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Knowledge of PEP and PrEP among people living with HIV/aids in Brazil
Laelson Rochelle Milanês Sousa ORCID: orcid.org/0000-0001-6018-54391,
Henrique Ciabotti Elias2,
Nilo Martinez Fernandes3,
Elucir Gir1 &
Renata Karina Reis1
BMC Public Health volume 21, Article number: 64 (2021) Cite this article
Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are key to preventing sexual transmission of HIV, whose sexual partners are at high risk of acquiring HIV.
We aimed to determine the factors associated with PrEP and PEP's knowledge as secondary prevention among people living with HIV/AIDS.
Cross-sectional analytical study carried out among people living with HIV/AIDS treated at five specialized services in the city of Ribeirão Preto, São Paulo, Brazil. Data were collected from July 2016 to July 2017. Individual interviews were conducted. We used multivariable logistic regression to determine factors associated with knowing PrEP and PEP.
Of the 397 participants, 140 (35.26%) were heterosexual women aged 40 to 49 years (36.2%).Participants with less than 11 years of study (adjusted odds: 0.29; 95% CI: 0.13–0.60); who did not have a low viral load or did not know their viral load (adjusted odds: 0.29; 95% CI: 0.09–0.83) and those with casual partners (adjusted odds: 0.29; 95% CI: 0.09–0.83) were less likely to know about the PrEP. MSM (adjusted odds: 2.88; 95% CI: 1.59–5.3) and those who used alcohol during sexual intercourse (adjusted odds: 1.7; 95% CI: 1.0–2.8) were more likely to know about the PEP.
The knowledge about PEP and PrEP is low in Brazil. This may undermine secondary prevention efforts. Educational interventions to raise awareness of these prevention methods are needed among people living with HIV and who have HIV-negative sexual partners.
Infection caused by the Human Immunodeficiency Virus (HIV), almost five decades after notification of the first cases, remains a worldwide public health problem, despite all the advances achieved in the treatment and expansion of prevention strategies. It is estimated that approximately 37.9 million people live with HIV worldwide by the end of 2018 [1].
In Brazil, in 2018, 43.941 new cases of HIV infection and 37.161 cases of AIDS were reported, totaling 966,058 AIDS cases detected in the country [2]. Since 1996, the country has offered antiretroviral treatment through the Unified Health System (SUS) for People Living with HIV (PLHIV) and was one of the pioneer countries among low and middle incomes. From 2013, SUS guarantees treatment for all PLHIV, regardless of the stage of the disease and the CD4 T lymphocyte count. More than 30 years after the first case, the epidemic continues to expand. New infection rates have remained persistently high over the past decade, with an estimated 48,000 new HIV infections per year, even with coverage of antiretroviral treatment (ART) in SUS [3].
The rate of AIDS detection has decreased in Brazil in recent years in the Southeast, South, and Midwest regions, while in the North and Northeast regions, they have shown an increasing trend in detection [2]. HIV infection in the Brazilian population has an estimated prevalence rate of 0.4%. However, the epidemic disproportionately affects key populations as women sex workers, men who have sex with men, and transgender women [4].
The main route of HIV transmission is sexual, among people aged 13 and over, in 2018 in all regions, both men (78.9%) and women (86.9%) [2]. In the early years of the HIV epidemic, condom use was practically the only method of preventing sexual transmission of HIV widely recommended and widespread throughout the historical path of the epidemic [5]. Condoms have advantages in low cost, easy access, and low adverse effects when they are adopted consistently and correctly. Besides, they effectively prevent other sexually transmitted infections [6] and are considered fundamental to a comprehensive approach to prevention [7].
However, this strategy does not eliminate the risk of HIV transmission. A systematic review study showed that the consistent use of condoms (for all acts of vaginal penetration) in heterosexual relationships results in an 80% reduction in the incidence of HIV [8] and 70% among male homosexuals (for anal sex) [9]. Studies have also shown inconsistent condom use among partners living with HIV and relating to HIV-negative people or with unknown HIV status [6, 10].
A study conducted in Brazil identified that PLHIV undergoing clinical-outpatient follow-up who had less education, multiple sexual partners, using alcohol or other drugs, do not receive advice from a healthcare professional. They have no knowledge of treatment as prevention. Not knowing that undetectable viral load reduces the risk of human immunodeficiency virus transmission was associated with inconsistent condom use [6], which reflects the difficulty in accessing health information to assimilate the orientations received and to change health behavior.
Also, aspects related to social gender norms determine a low power of sexual negotiation for Brazilian women making them more likely to have unprotected sex. Despite the advancement of feminist movements, women's role in sexuality and their responsibility for reproductive issues hinders dialogue with their partners and increases vulnerability [11].
Gender-based violence reduces engagement for women living with HIV at multiple care continuum levels [12]. It might be a particularly salient issue for the Latin American region, where high rates of intimate partner violence, sexual assaults, and femicide have been documented [13, 14].
Therefore, important advances in the field of HIV prevention have provided paradigm shifts with the implementation of combined biomedical, behavioral, and structural interventions [15]. Combined prevention is a broader concept that combines different prevention methods that can interfere with the sexual transmission of the virus, with the use of antiretrovirals, including Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP), termed as biomedical interventions. Such strategies have been considered to be effective in reducing the risk of HIV transmission and are part of combined prevention [16].
As a result of advances in HAART, post-sexual exposure to HIV prophylaxis (PEP) was implemented in 2012, is a method used in situations where sexual exposure to HIV occurs, especially when the sexual act was performed in the absence of condoms, or in times of condom failures, such as breakage or problems with structural characteristics due to inappropriate use. Their use can reduce the risk of acquiring the infection through a therapeutic regimen with antiretrovirals [16].
PrEP was implemented in Brazil by the public health system on December 1, 2017 [13] and is an important advance in prevention and is used before exposure to the virus, recommended for homosexuals, men who have sex with men (MSM), transgender, sex workers, people who use drugs, those who are incarcerated, serodiscordant partnerships, taking into account also the repetitions of anal and/or vaginal sexual practices with penetration without the use of condoms, frequency of sexual relations with casual partners, quantity and diversity of sexual partnerships, contexts of transactional sex (for money, valuables, housing, drugs, among others), history of sexually transmitted infections and repeated search for post-exposure prophylaxis (PEP) [17,18,19].
Although these two biomedical interventions based on drug treatment are considered essential for prevention, there are gaps in the knowledge of both HIV-negative/unknown people and among PLHIV. When revisiting studies that investigated the awareness of PrEP and PEP, it was found that the levels were below expectations. Even with the release of the use of PrEP in the United States [5]. Similar results were observed among Nigerian university students [14]. In Canada, MSM demonstrated incipient knowledge about PrEP, including those who were HIV-negative and HIV-positive [14].
To achieve relevant results in HIV prevention, through the use of such strategies, it is necessary to expand awareness and use education actions, focusing on people most exposed to the virus [20], such as sexual partners, whether fixed or casual, of PLHIV. Besides, expanding education actions for the general population may contribute to adherence to HIV prevention methods.
In general, knowledge about PrEP and PEP is surprisingly low, both in developed countries [21,22,23] and in developing countries, as in Brazil [23]. However, studies conducted in three countries in Latin America and the United States of America show that interest in using PrEP is high among key populations [5, 24].
Antiretroviral drugs, used as antiretroviral therapy (ART) and PrEP, are powerful HIV prevention tools for HIV serodiscordant couples. Although the HIV prevention effectiveness of ART and PrEP is proven, the prevention benefits are only realized when adherence is high [25]. Also, the residual risk of HIV transmission persists during the first 6 months of ART, with incomplete viral suppression in blood and genital compartments. For HIV-serodiscordant couples in which the infected partner is starting ART, other prevention options are needed, such as pre-exposure prophylaxis, until viral suppression is achieved [26].
In this context, current World Health Organization [27] guidelines recommend ART for all HIV positive adults diagnosed with HIV and PrEP as part of the HIV prevention combination for people at substantial risk of HIV, including HIV negative partners of couples. Due to the scarcity of studies that address the theme in Brazil, this study aimed to analyze the factors associated with the knowledge of PEP and PrEP as secondary prevention among people living with HIV/AIDS to improve policies for the implementation and distribution of strategies in a broader prevention plan among people at risk of infection.
This is a cross-sectional and analytical study conducted with people living with HIV undergoing clinical-outpatient follow-up at five health services in a city in the interior of the state of São Paulo, Brazil. The health services in which the study was conducted are specialized in serving people living with HIV.
Participants needed to meet the following criteria to be included in the study: being aware of the diagnosis of HIV infection; being 18 years of age or older; being under clinical-outpatient monitoring at selected health services; have an active sex life and a seronegative or unknown serological status partner for HIV in the last 6 months. Also, they were excluded if they were in confinement, regardless of the type of institution.
Data were collected from July 2016 to July 2017. Individual interviews were conducted, in a private environment, by researchers trained for this function. The participants' approach occurred at the time of their visits to the health services, and the interviews were scheduled according to the time chosen by the participant, before or after the medical consultation, if they agreed to participate. The interviews' average duration was 30 min and only started after the participant gave their free and informed consent in writing.
The sample size was estimated from the approximate number of people with active records in the municipality's specialized services where the study was conducted. Another parameter was the estimate of sexually active people living with HIV after diagnosis (62%). Therefore, the sample was set at 286. The calculation was performed with the aid of software R version 3.4.1. However, more people were included in the study to avoid potential losses from invalid or incomplete questionnaires.
