text:
Hallucinating Bob Marley: An Excerpt
By Brian McElmurry, April 25th 2014
The following is an excerpt from the novella, Rocket Man. Read the full book here.
Dylan said, "I'm going to make tuna casserole all by myself this time, and I'll ask you if I have any questions, okay?"
He asked me amounts, and I told him. He said, "Do you have this written down somewhere, or is it just in your head?"
"Oh, I know it by heart, but I do have it written down. It's my mom's recipe."
"That's awesome you can remember that." He said, "Because I can't remember shit, like my whole twenties is a blur because I was fucked up all the time. 'Cause I think the pain pills fucked up my memory, like I was aware of what was happening at the time, but because I was fucked up, like, it didn't get remembered, you know? Like all those years dealing and shit, like, I remember a lot of things, but I was popping so many pills, it was hard for me to remember what I did the day before."
"Yeah, I hear that, man. Do you remember when we went to Bob Marley Fest downtown, and Will got us in for free, and we were all walking around backstage and shit?"
"No, not at all." He asked, "Was this when I was dealing?"
"Yeah, like 2003, no 2004, when I was living in Ocean Beach with that one dude. And I was at my parents' doing my taxes. It was President's Day, I think. And you called me and left a message all down because you had two passes to go to Bob Marley Fest, but couldn't find anybody to go with, and just left the message."
He stood at the stove, raptly listening.
"And so I called you back and drove down to Long Beach. And I remember driving there with you, back in the day when you had your car, and we were smoking a blunt and it was sunny and beautiful. And we were driving on the 710 Freeway, I think, and we were like on some bridge coming into downtown, smoking the blunt and listening to that one rocking Sublime song, and I think even that 'Spaceship' song by Kanye West, just bumping it on your system. It was so fucking awesome. Does the 710 come into downtown Long Beach on like a white bridge?"
"Yeah, totally!"
"Yeah, so we got real blunted, and I remember some girls were talking to us because we kind of parked where the Long Beach Mall use to be, which they had made into a Walmart, I think, and these cute girls said something to us, but we were too stoned to realize they were drunk and hitting on us."
"Really what did they say?" He asked, adding the cheese packet to the boiling mixture.
"I can't remember, but they were drunk and real talkative and we just kind of kept walking, and then realized they had actually kind of invited us to a bar or something. We were so stoned we didn't even realize till they had gone."
"Huh, that's funny."
"And then we met Will by his car and he gave us these rainbow artists' wristbands that were large enough to be slipped off peoples' wrists, and we went inside with his passes the back way. And we're backstage walking in that big hall, and they had the food and water, and there were Rasta-looking dudes all around, but you know, I don't know what any of these guys looked like. And I remember Will was like, 'You can have water, but you needed tickets for food.' But I was stoked to have water because I'd been to two of them before, and you're smoking weed the whole time and getting totally dehydrated and waters like five dollars a bottle, so free water was awesome!"
Dylan smiled while he stirred the pot.
"So Will takes us out into the middle of the floor, right by the control booth, you know, right where the sound is the best and we smoked a blunt. And, like, right when he brought us out Julian Marley, who I think is one of Bob Marley's sons, had just started playing because Will had just been working setting everything up. And he was singing Bob Marley songs, and he sounded just like Bob Marley, and he moved just like Bob Marley, like the way he danced and sang. And he was wearing this yellow flannel like Bob Marley had in some of his live performances, and I was totally tripping like I was watching Bob Marley, and it wasn't till later that Will told me who it was." I said.
"That's awesome."
"Yeah, and then we went in the stands and smoked another blunt before we went and met Will again by this light, and smoked another blunt. Because you had rolled like five blunts, before we left, of chronic and they were big blunts too. Like, I was so fucked up, I actually thought I was watching Bob Marley on the stage. It was crazy. And then afterwards we went to Huntington Beach, some bar with Tim. But I was super burnt out from all the blunts."
"You must have." He said, turning off the burner and covering the pot.
"And, like, the next day I had like a weed hangover because I was so dehydrated because of how much weed I had smoked."
"Damn." He said, reaching into a cupboard and grabbing another pot. "I'm going to make corn too."
"Really? Do you think that will be good?"
"Yeah, the peas were awesome."
"Yeah, that's the good thing about tuna casserole. It inspires creativity." I smiled. "You like my story?"
"Yeah, that's awesome because I have no memory of that at all." He said. "It sucks like years of my life I can't remember because I was too fucked up nothing registered in the long term except, like, real major shit."
Like this excerpt? Check out the rest of Rocket Man here.
Featured image – Eddie
20 Somethings Bob Marley Culture & Art Drugs Music
The Night I Slept With A Girl For The First Time And Realized How Lonely I Truly Was
On Orange County, Date Rape Drugs, And Xanax
8 Things I Learned From Looking Like Bob Marley
100+ Inspirational Bob Marley Quotes on Peace
I Have No Idea Why, But Bob Dylan Played At My Bar Mitzvah
Your Suffering Polishes Your Soul
23 Real People Reveal The Weirdest Request They've Ever Received In Bed


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Brie Larsson As Captain Marvel, Cool Or No ?
filmizlehd50 November 9, 2018
The third row of Marvel Cinematic Universe films will end in the Avenger 4 series which will air in 2019. But before entering there, Marvel will be presenting their latest film titled Captain Marvel. The figure chosen to play the character Captain Marvel is Brie Larson.
This film became a highly anticipated film by Marvel fans. In the film that will air this will tell about the origin story of Captain Marvel. As we know, in the Avenger credit ending: Infinity Wars that aired some time ago, there was a last message from Nick Fury to Captain Marvel. This figure who is trusted will defeat Thanos who has collected the five infinite stones.
Entertainment Weekly finally released several first and exclusive photos from Captain Marvel. Brie Larson who was the main character in the film appeared on the cover of the September issue of Entertainment Weekly. Instead of being curious, just go ahead and see the latest photos!
Brie Larson does look very suitable when wearing Captain Marvel costumes. He looks like a very tough woman who will defeat Thanos! Cool isn't it?
Not only Brie Larson appeared in the latest photo, some other characters such as Ronan The Accuser and also Korath in the Guardian of the Galaxy series were also present!
Jude Law was appointed to play the role of Carol Danvers. He will play a role named Mar-Vell and is the leader of the Starforce Team. He will be the mentor of Carol Danvers (Brie Larson) before wearing the Captain Marvel costume.
In addition to information, the film Captain Marvel still tells about the origin story of Captain Marvel itself, where the character of Nick Fury will also appear at a young age. So for this episode, Captain Marvel will still not fight Thanos. Let's wait whether this film is worth watching or not.
Previous PostReview Movie : Venom 2018
Next PostFate And Fury, The Newest Korea Drama Will Aired On December

