Dr. Marco Merlo, Cardiovascular Department, "Ospedali Riuniti," University of Trieste, Via P. Valdoni 7, Trieste 34100, Italy.
Objectives In this study, the authors analyzed the prognostic role of right ventricular systolic function (RVF) longitudinal trends in a large cohort of patients affected by dilated cardiomyopathy (DCM).
Background RVF is a known prognostic predictor in DCM; however, whether RVF changes over time to better predict the long-term disease progression has not been investigated.
Methods From 1993 to 2008, we analyzed 512 patients with DCM (46 years of age [36 to 55 years of age], left ventricular ejection fraction 32% [25% to 41%]) with a potential follow-up of ≥72 months and available data at baseline and at least 1 pre-specified follow-up evaluation (i.e., 6, 24, 48, or 72 months). RV dysfunction was defined as RV fractional area change <35% at 2-dimensional echocardiography. The primary outcome measure was a composite of death or heart transplantation.
Results At enrollment, 103 (20%) patients had RV dysfunction. During follow-up, 89 of them (86%, 17% of the overall cohort) normalized RVF at a median time of 6 months, whereas 38 of the remaining 409 patients with normal baseline RVF (9%; 7% of the overall population) exhibited a new-onset RV dysfunction (median time: 36 months). RVF normalization was significantly associated with subsequent left ventricular reverse remodeling that was observed at a median time of 24 months (odds ratio: 2.49; 95% confidence interval [CI]: 1.17 to 5.3; p = 0.018). At baseline multivariate analysis, RV dysfunction was independently associated with the primary outcome measure (hazard ratio: 1.71; 95% CI: 1.02 to 2.85; p = 0.0413). At time-dependent model, RVF revaluation over time maintained an independent predictive value (hazard ratio: 2.83; 95% CI: 1.57 to 5.11; p = 0.0006).
Conclusions Patients with DCM frequently present RV dysfunction at first evaluation. However, a complete RVF recovery is largely observed early after optimization of medical therapy and predates subsequent left ventricular reverse remodeling. Systematic revaluation of patients including RVF throughout regular follow-up conferred additive long-term prognostic value to the baseline evaluation.
Dilated cardiomyopathy (DCM) is a primary heart muscle disease classically characterized by left ventricular (LV) systolic dysfunction and dilation (1). In the past several decades, the long-term prognosis of DCM has improved impressively, mainly through the effectiveness of treatments on left ventricular reverse remodeling (LVRR) (2). Indeed, LVRR has emerged as an important prognostic predictor in DCM, highlighting the importance of the systematic revaluation of patients during follow-up (3,4). Nevertheless, the prognostic stratification of DCM in clinical practice still remains particularly difficult. Recent data suggest that right ventricular systolic function (RVF) is crucial in prognostic assessment of patients with DCM. RV dysfunction, assessed by cardiac magnetic resonance scans, was found in a sizable number of patients with DCM and showed an incremental prognostic value in addition to that of LV evaluation (5). However, these data are limited to highly selected populations. To date, there are no data on the long-term natural history of RVF in patients with DCM undergoing optimal treatment or, similarly, on the prognostic significance of RVF revaluation during follow-up.
Therefore, the aims of the current study were to analyze the long-term evolution of RVF and to assess the prognostic impact of regular RVF revaluation over time in a large population of patients with DCM.
We retrospectively analyzed all 657 patients with DCM who were enrolled consecutively in the Trieste Heart Muscle Disease Registry between 1993 and 2008 (2). Patients who underwent extensive clinical and laboratory evaluation at baseline (including invasive tests, when indicated) and with at least 1 available evaluation at any of the pre-specified follow-up times (i.e., 6, 24, 48, 72 months) were considered for the present analysis. Follow-up ended on December 31, 2014, or at the time of death/heart transplantation (D/HT); thus, each patient had a potential minimum follow-up period of at least 72 months.
The institutional ethics board approved the study and informed consent was obtained under the institutional review board policies of the hospital administration.
The diagnosis of DCM was determined according to the World Health Organization criteria (1,6). Enrolled patients presented a left ventricular ejection fraction (LVEF) <50% in the absence of a possible known cause. Ischemic etiology was ruled out by coronary angiography, which was performed systematically in patients ≥35 years, with cardiovascular risk factors and/or without a familial history of DCM. Patients with significant coronary artery disease (stenosis >50% of a major coronary artery), history of severe systemic hypertension (>160/100 mm Hg), biopsy-proven active myocarditis, alcohol intake >100 g/day, significant organic valve diseases, tachycardia-induced cardiomyopathy, congenital heart diseases, and advanced systemic diseases affecting short-term prognosis were excluded (2). The patients' familial histories were strictly investigated and all familial DCM cases fulfilled the published criteria (7).
After enrollment, if not contraindicated, all patients received angiotensin-converting enzyme inhibitors/angiotensin receptor-blockers and beta-blockers titrated to the highest tolerated dose. An implantable cardioverter-defibrillator was implanted for primary prevention in patients with DCM who were considered at high risk of sudden cardiac death (i.e., persistent LVEF ≤35% and New York Heart Association [NYHA] functional class II to III on chronic, optimal medical treatment) (8). Cardiac resynchronization therapy in our center started in 2005 in patients with conventional indications (persistent LVEF ≤35%, left bundle branch block, and NYHA functional class ≥2) under optimal medical treatment, according to the available evidence (8).
The primary study endpoint was a composite of D/HT. Furthermore, we considered as secondary outcome measures pump failure death or HT compared with a composite of sudden cardiac death and malignant ventricular arrhythmias (i.e., aborted sudden cardiac death, ventricular fibrillation/flutter, sustained ventricular tachycardia, or appropriate implantable defibrillator shocks) in a competing risks analysis.
For this specific study, all echocardiographic examinations performed at baseline and at the pre-specified follow-up intervals were reviewed by a level 3–trained echocardiographer with specific expertise in cardiomyopathy imaging. The image analysis was conducted according to current international guidelines (9,10).
RV dysfunction was defined in accordance with current recommendations by a right ventricular fractional area change (RV-FAC) ([end-diastolic area – end-systolic area]/end-diastolic area ×100) <35% (9). LV volumes and LVEF were assessed using Simpson biplane method. LV measurements were indexed according to patients' body surface areas. LVRR was defined by an increase in LVEF ≥10 points (or a follow-up LVEF ≥50% in patients with a baseline LVEF between 45% and 49%), associated with a reduction in indexed LV end-diastolic diameter ≥10% or a follow-up indexed LV end-diastolic diameter ≤33 mm/m2 (3). LV filling pattern was classified as restrictive in presence of E-wave deceleration time <120 ms or E/A ≥2 associated with E-wave deceleration time ≤150 ms (11). Systolic pulmonary artery pressure was estimated from the maximal continuous-wave Doppler velocity of the tricuspid regurgitation jet using a systolic transtricuspidal pressure gradient calculated by the modified Bernoulli equation and the addition of estimated right atrial pressure (12). Functional mitral regurgitation was assessed using a multiparametric approach by measuring the regurgitant jet area and vena contracta width at color-flow Doppler and, if feasible, by measuring the effective regurgitant orifice area by the proximal isovelocity surface area method (13).
All measurements were obtained from the mean of 3 beats (patients in sinus rhythm) or 5 beats (atrial fibrillation).
Summary statistics of clinical and laboratory variables at enrollment were expressed as mean and SD, median and interquartile ranges (IQR), or as counts and percentage, as appropriate. Cross-sectional comparisons between groups were made by the analysis of variance test on continuous variables, using the Brown-Forsythe statistic when the assumption of equal variances did not hold, or the nonparametric median test when necessary. Chi-square or Fisher exact tests were calculated for discrete variables. Repeated measures between baseline and follow-up visits were evaluated by means of the paired Student t test for continuous Gaussian distributed parameters or the Wilcoxon test, as appropriate. For binary variables, the McNemar test was calculated. Moreover, mixed-effects generalized linear models were estimated to globally evaluate the time effect on RV dysfunction, RV improvement/worsening, and LVEF/LVRR trends (14). Logistic regression was used to investigate whether early RV improvement was associated with subsequent LVRR. Multivariable Cox regression was applied to evaluate predictors of the primary study endpoint, evaluated at baseline and with time-dependent covariates: a full-model strategy was applied by including in the multivariable model all relevant clinical and instrumental parameters. To assess the extent to which the time-dependent analysis leads to a better prediction when compared with the baseline model, patients' data rows were duplicated as necessary, and for the baseline model. We evaluated the predictive accuracy of the time-dependent model compared with the baseline model by areas under the curve and the net reclassification index using the R libraries "timeROC" and "survIDINRI," respectively, and considering the time horizon as 146 months (i.e., the median follow-up of the study population). Kaplan-Meier curves and the log-rank tests were calculated and compared between groups of patients defined according to their RV dysfunction presence/evolution. As an additional and secondary analysis, cumulative incidence functions for pump failure death/HT versus sudden cardiac death/malignant ventricular arrhythmias were estimated by means of univariable competing risks regression models, using as the covariate RV dysfunction at baseline and its evolution at follow-up. The approach adopted fits the "proportional subdistribution hazards" method described in Fine and Gray (15); this model directly assesses the effect of the covariate on the subdistribution of a particular type of failure in a competing-risks setting. Interobserver and intraobserver variability regarding RV areas and RV-FAC was verified by randomly selecting a sample size of 50 patients with DCM (3 observations per subject: 2 different operators and a double evaluation by each) to achieve 90% power and, thus, to detect an intraclass correlation (ICC) of 0.8 under the null hypothesis of ICC = 0.5, by using an F-test with a significance level of 0.05 (16). The Kappa agreement was computed for both the RV-FAC and RV dysfunction binary parameter. The intraobserver variability was evaluated by computing the paired correlations between repeated measures of the same operator. IBM SPSS software version 19 (IBM, Armonk, New York), and R statistical package version 3.1.2 (R Foundation for Statistical Computing, Vienna, Austria), were used for the analysis.
The study population included 512 of 657 enrolled patients, with at least 2 evaluations during the follow-up period. Owing to the single baseline evaluation, 123 patients were excluded: no significant baseline differences were found in comparison with the study population (data not shown). Finally, 22 patients were excluded because of poor image quality on their scans. The median follow-up of the study population was 146 months (IQR: 91 to 210 months).
The baseline characteristics of the patients are reported in Table 1. The median age was 46 years (IQR: 36 to 56 years). Despite a short disease duration (median time 1 month; IQR: 0 to 7 months), the patients presented significantly remodeled LV (LVEF 32%, IQR: 25% to 40%; indexed LV end-diastolic volume 88 ml/m2, IQR: 69 to 116 ml/m2). The large majority was optimally treated (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 95%; beta-blockers 84%) after the first evaluation (i.e., enrollment). During the follow-up, 19% and 8% of patients underwent implantable cardioverter-defibrillator or cardiac resynchronization therapy, respectively.
RV dysfunction was observed in 103 patients at first evaluation (20% of the study population). Compared with patients with preserved RV function, they exhibited a more advanced NYHA functional class, a poorer LV systolic function, and a greater hemodynamic impairment (lower systemic systolic blood pressure, higher prevalence of LV restrictive filling pattern, and higher systolic pulmonary arterial pressures). Interestingly, the rate of left bundle branch block was lower in patients with RV dysfunction (23% vs. 34%; p = 0.003) (Table 1, second and third columns).
Data from the pre-specified follow-up evaluations were available in 455, 360, 331, and 264 patients at 5 (IQR: 4 to 7), 25 (IQR: 22 to 29), 47 (IQR: 43 to 52), and 71 (IQR: 66 to 76) months, respectively.
Interestingly, longitudinal trends of RV dysfunction presented 2 distinct patterns: 89 of 103 patients with baseline RV dysfunction (86%; 17% of the overall cohort) normalized RVF in the short-term (median time 6 months; IQR: 5 to 7 months), whereas in 38 of 409 patients with preserved RVF at enrollment (9%; 7% of the total population), RV function deteriorated at a later follow-up (median time 36 months; IQR: 24 to 48 months) (Figure 1). Finally, RVF was stable throughout the follow-up period in the remaining patients, and none showed a decline in RVF after the initial improvement.
The solid line indicates patients' recovering RVF; the dashed line indicates patients' worsening RVF. Of note, RVF recovery occurs at a median time of 6 months, whereas the deterioration of RVF was delayed during the follow-up (median time 36 months; IQR: 24 to 48 months). *Significant between-visits variations by repeated measures tests. IQR = interquartile range; pts = patients; RV = right ventricular; RVF = right ventricular systolic function.
