Dr. Paul Muntner, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. 1700 University Boulevard, Suite 450, Birmingham, Alabama 35294.
Using cardiovascular disease (CVD) risk instead of or in addition to blood pressure (BP) to guide antihypertensive treatment is an active area of research. The purpose of this review is to provide an overview of studies that could inform this treatment paradigm. We review data from randomized trials on relative and absolute CVD risk reduction that can occur when antihypertensive treatment is guided by CVD risk. We also review population-level data on using CVD risk in conjunction with BP to guide antihypertensive treatment, the broad distribution in CVD risk for people with similar BP levels, and the use of CVD risk for guiding antihypertensive treatment among subgroups including older adults, young adults, and those with diabetes mellitus or chronic kidney disease. In addition, we review potential challenges in implementing antihypertensive treatment recommendations that incorporate CVD risk. In closing, we provide recommendations for using CVD risk in combination with BP to guide antihypertensive treatment.
Observational studies have demonstrated graded associations between both systolic (SBP) and diastolic (DBP) blood pressure and level of risk for cardiovascular disease (CVD) (1,2). The risk for CVD increases continuously between an SBP of at least 115 mm Hg and ≥180 mm Hg and a DBP of at least 75 mm Hg and ≥110 mm Hg. Despite these graded associations, hypertension is often diagnosed among people with SBP or DBP above certain thresholds, typically an average SBP/DBP ≥140/90 mm Hg (3). Individuals with hypertension are usually advised to make lifestyle changes, and most require antihypertensive medication for control of their blood pressure (BP). Adults with SBP and DBP below the levels used to define hypertension are often not prescribed antihypertensive medication, even though many of them may have high CVD risk. Several studies have considered whether subgroups of people with SBP and DBP below the levels used to diagnose hypertension are likely to benefit from the initiation of antihypertensive medication.
Using absolute CVD risk instead of or in addition to BP levels to guide antihypertensive treatment decisions was first proposed more than 20 years ago and has been adopted in several countries (4–8). In 1997, the sixth report of the Joint National Committee (JNC) on prevention, detection, evaluation, and treatment of high blood pressure (JNC6) recommended using CVD risk and BP levels to guide treatment (Table 1) (9,10); however, in 2003, the JNC7 reverted to a treatment paradigm based entirely on BP levels (3). The goal of this paper is to review the evidence related to incorporating an individual's CVD risk in the decision to prescribe medication and determine the intensity of antihypertensive medication. We provide an overview of evidence from randomized trials of antihypertensive medication on the prevention of outcomes for patients by CVD risk. Additionally, we review the data related to using a risk-based approach versus using BP alone in making antihypertensive treatment decisions; the variation in CVD risk for people with similar BP levels; the use of CVD risk to guide antihypertensive treatment decisions for population subgroups, including older adults, young adults, and those with diabetes mellitus or chronic kidney disease (CKD); and challenges that might be encountered in implementing an approach that incorporates CVD risk to guide antihypertensive medication use. In closing, we provide recommendations for how CVD risk can be used in conjunction with BP levels to make treatment decisions.
Pooled individual-level data from randomized trials comparing pharmacological BP-lowering therapy versus placebo and more versus less intensive antihypertensive treatment regimens reveal potential benefits of focusing antihypertensive medication treatment decisions on predicted CVD risk (11). The relative and absolute differences in CVD events associated with antihypertensive medications were evaluated across a range of absolute CVD risk from 11 trials that enrolled >50,000 participants. The risk ratio for CVD associated with BP reduction with antihypertensive medication did not vary across level of predicted CVD risk (Figure 1, left). The quite similar relative risk reduction at each CVD risk level corresponded with progressively larger absolute reductions in CVD risk among participants with increasingly higher 5-year predicted CVD risk (Figure 1, right). In addition, the authors estimated that treating 1,000 people with a 5-year risk <11% (observed 5-year event rate of 6.5%) would prevent 14 events over 5 years compared with 20, 24, and 38 events prevented if their 5-year risk of CVD was 11% to 15%, 15% to 21%, or >21% (observed 5-year event rates of 13.2%, 20.6%, and 24.8%), respectively. The number needed to treat for 5 years to prevent 1 CVD event was 71, 51, 41, and 26 for participants with a 5-year CVD risk <11%, 11% to 15%, 15% to 21%, or >21%, respectively. The patterns of larger absolute risk reductions with treatment for those with progressively higher predicted CVD risk were also observed for stroke, coronary heart disease (CHD), heart failure, and CVD death.
Data from a pooled analysis of 11 randomized controlled trials of antihypertensive treatment versus placebo (N = 51,917 participants). Participants were grouped into strata based on 5-year predicted risk for CVD events. (Left) The risk ratio for having a CVD event during follow-up was similar within strata of predicted CVD risk, ranging from 0.82 to 0.87. Circles represent risk ratios; vertical lines represent 95% confidence intervals. (Right) The absolute risk reduction associated with treatment versus placebo was progressively larger among participants with higher predicted CVD risk. The larger absolute risk reduction among those with higher predicted risk means that antihypertensive treatment will result in a greater reduction in events when high- versus low-risk people are treated. Circles represent risk differences (absolute risk reductions); vertical lines represent 95% confidence intervals. Reprinted with permission from Blood Pressure Lowering Treatment Trialists' Collaboration (11). BP = blood pressure; CVD = cardiovascular disease.
A simulation analysis that used the Third National Health and Nutrition Examination Survey (NHANES III) demonstrated that the use of CVD risk in conjunction with BP can prevent more CVD events than the use of BP levels alone for guiding antihypertensive treatment (12). This study evaluated U.S. adults 30 to 85 years of age who were initially without a history of myocardial infarction, stroke, or heart failure. The approach that used CVD risk in conjunction with BP assumed antihypertensive treatment would be allocated to U.S. adults with SBP ≥150 mm Hg or those projected to have an absolute CVD risk reduction >1.7% over 5 years with treatment, whereas the approach with BP alone assumed U.S. adults without diabetes mellitus would receive antihypertensive medication if they had SBP ≥140 mm Hg or DBP ≥90 mm Hg (SBP ≥130 mm Hg or DBP ≥85 mm Hg for U.S. adults with diabetes mellitus). The use of BP alone to guide treatment resulted in more U.S. adults being prescribed antihypertensive medication than the approach that used CVD risk in conjunction with BP (79 million vs. 63 million). However, over 5 years, the use of CVD risk and BP to guide treatment was projected to prevent 4.2 million CVD events compared with 3.3 million events for the approach that used BP alone. Additionally, the model suggested that the CVD risk– and BP-based approach would save more quality-adjusted life-years (22.2 million) than the approach that used BP alone (19.3 million). The potential benefits of CVD prevention with a CVD risk–informed approach versus a BP-based approach have also been noted in other U.S.-based analyses and for other countries (13,14).
Models for predicting CHD and CVD events have been in use for almost 50 years (15,16). The best-known risk prediction models were developed in the Framingham Heart Study (17–19). A model for predicting CHD by Framingham Heart Study investigators was published in 1967 (16). Equations to predict CHD have been refined and updated since that initial publication, and an equation published by the Framingham investigators was incorporated in the U.S. National Cholesterol Education Program Adult Treatment Panel guideline for the management of cholesterol (18–20). This equation was further expanded in 2008, when a model based on the Framingham Heart Study experience was developed to predict CHD, stroke, CVD death, heart failure, and claudication (17). In 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) published the Pooled Cohort risk equations (21). These equations are used to estimate 10-year risk for CVD (i.e., CHD and stroke) and were adopted by the 2013 American College of Cardiology/AHA guideline for the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults (22). This guideline incorporates a treatment approach that is based on CVD risk in conjunction with low-density lipoprotein (LDL) cholesterol levels. Specifically, statin therapy is recommended for adults with LDL cholesterol ≥190 mg/dl. In addition, statins are recommended for adults with a history of CVD or diabetes mellitus and for those with LDL cholesterol between 70 and 189 mg/dl if their 10-year risk for an atherosclerotic CVD event based on the Pooled Cohort risk equations is ≥7.5%. A number of other risk prediction models have been developed across a variety of study groups (19,23–26). Although the Pooled Cohort risk equations have exhibited good test properties in several studies, the choice of equation to estimate CVD risk in a specific setting relates to validation data showing good discrimination and calibration in the patients of interest (27–30).
The use of an equation to estimate 10-year predicted CVD risk has been shown to be substantially more accurate than clinician judgment or counting the number of risk factors for a patient (31–33). In addition, giving healthcare providers a patient's predicted CVD risk can change their treatment approach (34). A study using vignettes found that treatment increased among high-risk patients and decreased among low-risk patients when primary care providers were given the 10-year calculated CVD risk for patients. Still, risk prediction is underutilized in clinical practice (35). A survey of 952 physicians recruited from the American Academy of Family Physicians and the American College of Physicians found high awareness (92%) of global CHD risk calculators (35); however, only 41% of physicians reported using CHD risk assessment in their practice. Of those who reported calculating global CHD risk, 48% reported using it to guide antihypertensive medication treatment.
In addition to BP, older age, and history of CVD, diabetes mellitus, LDL and high-density lipoprotein (HDL) cholesterol, and smoking have substantial influences on CVD risk (21). Figure 2 shows the predicted CVD risk associated with SBP of 110 mm Hg and 130 mm Hg for hypothetical adults with low, medium, and high CVD risk estimated with the Pooled Cohort risk equations. The predicted risk for CVD among people with the same SBP can differ by >30-fold on the basis of an individual's age and the presence of other CVD risk factors. The increase in predicted CVD risk with higher BP is small among low-risk individuals, but a more substantial absolute increase in CVD risk is present for those with other CVD risk factors. On the basis of analysis of the NHANES data from 2009 to 2012, 78 million U.S. adults have SBP between 120 and 139 mm Hg or DBP between 80 and 89 mm Hg, and 31 million U.S. adults have SBP ≥140 mm Hg or DBP ≥90 mm Hg (36). In each of these populations, there is a wide range of 10-year predicted CVD risk (Figure 3). With the broad distribution of predicted CVD risk in these populations, the absolute risk reduction that results from taking BP-lowering medication can also vary. The use of BP alone to guide treatment decisions would result in the treatment of a sizable group that is likely to obtain only a small short-term reduction in absolute CVD risk.
