.
His Prime Minister, the famous Cardinal Ruffo, was also his confessor. The Cardinal was deeply annoyed by his penitent after learning that the king had been cheating on his wife, Queen Marie-Caroline, the sister of Marie-Antoinette. Further troubling the Cardinal, the king wasn't taking grand ladies as his mistresses, but rather common girls, women who had no business being in the company of the king. The Cardinal rushed to the king's office and admonished him for the shame of his conduct, insisting that he remain faithful to Queen Caroline in the future. The king balanced one foot atop the other and shook his head, mumbling something incomprehensible, just as his descendants, the Bourbon-Two Sicilies, do today when they are embarrassed. The Cardinal, sure that his message got through to the king, then left.
Shortly afterwards, the king invited the Cardinal to spend three days hunting with him at his marvelous hunting lodge on Lake Fusaro. The Cardinal arrived in the evening and a delicious pheasant soup was prepared for him for dinner. The following morning, for breakfast, he was served roasted pheasant, which raised his eyebrows. For lunch he was given boiled pheasant. The Cardinal was shocked. He was then served grilled pheasant for dinner. The Cardinal couldn't understand. After two days of this diet of pheasant prepared with various different sauces, the Cardinal erupted before the king, "Sempre fasano Majesta", "Always pheasant, your majesty". "Sempre Carolina, Eminenza", "Always Caroline, your eminence."
by Prince Michael of Greece
3 comments on "King Ferdinand's Infidelities"
cyrill smolky
September 22nd, 2016 - 1:05pm
A very proper answer! He was quite an eccentric king, poor old Ferdi, but certainly not a stupid one!
IANKAL21
September 23rd, 2016 - 9:56am
Delicious, eminently Italian !
Jean Claude De Guire
October 10th, 2016 - 2:07am
Your Royal Highness these petit conte pour enfant sage are delightfull. They should be publish in a small book. From the bottom of my heart many thanks
Still in Italy
EVRIKLES II
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When we last left Evrikles, Emperor Augustus, whom he served well, had rewarded him the island of Kythira as recompense for his efforts, making him the prince of the island. At that time, the territory of Kythira seemed constricting to Evrikles in every sense of the word. There wasn't much of a future in Kythira…
"THERE IS ROOM FOR ONE MORE"
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I saw this story in a very old black and white film. I read it in a collection of stories published by Benson, and had read before that it in a collection of true tales, of which I cannot recall the author. It took place in England in between 1905 and 1910. A man is…
The Marchioness of Serristori didn't want to leave her Palace
30 January 2017 - 1 min
Benedetta is a grand lady and a dear friend of mine who lives in Florence. Her grandmother, the Marchioness of Serristori, was one of the most important figures in Florentine society. The Marchioness owned a splendid palace which was filled with works of art. She loved her home and devoted all her time and energy…
The Fontanelle cemetery and the skulls that grant wishes
Ciro Palladino is a taxi-driver in Naples. He also happens to be an extraordinarily erudite man. He is familiar with every historic monument in the city, every legend, every story, and every noble family. He is the most unusual guide I have ever met, and it was he who introduced me to the skulls of…
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ANNE AND SARAH
24 May 2019 - 3 mins
In the winter of 1711, France and Louis XIV felt absolutely crestfallen. Frost had annihilated the harvest; it was so cold that people were dying in the streets; the Spanish War of Succession had been dragging on for more than ten years; there was no more money, troops, resources, and no more hope. France's enemies…
THE DIWAN AND THE DANCER
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In Queen Ahilya's inner circle there was a diwan, a minister of whom she was particularly fond. His name was Boliya Sarkar Chatri. She found him so remarkable that she offered him one of her relatives, a princess from Indore, in matrimony: but the diwan was smitten with a beautiful and loving dancer. He…
MUMBAI, TAJ MAHAL PALACE HOTEL
10 July 2018 - 2 mins
The Taj Mahal Palace Hotel in Mumbai is probably one of the most famous palaces of India. It dates back to the 20th century and remains by far one of my favourite hotels of the country, and one of my favourite hotel worldwide, due to its extraordinary location by the ocean, extravagant and sumptuous architecture,…
THE BOURBONS OF BHOPAL
2 July 2018 - 3 mins
Many years ago, I stumbled upon the trail of a branch of the Bourbon dynasty, which would have settled down in Bhopal, India. It was hard to find traces, proofs, and yet the story appealed to me. I conducted long researches. If Bourbon they were, they did not belong to the official genealogical tree of…
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© Michael of Greece


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Home News Duchess of Cornwall launches Reading Room book club
Duchess of Cornwall launches Reading Room book club
Published January 4, 2021 by Mark Chandler
The Duchess of Cornwall has launched a book club-style online hub of reading recommendations and author interviews on Instagram.
Called The Duchess of Cornwall's Reading Room, it is billed as a "celebration of literature in all its forms" and a hub for literary communities around the world.
Further details of its winter season will be announced on 15th January via a dedicated Instagram account, offering book recommendations, exclusive insight from authors and "a community space for book lovers of all ages, abilities and backgrounds".
Among the books featured is Charlie Mackesy's The Boy, The Mole, The Fox and The Horse (Ebury). The author and illustrator has been interviewed by the Duchess and supplied a handwritten, illustrated note to support the project.
The project was inspired by the popularity of the reading lists she published last year over Easter and the summer, which included Restless by William Boyd (Bloomsbury), The Secret Commonwealth by Philip Pullman (David Fickling) and The Architect's Apprentice by Elif Shafak (Penguin).
The Duchess of Cornwall's Reading Room
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A kinder, gentler Academy Awards was unveiled last night at the Kodak Theatre, as host Steve Martin prodded along the 2+ hour Hollywood soiree with his mostly ho hum attempts at light banter and "politically correct" humor. Celebrating 75 years, the 2003 Academy Awards experienced its most animated -- yet controversial -- moments when filmmaker Michael Moore accepted an award for his "Bowling for Columbine"documentary while criticizing the war with Iraq and berating President Bush.
Later in the evening, "The Pianist"'s Adrian Brody sailed past favorites Daniel Day-Lewis and Jack Nicholson to win the "Actor in a Leading Role" statuette and politely offered that we "pray for peace and swift resolution" in regards to the war.
"Chicago" lead the nominations charge with 13 and walked away with 6 Oscars in all, while Martin Scorsese's "The Gangs of New York" was completely shut out in the 10 categories. Julianne Moore, nominated for her work in "The Hours" ("Actress in a Supporting Role") and Far from Heaven" ("Actress in a Leading Role"), also left empty-handed.
Following is a complete list of winners for the 75th Annual Academy Awards.