The recovery of RVF was associated with a parallel improvement of the echocardiographic parameters related to hemodynamic status (specifically, the LV restrictive filling pattern [p < 0.001] and the systolic pulmonary arterial pressure [p = 0.019]) (Figure 2). It is noteworthy, as shown in Figure 3, that RVF normalization occurred mostly within 6 months, thereby preceding the LVRR that was observed at a median time of 24 months (IQR: 18 to 30 months). Moreover, RVF recovery at 6-month follow-up was significantly associated with the subsequent LVRR (odds ratio: 2.49; 95% confidence interval [CI]: 1.17 to 5.3; p = 0.018).
CI = confidence interval; LV = left ventricular; sPAP = systolic pulmonary arterial pressure; other abbreviations as in Figure 1.
Note that the rate of RV dysfunction (black line) decreased significantly earlier compared with the increasing rate of LVRR (pink line) that became significant at 24 months. *Significant between visits variations by repeated measures tests. The top row of numbers indicates the percentage of surviving patients, evaluated at every pre-specified follow-up interval. LVRR = left ventricular reverse remodeling; other abbreviations as in Figure 1.
A baseline prognostic multivariable model was initially obtained, including all the significant and clinically relevant predictors of D/HT at univariate analysis (Table 2). Through this model, independent prognostic predictors were a longer duration of disease, older age, a lower LVEF, together with RV dysfunction (hazard ratio: 1.71; 95% CI: 1.02 to 2.85; p = 0.0413) (Table 3). When the reassessment of RVF was considered in a time-dependent Cox model, it globally maintained an independent predictive value (hazard ratio: 2.83; 95% CI: 1.57 to 5.11; p = 0.0006). Even if the addition of RV dysfunction alone to the baseline and time-dependent models did not significantly increase the areas under the curves, the global time-dependent model showed an area under the curve of 0.83 (95% CI: 0.76 to 0.90) versus 0.78 (95% CI: 0.69 to 0.87) of the baseline model (p = 0.09), with a net reclassification index of 0.30 with respect to the baseline model (95% CI: 0.10 to 0.52; p = 0.04).
Figure 4 shows the long-term survival-free from HT curves of patients, according to the evolution of RVF. Patients with early recovery of RVF presented a similar events rate to those who had never experienced RV dysfunction (p = 0.205). On the other hand, the survival curves of patients with new-onset RV dysfunction diverged significantly beyond the 48-month follow-up, then approaching in the long-term the survival rates of patients with persistent RV dysfunction (p = 0.321).
Long-term survival curves according to the RV function evolution. Patients with early recovery of RV function (i.e., at a median of 6 months during follow-up) under treatment presented HT survival-free comparable with those who never experienced RV dysfunction (p = 0.205). The HT survival-free curves of patients with new-onset RV dysfunction (i.e., at a median of 36 months at follow-up) diverged significantly thereafter, approaching, in the long-term, the survival rates of patients with persistent RV dysfunction (p = 0.321). D/HT = death/heart transplantation; dysf = dysfunction; other abbreviation as in Figure 1.
Finally, impaired RVF, particularly a new-onset RV dysfunction after the initial evaluation, was mainly related to pump failure death or HT (p < 0.001 at baseline and p < 0.0001 at follow-up), whereas it was not related to major ventricular arrhythmic events, except for a trend in the very long term (p = 0.618 at baseline and p = 0.07 at follow-up) (Online Figure 1).
The present study describes for the first time the natural history of RV dysfunction in a large series of recently diagnosed patients with DCM, who were followed systematically over the long-term. The principal results were that: 1) the regular RVF revaluation over time provided an independent long-term prognostic value; and that 2) the RV function improvement under optimal treatment temporally preceded LVRR. These findings should be considered of remarkable importance in the long-term risk stratification and management of patients with DCM.
Few data exist about the prevalence of RV dysfunction in patients with DCM. In this large-cohort study, 20% of patients with DCM presented with impaired RV at the first evaluation. Notably, our findings refer to a stage close to the onset of the disease (median 1 month). Nevertheless, similar rates of prevalence were reported recently in a highly selected DCM population that was evaluated using cardiac magnetic resonance (5). Although cardiac magnetic resonance is considered to be the most accurate approach for the assessment of RV systolic function (17), RV-FAC obtained by transthoracic echocardiography has been demonstrated to strongly correlate with cardiac magnetic resonance (18). Furthermore, echocardiography still represents the first-line examination in patients with DCM: widely accessible also in secondary-level centers and less suffering from limitations in patient selection. Patients presenting with RV dysfunction at enrollment were contextually characterized by a higher grade of congestion and a more impaired hemodynamic condition. It is noteworthy that, at baseline, we observed a lower prevalence of left bundle branch blocks in patients with an impaired RV. In our opinion, this suggests that worse RVF might mostly be the expression of hemodynamic impairment, rather than of extensive biventricular structural damage.
In our cohort, RVF recovery largely occurred in the first few months during follow-up (Figure 1), which was likely from the beneficial hemodynamic effects of antineurohormonal therapy on peripheral resistance, LV filling pressures and, consequently, on RV afterload and ventricular interdependency (Figure 2) (19). This conclusion is also supported by the correlation between the evolution of RVF over time and pump failure death or HT, rather than to arrhythmic events (Online Figure 1).
Concerning the timing of the response to evidence-based therapy, in the current study, we observed a significant relationship between the improvement in RVF and LVRR. Of interest, the RV response occurred earlier than LVRR, which was indeed detectable at a median time of 24 months (Figure 3). LVRR represents, in fact, the intrinsic effect of pharmacological/nonpharmacological therapies on the LV structure; for this reason, it may need up to 24 months or even more to be expressed fully (3,20,21). Finally, RVF recovery remained stable throughout the observation period.
On the other hand, a minority of patients presenting with normal RVF experienced a reduction in RV systolic function, which usually occurred beyond the 48-month evaluation. Therefore, deterioration in RVF might reflect the intrinsic progression of the cardiomyopathy process that typically characterizes DCM in the long term (22).
In the present study, we confirmed the adverse impact of impaired RVF on survival rates in patients with DCM (5,23). Our population, compared with previously described series, included a larger number of patients more extensively treated with beta-blockers and with a shorter duration of disease. Moreover, it must be noted that in the multivariable model, baseline RV dysfunction showed a stronger impact than other previously demonstrated prognostic factors, such as NYHA functional class, functional mitral regurgitation, LV restrictive filling pattern, and LV dimensions.
Notably, we demonstrated for the first time the strong independent prognostic impact of serial RVF reassessment over time. This emphasizes the importance of a comprehensive echocardiographic evaluation, which should always include a careful assessment of both the right and left chambers at baseline and systematically during the follow-up, to improve the accuracy of clinical management and risk stratification of patients with DCM.
The intriguing hypothesis that specific genetic mutations might determine different phenotypes specifically affecting the RV in DCM, or causing overlap syndromes such as biventricular or left dominant arrhythmogenic cardiomyopathy (24), will require further, more focused studies. Unfortunately, in our series, only a few cases underwent comprehensive genetic testing; however, such testing was beyond the aims of the present study.
This study suffers from the limitations related to its observational nature. A possible selection bias of the population is limited, however, by the fact that all of the patients were enrolled consecutively in the same institution (a referral center for cardiomyopathies) using homogenous inclusion criteria. The length of the enrollment period could be considered a limitation, but we believe that it is simultaneously an important strength because it allowed us to analyze the evolution of RVF in the very long-term, in one of the largest existing DCM populations.
A total of 123 eligible patients were excluded from the initial population owing to the lack of follow-up assessment of RVF. However, no significant differences were found when they were compared with the study population; therefore, these patients can be fully considered as missing at random and not influencing the study results. Besides, the number of patients who underwent a complete RV evaluation at each pre-specified interval was sized adequately for the aims of this study (89% at 6 months, >300 within 48 months, and >250 at 72 months).
The assessment of RVF was obtained by using 2-dimensional echocardiography evaluation of RV-FAC. Because of several limitations related to this approach (25), we performed an interobserver and intraobserver variability analysis that indicated a good performance level (ICC for RV-FAC 0.86; 95% CI: 0.73 to 0.92; Kappa agreement for RV dysfunction 0.745; p < 0.001; intraobserver correlation for RV-FAC and RV dysfunction >0.90 and >0.81, respectively). Finally, we analyzed 50 patients with DCM with available RVF assessment by using both cardiac magnetic resonance and echocardiography (with a maximum interval between the 2 imaging studies of 1 month): a good correlation between the 2 techniques was obtained for both RV fractional area shortening and RV dysfunction (Spearman Rho correlation coefficient 0.74; p < 0.001).
The measurement of tricuspid annular plane systolic excursion as a simple parameter of RVF was not considered in our series because it was available only in a minority of patients and its reliability in assessing global RVF is questionable.
RV strain, strain rate and 3-dimensional echocardiography data were available only for a few patients. There is a growing body of data on the reliability of these techniques, and they will actually improve RV echocardiography in the future (26,27).
The effect of cardiac resynchronization therapy on RVF was not evaluated because it was not the specific aim of our study; however, it represents an interesting issue that needs to be investigated further in large-scale studies.
RVF is frequently impaired in recently diagnosed patients with DCM, with a prevalence of about 20% in our population. However, it largely and rapidly improves under evidence-based medical treatment, showing a strong relationship with subsequent LVRR. Serial revaluation of RVF during the follow-up emerged as a powerful determinant of long-term prognosis. These findings strongly suggest that systematic RVF reassessment may assist clinical decision-making, and that RV reverse remodeling should be considered an important therapeutic target in the early management of DCM.
COMPETENCY IN MEDICAL KNOWLEDGE: Right ventricular dysfunction is present in 20% of recently diagnosed patients with DCM; however, it promptly improved in the majority of patients under optimal treatment.
COMPETENCY IN PATIENT CARE AND PROCEDURAL SKILLS: Compared with baseline evaluation, re-evaluation of right ventricular function during regular follow-up has independent power in prognostic stratification of DCM patients.
TRANSLATIONAL OUTLOOK 1: Future genotype-phenotype correlation studies are needed to prospectively identify DCM patients with right ventricular involvement as an expression of specific mutations rather than of hemodynamic impairment.
TRANSLATIONAL OUTLOOK 2: Studies on reliability of cardiac magnetic resonance, right ventricular strain, strain rate, and 3-dimensional echocardiography data during follow-up of DCM patient are needed to confirm our results.
The authors are grateful to the association "Amici del Cuore" for its continuous support to DCM patients and their families.
(2008) Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Hear J 29:270–276.
(2014) Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years. Eur J Hear Fail 16:317–324.
(2011) Prevalence and prognostic significance of left ventricular reverse remodeling in dilated cardiomyopathy receiving tailored medical treatment. J Am Coll Cardiol 57:1468–1476.
(2012) Left ventricular dyssynchrony using three-dimensional speckle-tracking imaging as a determinant of torsional mechanics in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 109:1197–1205.
(1999) Guidelines for the study of familial dilated cardiomyopathies. Collaborative Research Group of the European Human and Capital Mobility Project on Familial Dilated Cardiomyopathy. Eur Hear J 20:93–102.
(2010) Ime4: Mixed-Effects Modeling with R (Springer, New York).
(1998) Sample size and optimal designs for reliability studies. Stat Med 17:101–110.
(2008) Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 117:1436–1448.
(2011) Right ventricular systolic function assessment: rank of echocardiographic methods vs. cardiac magnetic resonance imaging. Eur J Echocardiogr 12:871–880.
(2008) The right ventricle: anatomy, physiology and clinical imaging. Heart 94:1510–1515.
(2009) Prognostic utility of right ventricular systolic functions assessed by tissue Doppler imaging in dilated cardiomyopathy and its correlation with plasma NT-pro-BNP levels. Congest Hear Fail 15:234–239.
(2011) Right ventricular ejection fraction and left ventricular dyssynchrony by 3D echo correlate with functional impairment in patients with dilated cardiomyopathy. J Card Fail 17:309–317.


