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The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017
Lydia R Lucchesi1,
Catherine Bisignano1,
Erin B Hamilton1,
Nathaniel J Henry1,
Kris J Krohn1,
Darrah McCracken1,
Molly R Nixon1,
Jose C Adsuar2,
Amit Arora3,4,
Andrew M Briggs5,6,
Daniel Collado-Mateo7,8,
Cyrus Cooper9,10,
Lalit Dandona1,11,
Rakhi Dandona1,11,
Christian Lycke Ellingsen12,13,
Seyed-Mohammad Fereshtehnejad14,15,
Tiffany K Gill16,
Juanita A Haagsma17,
Delia Hendrie18,
Mikk Jürisson19,
G Anil Kumar11,
Alan D Lopez1,20,
Tomasz Miazgowski21,
Ted R Miller18,22,
GK Mini23,24,
Erkin M Mirrakhimov25,26,
Efat Mohamadi27,
Pedro R Olivares28,
Fakher Rahim29,30,
Lidia Sanchez Riera31,32,
Santos Villafaina7,
Yuichiro Yano33,
Simon I Hay1,34,
Stephen S Lim1,34,
Ali H Mokdad1,34,
Mohsen Naghavi1,34,
Christopher J L Murray1,34
1 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
2 Sport Science Department, University of Extremadura, Badajoz, Spain
3 School of Science and Health, Western Sydney University, Sydney, NSW, Australia
4 Oral Health Services, Sydney Local Health District, Sydney, NSW, Australia
5 School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia
6 Ageing and Life Course, World Health Organization (WHO), Geneva, Switzerland
7 Sport Science Department, University of Extremadura, Cáceres, Spain
8 Faculty of Education, Autonomous University of Chile, Talca, Chile
9 Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
10 Department of Rheumatology, University of Oxford, Oxford, United Kingdom
11 Public Health Foundation of India, Gurugram, India
12 Department of Pathology, Stavanger University Hospital, Stavanger, Norway
13 Norwegian Institute of Public Health, Oslo, Norway
14 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
15 Division of Neurology, University of Ottawa, Ottawa, ON, Canada
16 Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
17 Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
18 School of Public health, Curtin University, Perth, Western Australia, Australia
19 Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
20 University of Melbourne, Melbourne, QLD, Australia
21 Department of Hypertension, Pomeranian Medical University, Szczecin, Poland
22 Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
23 Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
24 Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India
25 Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
26 Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
27 Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
28 Institute of Physical Activity and Health, Autonomous University of Chile, Talca, Chile
29 Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
30 Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
31 Department of Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
32 Institute of Bone and Joint Research, University of Sydney, Syndey, NSW, Australia
33 Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
34 Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
Correspondence to Dr Spencer L James, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; spencj{at}uw.edu
Background Falls can lead to severe health loss including death. Past research has shown that falls are an important cause of death and disability worldwide. The Global Burden of Disease Study 2017 (GBD 2017) provides a comprehensive assessment of morbidity and mortality from falls.
Methods Estimates for mortality, years of life lost (YLLs), incidence, prevalence, years lived with disability (YLDs) and disability-adjusted life years (DALYs) were produced for 195 countries and territories from 1990 to 2017 for all ages using the GBD 2017 framework. Distributions of the bodily injury (eg, hip fracture) were estimated using hospital records.
Results Globally, the age-standardised incidence of falls was 2238 (1990–2532) per 100 000 in 2017, representing a decline of 3.7% (7.4 to 0.3) from 1990 to 2017. Age-standardised prevalence was 5186 (4622–5849) per 100 000 in 2017, representing a decline of 6.5% (7.6 to 5.4) from 1990 to 2017. Age-standardised mortality rate was 9.2 (8.5–9.8) per 100 000 which equated to 695 771 (644 927–741 720) deaths in 2017. Globally, falls resulted in 16 688 088 (15 101 897–17 636 830) YLLs, 19 252 699 (13 725 429–26 140 433) YLDs and 35 940 787 (30 185 695–42 903 289) DALYs across all ages. The most common injury sustained by fall victims is fracture of patella, tibia or fibula, or ankle. Globally, age-specific YLD rates increased with age.
Conclusions This study shows that the burden of falls is substantial. Investing in further research, fall prevention strategies and access to care is critical.
Falls are one of the most common mechanisms of injury and endure as a persistent risk to morbidity and mortality across all ages. The risk of an injurious fall in a population as well as the resulting disability may be governed by a wide array of factors ranging from drug and alcohol intoxication in younger populations to frailty and comorbidities in older adult populations. Falls pose sufficient risk in modern high-resource healthcare settings to necessitate the use of safety devices such as bed alarms and traction socks in inpatient wards and dedicated physical and occupational therapy services. Falls in young, otherwise healthy populations can produce lifelong disability in the form of traumatic brain injuries or spinal cord injuries and can also cause severe injuries that necessitate advanced surgical care, such as intra-abdominal organ injury or complicated skeletal fractures.1 In older populations, the morbidity experienced by falls may be further modulated by comorbid conditions such as osteoporosis, osteopenia, or usage of anticoagulant or antiplatelet medications.2 3 Given that many fall incidents are preventable, occur in any population and can lead to substantial morbidity and mortality, it is surprising that falls do not draw more attention as an important global issue.
In the Global Burden of Diseases, Injuries and Risk Factors Study 2017 (GBD 2017), global estimates of the burden of falls show that falls were ranked as the 18th leading cause of age-standardised rates of disability-adjusted life years in 2017, outranking conditions such as chronic kidney disease, Alzheimer's disease and other dementias, and asthma.4 Additionally, falls were noted to be the second leading cause of death due to unintentional injuries in 2017, following road injuries and outranking causes such as interpersonal violence and drowning.5 Research outside of the GBD Study on the epidemiology of falls has largely focused on older populations as this is where the global burden of falls is thought to be most concentrated. The World Health Organization (WHO) reports that most deaths from falls happen in those aged 65 and older.6 For those 70 years or older, falls are the leading category in injury-related deaths.7 With a burden highly concentrated in older adults, many recent studies have discussed the effects of population ageing, recognising the potential for far more incident cases and deaths from falls as people live longer.8–10 In addition, several studies have focused on younger populations as they are an important high-risk group to consider as well. An injury surveillance system pilot study conducted in 4 low/middle-income countries found that falls accounted for the largest percentage (56%) of recorded injuries among children.11 A study conducted in India similarly found that the most common type of home injury in children aged 0–14 was falling.12
Given the known extent of this burden, it is important to measure and understand how the burden of falls is distributed in terms of morbidity and mortality, across all age groups and between both sexes, and in every geographical region of the world. In addition, since the disability that results from falls may vary by location, it is of interest to systematically measure how the distribution of injuries resulting from falls varies by region.
The GBD Study represents the efforts of a global research collaboration that produces comprehensive estimates of hundreds of diseases, injuries and risk factors in 195 countries and territories using data and methods that are updated on an annual basis, most recently in GBD 2017. The specific estimates produced by the GBD include annual estimates of all-cause mortality, causes of death, non-fatal health outcomes (ie, incidence, prevalence and years lived with disability (YLDs)) and risk factors. These measures are estimated for all countries and territories, age groups and sexes, across a range of years. The intent of providing this level of estimation detail is to allow focused and nuanced analyses of death and disability across demographics, locations and causes of injuries. Falls is a category of injury in the GBD cause hierarchy and was included in the GBD 2017 results, but to date there have been no known studies that examined the findings for this cause in detail. Additionally, the injuries resulting from falls have not previously been reported using GBD 2017 results.
In this study, we use the GBD 2017 framework to analyse the morbidity and mortality caused by falls as reported in GBD 2017 and explore the burden of injuries resulting from falls.
GBD Study 2017
Methods used in the GBD Study 2017 have been described in extensive detail elsewhere, including description of the analytical estimation framework used to measure mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs).4 5 13–16 Online supplementary appendix 1 provides a methodological overview of different components used in the GBD Study design and analytical framework. The methodological components specific to the estimation of falls within the GBD framework are summarised below.
The GBD 2017 reported estimates in terms of external cause of injury (eg, falls) and measured disability based on nature of injury (eg, hip fracture). Causes of injury were defined in accordance with the International Classification of Diseases (ICD). For this study, falls were defined as ICD-9 codes E880–E886, E888 and ICD-10 codes W00–W19.9. In terms of the nature-of-injury codes, falls had 47 mutually exclusive and collectively exhaustive nature-of-injury categories which were specified with chapters S and T in ICD-10 and codes 800–999 in ICD-9 to quantify the various disabling outcomes that can occur with a fall.
Mortality and YLLs due to falls
For deaths due to falls, we estimated both mortality and YLLs due to premature mortality. Our approach for estimating causes of death for every cause, including falls, is provided in the GBD 2017 cause of death literature.17
First, we identified and obtained all available cause-of-death data sources. These sources included complete vital registration systems shared by countries; verbal autopsy studies published in literature; and mortality surveillance, censuses, surveys, hospital records and mortuary data. The cause of death estimates from these sources were mapped to the GBD cause list such that the corresponding ICD codes listed above were mapped to our 'falls' cause, as were non-ICD-coded reporting systems where 'falls' were designated as a cause of death, for example, in verbal autopsy studies which are typically not ICD coded but include a textual cause list.
Second, we conducted estimation models using the GBD Cause of Death Ensemble model (CODEm) to estimate cause-specific mortality for falls by age, sex, country and year. CODEm is an ensemble modelling approach for producing a large variety of possible models to estimate trends in causes of death using an algorithm that selects a wide array of combinations of covariates and different modelling methods.18
Third, we calculated YLLs by multiplying deaths by the residual life expectancy using the global maximum life expectancy at the age of death as derived from the GBD standard model life table. For example, if an individual dies at age 60 from a fall and their residual life expectancy is 20 years, then there were 20 YLLs due to that fall.
The method for estimating non-fatal injury outcomes including falls in GBD 2017 is described in more detail in related publications.19 A methodological summary is as follows.
First, we used DisMod-MR 2.1 to measure incidence of falls that lead to any form of medical care (inpatient or outpatient). DisMod-MR 2.1 is a meta-regression tool for epidemiological modelling built on a Bayesian compartmental model framework that solves differential equations that modulate the relationships between a susceptible population becoming injured (incidence) and then either recovering (remission) or dying (excess mortality). For incidence data, we used emergency department records, hospital records, survey data and literature studies to estimate fall incidence by location, year, age and sex, and used the coefficient from outpatient care to split subsequent estimation processes into inpatient and outpatient incidence estimates so that inpatient and outpatient-specific data could be used where possible to preserve differences in incidence and severity. Since survey items for falls can include non-injurious falls, we included an indicator variable for falls that resulted in injury. Since excess mortality is calculated based on locations where there are overlapping incidence and cause-specific mortality data, its computation also allows for estimation of incidence in locations with cause-specific mortality data but no incidence data, requiring an assumption that case fatality rates among falls are affected by income.
Second, we estimated the distribution of nature-of-injury categories among the incidence of all falls. To do this, we created a hierarchy of nature-of-injury categories. We assumed that the disability experienced by an individual who has an injurious fall was determined by the most severe nature-of-injury sustained due to this fall. For example, a fall resulting in a spinal cord injury would determine disability due to the fall instead of a co-occurring wrist sprain. The nature-of-injury hierarchy represents a combination of the likelihood of long-term disability and the corresponding GBD disability weight. To estimate the hierarchy, we used data from pooled follow-up studies in which we translated each individual's health status measure at 1 year after injury into a disability weight.20–26
Third, we used a Dirichlet regression method to estimate the proportion of falls that result in each nature-of-injury category being the most severe injury for each fall, since Dirichlet methods enforce coefficient estimates for proportions that must sum to 1.27 These matrices were derived from dual-coded hospital and emergency department data sets from multiple countries and data from the China injury surveillance system where both cause-of-injury and nature-of-injury diagnosis codes are present. The use of these data sources to inform this estimation process is described in more detail elsewhere.1 28 Separate cause-nature matrices were created for falls warranting hospital admission versus falls warranting other healthcare, high and low-income countries, male and female, and age category.
Fourth, we estimated short-term disability for falls by nature‐of‐injury category. For each nature-of-injury category and inpatient and outpatient injury, we used the Dutch Injury Surveillance System to derive average duration for treated cases, since for GBD 2017 this was the only available data source that could inform this parameter.23 24 These estimates were supplemented by expert-driven estimates of short-term duration for nature-of-injury categories that had insufficient numbers in the Dutch data set and for untreated injuries.
Fifth, we estimated the proportion of falls resulting in permanent disability for each nature-of-injury category by admission status and age. Disability due to falls was assumed to affect all injurious falls in the short term with a proportion having long-term (permanent) outcomes, defined as having persistent disability 1 year after the injury greater than the preinjury health status.
Sixth, we applied the ordinary differential equation solver used as the computational engine in DisMod-MR 2.1 to estimate the long-term prevalence for each fall-related nature-of-injury from incidence and the long-term mortality risk in cases with long-term disability based on meta-analyses of studies providing standardised mortality ratios. For example, since individuals with severe traumatic brain injuries die at a higher rate than the underlying population, we integrated the corresponding standardised mortality ratios to account for decreasing prevalence due to higher mortality risk in this injured population.
Finally, we calculated YLDs as prevalence of each health state multiplied by a disability weight for each nature-of-injury and corrected for comorbidity with other non-fatal diseases using microsimulation methods employed in GBD 2017.
Socio-demographic index
Socio-demographic index (SDI) is a composite indicator of development that is calculated based on income per capita, average educational attainment over age 15 and total fertility rate under age 25.15 The SDI has a scale that ranges from 0 representing the lowest income per capita, lowest educational attainment and highest fertility observed across all GBD locations from 1980 to 2017, to 1, representing the point at which the higher income per capita, higher educational attainment and lower fertility under age 25 are no longer associated with improved health. We used SDI values for each country and territory to categorise our estimates in this study by SDI quintile to help illustrate how burden trends differ by development level.
GATHER compliance
This study complies with theGuidelines for Accurate and Transparent Health Estimates Reporting (GATHER)recommendations (online supplementary appendix 2). Analyses were completed using Python version 2.7,Stata version 13.1, or R version 3.3. Statistical code used for GBD estimationis publicly available online at healthdata.org.
Results tables are listed as web appendix tables. Results by age, sex, year, subnational location and nature of injury are also available online via the GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool) and GBD Compare (https://vizhub.healthdata.org/gbd-compare/).
Figure 1 shows age-standardised incidence of falls by country and territory in 2017. This map illustrates the higher incidence rates in Eastern and Central European countries as well as Australia and New Zealand. Online supplementary appendix table 1 shows the all-ages incidence counts and the age-standardised incidence rates for 2017 as well as the percentage change in age-standardised rates from 1990 to 2017. Globally, the age-standardised incidence rate was 2238 (95% uncertainty interval 1990 to 2532) per 100 000 in 2017, representing a decline of 3.7% (7.4 to 0.3) from 1990 to 2017, and equating to 171 691 220 (152 472 652–194 061 874) new injuries from falls in 2017. The age-standardised incidence rate decreased in the high-middle and high SDI quintiles and increased in the middle, low-middle and low SDI quintiles. The largest decline was in the high SDI quintile, which decreased by 8.8% (−12.3 to −5.3). The geographic regions with the highest age-standardised incidence rates were Central Europe with 11 434 (10 103–12 996) cases per 100 000, Australasia with 8187 (6978–9553) cases per 100 000 and Eastern Europe with 8029 (7010–9233) cases per 100 000. Among the 21 GBD regions, 12 experienced significant increases in age-standardised incidence rates (Australasia, High-income Asia Pacific, Andean Latin America, Caribbean, Central Latin America, Tropical Latin America, South Asia, East Asia, Oceania, Southeast Asia, Central Sub-Saharan Africa, Southern Sub-Saharan Africa), 2 experienced significant decreases (Central Europe, High-income North America) and the remaining 7 regions experienced no significant change in age-standardised incidence rates (Central Asia, Eastern Europe, Southern Latin America, Western Europe, North Africa and Middle East, Western Sub-Saharan Africa).
Age-standardised incidence rates per 100 000 of falls, 2017, both sexes.
