Having been in the blogging world for years (and a mom!), I've been aware of The Humbled Homemaker blog for quite a long time. It's one of the big timers in the "mom blog" arena. Erin Odom writes on all sorts of topics related to motherhood and keeping a home — which can range from managing the family finances to meal planning.
Recently, she has published a book that brings together 100 tips and tricks for a mom to introduce into her home. When implemented, the idea is that the mom no longer has to work outside the home unless she wants to. It's specifically written toward those trying to stay home but can't at the present time.
Though no section goes into incredible detail, it's still a great resource for this group of people. Even if you're already a stay-at-home parent, utilizing some of her ideas could expand the comfort of your monthly budget. From being smarter with money to finding creative ways to increase income, there's at least a little nugget (probably more!) for everyone.
This was up my alley in the way that my family and I already implement much of her suggestions or have other creative ways of doing things, so it wasn't drastically life-altering. But I'm still glad to have it now! Especially so I can point fellow friends to it when related topics arise in conversation. Sometimes it's better to say, "You know what So-and-So says…" instead of, "You should do it like we do…" 🙂 It's also a cute, hardback book with a lovely ribbon bookmark, suggesting it would make a great gift.


Sony has officially unveiled the two new A/V receivers in its high-end ES (Elevated Standard) product line, the STR-DA3200ES and the STR-DA5200ES. The latter model offers the first-of-its-kind graphical user interface based on the Cross Media Bar GUI found on Sony's PSP and PlayStation 3, as previewed by CNET earlier this month.
Both receivers are specifically designed to dovetail with Sony's forthcoming Blu-ray standard bearers, the BDP-S1 and the PlayStation 3. As such, their HDMI inputs and outputs support HD resolution as high as 1080p, as well as uncompressed (linear PCM) 7.1-channel audio. In addition to its unique onscreen interface, the DA5200ES also boasts Faroudja's DCDi video-processing chip, which enables such abilities as scaling incoming analog video sources (for instance, composite and S-Video) to HD resolutions including 1080p, as well as offering picture-in-picture modes (a standard-definition source windowed over an HD one).
Both receivers will be available in October. The Sony STR-DA5200ES will cost $1,500 and the Sony STR-DA3200ES will retail for $900.


