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Big Issues
Explore the big challenges, opportunities, debates and frameworks for business and human rights. This section contains a selection of key portals curated by our global team.
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Alongside its core work providing a platform for Human Rights advocates, the Resource Centre runs several focused programme areas and regularly releases briefings and reports on areas of particular interest.
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Opinion pieces, interviews and blogs from across the business and human rights movement.
Workers must be the foundation of any human rights due diligence approach
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Lebanon: Tens of thousands …
Labour: General COVID-19 Denial of freedom of movement Migrant & immigrant workers General business & human rights
Lebanon: Tens of thousands of migrant workers trapped in highly abusive conditions due to restrictive and exploitative Kafala system
"Lebanon's Abusive Kafala (Sponsorship) System" 4 January 2022
Lebanon's restrictive and exploitative kafala (sponsorship) system traps tens of thousands of migrant domestic workers in highly abusive conditions amounting, at worst, to modern slavery. The law fails to protect the workers, and the establishment has no interest in changing the current system.
Lebanon's Labour Ministry estimates that the country hosts 250,000 migrant domestic workers, the majority of them women from Africa and Asia...the Labour Law specifically excludes migrant domestic workers, denying them protections that other workers are entitled to, including a minimum wage, limits on working hours, a weekly rest day, overtime pay, and freedom of association. Instead, their status in Lebanon is regulated by the kafala system...Workers cannot leave or change jobs without their employers' consent...
The high degree of control over workers' lives under the kafala system has led to cases of human trafficking, forced labour, exploitation and more...Amidst Lebanon's economic crisis and the Covid-19 pandemic, incidents of such abuse against migrant domestic workers have increased...
Employers have abandoned hundreds of workers outside consulates or embassies, often without money, passports, their belongings, or tickets for the flight back to their home countries...
The exploitation and abuse under the kafala system has led many workers to commit suicide or die while trying to escape their employers. A 2008 Human Rights Watch investigation found that one domestic worker dies every week from unnatural causes, with suicide and attempted escapes being the most common...
The kafala system and the exclusion of domestic workers from the provisions of the labour law violate human rights treaties and labour conventions that Lebanon has signed, including those abolishing forced labour. They also violate the principle of non-discrimination, and the right to just and favourable work conditions.
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Q: ViewAttached event is not fired I'm using durandal master details sample which is using composition.I have a view model with some events defined in it,
 var ctor = function(name, description) {
        this.name = name;
        this.description = description;
    };

    ctor.prototype.activate = function() {
        system.log('Model Activating', this);
    };

    ctor.prototype.deactivate = function () {
        system.log('Model Deactivating', this);
    };

    ctor.prototype.viewAttached = function (view) {
      system.log('this is not called !', this);
    };

All the events except the viewAttached are fired. I can't find the reason here ..

A: Actually I was using the latest version of the Durandal fro the GithHub repository.After looking it to the composition module found that they have renamed it to compositionComplete. This works as expected..
 ctor.prototype.compositionComplete= function (view) {
      system.log('works!', this);
    };

Edit
After getting Durandal 2.0 released , in documentation we have the attached event instead of viewAttached

A: If you are using Durandal 2.0, the 'viewAttached' method was renamed to 'attached'.

A: Without more information, the only thing I can suggest checking is this note from the Durandal docs:

Note: If you have set cacheViews:true then viewAttached will only be called the first time the view is shown, on the initial bind, since technically the view is only attached once. If you wish to override this behavior, then set alwaysAttachView:true on your composition binding.

Try setting alwaysAttachView:true in your binding, see if that works.

redpajama_set_name: RedPajamaStackExchange


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La Coupe d'Asie des clubs champions 1969 est la  de la Coupe d'Asie des clubs champions. La finale s'est jouée à Bangkok le  entre le Maccabi Tel-Aviv et le Yangzee FC et a vu la victoire du Maccabi Tel-Aviv sur le score de 1-0.

Participants
  Maccabi Tel-Aviv - Champion d'Israël 1966-1968
  Perak FA
  Persépolis Téhéran FC
  Toyo Kogyo SC - Champion du Japon 1968
  Kowloon Motor Bus FC - Champion de Hong-Kong 1966-1967

  Yangzee FC
  État de Mysore
  Bangkok Bank FC
  Vietnam Police
  Manila Lions

Compétition

Premier tour

Groupe A

|}

Groupe B

|}

Phase finale

Demi-finale

Match pour la

Finale

Liens externes
 Résultats complets sur le site RSSSF.com

1969
Football en 1969
1969 en Asie
Sport en janvier 1969

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Forest Park Eats
Forest Park History
Growing Community Media's Team
Inside FPR
A hyperlocal news site committed to in-depth reporting on issues concerning Forest Park, Illinois.
Wednesday Journal
Area schools prep for new handwriting requirements
Requires students to learn cursive before 5th grade, effective 2018
by Michael Romain December 19, 2017
Example of cursive writing with a pencil, Learning cursive writing
Starting on July 1, 2018, all public elementary schools in the state will be required to offer at least a unit of instruction in cursive writing to students before they completed the fifth grade.
Some local districts, like Forest Park Elementary School District 91, are already preparing for the new requirements.
Last month, both the Illinois Senate and House of Representatives voted overwhelmingly to override Gov. Bruce Rauner's veto of the bill creating the requirement.
In his veto message, Rauner argued that the "legislation constitutes yet another unfunded mandate for school districts that will not protect the health or safety of Illinois students.
"If the General Assembly believes that cursive writing instruction should be required in elementary schools because it will improve student outcomes, it should be included in the Illinois State Learning Standards and funded accordingly."
But supporters of the bill argued that the extra cursive instruction would give students a skill that's still essential — despite the changing technological landscape.
"As technology has advanced in the fast-paced world we live in, the way we write and communicate with each other needs to adjust as well," said state Rep. Emanuel "Chris" Welch (D-7th), who introduced the bill, just after both houses overrode Rauner's veto.
"To make our young students stronger readers, writers and critical thinkers, our schools will again teach cursive so they can begin to develop these necessary skills," Welch said.
"Cursive writing is a skill children will need throughout their lives," said state Sen. Kimberly Lightford (D-4th), who sponsored the bill in the Senate. "You cannot write a check, sign legal documents or even read our Constitution without an understanding of cursive writing."
Both Oak Park Elementary School District 97 and River Forest District 90 already teach cursive writing to elementary school students.
Chris Jasculca, the communications director for District 97, said that while his district offers cursive instruction to second- and third-graders, officials will still be taking steps to ensure future compliance with the new law.
"We'll be assessing and evaluating our practices in the months ahead to ensure that they meet the standards set forth by the law, are being implemented with consistency and fidelity, and are meeting the needs of our students," Jasculca said.
At least one area administrator has spoken out against the new law. Louis Cavallo, the superintendent of Forest Park School District 91, said that while his district already teaches cursive, "it's not a 21st-entury learning skill by any stretch of the imagination."
Cavallo said that he met with Welch last year before the cursive writing legislation passed and expressed his disapproval to the lawmaker.
"There's too much being added to all of our plates with nothing going away," Cavallo said. "You should look sometime at what is required, it's whenever any legislator finds something that they feel is their pet project.
"We have everything from Bosnian genocide, just some of them are crazy, date rape, they're important topics, but they say, 'You need to teach this, you need to teach this,' and they just keep getting added, but nothing ever goes away."
Nona Tepper contributed to this report.
CONTACT: michael@oakpark.com
One reply on "Area schools prep for new handwriting requirements"
Congressman, you have the floor
Language and literacy literally improve lives
Would we be heroes or turn the other cheek?
Innovation and collaboration
Ray Paulin, 89