The independent variables of the study were: sexual orientation, age, skin color, education (in years of study), work situation, length of HIV diagnosis, type of partner, partner's serology, use of alcohol during sexual intercourse, use of other drugs during sexual intercourse and condom use. The dependent variables were: having knowledge about PrEP (yes, no) and having knowledge about PEP (yes, no).
The data were tabulated in Microsoft Excel 2010, and after double typing, the databank was exported to the Statistical Package for the Social Sciences (SPSS), version 22.0. Descriptive statistics were used to characterize the sample. Association tests were performed (Chi-square and Fisher's Exact), considering a statistical significance level at p < 0.05.
Logistic regression analysis was used to assess the influence of independent variables on dependent variables, to have knowledge about PrEP and PEP. The automatic variable selection procedure called "Stepwise" was used for the selection of independent variables, using the Akaike Information criterion [28]. For the analysis, the significance level of 5% (α = 0.05) was used. The programs used in the analyzes were SPSS (IBM Corp. Released, 2013) version 22 and R (R Core Team, 2018) version 3.5.3.
The Research Ethics Committee approved the study of the Ribeirão Preto School of Nursing under protocol 084/2016 and CAAE: 52012515.0.00000.5393. All participants signed informed consent forms. The researchers guaranteed the participants anonymity.
This study included 397 people living with HIV. It is noteworthy that 140 (35.3%) were heterosexual women, 136 (34.3%) were men who have sex with men (MSM). 147 (37%) aged 35–44 years and 214 (53.9%) with less than 11 years of study. Notably, 254 (64%) used condoms consistently.
As for knowledge about PrEP, being MSM was a factor associated with having knowledge (p = 0.000). Having less than 11 years of study was associated with not having knowledge about PrEP (p = 0.000), according to Table 1.
Table 1 Sociodemographic and behavioral variables and knowledge aboutPrEP. Ribeirão Preto, SP, 2020
It is noteworthy that being an MSM, having more than 11 years of study, and being employed were associated with knowledge about PrEP (p = 0.001), according to Table 2.
Table 2 Sociodemographic and behavioral variables and knowledge about PEP. Ribeirão Preto, RP, 2020
As for the factors associated with PrEP, participants with less than 11 years of study were (adjusted odds: 0.29; 95% CI: 0.13–0.60) less likely to have knowledge about PrEP compared to participants with more than 11 years of study. Those who did not have a low viral load or did not know their viral load (adjusted odds: 0.26; 95% CI: 0.09–0.83) were less likely to have knowledge about PrEP compared to those with low viral load. Likewise, those with casual partners had (adjusted odds: 0.29; 95% CI: 0.09–0.83) less chance (or a 71% lower chance (1–0.29) of having knowledge about PrEP compared with those who were in a fixed relationship, as shown in Table 3.
Table 3 Adjusted model of factors associated with knowledge of PrEP. Ribeirão Preto, SP, 2020
As for the factors associated with PEP, MSM participants were 2.88 (Adjusted Odds: 2.8788; 95% CI: 1.5912–5.3092) times more likely to have knowledge about PEP than heterosexual male participants. Participants who used alcohol during intercourse were 1.73 (adjusted odds: 1.7305; 95% CI: 1.0656–2.8248) times more likely to have knowledge about PEP than those who did not use alcohol during intercourse.
Participants with less than 11 years of education (adjusted Odds: 0.4331; 95% CI: 0.2564–0.7271) were less likely to have knowledge about PEP compared to participants with more than 11 years of education. Participants who did not have a low viral load or did not know about their viral load (adjusted odds: 0.4054; 95% CI: 0.2493–0.6511) were less likely to have knowledge about PEP than those with low viral load, as shown in Table 4.
Table 4 Adjusted model of the factors associated with the knowledge of PEP. Ribeirão Preto, RP, 2020
Participants in this study had low knowledge of PrEP. People with less than 11 years of study, who did not have a low viral load or did not know about viral load rates, who had fixed partners, were less likely to have knowledge of PrEP. As for the knowledge about PEP, it was identified that MSM and individuals who reported using alcohol during sexual intercourse were more likely to have knowledge about PEP.
International evidence corroborates these findings and indicates that PrEP and PEP awareness is low, even among key populations that are considered a priority for infection control, the percentage of participants who had knowledge about either of the two methods ranges from 18.9 to 47.2% [14, 29]. Besides, a study with MSM identified low awareness of the two methods but a high level of interest in using them [5].
In general, priority populations do not have satisfactory knowledge about sexually transmitted infections and prevention methods. For example, in 12 Brazilian cities, 4176 MSM were recruited to evaluate the knowledge of these individuals about HIV/AIDS. The proportion who had a high level of knowledge was 23.7%, and those with 12 or more years of study were linked [30]. MSM are a key population and, therefore, have access rights to PrEP, and as far as PEP is concerned, it is recommended in specific cases [31]. However, these populations must have knowledge about the infection and its main forms of prevention so that they have access to the methods and can discuss them with their sexual partners.
Some facts have been reported in the literature as barriers to adherence to PrEP. These issues were noted in 2004 when the PrEP movement started in the United States. The volunteers were the target of prejudice with derogatory expressions aimed mainly at gay men. This association between promiscuity and homosexuality also happened in Brazil with headlines from magazines with high circulation. This view can provide individuals with distance from the possibilities of coping with new infections and the quality of life for those who live with HIV [31]. In this sense, the need is emphasized for populations at high risk of infections to have access to quality information about the infection and its prevention and control methods.
A higher level of education was associated with having knowledge about PEP among PLHIV/AIDS residing in Italy. Among MSM, a higher level of education remained an associated factor [32]. Data from a study conducted in the United States showed that attending a college or a higher education course was associated with awareness of PrEP [33]. Such a finding provokes interest in the construction of health education strategies that can reach people with a lower level of education through the provision of information that meets their needs in terms of understanding and access to information, especially with instructions that present the method to those with no knowledge [30].
PLHIV/AIDS and their sexual partners are central to controlling the epidemic [10, 34]. Therefore, providing support to PLHIV strengthens the health professional's bond and can expand their participation in health promotion activities. Community support was found to be relevant for a group of MSM and women. Those who received support were more likely to be aware of PrEP [35]. Building paths to enrich the knowledge of PLHIV about the infection seems to be a challenge that deserves the engagement of governmental and non-governmental entities, health professionals, and civil society to overcome barriers that can hinder access to all forms of prevention available.
The use of alcohol during sexual intercourse was shown to be positive given PEP's knowledge. It is worth mentioning that the use of alcohol in sexual relations makes the individual more vulnerable, including sexual practices without protection [36]. Another important contribution to this discussion is the belief in the toxicity of antiretrovirals with alcohol. That is, to believe that when consuming alcoholic beverages, there may be a decrease in the effect of the ingested medicine. A study on beliefs related to PrEP reported that 75% of participants had beliefs about interactive toxicity between alcohol and antiretrovirals [37].
In this sense, researchers highlighted that the forms of disclosure of PrEP could include messages that generate stigma against its users. A comprehensive view of health should guide strategies to include people without segregating them into pre-existing groups tied to old stigmas [38]. Other studies have corroborated the idea that adherence to PrEP is hindered by stigma, even though its central function is to prevent sexual transmission of HIV [39].
This study has limitations. The fact that this research did not include the affective/sexual partnerships of PLHIV who have negative/unknown serology reduces the understanding of the knowledge of the two methods addressed and centralizes the discussion of the approach to prevention from the perspective of PLHIV/AIDS. Therefore, future research should include sexual partnerships and investigate the complexity involved in negotiating the use of different methods to prevent sexual transmission of the virus.
Knowledge about PrEP and PEP is low among PLHIV in Brazil. People with less than 11 years of study, who did not have a low viral load or did not know their viral load, with casual partners, were less likely to have knowledge about PrEP. Knowledge about PEP was more satisfactory. MSM and participants who used alcohol during sexual intercourse were more likely to have knowledge about PEP. Therefore, providing health education at appropriate times for PLHIV reinforces their knowledge of these methods and may arouse interest in including different prevention strategies in their daily relationships with affective-sexual relationships with negative/unknown status partners.
The data sets used and/or analyzed during the present study are available with the corresponding author upon reasonable request.
HIV:
AIDS:
Human Immunodeficiency Syndrome
PLHIV:
PEP:
Post-Exposure Prophylaxis
MSM:
SPSS:
Statistical Package for the Social Sciences
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The authors would like to thank the São Paulo State Research Support Foundation for the financial support for research. Protocol number: 2015/23008-2.
The author RKR received financial support from the São Paulo State Research Support Foundation. Protocol number: 2015/23008–2.
Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, R. Prof. Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP, CEP: 14040-902, Brazil
Laelson Rochelle Milanês Sousa, Elucir Gir & Renata Karina Reis
Department of Nursing, Federal University of TriânguloMineiro, Uberaba, Minas Gerais, Brazil
Henrique Ciabotti Elias
Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
Nilo Martinez Fernandes
Laelson Rochelle Milanês Sousa
Elucir Gir
Renata Karina Reis
Conceptualization, L.R.M.S., R.K.R., and E.G.; Methodology, R.K.R., L.R.M.S., H.C.E., and N.M.F.; Formal Analysis, R.K.R., and N.M.F.; Investigation, L.R.M.S., and H.C.E.; Resources, L.R.M.S., H.C.E., N.M.F., E.G., R.K.R.; Data curation, R.K.R.; Funding acquisition, R.K.R.; Writing—original draft preparation, all authors.; Writing—review and editing, all authors.; Visualization, R.K.R and E.G.; Supervision, R.K.R and E.G.; Project administration, R.K.R and E.G.; All authors have read and agreed to the published version of the manuscript.
Correspondence to Laelson Rochelle Milanês Sousa.
The study was approved by the Research Ethics Committee of the Ribeirão Preto School of Nursing under protocol 084/2016 and CAAE: 52012515.0.00000.5393. All participants signed informed consent forms.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Sousa, L.R.M., Elias, H.C., Fernandes, N.M. et al. Knowledge of PEP and PrEP among people living with HIV/aids in Brazil. BMC Public Health 21, 64 (2021). https://doi.org/10.1186/s12889-020-10135-3
Infectious Disease epidemiology
Submission enquiries: bmcpublichealth@biomedcentral.com


