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Home > Archives > Vol 15, No 6 (2019)
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ORIGINAL STUDIES
Association of Self-Perceived Health with Social and Psychological Environment, the Mode of Life and Cardiovascular Risk Markers in Middle-Aged Men – Residents of Moscow
M. B. Kotova, V. B. Rozanov, E. I. Ivanova
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Aim. Estimation of the correlation of self-perceived health (SPH) with social and psychological environment, lifestyle and cardiovascular risk markers in middle-aged men.
Material and methods. A total of 301 men aged 41-44 years were examined. The study included clinical examination and interrogation using a standard form. Physical activity was estimated with the help of the International Physical Activity Questionnaires, the level of psychosocial stress – with the Reeder scale, signs of vital exhaustion with the Maastricht Questionnaire Vital Exhaustion Scale. To evaluate the mode and quality of life the questionnaire developed by I.A. Gundarev was used. All the examined people were divided in three groups according to the distribution of SPH rates by tertiles: the group 1 (from 7 to 60 scores) – bad health, the group 2 (61-79 scores) – satisfactory and the group 3 (80-100 scores) – good health.
Results. Parameters of the social and psychological environment of middle-aged men were the basic determinates of their health self-perception, at that majority of the indices of the quality and mode of life were independent of family material well-being. Bad SPH in middle-aged men was determined by such parameters as: increased blood pressure (BP), abdominal obesity, excessive alcohol consumption, psychosocial stress, vital exhaustion, low physical activity. Material wealth influenced systolic BP level, the waist/hips circumference ratio, a number of cigarettes per day and thus the SPH status. The most significant determinants of SPH were the level of personal happiness, nervous stress at work, support by family, sports activities, working conditions, total cholesterol level, satisfaction with own work.
Conclusion. When working on programs focused on public health improvement the social, psychological and behavioral determinants of health selfperception must be considered.
Russian Trial ALGORITHM: Implementation of Combined Antihypertensive and Hypolipidemic Treatment for Clinical Efficacy Achievement in Routine Clinical Practice
D. A. Napalkov
Aim. To study the clinical outcomes (achievement of target blood pressure [BP]) and tolerability of antihypertensive and hypolipidemic therapy with fixed combinations of indapamide/perindopril, amlodipine/perindopril, amlodipine/indapamide/perindopril and rosuvastatin in patients with hypertension and high/very high cardiovascular risk in real clinical practice.
Material and methods. The study included 16,788 patients from 104 cities of the Russian Federation. The duration of observation was 12 weeks. All patients had three monitoring visits. BP level was measured twice during the visits: the arithmetic mean of the obtained parameters was calculated. The results of the study were analyzed and presented by descriptive statistics.
Results. The average age of the patients was 60.6±10.2 years; 42.2% of the patients were men and 57.8% women. Patients who demonstrated systolicdiastolic hypertension (BP>140/90 mm Hg) at the initial visit accounted for 73.9% (n=12,413) of the total number of participants. The average level of systolic BP at the inclusion into the study was 162.94±13.07 mm Hg, the level of diastolic BP was 93.43±8.61 mm Hg. As expected, the Russian population consists of over 90% of patients with very high (57%; n=9,586) and high (35.9%; n=6,022) additional cardiovascular risk. Despite the fact that the overwhelming majority of patients with hypertension had a high and very high additional risk, more than a third of patients received monotherapy to control their BP level (36.8%; n=6,182), while 13.8% of patients (n=2,321) had never received antihypertensive therapy before. According to the results of therapy with combination drugs based on perindopril, 92.7% of patients managed to reach the target BP levels of <140/90 mm Hg. After treatment the average level of systolic BP decreased from 162.94±13.07 mm Hg to 127.80±7.56 mm Hg, and the level of diastolic BP – from 93.43±8.61 mm Hg to 78.54±5.59. Adherence to the treatment in more than 97% of cases was recognized as very high and high. Only 10 adverse events were recorded on a large sample of patients during 12 weeks of treatment.
Conclusion. In the Russian population, 73.9% of patients with hypertension and high/very high risk do not achieve the target BP levels. Application of combined therapy based on fixed combinations with perindopril allows achieving effective BP control in 93% of patients with hypertension having high and very high risk during 12 weeks with good tolerability of treatment.
Characteristics of Patients with Reproducible Masked Hypertension and its Diagnosis Approach
М. I. Smirnova, V. M. Gorbunov, Ya. N. Koshelyaevskaya, A. D. Deev, D. A. Volkov, N. V. Furman, P. V. Dolotovskaya
Background. Early diagnostics of masked hypertension (MH) is one of the key problems in modern cardiology due to the association of this blood pressure (BP) phenotype with doubled cardiovascular risk in comparison with normotension (NT). The current hypertension guidelines list numerous conditions, when the ambulatory BP monitoring (ABPM) is desirable in patients with normal office BP. However this list does not represent clearly defined, agreed and approved indications for ABPM as a diagnostic tool for MH.
Aim. To develop a method of MH diagnostics for the use in routine clinical practice based on the comparing characteristics of patients with reproducible MH vs NT.
Material and methods. The patients were selected from two trials that used ABPM (n=1778). The selection criteria included age 40-79 years, office BP<140/90 mm Hg, the absence of "hypertension" diagnosis or antihypertensive drug intake, and available results of two examinations (winter and summer): standard questionnaire, information about family history, chronic diseases and drug intake, height, weight, office and orthostatic BP and ABPM. We used the following definition of MH: elevated ambulatory BP (24-hour ≥130 and/or 80 mm Hg, daytime ≥135 and/or 85 mm Hg, or nighttime ≥120 and 70 mmHg) registered at both visits.
Results. In total, 153 patients with reproducible (both winter and summer) BP phenotype were included: 127 with MH, and 26 with NT (mean age 49.1Ѓ}7.8 years, 36.1% males). In multivariate analysis, reproducible MH was associated with body mass index (β2.097; p<0.0001), office diastolic BP (β2.152; p<0.0001), orthostatic systolic BP (β1.031; p<0.023) and orthostatic heart rate (β0.773; p=0.19). These parameters were used in the original "MH coefficient" formula.
Conclusions. MH is often found in patients with normal and optimal office BP and without "hypertension" diagnosis. The method described in the article helps to detect MH with high probability and define the individual indications for ABPM. The MH phenomenon in the category of patients warrants further investigation.
Prospects for Blood Pressure Remote Monitoring in Hypertensive Patients in the Ryazan Region
N. V. Aksenova, A. A. Nizov, O. N. Selyavina, E. I. Suchkova, E. V. Filippov
Aim. To study the effectiveness and benefits of blood pressure (BP) remote monitoring in outpatients with hypertension.
Material and methods. The study included 100 patients with a verified diagnosis of hypertension, who didn't achieve target BP pressure levels. The patients measured their BP twice a day over 6 months with facilities with automatic data transmission over GSM-channel to a remote monitoring center. BP parameters were being transmitted online to the remote monitoring center, where they were being processed and transferred to the personal account planner (created by the Web interface based on the software and hardware complex) of the attending physician and operator of the remote monitoring center. It is important that doctor received information only on clinically significant measurement results, based on which he determined the urgency of contact with the patient and the further tactics of his management.
Results. No malfunctions in the work of communication facilities, technical failures in the software and hardware complex were registered over the entire period of the study. After 6 months of the monitoring it was possible to achieve target BP levels less than 135/85 mm Hg in 70% of patients. The proportion of patients with a high level of normal BP increased from 10% to 19%, while the proportion of patients with grade 1 and 2 of hypertension decreased significantly (from 33% to 7% and from 54% to 3%, respectively). At the beginning of telemedicine monitoring 3% of patients had stage 3 of hypertension, at the end of the study – 1%.
Conclusion. The technology of telemedicine monitoring has shown itself as a simple, affordable and reliable way of management of outpatients with hypertension in conditions of real clinical practice. It was possible to achieve BP levels less than 135/85 mm Hg in 70% of patients by the method of remote outpatient monitoring. BP remote monitoring changed fundamentally the decision-making strategy of the patients management: it was not the patient who independently determined the need for consultation with a medical professional, but the attending physician made a decision on the method and urgency of contact with the patient on the basis of the data of objective monitoring indicators.
Safety of Non-Vitamin K Oral Anticoagulants in Elderly Patients with Atrial Fibrillation
M. A. Gabitova, P. M. Krupenin, A. A. Sokolova, D. A. Napalkov, V. V. Fomin
Aim. To study the safety of non-vitamin K oral anticoagulants (NOAC) in patients with atrial fibrillation (AF) over 75 years old.
Material and methods. The observation study included patients ≥75 years of age with confirmed AF, receiving dabigatran in a reduced dosage, apixaban or rivaroxaban in full or reduced dosage. Previous experience of NOAC treatment from the very beginning of therapy, if a patient was ≥75 years old, or from the point a patient reached 75 years was considered; episodes of NOAK change, as well as hemorrhagic and ischemic events associated with taking an anticoagulant, were recorded. Patient groups were comparable in risk score by CHA2DS2-VASc and HAS-BLED scales.
Results. Patients with AF (n=102; 39 men and 63 women; an average age 79.4Ѓ}4.1 years) were included: 32 patients were in dabigatran group, 34 patients – in apixaban group and 36 patients – in rivaroxaban group. 19 clinically significant bleedings were recorded, 10 occurred in patients taking dabigatran and 9 in those taking rivaroxaban. No hemorrhagic events in patients treated with apixaban were observed. Hematuria (31.6%), large subcutaneous hematomas (26.3%) and intensive nasal bleedings (26.3%) were the most frequent events. No ischemic cardioembolic stroke was recorded.
Conclusions. In elderly patients, all NOAC (dabigatran, rivaroxaban and apixaban) demonstrated good safety profile without major bleeding within a 1.5-year follow-up period.
Possibilities of PRECISE-DAPT Score for Risk Prediction of Ischemic and Hemorrhagic Events in ST-Elevated Myocardial Infarction (According to the Data of the Registry Study in Kemerovo)
D. Yu. Sedykh, V. V. Kashtalap, R. M. Velieva, O. L. Barbarash
Aim. We aimed to study in real clinical practice the clinical and anamnestic characteristics, the peculiarities of double antiplatelet therapy (DAPT) prescription as well the incidence of ischemic and hemorrhagic events in patients with ST-elevated myocardial infarction (MI) during a year of follow-up, taking into account the baseline PRECISE-DAPT scores.
Material and methods. The study included 680 patients with MI from the database of Kemerovo observational registry for acute coronary syndrome (ACS). All the patients retrospectively underwent an individual calculation using the PRECISE-DAPT score. Then, depending on the number of the points, all the patients were divided into the low (less than 25 points) and high (25 or more points) risks groups. Differences in clinical and anamnestic parameters, the peculiarities of DAPT prescription, as well as the incidence of ischemic and hemorrhagic outcomes during a year of follow-up after MI were estimated in the groups.
Results. The Russian patients with ST-elevated MI and the high PRECISE-DAPT hemorrhagic risk score had a history of renal pathology (р=0.010), multivessel coronary artery disease and polyvascular disease (р=0.002), prior angina pectoris (р=0.001), as well as the course of the index event with the manifestations of acute coronary failure (р=0.001) more often than the patients from the low-risk group. The patients of the high-risk group less often underwent coronary angiography with stenting (р=0.001), as well as coronary artery bypass grafting (р=0.010) at hospitalization and had a higher in-hospital mortality rate (р=0.002). The patients at high hemorrhagic risk according to the PRECISE-DAPT score were less often prescribed with DAPT within a year after MI (р=0.001) and aspirin monotherapy was preferred more often (р=0.001). At the same time, the patients at high hemorrhagic risk on the PRECISE-DAPT score had more often major bleedings, recurrent MI and deaths (р=0.001) within a year after MI.
Conclusion. In the present study, the possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the ACS registry in Kemerovo city. Good identification of patients with the high risks of hemorrhagic events and ischemic outcomes within 12 months of the follow-up after index MI has been shown, which allows to recommend the PRECISE-DAPT score for a clinical practice in order to rationalize the approaches to DAPT prescription and to optimize the existing approaches to the comprehensive risk assessment of patients with ACS along with existing scales.
NOTES FROM PRACTICE
Quantitative Assessment of Myocardial Ischemia in Multi-Vessel Coronary Artery Disease by Multimodal Stress Echocardiography with Semi-Supine Bicycle Ergometry
S. N. Koretskiy, O. M. Drapkina, F. B. Shukurov, D. K. Vasiliev
Stress echocardiography is a modern widely used method of noninvasive diagnosis of coronary heart disease and stratification of the risk of cardiovascular complications. In addition, exercise echocardiography is an important tool to clarify the localization of ischemia and establish a symptomassociated artery for management of patient with known coronary angiography data. This is especially important in multivessel lesions, the presence of an occluded artery or borderline stenosis. Currently, various stress agents are used for stress echocardiography in clinical practice: pharmacological drugs (dobutamine or adenosine), transesophageal or endocardial pacing, treadmill, semi-supine bicycle. To detect signs of ischemia usually used only visual estimation of local contractility in the two-dimensional gray-scale mode. Modern modes of myocardial imaging, such as speckletracking echocardiography or three-dimensional visualization, are practically not used. In the presented clinical case, the possibility of combining standard and modern imaging modes to clarify the localization and quantification of ischemia in multivessel coronary lesions, including chronic artery occlusion, is shown. As a stress agent, a semi-supine bicycle was chosen, the use of which allowed to obtain a qualitative image of the left ventricular myocardium at rest and at peak load, suitable for assessing deformation and threedimensional visualization. Evaluation of left ventricular myocardial deformation by speckle-tracking echocardiography was more accurate than standard diagnosis in detecting signs of ischemia in a patient with multivessel lesions. Three-dimensional imaging was inferior in sensitivity to speckletracking stress echocardiography and, at present, seems to have more research value.