Online supplementary appendix table 1 also shows the all-ages prevalence counts and the age-standardised prevalence rate for 2017 as well as the percentage change in age-standardised prevalence from 1990 to 2017. Globally, the age-standardised prevalence rate was 5186 (4622–5849) per 100 000 in 2017, representing a decline of 6.5% (7.6 to 5.4) from 1990 to 2017. There were 411 711 999 (366 390 987–465 354 952) prevalent cases in 2017. East Asia had the highest number of prevalent cases in 2017 with 62 282 056 (54 985 517–70 760 535) cases across all ages and both sexes. The age-standardised prevalence decreased in the high and high-middle SDI quintiles and increased in the low, low-middle and middle SDI quintiles. The regions with the highest age-standardised prevalence were Central Europe with 23 428 (20 453–26 911) cases per 100 000, Eastern Europe with 17 429 (15 114–20 228) cases per 100 000 and Australasia with 16 175 (13 641–19 647) cases per 100 000. Among the 21 GBD regions, 14 experienced significant increases in age-standardised prevalence rates (East Asia, Oceania, Tropical Latin America, South Asia, Caribbean, Andean Latin America, Australasia, Southeast Asia, High-income Asia Pacific, Southern Sub-Saharan Africa, Central Latin America, Central Sub-Saharan Africa, Eastern Europe, Eastern Sub-Saharan Africa), 6 experienced significant decreases in age-standardised prevalence rates (High-income North America, Southern Latin America, Central Asia, Western Sub-Saharan Africa, Central Europe, Western Europe) and the remaining region experienced no significant change in age-standardised prevalence (North Africa and Middle East).
Figure 2 shows age-standardised cause-specific mortality rates for falls in 2017 by country. This map illustrates how the countries with the highest incidence do not necessarily have the highest cause-specific mortality, with countries such as India, Vietnam and Burkina Faso having markedly higher cause-specific mortality than the areas of Eastern and Central Europe that had the highest incidence. These patterns are further revealed in figure 3, which shows country-specific ratios of age-standardised mortality rates to age-standardised incidence rates in 2017, approximating the risk of death given a fall. This figure shows how mortality-to-incidence ratios (MIR) vary across the world. The ratio is highest in countries in Southeast Asia such as Indonesia, Cambodia, Myanmar and Vietnam, which have MIRs exceeding 0.03, meaning on average more than three deaths occur per 100 falls. MIRs also appear high throughout much of sub-Saharan Africa, in Afghanistan and across India.
Age-standardised cause-specific mortality rate per 100 000 of falls, 2017, both sexes.
Ratio of age-standardised mortality to incidence rates, 2017, both sexes.
Online supplementary appendix table 2 shows the all-ages deaths and the age-standardised mortality rates for 2017 as well as the percentage change in age-standardised rates from 1990 to 2017. Globally, the age-standardised mortality rate was 9.2 (8.5–9.8) per 100 000 which equated to 695 771 (644 927–741 720) deaths in 2017 and represented a non-significant decrease of 5.9% (−13.7 to 3.5) in age-standardised mortality from 1990 to 2017. Across SDI quintiles, only the high SDI quintile experienced a significant decrease in age-standardised mortality rate with a decline of 16.6% (18.8 to 14.4) from 1990 to 2017. All other quintiles experienced a non-significant decline in age-standardised mortality rates. The regions with the highest age-standardised mortality rates were South Asia with 22.0 (20.0–25.0) deaths per 100 000, Eastern Sub-Saharan Africa with 12.2 (11.2–13.5) deaths per 100 000 and Southeast Asia with 10.5 (9.8–11.3) deaths per 100 000. South Asia had the highest number of deaths, with 239 791 (220 244–270 634) deaths estimated in 2017.
Online supplementary appendix table 3 shows the counts, age-standardised rates and per cent change from 1990 to 2017 of YLDs, YLLs and DALYs. Globally, falls resulted in 16 688 088 (15 101 897–17 636 830) YLLs, 19 252 699 (13 725 429–26 140 433) YLDs and 35 940 787 (30 185 695–42 903 289) DALYs, reflecting age-standardised rates of 217 (196–229) per 100 000, 243 (173–330) per 100 000 and 459 (387–547) per 100 000, respectively. Age-standardised YLLs, YLDs and DALYs declined by 18.5% (31.7 to 6.2), 9.3% (10.7 to 7.9) and 13.9% (21.3 to 8.0), respectively, between 1990 and 2017. The percentage of age-standardised DALYs caused by YLDs varied by region, with a high of 89% in Australasia and a low of 16% in Southeast Asia. The region with the highest age-standardised DALY rate was Central Europe with 1174 (875–1559) DALYs per 100 000 which represented 159 (153–165) YLLs per 100 000 and 1015 (713–1405) YLDs per 100 000.
Nature of injuries caused by falls
Globally, the average disability weight used in computing YLDs after comorbidity adjustment was 4%, meaning that the average person suffering from a fall lost 4% of their full health status. Figure 4 shows the distribution of nature-of-injury codes among all falls for age-standardised YLDs by region. This figure shows that for all 21 of the GBD regions, the leading cause of disability among fall victims is fracture of patella, tibia or fibula, or ankle. Fracture of hip and moderate/severe traumatic brain injury are the next leading causes of disability among fall victims across regions. Global age-specific distributions of nature-of-injury codes are shown in figure 5. This figure shows that fractures of patella, tibia or fibula, or ankle are the most common causes of disability after an injurious fall in all age groups, though fracture of hip and femur fracture increasingly contribute to disability in older age groups.
Age-standardised nature-of-injury composition of falls by region. TBI, traumatic brain injury; YLDs, years lived with disability.
Age-specific nature-of-injury composition of falls globally. TBI, traumatic brain injury; YLDs, years lived with disability.
This study represents the first time that GBD estimates for falls have been reported in this level of detail through recent years, and illustrates the substantial amount of mortality and health loss in every country, age group and sex. Globally, total deaths and DALYs due to falls have increased steadily since 1990, with death counts nearly doubling by 2017. Conversely, age-standardised mortality rates and DALY rates have slightly decreased over the same period. At the country level, age-standardised mortality due to falls was highest in the Solomon Islands, India and Vietnam. The patterns of MIRs described in the results of our study emphasise how mortality risk per fall varies substantially by country and reveal that certain areas of the world likely have inadequate capabilities of responding to injurious falls. Since mortality from falls is associated with age and since global populations are generally ageing, it is important for all countries to ensure that their older adult populations as well as their ageing populations have adequate access to caretaking and treatment resources now and in the future.10 More focused research in the countries with the highest MIRs should investigate the specific causes of injury deaths from falls, the associated risk factors, and the circumstances and context of falls in order to target prevention efforts and appropriately allocate treatment resources. We additionally describe how falls have improved in terms of incidence and cause-specific mortality in the highest SDI countries, but that these improvements have not necessarily been experienced in lower SDI countries. This pattern emphasises how it is critical for lower SDI countries to more thoroughly investigate patterns of falls and to invest in prevention and treatment programmes.
Among clinicians, falls are known to be an important risk in certain populations, as they can be an origin of injury that leads to more complex care, such as the otherwise healthy older adult who slips, falls, sustains a femur fracture and then is admitted to the hospital for surgical repair and develops a condition like healthcare-acquired pneumonia. Such vignettes emphasise how a fall can precipitate significant health loss and potentially death. 29However, a young person who falls can also suffer disability the rest of his or her life, leading to income loss, dependence on caretakers and adequate accessibility options. Among the countries with highest incidence in 2017 were Slovenia, Czech Republic and Slovakia—countries with high percentages of rural populations.30 In Slovenia, nearly half of the population lives in a rural area, and there is evidence that falls are less fatal and more frequent in rural older people.31 32 Age-standardised DALY rates were particularly high in specific regions, including Central Europe, Eastern Europe and Australasia. Many of these regions are experiencing intensive ageing of the population.33 Poland, for example, is projected to increase the population aged 65 and over by 4.9 million in the years 2015–2050, requiring significant public healthcare expenditure on therapeutic rehabilitation.34
Research suggests that falls can cause physical harm and psychological and financial harm. A 3-year longitudinal study conducted by Tinetti and Williams explored the short and long-term effects of a fall on the well-being of those 65 and older. Among the participants, injurious falls resulted in a variety of conditions, including hip fractures, other fractures and soft tissue injuries; ultimately these injurious falls led to a decline in daily functional status.35 Other research has shown that falling often triggers a fear of falling again, likely impairing one's sense of mobility and autonomy.9 This fear is a proven risk factor for future falls; thus, one fall can initiate a cascade of negative health outcomes.9 Ultimately, the initial morbidity of a fall can manifest into significant health loss over time, amounting to considerable treatment and care costs.36 Future GBD research may provide estimates on the probability of long-term disability for individuals who sustain injurious falls.
In general, research on the prevention of falls has shown that improving personal health as well as addressing unsafe external factors can be effective in preventing falls. For example, exercise programmes have been shown to reduce falls among community-dwelling individuals aged 65 and older.8 37 A person's surrounding environment has also been identified as a leading cause of falls,9 10 meaning it is possible to prevent falls through the improvement of living conditions and public spaces, especially if older adults and universal design principles attending to safety are kept in mind when spaces are designed, altered and maintained.38 While some external hazards for falls are well known (eg, slippery surfaces or poor lighting), others are less visible or obvious. For example, in the inpatient setting, a study by Vassallo et al found that the hospital wards with more inpatient beds within the sightline of the nursing station had fewer falls than the ward with poor visibility between beds and the nursing station.39 Location-specific research in falls prevention has also shown that exercise, home modification, educational materials and vision correction are all important.40 41 It is also important to consider how morbidity or mortality resulting from falls might be mitigated. Clinical literature has supported frequent medication review with avoidance of polypharmacy,42 and dietary supplementation with cholecalciferol (vitamin D3) for select patients as methods to both prevent fall incidents and to help minimise fracture risk, though more recent assessments and recommendations by the US Preventive Services Task Force have revealed mixed results in terms of the benefits of vitamin D supplementation.43–46
Our study has several limitations. The first limitation is a function of our case definition in non-fatal models, where we estimate the incidence of falls that require medical care. While not every fall leads to injury, it is possible that care-seeking behavior with similar injuries could vary by location. Similarly, it is possible that in survey data or routine outpatient care visits, a patient may not report falls in the past year even if they led to minor injuries. Since our case definition includes only falls that lead to injury, our MIR estimates are likely lower than if we included all falls regardless of whether they led to injury requiring medical care. However, since the purpose of estimating those ratios is to illustrate patterns in severity and access to treatment, this limitation does not impact the key themes highlighted in our study. In addition, a general limitation in GBD analysis is that some areas of the world that may have high burden of various diseases and injuries do not have reliable incidence and cause-of-death data, and therefore our estimation process relies more heavily on covariates and regional trends in those areas. Similarly, the nature-of-injury distributions and injury duration parameters rely more heavily on data from higher income locations and Dutch injury data, and therefore may benefit in the future from adding more data sources from lower income locations so that that these parameters can be refined with greater location heterogeneity in future studies. Accordingly, an emphasis of GBD estimation going forward is to continue seeking additional data sources to be used in our modelling process.
As reported in prior GBD literature, falls have persisted over the past three decades as a leading cause of morbidity and mortality globally. This study, which examines the burden of falls in more detail in terms of location and age-specific patterns, reveals that falls are concentrated in certain locations, but the burden of fall mortality reliably corresponds with burden of fall incidence. In other words, it appears that morbidity and mortality of falls are influenced by geographic factors that likely pertain to care access and fall severity. Further research should be conducted to better define and measure these relationships so that future policy and investment can be appropriately designed and implemented.
Prior research has shown that every region of the world experiences health loss from falls.
Falls have consistently been a leading cause of fatal and non-fatal health loss in the Global Burden of Disease Study (GBD).
While age-standardised incidence of injuries from falls decreased by 8.8% in the high socio-demographic index (SDI) quintile from 1990 to 2017, incidence increased in the middle, low-middle and low SDI quintiles during that time.
Countries with the highest incidence of injuries from falls do not necessarily have the highest cause-specific mortality.
For all 21 GBD regions, the most common nature of injury sustained by fall victims is fracture of patella, tibia or fibula, or ankle.
GBD 2016 traumatic brain injury and spinal cord injury collaborators
. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: A systematic analysis for the global burden of disease study 2016. Lancet Neurol 2019;18:56–87.doi:10.1016/S1474-4422(18)30415-0
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. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009;(2):CD007146. doi:10.1002/14651858.CD007146.pub2
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. Epidemiology of falls. Age Ageing 2001;30(suppl 4):3–7.doi:10.1093/ageing/30.suppl_4.3
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. Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study. Bull World Health Organ 2009;87:345–52.doi:10.2471/BLT.08.055798
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. An epidemiological study on home injuries among children of 0-14 years in South Delhi. Indian J Public Health 2018;62:4–9.doi:10.4103/ijph.IJPH_428_16
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. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1684–735.doi:10.1016/S0140-6736(18)31891-9
Murray CJL ,
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. Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1995–2051.doi:10.1016/S0140-6736(18)32278-5
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. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1923–94.doi:10.1016/S0140-6736(18)32225-6
China Zhuhai Study 2006-2007 - China CDC | GHDx. Available: http://ghdx.healthdata.org/record/china-zhuhai-study-2006-2007-china-cdc [Accessed 15 May 2018].
Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands | GHDx. Available: http://ghdx.healthdata.org/record/functional-outcome-25-5-9-and-24-months-after-injury-netherlands [Accessed 15 May 2018].
Health-Related quality of life after burns: a prospective multicentre cohort study with 18 months follow-up | GHDx. Available: http://ghdx.healthdata.org/record/health-related-quality-life-after-burns-prospective-multicentre-cohort-study-18-months-follow [Accessed May 15, 2018].
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. The national study on costs and outcomes of trauma. J Trauma 2007;63(6 Suppl):S54–S67.doi:10.1097/TA.0b013e31815acb09
Traumatic Brain Injury(TBI) Follow-Up Registry and Surveillance of TBI in the Emergency Department (ED); Notice of Availability of Funds, 2002. Federal register. Available: https://www.federalregister.gov/documents/2002/05/08/02-11359/traumatic-brain-injurytbi-follow-up-registry-and-surveillance-of-tbi-in-the-emergency-department-ed [Accessed 14 May 2018].
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Duan L ,
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. The National injury surveillance system in China: a six-year review. Injury 2015;46:572–9.doi:10.1016/j.injury.2014.12.013
Suraweera W ,
Keay L , et al
. Childhood and adult mortality from unintentional falls in India. Bull World Health Organ 2011;89:733–40.doi:10.2471/BLT.11.086306
Rural population (% of total population) | data. world bank. Available: https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=RU-AU-NZ-PL-SI-SK-CZ-US&name_desc=false [Accessed 19 Mar 2019].
Falls most common cause of hospitalised injury—with numbers rising. Australian Institute of health and welfare, 2018 published online May 16. Available: https://www.aihw.gov.au/news-media/media-releases/2018/may/falls-most-common-cause-of-hospitalised-injury-wit [Accessed 19 Mar 2019].
Huang J-W ,
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. Rural older people had lower mortality after accidental falls than non-rural older people. Clin Interv Aging 2017;12:97–102.doi:10.2147/CIA.S119186
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. Population ages 65 and above (% of total) | data. Available: https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS?locations=EU-B8&year_high_desc=true [Accessed 2 Apr 2019].
Kłak A ,
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Targowski T , et al
. A growing problem of falls in the aging population: a case study on Poland – 2015–2050 forecast. Eur Geriatr Med 2017;8:105–10.doi:10.1016/j.eurger.2017.02.004
Tinetti ME ,
Williams CS
. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998;53A:M112–M119.doi:10.1093/gerona/53A.2.M112
Florence CS ,
Bergen G ,
Atherly A , et al
. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc 2018;66:693–8.doi:10.1111/jgs.15304
Sherrington C ,
Fairhall NJ ,
Wallbank GK , et al
. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019;21.doi:10.1002/14651858.CD012424.pub2
Reis P ,
Moro A ,
Bins Ely V ,
Ely B , et al
. Universal design and accessibility: an approach of the influence of muscle strength loss in the risk of falls in the elderly. Work 2012;41 Suppl 1:374–9.doi:10.3233/WOR-2012-0185-374
Vassallo M ,
Azeem T ,
Pirwani MF , et al
. An epidemiological study of falls on integrated general medical wards. Int J Clin Pract 2000;54:654–7.
Romli MH ,
Tan MP ,
Mackenzie L , et al
. Falls amongst older people in Southeast Asia: a scoping review. Public Health 2017;145:96–112.doi:10.1016/j.puhe.2016.12.035
Hill KD ,
Suttanon P ,
Lin S-I , et al
. What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatr 2018;18:3. doi:10.1186/s12877-017-0683-1
Pit SW ,
Byles JE ,
Henry DA , et al
. A quality use of medicines program for general practitioners and older people: a cluster randomised controlled trial. Med J Aust 2007;187:23–30.
American geriatrics society workgroup on vitamin d supplementation for older adults
. Recommendations Abstracted from the American geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc 2014;62:147–52.doi:10.1111/jgs.12631
Cranney A ,
Horsley T ,
O'Donnell S , et al
. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 2007;158:1–235.
Guirguis-Blake JM ,
Michael YL ,
Perdue LA , et al
. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US preventive services Task force. JAMA 2018;319:1705–16.doi:10.1001/jama.2017.21962
. Interventions to prevent falls in community-dwelling older adults: a systematic review for the U.S. preventive services Task force. Rockville, MD: Agency for Healthcare Research and Quality (US), 2018.
Funding This study was supported by the Bill and Melinda Gates Foundation (OPP1152504).
Competing interests SJ reports grants from Sanofi Pasteur outside the submitted work; AB reports personal fees from World Health Organization outside the submitted work; CC reports personal fees from Amgen, personal fees from Danone, personal fees from Eli Lilly, personal fees from GlaxoSmithKline, personal fees from Kyowa Kirin, personal fees from Medtronic, personal fees from Merck, personal fees from Nestle, personal fees from Novartis, personal fees from Pfizer, personal fees from Roche, personal fees from Servier, personal fees from Shire, personal fees from Takeda, and personal fees from UCB outside the submitted work.
Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.