Judge Napolitano said that former Attorney General Loretta Lynch could face 5-10 years in prison for her conduct during the 2016 presidential election. Get ready to see what he says below.
Judge Napolitano says that Attorney General Loretta Lynch may be facing jail time, according to Fox News.
"It is alleged, this document has not seen the light of day yet, if it exists that there is one or several emails between Debbie Wasserman Shultz and Loretta Lynch concerning the behavior that Loretta Lynch will take to further the DNC interests while Mrs. Lynch was the Attorney General, that if it happened, would be misconduct in office," he said.
This needs to get out right now. Loretta Lynch is a frickin' criminal allegedly. It's time to drain that swamp.
Share this to make this go viral. It's time to drain the swamp. Let's start with Lynch. Thanks for reading.


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Home / Arizona Cannabis News / 5 Differences Between Marijuana and Hemp
5 Differences Between Marijuana and Hemp
Dan Kingston April 20, 2015	Arizona Cannabis News
Marijuana and hemp are the two most commonly known names for the cannabis plant.
Cannabis has just as much to do with industrial hemp products as it does with the recreational drug better known as marijuana or pot or weed. This begs the question — how is hemp different from marijuana?
Cannabis is believed to be one of the oldest domesticated crops. Throughout history, humans have grown different varieties of cannabis for industrial and medical uses.
Tall, sturdy plants were grown by early civilizations to make a variety of foods, oils and textiles, such as rope and fabrics. These plants were bred with other plants with the same characteristics, leading to the type of cannabis we now know as hemp.
Other plants were recognized for being psychoactive and were bred selectively for medical and religious purposes. This led to unique varieties of cannabis that we now know as marijuana.
According to Dan Sutton of Tantulus Labs, a Canadian company that specializes in cannabis cultivation technology, "the core agricultural differences between medical cannabis and hemp are largely in their genetic parentage and cultivation environment."
In fact, scientists believe the early separation of the cannabis gene pool led to two distinct types of cannabis plants. The two species (or subspecies) of cannabis are known as Cannabis indica and Cannabis sativa.
2. THC Content
Cannabis plants contain unique compounds called cannabinoids. Current research has revealed over 60 different cannabinoids so far, but THC is the most well known. THC is credited with causing the marijuana high.
While marijuana plants contain high levels of THC, hemp contains very little of the psychoactive chemical. This single difference is what most rely on to distinguish hemp from marijuana. For example, countries like Canada have set the maximum THC content of hemp at 0.3%. Any cannabis with higher THC levels is considered marijuana instead.
In comparison, medical marijuana produces anywhere between 5-20% THC on average, with prize strains tipping the scale at 25-30% THC.
Hemp and marijuana plants contain another important cannabinoid: CBD. Hemp plants produce more CBD than THC, while marijuana produces more THC than CBD. Interestingly, research has shown that CBD acts to reduce the psychoactive effects of THC, separating hemp further from marijuana.
3. Cultivation
Hemp and marijuana are grown for different uses, and therefore require different growing conditions.
"Medical cannabis has been selectively bred over generations, and its characteristics are optimized in its cultivation environment to produce female flowering plants that yield budding flowers at the flowering stage of their life cycle," explains Sutton.
In contrast, Sutton describes hemp plants as "primarily male, without representing flowering buds at any stage in their life cycle." Instead, centuries of selective breeding have resulted in "relatively low concentrations of THC, and tall, fast growing plants optimized for higher stalk harvests."
Achieving maximum THC levels in marijuana is tricky and requires close attention to grow-room conditions. Marijuana growers usually aim to maintain stable light, temperature, humidity, CO2 and oxygen levels, among other things.
On the other hand, hemp is usually grown outdoors to maximize its size and yield and less attention is paid to individual plants.
4. Legal Status
As you might already know, all cannabis is illegal to produce in the United States.
Both hemp and marijuana are classified as Schedule I drugs under the Controlled Substances Act.
However, outside the U.S., hemp is grown in more than 30 countries. In 2011, the top hemp-producing country was China, followed by Chile and the European Union. Hemp production is also expanding in Canada, with the country's annual crop reaching a record high of 66,700 acres in 2013.
Interesting enough, it is legal to import hemp products into the United States. According to the Hemp Industry Association, about $500 million worth of hemp product is imported every year.
Marijuana, on the other hand, remains illegal in most countries. A few, such as Israel and Canada, have recently started to regulate marijuana as a medicine. But the legal production of marijuana is subject to stricter rules than hemp, since it is still widely considered a narcotic.
The strict laws surrounding both forms of cannabis — hemp and marijuana — makes any research very difficult.
"The political implications of that scheduling, from a research perspective, are limiting," explains Sutton. "To my knowledge, of the thousands of academic and research bodies in the United States and Canada whom would be equipped to perform agricultural or medical research on this unique species, only around 40 have actual research licenses to study the plant in a limited context."
Despite these barriers, researchers are making progress in understanding the way medical marijuana works to assist in managing an ever-expanding list of disorders.
What's more, developments in hemp technology continue to reveal new and intriguing ways that this industrial plant can contribute to society in the future. Recently, researchers at the University of Alberta created a supercapacitor using raw hemp material, making the manufacturing of cheap, fast-charging batteries from hemp a real possibility.
Hemp fibre is also being used to develop new forms of renewable plastic, which has made it a common material in the car parts industry.
But as legalization spreads across the globe, the opportunities to explore the potential of the cannabis grows too. The possibilities are endless, and this is one thing hemp and marijuana have in common.