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Partner-Driven Projects
School Health and Wellness
Lessons and Curricula
Overweight and obesity are leading health concerns among our nation's children, but students and families are receiving very little education on nutrition and physical activity. This page provides fun and engaging presentations, lesson plans, interactive learning and recipes for students and families that will give them guidance on how to make healthier lifestyle choices. All lessons are created from evidence-based sources by registered dietitian nutritionist and support Arizona's College and Career Ready Standards. Use these lessons to spread the word about the benefits of nutrition and physical activity so that students and families can make better, informed decisions about living healthier lives!
Nutrition & Physical Activity Curricula
Hand Washing Lesson
Complete this interactive hand washing course and earn your certificate for demonstrating proper hand-washing technique!
Start the Lesson
How to Wear a Face Mask
Complete this interactive lesson and follow 5 easy steps to earn your certificate for properly wearing a face mask!
Nutrition and Physical Activity Curricula
This tabs below provide fun and engaging presentations, lesson plans, and activities for students that will give them guidance on how to make healthier lifestyle choices. All lessons are created from evidence-based sources and support Arizona's College and Career Ready Standards. Use these lessons to spread the word about the benefits of nutrition and physical activity so that students can make better, informed decisions about living healthier lives!
Choose MyPlate!
Choose MyPlate! focuses on the five food groups, why it's important to "eat a rainbow" of fruits and vegetables, and how staying active keeps our bodies healthy.
Curriculum Notes
Count How Many
Create a Healthy MyPlate
MyPlate Activity
Fruit and Veggie Fitness Fun
Let's Eat a Rainbow!
Let's Eat a Rainbow! concentrates on our favorite fruits and vegetables, why we should eat a variety of fruits and vegetables, and where all these colorful foods are grown.
The ABCs of Fruits and Veggies
The ABCs of Fruits and Veggies is a fun, colorful way to teach the letters of the alphabet! Discover interesting facts about each one and go on a fruit and vegetable adventure at the end!
ABCs of Fruits and Vegetables
Do Your Dairy!
Do Your Dairy! talks about what foods fit into the Dairy Group, why these foods help our body, and the bone-benefits of physical activity.
G is for Grains!
G is for Grains! talks about the Grains Group and what foods belong in the category. MyPlate and the benefits of grains are also discussed.
Take-Home Handouts for the Family
Healthy habits can also begin at home. Listed below are handouts for students to take home and share with their family. These handouts are taken from the USDA's "10 Tips Nutrition Education Series" and reflect the messages presented in the lessons. Available in English and Español below:
Be a Healthy Role Model for Children (English) (Español)
Choose MyPlate (English) (Español)
Cutback on Your Kids' Sweet Treats (English) (Español)
Eating Better on a Budget (English) (Español)
Add More Vegetables to Your Day (English) (Español)
Focus on Fruits (English) (Español)
Kid-Friendly Veggies and Fruits (English) (Español)
Liven Up Your Meals with Vegetables and Fruits (English) (Español)
Smart Shopping for Veggies and Fruits (English) (Español)
Got Your Dairy Today? (English) (Español)
This material was funded by USDA's Supplemental Nutrition Assistance Program - SNAP. The Supplemental Nutrition Assistance Program (SNAP) provides nutrition assistance to people with low income. It can help you buy nutritious foods for a better diet. To find out more, contact 1-800-352-8401. This institution is an equal opportunity provider and employer.
Choose MyPlate! focuses on the five food groups, why it's important to "eat a rainbow" of fruits and vegetables, and how staying active keeps our bodies healthy. This lesson also discusses where our food comes from and the difference between whole versus processed foods.
Family Dinner Story
Filling MyPlate
Fruit and Vegetables Make Me Smile!
Fruit and Vegetables Make Me Smile! talks about the different fruits and vegetables and the many forms in which they come. It introduces Vitamins A and C, the digestive system, and how much fruits and vegetables kids need to stay healthy. The lesson ends with details on where these foods grow.
Grocery Story Activity
Grocery Store Word Problems
Do Your Dairy! visits the different foods found in the Dairy Group and where these foods come from. The lesson introduces the nutrients Calcium and Vitamin D and why these nutrients are good for us. Lactose intolerance and other ways to get these key nutrients are discussed. The concept of low-fat and fat-free dairy foods is explained. The lesson is concluded by addressing activities that help build our bones.
Healthy habits can also begin at home. Listed below are handouts for students to take home and share with their family. These handouts are taken from the USDA's "10 Tips Nutrition Education Series" and reflect the messages presented in the lessons. Available in English and Español below:
Cutback on Your Kids' Sweet Treats (English) (Español)
Choose MyPlate! focuses on the five food groups and why each group is important for our health. The concept of whole grains is discussed. The lesson is concluded with key messages that help us to lead a healthy lifestyle.
Grocery Store Story
Online MyPlate Activity
Dairy Story
Fun with Numbers


South Vietnam Military History and Insignia contains 125 pages packed with over 60 pages of color insignia as well as hundreds of b/w insignia that includes background history on South Vietnam's major military units and structure. This is a book by a collector for a collector and it will be the standard reference book for years to come.
South Vietnam Military History and Insignia contains 125 pages packed with over 60 pages of color insignia as well as hundreds of b/w insignia that includes background history on South Vietnam's major military units and structure. It is the most complete book ever done on the subject and one that will become the "go to" book for military and insignia buffs of the Vietnam War. The book is a 6x9 perfect bound paperback with laminated cover. Illustrations also cover uniforms and rank insignia. This is a book by a collector for a collector and it will be the standard reference book for years to come.
Gary Murtha was born and raised in Kansas City, Missouri. He joined the U.S. Marine Corps and served six years of active duty . He served as an 0311 (rifleman) in Vietnam from December 1966 to January 1968 with Foxtrot Company 2nd Battalion, 7th Marine Regiment, 1st Marine Division. He graduated from the University of Missouri-at Kansas City with a B.A. in History. Gary and his wife reside in Raymore, Missouri.


"Flight of the Mind" layers images of flight, exploration and education with elements of the history and landscape of the Vancouver area. The framework of the design is based on the original photo taken in first bubble chamber, which has played an important role in experimental particle physics. These photographs represent the study of science and technology while referring to mysterious patterns of life. On the right of the Columbia river three basalt stone pillars are painted with images of nurses and a Chinook woman. Next to the pillars is the well-known petroglyph, "She Who Watches". A key part of the history of the Vancouver is the first Trans Polar landing and its role as a center for the early development of flight. The famous Russian airplane, the ANT 29, flies toward the top of the wall. An engineering drawing, by the artist's grandfather Pete Blanchard, of a patented propeller design from this period creates a pattern on the left side while a large propeller circles off the wall to the right. Circular shapes move like planets around the spirals. The petroglyph of a bird flies upward and Mount St. Helens billows up in ash. Other images include a section of the Lewis and Clark map, Mount Hood, Fort Vancouver, coins and colonial buttons from the days of trading. Texts by contemporary Native American poet Gail Tremblay and by environmentalist Buckminster Fuller bring the viewer into the work through their words. The color, lines and words "Lifelong Learning" are inlaid in the floor to integrate with the painting. Commissioned by the Washington State Arts Commission.