text:
Christianity, Politics
Gov. Mike Pence's Dilemma. . . and ours
I watched Gov. Mike Pence's press conference this morning with great interest. He is trying to face down an enormous backlash against Indiana's recent Religious Freedom Restoration Act (RFRA), which has been mischaracterized nationally as a license to discriminate against gay people. Nevertheless, he called a press conference and announced his intention to consider a legislative "fix" or "clarification" of the RFRA law. He did not explain what that legislative "fix" might consist of, but he said that something is coming.
I like Gov. Pence, and I think that he has been trying to fight the good fight. But he has gotten himself into a dilemma that has no good political outcome for him. His press conference has had the result of refocusing the national debate. Going forward, this conversation will be less about the RFRA and more about whether sexual orientation should be a protected class in Indiana state law.
A reporter asked Gov. Pence about this issue during the press conference, and Gov. Pence did not answer the question. When asked whether he would support making LGBT into a protected class, Gov. Pence said that was not on his "agenda." Two things are problematic with that response. First, Gov. Pence did not rule out a "fix" that would make sexual orientation into a protected class. Second, Gov. Pence is not in control of his "agenda" right now. His agenda is being set by events unfolding around him. Whether he likes it or not, he will have to face this question and answer it one way or the other.
And that brings us to his current dilemma. There is no legislative "fix" that will please all sides of this debate. On the one hand, any "fix" that falls short of recognizing LGBT as a protected class in Indiana law will not be acceptable to critics. Gay rights activists in the state won't be satisfied, and neither will the business interests (NCAA, Angie's List, Apple, etc.) who are threatening to pull out of the state. None of the critics are going to be mollified if the "fix" fails to recognize sexual orientation as a protected class.
On the other hand, any "fix" that makes sexual orientation a protected class in Indiana law would arguably leave religious liberty in worse shape than before the RFRA was passed. It was precisely this kind of law that led the Washington State attorney general to sue a 70-year old grandmother for declining to participate in a gay wedding. She had been serving and employing gay people in her flower shop for years. But when she declined to participate in a gay wedding, the AG and the gay couple sued her. The AG based his case against her on Washington State's law that makes LGBT into a protected class. The 70-year old florist lost the case and is now in jeopardy of losing her flower shop, her home, and her retirement. It is that kind of law that critics want Gov. Pence to pass in Indiana, and it is that kind of law that potentially causes serious conflict with religious liberty.
So Gov. Pence faces a real dilemma right now, and so does the country. I am not confident that Americans realize what is unfolding before our very eyes in our nation. It is clear to everyone that the Supreme Court will likely declare gay marriage a constitutional right this June. That means that gay marriage will be legal in every state of the union this summer. What I don't think Americans realize is that many proponents of gay marriage do not want to allow any legal accommodation for religious people who continue to believe in traditional marriage. The activists want to force the 70-year old grandmother to participate in the gay wedding or face crippling fines that put her out of business. No compromise. No retreat. They are willing to dismiss such principled religious dissenters as bigots and "Jim Crow" throwbacks. Gay marriage will be the law of the land, but does the average American know at what cost?
I'm less concerned about Gov. Pence's dilemma right now than I am about the larger question that our country is facing. Are we really going to become the kind of country that offers no accommodation to principled religious dissent? Are we really going to forget about our first freedom in the Bill of Rights—religious liberty? I hope not. But the events of the last five days seem to indicate otherwise.
God's Calling on Men to Be Protectors
Can Calvinists Sing "Softly and Tenderly, Jesus Is Calling"?
¯\_(?)_/¯ (@Frank_Turk)
Somebody needs to say out loud that, however born that way the LGBT crowd may be, what they actually do is repugnant and unloving toward each other. CDC stats demonstrate that easily. And for me not to want to celebrate those things which they do to each other is actually my right — unless it is about to become illegal to refuse to participate in that behavior.
We need to buck up, and if the persecution starts, we should love Christ at least that much.
Nathan Cesal
@Frank_Turk
The CDC stats easily demonstrate what happens when you don't have marriage equality.
Is that the standard you'd apply, without nuance?
"I won't serve Jews because they're part of a conspiracy to take over the country."
"I won't serve Christians because they profanely call Allah by a different name and neglect to recognize Mohammed, his Prophet."
"Black people are morally corrupt. FBI crime stats demonstrate that easily. Consequently, I don't want them in my store."
Michael Hutton
that can go back the other way.
"You must fight in this war and your personal ideologies are irrelevant."
"You must terminate this pregnancy and your personal wishes are not material."
"You must offer incense at this altar and your personal faith brings no concession."
There is a conflict here between the state legislating morality and the individual asserting his right to dissent.
Burk has accurately revealed the situation that at present the forefront of the homosexual rights movement allows no dissent. It seems only likely to gain momentum and tighten restrictions rather than loosen them.
I can see why it's stupid for some redneck to refuse to serve a person with dark skin. he's losing business. I can see how it's wicked for a whole town to refuse education or hospital care to an individual because of their ethnicity.
But in this clash of rights I honestly can't see why it's worse for a minority of the community to say, "I don't want to be part of that" when identical service is available down the street than for the government to bring all it's legal, judicial and physical power to bear to force people to act against their conscience.
April 1, 2015 at 12:16 am Reply
Those are examples of the govt. forcing an individual to do something outside the context of regulating economic activity. There is no basis whatsoever for the govt. to require someone to burn incense at a particular altar. The bill of rights pretty much covers "requiring someone to practice a particular religion".
In the case of Christian bakers, etc. the state is creating a condition for doing business. IF you want to sell wedding cakes THEN you cannot refuse to do business (in the context of selling wedding cakes) with the class of individuals who are same-sex attracted.
It is not "legislating morality". State and local governments aren't saying, "You must think homosexual activity is 100% A-OK." They're saying, "You're free to think whatever you want about homosexuality, but you can't shut gay people out of the marketplace."
I'm actually of the opinion that this sort of discrimination should be allowed because the impact is so minor, because the discrimination is entirely contextual (i.e. just weddings as opposed to targeting all homosexuals), and because its motivation is explicitly religious (which is different from racial discrimination). That said, disallowing it doesn't seem (to me) to be the extreme example of govt. overreach it's being characterized as.
Is a wedding not a religious ceremony? Is the Baronelle lady not being forced to take part in a religious ceremony? What happened to your bill of rights when she needed it?
You say you are free to think what you want about homosexuality, but you are not free to think what you want about marriage though, are you? Yet marriage has been and remains (despite some secularization and a whole lot of dumb thinking) a religious activity.
Please step back, have a look at the cases before the courts. Ask yourself, "Who is being shut out here?"
Come on, in the cases we have seen homosexuals have not been shut out of the marketplace, but that little old lady definitely is.
Suppose a little old Jewish lady set up a shop to make Bar Mitzvah cakes. Suppose then a Lebanese (or Tongan, or anything else) man wanted a coming of age ceremony for his son. And went and asked for Bar Mitzvah cakes. The little old lady says, sorry it's not a Bar Mitzvah. Then the government says it is so and you will make those cakes or go out of business.
Go and tell Baronelle that it's not government overreach. She's just imagining it.
April 1, 2015 at 8:45 am Reply
"what they actually do is repugnant"
Right, but I think people are looking for you to back that up somehow, and moreover demonstrate why the activity should be curbed. You've employed a "gay sex is 'icky'" argument, and it's the kind of argument my 4 year old niece deploys against any food that isn't candy.
I think that our country does offer principled religious dissent now, but not in areas where BOTH people's faith AND their public business enterprise intersects. It is at those junctures that people of faith cannot compromise, nor apparently is the public willing to tolerate public discrimination as a result of a business owner's religious principles.
Is it possible that people can at least TALK about this openly as concerned citizens rather than taking actions that further confuse the issue? Essentially, the country has no wish to harm grandmothers like Mrs Stutzman, who is sincere in her faith and offered to help the gay customers find other appropriate services . . . she is an innocent in this nightmare, and people understand that the actions taken against her were punitive and were over-the-top political maneuvering. On the other hand, the country does not wish to sanction any public discrimination against any minority group of Americans. The memories of many of us retain the images of the treatment of black people during the fifties and sixties . . . and yes, they WERE a minority and they WERE discriminated against publicly, rather horribly to be honest.
Am I 'lumping' gay people together with other minorities here? Yes. LBGT folk are in the minority in our country, but they are as American as you or I, and we should not ever want them to be treated without dignity as human persons in any public venue.
This is a 'moral dilemma'. The only real permanent answers to it will come from the resolve of our country to find compassion for the specific people of faith affected and offer them reasonable alternatives for those public business situations where their faith may bring them into collision with the rights of all manner of American customers. That is going to take some really sensitive work but it is not beyond the scope of our country to find better answers than we can now envision.
Andy Moffat
Some good thoughts there Christianne – especially the first paragraph. That really is the issue that needs to be figured out. Which rights outweigh the other? And in what context?
Would we allow an African American printer to refuse to print a flyer for a KKK meeting? Is that the same kind of conundrum?
David Howard Gleit
Here's what I see as the essential weakness of your argument: in no way is that 70 year old grandmother being forced to change her beliefs. She has the full freedom to believe whatever she wants, and I will defend to my death her right to express and hold on to those beliefs. She just does not have the right to "act" in a very specific and limited way which society (now) views as unacceptable: i.e., to specifically and discriminatorily refuse service to someone based on their sexual orientation. It's not about beliefs, it's about actions. Very specific actions.
Johnny Mason
"in no way is that 70 year old grandmother being forced to change her beliefs"
And yet, if she does not change them, she will lose her business. Nothing to see here.
" I will defend to my death her right to express.. those beliefs"
Apparently not, since in the next breath you say she cannot act on those beliefs. What is expression if not action?
Also, she did not refuse service to someone based on their sexual orientation. She had gay customers. Regular gay customers. She never refused to serve any of them. She just did now want to participate in a gay wedding. She was refusing the event (the wedding) and not the person. And you would have her lose her business if she does not comply.
James Bradshaw
Johnny: I know that there are a great many self-professed "Bible believing Christians" who believe divorce to be gravely immoral in most circumstances (along with remarriage). Many oppose interfaith marriages.
Do you believe that these folks' religious freedoms have been unduly infringed upon by the legal existence of civil divorce or heterosexual remarriage? In other words, have the rights of civil clerks, attorneys and/or small business owners been curtailed by the existence of these civil partnerships?
If not, how is gay marriage any different?
Look, I understand what you're saying. Personally, I would not have sued this woman, and I find using punitive measures to make someone do something they don't want to do to be ugly. Let's face it, though: we both know that this "principled opposition" only exists when it involves gays. In any other scenario, no one seems the slightest bit inconvenienced.
As Christiane noted, perhaps if our nation hadn't had a history of locking an entire segment of society out of the free markets because of vile racism (often under the banner of religious dogma), this discussion would look very different and we'd all be a bit more capable of tolerance (on all sides).
One other thing: having to bake a cake (for compensation at market price, no less) is far less an example of "persecution" than losing one's military career because someone doesn't want to work alongside a "queer". Do I need to remind everyone here of the opposition to the lifting of DADT? Some perspective is in order, here.
@James – No, my religious rights have not been infringed by the existence of divorce and remarriage. But we are not talking about the existence of a thing. We are talking about the participation/approval of a thing, because if you were to force someone to celebrate a divorce or remarriage against their conscience, then you have infringed their right.
Tim Elliott
"Let's face it, though: we both know that this "principled opposition" only exists when it involves gays. In any other scenario, no one seems the slightest bit inconvenienced."
Really? Have you witnessed every single "principled opposition"? Be careful. I believe you have weakened your argument by your implied omniscience.
No contradiction "in the next breath" at all. There is indeed a distinction between "freedom of religion" and "acting on those beliefs." Fundamentalist Mormons have a right to believe in their "plural marriage" doctrine. I will defend their right to hold those beliefs and to express them openly. But "in the next breath" I also support forbidding them from actually acting on those beliefs, for reasons I'm sure you understand. Is that a violation of their "freedom of religion?" Well, in their Fundamentalist Mormon minds, it surely is. But not in the mind of most Americans.
That's what you're up against – the disconnect between how you apparently view discrimination and the way most Americans now view it. Now, if you do agree that a business owner should not be allowed to "refuse service to someone based on their sexual orientation" then maybe we're closer then it appears. I don't know the particulars of what being forced to "participate in a gay wedding" even means (doesn't sound good, admittedly), but maybe we can agree at least that there should indeed be no discrimination based on sexual orientation?
Gus Nelson
That doesn't make sense. If she didn't have the beliefs, she wouldn't be acting the way she did. They're inextricably intertwined. It does her no good for you to proclaim you'll defend her right to express and hold her beliefs . . . except whenever you won't.
merletemple
You cannot separate beliefs from actions, because the state would require her to take action that would violate her beliefs. Obama and Hillary changed the term "freedom of religion" to "freedom of worship," early in his administration. It was a clear signal that Christians can worship behind the walls of their churches, but when they come outside, they belong to, and are at the mercy of, the state. She never has refused to serve customers based on orientation, only on same sex marriage requests that violate her faith by way of required action. She had known the customer for a long time, served him, but when he made this request, she gently took his hand, professed her love for him, but respectfully told him that she couldn't service an act that violated her faith. This man she thought the world of then threw her to the wolves of the messianic state. The absence of love and tolerance is not and was not from the 70-year-old grandmother.
The grandmother's refusal of service was not based on the client's sexual orientation. It is very clear that she served gay customers on a regular basis. The issue is whether or not she is allowed to refuse service when she is being asked to participate in a ceremony she disagrees with.
Thought exercise: would refusing to bake cakes for Christian weddings, christening ceremonies, and Christmas/Easter celebrations be discriminatory toward Christians?
Yes. Discrimination based on religious background is wrong and illegal.
But I wouldn't be discriminating on the basis of religion. I'm happy to serve Christians; I just don't want to participate in Christian ceremonies, which I find repugnant and immoral and which conflict with my sincerely held religious beliefs. I'm happy to bake a birthday cake for a Christian; I just don't want to bake wedding cakes, christening cakes, Christmas cakes, Easter cakes, etc.
Brian Sanders
buddyglass: "Thought exercise: would refusing to bake cakes for Christian weddings, christening ceremonies, and Christmas/Easter celebrations be discriminatory toward Christians?"
If anyone for any reason. other than "gay" marriage, went into a bakery and asked for something they did not offer that would simply be the end of the discussion. No uproar, no national news, no complaints even to the neighbor, just go on down the street to the next establishment and get what you want.
I'm pretty sure a baker refusing to bake cakes for Christian wedding ceremonies would make the national news. Conservative news outlets would go bonkers.
Scott Greider
Yes, and it should be legal. As should all forms of discrimination. First Amendment. Freedom of association. We're either all in, or all out. This latest debacle is the inevitable result of trying to allow some while denying others.
That view is at least consistent. However, it's not the view commonly held by the folks who argue Christian bakers, etc. should be free to discriminate against gay customers. Most folks making that argument likely support anti-discrimination laws in the contexts of race, religion, gender, etc.
Scott, would you be saying that if you were not a white, Christian heterosexual male? You're speaking from a place of privilege, particularly in America.
De facto segregation existed long after slavery and Jim Crow laws ended. We're still paying the price for that, and that is why there is a compelling interest in requiring businesses to serve everyone, regardless of any personal discomfort on the part of the business owner.
The greatest harm that can be inflicted on the owner is far less than what happens when minorities are effectively shut off from access to the free market and any services it provides.
How can it be a free market when someone is being compelled?
See my answer above. So are you perhaps agreeing that "refusal of service.. based on the client's orientation" (which you say Grandma did not do) is something society (government) has a right to intervene on and prohibit? Can we agree on that?
Ike Lentz
What Pence's press conference and this post finally admit, is that the problem isn't that people don't understand the bill, it's just a semantic argument over what constitutes discrimination.
Dal Bailey
I had a friend ask me what I'd do if I was a baker, florist or photog. I answered "I'd bake the cake, because "I" am not attending the wedding. If I was a florist or photog, I'd have a "Contractual" third party who would take the job.
Result, everyone is happy.
John Kreiner
Unfortunately, the way things are going, people might very well want to know why you can't do it yourself when you do it for other people. Then when you are honest about it, they would sue you.
Dal, you are living in a fantasy land if you think that will work.
"There was a doctor in California who didn't want to do an in vitro fertilization for a lesbian couple. She referred the couple to her partner in the same practice. They said, "Not good enough, we're terribly insulted" and so forth. California is not a RFRA state and the doctor lost."
http://www.vox.com/2015/3/31/8319415/indiana-religious-freedom-discrimination
"I'd have a "Contractual" third party who would take the job.
Yes, that's been my suggestion/feeling as well. Smart business owners should be networking to find others who would be willing to step in for them should this type of need arise.
Would the result be that everyone would be happy though? It seems doubtful to me.
There's the million dollar idea for someone though: Start a clearinghouse website for just this type of situation.
Noah Morgan
"Yes, that's been my suggestion/feeling as well. Smart business owners should be networking to find others who would be willing to step in for them should this type of need arise. "
No. I will not serve a homosexual couple, nor will I help facilitate their sin by sending them to someone who will enable it. They require salvation, not condonation.
I should add, as I noticed that Walmart has asked for a veto of the Arkansas RFRA law, and not that has anything to do with the current discussion, if, in our area, you were to have a conscientious Muslim cashier at Walmart who's customer has pork products Walmart will happily bring another cashier to that line so the Muslim can avoid having to tough pork products.
Randall Seale
Maybe Ms. Stutzman et al. should let it be known that all profits from cakes baked for gay weddings will be forwarded to US ally Saudi Arabia to help pay for their execution of gays (and all in honor of Apple's retail stores there).
Governor Mike Pence's Dilemma And Ours | Prisoner of Christ
I think everyone, those on both sides of the debate, should take a look at this page. This business owner was asked by a news crew what they thought of the law passed in Indiana and would they serve gay customers. The owner was for the law, said they would gladly serve gay customers, all customers, their pizza, but would not cater a gay wedding. Now, forget for the moment the absurdity of catering pizza at a wedding. Now look at their facebook page and tell me who needs to be protected here? Who is the one being harmed? Which side is showing animus?
https://www.facebook.com/pages/Memories-Pizza/289745361236608
What's your point, Johnny? Argue on the merits. There's always going to be people on the extremes who show animus. Let's not pretend this reflects all opposition to the law.
I tend to favor religious liberty protections for photographers and florists whose physical presence would be required at marriage ceremonies. I don't tend to consider fulfilling a catering order to provide pizzas for a gay wedding as celebrating that event but that's their right. If you go that far you might as well refuse to serve gay customers who walk in the door for a slice. I think in some cases people see this law as a way to express moral disapproval of gay marriage as opposed to violations of conscience.
Your example actually supports what some people who post here would like to see happen in allowing any business owner to refuse service for any reason. The market would handle them for good or bad. You might not like how that manifests.
James: White privilege? Seriously? You are usually much more thoughtful. Moreover, isn't this the very kind of treatment about which gays are complaining? Being treated not for who they are but for what they are? The same could be said of "personal discomfort." That's really weak coming from someone who often has compelling and interesting arguments. Many Christians have a very serious personal conviction that gay marriage is wrong and sinful. Frankly, I wish the Bible said homosexuality is fine so none of this would be an issue. But Scripture does not condone homosexual behavior at any point and clearly points to it as sin at several points. Convicted believers find themselves compelled to accept Scripture's teaching, even when they wish it were otherwise. To try to turn it into a matter of mere discomfort is like saying that a gay man should stop being gay because it's just a matter of comfort. I doubt you would take that argument very seriously.
heddrick steele
There is merit in the libertarian response that people should just be left alone to make up their own minds how to run their businesses. Those who drive off customers will end up with fewer customers and have their foolishness eventually kill their business.
There is some logic in it, but it doesn't take into account the reality of living in America. In many locations there is a monolithic approach due to similarity of origin that could lead an entire town, for example, to be unwelcoming to minorities. It would be a terrible thing to pass through one of those locations, if a libertarian 'let them be themselves' philosophy ruled. There'd be no place for a cup of coffee, no place to relieve oneself.
Should there be some government body enforcing these things. No. Better simply to allow people to dispute what they perceive as mistreatment and give them standing in court to register their dispute. What that means is that a religious person should be permitted to use his/her religious beliefs as a defense, since religion is the first freedom protected in our Constitution. That doesn't mean they'll win, but at least they get to be heard before they are deprived of any liberty…the very thing the 1st and 14th amendments, when combined, recommend.
Gov Mike Pence's Challenge, and Ours - Bethel Baptist Church
The False Dichotomy of the Gay Wedding Cake | Thoughts From a Former Fundamentalist