redpajama_set_name: RedPajamaCommonCrawl


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U.S. Preventive Services Task Force
Screening for Adolescent Idiopathic Scoliosis: Recommendation Statement
Am Fam Physician. 2018 May 15;97(10):online.
Related Putting Prevention into Practice: Screening for Adolescent Idiopathic Scoliosis.
Summary of Recommendation and Evidence
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents aged 10 to 18 years (Table 1). I statement.
Enlarge Print
Screening for Adolescent Idiopathic Scoliosis: Clinical Summary of the USPSTF Recommendation
Children and adolescents aged 10 to 18 years
No recommendation. Grade: I (insufficient evidence)
Excluded populations
This recommendation does not apply to children and adolescents presenting for evaluation of back pain or obvious deformities in spinal curvature.
Adequate evidence indicates that currently available screening tests can accurately detect adolescent idiopathic scoliosis when used in combination. Radiography is used to confirm the diagnosis and also to quantify the degree of curvature (i.e., the Cobb angle); the Risser sign (the stage of ossification of the iliac apophysis) is used to monitor curve progression.
Information about the benefits or harms of treatment of screen-detected adolescent idiopathic scoliosis is inadequate. Treatment is determined by the degree of spinal curvature and the potential for further skeletal growth, and may include observation, exercise, bracing, or surgery.
Note: For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, go to https://www.uspreventiveservicestaskforce.org/.
USPSTF = U.S. Preventive Services Task Force.
Adolescent idiopathic scoliosis is a lateral curvature of the spine of unknown cause with a Cobb angle (a measure of the curvature of the spine) of at least 10° that occurs in children and adolescents aged 10 to 18 years. It is the most common form of scoliosis and usually worsens during adolescence before skeletal maturity. In the United States, the estimated prevalence of adolescent idiopathic scoliosis with a Cobb angle of at least 10° among children and adolescents aged 10 to 16 years is 1% to 3%.1,2 Most patients with a spinal curvature of greater than 40° at skeletal maturity will likely experience curvature progression in adulthood. Severe spinal curvature may be associated with adverse long-term health outcomes (e.g., pulmonary disorders, disability, back pain, psychological effects, cosmetic issues, and reduced quality of life).1,3 Therefore, early identification and effective treatment of mild scoliosis could slow or stop curvature progression before skeletal maturity, thereby improving long-term outcomes in adulthood.
The USPSTF found adequate evidence that currently available screening tests can accurately detect adolescent idiopathic scoliosis. The accuracy of screening was highest (93.8% sensitivity and 99.2% specificity) when 3 separate screening tests were used (e.g., the forward bend test, scoliometer measurement, and Moiré topography); sensitivity was lower when screening programs used just 1 or 2 screening tests (e.g., 71.1% for the forward bend test and scoliometer measurement and 84.4% for the forward bend test alone).
BENEFITS OF EARLY DETECTION AND INTERVENTION OR TREATMENT
The USPSTF found no direct evidence regarding the effect of screening for adolescent idiopathic scoliosis on patient-centered health outcomes. The USPSTF found inadequate evidence on the treatment of idiopathic scoliosis (Cobb angle < 50° at diagnosis) in adolescents with exercise (2 small studies) or surgery (no studies) or its effects on health outcomes or the degree of spinal curvature in childhood or adulthood. The USPSTF found adequate evidence (5 studies) that treatment with bracing may decrease curvature progression in adolescents with mild or moderate curvature severity (an intermediate outcome). However, it found inadequate evidence on the association between reduction in spinal curvature in adolescence and long-term health outcomes in adulthood.
HARMS OF EARLY DETECTION AND INTERVENTION OR TREATMENT
The USPSTF found no studies on the direct harms of screening, such as psychological harms or harms associated with confirmatory radiography. The USPSTF found inadequate evidence to determine the harms of treatment.
USPSTF ASSESSMENT
The USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for adolescent idiopathic scoliosis cannot be determined.
Clinical Considerations
PATIENT POPULATION UNDER CONSIDERATION
This recommendation applies to asymptomatic children and adolescents aged 10 to 18 years. This recommendation does not apply to children and adolescents presenting for evaluation of back pain, breathing difficulties, abnormal radiography findings or other imaging studies, or obvious deformities in spinal curvature.
Most screening tests for adolescent idiopathic scoliosis are noninvasive. Screening is usually done by visual inspection of the spine to look for asymmetry of the shoulders, shoulder blades, and hips. In the United States, the forward bend test is commonly used to screen for idiopathic scoliosis. First, a clinician visually inspects the spine of a patient while the patient is standing upright. Next, the patient stands with feet together and bends forward at the waist with arms hanging and palms touching. The clinician repeats the visual inspection of the spine.1,4 A scoliometer, which measures the angle of trunk rotation, may be used during the forward bend test. An angle of trunk rotation of 5° to 7° is often the threshold for referral for radiography.1 Other screening tests include a humpometer, the plumb line test, and Moiré topography (creating a 3-dimensional image of the surface of a patient's back) (Table 2).
Screening Tests for Adolescent Idiopathic Scoliosis
Forward bend test
The child bends forward at the waist until the spine is parallel to the horizontal plane. The examiner checks the child's back for rib humps or other spinal asymmetries. This test is commonly used in school-based scoliosis screening programs, with or without a scoliometer.
Scoliometer
A noninvasive, handheld instrument used to measure the angle of trunk rotation. The examiner places the instrument on the child's spine during the forward bend test and reads the angle. An angle of trunk rotation of 5° to 7° is the recommended threshold for referral to radiography.
Humpometer
A series of movable strips are placed along the child's back perpendicular to the spine. The examiner locks the strips into place, transfers the contour lines to graph paper, adds the size of rib humps and depressions, and obtains a measure of back deformity. A back deformity of ≥ 5 mm may indicate a positive screening result.
Plumb line test
The examiner holds a plumb line at the child's C7 vertebra (in the neck) while the child is standing upright and allows the line to hang below the hips. The amount to which the plumb line moves from the center of the spine is measured.
Moiré topography
A specialized device projects contour lines, called Moiré fringes, on the child's back. The examiner takes a photograph of this projection and counts the number of asymmetric contour lines. A child with ≥ 2 asymmetric Moiré fringes is usually referred to radiography.
If idiopathic scoliosis is suspected, radiography is used to confirm the diagnosis and to quantify the degree of curvature (i.e., the Cobb angle) and the Risser sign (the stage of ossification of the iliac apophysis).1 U.S. organizations that advocate screening recommend the forward bend test combined with scoliometer measurement.
The goal of treatment is to decrease or stop progression of spinal curvature during the period of adolescent growth prior to skeletal maturity. Treatment of adolescent idiopathic scoliosis is determined by the degree of spinal curvature and the potential for further growth and generally includes observation, bracing, surgery, and exercise.1
SUGGESTIONS FOR PRACTICE REGARDING THE I STATEMENT
Potential Preventable Burden. Most children and adolescents with scoliosis do not have symptoms. Generally, smaller spinal curvatures remain stable, while larger curvatures tend to progress in severity.
Pulmonary dysfunction can be clinically significant in patients with spinal curvatures greater than 100°; however, curvatures of that severity are rare. Back pain is more common, but its effect on functioning or disability is unclear.1 Current evidence suggests that the presence of back pain does not necessarily correlate with the degree of spinal curvature in adulthood. Adults with adolescent idiopathic scoliosis may have poor self-reported health, appearance, and social interactions. Mortality is similar to that among unaffected adults.1
Potential Harms. Evidence on the harms of screening for adolescent idiopathic scoliosis is limited. False-positive results are an important potential harm, with rates ranging from 0.8% to 21.5%.1,5,6 However, the direct harms of screening are unclear. Potential harms of false-positive results include unnecessary follow-up visits, increased cancer risk attributable to radiation exposure, overtreatment, or psychosocial effects associated with the diagnosis of clinically nonsignificant scoliosis.1
Current Practice. Various organizations have recommended routine screening for scoliosis in children and adolescents since the 1980s.1,4 More than half of U.S. states either mandate or recommend school-based screening for scoliosis.1,4,7 Children and adolescents are usually screened with the forward bend test, with or without scoliometer measurement.1,4
In general, patients with a Cobb angle of less than 20° are observed without treatment; however, exercise may be recommended at this time. Patients with a Cobb angle greater than 30° or a Cobb angle of 20° to 30° that progresses 5° or more over 3 to 6 months are treated with bracing. Patients with a Cobb angle of 40° to 50° may be treated with bracing or surgery, while those with a Cobb angle greater than 50° typically require surgery.1
This recommendation statement was first published in JAMA. 2018;319(2):165–172.
The "Other Considerations," "Discussion," "Update of Previous USPSTF Recommendation," and "Recommendations of Others" sections of this recommendation statement are available at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/adolescent-idiopathic-scoliosis-screening1.
The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.
1. Dunn J, Henrikson NB, Morrison CC, Nguyen M, Blasi PR, Lin JS. Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence synthesis no. 156. AHRQ publication no. 17-05230-EF-1. Rockville, Md.: Agency for Healthcare Research and Quality; 2017....
2. Weinstein SL. Natural history. Spine (Phila Pa 1976). 1999;24(24):2592–2600.
3. Dunn J, Henrikson NB, Morrison CC, Blasi PR, Nguyen M, Lin JS. Screening for adolescent idiopathic scoliosis: a systematic review and evidence report for the U.S. Preventive Services Task Force. JAMA. 2018;319(2):173–187.
4. Rosenberg JJ. Scoliosis. Pediatr Rev. 2011;32(9):397–398.
5. Yawn BP, Yawn RA, Hodge D, et al. A population-based study of school scoliosis screening. JAMA. 1999;282(15):1427–1432.
6. Karachalios T, Sofianos J, Roidis N, Sapkas G, Korres D, Nikolopoulos K. Ten-year follow-up evaluation of a school screening program for scoliosis: is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis? Spine (Phila Pa 1976). 1999;24(22):2318–2324.
7. Linker B. A dangerous curve: the role of history in America's scoliosis screening programs. Am J Public Health. 2012;102(4):606–616.
As published by the U.S. Preventive Services Task Force.
This summary is one in a series excerpted from the Recommendation Statements released by the USPSTF. These statements address preventive health services for use in primary care clinical settings, including screening tests, counseling, and preventive medications.
The complete version of this statement, including supporting scientific evidence, evidence tables, grading system, members of the USPSTF at the time this recommendation was finalized, and references, is available on the USPSTF website at https://www.uspreventiveservicestaskforce.org/.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of USPSTF recommendation statements published in AFP is available at https://www.aafp.org/afp/uspstf.
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A Christian-protestant Guy who is willing to grow old with me bonded with love and harmony :D "Charm is deceitful and beauty is passing, but a woman who fears the LORD, she shall be praised!! :)"