Mon 1 File Form 730 and pay the tax on wagers accepted during May.
Mon 1 File Form 2290 and pay the tax for vehicles first used during May.
Mon 1 File Form 11-C to register and pay annual tax if you are in the business of taking wagers.
Wed 3 Deposit payroll tax for payments on Jun 26-28 if the semiweekly deposit rule applies.
Mon 8 Deposit payroll tax for payments on Jun 29 – Jul 2 if the semiweekly deposit rule applies.
Wed 10 Deposit payroll tax for payments on Jul 3-5 if the semiweekly deposit rule applies.
Wed 10 Employers: Employees are required to report to you tips of $20 or more earned during June.
Fri 12 Deposit payroll tax for payments on Jul 6-9 if the semiweekly deposit rule applies.
Mon 15 Deposit payroll tax for Jun if the monthly deposit rule applies.
Wed 17 Deposit payroll tax for payments on Jul 10-12 if the semiweekly deposit rule applies.
Fri 19 Deposit payroll tax for payments on Jul 13-16 if the semiweekly deposit rule applies.
Wed 24 Deposit payroll tax for payments on Jul 17-19 if the semiweekly deposit rule applies.
Fri 26 Deposit payroll tax for payments on Jul 20-23 if the semiweekly deposit rule applies.
Wed 31 Deposit payroll tax for payments on Jul 24-26 if the semiweekly deposit rule applies.
Wed 31 File Form 720 for the second quarter.
Wed 31 File Form 730 and pay the tax on wagers accepted during June.
Wed 31 File Form 2290 and pay the tax for vehicles first used during June.
Wed 31 Employers: File Form 5500 or 5500-EZ.
Wed 31 Deposit FUTA owed through June if more than $500.
Wed 31 File Form 941 for the second quarter.
Fri 2 Deposit payroll tax for payments on Jul 27-30 if the semiweekly deposit rule applies.
Wed 7 Deposit payroll tax for payments on Jul 31 – Aug 2 if the semiweekly deposit rule applies.
Fri 9 Deposit payroll tax for payments on Aug 3-6 if the semiweekly deposit rule applies.
Mon 12 Employers: Employees are required to report to you tips of $20 or more earned during July.
Mon 12 File Form 941 for the second quarter if you timely deposited all required payments.
Wed 14 Deposit payroll tax for payments on Aug 7-9 if the semiweekly deposit rule applies.
Thu 15 Deposit payroll tax for Jul if the monthly deposit rule applies.
Fri 16 Deposit payroll tax for payments on Aug 10-13 if the semiweekly deposit rule applies.
Wed 21 Deposit payroll tax for payments on Aug 14-16 if the semiweekly deposit rule applies.
Fri 23 Deposit payroll tax for payments on Aug 17-20 if the semiweekly deposit rule applies.
Wed 28 Deposit payroll tax for payments on Aug 21-23 if the semiweekly deposit rule applies.
Fri 30 Deposit payroll tax for payments on Aug 24-27 if the semiweekly deposit rule applies.
Tue 3 File Form 730 and pay tax on wagers accepted during July.
Tue 3 File Form 2290 and pay the tax for vehicles first used during July.
Thu 5 Deposit payroll tax for payments on Aug 28-30 if the semiweekly deposit rule applies.
Fri 6 Deposit payroll tax for payments on Aug 31 – Sep 3 if the semiweekly deposit rule applies.
Tue 10 Employers: Employees are required to report to you tips of $20 ore more earned during August.
Wed 11 Deposit payroll tax for payments on Sep 4-6 if the semiweekly deposit rule applies.
Fri 13 Deposit payroll tax for payments on Sep 7-10 if the semiweekly deposit rule applies.
Mon 16 Individuals: Pay the third installment of your 2013 estimated tax.
Mon 16 Partnerships: File Form 1065 if you timely requested a 5-month extension.
Mon 16 Corporations: File calendar year Form 1120 or 1120S if you timely requested a 6-month extension.
Mon 16 Corporations: Deposit the third installment of your 2013 estimated tax.
Mon 16 Deposit payroll tax for Aug if the monthly deposit rule applies.
Wed 18 Deposit payroll tax for payments on Sep 11-13 if the semiweekly deposit rule applies.
Fri 20 Deposit payroll tax for payments on Sep 14-17 if the semiweekly deposit rule applies.
Wed 25 Deposit payroll tax for payments on Sep 18-20 if the semiweekly deposit rule applies.
Fri 27 Deposit payroll tax for payments on Sep 21-24 if the semiweekly deposit rule applies.
Mon 30 File Form 730 and pay tax on wagers accepted during August.
Mon 30 File Form 2290 and pay the tax for vehicles first used during August.


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CIMAMASR TO BUILD STREET CINEMAS
Winged Isis
Post by Winged Isis » Wed May 15, 2019 11:15 pm
Here's hoping for Luxor.
CIMAMASR TO BUILD STREET CINEMAS IN 27 GOVERNORATES ACROSS EGYPT
The beginning of a second Golden Age for Egyptian cinema?
CAIROSCENE TEAM
Who doesn't love unwinding to a movie after a long day at work? Sure, nowadays we do most of our movie-binging on Netflix, but there's nothing quite like the added drama and ambiance that comes with watching a film in the cinema.
Chanelling this somewhat purist spirit, CimaMasr, is making cinemas more accessible in an effort to revive movie theatre culture with an innovative new initiative built around street cinemas.
The project will see its first cinema constructed as soon as July this year and fully functioning by August, while all 55 planned cinemas are scheduled to be ready and fully running by January 2020.
It's not just about taking a break from Netflix and getting off the couch, though. These cinemas aim to be inclusive of everyone by being affordable and encouraging young local actors, writers and creatives to pursue their talent by granting them exposure with an all-inclusive platform.
In giving Egypt's youth a medium to voice their creativity, Cima Masr aims to provide more job opportunities and create exposure for local talents. The project's Business Development Manager, director Hady El Bagoury, hopes to also give the country's youth direction and a space to grow their skills, be it in scriptwriting, acting, casting or directing.
With tickets costing EGP 10, the cinemas will be built in 27 different governorates and will accommodate up to 345 viewers each, with 24 of the seats built for the physically challenged.
Brought to life by independent, non-profit organisation, the Egyptian Foundation for Strategic Studies and Research (EFSSR), the street cinemas also come in an effort to promote cinema production throughout the country. By encouraging more Egyptians to expand their film palette, the street cinema project hopes to revive Egyptian cinema traditions and values through the project.
EFSSR is a non-profit organisation headed by Hany Ghoneim and its main role is to research ways and strategies that work towards benefiting and promoting local communities in Egypt.
Re: CIMAMASR TO BUILD STREET CINEMAS
Post by carrie » Sat May 18, 2019 10:33 am
I don't know if anyone remembers the cinema that used to be on Station street what a flea pit that was. I have been to the cinema in Cairo and that wasn't a very happy experience what with the mobile phones ringing and people chatting the place was clean enough but never again.
I build a Ship...
by Who2 » Fri Aug 10, 2018 3:17 pm » in Literary Corner
Words from the Druid Taliesin:
Whence I came, I know. Whither I go, I know not. I came forth from the womb of Experience.
What I know, that I am. What I know not, is the limitless measure of what...
Of course, Philosophy is for lazy buggers who don't want to work for a living and escape the real life.
You can with Philosophy justify anything, which is worrying.
Sure it look inspirational, but...
Last post by John Landon
Samsung to build first Middle East factory in Egypt
by DJKeefy » Thu Sep 13, 2012 10:40 pm » in Know Egypt
Samsung signed a memorandum of understanding with the governor of Beni Suef on Thursday to build its first factory in the Middle East and Africa. The factory is planned to be fully operated in 2013....
Something like this is needed so badly in Luxor.
Last post by hatusu
OneraSystems offers to build $90 mn solar power plant...
by DJKeefy » Sun Nov 16, 2014 5:25 pm » in Know Egypt
OneraSystems offers to build $90 mn solar power plant in Egypt.
A consortium of Egyptian investors is planning to build four solar powered electricity stations with a capacity of 50 megawatts (mW)...
Gay ? 'Not likely the lads got through 12 Betty's in their time…. :cool:
Yes but were the 12 Betws y Coed? ;) ;)
Last post by Brian Yare
Egypt takes $25 bln loan from Russia to build nuclear plant
by DJKeefy » Fri May 20, 2016 8:26 pm » in Know Egypt
Egypt's president Sisi approved a $25 bln loan from Russia to build a nuclear power plant in Dabaa, according to the state's official newspaper published on Thursday.
The presidential decree 484 for...
OK MT lets have the nuclear power plant built just outside Luxor, I will feel much happier and safer. :roll:
Last post by carrie
Disney in talks to build theme park in Egypt: Minister
by DJKeefy » Tue Nov 18, 2014 11:01 pm » in Know Egypt
Disney is considering building a theme park in Egypt, its first in the Middle East, state-run news agency MENA reported on Tuesday.
There are discussions going on between Disney International to...
Well, that is a disappointment, suppose that we will just have to remain content with the cartoon characters we already have here in good old Luxor, exit stage left. :snig:


Since it invented the world's first anti-theft protection technology using encrypted codes on consumer electronic products, DISA has focused its resources on its anti-theft business and ramped down its other businesses.
Given that Walmart is using DISA's technology, it is time to boost market penetration. As the first mover providing a digital point-of-sale activation solution, it should get at least three top US retailers on its platform.
The key risks are that slow user adoption and a breach in DISA's encryption could lead to reputational damages and a fall in revenue. The concern is if DISA fails to scale and to cover its burn rate. It is at an inflection point and must convince retailers and suppliers to adopt its technology as the industry standard. If it cannot do so, debt and equity financing solutions could dry up as investors lose faith.
There could also be unexpected costs to improve its information technology infrastructure, and these may add to the cash burn rate. Like most tech firms at an inflection point, it is critical DISA maintains investors' trust.