The 10-year predicted CVD risk is shown for 6 hypothetical people: 3 people with SBP of 110 mm Hg and 3 with SBP of 130 mm Hg. For each blood pressure level, each of the 3 people has a different CVD risk factor profile. This figure shows that people's 10-year predicted CVD risk can vary >30-fold, despite having the same blood pressure level. Low risk: 50-year-old white woman, nonsmoker, without diabetes, not taking antihypertensive medication, total cholesterol of 180 mg/dl, and HDL cholesterol of 54 mg/dl. Intermediate risk: 60-year-old black man, nonsmoker, with diabetes, not taking antihypertensive medication, total cholesterol of 240 mg/dl, and HDL cholesterol of 50 mg/dl. High risk: 70-year-old white man, nonsmoker, with diabetes, not taking antihypertensive medication, total cholesterol of 240 mg/dl, and HDL cholesterol of 40 mg/dl. CVD = cardiovascular disease; HDL = high-density lipoprotein; SBP = systolic blood pressure.
The distribution of 10-year predicted cardiovascular disease risk among U.S. adults with SBP between 120 and 139 mm Hg and/or DBP between 80 and 89 mm Hg (Top) and for those with SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg (Bottom). These data were calculated using the 2009 to 2012 National Health and Nutrition Examination Survey. For each blood pressure group, there is a broad range of 10-year predicted cardiovascular disease risk. DBP = diastolic blood pressure; SBP = systolic blood pressure.
The vast majority of incident CVD events occur among adults with a 10-year predicted CVD risk ≥7.5%. Over the first 8 years of follow-up in the U.S. population–based REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, >85% of CVD events occurred among participants with a 10-year predicted CVD risk ≥7.5% (28). Although those with SBP ≥140 mm Hg or DBP ≥90 mm Hg have a higher risk for CVD than their counterparts with SBP <140 mm Hg and DBP <90 mm Hg, most incident events in contemporary studies do not occur in those in the higher BP group (37). In a pooled analysis of participants not taking antihypertensive medication from 3 observational cohort studies, only 26% of CVD events occurred among participants with SBP ≥140 mm Hg, compared with 65% of events that occurred among participants with a 10-year CVD risk ≥7.5% (37). If BP level alone was used to guide treatment, most participants who went on to have CVD events in this study would not have been recommended antihypertensive medication.
BP levels also present the challenge of measurement error and visit-to-visit variability. In an analysis of ALLHAT (Antihypertensive Lipid-Lowering to Prevent Heart Attack Trial), BP varied substantially within individuals across their follow-up visits (38). Staff members in ALLHAT were trained to measure BP, which was measured twice at each visit according to a standardized technique. Visit-to-visit BP variability is likely to be even greater in clinical practice, where BP can vary depending on the choice of sphygmomanometer and the protocol used to measure BP (39). Although treatment decisions should be made on the basis of BP averaged across multiple visits, high visit-to-visit BP variability can lead to misclassification. Additionally, visit-to-visit BP variability can mask the true reduction in BP that occurs after treatment initiation, which has led some people to propose that follow-up BP assessments should not even be conducted after treatment initiation or titration (40).
Although BP varies substantially across visits, studies have shown that predicted CVD risk has fewer intraindividual changes over short periods of time. Using data from 808 participants enrolled in NHANES III, Ye et al. (41) evaluated changes in BP and 10-year predicted CVD risk by the Pooled Cohort risk equations that occurred between 2 clinic visits conducted a median of 18 days apart (range 3 to 48 days). For individual participants, the change in SBP across these 2 visits ranged from −23 to 32 mm Hg (1st and 99th percentiles, respectively). Changes in 10-year predicted CVD risk between visits were smaller. Overall, 34% of participants had an 8 mm Hg or larger difference in SBP between visits, whereas only 8% had a ≥3% difference in 10-year predicted CVD risk. Given its stability over short periods of time, 10-year predicted CVD risk could confer utility for clinical decision making.
Age is unquestionably the most important determinant of CVD risk, presumably because it represents the cumulative exposure to risk factors (42,43). Because CVD risk increases with age, almost all adults ≥65 years of age have a high CVD risk (43). Concern has been raised about antihypertensive treatment for older adults, especially those who are frail (44). In SPRINT (Systolic Blood Pressure Intervention Trial), the treatment of SBP to a goal of 120 mm Hg (intensive goal) was associated with a lower risk of CVD and all-cause mortality than for participants treated to a goal SBP of 140 mm Hg (usual goal) (45). The CVD and mortality benefits were present among participants ≥75 years of age and in subgroups with and without indications of frailty (46). It is noteworthy that SPRINT enrolled adults with high CVD risk, defined by a history of CVD, estimated glomerular filtration rate of 20 to 59 ml/min/1.73 m2, age ≥75 years, or 10-year predicted global CVD risk (including heart failure and claudication) ≥15% on the basis of the Framingham CVD risk score (47).
Several guidelines have incorporated global CVD risk into their treatment decision-making recommendations using a 5-year or 10-year time horizon (7,8,22,48). These 5- and 10-year intervals are used because they identify people who are likely to benefit from treatment in the short term. Only a small proportion of adults <50 years of age have a high 10-year predicted CVD risk (49). The use of 10-year predicted risk to guide antihypertensive treatment results in a disproportionate selection of older adults, even though a substantial proportion of young adults have a high 30-year and lifetime risk for CVD (50,51). For example, a 45-year-old woman with total cholesterol of 260 mg/dl, HDL cholesterol of 35 mg/dl, and untreated SBP of 160 mm Hg would be predicted to have a 10-year CVD risk <10% but a 30-year CVD risk of almost 30%. Furthermore, preventing 1 CVD event in a younger adult could result in substantially more life-years gained compared with preventing an event in an older adult. Patients might value the short-term benefit of treatment more than future benefits that accrue over a long time horizon. To account for this valuation, economists often apply a discount that weights near-term risk reduction benefits more than those that occur in the future. In one example, Jackson et al. (52) applied a 3% annual discount such that events that were prevented in the first year of follow-up were weighted at 100%, whereas those prevented in the next year were valued at 97%, and in the year after at only 94% (52,53). With application of a 3% annual discount to allow for this value judgment, and with recognition of the higher case-fatality rate associated with CVD events at older age, the difference in average life expectancy gained with antihypertensive treatment between young and old adults is smaller than one would assume. In addition, although older adults are more likely to experience disability from a CVD event, it is possible that younger adults could lose more quality of life than older adults after an event. However, this has yet to be quantified. Another concern with not treating high BP among young adults is the risk for the development of left ventricular hypertrophy or albuminuria. It is uncommon for young adults with high BP but no other risk factors to develop organ damage (54).
Antihypertensive medication is a cornerstone therapy among patients with diabetes mellitus and CKD (55–57). Because most people with CKD or diabetes have high CVD risk, and more patients with CKD die of CVD than develop end-stage renal disease, a risk-based treatment approach might allocate antihypertensive treatment to a higher proportion of those with CKD or diabetes than treatment on the basis of BP alone (58–61). Colantonio et al. (62) used data from the REGARDS study to show that only 8% of adults with CKD not taking statins have a 10-year predicted CVD risk <7.5%. The incidence of CVD was very low in those with CKD and a 10-year predicted CVD risk <7.5% (3 events per 1,000 person-years) (62). The use of predicted CVD risk would result in the recommendation that almost all adults with CKD and diabetes receive antihypertensive treatment. Data from the REGARDS study suggest that treatment for the small subgroup of adults with CKD and low 10-year predicted CVD risk can be delayed; however, there might be some young adults with a substantial reduction in estimated glomerular filtration rate or heavy proteinuria for whom treatment could still be warranted, despite having low CVD risk.
The HOPE (Heart Outcomes Prevention Evaluation) 3 trial randomized 12,705 adults at intermediate CVD risk to 12.5 mg of hydrochlorothiazide/16 mg of candesartan or placebo (63). In a pre-specified subgroup analysis, antihypertensive treatment was associated with a statistically significant 27% risk reduction of the primary outcome (death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke) among participants with baseline SBP >143.5 mm Hg, but no risk reduction was present among those with SBP ≤131.5 mm Hg or 131.6 to 143.5 mm Hg. Although HOPE-3 did not address treatment of high-risk populations, it does support treating all people with SBP ≥140 mm Hg. Additionally, the HOPE-3 data suggest that moderate BP lowering with fixed-dose agents among low- or intermediate-risk patients with SBP <140 mm Hg might not prevent CVD events.
The extent to which predicted CVD risk aligns with the observed risk (i.e., calibration of the risk prediction equations) has been studied extensively over the past several years. Some studies have found that risk prediction equations accurately estimate risk, whereas others suggest a discrepancy between predicted and observed risk in the context of contemporary clinical practice with frequent use of risk-lowering medications (27–30). CVD incidence in the United States has declined over the past 30 years in association with greater use of preventive medications, and many risk prediction equations were developed in cohorts that were initiated in the 1980s and 1990s, when preventive medications were used less often (70,71). In countries where the risk of CVD is declining, poor calibration of risk prediction equations could result in treating populations with a lower risk than intended. The application of risk prediction models in populations other than those in which they were developed, including in contemporary clinical practice, might require recalibration (72,73).
Most CVD risk prediction equations are focused on CHD and stroke as outcomes. There are risk prediction models, including the Framingham global CVD risk score for general practice, that include a broader range of CVD outcomes, including heart failure and claudication (17). High BP is associated with an increased risk for left ventricular hypertrophy, CKD, end-stage renal disease, atrial fibrillation, dementia, peripheral artery disease, and retinopathy (74–80). CVD risk scores do not include these as outcomes. Additional research could be conducted to investigate the development of risk prediction equations that focus on hypertension-related CVD as outcomes, as well as to test whether these models would be more cost-effective and would address patient preferences better than existing risk prediction models.
The discussion of the evidence related to incorporating CVD risk in clinical decisions for antihypertensive medication initiation and treatment intensification should not distract from the need for primordial prevention. It has been shown that almost all adults will eventually develop a 10-year predicted atherosclerotic CVD risk ≥7.5%, despite maintaining an optimal risk factor profile (43). Many people have a high CVD risk early in life because they develop modifiable risk factors. Preventing these risk factors will delay the development of high CVD risk into older age. Physical activity, weight loss, reducing alcohol intake, and dietary changes (reduced sodium intake, increasing potassium intake, and following the DASH [Dietary Approaches to Stop Hypertension] diet) have been demonstrated in randomized trials to lower BP (81). These factors, as previously studied, are relevant to all people, regardless of CVD risk or BP level.