ASSOCIATED PROBLEMS OF CARDIOLOGY
Chronic Heart Failure in Rheumatoid Arthritis Patients (Part III): Effects of Antirheumatic Drugs
D. S. Novikova, H. V. Udachkina, I. G. Kirillova, T. V. Popkova
Chronic autoimmune inflammation is one of the leading risk factors for the development of chronic heart failure (CHF) in rheumatoid arthritis (RA). The purpose of the review is to analyze the results of investigations on the effects of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), biological disease-modifying anti-rheumatic drugs (bDMARDs), and targeted csDMARDs on cardiac function and the risk of developing CHF in patients with RA. Methotrexate may reduce the CHF risk and have a positive effect on the course of this condition in patients with RA. Despite the data on the presence of leflunomide effects that impede myocardial remodeling, there is no evidence of the role of the drug in the prevention of CHF in RA patients. Hydroxychloroquine may contribute to the prevention of CHF, but the risk of developing severe cardiotoxicity should be considered when taking the drug for a long time. Most studies have not revealed the negative effect of tumor necrosis factor inhibitors on the prevalence and incidence of new cases of CHF in RA patients, and an improvement in the structure and function of the heart during therapy has been shown. Inhibitors of interleukin (IL) -1, inhibitors of IL-6, inhibitors of T-cell co-stimulation, anti-B-cell therapy, targeted csDMARDs do not increase the risk of CHF and may have cardioprotective effects, including slowing the progression of left ventricle myocardial dysfunction. Due to the high risk of CHF and CHF-associated mortality in RA patients, early diagnosis of cardiac dysfunction, development of a prevention and treatment strategies are needed, including high-quality prospective studies to assess the effect of anti-rheumatic therapy on myocardial function, risk of developing and decompensation of CHF in RA patients. It is possible that some drugs may possess protective effects on cardiomyocytes so they could become the first-line drugs in patients with CHF or the risk of its development.
Seasonal Indicators of Blood Pressure, Data of Asthma Control Questionnaires and Quality of Life in Hypertensive Patients with Bronchial Asthma
G. F. Andreeva, M. I. Smirnova, V. M. Gorbunov, A. S. Kurekhyan, Ya. N. Koshelyaevskaya
Aim. To study the seasonal indicators of quality of life and control of bronchial asthma in hypertensive patients with bronchial asthma, observed by a cardiologist of the state outpatient institution.
Material and methods. Data from a prospective cohort study of hypertensive patients, some of which had bronchial asthma without exacerbation, were analyzed. Patients who were observed by a cardiologist at a state outpatient clinic took part in the study. There were other concomitant diseases that occurred in the participants, in addition to hypertension and bronchial asthma. Two groups of patients were formed: the control group (n=85) included patients with hypertension only, the main group (n=40) included hypertension and bronchial asthma. Patients had 3 visits: initial one, and after 6 and 12 months and then data on outcomes (30.1Ѓ}7.6 months of follow-up) were collected. The first and third visits included clinical measurements of blood pressure (BP), 24-hour BP monitoring, spirometry, clinical and biochemical blood tests, a standard survey, survey with questionnaires evaluating the control of bronchial asthma (Asthma Control Questionnaire; ACQ) and the patients quality of life (General Well-Being Questionnaire; GWBQ). The second visit included clinical BP and ACQ and GWBQ questionnaires. A comparison of the average indicators from the total number of observations carried out in winter, spring, summer and autumn periods has been performed.
Results. Hypertensive patients with/without bronchial asthma (n=125; 28 men, 97 women, average age 62.6Ѓ}8.8 years, duration of hypertension – 11.6Ѓ}8.6, duration of bronchial asthma – 9.3Ѓ}11.9 years) took part in the study. Outpatient BP levels throughout the study period were maintained at target values in both groups. It was shown that seasonal BP levels do not differ in the compared groups, except for winter indicators: winter daytime systolic BP levels were higher in the main group (p=0.03). Seasonal fluctuations in BP were not detected in the control group, however, they were present in the patients of the main group: winter daytime levels of diastolic BP and average daily levels of diastolic BP and systolic BP were higher than summer ones, and winter daytime systolic BP values (p<0.05) and clinical diastolic BP (p=0.004) – higher than autumn levels. Seasonal quality of life indicators in the main group were worse than in the control group in all seasons. Significant seasonal dynamics of quality of life indicators in patients in two groups was not detected. The ACQ questionnaire showed that asthma control changed in different seasons in accordance with the ACQ total score: in winter and spring – uncontrolled bronchial asthma (total score >1.5), in summer and autumn – partially controlled (total score ≤1.5). During the analysis of various factors associated with the combined primary endpoint (death, transient ischemic attack, angina pectoris, cardiac arrhythmias, arterial revascularization), relationships with quality of life indicators were revealed: negative connections – with indicators characterizing positive psychological health, mood at visit, positive correlations – with psychological abilities.
Conclusion: Seasonal fluctuations in ambulatory BP levels were not found in the control group and were found in the main group. The quality of life indicators for patients of the main group were significantly worse than in the control group for all components in all seasons. The control of asthma changed in different seasons in accordance with the ACQ total score: uncontrolled bronchial asthma occurred in winter and spring, partially controlled – in summer and autumn. Correlations of the combined primary endpoint with quality of life indicators were found after analyzing various factors.
Study of the Effect of Proton Pump Inhibitors on the Development of Hypomagnesemia in Patients with Paroxysmal Atrial Fibrillation on the Background of Autonomic Sinus Node Dysfunction
Ya. G. Bozhko, M. V. Arkhipov, N. A. Belokonova
Aim. To study the effect of proton pump inhibitors (PPIs) on the development of hypomagnesemia in patients with paroxysmal atrial fibrillation (AF) on the background of autonomic sinus node dysfunction (ASND).
Material and methods. A prospective cohort study included 32 patients with an established diagnosis of ASND and often recurrent paroxysmal AF. The main group consisted of 17 patients who took pantoprazole at a dose of 20 mg 2 times a day as treatment of diagnosed duodenal erosions within 6 weeks from the time of the initial visit to an arrhythmologist. The remaining 15 patients did not take PPIs and were included in the control group. The determination of magnesium in whole blood, plasma and formed elements was carried out twice in all patients – at the initial visit and after 6 weeks. In addition, in the experiment, complex-forming activity of solutions of various PPIs (esomeprazole, pantoprazole, rabeprazole and omeprazole) with respect to magnesium ions was studied. The author's method was used, based on turbidimitric determination of the light transmission during the heterogeneous reaction of the formation of magnesium phosphates in the presence of the analyzed drug or without it.
Results. There were no significant differences in the magnesium content in the blood of patients of the main and control groups before taking PPIs. After taking of pantoprazole by the patients of the main group there were significant differences between main and control groups in magnesium in whole blood (0.48 [0.44-0.51] mmol/l vs 0.55 [0.5-0.61] mmol/l, p=0.01) and its values in formed elements (0.52 [0.45-0.67] mmol/l vs 0.75 [0.65-1.2] mmol/l, p=0.009). Analysis of magnesium content in patients of the main group before and after taking of pantoprazole also showed a significant decrease in intracellular concentrations of the element (0.6 [0.51-1.0] mmol/l vs 0.52 [0.45-0.67] mmol/l, p=0.002), as well as decrease in its total content in whole blood (0.51 [0.45-0.59] mmol/l vs 0.48 [0.44-0.51] mmol/l, p=0.04). To substantiate the observed effects it was experimentally proved the possibility of formation of strong complex compounds between the ions of magnesium and PPIs: the highest activity was demonstrated by rabeprazole and pantoprazole (coefficients of complex formation per unit of total organic carbon – 1.5 and 0.72, respectively) and the lowest – omeprazole and esomeprazole (0.04 and 0.09, respectively).
Conclusion. A decrease of magnesium content in whole blood and formed elements in patients with paroxysmal AF on the background of ADSN was mediated by a six-week intake of pantoprazole in a dose of 20 mg 2 times a day for the treatment of concomitant erosion of the duodenum. When choosing PPIs for arrhythmological patients with concomitant gastro-duodenal pathology, it is advisable to be guided by the complexing activity of drugs with respect to magnesium ions: the most pronounced metal-ligand interaction with magnesium was shown by rabeprazole and pantoprazole, and the least – omeprazole and esomeprazole.
PREVENTIVE CARDIOLOGY AND PUBLIC HEALTH
Outpatient Registry REGION: Prospective Follow-up Data and Outcomes in Patients After Acute Cerebrovascular Accident
M. M. Loukianov, S. S. Yakushin, S. Yu. Martsevich, A. N. Vorobyev, K. G. Pereverzeva, E. Yu. Okshina, A. V. Zagrebelnyy, V. G. Klyashtorny, E. V. Kudryashov, S. A. Boytsov, O. M. Drapkina
Aim. To estimate outcomes and risk of all-cause mortality, cardiovascular (CV) mortality, and non-fatal CV events in patients with a history of acute cerebrovascular accident (ACVA) according to data of outpatient prospective registries.
Material and methods. 986 patients with a history of ACVA (aged 70.6Ѓ}10.9 years; 56.8% women) were enrolled into the outpatient registry REGION-Ryazan, including the registry of patients with ACVA of any remoteness (ACVA-AR) – 511 (aged 70.4Ѓ}10.5 years; 58.5% women) and the registry of patients, visited outpatient clinics for the first time after ACVA (ACVA-FT) – 475 (aged 70.8Ѓ}11.3 years; 54.9% women). Outcomes, risk of all-cause and CV mortality, composite CV endpoint (CV death, nonfatal myocardial infarction and ACVA), hospitalizations due to CV diseases (CVD) were evaluated during 37 (17;52) months of follow-up period.
Results. 310 (31.2%) patients died during the follow-up. The most part of fatal outcomes (56.4%) was registered during the first year of follow-up, especially during the first 3 months (33.9%). Mortality among men (35.9%) was higher than among women (28.0%), р=0.008. 147 (28.8%) and 163 (34.3%) patients died in registries ACVA-AR and ACVA-FT, respectively (70.4% and 90.2% of fatal outcomes were from CV causes, respectively; р=0.04). The higher risk of death was associated with the following factors: age – hazard ratio (HR) 1.10 for each next year of age (95% confidence interval [95%CI] 1.09-1.12); sex (men) – HR 2.01 (95%CI 1.55-2.62); atrial fibrillation (AF) – HR 1.42 (95%CI 1,09-1,86); recurrent ACVA – HR 1.64 (95%CI 1.23-2.19); history of myocardial infarction (MI) – HR 1.45 (95%CI 1.09-1.93); low blood hemoglobin level – HR 2.44 (95%CI 1.59-3.79); heart rate ≥80 beats/min – HR 1.51 (95%CI 1.13-2.03); diabetes – HR 1.56 (95%CI 1.16-2.08); chronic obstructive pulmonary disease (COPD) – HR 1.89 (95%CI 1.34-2.66); no antihypertensive therapy in arterial hypertension – HR 2.03 (95%CI 1.42-2.88). The lower risk of death was associated with the following factors: prescription of ACE inhibitors (ACEI) – HR 0.60 (95%CI 0.42-0.85); angiotensin II receptor blockers (ARB) – HR 0.26 (95%CI 0.13-0.50), beta-blockers – HR 0.71 (95%CI 0.50-0.99); statins – HR 0.59 (95%CI 0.42-0.82). Factors, listed above, had significant association not only with all-cause mortality but also with CV mortality and composite CV endpoint. The higher rate of hospitalizations due to CVD was associated with younger age (incidence rate ratio [IRR] for 1 year 1.03; 95%CI 1.02-1.05; р<0.001), female sex (IRR 2.40; 95%CI 1.79-3.23; р<0.001), COPD (IRR 2.44; 95%CI 1.63-3.65; р<0.001) and heart rate ≥80 beats/min (IRR 1.51; 95%CI 1.12-2.04; р=0.007).
Conclusions. All-cause mortality in patients with a history of ACVA, enrolled in outpatient registry REGION, was 31.2% during 3-year follow-up. The proportion of CV death among the fatal cases was higher in the ACVA-FT registry than in ACVA-AR registry. The higher mortality rate was associated with the following factors: age, sex (male), recurrent ACVA, history of MI, diagnosis of AF, COPD and diabetes, low blood hemoglobin level, heart rate ≥80 beats/min, no antihypertensive therapy in arterial hypertension. The higher incidence of hospitalizations due to CVD was associated with younger age, sex (female), COPD and heart rate ≥80 beats/min. Prescription of ACEI, ARB, beta-blockers and statins was associated with lower risk of death and composite CV endpoint.
Association of Family History of Cardiovascular Diseases in Boys Aged 12-13 Years with Structural and Functional Indicators of the Left Ventricle and Arterial Stiffness in the Age of 43-46 Years (Results of 32-Year Prospective Follow-up)
O. Yu. Isaykina, V. B. Rozanov, A. A. Aleksandrov, I. V. Leontyeva, M. B. Kotova, E. I. Ivanova
Aim. To evaluate the association of Family History (FH) of cardiovascular diseases (CVD) in boys aged 12-13 years with the development of structural and functional changes in the left ventricle and stiffness of the main arteries in adulthood (43-46 years old) according to prospective study.
Material and methods. For the initial examination, boys were selected whose parents suffered from CVD at a young age or died prematurely from them (risk group). The comparison group was formed from a population sample of boys of a similar age without FH of CVD. The examination included a survey on a standard questionnaire, measurement of anthropometric indicators, blood pressure (BP), pulse counting, determination of the blood lipid spectrum. The intima-media complex thickness (IMT) of the common carotid arteries was measured; echocardiography and applanation tonometry were performed.