Just What Does National Reciprocity Mean?
The media has not been great about explaining what national concealed carry reciprocity means. And for non-gun people, it can be confusing. Newsweek recently published a great article breaking everything down in an easy to understand way. Let's hope that non-gun people read it! Let's look at the laws here.
In early March, Senate Majority Whip John Cornyn (Republican), the second most powerful Republican Senator behind Speaker of the House Paul Ryan, introduced Senate Bill 446, the "Concealed Carry Reciprocity Act of 2017." this bill, introduced into the Senate, would require states that issue concealed carry gun permits to recognize concealed carry permits issued by other states. North Carolina Republican Richard Hudson introduced a similar bill into the House, HR 38, "The Concealed Carry Reciprocity Act of 2017," on January 3 this year.
Similar legislation has been blocked in the past. But now, Republicans control both the House and the Senate, so the bills have their best chance ever of passing.
Every state including Washington DC allows some form of concealed carry. Some states, like New Jersey, Maryland, New York, California and Hawaii, force residents to show that they have a "justifiable need," "good cause," or "substantial reason" to get a permit. States also are allowed to set their own limits on where guns can be carried or not carried, such as schools, places where alcohol is served, sporting arenas, hospitals and government buildings. Some states require proof of having passed a training class before they will issue a concealed carry permit. Some don't have this requirement.
Thirty-nine states require a state-issued permit to legally carry a concealed weapon (in public) within the bounds of that state. Eleven states (Alaska, Arizona, Idaho, Kansas, Maine, Mississippi, Missouri, New Hampshire (as of just recently), Vermont, West Virginia and Wyoming) do not require a permit. Some states, like Alabama, are considering passing laws allowing permit-less carry. Some of these states do not allow non-residents with concealed carry permits to carry in their state. Some states do not permit you to transport a gun unless it is locked in the trunk and unloaded. Some states do not restrict how a permitted weapon may be transported by vehicle.
The hodge-podge of conflicting laws is one reason that gun rights supporters want a concealed carry national reciprocity system. Our argument is that a driver's license works in every state. If you demonstrate that you can responsibly drive a car in your home state, then every other state in the nation lets you drive there. How hard is that? We want the same system for gun ownership. We have no problem undergoing some training–we are always talking about how important safety training is regardless of whether or not your state requires training or not. That's not a big deal. But let us get our permit in California and drive across the country to New York and be able to follow the same laws the whole way.
Let's get these laws passed, politicians.
Republican Congressman Draws Up National Concealed Carry Reciprocity Bill Virginia Announces Changes to Permit Reciprocity Agreements National Right to Carry Reciprocity Legislation Can I Carry in a State That Doesn't Honor My Concealed Permit?