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text:
package org.apache.struts2.fastjson;

import java.io.IOException;

import javax.servlet.http.HttpServletRequest;
import javax.servlet.http.HttpServletResponse;

import org.apache.struts2.StrutsConstants;
import org.apache.struts2.StrutsStatics;
import org.apache.struts2.fastjson.utils.JSONOutputUtils;
import org.apache.struts2.fastjson.utils.SerializationParams;
import org.slf4j.Logger;
import org.slf4j.LoggerFactory;

import com.opensymphony.xwork2.ActionContext;
import com.opensymphony.xwork2.ActionInvocation;
import com.opensymphony.xwork2.Result;
import com.opensymphony.xwork2.inject.Inject;
import com.opensymphony.xwork2.util.ValueStack;

@SuppressWarnings("serial")
public abstract class JSONResultSupport implements Result {

	protected static final Logger LOG = LoggerFactory.getLogger(JSONResultSupport.class);

    protected String encoding;
    protected String defaultEncoding = "ISO-8859-1";
    protected String root;
    protected boolean wrapWithComments;
    protected boolean prefix;
    protected boolean enableGZIP = false;
    protected boolean noCache = false;
    protected int statusCode;
    protected int errorCode;
    protected String callbackParameter;
    protected String contentType;
    protected String wrapPrefix;
    protected String wrapSuffix;

    @Inject(StrutsConstants.STRUTS_I18N_ENCODING)
    public void setDefaultEncoding(String val) {
        this.defaultEncoding = val;
    }

    public void execute(ActionInvocation invocation) throws Exception {
        ActionContext actionContext = invocation.getInvocationContext();
        HttpServletRequest request = (HttpServletRequest) actionContext.get(StrutsStatics.HTTP_REQUEST);
        HttpServletResponse response = (HttpServletResponse) actionContext.get(StrutsStatics.HTTP_RESPONSE);
        try {
        	Object rootObject = findRootObject(invocation);
        	String jsonString = createJSONString(request, rootObject);
            writeToResponse(response, addCallbackIfApplicable(request, jsonString), enableGzip(request));
        } catch (IOException exception) {
            LOG.error(exception.getMessage(), exception);
            throw exception;
        }
    }

    protected abstract String createJSONString(HttpServletRequest request, Object rootObject);

	protected Object findRootObject(ActionInvocation invocation) {
        Object rootObject;
        if (this.root != null) {
            ValueStack stack = invocation.getStack();
            rootObject = stack.findValue(root);
        } else {
            rootObject = invocation.getStack().peek(); // model overrides action
        }
        return rootObject;
    }

    protected boolean enableGzip(HttpServletRequest request) {
        return enableGZIP && JSONOutputUtils.isGzipInRequest(request);
    }

    protected void writeToResponse(HttpServletResponse response, String json, boolean gzip) throws IOException {
        JSONOutputUtils.writeJSONToResponse(new SerializationParams(response, getEncoding(), isWrapWithComments(),
                json, false, gzip, noCache, statusCode, errorCode, prefix, contentType, wrapPrefix,
                wrapSuffix));
    }

    /**
     * Retrieve the encoding <p/>
     *
     * @return The encoding associated with this template (defaults to the value
     *         of param 'encoding', if empty default to 'struts.i18n.encoding' property)
     */
    protected String getEncoding() {
        String encoding = this.encoding;

        if (encoding == null) {
            encoding = this.defaultEncoding;
        }

        if (encoding == null) {
            encoding = System.getProperty("file.encoding");
        }

        if (encoding == null) {
            encoding = "UTF-8";
        }

        return encoding;
    }

    protected String addCallbackIfApplicable(HttpServletRequest request, String json) {
        if ((callbackParameter != null) && (callbackParameter.length() > 0)) {
            String callbackName = request.getParameter(callbackParameter);
            if ((callbackName != null) && (callbackName.length() > 0))
                json = callbackName + "(" + json + ")";
        }
        return json;
    }

    /**
     * @return OGNL expression of root object to be serialized
     */
    public String getRoot() {
        return this.root;
    }

    /**
     * Sets the root object to be serialized, defaults to the Action
     *
     * @param root OGNL expression of root object to be serialized
     */
    public void setRoot(String root) {
        this.root = root;
    }

    /**
     * @return Generated JSON must be enclosed in comments
     */
    public boolean isWrapWithComments() {
        return this.wrapWithComments;
    }

    /**
     * Wrap generated JSON with comments
     *
     * @param wrapWithComments
     */
    public void setWrapWithComments(boolean wrapWithComments) {
        this.wrapWithComments = wrapWithComments;
    }

    public boolean isEnableGZIP() {
        return enableGZIP;
    }

    public void setEnableGZIP(boolean enableGZIP) {
        this.enableGZIP = enableGZIP;
    }

    public boolean isNoCache() {
        return noCache;
    }

    /**
     * Add headers to response to prevent the browser from caching the response
     *
     * @param noCache
     */
    public void setNoCache(boolean noCache) {
        this.noCache = noCache;
    }

    /**
     * Status code to be set in the response
     *
     * @param statusCode
     */
    public void setStatusCode(int statusCode) {
        this.statusCode = statusCode;
    }

    /**
     * Error code to be set in the response
     *
     * @param errorCode
     */
    public void setErrorCode(int errorCode) {
        this.errorCode = errorCode;
    }

    public void setCallbackParameter(String callbackParameter) {
        this.callbackParameter = callbackParameter;
    }

    public String getCallbackParameter() {
        return callbackParameter;
    }

    /**
     * Prefix JSON with "{} &&"
     *
     * @param prefix
     */
    public void setPrefix(boolean prefix) {
        this.prefix = prefix;
    }

    /**
     * Content type to be set in the response
     *
     * @param contentType
     */
    public void setContentType(String contentType) {
        this.contentType = contentType;
    }

    public String getWrapPrefix() {
        return wrapPrefix;
    }

    /**
     * Text to be inserted at the begining of the response
     */
    public void setWrapPrefix(String wrapPrefix) {
        this.wrapPrefix = wrapPrefix;
    }

    public String getWrapSuffix() {
        return wrapSuffix;
    }

    /**
     * Text to be inserted at the end of the response
     */
    public void setWrapSuffix(String wrapSuffix) {
        this.wrapSuffix = wrapSuffix;
    }