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navy seal wall of shame list
Trump awards Medal of Honor to Navy SEAL accused of war crimes "SEAL Team 6 added Slabinski to the "rock of shame," a list of former members of SEAL Team 6 who were no longer welcome to visit the command. These names are on this rock because these people conducted themselves in a way that did not bring glory to the teams. Andy WRIGHT Edmonton Area, Alberta. That's approximately one (1) former Navy SEAL for every 45 THOUSAND citizens… You have a far greater chance of meeting a former NFL football player than you have of ever encountering a real Navy SEAL. The Shadow of Shame Children Walk Enduring a Phony SEAL Father... 05/09/20 00:21:38. Former US Navy SEAL Mark Bissonnette, the best selling author sellout who wrote "No Easy Day," the unauthorized (and possibly embellished) story of the raid that killed Osama Bin Laden, is back in the news and back in trouble with the law. The member of SEAL Team Six claiming to have shot and killed Osama bin Laden in a daring night raid in May 2011 is Robert O'Neill, multiple news sources have confirmed.O'Neill has … Steve Waterman is the real deal; a bona fide Navy diver who served alongside the 500 other SEALS operating during the war in Vietnam. A retiree … He says a network of fellow phony-hunters—mostly former SEALs—feeds him updates with each new class: "A lot of people find this hard to believe, that there's a list of these guys, because it seems so secretive, but that's bullshit—there are records kept, and we have ways to access them." (The Navy SEALs press office doesn't comment on the actions of its former members.) The founder of 'Hell Week' and trainer of the teams that became the Navy SEALs knew valor alone was worthless. ; Roy Boehm – WWII veteran of Coral Sea, Bougainville, Truk, Green Island, Emeru, Saipan, Tinian and Guam.First commanding officer of SEAL Team 2 (1962), considered godfather of all SEALs. List. He has a YouTube channel and posts under the name Buds 131. A Navy SEAL platoon was ordered home from Iraq during an ISIS fight for rape allegation and drinking alcohol while deployed. See more ideas about Stolen valor, Veterans discounts, Shame. Warriors Rest, military phony busting, wounded warriors hunting, and more! Check out AuthentiSEAL's Wall of Shame and VeriSEAL's Hall of Shame. Phony Navy SEAL of the Week. 0. log in. Already barred from serving at SEAL Team 6, Slabinski was now physically banished." Those who falsely claim to be Navy SEALs -- to have gone through the rugged training and fought along side other SEALs on dangerous secret missions -- are in for a rough ride. SEALs and SEAL organizations actually investigate suspicious claims and publicize the names of imposters. join. Navy veteran John Garofalo appeared on a Fox News segment this month, showing off a massive presidential seal he carved for President Trump while receiving praise for his service in Vietnam as a SEAL. The Crimes of SEAL… Problem is that Ilkich never served he's just another in a long line of phonies trying to act like their badasses. Nearly 700 names have been posted on the ``Wall of Shame' by CyberSEALs, whose members include ex-SEALs and a former Navy wife who once lived in Hampton Roads. I was able to pass since I had about a 10% body fat. non-serving) Navy SEALs scattered among our nation's population of 313+MILLION. Dicken, who boasted about being the most decorated Navy SEAL ever, she was … Check it out. Feb 2, 2017 - Explore Dean Dyer's board "the wall of shame, aka stolen valor stooges", followed by 109 people on Pinterest. Man Posing As Navy SEAL Sentenced To Federal Prison William J. Burley A California man who falsely claimed to be a Navy SEAL to defraud non-profit organizations got sentenced to federal prison this week. There are only about 7,000 former (i.e. BUDS131 Youtube,Stolen Valor, busting phony navy SEALs. For instance, I was 72 inches and 205 lbs. Dwayne Curtis EISEN Okanagan Falls, BC First, by memorializing those SEALs who gave their lives in service to their country, by publishing comments and writings by SEALs, and by giving the public a way to find out more about the REAL SEALs by providing links to the personal, political and business pages of the REAL SEALs. As Shane stated, Senior Chief Don Shipley has some great stuff out there on phoney SEALs. Find recipients of the Purple Heart, Medal of Honor, and other military medals in our database of U.S. conflicts, including WW2, Vietnam, and the Gulf War. Navy SEALs train and work in all manner of environments, including desert and urban areas, mountains and woodlands, and jungle and arctic conditions. The Navy SEALs are a special operations group associated with the Navy. The imposter, 36-year-old William J. Burley, was sentenced to three years in prison followed by another three years of supervised release. The Navy SEALs Wall Of Shame page: 1. Hunting Dux in Maryland while Bob Wall takes a few SWINGS at Dux. Typical missions may involve insertion into a combat objective by any number of means: parachute, submarine, helicopter, high-speed boat, foot patrol or by a combat swimmer insertion. Founded in 1962, the SEALs are the U.S. Navy's principal special operations force. Ken wore a Navy SEAL Trident which obviously drew attention. The name "SEALs" represents the environments in which they operate: sea, air and land. This is an elite team of military personnel. A SEAL must embody duty and honor, too. 02/17/18 00:34:26. Hendrik Van der pol Summerside, PEI Mark S Beres Beachville, Ontario Johann JEPPE Calgary, Alberta. It surely is a bad idea to annoy the Navy and an even worse one to annoy a Navy SEAL. The Navy SEAL Memorial: The Names of Those Who Made the Ultimate Sacrifice. First Navy SEAL to achieve the rank of vice admiral and four-star admiral; the first Navy officer to command U.S. Special Operations Command. With the proliferation of bogus UFO and military documents in the past 10 years from people claiming to be Navy SEALs… A 68-year-old Wisconsin man who falsely claimed to be a Navy SEAL wounded four times in Vietnam has been sentenced to four years in prison for theft and faking paperwork. The Memorial Wall is located in the Original Headquarters Building lobby on the north wall. Ilkich boasted of his inner killer and number of bad guys he smoked on the battlefileds as a U.S. Navy SEAL. share: Byrd. BUD/S Class 76. This is a list of notable current and former members of the United States Navy SEALs. Jan. 3, 2014— -- When Navy veteran Carol Roberts first met A.J. The rock of shame is a large rock (boulder, really) that has the names of specific members of the Navy SEALs. It's the latest scandal to rock the elite fighting force. Mar 13, 2015 - A Minnesota man photographed wearing the uniform of a Ranger-tabbed command sergeant major at a charity motorcycle ride honoring fallen service members will serve five years in prison for firearms offenses, which came to light as officials investigated stolen valor accusations. He went on to say that he was a LCDR in the Navy - the shit just kept getting deeper! After retiring Beck came out as a transgender woman in 2013, changed her name to Kristin and authored Warrior Princess. for a significant time while in the Navy. It is the goal of this site to uphold the honor and integrity of the US Navy SEALS in two ways. Ken was eventually called out for it and ended up listed in an older effort to keep track of SEAL imposters in what was called "SEAL Wannabes by Watchlords" which in turn came from an older effort called "VeriSEAL." The list is still around but has not been updated. Ilkich, Dan – Fake SEAL We highlight this special shitbird one Dan Ilkich. The National Navy SEAL Museum is home to the only Memorial dedicated solely to honoring Navy SEALs and Frogmen for their sacrifice and love of country. When I was at BUD/S, I was 72 inches and 195 lbs. Phony Navy SEAL of the Week. posted on Dec, 27 2002 @ 09:15 AM link . Kristin Beck – Former DEVGRU member. There are 133 stars carved into the white Alabama marble wall, each one representing an employee who died in the line of service. I have long wanted to see a Wall of Shame, and not just for Wannabe's ... and the second guy saying he was a SEAL (I contacted the guys at the SEAL locator and they said they were 100% certain he was not a SEAL… The centerpiece of the Memorial is a bronze sculpture of a modern Navy SEAL combat swimmer. Memorial.
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Het Vasteland is een korte drukke weg ten zuiden van het centrum van Rotterdam en maakt deel uit van de Centrumring S100. De weg ligt in het verlengde van de Westzeedijk en loopt tot aan het kruispunt Schiedamsedijk/Boompjes/Erasmusbrug. In de middenberm van de autoweg liggen de tramrails van tramlijn 8. Op de hoek met de Schiedamsedijk bevindt zich de Maastorenflat, die na de bouw enige tijd het hoogste woongebouw van Nederland was.