redpajama_set_name: RedPajamaCommonCrawl


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Homepage / Aerial Warfare / 2 Turkish-made T129 ATAK Attack Helicopter from Turkey Arrive in Philippine
2 Turkish-made T129 ATAK Attack Helicopter from Turkey Arrive in Philippine
March 9, 2022 March 10, 2022 by admin
The Philippine Air Force (PAF) announced that two of the six units of the Turkish-made T129 "ATAK" attack helicopters it has acquired arrived at Clark Air Base, Pampanga early Wednesday. The A-400Ms are cargo aircraft of the Turkish Air Force. One of the A-400Ms carried the two helicopters while the other aircraft transported the initial logistics requirement of the two T129s. The helicopters would undergo technical inspection and flight tests before being accepted for service to the PAF. It will undergo inspection, it will undergo acceptance (test), test flights before the acceptance ceremonies can be done and it will go through a lot of orientation in (the) country, together with the pilots and the crew.
The two T129 helicopters are to be commissioned within one or two months at the most. The Turkish-made attack helicopters are expected to enhance the "surface strike system" of the Air Force. The six T129s were acquired by the PAF from the Turkish Aerospace Industries in line with the Armed Forces of the Philippines (AFP) Modernization Plan – Horizon 2. The PAF's 15th Strike Wing would operate the T129s, which will be used for close-air support for ground troops and armed surveillance and reconnaissance. The T129 is a dedicated attack helicopter, much like the (Bell) AH-1S Cobra. This new system will complement the several surface strike systems of the Air Force and will be another game-changer in support of the numerous missions of the AFP.
Philippine Air Force T129 ATAK Attack Helicopter
On 18 December 2018, the Philippines and Turkey signed a Memorandum of Understanding on Defense Industry Cooperation that will allow Government-to-Government (G2G) acquisition and production, as well as technical cooperation on defense industry development. The first two units were supposed to be delivered in December but this did not push through for still unknown reasons. This is the total contract price for the 6 units of T129 helicopters PHP13,727,248,240. This is to includes the logistics support and training of pilots and crew in Turkey. The PAF is looking at acquiring dedicated but affordable attack helicopters to beef up its fleets of lightly-armed helicopters, such as the MG-520 and AW-109E that are being used for counter-terror and ground support missions.
The TAI/AgustaWestland T129 ATAK is a twin-engine, tandem seat, multi-role, all-weather attack helicopter based on the Agusta A129 Mangusta platform. The T129 was developed by Turkish Aerospace Industries (TAI) with partner Agusta Westland. The helicopter is designed for advanced attack and reconnaissance missions in hot and high environments and rough geography in both day and night conditions. The ATAK program was begun to meet the Turkish Armed Forces' requirements for an attack and tactical reconnaissance helicopter. The T129 is the result of the integration of Turkish-developed avionics, airframe modifications, and weapon systems onto the AgustaWestland A129 airframe, with upgraded engines, transmission, and rotor blades. The helicopter has a unit cost of roughly US$50 million.
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Prevalence of high-risk HPV genotypes, categorised by their quadrivalent and nine-valent HPV vaccination coverage, and the genotype association with high-grade lesions
María Paz-Zulueta1,
Ledicia Álvarez-Paredes2,
Juan Carlos Rodríguez Díaz3,
Paula Parás-Bravo1,
Ma. Encarnación Andrada Becerra4,
José María Rodríguez Ingelmo5,
María Montserrat Ruiz García6,
Joaquín Portilla7 &
Miguel Santibañez1
BMC Cancer volume 18, Article number: 112 (2018) Cite this article
The new nine-valent vaccine against human papillomavirus (HPV) includes the four HPV genotypes (6, 11, 16, and 18) that are targeted by the older quadrivalent HPV vaccine, plus five additional oncogenic types (31, 33, 45, 52, and 58) remain significantly associated with high grade lesions. We aimed to determine the prevalence of high-risk HPV genotypes in unvaccinated subjects and the association of these genotypes with the incidence of high-grade lesions. We also assessed which, if either, of these two HPV vaccines could have prevented these cases.
This cross-sectional study, conducted from 4 January 2010 to 30 December 2011, was composed of 595 women attending the Hospital General Universitario de Elche (Spain) gynaecology department who were positively screened for opportunistic cervical cancer by pap smears and HPV detection during a routine gynaecological health check. The pap smear results were classified using the Bethesda system. HPV genotyping was performed with the Linear Array HPV genotyping test, and viruses were classified by the International Agency for Research on Cancer assessment of HPV carcinogenicity. Odds ratios (ORs) with their 95% confidence intervals (95% CI) were estimated by logistic regression, adjusting for age and immigrant status. The prevented fraction among those exposed (PFe-adjusted) was determined as a measure of impact.
At least one of the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine was detected in 20.5% of subjects. After excluding women with genotype 16 and/or 18 co-infection, high-risk genotypes (31, 33, 45, 52, and 58) were associated with a higher risk of intraepithelial lesion or malignancy: adjusted OR = 3.51 (95% CI, 1.29–9.56), PFe-adjusted = 0.72 (95% CI, 0.22–0.90). Genotypes that are still non-vaccine-targeted were detected in 17.98% of the women, but these were not significantly associated with high-grade lesions.
The greater protection of the nine-valent HPV vaccine is likely to have a positive impact because, in the absence of genotype 16 or 18 infection, these five genotypes on their own remained significantly associated with high-grade lesions.
Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States and Europe [1]. Persistent HPV infection with a high-risk oncogenic genotype, as well as co-infection with high-risk genotypes, contributes to neoplastic progression [2,3,4]. Cervical cancer (CC) and other HPV-related cancers represent a major global public health problem. Cervical cancer is the third most common cancer among women worldwide [5]. It has been found that according to the severity of cervical lesions, the overall prevalence of HPV increases from 12% in women with normal cytology to 89% in women with CC [6]. The most frequent viral types are HPV 16, 18, 31, 33, 35, 45, 52 and 58. However, there are differences of specific type prevalences according to the region analysed. HPV 16 and 18 are the two most prevalent types worldwide [7]. HPV genotypes 16 and 18 cause 70% of cervical cancer cases as well as an even higher proportion of other cancers associated with HPV infection, such as cancer of the vulva, vagina, penis, anus, and oropharynx [8,9,10].
Two preventive strategies are used in combination to prevent cervical cancer: vaccination against HPV (primary prevention) and cervical screening programmes (secondary prevention). Cervical smears allow the detection of pre-cancerous lesions and cancer. Although it is a very effective method, its implementation only helps to prevent cervical cancer [11, 12]; there are no screening tests for other types of HPV-related cancer. In Spain, cervical screening is available but not mandatory. Cervical screening is performed opportunistically, its success depends on participant uptake.
In Europa, there are currently three vaccines authorised against HPV. The bivalent HPV vaccine Cervarix® provides protection against HPV 16 and 18 (high-risk oncogenic genotypes); the quadrivalent HPV vaccine Gardasil® provides protection against HPV 6 and 11 (low-risk oncogenic genotypes related with the appearance of 90% of genital warts) [13] together with genotypes 16 and 18. Nowadays in Spain, we use bivalent HPV vaccine Cervarix® and quadrivalent HPV vaccine Gardasil®. Depending on the region, one or other vaccine is included in the childhood immunization schedule. The last approved nine-valent HPV vaccine Gardasil9® provides protection against HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 [14]. This new vaccine extends protection to a further five oncogenic types (HPV 31, 33, 45, 52, and 58), in addition to the four types included in the original Gardasil®. Thus, the nine-valent HPV vaccine is estimated to potentially prevent close to 90% of cancers of the cervix, vulva, vagina, and anus, as well as 80% of pre-cancerous lesions [15]. Scientific evidence regarding the safety profile [16], immunogenicity [17, 18], and safety and efficacy [19,20,21,22] of these vaccines is well established.
The aims of our study were to determine the prevalence of high-risk HPV genotypes and analyse how effective the protection offered by the quadrivalent HPV vaccine and the new nine-valent HPV vaccine would be in this population as well as to investigate the association with and potential impact of these genotypes on the incidence of high-grade lesions.
This was a cross-sectional study of 595 women.
During the study period (January 4,2010 to December 30,2011), women who came to the gynecology department of the Hospital General Universitario de Elche (Spain) for a routine gynecological check-up were treated according to the cervical cancer screening protocol: a combined Pap smear test and HPV screening. For our study, we included 595 consecutive women in whom the linear combined HPV genotyping test had detected HPV infection in a cervical smear.
We obtained the data for each patient from computerized hospital records of gynaecology and microbiology services. When necessary, this information was completed with data from paper medical records and the histopathology department Cliniviewer.
The primary variables included date of birth, country of birth, patient's VPH vaccine status, Pap smear result, and determination of HPV genotype by polymerase chain reaction (PCR) assay.
The results of the pap smears were classified according to the Bethesda 2001 histological classification [23]. Positive pap smears were defined as those that presented abnormal epithelial cells. The result was classified as: atypical squamous cells of undetermined significance or atypical glandular cells (ASC-US/AGC), low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL), squamous cell carcinoma, adenocarcinoma in situ, or adenocarcinoma.
HPV genotyping was performed using the Linear Array HPV genotyping test (Roche Diagnostics), a qualitative in vitro assay that utilizes the amplification of target DNA by PCR and nucleic acid hybridization and detects 37 HPV genotypes: 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73 (MM9), 81, 82 (MM4), 83 (MM7), 84 (MM8), IS39, and CP6108. HPV types were classified according to the World Health Organization (WHO) International Agency for Research on Cancer (IARC) Monographs Working Group assessment of the carcinogenicity of different HPV types [24,25,26]: 13 high-risk (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) and 5 likely high-risk (53, 66, 70, 73 MM9, and 82 MM4). The finding of two or more high-risk genotypes in the same patient was defined as co-infection [27].
Based on the protection that would have been provided by the quadrivalent or new nine-valent HPV vaccines, the high-risk genotypes were classified into [28]:
vaccine-targeted high-risk HPV genotypes (16 and 18);
quadrivalent HPV-targeted genotypes (6, 11, 16, and 18);
the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine (31, 33, 45, 52, and 58);
high-risk HPV types other than 16 and 18 (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68); and
other non-vaccine targeted high-risk types (35, 39, 51, 56, 59, and 68).