    /**
     * If defined will be used instead of {@link #defaultEncoding}, you can define it with result
     * <result name="success" type="json">
     *     <param name="encoding">UTF-8</param>
     * </result>
     *
     * @param encoding valid encoding string
     */
    public void setEncoding(String encoding) {
        this.encoding = encoding;
    }

}

redpajama_set_name: RedPajamaGithub


Race for Reliability: Aesthetics, Costs or Reliability?
When it comes to purchasing a new car, do you look for the most beautiful model, the cheapest choice, or is it reliability that will win you over? Just Tyres reveal the most and least reliable car models, as well as the cost to repair them.
Based on our sponsor; Warranty Direct's reliability index, Just Tyres ranked 323 car models to show the most and least reliable as well as how much they will cost you to repair. But, which car can you rely on to get you across the finish line?
So, does reliability cost? According to the piece, the top 10 most reliable cars are all cheaper to repair than the least reliable. To spare you parting with your cash, the car to get is the Mitsubishi Lancer which comes in as the most affordable car and the second most reliable.
Other cars that placed in the top 10 most reliable list – but were much more expensive to fix – were the Hyundai Getz and the Honda Jazz.
The Hyundai Getz is the 5th most reliable car in the list, but the average price to repair is not so attractive at £400.92. The Honda Jazz ranks as the 8th most reliable car but it's repair price follows closely behind at £394.95.
The cars to avoid, that are the most expensive to repair and the least reliable, include the Maserati Granturismo, the Nissan GT-R and the Aston Martin DB9.
All of them take places in the bottom 10 reliability rankings, placing 7th, 8th and 9th respectively, and have average repair costs of over £900. Although they are the most expensive cars to fix, they do not take bottom spot; the most unreliable car in the race is the Audi Q7. Dubbed Audi's 'mighty flagship SUV' this unreliable number will set you back £731.35 to repair.
The most expensive car to repair is the Nissan GT-R, with an average cost of £3,516.01.
That's over 50 times the cost of the Mitsubishi Lancer, and still £1,000 more than the top 10 most reliable car repair costs put together.
How do you know which car makes to trust when considering your next vehicle splurge?
Citroen, Mercedes-Benz, Nissan appear in both the most reliable and least reliable top 10 lists, but Hyundai is the only car make to appear twice in the top 10 most reliable list.
The 'Race for Reliability' reveals that beauty costs, not reliability, as the likes of Aston Martin, Maserati and Bentley feature in the 10 most unreliable cars. Find out more by viewing the 'Race for Reliability' graphic for yourself here.


