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All About Kat Timpf's Boyfriend, Life, and Career
Posted by Christian AhanonuPosted in Personalities April 16, 2021
Strange that Kat Timpf's Boyfriend is an ex-Army Officer under the USA Military. Yet, Kat Timpf bears the known personality of a cat; a Television spokesperson and commenter in the day, and comedienne at night. Double life she leads and she does this perfectly well, at no time mistaking one for another.
Then this is not all, the self-opinionated female has had her share of personal misfortunes, one of which is losing her mother. Adding to this is the consequence of making jokes about Star Wars that incurs the anger of Star Wars lovers! Pheewwww! Close call!
However, regardless of the public perception about her, Kat Timpf is undeterred. She loves what she stands for, what she represents and she values the freedom to do or say her views. So even though she seeks better offers, higher platforms, Kat keeps screaming her views no matter what. Still, what beats my imagination is how she does his effortlessly, like without breaking a sweat!
Now not everyone will feel comfortable wearing multiple hats, all divergent and seemingly unrelated nor interconnected. Plus, not everyone can handle the duties and obligations attached to these roles without a mental crash. Meant for the few select persons who can, society considers them geniuses even though they really might be average persons.
Kat Timpf proves to fit perfectly into every hole and what more? Kat Timpf's boyfriend is Cameron Friscia who she loves and enjoys intimate moments with. Nevertheless, come ride with us and be familiar with the world of Kat Timpf and maybe you get to learn more.
Kat Timpf's Boyfriend
Recently she has denied committing to any romantic relationship with Joel Pavelski although there are rumors that they once dated. RJ Blake is also a former boyfriend to Kat Timpf.
However, Kat Timpf's boyfriend is an army veteran standing at 6ft and works at Coatue Management as a Research Associate. Though a resident of White Plains New York, Kat Timpf lives no farther too. Not much is known about the two love birds beyond this except we know him to be Cameron Friscia.
Bio and Body Stats
Kat Kimpf is born Katherine Clare Timpf on the 29th of October 1988 to Daniel Timpf and Anne Marie Timpf. She is raised in Detroit, Michigan and although she is American, she has a German and Polish heritage.
Brainy Kat Timpf earned a scholarship in High School, giving the class Valedictorian Speech upon graduation. She obtained admission to the prestigious Hillsdale College, graduating magna cum laude in 2010.
Besides, Kat Timpf lost her mom to a terminal illness – cardiac amyloidosis, just three months after she got a job. The hazel-eyed blond weighs 54kg with a height of 5ft 6in, hips 35, and waist 24
While on campus, Kat worked for a website titled "CampusReform" reporting various campus misconduct. Upon graduation from college, she secured a job as an anchor for NASA's Third Rock Radio. Adding to this pedigree, she also at some point in her career worked as Digital Editor for Washington Times. Contributing also to Orange County Register and Investor's Business Daily as a columnist. Initially securing a columnist job at the National Review Online, Kat is known for her radical views and satires.
2015 sees her coming onboard the Fox News Network. In June 2019, Kat Timpf assumed the position as Host on Fox Nation's Show and Sincerely Kat. Subsequently, she has worked as a Producer and Reporter at Total Traffic Network Santa Ana California. Presently, she runs the Kat Timpf Show and co-hosts the Fox News Specialists. She has also appeared on The Nightly Show with Larry Wilmore. Primarily, she had interned at the Fox Biz News and the KFI News in California. She runs the Tyrus and Kat Podcasts also.
Notwithstanding, she has had some appearances with Sustern, Stossel, and Sunday Morning with Maria Bartiromo. Furthermore, she has appeared on the Greg Gutfeld Show, Fox and Friends, American Live with Megyn Kelly. Kat performs standup comedy sessions in clubs like Gotham Comedy Club in New York and the Improv in Los Angeles at some point. Likewise, she has appeared on the Morning Drive Show Baltimore 98 Rock as a comedienne.
Asides from all these, she was a speaker for Silicon Valley at the 2019 YALCIN. In 2012, she received an award from The Robert Novak Journalism Fellowship Program for her professionalism in Journalism. Kat Timpf has a net worth of $1 million. More information on her? Please kindly
Kat Timpf's satires and innuendos on political events are refreshing especially coming from a liberalist. The one thing she struggled with during her days as a columnist on National Review was watching her mom slowly pass away. Made it even more difficult having to travel from New York to Boston.
This little incident did not stop her from being the professional that she is or expressing her views on political events. Her meteoric rise into being a force to be reckoned with (both on Television Shows and by writing) only means one thing. Kat Timpf is here to stay.
Elin Zetterstrand: 8 Lesser Known Facts About Markus Persson's Ex-wife That Will Shock You
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Top 10 secrets about Roberta Raffel, the wife of Marcus Lemonis
Roberta Raffel whose full name is Roberta Bobbi Raffel came into the limelight after her relationship which eventually led to …


Police in Anaheim, Calif., have restored order after violent protests over weekend police shootings caused injuries and two dozen arrests.
This entry was posted on July 25th 2012 at 4:44pm/16:44 and is filed under Live News Column 1. You can follow any responses to this entry through the RSS 2.0 feed.


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Yemen cholera outbreak kills 2,150
Edited By Odishatv Bureau Published By IANS On Oct 14, 2017 - 9:24 AM
United Nations: The cholera outbreak in the war-torn Yemen is the largest single-year cholera outbreak ever on record and over 2,150 people have died since April, said a UN official.
"Over 820,000 suspected cholera cases and over 2,150 associated deaths since April 27 have been reported as of Thursday," UN Spokesman Stephane Dujarric, told reporters on Friday at the UN Headquarters, Xinhua news agency reported.
"The outbreak has spread to 92 per cent of Yemen's districts," he said. This week the World Health Organization (WHO) chartered two flights to the traditional capital of Sanaa carrying more than 53 tons of essential medicine and medical supplies.
9 killed, 33 injured in blast outside Kabul University
After ICJ rap, Pakistan agrees to grant consular access to…
Dujarric said humanitarian workers reached "more than 2.2 million people with essential medicine and (medical) kits, including providing some 600,000 with medicines for non-communicable diseases."
He also said the WHO and the UN children's agency (UNICEF) were helping local health authorities in all of Yemen's governorates in a polio vaccination campaign aimed at reaching 5.3 million children under the age of five.
Yemen has been caught up in a civil war since a Shia insurgency led by Hussein al-Houthi began in 2004 and has now drawn in a Saudi Arabia-led coalition to help the government counter it.

redpajama_set_name: RedPajamaCommonCrawl


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Victor Hedman Stats
D | Tampa Bay Lightning
29 48th
Victor Hedman Last 10 Games
Victor Hedman News
Victor Hedman • D • Lightning
Victor Hedman Won't Play On Friday
Tampa Bay Lightning defenseman Victor Hedman will miss Friday's matchup against Winnipeg for personal reasons. He has returned home to be with his wife as the couple is expecting their second child. It's the third game Hedman misses this season. The former Norris Trophy winner had a quiet start to 2022-23, but he has picked up the pace lately and exits the lineup after having a run of 13 points in 10 games. Hedman had managed 25 points in 35 games for the whole campaign. Tampa's No. 1 defenseman has spent a lot of time with Mikhail Sergachev lately, but the Russian rearguard will now be joined by Nick Perbix on Friday. The 24-year-old rookie is also set for second power-play duty, so he could be an intriguing fantasy piece for Friday's slate.
Jan. 1st • 7:50 AM
Victor Hedman Dishes Out Three Assists
Tampa Bay Lightning defenseman Victor Hedman was in a giving mood in the final game of 2022, recording three assists in a 5-3 win over Arizona. Two of his helpers came with the man advantage. Hedman has recovered well from a slow start and heads into 2023 with a run of 11 points in eight games. He's on 23 points overall in 33 games with 68 shots, 51 hits and 58 blocks. By averaging over two shots on goal, Hedman has been a busy man in the offensive zone, but he has lit the lamp just once so far and will definitely hope for more puck luck in 2023.