Results. The group with FH of CVD significantly (p<0.05) differed in childhood in terms of the body mass index (BMI) (18.8 vs 17.6 kg/m2), systolic BP (SBP) (117 vs 107 mm Hg), diastolic BP (DBP) (67 vs 56 mm Hg), average BP (81.8 vs 72.7 mm Hg) and triglycerides (0.79 vs 0.58 mmol/L). In adulthood, increased total cholesterol (TC) level (6.3 vs 5.8 mmol/L; p=0.036) and other indicators of atherogenesis were revealed in the risk group. The risk of fatal outcomes from CVD in the next 10 years in men with a family history of CVD in childhood was significantly higher compared to the control group (1.94 vs. 1.28; p <0.001). The main contribution to the total risk of fatal CVD in middle-aged men was made by TC and smoking. In the group with FH of CVD, higher stiffness of the arteries in adulthood was observed. There were found significant (p=0.002) intergroup differences in the IMT (0.73 vs 0.63 mm). A statistically significant positive relationship between BMI and some structural and functional indicators of the left ventricle and stiffness indicators of the main arteries was revealed. DBP and mean BP in childhood are associated with arterial stiffness in adulthood according to the parameters of central SBP and central DBP. BMI in boys is the most significant predictor for most structural and functional indicators of LV myocardial hypertrophy, in particular, LV myocardial mass (private R2=0.140) and interventricular septum thickness (R2=0.164; p=0.001), and arterial stiffness by central DBP parameter (R2=0.043; p=0.024) in adulthood. The risk of increased IMT development in males in adulthood with FH of CVD is 6.1 times higher than that of their peers without FH.
Conclusion. FH of CVD revealed in childhood in males is a risk factor for the development of early atherosclerosis and, due to its ease of detection, can be used as one of the criteria for the formation of high-risk groups for the purpose of primary prevention.
PAGES OF RUSSIAN NATIONAL SOCIETY OF EVIDENCE-BASED PHARMACOTHERAPY
Adherence to Treatment with New Oral Anticoagulants in Atrial Fibrillation Patients in Real Clinical Practice (Results of the ANTEY Study)
S. Yu. Martsevich, Yu. V. Lukina, N. P. Kutishenko, S. N. Tolpygina, V. P. Voronina, N. A. Dmitrieva, O. V. Lerman, N. A. Komkova
Aim. To study adherence to treatment with new oral anticoagulants (NOAC) and factors associated with it in patients with non-valvular atrial fibrillation (AF) within the outpatient PROFILE registry.
Material and methods. ANTEY study included 201 patients with AF from the PROFILE registry (89.3%): 118 males (58.7%) and 83 females (41.3%), aged 71.1Ѓ}8.7 years. The study consisted of two visits half a year apart (V0, V1) and a phone contact (PC) one year after V0. During V0 all patients were recommended to start therapy with one of the NOACs. Adherence to therapy was assessed during all visits with the use of the original questionnaire – National society of evidence-based pharmacotherapy (NSEPh) adherence scale, 8-item Morisky Medical Adherence Scale (MMAS-8) and direct doctors' questioning.
Results. During V0 111 (55.2%) patients were recommended the use of rivaroxaban; 47 (23.4%) – the use of dabigatran and 43 (21.4%) – the use of apixaban. During V1 based on the results of the NSEPh adherence scale 155 (77.5%) patients were completely adherent (strictly followed doctors' recommendations), 5 patients were partially adherent (violated doctors' recommendations), 7 patients were partially non-adherent (stopped taking NOACs), and 33 patients were completely non-adherent (did not start taking NOACs). Out of 197 patients who completed MMAS-8 questionnaire 157 (79.7%) patients were partially adherent to treatment and 40 (20.3%) patients were non-adherent. None of the patients were completely adherent to treatment. According to doctors' questioning, by the time of the PC 15 patients had not started taking the recommended NOAC – were completely non-adherent (CNA). According to the NSEPh adherence scale, by the time of the PC out of 197 patients (4 patients died) 158 patients were completely adherent to treatment, 6 – partially adherent, 18 – partially non-adherent and 15 – CNA. According to MMAS-8, by the time of the PC 153 (77.7%) patients were partially adherent to treatment, and 44 (22.3%) patients – non-adherent (none of the patients were completely adherent). Out of 15 CNA patients MMAS-8 revealed only 4 (27,6%) during B1, and 6 (40%) during the PC. NSEPh adherence scale revealed all CNA patients. The main reason for refusing to start NOAC therapy was their high price. Recently started use of NOACs was stopped mostly due to adverse effects of therapy (bleeding). The most common factors increasing patients' adherence to NOACs were previous experience of taking this group of drugs and no history of any adverse effects during therapy.
Conclusion. The ANTEY study showed relatively high adherence to NOACs prescribed by doctors of the specialized cardiology department of the scientific center. The most common factors associated with early non-adherence to the new drug were high price and adverse effects of therapy, the latter influenced prolonged adherence as well. Previous experience of taking this group of drugs and no history of any adverse effects during therapy increased adherence to NOACs.
New Opportunities for Improving the Prognosis of Patients with Chronic Ischemic Heart Disease
N. B. Perepech
Resources and methods for improving the prognosis in patients with chronic ischemic heart disease (IHD) are presented in the review. Information on the classes of drugs that improve the prognosis, and target values of the main physiological parameters that should be monitored during the treatment of patients with chronic IHD are also presented. The main attention is paid to antiplatelet agents and anticoagulants. The results of the most significant randomized clinical trials of the efficacy and safety of drugs from these classes in the treatment of chronic IHD are discussed. The results of the COMPASS study, which obtained confirmation of the positive effect of combined therapy with rivaroxaban and acetylsalicylic acid on the prognosis of patients with chronic IHD or peripheral artery disease, are presented in detail. The safety aspects of this therapy are discussed. The position of rivaroxaban in the treatment of patients with chronic IHD with sinus rhythm is presented according to the Recommendations of the European Society of Cardiology for the diagnosis and treatment of chronic IHD (2019).
Myocardial Infarction with Non-Obstructive Coronary Arteries: Contemporary Diagnostic and Management Approaches
T. H. Hoang, P. V. Lazarev, V. V. Maiskov, A. I. Meray, Zh. D. Kobalava
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is diagnosed in the absence of anatomically significant stenoses (<50% of lumen diameter) on coronary angiography and characterized by heterogeneity of etiologic factors. Recently, the mechanisms of MINOCA as well as the performance of diagnostic algorithms and therapeutic strategies have been extensively studied. The purpose of this review is to reflect the current concepts regarding the etiology and pathogenesis of MINOCA, diagnostic work-up methods and individualized treatment approaches. The article covers contemporary epidemiologic data, demographic and clinical patients' characteristics and principal causes of MINOCA. We discuss aspects of disease definition and classification of related conditions involving troponin increase in the presence of normal coronary arteries. The importance of management strategy personalization for individual patients is stressed alongside stratification of risks of recurrent cardiovascular events. This review reflects key points from international consensus statements published by leading experts and suggests promising directions for future research.
Markers of Endothelial Dysfunction: E-selectin, Endothelin-1 and von Willebrand Factor in Patients with Coronary Heart Disease, Including in Combination with Type 2 Diabetes Mellitus
A. V. Zhito, A. O. Iusupova, E. V. Privalova, N. V. Khabarova, Yu. N. Belenkov
The prevalence of coronary heart disease (CHD) and type 2 diabetes mellitus (type 2 diabetes) in Russia and in the world continues to increase. Despite the prevention and optimization of therapy, CHD retains its leadership among all causes of death, and the mortality rate from type 2 diabetes and its complications gradually increases too. To improve the treatment of the above mentioned diseases, it is necessary to clarify the pathogenetic mechanisms of their development. The formation of endothelial dysfunction, characterized by an increase in the level of cell adhesion molecules and vasoconstriction, is a common link characteristic for the course and progression of CHD and type 2 diabetes. This article presents an analysis of preand clinical studies on the role of endothelial dysfunction markers: cell adhesion molecules (E-selectin), vasoconstriction (endothelin-1) and von Willebrand factor in patients with CHD, including those with type 2 diabetes mellitus.
Coronary Heart Disease in HIV-Infected Patients
M. A. Arzhakova, T. A. Shekhovtsova, D. V. Duplyakov
Currently, there are methods of drug exposure to the infection caused by the human immunodeficiency viruses (HIV), that allow to suppress the active replication of the virus in the patient's body. The era of antiretroviral therapy, which has allowed HIV-infected people to live longer, has begun. This led to an increase in their cardiovascular diseases, which occur at an earlier age and are more severe than in people without HIV. Specific or "nontraditional" risk factors damaging vascular wall occur in HIV patients along with traditional risk factors. These factors include: the negative impact of HIV on endothelium, an imbalance of inflammatory mediators, pathological immune activation, a decrease in the level of CD4 cells, a change in the number and function of platelets. The question of the effect of antiretroviral therapy on the occurrence of atherosclerotic vascular lesions remains debatable. Acute coronary syndrome (ACS) is one of the most frequent and most severe cardiovascular events in HIV-infected patients. The risk of myocardial infarction is highest in patients with a viral load of HIV-1 ribonucleic acid (RNA)≥500 copies/ml and a CD4 cell count of <200/ml. The most common form of ACS in HIV patients is ACS with ST segment elevation. Treatment of ACS in HIV patients has some difficulties: a high frequency of stent thrombosis, the frequent occurrence of thrombocytopenia, drug interactions with antiretroviral therapy. The high risk of developing cardiovascular diseases in HIV patients necessitates the introduction of active measures of primary and secondary prevention, taking into account the specific interaction of all drugs taken by the patient.
CURRENT QUESTIONS OF CLINICAL PHARMACOLOGY
Current Trends in the Treatment of Hypertension: Focus on Improving Prognosis. The Capabilities of an Amlodipine/Telmisartan Single-Pill Combination
O. D. Ostroumova, A. I. Kochetkov
Nowadays, the modern approach to antihypertensive therapy is to prescribe in the most hypertensive patients fixed-dose combinations of antihypertensive drugs as initial therapy. This concept is reflected in the latest revisions of European and Russian guidelines for the management of arterial hypertension (AH). Above mentioned principle is referred as "single-pill combination" strategy and is given high priority in clinical practice with a high evidence level. According to this approach, one of the possible first line single-pill combinations is the combination of an angiotensin II receptor blocker and a calcium channel blocker. In both classes, the reference and the best representatives include, respectively, telmisartan and amlodipine, as a result of broad experience in their practical application and, most importantly, extensive body of evidence regarding to its effectiveness and safety. Both antihypertensive drugs are distinguished by an extra-longstanding antihypertensive effect that exceeds such one of other representatives in their classes, thereby a stable blood pressure control throughout the day is realized, and most importantly, in the early morning hours, that are the most dangerous in terms of adverse cardiovascular and cerebrovascular events. Another important telmisartan and amlodipine characteristics is their targetorgan protective properties, which is realized at all the levels. In addition, telmisartan has a unique ability to activate PPAR-у-receptors and improves the carbohydrate metabolism and lipid profile, which is advantageous in patients with concomitant metabolic syndrome and diabetes mellitus. The telmisartan and amlodipine features and their proven ability to improve prognosis in hypertensive patients served as background for creating a singlepill combination of these antihypertensive drugs, which fully meet with the requirements of current clinical guidelines for AH management and in which these drugs synergistically coupling resulting in more effective blood pressure control, increases the reliability of target-organ protection, and also improves the therapy safety profile.
Glycoprotein IIb/IIIa Receptor Inhibitors in Patients with ST-Segment Elevation Myocardial Infarction and Primary Percutaneous Coronary Intervention
A. S. Tereshchenko, Е. V. Merkulov, A. M. Samko
Recently, there has been a positive trend to reduce mortality from myocardial infarction. One of the reasons for such dynamics is the development of angiographic service in our country and the increase in the number of primary percutaneous coronary interventions. One of the most serious complications of endovascular interventions affecting the prognosis is the development of the phenomenon of slow or unrecoverable blood flow (≪slow/no-reflow≫ phenomenon). The reason for the development of this phenomenon is associated, first of all, with distal embolization by thrombotic masses and fragments of atherosclerotic plaque. In order to prevent this complication, manual thromboextraction was developed – the aspiration of thrombotic masses from the infarct-related artery. The manual thrombus aspiration has not been proven effective in a number of large randomized trials. In addition to the lack of influence on the prognosis, the method of manual thrombus aspiration significantly more often led to the development of ischemic strokes and currently should not be routinely carried out. Another method of preventing the phenomenon of delayed or unrecoverable blood flow is the use of glycoprotein IIb/IIIa receptor inhibitors which is, in contrast to the instrumental method, effective and relatively safe. According to a number of large randomized trials, drug treatment of this complication influences life expectancy in patients with ST-elevation myocardial infarction. At a time when there is already a meta-analysis on the routine use of glycoprotein IIb/IIIa receptor inhibitors during primary percutaneous coronary intervention and their positive impact on survival, in our country, unfortunately, the importance of these drugs is underestimated and according to the register they are used only in 3% of patients with ST-segment elevation myocardial infarction. This review presents studies and comparisons of glycoprotein IIb/IIIa receptor inhibitors existing on the market.
Academicians and Corresponding Members of the Russian Academy of Science (Division of Medical Sciences) Elected by the General Meeting of Members of the Russian Academy of Science in November 14-15, 2019
Index of the Papers Published in the "Rational Pharmacotherapy in Cardiology" Journal in 2019