redpajama_set_name: RedPajamaCommonCrawl


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the washingmachinepodcast
yes, at long last, trivia arrives on your ipod. quality isn't as great as it could have been because the fan on my powerbook cut in midway through, but it's all a learning curve and next one should be better.
and if i followed the rss procedure correctly, you should be able to get it on itunes
download here (8.1mb - this format might only work on apple ipods))
fame at last
boy was i surprised to open my christmas issue of cycling plus and discover that thewashingmachinepost is website of the month!
'chuffed' does not begin to describe it. thank you cycling plus.
discovery channel?
a rare photograph of the assembled multitude: vc port wemyss (also known as velo club d'ardbeg) outside the well known tea/coffee and carrot cake stop, the croft kitchen in port charlotte. this after cycling three centuries before lunchtime (ok, i made the last bit up).
l to r: directeur sportif dave thomas, james from islay it, me (notice the rapha training top), and jeremy from islay birding
sunday 4 december, i made it half way to bruichladdich but turned back because of torrential rain. jeremy waited out the rain in the bus shelter at bruichladdich, then cycled to bowmore to berate me for being a fairweather cyclist (!). don't think the ds left port wemyss, and james never surfaced.
only reason for subjecting you to this excruciating minutiae is by way of introducing you to the idea of the 'mince pie ride' on sunday 18th december. the idea is to cycle somewhere (weather permitting) before returning to the croft kitchen for mince pies which ish says she will have ready and waiting. if you're on the island, with bike, feel free to join in. e-mail me for details.
oh, and i've added some pics to the velo club d'ardbeg page. click the link to the left for a peek
more stuff...now!
i'm pretty sure that i've touched on this subject before, but i don't really see why that means i can't do so again. after all, the monthlies seem to have endless mileage in lighting features every time the clocks go back.
in the early part of my cycling career (i like to think of it as a career because it makes me feel as if i might be getting somewhere), i was known as 'muddy fox', partly because some folks didn't realise that it was the name of a bike company, and also because that's the type of mountain bike that i rode. in fact that very same mountain bike still occupies space in thewashingmachinepost bike shed (glaringly overshadowed by a colnago on the workstand).
and this muddy fox used to be the recipient of many an anodised trinket, some very high quality handbuilt wheels (did i ever mention that i was into wheelbuilding?), a very early pair of rock shox (still on the bike) and, at one time, a coloured crud guard. and if you were ever, or still are, a reader of mbuk (is mint sauce still in evidence?) rarely did a month pass by without some new highly priced piece of titanium thingy being made available that would save grams from the favourite steed - never mind the fact that the same weight could be lost by me having a decent haircut, or that all would be negated by the amount of gloopy mud that adhered to the mega frame.
so there was an inherent danger that instead of being obsessed by incessant cycling, obsession fixated on all the new gizmos i could bolt on. but then, mountain biking was the 'new' thing and it's probably quite natural that manufacturers were refining the concept and making large amounts of money out of redundant products (neoprene chainstay protectors anyone?).
so, aside from having the 'been bags' almost permanently in the washing machine (can you begin to see a train of thought here?) or the tumble dryer, the thoughts turned from mud to road. after all, once you'd bought, or built your road bike, what else would there be to buy. and at one time, that was almost true. get a decent steel frame - only cannondale made aluminium - fit with campag and a decent set of wheels and you were set for life.
then titanium reared its stylish head - seatposts, saddle rails, bolt kits (i actually still have a set of titanium chainring bolts on my chorus chainset that i bought about ten years ago). of course, all this titanium was only in the interests of protection against the corrosive islay weather. surely you don't think it had anything to do with style? (if you've ever seen me cycle, any addition of style would be welcome). then of course it was necessary to replace 653 with columbus brain in the shape of a new colnago (superissimo), which had to have a titanium seatpost (the record carbon was out of stock) and eventually up to date with an all carbon c40hp.
along the way, mavic dropped the ksyrium on us, followed by just about everyone else (drool over a pair of hyperon ultras which actually cost more than i paid for the c40 frame!) then carbon took over completely. i've actually just seen a pair of tektro carbon fibre brake calipers. can it be long before campagnolo introduce the same to their record groupset?
anyway, either the upside or downside of any type of cycling (because i figure all this pervades commuting to a greater or lesser degree as well) is that buying a bike is likely to be just the beginning. clothing has also experienced a similar upgrade: it used to be enough to have a few trade tops of teams that no longer exist (claas cajastur, ariostea), a polyester look top and some ludicrous purple pearl izumi leggings. well witness some of the assos and rapha clothing reviewed in these very pixels over the last few months. even matt seaton of 'two wheels' fame in the guardian figures rapha to be a dangerous place, since he's almost spent the kids' inheritance on more than one occasion.
and it's great - no money, and look at all the stuff we can't spend it on. i really wouldn't have it any other way.
i've just got hold of a pair of assos roubaix kneewarmers to try out, now that the weather has headed into colder climes. they're black, sort of soft and fleecy inside and definitely warm (it's been very cold over here lately). in comparison to my old and knackered knee warmers, there's a very tight elastic section at the bottom to stop the leg warmers riding up, but the surprise was no elastic at the top.
this actually makes perfect sense since the top fits under the leg of your shorts. my old ones did have elastic at the top and with such well developed thighs such as mine (stop sniggering at the back), these were often uncomfortable. i like the assos version much better.
so altogether, assos have come up trumps yet again. their clothing may well be among the most expensive on the market, but it's almost certainly the best technical cycle gear money can buy. you pays your money, you takes your choice
warm for winter
those really nice people at rapha are offering winter packs with substantial discounts: the £60 winter pack consists of three pairs of merino socks (best on the planet), a pair of sportwool armwarmers, and a merino base layer. this gives a total saving of £45; the £120 Winter Pack has a classic sportwool jersey (best jersey i've ever bought) a pair of sportwool armwarmers, an epic cap, and a merino base layer. this saves £55 in total; and lastly, for the well heeled cyclist, the £300 winter pack: a softshell jacket, a merino training top (luxury), a merino base layer, an epic cap, and three pairs of merino socks (get the black ones, wear them with kneewarmers and change your name to bram de groot). this saves a whopping £140.
these offers are only available from rapha's website. click here to see.
they're also bringing out a range of clothing called 'fixed', starting with a rather super merino wool jersey for a mere £80. have a look here. according to rapha, the jersey is 'designed for the rigours of all day urban riding, the jersey is made from hard wearing pure merino wool, with a generous cut and understated style.' and no, they're not sponsoring the post - it's just ruddy good cycle stuff.


text:
require 'test_helper'

describe Iris::MQTT::Packet do

  # Runs codes before each expectation
  before do
  end

  # Runs code after each expectation
  after do
  end

  let(:byte) {144}

  describe "Message from header" do
    it "Should equal Message" do
      packet = Iris::MQTT::Packet.create_message_from_header(byte)
      message = Iris::MQTT::Message::Suback.new({})
      packet.must_be_instance_of message.class
    end

    it "Wont equal Message" do
      packet = Iris::MQTT::Packet.create_message_from_header(byte)
      message = Iris::MQTT::Message::Disconnect.new({})
      packet.wont_be_instance_of message.class
    end
  end
end

redpajama_set_name: RedPajamaGithub


text:
Q: How can I find the value of Kramers Kronig transform at infinity? I would like to apply the Kramers Kronig relations on measurements of the dispersive electromagnetic materials. But the big restriction is the upper value of the integral which is at infinity as in the equation below $$\int_{x=0}^\infty \frac{(xIm(x)-wIm(w))}{x^2-w^2}dx $$
When I solve this equation, I get undefined value of the integral at infinity which is $$\lim_{x\to \infty}\ln(x^2-w^2)$$
This part will give infinity and therefore will give an error in the measurement, so how can I overcome the upper part of the integral?

redpajama_set_name: RedPajamaStackExchange


Each year, Shoreline Amphitheater hosts a July 4th concert and fireworks show. I've attended the concert once, but the wait to exit the parking lot after a long night was a bit too much.
Instead, I showed up early at Shoreline Lake to reserve a spot. In afternoon light, I experimented with an ND filter.
At 8:18 PM, the sun finally started to set. Turning away from the lake, I could see the sun drop behind the baylands.
The four bright lights are located at the amphitheater. You get a clear view of the fireworks, but the sound from the concert does not carry this far.
Looks like a sunset, but it is not. Changing the aperture from f/16 to f/8 increases the amount of light by 4x. Increasing the shutter speed from 15.0s to 30.0s, also doubles the light. So, even though the photo below (9:30 PM) was taken later than the one above (9:06 PM), changing the aperture and shutter speed alters the character of the scene. You can even see a few stars showing up in the night sky.
Having been to the Shoreline Lake fireworks show, I knew that a 50mm lens would be about right.
I used a Nikon MC-30A cable release to adjust the shutter speed. I set the camera to manual mode and shutter to bulb. I clicked when a new firework was launched, and released as it faded. Just adjust the aperture to arrive at the correct exposure.
Some more traditional red, white and blue fireworks.
Even though you are taking photos of fireworks at night, you don't need a "fast" lens. I like the f/5.6 series of photos best. You get just enough background without all the smoke from the fireworks showing up as well.