On the basis of data from observational studies, concern has been raised about potential increased CVD and mortality risk among people with low BP, particularly among those with heart disease or diabetes (82–84). This effect might reflect very low BP not being sufficient for organ perfusion, a low pressure due to preexisting organ damage, or confounding. Meta-analyses of randomized controlled trials have suggested that lowering BP to <120 mm Hg does not increase CVD or mortality risk (85–87); however, there may be little benefit associated with lowering SBP much below 120 mm Hg (86). Considering both observational and randomized controlled trial data, it would be hard to justify prescribing or intensifying antihypertensive medication for people with SBP <120 mm Hg or DBP <60 mm Hg, regardless of their global CVD risk.
We think it is important to consider both CVD risk and BP levels in making treatment decisions. Meta-analyses of randomized trials have demonstrated clear CVD risk reduction benefits with treatment of SBP ≥140 mm Hg or DBP ≥90 mm Hg, but these trials have generally excluded low-risk individuals (88). Additionally, there are data supporting antihypertensive treatment for individuals with lower BP levels, especially among adults with CVD or a high global CVD risk (85). Within this context, for example, one approach might be to treat all adults with SBP ≥140 mm Hg or DBP ≥90 mm Hg, as well as those with SBP of 130 to 139 mm Hg or DBP of 80 to 89 mm Hg and a 10-year CVD risk ≥10% according to the Pooled Cohort risk equations (Central Illustration). The 10% CVD risk threshold is consistent with event rates from previous meta-analyses (11,89). Cost-effectiveness studies and consideration of patient preference will be useful for guiding the level of CVD risk at which populations should be recommended antihypertensive medication treatment initiation.
Previous and new recommended approaches to determining which patients should receive antihypertensive treatment.
The current review summarizes the evidence related to incorporating patients' absolute CVD risk, in addition to their BP levels, into the decision for antihypertensive medication use. The use of predicted CVD risk in conjunction with BP levels to guide antihypertensive treatment initiation will focus risk reduction on patients who are most likely to receive a benefit from treatment, while avoiding therapy for those who are likely to receive little risk reduction benefit. This approach would acknowledge that people with the same BP level can have markedly different 10-year CVD risks and that the vast majority of CVD events occur in high-risk populations. In conclusion, the use of global CVD risk and BP levels to guide antihypertensive treatment could provide a more personalized approach for reducing risk.
Dr. Whelton is Chair and Dr. Muntner is a member of the American College of Cardiology/American Heart Association Guideline for the Management of Hypertension writing committee; however, this work does not reflect the opinion of the American College of Cardiology, American Heart Association, or the writing committee. Dr. Muntner was supported by grant 15SFRN2390002 from the American Heart Association; and has received research support from Amgen, Inc. unrelated to this paper. Dr. Whelton has reported that he has no relationships relevant to the contents of this paper to disclose.
Revision received February 16, 2017.
(2002) Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–1913, [published correction appears in Lancet 2003;361:1060].
(2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560–2571, [published correction appears in JAMA 2003;290:197].
(1993) Blood pressure management: individualized treatment based on absolute risk and the potential for benefit. Ann Intern Med 119:329–335.
(1993) Management of raised blood pressure in New Zealand: a discussion document. BMJ 307:107–110.
(2007) European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 28:2375–2414.
(2016) Guideline for the diagnosis and management of hypertension in adults: 2016. Med J Aust 205:85–89.
(2011) NICE clinical guideline 127. Hypertension: clinical management of primary hypertension in adults (NICE, London, UK).
National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. NIH publication no. 98-4080. 1997. Available at: https://www.nhlbi.nih.gov/health-pro/guidelines/archive/hypertension-jnc6. Accessed March 9, 2017.
(1997) The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 157:2413–2446, [published correction appears in Arch Intern Med 1998;158:573].
(2014) Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 384:591–598.
(2013) Using benefit-based tailored treatment to improve the use of antihypertensive medications. Circulation 128:2309–2317.
(2016) Alternative strategies to achieve cardiovascular mortality goals in China and India: a microsimulation of target- versus risk-based blood pressure treatment. Circulation 133:840–848.
(2011) Individualized guidelines: the potential for increasing quality and reducing costs. Ann Intern Med 154:627–634.
(1973) Coronary Risk Handbook: Estimating the Risk of Coronary Heart Disease in Daily Practice (American Heart Association, New York, NY).
(1967) A multivariate analysis of the risk of coronary heart disease in Framingham. J Chronic Dis 20:511–524.
(1976) A general cardiovascular risk profile: the Framingham Study. Am J Cardiol 38:46–51.
(2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2935–2959, [published correction appears in J Am Coll Cardiol 2014;63 pt B:3026].
(2014) 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2889–2934, [published corrections appear in J Am Coll Cardiol 2015;66:2812 and J Am Coll Cardiol 2014;63 pt B:3024–5].
(2007) Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA 297:611–619, [published correction appears in JAMA 2007;297:1433].
(2008) C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation 118:2243–2251, 4p following 2251.
(2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Münster (PROCAM) study. Circulation 105:310–315, [published correction appears in Circulation 2002;105:900].
(2016) Development and validation of risk prediction models for cardiovascular events in black adults: the Jackson Heart Study Cohort. JAMA Cardiol 1:15–25.
(2014) Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations. JAMA 311:1406–1415.
(2015) An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med 162:266–275.
(2016) Accuracy of the atherosclerotic cardiovascular risk equation in a large contemporary, multiethnic population. J Am Coll Cardiol 67:2118–2130.
(2003) Physicians' ability to predict the risk of coronary heart disease. BMC Health Serv Res 3:13.
(1995) Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study. BMJ 310:975–978.
(1996) Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease. Ann Intern Med 124:414–421.
(2013) Providing clinicians with a patient's 10-year cardiovascular risk improves their statin prescribing: a true experiment using clinical vignettes. BMC Cardiovasc Disord 13:90.
(2012) Use of global coronary heart disease risk assessment in practice: a cross-sectional survey of a sample of U.S. physicians. BMC Health Serv Res 12:20.
National Center for Health Statistics. National Health and Nutrition Examination Survey 2011-2012 overview. CDC. Available at: https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/Overview.aspx?BeginYear=2011. Accessed March 16, 2017.
(2015) Identifying individuals at risk for cardiovascular events across the spectrum of blood pressure levels. J Am Heart Assoc 4:e002126.
(2015) Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: a cohort study. Ann Intern Med 163:329–338.
(2005) Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 45:142–161.
(2009) Mixed models showed no need for initial response monitoring after starting antihypertensive therapy. J Clin Epidemiol 62:650–659.
(2014) Effect of change in systolic blood pressure between clinic visits on estimated 10-year cardiovascular disease risk. J Am Soc Hypertens 8:159–165.
(2015) Heart disease and stroke statistics: 2015 update: a report from the American Heart Association. Circulation 131:e29–e322, [published corrections appear in Circulation 2016;133:e417 and Circulation 2015;131:e535].
(2012) Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 172:1162–1168.
(2015) A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373:2103–2116.
(2014) The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials 11:532–546.
(2016) Prevalence of eligibility criteria for the Systolic Blood Pressure Intervention Trial in US adults among excluded groups: age <50 years, diabetes mellitus, or a history of stroke. J Am Heart Assoc 5:e003547.
(2012) Lifetime risk and years lived free of total cardiovascular disease. JAMA 308:1795–1801.
(2005) Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk. Lancet 365:434–441.
(1996) Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 276:1253–1258.
(1997) The hypertension detection and follow-up program: 17 years on. JAMA 277:167–170.
(2015) (8) Cardiovascular disease and risk management. Diabetes Care 38(Suppl):S49–S57.
(2013) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. Am J Kidney Dis 62:201–213.
(2000) Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 36:646–661.
(2007) The impact of reclassifying moderate CKD as a coronary heart disease risk equivalent on the number of US adults recommended lipid-lowering treatment. Am J Kidney Dis 49:37–45.
(2008) Risk prediction of cardiovascular disease in type 2 diabetes: a risk equation from the Swedish National Diabetes Register. Diabetes Care 31:2038–2043.
(2011) Trends in the risk for coronary heart disease among adults with diagnosed diabetes in the U.S.: findings from the National Health and Nutrition Examination Survey, 1999–2008. Diabetes Care 34:1337–1343.
(2015) Cause of death in patients with reduced kidney function. J Am Soc Nephrol 26:2504–2511.
(2015) Contrasting cholesterol management guidelines for adults with CKD. J Am Soc Nephrol 26:1173–1180.
(2016) Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 374:2009–2020.
(2010) The effect of giving global coronary risk information to adults: a systematic review. Arch Intern Med 170:230–239.
(2006) The impact of a decision aid about heart disease prevention on patients' discussions with their doctor and their plans for prevention: a pilot randomized trial. BMC Health Serv Res 6:121.
(2002) Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary risk. Health Expect 5:3–15.
(2006) A multidimensional integrative medicine intervention to improve cardiovascular risk. J Gen Intern Med 21:728–734.
(2003) A factorial randomised controlled trial of decision analysis and an information video plus leaflet for newly diagnosed hypertensive patients. Br J Gen Pract 53:446–453.
(2009) Individuals' responses to global CHD risk: a focus group study. Patient Educ Couns 76:233–239.
(2014) Declines in coronary heart disease incidence and mortality among middle-aged adults with and without diabetes. Ann Epidemiol 24:581–587.
(2012) Twenty-two-year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987-2008. Circulation 125:1848–1857.
(2005) The accuracy of the Framingham risk-score in different socioeconomic groups: a prospective study. Br J Gen Pract 55:838–845.
(2004) Predictors of new-onset kidney disease in a community-based population. JAMA 291:844–850.
(1997) Incidence of and risk factors for atrial fibrillation in older adults. Circulation 96:2455–2461.
(1999) Retinal arteriolar diameters and elevated blood pressure: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 150:263–270.
(1996) 15-year longitudinal study of blood pressure and dementia. Lancet 347:1141–1145.
(2001) Peripheral vascular disease and hypertension: a forgotten association? J Hum Hypertens 15:447–454.
(1987) Left ventricular hypertrophy in hypertension: prevalence and relationship to pathophysiologic variables. Hypertension 9:II53–II60.
(2012) Blood pressure indexes and end-stage renal disease risk in adults with chronic kidney disease. Am J Hypertens 25:789–796.
(2002) Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 288:1882–1888.
(2012) Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes: retrospective cohort study. BMJ 345:e5567.
(2012) Blood pressure j-curve: current concepts. Curr Hypertens Rep 14:556–566.
(2016) Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 387:435–443.
Optimal systolic blood pressure target after SPRINT: insights from a network meta-analysis of randomized trials. Am J Med, [E-pub ahead of print]. 2017 Jan 19.
(2016) More versus less intensive blood pressure-lowering strategy: cumulative evidence and trial sequential analysis. Hypertension 68:642–653.
(2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338:b1665.
(2015) Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis. Ann Intern Med 162:184–191.