text:
Penn College Men's Volleyball Team Set for Playoffs
March 25, 2010 Sports Comments are disabled after 182 days.
With an 11-0 regular season and the Middle Atlantic Club Volleyball Conference Northwest Division championship under its belt, the Pennsylvania College of Technology men's team now turns its attention to postseason play.
On Saturday, the Wildcats will compete in the 16-team MACVC Championships at Rowan (N.J.) University. Action begins at 9 a.m. and, should they go all the way to the title match, the day could involve as many as seven matches and up to 35 games.
"Stamina? I think they are ready to go," coach Wes Strayer said. "It is an issue, without a doubt, but what they have to do is just take care of business one game at a time and not make it a five-game match during the day. They can't let teams come back. They can't play down to teams. It's my job as a coach to keep their minds in it."
Penn College starters are expected to be middle hitters Andy Epley (New Oxford) and Adam Smith (Duncannon), setter Cody Goss (State College) and outside hitters Bill West (Wyomissing) and James Fortenberry (Lemoyne). Either Phil Reist (Washington) or Ryan Haines (Lancaster) will be at libero. Key defensive players are Jared Palko (Waymart), Shawn Wesche (Angelica, N.Y.) and Haines.
"Nobody has an answer for my middles, which is good. Most offenses run through their outside hitters and then use their middles. We run ours the opposite way. We run our whole offense through the middle and then go outside and teams aren't ready for that," said Strayer, who is in his seventh season as coach.
"They went above what I expected this year. I have two freshmen and a first-year player starting. I am just elated at how they have played and how they have come together," Strayer said of the season thus far. "I expect to win it (MACVC) and they expect to win it."
Regardless of what happens Saturday, the season will continue next week for the Wildcats when they compete April 1-3 in the National Collegiate Volleyball Federation Championships in Louisville, Ky. Penn College is scheduled to compete in Division I-IAA against club teams from some of the largest colleges and universities in the country, among them Penn State.
Penn College cancels winter sports competition
Penn College esports coach assesses first full season
More memorable Wildcat moments recalled
Student-athletes' memorable moments recalled
Klingerman family gift supports renovation of athletics suite

