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Service Engineer Garage Equipment job van cleef & arpels bracelet fake with Glen Callum Associates Ltd
Service Engineer Garage Equipment
A Technical Engineer is required to service, maintain and install small to medium sized garage equipment and tooling into multi site garages, workshops, fast fit chains and the wider automotive aftermarket.
The company handles maintenance, calibration and emergency breakdowns for some of the UK largest vehicle servicing groups. The company offers excellent prospects for career progression.
The company recently secured a prestigious maintenance and calibration contract, and also won business with a number of other significant customers across the UK. To service these, they currently have vacancies within their team for engineers to assist with inspection, maintenance and calibration of all types of garage equipment.
The Role
The maintenance and repair of van cleef & arpels bracelet replica garage equipment.
Service of Tyre and Wheel related equipment.
Plan and work effectively and in conjunction with the company field sales team, telesales, marketing and all other divisions within the organisation.
To satisfy the requirements of the customer.
Good working knowledge and experience of garage equipment repair
Full UK driving license
Ability to understand procedures and work instructions, working to specified standards for inspections, calibrations and maintenance, and an eye for detail
Excellent verbal and written communication skills.
Ability to work under own supervision
Accurate control of own van stock
Desirable but not essential requirements include:
Experience of maintaining all makes of MOT and ATL/ATF equipment
The company has the ability to make quick well informed decisions based upon market and customer van cleef and arpels bracelets replica requirements. Equally this opportunity is linked to genuine career advancement and wider responsibilities upon individual and team performance.
What Now?
This is an exciting opportunity to join a fast growing garage equipment company.
To apply for the role of Service Engineer in a rapidly growing, well established company then send your CV today to Claire Thomas at Glen Callum Associates Ltd.
Claire is an ethical IRP registered recruiter and will deal with your application in strict confidence. If your application is successful you will be contacted directly by Claire and she will talk you through in detail the full company role and specifics.
Service Engineer Garage Equipment
A Technical Engineer is required to service, maintain and install small to medium sized garage equipment and tooling into multi site garages, workshops, fast fit chains and the wider automotive aftermarket.
The company handles maintenance, calibration and emergency breakdowns for some of the UK largest vehicle servicing groups. The company offers excellent prospects for career progression.
The company recently secured a prestigious maintenance and calibration contract, and also won business with a number of other significant customers across the UK. To service these, they currently have vacancies within their team for engineers to assist with inspection, maintenance and calibration of all types of garage equipment.
The Role
The maintenance and repair of van cleef & arpels bracelet replica garage equipment.
Service of Tyre and Wheel related equipment.
Plan and work effectively and in conjunction with the company field sales team, telesales, marketing and all other divisions within the organisation.
To satisfy the requirements of the customer.
Good working knowledge and experience of garage equipment repair
Full UK driving license
Ability to understand procedures and work instructions, working to specified standards for inspections, calibrations and maintenance, and an eye for detail
Excellent verbal and written communication skills.
Ability to work under own supervision
Accurate control of own van stock
Desirable but not essential requirements include:
Experience of maintaining all makes of MOT and ATL/ATF equipment
The company has the ability to make quick well informed decisions based upon market and customer van cleef and arpels bracelets replica requirements. Equally this opportunity is linked to genuine career advancement and wider responsibilities upon individual and team performance.
What Now?
This is an exciting opportunity to join a fast growing garage equipment company.
To apply for the role of Service Engineer in a rapidly growing, well established company then send your CV today to Claire Thomas at Glen Callum Associates Ltd.
Claire is an ethical IRP registered recruiter and will deal with your application in strict confidence. If your application is successful you will be contacted directly by Claire and she will talk you through in detail the full company role and specifics.
Regular flights return to Isle of Skye for first time in over 20 years
A spokesman for the Loch Lomond Seaplanes said: 'Our highly experienced pilots have flown seaplanes in locations all over the world such as Thailand, Indonesia, Alaska, Dubai, Vancouver and the Maldives and all believe that there is nowhere that can offer such a breathtaking experience as the Highlands and Islands of Scotland, particularly the Isle of Skye.