text:
Labour market...
Labour market participation and retirement after stroke in Denmark: registry based cohort study
CCBYNC Open access
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2022-072308 (Published 03 January 2023) Cite this as: BMJ 2023;380:e072308
Nils Skajaa, doctoral student1 2,
Kasper Adelborg, associate professor1 3,
Erzsébet Horváth-Puhó, associate professor1,
Kenneth J Rothman, professor1 4 5,
Victor W Henderson, professor1 6 7,
Lau Caspar Thygesen, professor2,
Henrik Toft Sørensen, professor1 4 6
1Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
2National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
3Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark
4Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
5RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC, USA
6Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
7Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
Correspondence to: N Skajaa nilsskajaa{at}clin.au.dk (or @nskajaa on Twitter)
Accepted 24 November 2022
Objective To examine labour market participation and retirement among patients with stroke and matched people in the general population according to stroke subtype.
Design Nationwide, population based, matched cohort study.
Setting Danish Stroke Registry, covering all Danish hospitals, and other nationwide registries (2005-18).
Participants Patients (aged 18-60 years and active in the labour market) with a first time diagnosis of ischaemic stroke (n=16 577), intracerebral haemorrhage (n=2025), or subarachnoid haemorrhage (n=4305), and individuals from the general population, matched on age, sex, and calendar year (n=134 428). The median Scandinavian stroke scale score was 55.
Main outcome measures Unweighted prevalences of labour market participation, receipt of sick leave benefits, receipt of disability pension, voluntary early retirement, state pension, and death were computed for each week and up to five years after stroke diagnosis. A log-linear Poisson model was used to obtain exact prevalence estimates as well as propensity score weighted prevalence differences and prevalence ratios at six months, one year, two years, and five years after stroke diagnosis.
Results Most patients (62% of those with ischaemic stroke, 69% of those with intracerebral haemorrhage, and 52% of those with subarachnoid haemorrhage) went on sick leave within three weeks of diagnosis. Prevalence of labour market participation among patients with ischaemic stroke compared with matched individuals from the general population was 56.6% versus 96.6% at six months, and 63.9% versus 91.6% at two years. Prevalence of sick leave was 39.8% versus 2.6% at six months, and 15.8% versus 3.8% at two years. Prevalence of receipt of a disability pension was 0.9% versus 0.2% at six months, and 12.2% versus 0.6% at two years. Adjusting for socioeconomic and comorbidity differences between patients and matched individuals from the general population using propensity score weighting methods had little impact on contrasts. Patients with intracerebral haemorrhage had higher prevalences of sick leave and receipt of a disability pension and thus a lower prevalence of labour market participation, while prevalences for patients with subarachnoid haemorrhage were similar in magnitude to those for patients with ischaemic stroke.
Conclusions In a highly resourced country, about two thirds of working age adults with ischaemic stroke of primarily mild severity participated in the labour market two years after diagnosis. Sick leave and receipt of a disability pension were the most common reasons for non-participation. Patients with intracerebral haemorrhage were less likely to return to the labour market than patients with ischaemic stroke and subarachnoid haemorrhage.
Although stroke continues to be a leading cause of death and disability worldwide, stroke mortality has decreased in most high income countries.1 In Denmark, 30 day stroke mortality decreased between 2005 and 2018 from 2.3% to 0.1% among patients aged 18-49 years, and from 8.2% to 6.0% among patients aged at least 50 years.2 Decreasing risks over time have been observed for some non-fatal outcomes, such as stroke recurrence and post-stroke neurological and psychiatric disorders.34 The extent to which the improved prognosis has led to improved social outcomes remains less clear.
Stroke and its sequelae might hinder the ability to work, which is particularly important for adults of working age. Returning to work after stroke is important for financial stability, independence, and mental wellbeing.56 On a societal level, the cost attributable to loss of productivity due to illness after stroke is substantial: this figure was recently estimated to exceed €630m (£540m; $655m) a year in Denmark (about 25% of the total annual stroke cost).7
Research on return to work after stroke8910111213141516171819 has generally used small study sizes (<1000 patients),891213141618 used questionnaires or other self-reported data to assess employment status,89121518 not examined stroke subtypes and relevant patient subgroups,8910111213141516171819 and not contextualised findings in comparison with what was expected among the general population.891011121415161819 The Danish welfare system provides universal healthcare, unemployment benefits, and retirement benefits. A unique nationwide registry with weekly longitudinal information on all public transfer payments from Danish authorities permits examination of labour market dynamics with high granularity.2021
In a nationwide, population based cohort study, we examined labour market participation and retirement among patients with stroke and matched general population comparators. We assessed patterns separately for major stroke subtypes and among patient subgroups.
Setting and data sources
Denmark has a state funded healthcare system that provides free access to healthcare for all residents, regardless of employment status.22 In addition, Denmark provides public welfare benefits and other social services to all residents. A rich infrastructure of nationwide, population based clinical and administrative registries has been created in the country.22 All residents are assigned a unique personal identification number that allows unambiguous linkage across registries at an individual level, as well as complete long term follow-up.23
In the current study, we obtained data from the following nationwide registries, all with population wide coverage:
• Danish Stroke Registry,24 which collects clinical data on all acute hospital admissions for stroke (eg, stroke subtype, stroke severity, and in-hospital acute treatment). All hospitals treating patients with stroke, as defined by the World Health Organization's criteria, must report to this registry.
• DREAM,20 the Danish national registry on public transfer payments, which contains weekly information on residents receiving public welfare benefits of any kind.24
• Danish National Patient Registry25 and Danish Psychiatric Central Research Register,26 which collectively record all non-psychiatric and psychiatric inpatient and outpatient clinic diagnoses, coded according to ICD-8 (international classification of diseases, 8th revision) between 1977 and 1993 and ICD-10 after 1993.
• Danish National Prescription Registry,27 which records all prescriptions filled in community pharmacies, coded according to the anatomical therapeutic chemical classification system.
• Statistics Denmark's income and education registries,28 which collectively contain information on income and highest level of completed education.
• Danish Civil Registration System,23 which contains information on date of birth, sex, and vital status for the entire Danish population, updated daily.
This study was registered with the Danish Data Protection Agency at Aarhus University (record No 2016-051-000001-1502). In Denmark, ethical approval is not required for registry based studies. We followed the reporting guidelines suggested by STROBE (strengthening the reporting of observational studies in epidemiology).29
Study cohorts
We identified a cohort of working age adults (18-60 years) admitted to hospital with a first time ischaemic stroke, intracerebral haemorrhage, or subarachnoid haemorrhage between 1 May 2004 and 31 December 2018. We required that patients were active in the labour market (defined below) at four weeks before the stroke admission date (referred to here as the index date).30 We did not require patients to survive the length of their hospital admission. Patients with ischaemic stroke and intracerebral haemorrhage were identified from the stroke registry.24 Diagnoses in this registry have a high positive predictive value (>90%).3132 Patients with subarachnoid haemorrhages were identified from the Danish National Patient Registry, as these patients were not included in the stroke registry until 2017.25 Patients with transient ischaemic attack, epidural haemorrhage, subdural hematoma, retinal infarct, and infarct caused by trauma, infection, or an intracranial malignant process were not included.24
To contextualise findings on labour market participation after stroke with findings expected in the general population, we matched each patient with stroke with up to five people from the general population on birth year and sex. Matching was conducted with replacement. To be eligible for matching, comparators were required to have no stroke diagnosis before the index date of the matched patient with stroke, to be alive and living in Denmark, and to be part of the labour market at four weeks before the index date.33 Comparators were assigned an index date corresponding to the stroke diagnosis date of their matched patient. If comparators had a stroke during follow-up, they then contributed risk time to both cohorts, to avoid informative censoring.33
Patients with stroke and matched general population comparators were followed for up to five years after their index date using registry data. Data were available until 31 December 2018.
Labour market participation
We compiled information on labour market participation from the DREAM registry. Founded in 1991 and administered by the Danish Ministry of Employment, DREAM contains weekly information on all public transfer payments from Danish authorities.20 The data in the registry are considered to be of high quality.2034 For each week, starting from the index date and continuing for up to five years, we grouped patients into six mutually exclusive categories according to the type of transfer payment received: labour market participation (ie, employed or receiving state educational grants, parental leave payments, or unemployment payments unrelated to health); sick leave (ie, receipt of sick leave payments or other unemployment payments related to health; disability pension; voluntary early retirement; state pension (received at retirement age); and death. People who were not recorded in the registry or had no entry for a given week were considered to be self-supporting and participating in the labour market.20 In Denmark, sick leave payments are issued for a limited period to people unable to work due to illness. Retirement includes several different pension schemes: disability pensions, available to individuals of any age with permanently reduced work capacity; voluntary early retirement, available in various forms for certain individuals at least 50 years of age; and state pensions, available to individuals on reaching the public retirement age (65-69 years, depending on birth year).
Covariates
The primary aim was to describe labour market participation and retirement in patients with stroke and a comparison cohort from the general population. Therefore, we prioritised the presentation of unadjusted estimates.35 Yet, even when the objective is descriptive (ie, not implying a causal question), adjustment for certain differences across exposure groups might be preferable.35 Even apart from the effects of a stroke, patients with stroke differ from the general population in factors related to socioeconomic position and comorbidity. Such differences might directly or indirectly affect labour market participation, even after matching on age and sex. Therefore, we compiled information on a range of factors: using nationwide registries on income and education, we compiled information on average five year disposable income and highest level of education attained in the year before the index date. To account for inflation and salary changes over time, we categorised income levels as low, medium, or high, according to tertiles of the income distribution in both cohorts for each index year.36 Based on the international standard classification of education, education levels were grouped into low (primary or lower secondary), medium (upper secondary or academic professional degree), or high (university education at the bachelor's level or higher) levels.
We identified non-psychiatric and psychiatric comorbidities recorded between 1994 and the index date. Based on prior work,3738 non-psychiatric comorbidities included hypertension, dyslipidaemia, ischaemic heart disease, atrial fibrillation or flutter, valvular heart disease, heart failure, peripheral artery disease, venous thromboembolism, diabetes, thyroid disorder, gout, chronic pulmonary disease, allergy, ulcer/chronic gastritis, chronic liver disease, inflammatory bowel disease, diverticular disease of the intestine, chronic kidney disease, prostate disorders, connective tissue disorders, osteoporosis, painful conditions, HIV/AIDS, anaemias, cancers, vision problems, hearing problems, migraine, epilepsy, Parkinson's disease, multiple sclerosis, and neuropathies. Psychiatric comorbidities included organic disorders, substance abuse, schizophrenia, mood disorders, neurotic disorders, eating disorders, personality disorders, intellectual disabilities, developmental disorders, and behavioural disorders. Comorbidities were identified from discharge diagnoses recorded in the Danish National Patient Registry and the Danish Psychiatric Central Research Register and, when applicable, on filled prescriptions during the year before the index date recorded in the Danish National Prescription Registry. We also identified the use of other drugs, not used in a definition of a comorbidity, in the year before the index date: anticoagulants, antiplatelets, statins, proton pump inhibitors, and antipsychotic drugs. We categorised the burden of non-psychiatric and psychiatric comorbidity as the number of conditions (0, 1, ≥2) for each patient/comparator.
For patients with ischaemic stroke and intracerebral haemorrhage only, we also obtained information from the stroke registry on stroke severity according to the Scandinavian stroke scale (mild (45-58), moderate (30-44), and severe or very severe (0-29)),39 Essen risk score (0, 1, 2, ≥3),40 thrombolysis in hospital (yes, no, contraindicated), and thrombectomy in hospital (yes, no, contraindicated). The Scandinavian stroke scale is a validated neurological stroke scale with scores ranging from 0 (worst) to 58 (best). The score is evaluated by the attending physician early in the admission phase.39 The scale is conceptually similar to the more widely used National Institutes of Health stroke scale.41 The Essen risk score is a risk stratification tool that predicts the one year risk of recurrent ischaemic stroke and combined cardiovascular events on a nine point scale (one point for ages 65-75 years, two points for age >75 years, and one point for the occurrence of each of the following conditions: hypertension, diabetes, myocardial infarction, other cardiovascular disease, peripheral artery disease, smoking, and transient ischaemic attack).40 All definitions and codes used in this study are presented in supplemental table 1.
Main analyses
For patients with stroke and matched general population comparators, we computed and illustrated graphically the prevalence of being in each of the following categories for each week up to five years after the index date: labour market participation, sick leave, disability pension, voluntary early retirement, state pension, and death. We then used log-linear Poisson regression with a robust error variance to obtain exact prevalence estimates at six months, one year, two years, and five years.42 This analysis allowed cohort members to move in and out of each category (eg, labour market participation or sick leave) on a weekly basis, thereby capturing the dynamics of labour market participation. We performed this analysis separately for each stroke subtype (matched pairs were kept).
Then, to isolate the stroke specific effect on labour market participation, we calculated propensity score weighted prevalence differences and prevalence ratios for the same time points described above, comparing patients with stroke with matched general population comparators. Using a multivariable logistic regression model, we estimated the predicted probability of being diagnosed with stroke conditional on age (continuous), sex, calendar period, and the covariates measured for both cohorts, as listed above. Patients with stroke were assigned a weight of one and comparators a weight equal to the odds of the exposure probability. This weighting approach reweights the comparator cohort so that its covariate distribution resembles that of the stroke cohort. We handled missing data on income (about 0.1%) and education (about 2%) in the propensity score estimation using a missing data indicator variable.43 We chose this adjustment strategy over more conventional regression methods for easier estimation of adjusted absolute probabilities. We computed 95% confidence intervals based on likelihood ratios for prevalence differences and ratios.
Subgroup analyses
To examine effect measure modification and to identify patient subgroups with particular susceptibility to poor labour market participation after stroke, we recalculated the estimates of prevalences, propensity scoreweighted prevalence differences, and prevalence ratios comparing patients who have stroke with matched general population comparators at two years after diagnosis in subgroups according to age (18-30, 31-40, 41-50, and 51-60 years), sex, calendar period of stroke diagnosis (2004-08, 2009-12, 2013-15, and 2016-18), labour market participation at four weeks before the index date (employed, receiving state educational grants, parental leave payments, or unemployment payments unrelated to health), income (low, medium, high), education (low, medium, high), number of non-psychiatric comorbidities (0, 1, ≥2), and number of psychiatric comorbidities (0, 1, ≥2). For these analyses, the matching was dissolved. In four additional subgroup analyses, we stratified the analyses by stroke severity (mild, moderate, severe), Essen risk score (0, 1, 2, ≥3), thrombolysis in hospital (yes, no, contraindicated), and thrombectomy in hospital (yes, no, contraindicated), for which the matching was kept (as matched comparators did not have information on these variables). Propensity scoreweights were re-estimated within each examined stratum.44
Cumulative probability of returning to the labour market
In an auxiliary analysis, we focused on patients with stroke who received sick leave payments within the first three weeks after diagnosis (>98% of patients receiving sick leave payment after diagnosis did so within the first three weeks). Thus, unlike the main analysis, this analysis examined the return to the labour market among patients leaving the labour market immediately after stroke. In a time-to-event analysis, we used the Aalen-Johansen estimator, considering death and retirement as competing events,45 to compute the six month, one year, two year, and five year cumulative probability of return to labour market participation, defined as four consecutive weeks with the classification of labour market participation. This estimator should be interpreted as the probability of four consecutive weeks of labour market participation at any point before time t and before the occurrence of death. Unlike in the main analysis, participants in this analysis were not allowed to move in and out of the labour market. Patients were followed from the initial receipt of a sick leave payment.
Impact of stroke recurrence on labour market participation
Because stroke recurrence is associated with an adverse prognosis,3 we performed a separate analysis among patients who had a recurrent stroke. As in our earlier work,3 recurrent stroke was defined as any stroke subtype, occurring at least 24 hours after the onset of the first time stroke, irrespective of vascular territory. We applied the same eligibility criteria as in the main study cohort (ages 18-60 years, recurrent stroke occurring between 1 May 2004 and 31 December 2018, and requiring patients to be active in the labour market at four weeks before the admission date for the recurrent stroke). New general population comparators were sampled, using the same method as for the main study cohort. For this cohort, we then repeated the main analyses, as described above.
No patients or members of the public were involved in determining the research question or the outcome measures, nor did they take part in developing plans for the design or implementation of the study. No patients or members of the public were asked to advise on the interpretation or reporting of results. The primary barrier was the use of pseudonymised registry data.
The analyses comprised 22 907 patients with stroke (16 577 (72%) with ischaemic stroke, 2025 (9%) with intracerebral haemorrhage, and 4305 (19%) with subarachnoid haemorrhage), aged 18-60 years and participating in the labour market at four weeks before their hospital admission date (82% employed, 2% receiving state educational grants, 1% receiving parental leave payments, and 16% receiving unemployment payments unrelated to health), as well as 98 007 individuals from the general population matched by age, sex, and calendar year (table 1). In both cohorts, the median age was 51 years, 62% were men, and the median Scandinavian stroke scale score among patients with stroke was 55. Compared with matched individuals from the general population, patients with stroke had lower income and education levels and were more likely to have non-psychiatric and psychiatric comorbidities. After propensity score weighting, these differences were minor (table 1, supplemental fig 1).
Characteristics of patients aged 18-60 years with a first time stroke and individuals from the general population matched by age, sex, and calendar year, in Denmark, 2004-18
Figure 1 shows the dynamic changes in labour market participation in people who had a stroke according to stroke subtype and in matched individuals from the general population. Table 2 contains exact prevalence estimates, propensity score weighted prevalence differences, and propensity score weighted prevalence ratios compared with matched individuals from the general population at specific time points. Most patients (62% among those with ischaemic stroke, 69% among those with intracerebral haemorrhage, and 52% among those with subarachnoid haemorrhage) went on sick leave within three weeks of diagnosis. Among patients with ischaemic stroke compared with individuals from the general population, the prevalence of sick leave six months after the index date was 39.8% versus 2.6% (propensity score weighted prevalence difference 36.2% (95% confidence interval 35.4% to 37.1%)); prevalence of labour market participation was 56.6% versus 96.6% (−38.5% (−39.4% to −37.6%)).
Weekly prevalences of labour market participation, sick leave, receipt of a disability pension, voluntary early retirement, receipt of a state pension, and death among patients with ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage and among individuals from the general population matched by age, sex, and calendar year
Prevalences (%) of labour market participation, sick leave, receipt of a disability pension, voluntary early retirement, receipt of a state pension, and death, and propensity score weighted differences and ratios comparing patients with stroke according to stroke subtype, with individuals from the general population matched by age, sex, and calendar year
With time elapsed since the index date, the prevalence of sick leave decreased while that of labour market participation and receipt of a disability pension increased. For example, the prevalence of sick leave was 15.8% for patients with stroke versus 3.8% for people from the general population two years after an ischaemic stroke diagnosis (propensity score weighed prevalence difference 10.3% (95% confidence interval 9.5% to 11.1%)). Corresponding prevalences of labour market participation was 63.9% versus 91.6% (−24.0% (−25.1% to −22.8%)), and prevalences of disability pension receipt was 12.2% versus 0.6% (10.7% (10.1% to 11.3%)). These patterns generally appeared for all stroke subtypes, but the prevalences of sick leave and receipt of a disability pension were higher for people who had an intracerebral haemorrhage than for those with ischaemic stroke or subarachnoid haemorrhage. For example, six months after intracerebral haemorrhage, prevalence of sick leave was 53.9% versus 2.6% (48.7% (45.6% to 51.8%)). For all stroke subtypes, retirement schemes showed a substitution effect: receipt of a disability pension was much more frequent in patients with stroke, while voluntary early retirement appeared to be as likely or less likely in these patients compared with matched individuals from the general population.
Prevalence estimates of labour market participation at two years after stroke, as well as propensity score weighted prevalence differences and propensity score weighted prevalence ratios in different patient subgroups, are depicted in figure 2 (ischaemic stroke), supplemental figure 2 (intracerebral haemorrhage), and supplemental figure 3 (subarachnoid haemorrhage), with exact estimates presented in supplemental tables 2-4. In patients who had an ischaemic stroke, the prevalence was higher among those aged 18-40 years (76.0%, propensity score weighted prevalence difference v the general population −18.7%) than among those aged 51-60 years (59.2%, −30.1%). Men and women had similar prevalences. The prevalence was slightly higher for strokes diagnosed during 2016-18 (68.4%, propensity score weighted prevalence difference v general population −27.3%) than for those diagnosed in 2004-06 (57.0%, −32.0%).
Prevalence of labour market participation two years after ischaemic stroke and propensity score weighted differences and ratios compared with individuals from the general population matched by age, sex, and calendar year, in patient subgroups. Propensity score weights calculated based on the following covariates: age (omitted when stratifying by this variable), sex (omitted when stratifying by this variable), calendar period (omitted when stratifying by this variable), labour market participation at four weeks before the index date (omitted when stratifying by this variable), income level (omitted when stratifying by this variable), education level (omitted when stratifying by this variable), hypertension, dyslipidaemia, ischaemic heart disease, atrial fibrillation or flutter, valvular heart disease, heart failure, peripheral artery disease, venous thromboembolism, diabetes, thyroid disorder, gout, chronic pulmonary disease, allergy, ulcer/chronic gastritis, chronic liver disease, inflammatory bowel disease, diverticular disease of intestine, chronic kidney disease, prostate disorders, connective tissue disorders, osteoporosis, painful conditions, HIV/AIDS, anaemias, cancers, vision problems, hearing problems, migraine, epilepsy, Parkinson's disease, multiple sclerosis, neuropathies, organic disorders, substance abuse, schizophrenia, mood disorders, neurotic disorders, eating disorders, personality disorders, intellectual disabilities, developmental disorders, behavioural disorders, anticoagulants, antiplatelets, statins, proton pump inhibitors, antipsychotic drugs, number of non-psychiatric comorbidities (omitted when stratifying by this variable), and number of psychiatric comorbidities (omitted when stratifying by this variable). PS=propensity score
We observed a socioeconomic gradient in labour market participation for patients who had an ischaemic stroke: the prevalence was higher for those with high education level (77.9%, propensity score weighted prevalence difference v general population −16.8%) than for those with low education level (61.9%, −29.6%). A similar pattern was observed for income levels, albeit less strongly. Although the prevalence of labour market participation was higher with decreasing numbers of non-psychiatric and psychiatric comorbidities, differences within these groups were slight when compared with matched individuals from the general population. The strongest predictor of labour market participation was stroke severity: after two years, the prevalence was 69.4% for mild stroke (−23.4%), 50.5% for moderate stroke (−43.1%), and 24.8% for severe or very severe stroke (−67.9%). These patterns of effect measure modification were generally apparent for all stroke subtypes.
Among patients with ischaemic stroke receiving sick leave payments within three weeks after stroke, the cumulative incidence of return to labour market participation, after considering death and retirement as competing events, was 35.1% at six months, 55.9% at one year, 71.0% at two years, and 75.5% at five years (table 3). The corresponding estimates after intracerebral haemorrhage were 17.8%, 32.7%, 50.2%, and 56.9%, and those after subarachnoid haemorrhage were 31.2%, 49.3%, 65.6%, and 70.8%.
Cumulative probability of labour market participation (defined as four consecutive weeks with the classification of labour market participation) among patients with stroke who received sick leave payments within three weeks after the index date, after considering death and retirement as competing events
In a separate analysis comprising 1147 patients with recurrent stroke (694 (61%) with ischaemic stroke, 74 (6%) with intracerebral haemorrhage, and 379 (33%) with subarachnoid haemorrhage), the prevalence of labour market participation was slightly higher at six months after recurrent stroke than after first time stroke (ie, in the main analysis) (supplemental fig 4, supplemental table 5). However, this pattern reversed after one year. For example, among patients with ischaemic stroke compared with individuals from the general population, the prevalence of labour market participation was 58.5% versus 96.8% (propensity score weighted prevalence difference −38.8% (95% confidence interval −43.0% to −34.7%)) at six months after recurrent stroke and 56.6% versus 91.9% (−24.1% (−35.8% to −12.4%)) at two years after recurrent stroke. Mortality was higher after recurrent stroke than after first time stroke.
Among working age adults with ischaemic stroke of primarily mild severity, about two thirds participated in the labour market at two years after stroke diagnosis, with sick leave and receipt of disability pension being the most common reasons for non-participation. Compared with matched individuals from the general population, patients with ischaemic stroke had a 24% reduced absolute prevalence of labour market participation at two years after diagnosis, after adjusting for differences in age, sex, calendar year, education, income, and comorbidity. While a similar impact on labour market participation was observed for patients with subarachnoid haemorrhage, patients with intracerebral haemorrhage had lower prevalences, largely attributable to much higher prevalences of sick leave and receipt of a disability pension.
Research in context
Based on 29 studies, most of them small in size, a 2018 systematic review reported that the probability of returning to work was 41% at six months, 53% at one year, and 66% at two years after stroke.46 Our findings regarding ischaemic stroke correspond reasonably well with the findings of this meta-analysis. However, the results from the individual studies in the meta-analysis, as well as the results from newer studies, have varied greatly. For example, in a Finnish cohort of 769 patients with ischaemic stroke aged 15-49 years from the Helsinki young stroke registry, 62% were working after one year and 58% were working after two years, aligning with the results from our study and those from the meta-analysis.16 In one of only two studies that included a comparison cohort from the general population, the Dutch FUTURE study (a follow-up study of risk factors and prognosis among young patients with stroke) reported results based on 694 patients with stroke aged 18-50 years. The FUTURE study's finding that patients with stroke were two to three times more likely to be unemployed than the general Dutch population after a mean follow-up of eight years largely agrees with the relative contrasts found in our study.13 By contrast, in the South London stroke register, among 940 patients with stroke in paid employment before diagnosis (mean age 53 years), only 18% were working after one year, decreasing to 12% after five years.18 Discrepancies between these findings probably stem from a variety of causes, including varying cohort inclusion criteria (eg, age, stroke subtype, and employment status at baseline), measures of employment (eg, questionnaire data, other self-reported data, or registry data), and national government structures (eg, universal welfare states or more selective welfare states).
This study adds to the literature in several important areas. Principally, the large cohort size and the nationwide, weekly data on public transfer payments from Danish authorities permitted a comprehensive assessment of labour market dynamics after stroke. In our main analyses, patients could move in and out of the labour market (eg, from labour market participation to sick leave to disability pension) during follow-up. This approach allowed us to capture and illustrate labour market participation dynamically. We found that the prevalence of labour market participation was highest at about two years after stroke, and began to decline after that owing to a rise in receipts of disability pensions and other pensions. Another important finding is that although stroke affected labour market participation with the general population as a reference, more than half of patients with ischaemic stroke were part of the labour market just six months after their diagnosis, increasing to around two thirds after two years. On one hand, this high labour market participation is an encouraging finding, which could be explained by the relatively young age of working age adults compared with the total adult population, the establishment of specialised stroke units, better acute care including scaling up thrombolysis and thrombectomy, and increasing rates of mild strokes.2 The slightly increasing prevalence of labour market participation over calendar periods supports this view. On the other hand, while much focus has been on stroke prevention, diagnosis, and acute treatment, less focus has been on rehabilitation and long term consequences.
In the newly presented national stroke action plan (the first of its kind in Denmark), the Danish Stroke Association called for increased and sustained cross disciplinary focus on both physical and cognitive rehabilitation.47 Although mental illness after stroke is well described,4 a clear approach to organising cognitive rehabilitation services is lacking.47 With the ongoing implementation of a national action plan and tangible goals, it seems likely that the impact of stroke on labour market participation could decline in years to come. Unlike most previous studies,891215161718 we examined labour market participation separately for each stroke subtype, because these have distinct pathophysiology and impact on prognoses.34 Although patients with intracerebral haemorrhage accounted for only around a tenth of patients with stroke in the current study, these patients were much less likely to return to the labour market (43% at two years) than either patients with ischaemic stroke (64% at two years) or patients with subarachnoid haemorrhage (61% at two years). Stroke severity is on average higher for intracerebral haemorrhage, as also evidenced by the higher probabilities of sick leave and receipt of a disability pension for these patients, which could explain this finding. Similarly, while subarachnoid haemorrhage is associated with high short term mortality (mortality risk at six months 12.7%), after considering death and retirement as competing events, both prevalences and cumulative probabilities for labour market participation were similar in magnitude to those found for ischaemic stroke. This finding demonstrates that early survivors of subarachnoid haemorrhage generally have a favourable prognosis.
Many factors have been identified as being predictive of labour market participation after stroke. Unlike studies that assessed predictors within a stroke cohort,891011121415161819 we assessed effect measure modification, which assessed whether the impact of stroke, in reference to matched individuals from the general population, differed across patient subgroups. As such, this type of analysis might be better suited to identify patients with susceptibility to poor labour market participation specifically in a stroke population. For example, although the prevalence of labour market participation after two years was higher among patients with ischaemic stroke without non-psychiatric comorbidities (67%) than among those with two or more non-psychiatric comorbidities (55%), the propensity score weighted prevalence difference, compared with matched individuals from the general population, was −34% and −27%, respectively, indicating little effect modification.
Our findings confirm that younger patients are more likely than older patients to return to the labour market.911121819 Younger patients might be more likely to resume working owing to less disabling strokes (ie, lower stroke severity),2 a higher probability of being offered cognitive rehabilitation services,47 a lower risk of cognitive impairment (eg, dementia and delirium),4 and the strict criteria in Denmark for receiving a disability pension for people younger than 40 years. Unlike a previous Danish study11 and other research on this topic,91319 we did not find evidence of clear sex differences in labour market participation after stroke. As the risk of stroke recurrence and mortality is higher among women than among men,3 the similar propensity between the sexes to return to the labour market is reassuring. In alignment with several other studies,1213161819 stroke severity strongly predicted labour market participation. As for other outcomes, such as recurrence, mortality, and mental illness,34 stroke severity (measured by, for example, the Scandinavian stroke scale) could be a useful tool to predict an adverse prognosis. However, whether a targeted focus on patients with severe stroke (only 8% of the participants in our study) is cost effective is questionable.
In a separate, auxiliary analysis of the impact of recurrence, the prevalence of labour market participation was slightly higher at six months after recurrent stroke than it was at six months after first time stroke. Survivor bias is a likely explanation for this seemingly counterintuitive result. Another possible explanation is that because recurrent strokes are more likely than first time strokes to be ischaemic rather than haemorrhagic,3 recurrent strokes are on average milder, thereby leading to a higher probability of labour market participation.
Limitations and generalisability of the study
Our study has some limitations. Firstly, the DREAM registry does not capture short term sick leave (ie, sick leave periods of less than four weeks). Therefore, some patients on short term sick leave might have been misclassified as having never left the labour market; consequently, we might have underestimated the proportion of patients with stroke going on sick leave immediately after diagnosis. However, the impact of this source of misclassification on prevalence estimates after six months or longer is probably negligible. Secondly, receipt of a disability pension has been difficult for people under 40 years old since 2013, even in case of reduced work capacity, owing to a new law. This difficulty could have affected estimates after subarachnoid haemorrhage, because the average age of patients at diagnosis with this stroke subtype was lower (45 years in our study) than that of ischaemic stroke (50 years) and intracerebral haemorrhage (50 years). Thirdly, we lacked detailed clinical data on, for example, the underlying causes of stroke for all subtypes. Knowledge of these causes can guide treatment choice and is most likely an important predictor of labour market participation.16
If valid, our results likely generalise to other Nordic countries with a welfare and support system similar to Denmark's.48 Notably, in this study, stroke severity was on average mild (median Scandinavian stroke scale score 55). This relatively lower stroke severity is principally because the study population included working age adults, and stroke severity increases with age.2 The incidence of mild stroke has increased over time in Denmark,2 attributable to improved awareness of stroke symptoms in the Danish general population and prehospital response leading to faster diagnostics as well as more accessible neuroimaging.4950 In this context, stroke severity could be milder on average in Denmark than in other countries.
In this large cohort study of working age adults with first time stroke of primarily mild severity, the majority participated in the labour market at two years after diagnosis. Labour market participation was lower for patients with intracerebral haemorrhage than for patients with other stroke subtypes. Denmark has a strong welfare and support system, which might limit the generalisability of these results to other settings. Nonetheless, the absolute and relative probabilities of labour market participation reported in this study could serve as a starting point when designing and implementing stroke rehabilitation programs and intervention studies.
What is already known on this topic
Stroke survival has improved in recent decades, but the extent to which the improved prognosis has led to improved social outcomes remains less clear
Returning to work after stroke is important for financial stability, independence, and mental wellbeing
Research on return to work after stroke has used small study sizes, used questionnaires or other self-reported data to assess employment status, not examined stroke subtypes, and not contextualised findings compared with what was expected among the general population
What this study adds
Compared with matched individuals from the general population, patients with ischaemic stroke had a 24% reduced absolute prevalence of labour market participation at two years after diagnosis, after adjusting for differences in age, sex, calendar year, education, income, and comorbidity
Labour market participation was similar for patients with ischaemic stroke and subarachnoid haemorrhage, but patients with intracerebral haemorrhage had lower participation, largely attributable to much higher prevalences of sick leave and receipt of disability pensions
Ethical approval is not required for registry based studies in Denmark. The study was approved by the Danish Data Protection Agency at Aarhus University (No 2016-051-000001-1502).
Data presented in this study were obtained from Danish registries. Owing to data protection rules, we are not allowed to share individual level data. Other researchers who fulfil the requirements set by the data providers could obtain similar data.
Contributors: All authors contributed to the design of the study. NS, KA, EHP, and HTS acquired the data. All authors directed the analyses, which were carried out by NS with supervision from EHP. NS wrote the initial draft. All authors contributed to the discussion and interpretation of the results, which secured the intellectual content of the manuscript. All authors approved the final version for submission. HTS is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: No specific funding was given to this study. NS is supported by a scholarship from Aarhus University and a grant from Helsefonden. VWH received support from National Institutes of Health grant P30 AG066515. The funding sources played no part in the design and conduct of the study, analyses, or interpretation of the data.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. The Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, receives funding from private and public institutions in the form of research grants to (and administered by) Aarhus University. None of these grants has any relation to the present study.
The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Dissemination to participations and related patient communities: The findings of this study will be shared with clinicians and advocacy groups via the websites of the authors' institutions and on social media.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Skajaa N, Adelborg K, Horváth-Puhó E, Rothman K J, Henderson V W, Thygesen L C et al.
Labour market participation and retirement after stroke in Denmark: registry based cohort study BMJ 2023; 380 :e072308 doi:10.1136/bmj-2022-072308
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Ted R. Brown Joins Holland & Knight's Real Estate Practice Group
Orlando, Fla. – July 15, 2013 – Holland & Knight is pleased to announce that environmental and land use law attorney Ted R. Brown has joined the firm's Orlando office. He was previously with Baker Hostetler.
Mr. Brown's practice is centered on the representation of developers and companies active in land acquisition and development. From 1988 until 1996, he served as vice president/general counsel of Arvida Company, a firm engaged in the development of master-planned communities in various markets around the United States. In that capacity, Mr. Brown was responsible for managing the legal affairs of the company and, in particular, the land entitlement and environmental permitting processes.
Mr. Brown is recognized as a top attorney in environmental, real estate, and land use law by Chambers USA, The Best Lawyers in America,and Super Lawyers magazine. He is a full member of the Urban Land Institute and currently serves on its Community Development Council. He also is a former president of the Foundation for Environmental and Economic Progress, a coalition of land development companies seeking to make the Section 404 wetlands program and the Endangered Species Act operational protocols more balanced. During his tenure, Mr. Brown testified before the U.S. House of Representatives and the U.S. Senate on the reauthorization of both the Clean Water Act and Endangered Species Act.
Holland & Knight's real estate practice is one of the largest of any U.S. law firm, with more than 200 lawyers who work in collaboration to address the legal needs of clients engaged in the development, construction and operation of real estate projects around the globe. U.S. News - Best Lawyers named Holland & Knight the "2013 Law Firm of the Year" in Real Estate Law.
Ted R. Brown
Real Estate Environment Land Use: Florida Land Use and Government Residential and Master-Planned Communities
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The Abé's motorcycle season opening together with the Mass led by Father Laďa Heryán at Svatá Hora in Příbram has already became a tradition.
This year, we added to that a visit to our friend, the composer and biker Petr Hapka - at the cemetery near Okoř. The Mass was held in a beautiful environment of just renovated private chapel of the Redemptorist order in a monastery at Svatá Hora. We could see, as the first of the public, a rediscovered ceiling painting which has been hidden under plaster in place of a chandelier. Brilliant ... :).
Thank you Father Heryán, thank you Abé, and thank to all of you who attended and accepted our invitation to this year's VIII. MDA RIDE at Václavské náměstí (Wenceslas Square) in Prague on 6/18/2016.