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Getting my wall posts or friends from Facebook - lists are empty I performed following:

*

*installed 2 kinds of the Facebook APIs: pip install facebook and pip install fb

*Went to https://developers.facebook.com/tools/access_token/, registered my app and got User Token (some long string, used currently as hardcoded in the code, I'll change it later)

*Created the following code (please see comments what and how works or doesn't:
import re
import urllib2
import requests
import facebook
import fb

token="User Token"
graph = facebook.GraphAPI(token)
profile = graph.get_object("me")   #POSITIVE: I can get profile info
friends = graph.get_connections('me', "friends")  #POSITIVE: I can get real friends count, NEGATIVE - the list itself is empty
posts = graph.get_connections('me', "posts")  #NEGATIVE - the list itself is empty, no count is returned, as in "friends" case
feed= graph.get_connections('me', "feed")  #NEGATIVE - the list itself is empty, no count is returned, as in "friends" case

fb1=fb.graph.api(token)
profile = fb1.get_object(cat='single', id="me")  #NEGATIVE - error in given parameters

To be sure I used also https://developers.facebook.com/tools/explorer with the same token and got the same results:
GET me\friends:
{
  "data": [
  ],
  "summary": {
    "total_count": 575
  },
}

GET me\feed:
{
  "data": [
  ],
}

Why the returned lists are empty?
Thanks!
Update: I found that I have no permissions, only those. How to get more? and why with permission "friends" I can't see info about them, but only total number of them?
{
  "data": [
    {
      "permission": "user_friends",
      "status": "granted"
    },
    {
      "permission": "public_profile",
      "status": "granted"
    }
  ],
}

Resolved: I found where the problem! I didn't get app token with all permissions. Perform the following:

*

*Go to the https://developers.facebook.com/tools/explorer

*Choose your APP name (my is lj_for_me in attached image)

*Press "Get User Token" and check all boxes (or what you really need).
Now you APP will have permission to get post and photos and etc from YOUR FB account. For getting the same from other users accounts you need to get such permission from FB (as far as I understood, but I did not enter too deep into this subject)

A: Since v2.0 of the Graph API, you can only get friends who authorized your App with the user_friends permission too, for privacy reasons. You only get the total_count if none of your friends authorized the App.
Access to wall posts is possible with the user_posts permission, btw.

redpajama_set_name: RedPajamaStackExchange


ariqafatina0102Great seller to deal with!
Size 32mm Black leather strap 14mm Wore twice only!! Nego price!!
Swiss Made Calvin Klein Sapphire Glass 100% Original.
We're selling high quality DW watches ,just same like pic. More info just dm me.
I bought at sunway pyramid for RM790 and sell for only RM390. Very good condition. Comes with box and warranty card.


text:
Live at 3: Gov. Sununu holds briefing about NH's COVID-19 response 26 MIN Breaking News: LIVE: Executive Council holds hearing about MacDonald's nomination to be chief justice 43 MIN Breaking News: COVID-19 in New Hampshire: Key data, maps and graphs Breaking News: Sign up for our Coronavirus & Rossen Reports Newsletters Closings There are currently 2 active closings or delays <% if ( weatherAlerts > 0 ) { %> Severe Weather <% var weatherAlertsMessage = "There " + ( weatherAlerts > 1 ? "are" : "is" ) + " currently " + weatherAlerts + " active weather " + ( weatherAlerts > 1 ? "alerts" : "alert" ); %>
As remote learning begins in NH, officials say it could be extended
Officials say all students have access to remote learning
Tim Callery
TABLE, INCLUDING AN EXTENSION ON THE STATE'S SCHOOL CLOSURE. TODAY MARKED A NEW KIND OF FIRST DAY OF SCHOOL FOR GRANITE STATE STUDENTS AS NEW HAMPSHIRE SCHOOLS OFFICIALLY LAUNCH REMOTE LEARNING. >> ONE WEEK AGO UNTIL TODAY, WE HAVE SEEN A SIGNIFICANT PROGRESS AS WE HAVE MOVED TO A MODEL WHERE TODAY ALL OF OUR STUDENTS HAVE ACCESS TO REMOTE INSTRUCTIONAL OPPORTUNITIES. TIM: FOR THE NEXT TWO WEEKS, TEACHERS WILL BE USING GOOGLE CLASSROOM AND OTHER APPLICATIONS TO SHARE ASSIGNMENTS AND HOMEWORK. THEY WILL BE IN CONTACT WITH STUDENTS AND THEIR PARENTS THROUGH THOSE ONLINE SOURCES, AS WELL AS BY TELEPHONE AND EMAIL. >> WE CONTINUE TO PROVIDE THROUGH OUR SCHOOLS AND COMMUNITY PARTNERS FOR OUR FOOD PROGRAMS FOR STUDENTS WHO ARE FOOD INSECURE. TIM: EDUCATION COMMISSIONER FRANK EDELBLUT SAYS THIS IS A LIFE LESSON FOR EVERYONE INVOLVED. HE'S ENCOURAGING PARENTS TO HAVE PATIENCE AND TO REACH OUT TO SCHOOLS FOR SUPPORT. >> STUDENTS ARE LEARNING, FAMILIES ARE LEARNING, EDUCATORS ARE LEARNING, AND I THINK WE ALL IS A STATE ARE LEARNING AS WE MOVE THROUGH THIS CRISIS. TIM: REMOTE LEARNING COULD BECOME THE NEW NORM FOR THIS ACADEMIC YEAR, AS EDELBLUT AND THE GOVERNOR CAUTION AN EXTENSION OF THE SCHOOL CLOSURE IS POSSIBLE. >> APRIL 3 IS THE REEVALUATION DATE. WE HAVE SIGNALED TO SCHOOLS IT IS LIKELY WILL CONTINUE, AND PLAN FOR THE INEVITABILITY. >> WHETHER IT IS TWO WEEKS FROM NOW, SIX WEEKS FROM NOW OR NEXT YEAR, WHAT WE HAVE CREATED IS SOMETHING THAT CAN LAST FOR LONG TIME AND IT GIVES OPTIONS. TIM: AS FOR HOW LONG REMOTE LEARNING COULD BE EXTENDED, WHETHER IT IS WEEKS OR MONTHS, THE COMMISSIONER SAYS HE WILL
New Hampshire schools officially launched remote learning Monday, a practice that will last at least the next two weeks and maybe longer.>> Download the FREE WMUR appEducation Commissioner Frank Edelblut said the situation is fluid, and all options are on the table, including extending the state's school closures.>> COVID-19 in New Hampshire: What you need to know"One week ago until today, we have seen significant progress as we have moved to a model where today, I can tell you that all of our students have access to remote instructional opportunities," Edelblut said.>> Latest COVID-19 coverage from WMURFor the next two weeks, teachers will be using Google Classroom and other applications to share assignments and homework. They will be in contact with students and their parents through those online sources, as well as by telephone and email."We continue to provide through our schools and our community partners for our food programs and for our students who are food insecure," Edelblut said.The commissioner said the experience is a life lesson for everyone involved. He encouraged parents to have patience and to reach out to schools for support. "Students are learning, but our families are learning. Our educators are learning," he said. "I think we all, as a state, are learning as we move through this particular crisis."Remote learning could become the new norm for this academic year, as Edelblut and the governor cautioned that an extension of the school closure is possible."April 3 is a re-evaluation date," Edelblut said. "We have signaled to the schools that's it's likely that it may continue and to plan for that inevitability.""Whether it's two weeks from now or six weeks from now or next year, what we created just in one week here is something that can be lasting for quite a long time, and it gives options," New Hampshire Gov. Chris Sununu said.As for how long remote learning could be extended -- whether it's weeks or months -- Edelblut said he and his team will assess when April 3 nears.
CONCORD, N.H. —
New Hampshire schools officially launched remote learning Monday, a practice that will last at least the next two weeks and maybe longer.
Education Commissioner Frank Edelblut said the situation is fluid, and all options are on the table, including extending the state's school closures.
>> COVID-19 in New Hampshire: What you need to know
"One week ago until today, we have seen significant progress as we have moved to a model where today, I can tell you that all of our students have access to remote instructional opportunities," Edelblut said.
>> Latest COVID-19 coverage from WMUR
For the next two weeks, teachers will be using Google Classroom and other applications to share assignments and homework. They will be in contact with students and their parents through those online sources, as well as by telephone and email.
"We continue to provide through our schools and our community partners for our food programs and for our students who are food insecure," Edelblut said.
The commissioner said the experience is a life lesson for everyone involved. He encouraged parents to have patience and to reach out to schools for support.
"Students are learning, but our families are learning. Our educators are learning," he said. "I think we all, as a state, are learning as we move through this particular crisis."
Remote learning could become the new norm for this academic year, as Edelblut and the governor cautioned that an extension of the school closure is possible.
"April 3 is a re-evaluation date," Edelblut said. "We have signaled to the schools that's it's likely that it may continue and to plan for that inevitability."
"Whether it's two weeks from now or six weeks from now or next year, what we created just in one week here is something that can be lasting for quite a long time, and it gives options," New Hampshire Gov. Chris Sununu said.
As for how long remote learning could be extended -- whether it's weeks or months -- Edelblut said he and his team will assess when April 3 nears.