text:
Presubmission Inquiries
PLOS Medicine publishes research and commentary of general interest with clear implications for patient care, public policy or clinical research agendas.
Why Publish with PLOS Medicine?
Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study
Mark A. Boyd ,
Roles Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing
* E-mail: mark.boyd@adelaide.edu.au
Affiliations Kirby Institute, University of New South Wales, Sydney, Australia, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
Amanda Mocroft,
Roles Formal analysis, Methodology, Writing – review & editing
Affiliation Department of Infection and Population Health, University College London, London, United Kingdom
Lene Ryom,
Roles Data curation, Methodology, Writing – review & editing
Affiliation Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Antonella d'Arminio Monforte,
Roles Methodology, Writing – review & editing
Affiliation Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera–Polo Universitario San Paolo, Milan, Italy
Caroline Sabin,
Wafaa M. El-Sadr,
Affiliation ICAP at Columbia University, New York, New York, United States of America
Camilla Ingrid Hatleberg,
Stephane De Wit,
Affiliation Division of Infectious Diseases, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
Rainer Weber,
Affiliation Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Eric Fontas,
Affiliation Department of Public Health, Nice University Hospital, Nice, France
Andrew Phillips,
Fabrice Bonnet,
Affiliations Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France, Bordeaux Population Health, INSERM U1219, Université de Bordeaux, Bordeaux, France
Peter Reiss,
Affiliations Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, HIV Monitoring Foundation, Amsterdam, The Netherlands
Jens Lundgren,
Roles Conceptualization, Methodology, Writing – review & editing
Matthew Law
Roles Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing
Affiliation Kirby Institute, University of New South Wales, Sydney, Australia
Mark A. Boyd,
Eric Fontas
https://doi.org/10.1371/journal.pmed.1002424
Mark A. Boyd Amanda Mocroft ... Matthew Law
The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m2) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events.
Methods and findings
We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m2, and a confirmed (>3 months apart) eGFR < 60 ml/min/1.73 m2 thereafter to calculate CVD and CKD risk scores. We calculated CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%–5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, p = 0.005) increase in CVD events compared to those at low risk. Participants' CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (p = 0.329 and p = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints.
We found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes, and compared to those at high predicted risk for only CVD or CKD events. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results further encourage clinicians to prioritise addressing modifiable risks for CVD and CKD in HIV-positive people.
Why was this study done?
Access to combination antiretroviral therapy has increased the life expectancy of HIV-positive people.
Despite this success, there is evidence that HIV-positive people may experience an earlier onset of comorbidities (e.g., cardiovascular disease [CVD] and chronic kidney disease [CKD]) in comparison with their HIV-negative peers.
The D:A:D study has developed specific models to predict the risk for CVD and CKD events in HIV-positive people.
This study was designed to investigate whether HIV-positive people at high risk for both CVD and CKD are at even greater risk for CVD and CKD events, and may therefore warrant particularly close clinical attention and management.
What did the researchers do and find?
The D:A:D study is a prospective observational study that combines 11 cohorts of >49,000 HIV-positive people followed prospectively since 1999.
We performed a study that included the 27,215 participants with the requisite data to calculate their D:A:D CVD and CKD risk scores. We calculated the CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%–5%, >5%) and analysed whether CVD and CKD risk group effects were multiplicative.
We found that people at high predicted risk for both CVD (>5%) and CKD (>5%) events have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes and those at high predicted risk for CVD or CKD events alone.
What do these findings mean?
HIV-positive people not uncommonly have high predicted CVD and/or CKD risk; these interact to create substantial risks for future morbid events.
Our results suggest that CVD and CKD risk in HIV-positive people should be assessed together.
The results should further encourage clinicians to prioritise addressing modifiable risks for CVD and CKD in HIV-positive people.
Citation: Boyd MA, Mocroft A, Ryom L, Monforte Ad, Sabin C, El-Sadr WM, et al. (2017) Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study. PLoS Med 14(11): e1002424. https://doi.org/10.1371/journal.pmed.1002424
Academic Editor: Steven G. Deeks, San Francisco General Hospital, UNITED STATES
Received: June 8, 2017; Accepted: October 3, 2017; Published: November 7, 2017
Copyright: © 2017 Boyd et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The D:A:D Study Steering Committee encourages the submission of concepts for research projects. Concepts can be submitted for review by the D:A:D Steering Committee using an online research concept, please see http://www.cphiv.dk/OngoingStudies/DAD/Submit-research-concept. Once submitted the research concept will undergo review by the D:A:D SC for evaluation of the scientific relevance, relevance to the D:A:D study, design, statistical power and feasibility and overlap with already approved projects. Upon completion of the review, feedback will be provided to the proposer(s). In some circumstances, a revision of the concept may be requested. If the concept is approved for implementation, a writing group will be established consisting of the proposers (up to 3 persons that were centrally involved in the development of the concept) and members of the D:A:D Steering Committee (or other appointed cohort representatives) Statistical department and Coordinating Center. All persons involved in the process of reviewing these research concepts are bound by confidentiality. Requests can be made to the D:A:D Coordination Office att. Camilla Hatleberg (Camilla.hatleberg@regionh.dk). To obtain data, please contact Dorthe Raben, Director of Research Coordination (Dorthe.raben@regionh.dk).
Funding: Data on Adverse Events (D:A:D) Study:The D:A:D study was supported by the Highly Active Antiretroviral Therapy Oversight Committee (HAARTOC), a collaborative committee with representation from academic institutions, the European Agency for the Evaluation of Medicinal Products, the United States Food and Drug Administration, the patient community, and pharmaceutical companies with licensed anti-HIV drugs in the European Union: AbbVie, Bristol-Myers Squibb, Gilead Sciences Inc., ViiV Healthcare, Merck & Co Inc. and Janssen Pharmaceuticals. Supported also by a grant [grant number DNRF126] from the Danish National Research Foundation (CHIP & PERSIMUNE); by a grant from the Dutch Ministry of Health, Welfare and Sport through the Center for Infectious Disease Control of the National Institute for Public Health and the Environment to Stiching HIV Monitoring (ATHENA); by a grant from the Agence nationale de recherches sur le sida et les hépatites virales [ANRS, Action Coordonnée no.7, Cohortes] to the Aquitaine Cohort; The Australian HIV Observational Database (AHOD) is funded as part of the Asia Pacific HIV Observational Database, a program of The Foundation for AIDS Research, amfAR, and is supported in part by a grant from the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) [grant number U01-AI069907] and by unconditional grants from Merck Sharp & Dohme; Gilead Sciences; Bristol-Myers Squibb; Boehringer Ingelheim; Janssen-Cilag; ViiV Healthcare. The Kirby Institute is funded by The Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New South Wales; by grants from the Fondo de Investigación Sanitaria [grant number FIS 99/0887] and Fundación para la Investigación y la Prevención del SIDA en Espanã [grant number FIPSE 3171/00], to the Barcelona Antiretroviral Surveillance Study (BASS); by the National Institute of Allergy and Infectious Diseases, National Institutes of Health [grants number 5U01AI042170-10, 5U01AI046362-03], to the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA); by primary funding provided by the European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement n° 260694 and unrestricted grants by Bristol-Myers Squibb, Janssen R&D, Merck and Co. Inc., Pfizer Inc., GlaxoSmithKline LLC, (the participation of centres from Switzerland is supported by The Swiss National Science Foundation (Grant 108787)) to the EuroSIDA study; by unrestricted educational grants of AbbVie, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Pfizer, Janssen Pharmaceuticals to the Italian Cohort Naive to Antiretrovirals (The ICONA Foundation); and financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #148522) and by the SHCS research foundation. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: MB has received research grants, paid to his institution from Merck Sharp & Dohme and Gilead Sciences. MB has also received honoraria for participation on HIV advisory boards and preparation and delivery of educational materials from Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme and ViiV Healthcare. AM has received honoraria, travel support, speaker fees and consultancy fees from ViiV, BMS, BI, Gilead, and Wragge LLC; AP received speaker fees for a 2015 conference for Gilead Sciences; ML has received unrestricted research grants, paid to his institution, from Boehringer Ingelhiem, Gilead Sciences, Merck Sharp & Dohme, Bristol-Myers Squibb, Janssen-Cilag, ViiV HealthCare; ML has also received consultancy and presentation fees from Gilead Sciences, and DSMB sitting fees from Sirtex Pty Ltd; PR through his institution has received independent scientific grant support from Gilead Sciences, Janssen Pharmaceuticals Inc, Merck & Co, Bristol-Myers Squibb and ViiV Healthcare; PR has served on a scientific advisory board for Gilead Sciences and ViiV Healthcare, as well as on a data safety monitoring committee for Janssen Pharmaceuticals Inc, and has chaired a scientific symposium by ViiV and received remuneration; CS's institution has received a grant from the D:A:D Oversight Committee for the analysis and co-ordination of the D:A:D Study; CS has also received personal fees from Gilead Sciences, ViiV Healthcare and Janssen-Cilag for the membership of Data Safety and Monitoring Boards, Advisory Boards, Speaker Panels and for the preparation of educational materials.
Abbreviations: BP, blood pressure; CKD, chronic kidney disease; CVD, cardiovascular disease; D:A:D, Data Collection on Adverse Events of Anti-HIV Drugs; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; HBV, hepatitis B virus; HCV, hepatitis C virus; HDL, high-density lipoprotein; IDU, injecting drug use; IRR, incidence rate ratio; N(t)RTI, nucleoside/nucleotide reverse transcriptase inhibitor; PI, protease inhibitor; pyrs, person-years
Combination antiretroviral therapy has transformed the lives of HIV-positive people. Over the past 20 years in high-income countries, rates of opportunistic diseases have declined and life expectancy has reached levels similar to that of the HIV-negative population [1–4]. However, there is evidence suggesting that people living with HIV experience greater and earlier onset of comorbidities compared with their HIV-negative peers [5–7]. The relative extent to which this observation relates to a higher prevalence of behaviours and risks associated with such comorbidities, increased levels of immune activation and coagulopathy despite sustained virological suppression, antiretroviral treatment, and/or other mechanisms remains unclear [8,9].
In the general population, it is well established that chronic kidney disease (CKD) is an important and independent risk factor (covariate) for cardiovascular disease (CVD) [10]. It has been argued that CKD should be considered a coronary risk factor, and that aggressive risk factor reduction for other CVD risk factors should be part of standard therapy for patients with CKD [11].
CVD in turn is associated with CKD. This may be mediated by the development of atherosclerosis, or may result as a consequence of shared risk factors with CKD such as hypertension and diabetes mellitus. It is well recognised that the effects of comorbidity may be greater than the effects of the sum of risk of each disease, and that their co-existence may lead to more severe illness, poorer prognosis, and premature death [11].
In HIV-positive people, a similarly strong relationship between CKD and CVD has been reported [12]. The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) collaboration has developed HIV-specific predictive risk models for CVD [13] and CKD [14] in an attempt to help guide care in these individuals. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events, and may therefore warrant particularly close clinical attention and management.
The D:A:D study is a prospective observational study that combines 11 cohorts of HIV-positive people. Its objective is to establish whether the use of combination antiretroviral therapy is associated with an elevated risk of CVD, end-stage renal disease (ESRD), liver disease, cancer, and death. The 11 cohorts contribute data on 49,717 participants enrolled at 212 clinics in Europe, the US, Argentina, and Australia. The standardised dataset includes information on socio-demographics, AIDS events and death, known CVD risk factors, height and weight, laboratory markers, antiretroviral treatment history, estimated glomerular filtration rate (eGFR) (Cockcroft—Gault equation), and treatments including those prescribed for CVD risk.
The main analyses in this study were performed according to a prospectively established statistical analysis plan (S2 Text). The non-prospectively defined analyses were those investigating the covariates of the CVD risk score as predictors for CKD events adjusted for CKD risk group, the covariates of the CKD risk score as predictors for CVD events adjusted for CVD risk group, and the prevalence of diabetes at baseline according to predicted CKD and CVD risk group.
All participating cohorts in the D:A:D study followed local national guidelines/regulations regarding patient consent and ethical review.
In this study we included individuals for whom a complete set of risk covariate data was available after 1 January 2004 as required by both the D:A:D CVD and CKD risk equations, except for missing data for exposure to viral hepatitis C and family history of CVD, in which case these were imputed to be negative (thus slightly underestimating CVD risk in these individuals). All those included in the analysis had an eGFR > 60 ml/min/1.73 m2 at baseline and an eGFR ≤ 60 ml/min/1.73 m2 observed subsequently on at least 2 consecutive occasions at least 3 months apart. We used definitions of endpoints indicating CVD and CKD as defined in previous D:A:D publications [13,14], but note that CVD events were centrally validated clinical events (myocardial infarction, stroke, and invasive cardiac procedures), whereas CKD events were based on confirmed laboratory criteria.
Patient follow-up was censored at the earliest of the following: last eGFR, last visit plus 6 months, or 1 February 2015. We excluded participants with a previous history of CVD, baseline eGFR ≤ 60 ml/min/1.73 m2, or a CVD or CKD event that occurred within 30 days of baseline. We included CVD events and follow-up after the definition of a CKD event had been met and CKD events after the definition of a CVD event had been met.
We calculated the 5-year predicted risk for CKD and CVD using the D:A:D risk equations [13,14]. The CVD equation includes age, sex, diabetes, CVD family history, current and former smoking, total cholesterol, high-density lipoprotein (HDL) cholesterol, systolic blood pressure, current CD4 count, current receipt of abacavir, and cumulative exposure to protease inhibitors (PIs) and nucleoside/nucleotide reverse transcriptase inhibitors (N[t]RTIs). We censored PI and N(t)RTI at 3 and 7 years, respectively, as this reflects the range of data on which the models were developed and so avoids over-predicting risk. The CKD equation includes age, sex, exposure to HIV through injecting drug use, hepatitis C coinfection, baseline eGFR, nadir CD4 count, hypertension, prior CVD and diabetes, adjustment for current receipt of unboosted atazanavir or ritonavir-boosted lopinavir, and a higher adjustment for tenofovir disoproxil fumarate, ritonavir-boosted atazanavir and any other PI.
We stratified the 5-year predicted CKD and CVD risk into groups as ≤1%, >1%–5%, and >5%. We did this rather than use predicted risk as a continuous measure for 2 reasons. First, this reflects how clinicians and their patients use these risk equations, categorising predicted risk into groups that then indicate possible interventions. Second, using risk groups in this fashion allows clear presentation of the rates of CKD and CVD events in each predicted risk group. We deliberately chose not to use the low, moderate, and high CKD risk groups defined by Mocroft et al. [14] in order that the CVD and CKD risk groups could be interpreted in the same fashion. We performed a secondary analysis of events using the Framingham equation, recalibrated to the D:A:D study as described in a previous publication [13], to assess whether the results would be similar compared to the primary analysis. We also examined CKD and CVD events using predicted risks as continuous covariates as a sensitivity analysis.
