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Genetic Code
Genetic Code Definition
The genetic code is the code our body uses to convert the instructions contained in our DNA the essential materials of life. It is typically discussed using the "codons" found in mRNA, as mRNA is the messenger that carries information from the DNA to the site of protein synthesis.
Everything in our cells is ultimately built based on the genetic code. Our hereditary information – that is, the information that's passed down from parent to child – is stored in the form of DNA. That DNA is then used to build RNA, proteins, and ultimately cells, tissues, and organs.
Like binary code, DNA uses a chemical language with just a few letters to store information in a very efficient manner. While binary uses only ones and zeroes, DNA has four letters – the four nucleotides Adenine, Cytosine, Guanine, and Thymine/Uracil.
Thymine and Uracil are very similar to each other, except that "Thymine" is slightly more stable and is used in DNA. Uracil is used in RNA, and has all the same properties of Thymine except that it is slightly more prone to mutate.
This doesn't matter in RNA, since new RNA copies can be produced from DNA at any time, and most RNA molecules are intentionally destroyed by the cell a short time after they're produced so that the cell does not waste resources producing unneeded proteins from old RNA molecules.
Together, these four letters of A, C, G, and T/U are used to "spell" coded instructions for each amino acid, as well as other instructions like "start transcription" and "stop transcription."
Instructions for "start," "stop," or for a given amino acid are "read" by the cell in three-letter blocks called "codons." When we talk about "codons," we usually mean codons in mRNA – the "messenger RNA" that is made by copying the information in DNA.
For that reason, we talk about codons made of RNA, which uses Uracil, instead of the original DNA code which uses Thymine.
Each amino acid is represented in our genetic instructions by one or more codons, as seen below.
One of the most remarkable evidences for the common descent of all life on Earth from a single ancestor is the fact that all organisms use the same genetic code to translate DNA into amino acids.
There are a few slight exceptions to be found, but the genetic code is similar enough across organisms that when a gene from a plant or jellyfish is injected into a mammal cell, for example, the mammal cell will read the gene in the same way and build the same product as the original plant or jellyfish!
Function of Genetic Code
The genetic code allows cells to contain a mind-boggling amount of information.
Consider this: a microscopic fertilized egg cell, following the instructions contained in its genetic code, can produce a human or elephant which even has similar personality and behaviors to those of its parents. There is a lot of information in there!
The development of the genetic code was vital because it allowed living things to reliably produce products necessary for their survival – and pass instructions for how to do the same onto the next generation.
When a cell seeks to reproduce, one of the first things it does is make a copy of its DNA. This is the "S" phase of the cell cycle, which stands for the "Synthesis" of a new copy of the cell's DNA.
The information encoded in DNA is preserved by the specific pairing of DNA bases with each other. Adenine will only bond with Thymine, Cytosine with Guanine, etc..
That means that when a cell wants to copy its DNA, all it has to do is part the two strands of the double helix and line up the nucleotides that the bases of the existing DNA "want" to pair with.
This specific base pairing ensures that the new partner strand will contain the same sequence of base pairs – the same "code" – as the old partner strand. Each resulting double helix contains one strand of old DNA paired with one strand of new DNA.
These new double helixes will be inherited by two daughter cells. When it's time for those daughter cells to reproduce, each strand of these new double helices, act as templates for a new double helix!
When the time comes for a cell to "read" the instructions contained within its DNA, it uses the same principle of specific pair bonding. RNA is very similar to DNA, and each RNA base bonds specifically to one DNA base. Uracil binds to Adenine, Cytosine to Guanine, etc..
This means that, just like DNA replication, the information in DNA is accurately transferred to RNA as long as the resulting RNA strand is composed of the bases that bind specifically with the bases in the DNA.
Sometimes, the RNA strand itself can be the end product. Structures made of RNA perform important functions in ourselves, including assembling proteins, regulating gene expression, and catalyzing the formation of proteins.
In fact, some scientists think that the first life on Earth might have been composed mainly of RNA. This is because RNA can store information in its base pairs just like DNA, but can also perform some enzymatic and regulatory functions.
In most cases, however, the RNA goes on to be transcribed into a protein. Using the amino acid "building blocks of life," our cells can build almost protein machines for almost any purpose, from muscle fibers to neurotransmitters to digestive enzymes.
In protein transcription, the RNA codons that were transcribed from the DNA are "read" by a ribosome. The ribosome finds the appropriate transfer RNA (tRNA) with "anti-codons" that are complimentary to the codons in the messenger RNA (mRNA) that has been transcribed from the DNA.
Ribosomes catalyze the formation of peptide bonds between the amino acids as they "read" each codon in the mRNA. At the end of the process, you have a string of amino acids as specified by the DNA – that is, a protein.
Other building blocks of life, such as sugars and lipids, are in turn created by proteins. In this way the information contained in the DNA is transformed into all of the materials of life, using the genetic code!
Types of Genetic Mutations
Because the genetic code contains the information to make the stuff of life, errors in an organism's DNA can have catastrophic consequences. Errors can happen during DNA replication if the wrong base pair is added to a DNA strand, if a base is skipped, or if an extra base is added.
Rarely, these errors may actually be helpful – the "mistaken" version of the DNA may work better than the original, or have an entirely new function! In that case, the new version may become more successful, and its carrier may outcompete carriers of the old version in the population. This spread of new traits throughout a population is how evolution progresses.
Silent Mutations and Redundant Coding
In some cases, genetic mutations may not have any effect at all on the end product of a protein. This is because, as seen in the table above, most amino acids are connected to more than one codon.
Glycine, for example, is coded for by the codons GGA, GGC, GGG, and GGU. A mutation resulting in the wrong nucleotide being used for the last letter of the glycine codon, then, would make no difference. A codon starting in "GG" would still code for glycine, no matter what letter was used last.
The use of multiple codons for the same amino acid is thought to be a mechanism evolved over time to minimize the chance of a small mutation causing problems for an organism.
Missense Mutation
In a missense mutation, the substitution of one base pair for an incorrect base pair during DNA replication results in the wrong amino acid being used in a protein.
This may have a small affect on an organism, or a large one – depending on how important the amino acid is to the function of its protein, and what protein is effected.
This can be thought of like furniture construction. How bad would it be if you used the wrong piece to bolt a chair leg in place? If you used a screw instead of a nail, the two are probably similar enough that the chair leg would stay on – but if you tried to use, say, a seat cushion to connect the leg to the chair, your chair wouldn't work very well!
A missense mutation may result in an enzyme that almost as well as the normal version – or an enzyme that does not function at all.
Nonsense mutation
A nonsense mutation occurs when the incorrect base pair is used during DNA replication – but where the resulting codon does not code for an incorrect amino acid.
Instead, this error creates a stop codon or another piece of information that is indecipherable to the cell. As a result, the ribosome stops working on that protein and all subsequent codons are not transcribed!
Nonsense mutations lead to incomplete proteins, which may function very poorly or not at all. Imagine if you stopped assembling a chair halfway through!
In a deletion mutation, one or more DNA bases are not copied during DNA replication. Deletion mutations come in a huge range of sizes – a single base pair may be missing, or a large piece of a chromosome may be missing!
Smaller mutations are not always less harmful. The loss of just one or two bases can result in a frameshift mutation that impairs a crucial gene, as discussed under "frameshift mutations" below.
By contrast, larger deletion mutations may be fatal – or may only result in disability, as in DiGeorge Syndrome and other conditions that result from the deletion of part of a chromosome.
The reason for this is that DNA is very much like computer source code – one piece of code might be crucial for the system to turn on at all, while other pieces of code might just ensure that a website looks pretty or loads quickly.
Depending on the function of the piece of code that is deleted or otherwise mutated, a small change can have catastrophic consequences – or a seemingly large corruption of code one can result in a system that is just a bit glitchy.
An insertion mutation occurs when one or more nucleotides is erroneously added to a growing DNA strand during DNA replication. On rare occasions, long stretches of DNA may be incorrectly added in the middle of a gene.
Like a missense mutation, the impact of this can vary. The addition of an unnecessary amino acid in a protein may make the protein only slightly less efficient; or it may cripple it.
Consider what would happen to your chair if you added a random piece of wood to it that the instructions did not call for. The results could vary a lot depending on the size, shape, and placement of the extra piece!
A duplication mutation occurs when a segment of DNA is accidentally replicated two or more times. Like the other mutations listed above, these may have mild effects – or they may be catastrophic.
To imagine if your chair had two backs, two seats, or eight legs. A small duplication and the chair may still be useable, if a little odd-looking or uncomfortable. But if the chair had, for example, six seats attached to each other, it may rapidly become useless for its intended purpose!