Nov. 5th • 6:36 PM
Victor Hedman Returns To Action Saturday
Tampa Bay Lightning defenseman Victor Hedman (upper body) appears ready to rejoin the lineup Saturday versus Buffalo after missing two games. He is taking pregame warmups, as is Nicholas Paul (undisclosed), who made an early exit Thursday against Carolina. Hedman has been in beast mode at both ends of the ice this season and is looking to add to eight points, 16 blocks and 14 hits on Saturday. He's gone scoreless just twice in nine previous outings this season, and he should be an automatic starter for fantasy managers when healthy.
Nov. 2nd • 9:36 PM
Victor Hedman Listed As Day-To-Day
Tampa Bay Lightning defenseman Victor Hedman missed his first game of the season Tuesday versus Ottawa, and he's now listed day-to-day with an upper-body injury. Hedman was a game-time decision for the match and ended up not playing to focus on treating his ailment. The Lightning lost a massive part of their team, but they were still able to sneak a 4-3 victory. Mikhail Sergachev picked up most of the slack and ended up logging a season-high 25:04. He had a goal and an assist in the contest. The Russian rearguard will continue to play a huge part until Hedman is ready to return to action.
Tampa Bay Lightning Top Scorers
Brayden Point 29 25 54
Steven Stamkos 24 33 57
Brandon Hagel 19 22 41
Nikita Kucherov 19 53 72
Nick Paul 16 10 26
Alex Killorn 14 20 34
Ross Colton 10 11 21
Corey Perry 9 10 19
Mikhail Sergachev 6 27 33
Vladislav Namestnikov 5 1 6
Victor Hedman Game Logs


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Asia-Pacific Roundup: TGA ends COVID exemptions for ventilators, PPE
Roundups | 02 February 2021 | By Nick Paul Taylor
Australia's Therapeutic Goods Administration (TGA) has let the emergency measures imposed to help the supply of medical devices during the pandemic lapse. The change means products will need to be included in the Australian Register of Therapeutic Goods (ARTG) to be supplied in the country.
In March and April 2020, Australia responded to worries about the availability of personal protective equipment (PPE) and ventilators by enacting emergency exemptions. The ventilator exemption gave hospitals the option of sourcing equipment that was manufactured to certain minimum technical requirements but was not approved by TGA.
Similarly, the PPE exemption freed suppliers of masks and other protective equipment from certain rules, including those related to conformity assessments, provided they had a contract with an agency such as the Australian Government Department of Health. Both exemptions ended on 31 January.
With Australia currently averaging around six cases of COVID-19 a day, the situation in the country has stabilized to the extent that TGA has allowed the exemptions to lapse.
The change has implications for organizations that sourced equipment under the exemptions. TGA said hospitals with unapproved ventilators can continue to use them but are responsible for considering how and when to deploy the equipment. Those considerations should take the limitations of the ventilators into account. From now on, only ventilators in the ARTG can be supplied in Australia.
TGA Notice
Pakistan posts guidelines on responsible use of antimicrobials in humans
The Drug Regulatory Authority of Pakistan (DRAP) has published guidelines intended to reduce the inappropriate use of antimicrobials in humans. Pharmaceutical and diagnostic companies are among the stakeholders targeted in the guidelines.
DRAP wants the pharmaceutical industry to ensure marketing and promotional activities aimed at healthcare professionals in Pakistan comply "with the particulars listed in the summary of product characteristics" and encourages "the rational use of the medicinal product." The agency also called on drugmakers to align financial incentives with the principles set out in the guidelines and to monitor for evidence of drug resistance and off-label use of their products.
The guidelines also target the diagnostic industry. DRAP wants the industry to address the need for point-of-care surveillance as well as surveillance and support studies into the use and cost-effectiveness of novel antimicrobial tests.
The guidelines also directly address the regulation of antimicrobials. DRAP is planning to limit the use of last-resort antimicrobials, ensure labels carry up-to-date information about resistance and "review, or establish, the legal provisions on over-the-counter and without prescription availability of antimicrobials." Additional labeling to highlight the risk of causing resistance through the irrational use of antimicrobials is under consideration.
DRAP created the guidelines in response to the World Health Organization's (WHO) 2015 global action plan on antimicrobial resistance. WHO called on all countries to establish national action plans aligned with its own global proposal and the standards and guidelines of intergovernmental bodies.
DRAP Guidelines
TGA fines Life Biotech $81,000 over alleged false and misleading information
TGA has fined Life Biotech AU$106,560 ($81,250) for alleged non-compliance with requests for information and face mask samples in relation to COVID-19. The agency has accused the Australian seller of products including KN95 respirators of "providing false and misleading information."
A postmarket review of face masks by TGA found that Life Biotech failed to comply with a number of requests for information and samples. The Therapeutic Goods Act 1989 requires companies to respond within specified time frames. When Life Biotech responded to other requests, it allegedly provided "partial, late and misleading responses."
Now, TGA has issued eight infringement notices related to Life Biotech's alleged noncompliance with the reporting requirements. The multiple infringements resulted in one of the largest fines issued by TGA in relation to COVID-19.
The fines follow other questions about masks that claim compliance to KN95, a performance rating under a Chinese standard. Concerns that the masks may fail to provide consistent and adequate respiratory protection have led regulatory agencies including Health Canada and the US Food and Drug Administration to issue safety notices.
DRAP shares advice on CTD filings, creates regulatory support desk
DRAP has published advice on the use of Form 5F to apply for marketing authorization for a new or generic drug product. The publication comes months after DRAP shared guidance on the Common Technical Document (CTD)-based Form 5F.
In the new documents, DRAP answers common questions about the switch to the CTD format and discusses the creation of targeted regulatory support. The frequently asked question text explains that companies seeking marketing authorizations for new and generic drugs need to use Form 5F. Companies seeking to export drugs can use either Form 5F or Form 5D. Manufacturers of veterinary medicines cannot use Form 5F.
DRAP also clarifies how Drug Master Files (DMF) interact with CTD filings. Submission of a DMF is optional, DRAP explained, but details of the drug substance need to be shared in the relevant sections of Form 5F.
Manufacturers that need additional support can reach out to the recently created CTD Facilitation Desk. DRAP has established the desk and published documents including a pre-submission screening checklist to improve implementation of Form 5F. The flurry of activity follows the release of guidance intended to increase the consistency of submissions made to DRAP.
DRAP FAQ, More
China's CDE issues update on breakthrough drug designation program
China's Center for Drug Evaluation (CDE) has shared details of the progress of its breakthrough drug designation program. CDE has accepted 26 therapies onto the breakthrough channel since publishing details of the initiative in July.
The initiative, which is intended to accelerate access to new medicines and improve use of regulatory resources, attracted early applications from Legend Biotech, Takeda Pharmaceutical and Johnson & Johnson's Chinese R&D arm Xian Janssen. Legend Biotech became the first company to have a drug accepted into the program less than one month after CDE posted the program's details.
The rate at which CDE accepted drugs into the program accelerated later in 2020. Toward the end of the year, companies including CStone Pharmaceuticals and Bayer secured breakthrough designations for their candidates, driving the total number of products with the status up toward 30.
CDE Notice, More (both Chinese)
Other News:
TGA has shared details of Boxed Warnings now carried by products containing pregabalin and gabapentin. The additions warn both drugs pose a risk of misuse. The gabapentin warning also states it carries a risk of dependence. The risks can be life threatening. The addition of the warnings follows a TGA investigation into continuing reports of misuse, abuse and dependence. TGA Notice
China's CDE has issued guidance on adaptive clinical trials. The guidance addresses the factors sponsors need to consider when evaluating the suitability of an adaptive design, before going on to discuss commonly used techniques such as group sequential design, sample size re-estimation and adaptive enrichment. CDE Guidance (Chinese)
Malaysia's National Pharmaceutical Regulatory Agency (NPRA) has published the third edition of its Drug Registration Guidance Document. NPRA described the document as a major revision of the text it released in 2016. NPRA Guidance
Recon: FDA rejects Biocon insulin biosimilar; Olympus says it's fixing issues raised by FDA at Japanese facilities
Advocacy groups, AdvaMed vie for next phase of TAP pilot


A number of recent arrests have highlighted the role citizen smartphones can play in documenting police action, and while courts have sided with camera-wielding observers in the past, civilians who tape police making a bust may still face their own arrest, legal experts and activists say.
Several court rulings have upheld a civilian's First Amendment rights to videotape cops performing their jobs in public places, legal experts say.
On July 1, cellphone footage from a passerby showed a California Highway Patrol officer allegedly holding a 51-year-old woman on the ground near a Santa Monica freeway and repeatedly striking her.