We calculated CKD and CVD event rates by CKD and CVD risk group. We fitted Poisson models to assess whether CKD and CVD risk group effects are additive or multiplicative. In an attempt to assess how the predicted CVD risk score was contributing to prediction of CKD events, we investigated predictors of CKD events, fitting the CKD risk score group and then each of the covariates in the CVD risk score that are not included in the CKD risk score. We also investigated predictors of CVD events, fitting the CVD risk score group and then each of the covariates in the CKD risk score that are not included in the CVD risk score.
Baseline characteristics
Of the 49,717 individuals enrolled in the D:A:D study, 27,215 (55%) had the required complete covariate data after 1 January 2004 and were included in this analysis, contributing 202,034 person-years (pyrs) of follow-up.
Characteristics of the 27,215 individuals included at baseline, defined as the first time each individual had complete CVD and CKD risk factor data available after 1 January 2004, are shown in Table 1. The median (IQR) baseline year of follow-up was 2005 (2004, 2008). The cohort was 74% male, with a median (IQR) age of 42 (36, 49) years. Fifty percent were smokers at baseline, and 3.8% had a diagnosis of diabetes mellitus. The median (IQR) 5-year predicted CKD risk was 1.1% (0.6%, 3.7%), and the median (IQR) 5-year predicted CVD risk was 1.6% (0.8%, 3.3%).
Table 1. Participant baseline characteristics.
https://doi.org/10.1371/journal.pmed.1002424.t001
Of the 1,415 people with a CKD event and 918 people with a CVD event, 154 (10.9%) experienced both types of event. Eighty-six (56%) of those who had both events experienced the CVD event first, and 67 (44%) the CKD event first. In 1 person the CKD and CVD event occurred on the same day. The majority of the CKD and CVD events (117, 76%) occurred 1 or more years apart.
Overall CVD and CKD risk
The numbers of participants in each predicted risk group combination are expressed in Table 2. Of the 3,560 people with a 5-year predicted CVD risk > 5%, 3,331 (94%) were men and 229 (6%) were women. In these 3,331 men there were 528 CKD events (rate 23.0 per 1,000 pyrs), and in the 229 women there were 53 CKD events (rate 37.3 per 1,000 pyrs).
Table 2. Numbers of participants in each predicted risk group combination.
CKD event rates according to CKD and CVD risk
We observed 1,415 CKD events during follow-up, an overall rate of 7.00 per 1,000 pyrs (95% CI 6.6–7.7 per 1,000 pyrs). CKD event rates by predicted CKD and CVD risk group are shown in Fig 1, indicating that within each CKD risk group, the CKD event rate increases with higher predicted CVD risk.
Fig 1. CKD event rates according to CKD and CVD risk.
CKD, chronic kidney disease; CVD, cardiovascular disease; pyrs, person-years.
https://doi.org/10.1371/journal.pmed.1002424.g001
This multiplicative effect of CKD and CVD predicted risk group on CKD events is confirmed by the Poisson regression models (Table 3), which show a highly statistically significant association between predicted CVD risk group and CKD events, after adjustment for CKD risk group. In these models there was no statistical evidence of an interaction between the predicted CKD and CVD risk groups, suggesting that the effects are multiplicative (i.e., additive on a log scale). This means, for example, that for an individual with a high predicted 5-year risk of both CKD and CVD, the incidence rate ratio (IRR) for CKD events would be 13.81 multiplied by 5.63, which equals 77.75, compared with an individual at low predicted risk for both CKD and CVD.
Table 3. Combined effect of CKD and CVD risk groups in predicting CKD and CVD events.
The CKD event rates by predicted Framingham CVD and CKD risk strata were similar to the findings in the primary analysis (S1 Table).
CVD event rates according to CKD and CVD risk groups
There were 918 CVD events documented during follow-up, an overall rate of 4.5 per 1,000 pyrs (95% CI 4.2–4.8 per 1,000 pyrs). CVD event rates by predicted CVD and CKD risk groups are shown in Fig 2. This figure shows large increases in CVD event rates with increasing predicted CVD risk, as would be expected. But there is also some evidence of increasing CVD events with increasing predicted CKD risk.
Fig 2. CVD event rates according to CKD and CVD risk.
The Poisson regression models did confirm a statistically significant association between higher predicted CKD risk group and CVD events after adjustment for predicted CVD risk (Table 3). But the magnitude of this association was smaller than was seen for the association between predicted CVD risk group and CKD events. Again, there was no statistical evidence of an interaction between predicted CVD and CKD risk groups.
The CVD event rates by predicted Framingham CVD and CKD risk strata were also similar to the findings made in the primary analysis (S2 Table).
Investigating covariates of the CVD risk score as predictors of CKD events
The relationship between the covariates of the CVD risk score and prediction of CKD events (adjusted for CKD risk group) is summarised in Table 4. We found that total plasma cholesterol level was associated with risk of a CKD event (IRR 1.48 per unit log total cholesterol, 95% CI 1.20, 1.83, p < 0.001), as were baseline CD4 count (IRR 0.90, 95% CI 0.86, 0.95, p < 0.001) and cumulative exposure to a PI (IRR 1.11 per year exposure, 95% CI 1.06, 1.15, p < 0.001) or to an N(t)RTI (IRR 1.05 per year exposure, 95% CI 1.03, 1.08, p < 0.001). We did not find statistically significant relationships for having a family history of CVD, being an ex- or current smoker, HDL cholesterol, or currently receiving abacavir.
Table 4. Covariates of CVD risk score as predictors for CKD events adjusted for CKD risk group.
In a multivariate analysis, after adjusting the covariates for each other as predictors of CKD events, we found similar associations as for the analysis adjusted only for CKD risk group, although the association for receiving a PI lost statistical significance (IRR 1.04, 95% CI 0.99, 1.10, p = 0.149).
Investigating covariates of the CKD risk score as predictors of CVD events
After adjustment for CVD risk group, we found 1 covariate in the CKD risk score that was associated with CVD events (Table 5). Higher nadir CD4 count was associated with a reduced risk of CVD events: IRR 0.94 per 100 cells (95% CI 0.091, 0.98, p = 0.002). We did not find associations between predicted CKD risk and HIV exposure through injecting drug use, baseline eGFR, or being coinfected with viral hepatitis C.
Table 5. Covariates of CKD risk score as predictors for CVD events adjusted for CVD risk group.
Diabetes by predicted CKD and CVD risk
Diabetes is a key covariate in both the CKD and CVD risk scores. Therefore, we were interested in exploring the prevalence of diabetes in the CKD and CVD predicted risk groups (Table 6). The prevalence of diabetes at baseline increased markedly with higher predicted CVD risk group. The association was less clear with CKD risk group, but of the 1,585 people at >5% predicted risk for both CVD and CKD, 366 (23.1%) had been diagnosed with diabetes.
Table 6. Diabetes prevalence at baseline by predicted CKD and CVD risk group.
We conducted sensitivity analyses assessing the predicted CKD and CVD risk scores as continuous measures rather than in groups. After adjustment for 5-year predicted CKD risk, 5-year CVD predicted risk was significantly associated with CKD events: IRR 1.065 per 1% increase (95% CI 1.058, 1.072, p < 0.001). Five-year CKD predicted risk was not significantly associated with CVD events after adjustment for 5-year CVD predicted risk: IRR 1.005 per 1% increase (95% CI 1.000, 1.011, p = 0.052). These analyses suggest that the multiplicative effects of predicted CKD and CVD risk groups on CKD and CVD events are not simply due to a loss of precision by categorising the predicted risks as ≤1%, >1%–5%, and >5%.
In this analysis we found that HIV-positive people with high predicted CVD or CKD risk were at significant risk for a future CVD or CKD event, and that this risk was multiplicative for those with greater degrees of risk. For instance, we observed a far higher CKD event rate for those at high risk (>5%) for both CVD and CKD (44.0 per 1,000 pyrs) compared to those at low risk for both (0.5 per 1,000 pyrs) and those at intermediate risk for both (5.1 per 1,000 pyrs). We found that the CKD event rate in those with a high CKD risk was highly sensitive to the degree of CVD risk, with a CKD event rate of 7.1, 21.9, and 44.0 events per 1,000 pyrs for a CVD risk of ≤1%, >1%–5%, and >5%, respectively. For CVD events we found that event rates were multiplicative in that there was a gradient from those at low risk for both events (0.45 per 1,000 pyrs) to those at high risk for both events (16.50 per 1,000 pyrs), with those at intermediate risk in between.
It is widely acknowledged that there are complex relationships between CVD and CKD, and that the risks that mediate both of these conditions can interact, leading to more severe illness and poorer prognosis [10]. Our results are consistent with this understanding in that we found that both chronic diseases were associated with an elevated risk for the other. Overall our results suggest that among people living with HIV, the association between CVD risk and a future CKD event is stronger than the association between CKD risk and a future CVD event, and that the strength of the association may be particularly marked in those who are at high risk for both CVD and CKD. This is a novel finding, as the opposite has consistently been noted in the general population, where those with CKD are at markedly elevated risk for CVD. For the general population, for instance, when adjusted for traditional cardiovascular risk factors, impaired kidney function and raised concentrations of albumin in urine increase the risk of CVD 2- to 4-fold [11]. In interpreting these findings, it should be noted that this difference may be a function of the difference in the definition of the 2 disease endpoints used in the study; CVD is a clinical event adjudicated centrally according to specific criteria, whereas CKD is defined by the presence of impaired renal function as indicated by a laboratory biomarker (eGFR) observed over 2 consecutive occasions at least 3 months apart. This laboratory-based definition is thereby a sensitive measurement that captures people with true CKD but may also include people with transient decreases in eGFR not indicative of irreversible renal function deterioration.
In terms of the risk factors for development of CKD events in those with CVD risk, we found that total cholesterol level and cumulative PI and N(t)RTI use raised the risk of CKD events, and that a higher baseline CD4 count was associated with a lower rate of future CKD events. These findings are consistent with results previously reported in the D:A:D cohort [15–18]. We found that cumulative exposure to N(t)RTIs predicts CKD events, despite tenofovir exposure being included as an adjustment in the CKD predicted risk score. This may be because tenofovir exposure was included in the CKD predicted risk model as an acute effect rather than an effect that increases with increasing exposure.
For CVD events according to CKD risk, we did not find an association between eGFR and CVD risk. This is not consistent with findings in the general community. However, the failure to find such an association may be due to effective management of renal insufficiency, with a resultant decrease in the risk of CVD in this population. This finding also seems inconsistent with previous D:A:D analyses [12]. This apparent inconsistency is likely explained by the fact that the present analysis was based on a single baseline eGFR with participants selected with eGFR in a relatively healthy range (>60 ml/min/1.73 m2), whereas previous analyses were time updated and included far lower eGFR values.
It is recognised that both CKD and CVD are largely preventable conditions and that modifying and controlling their risk factors will reduce the risk of onset of both diseases. Despite this evidence and much effort over the past decade to focus attention on reducing CVD risk in HIV-positive people, a lack of attention to the management of CVD in people living with HIV has been documented [19]. A recent modelling analysis within the ATHENA cohort examined the impact of several interventions, such as earlier antiretroviral treatment, smoking cessation, and anti-hypertensive or lipid-lowering treatment, on future CVD events among HIV-positive people [20]. The results suggested that all the selected interventions, but especially smoking cessation and blood pressure and serum lipid control, would have a positive effect in reducing CVD.
We performed an analysis that assessed the extent to which the presence of diabetes in the participants may provide at least a partial explanation of the multiplicative risks we observed in those with higher degrees of risk, and particularly in those with a high risk for both events. We found that nearly a quarter of those with a high 5-year CKD and CVD risk had been diagnosed with diabetes, compared to very few individuals diagnosed with diabetes (0.4%) in the low CKD and CVD risk groups. This confirms that diabetes is a powerful risk factor for poor outcomes in HIV-positive people, as in the general community, and it behoves all clinicians to adequately screen, diagnose, treat, and, above all, prevent this complication to facilitate the optimal longevity and quality of life in HIV-positive people.
Our study has some limitations. Prediction models are limited by restrictions in the available data, and some variables that may affect CKD and CVD risk were not available for analysis (e.g., inflammatory markers). In this analysis, the risk equations were applied to the datasets that were largely used to develop them. It may be, therefore, that the equations predict more accurately in D:A:D data than they would in other independent datasets, and this may limit the generalisability of our findings. Both equations, however, were validated: the CVD equation using internal—external cross-validation, and the CKD equation on independent datasets. The CVD and CKD endpoints used in this analysis are quite different. CVD is a serious clinical event, subject to central validation, whereas CKD is an earlier, less serious event based on a confirmed laboratory marker. As noted above, compared with the more specific adjudicated CVD endpoint, the CKD definition may be capturing a broader set of events that might include true episodes of chronic and progressive CKD but also transient events in people who may be temporarily systemically unwell, hospitalised, and/or undergoing a medical procedure, all of which may lead to episodic decreases in eGFR without this necessarily resulting in persistent renal dysfunction. We attempted to minimise the possibility of miscategorising people with CKD by requiring there to be at least 2 consecutive eGFR measurements ≤ 60 ml/min/1.73 m2 to make the diagnosis. However, the 'softer' definition of CKD may at least partially explain the finding that the magnitude of association was greater when analysing CKD events by CVD risk than when analysing CVD events by CKD risk. It is uncertain how the results might have differed if a hard clinical endpoint for renal disease, such as ESRD, had been used. Such an approach, however, was not possible in our analyses, as a prediction tool for ESRD in HIV-positive people is not available, and the number of ESRD events in D:A:D is not large. In the D:A:D database, we are unable to distinguish cases of either CKD or CVD that were a direct result of a previous event.
In conclusion, we have shown that HIV-positive people not uncommonly have high predicted CVD and/or CKD risk, and that these interact to create substantial risks for future morbid events. We found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD compared with those at low predicted risk for both, and those at high predicted risk for only CVD or only CKD. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. These data also suggest that the primary prevention and effective management of these comorbidities, prioritising those interventions that have been repeatedly shown to be effective in the general population, will convey the same if not greater benefits for the population of HIV-positive people. Primary prevention and the effective management of comorbidities should be incorporated into the development of guidelines and defining future research priorities for HIV-positive people.
S1 STROBE Checklist.
https://doi.org/10.1371/journal.pmed.1002424.s001
S1 Table. CKD event rates by predicted Framingham CVD and CKD risk strata.
S2 Table. CVD event rates according to predicted Framingham CVD and CKD risk strata.
S1 Text. Full list of members of the D:A:D Steering Committee and Study Group.
S2 Text. D:A:D concept study sheet.
For a list of the full members of the D:A:D Steering Committee and Study Group, please refer to S1 Text.
The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned in the list of funders.
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Q: Insert plain html/css/js pages and add address (route) to them Say I have html template https://www.free-css.com/free-css-templates/page244/debut How do I insert them into Drupal correctly so that it works exactly as I if've put these files from archive alongside Drupal...? So that if I open "mysite.com/contact.html" I get exactly the contents of contact.html an everything inside (links to css/js files) works.