So you stocked your bar as per my instructions last week, right? Well, if not, read my last post and then we'll resume.
Are you with me now? OK, good.
When it comes to buying liquor for parties, I always go for volume and buy vodka and rum in the 1.5 liter size. The per-unit price is actually less than buying a smaller bottle, and you don't have to worry about running out. I also recommend hitting Costco , BevMo , or a supermarket, as they will generally have much better deals and variety.
You will need a 2- quart pitcher for each drink. You can fancy it up a bit by using nice glass pitchers, or even a large wine carafe. In a pinch you can even use a large mixing bowl, throw in a ladle and call it a punch party.
Each drink will start with a mix of vodka and triple sec at a 3/1 ratio. Considering the volume, you don't even need to be completely accurate. I usually use a standard coffee mug to measure. Remember to taste as you mix and adjust the flavors until they taste good to you.
Combine all ingredients in pitcher, and stir. Be careful when using lime or lemon products, as some will be substantially more tart than others. You can always add a little more later, but it's much harder to fix a drink that is too sour. Lime juice is very sour as opposed to limeade, which has added sugar.
1½ cups peach or mango nectar.
Combine all ingredients in pitcher and stir. I recommend nectars instead of juices because they are much more concentrated in flavor. So while they may cost a bit more, you only need to use a little to bring a fresh pop of flavor to your drinks. I recommend Looza™ products, but any other nice nectars will do. If you can't find any, you can also substitute pineapple juice.
To serve these drinks, put them out with a separate bowl of ice for people to serve themselves. You want the flavors to be strong, so the first time your drink should meet any ice is when you mix them in your glass. That way the ice will mellow out the flavors without watering down the drink.
One final note: use smaller glasses. Bars will never serve you a nice cocktail in a large glass, neither should you. Whether you are using glass or plastic, chose smaller glasses no larger than 10 oz. The drinks will taste better, the mix will last longer, and at the end of the night you won't have all those half empty glasses all over the place.
vodka, limenade, camberry !! I fly now haha..


text:
WKFSA Newsletter: December 2020
Note from the Chair:
Sandile Hlophe (SA, WK 84-89)
The year 2020 has been a tumultuous one for us all. Not only did we retreat to the relative safety of our homes, but many around us and within our immediate circles fell ill and some lost their lives. It is in the midst of this fear and sorrow that we have re-discovered our capacity for kindness and for gratitude.
You will be pleased to know that WK UWCSA coped remarkably well with the school year. All students who could travel home were dispatched off campus within a day. Most staff continued to work remotely. Within 4 weeks, the school had established a remote teaching and learning capacity that worked incredibly well. With additional donor support, they were able to support the learners who struggled to access wifi or had related needs. Not only has no student been left behind, but most have thrived and achieved their academic goals.
This apparently seamless transition was due to the team effort of the staff and headmaster, confirming the sound culture and foundations of the school.
Sadly, we must now bid the headmaster, Stephen Lowry, farewell as he embarks on his next career experience. I believe we can all recall every headmaster that guided us through our time at WK, such is the lasting impact they have on our hearts. Stephen's parting words at the final assembly were "Live lives of significance rather than of success"
The alumni body is indeed testimony to striving to meet this high objective wherever they are. We trust that you have been able to reconnect in some way with WK UWCSA during the year. Many joined the alumni webinars that were put together by the Advancement Office. This newsletter from the WK Foundation of SA serves to get in touch, refresh your connection with the school, and wish you all of the best for 2021.
Tandi Nzimande (SA, WK 82-88)
New Solidarity Fund boss up for the job – Tandi Nzimande (nee Mzimba) credits her suitability to be CEO of Solidarity Fund to her alma mater.
She says, "As a teacher, my mother obviously valued education and tried to get the best she could for us, so I ended up going to Waterford Kamhlaba College in Mbabane, a school that without sponsorship and bursaries would have been impossible for me."
Nzimande credits the school for helping shape her world view. "Maybe after a person has left high school they blow up their memories, but for me, one of the things about Waterford was it tried to truly accommodate a wide range of backgrounds. My one friend's parents were both unemployed, my other friend's father was the president. As a result of that grounding I think I have a greater ability to be at ease in very varied spaces," she says.
According to Nzimande, the school emphasised community service and the pupils would take turns to visit ill and disabled orphans in a nearby hospital. She says that even though they weren't always enthusiastic about this, it proved to be a valuable lesson.
"We were young and it felt like hard work; we never wanted to go but afterwards we always felt fulfilled, like we'd made a difference, even just to shine a ray of sunlight for a short while into somebody's life. I guess that formed a foundation in me, aligned with how my mother interacted with the community," she says.
Kamhlaba Challenge Fund
David Crush (Luxembourg, WK 70 - 74), a trustee of the WK Foundation of South Africa (WKFSA), writes:
"At Waterford in the early to mid-1970s, we seemed to spend a lot of our time running – to class, to the tuckshop, to the kitchen for "spares" of peri-peri chicken, up Tom and/or Kelly when we fell out with a teacher or prefect. Having shuffled through a number of marathons since I hit my forties I decided, once I hit my sixties (in 2018) to attempt to run a marathon a month for the year to help raise funds for WKFSA to sponsor a student from Swaziland (eSwatini) through the IB course at the school. Two marathons in South Africa, two in the Netherlands, two in Canada, two in Sweden, two in the United Ki….no..wait…one in Scotland, one in England, one in Italy and one, by far the toughest, on the remote island of St Helena. By tapping into the pockets of friends, relations, work colleagues it was possible in the end to raise enough for a scholarship which allowed an amazing young lady from eSwatini to complete her IB.
This got us thinking on the Committee and we are currently building a website to enable all ex-Kamhlabans to easily set up their own challenge – running, swimming, walking, chess-a-thons, litter-a-thons, sing-a-thons, whatever-a-thons and tap their networks for finance that would be channelled into a Kamhlaba Scholarship Fund. We plan to have the website up and running in the New Year and we will work with the Development Office at the school to roll out this new fundraising tool which we hope will allow people to hit the roads, rivers, chess boards with gusto once Covid lockdowns become a dim and distant memory."
But in the meantime…why not donate now to the WK Foundation of South Africa?
WST Founder on CNN!
"There is no point in dying now that I have lived this long, is there?" said Waterford School Trust (WST) founder, Martin Kenyon. He is one of the first people to receive Pfizer Covid-19 vaccine. He played a crucial role in the establishment of Waterford Kamhlaba UWCSA. We wish him a very long and healthy life. Watch the full CNN interview here.
Follow WK on Social Media
Copyright © 2020 Waterford Kamhlaba UWCSA, All rights reserved.


text:
Home / Homepage Super / A Guide to All Three-Michelin-Star Restaurants in the UK
By Emma Al-Mousawi | June 11 2021
Helene Darroze at The Connaught / ©Maybourne Hotel Group
There is a grand total of 166 Michelin-starred restaurants in the UK, but out of all of them, only seven have achieved the ultimate accolade of three Michelin stars.
Though the UK still has a bit of a way to go to catch up with Michelin's favorite nations of France and Japan (30 and 22 three-Michelin-starred restaurants respectively), Britain has been steadily building its gastronomic reputation on the international stage, shedding British cuisine's historically 'bland' stereotype. Though it must be said, French cuisine does feature heavily within some of the eateries on the list.
Despite a wealth of one-Michelin-starred establishments dotted outside London and the surrounding counties (and half a dozen two-starred eateries as well), all seven three-Michelin-star restaurants in the UK are concentrated in London and the South East. Two of which – Core by Clare Smyth and Helene Darroze at The Connaught, both helmed by female chefs – were awarded a coveted third star earlier this year. No mean feat during a global pandemic.
Elite Traveler takes a closer look at all seven three-Michelin-star restaurants in the UK.
[See also: A Guide to All Three-Michelin-Star Restaurants in Spain]
Alain Ducasse at The Dorchester
Alain Ducasse at The Dorchester is the chef's only British restaurant / ©Alain Ducasse
One of the most esteemed of all French chefs, Alian Ducasse has built a culinary empire that spans 34 restaurants across seven countries, amassing a total of 21 Michelin stars, only surpassed by his fellow countryman, the late Joël Robuchon.
Claiming three of those Michelin stars is Alain Ducasse at The Dorchester, the French chef's only British restaurant. Located on the first floor of the iconic Dorchester Hotel overlooking Park Lane, it has held three Michelin stars since 2010.
The centerpiece of the restaurant is the shimmering 'Table Lumière', a luminescent curtain of 4,500 twinkly fiber optics, which acts as one of London's most coveted private dining spaces. The dining room is elegant, as is the food. Ducasse's signature stamp of sophisticated and contemporary French haute-cuisine is executed by executive chef Jean-Philippe Blondet, who like Ducasse, is a champion of fine seasonal produce. Classics like 'sauté gourmand' of lobster are served alongside more original dishes like caramelized celeriac with fermented hazelnut and citrus from the restaurant's vegetarian menu (Menu Jardin).
CORE by Clare Smyth
"Casual luxury" at CORE by Clare Smyth / ©Food Story Media Ltd
Northern Irish chef Clare Smyth opened CORE in 2017 to high expectations. As Gordon Ramsay's protege, she left his three-Michelin-star London restaurant to go it alone. And what a great decision that was.
CORE has a more laid-back vibe than many of the other restaurants on our list, something that Smyth describes as "casual luxury". The dishes follow a similar theme; simple sustainably sourced high-quality British produce is transformed into beautifully crafted dishes.
Don't let the simplicity of the menu fool you. Smyth has a unique knack for turning seemingly ordinary ingredients into something special (The 'Lamb Carrot' which features braised lamb but with the carrot front and center, is something of staple). The signature dish is the understated 'Potato and roe' which features decadent dulse beurre blanc and herring and trout roe.
Fat Duck
The Fat Duck celebrated its 25th-anniversary last year / ©The Fat Duck
Often lauded as one of the world's best fine-dining restaurants, Heston Blumenthal's Fat Duck has been drawing foodies to the village of Bray, near Windsor, for over a quarter of a century.
Credited with taking molecular gastronomy mainstream (though Blumenthal is said to dislike the elitist connotations of the phrase), The Fat Duck is a delight for the senses as art, chemistry and ingredients all come together to take diners on a culinary adventure.
To sample Blumenthal's latest offering, Anthology, which celebrates the eatery's 25 years, one doesn't reserve a table, instead, you must "book a ticket". Anthology features a new seasonal menu – or Volume – each quarter, which explores the chef's most celebrated and wondrous dishes. Volume 1 has seen the return of his famed Snail porridge as well as Nitro poached green tea and lime mousse. Booking in advance is a must.
Chef's table at Hélène Darroze at The Connaught / ©Maybourne Hotel Group
French chef Hélène Darroze began her career working for Alain Ducasse at the famed Le Louis XV in Monaco in the early 1990s before going on to receive critical acclaim for her Michelin-starred Paris eatery. In 2008, the Connaught came calling and Darroze opened the doors of her namesake restaurant within the landmark hotel.
Following a multimillion refurbishment in 2019, the restaurant reopened with a slightly less formal look complete with two Damian Hearst butterfly collages and a beautiful pink marble chef's table overlooking the kitchen.
The fourth-generation chef splits her time between her London and Paris restaurants with Darroze placing her UK restaurant in the capable hands of head chef Marco Zampese while she is away. The menu offers fresh seasonal produce, carefully selected by Darroze with French, as well as British and international, influences. The Cornish brown and spider crabs with pomelo and lampong pepper is a real highlight.
Restaurant Gordon Ramsay
Restaurant Gordon Ramsay is the famed chef's flagship restaurant / ©Restaurant Gordon Ramsay
Retaining three Michelin stars since 2001, Restaurant Gordon Ramsay is one of the longest-standing three-Michelin-starred restaurants in not only the UK but the world. Ramsay, who himself needs no introduction, now co-owns the restaurant with head chef Matt Abé, who channels Ramsay's approach to culinary excellence into every dish that leaves the pass.
The menu features your more typical Ramsay modern-French-style dishes like the incredible Ravioli of lobster, langoustine and salmon, alongside newer dishes such as Organic spelt with artichoke, maitake mushroom and black garlic from the vegetarian menu. Abé's new Carte Blanche menu was introduced at the end of 2020 and features a bespoke selection of delights utilizing seasonal ingredients sourced from the best producers and artisans from across the globe.
Ramsay's flagship London eatery has an intimate ambiance and with just 14 tables, diners are offered just the right level of attention.
Sketch – The Lecture Room & Library
Sketch's Lecture Room & Library / ©Sketch
The penultimate eatery on our guide to all seven three-Michelin-star restaurants in the UK is the Lecture Room & Library at Sketch.
Haute-cuisine by the remarkable chef Pierre Gagnaire is served up upon the second floor of the fashionable Grade II listed surrounds of Christian Dior's former London HQ, just above the playful pink-hued parlor on the ground floor.
Gagnaire has entrusted head chef Johannes Nuding with executing a generous menu adorned with the famed chef's trademarks. Finely executed dishes such as Scottish langoustines five-ways and salt-chamber duck marinated with coffee beans sit alongside delectable wine pairings. The sweet feast that is the 'Grand Dessert' is a must-try.
Waterside Inn
Another legendary eatery awaits diner's in the Berkshire village of Bray: the beautifully situated Waterside Inn.
Guests are warmly welcomed to this Thameside restaurant, which was opened in 1972 by the late Michel and Albert Roux (five years after the brothers opened the iconic, Le Gavroche). The Waterside Inn is now one of the longest-standing Michelin-starred restaurants in the UK but it is still as relevant as it was nearly 50 years ago. Now helmed by Alain Roux, Michel's son, the ambiance is elegant yet relaxed.
Carefully executed, classic French dishes prepared with a light, modern edge using carefully sourced ingredients is the order of the day. The pan-fried lobster medallions with white port sauce is particularly good.
[See also: How the Prestigious Michelin Star System Really Works]