text:
A statue of Imhotep in the Louvre. Imhotep was the vizier of Pharaoh Netjerikhet of the 3rd dynasty of Egypt. He may well be the Joseph of the Bible.
Amenemhat IV. Could this be Moses of the Bible?
The Amenemhet I pyramid at El-Lisht. Amenmehet I was a vizier of Mentuhotep IV of the previous dynasty. He is thought to have overthrown Mentuhotep IV and founded the 12th dynasty. This was the beginning of the Middle Kingdom of Egypt. The pharaohs of the 12th dynasty contructed pyramids out of mudbricks which were faced with a limestone veneer. They needed to have had a large slave labour force in order to make the mudbricks. A workers village was found by Petrie in 1891 at Kahun. He found scarabs in the town that indicated that it was occupied during the 12th dynasty up until the 13th dynasty. He also found evidence of a sudden exodus from the village in the 13th dynasty. He thought that many of the semitic slaves were Isralites. The Israelites numbered only 70 when they came to Egypt in the third dynasty. By the 12th dynasty, they numbered over a million and the pharaoh had long forgotten their connection to Joseph who had saved Egypt from famine and may have built the first pyramid (If Joseph and Imhotep were one and the same person). The Jews lived in Egypt 430 years. Joseph was 110 yrs when he died and came to Egypt at the age of 30 yrs.
The 12th dynasty pyramid of Sensuret II (Sesostris II) at Lahun.
Mud bricks in the Ameenhet III pyramid at Hawara. This was the last great pyramid to be built.
"I tell you," he replied, "if they keep quiet, the stones will cry out." Luke 19:40
The stones of the wall will cry out, and the beams of the woodwork will echo it. Hab 2:11
"See!" he said to all the people. "This stone will be a witness against us. It has heard all the words the LORD has said to us. It will be a witness against you if you are untrue to your God." Jos 24:27
Categories: Israelite Slaves in Egypt, Pharaoh of the Exodus, Pharaohs of the Oppression, Pyramids, slavery	| Tags: against, Egypt, History, Israel, Israelites, pyramids, slavery, stones, testimony, witness	| Leave a comment
Posted on December 18, 2014 by gospelclips
The pyramids of Egypt remain one of the great wonders of the world.
How the Ancient Egyptians managed to cut the huge solid limestone blocks, transport them and lift them into position before the wheel was even invented remains a mystery.
The first pyramid to be built was the Stepped Pyramid of Djoser (Netjerikhet) which is part of a complex in Saqqara Egypt that appears to be a grain storage and distribution center. The Step Pyramid itself was built on top of a shaft that was originally used as a grain silo but then converted into a tomb for the Pharaoh. The Step Pyramid is really a series of Mastabas, made from solid limestone blocks, stacked up on top of one another. The Step Pyramid was used to bury Netjerikhet's 3 wives and 11 daughters and Netjerikhet's sarcophagus was placed on a platform in the shaft beneath the Stepped Pyramid.
The Step Pyramid was designed by Imhotep who may well be the Joseph of the Bible. Joseph and Imhotep have many similarities but have not been thought to be one in the same person because of discrepancies between the estimated dates of their existence.
The Step Pyramid became the standard for the burial of pharaohs in subsequent dynasties.
Joseph would have lived well into the fourth dynasty if he was Imhotep of the 3rd dynasty and would no doubt have served more than one pharaoh.
The great pyramids of Giza far surpass the size of the first pyramid at Saqqara and contain enormous blocks that still leave the experts puzzled as to how they could have been lifted into place with the technology of the day.
The 12th dynasty appears to have arisen out of the 11th dynasty which was contemporary with the 6th dynasty. The Middle Kingdom of Egypt, therefore, directly followed the Old Kingdom. There was no first intermediate period as such.
The pyramids of the 12th dynasty were made from mudbricks that contained straw as a reinforcement. Each pyramid would have contained millions upon millions of these mudbricks which were about 24 inches by 12 inches by 6 inches in size. The 12th dynasty pyramids thus had a core that was made of mud bricks but the outer veneer was made of limestone which was becoming more difficult to quarry by the 12th dynasty and therefore in short supply. Over the centuries, the outer veneer of limestone has fallen down and been pilfered exposing the inner mudbrick core.
Paradoxically, the first pyramids to have been built, those of the 3rd and 4th dynasty (Old Kingdom Pyramids), have stood the test of time better than those built in the 12th dynasty (Middle Kingdom Pyramids). This is because the Old Kingdom Pyramids were made entirely out of solid limestone blocks while the Middle Kingdom Pyramids were made largely from Mud Bricks (the core) and only had a veneer of limestone.
The pharaohs of the 12th dynasty would have required a large slave labor force to make the mudbricks for the 12th dynasty pyramids.
The Israelites had come to number around 2 million by the time of the Exodus. The seven pyramids of the 12th dynasty were built over a 200 year period. Flinders Petrie found evidence of a sudden massive exodus of slaves from the town of Kahun in the 13th dynasty. The town of Kahun was a semetic workers village where the builders of the 12th dynasty pyramids lived.
If the Israelite exodus took place in the 13th dynasty then it would seem likely that it was the Israelites who were enslaved during the 12th dynasty and given the task of making mudbricks for the pyramids. After the Exodus in the 13th dynasty, no more pyramids were built.
If the first pyramid was designed by an Israelite, Joseph-Imhotep, and the Israelites were slaves in Egypt up until the last pyramid of the 12th dynasty was built, then the Pyramid age would coincide with the Israelite Sojourn in Egypt! It therefore follows that the pyramid age spanned a 400 year period from around 1900BC to 1500BC.
see Evidence for the Israelite Sojourn in Egypt
Categories: Israelite Slaves in Egypt, Mud bricks containing straw, Pharaoh of the Exodus, Pharaohs of the Oppression, Pyramids	| Tags: 12th dynasty, 13th dynasty, 14th dynasty, 3rd dynasty, 6th dynasty, Amenemhet I, Amenemhet III, Amenemhet IV, Djoser, Egypt, exodus, Flinders Petrie, Imhotep, Israel, Joseph, Moses, Netjerikhet, Petrie, Pharaoh, Pyramid, pyramid age	| Leave a comment
Moses is the only Israelite in history who was in a position to become a Pharaoh of Egypt. Not even Joseph could lay claim to this although he came very close, becoming a vizier to Pharaoh Netjerikhet in the 3rd dynasty. Joseph, having saved Egypt from a seven year famine and having brought up all the land of Egypt for the Pharaoh was, however, a very prominent person in Egyptian History to the extent that the Egyptians and the Greeks almost deified him (Imhotep). As time went by, Netjerikhet started to become known as the Pharaoh of Joseph (Djoser). Temples were built in Joseph-Imhotep's name and pilgrims would bring mummified animals to offer to his tomb in the hope of being healed over a 1000 years after his death.
Moses was an equally prominent figure in Egyptian History, not because he made it to the top job, but because of the impact that his disappearance had on the 12th dynasty and because of the impact that the Exodus had on Egypt. In the first half of their sojourn, the Israelites were well received and well treated by the Egyptians. As they flourished and grew in number, the Egyptians began to feel threatened. At the end of the Old Kingdom there was an uprising in Upper Egypt. Amenemhet I, the vizier of Mentuhotep IV of the 11th dynasty, based in Thebes, assassinated Mentuhotep IV and gradually took over the rest of the country. This was the beginning of Egypt's Middle Kingdom or the 12th dynasty as it was called by Manetho. The pharaohs of Egypt's Middle kingdom had a very different attitude towards the Israelites to the extend that the Israelites were enslaved and forced to make mud bricks for the public works of the 12th dynasty pharaohs. Eventually, the 12th dynasty pharaohs became so oppressive that they even practiced genocide by killing the male infants of the Israelites. 65% of the graves in Tel ed Daba where the Israelites lived were for infants and many coffins containing babies were found in Kahun which was also an Israelite village.
The Israelite oppression ended when the 12th dynasty ended (marking 400 years in Egypt) but the Israelites did not leave Egypt until 30 years later when Moses returned to confront Neferhotep I of the 13th dynasty.
Moses-Amenemhet IV's disappearance at the age of 40 was bad news for the 12th dynasty when Egypt's wealth and power was at a peek because there was nobody to continue the 12th dynasty when Amenemhet III died other than his daughter Sobeknefru. Sobeknefru only reigned for 8 years and then she died. Egypt became politically unstable and began to decline. When Moses-Amenemhet IV returned to Egypt to confront the pharaoh (Neferhotep), inflicting the ten plagues and then leading the Israelites (numbering 2 million) out of Egypt, Egypt was crippled due to the loss of it's firstborn, the loss of it's army, chariots, crops and animals; not to mention it's SLAVES. Egypt became easy pickings for foreign invaders. It was not long after the Exodus that the Hyksos (Amalekites) invaded Egypt and built a fort at Avaris (previously called Tel ed Daba) which was where the Israelites had lived. From Avaris, the Hyksos occupied and controlled lower Egypt for the next 400 years until Sequenre and Kahmose in Thebes, Upper Egypt, (17th dynasty) mounted a rebellion to force the Hyksos to leave Egypt where they were to encounter Saul of Israel who all but wiped them out. The 18th dynasty, or Egypts New Kingdom had begun. Many of the Pharaohs of the New Kingdom seem to have been named after Moses perhaps indicating that the Egyptians had considerable respect for Moses.
Given the enormous impact Moses had on Egyptian History and the fact that he was in a position to become a pharaoh at the end of a mud brick making empire in which his family were the major mud brick producers, it is very plausible and in deed, highly likely that Moses did manage to get to the top job, even if only as a junior co-regent. Things may have been different if he was allowed to rule by himself but then Moses-Amenemhet IV may not have achieved what God had intended for him. God had allowed the Israelites to grow into a nation in Egypt and it was Moses' job to lead the Israelites back to the promised land as God had promised he would to Abraham.
Categories: 12th dynasty, 13th Dynasty, Birth Pharaoh, Egypt, Israel, Israelite Slaves in Egypt, Kahun - Worker Village of the Middle Kingdom, Moses, Mud bricks containing straw, Pharaoh of the Exodus, Pharaohs of the Oppression, Pyramids	| Tags: 18th dynasty, 3rd dynasty, 400 years, 430 years, Amenemhet IV, Hyksos, Imhotep, Joseph, Moses, Pharaoh	| Leave a comment
Moses was born during the co-regency of Senusret III and Amenemhet III in the 12th dynasty during the Israelite Oppression. The 12th dynasty was doomed when Moses (Amenemhet IV) went into exile and it was crippled by the Exodus of the Israelites 40 years later.
Moses was an Israelite who was adopted by the Pharaoh's daughter and raised as her own. Moses spend the first 40 years of his life growing up in Pharaoh's household. There was no change of pharaoh during this time. As the princess did not have any other children, Moses would have become the next pharaoh if he did not have to flee to Midian after showing his loyalty to the Israelites.
Moses was born 80 years before the Exodus and fled to Midian 40 years before the Exodus.
Moses was born during the Israelite Oppression at a time when the Pharaoh was trying to kill all the Hebrew baby boys.
The Israelites had been in Egypt for 430-80=350 years and had been forced into slavery for about 150 years since the start of the 12th dynasty.
Senusret III (Sesostris III) – (The father of Amenemhet III)
Amenemhet III, the 6th pharaoh of the 12 dynasty, the last pharaoh to build a great pyramid, had an ambitious building program. His first pyramid at Dashur had flawed foundations and so he built a second pyramid at Hawara. He also build the Labyrinth; considered, in it's day, to be one of the great wonders of the world by Heroditis. Both of his pyramids were constructed with a core that contained millions upon millions of mud bricks (as was the case for all the pyramids of the 12th dynasty). The labyrinth was a mortuary building that had over one thousand rooms. It was also built from mud bricks and was equal in grandeur to the pyramids themselves.
The Israelites now numbered around 2 million and the Bible says that their chief occupation was making mud bricks for the Pharaoh.