Frameshift mutation
A frameshift mutation is a subtype of insertion, deletion, and duplication mutations. In a frameshift mutation, one or two amino acids are deleted or inserted – resulting in a shifting of the "frame" which the ribosome uses to tell where one codon stops and the next begins.
This type of error can be especially dangerous because it causes all codons that occur after the error to be misread. Typically, every amino acid added to the protein after the frameshift mutation is wrong.
Imagine if you were reading a book – but at some point during the writing, a programming error happened such that every subsequent letter shifted one letter later in the alphabet.
A word that was supposed to read "letter" would suddenly become "mfuuft." Boe tp po.
This is approximately what happens in a frameshift mutation.
1. The base pairing rules of DNA and RNA are as follows:
A – T/U (Uracil is used instead of thymine in RNA.)
C – G
G – C
T/U – A
Given that, which of the following would be the anti-codon sequence for an mRNA codon reading "UUGCUGCAG?"
A. AAGGACGUC
B. AACGAGGUC
C. AACGACGUC
D. AACGACGUG
C is correct. It contains the correct compliment of all the letters in the three mRNA codons provided.
2. Which of the following could NOT occur as a result of the deletion of a single nucleotide?
A. A missense error.
B. A nonsense error.
C. A frameshift mutation.
A is correct. The deletion of a single nucleotide would result in the frameshift mutation, since every amino acid is coded for by three bases. The ribosome would continue to read nucleotides in sets of three – and since one nucleotide was missing every set of three after that deletion would be incorrect.
3. What amino acid string is coded for by the mRNA sequence UUGCUGCAG?
A. Leucine-Isoleucine-Glutamine
B. Leucine-Leucine-Glutamine
C. Leucine-Leucine-Arginine
D. Isoleucine-Isoleucine-Glutamine
B is correct. If you consult the table of the genetic code at the top of this article, you will see that this is the correct translation of this nucleotide sequence.
What kinds of gene mutations are possible? – Genetics Home Reference. (n.d.). Retrieved May 10, 2017, from https://ghr.nlm.nih.gov/primer/mutationsanddisorders/possiblemutations
Writer, L. G. (2016, September 29). Do Humans and Bacteria Share Common Genetic Codes? Retrieved May 10, 2017, from http://education.seattlepi.com/humans-bacteria-share-common-genetic-codes-4511.html
Crick, F. (1990). What mad pursuit: a personal view of scientific discovery. Harmondsworth: Penguin.
Anticodon
Start Codon
Point Mutation
Ribosome
Proteins and Nucleic Acids
Silent Mutation
Deletion Mutation


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HP and Autonomy: Unanswered questions
The claimed financial shenanigans at Autonomy in the lead up to HP's botched acquisition should serve as lessons to us all.
By Dennis Howlett for Irregular Enterprise | November 20, 2012 -- 16:06 GMT (08:06 PST) | Topic: Hewlett Packard Enterprise
So HP has put its hands up and said that it is taking a $5 billion hit on its $10 billion Autonomy acquisition. Note: most are assuming it is an $8 billion hit. They're wrong. Check the press release:
HP today announced a non-cash impairment charge of $8.8 billion related to Autonomy in the fourth quarter of its 2012 fiscal year. The majority of this impairment charge, more than $5 billion, is linked to serious accounting improprieties, misrepresentation and disclosure failures discovered by an internal investigation by HP and forensic review into Autonomy's accounting practices prior to its acquisition by HP.
As I looked over the reporting on this topic I was puzzled. Sure, HP paid a massive premium for a company that for years had question marks over its accounting practices. But if this is another CA in the making then were the auditors, audit committee and analysts generally asleep at the wheel? Or is this a case of a business model HP could not understand? That's hard to tell at this stage of proceedings.
So far, HP has only said that some 10-15% of the write off relates to Autonomy's hardware business - one that it was exiting at the time of the acquisition. That's around $0.5-0.75 billion of the total provision and I am guessing most of that will likely represent goodwill and possibly trade debtor write downs. Inventories only represented about $170,000 at the tme of acquisition. That leaves a whopping $0.32-0.58 billion in the 'shady deals' bucket.
Without further detail, it is difficult to know exactly where HP is pointing the finger unless it is implying multi-year restatements are in order. The problem with that analysis is that a quick drive by at the 2010 Autonomy accounts doesn't show anything especially noteworthy in the cashflow or balance sheet to indicate where irregularities might have occurred. Cash balances are readily provable - unless of course we are seeing another Satyam. My personal take is that is highly unlikely but then I have been spectacularly wrong on this point in the past.
If HP's current analysis is correct then it suggests:
Due diligence at the time of acquisition was less than pristine. The Register hints at this. Given what I have seen in recent months, this does not surprise. High level executives get bees in their bonnets about changes of direction or acquiring market share and all fiscal sense goes out the window. Analysts grumble but almost never do enough homework to discover the facts other than to pontificate around valuations.
Mike Lynch, founder and CEO Autonomy plus former CFO Sushovan Hussain are up to their armpits in questionable financial engineering over a long period of time, operating at a level of skill that auditors failed to detect. Past grumblings by analysts may support that theory. If true then the auditors were blind to miss the danger signals coming out of reports stretching back over many years.
My questions are somewhat mundane. Bloomberg observes that:
"It seems very late in the day that HP would find accounting irregularities," said George O'Connor, an analyst at Panmure Gordon & Co. "It looks as though they're trying to find a way to write off the deal."
I agree. HP has had ample time to find problems. Unless of course it went comatose after acquiring the company. I cannot believe that given the furore over the purchase at the time and the eventual sacking of then CEO Leo Apotheker.
What happened other than due diligence falling to the then CEO and chief strategy officer? Was everyone else who was party to the deal silent about deal risks or was HP so desperate to find something upon which to hang a software hat that proberty was tossed over the side? If so then caveat emptor.
The CFO left in November 2011 so how come it wasn't until after May 2012 that problems emerged? That's two full quarters during which any serious problems would have emerged. HP can take a pass on the December 2011 quarter but it doesn't have that same luxury for Q1 2012.
Is HP trying to convince us that a whistleblower was what it took to force sunshine onto a botched investment? I understand the importance of whistleblower evidence but this seems highly contrived.
Why did it take from May until now for HP to 'fess up on this issue? They can argue it has taken time to do the work but if there were strong suspicions then its board has a duty to inform the market at the earliest opportunity.
There is a suggestion in the current explanation that Autonomy was engaged in channel stuffing in the pre-acquisition period. This would be obvious relatively quickly and would have to be on a significant scale to make a demonstrable difference to financial statements. Movements on the balance sheet were certainly large but then I would expect auditors to undertake significantly more test work to ensure those numbers made sense. If not - then they're in the coconut shy for a hefty law suit.
How does current management continue to have faith in Autonomy when it wants to write off 50% of the investment? That doesn't make sense. What parts of the business does it consider worth retaining and/or developing?
This is likely the tip of the iceberg. HP is setting itself to get at least some compensation from Autonomy shareholders. The chances are slim though they can always go after Deloitte as auditors - a likely sencond string course. The fact they have asked the UK's Serious Fraud Office to investigate implies evidence of serious criminal action. It will be interesting to see if the UK's fraud enforcers are up to the task - they don't have a great track record in this area.
Data Centers Cloud Storage Networking Servers
More from Dennis Howlett
It's time to go.
Accounting on the cloud: WOW
SAP Standard Support price rise: why now?
CMO to have more spend power? Don't make me weep
Hyperconverged systems sales surge in Q1, Dell Technologies, VMware, Nutanix lead
Dell Technologies portfolio companies dominated the hyperconverged space, according to IDC.
HPE aims to make its product lineup as-a-service, updates GreenLake, unveils Primera storage
At HPE Discover, the company outlined a portfolio revamp that revolves around making its infrastructure consumed as a service.
HPE buys supercomputer company Cray for $1.3 billion
At the core of the deal is Cray's high-performance computing (HPC) technology, which HPE wants to offer as a future HPC-as-a-Service platform.
HPE, Nutanix partner on hybrid cloud as a service offering
Nuntanix will now offer its hyperconverged software as a managed private cloud service and on HPE-branded appliances.
Hewlett-Packard reverses Australian loss to profit AU$54 million in 2018
The US multinational pocketed AU$54 million from its operations known as Hewlett-Packard South Pacific.
HPE beats Q1 earnings estimates with growth in "intelligent edge"
Shares were up in after-hours trading, as the company also raised its FY 2019 EPS outlook
HPE's Edgeline EL8000 brings higher performance to the edge
HPE is partnering with Samsung and Tech Mahindra to bring the platform to customers transitioning to 5G.
HPE teams up with Girl Scouts to teach girls about cybersecurity
HPE and the Girl Scouts have developed a game, a curriculum, and of course, a Girl Scout patch focused on cyber risks and best practices.