How and when a person takes video of police officers in action may play a role in whether or not the camera-holder could him or herself be arrested.
In May, the U.S. Court of Appeals for the First Circuit wrote that, "reasonable restrictions on the exercise of the right to film may be imposed when the circumstances justify them." Those factors could include officer and suspect safety, or the ability of law enforcement personnel to control chaos at the scene.
"The weasel word here, of course, is 'reasonable,' and courts are likely to give deference to the judgment of law enforcement personnel on that issue," Calvert said.
For practical purposes, an old real-estate mantra applies here: location, location, location.
Advocates and family members are demanding answers following the death of a man who had a heart attack and died in police custody after officers put him in a chokehold – a tactic prohibited by NYPD policy.
This debate is, of course, as old as the Rodney King case –- the 1991 arrest and beating of King by Los Angeles police following a high-speed chase. A balcony-perched witness, George Holliday, videotaped as officers hurled blows against King's body.
New York City police officials did not respond to an email from NBC News asking whether citizens in that jurisdiction are legally allowed to film arrests.
James Pasco, executive director of the Fraternal Order of Police, said through a receptionist that he is "not doing interviews on that" subject.
Keeping a "reasonable distance" from officers.
Not positioning "themselves in a manner that would either passively or actively hinder, impede" officers, first responders or traffic.
Not filming "sensitive police operations and tactical situations if they could reasonably jeopardize the safety of officers or third parties," for example, a police response to a school shooting.
With those rules in place, anyone filming officers -– even in public places –- is at risk for arrest, "rightly or wrongly depending on the facts, on charges ranging from disorderly conduct and obstructing with an arrest to eavesdropping and the failure to obey an order to stop filming," said Calvert, the First Amendment expert.


I want to hear from you. So, I am including a contact form (below) for those of you who share my affinity for forms. You can use this e-mail address: writedrhodari(at)gmail.com or like me on Facebook or follow me on Twitter.


'When the smoke finally clears, people will understand what was going on,' Young Money MC tells Daily News.
At the taping of his 'Unplugged,' the YM boss explains his strategies for Lil Twist, Cory Gunz and Shanell.
'Regardless if you're writing a verse for somebody else's album, write it like it's for yours,' MC tells MTV News of what he's learned from Weezy.
Finishing touches are still being put on the clip, which was set to debut Thursday on MTV.
'Some beats you hear ... and they hit you in a certain kind of way,' the Young Money upstart tells MTV News.
'I got nothing but respect for him. Free Wayne,' Gunz says of his new boss, in Mixtape Daily.
Weezy says Gunz is joining Young Money in one of several videos made before Monday's sentencing.
'It was all done in fun to get the crowd hype,' says Gunz, who was celebrating his birthday with Shaq that night.


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Suspected Schizophrenia Gene Isn't On Chromosome 1
Despite promising evidence that a gene closely linked to schizophrenia would be found on human chromosome number 1, an international team of scientists who scoured the chromosome in more than 1,900 patients concludes it isn't there.
"The bad news is we couldn't find it, but the good news is we can now concentrate on other regions of the genome, such as chromosomes 6, 8 and 13," says Ann Pulver, Sc.D., associate professor of psychiatry at Johns Hopkins and co-author of the study.
The gene hunters' findings, published in today's issue of Science, highlight the challenge of identifying the genetic roots of complex diseases.
"Schizophrenia is a complex psychiatric disorder," says Pulver. "It can't be explained by either a single altered gene or a single environmental cause. There are clearly genetic components, but they are likely to be varied and to interact in many ways with non-genetic factors."
Recent studies had suggested that genes associated with susceptibility to schizophrenia would be found on the "q" or long arm of chromosome 1, a region separated from the short arm, known as "p."
In their study, Pulver and colleagues searched for associations between genetic markers on chromosome 1 and schizophrenia in families that have more than one member with the disease. This approach, called genetic linkage analysis, is used to detect the location on the chromosome where disease genes reside.
"By pooling our resources and data, and agreeing on how to attack the problem in a large sample of affected families, we were able to quickly use this type of genetic linkage analysis to tell if we were on the right track," says Pulver.
It's still possible that genes on chromosome 1q contribute to the disease, she says, but these would influence only a small proportion of patients.
"Biology is complicated, and the search for genes that contribute to large numbers of cases continues," she says.
"This paper highlights the difficulty of unraveling complex diseases," says Solomon Snyder, M.D., professor of neuroscience at Hopkins and author of a review article in the same issue of Science, with Akira Sawa, M.D., Ph.D., on schizophrenia research.
Snyder points out that a variety of genetic and environmental factors are at play in cancer, cardiovascular disorders and diabetes.
"Despite the difficulties," says Snyder, "we are getting closer to understanding the molecular causes of schizophrenia. Advances in imaging, neuroanatomy, genetic analysis and psychopharmacology are being applied in earnest to this debilitating disease."
The study was funded by the National Institute of Mental Health, Medical Research Council (UK), Deutsche Forschungsfemeinschaft, the German-Israeli Foundation for Scientific Research, the National Health and Medical Research Council of Australia, and the Centre National de la Recherche Scientifique.
The lead author of the study is Douglas Levinson, Department of Psychiatry, University of Pennsylvania. Other Hopkins scientists involved in the study are Gerald Nestadt, M.D., and Kung Yee Liang, Ph.D. - By Trent Stockton
The Johns Hopkins Department of Psychiatry and Behavioral Sciences
The Johns Hopkins Genetic Schizophrenia Epidemiology Program
The Johns Hopkins Department of Neuroscience
[Contact: Trent Stockton]
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Last edited by Shaktim
2 edition of Public libraries in the knowledge society found in the catalog.
Public libraries in the knowledge society
S. M. Dhawan
an Indian experience
by S. M. Dhawan
Published 2010 by Shipra Publications in Delhi .
About the Edition
Contributed articles.
Statement editors, S.M. Dhawan ... [et al.].
Pagination vii, 217 p. ;
LC Control Number 2010318205
OCLC/WorldCa 624080953
The book is an extraordinary chronicle of a hugely ambitious trip Theroux undertook, where he drove the entire length of the US-Mexican border, and then deeper into Oaxaca and Chiapas. Along the way, Theroux spends time with Zapotec mill workers, attends a Zapatista party meeting, and teaches a creative writing class in Mexico City. The United Nations Agenda for Sustainable Development is a framework of 17 Sustainable Development Goals (SDGs) with a total of Targets spanning economic, environmental and social development. They lay out a plan for all countries to engage actively in making our world better for its people, with no-one left behind. Libraries are key institutions for achieving the Goals.
Knowledge Is Power: Serving Gender Diverse Youth in the Library by Kathleen Hughes on KATHLEEN M. HUGHES is the Editor of Public Libraries and Manager of Publications for PLA in Chicago. The prototypical public library in the knowledge society has two core services: (1) to support citizens, companies and administrations in their city and region with digital services, namely e.
ian society did not only take over private industries and busi nesses, they also took over all private and public libraries de~ creeing all to be state institutions. They realized the revolu tionary role of libraries and not only used it as an agency for mass education but also as a . Rio Rancho Public Libraries, Rio Rancho, NM. K likes. Our mission is to provide a welcoming environment with access to information along with a full range of /5(7).
RESTRAN: Residual Strength Analysis of Impact Damaged Composite Laminates. Volume I
To the Gulf and Back
practitioners probate manual, containing instructions as to procedure in obtaining grants of probate and administration, with miscellaneous information, rules and orders, list of registries, fees &c.
The History of Melanesian Society
Homespun and blue
The Friendship Pact (Grades 4-6)
Qualitative Research Methods in Public Relations and Marketing Communications
democratic structure of the R.C.A..
Opera and dance
bourgeois in the French novel, 1789-1848.
MCAD/MCSD
Wills of Westmoreland county, Virginia, 1654-1800
Public libraries in the knowledge society by S. M. Dhawan Download PDF EPUB FB2
Committee on the Public Libraries in the Knowledge Society The committee must focus on continuous development of the public libraries in Denmark. This inclu-des the public libraries' interaction with other libraries and relevant institutions. Focus must be on the libraries as an easily accessible offer to File Size: KB.