Novo Holdings, the holding company in the Novo Group, is responsible for the management of the assets of the Novo Nordisk Foundation, which are currently valued at more than DKK 300 billion.
Novo Holdings is a private limited liability company fully owned by the Novo Nordisk Foundation.
Besides being the major shareholder in the Novo Group companies, Novo Holdings provides seed and venture capital to development stage companies and takes significant ownership positions in well-established companies, within life science, as well as manages a broad portfolio of financial assets.
As the majority shareholder in three large Danish companies, Lundbeck, Falck and ALK-Abelló, Lundbeckfonden is one of the largest, industrial foundations in Denmark. In 2015, the market value of the foundation's commercial activities amounted to close to DKK 50 billion including a portfolio of internally managed securities of about DKK 15 billion. In addition to this, the foundation manages a portfolio of more than 20 life science investments. Lundbeckfond Emerge is the early stage investment unit of the foundation.
With a primary focus on brain health, Lundbeckfonden annually grants DKK 400 - 500 million to support biomedical research of the highest, international quality as part of the foundation's vision to create better lives through new knowledge.


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Talented students at Samarkand state university
Positive traditions are held at Samarkand state university in order to support and award talented students. Adopting the students into scientific researches and creative surrounding of the university, special attention is paid for attracting them in participation in State Scholarship of the President of the Republic of Uzbekistan, named scholarships, competition on disciplines, contests, scientific projects in the framework of State program, to the scientific schools and constructional offices, conferences and seminars, for publishing article, story and poems in scientific and public publications.
The students of Samarkand state university participate actively in contests of State Scholarship of the President of the Republic of Uzbekistan and named scholarships and competitions on disciplines. During independence years, our 16 students were the winners of State Scholarship of the President of the Republic of Uzbekistan, 98 students were the winners of State Scholarship of Navai, Beruni, Ulugbek, Islom Karimov.
More than 180 students got honourable places on competitions of discipolines. Besdies it, annually almost 20 students get University Scholarships named after academicians Аkbar Otakhodjaev, Vohid Abdulklaev, Gafur Gulyam, Boturkhon Valikhodjaev, Sadi Sirojiddinov, Ibrohim Muminov, Yahyo Gulomov and Jura Saidov in order to stimulate talented students.
Oripov Khasan Abdivakhobovich,
Winner of the State Scholarship of the President of the Republic of Uzbekistan
Oripov Khasan Abdivakhobovich was admitted to the master's degree to the Faculty of Psychology and Social Sciences of Samarkand State University in "Methods of teaching social sciences (Fundamentals of Spirituality) in the 2018-2019 academic year,."
Oripov Khasan is one of the leading students of the faculty, distinguished by his exemplary behavior, excellent grades in all subjects and active participation in public affairs. During this period, he has shown himself with initiative, activism and passion for science.
Oripov Khasan Abdivakhobovich took the 2nd place in the regional stage of the republican festival "Highly spiritual generation" in 2016 in the nomination "Scholar of the works of the President."
Currently, as a gifted student, he conducts research on "The deepening trends of global crisis in social networks and the impact on personal information culture," and as a result of his research published about 20 scientific articles in national and international newspapers and magazines and conference proceedings.
Oripov Khasan Abdivakhobovich is the winner of the State Scholarship named after Navoi in the 2016-2017 academic year, the State Scholarship of the President of the Republic of Uzbekistan in the field of pedagogy in the 2019-2020 academic year.
Isakhonov Jafarkhon Akbar ugli
Winner of Navoi State Scholarship
Isakhonov Jafarkhon Akbar ugli was admitted to the bachelor's degree in "Social Work" of the Faculty of Psychology and Social Sciences of Samarkand State University in the 2016-2017 academic year.
During his studies at the university, Isakhanov Jafarkhan earned the respect and attention of the university community for his diligence, inquisitiveness, sincerity and kindness, leadership skills, exemplary behavior and activism.
Isakhanov Jafarkhon Akbar ugli has published more than 20 articles in international and national scientific journals, as well as in a number of national conferences and foreign collections. Fluent in Russian and English, works on himself regularly.
Isakhonov Jafarkhon Akbar ugli is the winner of the Navoi State Scholarship in the 2019-2020 academic year.
Isakhanov Jafarkhon Akbar ugli has been showing interest and talent in science, spiritual and educational activities during his studies at the university.
Shamsiev Jamshid Isomiddin ugli
Winner of the State Scholarship named after Islam Karimov
Shamsiev Jamshid Isomiddin ugli was admitted to the bachelor's degree in "Personnel Management" of the Faculty of Socio-Economics of Samarkand State University in the 2017-2018 academic year.
Shamsiev Jamshid is distinguished among the students of the faculty and the university by his exemplary behavior, excellent grades in all disciplines, as well as his initiative, activity, active participation in public affairs.
Shamsiev Jamshid won the regional stage of the competition "Youth Union Scholarship" for the 2018-2019 academic year and received a ticket to the republic stage. Currently, as a gifted student, he conducts research on "Ways to increase the competitiveness of the tourism industry" and as a result of his research published about 20 scientific articles in national and international newspapers and magazines and conference proceedings.
Shamsiev Jamshid Isomiddin ugli is the winner of the State Scholarship named after Islam Karimov in the 2019-2020 academic year.
Shavkiev Oybek Salimboy ugli
Winner of the Navoi State Scholarship
Shavkiev Oybek Salimboy ugli was admitted to the bachelor's degree in "National Ideology, Fundamentals of Spirituality and Legal Education" of the Faculty of Psychology and Social Sciences of Samarkand State University in the 2016-2017 academic year.
Shavkiev Oybek is distinguished among the students of the faculty and the university by his exemplary behavior, excellent grades in all disciplines and initiative, activism, aspiration to science, active participation in public affairs.
Shavkiev Oybek regularly participated in events with personal initiatives and articles at the Department of "Legal Education" of Samarkand State University, as the leader of the circle "Legal Advocacy" during the 2016-2018 academic year. He conducts research on "Development of scientific, religious and philosophical views in Central Asia." He has been actively participating in more than 15 national and university conferences, seminars and foreign (US, Polish, Ukrainian, Russian and Kazakh) journals with his thesis and articles.
Shavkiev Oybek Salimboy ugli is the winner of the Navoi State Scholarship in the field of social sciences and humanities in the 2019-2020 academic year.
Sayidkulov Asliddin Khusniddin ugli
Winner of the State Scholarship named after Ulugbek
Sayidkulov Asliddin Husniddin ugli was admitted to Samarkand State University, Faculty of Applied Mathematics and Informatics for a bachelor's degree in "Applied Mathematics and Informatics" on the basis of a state grant in the 2017-2018 academic year.
Sayidkulov Asliddin is distinguished among faculty and university students by his exemplary behavior, excellent grades in all disciplines and initiative, activism, aspiration to science, active participation in public affairs.