For the categorical and discrete variables, proportions were estimated using the Pearson Chi-squared test to make comparisons and using Fisher's exact test when necessary. Continuous variables were expressed as the mean and standard deviation (SD); a Student's t-test was used for comparisons following normality testing using a Shapiro-Wilk test.
Cytological results were classified as being a "Non-high-grade lesion" (smear negative for intraepithelial lesion, ASC-US/AGC, or LSIL) or a "High-grade lesion" (HSIL, squamous cell carcinoma, adenocarcinoma in situ, or adenocarcinoma), and this classification was treated as a dependent variable in the logistic regression models.
As a measure of association, the crude odds ratios (ORc) as well as the odds ratios adjusted (ORa) for age (continuous variable) and immigrant status were estimated by unconditional logistic regression, together with their 95% confidence intervals (95% CI).
As a measure of impact, the adjusted attributable fraction in the total exposed (AFe-adjusted) was calculated using the formula [(ORa – 1)/ORa] together with its 95% CI using the formula [((lower limit 95% CI of the ORa – 1)/lower limit 95% CI of the ORa) to ((upper limit 95%CI of the ORa − 1)/upper limit 95% CI of the ORa)] when the ORa was statistically significant. The alpha error was set at 0.05, and all p were two-sided. All statistical analyses were performed using IBM SPSS Statistics V22.0.
Of the total participants, 73.11% (95% CI, 69.43–76.76) of women presented with at least one high-risk HPV genotype. High-risk HPV genotypes not targeted by the quadrivalent HPV vaccine were found in 38.49% of women (95% CI, 34.49–42.48%). At least one of the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine (31, 33, 45, 52, or 58) was found in 20.50% of women (95% CI, 17.18–23.83%) (Table 1).
Table 1 High-risk HPV genotypes, vaccine-targeted high-risk HPV genotypes, and single type infections and multiple type infections
High-risk HPV genotypes not targeted by either the quadrivalent HPV or the nine-valent HPV vaccine (35, 39, 51, 56, 59, or 68) were found in 17.98% of women (95% CI, 14.81–21.15%) (Table 1).
The mean age of the women included in this study was 34.34 years [SD: 10.70]; 89.75% were Spanish. Of the participants, 41.36% had at least one smear with morphological changes (ASC-US, LSIL, HSIL, squamous cell carcinoma, adenocarcinoma in situ, or adenocarcinoma). The prevalence of ASC-US was 8.14% (95% CI, 5.85–10.43), that of LSIL was 19.49% (95% CI, 16.21–22.77), and that of HSIL was 11.53% (95% CI, 8.86–14.19). The prevalence of cancerous lesions (squamous cell carcinoma, adenocarcinoma in situ, or adenocarcinoma) was 2.20% (95% CI, 0.93–3.47) (Additional file 1).
A single low-risk genotype (6, 11, 42, 43 or 44) was detected in 33.61% of the women (95% CI, 29.73–37.49), and a single likely high-risk genotype was detected in 25.88% (95% CI, 22.28–29.49). A single high-risk genotype was detected in 45.04% of participants (95% CI, 40.96–49.12), and two high-risk genotypes were detected in the 20.50% (Additional file 1). The most common multiple infections were by genotype 16 (19.33%), 52 (12.94%), or 51(9.24%) (Table 1). Genotype 16 was the most commonly detected HPV genotype, found in 30.08% of study participants (95% CI, 26.32–33.85). Genotypes 16 and/or 18 were detected in 35.46% of the women (Table 2). When we analysed the percentages of infection prevalence for the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine, we found that 14.29% of women were infected by genotype 52, 9.41% by genotype 31, 6.22% by genotype 58, 4.71% by genotype 33, and 3.03% by genotype 45 (Table 1). Regarding the percentages of infection by high-risk HPV genotypes that are not targeted by either the quadrivalent or nine-valent HPV vaccine, we found that 11.60% of subjects were infected by genotype 51, 9.24% by genotype 56, 7.73% by genotype 39, 4.71% by genotype 59, 2.86% by genotype 35, and 2.19% by genotype 68 (Table 2).
Table 2 Characteristics of the studied population, distribution of HPV genotypes, and histological classification of cervical smears
Table 3 shows the crude and adjusted measures of association (OR) and impact (AFe) of the risk of high-grade lesions, in relation to the HPV genotype and its potential protection by the quadrivalent and nine-valent HPV vaccines. After adjusting for age and immigrant status, the presence of HPV genotype 16 or 18 individually increased the possibility of having a high-grade lesion by 10.40-fold. The concomitant presence of both of these genotypes increased the risk of lesion as follows: adjusted OR = 63.58; linear p trend < 0.001; AFe = 0.98 (95% CI, 0.88–1.00). The presence of a high-risk genotype not covered by the quadrivalent HPV vaccine increased the risk of a high-grade lesion significantly, although to a lesser extent than the presence of genotype 16 or 18: adjusted OR = 2.71 (95% CI, 1.05–7.01).
Table 3 Prevalence of high-risk human papillomavirus genotypes according to the vaccine-targeted high-risk human papillomavirus genotypes
By sub-dividing these genotypes based on the ability of the new nine-valent HPV vaccine to protect against them, we found that although the presence of high-risk genotypes not covered by the new nine-valent HPV vaccine was not associated with a significant increase in the risk of lesions (adjusted OR = 1.76; 95% CI, 0.54–1.70), the presence of a high-risk genotype not covered by the quadrivalent HPV vaccine but covered by the new nine-valent HPV vaccine was associated with a significant increase in this risk (adjusted OR = 3.51, 95% CI, 1.29–9.56; adjusted AFe = 0.72, 95% CI, 0.22–0.90) (Table 4).
Table 4 Associations and impact between the risk intraepithelial lesion/malignancy and the vaccine-targeted high-risk HPV genotypes
Our results show that in the absence of infection with HPV genotypes 16 or 18, the greater level of protection provided by the new nine-valent HPV vaccine compared with that provided by the quadrivalent HPV vaccine is likely to have a measurable impact. The extra five HPV genotypes remained significantly associated with high grade lesions.
Our results show a high prevalence of infection by a single high-risk oncogenic HPV genotype (45.04%) [29,30,31,32]. The percentage of women who presented a morphological change in their pap smear (positive screening) was also high (41.36%) [33, 34]. This could be due to the characteristics of our sample, since our study was not conducted on the general population but rather it specifically included women with a confirmed HPV infection. Similarly, with respect to the prevalence of genotypes 16 and 18 in our sample, we found higher prevalences (30.08% and 5.38%, respectively) than those described in previous population-based studies [29, 32]. Our findings are closer to those reported by Garcia Espinosa et al. [35], who showed that the most common HPV genotypes found in all specimens were genotypes 16 (26.0%), 31 (10.7%), and 58 (8.0%). In their study, genotype 18 was detected in only 5.0% of women.
Here, the prevalence of genotype 52 was higher than that found by other authors in national studies [36, 37]. Our results also do not coincide with the prevalence reported by the 2016 ICO-WHO report [38], which detected genotype 52 in 5.4% of HSIL and in 2.4% of cancerous lesions. This difference could be due to the high population of immigrants from East Africa that plays an important role in our health area; a very high prevalence of HPV 52 infection has been reported for this geographic area [39]. In contrast, the data published by Castellsagué et al. and Delgado et al. [30, 40] regarding the prevalence of HPV 52 are similar to those obtained in our study. Castellsagué et al. found that after HPV 16, genotype 52 was the most prevalent, and Delgado et al. reported the prevalence for genotype 52 as 12%.
The most common high-risk type detected in this study was HPV16 which is consistent with published studies and that vaccination will likely have a significant impact [20,21,22, 41]. Furthermore, HPV genotype 16 or 18 cause 70% of cases of cervical cancer and an even higher proportion of cancers of the vulva, vagina, penis, anus, and oropharynx [8,9,10]. Thus, current HPV vaccines (Cervarix® and Gardasil®) prevent approximately 70% of cervical cancers through protection against genotypes 16 and 18.
Partial cross-protection against non-vaccine targeted HPV types has been reported for both licensed vaccines, although the clinical significance of this finding remains uncertain [42]. In the FUTURE I / II and PATRICIA studies, conducted in young women, the bivalent vaccine showed significant efficacy against HPV31, 33, 45 and 52, and the tetravalent vaccine against HPV31. The bivalent vaccine showed significant efficacy against CIN2 + related to HPV31 and 33 (excluding co-infection with HPV16 and / or 18) and related to HPV45 (included co-infection with HPV16 and / or 18) [43, 44]. The possible cross-protection of the new nine-valence vaccine is still unknown. It would be necessary to evaluate whether the nine-valence vaccine also protects against other non-HPV oncogenic HPV types not included in this vaccine.
Concomitant infection by both genotypes 16 and 18 also suggests an interaction, with co-infection multiplicatively increasing the risk of high-grade lesions (adjusted OR = 63.58), with an adjusted AFe of 90% and 98% for isolated or joint infection, respectively. Thus, protection against infection with one of these genotypes (16 or 18) would prevent approximately 90% of high-grade lesions, while protection against both would prevent 98% of the high-grade lesions present in women co-infected with genotypes 16 and 18. These findings support the preventive impact of both the quadrivalent and the nine-valent HPV vaccine, as both cover genotypes 16 and 18 [19, 42, 45, 46].
The new nine-valent HPV virus-like particle includes the four HPV types (6, 11, 16 and 18) present in the quadrivalent HPV vaccine, plus five additional oncogenic types (31, 33, 45, 52, and 58) and potentially increases the overall prevention of cervical cancer from around 70% to around 90% [47]. Our study supports this increased efficacy. The greater level of protection by the new nine-valent HPV vaccine compared with that of the quadrivalent HPV vaccine is likely to have an observable impact, given our finding that these genotypes on their own (in the absence of infection by genotypes 16 or 18) remained significantly associated with high grade lesions, with an adjusted AFe of 72%. Thus, our results suggest that had the 121 patients who presented with at least one of these HPV genotypes (but not genotype 16 or 18) been vaccinated with the new nine-valent HPV vaccine, approximately 72% of the high-grade lesions present in these women would have been prevented. In other words, if all these 121 patients had been vaccinated, and the efficacy of the vaccination for these genotypes (31, 33, 45, 52, and 58) was 100%, approximately 87 high-grade lesions would have been prevented. Joura et al. showed an efficacy of 96.7% against high-grade lesions related with infection by HPV 31, 33, 45, 52, and 58 in their analysis of a cohort of 14,215 women aged 16 to 26 years [22]. Monsonego et al. showed that a high proportion of high-grade cervical lesions (60.6% of genotyping assay-positive CIN2+) were associated with HPV types 31, 33, 45, 52, or 58 [48].
In our study, 17.98% of women were infected with high-risk genotypes that are not covered by either the quadrivalent or the new nine-valent HPV vaccine. In the absence of infection with genotypes 16 or 18, infection with the remaining high-risk genotypes not covered by the new nine-valent HPV vaccine (genotypes 35, 39, 51, 56, 59, and 68) was associated with a non-statistically significant risk of high-grade lesions, with an AFe close to 40%.