migraine is clearly an important future direction in this research. General population samples are critical for investigating associations between migraine and other disorders. In fact, the first reference to the term "comorbidity" described potential confounding and bias in treatment trials that fail to consider secondary conditions that are overrepresented in clinical samples. Although comorbidity of migraine and numerous other conditions have long been reported in clinical samples, etiologic inferences are precluded by the role of comorbid disorders in treatment seeking for primary disorders.[98, 99] There is now a strong evidence base from population-based surveys regarding Selleckchem Gefitinib associations between migraine and musculoskeletal conditions, cardiovascular disease, particularly ischemic stroke, asthma, allergies, and other immune and inflammatory disorders, and epilepsy.[6, 49, 54, 99, 100] Although most studies of comorbidity have been conducted in Europe and the U.S., there are also emerging data from Africa, Asia,[69, 101, 102] and South America. Many of these studies have examined the specificity of the associations between comorbid disorders with migraine by including comparison groups of non-migraine headache and other pain conditions.


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WCW Blog
Research & Action Report
Women's Review of Books
Scholars & Trainers
Council of Advisors
Why So Few Women at the Top? A Review of Women's Corporate Leadership Literature
Author: Sumru Erkut, Ph.D.
There is greater gender and racial/ethnic diversity in top corporate leadership in the new millennium than existed even three decades earlier. Nevertheless, visible leadership remains primarily white and male. The goal of this literature review is to examine critically the commonly debated explanations of why women's progress to upper levels of corporate leadership has been slow. The literature review identifies external barriers such as the workplace not being designed with women's needs in mind, the burdens of tokenism, and covert discrimination, especially against women of color. The paper concludes with the observation that, more than anything else, the perception of leadership as a masculine activity and the belief that women lack the necessary qualifications to function effectively in executive positions explain why so few women have reached the top of the corporate hierarchy. The good news is that if decision makers are familiar with a woman and her record of accomplishment, she is more likely to be promoted. In other words, knowledge of a woman's work can trump the negative impact of stereotypes.
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You can use the Duplicate Post plugin if you want to be able to make copies of Services pages rather than starting with a blank page each time you create a new service.
1. Install the Duplicate Post plugin.
2. Go to Settings > Duplicate Post and click the "Permissions" tab.
3. Under "Enable for these post types" section, check the "Services" checkbox.


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OCT Imaging Best to Determine Stent Size?
— Triple comparison trial says yes, but clinical impact still unclear
by Nicole Lou, Staff Writer, MedPage Today October 31, 2016
WASHINGTON -- Using optical coherence tomography (OCT) to guide percutaneous coronary intervention (PCI) didn't lead operators to undersize stents compared with intravascular ultrasound (IVUS), the randomized ILUMIEN III: OPTIMIZE PCI study found.
With a standardized OCT strategy for stent sizing based on pre-intervention OCT measurements of external elastic lamina, to overcome the problem of incomplete vessel wall visualization, minimum stent area was comparable for OCT- as for IVUS-guided procedures in the cath lab (median 5.79 versus 5.89 mm2, Pinferiority=0.001).
OCT was not superior to minimum stent area after angiography, the go-to for most operators (P=0.12), reported Ziad A. Ali, MD, DPhil, of New York-Presbyterian Hospital/Columbia University Medical Center, at the annual Transcatheter Cardiovascular Therapeutics meeting and online in The Lancet.
However, OCT led to greater stent expansion (16.6% versus 12.9%, P=0.02) and acute procedural success (P<0.05) than did angiography as well as fewer untreated major dissections (14% versus 26%, P=0.009) and cases of malapposition (11% versus 21%, P=0.02) than with IVUS guidance, Ali's group noted.
"These data warrant a large-scale randomized trial to establish whether or not OCT guidance results in superior clinical outcomes to angiography guidance," the authors wrote.
"Although this finding certainly appears to be important, the clinical significance of these imaging-detected complications remains to be further elucidated. Indeed, use of potential surrogate measures of clinical outcomes (the primary measure and focus of this study) should be viewed with caution," argued Ravinay Bhindi, MBBS, PhD, and Usaid K. Allahwala, MBBS, both of Australia's Royal North Shore Hospital.
"The notion of changing management by a strategy such as OCT because of its ability to detect suboptimal stent deployment is based on perceived issues or problems rather than real validated prospective clinical outcomes. This putative advantage has been speculated as a benefit for years, yet has not translated into any meaningful clinical result yet," they wrote in an accompanying editorial.
Procedural major adverse cardiac events occurred in 3% of OCT, 1% of IVUS, and 1% angiography cases (P=0.37 for difference between OCT and IVUS/angiography) in ILUMIEN III: OPTIMIZE PCI, which included 450 patients randomized to OCT, IVUS, or angiography for guidance of stenting done between 2015 and 2016 at 29 hospitals in eight countries.
The external elastic lamina measurement that was the proposed basis for sizing by OCT was measured by operators in 85% of cases and actually used for sizing only in 75% of cases, Bhindi and Allahwala commented. "Furthermore, operators using this technique had considerable expertise in intravascular imaging, meaning its broad applicability is unknown."
The editorialists suggested weighing the potential benefit of increasing minimum stent area against the negatives of OCT, "including disruption of plaques in vessels during imaging, patients having longer procedures with more contrast than with angiography alone, and the obvious extra cost to the patient, insurer, and health-care system."
"Although this study strengthens the evidence for intracoronary OCT use, whether or not it should be used routinely in all cases remains unclear and in this regard, is therefore still not ready for widespread use and further clinical outcome-based studies are necessary," Bhindi and Allahwala concluded.
ILUMIEN III was funded by St. Jude Medical.
Ali reported receiving grants from St. Jude Medical and personal fees from St. Jude Medical, Acist Medical, and Cardiovascular Systems.
Co-authors declared numerous ties to device makers as well.
Bhindi and Allahwala disclosed no relevant conflicts of interest.
Source Reference: Ali ZA, et al "Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): A randomised controlled trial" Lancet 2016; DOI: 10.1016/S0140-6736(16)31922-5.
Source Reference: Bhindi R and Allahwala UK "Optical coherence tomography: Not quite ready" Lancet 2016; DOI: 10.1016/S0140-6736(16)32062-1.