'As one of our pilots put it, "every few seconds the Scottish landscape changes as it unfolds below the seaplane a majestic mountain peak, a stunning glen, a mysterious loch, hillside colours beyond belief, even the light bursting through clouds can change the whole scene.
Speaking on behalf of FlySkye, local restaurant owner Shirley Spear said: 'This is the kind of business that we see as being complementary to our aims. FlySkye remains determined to see regular, year round scheduled air services restored between Skye and Lochalsh and the Central Belt of Scotland.
'Whilst any regular air service will more than likely need to be supported by a public service obligation, the Skye seaplane initiative does recognize that Skye is a major tourist destination and that there are attractions in offering commercial services by third party operators.
'We also recognise that bracelet van cleef and arpels fake initiatives like that of Skye Seaplanes offer additional choice and increase the use of the facilities at the airport, particularly once these are brought up to proper standards.
'We see this type of activity as something that will contribute significantly to the future development and success of the airfield.'
Loganair flew commercial flights out of Ashaig until the imitation van cleef and arpels clover bracelet late 1980s.
Highland Council, which is responsible for the airfield, and transport body Hitrans and Highlands and Islands Enterprise commissioned research into what resurrecting the service would cost.
The results of the study were published in March and suggested the price could be between 9.7m and 15.3m.
The Scottish government has ruled out providing funding for the work needed because it would involve significant capital spending.
In February, VisitScotland announced that it would be giving away thousands of free ferry tickets to knock off van cleef rose gold bracelet encourage more people to visit Scotland's islands.
A total of 8,000 free trips to places such as Orkney, Shetland and the Outer Hebrides were offered to holidaymakers as part of the Year of Homecoming celebrations.
The free ticket scheme was a partnership between VisitScotland and ferry companies Caledonian MacBrayne (CalMac) and Serco NorthLink Ferries.
CalMac managing director Martin Dorchester said: 'Scotland's islands offer something for everyone and we look forward to welcoming visitors on board for their trip to a brilliant island.'
Most watched News videos EXCLUSIVE: Ariana Grande plane arrives back in the US Homeless man describes how he helped after Manchester attack Moment bomb explodes at Ariana Grande concert Eye witness describes spotting the Manchester attacker Armed police prepare to raid of Manchester suicide bomber Threat level now CRITICAL: PM raises terror level Blood seen dripping from victim leg after Manchester Forensic officers raid of Manchester suicide bomber Man is arrested by police outside Buckingham Palace Moment armed police storm of Manchester suicide bomber Sickening video warns of more attacks after Manchester Mum of Manchester attack victim Georgina Callander releases balloons
EXCLUSIVE: First photos of Ariana Grande since Manchester. Help for the homeless heroes: Millionaire West Ham owner. The schoolgirls massacred by ISIS coward: Five teenagers. Revealed: Manchester bomber returned to Britain from. Theresa May warns a fresh terror attack is feared to be. 'Our little princess has been so lucky': Father's joy as. Britain on lockdown: Army deploys 1,000 heavily armed. Mother of child actress pictured hugging a female police. Horror on the M6: Lorry driver is arrested after four. Tourists watch in horror as armed police arrest man. Aaron Hernandez's hell behind bars: NFL star killed. More than 24 hours on, desperate families still search. BREAKING NEWS: My son is innocent, insists father of. Grisly photos of scorched remnants of suicide bomber's. Comedian Jason Manford deletes Twitter after being. 'I won't forget what you said!' Trump tells Pope after. Terrorist's brother arrested: Dramatic moment armed. Melania and Ivanka wear black veils to meet the Pope at. MOST READ NEWS Previous.
A spokesman for the Loch Lomond Seaplanes said: 'Our highly experienced pilots have flown seaplanes in locations all over the world such as Thailand, Indonesia, Alaska, Dubai, Vancouver and the Maldives and all believe that there is nowhere that can offer such a breathtaking experience as the Highlands and Islands of Scotland, particularly the Isle of Skye.
'As one of our pilots put it, "every few seconds the Scottish landscape changes as it unfolds below the seaplane a majestic mountain peak, a stunning glen, a mysterious loch, hillside colours beyond belief, even the light bursting through clouds can change the whole scene.