Geschiedenis
Het Vasteland is een onderdeel van Schielands Hoge Zeedijk, de primaire waterkering van het hoogheemraadschap van Schieland. Dit gedeelte tussen Rotterdam en Schoonderloo werd kort voor 1288 aangelegd. In 1599 werd op het Vasteland een nieuwe Schiedamse Poort gebouwd, ter vervanging van de oude Schiedamse Poort die ter hoogte van het huidige Schielandshuis stond. Deze nieuwe poort werd ook Rode Poort genoemd. In 1638 vestigden zich de haringreders uit Delfshaven aan het Vasteland naast het lijnbaanhuis van de Oostindische Compagnie. De Delfshavense reders kregen hier van de stad Rotterdam een erf aangeboden om hun taanhuis te bouwen en verhuisden hun 40 haringbuizen van Delfshaven naar Rotterdam. Omdat de grond in het gebied ten westen van de Leuvehaven regelmatig verzakte moesten de eigenaren hun erven regelmatig ophogen. Slechts een gedeelte van het gebied lag op vaste bodem. De eigenaren van deze erven gaven het de naam Vasteland, een naam die omstreeks 1720 in gebruik komt. Dit gebied stond eerder bekend als Stadsplein.

Fotogalerij

Externe link
 Wegenwiki

Straat in Rotterdam Centrum

redpajama_set_name: RedPajamaWikipedia


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Digital Makeover: Buy an Album
When was the last time you actually purchased a record? Here are five ways you can buy music and support the artists you love.
CASH Music
You can stream and/or download vast quantities of free music through a variety of places these days, both legal and not so much. But when was the last time you actually purchased a record either online or in your local record store? If it's been a while, we here at CASH Music would like to encourage you to do it today.

	While streaming services can be a great way to discover new bands, they only pay artists a fraction of what a digital sale would. It's hard for musicians to make a living from what they're paid by streaming services alone. If you want to make sure your favorite band can release more records, play a show in your town, and just continue to rock in general, then why not buy a record?

	Here are five ways to buy:

	1) Head to your local record store. This way you're not only supporting the musicians you love, you're also keeping your money in your community.

	2) Buy the record directly from the band on their own website. Musicians always make the most money out of direct transactions, whether it be for digital or physical copies. And while you're at it, sign up for the band's newsletter so you don't miss their shows.

	3) Go to the band's concert and buy the record from the merch table. I know from personal experience that this will help the band gas up to make it to their next show. Plus, a cool bonus for you is that bands will often have hard-to-find limited edition t-shirts and music releases on tour with them. (Don't forget to stop by the cash machine on the way to the show—most bigger bands will be able to take credit cards at their tables but cash is always best.)

	4) Mailorder! Learn what label the band you like is on and visit their website. Don't forget to check out the label's other bands while you're there—it's likely you'll be into something else they've released.

	5) Buy it from your favorite digital store. eMusic, iTunes, and BandCamp are all fine places to show your support for great music.

 30 Days of GOOD is moving! As of Monday 9/24, we'll be discontinuing the daily emails, so get over to our new site and register so you can keep following 30 Days of GOOD. There's much to explore in the new site. Looking forward to seeing you there!

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Digital Makeover: Learn How to Protect Yourself Against Viruses and Malware #30DaysofGOOD


As you probably already know, The Aquaman Shrine is the place to go to get new Aquaman information, reviews and fun. Also be sure to follow the shrine on Twitter.
I'll update here when I have the chance, but I work full-time and, until recently, had a very slow computer. So be sure to check out the Shrine for current stuff.


Easy online booking at 1 accommodation options in Evaton. Browse Evaton self-catering, guesthouses, B&Bs and hotels with great rates. Find Evaton holiday accommodation for all tastes and budgets, with TravelGround.com.
Water on Waldrift is situated in the heart of the Vaal, within easy reach of towns like Meyerton, Vereeniging, Vanderbijlpark, Heidelberg and approximately a 40-minute drive from Johannesburg. Water on Waldrift pro...Flexible Cancellation!
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Check 5th Class Result 2018 Swat Board online at Result.pk for free (Grade 5 Gazette Online)).
5th Class result other than 5th Class Result 2018 Swat Board from other various educational boards, BISE, Federal Directorate of Education, Punjab Education Commission, Educational Bodies like FDE.gov.pk, PEC.edu.pk, SEC, BED, KPKED, AJKEC can be viewed on their Gazette pages online at Result.pk, which can be accessed from top or left menu.
Swat is a famous and beautiful area in KPK province and there were thousands of KPK students who appeared in the 5th class annual exams 2018 which were conducted by KPK Education Commission couple of months ago. Now according to the KPK Education Commission, the result of these 5th class exams will be announced by KPKEC on 31st March 2018 in the whole province and the anxious students will be relieved to view their 5th class result 2018 Swat. All the students, including students from Swat, can view their results at this website where it will be available soon after its announcement by the authority.