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Visiting the Historic Harpers Ferry – Things to Do & Travel Guide
Posted on Friday, June 3, 2022
I live so close to Harpers Ferry and had heard so much about it from friends. But for some reason, I hadn't been until during the pandemic. However, I was so pleasantly surprised to visit and see this centuries-old town for myself.
A History of Harpers Ferry
Harpers Ferry has a fairly straightforward history. The land belonged to a man named Robert Harper in 1750, and in 1761 he established a ferry to bring passengers into the Shenandoah Valley and farther west – thus the name Harpers Ferry. (the lack of an apostrophe was intentional) Being right at the corner of Maryland and Virginia (West Virginia didn't exist until the Civil War), the site was a gateway to the west. In 1833-34, Harpers Ferry became a part of the Chesapeake & Ohio Canal as well as the B&O Railroad.
After the Revolutionary War, when tensions with the British were still high, an arsenal and armory were put in Harpers Ferry. This became very important because on October 16, 1859, Harpers Ferry's most famous event occurred: John Brown and 21 men raided the arsenal and attempted to supply a slave uprising. They were only successful for a few hours before they were captured and John Brown was hanged for treason. If you've studied the American Civil War at all, you've probably heard of John Brown's Raid on Harpers Ferry. It was one of the uprisings that helped spark the Civil War a year later.
Harpers Ferry was always a transient place, but a lot of the locals left during the Civil War because of all the turmoil. Because of its location, again, it became a highly militarised area.
Map thanks to Wanderlog, a vacation planner app on iOS and Android
Things to Do in Harpers Ferry
Today, it's still a sleepy town, but one that's popular with local hikers. I didn't know what Harpers Ferry was all about until I visited and I was pleasantly surprised by how attractive this place is. It's a step back in time to the 19th century and the striking scenery is gorgeous.
There are small museums scattered throughout the town that tell the history of what Harpers Ferry was like in the 1850s/60s. It's really cute to see everything done up with decor that would've been used centuries ago. The museums are small but free to stop in and have a peek. You can see John Brown's Fort and imagine what it must have been like back in 1859.
One place I recommend going is True Treats Historic Candy. It's a candy shop that sells historically accurate and inspired candy and it's not just limited to the Civil War era. The tags also have historical facts about the candy so it's a learning experience as well. I found out the ancient Egyptians had marshmallows. This is a super cool place to stop in and buy from. But don't worry – if you can't make it to Harpers Ferry, they do sell their products online.
Aside from the hike (detailed below), the main appeal of Harpers Ferry is its old town charm. The U.S. has a lot of its history in mining and the industrial revolution but very few small industrial towns like Harpers Ferry remain. It's a unique place and all the buildings along the hills make it incredibly picturesque. The operating buildings are also filled with restaurants and independent craftsmen.
There are also a lot of small museums you can pop in, each dedicated to what life looked like in 1859. You can visit the John Brown's Museum and John Brown's Fort, where the men barricaded themselves in during the raid. There's also a Civil War Museum and a small Industry Museum. There are other historic places to stop in like a convenience store, a provost office, and a clothing store. All these places are very small and you can only look into several of them. If you want to see everything mentioned then you'll probably need a couple of hours maximum as there's not so much to see.
The Harpers Ferry Hike
I made a big mistake when I went to Harpers Ferry: I didn't know it was a place for hiking! My GPS gave me directions to the lookout area so I thought, "Oh, I'll just drive up to the viewing platform since I'm not a big hiker." Well, GPS was wrong. The only way to get up to the hill that overlooks Harpers Ferry is to climb. So there I was on a very hot day without good shoes, food, or water.
"Doesn't look like a huge climb," I thought. So I got across the bridge and up the hill a bit. I was dying but I felt I'd made a lot of progress. Then I got to a sign that said:
Welcome to the Harpers Ferry Hike! It will take at least 3 hours to reach the top from here.
(That's not verbatim but close enough.)
The hike loops around the hill, which is why it takes a lot longer than I'd imagined. Since I was half dead at this point, I decided to just turn around. Maybe I'll make it back one day, but now you know not to make the same mistake I did!
To access the hike, you'll have to go across the bridge to the other side of the river. Then you'll go to the left parallel to the street on a walking path. After walking a few minutes, you'll see a bridge on the right hand side of the path. (There are a few bridges but this is the first one you'll see.) Go across the bridge and across the street to the entrance of the hike. There's no big sign or anything but you'll see there's a cleared path that starts up the mountain. After a few minutes walking up, you'll get to the welcome sign that has the map of the trail.
Hopefully, there will be enough people there to follow so you don't need to find the way yourself. But definitely make note of where the hike starts because it's difficult to find if you don't know where to look.
Also important to know is parking! I skipped a few spaces in town and headed towards the official parking lot. Big mistake. Not only did it cost $20 (!!!) to get in, but it's so far away that you'll either need to do a 2-mile hike or take a free shuttle between town and the parking lot. Of course the money does go to the U.S. Park Service but it's still a steep price. (However it would be included if you have a Park Service membership.)
Harpers Ferry is an incredibly cute town just a few hours away from other places like Washington, DC and Baltimore. It's so small that I can't imagine spending more than a few hours to a day here but is worth putting on your itinerary if you're in the area.
A Visit to Historic Gettysburg – Things to Do & Travel Guide 7 Charming Towns on Maryland's Eastern Shore A Look at the Underrated City of Richmond, VA – Things to Do & Travel Guide The Splendor of Miyajima Island (Itsukushima) – Things to Do & Travel Guide 33+ Things to Do in Edinburgh A Local's Annapolis, MD Travel Guide: Things to Do & See
Tags: harpers ferry, north america, united states, west virginia


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THE PENNY CARS STADIUM
Kyle earns improved deal
We are pleased to announce that defender Kyle MacDonald has signed a new improved deal with the club.
Kyle (19) joined from Motherwell in the summer, initially signing a contract with incentive-based clauses.
After injury had hampered his start at the club, Kyle has come into the side and performed well, triggering the new deal - which has pleased manager Ian Murray.
"Kyle had a tough pre-season, but he's done really well since coming into the side. For a young player with no previous experience at this level, he's come in and done a fantastic job and fully merits his new contract.
"Hopefully Kyle can keep progressing, and we look forward to watching him do that."
All content © Airdrieonians Football Club. All rights reserved.


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Where is Riches Filmed?
Naman Shrestha
Image Credit: David Hindley/Prime Video
Created by Abby Ajayi, Amazon Prime's 'Riches' is a British drama series that follows a well-established, self-made man named Stephen Richards, who has built a cosmetics empire from scratch with his successful company, Flair & Glory. Following all the success he and his company has received, he is considered an influencing figure when it comes to Black-owned businesses. However, when he suffers from a stroke, he realizes that it is time to hand over the reins of his empire to a deserving family member.
This results in a fight for control within the family, and as a result, the buried secrets of several members of the family come out, which complicates the situation even further. The dramatic narrative is complemented by the impressive onscreen performances from a group of talented actors and actresses, including Deborah Ayorinde, Hugh Quarshie, Sarah Niles, and Brendan Coyle. Moreover, the interesting use of locations is bound to make one wonder where 'Riches' is actually shot. If you are one such curious soul, you might be interested in what we have to share about the same!
Riches Filming Locations
'Riches' is filmed in England and New York, specifically in London and New York City. According to reports, the principal photography for the inaugural iteration of the British series commenced in November 2021 and seemingly wrapped up in March 2022. Now, let's traverse all the specific sites that make an appearance in the Amazon Prime show!
A post shared by Abby Ajayi (@abbyajayi)
Most of the pivotal sequences for 'Riches' are lensed in and around London, the capital and largest city of England as well as the United Kingdom. From the looks of it, the production team seemingly sets up camp at various locations across the city to tape different scenes against suitable backdrops. Some key portions of the debut season were possibly recorded in Stork Restaurant at 13-14 Cork Street in London.
A post shared by Deborah Olayinka Ayorinde (@itsdeborah)
Situated on River Thames in the southeast region of England, London is home to a number of iconic and historic landmarks, such as the Tower of London, the London Eye, Buckingham Palace, the British Museum, St. Paul's Cathedral, and British Library. Apart from 'Riches,' it has served as a pivotal production location for many movies and TV shows, including 'See How They Run,' 'The Batman,' 'Inside Man,' and 'The Peripheral.'
For shooting purposes, the filming unit of 'Riches' also travels to New York City, the most populous city in the United States. Also known as the Big Apple, NYC is a regular feature in different kinds of productions as filmmakers tend to frequent the city every once in a while. You can spot the locales of New York City in 'Disenchanted,' 'She Said,' 'The Wolf of Wall Street,' 'New Amsterdam,' and 'The Watcher.'
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Read More: Is Riches Based on a True Story?