A: If I'm understanding, you want to serve a static HTML file from the same domain as a Drupal site, and not bootstrap Drupal in the process, so the static HTML gets served directly. I'd recommend using the Pathed Files module (https://www.drupal.org/project/pathed_files) which lets you upload a static file or paste its contents into a form, and specify a custom URL for it. Alternatively, if you just put an HTML file in the Drupal files directory (e.g. https://your.website.com/sites/default/files/your-html-file.html), your Web server will happily serve it as is, but you have to live with that /sites/default/files/ path in the URL. Truth be told, you could put it right in the Drupal Web root, alongside index.php, and the Web server will serve it without bootstrapping Drupal. But that's very ugly, and you really, really should not do that.


We would like to say a BIG thank you to all of our wonderful clients for your support and generosity with the recent 2015 'Salon Select Smiles For Starlight' campaign!
With your help, we are proud to announce that the initial fundraising target has been exceeded and we have raised an incredible $77,250 for Starlight Children's Foundation!
We were joined by over 300 other Salon Select hair salons around the country and KDelmé Hairdressing and the Australian Hairdressing Council are very excited to now be able to grant 11 Starlight Wishes for seriously ill children within Australia. A Starlight Wish is a once-in-a-lifetime experience for a seriously ill child and their family and is the gift of hope during these tough times.
We greatly appreciate and thank you for your support of Starlight Children's Foundation, a cause that is very close to our hearts here.