Fundamental questions are being asked about the future of society and the bedrock organisations that underpin it. Libraries and Society considers the key aspects of library provision and the major challenges that libraries – however defined, managed, developed and provided –.
It is felt that Public libraries, if any are given the required inputs, resources and infrastructure, can become useful in helping the country to become a Knowledge Society. The book is a Festschrift volume dedicated to Shri PSN Murthy, former Library Manager Visakhapatnam Steel Plant, who is known for introducing new techniques in libraries.
"A book for anyone with a deep and abiding love of libraries. Dawson's latest project is a powerful argument for the continued relevance of our public libraries as information and community centers, even as libraries adapt to changing technological and budgetary landscapes."/5(47).
DE GRUYTERAgnes Mainka et al., Public Libraries in the Knowledge Society The Economic Value of Public Libraries in the Knowledge Society There are many studies on the economic value of librar-ies in general (e.g., Poll ; McCallum and Quinn Public libraries in the knowledge society book.
Public libraries in cities of the knowledge society are not only so location factors (as before), but form essential parts of the city's (digital, knowledge, creati ve, and smart). Libraries have been started with wills from other benefactors.
For example, the Bacon Free Library in South Natick, Massachusetts, was founded in after a benefactor left $15, in a will; it has operated as a public library since then. Women's clubs in the late s and early s supported the creation of libraries in their communities.
Once the idea of the public library as an. He has worked extensively on national library policy and strategies for both research and public libraries and written numerous reports, reviews, articles and analyses.
He was secretary for the committee on public libraries in the knowledge society that published its report in and co-author of the report on a joint digital library for the Cited by: 1. Public Libraries in the Modern World: /ch Modern society has various needs such as education, research, cultural advancement, information, spiritual and ideological pursuits, pastime and : M.N.
Venkatesan. Klinenberg's book is just one of a series of recent high-profile tributes to America's public libraries. The New Yorker writer Susan Orlean's most recent book, called simply The Library Book, begins with a personal love song to the subject before diving into the rich, troubled history of the Los Angeles Public Library and its iconic.
A public library is a library that is accessible by the general public and is usually funded from public sources, such as taxes. It is operated by librarians and library paraprofessionals, who are also civil servants.
There are five fundamental characteristics shared by public libraries: they are generally supported by taxes (usually local, though any level of government can and may. It may not surprise you that we here at Book Riot are big fans of libraries, so a round-up of the best library quotes was necessary.
Since I was a child, libraries have been everything to me. I started reading at 4 and never had less than the maximum number of books checked out from the library nearest my grandma's house, a thirty minute drive : Sarah Nicolas. Still, an attempt to produce a habit-forming killer solution for a public library sounds impossible, but the Taskukirjasto (Pocket Library) application of Vantaa City Library in Finland seems to have done the magic.
As ever, there's a simple secret behind the trick. Viewpoint: No. Each public library functions to serve its community in different ways, but its core functions are: To make available all of the information, entertainment (within limits), and resources possible to every patron, regardless of age, financial statu.
This book is called The Public Library: a Photographic Essay and is written by Robert Dawson. The majority of the book has pictures of libraries and a little caption informing the reader of its location.
The rest of the book has little essays that discuss the glory days/5. While reading and book borrowing (in all formats) remain at the heart of public libraries, new technologies play an increasingly important part in the service, both behind the scenes, with developments in library management and support systems, ebook and electronic resource platforms, and front of house, with PCs, tablets and other devices.
An information society is a society in which the creation, distribution, diffusion, uses, integration and manipulation of information is a significant economic, political, and cultural activity.
The knowledge economy is its economic counterpart whereby wealth is created through the economic exploitation of File Size: 1MB. knowledge Society: The term knowledge society refers to a society in which the creation, dissemination, and utilization of information and knowledge has become the most important factor of such a society, knowledge assets are the most powerful producer of wealth, sidelining the importance of land, the volume of labour, and physical or financial capital.
Guaranteeing Access to Knowledge: The Role of Libraries. August By Ben White, Head of Intellectual Property, British Library 1. As gateways to knowledge and culture, libraries play a fundamental role in society.
The resources and services they offer create opportunities for learning, support literacy and education, and help shape the new.
What is Library Development. Public libraries are a cornerstone of a democratic society. It is the mission of ODL's Office of Library Development to assist public libraries across the state to expand and improve their services.
The office also assists institutional libraries. Libraries stand for and exemplify something that needs defending: the public institutions that — even in an age of atomization, polarization and inequality — serve as the bedrock of civil : Eric Klinenberg.Wayne A. Wiegand is F.
William Summers Professor Emeritus of Library and Information Studies at Florida State University and former director of the Florida Book Awards.
Often referred to as the "Dean of American library historians," he is the author of more than one hundred articles and numerous award-winning books, including An Active Instrument for Propaganda: American Public Libraries Cited by: March: Read a book that takes place in the future.
April: Read a book about "Public Libraries" May: Read a book about "Magic" Jun: Read a book set in a different country. Jul: Read a book with only one word in a title.
Aug: Read a love story. Sept: Read a book you own but that you haven't read before. Oct: Read a book set in the Colonial era4/5.
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Billy Roth threw four shutout innings today.
The Pittsburgh Pirates took right-handed pitcher Billy Roth in the 16th round of the 2013 draft, giving him a $190,000 bonus, which amounted to $90,000 against the draft pool. Roth was a highly rated prep pitching prospect with a clean delivery, a fastball that could touch 92 MPH, and a sharp breaking ball. Coming into today's start he had a 1.50 ERA in 12 innings on the season. Today was the first time I had a chance to see Roth pitch, and he once again put up strong results, throwing four shutout innings with two walks, two hits, and one strikeout.
Roth retired the side in order in the first inning, sitting 90-91 MPH and touching 92 twice. He sat in the 90-91 MPH range the entire outing, dipping down to 89-91 in the fourth inning, but never reaching 92 after the first. To put this in perspective, Tyler Glasnow and Nick Kingham were also both 89-91 MPH out of high school, and didn't see their velocities increase until their second and third years in pro ball. Most high schoolers are in the mid-to-upper 80s, so sitting 90-91 for a few innings at this age is a good thing.
Roth started the second inning with a strikeout looking on a nice changeup. The pitch had a lot of break, and looked almost like a slider. The changeup sat 83-84 MPH, giving him some good separation from the fastball. He also threw a few curveballs in the 77-81 MPH range, but he was mostly sitting fastball/changeup. The curveball also showed some good break. His curveball was advertised as his best off-speed pitch out of the draft, and his changeup was advertised as needing work. I was surprised not only at how good the changeup looked, but at how comfortable he was throwing it.
The outing looked great on paper, with Roth throwing four shutout innings and giving up two walks and two hits. He was saved by his defense on a few occasions, and dealt with some control issues in the third and fourth innings. In the second inning he gave up a double on a hard hit ball to straightaway center field. Austin Meadows initially turned the wrong way, and because of that he had no shot on the play. It was difficult, but he might have made the catch if he would have gone to his left initially. He made up for that by making a strong throw from deep center to get the runner trying to stretch a double to a triple.
Roth hit a batter in the third inning, but the runner was erased on a caught stealing by Reese McGuire. I managed to get that caught stealing on video, which you can see below. The video is distorted due to some issue with my Instagram app, but you can still see the good footwork by McGuire, the quick release, and the strong and accurate throw down to second. This is what I've seen out of McGuire every time he's made a throw.
Billy Roth pitching and Reese McGuire throwing out a runner. Sorry for the distorted view. Instagram changed things up on me.
Roth gave up a leadoff single in the fourth inning, followed by a fly out to center field. He then got out of the inning thanks to an amazing play by shortstop Trae Arbet. Roth got a hard grounder to the right of the mound, which had Arbet setting up for the easy 6-4-3 double play. Roth went for the ball and it deflected off his foot and up in the air, in the opposite direction that Arbet was moving. The shortstop made a quick change in direction, fielded the ball cleanly, and made a quick release to barely get the runner at second. A quick turn and a strong throw from Ulises Montilla got the runner at first to end the inning and end Roth's day. It was an impressive play by Arbet on an unfortunate hop that probably should have gone for a hit.