Security vendors are responding to customer demands for technologies that can prevent attacks, instead of simply warn of their presence.
Entercept Security Technologies Inc. and TippingPoint Technologies Inc. are both set to unveil IPS (intrusion prevention system) products in the coming weeks. And a trio of leading vendors—Check Point Software Technologies Ltd., Okena Inc. and IntruVert Networks Inc.—last week partnered to integrate their products and create what theyre calling the Intrusion Prevention Ecosystem.
IDSes (intrusion detection systems) are falling out of favor with many network administrators and security specialists, who have become frustrated by the incessant false alarms and passive nature of the technology. While theyre not ready to rip their IDS out altogether, many users say it will likely serve as nothing more than a kind of traffic recorder for post-attack analysis.
Entercept this week will introduce its Database Edition, a companion to its flagship Web server protection product. Designed to protect servers running Microsoft Corp.s SQL Server 2000, Database Edition uses a purpose-built software engine to intercept SQL queries before they reach the database engine.
The engine inspects all queries coming into the database and looks for telltale signs of known attacks such as SQL injection or buffer overruns. The product also includes a technology known as database shielding, which prevents attackers from gaining access to database files, even if they have valid credentials.
"Weve made it so that even if someone gets root access, they wont be able to manipulate files or use the server as a way to attack other servers. Its another way to stop attacks before they start," said Lou Ryan, president and CEO of Entercept, of San Jose, Calif.
"I still look at IDS as key, but whatever we can use to predict attacks before they occur and stop them is great," said Ash Shehata, director of IS and telecommunications at Antelope Valley Hospital, in Lancaster, Calif., and an Entercept customer. "[Database Edition] will give us the ability to stabilize and protect our mission-critical applications. More and more of them are using SQL, and they cant go down."
TippingPoint, meanwhile, will release its UnityOne IPS product at the end of the month. The company has taken a hardware-based approach to IPS with its line of UnityOne appliances. Both appliances use the Threat Suppression Engine, which does packet and flow reassembly and stateful inspection of incoming traffic.
Unlike traditional IDS systems, UnityOne can see sophisticated attacks that come through in fragmented packets.
"We dont have to guess at what its going to be when it reassembles," said Marc Willebeek-LeMair, chief technology officer of TippingPoint, of Austin, Texas. "We can impose an algorithm on it and see exactly what it will be. That process where the IDS has to alert the firewall isnt sufficient. You have to be able to drop bad packets as soon as you see them."
Okena and IntruVert have combined their respective technologies with Check Points VPN-1 and FireWall-1 products to create intrusion prevention solutions for large enterprises. The solutions include network and host IDS capabilities and have real-time attack prevention capability, the companies said.