CitySightseeing was made in 1999 in Seville, Spain and is presently outstanding element in the right around 100 areas overall which traverse six of the seven landmasses.
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Wanted an original W460 The driver's seat. Really any condition considered, but would prefer something ratty and moth eaten as it is to be rebuilt and reupholstered. Email michaelrozzell@hotmail.co.uk or message on here.
I would be quite happy with one like this.
The front seats on my 460 seats were awful.
Fortunately the bases were sound.
Happily, I managed to source a pair of Audi 80 seats (other seats are available) and spent a jolly while mounting them onto the bases.
The principle difficulty is that there is not much room between the doors and door pockets and the transmission tunnel, so the choice of donor seats is limited.
However, it is do-able and a marked improvement.
This assumes, of course, that you have the bases in the first place.
I believe that hens' teeth are more readily available.
Yes,I have the bases Nick. If I can't get a genuine drivers seat frame then my next option is to get a pair of Recaros from a Ford or Opel / Vauxhall and get them retrimed in this.
Thanks for bothering to reply.


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Biografia
Dopo i primi periodi passati a Trinidad e Tobago, si stabilì definitivamente nello stato di New York. Allieva del City College di New York, la Goodman divenne nota per aver ideato uno one woman show intitolato Hazelle!, che venne poi adattato per la televisione e trasmesso dalla HBO nel 1995. Per questo lavoro ottenne due candidature ai Cable Ace Awards come miglior commedia e miglior interprete.

Nel 1997 Woody Allen le affidò il ruolo di Cookie nel film Harry a pezzi. Nello stesso anno la Goodman ebbe un ruolo ricorrente nella serie televisiva Homicide, interpretando la spacciatrice Georgia Rae Mahoney.

Negli anni successivi tornò a recitare sul grande schermo in pellicole come Hannibal, All the Invisible Children e Molto forte, incredibilmente vicino. Inoltre continuò a lavorare in teatro, interpretando la Regina nel Cimbelino di Shakespeare e recitando ne I monologhi della vagina al Madison Square Garden. Fu anche ideatrice e interprete di un altro one woman show, To the Top Top Top!.

Filmografia

Cinema
Heat - La sfida (Heat), regia di Michael Mann (1995)
Harry a pezzi (Deconstructing Harry), regia di Woody Allen (1997)
Hannibal, regia di Ridley Scott (2001)
All the Invisible Children, regia di Spike Lee (2005)
Molto forte, incredibilmente vicino (Extremely Loud & Incredibly Close), regia di Stephen Daldry (2011)

Televisione
Hazelle! - show TV (1995)
Happily Ever After: Fairy Tales for Every Child - serie TV (1995) -  (voce)
Homicide - serie TV (1997)
Squadra emergenza (Third Watch) - serie TV (2001)
Ed - serie TV (2000)
Law & Order - I due volti della giustizia (Law & Order) - serie TV (2004)

Note

Collegamenti esterni

redpajama_set_name: RedPajamaWikipedia


Cancer immunotherapies and targeted therapy have revolutionised how clinicians take care of patients with advanced skin cancer and have led to long lasting treatment responses for many of them.
However, little is known about the survival impact of these therapies for a substantial group of patients.
Melanoma patients with cancer that has spread to the brain have been excluded or underrepresented in clinical trials of immunotherapies due to concerns about whether such drugs can cross the blood-brain barrier or will interfere with other forms of treatment.
A new study led by investigators at Brigham and Women's Hospital evaluates data from more than 1,500 cancer programs across the country to gather a large enough dataset to determine the effectiveness of checkpoint blockade immunotherapies.
The study found that these therapies provided significant improvements in overall survival for patients with melanoma brain metastases.
Their results are published this week in Cancer Immunology Research.
"Our findings build on the revolutionary success of checkpoint blockade immunotherapy clinical trials for advanced melanoma and demonstrate that their substantial survival benefits also extend to melanoma patients with brain metastases," said corresponding author J. Bryan Iorgulescu, MD, postdoctoral fellow in the Department of Pathology at Brigham and Women's Hospital/Harvard Medical School and Department of Medical Oncology at the Dana-Farber Cancer Institute.
Approximately 1 in 54 people will develop melanoma in their lifetime, most of whom will be diagnosed early and cured by having the tumour surgically removed.
But for patients with advanced disease, the median overall survival rate is less than a year. Advanced melanoma tends to spread to the brain and is the third most common cause of metastatic brain cancer.
Recent FDA approval of checkpoint blockade immunotherapies and targeted therapies, such as BFAF inhibitors, have added new options for treating advanced melanoma.
These novel therapeutics have produced exciting preliminary results in clinical trials of patients with advanced melanoma.
However, many trials to date have excluded patients whose skin cancer has spread to the brain, making it unclear if these benefits would extend to this patient population.
In the current study, a research team that included investigators from the Brigham and Dana-Farber Cancer Institute compiled data from more than 2,753 patients from cancer hospitals across the country.
Patients who received checkpoint blockade immunotherapy had an average survival of 12.4 months (compared to 5.2 months for those who did not receive immunotherapy), and had a four-year survival rate of 28.1 percent (compared to 11.1 percent for those who did not receive immunotherapy).
For patients whose cancer had not spread beyond the brain (to the lungs and/or liver, for instance), these improvements were even more dramatic.
The authors note that insurance status was an important barrier to receiving checkpoint blockade immunotherapy in melanoma brain metastasis patients.
Uninsured patients were significantly less likely to receive the treatment than those who were insured privately or through Medicare – a situation suggesting that additional efforts are needed to ensure patient access to these critical therapies.


In movies section you can also watch HD movies, Action Movies, Western Movies, LMN movies, Hallmark Movies, 1920 to 2009 Movies, Old Horror Movies and many more. Using a good VPN with Kodi is always suggested for privacy and security.... In movies section you can also watch HD movies, Action Movies, Western Movies, LMN movies, Hallmark Movies, 1920 to 2009 Movies, Old Horror Movies and many more. Using a good VPN with Kodi is always suggested for privacy and security.
How to Download and Install the Movie Vault Addon We will now begin the installation process by going to the System heading of Kodi, and selecting File manager as shown by the green arrow below. Once in the file manager section, select the Add source option.... How to Install Elektra Vault on Kodi Krypton Version 17 or Higher. To install Elektra Vault on Kodi, you need to Open Kodi Krypton > Go to Settings icon that you see top > Now select an option called File Manager > Double Click Add Source listed on the left-side.
Congratulations, your Elektra Vault Add-on is now installed and ready to use. Kodi third party add-ons are NOT supported by the Kodi/XBMC foundation. Please do not post questions on the forum.kodi.tv website relating to this Elektra Vault add-on.... NIGHT TERRORS Addon How to install Night Terrors 3rd Party Kodi addon guide The night is dark and full of terrors. So says NuttyTony, who brings to you this tidy add-on for the paranormal and true crime content junkies out there.
The best method to install Uranus on Kodi 17.6 latest. Uranus Add-on for Kodi is a new Add-on to enjoy free unlimited Movies and TV shows. Uranus Add-on for Kodi is a new Add-on to enjoy free unlimited Movies and TV shows.
If you want to install the new Fusion repo on Kodi 17.3 Krypton, follow the steps below. Just after launching Kodi Krypton, the first thing you have to do is click on Settings Icon in the top left corner.
Overview of 123 Movies Add-on and Kodi 17 Krypton 123Movies streams movies and has a nice setup such as Most Viewed, Most Ratings, Top IMDB, Genre and more. So far in testing it is a good add-on and works well with Krypton.