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Moscow's Second Chechnya War
Boris Kagarlitsky
IN THE EAST there is a proverb: "Don't brag when you're on your way to war." Vladimir Putin's generals have obviously never come across it.
The Chechens undoubtedly planned on eventually abandoning Grozny. While Grozny could not be surrendered without a fight, no one would have set out to hold it at any price. The Chechens' primary aim is to keep Russian forces relatively confined and immobile, while causing them continual, debilitating losses.
Daily, the Russian state media outlets boast of the deaths of thousands of Chechen fighters. Quieter reports tell of aircraft bombing friendly troops and organizational chaos.
The second Chechnyan war began with a saturation media campaign, to the refrain of "we will not repeat the mistakes of 1994." Then, General Grachev's strategy had been to make a single thrust into Grozny in the shortest possible time. He aimed to smash the Chechen militias and their political structures before they could organize partisan resistance.
Militarily, the 1994 plan made sense but its execution was inept. The assault on Grozny failed and became a lengthy siege of the city. This allowed General Dudayev, the then-Chechen president (later killed in a Russian assault-ed.), to prepare a base for protracted resistance in the mountains of southern Chechnya. The Russian army was sucked into a drawn-out war they could not win with the resources available.
After the war, the generals convinced themselves that the defeat was caused by government irresolution and popular hostility. They concluded that before relaunching the war, they would need unanimous support from political elites and silence from the critics.
The second Chechnyan war has seen the lessons of NATO's Kosovo campaign interpreted in Russian fashion. The population has been swamped with propaganda. Opponents of the war have been denied access to the mass media or intimidated into silence.
Despite this, polls indicate that Russian support for the conflict is far from universal. But the image of the courageous Chechen fighter battling the despised Yeltsin regime has faded too, and apathy reigns. Since Chechnya gained effective independence in 1996, prominent field commanders have turned into criminal bosses, closely linked to the worst elements of the Russian elite.
At one point, the Chechen President Aslan Maskhadov told journalists of field commanders whose mobile phone bills were being paid by Moscow oligarch Boris Berezovsky. For big-time Russian criminals, the existence of a territory within Russia's nominal boundaries but outside the control of the state, has created phenomenal opportunities.
The republic has provided a sanctuary for operations including: contraband, money-laundering, drug-running and kidnapping. Even Maskhadov's friends understand that he is quite powerless against these forces.
Over the 1990s, the brazenness of Chechen bandits, and their supposed fascination with explosives, became part of Russia's political folklore. When a series of urban apartment bombings claimed some 300 Russian lives in early autumn, Chechens were automatically blamed. Despite the lack of any proof, tanks then rolled over the Chechen border.
Behind the War
The notion that the invasion was aimed at thwarting crime and rooting out terror, however, is naive. For Russia's elite, the fact that Chechnya is a criminal haven is not necessarily cause for attacking it. The fact that it is nominally Russian, and outside Moscow's control, is.
Chechen independence has been an advertisement for the feebleness of the Kremlin's authority. As Yeltsin's fortunes waned over the summer, the attractions of a show of force in Chechnya increased.
By summer, Yeltsin's political supporters, the people who might keep the "family" (the corrupt circle surrounding Yeltsin, including his relatives-ed.) out of jail, were clearly unelectable.
The need was pressing for another made-to-order crisis that would facilitate the introduction of censorship to "consolidate" the nation around the regime. When "Chechen" bombs began demolishing Russian apartment buildings, the fit with the regime's political needs was almost too perfect.
For Western governments who trumpeted outrage at Serb atrocities in Kosova, Russian actions in Chechnya have always been a delicate matter. The Russian authorities' conclusion that their Western friends would stick with them through another Chechnya campaign, no matter the body count, appears to have proved accurate.
Western leaders, after all, expressed a distinct lack of indignation during the slaughter of 1994-1996. The problem for Russia and the West is that a repeat of that debacle is all but certain.
Grachev's strategy in 1994 was correct in textbook terms, but the one adopted in 1999 is not even that. The army has moved slowly to Grozny, without involving itself in major battles.
The Chechen fighters "forced out" from their positions by artillery and air strikes have only retreated. This allows the army to claim victories and advance, but the Chechen formations have withdrawn in good order.
The Chechens have not seriously tried to hold a front according to the rules of the first and second world wars. They are conducting a partisan struggle aimed at slowing the Russian advance, and making it costly. One suspects that the Russian strategy which allows this is dictated more by fear of the enemy than subtle planning.
1812 in Reverse
The Russian generals conducting the campaign have obviously not read the works of Mao and Guevara on guerilla war. But in military academy, they must have studied the 1812 campaign in which the Russian army defeated Napoleon.
The French moved slowly into Russia, while the weaker Russian armies under Barclay de Tolly and Kutuzov slowly retreated, avoiding a decisive battle. After the French had captured Moscow and declared themselves victorious, partisan warfare began throughout the entire territory they had occupied. Abandoning a burnt-out and uninhabitable Moscow, the French emperor fled.
The key difference with the present Chechen situation is that Napoleon understood enough to try to force the Russians into an all-out battle. Today's Russian generals are scared to risk anything more than a skirmish.
Even successes like the capture of Grozny will not affect the overall course of the war. Because of the slowness of the federal forces, defending the city was less important for the Chechens in 1999 than even in 1994.
The army appears to think it will be hard for the Chechens to spend winter in the mountains, even though Dudayev's relatively ill-prepared partisan units survived two winters there. No one is considering how the Russian army itself will cope with the Chechen winter.
The military supply system is in a decrepit state, far worse than in 1994, and in precise analogy with Moscow in 1812, a burnt-out Grozny will not provide winter quarters for a huge army.
So far, Russian forces have avoided population centers but they cannot spend the winter in the open, nor can they retreat. Chechen fighters will return as soon as they depart. Consequently, Russian forces must remain indefinitely, trying to control every village. They have neither the military strength nor financial resources for this.
Chechnya and the Russian Left
Three years of independence have left the Chechen population bitterly disappointed. Dudayev promised them prosperity, democracy, secularism and socialism. By 1999, the Chechens had been delivered poverty, chaos, religious extremism and a dictatorship of corrupt warlords.
However, the Kremlin's assumption that by comparison, Russian rule will seem benign is mistaken. Chechens recall the nightmare of the 1994 Russian invasion as the precursor to the outrages that followed.
Meanwhile, the racism and corruption of the Russian forces, along with the chaos they have visited on refugees, will probably alienate many Chechens who might otherwise have felt sympathetic.
The rocketing of marketplaces, bombing of refugee columns and other "technical errors" will again make Chechen fighters seem like heroes. This will be even more so as new Chechen field commanders quickly emerge, free of responsibility for the mayhem wrought by their predecessors.
Moscow can not rebuild Chechnya or create jobs, it can only continue the destruction. In practice, Chechnya's young will find their vocation shooting at targets dressed in Russian army uniforms.
The failure of the second Chechnya campaign will become obvious by spring. There are a number of possible scenarios, ranging from an agonizing, ruinously expensive war against "invisible" partisans to total rout of the army and disintegration of the command structure, as happened to the French in 1812.
Revolution and reform in Russia often begin with lost wars, and the present Chechnya campaign may well repeat the pattern. The unanimous support given by Russia's politicians to the war means that a deep political crisis will follow military defeat.
A Chechen victory could act as a pivot for social consciousness, radicalizing large numbers and inspiring protest. Or Russian society, which has meekly endured many humiliations, may reconcile itself to this one as well.
Whatever the case, Russian generals are continuing to arrogantly march into the traps that have been set for them. The denouement will be bloody and convulsive, accompanied by calls for a broad suppression of dissent to allow the crusade against "terrorism" to be redoubled.
On the left, there must be no equivocating: the Chechens have the unconditional right to independence. Russian leftists face a dual challenge: even before taking the antiwar fight to the government, we must wage a sharp political struggle to secure our own forces to resist chauvinist disorientation.
This task will not be made easier by the fact that there is only one progressive thing about today's Chechen leaders: that for fleeting reasons they are heading a struggle with a liberating dynamic; that for contradictory reasons, they are fighting against people far more dangerous to the international working class than they are themselves.
Boris Kagarlistsky is an independent socialist in Russia and the author of several books on the failures of reform. This article was originally published in early january for the British magazine Red pepper and is reprinted with permission.


Despite Chrysler's promise earlier this year to ramp-up efforts to fix more than a million Jeeps recalled over a year ago, consumers continue to report issues with obtaining the needed repairs.
The Wall Street Journal reports that although Chrysler announced earlier this month that plenty of parts were on hand to fix the recalled Jeeps, consumers are often told the parts aren't available or that other repairs – to be done at their own expense – are needed before the recall remedy can be installed.
Ever since the recall was first announced in the summer of 2013, it's been at the center of much controversy and debate.
The National Highway Traffic Safety Administration sought the recall over concerns that the vehicle's gasoline tanks could split and catch fire in rear-end collisions.
According to the original recall notice [PDF] model year 1993-1998 Jeep Grand Cherokee and 2002-2007 Jeep Liberty vehicles have rear-mounted fuel tanks that sit too low and are at risk for rear-end explosions.
So far, NHTSA has linked 51 deaths to fiery rear-end collisions involving the vehicles.
It's unclear if that figure includes a pregnant Michigan woman's death last week. According to the WSJ, the 23-year-old woman died when her 2003 Jeep Liberty was struck from behind and caught fire. An attorney for her family says the vehicle had not yet been repaired.
From the beginning, Chrysler has maintained that the issue is not a safety defect. However, last summer, the car manufacturer and NHTSA agreed to a remedy for the issue that involved equipping vehicles with a trailer hitch that could reduce the risk of fires.
It was reported last week that only about 8.6% of the 1.56 million Jeeps involved in the recall have been fixed.
While NHTSA officials criticized Chrysler for the slow-moving repairs earlier this summer, the manufacturer has since said it has about 461,000 parts on hand to provide fixes.
Still, a majority of the recent complaints filed with NHTSA regarding the recall involve a lack of parts from dealers.
A complaint filed just last month highlights consumers' continued struggle to have their vehicles repaired.
The owner of a 1998 Grand Cherokee reports that when the vehicle was brought to a dealer, he was told the parts were not available. The dealer didn't give a specific date for when parts would be available. He then contacted Chrysler and was told they could not provide an estimated date for when the vehicle might receive the recall repairs.
Another owner tells NHTSA of the numerous issues they experienced when trying to remedy the recall.
A lack of parts isn't the only issue consumers have faced when it comes to attempting to repair the recall issue. Some owners say they've been told their vehicles can't be fitted for the hitch until they make other costly repairs.
In one complaint the owner of a 2003 Jeep Liberty says that after receiving a recall notice from NHTSA he was informed that the dealer was unable to install the hitch due to corrosion on the vehicle's frame.
Another consumer tells the WSJ that he was handed an estimate of more than $3,000 to fix corrosion issues on this SUV before it was capable of actually fixing the recall issue.
Additionally, NHTSA says that the manufacturer isn't responsible for repairs to previous vehicle damage.