When extrapolating our results, various aspects that could result in lower attributable fractions in the population must be considered. The effectiveness of the HPV vaccines is likely less than 100%, and therefore the protection level is not 100% in 100% of the women vaccinated. Furthermore, we cannot rule out the false sense of security reported by several authors [49, 50], which can lead to a higher prevalence of risky lifestyles or sexual habits, such as a lower use of condoms. Another limitation is the fact that the attribution of lesions to specific HPV types is complicated by the detection of multiple HPV infections. Therefore, the potential benefit of a HPV vaccine is not easily assessable.
On the other hand, another caveat is that cervical lesion was performed on exfoliated cervical cells instead of biopsy samples with laser dissection, so we did not have confirmation of high-grade lesions by histological study (biopsy). However, studies evaluating the category HSIL compared to biopsy as gold standard support a very high probability of an accurate diagnosis [47, 51].
In our study, the enrolled women had attended the gynaecology department of the Hospital General Universitario de Elche (eastern Spain) testing positive for HPV infection in the cervical smear performed during a routine gynaecological health check in an opportunistic cervical screening program. Since the population is limited to those attending opportunistic screening further selected on the basis of their HPV status and not primarily vaccine status, it prevents to make generalizations on potential vaccine impact in the general population. However, our results circumscribed to the study population, show the prevalence of high-risk HPV genotypes in unvaccinated subjects and the association of these genotypes with the presence of high-grade lesions, allowing to assess the potential impact of quadrivalent and nine-valent HPV vaccines by using epidemiological impact measures. One advantage of using adjusted ORs is that derived from these adjusted OR, it is possible to estimate as a measure of impact, the adjusted attributable fraction in the total exposed together with its 95%CI. We think that our methodology can complement the information provided with other methodologies such as the one followed by the recently published study by Capra et al. [52], and that it could be useful for future reviews or meta-analysis. The description of high-risk HPV epidemiology is a key feature for the design of strategies to prevent cervical cancer, and the results from this study can be used with this purpose in future reviews and meta-analysis, in order to estimate the potential impact of vaccination by either the quadrivalent or nine-valent vaccine relative to other studies with similar aims.
HPV genotypes 16 and 18, especially in co-infection, are the two HPV genotypes that have most impact on the presence of high-grade lesions in our unvaccinated population attending an opportunistic screening in eastern Spain. Based on our associations and impact epidemiological results, in the absence of infection with HPV genotypes 16 or 18, the greater level of protection provided by the new nine-valent HPV vaccine (five genotypes) compared with that provided by the quadrivalent HPV vaccine is likely to have a measurable impact because these genotypes on their own remained significantly associated with high-grade lesions. In our population, there is a percentage of women (17.98%) who are infected with high-risk HPV genotypes that are not covered by any of the currently available vaccines (quadrivalent HPV or nine-valent HPV vaccines); however, as a whole, the impact of these HPV genotypes on the risk of high-grade lesions appears to be lower than the risk posed by other common HPV genotypes.
AFe:
Adjusted attributable fraction in the exposures
AGC:
Atypical glandular cells
ASC-US:
Atypical squamous cells of undetermined significance
HSIL:
High grade squamous intraepithelial lesion
IARC:
World health organization international agency for research on cancer
LSIL:
Low grade squamous intraepithelial lesion
Odds ratios
Odds ratios adjusted
ORc::
Crude odds ratios
PFE:
Prevented fraction among the exposed
SD:
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Pista A, de Oliveira CF, Cunha MJ, Paixao MT, Real O. CLEOPATRE Portugal study group. Prevalence of human papillomavirus infection in women in Portugal: the CLEOPATRE Portugal study. Int J Gynecol Cancer. 2011;21(6):1150–8.
Dunne EF, Unger ER, Sternberg M, Mc Quillan G, Swan DC, Patel SS, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007;297:813–9.
Dickson EL, Vogel RI, Geller MA, Downs LS Jr. Cervical cytology and multiple type HPV infection: a study of 8182 women ages 31-65. Gynecol Oncol. 2014;133(3):405–8.
Asiaf A, Ahmad ST, Mohammad SO, Zargar MA. Review of the current knowledge on the epidemiology, pathogenesis, and prevention of human papillomavirus infection. Eur J Cancer Prev. 2014;23:206–24.
García-Espinosa B, Moro-Rodríguez E, Alvarez-Fernández E. Genotype distribution of human papillomavirus (HPV) in histological sections of cervical intraepithelial neoplasia and invasive cervical carcinoma in Madrid, Spain. BMC Cancer. 2012;12:533.
Otero-Motta AP, Ordonez JL, Gonzalez-Celador R, Rivas B, Macias Mdel C, Bullon A, et al. Prevalence of human papillomavirus genotypes in cytologic abnormalities from unvaccinated women living in north-western Spain. APMIS. 2011;119:204–15.
Cobo F, Concha A, Ortiz M. Human Papillomavirus (HPV) type distribution in females with abnormal cervical cytology. A correlation with histological study. Open Virol J. 2009;3:60–6.
ICO. Spain human Papillomavirus and related cancers. Information Centre on HPV and cancer, fact sheet 2016.
De Sanjose S, Diaz M, Castellsague X, Clifford G, Bruni L, Munoz N, et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007;7:453–9.
Delgado D, Marin JM, de Diego J, Guerra S, Gonzalez B, Barrios JL, et al. Human papillomavirus (HPV) genotype distribution in women with abnormal cervical cytology in the Basque Country, Spain. Enferm Infecc Microbiol Clin. 2012;30:230–5.
Kjaer SK, Frederiksen K, Munk C, Iftner T. Long-term absolute risk of cervical intraepithelial neoplasia grade 3 or worse following human papillomavirus infection: role of persistence. J Natl Cancer Inst. 2010;102:1478–88.
Schiller JT, Castellsagué X, Garland SM. A review of clinical trials of human papillomavirus prophylactic vaccines. Vaccine. 2012;30(Suppl 5):F123–38.
Brown DR, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, et al. The impact of quadrivalent human papillomavirus (HPV; types 6, 11, 16, and 18) L1 virus-like particle vaccine on infection and disease due to oncogenic nonvaccine HPV types in generally HPV-naive women aged 16-26 years. J Infect Dis. 2009;199(7):926–35.
Wheeler CM, Castellsagué X, Garland SM, Szarewski A, Paavonen J, Naud P, et al. Cross-protective efficacy of HPV-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by non-vaccine oncogenic HPV types: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. Lancet Oncol. 2012;13(1):100–10.
Muñoz N, Kjaer SK, Sigurdsson K, Iversen O-E, Hernandez-Avila M, Wheeler CM, et al. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst. 2010;102:325–39.
Hildesheim A, Wacholder S, Catteau G, Struyf F, Dubin G, Herrero R, et al. Efficacy of the HPV-16/18 vaccine: final according to protocol results from the blinded phase of the randomized Costa Rica HPV-16/18 vaccine trial. Vaccine. 2014;32:5087–97.
Serrano B, Alemany L, Tous S, Bruni L, Clifford GM, Weiss T, et al. Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease. Infect Agent Cancer. 2012;7:38.
Monsonego J, Zerat L, Syrjänen K, Zerat JC, Smith JS, Halfon P. Prevalence of type-specific human papillomavirus infection among women in France: implications for screening, vaccination, and a future generation of multivalent HPV vaccines. Vaccine. 2012;30(35):5215–21.
Henderson L, Clements A, Damery S, Wilkinson C, Austoker J, Wilson S. HPV Core messages writing group. 'A false sense of security'? Understanding the role of the HPV vaccine on future cervical screening behaviour: a qualitative study of UK parents and girls of vaccination age. J Med Screen. 2011;18(1):41–5.
Hendry M, Lewis R, Clements A, Damery S, Wilkinson C, HPV? Never heard of it': a systematic review of girls' and parents' information needs, views and preferences about human papillomavirus vaccination. Vaccine. 2013;31(45):5152–67.
Mukhopadhyay S, Ray S, Dhar S, Bandyopadhyay R, Sinha SK. Evaluation of the category high-grade squamous intraepithelial lesion in the Bethesda system for reporting cervical cytology. J Cytol. 2013;30(1):33–5.
Capra G, Giovannelli L, Matranga D, Bellavia C, Guarneri MF, Fasciana T, et al. Potential impact of a nonavalent HPV vaccine on HPV related low-and high-grade cervical intraepithelial lesions: a referral hospital-based study in Sicily. Hum Vaccin Immunother. 2017;13(8):1839–43.
The authors would like to thank the study participants and the clinicians, nurses and laboratory technicians of University General Hospital of Elche who were involved in the study.
This work was supported by the "Fundación para la Investigación del Hospital Universitario de Elche" (FIBELX) and the private Fundación Navarro Tripodi. The funders were not involved in the study design, data collection, analysis, or manuscript writing nor in the decision to submit the manuscript for publication.
The dataset supporting the conclusions of this article are available upon request to the corresponding author.
Faculty of Nursing, University of Cantabria, Avda Valdecilla s/n. C.P.: 39008, Cantabria, Spain
María Paz-Zulueta, Paula Parás-Bravo & Miguel Santibañez
Department of Microbiology and Parasitology, University Hospital of Burgos, C/ Islas Baleares, 3 - C.P.: 09006, Burgos, Spain
Ledicia Álvarez-Paredes
Department of Microbiology, University General Hospital of Alicante. Pintor Baeza, 11- C.P.: 03010, Alicante, Spain
Juan Carlos Rodríguez Díaz
Department of Pathological Anatomy, University General Hospital of Elche. Camí de l'Almazara, 11 – C.P.: 03203, Alicante, Spain
Ma. Encarnación Andrada Becerra
Department of Gynecology, University General Hospital of Elche. Camí de l'Almazara, 11 – C.P.: 03203, Alicante, Spain
José María Rodríguez Ingelmo
Department of Microbiology, University General Hospital of Elche. Camí de l'Almazara, 11 – C.P.: 03203, Alicante, Spain
María Montserrat Ruiz García
Department of Infectious Diseases, University Hospital of Alicante. Pintor Baeza, 11- C.P.: 03010, Alicante, Spain
Joaquín Portilla
María Paz-Zulueta
Paula Parás-Bravo
Miguel Santibañez
MPZ, MS, JCRD were responsible for the study conception and design; MPZ and LAP were responsible for data interpretation and manuscript preparation. PPB interpreted analyses and edited manuscript. MEAB and JMRI managed the study including data collection and conceived manuscript. MMRG and JP made critical revisions to the paper for important intellectual content. All authors read and approved the final version of manuscript.
Correspondence to María Paz-Zulueta.
The research protocol was approved by the Elche clinical research ethics committee and data were anonymised prior to statistical analysis. Data were treated anonymously and confidentially under Spanish Organic Law 15/1999 of 13th December, on Personal Data Protection.
The written human subject consent was not considered necessary by the Elche clinical research ethics committee. Our study was a cross-sectional study and we used secondary records of gynaecology and microbiology services.
Characteristics of the studied population, distribution of HPV genotypes, and histological classification of cervical smears. (DOCX 18 kb)
Paz-Zulueta, M., Álvarez-Paredes, L., Rodríguez Díaz, J.C. et al. Prevalence of high-risk HPV genotypes, categorised by their quadrivalent and nine-valent HPV vaccination coverage, and the genotype association with high-grade lesions. BMC Cancer 18, 112 (2018). https://doi.org/10.1186/s12885-018-4033-2
Accepted: 23 January 2018
Inoculation
High-risk Genotypes
Nine-valent Vaccine
Unvaccinated Subjects