HPE losing server market share as Dell extends lead during Q3
Dell Inc beats out close competitor HPE by 100,000 units in the third quarter of 2018, IDC reports.

redpajama_set_name: RedPajamaCommonCrawl


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Mike Pence, A Dozen Republican Senators, And 140 House Members Are Promoting Treason And Sedition!
January 3, 2021 Ronald 22 Comments
We are about to witness treason and sedition being promoted by Vice President Mike Pence, along with a dozen or more Republican Senators, and at least 140 House Republicans.
What is normally and traditionally a ceremonial counting of the Electoral Vote in a joint session of Congress, presided over by the sitting Vice President, is now becoming a mockery, as Donald Trump contested the result and has lost in every court setting, including twice in the Supreme Court with a Republican majority, including three Trump appointees!
Mike Pence is going along with a challenge in order to promote his own future Presidential candidacy, in the hope that Donald Trump will not run in 2024, and will support him, and the same is the reasoning why Senator Josh Hawley of Missouri and Senator Ted Cruz of Texas are leading a fight that undermines the Constitution and rule of law.
The 14th Amendment, Section 3, makes clear that what these Republicans in Congress and the Vice President are doing is promoting treason and sedition. By all rights, they should all face arrest, trial, and incarceration, as they are provoking dangerous and reckless behavior by Trump and his supporters, leading to likely confrontations, bloodshed, and violence on Wednesday, January 6, and even more seriously, on Inauguration Day, January 20, 2021, when Joe Biden and Kamala Harris are inaugurated President and Vice President.
America is not a banana Republic, but Donald Trump has no issue in burning down the Republican Party, and the future of public safety in the middle of a pandemic worsened by his own lack of concern for human life!
Mike Pence's job on Wednesday is not to promote his own advancement, but rather fulfill his constitutional duty followed by every Vice President, those on the winning side of an election, but also those on the losing side, as for instance, Richard Nixon in 1961 and Al Gore in 2001.
History will condemn these law breaking Republicans and Mike Pence for the disgraceful actions they are taking, but at the end, Joe Biden and Kamala Harris will be in charge of the government in 17 days!
News and Politics	"Treason And Sedition", 14th Amendment, Al Gore, Bloodshed And Violence, Congress, Donald Trump, Electoral Vote Ceremony, Inauguration Day 2021, Joe Biden, Josh Hawley, Kamala Harris, Presidential Election Of 2024, Public Safety, Republican House Members, Republican Party, Republican Senators, Richard Nixon, Rule Of Law, Supreme Court, Ted Cruz, Trump Court Appointees, US Constitution, US Senate, Vice President Mike Pence
The Attack On Birthright Citizenship And The 14th Amendment By Donald Trump, Mike Pence, And Lindsey Graham
October 31, 2018 Ronald 4 Comments
Donald Trump has opened up a new area of attack on constitutional law, claiming that he can, by executive order, end birthright citizenship for infants born of undocumented immigrants, bypassing the 14th Amendment's guarantee of citizenship for all born in the United States in 1868, exactly 150 years ago.
Speaker of the House Paul Ryan, for once, is correct when he says that is not possible legally, as executive orders cannot end what is in the Constitution or its amendments.
It is also a fact, despite some, like Vice President Mike Pence, and South Carolina Senator Lindsey Graham who claim otherwise, that legislation by Congress also cannot end what is in the Constitution or the amendments.
The only way to change what is in the Constitution or its 27 amendments is by another constitutional amendment, as occurred when the 18th Amendment banning liquor (Prohibition) was passed in 1919 and fourteen years later, with much discontent, the amendment was repealed by the 21st Amendment, the only way Prohibition would ever have ended.
If it was that easy to change what is in the Constitution or its amendments, then there would be a move to end the Electoral College, but that will never happen legally unless an amendment is passed by two thirds of each of the two houses of Congress, and three fourths of the states' legislatures (38 out of 50).
The idea that Lindsey Graham is suddenly a great friend of Donald Trump, after the way that Trump trashed his good friend, the late Arizona Senator John McCain, is infuriating. One can be certain that McCain would fight this idea that Trump has suggested that he has the authority, all on his own, to destroy the language of the 14th Amendment. It is certain that McCain would be angry at Graham for his changed behavior, and it makes one wonder what is going on in Graham's disturbed mind that he does not know the basic reality of constitutional law.
Of course, those on the Right would say the Supreme Court could justify what Trump wishes to do, and in theory, a lawless Court, which has already made decisions clearly and purely political in the last ten years, could by a 5-4 vote, including compromised Justice Brett Kavanaugh, do such. But it is hard to imagine that Chief Justice John Roberts would wish to be part of a majority that would undermine his reputation and that of his Court in the long run of history.
If such a disgrace were to happen, the Supreme Court would lose its credibility for all time, and would be helping Donald Trump to destroy our democracy, and impose an authoritarian dictatorship on our nation.
There is absolutely no moral or ethical way that this could happen, and be allowed to stand!
And also, the thought that an infant would not have the opportunity for a good life in America, simply because his or her parents were not documented at the time of his or her birth, is to deny the whole point of the Statue of Liberty and Ellis Island, and the reality that tens of millions of immigrants, and not all legal, with many "slipping in" through our borders and not realized what they had done, contributed to our nation's greatness.
Think of the refugees from Cuba and Vietnam who came to a nation welcoming them from their personal tragedies in the past half century, and think of the refugees who came from all over the world over two centuries to a nation that gave them a chance to succeed and prosper, and benefit all of the American people!
News and Politics	14th Amendment, 18th Amendment, 21st Amendment, Arizona, Authoritarian Dictatorship, Birthright Citizenship, Brett Kavanaugh, Congress, Constitutional Amendments, Constitutional Law, Cuban Refugees, Democracy, Donald Trump, Electoral College, Ellis Island, Executive Order, John McCain, John Roberts, Lindsey Graham, Mike Pence, Morality And Ethics, Prohibition Of Liquor, Refugees, Roberts Court, South Carolina, Speaker Of The House Paul Ryan, Statue Of Liberty, Supreme Court, Undocumented Immigrants, US Constitution, US House Of Representatives, US Senate, Vietnamese Refugees
US V Nixon; Clinton V Jones; And Now US V Trump?
February 7, 2017 Ronald 6 Comments
In 1974, the Supreme Court, by 8-0 vote, told Richard Nixon that he had to hand over the Watergate tapes to the Special Prosecutor, which led to Nixon's resignation a few weeks later.
In 1997. the Supreme Court, by 9-0 vote, told Bill Clinton that he could not avoid trial on sexual harassment charges brought by Paula Jones, simply because of his Presidential duties, which led to the impeachment and trial in 1998-1999.
The point of these two cases, US V Nixon, and Clinton V Jones, is that the President is not in total charge, and can be held to account by the Court system of America.
Donald Trump is about to get the same reality check, as the case involving the ban of all immigration from seven Muslim nations goes to the 9th Circuit Court, after a District Court Judge showed courage in stopping the enforcement of the President's executive order. This is seen by most legal experts as unconstitutional, as a violation of the First and 14th Amendments, and being used against nations that have sent no terrorists to America, while other nations that have, are not included in the ban.
Donald Trump seems to think he is above the law, and his authoritarian, autocratic and tyrannical behavior must be nipped in the bud right now!
News and Politics	14th Amendment, 9th Circuit Court, Bill Clinton, Clinton Impeachment Trial, Clinton V Jones, Donald Trump, First Amendment, Muslim Ban, Paula Jones, Richard Nixon, Sexual Harassment Charges, Supreme Court, Terrorism, Trump Executive Orders, US V Nixon, US V Trump, Watergate Scandal
Urgency For Republican Party And Entire Nation To Condemn Donald Trump And Prevent His Presidential Nomination In 2016!
December 8, 2015 Ronald 13 Comments
Racist, nativist, bigoted Fascist demagogue Donald Trump has just gone beyond the pale with his call for the banning of all Muslims to the United States, including any Muslim citizens who are traveling overseas as tourists or on business.
This is against the 1st, 5th, and 14th Amendments to the Constitution, and reminds us of the Chinese Exclusion Act of 1882 and the Japanese American internment in prison camps from 1942-1945!
We cannot sit idly by as this dangerous man is stirring up the extremist groups in America, and even his rhetoric is bound to cause violence against decent, law abiding Muslims in America, which would mean Trump has blood on his hands.
The Republican Party must declare that under no circumstances will they allow Trump to be their nominee, or else they will lose their status as a serious political party, as the party of Lincoln, TR, and Ike, cannot sit idly by as Trump totally destroys their historical image!
Anti Trump rallies must be organized around the nation, and make it clear that anyone who supports Trump on this matter shall be repudiated and isolated by family and colleagues as unAmerican!