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Discovering L'Aquila
You are here: Home / Discovering L'Aquila
The little known capital city of Abruzzo, L'Aquila is truly a hidden treasure simply waiting for you to discover her wonders. L'Aquila is the capital of one of the most beautiful sections of Italy and the natural surroundings are only a portion of what makes the town so attractive and interesting.
The Young City
By Italian standards, L'Aquila is a rather young city. It was founded in the thirteenth century when Frederick II of Hohenstaufen called on the inhabitants of ninety-nine castles in the surrounding area to consolidate into a strategically allied position. The town became a stronghold between the Middle East and Northern Europe. The formation of the town and its ninety-nine founders are remembered throughout the city, particularly in the fountain of 99 spouts located in Piazza di Porta Rivera.
Discovering the Town
Full of interesting landmarks and must-see areas of interest, the town of L'Aquila is too much to cover in a day, especially on a single walk. Indeed the best way to see the whole of the town it to spend multiple days exploring its sights and surrounding mountainous region. Set off with a particular destination in mind, but pop into open doors or areas that spark your curiosity and you might find yourself in a medieval courtyard or the midst of another wonderful surprise.
Santa Maria di Collemaggio
A definite must-see in the town, Santa Maria di Collemaggio is an architectural masterpiece of pink and white stone façade, 14th century frescos, pure gothic interior and the only Holy Door found outside of Rome. But the history of the church is just as interesting.
Pietro Angeleri was a reclusive monk who lived the life of a hermit for three years. He sent a letter of protest to the Cardinals in Rome and then was rather unexpectedly elected Pope. He changed his name to Celestine V. As a new pope, he extended a pardon to everyone who made the pilgrimage to his parish church. Three months later he became the only Pontiff to ever relinquish his throne and Celestine/Angeleri begged to return to his hermitage. The new pope, Boniface VIII, locked him up in Fumone Castle instead where he died two years later.
After his death, his body was returned to his beloved church and the town of L'Aquila has a wonderful celebration of the general pardon every year on August 28 and 29 with two large processions complete with period costumes.
Abruzzo Classic Itineraries: discovering the South
Abruzzo: An Assortment of Italy's History
Pienza: Middle Ages and Renaissance in Tuscany
Discovering Naples – And Understanding the Stereotypes
Abruzzo, Italy Abruzzo, Celestine V, Fountain of 99 spouts, L'Aquila, piazza di porta rivera, Pietro Angeleri, Santa Maria di Collemaggio


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Category Archives: Chris Kuzneski
Chris Kuzneski : Prisoners Gold (Review)
Chris Kuzneski attended the University of Pittsburgh, where he played football, wrote for three newspapers, and passed most of his classes. He earned a master's degree in teaching, then taught English for five years before pursuing a career in writing. His first novel, THE PLANTATION, introduced the characters of Payne and Jones, and received rave reviews.
Prisoners Gold:
Book three in the #1 bestselling action series
THE TREASURE:
At the end of the 13th century, Chinese Emperor Kublai Khan gave an Italian merchant unfettered access to his kingdom. The traveler was Marco Polo, and his journey would become legendary. Aided by a special passport that protected him throughout the land, Polo amassed unbelievable wealth and hid it before his return to Italy. To this day, the location of his treasure remains a mystery.
THE MISSION:
The Hunters – an elite group assembled by an enigmatic billionaire to locate the world's greatest treasures – are tasked with finding the missing fortune. Guided by firsthand accounts of Polo's travels, they quickly discover there are hostile forces willing to do anything to stop them from taking the riches from Chinese soil. Before long, the treasure hunt becomes a deadly game of cat-and-mouse that will rewrite history while taking the lives of many.
As the danger mounts, will the Hunters rise to the challenge? Or will the team be killed before they find Polo's treasure?
Chris Kuzneski has over the course of the Hunters series become a guilty pleasure, his characters remind me of the fun and enjoyment I felt when I first read Clive Cussler, and it was amusing to see he had emulated the man with a small cameo (I hope he keeps these up, they always give me a laugh).
This is book three of the Hunters series and sends our team once more on a seemingly impossible mission, first Nazi treasure, then the tomb of Alexander the Great, now they search for the treasure of Marco Polo. The team are still mourning the loss of one of their own when a new member is introduced adding a new dimension to the team, and much needed expertise on a search thats begins with rumour and worse than third hand knowledge. In the background Cobb is still trying to uncover why they are being asked to solve these great mysteries and why the Frenchman takes no credit for them, who is really pulling the strings and for what reason, and how much danger are the team in?
As per the rest of the series the book is an explosive action packed thrill ride, tempered with real laugh out loud moments, (usually courtesy of their resident sniper and weapons expert, you just can't beat gallows humour). Many of this style of action adventure lack plot maturity, but that's not the case with Prisoners Gold or the other books in the series, the plot has multiple layers and enough twists and turns to wrap you in knots, and yet a balance and flow that means you just cannot put it down, once again the author has written a sleep killer of a book.
Highly recommend this and cannot wait to see it on the big or small screen, because its perfect for either format.
Payne and Jones
1. The Plantation (2000)
2. Sign of the Cross (2006)
3. Sword of God (2007)
4. The Lost Throne (2008)
5. The Prophecy (2009)
6. The Secret Crown (2010)
7. The Death Relic (2011)
8. The Einstein Pursuit (2013)
Slipcase: Sign of the Cross / Sword of God / Lost Throne(omnibus) (2011)
1. The Hunters (2013)
2. The Forbidden Tomb (2014)
3. The Prisoner's Gold (2015)
Filed under Action/ Adventure Thrillers, Chris Kuzneski
Chris Kuzneski: The Forbidden Tomb (Review)
Click to go to Author Website
Chris Kuzneski attended the University of Pittsburgh, where he played football, wrote for three newspapers, and passed most of his classes. He earned a master's degree in teaching, then taught English for five years before pursuing a career in writing. His first novel, THE PLANTATION, introduced the characters of Payne and Jone
The Forbidden Tomb
If you seek, they will find…
For over two thousand years, the legendary tomb of Alexander the Great – and the riches concealed within – has evaded discovery. Now, after centuries of searching, an ancient map has come to light that could hold the key to finding the fabled vault. Only one team has the skill and the expertise to solve the mystery once and for all.
It's up to The Hunters – an elite group assembled to track down the world's greatest treasures – to find the tomb. But on arriving in Alexandria, it quickly becomes clear that hostile forces are on their trail. And when one of the team is captured in cisterns deep below the city, what began as a treasure hunt becomes a deadly rescue mission.
For there are some who will use any means possible to destroy The Hunters' efforts, and now there is more at stake than they ever could have imagined.
High-octane action. Brilliant characters. Classic Kuzneski.
My first taste of Chris Kuzneski's work was last years The Hunters , I'm always on the lookout for another great thriller writer, James Rollins, Andy McDermott and co can only turn out so many books a year, after that its the cheesy end of the market, the Dan Brows etc. So finding that the Hunters was not just good, but brilliant was as much a relief as it was a revelation.
In book two "The Forbidden Tomb" we see the return of the excellent, multi-layered and utterly human characters created in book one. A complex team, compiled from each needed skill set for the first mission, and just as apt for this new mission. As such we are treated to another search for the impossible, a hunt to find something lost and no real clues to its location, in this case the Tomb of Alexander the Great. But as i have come to expect in any book of this type, all is not what it seems. Why has the tomb never been found? Why are there so few clues? Is someone protecting the history of Alexander and his Tomb? Who? What? Why? I love the stream of unknown. Read the book and find out! (i cannot give any more away)
For me i found the story breathtaking (i'm a huge fan of Alexander the great and stories about him). The plot isn't just a balls out action thriller, it has more intelligence than that, it has the ability to keep you guessing all the way to the end. This book has so many twists and turns you just don't want to put the book down. I think this is the first book in years that has made me physically sit bolt upright and exclaim out loud "No F….ing way!" I take my hat off to you sir, that part of the plot took real balls, i was shocked, surprised, amazed, appalled and yet transfixed by the incident with Jasmine.
This book is truly an action packed thinking mans thriller, with a plot that spans the centuries and is packed with more surprises than is good for the heart. Loved it, and already cannot wait for the next one. I really do promise to make time to read the Payne and Jones series, which if its even half as good, is going to be worth making the time to read.
1. The Hunters (2013) My blog and review for book 1
Filed under Action/ Adventure Thrillers, Chris Kuzneski, Historical Fiction, Thrillers
Tagged as Action, adventure, alexander the great, Chris Kuzneski, death, explosions, guns, Swords, thriller