text:
University of California data breach compromises confidential information
What the Colonial Pipeline ransomware attack suggests about critical infrastructure security
Accellion FTA,
cyberattack,
cybersecurity,
Data Breach,
data leaking,
hacking,
Incidents,
The recent cybersecurity incident at the University of California led to the compromise of confidential information, as confirmed by university executives this week. This unauthorized access was reportedly realized through abuse of a critical vulnerability on the Accellion FTA server, an online file sharing platform.
On Monday, the University published a more detailed report on the incident, confirming that threat actors managed to compromise information from former and current administrative employees, pensioners, beneficiaries, students, professors and others who participated in some programs open to the general public.
Among the information compromised are confidential details such as
Full names
Dates of birth
Social security numbers
The report also mentions that people who applied for courses from the 2021-2022 academic periods may also have been affected by this incident.
As a result of this incident, the University's executives decided to stop using Accellion FTA, so right now they are migrating their resources to a more secure solution: "We have de- unsubscribed the FTA system from our networks and are in the process of transitioning to a new file transfer system with enhanced security controls, implementing additional system monitoring across our network." However, the security flaw in Accellion abused by the hackers responsible for this attack was also corrected.
In addition, the University will offer all affected individuals one year of free monitoring service to prevent any attempted attack related to this incident: "Within the next 45 or 60 days we will notify all users about the incident, plus we will establish mechanisms to address the data breach," concludes the University of California.
So far an exact number of affected users have not been confirmed, although the incident will be investigated by the Federal Bureau of Investigation (FBI) and private security firms to hear all the details of the matter.
To learn more about information security risks, malware variants, vulnerabilities and information technologies, feel free to access the International Institute of Cyber Security (IICS) websites.
The post University of California data breach compromises confidential information appeared first on Information Security Newspaper | Hacking News.
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Job perspectives for mechanical engineers are outstanding. Machine building is the most important industry in Germany, and mechanical engineers trained in Germany have a broad range of employment possibilities.
Mechanical engineers are empoyed at lot of business branches. These are not only the typical machinery manufacturers, but also plastics industriy, all types of material processing, automotive industry and energy.
In the seventh semester students do a 900 working hour internship and write their bachelor's Thesis.This is already on the path to a job in industry. During this internship the students are obliged to work "like a young engineer" - this means to assist at engineering tasks in a company.