Sayidkulov Asliddin Khusniddin ugli took the honorary 1st place in the regional stage of the 2018 International Olympiad in Informatics. In 2018, he took the 2nd place in the Republican stage of "Innovation Idea & Software - 2018" organized by TATUSF. He also participates in the Republican Science Olympiads on the basics of programming. Currently, as a gifted student, he conducts research on "Methods of management based on the automation of the educational process" and as a result of research published about twenty scientific articles in national and international newspapers and magazines and conference proceedings.
Sayidkulov Asliddin Khusniddin ugli is the winner of the State Scholarship named after Ulugbek for bachelors of the Republic of Uzbekistan in the 2019-2020 academic year.
Meliev Khudoyor Tashkobil ugli
Winner of the State Scholarship named after Navoi
Meliev Khudoyor Tashkobil ugli was admitted to Samarkand State University to study at the bachelor's degree in "Personnel Management" of the Faculty of Economics and Business in the 2016-2017 academic year.
Meliev Khudoyor stands out among the students of the faculty for his exemplary behavior, excellent grades in all disciplines and active participation in public affairs.
Meliev Khudoyor is the head of the "Youth Union" of Faculty of Economics and Business of Samarkand State University. As a gifted student, he is currently conducting research on "Employment and its efficiency in a market economy" and as a result of his research has published about 20 scientific articles in national and international newspapers and magazines and conference proceedings. .
Meliev Khudoyor Tashkobil ugli is the winner of the Navoi State Scholarship for bachelors of the Republic of Uzbekistan in the 2019-2020 academic year.
Kakhorova Aziza Nuridinovna
Kakhorova Aziza Nuridinovna was admitted to the bachelor's degree in "Physics" at the Faculty of Physics of Samarkand State University in the 2017-2018 academic year.
Kakhorova Aziza Nuridinovna is distinguished among the students of the faculty and the university by her exemplary behavior, excellent grades in all disciplines and initiative, activism, aspiration to science, active participation in public affairs.
Aziza regularly participates in national and international scientific conferences and competitions. Her more than 10 articles and theses have been published in international and national journals. Fluent in Russian and English, works on himself regularly.
Kakhorova Aziza Nuridinovna is a laureate of the State Scholarship of the President of the Republic of Uzbekistan in the field of natural sciences in the 2020-2021 academic year.
Mullaeva Mehrangiz Akhtam kizi,
Mullaeva Mehrangiz Akhtam qizi was admitted to the bachelor's degree in "Professional Education: Economics" at the Faculty of Economics and Business of Samarkand State University in the 2017-2018 academic year.
Mehrangiz is one of the leading students in the faculty due to his exemplary behavior, excellent grades in all subjects and active participation in public affairs. During this time, he has shown himself to be enterprising, active, and eager for science.
Mullaeva Mehrangiz regularly participates in scientific conferences and various competitions at the national and regional levels. More than 10 scientific articles have been published in national and regional journals. Fluent in Russian and English, works on himself regularly.
Mullaeva Mehrangiz is the winner of the Navoi State Scholarship for bachelors of the Republic of Uzbekistan in the 2020-2021 academic year.
Dustmurodov Nursultan Ilkhom ugli,
Dustmurodov Nursultan Ilkhom ugli was admitted to the bachelor's degree in "Physical Culture" of the Faculty of Physical Culture of Samarkand State University in the 2017-2018 academic year.
Nursultan Dustmurodov regularly took part in competitions between the republican, regional and higher educational institutions, won various prizes.
Nursultan won the three-time champion of Uzbekistan in academic rowing, as well as was awarded a diploma of the 2nd degree in the Cup of Uzbekistan.
He is an active participant in the annual student scientific conferences. About 10 scientific articles have been published in national and international journals. Fluent in Russian and English.
Dustmurodov Nursultan Ilkhom ugli is the winner of the Navoi State Scholarship for bachelors of the Republic of Uzbekistan in the 2020-2021 academic year.
Teshayev Doniyor Majid ugli,
Teshaev Doniyor Majid ugli was admitted to the bachelor's degree in "Social Work" of the Faculty of Psychology and Social Sciences of Samarkand State University in the 2017-2018 academic year.
Doniyor is known among faculty and university students for his exemplary behavior, excellent grades in all subjects, and initiative, activism, passion for science, and active participation in public affairs.
Doniyor's more than 10 scientific articles have been published in national and foreign scientific journals. Fluent in Russian and English, works on himself regularly. University and faculty are one of the most active students in public affairs.
Teshaev Doniyor Majid ugli is the winner of the competition "Scholarship for scientific research" of the Federation of Trade Unions of Uzbekistan.
Teshaev Doniyor Majid ugli is the winner of the Navoi State Scholarship for bachelors of the Republic of Uzbekistan in the 2020-2021 academic year.
Sayfinov Rustam Sadulla ugli,
Sayfinov Rustam Sadulla ugli was admitted to the bachelor's degree in "Physics" of the Faculty of Physics of Samarkand State University in the 2017-2018 academic year.
Rustam is distinguished among faculty and university students by his exemplary behavior, excellent grades in all disciplines and initiative, activism, aspiration to science, active participation in public affairs.
Rustam regularly participates in scientific conferences and competitions at the national and university levels. His more than 10 articles and theses have been published in international and national journals. Fluent in Russian and English, works on himself regularly.
Sayfinov Rustam Sadulla ugli is the winner of the State Scholarship named after Ulugbek for bachelors of the Republic of Uzbekistan in the 2020-2021 academic year.
Husanov Abdurozik Zarifjon ugli,
Husanov Abduroziq Zarifjon ugli was admitted to the bachelor's degree "Mathematics" of the Faculty of Mechanics and Mathematics of Samarkand State University in the 2017-2018 academic year.
Abdurozik is known among faculty and university students for his exemplary behavior, excellent grades in all disciplines, and initiative, activism, aspiration for science, and active participation in public affairs.
Husanov Abdurozik Zarifjon ugli regularly participates in scientific conferences and various competitions at the national and university levels. His more than 15 articles and thesises have been published in international and national journals. Fluent in Russian and English, works on himself regularly.
Husanov Abduroziq Zarifjon ugli is the winner of the State Scholarship named after Ulugbek for bachelors of the Republic of Uzbekistan in the 2020-2021 academic year.
Abduvohidova Mokhinur Akmalovna,
Abduvahidova Mokhinur Akmalovna was admitted to the bachelor's degree in "Economics " at the Faculty of Economics and Business of Samarkand State University in the 2017-2018 academic year.
Abduvahidova Mokhinur Akmalovna regularly participates in scientific conferences and various competitions at the national, regional and higher levels.
To date, about 10 scientific articles by Abduvahidova Mokhinur Akmalovna have been published in national and regional journals. Fluent in Russian and English, works on herself regularly.
Abduvahidova Mokhinur has been showing interest and talent in science, spiritual and educational activities during her studies at the university.
Abduvahidova Mokhinur Akmalovna is the winner of the State Scholarship named after Islam Karimov for bachelors of the Republic of Uzbekistan in the 2020-2021 academic year.
Samarqand davlat universiteti stipendiatlari to'g'risida ma'lumot
Note for master's student Timetable of classes Progress Attendance Capable students Scholarships Student residences State examinations Announcement of the topic of master's thesis Master's thesis defense