Petrie found a workers village at Kahun, not far from Hawara, where the 12th dynasty pyramids were centered. From his detailed collection of scarabs found in the village, he was able to determine that the village had been occupied from the time of Sesostris II (Senusret II) up until the time of Neferhotep I. The village appeared to have been evacuated fairly suddenly. Petrie also found numerous boxes containing the skeletons of one, two or three babies at a time. The boxes were found under the floors of the houses in the village and were left almost to commemorate the deaths hundreds of babies in the town.
The thirteenth dynasty was only a short dynasty but there was a quick succession of Pharaohs. Neferhotep I was the longest ruling pharaoh of that dynasty, ruling 11 yrs. His body was never found. As the slave village at Kahun was occupied up until the time of Neferhotep I and Neferhotep I ruled 20 to 30 years after the end of the 12th dynasty, it is likely that Neferhotep I was the Exodus Pharaoh whom Moses confronted when he returned from Exile.
There was a large Exodus of slaves during the reign of Neferhotep I according to Petrie. These slaves lived in Kahun which was a workers village for the builders of the 12th dynasty pyramids.
It is quite likely that these slaves were the Israelite slaves who were lead out of Egypt by Moses when he was 80yrs old, 30 years after the 12th dynasty ended.
The 6th pharaoh of the 12th dynasty Amenemhet III, the last pharaoh to construct any pyramids, constructed 2 mud brick pyramids and the labyrinth. He reigned for 46 yrs and so he was reigning long enough to have seen Moses adopted by his daughter (Sobeknefru) and reach 40 years of age.
Amenemhet III did have a 9 year co-regency with a figure called Amenemhet IV whose ancestry is not recorded in Egyptian records. Amenemhet IV suddenly disappeared and never got to reign over Egypt by himself.
When Moses-Amenemhet IV fled to Midian, the 12th dynasty continued for another 10 years. When Amenemhet III died 2 yrs after Moses fled to Midian, Sobeknefru had to assume the throne as there were no other heirs. She only lived for another 8 yrs and when she died, the 12th dynasty ended. Egypt became unstable and there was a rapid succession of pharaohs in the 13th dynasty until Neferhotep I.
The loss of Moses-Amenemhet IV in itself was a big blow to Amenemhet III as it meant that he had no male successor to the throne. His daughter Sobeknefru had to take over when he died. She did not build a pyramid and there are very few monuments commemorating her. Amenemhet IV's tomb and mummy have never been found. This is likely to be because Amenemhet IV was Moses who fled to Midian and then returned 40 years later to confront a different pharaoh (Neferhotep I), and lead the Israelites out of Egypt.
The Exodus of the Israelites was an even bigger blow to Egypt because Egypt lost not only it's slave labor force, it lost it's army, it's pharaoh, it's transportation system, it's firstborn children and much of it's crops and animals. It is little wonder that Egypt was not able to undertake massive projects like the construction of pyramids after the Exodus had taken place. What's more, Egypt had lost all of it's defenses and was recovering from the plagues that had besmitten it. Consequently, Egypt was vulnerable to invasion and this is just what happened. Egypt was invaded by the Hyksos (also known as the Amu or the Amalekites) shortly after the Exodus. The Hyksos set up a fort at Avaris where they occupied and controlled Lower Egypt for the next 400 years. During this time, the Israelites were in the wilderness for 40 years and then in the Promised Land where they were ruled by a series of Judges.
Categories: 12th dynasty, 13th Dynasty, Egypt, Israel, Israelite Slaves in Egypt, Kahun - Worker Village of the Middle Kingdom, Pharaoh of the Exodus, Pharaohs of the Oppression	| Tags: 12th dynasty, 13th dynasty, 400 years, 430 years, 6th Pharaoh, Amalekites, Amenemhat III, Amenemhat IV, Amenemhet III, Amenemhet IV, Amu, Dashur, exodus, Hawara, Hyksos, Israelites, Kahun, midian, Moses, Neferhotep I, Petrie, Senusret II, slaves, Sobekneferu, Sobeknefru	| Leave a comment
The Israelites numbered about 70 when they first came to live in Egypt at the invitation of the Pharaoh whose vizier was Jacob's 11th son Jospeh-Imhotep. They were allowed to live in the best part of the land; Goshen. Here they flourished and multiplied under the protection of Joseph who was second in charge of Egypt and had saved the country from a seven year famine by storing up grain to sell before the famine started. Joseph had brought up all the land of Egypt and had made the Pharaoh very rich and powerful. Joseph lived until the age of 110 years and served several pharaohs. When he died, he was embalmed and given a royal Egyptian burial – some 80 yrs after he first entered Egypt.
The Israelites came to Egypt in the 3rd dynasty when Netjerikhet was the Pharaoh. Pharaoh Netjerikhet came to be know as Pharaoh Djoser as time went by (the pharaoh of Joseph). The Israelites flourished and multiplied during the 3rd & 4th dynasties while Joseph was alive and continued to multiply during the 5th & 6th dynasties after his death. The 6th dynasty, which was based in Memphis in Lower Egypt, was contemporary with the 9th and 10th dynasties based in Herakleopolis and the 11th dynasty based in Thebes.
About 100 years after Joseph's death, a pharaoh who did not know Joseph came to power. Amenemhet I was the vizier of Mentuhotep IV of the 11th dynasty based in Thebes (Upper Egypt). He assassinated Mentuhotep IV of the 11th dynasty and took over both Upper and Lower Egypt to start what is known as the 12th dynasty (or Egypt's Middle Kingdom). The pharaohs of the middle kingdom did not like the Israelites and felt threatened by them. Fearing that they would join their enemies, they forced the Israelites into slavery.
The 12th dynasty pharaohs constructed their pyramids from mud brick with only a veneer of limestone. The 12th dynasty pharaohs needed a large slave labor force to make the mud bricks required for their pyramids. This became the task of the Israelites who by the time of the Exodus had come to number over two million. The 12th dynasty lasted some 200 years and during this time, 7 pyramids were constructed as well as the Labyrinth. The Labyrinth was considered one of wonders of the ancient world by Heroditis.
Moses was born during the co-reign of Senusret III and Amenemhet III about 4yrs into Amenemhet III's reign. Amenemhet III built two pyramids and the Labyrinth. He was very cruel to the Israelites and it was probably he who ordered the midwives to kill the Hebrew baby boys. His daughter Sobeknefru was childless and there was no male heir to the throne. Sobeknefru adopted a Hebrew baby Moses that she found in a basket amongst the reeds of the Nile and she brought him up as her own in her household. He was known as Amenemhet IV.
When Amenemhet IV was old enough, 30yrs, he began a co-regency with Amenemhet III. This lasted 9 yrs and then Amenemhet IV suddenly disappeared. This left no male heir to the throne. Consequently, Sobeknefru had to assume the throne but she only lived for 8yrs and then she died. When she died, the 12th dynasty ended and Egypt became unstable. There was a rapid succession of pharaohs in the 13th dynasty. The longest ruling was Neferhotep I who reigned for 11 years. It was Neferhotep I who was the pharaoh when Moses-Amenemhet IV returned from exile. Neferhotep I was the Exodus Pharaoh who chased the Israelites and whose army and chariots were drowned in the Red Sea.
Egypt was crippled by the Exodus of the Israelites and became vulnerable to invasion. Not long after the Exodus, the Hyksos, shepherd kings from Arabia, invaded Egypt and built a fort at Avaris. From there, they occupied and controlled Lower Egypt for the next 400 years.
Categories: 11th dynasty, 12th dynasty, 13th Dynasty, Egypt, Israel, Israelite Slaves in Egypt, Pharaohs of the Oppression	| Tags: 10th dynasty, 11th dynasty, 12th dynasty, 13th dynasty, 14th dynasty, 3rd dynasty, 430 years, 5th dynasty, 6th dynasty, 6th Pharaoh, Amenemhat III, Amenemhat IV, Amenemhet I, Amenemhet III, Amenemhet IV, Djoser, drnhawkins, dynasties, Egypt, first intermediate period, Imhotep, Israelite, Joseph, Mentuhotep IV, Neferhotep, Netjerikhet, Sesostris III, slaves, Zozer	| Leave a comment
Egypt lost all it's chariots at the time of the Exodus. The Exodus would have immediately PRECEDED the dynasty in which chariots reappeared in Egypt.
The Hyksos used chariots to invade Egypt after the Exodus
The Hyksos were able to invade Egypt with little resistance because Egypt had lost it's army and all it's chariots at the time of the Exodus.
While the Hyksos are credited with having introduced the horse drawn chariot to Egypt, this should be an indication to Bible scholars that the Exodus took place just prior to the Hyksos invasion.
No discoveries horse drawn chariots have been found prior to the 15th dynasty. This would tend to suggest that the Exodus took place before the 15th dynasty. One would not expect to find chariots of dynasties prior to the Exodus because they were all destroyed at the time of the Exodus.
Wyatt found chariot wheels covered with coral strewn across the bottom of the Red Sea. There was a well preserved golden 4 spoked chariot wheel. He also found six and eight spoked chariot wheels covered with coral from one side of the Red Sea to the other in the Gulf of Aqaba where there is a large beach and a natural land bridge at the opening of the Wadi Wadir, just a little bit north of Jabel Lawz on the opposite side. Wyatt also found a pair of columns which appeared to have been left by Solomon to mark the site of the Red Sea crossing at this point.
Unfortunately, as no examples of 12th dynasty chariots have been found, the chariot wheels found by Wyatt were dated to the 18th dynasty. This has lead many an archaeologist to go looking for the Exodus in the 18th dynasty. There is no evidence for a mass Exodus in the 18th dynasty. There was an exodus at the end of the second intermediate period but this is when the Hyksos kings were evicted from Egypt and is clearly not the Israelite exodus.
The Bible states that the exodus pharaoh pursued the Israelites with all of Egypt's chariots and that these were lost in the Red Sea. One would, therefore, not expect to find a chariot that predated the exodus. If a chariot has been found, other than in the Red Sea, then it must have been produced after the Exodus.
While the Hyksos (15th dynasty) did use chariots to invade and occupy lower Egypt, they were only able to do this because the Egyptian army had been decimated by the Exodus and all of it's chariots were at the bottom of the Red Sea.
Many historians and archaeologists believe that the horse drawn chariot was introduced to Egypt by the Hyksos because there are no findings of 12th and 13th dynasty chariots. If all of Egypt's chariots were lost at the time of the exodus, the finding of 15th dynasty chariots should suggest that the Exodus occurred prior to the 15th dynasty, namely the 13th dynasty. It also follows that the chariot wheels found in the Red Sea by Wyatt were from the 12th and 13th dynasties.
The Hyksos were credited with having introduced the chariot to Egypt only because no 12th and 13th dynasty chariots have been found until 1978 when Wyatt discovered chariot wheels covered with coral strewn across the bottom of the Red Sea at Nuweiba. The fact that Hyksos chariots are the earliest surviving chariots to have been found means that the Exodus took place immediately before the Hyksos entered Egypt. This would further support a 13th dynasty Exodus.
Also supporting a 13th dynasty exodus is the prolific use of mudbricks in the 12th dynasty and the finding of a slave village at Kahun that was rapidly evacuated in the 13th dynasty when Neferhotep I was ruling (as evidenced by scarabs found by Petrie). Amenemhet III has the credentials to be the pharaoh of Moses birth and the pharaoh that Moses fled from. Sobeknefru has the credentials to be Moses foster mother and Amenemhet IV has the credentials to be Moses himself!
Categories: 12th dynasty, 13th Dynasty, 4 spoke, 8 spoke, chariot wheels, Egypt, Israel, Israelite Slaves in Egypt, Kahun - Worker Village of the Middle Kingdom, Moses, Mud bricks containing straw, Pharaoh of the Exodus, Pharaohs of the Oppression, Pyramids, Red sea, six spoke, slavery	| Tags: 12th dynasty, 13th dynasty, 15th dynasty, Amenemhat III, Amenemhat IV, Amenemhet III, Amenemhet IV, chariot wheels, crossing, Egypt, exodus, Hyksos, Israelite, Mt Sinai, Nuweiba, Red Sea, Wyatt	| Leave a comment
Sesostris III built the cities of Bubastis, Qantir, and Ramses
Meshing Egyptian and Biblical Timelines by Michelle Isenhoff
The New Answers Book 2 by Ken Ham
Categories: 12th dynasty, Egypt, Israel, Israelite Slaves in Egypt, Mud bricks containing straw, Pharaohs of the Oppression	| Tags: Bubastis, built, cities, Qantir, Ramses, Sesostris III	| Leave a comment