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home // News // Watertown: Another Group Joins Fluoridation Struggle //
Watertown: Another Group Joins Fluoridation Struggle
Source: WWNY TV 7 | February 23rd, 2013
Location: United States, New York
The great fluoride debate isn't likely to end anytime soon.
A second group of fluoride opponents has surfaced in Watertown. Mothers Against Fluoride seeks to have the city stop adding fluoride to the water supply, something that's been done since 1962.
Fluoridation has been widely held to be a safe, effective means of promoting dental health for decades. It enjoys broad support among dentists.
However, from the beginning fluoridation has also had its critics, primarily for health reasons; in Watertown, those critics began to surface last fall when the city announced plans to spend $70,000 on new fluoridation equipment.
"I think a lot of people are stuck in the mindframe 'Oh, they've been doing it for a long time, it must be all right," said Christine Davenport, from Mothers Against Fluoride.
Davenport lives in LaFargeville but works in Watertown, and says the health implications of fuoride worry her.
"In a day and age when there's so much autism and ADHD and cancer, childhood cancer is going like crazy, we need to look at what are the system long term effects of these chemicals," she said.
In response to the groups – there are two so far – the city is organizing a committee to study fluoridation.
However, city water superintendent Mike Sligar remains a staunch advocate of fluoridation.
"Show me a community that doesn't have enough (fluoride) and I'll show you a community that has a high level of…diseases of the teeth," Sligar said Friday.