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David Wynen
DAVID WYNEN's theatre credits include the Australasian tour of 42nd Street, Hocus Pocus,Showstoppers, and The Australian Opera as well as in the Australian cast of Billy Elliott. He has performed for the Olympics and was featured in the movie Blonde and Brenda Bufalino's Last Rehearsal Hall (USA). David also presented his cabaret: David Wynen Unplugged and Untapped to sold-out audiences. He is constantly in demand as a Director, Choreographer and Music Theatre educator. David has choreographed Anything Goes, Guys and Dolls, The Wizard of Oz, Kiss Me Kate, Working, Company, Prodigal, Merrily We Roll Along, Sweet Charity, The Witches of Eastwick, The White Rose, Smash Hit, and Godspell. In addition, he directed and choreographed , The World Goes Round, The Life, Thoroughly Modern Millie, Sweet Charity, Addams Family and 42nd St. He also produced, choreographed and directed Cabaret in the Deluxe Spiegeltent.
He has also been awarded the EJ Barker Fellowship, the Dean's Award and the Vice Chancellor's' Award for outstanding leadership in his field. David was awarded the Australian Government Citation for Learning and Teaching for his ground-breaking international work on Tap Rhythm—the first online tap syllabus of its kind: taprhythm.com. In December, 2015, David choreographed for a tribute to Luigi at Symphony Space in New York featuring Broadway veteran, Rachelle Rak.
He has lectured at the VCA, Lehman College (NY), and Carnegie Mellon University (USA), and until June 2017 was the Senior Lecturer, and Program Leader of Music Theatre at Federation University, Australia. In August 2017, David joined the faculty of the State University of New York.
David has been instrumental in teaching and mentoring students and professionals, working in such diverse fields as: film, TV, event management, choreography, direction, writing and performance. His students have appeared in international productions such as: Kinky Boots, Beautiful, Muriel's Wedding, Mamma Mia, We Will Rock You, Wicked, Legally Blonde, Jersey Boys, Matilda, Les Miserables, The Sound of Music, Fiddler on the Roof, Hairspray, Cats, Strictly Ballroom, Chorus Line, Lion King and The Producers.


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Julia Samoylova set to return for Russia!
29 January 2018 at 18:45 CET
Julia Samoylova will represent Russia in the 2018 Eurovision Song Contest. Channel One Russia
Channel One Russia has confirmed that Julia Samoylova will represent Russia in the 2018 Eurovision Song Contest. Yulia has already started her preparations for Lisbon, her song will be released in the coming weeks.
Julia Samoylova was born in 1989 in Ukhta, Russia. The singer-songwriter was a finalist in X Factor in Russia and has also won an award called Alla's Golden Star, which was named after Russia's 1997 Eurovision participant Alla Pugacheva. Julia also performed during the opening ceremony of the Winter Paralympics in Sochi in 2014.
Julia was originally chosen to represent Russia in the 2017 Eurovision Song Contest with the song was Flame Is Burning. Broadcaster Channel One Russia are honouring the commitment made to Julia and she will appear in the 2018 contest in Lisbon.
Russia in the Eurovision Song Contest
Russia first participated in the Eurovision Song Contest in 1994 but it wasn't until 2000 that the country reached the top three for the first time. Since then Russia has gone onto have a strong record in the contest. Russia won the contest in 2008 and has scored four top five placings, since 2011 Russia has always finished inside the top ten.
Russia has been drawn to perform in the first half of the Second Semi-Final of the 2018 Eurovision Song Contest on Thursday 10th May.
Manizha's 'Russian Woman' wins on International Women's Day
AWS lead singer Örs Siklósi has died


Experts at merging form with function, we translate the most relevant apparel and home decor trends into fashion-forward products across a range of styles, price points and categories Ð including rugs, pillows, throws, wall decor, lighting, accent furniture, decorative accessories and bedding. From classic to contemporary, our selection of inspired products provides fresh, colorful and on-trend options for every lifestyle and budget..Going for a more nature like feel in your home? The faux wood from the Sycamore lamp will make you feel like you are outdoors.


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You are here: Home / Latest News / Scan Inter to buy into 170-MW solar project in Myanmar
Scan Inter to buy into 170-MW solar project in Myanmar
May 29, 2018 by thiha
May 15 – The board of Thai natural gas seller Scan Inter PCL (BKK:SCN) has approved the company's planned minority investment in the entity that owns a 170-MW solar power project in Minbu City, Myanmar, it was announced on Monday.
Scan Inter has signed a deal to buy a 30% stake in Green Earth Power (Thailand) Co Ltd, or GEP Thailand, from Planet Energy Holdings Pte Ltd for USD 38.5 million (EUR 32.4m). GEP Thailand is the sole owner of the Build-Operate-Transfer (BOT) concessionaire that will develop and operate the above-mentioned project.
The solar park will be developed in four stages, three of 40 MW and one of 50 MW. It has a 30-year power purchase agreement (PPA) with Electric Power Generation Enterprise (EPGE) at a tariff of USD 0.1275 per kWh. Completion of Phase 1 is scheduled for the first quarter of 2019. The total investment value of the project is estimated at USD 292.62 million.
Upon completion of the share purchase transaction, Planet Energy will continue to own an 18% stake in GEP Thailand. The remaining shareholders, in addition to Scan Inter, will continue to be Noble Planet Pte Ltd with a 5% stake, Vintage Engineering PCL with 12%, ECF Power Co Ltd with 20% and QTC Global Power Co Ltd with 15%.
Source : Renewables Now
Filed Under: Latest News Tagged With: Green Earth Power (Thailand) Co Ltd, Minbu City, Myanmar, Planet Energy Holdings Pte Ltd, QTC Global Power Co Ltd, Scan Inter PCL, Vintage Engineering PCL


Posted on 02.01.2018 02.01.2018 by LONI P.
Is certainly the particular Readymade Also Revolutionary?
Ready-made fine art is actually the particular lead take advantage of in constructed customer products and services within fine art. DuChamp's the majority visible and suspect section was Water feature, a item which in turn acquired disrespect through typically the total public, simply because the application appeared to be not even thought to be art.3.3/5(3).
And / or is usually it?, a express who considers the way musicians and artists usually are employing and additionally doing readymades. For the reason that this craft type nears its 100th husband's, all the present research precisely how the item seems to have evolved. Is definitely the particular Readymade Even now Revolutionary? Camera Houston contains The item might be This client is definitely expected through several about any displaying painters to query that fact which usually that they are usually brought to you having because your.
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Through 1967, all the artist Sol LeWitt brought a new variety it is list inside his / her dissertation "Paragraphs relating to Conceptual Art," on of which your dog submitted, "The approach alone, sometimes whenever not even made aesthetic, might be like substantially a new deliver the results connected with paintings mainly because whatever concluded product." Conceptual writers and singers utilised their own job to be able to concern typically the notion from precisely what paintings can be, along with to make sure you analyze your basic ideological.
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Readymades connected with Marcel Duchamp. Go to be able to sat nav Start so that you can investigation Duchamp exclusively made an important 100 % from 13 readymades across a good interval regarding period involving 25 ages. Robert Fulford referred to Duchamp's ready-mades like indicating "an furious nihilism". Any items independently. By simply uploading a few associated with these as talent for you to art form juries, typically the open, together with an individual's players, Duchamp.


Hiring a psychologist is an increasingly popular option (see article). But for those willing to cheat, the obvious source is performance-enhancing drugs. Mr Fouché claims that traditional anti-doping tests, which examine urine samples for banned substances, are obsolete. Just 0.5% of the competitors at the Athletics World Championships in 2011 failed tests; an anonymised survey published in August found that more than 30% of them admitted to having used illegal drugs in the year before the competition.
In the past decade sporting authorities have widely adopted "athlete biological passports", which look for sudden changes in the blood or urine but rarely provide incontrovertible proof. Evidence of how easy it is to hoodwink them has come from Bryan Fogel, another cyclist-turned-commentator, whose documentary "Icarus" was released by Netflix last month. The film follows the doctor who masterminded Russia's state-sponsored steroids programme, which was eventually busted in 2015, and shows the World Anti-Doping Agency's incredulity as each layer of the deceit is gradually revealed.
Yet Mr Fouché contests the "perception that the most prominent technoscientific changes within sport have been pharmaceutical". Much of the gain in performance can be explained by vastly improved equipment. Pole-vaulters are propelled by carbon-fibre rods; golf balls by titanium clubs. The author devotes a chapter to the body-length polyurethane suit manufactured by Speedo, a swimwear company. More than 130 world records were toppled in the 18 months after it was launched in February 2008.
"Game Changer" argues that the physical differences between competitors "may become so infinitesimal that athletic performance may cease to determine the outcomes", and thus that technological advances are gradually eroding sport's authenticity. The common solution has been to prohibit them. FINA, swimming's governing body, banned full-length suits in July 2009. Anti-doping, too, has been a check on scientific enhancement. But doping is regulated with good reason. Erythropoietin (commonly known as EPO), a blood-thickening drug, was linked to the deaths of 18 cyclists in the five years after its initial clinical trials in 1986.
Sporting administrators have to draw lines somewhere. They are often blurred, temporary and unpopular. Mr Fouché considers the examples of Oscar Pistorius, an amputee runner whose prosthetic legs might have given him an advantage at the Olympics, and Caster Semenya, a female runner who was accused of being a man. The IAAF, athletics' governing body, allowed both to compete after extensive testing but left no definitive precedent for future cases. Authorities are hasty to ban innovations that change the balance of a sport, and prone to dithering, as has happened with the constantly changing specifications in college baseball for aluminium bats, which give hitters more distance. Doping policy is equally erratic. Russian hackers have leaked hundreds of "therapeutic-use exemptions" (TUEs): certificates that allow athletes to take steroids for medical purposes.
With his "sporting publics" and "dominant narratives", Mr Fouché is clearly writing for academics. Casual fans will be far more entertained by Mr Fogel's Orwellian tale of doping doublethink. Nonetheless, Mr Fouché makes important points about sport's growing grey areas. Athletes strive for the Olympic motto: citius, altius, fortius, or "faster, higher, stronger". They ought to compete ceteris paribus—another Latin phrase, beloved of economists, which means "with all else being equal". But that, as any wily Ancient Greek wrestler could have told you, is a fantasy.