redpajama_set_name: RedPajamaCommonCrawl


As a basic concept; you can take it orally as raw leaves, juice, and oil; or, as one of the ingredients in cooked foodstuffs. Alternatively, you can use it the same way as most recreational users – which is usually by inhalation; whether smoking or by other means. What you are looking for is not to get high but to obtain relief from a debilitating condition that is affecting the quality of your life.
This is the crucial point when it comes to society's attitudes to the use of cannabis (medicinal or otherwise). No one is 100% certain as to what is actually happening when a sufferer takes something that is classified as a class 1 substance on the Federal Government's 1970 list of Controlled Substances Act. It might be an observable fact that the patient shows signs of improved comfort and less distress but what is the hard science behind this?
The Class 1 classification is reserved for drugs that have a high potential for misuse and abuse; have no currently accepted medicinal use and where there is a lack of existing accepted safety measures for that use. The problem being that no one is quite sure who it will be that will be recognized to provide such acceptable and proven evidence to convince both the Drug Enforcement and Food and Drug Administrations that medicinal cannabis needs to be reclassified. Despite a wealth of clinical reports on patient's gaining much improvement from the use of medicinal cannabis; the Federal Authorities remain steadfast in their stance that all use (including legitimate research) is illegal.
We know that the active ingredient is tetrahydrocannabinol (THC) which is responsible for both the recreational high and the remedial effects. We also know that the natural plant contains many other cannabidiols that can cause changes in a user's mind and body.
There is even some evidence that shows that our bodies can generate endogenous cannabinoids and that; if natural levels are low, then; the body will suffer functional breakdowns. Linked to this is reliable evidence that taking medical marijuana in Northbrook (or anywhere else) can raise these natural levels to a point where bodily functions return to normal.
What Can A Sufferer Do?
Fortunately; in Illinois, the State has passed a Compassionate Use of Medical Cannabis Pilot Program Act that; under strictly controlled rules, does allow any qualified person to purchase and use small quantities of therapeutic cannabis. Therefore; under State Law, such use is legal.
For sufferers whose doctors certify that they would benefit from Medical Marijuana in Northbrook; Greenhouse are establishing a number of fully licensed dispensaries where suitably qualified people can legally purchase their state legal quota, contact now.