News and Politics	14th Amendment, Abraham Lincoln, Chinese Exclusion Act, Civil Liberties, Constitution, Donald Trump, Dwight D. Eisenhower, Fascism, Fifth Amendment, First Amendment, Japanese American Internment, Muslims, Nativism, Presidential Election Of 2016, Racism, Republican Party, Theodore Roosevelt
The Complete Reversal Of American Politics: Republicans In The South, Democrats In Large Populated Northeastern, Midwestern And Western States!
December 8, 2014 Ronald Leave a comment
The defeat of Louisiana Senator Mary Landrieu on Saturday marks the complete reversal of American politics from the years 1877 to the present.
After the Reconstruction of the South ended, with Union Army troops leaving, twelve years after the Civil War, the South became an area totally dominated by Democrats, resentful of the Republican Party, Abraham Lincoln, the Civil War defeat, and the passage of Amendments 13, 14, and 15, ending slavery, making blacks citizens, and giving the men the right to vote.
The South went into massive resistance, creating Jim Crow segregation to replace slavery, and until the election of Herbert Hoover in 1928 and Dwight D. Eisenhower in 1952, it was always a solid Democratic South with no black voting, due to discriminatory state laws that were ignored by generations of the federal government. Hoover won much of the South due to his Catholic opponent, Alfred E. Smith, in 1928, and Eisenhower won over Adlai Stevenson twice in the 1950s due to his personal popularity and World War II D Day reputation.
But only when the Civil Rights Movement was in full swing, starting in the 1950s, and reaching its peak with the passage of the Civil Rights Act of 1964 and the Voting Rights Act of 1965 under Lyndon B. Johnson, did we see the beginning of a mass exodus of office holders and ordinary white population, to the Republican Party, starting with Senator Strom Thurmond of South Carolina in 1964, switching parties to back Republican Senator Barry Goldwater against President Lyndon B. Johnson.
As the Democrats started to lose power in the South, the nomination of Southern governors Jimmy Carter in 1976 and Bill Clinton in 1992 and 1996, and the rise of "New South" Governors like them and others in the Democratic Party, slowed up the switch to the GOP.
But the election of Barack Obama, considered anathema in the South, has now led to the entire wiping out of Southern Democrats in Congress, except for black and Jewish members of the House in districts gerrymandered that give the Republicans more total Congressional and state legislative seats in the South. Only a few other white non jewish members of the House remain, and they are endangered in the political climate of the South in 2014.
Only Virginia has both its Senators and Governor (Mark Warner, Tim Kaine, Terry McAuliffe) as Democrats, and only Florida has one other Democratic Senator, Bill Nelson at this point, as we enter 2015.
And both Virginia and Florida have Republican dominated legislatures, as well as the other states that made up the Confederate States of America.
And, of course, Florida includes the heavily Northern South Florida, and Virginia has the heavily Northern North Virginia, influenced by being part of the DC suburbs, and otherwise, these three Senators and one Governor would not be in public office.
So the complete reversal of a century and a half ago has occurred, and is unlikely to be changed for a generation or more, at the least.
This means that the South will remain as it is now for a generation or more, and that the issue of race nearly a century and a half ago, again stands out as the key difference that separates that section from the rest of the country.
Meanwhile, the heavily populated areas of the nation in the Northeast, Midwest and West are more Democratic than ever, and are unlikely to change either over time, creating political deadlock long term over the future, stifling change and creating constant political conflict and deadlock!
News and Politics	"Jim Crow" Segregation, 13th Amendment, 14th Amendment, 15th Amendment, Adlai Stevenson, African Americans, Alfred E. Smith, Barack Obama, Barry Goldwater, Bill Clinton, Bill Nelson, Civil Rights Act Of 1964, Civil Rights Movement, Civil War, Confederate States Of America, Democratic Party, Dwight D. Eisenhower, Florida, Herbert Hoover, Jimmy Carter, Louisiana, Lyndon B. Johnson, Mark Warner, Mary Landrieu, Midwest, New South Governors, Northeast, Northern Virginia, Presidential Election Of 1928, Presidential Election Of 1952, Presidential Election Of 1956, Presidential Election Of 1964, Presidential Election Of 1976, Presidential Election Of 1992, Presidential Election Of 1996, Presidential Election of 2008, Reconstruction, Republican Party, South, South Florida, Southern Democrats, Southern Governors, Strom Thurmond, Terry McAuliffe, Tim Kaine, US Senate, Virginia, Voting Rights Act Of 1965, West
Conservative Right Wing Attack On The Constitution: The Threat Of Another Constitutional Convention Wiping Out Constitutional Amendments!
July 6, 2014 Ronald 1 Comment
The Founding Fathers gave us a Constitution, admitting in the process that there would always be room for improvements, so made clear that amendments were appropriate over time.
So we have had 27 Amendments, including the first ten that make up the Bill of Rights.
When one looks at the amendments, particularly those that came after the Bill of Rights, one realizes that the vast majority of them were "progressive" in tone, designed to expand democracy in America, or else, amendments dealing with the office of the Presidency.
So the "progressive" amendments included the 13th (ending slavery and involuntary servitude); the 14th (promoting due process and equal protection and making African Americans citizens); the 15th (guaranteeing the right to vote for African Americans and others which had been denied that right); the 16th (providing for a federal income tax to raise revenue to deal with mounting social and economic issues); the 17th (granting the people the right to elect their two United States Senators by popular vote); the 19th (guaranteeing women the right to vote); the 23rd (guaranteeing residents of Washington, DC the right to vote); the 24th (preventing a poll tax for voting); and the 26th (guaranteeing young people 18-21 the right to vote).
So nine of the seventeen amendments after the first ten of the Bill of Rights promote progressive change, while the 12th, 20th, 22nd and 25th deal with the office of the Presidency.
The only amendment that was ever passed to limit the freedom of Americans was the 18th (prohibition of liquor), but later repealed by the 21st Amendment.
Now we have the real threat by right wing conservatives, including the Tea Party Movement, who want a new Constitutional Convention to wipe out these "progressive" amendments!
They do not like voting rights for African Americans, other minorities, women, residents of Washington DC (mostly African Americans) and young people; and they are unhappy that African Americans are considered equal under the law, and if they had the ability to do so, they would love to re-enslave poor people, which by corporate power is occurring in an informal way for many minorities, as well as white lower class people struggling every day to survive!
And they wish they could restore the US Senate elections to the corrupt state legislatures, taking away the popular vote. Finally, they hate the federal income tax, even though many of them avoid substantial taxation by having investments, rather than working for a living like most of us do. So they would prefer a sales tax, which is regressive, and would hurt the middle class and the poor much more than the wealthy elite!
But that is exactly the extremist right wing intention—to restore the "good old days" when they were in charge, and everyone had to kowtow to them!
We must not allow such a threat to develop, so the battle for progressivism is never ending, as a result!
News and Politics	"Minorities", 12th Amendment, 13th Amendment, 14th Amendment, 15th Amendment, 16th Amendment, 17th Amendment, 18th Amendment, 19th Amendment, 20th Amendment, 21st Amendment, 22nd Amendment, 23rd Amendment, 24th Amendment, 25th Amendment, 26th Amendment, African American Citizenship, African Americans, Bill Of Rights, conservatives, Constitution, Constitutional Amendments, Constitutional Convention, Corporations, Democracy, District Of Columbia Voting, Due Process, Equal Protection, Federal Income Tax, Founding Fathers, Middle Class, National Sales Tax, Poll Tax, Poor People, Popular Vote For US Senators, Presidency, Progressives, Prohibition Of Liquor, Prohibition Repeal, Right Wing Extremism, Slavery, State Legislatures, Tea Party Movement, US Senate, Voting Rights, Wealthy Elite, White Lower Class, Women, Women Suffrage, Young People
Republicans, Race, And The Confederate South: Successors To Old Southern Democrats!
April 28, 2014 Ronald Leave a comment
The Republican Party, the party of Abraham Lincoln; the Emancipation Proclamation; the 13th, 14th, 15th Amendments; large scale support for civil rights in the 1960s; and having three progressive Southerners as President (Lyndon B. Johnson, Jimmy Carter, Bill Clinton); and many New South Governors (including Jimmy Carter, Reuben Askew, Dale Bumpers, Bill Clinton), has now fully adapted itself to the old Confederate South, the old Southern segregationist Democrats, the South that wants the "good old days" of slavery and discrimination that existed before the Civil War and continued for another century until the civil rights movement transformed the South, or seemed to do so.
The fact is that the old Confederate South still exists, and the Republicans have become the successor to the old racist, Southern Democrats. Many of the members of Congress from the South and the Border States have no problem spewing racist statements, and backing racists, including, just recently: Cliven Bundy, Donald Sterling, Paula Deen, George Zimmerman, Ted Nugent–all of whom identify with the Republican Party.