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Home About Parliament Parliamentary departments Department of the House of Representatives
The Department of the House of Representatives provides services to support the efficient conduct of the House of Representatives, its committees and certain joint committees as well as a range of services and facilities for Members in Parliament House.
The department also undertakes activities to promote the work of the House in the community and is responsible for the conduct of the Parliament's international and regional relations.
The Speaker has accountability obligations to the Parliament for the department. The Clerk of the House of Representatives is responsible for managing the department.
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The department also publishes a wide range of other information about what we do and the work of the Parliament. This includes:
Information on the role and work of parliamentary committees
Information on proposed laws, laws and how laws are made
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Documents of the House of Representatives
About the House of Representatives
The House of Representatives has a number of important functions: it determines the government, debates and passes laws, watches over government administration and expenditure, and provides a forum for public debate on issues of national importance. It shares the power to make laws with the other House of Parliament, the Senate.
There are currently 151 members who have been chosen at a general election to represent the interests of the community. Each member represents one geographic area of Australia. Members are elected for a 3 year term and when in parliament take part in debate on proposed laws and public policy, representing the views of the people in their electorate.
26/02/23 Inquiry Submission Closing Redress47
27/02/23 Inquiry Submission Closing ASIC investigation
27/02/23 Inquiry Submission Closing Digital platforms
27/02/23 Inquiry Submission Closing Resilient Roads
27/02/23 Inquiry Report Tabling Reconstruction Bill 2022
27/02/23 Inquiry Report Tabling Climate Trigger Bill 2022
28/02/23 Inquiry Report Tabling Invasive marine species
28/02/23 Inquiry Report Tabling Community Safety
28/02/23 Inquiry Report Tabling Telecommunications 47
28/02/23 Inquiry Submission Closing VET Inquiry
01/03/23 Inquiry Submission Closing Sexual consent laws
01/03/23 Inquiry Report Tabling Safeguard Mechanism
02/03/23 Inquiry Submission Closing CFS 2021-22
05/03/23 6-9 March House sitting


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Georgia double homicide suspect arrested in northern Arizona
Fugitive wanted in Georgia for double homicide arrested in Flagstaff
U.S. Marshals arrested a suspect in a double murder at the Greyhound bus station in Flagstaff.
FLAGSTAFF, Ariz. - An Alabama man wanted for a double homicide in Georgia was arrested in northern Arizona on Jan. 12, the U.S. Marshals and Flagstaff Police Department said.
Joshua Sanders, originally from Birmingham, Alabama, was arrested in Flagstaff after authorities say he's responsible for the death of a mother and her daughter on Jan. 6. He was wanted by the Georgia Bureau of Investigations.
When being taken into custody, authorities say Sanders admitted to the possibility of shooting the arresting officers if he had the chance so that he could escape.
"The arrest of Sanders at the Greyhound Bus Station in Flagstaff was executed in a manner that ensured other passengers and the public at the station were not placed in any danger", said United States Marshal David Gonzales. "Sanders, who was recently released from prison, and had 3 handguns in his possession, told Deputy Marshals at the time of his arrest that if he had the opportunity, he would have shot at them in order to make an escape."
The suspect was reportedly responsible for the shooting and killing of a female acquaintance and her mother in Vidalia, Georgia, during a domestic dispute.
"After the shooting, Sanders stole the victim's vehicle and fled back to Birmingham, Alabama where the vehicle was later discovered abandoned," authorities said.
Through an investigation, it was revealed that Sanders reportedly took a bus from Tulsa, Oklahoma on Jan. 11 to Los Angeles. While en route to California, he was arrested.
"The U.S. Marshal Service, with the assistance of Flagstaff Police Department, were able to establish surveillance at the Greyhound bus station. At approximately 1:40 pm, Sanders was positively identified exiting the Greyhound Bus and was taken into custody by U.S. Marshal deputies and Flagstaff Police Officers," authorities explained.
He was booked into the Coconino County Jail and will be extradited back to Georgia.
Joshua Sanders was arrested in Flagstaff, Arizona on Jan. 12 after authorities say he's responsible for the deaths of a mother and her daughter on Jan. 6.
Toddler accidentally shot in Phoenix rushed to hospital, police say
Buckeye man accused of kidnapping, sexually assaulting neighbor
Man shot, killed in Chandler neighborhood; murder investigation underway
Get breaking news alerts in the FREE FOX 10 News app. Download for Apple iOS or Android.
Driver arrested after going 115mph in a residential neighborhood: Scottsdale police
Beautiful downtown mural pays homage to city of Phoenix and is in memory of Hans Hughes
Saguaro High School student selected for Disney Dreamers Academy


This vine has beautiful, small, white, fragrant blossoms in the spring and these pod things in the fall. When the vine is cut there is a milky white substance as a sap. Last winter, the ice pulled it away from the wall and we've had no success getting it to reclimb. Our thought is to prune it back severely and install a trellis. Is now a time we could do that or what is your suggestion?
I adore this plant. It is commonly called Confederate jasmine-- Trachelospermum jasminoides. It is not a true jasmine but the blooms are so fragrant, that it is called one. This plant does not grow easily on a brick wall without some type of support. Your plant is obviously healthy and happy, but do not prune it until after it blooms next spring. Pruning now will remove your spring blooms. You can use a trellis, or use some masonry nails and fishing twine to give it something to grow on and it can cover the wall. For years we struggled getting this plant to survive the winter, but for the past 15 or so it has done well. I have it on a brick wall in full afternoon sun and have had no damage to it.
I live in White Hall, AR and I have two issues to ask you about. First, I have a confederate jasmine on a trellis that has filled in and covers the trellis perfectly and is loaded with blooms. My question is: Should I prune it and if so, when? The only reason I would want to prune it is to contain its size for the trellis or if needed to insure blooming in the future. Second issue: I am putting up another trellis (in a flower bed with southern exposure) and would like another evergreen vine. I saw a Pretty Crimson (a Sun Parasol mandevilla hybrid) and fell in love with it. Being more of a tropical vine, will this survive our winters, if planted in the ground? If not, any suggestions as to what I can plant? I prefer to have a vine on the trellis throughout the year.
I love confederate jasmine (Trachelospermum jasminoides) which is neither confederate or a true jasmine. It is great evergreen vine with some of the most fragrant blooms. It typically is covered in flowers from late April through early June, and can have some sporadic flowers off and on during the summer. Since it is a prolific vine, some pruning may be needed to keep it in check. Do so, as needed, when the main flowers have faded. Mandevillas now come in a wide range of colors, but none of them would overwinter outdoors regardless of how protected. Carolina jasmine (Gelsemium sempervirens) is another evergreen vine with beautiful yellow flowers in the spring. An evergreen clematis- -Armand clematis has lovely white flowers in the spring, and there are many deciduous clematis you could mix in which have huge showy flowers in a wide array of colors.
When visiting in Charleston, S.C. recently, I saw a plant called Confederate Jasmine. Does this grow in Southeast Arkansas? I fell in love with its blooms and the wonderful fragrance. I was told the plant blooms all summer. I am not familiar with this but have a perfect place to put it on a fence in Drew County. Will it work?
Confederate jasmine – Trachelospermum jasminoides is a wonderful vine or groundcover for semi-shady areas in the south. It is definitely winter hardy in southern Arkansas, and has been faring quite well in central Arkansas. It is listed as hardy to zone 8, but as I said it has been doing well in zone 7. It blooms most prolifically in May and June but you can have scattered flowers thereafter as well. It needs a trellis or fence to grow on and will need a bit of training to get it there. The plant is evergreen, but has been zapped back occasionally in a cold winter.