redpajama_set_name: RedPajamaCommonCrawl


RENTON, Wash. — The Seattle Seahawks have signed special teams standout Sean Morey to a multiyear contract.
The team announced Monday that it had a deal with the 2008 Pro Bowl selection from the Arizona Cardinals. The 34-year-old was an alternate for last season's Pro Bowl.
Morey's specialty is punt and kickoff coverage.
Morey was a seventh-round draft choice by New England in 1999. He spent the past three seasons with the Cardinals and has made 151 tackles on special teams in 109 games.
He has led his team in special teams tackles five times in seven full NFL seasons. He has 11 career receptions as a wide receiver.


If you employ people simply because they're able to do a job, they'll get the job done for your wealth. Use exactly the same process to spot and rate competencies to be able to pinpoint which ones are vital to the job. At length, define the way the job relates to other positions in the corporation. Whether you need assistance getting your very first job, starting your own company, or navigating through... Read More Not lots of us are good book learners.
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Tag: pattullo bridge
Speed on the Pattullo Bridge
September 21, 2015 January 24, 2016
Driving, New Westminster
In April 2015 G. Ho Engineering Consultants prepared a report for TransLink titled Pattullo Bridge Road Safety Assessment. In it they examined (amongst other things) speed levels on the Pattullo.
The speed limit on the Pattullo Bridge is 50 km/h, as the bridge is narrow, lacks a barrier between opposing traffic flows, lacks a barrier between the sidewalk and the adjacent traffic lane, and lacks modern crash standards on the parapets (the sides of the bridge that would stop cars from swan diving into the Fraser).
They collected speed data on November 7, 2014, and what they found was fairly alarming. 50% of northbound (Surrey to New Westminster) were travelling over 50 km/h, while nearly 95% of southbound were breaking the speed limit. About 12% of the vehicles were travelling faster than 70 km/h, the critical speed to safely negotiate the curve on the south side of the bridge.
But in the week between November 2 and November 8, over 1600 vehicles were recorded going over 100 km/h. This is faster than the 90 km/h speed limit on parts of the new, five-lane Highway One, on a bridge that's half the size!
The engineering consultants gave three recommendations for improving the safety on the Pattullo Bridge:
close the middle lanes for 16 hours a day, opening them only for the morning and afternoon peak periods;
install a permanent concrete median barrier and remove one northbound travel lane; or
install a permanent concrete median barrier and remove one lane in each direction.
Options 2 and 3 are non-starters, as neither Surrey nor New Westminster want to deal with horrendous traffic caused by drivers trying to shoehorn into one lane on the bridge.
Of course, the proper fix is to tear down the Pattullo and build a new, safer bridge, but that's not going to happen any time soon. As this story puts it: "A transit plebiscite that was to secure funding for the replacement had failed earlier this year." And of course the province isn't going to do anything about it (yet they can apparently study a bridge to the Sunshine Coast).
If I could be so bold as to offer another safety-improving measure (and I will) that would be photo radar. The Pattullo Bridge is the perfect location for it. Put cameras on the mid-bridge spans and at either end. Have them ticket drivers going faster than 65 km/h. The 1600 people driving faster than 100 km/h would be hit with a $368 fine for excessive speed, netting nearly $600,000 in fines. Over a year, that's over $30 million!
But realistically that's a non-starter as well. The Liberal government axed photo radar in BC because for some reason people enjoy breaking the laws of the road and getting away with it, and for some reason the Liberals listened to all of those people whining about getting a ticket in the mail. And that's a shame, because whining wins out against safety.
Referendum Facts: The Pattullo Bridge
2015 Transit Referendum, New Westminster, TransLink, Transportation
No matter what happens in the upcoming Metro Vancouver transportation referendum, the Pattullo Bridge will be replaced, and it will be tolled.
The Pattullo Bridge went into service in 1937. It was constructed to the standards of the time, which means that today it is too narrow, it's dangerous, and if an earthquake hits it's coming down. It's so dangerous that TransLink closes the central two lanes at night to prevent head-on collisions. Cycling or walking over the bridge is nearly unheard of.
In short, it's a bridge in dire need of replacement. It will be replaced.
And tolls? In 2008 TransLink announced its replacement would be tolled. That was six years before any hint of a referendum. Tolling the replacement Pattullo is a foregone conclusion. At current traffic levels, a $3 toll would pay off a $900 million bridge in about 30 years, so the tolls would eventually be dropped.
Now that that's out of the way, here's why voting 'yes' in the referendum is important for the areas around the Pattullo Bridge:
1) The 0.5% PST increase will fund its replacement.
2) Along with the big capital projects, bus and SkyTrain service will be improved. This means that transit in Surrey, Langley, Delta, and New Westminster will become more attractive, shifting some driving commuters to transit commuters. This will help to slow the increase in congestion around the Pattullo Bridge.
3) The LRT lines in Surrey and Langley will also help shift people away from cars to transit, as connections with SkyTrain from Surrey to New Westminster, Burnaby, and Vancouver will be easier for commuters to make. This will also help to slow the increase in congestion around the Pattullo Bridge.
And here's what voting 'no' in the referendum will result in, around the Pattullo Bridge:
1) Property tax increases will fund its replacement.
2) Because bus and SkyTrain service is not improved, traffic around the Pattullo Bridge will get worse at a greater rate. In fact, keeping funding levels steady means that bus and SkyTrain service could get worse, as operational costs increase. This could shift transit commuters into cars.
Voting 'no' means you get a new Pattullo Bridge, have to pay tolls on it, and traffic gets worse.
Voting 'yes' means you get a new Pattullo Bridge, have to pay tolls on it, and traffic gets better. And with improved bus and SkyTrain service (and the Surrey/Langley LRT lines) you might decide to take transit and skip paying the tolls altogether.
Vote 'yes', not only for a new Pattullo, but for improved bus and SkyTrain service in Surrey, Delta, and New Westminster, and for less congestion over the Pattullo.


Remember when you fired your dad's shotgun as a youth? We'll wager his old shotgun didn't fit you very well, and perhaps the experience was not all that pleasant. Not all shooters and hunters are built the same, and often it takes some fitting to get a shotgun to shoulder quickly, point well and swing on target, even for full-sized shooters. For smaller-framed shooters, women and youth, the new Super X3 Compact in 12 or 20 gauge could change their entire outlook on hunting and sport shooting. You feel the difference as soon as you pick one up. The lightweight aluminum alloy receiver, ultra light magazine tube and spring, satin walnut stock with a shortened length of pull trim nearly 3/4 of a pound of weight compared to the Super X®2. A premium Pachmayr® Decelerator® recoil pad helps manage felt recoil. The lighter weight barrel further reduces weight with a narrow profile and a machined rib. Both 12 and 20 gauge models feature Back-Bored Technology for the ideal combination of shot uniformity and velocity. The gunmetal gray Perma-Cote™ UT (Ultra Tough) finish is more durable and corrosion resistant than traditional blued finishes. For balance, superior fit and smooth follow-through there is nothing more suited for younger, lighter-framed shooters than the new Winchester® Super X3 Compact.
Barrel Length 26" Overall Length 15 3/4"
Length of Pull 13 1/4" Drop at Comb 1 1/2"
Length of Pull 13 1/4" Drop at Comb 1 5/8"


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Pregnancy weight gain correlates with kids' obesity, study says
Updated Jan 09, 2019; Posted May 06, 2016
By Laura Frazier | The Oregonian/OregonLive
A pregnant woman is seen by a midwife. A recent study looked at how a mother's weight gain and blood sugar during pregnancy can affect their child's risk of obesity. (CLAUDIO SANTANA/AFP/GettyImages)
A baby born at a normal size but to a mother who gained too much weight during pregnancy is more likely to be overweight or obese, a new study found.
The study, released Friday, analyzed how a woman's weight and blood sugar levels during pregnancy can affect her child's risk of becoming overweight or obese, even when the child was born within the range of a "normal" birth weight.
The study found that normal-weight babies whose mothers had the highest blood sugar levels were 30 percent more likely to be obese or overweight during childhood. Those whose mothers had excessive weight gain were 15 percent more likely to be overweight or obese.
Researchers already knew that a mother's high blood sugar and weight gain can result in a heavy baby with an increased risk of obesity, the study said. Babies born at a low birth weight are also at greater risk for obesity. For the latest study, researchers focused on babies born at 5.5 to 8.8 pounds, considered the range for a normal birth weight.
"You can't just assume they are normal based on their birth weight," said Teresa Hillier, endocrinologist and senior investigator with Kaiser Permanente's Center for Health Research and study author.
The study, said to be the largest conducted on the topic, followed more than 24,000 mothers and their children over the course of 10 years. Of the children born to those mothers, some were excluded from the study sample for various reasons, including if the baby had low birth weight, the study said. The mothers and babies were Kaiser Permanente members in Oregon, Hawaii and Washington.
Ultimately, the study tracked 13,037 normal weight babies born between the years 1995 and 2003. To calculate body mass index, researchers measured each child's height and weight an average of 9.5 times between the ages of 2 and 10. Mothers were screened for gestational diabetes and weighed multiple times, Hillier said.
All of the children who were born to mothers who had elevated blood sugar levels during pregnancy were at a higher risk of obesity, the study found. But children whose mothers had gestational diabetes, the highest levels of elevated blood sugar, were at least 30 percent more likely to be overweight in comparison to children whose mothers had normal blood sugar levels.
Researchers also evaluated the effects of a mother's excessive weight gain, noting that the Institute of Medicine recommends that women gain no more than 40 pounds during pregnancy. The study found that children whose mothers' weight gain hit or surpassed that benchmark were at least 15 percent more likely to be overweight or obese. Gaining less than 40 pounds would have prevented childhood obesity in about 426 children tracked for the study, authors wrote.
The increases in a mother's blood sugar and excessive weight gain appeared to have affected her child's metabolism, causing an "imprint" for obesity, Hillier said. The babies were adapting to either too much weight or too much sugar.
"There is a critical window in pregnancy where nutrition alters the metabolism in some way that permanently alters it for the baby," Hillier said. "Somehow, the baby is sensing an overfed environment."
Other factors aside from pregnancy weight gain and blood sugar levels, such as poor exercise and lack of access to healthy foods, can also affect a child's risk of obesity, Kaiser Permanente said in a statement. The Centers for Disease Control and Prevention reported that more than a third of children and adolescents were overweight or obese in 2012.
The study shows that what happens to a child's metabolism in the womb may be equally as important as their care after they are born, according to a statement. Hillier hopes the study will show women that they can work with their healthcare providers to help their babies get "the best metabolic chances."
"There's something they can do during their pregnancy that can potentially make a big impact in improving their child's long term health," Hillier said. "For future mothers, we can intervene to help them have a healthy pregnancy."
The study was published in the Maternal and Child Health Journal.
--Laura Frazier
lfrazier@oregonian.com
@frazier_laura