Roth didn't look bad at all. The defense helped him out, and he had some control issues. He didn't look as dominant as his stat line, but he showed some promise with his pitches, and wasn't afraid to throw the changeup often, with some good movement on the pitch. That changeup development is usually the key for a prep pitcher to go to Jamestown in his first full season, so that will be a thing to watch with Roth's development. Overall Roth was as advertised, and it looks like that changeup development and his fastball command will be the biggest priorities, as they are with every pitching prospect in the lower levels of the Pirates' system.
Yhonathan Barrios was sitting 93-95 MPH today out of the bullpen.
Today was the first time I had a chance to see Yhonathan Barrios pitch. Barrios was signed in 2008 as a shortstop, getting a $250,000 bonus. That was one of the biggest international bonuses of all time for the Pirates when it was signed. He was advertised as an offensive minded shortstop with some pop in his bat, but stalled out in the NYPL with a .187/.244/.223 line in 166 at-bats over the last two years. The Pirates recently switched him to a reliever, trying to give him a better shot at extending his career.
Barrios was impressive in one inning of work today. His first fastball came in at 91 MPH, which would have been impressive for a guy who just picked up pitching. Everything after that was 93-95 MPH, with Barrios hitting 95 twice. His fastball had some good downward movement and he was throwing it for strikes.
He also threw two sliders and two changeups. The sliders were both 79 MPH and had some front door breaking action, starting off outside the plate on the right side and breaking in at the last second. I was more impressed with his ability to get movement on the pitch. The slider right now isn't a great pitch, but could have a chance to improve.
The changeup was the most impressive pitch. He was 81-82 MPH with the pitch, showing good late break away from the one left-hander he faced. He started off with two changeups in that at-bat, then followed up with a 95 and a 94 MPH fastball to get his second ground out of the inning.
Barrios only needed about ten pitches to get through the inning. I wouldn't go crazy projecting him right now. Minor league relievers usually end up as organizational depth, even if they can hit 93-95 with good off-speed stuff. That's especially true in the GCL. Barrios has now given up one run on four hits in nine innings as a pitcher, with a 7:4 K/BB ratio, so he's off to a good start. I don't know if this will get him to the majors, but I know that he wasn't making it out of short-season ball as a hitter, and he's got a shot to at least reach high-A with the stuff he has now. That's all based on one month as a pitcher, so there could be room for improvement going forward.
The Pirates had three outfield assists today, one from each outfielder. Meadows had an assist in the second inning. He also went 1-for-3 with his 11th double of the season. Henrry Rosario showed off a cannon in right field, throwing out a runner at third. Rosario's throw was a bit high, but it had plenty of time to get the runner who was trying to go from first to third on a single. Enyel Vallejo had the other outfield assist, throwing out a runner at home to preserve the shutout. Vallejo went 1-for-4 at the plate.
I would figure Ramirez to be faster than Meadows. Does that play into it or is it based on experience at this point? I guess it doesn't matter. Neither guy would be playing CF in 3 years or so unless Cutch is gone and Marte and Polanco both fail.
What I'm most interested in for next season is catcher at West Virginia. McGuire, Mattheison and Jhang are all lined up to head there logically. I guess two could play C and DH and one will be McGuire. But who is the odd man out and does he change positions, or get pushed ahead to Bradenton?
Ramirez hasn't been playing CF much this season so I'd assume Meadows.
Are Ramirez and Meadows both going to be in WV next year? If so who gets to play CF?
I think that would be the outfielders who are in between Meadows and the current group. Guys like Josh Bell and Harold Ramirez.
Ok. I'm about 2 or 3 years ahead of myself but staying in CF would help his trade value.
The earliest Meadows would arrive would be mid-2016 or 2017. He would be 21-22 in those years. Andrew McCutchen and Starling Marte are both currently under control through the 2018 season. Meadows might be the guy who takes over if McCutchen leaves.
How's Meadow's arm? I've heard varying reports and figured most if not all of his value would come from the offensive side.
I've seen him make two strong throws from the center field wall this year, with today's being the second one. He's got some defensive tools that could keep him in center.


text:
'A beautiful thing': Children given the gift of sight take in Henrico tacky light tour
HENRICO COUNTY, Va. (WRIC) — Conexus, a local non-profit organization that provides free glasses and eye exams to children in need, has focused on giving the gift of sight this holiday season.
Children helped through Conexus's Gift of Light program got the chance to put their new frames to the test on Tuesday while checking out the Tacky Light tour in Glen Allen.
8News joined in on the fun to see the children's priceless reactions when they got a chance to look at the lights, some for the first time with 20-20 vision and others for the very first time.
"They struggle in the classroom because they can't see, but they struggle in life because they can't see," Jeff Baldwin, who is with Conexus, said. "So, to provide them with a brand new pair of glasses with a prescription just for them, is a beautiful thing."
Out of roughly 3,500 children screened by Conexus per year, 90% need glasses. The non-profit has partnered with three school districts to provide glasses and exams to children who need them.
Conexus mobile clinic delivers free eye exams to Richmond students
Conexus mobile clinic working to bring healthy vision to students across Richmond
Conexus needs help to give the gift of clear sight to kids across RVA and beyond
Micheyla Coleman, a 9-year-old helped through Conexus' program, couldn't get her glasses initially because of an insurance loophole but now is sporting blue frames she picked out herself.
"I've been taking really good care of them so far," Coleman told 8News.
Coleman and 12 other children helped through the program checked out a Tacky Light tour in Henrico County. For most, it was the first time seeing lights crystal clear.
"It was kind of hard to see far away, because there was lights far away so it was really hard to see," Coleman explained while discussing her difficulties with her vision.
"It's like zoomed in and I can see them a lot," she said when asked about how her new frames have helped.
You can help give more children the Gift of Light by donating to Conexus on-line through this secure website. Click here to donate today.
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7/20/2007 4:18:15 PM - Virtual anticoagulation clinics are becoming very popular as an effective approach to manage warfarin patients, primarily using phone consultations and electronic databases, in a centralized community location. One such clinic in Cedar Rapids, Iowa, The Community Anticoagulation Therapy (CAT) Clinic, was created solely as a virtual clinic in 2005. The CAT Clinic developed the documentation and infrastructure based on the best practices of other clinics across the country. The clinic has no direct patient contact on site, following the initial evaluation and registration.
The goal of the CAT clinic is to provide patients with efficient and high quality services in managing their Coumadin/warfarin, while maintaining the structure to comply with future ISO-9000 requirements.
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Understand the importance of contacting the clinic when they have health-related questions.
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Overcast with rain showers at times. A few flurries or snow showers possible. Temps nearly steady in the mid 30s. Winds NW at 15 to 25 mph. Chance of rain 40%..
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South Dakotans voted to legalize marijuana for any purpose on Nov. 3 by passing Amendment A, but this is now being challenged in court.
Photo by Wiki Commons
hot spotlight topical watchdog enterprise featured special report
Marijuana advocate responds to law enforcement challenge
By ABBY WARGO abby.wargo@capjournal.com
Abby Wargo
Nov 23, 2020 Updated Jan 8, 2021
On Nov. 3, 54% of South Dakotans who voted chose to legalize marijuana for recreational use by passing Amendment A. This included a narrow two-vote majority of voters in Hughes County, though Stanley County voters opposed the measure by 61 votes.
On Friday, Pennington County Sheriff Kevin Thom and South Dakota Highway Patrol Superintendent Rick Miller filed two causes of action challenging the constitutionality of Amendment A, which legalizes, regulates and taxes marijuana in the state of South Dakota. Amendment A was approved by the majority of voters on Election Day, with 225,260 "yes" votes compared to 190,477 "no" votes. The challenges were filed in Hughes County Circuit Court.
If the court finds the challenges are valid, all ballots cast for Amendment A will be declared null and void and the amendment will not be ratified as a part of the state Constitution.
"I've dedicated my life to defending and upholding the rule of law," Thom stated via news release. The South Dakota Constitution is the foundation for our government and any attempt to modify it should not be taken lightly. I respect the voice of the voters in South Dakota. However, in this case I believe the process was flawed and done improperly, due to no fault of the voters."
"Our constitutional amendment procedure is very straightforward," Miller said in a statement. "In this case, the group bringing Amendment A unconstitutionally abused the initiative process. We're confident that the courts will safeguard the South Dakota Constitution and the rule of law."
South Dakotans for Better Marijuana Laws, the advocacy group that pushed for legalization, will be filing to intervene in the case to defend Amendment A against the lawsuit, according to Campaign Manager Drey Samuelson.