Outdoor Restaurants and Their Unique Cleaning Challenges - Kaivac Cleaning Systems to clean their water-safe outdoor seating area. This tool sprays an effective cleaning solution onto all the surfaces that need to be cleaned. After allowing the solution to sit for a moment, you can use the high-powered spray on the system to remove soil and germs from the tables and chairs, then hose down the patio surface. Kaivac's KaiPow degreaser solution is certified by Green Seal, so it's environmentally friendly and helps break up the tough grease that can collect on your outdoor surfaces. A wet-vac system will also vacuum up all of the soils and wastewater for safe, environmentally friendly disposal.
For more information on restaurant cleaning, click here.
The weather is warming up, and even restaurants in the north are moving their outdoor furniture into courtyards and sidewalk areas. Outdoor restaurants have an edge over indoor-only establishments, but they have unique cleaning challenges, as well. Trash blown in from the street, animal droppings, and cigarette ashes are just some of the extra cleaning problems you have to deal with when you serve your customers outside. Regulars may love to have a drink on your patio or enjoy lunch in the summer sun, but outdoor dining areas get dirtier than indoor ones ever do, and it takes more effort to keep them clean.
For decades, the only way to clean your outdoor furniture was by using a rag or scrub brush along with a bucket of cleaning solution. This was far from the ideal solution, for a number of important reasons. First, this labor-intensive process ties up one or more of your employees for a long time?time they could be devoting on other cleaning chores indoors. Wiping tabletops, table legs, and each individual chair to make sure the area is thoroughly clean is very exacting and detailed work, especially when dealing with cleaning the grease off your outdoor tables. Animals also make more permanent messes than humans, and these problems have to be dealt with right away to keep the dining area safe. In addition, the flooring or cement under your tables should be cleaned as often as the tables themselves because of all the dirt and foreign objects that can be blown in from the surrounding area.
It's also long been known that traditional cleaning solutions can be bad for the environment, but when you're cleaning outdoors, the problem doubles. With the traditional mop-and-bucket approach, your cleaning staff has to be very careful to contain all the wastewater and empty it in a proper slop sink or drain afterward. Failing to do so violates regulations set by the Environmental Protection Agency. In addition, if you've got landscaping plants around your building, spraying cleaning solution in the area can damage tender leaves and growing plants.
Outdoor restaurants that want to take a safer route should use a system like Kaivac's OmniFlex Spray-and-Vac to clean their water-safe outdoor seating area. This tool sprays an effective cleaning solution onto all the surfaces that need to be cleaned. After allowing the solution to sit for a moment, you can use the high-powered spray on the system to remove soil and germs from the tables and chairs, then hose down the patio surface. Kaivac's KaiPow degreaser solution is certified by Green Seal, so it's environmentally friendly and helps break up the tough grease that can collect on your outdoor surfaces. A wet-vac system will also vacuum up all of the soils and wastewater for safe, environmentally friendly disposal.


text:
La stazione di Carimate è una stazione ferroviaria posta sulla linea Chiasso-Milano, a servizio dell'omonimo comune.

La gestione degli impianti è affidata a Rete Ferroviaria Italiana (RFI) controllata del Gruppo Ferrovie dello Stato.

Storia
Nonostante la linea fosse stata attivata nel 1849, la stazione venne attivata solo successivamente. Con la costruzione dell'Alta Velocità Chiasso-Milano il fabbricato viaggiatori verrà demolito

Strutture e impianti

Il fabbricato viaggiatori si compone di tre corpi: il corpo centrale si sviluppa su due livelli (soltanto il piano terra è aperto al pubblico), i corpi laterali si sviluppano simmetricamente e dispongono di un solo livello.
L'edificio è in muratura.

La stazione dispone di uno scalo merci con annesso magazzino.

La pianta dei fabbricati è rettangolare.

Il piazzale è composto da tre binari. Nel dettaglio:
Binario 1: viene utilizzato dai treni con numerazione dispari, cioè quelli che si dirigono verso Sud in direzione Milano.
Binario 2: viene utilizzato dai treni con numerazione pari, cioè quelli che si dirigono verso Nord in direzione Como-Chiasso.
Binario 3: è un binario su tracciato deviato e viene usato per le precedenze fra i treni.

Tutti i binari sono dotati di banchina.

Movimento

La stazione è servita dai treni della linea S11 (Chiasso-Rho) del servizio ferroviario suburbano di Milano, con frequenza semioraria durante le ore di punta, e oraria durante le ore di morbida.

Fino a qualche anno fa faceva li da capolinea per il chiasso-Carimate composto da carri bisarche siccome è situato il deposito della ford.

Servizi
La stazione offre i seguenti servizi:
 Parcheggio di interscambio auto
 Bar
 Capolinea autolinee ASF
 Sala di attesa

Interscambi
Vicino alla stazione è presente un parcheggio di interscambio che ospita 64 autovetture. Il parcheggio è stato ampliato nel gennaio 2011.

Per quanto riguarda il trasporto pubblico, nel piazzale antistante il fabbricato viaggiatori è presente una fermata autobus.

Note

Altri progetti

Collegamenti esterni

Carimate
Carimate

redpajama_set_name: RedPajamaWikipedia


Anyway, for those of you that don't know…many of the characters from the shows went on to do big things in fashion, style, and the entertainment industry.
What I love about Lo (yes, we're on a first name basis) is how she used her own female health experiences to create a suite of personal care products for women everywhere. She also has an awesome blog (The Lo Down) filled with recipes, self-care and other goodies for women).
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Most of the products are all-natural, organic and vegan. They do have some products that don't fit within these categories and are transparent about their product ingredients on their FAQ page.
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If you want to give them a try, you can get $10 bucks off your first order of $30 or more using my link.


text:
Home Music Music Lists
May 18, 2020 7:00AM ET
Readers' Poll: The 10 Best George Strait Songs
See which classic hit managed to top "The Chair" and "Ocean Front Property"
Chris Parton
David Menconi
Beville Dunkerley
Rolling Stone Country readers vote on best George Strait songs.
On May 18th, 1952, in the tiny town of Poteet, Texas, a future king was born. George Strait, one of the most celebrated recording artists of all time, has released 28 studio albums with one theme tied throughout: pure country. He has sold more than 69 million LPs, charted 60 Number One hits and won 23 CMA awards. And though the 63-year-old entertainer has now retired from touring, he's still making music — he has at least five more albums coming, per his MCA Records deal, and in April released a new single, "Let It Go." To celebrate the undisputed King of Country Music's birthday, we asked Rolling Stone Country readers to vote on their favorite songs from his unparalleled catalog. Here are your top 10 picks.
[This list was originally published in 2015.]
In This Article: George Strait
NRA to Declare Bankruptcy, Reorganize in Texas


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text:
namespace es2
{
class Buffer;
class Shader;
class Program;
class Texture;
class Renderbuffer;
class Sampler;
class FenceSync;

enum TextureType
{
	TEXTURE_2D,
	TEXTURE_3D,
	TEXTURE_2D_ARRAY,
	TEXTURE_CUBE,
	TEXTURE_EXTERNAL,

	TEXTURE_TYPE_COUNT,
	TEXTURE_UNKNOWN
};

class ResourceManager
{
public:
	ResourceManager();
	~ResourceManager();

	void addRef();
	void release();

	GLuint createBuffer();
	GLuint createShader(GLenum type);
	GLuint createProgram();
	GLuint createTexture();
	GLuint createRenderbuffer();
	GLuint createSampler();
	GLuint createFenceSync(GLenum condition, GLbitfield flags);

	void deleteBuffer(GLuint buffer);
	void deleteShader(GLuint shader);
	void deleteProgram(GLuint program);
	void deleteTexture(GLuint texture);
	void deleteRenderbuffer(GLuint renderbuffer);
	void deleteSampler(GLuint sampler);
	void deleteFenceSync(GLuint fenceSync);

	Buffer *getBuffer(GLuint handle);
	Shader *getShader(GLuint handle);
	Program *getProgram(GLuint handle);
	Texture *getTexture(GLuint handle);
	Renderbuffer *getRenderbuffer(GLuint handle);
	Sampler *getSampler(GLuint handle);
	FenceSync *getFenceSync(GLuint handle);

	void checkBufferAllocation(unsigned int buffer);
	void checkTextureAllocation(GLuint texture, TextureType type);
	void checkRenderbufferAllocation(GLuint handle);
	void checkSamplerAllocation(GLuint sampler);

	bool isSampler(GLuint sampler);

private:
	std::size_t mRefCount;

	gl::NameSpace<Buffer> mBufferNameSpace;
	gl::NameSpace<Program> mProgramNameSpace;
	gl::NameSpace<Shader> mShaderNameSpace;
	gl::NameSpace<void> mProgramShaderNameSpace;   // Shaders and programs share a namespace
	gl::NameSpace<Texture> mTextureNameSpace;
	gl::NameSpace<Renderbuffer> mRenderbufferNameSpace;
	gl::NameSpace<Sampler> mSamplerNameSpace;
	gl::NameSpace<FenceSync> mFenceSyncNameSpace;
};

}

#endif // LIBGLESV2_RESOURCEMANAGER_H_


This baby wellness studio offers first aid and CPR courses for friends and family and domestic workers. Also offers pre- and post-natal courses.
First aid training encompassing paediatrics. The academy can make arrangements for groups and you can choose the venue.
CPR and level 1-3 first aid courses.
They provide courses in first aid level 1, 2 and 3 as well as basic CPR and choking.
Covering CPR, choking, drowning, poisoning, fevers, fits, breathing difficulties and more.


i am going to make a php game called the fallen urban, it is a simple rpg.
you can use the battle system to have a real time battle, that means players can choose the move each turn. the world has a map, and on each place it has a pic to show you how you go.
it has a real time chat too.
in this game, i am trying to use the ajax.


text:
Q: How to shift block (key and value) from hash in Perl? I have the following partly code:
while(my $path = shift(@paths)) {
    # Do stuff
}

Inside the loop there is a case where I add another key to the @paths so in the next iteration it will handle that path.
I had to change the structure of @paths from array to hash. How can I replace the while-loop? From this topic, I tried:
while(my $path = shift(@{[keys(%paths)]}))

But the problem is that it will do an infinite loop since the shift works on the anonymous array and not on %paths. Also I need to keep in mind the case where I update the %paths inside the loop:
my $p = "/some/path";
$paths{$p} = "open";

So that in one of the next iterations of the loop it will handle this path as well. I also can't use foreach since I update %paths. What would be the best solution here?

A: Retrieve the key, then delete the hash entry
while (my ($key) = keys %paths) {       # NB: list context assignment
    my $value = delete $paths{$key};
    ...
}

A: Another possibility is to use a bare block with manual loop control:
use strict;
use warnings;

my %hash = (
    foo => 1,
    bar => 2,
    baz => 3,
);

HASH: {
    my ($key) = keys %hash;
    my $value = delete $hash{$key};

    print "$key => $value\n";

    # Sometimes new values will be added to the hash.
    #
    if ( $key eq 'foo' ) {
        $hash{quux} = 42;
    }

    redo HASH if %hash;
};

I feel bare block loops are underused.

A: You can do the same thing you were doing before, but with a different queue:
my @queue = keys %path;

while( my $key = shift @queue ) {
    $path{$new_key} = ...;
    push @queue, $new_key;
    }

I'm generally nervous about changing the data structure that I'm iterating over. Perl can have some weird effect there.

A: It was a mistake to switch to a hash. Use an array of path-value pairs.
my @todo = ( [ "/some/path", "open" ] );
while (@todo) {
   my ($path, $value) = @{ shift(@todo) };

   ...

   push @todo, [ ..., ... ];

   ...
}

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