At the same time, the majority of the Supreme Court, appointed by Republicans, have weakened the Voting Rights Act enforcement and have now made affirmative action something that will be ended, rather than reformed; and the use of abusive language toward the first African American President has been done with absolutely no sign of any respect or deference for a person in the Presidency, who at least has the right to expect that. Some would say that every President suffers abuse, but none since Abraham Lincoln has faced as much hate and personal threats as Barack Obama.
Additionally, the Republican Party has done everything it can to limit the right to vote to African Americans and other minorities as the only way for them to keep power in the South, but also in the heartland, as well!
It is indeed sad that the GOP has become what conservatives love to condemn the old Southern Democrats for doing, but indeed have copied–a party of support of racism and inequality of treatment!
News and Politics	"Minorities", 13th Amendment, 14th Amendment, 15th Amendment, Abraham Lincoln, Affirmative Action, African Americans, Barack Obama, Bill Clinton, Civil Rights, Cliven Bundy, Confederate South, conservatives, Dale Bumpers, Democratic Party, Donald Sterling, Emancipation Proclamation, George Zimmerman, Jimmy Carter, Lyndon B. Johnson, New South Governors, Paula Deen, Racial Segregation, Racism, Republican Party, Reubin Askew, Slavery, Southern Democrats, Supreme Court, Ted Nugent, Voting Rights Act
Federal District Court Judges And Same Sex Marriage Bans Collapsing!
February 14, 2014 Ronald 1 Comment
The move toward same sex marriage churns on, with federal judges having utilized the 14th Amendment in four "Red" states in the past two months now to end the discrimination against gays marrying.
So on Valentine's Day, it now looks more evident than ever that a national Supreme Court decision is in the offing, with Associate Justice Anthony Kennedy, who wrote the majority decision in Lawrence V. Texas in 2003 igniting the gay civil rights movement, likely to be the fifth and decisive vote in any case that goes to the high Court!
Who would ever have thought that Utah, Oklahoma, Kentucky, and now, newly turned "Blue" Virginia (the state of the Loving V. Virginia interracial marriage case in 1967), would see such rapid action to defy the bigots and the haters?
The federal courts have been the herald of the future in so much of modern history, as with Brown V. Board of Education on racial integration, and Roe V. Wade on abortion rights, and Lawrence V. Texas on gay rights, and the courage of federal district judges across the nation to push the Supreme Court toward a final determination of same sex marriage is an indication that often we have to leave it to appointed judges to lead us to our better side of human nature, the ending of discrimination and injustice!
Sadly, we see right wing evangelicals, Catholics, and Mormons fighting a rear guard action, which only makes one realize the evils of these organized groups that have in the past been on the wrong side of many moral and ethical issues, overlooking slavery, segregation, women's rights, and now gay rights. This is a losing battle long term, and these groups fighting against progress and human rights will pay the price in loss of membership by their willingness to fight a battle that is already lost!
News and Politics	"Blue" States, "Red" States, 14th Amendment, Abortion Rights, Anthony Kennedy, Brown V. Board Of Education, Catholic Church, Ethical Issues, Federal District Court Judges, Gay Rights, Human Rights, Interracial Marriage, Kentucky, Lawrence V. Texas, Loving V. Virginia, Moral Issues, Mormon Church, Oklahoma, Racial Integration, Right Wing Evangelicals, Same Sex Marriage, School Integration, Slavery, Supreme Court, Utah, Virginia, women's rights
Time For Gay Marriage Case Before Supreme Court, As With Interracial Marriage Case In 1967!
December 24, 2013 Ronald Leave a comment
With recent gay marriage advancements in New Mexico and Utah, making it now a total of 18 states and Washington DC allowing same sex marriage, it is time for a case to come before the Supreme Court regarding the right of two gay men or two lesbians to be able to marry and be accepted as equal everywhere in the United States.
Just because many "religious" people, both Christian and Jewish, do not wish to accept gay marriage is not a reason to deny equal protection under the 14th Amendment to the Constitution.
No one is saying that any particular church or synagogue must perform gay marriages, or that everyone has to be happy and approving of such marriages.
Marriage should not be based on what others think about it, as it is a basic human right, that one has a right to be happy, to love whoever he or she chooses, and to have it acknowledged in civil law.
If one does not like gay marriage, fine, but one does not have the right to deny others because you have a problem with the lifestyle of others.
The same situation existed regarding interracial marriage, and only in 1967, in Loving V. Virginia, did the Supreme Court rule that no state or locality could ban or prevent two adults of any race from marrying.
Even back then, there were religious leaders and sects who disapproved of interracial marriage, and people were being prosecuted for trying to marry, or even living together.
Such a concept is oppressive government, and it is time for this to stop, and for all people to be given the right to do what they wish regarding relationships in their adult lives.
So Supreme Court, it is time to accept a case, maybe out of the Utah government fighting the new gay marriage edict of a federal judge, and to expand human rights, which is the whole basis of American democracy, and the sooner the better!
News and Politics	14th Amendment, Christianity, Civil Law, Democracy, Gay Marriage, Human Rights, Interracial Marriage, Judaism, Loving V. Virginia, New Mexico, Same Sex Marriage, Supreme Court, US Constitution, Utah
The Battle For The Dignity And Respect For The Office Of The American Presidency!
October 3, 2013 Ronald 18 Comments
President Barack Obama has made it clear that he is NOT going to cave in to the Republican hostage takers on the subject of ObamaCare, and all power to him!
ObamaCare is Obama's signature accomplishment, and Franklin D. Roosevelt, Lyndon B. Johnson, and every other President who has had a major domestic accomplishment would react the same way Obama is reacting—no bargaining on something already in the law and approved by the Supreme Court!
But Obama has also made it clear that the office of the Presidency deserves dignity and respect, and he will not bargain away the power of that office to a group of radical anarchists known as the Tea Party Movement!
This is not just for the Obama legacy that Obama is fighting, but also for the future of the office, as the Congress, or a radical part of it, cannot be permitted to undermine the powers and prerogatives of that office, whether we have a Republican or Democratic President in the near and far future!
Only the President is voted on by the entire population, and only he, or a future she, truly represents the nation at large!
Congress must know its place in the constitutional system, and if they are, or a faction of them are, ready to allow the full faith and credit of the American government to be breached by a failure of Congress to raise the debt limit in the next two weeks, then the President, and really any President, in the future must take executive action!
The 14th Amendment allows the President to intervene and guarantee payment of all debts, and the raising of the debt limit, and if Congress does not do it, then the President, by executive order, can and MUST do do, and let the chips fall where they may, which might, very well, include a movement by the Republican Party in the House of Representatives to impeach the President!
Obama may provoke such reckless actions by what he does, but there would never be a conviction in the US Senate, even if the GOP won a majority and controlled the chamber.
So it would be another example of what the Republicans did to Bill Clinton, which may have besmirched his historical record and his future obituary, but also greatly harmed the GOP brand.
It is time for Barack Obama to throw down the gauntlet, and say to the GOP, "Bring It On!"
News and Politics	"ObamaCare", 14th Amendment, Barack Obama, Bill Clinton, Congress, Debt Limit, Democratic Party, Franklin D. Roosevelt, Impeachment, Lyndon B. Johnson, Presidency, Republican Party, Supreme Court, Tea Party Movement, US House Of Representatives, US Senate


text:
Q: How Can I Use Twitter Bootstrap in my Existing Web application? I develop a web using
my own StyleSheets.. now what's an easy way to add twitter bootstrap in it?

A: Bootstrap is a collection of style sheets and JS scripts that you can simply plugin to your website. Its implementation really depends on what features you want to use for your website. If you want to use the styleshees and re-write your website DOM structure to be responsive OR grid based, then you should include the CSS files, find the methodology under scaffolding.
You can also use the modals, sliders available within Bootstrap by including the bootstrap.js file. Find instructions under the Javascript Section..
Additionally, you should look at their examples.

A: You could have a look at the examples they provide.

redpajama_set_name: RedPajamaStackExchange


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Email marketing is almost ideal: fast, low-cost and efficient in comparison with other digital channels.
Almost. Because to make it work you need subscribers. And even if you already have them, you have to constantly be engaged in the list building.
Because your email database naturally decays for almost 23% every year. By the way, you can find a free email database decay calculator here and check it yourself.
So, to have good quality email list you will have to make continuous efforts to recruit new subscribers and keep your database up to date.
Here are some tips that can help you with that.
Sometimes, when you just start building your email list, it makes more sense to skip advertising for a while (especially if you have no budget for that) and focus solely on inbound marketing.