When politicians say, "Support our troops" or "Honor our troops," it sounds bossy, hypocritical, and self serving to me. The more I listen to politicians, the more I realize that they are obsessed with power and their careers. To get power and secure a long career, they avoid standing alone, so they bury themselves in their political party and its agenda. Then, money and support from their political party pours in.
When I hear politicians talk about our troops, I get the feeling they are alluding to our soldiers as belonging to their political party. The honorable solder I envision is of neither political party. That soldier embraces ideals that are higher and transcend petty politics. His or her values and character must stand up against life and death struggles.
When I think of our veterans in a positive way: that is, when a politician is not in my face using our military forces as a propaganda tool, I think of an individual soldier; that soldier's sacrifices; the parents, spouse, and children s/he had to leave behind. I see that soldier following orders with unquestioning and unwavering obedience. S/he is asked to risk his or her life and to kill.
S/he is required to be courageous. REQUIRED! That's the minimum required of every solder and it is a high standard. I also picture that soldier as being good and making good decisions, representing the United States with honor. By "good," I mean possessing character s/he manages to cling to through adversity while looking outside self to do good under the circumstances; disabling the enemy, supporting each other, and honoring innocent life.
When that solder returns home s/he is wasted and tired inside. S/he has faced life and death fear. S/he has lost friends. S/he may have lost body parts. S/he may have enjoyed killing the enemy and s/he cannot express that and it has no context here at home. S/he needs time to decompress and reorient. S/he needs time to appreciate and adopt civilian peacetime values.
We were not generous in giving that soldier armor while they were abroad in the fight: body armor or an armored vehicle. When s/he returns home, we are not generous with giving the veteran time or support to regain peacetime mental health. That soldier pushes on without complaining the best they can as they always have. Some soldiers adapt to civilian life and some don't.
Why politicians don't support our troops and veterans more than they do, while talking so much about it, escapes my comprehension.