Really the number one best remedy is to act very quickly. This is the best way to treat any stain. In fact this weekend I was painting my daughters room when I carelessly rolled the paint roller onto the carpet, not just a little drop of paint either. I left at least a 3 by 2 inch blotch of paint on the carpet. So immediately I grab several terry towels and cleaning cloths and a cup of water (thankfully the paint was water based). I blot up with the dry terry cleaning towel, and then apply water to the stain and blot using a dry towel until the stain was completely removed. This took several applications of a little water and blotting action with the dry towels. Leaving this stain for any amount of time would have left the carpet with a permanent purple stain. However the quick action left no evidence of my carelessness.
Blot or scrape up if the spill is thicker than a regular liquid (cat vomit etc.), remove as much as you can this first.
Never scrub or rub a spill, you will end up spreading and pushing the stain deeper.
If you use a stain remover test a small spot first in an unseen area to be sure its safe on your carpet. However if you act right away most stains can be cleaning with water and a small amount of dish detergent mixed in, then rinse with plain water.
I love the tips you give in this blog. Not scrubbing is a very important one and alot of people forget to follow that important rule.
Not acting quickly is the number one reason that a stain becomes Permanente.
Exactly, no scrubbing is the main thing to remember it makes your life so much harder.


Virtualization combined with cloud processing provides an innovative way of running a SAP HANA installation that can be easily scaled to meet the demands of a company as that company grows. As an enterprise-level software, SAP HANA can scale upwards or scale outwards to have more physical entities available as connection nodes. Both of these may require a company to invest in more hardware in order to deal with the added load. Virtual servers could serve as a temporary (or possibly permanent) solution to this problem of scaling. VMWare provides a robust virtual machine framework that can be used alongside Cloud AWS in order to develop a series of virtual servers on a handful of existing machines. VMWare's vSphere framework is ideal for the serving of virtual machines with a dedicated purpose. But how does the system perform when put to the test?
In order for us to verify how well SAP HANA performs on virtual machines, we decided that the best method was to actually install the software on a few virtual nodes and see how they performed under stress. We used the VMWare Cloud Foundation (a unified SDCC platform and comes included in the cloud infrastructure provided for use with the cloud platform) to run the system through a series of tests which exercised functionalities of the VMWare Cloud including vMotion, DRS and HA, using those to simulate the day-to-day operations of a large SAP HANA installation on a virtual machine. The size of the virtual machine we used ran 32 vCPU's and had access to 450 GB of RAM (since this was the closest approximation we could get to the limitations of our physical server which had 32 processing cores and 500GB of RAM). We followed industry best-practice when sizing the hard drives to be used for SAP visitor management system and allocating the memory dedicated to the virtual machine running HANA. In order to ensure that our database was running properly, we ran a series of standard OLAP queries (TPC-DS). During the performance test, vMotion was used to verify that the system could move high-performance applications while in a stress-heavy environment.
Installing SAP S4/HANA wasn't much different on a virtual system than it was installing to a physical system. After completing the installation, we did verification checks with the OLTP and OLAP tests in order to give us peace of mind that the database installation was both successful as well as functioning properly. The second thing we wanted to focus on in this testing environment was to delve into the viability of using vSphere functionality on a SAP S4/HANA install. We intended to test a case where we would utilize VMware Cloud with a massive-sized SAP S4/HANA install, taking up almost the entire ESX hosting platform, with the expectation that if it could work under these circumstances, it could work in almost any situation.
The first testing simulation involved a reboot that happened without prior warning. Under these circumstances, the VMware HA kicked in, restarting the SAP virtual servers on another of the redundant hosts, ensuring uptime even when the primary system went down unexpectedly. DRS also performed remarkably well, migrating a couple of the smaller VM's to distributed nodes, thereby providing a more efficient processing environment. The recovery time for the SAP S4/HANA system running on VMware was in the vicinity of a few minutes, proving the effectiveness and viability of vSphere technology alongside the VMware AWS Cluster. The second testing simulation involved simulating the use of vMotion for moving a large virtual machine which was doing processing on our SAP S4/HANA database. We ran this test multiple times and it was confirmed that migration of such a large system under heavy stress was reliable.
While it's not recommended that a company look into running live versions of their SAP S4/HANA database on virtual machines until the testing with the system is complete and SAP verifies its viability, these tests prove that Dev and Test versions of SAP S4/HANA can indeed function on Cloud AWS. Additionally, it proves that SAP S4/HANA workloads that encompass the entire Physical ESXi host can be run as well as confirming that SAP HANA workloads on the cluster can be used in conjunction with HA and DRS. Finally, we can see from the results that even virtual machines under heavy load can benefit from vMotion reliably, time after time.