What keeps bringing new lead is converting visitors of your blog or people who are interested in free content you offer them (like webinars, podcast etc.) into subscribers is.
So, how can you make your visitors subscribe if they have already landed on your website?
Your visitors, before they subscribe, usually make sure that they don't give you their email in vain and they will get updates regularly.
If you are developing a long-term strategy of increasing your blog subscriptions, you should define your value proposition first.
So, you define what is unique you can offer your subscribers: expertise, content, frequency etc.
You have to decide what value you bring to your readers and how exclusive is your content.
You readers are already interested in the content you offer, they landed in you blog.
So, why not to offer them an advanced version of the same content in exchange for their email?
Actually, 20% of your blog pages are driving 80% of the traffic. You can find out these pages using analytics and use them to create advanced content that will force your visitors to subscribe.
You definitely have seen plenty of websites offering e-books, white papers, resource lists, webcasts or free software in exchange for email subscription.
You either like them or hate them, but you cannot ignore popups.
Popups still work and bring in more subscribers that their absence.
So, Social Media Examiner says that 70% of their subscriptions come from popups.
Don't forget that your popup's copy should reflect the overall value proposition of your blog or newsletter.
Just not to seem overly annoying, it is better to set up popups in such a way that they appear with a short delay, when your visitor was already able to estimate whether he likes your content or not.
For instance, you can make a popup appear after the first three paragraphs of the text or with 5 second delay. And another one at the end of your blog post!
One of the simplest ways to make social proof increase your email subscription is to mention the number of subscribers: 2,000; 20,000 or even 190,000 followers. Any of these numbers will look impressive and make your visitors to think that a lot of other people like what you are doing.
Here the word 'followers' means not only email subscribers, but also social network followers.
Mentioning publication in a magazine or newspaper, a book you wrote on the subject will also be a good example of social proof.
If you are already connected with your audience through social, that's great. Just offer them a subscribe option in the social media.
If not, you can use a giveaway to collect emails.
Some people even managed to add almost 200k emails in their list in less than two weeks using giveaways.
GetResponse study showed that emails with social share buttons generate 158% more click through rate than the ones without them.
Some people tend to share content even without reading it. But this habit plays in your favor, isn't it?
People who come to your website via shares can be your new subscribers.
Along with social share buttons, don't forget the share with a friend button. Just in case your offer is extremely interesting, valuable or outrageous.
Do you have anything to add to this topic? Go on and post a comment now.


Using paper currency as both inspiration and raw material, Knowles has coated a ten dollar bill on both sides with copper leaf. A delicate palimpsest of the bill's texture shows through, but the original is recognizeable only upon the closest examination. From a signed and numbered edition of 5.


Troponin, a marker of myocardial injury, frequently increases and is related with poor outcome in ischemic stroke patients. However, the long-term outcome of this elevation remains uncertain. We, therefore, investigated the prognostic significance of troponin elevation for long-term mortality, and explored factors affecting troponin elevation after ischemic stroke.
We retrospectively analyzed the medical data of stroke patients who were admitted within 24 hours of symptom onset and underwent a serum cardiac troponin I test at admission during a five-year period. Information on mortality as the outcome was obtained from the National Death Certificate system.
A total of 1,692 patients were eligible for inclusion with 33 months of median follow-up. Troponin elevation that exceeded the 99th percentile (>0.04 ng/mL) of values was detected in 166 patients (9.8%). After adjusting for baseline characteristics, troponin elevation was associated with previous ischemic heart disease and congestive heart failure, comorbid atrial fibrillation and active cancer, and increased National Institutes of Health Stroke Scale score. Patients with troponin elevation had a high risk of overall death (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40-2.40), including stroke-related (HR 1.71, 95% CI 1.14-2.55), cardiac-related (HR 3.17, 95% CI 1.49-6.74), and cancer-related (HR 1.98, 95% CI 1.14-3.45) death than those without troponin elevation.
Troponin elevation in the acute stage of ischemic stroke was associated with long-term mortality, mainly due to increased stroke- and cancer-related death in the first year and cardiacrelated death in the later period.
Cardiac troponins are sensitive and specific biomarkers of cardiac injury; thus, elevated level of troponin is widely used for the diagnosis of acute myocardial infarction , risk stratification of future cardiovascular events for patients with coronary disease or stable angina, and even in apparently healthy individuals . Furthermore, currently, troponin elevation has also been frequently observed in patients with ischemic stroke [3,4] and related with increased risk of death or disability and both in these patients .
However, the pathomechanism of troponin elevation in ischemic stroke patients is still controversial, whether it is due to the concomitant cardiac [3,6] or neurological [7,8] problems or others . In addition, the evaluation of clinical impact of troponin elevation was limited to a short-term period within 1 year after stroke; thus, the prognostic value of troponin elevation in ischemic stroke patients for a long-term survival has not been fully explained.
Therefore, we aimed to assess the determinants of troponin elevation and investigate the long-term mortality and cause of death on the basis of the elevation of cardiac troponin I in patients at the acute stage of ischemic stroke. In addition, we reconfirmed the long-term prognostic value of troponin elevation using a different cut-off point for the definition of troponin elevation based on tertiles of a detectable troponin I instead of the standard cut-off point (e.g., the 99th percentile of troponin) and in subgroups according to the presumable etiologies of ischemic stroke.
We conducted a retrospective analysis of prospectively registered patients with acute stage of ischemic stroke who were consecutively admitted to Asan Medical Center within 24 hours of symptom onset between May 2007 and December 2011 in electronic medical record. All patients underwent cardiac enzyme testing, including troponin I level, and a 12-lead electrocardiographic (ECG) investigation at admission according to the stroke study protocols in our center, which abide by the guidelines from 2007 . Patients underwent additional cardiac evaluations by a cardiologist if they were suspected acute coronary syndrome during the emergency department evaluation. After admission to the stroke center, patients were excluded if 1) they were diagnosed with acute coronary syndrome during hospital stay; or 2) having insufficient clinical, laboratory, or ECG data.
Clinical data, including demographic characteristics, conventional risk factors for stroke, comorbidities, reperfusion therapy, and the National Institutes of Health Stroke Scale (NIHSS)  were obtained from the registered data. Comorbidities included previous history of stroke, ischemic heart disease (IHD; comprising history of acute myocardial infarction, angina, percutaneous coronary intervention and coronary artery bypass grafting) and congestive heart failure (CHF; defined as having a history of cardinal manifestations and treatment for heart failure), and concomitant atrial fibrillation (AF; known medical history of AF, evidence of AF on admission 12-lead ECG and newly diagnosed AF after admission), renal insufficiency (estimated glomerular filtration rate <60 mL/min/1.73 m2 at admission) and active cancer (cancer within 6 months prior to enrollment, any treatment for cancer within the previous 6 months, or recurrent or metastatic cancer). Reperfusion therapy was defined as intravenous tissue plasminogen activator or intra-arterial reperfusion therapy and both . The pathogenesis of ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification . The Institutional Review Board of the Asan Medical Center approved this study.
The lower limit of detection of serum cardiac troponin I (Abbott Laboratories, Abbott Park, IL, USA: 3rd generation troponin I assay [i.e., sensitive contemporary assay]) was 0.006 ng/mL, and the 99th percentile of the upper reference limit of this study was 0.04 ng/mL. Hence, significant elevation of troponin was defined as >0.04 ng/mL based on the 99th percentile rule as a standard cut-off point. In addition, troponin elevation was differently defined as above the 3rd or 2nd tertile of a detectable troponin I (>0.006 ng/mL) to reconfirm the long-term prognostic value of troponin elevation with an increased sensitivity and predictive power. A 12-lead ECG was recorded in all patients at admission and processed using the Marquette 12SL ECG Analysis Program (GE Healthcare, Waukesha, WI, USA). The resultant 12-lead ECG waveforms were uploaded in digital form and interpreted by a cardiologist according to a modified version of the Minnesota code .
Two-dimensional transthoracic echocardiography was conducted in patients with cardiac diseases and suspected of cardiogenic embolic or unknown etiologies of stroke. Wall motion abnormality (WMA) was defined as wall motion score index >1 using a standard 16-segment model. Hypertrophic myocardium (HM) was defined as left ventricular mass index >95 g/m2 for women and >115 g/m2 for men. Reduced ejection fraction (EF) was defined as <50% [15,16].
Follow-up information for patients was obtained using the National Death Certificate data from the Korean National Statistical Office until December 31, 2012. The official nationwide data for death certificates produced by the Korean National Statistical Office are updated annually and have been used in previous studies as a reliable data source. Deaths were classified according to the International Classification of Diseases (ICD), Tenth Revision . The causes of death were classified as stroke death (ICD code: I60-I69), cardiac cause (ICD code: I20-I25 or I30-I52), malignancies (ICD code: C00-C96), and other causes.