An Australian university is using regenerative stem cell research to save a national icon from cancer.
Researchers from the University of Adelaide in South Australia are seeking to raise $5000 to further investigate a cure for a transmissible cancer called Devil Facial Tumour (DFT) that threatens the declining population of Tasmanian devils.
The Tasmanian devil is the largest carnivorous marsupial in the world and was formally upgraded to endangered status by the Australian Federal Government in May 2009. The mortality rate of a devil infected with DFT is 100 per cent, with the transmissive nature of the cancer causing it to spread like any other contagious disease.
University of Adelaide PhD candidate Chelsea Graham has launched a Pozible campaign to cover the costs of her research, which is replicating human stem cell research for the first time in marsupials.
"Devil Facial Tumour is an infectious cancer that only affects Tasmanian devils. It has reduced the wild population of devils by 80 per cent in just the last 20 years," Graham said.
"This research is focused on the stem cells located in the pulp tissue of devil canine teeth – known as dental pulp stem cells.
Graham said the cancer originated from a Schwann cell and is responsible for the rapid decline of the devil's wild population since its emergence over a decade ago.
"Devils pass the aggressive, transmissible cancer to one another when they bite each other. The animals die within six months of being infected, as disfiguring facial tumours prevent them from eating," said Graham.
Graham is replicating human stem cell research with dental pulp stem cells to better understand the tumour's biological makeup, which she believes is a crucial step to tackling the disease.
"We're replicating previous research that has been used mostly in neural regenerative research in humans. DFT originates from the Schwann cells and we aim to turn harvested stem cells into Schwann cells to gain a better understanding of the development of the cancer," said Graham.
Chelsea Graham, from the University of Adelaide, is researching the use of stem cells to stop Devil Facial Tumour from wiping out Tasmanian devils.
The research is being carried out at the South Australian Health and Medical Research Institute (SAHMRI), South Australia's flagship health and medical research institute which has the technology necessary for her research.
Graham is working in collaboration with University of Adelaide senior lecturer Dr Stephen Pyecroft, one of the first scientists to describe DFT and discover that it was a transmissible cancer.
"This research is a crucial step towards tackling the devastating disease and saving the Tasmanian devils," said Dr Pyecroft.
"Money raised from the crowdfunding campaign will help Chelsea obtain more devil tooth samples and use the harvested stem cells to recreate the Schwann cell line. This will be pivotal to understanding Devil Facial Tumour," he said.
For ethical reasons, Graham must obtain all of her teeth samples from deceased Tasmanian devils. Due to the limited population of devils in captivity in South Australia, Graham must fly to Tasmania and return with the canines within 48 hours before the samples are rendered unusable.
Funds raised will be dedicated to travel costs and cell cultures required for the research.
Graham has raised more than $1400 towards her campaign with one month remaining.