Guy A sits down and meditates about being a great guitarist. Although I respect your opinion, I would suggest that you should do some more detailed research on the subject. How do I feel being with this person? Remember, it's all about having a balanced perspective, which is what meditation helps facilitate. The beginning and the end of the day are the best times for sitting meditation. Mindfulness-based stress reduction as a stress management intervention for healthy individuals: A systematic review.
And even when the mind does start to wander, because of the new connections that form, meditators are better at snapping back out of it. What are the dangers regarding Buddhist meditation? In the end, this means that you are able to see yourself and everyone around you from a clearer perspective, while simultaneously being more present, compassionate and empathetic with people no matter the situation. This is a state in which the excessive and stress producing activity of the mind is neutralized without reducing alertness and effectiveness. For example, when you experience pain, rather than becoming anxious and assuming it means something is wrong with you, you can watch the pain rise and fall without becoming ensnared in a story about what it might mean. Hey Victor, You may want to think of meditation as the art of not thinking.
The one apparent answer is guiding people to perform devotional exercises. Everyone from and congressman Tim Ryan to companies like Google and Apple and Target are integrating meditation into their schedules. That spiritual meaning could be a connection with something or someone else when chanting the word or sound. What is important is to be physically comfortable. With increased mental sensitivity the short-term pleasure often seems less and less worth the frequent bad side-effects have you ever seen anyone with a bad hangover? Thank you very much and looking forward for more informative articles in the future.
I prefer to sit on a mat with my back leaning against the pillow on the wall. You can only control the impulse to indulge in your weakness when you Inner Observer is strong enough to detect it. Erwan Meditation can be an effective form of stress reduction and has the potential to improve quality of life and decrease health care costs. Notice the difference when you look out on a sunny day. After a few years, Guy B is a pretty good guitarist. Physical body feels as if it dissolves into energy, mind is without thought, with complete awareness, breath flows in and out as if in a constant flow, one moves without any apparent effort, and there is only feeling of peaceful joy in the heart.
Sitting still and doing nothing is for retirees. If the value of S. Bottom line - meditation will help people who focus too much on other people because it will allow them to activate their lateral prefrontal cortex Assessment Center more often which will allow them to take a more balanced approach to themselves and others. If I could give you the single one advice about life that would be it:. I take two people and I put a small object like a dice or a coin and put it between them on the table. Although this is not something I have thought a lot about, that is my best answer right now. We have a nice expression in the monastery using the image of the donkey - 'No carrot, no stick'.
In addition, our practice can help us relax, release stress, and return to our present-time experience. One of the main problems I had when I began meditating was restlessness. Focusing the mind on the natural rising and falling of the breath brings a lot of calm. Sometimes, sitting still, a clear mind after a day of good effort in practice, it seems to be right next to me. Socializing with people is much easier now, more spontaneous. If the blueprint doesn't work, no one can follow it. If you love to do garden work, then every time you hear meditation replace it with gardening.
Last Updated On: December 11, 2018 5 Simple Ways to Practice Meditation at Work Trying to practice meditation at work can be difficult. I get the same feeling from running, swimming, or even climbing a tree. Meditation can help carry you more calmly through your day and may help you manage symptoms of certain medical conditions. How does meditation restrain the senses? Mindfulness exerts its effect by promoting a sense of detachment and by reducing the subjectively experienced saliency of the heated metal plate. Buddhism is just one path to freedom - some people find it useful, some not. And when I notice fear has replaced love as my operating fuel, then I try to focus on my breath—counting at least one in and one out.
Calmness and clarity are the social or psychological results of meditation. Our advice for new practitioners is to try meditation daily for a month, then weigh the pros and cons. Also to think on abstract issues, that have no words. Choose one usually simple thing as your meditation object. Due to his way of life, attitude, and exercise regim, the relative improvment by meditation would be so small.
Back in the early 2000s, the Dalai Lama asked Emory University to develop a sustainable curriculum in modern science for his Tibetan Buddhist monks and nuns in exile in India. I remember reading a story about a well-respected zen monk who was asked when does he meditate? The Earth will not stop revolving. Clarity, calmness, and improved focus are some of the potential psychological that come to light relatively quickly. Without meditation practice, many people are too internally self-centered, take everything personally, and do not consider others' wellbeing as they pursue their own. So, if I have been very busy and my mind is all stirred up, I begin my meditation with some samatha. However, it does little for spelling or typing skills…have fun.
Can anyone give me any suggestions. By being unable to sit for 10 minutes without anxiety shows you have other problems. Recommend this article by Roosh V : This is great. I believe some people don't benefit from meditation, and I wish more meditation advocates would be more forthright about this. Walking meditation is my chosen way, it allows me to breathe deeply, quiet my mind, and get the exercise benefits of walking. I tell beginners to be flexible in how they bring mindfulness into their lives.


text:
Q: Using gglocator() within another function I'm trying to use gglocator() within a function that looks like this:
my_function<- function(point_num) {

 x11()

 iris %>%
   ggplot()+
     aes(Sepal.Width,Sepal.Length)+
     geom_point()

 points <- gglocator(n = point_num, mercator = FALSE)

 return(points)
}

which gives me the error: Error in gglocator(n = point_num, mercator = FALSE) :  ggplot graphic not detected in current device
It works fine if I do it line by line outside the function.
What am I missing?

A: Running ggplot inside a function doesn't automatically print the produced ggplot object the way it does in the console.
Remember that in an interactive session in the console, any object returned by the code you type will be automatically printed: if you type sum(1:5) in the console, then the result [1] 15 is printed to the console. However, if you randomly include the line sum(1:5) in the middle of a function, it will have no effect and the result is not printed. The same is true of ggplot objects.
So the solution is to wrap your plotting code in an explicit call to print:
library(ggmap)

my_function<- function(point_num) {

 x11()

 print(iris %>%
   ggplot()+
     aes(Sepal.Width,Sepal.Length)+
     geom_point())

 points <- gglocator(n = point_num, mercator = FALSE)

 return(points)
}

my_function(1)

#>   Sepal.Width Sepal.Length
#> 1    2.707581     5.196849

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Pet Juice Bottles of superior range and quality is available with us. The pet Juice Bottles are fabricated using the superior grade PRE FORM as the raw materials and advanced machinery that are purchased from best manufacturers in the industry. The Pet Juice Bottles are widely used in, juice making, Retail and Packaging industries. The Pet Juice Bottles have gained wide popularity in the domestic and international market.


text:
Portugal - Domestic Material Consumption of Wood
Since 2014, Portugal Domestic Material Consumption of Wood rose 3.1% year on year. In 2019, the country was ranked number 7 comparing other countries in Domestic Material Consumption of Wood at 16.8 Million Metric Tons. Portugal is overtaken by United Kingdom, which was number 6 at 20.92 Million Metric Tons and is followed by Austria at 16.8 Million Metric Tons. Sweden lead the ranking with 52.6 Million Metric Tons in 2019, that is a fall of 1.5% versus 2018. Finland, Germany and France respectively ranked number 2, 3 and 4 in this ranking. Croatia recorded the best 5 years average growth at +13.8% per year, while Slovenia witnessed the worst performance at -12.8% per year.
How does Portugal rank in Domestic Material Consumption of Wood?
20.92 2019 +2.2 % +4.5 % View data
How does Portugal perform in the Wood industry?
Export of Wood Marquetry and Inlaid Wood, Cases for Jewellery or Cutlery and Similar Wooden Articles, Statuettes and Other Wooden Ornaments from Portugal
Exports of Wood Prefabricated Buildings in Portugal
Import of Parts and Accessories of Machine Tools for Working Wood, Cork, Stone, Hard Rubber and Similar Hard Materials to Portugal
Gross Domestic Product Per Domestic Material Consumption of Wood in Portugal
Timber Domestic Material Consumption in Portugal


Acoustic demos for the Machina album, recorded at Billy's home. The tape includes two lyrically different versions of Blue Skies Bring Tears, one containing the lyrics from the arrangement of the song performed during The Arising! Tour in April 1999. Lover is the song bootlegged as Don't Wanna Be Your Lover or One Less Moment.


text:
Il cebo dorato o cappuccina bionda (Sapajus flavius ) è un primate platirrino della famiglia dei Cebidi.

Distribuzione e habitat
Vive nelle aree costiere del Brasile nord-orientale (stati di Pernambuco, Alagoas, Paraíba).

Tassonomia

Note

Altri progetti

Cebidi
Fauna endemica del Brasile

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