The characteristics of study subjects (Table 1) were compared between those with troponin elevation and without troponin elevation. For the comparisons, Pearson's chi-square test, Fisher's exact test, Student's t-test, and Wilcoxon rank sum test were used according to the types of variables, as appropriate. To analyze the factors affecting troponin elevation, variables in Table 1 (except stroke subtype) were included as potential factors in the multivariable logistic regression. Cumulative incidence rates of mortality were estimated by the Kaplan-Meier method and compared by the log-rank test. To reduce the effect of selection bias and potential confounding, we adjusted for differences in baseline characteristics by weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting (IPTW) . With this technique, weights for patients with troponin elevation were the inverse of the 1-propensity score, and weights for patients without troponin elevation were the inverse of the propensity score. When applying the IPTW method, a stabilized weight was used to maintain the same number of subjects used in the weighted analysis as the number of original study subjects and to yield more precise interval estimates closer to 95% coverage probabilities [19,20], The discrimination and calibration abilities of the propensity score model were assessed using C statistics and the Hosmer-Lemeshow test. The model was fairly calibrated (P=0.066 by Hosmer-Lemeshow test) with reasonable discrimination (C statistics=0.696) (Supplementary Table 1). In addition to reduce residual confounding, we investigated the predictive value of troponin elevation for all-cause and cause-specific mortality in different etiological subgroups (e.g., cardioembolic and non-cardioembolic stroke subtype) after adjusting for baseline characteristics, with the additional inclusion of C-reactive protein (CRP) level by weighted Cox proportional hazards regression models. All reported P-values were two-sided, and a P<0.05 was considered statistically significant. SAS software, version 9.4 (SAS Institute Inc., Cary, NC, USA), was used for statistical analyses.
Among 1,823 patients who were admitted to the stroke center with acute ischemic stroke within 24 hours of symptom onset, 131 patients were excluded due to the diagnosis of acute coronary syndrome (n=18) during hospitalization at the stroke center and insufficient quality of clinical, laboratory, or ECG data (n=113). Finally, 1,692 patients were eligible for the analysis. The mean age was 66.0±12.4 years (range, 24-96 years), and 1,034 patients (61.1%) were male patients. The range of serum cardiac troponin I values in all patients was 0.057±0.699 ng/mL (mean±standard deviation [SD]) with an extremely skewed distribution to the right side because 950 patients (56.3%) had a minimum level of troponin I (0.006 ng/mL) and 742 patients (43.7%) had a wide range of troponin I level (from 0.007 to 25.10 ng/mL). Among 742 patients who had a detectable troponin I (>0.006 ng/mL), the 3rd and 2nd tertile of a detectable troponin was a 0.025 ng/mL and 0.012 ng/mL respectively (Figure 1).
Troponin elevation was identified in 166 patients (9.8%) patients, and the mean duration of time interval from the symptom onset to admission (7.7±6.6 hours [mean±SD] vs. 8.4±7.0 hours [mean±SD], P-value=0.19 by the Student's t-test) was not different between patients with and without troponin elevation. Patients with troponin elevation were older and had a more rapid heart rate, previous history of IHD and CHF, and comorbid AF, renal insufficiency and active cancer than those without troponin elevation. In terms of stroke characteristics, patients with troponin elevation often displayed higher NIHSS score and more cardiogenic embolic subtypes present than other etiologies of stroke compared with those without troponin elevation (Table 1).
A multivariable regression analysis revealed previous IHD (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.49-3.70), CHF (OR 2.05, 95% CI 1.31-3.22), comorbid AF (OR 1.52, 95% CI 1.04-2.23), active cancer (OR 4.99, 95% CI 2.98-8.37), and increased stroke severity (1-point increase in NIHSS score; OR 1.05, 95% CI 1.02-1.08) were identified as factors affecting troponin elevation (Supplementary Table 2).
Over a median follow-up period of 33 months (interquartile range, 20-48 months), 331 patients (19.6%) died. Patients with troponin elevation had a higher risk of death (46% vs. 17%) during observation period than those without troponin elevation. Of the time-specific cause of death, stroke-related (P<0.01) and cancer-related (P<0.01) deaths frequently occurred within 1 year after stroke, whereas cardiac-related (P<0.01) death was predominated beyond one year after stroke in patients with troponin elevation than those without troponin elevation (Figure 2). The Kaplan-Meier plot for the longterm survival revealed that troponin elevation was associated with higher mortality and incidence of stroke-, cardiac-, and cancer-related death than those without troponin elevation during the 6-year period (Figure 3).
As shown in Table 2, the risk of overall mortality, stroke-related, cardiac-related, and cancer-related death was significantly higher in the patients with troponin elevation than in patients without troponin elevation using adjusted multivariable analysis using Cox regression method and IPTW method. In addition, using a different definition of troponin elevation based on tertiles of a detectable troponin I level, the overall mortality was still higher in patients with a troponin level exceeding the 3rd tertile of a detectable troponin level than in those without troponin elevation mainly due to an increased risk of stroke- and cardiac-related death. The overall mortality tended to be higher in the patients with a troponin level exceeding the 2nd tertile of a detectable troponin level than in those without troponin elevation mainly due to an increased risk of cardiac-related death. These trends persisted among the different etiological subgroups even after adjusting for baseline characteristics with the additional inclusion of CRP level (Supplementary Table 3).
Prevalence of comorbidities (e.g., included AF, previous IHD, CHF, and renal insufficiency) and median NIHSS score (4 [2, 8] and 4 [2, 8] vs. 5 [2, 10] vs. 6 [3, 14]; P<0.01 followed by Tukey's posthoc test) was gradually increased with increasing levels of troponin (Figure 4).
Among 1,692 patients, 988 patients (58.4%) performed transthoracic echocardiography (Supplementary Table 4). The overall prevalence of echocardiographic abnormalities including WMA, and reduced EF and HM were higher in patients with troponin elevation than those without elevation, and still higher in patients with troponin elevation than those without elevation among patients having a previous history of IHD, CHF, or both (Figure 5).
This study revealed the high prognostic significance of troponin elevation for long-term mortality in patients with acute ischemic stroke. Stroke patients with elevated troponin levels had a higher risk of death (46% vs. 17%) than those without elevated troponin level, even after controlling for multiple factors that might contribute to mortality. We also identified the factors affecting troponin elevation, which could explain the increased risk of stroke-, cardiac-, and cancer-related death in patients with troponin elevation. Furthermore, even after using a lower cut-off point (e.g., the 3rd tertile [0.025 ng/mL] or the 2nd tertile [0.012 ng/mL] of a detectable troponin) compared to the standard cut-off point (e.g., the 99th percentile [0.040 ng/mL]) to define troponin elevation, the overall mortality was still higher or tended to be higher in patients with troponin elevation than in those without elevation, respectively (Table 2), and still persisted among the different etiological subgroups (e.g., cardioembolic and non-cardioembolic stroke subtype; Supplementary Table 3). Traditionally, in the presence of a clinical history suggestive of acute coronary syndrome, the maximal concentration of cardiac troponin exceeding the 99th percentile of values is considered indicative of myocardial necrosis consistent with myocardial infarction . However, with the widespread use of more sensitive assays for cardiac troponin in various populations, the proportion of patients with low-level elevations of cardiac troponin below the 99th percentile has increased substantially and these low-level elevations are still associated with future adverse cardiovascular outcomes . Thus, our results also demonstrate that cardiac troponin values at or even below the 99th percentile have a prominent role in the risk prediction of long-term mortality after ischemic stroke.
We showed that troponin elevation was closely associated with increased stroke severity, leading to increased risk of stroke-related death, particularly within 1 year after stroke (Figure 2B). Early mortality in stroke patients depends strongly on the severity of stroke upon hospital admission  and is usually related to cardioembolic stroke because of greater risk of baseline severity than other etiologies . Furthermore, previous literature suggests that troponin elevation can be a marker of stroke severity through the mechanism of neurally mediated myocytolysis , as well as emboligenic cardiac conditions mainly related to AF . Therefore, troponin elevation can reflect stroke severity at baseline and predict future risk of stroke-related death mainly due to cardioembolic stroke. Indeed, the overall mortality in our patients with troponin elevation (46% during the median of 33 months) was similar to the previous results of cardioembolic stroke (40-60% of fatality rate within 5 years after ischemic stroke) .