For most Americans, hearing news that one of our children's products has been recalled can induce much anxiety. When we buy products for our kids, such as a car seat or a high chair, we expect that they are going to be safe to use, and that they will not have any defects. However, product defects occur more often than we think. More concerning is a recent article in USA Today, which cited a new child safety report from Kids in Danger (KID), a children's safety advocacy group based in Chicago. The KID report's findings indicate the fact that children's product recalls are largely ineffective. According to the report, only about 10 percent of recalled children's products are returned to the manufacturer or undergo repairs.
Does this small percentage imply that parents continue to use recalled products? The article intimated that "such a low number of successfully recalled products means many commonly used items that could injure or kill children likely remain in use." The executive director for KID, Nancy Cowles, stressed the fact that "the return rate of recalls is really abysmal." She attributes the problem to people either failing to hear about recalled products or, worse yet, simply failing to respond to them.
The Consumer Product Safety Commission (CPSC) details three different ways to remedy a defective product under a recall situation: companies can refund, repair, or replace the dangerous product. It is up to each company to decide which type of remedy it wants to offer.
The primary causes of death involving defective nursery products included asphyxiation, strangulation, and drowning.
Many of the injuries and fatalities reported to the CPSC were directly attributed to a product defect, including design defects, manufacturing defects, and even marketing defects.
Given the recent Graco recall, and the sobering child injuries and fatalities reported by the CPSC, it is extremely important to be aware of children's product recalls. If your child has been injured by a defective product, you should contact a product liability lawyer as soon as possible.