Mercedes Elizalde thinks the race to represent the Seattle City Council's 5th District will be won or lost on neighborhood doorsteps.
Elizalde is the most recent candidate to launch a campaign in the North Seattle district as the council moves to geographic representation this year for seven of its nine seats.
The 28-year-old, who rents an apartment in Jackson Park and works in community engagement at the Low Income Housing Institute, announced last month.
"I've been working for nonprofits for a long time and I know how to raise money," she said.
The 5th District, in addition to Jackson Park, includes neighborhoods such as Broadview, Bitter Lake, Northgate and Lake City.
Elizade has lived in her current apartment for only eight months, and two years is the longest she's lived in a single home since moving to Seattle about five years ago.
"That's part of why I'm running. I've had to chase affordable rents," she said.
"With rents going up 5 to 10 percent and incomes for most people going up 2 percent, if at all, it's really hard for people to put down roots," the candidate added.
Elizalde, who co-chairs the Seattle Women's Commission, says officials should be looking at boomtown neighborhoods such as Ballard as they prepare for growth elsewhere.
Light-rail is coming to the 5th District, and the city should complement it with sufficient affordable housing, sidewalks, street lights and police resources, she said.
"Ballard is a great example of somewhere that has had a lot of housing built but not as much planning around what happens with transportation and public safety," she said.
"Development is coming to the North End. It's not a question of if. It's a question of how," Elizalde went on, suggesting that the focus be on holistic, "community-centered" growth.
Other candidates in the 5th District are Mian Rice, son of former Seattle Mayor Norm Rice; Sandy Brown, a former Methodist pastor; and Halei Watkins, a political organizer for Planned Parenthood.


The study was more informative than the "smoking cessation trial"-style trials with THR products (the fatal flaws in which we have discussed before) because subjects were smokers without an active interest in quitting and were offered e-cigarettes in what sounds like a fairly real-life manner. A remarkable number of them switched — hooray!
See also Bergen's interview with Polosa.
He recognizes that the inventorying of chemicals in tobacco products is required by law, but urges FDA to downplay the results, since claims that fiddling with chemistry reduce harm for cigarettes (or matter at all for low-risk alternatives) are contrary to FDA's promised science-based approach. This very short, cogent comment would affect the behavior of anyone with shame about making silly scientific claims. In other words, it will be ignored.
It is kind of an interesting experiment, given that smokeless tobacco is hugely over-taxed and e-cigarettes have to be smuggled in: How much do you have to lower the price of pharma products to make them more attractive for THR. Apparently "free" is sufficient, since there was huge interest on the first day. It will be interesting to see what they do when they figure out that most people taking the offer are not trying to become abstinent.
The National Institute of Health and Clinical Excellence awards a grant for "guidance development services", whatever that means. But regular readers will recall that NICE is basically just trying to co-opt the term THR for business-as-usual extremist approaches (and you will recall that they allowed us to be a "registered stakeholder" for these efforts — until they got our comments, at which time they booted us). So it seems safe to decide that the best we can hope for is that nothing comes of this.
Fortunately for us, even Waxman cannot manage to kill countless people by restricting food marketing, as he has done with anti-THR. Perhaps not so fortunate for food companies, though.
In response to trumped up worries about PG exposure from e-cigarettes from several of what he calls "anti-smoking and health groups" (he cannot bring himself to identify the as anti-tobacco extremists), Michael Siegel wonders why they are not calling for a removal of PG in cigarettes. This, of course, is also disingenuous, since the quantity of PG taking in from smoking is much smaller, but that is what makes it such a great "nyah nyah": force the people who are making anti-scientific claims to try to figure out how to argue the science.
Landmark Supreme Court ruling over Vancouver site clears the way for Quebec. Can we expect e-cigarette promotion to follow? Not a chance (see the first article above).
The new cause of drag is the Conservative opposition in the Senate questioning the wisdom of the policy, and so delaying a vote. Supporters of the proposal immediately leaped into full paranoia/denial/Orwell mode, suggesting that any opposition to them must be about tobacco company interests. Meanwhile, the UN is shocked! shocked! that cigarette companies whose core assets (brand identity) would effectively be confiscated by this policy are taking legal action, and this action might discourage other countries from pursuing the same treaty-violating policies. The bastards.
David Sweanor does not use most of those words in this brief commentary, but that is the basic message. It contains nothing that our regular readers do not already know, but it is a nice mash-up of the two themes, silly extremist behavior and the basic case for THR.
Arguably even sillier than opposing THR while coming up with controversial policy interventions that have measurable effects only in someone's dreams, Legacy has skipped the policy and skipped right to the dreaming with their book and associated only discussion, "After Tobacco: What Would Happen If Americans Stopped Smoking?" …. Sorry, zoned out there for a minute, thinking about how nice it would be to get paid big bucks to daydream about what will happen when the extremists stop working to prevent THR.
In fairness, it only increased from 2% of the market to 10%, so it is still way short of Canada's and many other black markets. We were just following the lead of the ANTZ, who would use the huge-sounding relative figure if it was a statistic they wanted to create alarm about.
This must mean that Big Pharma is marketing to kids, right?
In a study to be presented at this year's American Academy of Pediatrics National Conference and Exhibition, it was found that kids and teachers could not tell the difference between medicine and candy 20% of the time. The study was conducted by two seventh-grade students (not yet inculcated in ANTZ thinking patterns) who came to the common sense conclusion that safe storage was the key rather than removing the medicines from the market.
« There's more elephants in the room or on contemplating the new user red herring.


text:
Buffy Comic Collections, Season Nine
Welcome to the Team
Buffy the Vampire Slayer Season Nine vol. 4
Guarded The Core
Andrew Chambliss
Penciller(s)
Georges Jeanty
Karl Moline
Scott Allie
Sierra Hahn
Cover artist(s)
Jo Chen
"Welcome to the Team" is the fourth volume of Buffy the Vampire Slayer Season Nine trade paperbacks, collecting issues sixteen to twenty of the comic book series.
Buffy is unwillingly recruited by the demon Illyria and a mystical council to take down the Siphon — for good. He is on the loose again, and a danger to all remnants of magic! Meanwhile, back home the loss of magic has begun to affect those closest to Buffy…[1]
Welcome to the Team, Part One
Welcome to the Team, Part Two
Welcome to the Team, Part Three
Welcome to the Team, Part Four
Buffy Summers (5/5)
Dawn Summers (5/5)
Xander Harris (5/5)
Anaheed (4/5)
Billy Lane (4/5)
Illyria (4/5)
Severin (4/5)
Andrew Wells (3/5)
Eldre Koh (3/5)
Robert Dowling (3/5)
D'Hoffryn (2/5)
Simone Doffler (2/5)
Cover gallery and sketchbook.
French: Bienvenue dans L'Équipe (Welcome to the Team)
German: Willkommen in der Gang (Welcome to the Gang)
Italian: La Nuova Recluta (The New Recruit)
Spanish: Bienvenida al Equipo (Welcome to the Team)
Cover artwork
Cover in France
Cover in Germany
Cover in Italy
Cover in Spain
↑ "Buffy the Vampire Slayer Season 9 Volume 4: Welcome to the Team TPB". Dark Horse Comics.
Retrieved from "https://buffy.fandom.com/wiki/Welcome_to_the_Team?oldid=173390"
Buffy Comic Collections
Season Nine


This Corvette 427/400hp is 1 of 1,932 L68 models produced in 1968. It is a true numbers matchingvehicle, engine runs flawlessly and the paint is in excellent condition. Power steering, power brakes and telescoping steering wheel. This car has always been garaged and well maintained. Vehicle factory production information documented by NCRS.
Original POS Dealership:DON LERCH CHEVROLET, DOYLESTOWN, OH. ZONE #28/ DLR # 324.
VIN: 194678S421533. Engine Block: I8S421533. Casting Date: C-7-8. (Thursday March 7th, 1968).
Engine type: Big Block 427ci / L68 / 400hp / 3 two barrel carbs / 4 speed manual transmission. Manufacture Plant #T0424IM. (Tonawanda, 04= April, 24= 24th day (Wednesday), IM code is Chevy 400hp).
Intake Manifold: 3937795. Manufacture Date: 12/67.
Carbs- End carbs #3659. Center Carb #4055.
Exhaust Manifolds- Left #3880827. Right #3880828.
Transmission tail housing: #3857584 GM.
Transmission ID stamp: #6A12343 / P1026.
Rear end casting number: #3818753-N.
Rear end ratio- 3:08 to 1.
Paint Code: 992 (Corvette Bronze). Current color- Chevrolet Rally Red.
Interior: Black. Soft top: Black.
Interior restoration: 3/09. New:Factory original correct: leather seat covers/door panels/carpet/center console. Re-chrome rear bumpers.
Engine rebuild Date: 4/09. OD Mileage at time of rebuild: 78,644.
Please email if you have further questions (ssontag@yahoo.com).