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Call for Airbnb owners to act responsibly
April 7, 2020 2 min read
Owners of Airbnb and other rental properties in Liverpool are being urged not to host bookings from visitors and tourists during the coronavirus pandemic.
The council's Environmental Health Team has received a number of complaints about homes and apartments still being rented out – despite advice from health officials for people not to travel unless it is absolutely necessary, and Government guidance that short term lets should be closed.
The council is to write to Airbnb and other rental providers urging them to make their advertisements very clear that the UK is subject to restrictions which discourages non-essential travel and makes going out for sightseeing and other gatherings unlawful.
Any complaints about properties persistently used as short term lets where there is no valid reason for travel will be referred to the appropriate authorities.
Stays booked on Airbnb before 14 March for check-in dates up until 31 May are covered by an 'extenuating circumstances' policy with a variety of cancellation and refund options, and hosts can cancel without charge or impact on their Superhost status. More information is available at www.airbnb.co.uk
There are around 300 properties listed for rent in Liverpool in on the Airbnb website at the moment.
Cabinet member for public health, Councillor Paul Brant, said: "Liverpool is one of the most popular tourist destinations in the country and it is absolutely heart-breaking that we are not able to welcome visitors at this time.
"However, the health and wellbeing of our residents is absolutely paramount and the simple fact is that we are in the middle of a pandemic which has already led to the death of dozens of people in our city, as well as hundreds of confirmed cases so far.
"We need the home rental sector to follow the lead of our hotels in acting responsibly and making sure that they cancel bookings for the foreseeable future.
"The more united we are in obeying the restrictions, the quicker we will reach the peak of infections and the sooner we can get to a position where life can begin to return to normal.
"This is not about targeting key workers who are staying in temporary accommodation to carry out a valuable role in keeping vital public services going, such as the NHS.
"It is about unnecessary travel which flouts the very clear guidelines from the Government's health experts just puts the lives of innocent people at risk and will prolong the current challenges for even longer and may need lead to even tougher restrictions on our lives."


The time had come and we set of from Lancashire towards Snowdonia for the Trail Marathon Wales. The drive down through North Wales' mountains was beautiful, made even more so by bright blue skies with only the odd small cloud (thank goodness we'd packed sunscreen ). Arriving at the Coed-y-Brenin visitor centre around lunch time and after parking the car one of the first things we saw was a sign pointing towards registration.
It was real, we were really here, I don't think I could have been more excited if all my birthdays had arrived at once. Past the sponsors, some of whom were still setting up, we picked up our goodie bags which contained our numbers, some leaflets, a 9bar, a great t-shirt, Salomon socks and a Torq gel voucher and after a quick look round to try and calm down a bit (we failed) we had a great lunch while reading through some of the leaflets. We called in at the Torq stand to 'cash in' our vouchers and to try their gels which were surprisingly good, I took a Rhubarb and Custard one, Wendy a Raspberry Ripple.
Leaving the visitor centre after taking a few more photos we made our way to the Cross Foxes about 25 minutes away where we checked in for our two night stay, unpacked and generally faffed about in an over excited need to calm down sort of way. We spend the afternoon either on the balcony or in the garden next to a lovely stream relaxing in the beautiful welsh mountains. Martin arrived later in the afternoon and after more cups of tea the three of us made our way back to the visitor centre so Martin could pick up his stuff and to watch the end of the 9bar9 race and grab some pasta bake at the welcome party.
I'm glad we decided to go to the welcome party as we were a bit undecided and thought it would just be full of super fit people who run up and down mountains as a way of life. Instead, after some great food put on by the staff at the visitor centre we all had a seat in the conference room where we picked up yet another goody bag (more socks, DVDs and other bits and pieces). Matt Ward, the organiser, introduced himself and gave us a brief speech on the ethos behind Trail Marathon Wales and there was a quick question and answer session with some of the elite runners. It was well worth the time and it gave a real sense of what the team are aiming for with the trail running at Coed-y-Brenin where there will be a dedicated trail running shop opening soon.
Waking just before 7am (the race was at 9am) we had our usual porridge and coffee or tea then gathering our racing things together and our drop bags full of post race snacks we set off once more to Coed-y-Brenin. It was a lot busier today but we got parked up easily enough and had time enough for the usual last breaks and to take a few pre race photos. Matt gave the run briefing and then Martin and I left Wendy on the balcony of the visitor centre (she was running the half marathon) as we made our way to the start.
The sense of 'something wonderful' hit me just before the bang of the starting gun (literally, it was Shotgun), the training and early morning runs had come to this, I was about to run my first ever marathon and it was in the magnificent mountains of Snowdonia. It felt incredible.
I'll never forget the moment just before the start when I looked towards the balcony and saw Wendy ready to cheer me on, I smiled and sent a thought her way… "Good luck with your race darling, see you in a bit". I felt a stillness, almost as if my world paused and then bang, we were off.
I looked at Martin who was grinning at me, I think I grinned back although I can't be sure as I was a little overwhelmed by the experience. Quickly we were over the start and under the balcony, through the cheers from spectators, half marathon runners waiting for their turn and visitors to the forest and then a sharp right and we were onto the trails.
The initial climb took a while as everyone sorted themselves out but it did do us a favour and stopped everyone going out too fast as we jogged up through the forest. I can't really give a description of the course as around every corner Snowdonia presented us with something different. Whether it was single track running through the dappled light in the forest, fire roads descending (or ascending) forever up (and down) the hills or tracks over the open moorland in the 2nd half, the trail had everything and it was, without a doubt, the best, most beautiful and spectacular run I've ever done.
I remember breaking out of the forest to see the mountains of Snowdonia in the distance, a view so magnificent Wendy stopped to take a photo.
Bouncing across the aerial bridge with the River Mawddach crashing below us. The 'sting in the tail' around mile 11 (near the finish of the half marathon), an incredibly brutal climb that just would not end that was then followed by an amazing descent which switched left and right down the single track through the forest.
After some amazing descending Martin arrived at the half way feed station at the visiter centre just before me, so we had a very quick chat and I refuelled while he set off on the second half of the race. As far as races went we were now heading into unknown territory. Would our training hold up? Had we done enough?
After going under the main road we started the second half with a gentle climb alongside the river Eden, it wasn't gentle for long. This half of the race was a lot more technical than the first and although overall there wasn't as much elevation what climbing there was ,was hard work as a lot of the this section was the Red Bull mountain bike track but run in reverse. Yes, we were running up a downhill mountain bike course.
A lot of these up hill sections were large rock slabs or steps and I found I could power walk up them faster and easier than running them, most people around my pace were doing the same so it seemed the thing to do. At the furthest point we passed one of the many food stations and ran a loop over a newly made path through some scrubland. As I arrived back at the food station I refilled one of my bottles with an isotonic drink (with salts in it, I was getting a bit of cramp, probably due to the heat and sweating more than anticipated) but even with this new found pain I couldn't help but smile as in my head, knowing how far I'd run, I was on my way 'home'.
I remember the last descent before we crossed back over the road to rejoin the half marathon route, birds singing, blue sky and in the distance the cheering of the crowds as runners arrived at the finish, and although I was exhausted it felt wonderful.
And then it was my turn, one final push along the River Eden, a sharp left turn and then the final 100 or so meters up a hill (I know, it was a touch harsh) and crossing the finish, physically spent beyond anything else I've ever done to collapse into Wendy's arms, her smile lifted me so much I could almost have run it again, in my head at least.
I picked up my 'prize', a lovely wooden coaster then collected my bag and proceeded to eat and drink everything inside it, if eating was a sport I'd have won it there and then. Not long after Martin came through the finish, I'd passed him around mile 16, the 'sting' of the half marathon had taken its toll and slowed him down a little. After a good stretch we had lunch (a little late) of the best bacon sandwich in the world then made our way back to the Cross Foxes for showers and an afternoon of relaxing with cold drinks. I'd picked up a tip from one of the elite runners the night before and found a rock next to the stream, sat on it and cooled my calves and feet, after the initial shock it felt great and I'm sure that's one of the reasons I don't feel as beaten up as I thought I would.
The three of us met for dinner where we all had starters then burgers of some type, all huge and very tasty and the best pint of ale I've ever had closely followed by another one. The food was wonderful, the service excellent and the atmosphere just right as we took our time and chatted about the days adventures.
After retiring you'd think sleep would have come easily but I kept waking up, my body was exhausted but my mind wouldn't shut off, over and over it kept telling me 'I've just run a marathon', I'm sure when I finally fell asleep I was still smiling.
Breakfast was a 'full welsh' after which we ventured back to Coed-y-Brenin for a walk to gently stretch aching legs and take in some of the beautiful scenery but at a somewhat more leisurely pace. After a quick lunch and thanking Matt who'd taken out some runners that morning we made our way home after what I can only describe as an amazing weekends running.
This marathon is only a stop along the way, the 'journey' goes on.
Fantastic read mate, many congratulations to you, Martin and of course Wendy. Simply inspiring!


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