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ryknolesdunnflea's blog
ryknolesdunnflea Fri, 09/21/2007 - 7:41pm
"9/11 should have and could have been prevented"- Michael McConnell in Reason Magazine
See the article over at http://www.reason.com/news/show/122604.html
The Banality of Truth
The government finally admits pre-9/11 bumbling
Jeff Taylor | September 21, 2007
On Tuesday Director of National Intelligence Michael McConnell told the House Judiciary Committee things that, had a government official said them in the days, weeks, or months following 9/11. would have sparked public outrage—and may have significantly blunted the push for greater police and surveillance powers like the PATRIOT Act.
McConnell told lawmakers that "9/11 should have and could have been prevented."
Specifically, McConnell cited the pilot training sought by hijackers Khalid al Mihdhar and Nawaf al Hazmi and convicted terrorist Zacarias Moussaoui in the United States as an obvious warning sign that was ignored by Washington after feds on the ground flagged the activity.
"For whatever reason, we didn't connect the dots," McConnell said, not quite coming clean on the reasons.
ryknolesdunnflea Sun, 08/05/2007 - 1:31pm
UPN News Footage Puts Michael Hess out of WTC 7 by approximately 11:30
Barry Jennings
Michael Hess
WTC 7 damage
I have obtained a copy of the live footage broadcast by UPN 9 News, WWOR-TV, on 9/11, and it reveals that Michael Hess, along with Barry Jennings, seem to have been out of the building much earlier than NIST stated in their June 2004 Progress Report. In NIST's report, it places the two individuals' rescue between 12:10 and 12:15, but as can be seen in the video, which I have not the means to upload right now, places he and Mr. Jennings out by around 11:30, because he is speaking live on the news (via telephone with a reporter), at 11:34. The video starts at 10:37, and Michael Hess appears 57 minutes into it. The interviewing reporter, Frank Ucciardo, appears several seconds before. We can further estimate how long Michael Hess had been out of the building by reasoning that he was interviewed "on Broadway about a block from city hall", which puts him near the intersection of Broadway and Chambers Street. On Yahoo maps, the shortest route from what used to be the north face of WTC 7 on Barclay to that intersection is four-tenths of a mile. It seems reasonable to assume that it took no less than five minutes (and probably significantly longer) for Mr.
Wanted: Photographer who took this picture.
Simply, I need the help of the community to direct me toward the person who took this photograph, as it appears on 911research.com.
http://www.911research.com/wtc/evidence/photos/wtc7fire3.html
I am just hoping that I am a Johnny-come-lately, but I have been unable to find a source for this picture. Whoever answers the e-mails at 911research.com has not gotten back to me. Does anyone know where this picture is from?
ryknolesdunnflea Sat, 07/07/2007 - 1:22pm
Michael Hess interviewed by In Memoriam?
I am sure there are people out there who have seen this film. I have just been doing research, actually not about Barry Jennings or Michael Hess, and came across this interview with Michael Hess done by HBO's documentary In Memoriam. The thing is, while it is listed on the site, both links to watch it (as well as all the links for all the videos) failed for me. Can anyone else see it?
http://www.hbo.com/docs/programs/9_11/
Go to the interactive site.
Click on 911 and go to staff interviews. Michael Hess is pictured fourth from the left on the top row of pictures. I can't watch the interview. Can anyone? If not, we should write to HBO and try to obtain that interview. It COULD be telling.
ryknolesdunnflea Wed, 07/04/2007 - 2:06pm
Going to National Archives
collapse photos
I am planning to go to the National Archives in D.C. (actually the branch in College Park, Maryland) to look at this http://arcweb.archives.gov/arc/arch_results_detail.jsp?&pg=52&si=0&nh=65&st=b
Do you guys think it will be worth it? It ostensibly has over 1,400 images. Has anyone else gone to see if there is anything of value in terms of new photographs, especially of damage to wtc 7? I don't want to waste my time and money if anyone can convince me it won't be a fruitful search. It does talk about the photos being of the "aftermath", but I don't know if that means it has pictures from the day or not. Anyway, any recommendations would be appreciated.
Shyam Sunder Confronted with 9/11 Conspiracy Theories
http://www.pbs.org/wgbh/nova/wtc/cons-flash.html
On NOVA's website for "How the Towers Fell" there is an interview with Dr. Shyam Sunder who makes seemingly unfounded, speculatory excuses for the speed of the collapses, as well as for molten metal dripping from the South Tower (which Dr. Steven Jones has already explained CANNOT be aluminum), and other anomalies such as the puffs of dust, ignoring evidence to the contrary. It's a nice little interview- the interviewer does very little arguing, but does bring up the relevant topics of interest.


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Free Books / Travel / Concise Gazetteer Of The World /
Tlaxcala - Tokat
This section is from the book "Chambers's Concise Gazetteer Of The World", by David Patrick. Also available from Amazon: Chambers's Concise Gazetteer Of The World.
Tlaxcala (Tlaskah'la), the smallest state of Mexico. Area, 1506 sq. m.; population, 175,000. The capital, Tlaxcala, stands 7300 feet above the sea; pop. 2850.
Tlemcen (Tlem-sen'), a town of Algeria, 80 miles SW. of Oram Pop. 35,382.
Toba'go, the most southerly of the Windward Islands belonging to Britain, lies 18 1/2 miles NE. of Trinidad (of which it is a dependency), is 32 miles long by 7 broad, and has an area of 114 sq. m. It was discovered by Columbus in 1498, and named by him Assumption; the name Tobago probably arose from the free use of tobacco by the Carib natives. It was long contested between Dutch, Spaniards, and French, but came to Britain in 1763. The island is volcanic, mountainous (1800 feet), and picturesque. Scarborough, its chief town, is on the S. side, and at the base of a conical hill (425 feet), crowned by Fort King George, now without garrison. The exports (rum, molasses, cocoa-nuts, livestock, etc.) amount to from £20,000 to £40,000 a year; the imports to from £20,000 to £30,000. Pop. 18,750.
Tobercurry
Tobercurry, a Sligo market-town, 9 miles SW. of Ballymote. Pop. 870.
Tobermo'ry. See Mull.
Tobolsk
Tobolsk, a town of W. Siberia, at the Tobol's influx to the Irtish, nearly 2000 miles E. of St Petersburg. Pop. 20,630. - Area of Tobolsk government, 539,659 sq. m.; pop. 1,500,000.
Toboso
Tobo'so, El, a town (pop. 1925) in the Spanish district of La Mancha, 60 miles SE. of Toledo, the home of Don Quixote's peerless Dulcinea.
Tocantins', an important river of Brazil, rises in the state of Goyaz, flows 15 miles N., and finally widens into the Para (q.v.), 138 miles from the Atlantic. Its affluent, the Araguay (1600 miles), bears along a greater volume of water than the Tocantins itself. Steamers ascend for 400 miles from the sea; above the rapids 400 miles more is navigable.
Toddington, a town of Bedfordshire, 5 miles N. of Dunstable. Pop. of parish, 2087.
Tod'morden, a market-town on the border of Yorkshire and Lancashire, prettily situated among hills on the Calder, 9 miles N. by E. of Rochdale, 18 1/2 NNE. of Manchester, and 13 W. of Halifax. The classical town-hall was erected in 1875, and in front of it is a bronze statue by Foley of John Fielden, M.P. (1784-1849), the founder here of an enormous cotton-mill. Coal abounds in the vicinity. Pop. (1871) 21,764; (1901) 25,418.
Togoland
To'goland, since 1884 a German protectorate on the Slave Coast, east of the British Gold Coast, between 0° 30' E. long. and 1° 41' E., the boundary towards the interior being somewhat indefinite. Area, 33,000 sq. m.; pop. 2,000,000. It is the most prosperous of Germany's African possessions. Togo, the largest native town (pop. S000), is on Lake Togo; Little Popo is the capital, and Lome the chief port.
Tokat', a town of Sivas province, Asia Minor, 70 miles inland from the Black Sea. Pop. 30,000.
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Booster jags: Why AstraZeneca isn't used as a Covid booster vaccine - and if you can have a Pfizer booster after an AZ jab
CBD Oil UK: The 8 Best (& Tested) CBD Oils for 2022
Oily fish could delay menopause while carbs may hasten it
A diet rich in oily fish could help delay the menopause, new research has found, while carbohydrates might quicken its onset.
Tuesday, 1st May 2018, 7:00 am
A diet rich in oily fish could help delay the menopause, new research has found, while carbohydrates might quicken its onset. Picture: PA
An additional daily portion of refined white pasta or rice was linked with women reaching the menopause around one-and-a-half years earlier, according to a study by the University of Leeds.
However, an extra daily serving of oily fish such as salmon, mackerel and sardines was associated with a delay of more than three years.
The research, published in the Journal of Epidemiology and Community Health, drew on data from around 14,000 women in the UK, and a follow-up survey four years later.
More than 900 women between the ages of 40 and 65 had experienced a natural start to the menopause by that time.
The average age of menopause was 51, but the researchers found certain foods were associated with its timing.
As well as oily fish, a diet high in fresh legumes such as peas and beans was linked with women reaching the menopause around a year later.
A higher intake of vitamin B6 and zinc also appeared to delay the onset.
The researchers noted that women who go through the menopause early are at an increased risk of osteoporosis and heart disease, while those who do so later are more likely to develop breast, womb, ovarian cancers.
Study co-author Janet Cade, professor of nutritional epidemiology, said: "The age at which menopause begins can have serious health implications for some women.
"A clear understanding of how diet affects the start of natural menopause will be very beneficial to those who may already be at risk or have a family history of certain complications related to menopause."
The researchers suggest the maturation and release of eggs can be affected by reactive oxygen species and so antioxidants, found in legumes, may help preserve menstruation for longer.
Omega 3 fatty acids, abundant in oily fish, are thought to stimulate antioxidant capacity in the body.
Meanwhile, refined carbohydrates can increase the risk of insulin resistance, interfering with the activity of sex hormones and boosting oestrogen levels.


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Q: Finding a point inside Polygon for Latitude and Longitude Here is my code which I modified and took from this question Find Point in polygon PHP
And the vertices x and y form a rectangle..I am not still able to make it work even though the point y and x are inside polygon it's not displaying the correct result..What I am doing wrong here..
<?php
$vertices_x = array(45.007243,45.007243,46.3734,46.3734); // x-coordinates of the vertices of the polygon
$vertices_y = array(-75.007095,-72.506332,-72.506332,-75.007095,); // y-coordinates of the vertices of the polygon
$points_polygon = count($vertices_x);
$latitude_y =  45.5086699;  // x-coordinate of the point to test
$longitude_x = -73.553992;

if (is_in_polygon($points_polygon, $vertices_x, $vertices_y, $longitude_x, $latitude_y)){
  echo "Is in polygon!";
}
else
{
echo "Is not in polygon";
}

function is_in_polygon($points_polygon, $vertices_x, $vertices_y, $longitude_x, $latitude_y)
{
  $i = $j = $c = 0;
  for ($i = 0, $j = $points_polygon-1 ; $i < $points_polygon; $j = $i++) {
    if ( (($vertices_y[$i] > $latitude_y != ($vertices_y[$j] > $latitude_y)) &&
    ($longitude_x < ($vertices_x[$j] - $vertices_x[$i]) * ($latitude_y - $vertices_y[$i]) / ($vertices_y[$j] - $vertices_y[$i]) + $vertices_x[$i]) ) )
        $c = !$c;
  }
  return $c;
}
?>

A: One issue is the initialization of the latitude_y and longitude_x variables:
latitude_y appears to contain the 'x' coordinate.
longitude_x appears to contain the 'y' coordinate.

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