We found that troponin elevation was also associated with a previous history of IHD and CHF as well as concomitant AF, leading to increased risk of cardiac-related death particularly beyond 1-year after stroke (Figure 2C). Cardiovascular complications are responsible for 2-6% of total mortalities 3 months after ischemic stroke ; thus, for 1-year survivors of stroke, cardiac death is the most common cause of death during the first 5 years . In our study, although the rate of overall cardiac-related deaths (0.7% per year; 32 of 1,692 cardiac deaths for median of 33 months) was rather lower than that of previous meta-analysis (the annual risk of non-stroke vascular death; 2.2% [95% CI 1.7-2.7] in patients with ischemic stroke during the period of 1980 to 2005) , the rate of cardiac-related death in patients with troponin elevation (4.4% per year; 22 of 166 deaths) was still high despite the initial exclusion of patients with suspicion of acute coronary syndrome. Furthermore, patients with troponin elevation had more severely deteriorated structural/functional cardiac abnormalities diagnosed by echocardiography than those without troponin elevation even with a previous history of IHD, CHF or both (Figure 5B). Thus, the risk of stroke- and cardiac-related death in patients with troponin elevation could be further increased beyond known or undetected underlying comorbidities.
Interestingly, non-vascular etiology such as cancer-related death was also six times higher in patients with troponin elevation, particularly within 1 year after stroke (Figure 2D). Cancer is known as one of the main causes of mortality in survivors after stroke because the incidence of cancer increases with increasing age . Furthermore, cancer is a risk factor for stroke because cancer and its treatments cause alterations in platelet, coagulation, and endothelial functions, which in turn can lead to thrombosis or hemorrhage . Although available data are scarce, several studies have shown that the troponin elevation or myocardial strain measured by echocardiography correlates with the risk of high-dose chemotherapy-induced cardiotoxicity . Thus, future studies are required to focus on the cellular level of myocytic damage and discriminate whether those elevations are due to chemotherapy (e.g., type and duration of treatment) or cancer itself (e.g., type and stage of cancer and the presence of metastasis or hypercoagulable state) .
Although our findings show that troponin elevation can indicate various vascular and non-vascular problems and consequently predict future vascular and non-vascular death, the clinical value of measuring troponin is still limited due to an additional diagnostic challenge to discriminate various conditions for troponin elevation . Currently, we proposed a concept that synergistic effect on troponin elevation in a combination of the cardiac vulnerability (e.g., hypertrophic or damaged myocardium by ischemia, and possibly tachycardia) to cerebrogenic stress (e.g., by severe neurological deficits or insular cortical lesion) could be a practical interpretation of troponin elevation in stroke patients . In our study, the median score of NIHSS and prevalence of comorbidities (e.g., mainly due to a gradual increase in cardiac-comorbidities including AF, IHD, and CHF) was gradually increased in a dose-dependent manner with increase in four levels of troponin (Figure 4). Therefore, for the prediction of cardiac-related death, the cut-off point for troponin level could be lowered below the 99th percentile because of the gradual increase in cardiac vulnerability in parallel with a gradual increase in troponin from the very low-level elevations. Otherwise, for the prediction of stroke- or cancer-related death, the 99th percentile of troponin would be an appropriate cut-off value because of the additive neurogenic stress on vulnerable cardiac status or additional myocardial damage/dysfunction induced by cancer- or chemotherapy-related insult, which usually leads to further increase in the troponin level compared to isolated cardiac disease.
There are some limitations of our study. First, the design of the study was retrospective, and the study was performed at a single center. Second, we could not show non-fatal major adverse cardiac events because we reconfirmed the rate of longterm mortality using the data obtained from the National Death Certificate system for the investigation of precise rate of mortality. Third, we were unable to perform intensive cardiac investigations comprising serial troponin and ECG testing and coronary angiography. Thus, we could not identify the patients with subclinical cardiac events like as non-ST segment elevation myocardial infarction or stress-induced cardiomyopathy during hospitalization leading to underestimation of the frequency of troponin elevation and cardiac comorbidities. Thus, we are currently conducting a prospective observational study with serial troponin and ECG tests (for detection of newly developed cardiac events), and serum B-type natriuretic peptide (e.g., BNP for identifying heart failure) and D-dimer/Fibrinogen (for identifying cancer activity) in acute ischemic stroke patients (Clinical implications of elevated cardiac troponin-I elevation in acute stroke patients; KCT0000682; https://cris.nih.go.kr/cris). Future studies should focus on adjusting for covariables with possible impact on vascular or cancer-related mortality including other laboratory parameters and detailed information of cancer state to reduce possible confounding effects.
Troponin elevation in ischemic stroke was prevalent and associated with long-term mortality independent of other known risk factors. The etiology of troponin elevation and the cause of death in stroke patients with troponin elevation were correlated; this could explain the reasons for increased risk of strokeand cancer-related death in the first year and cardiac-related death in the later period. Furthermore, even after using a lower cut-off value to define troponin elevation compared to the standard value, the overall mortality was higher in patients with troponin elevation than in those without elevation. Thus, the measurement of troponin level could be helpful in patients with stroke for identifying the underlying cardiac and non-cardiac problems and useful for risk estimation for long-term mortality during the post-stroke period.
This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare Republic of Korea (HI10C2020 and HI14C1731).
Supplementary materials related to this article can be found online at https://doi.org/10.5853/jos.2016.01942.
Distribution of serum cardiac troponin I level and different cut-off point for the definition of troponin elevation.
Overall cause of death in elevated and non-elevated troponin groups. Overall cause of death (A) and percentage of stroke-related (B), cardiac-related (C), and cancer-related (D) death within and beyond 1 year after stroke onset in elevated and non-elevated troponin groups. *P<0.05 using Chi-square test; † P<0.05 using Fisher's exact test.
Kaplan-Meier plots in elevated and non-elevated troponin groups. Kaplan-Meier plots of overall mortality (A) and risk of stroke-related (B), cardiac-related (C), and cancer-related (D) deaths in relation to baseline troponin levels. P-values are derived using the log-rank test.
Comorbidities and stroke severity in four subgroups according to the troponin level. Prevalence of cardiac- and non-cardiac comorbidities and median score of NIHSS in four subgroups according to the tertile ranges of a detectable troponin and non-detectable troponin. NIHSS, National Institutes of Health stroke scale; AF, atrial fibrillation; IHD, ischemic heart disease; CHF, congestive heart failure. *P<0.05 using linear-by-linear association Chi-square test; † P<0.05 using analysis of variance (ANOVA).
Prevalence of echocardiographic abnormalities in elevated and non-elevated troponin group. Prevalence of echocardiographic abnormalities in elevated and non-elevated troponin groups (A) and in subgroups according to the presence of a previous history of IHD, CHF, or both (B). WMA, wall motion abnormalities; EF, ejection fraction; HM, hypertrophic myocardium; IHD, ischemic heart disease; CHF, congestive heart failure. *P<0.05 by chi-square test.
Variables are presented as mean±standard deviation, median [interquartile range], or number (%).
* P-values are calculated by Pearson chi-square test, Fisher's exact test, Student's t-test and Wilcoxon rank sum test as appropriate.
PH, proportional hazards; IPTW, inverse-probability-of-treatment weighting; HR, hazard ratio; CI, confidence interval; N/A, not applicable.
* Adjustments were made for variables listed in Table 1 except for the stroke subtypes.
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I read an article about the pathetic and poor domestic service of our national airline and its only reminds me again of the many encounters and same experiences we had while travelling from Kaghau to Honiara.
Once I had my excess luggage off loaded when I was ready to pay only to find out later that most of the weight was all taken up by that person who own the airfield. Whether he pays for his freight or not is a my big question mark to date.
On another occassion, few relatives from Waghena had to travel to Kaghau airfield as their ticket was already paid for in Honiara. Travelling from Waghena to Kaghau is very expensive as you've got to purchase fuel which is about $60/gallon and you will need approximately 5 gallons so you have to spend $300 per trip. This is in addition to the air ticket cost. Frustratingly, these travellers were advised by the same fellow that he will only accommodate those whose ticket were bought from him in Kaghau. These poor fellas from Waghena had to travel back on canoe again waiting for the next flight which will cost them another $300.
In a village, loosing $300 or $600 a week is a huge money and I felt very sorry for these travellers. Incidentally, during the same encounter he was trying to tell one of the travellers, married to a Lauru lady, that he was not going too on that flight. The man stood his ground and very courageously told him that, no way my ticket had been paid in Honiara and I'm definetly flying with my family. This man knew his right and he flew. Unfortunately for my wantoks who are so kind hearted, they had to miss that flight and their space taken up by the loggers.
Sometimes, it becomes confusing when you're in situations like these and you begin to ask, who na owner blong Solomon Airlines?
No wonder Solomon Airlines em no save grow because some fela yia tink em blong olgeta. Me shame on behalf no moa.
Disclaimer: The views and opinions expressed in this letter are those of Teriba T and do not necessarily reflect the official policy or position of Solomon Times Online.