Details: Meet at the Belvidere Park boat launch (parking lot just NW of Appelton Rd. bridge) at 10:00 am to unload you boat and gear. Car shuttle promptly at 10:30. This stretch of river is 7.2 miles long and is rated advanced beginner/intermediate at normal water levels due to the many riffles and frequent downfall to navigate. However, water is very low which should push it toward the easier side.
Warning: there may be a portage or two and plenty of downfall to navigate through. Also, the low water levels will make this trip scratchy and may require getting in and out of your boat to pull it over shallow areas -- so don't bring a boat that doesn't like the scratches.
Wear quickdry/fleece clothing and bring a waterproof dumpbag with a second set of clothes (just in case). A PFD (lifejacket) must be worn on the trip. Bring a snack/lunch and water as we will take a short break about half way through the trip.


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4 Ways to Maximize Your Startup's Hometown Advantage
This is no time to be complacent, says Steve Case. Hustle and maximize every resource.
By Linda Lacina October 4, 2016
Entrepreneur is on the road with startup platform Rise of the Rest. Check out Startup Anywhere for stories from the October road trip as well as for insights from thought leaders and community leaders showing there's an entrepreneurial world outside Silicon Valley.
Tom Merton | Getty Images
The lion's share of all venture funding in the United States goes just to three states California, New York and Massachusetts. Experts in the entrepreneurial world and VCs often state these major startup hubs eat up to 75 percent of the funding, leaving the remaining 47 states left to scrap over the last dollars available.
Chances are you know this statistic. It's well-known in startup circles and was referenced often Monday at the Nebraska stop of Rise of the Rest, a startup celebration of American entrepreneurship. Throughout a day's worth of programming in both Omaha and Lincoln, founders, investors and community leaders alike repeatedly acknowledged that despite great successes, startups outside Silicon Valley still had steep mountains to climb.
It was a warning. Being innovative or original isn't good enough. They need to execute. They need to win -- and keep winning. "This is no time to get complacent," said Steve Case, AOL co-founder and brainchild of the Rise of the Rest tours.
So if being great isn't good enough, what more is there to do? Our experts from the tour's first day have some suggestions.
Take a look -- and make the most of your hustling.
Related: Join Entrepreneur on the Road This Week With Steve Case's 'Rise of the Rest'
1.Stop being humble.
When you have a success, you need to tell people. When your community has a success, you need to tell people. In fact, the rallying cry for Omaha startups Monday was "Bang the Drum," a reminder to tell the world about what's going well and what only you can do.
For a humble midwest sensibility, this could be a challenge -- but it's one to be conquered, says Case. "Humility is positive, but it gets in the way of promoting the successes of these cities."
If you have trouble touting your own accomplishments, talk about someone else. Consider being a booster for your team or the great partners and startups around you. As Case reminds us, one startup's success and visibility can put an entire city on the map, helping others rise up and drawing both investors and talent. "Then the rest truly will rise," Case says.
Related: Steve Case on Opportunity Outside Silicon Valley: 'There's Still Work to Be Done'
2. Study your idols.
Ask yourself: Who's doing it right? Is there a hot shot local company you admire? Maybe this company mastered social media or snagged impressive funding or has proved to be staggeringly talented. Don't be afraid to reach out, says David Hall, a partner at Revolution Ventures. Most people are happy to meet for coffee and with any luck you'll forge a connection that works for you both -- one where each side can provide a source for advice, referrals, gut checks and tips on navigating a city you both share.
Related: 4 Ways to Use Your Local Community to Scale Your Business
3. Lure (former) locals.
If you can't find the talent you need, consider friends and colleagues who might have once lived in your city but moved away for other opportunities, says Case. Update these ex-pats on why you live and build in that city -- and what excites you about it.
Conversions might not come quickly, but the time you invest could pay off. With some luck and persuasion, you might snag proven people who know you and your market.
4. Give back.
If you are a startup outside Silicon Valley that's won success, remember, you have some responsibilities. You brought visibility to your city and your efforts can help others. Case stressed this at a visit to the headquarters for Hudl, a breakout company that provides tools to teams of all sizes to improve athletic performance. Hudl turned heads last year for snagging $87.5 million in funding. "You have a responsibility," he said, to help the others rise.
Linda Lacina
Entrepreneur Staff
Linda Lacina is the former managing editor at Entrepreneur.com. Her work has appeared in the Wall Street Journal, Smart Money, Dow Jones MarketWatch and Family Circle. Email her at llacina@entrepreneur.com. Follow her at @lindalacina on Twitter.
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Hong Kong is the great, roaring dragon of Asia with a bustling population of more than seven million. Yet it flits effortlessly from glitz and glamour to serene island life, attracting everyone from suits to surfers. It is not just rich with business, but with history, too. Marvel at the elegant double decker trams, winding their way round narrow streets amid the onslaught of traffic. Despite the rapid advancement of its technologies and industries, Hong Kong retains a strong sense of its identity and its past.
Sham Shui Po is a district of simple pleasures. As a historically blue-collar neighbourhood, this area just north of Boundary Street offers a lot of cheap but cheerful experiences that can't be found anywhere else in the city. Instead of glitzy, glass-panelled skyscrapers, here you'll find buildings that hide a rich history behind their humble façades. Don't come here for a fancy gourmet meal. Instead, come here if you want to try Michelin-recommended noodles and snacks that only cost HKD50. And if you're planning to do a bit of shopping, be prepared to spend several hours here, sifting through all the eclectic wares at the open-air street markets.
If you want to experience Sham Shui Po to the fullest, this walking guide will show you the best things to see, eat, buy and do, from traditional temples built by early immigrants to concept stores and coffee shops that are bringing a new energy and attitude to this bustling district. Along the way, you'll discover all the simple pleasures that give Sham Shui Po its distinct charm.
Experience the sights and sounds at your own pace while strolling through the streets of Central and neighbouring Sheung Wan on a self-guided walk. Four distinctively themed walking routes namely Heritage: Time Traveller, Art: Crazy for Art, Dining: Tasting Hong Kong, and shopping: Treasure Hunt, have been thoughtfully designed in a form of a walking guide to illustrate Hong Kong's rich history and culture. To best discover and experience the vibrant Central district including its colonial monuments, temples, art galleries, street art displays, antique stores, hip boutiques, trending restaurants, rooftop bar and local delicacies. Download the e-guide here.
Take your taste buds on a tour of Central - paradise for food lovers, offering a world of choices that are steps away from each other. From century-old traditional dim sum, to local traditional dai pai dong, to street food and delicious souvenirs, and fusion cuisines to international fine wine, there's something that appeals to everyone's taste buds. Discover more here.