"We are prepared to defend Amendment A against the lawsuit filed by Pennington County Sheriff Kevin Thom and Superintendent of the South Dakota Highway Patrol Colonel Rick Miller. Amendment A was carefully drafted, fully vetted, and approved by a strong majority of South Dakota voters this year," Samuelson said.
The causes of action are based on the assumption that Amendment A did not adhere to the requirements for an amendment that are set forth in the state Constitution.
"Pennington County Sheriff Kevin Thom and Superintendent of the South Dakota Highway Patrol Colonel Rick Miller are trying to invalidate Amendment A and overturn the will of the voters on the basis of two incorrect legal theories," Samuelson said. "And this lawsuit was filed incorrectly under South Dakota law, as a 'contest' to an election. However, the complaint has nothing to do with the manner in which the election was conducted and only relates to the text of Amendment A."
According to Article XXIII, Section 1 of the South Dakota Constitution, "A proposed amendment may amend one or more articles and related subject matter in other articles as necessary to accomplish the objectives of the amendment; however, no proposed amendment may embrace more than one subject."
"A major purpose of the one-subject rule is to avoid requiring voters to accept part of a proposed amendment that they oppose in order to obtain a change in the constitution that they support, resulting in votes that do not accurately reflect the electorate's approval of the proposed amendment," according to the challenge.
The challenge posits that Amendment A "embraces at least five separate subjects," including the legalization of recreational marijuana; regulation, licensing, and taxation of commercial sale of recreational marijuana; regulation and licensing by political subdivisions; regulation of medicinal marijuana; and regulation of hemp.
"The first theory claims that Amendment A is not limited to a single subject. But anyone who reads Amendment A can see that every word relates to the cannabis plant. Furthermore, Amendment A follows the interpretation of the single subject rule used by the legislature. South Dakotans have a constitutional right to a ballot initiative process and it's clear that Amendment A meets the single subject standard," Samuelson said.
Amendment A would insert a new article into the Constitution; the first time this has ever happened since voters were first allowed the right to amend the state Constitution via the initiative process in 1972. While amendments can change existing articles to the Constitution, they cannot be used to adopt a new article, make "broad changes" to the Constitution, or make changes that address new subjects not included in previous articles.
The challenge says that Amendment A should have been considered a constitutional revision, which involves a "more stringent procedure" — revisions cannot be adopted without approval by members of a constitutional convention, according to Article XXIII, Section 2.The elected members of the convention then have to approve the proposed revisions by a majority before the public can vote on the revision.
"Proponents of Amendment A failed to follow the proper constitutional procedure and deprived South Dakota voters of the opportunity to have a substantial revision to the Constitution properly scrutinized and presented for ratification," according to the lawsuit. "Therefore, the election as to Amendment A is a nullity and did not result in a free and fair expression of the will of the voters."
"The second theory claims that Amendment A was improperly enacted because it created a new article in the constitution as opposed to adding a section to an existing article. This manufactured distinction is unsupported in the law and is utterly insufficient as a basis for overturning a constitutional amendment approved by voters," Samuelson said.
"Pennington County Sheriff Kevin Thom and Superintendent of the South Dakota Highway Patrol Colonel Rick Miller are trying to invalidate Amendment A and overturn the will of the voters on the basis of two incorrect legal theories."
South Dakotans for Better Marijuana Laws Campaign Manager Drey Samuelson
Noem still working to stop legal weed
According to the South Dakota Secretary of State's Office, roughly 52,000 more residents voted for recreational marijuana in 2020 than voted f…
Kevin Thom
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Hey, everyone. Thank you for giving me company on this beautiful journey of HDPCD certification. We are almost done with the Data Transformation section of the certification and are only left with Data Analysis section using Apache Hive. The section of Data Analysis, in my opinion, is easier than this section so you can say that the difficult part of the certification is over with only hive left for the preparation.
In the previous tutorial of this series, we saw the process of performing the Replicated JOIN in Apache Pig. This tutorial is different than the last one. In this, we are going to see how to run a pig script in the TEZ execution mode.
For doing this, we are going to follow the below steps.
As you can see from the above screenshot, we are not doing anything extraordinary in this tutorial. Our focus is to run this pig script using TEZ as the execution mode.
We are going to use the traditional vi editor to create the input file in local file system.
I have uploaded this file to my GitHub profile under HDPCD repository with the name "35_input_TEZ_mode.txt". You can download this file by clicking here and it looks as follows.
You can use the following commands to create this input file.
As you can see from the above screenshot, this input file was successfully created in the local file system.
We are going to use the following set of commands to push this input file from the local file system to HDFS.
And the output of these commands is shown in the following screenshot.
This confirms that the file was successfully pushed to HDFS.
Let us create the pig script now.
This pig script is executed in TEZ execution mode.
I have uploaded this pig script to my GitHub profile under HDPCD repository with the name "36_pig_script_tez_mode.pig". You can download this file by clicking here and it looks as follows.
Let me explain this pig script in brief, though there is not much to explain.
LOAD command is used to load the contents in file post24.txt into the pig relation input_data.
STORE command is used to load the data stored in input_data pig relation into an HDFS directory "/hdpcd/output/post24".
I believe this is the simplest explanation of the pig script that we are going to create with the help of the following commands.
Let us go ahead and execute this pig script in TEZ execution mode.
We are going to run this pig script in the TEZ execution mode with the help of the following command.
As you can see in the above screenshot, the execution mode is TEZ.
From the above screenshot, it is clear that the pig script ran successfully with the expected output. The screenshot suggests that a total of 3 records were read from the input HDFS file post24.txt and the output directory /hdpcd/output/post24 was loaded with a total of 3 records.
Let us go to HDFS and view these output records.
The following commands are used to view the records stored in the output HDFS directory.
As you can see from the above screenshot, the output HDFS file contains the expected number of records in the expected format. This concludes that pig script ran successfully in the TEZ execution mode.
Hope the content and the screenshot makes sense and are helping you to understand the concepts to the core. Please follow my blog for the further updates.
In the next tutorial, we are going to see how to register a jar file in Apache PIG session.


text:
Validity of self blood pressure measurement in the control of the hypertensive patient: factors involved
Arleen De León-Robert ORCID: orcid.org/0000-0002-9191-70891,
Juan José Gascón-Cánovas2,
José Joaquín Antón-Botella3,
Isabel María Hidalgo-García4,
Carmen López-Alegría5,
Yoalys Dilvani Pérez-Cabrera6 &
Heidy Merari Campusano-Castellanos7
BMC Cardiovascular Disorders volume 19, Article number: 171 (2019) Cite this article
Improving clinical practice aimed at controlling hypertension is a pending issue in health systems. One of the methods currently used for this purpose is self blood pressure measurement (SBPM) whose use increases every day. The aims of this study are to establish the optimal cut-off point for the 3-day SMBP protocol and to identify factors that could affect the precision of the 3-day SMBP protocol using 24-h ambulatory blood pressure monitoring (ABPM) as a reference.
This is a cross-sectional descriptive study to validate a diagnostic test performed by a primary care team in Murcia, Spain. A total of 153 hypertensive patients under 80 years of age who met the inclusion criteria were evaluated. ABPM was performed for 24 h. The SBPM protocol consisted of recording 2 measurements in the morning and 2 at night for 3 days.
The cut-off point for SBP was set at 135 mmHg (sensitivity: 80.39%, specificity: 74.19%), and for DBP, it was set at 83 mmHg (sensitivity: 76.48%, specificity: 84.89%), which yielded the highest combined sensitivity and specificity. After carrying out the validation study with the new figures, we proceeded to establish which socio-demographic factors prevented a correct classification of patients. These errors were more common in male patients for the assessments of both DBP (OR = 2.4) and SBP (OR = 2.5); hypertensive patients with age < 67,5 years (OR = 1,5); having no work activity (OR = 3,6) and with concomitant chronic kidney disease (CKD) (OR = 5.0).
Being male, older than 67.5 years, with CKD or with no work activity increases the probability of being misclassified for hypertension during follow-up as assessed by SBPM over 3 days.
Trial registration
This study was approved by the research ethics committee of the University of Murcia under registration number 1018/2015.