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FyVReads
Our Manifesto.
We aim to inspire and encourage travellers and new residents in Mexico to make food choices that will connect them to vital community sources, in turn supporting local economies.
Our focus on plant foods reflects their profound significance in Mexican identity and as the foundation for healthy people and communities.
As food professionals we believe that for a healthier future, we are wise to value traditional ecological knowledge and systems. It's our intent to positively contribute to their protection and to inspire others to do the same.
We do this by creating opportunities for travellers and new residents to learn about and experience the most humble ingredients that are most relevant to the people of each region.
We seek to be allies in the food sovereignty movement in Mexico by presenting food experiences that focus on sharing and celebrating local foods and food systems, honoring the needs of the people the role of these foods in their identity, their communities and their local economy.
Why 'Frutas y Verduras'?
Frutas y Verduras means, very simply: 'Fruits and Vegetables'. As I travelled Central and Southern Mexico exploring the produce, in almost every city and pueblo I noticed these words painted on the street side wall of a shop, or above a market vendor's display to announce what was sold there. Very rarely was there another name for the tienda, not even the name of the proprietor like "Mary's Frutas y Verduras".
As I explored the frutas y verduras, myself, I began to learn more about the people and the culture of Mexico than I expected. There was so much more beyond flavor experiences. Connecting with people whose lives revolved around subsistence agriculture was giving me a window into what I'd say is the soul of Mexico. Indigenous people for whom the cycle of a day, of a season, involves processes directly connected to the land.
Eating is an agricultural act...
an ecological act, and a political act, too"
Be a FyV Collaborator
Frutas y Verduras gathers people with a passion for healthy food and a who care deeply about culture, community, food justice and sustainability. Their focus may be culinary or gastronomic, food history or anthropology, but one thing is for sure; they know how practices and processes around food are crucial to the future of food. When they talk about their communities, they express a strong sense of responsibility and a drive to make a difference.
Beyond their own expertise and knowledge, the Mission for our collaborators is to be a cross-cultural bridge, giving a voice and platform to enable locals to share their heritage with you. Whether that's the vendor in the market or the woman who invites us into her home kitchen, it's the connection between our guests and hosts that generates the greatest joy.
Collaborating for greater impact
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Occasional stories, links and articles along with updates about our local collaborations.
All content copyright Margaret Hefner and Frutas yVerduras Mexico (ONT) 2016-2019
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Q: Cannot Map the input Column,because the datatype doesnt match When I tried to match the lookup columns inside the lookup shape I get the mentioned error in SSIS 2012 version.
I checked and corrected the data types in the source and the destination but till the error occurs. How can I match the columns for this case.
Can someone help ?

redpajama_set_name: RedPajamaStackExchange


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Nathan Elams Cockrell
Nathan Elams Cockrell (September 27, 1833 – June 3, 1859) was a founder of the Sigma Alpha Epsilon fraternity.
Nathan Elams Cockrell was born on September 27, 1833 in Livingston, Alabama.[1] His father was Dempsey Cockrell and his mother, Millicent Carpenter.[2] His maternal uncle, Captain Nathan Mullin Carpenter, was the owner of the Everhope Plantation in Eutaw, Alabama.[3]
He attended the University of Alabama, where he was a founding member of Sigma Alpha Epsilon.[4] He graduated in 1856.[1][4]
CareerEdit
Cockrell managed his father's plantation. Later, he became the editor of the Livingston Messenger newspaper.[1]
DeathEdit
Cockrell died on June 3, 1859.[1]
^ a b c d A Register of the Officers and Students of the University of Alabama, 1831-1901, Tuscaloosa, Alabama: University Press of Alabama, 1901, p. 118 [1]
^ Nathan Elams Cockrell, Ancestry.com
^ Ante Bellum Home Offered For Sale By Coleman Realty Co., The Tuscaloosa News, October 15, 1972
^ a b William Raimond Baird, American College Fraternities, J.B. Lippincott, 1898, p. 210 [2]
Retrieved from "https://en.wikipedia.org/w/index.php?title=Nathan_Elams_Cockrell&oldid=867352548"


text:
/* ------------------------------------------------------------------
 * Copyright (C) 1998-2009 PacketVideo
 *
 * Licensed under the Apache License, Version 2.0 (the "License");
 * you may not use this file except in compliance with the License.
 * You may obtain a copy of the License at
 *
 *      http://www.apache.org/licenses/LICENSE-2.0
 *
 * Unless required by applicable law or agreed to in writing, software
 * distributed under the License is distributed on an "AS IS" BASIS,
 * WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either
 * express or implied.
 * See the License for the specific language governing permissions
 * and limitations under the License.
 * -------------------------------------------------------------------
 */
/*

 Pathname: ps_all_pass_filter_coeff.h

------------------------------------------------------------------------------
 REVISION HISTORY

 Who:                   Date:
 Description:

------------------------------------------------------------------------------
 INCLUDE DESCRIPTION

 Header file for all pass filter coefficients

------------------------------------------------------------------------------
*/

/*----------------------------------------------------------------------------
; CONTINUE ONLY IF NOT ALREADY DEFINED
----------------------------------------------------------------------------*/
#ifndef PS_ALL_PASS_FILTER_COEFF_H
#define PS_ALL_PASS_FILTER_COEFF_H

/*----------------------------------------------------------------------------
; INCLUDES
----------------------------------------------------------------------------*/
#include "pv_audio_type_defs.h"
#include "s_ps_dec.h"

/*----------------------------------------------------------------------------
; MACROS
; Define module specific macros here
----------------------------------------------------------------------------*/

/*----------------------------------------------------------------------------
; DEFINES
; Include all pre-processor statements here.
----------------------------------------------------------------------------*/

/*----------------------------------------------------------------------------
; EXTERNAL VARIABLES REFERENCES
; Declare variables used in this module but defined elsewhere
----------------------------------------------------------------------------*/

extern const Char groupBorders[NO_IID_GROUPS + 1];
extern const Int16 aRevLinkDecaySerCoeff[NO_ALLPASS_CHANNELS][NO_SERIAL_ALLPASS_LINKS];
extern const Int32  aRevLinkDelaySer[];
extern const Int16 aFractDelayPhaseFactorReQmf[NO_QMF_ALLPASS_CHANNELS];
extern const Int16 aFractDelayPhaseFactorImQmf[NO_QMF_ALLPASS_CHANNELS];
/* the old center frequencies (found in "else") were too small (factor 1/2) */
extern const Int16 aFractDelayPhaseFactorReSubQmf[SUBQMF_GROUPS];
extern const Int16 aFractDelayPhaseFactorImSubQmf[SUBQMF_GROUPS];
extern const Int32 aFractDelayPhaseFactorSubQmf[SUBQMF_GROUPS];
extern const Int32 aFractDelayPhaseFactor[NO_QMF_ALLPASS_CHANNELS];
extern const Int32 aaFractDelayPhaseFactorSerQmf[NO_QMF_ALLPASS_CHANNELS][3];
extern const Int32 aaFractDelayPhaseFactorSerSubQmf[SUBQMF_GROUPS][3];
extern const Char bins2groupMap[NO_IID_GROUPS];
extern const Int32 aaFractDelayPhaseFactorSerReQmf[NO_QMF_ALLPASS_CHANNELS][3];
extern const Int32 aaFractDelayPhaseFactorSerImQmf[NO_QMF_ALLPASS_CHANNELS][3];
extern const Int32 aaFractDelayPhaseFactorSerReSubQmf[SUBQMF_GROUPS][3];
extern const Int32 aaFractDelayPhaseFactorSerImSubQmf[SUBQMF_GROUPS][3];

/*----------------------------------------------------------------------------
; SIMPLE TYPEDEF'S
----------------------------------------------------------------------------*/

/*----------------------------------------------------------------------------
; ENUMERATED TYPEDEF'S
----------------------------------------------------------------------------*/

/*----------------------------------------------------------------------------
; STRUCTURES TYPEDEF'S
----------------------------------------------------------------------------*/

/*----------------------------------------------------------------------------
; GLOBAL FUNCTION DEFINITIONS
; Function Prototype declaration
----------------------------------------------------------------------------*/

/*----------------------------------------------------------------------------
; END
----------------------------------------------------------------------------*/
#endif  /* PS_ALL_PASS_FILTER_COEFF_H */

redpajama_set_name: RedPajamaGithub


Gobsmack Comics was established by Drew Dewsall in 2014 and for two years the store has been in Swan Walk. Click here.
Altered Wings, a newly-established studio in Horsham has quickly established a reputation for detailed portrait work. Click here for full story.
Back in 2005, Sarah Payne started making brownies as a way to make some money. Now in Swan Walk, some people thinks its a major franchise! For full story click here.
The Burrell family, who live at Knepp Castle, has created a small campsite on a wild meadow at the southern end of the estate. Click here.