text:
propertyskipper - Property for Sale in Guernsey
Alderney Castel Forest Sark St. Andrew's St. Martin's St. Peter's St. Peter Port St. Sampson's St. Saviour's Torteval Vale
Property Type Commercial Holiday Accommodation Land Property
Min TRP 25 50 75 100 150 200 250 300 350 400 450 500 550 600 650 700 750 800 850 900
4 Bed Property in St. Saviour's, Guernsey
GBP £795,000
This detached family home is situated in a quiet, rural lane in the heart of St. Saviour, close to Perelle Bay. Extended in recent years, the accommodation is well-proportioned and comprises entrance hall, two bedrooms,…
Property Details Add to Shortlist
Location Situated in a quiet lane just inland in between Perelle and L'Eree Bay, enjoying nearby amenities including Perelle garage and supermarket, The Driftwood Inn Hotel and Bistro and The Taste of India restaurant. A…
196 TRP
This wonderful family home has been recently upgraded by the current owners and is presented to the market in move-in condition. La Mielle sits in a very quiet lane in a coastal location, just inland between Perelle Bay…
Guernsey Sales
Property for Sale Alderney
Property for Sale in St. Peter Port
Property for Sale Castel
Property for Sale St. Martin's
Property for Sale Forest
Property for Sale St. Andrew's
Guernsey Rentals
Property to Rent in Alderney
Property to Rent in St. Peter Port
Property to Rent Castel
Property to Rent St. Martin's
Property to Rent Forest
Property to Rent St. Andrew's


It is a small former industrial town suffering from a depressed economy as industry has dried-up within the borough. Pottstown has suffered from spiritual dryness as well, and for some time - years in fact.
The area has suffered from scandal and a general lack of trust within the Christian community, including Church splits and strife among denominations. The Christian community is longing for Kingdom Work and a rebuilding of trust, first within the church, and a commitment to be the Body of Christ within the community.
We intend to connecting with local Churches and Ministries to partner and become part of the local faith community leadership to help reestablish a visible church that cares.
Pottstown's social problems are based economically, between those who have, living on the borders of the borough, and those without becoming more distinct in their differences as one lives closest to the center of town, creating a polarizing effect between the haves and have-not's.
This can be seen by the sever drop in income, the mentally challenged, and reliance on governmental programs, the closer one live to the center of town, and the affluence that is evidenced the further one moves from the center of town.
Washington and Chestnut Streets are at the heart of Pottstown. Here, life is busy, as people struggle to make ends meet. It is these people Jesus loves and has called us to with the message of God's love, and His kingdom.
Profusion, the mad rush to keep-up, births fear and desperation. In his book, Hurtling Toward Oblivion, Dr. Richard Swenson outlines a logical argument for the end of the age that he calls profusion. In his book, he describes the effects of the realistic phenomenon of More/Faster; a simple equation that is being played-out within our world today.
More + Faster + Fallen-ness = The End of the Age.
Health and Welfare: the way we view, and ultimately take care of people; etc.
Working within corporate America, I have a real vantage point to see why these trickle-down effects impact us, seemingly for no reason. They are economicly driven by investment. Money is the motivation for efficiency, downsizing, and any number of buzz-words that mean layoff, little opportunity and poor wages for those who cannot keep-up.
We have heard the complaint both on the street, and up to the Vice Presidents office within major corporations, and there is no turning back time. Those on the street (who do not have the perspective or the stamina of the upper office) truly are tossed and have no idea why. Their lives are busy hectic from trying to stay ahead of the wrecking ball while on a rollercoaster that seems to be getting faster and more fierce all of the time.
How can they become quieted - still - content - peaceful, in order to hear from God; to hear His still small voice.
We would like to work hard to create a place called still waters, that the people of Pottstown would be able to find that peace and quietness, in order to hear from God and be changed; so that they could walk with God in the cool of the day.


The kids have been wanting them for a while, and I was all, "Hey, it's that gifty time coming up soon!" So I made them. These patterns aren't mine!
We went back and forth a bit. Spider-Man Minion, Pikachu, Burpy, Pikachu… This is what we ended up with. Of course, the day I was assembling it, my son was all, "I just want a Spider-Man Minion." Well, tough. You're getting Pikachu.
Pattern found here. It's a really good pattern, very straightforward and easy-to-follow, with clear pictures of how to put it all together.
Kreacher! She loves Kreacher so much. I have Lego Harry Potter and she LOVES playing Kreacher. I don't know why, but… Here he is!
Pattern found here. To sum up beforehand, I would recommend this pattern, but definitely not for someone new to amigurumi. At length: let me say first of all that I LOVE how he looks all put together. The shaping is excellent and the designer did a really good job designing him. Also, the first part of the pattern is very well-written. There are clear pictures on how to put everything together on the head, and the fingers are done interestingly, and again… Very clear. However. The last part of the pattern isn't done as well. Stitch counts are missing, and there's no clear pictures or instructions on how to assemble everything to the body. The angle for the head, especially, would have been good. What I did was I sewed the head on, sewed the shirt on, and then sewed the arms into the armholes so that I knew it would fit.
I also made a gallbladder. 😀 There will be pics of that soon and a free pattern up on here. Next will be… Probably the Dorothy outfit for my other 18″ doll so she can stop being naked, but I also want to crochet a strand of Christmas lights to hang up in here. So that'll probably come first.


This was allegedly the first iPod ad to deploy Apple's "Rip. Mix. Burn" slogan in 2006. A white teenager enters a concert hall filled with popular musicians, each of whom responds to their inclusion on a simulated playlist by being extremely compliant, friendly and/or flirtatious to illustrate the ease of assembling collections of even extremely eclectic music.
Representing a utopian moment in the digitization of commercial music, it is difficult to reconcile this portrayal of collaborative rapport between musicians and consumers seen in this ad with the concurrent shock-and-awe tactics of the RIAA in prosecuting its customers for ripping, mixing and burning music in other contexts.


Ratin is a 41 years old lady from Malang, Indonesia. She is a Muslim and she is married and have 2 children, age 24/ 12 y.o. She is not able to eat pork but she can handle pork. Her highest qualification is Junior high school. Previously, she have experience in Singapore for 2 years. Finished Contract.
She has the patience and experience taking care of children( 2, 7, 10 y.o). She can sent them to school, make breakfast, dress them school uniform, play with them, and she can sleep with them as well.
She is willing to taking care or elderly. And willing to learn. She can bring them for medical checkup/ exercise and assist in works. She can help to remind them eat medicines timely.
She can cook food like nasi lemak, rendang, grilled chicken and fish, chicken black sauce, soto, satay chicken, stir fry spicy prawn/ squid, spicy eggplant, ayam penyet, curry chicken, fried rice, fried veggies, fried chicken, chicken soup, fried noodle, porridge. Her cooking is nice and she is confident in her cooking. And she willing to learn more.
She can speak basic English. And she is willing to learn.
She wishes to have 1 off day and FOR SALARY ENQUIRIES AND SET-UP INTERVIEW, PLEASE CONTACT THE AGENCY AT 8372 1338 / 9851 7061.
2015 2017 Singapore Malay FAMILY Her duties was taking care of children( 2, 7, 10 y.o) boys and girl. Do general house works, cleaning, prepare food for madam to cook. It is a HDB, 4 rooms. There are 5 members in the family- Sir, mam, and 3 children. Finished contract.


New buildings often capture the imagination of policy-makers tasked with economic development in cities. However, too often they have lacked the data and knowledge they need to make the best decisions on commercial space in their places.
This is a gap we've tried to address in our recent report Building Blocks, which examines the composition on commercial property in cities in England and Wales. And to complement the report, we've also launched a handy new data tool, which will enable policy-makers and property professionals to compare commercial space across cities for the first time.
The dashboard allows you to look across three datasets: the types of commercial space in each city centre and suburb, high street vacancies across city centres, and the average quality of office space in city centres.
As a quick example, let's compare two city economies – Leeds and Bradford.
Leeds has a roughly average amount of office space in its city centre, but its offices are also of above average quality. However, although Leeds has slightly less retail space than other city centres, it also has a larger than average share of high street vacancies in the city centre. This suggests that while the city already has many office jobs, it may need to attract more to increase footfall for the high street. Another consideration could be to reduce or convert poor quality and unoccupied retail space into other uses in higher demand.
Bradford looks very different. It has less city centre office space than average, and much more retail – 40 per cent of the city centre are shops, compared to the average of 26 per cent across English and Welsh cities. Not only does Bradford have more shops than average, it also has twice as many high street vacancies – suggesting it has too many shops for the current size of its economy. The city also has far fewer-than-average high quality offices.
The dashboard shows that the commercial property issues faced by Leeds and Bradford are significantly different. While the commercial space in Leeds' city centre is already orientated around office jobs and high-skilled, exporting work, Bradford relies too much on its weak high street shops.
To revive the fortunes of their high streets, cities like Bradford need to attract more jobs in high-skilled exporting firms which prefer to locate in city centres – like marketing, IT, and graphic design – which can then support local services like shops and cafes. Building Blocks shows how Bradford's City Hub office scheme is providing exactly the kind of commercial space needed to attract these kinds of firms to the city centre.
The dashboard's maps on office quality and high street vacancies also reveal significant geographic patterns across the country.
We'll continue to explore more of the report's findings in more blogs over the coming weeks, and feel free to get in touch if you have any questions about the report or the dashboard.
Explore the Building Blocks commercial property dashboard here.


text:
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The folks at the Hotel Metro pride themselves on never overbooking, a common practice at larger properties. "I can count on one hand the number of times we had to walk a visitor to another property," Amy Schmidt, the sales manager, told me. "And then it was because of a guest staying longer than they originally said they would." It's that sort of up-front friendliness and honesty that makes this a prime choice in midtown. It's not the most stylish hotel (think rather bland, modern Art Deco décor, in tans and burgundies), but this 1901 property has capacious rooms for this price category, and such nice extras as a free--and generous—continental breakfast, a library that guests can use as a lounge, and roof-top bar with Empire State Building views. The gym is a good-size, too, also with terrific views, so you don't have to stare at the wall as you work out. An excellent choice for families, as their two-room suite feature three, large beds (so no one gets stuck sleeping on the fold-out sofa).