A primary objective in any primary care consultation is to achieve good blood pressure (BP) control in hypertensive patients in order to reduce the likelihood of future cardiovascular events. Hypertension (HT) in Spain affects 36.7% of the total population, while approximately 40% of the general population in Europe is affected [1]. In both men and women, this prevalence increases significantly with age, reaching 68% of those over 60 year [2]. In terms of morbidity and mortality, HT has been associated with 1 in 2 deaths of cardiovascular origin in individuals older than 50 years [3].
Currently, SBPM is considered a useful tool both in the diagnosis and monitoring of hypertension [1, 4,5,6]. Although it cannot replace ABPM as a gold-standard assessment method, it is considered a complementary method in the diagnosis of high blood pressure [7].
The main advantage of SBPM lies in its ability to obtain multiple BP records outside of the health care environment. Likewise, SBPM shows considerable agreement with ABPM in regard to detecting normotension and masked hypertension [4]. The SBPM's correlation with damage to target organs and its ability to predict cardiovascular events is higher than in-office blood pressure measurements [8] and is similar to that of ABPM [9]. Patients monitored with this technique show better adherence to long-term pharmacological treatments and therefore improved control rates, lower follow-up costs, better assessments of the effects of pharmacological treatments at different times of the day, the elimination of observer bias, and less clinical inertia [4].
There is no doubt that SBPM is a useful clinical tool for hypertensive patients in Primary Care, where the good management of the short time available for the consultation and the reliability are essential for appropriate control of HT. Therefore, it is also necessary to have reliable cut-off values and an efficient daily SBPM decision-making scheme. Therefore, after demonstrating that the 3-day protocol is the most efficient option for the control of blood pressure in primary care, with a discriminative capacity and agreement with ABPM similar to other protocols [10, 11], the aims of the present study are to establish the optimal cut-off point for the 3-day SBPM protocol and to identify the socio-demographic factors that can influence erroneous classification by SBPM during the monitoring of hypertensive patients.
This is a cross-sectional descriptive study for the validation of a diagnostic test.
We worked with hypertensive patients registered in the computer system at the Vistalegre-La Flota Urban Health Centre in Murcia, Spain and those receiving routine care.
December 2011 to December 2012.
Criteria for inclusion and exclusion
Inclusion criteria included the diagnosis of complicated and uncomplicated hypertension, an age of 18–80 years, sufficient vision and hearing to perform the self-measurement, and adequate intellectual capacity to obtain the measurements or the oversight of a responsible caregiver for doing so. The exclusion criteria that were considered are those considered valid in various international HT guidelines [1, 5]: Immobilized patients without a responsible caregiver and hypertensive patients diagnosed with obsessive-compulsive disorder.
Selection mechanism
Duplicates, diagnostic errors, patients in the computerized clinical history, and those with their last visit to the health centre (to see a doctor or nurse) in the year prior to the start of the patient selection (N = 2,245) were filtered from anonymized lists. The sample was calculated with an accuracy of 5%, a confidence level of 95%, and a sensitivity and specificity of 85.7 and 75%, respectively. An estimated prevalence of patients with uncontrolled BP of 35% (n = 141) was determined. From this figure, we calculated a percentage of expected losses of 15%, leading to a sample size of n = 153. The calculation of the sample size was performed using the online calculator by Fisterra [12].
Sampling method
A systematic random sampling procedure was carried out. The first subject was chosen at random, and the sampling fraction used was 1/10 patients. The patients were recruited through telephone contact or through their doctors, for those who went to the health centre during the patient selection period. In the case of negative or no contact after several attempts, the next patient was chosen from the list. The recruitment flowchart is shown in Fig. 1.
Flow chart diagram of patient inclusion
After giving consent, each selected patient who agreed to participate was scheduled for an appointment at 8:30 a.m. to perform the ABPM. The perimeter of the patient's arm was measured, and the appropriate cuff was provided. If the arm circumference was greater than 32 cm, a large cuff was provided. The blood pressure was measured in both arms, and the non-dominant arm was chosen as the measuring arm. If both measurements were equal, the cuff was placed on the left arm for right-handed patients or on the right arm for left-handed patients. After the placement of the ABPM device, a forced measurement was immediately carried out. The recording began in the morning at the time the device was placed.
The patients were instructed to perform normal daily activities, except that when the cuff warned that a measurement was about to begin, the arm should be kept in a relaxed position. The patients were asked to return the next day at the same time.
The programming of the device was as follows: Frequency of readings: every 15 min during daytime and every 30 min while sleeping. For this, the patient was questioned when placing the device about their sleep schedule, which was confirmed and readjusted the next day when the device was removed. With these data, the program calculated the beginning of the night or sleep period and the day or activity period for the purposes of the analysis. Types of recordings: Measurement of SBP, DBP and HR over 24 h, daytime and evening. Measurement range: HR: 40 to 180 beats per minute. Pressure: 70 to 285 mmHg for systolic; 40 to 200 mmHg for diastolic and 60 to 240 mmHg for mean blood pressure values. Valid record criteria: 70% valid measurements on the ABPM, more than 14 valid measurements of systolic and diastolic BPs during the day and more than 7 measurements of systolic and diastolic BPs during the night.
The next day, the ABPM device was removed and the patient was shown how to use the validated semi-automatic tensiometer to obtain SBPM records. The subject was seated, and after a period of 5 min of rest, 2 measurements were taken from the dominant arm with a 1-min interval between them. A third measurement was taken if the first 2 had a difference of greater than 5 mmHg.
After the demonstration, the patient was instructed in the proper handling of the device, specifically that the measurements should be taken while sitting, at rest, with the cuff placed on the arm that showed the highest BP. The patient was also instructed on how to place the cuff, which was to be 2–3 cm above the flexure of the elbow, its fit on the arm, and the position at which to take the pressure reading.
The correct performance of the first 2 measurements on the first day was verified by the patient in front of the researcher. Then, the blood pressure monitor was given to the patient, who was instructed in writing to take 2 measurements in the morning (between 7:00 and 10:00 a.m.) and 2 before going to bed (between 21:00 and 23:00 p.m.) with 1–2 min between measurements for 3 consecutive days. A total of 12 measurements were obtained for each patient (the first day measurements were later discarded), establishing the 3-day SBPM pattern. The instruments used in this study included 2 ABPM devices Microlife Watch BP 03 (Microlife, Widnau, Switzerland) [13] and 10 automatic arm blood pressure monitors for SMBP (Microlife Watchbp Home) that were validated according to the standards of the Spanish Hypertension Society (SEH) and the British Hypertension Society (BHSOC) (accessible on January 11, 2016 at: https://www.seh-lelha.org/microlife-watchbp-o3/ and https://bihsoc.org/bp-monitors/for-home-use/).
Regarding the definitions of the variables applied in this study, we defined poor HT control as when the mean BP measured by ABPM over 24 h was greater than 130/80 mmHg. For the 3-day SMBP, we considered uncontrolled average blood pressure as greater than 135/85 mmHg.
This descriptive study was carried out with the demographic variables of age, sex and work status, taking into account the records of spanish administrative document (TSI) that accredits access to citizens to health care benefits. If the patient was not active: TSI < 002 (Without income, retired) or active: TSI 003 (income level < € 18,000/year); TSI > 4 (income level > € 18,000/year). Clinical variables included associated comorbidities such as a diagnoses of dyslipidaemia, diabetes mellitus, chronic kidney disease, atrial fibrillation, and stroke.
The statistical programs SPSS version 22 and Epidat version 3.1 were used to analyse the data.
Categorical variables are presented as absolute frequencies (%) and quantitative variables as the means and standard deviations. Values of p < 0.05 were considered statistically significant, and 95% confidence intervals (95%CI) were calculated. The sources of the data were the BP records collected by SBPM and ABPM as well as the electronic health records of the patients in the OMI-AP program.
Test validation analysis
A comparison of the data collected using the 3-day SBPM (discarding measurements from the first day) was performed using the figures obtained by the 24-h ABPM as the reference standard. Given the results obtained by De León-Robert et al. [10], the 3-day pattern was chosen (SBPM-DAYS-2&3) and an optimal cut-off point was obtained. The calculations of the predictive capacity of the 3-day protocol with the new cut-off point were performed using a statistical calculator. With the data obtained, the cases with misclassifications (false positives and negatives) in the SBPM-DAYS-2&3 data were identified at the cut-off point where the sensitivity and specificity of the diagnosis of HT were optimized, using the 24-h ABPM as the gold standard (130/80 mmHg). An analysis of how sociodemographic and clinical factors related to errors in diagnostic classifications was performed. Calculations were performed for the crude and adjusted odds ratios, according to sex, of the diagnostic classification errors for both systolic and diastolic HT. These were performed using logistic regression models that included age, income level, and clinical comorbidities such as diabetes, dyslipidaemia, chronic kidney disease, ictus, and atrial fibrillation as predictor variables. The estimating of the agreement between ABPM and SBPM readings were perfomed using the Bland-Altman plot analysis and the concordance was determinated using intraclass correlation coefficient (ICC).
A total of 419 patients were selected for inclusion in the analysis, of whom 153 completed SBPM and ABPM with the required quality (Fig. 1). Of these patients, 50.3% were women. The mean age was 61.54 with a range of 23–80 years. In terms of economic activity, 67.3% were classified as having no work activity (pensioners and the unemployed) (Table 1).
Table 1 Socio-demographic and baseline clinical characteristics of the study subjects
In addition to HT, other associated chronic pathologies were found among the hypertensive patients studied (Table 1). The most common was dyslipidaemia (41.8%).
According to the results of the ROC curve, the cut-off point where sensitivity and specificity were optimized was 135.5/83 mmHg for the diagnosis of uncontrolled HT. The mean differences between the two methods (ABPM and SBPM) are 10 and 5 mmHg for systolic and diastolic pressure respectively (Fig. 2). The concordance between SBPM and ABPM according ICC was higher for diastolyc pressure (0,64; p < 0.001) than for systolic pressure (0,44; p < 0.001).
Bland-Altman plots. SBPM-3 days: Self-blood pressure monitoring during 3 days. ABPM: 24H Ambulatory blood pressure monitoring
Based on this cut-off point, the sensitivity of the SBPM-DAYS-2&3 test for identifying cases with control problems in some BP measurements was 87.7%, while its specificity was notably lower (62.5%) (Table 2). More specifically, this test was more sensitive for the isolated diagnosis of abnormal SBP values (87.7%) than for diagnosing abnormal DBP values (70.6%); In contrast, it had a greater specificity when the uncontrolled blood pressure was diastolic (85.7%) instead of systolic (74.2%) (Table 2). On the other hand, the predictive capacity of the test for the diagnosis of a lack of control of systolic or diastolic values, with a prevalence in the study sample of 42.5%, was elevated for a negative result (87.3%) and moderate for a positive result (63.35%) (Table 2).
Table 2 Validation of self-monitoring of blood pressure for 3 days (cut-off point = 135.5/83 mmHg) for the control of hypertension. Gold standard: 24-h ambulatory blood pressure monitoring
With the SBPM-DAYS-2&3, approximately 1 out of every 4 hypertensive subjects had their systolic HT incorrectly classified (false positive or negative); this figure dropped to 1 out of every 6 for the assessment of diastolic HT. The variables associated with obtaining an erroneous result with the SBPM-DAYS-2&3 test were sex, age, work status and chronic kidney disease. These errors were approximately 2.5 times more common in male patients for the assessments of both DBP (OR = 2.4) and SBP (OR = 2.5). Regarding the latter, in subjects of more advanced ages (> 67.5 years), the validity of the test was lower (OR = 1.5). The same pattern occurred in patients with TSI < 3 (low income level) (OR = 3.6) and in hypertensive patients with concomitant chronic kidney disease (OR = 5.0) (Table 3).
Table 3 Factors that influence the misclassification of hypertension by SBPM. Gold standard: ABPM (130/80 mmHg). SBPM test 1 on 3rd day: (135.5/83 mmHg)
The diagnostic capacity of SBPM, using ABPM as a reference, for the assessment of HT has been widely investigated by several studies [14]. The possibility of using its different protocols without diminishing that capacity has also been investigated, with good results [15]. Taking into account the data obtained to date, as well as the need in primary care for an efficient protocol, we decided to evaluate the SBPM-DAYS-2&3. We also investigated which factors we should take into account for its correct application and interpretation. The analysis with ROC curves for the 3-day protocol resulted in cut-off values of 135.5 mmHg for SBP and 83 mmHg for DBP, differing from the results of another study [11] by 3 mmHg for SBP and just 0.2 mmHg for DBP. However, the SBPM-DAYS-2&3 yields higher values for both sensitivity and specificity for both pressures with our cut-off values.
The current guidelines on hypertension by various societies do not provide clear recommendations in their protocols about all of the factors that can diminish the accuracy of SBPM as a follow-up method in HT. The Japanese and Brazilian guidelines refer to the need for bladder emptying before taking BP measurements, something not mentioned in the European or American guidelines [16]. For Almeida et al. [16], who also used the 3-day protocol, a factor that limits the accuracy of SBPM is whether BP measurements are taken after urination. Other studies, such as ours, note that sex and age are possible factors. However, they also add the systolic and diastolic figures, the number of readings, food intake, alcohol consumption, the taking of BP measurements after bathing, and being a smoker [14, 17,18,19]. However, some of those studies accounted for the daytime ABPM to make their comparisons [16, 19].
Among the clinical factors evaluated by our study, it is worth mentioning the significant influence of the diagnosis of chronic kidney disease in the sample as a factor involved in limiting the accuracy of the SBPM-DAYS-2&3 protocol. Studies in kidney patients indicate greater arterial rigidity in these patients, which could be the cause. Although arteriosclerosis is also common among diabetic patients, no significant difference was found between diabetic and non-diabetic patients.
This study was performed with a small sample size in a single health centre in Spain, wich is not necessarily representative of the general population. However, as a strength, the study was conducted in the field of usual clinical practice.
The cut-off point with the highest joint sensitivity and specificity for the SMBP-DAYS-2&3 protocol is 135.5/83 mmHg. Being male, over 67.5 years of age, having low income level, and having a diagnosis of chronic kidney disease can all reduce the validity of the SMBP-DAYS-2&3 protocol for classifying hypertensive patients as poorly controlled during follow-up.
The datasets generated and/or analysed during the current study are not publicly available due to data privacy laws but are available from the corresponding author on reasonable request.
ABPM:
Ambulatory blood pressure monitoring for 24 h
HR:
HT:
IC95%:
ROC CURVES:
Receiver operating characteristic curves.
SMBP:
Self-monitoring of blood pressure
SMBP-DAYS-2&3:
3-day protocol of self-monitoring of blood pressure
TSI:
Individual health card
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We thank the patients and the physicians at the Vistalegre-La Flota Health Centre for their collaboration.
This research work has been partially funded through a research grant from Cajamurcia with the file number FFIS/CM10/031.
Fortuna Health Centre, Murcia, Spain
Arleen De León-Robert
Faculty of Medicine (University of Murcia) - Instituto Murciano de Biosanitaria - Arrixaca (IMIB-Arrixaca), Murcia, Spain
Juan José Gascón-Cánovas
Murcia Health Centre, Murcia, Spain
José Joaquín Antón-Botella
Vistalegre-La Flota Health Centre, Murcia, Spain
Isabel María Hidalgo-García
Cieza Este Health Centre, Murcia, Spain
Carmen López-Alegría
Morella Health Centre, Castellón, Spain
Yoalys Dilvani Pérez-Cabrera
Abanilla Health Centre, Murcia, Spain
Heidy Merari Campusano-Castellanos
All of the authors participated in the conception of the study. The bibliographic reviews were made by IHG, CLA, YDPC, JJAB and ADR. The study design and analysis were carried out by JJGC. The field work was performed by CLA, YDPC, IMHG and ADLR. The successive versions of the manuscript were written by ADLR and JJGC. All of the authors participated in the review of the article with important contributions and accepted the final version.
Correspondence to Arleen De León-Robert.
This study was approved by the research ethics committee of the University of Murcia under registration number 1018/2015, after which, the consent of the patients was obtained verbally, after a verbal report of the procedures to be performed.
De León-Robert, A., Gascón-Cánovas, J.J., Antón-Botella, J.J. et al. Validity of self blood pressure measurement in the control of the hypertensive patient: factors involved. BMC Cardiovasc Disord 19, 171 (2019). https://doi.org/10.1186/s12872-019-1145-9
Self blood pressure