Speaking on behalf of FlySkye, local restaurant owner Shirley Spear said: 'This is the kind of business that we see as being complementary to our aims. FlySkye remains determined to see regular, year round scheduled air services restored between Skye and Lochalsh and the Central Belt of Scotland.
'Whilst any regular air service will more than likely need to be supported by a public service obligation, the Skye seaplane initiative does recognize that Skye is a major tourist destination and that there are attractions in offering commercial services by third party operators.
'We also recognise that bracelet van cleef and arpels fake initiatives like that of Skye Seaplanes offer additional choice and increase the use of the facilities at the airport, particularly once these are brought up to proper standards.
'We see this type of activity as something that will contribute significantly to the future development and success of the airfield.'
Loganair flew commercial flights out of Ashaig until the imitation van cleef and arpels clover bracelet late 1980s.
Highland Council, which is responsible for the airfield, and transport body Hitrans and Highlands and Islands Enterprise commissioned research into what resurrecting the service would cost.
The results of the study were published in March and suggested the price could be between 9.7m and 15.3m.
The Scottish government has ruled out providing funding for the work needed because it would involve significant capital spending.
In February, VisitScotland announced that it would be giving away thousands of free ferry tickets to knock off van cleef rose gold bracelet encourage more people to visit Scotland's islands.
A total of 8,000 free trips to places such as Orkney, Shetland and the Outer Hebrides were offered to holidaymakers as part of the Year of Homecoming celebrations.
The free ticket scheme was a partnership between VisitScotland and ferry companies Caledonian MacBrayne (CalMac) and Serco NorthLink Ferries.
CalMac managing director Martin Dorchester said: 'Scotland's islands offer something for everyone and we look forward to welcoming visitors on board for their trip to a brilliant island.'
Most watched News videos EXCLUSIVE: Ariana Grande plane arrives back in the US Homeless man describes how he helped after Manchester attack Moment bomb explodes at Ariana Grande concert Eye witness describes spotting the Manchester attacker Armed police prepare to raid of Manchester suicide bomber Threat level now CRITICAL: PM raises terror level Blood seen dripping from victim leg after Manchester Forensic officers raid of Manchester suicide bomber Man is arrested by police outside Buckingham Palace Moment armed police storm of Manchester suicide bomber Sickening video warns of more attacks after Manchester Mum of Manchester attack victim Georgina Callander releases balloons
EXCLUSIVE: First photos of Ariana Grande since Manchester. Help for the homeless heroes: Millionaire West Ham owner. The schoolgirls massacred by ISIS coward: Five teenagers. Revealed: Manchester bomber returned to Britain from. Theresa May warns a fresh terror attack is feared to be. 'Our little princess has been so lucky': Father's joy as. Britain on lockdown: Army deploys 1,000 heavily armed. Mother of child actress pictured hugging a female police. Horror on the M6: Lorry driver is arrested after four. Tourists watch in horror as armed police arrest man. Aaron Hernandez's hell behind bars: NFL star killed. More than 24 hours on, desperate families still search. BREAKING NEWS: My son is innocent, insists father of. Grisly photos of scorched remnants of suicide bomber's. Comedian Jason Manford deletes Twitter after being. 'I won't forget what you said!' Trump tells Pope after. Terrorist's brother arrested: Dramatic moment armed. Melania and Ivanka wear black veils to meet the Pope at. MOST READ NEWS Previous.
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The clinical importance of white matter hyperintensities on brain magnetic resonance imaging
AbstractObjectives To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death.Study selection Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death.Data extraction Population studied, duration of follow up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome.Data synthesis 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested.Conclusion White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.IntroductionAs magnetic resonance imaging has become widely available and brain magnetic resonance imaging is increasingly being carried out in various clinical settings, clinicians often have to deal with the incidental discovery of white matter lesions, appearing as hyperintensities on T2 weighted images (fig 1). In the general population the prevalence of white matter hyperintensities ranges from 11 21% in adults aged around 64 to 94% at age 82.1 2 Pathological findings in regions of white matter hyperintensity include myelin pallor, tissue rarefaction associated with loss of myelin and axons, and mild gliosis.3 4 These lesions are located in the deep white matter, typically sparing subcortical U fibres, and are often seen together with vessels affected by small vessel disease.5 The affected vessels are presumed to induce the lesions in deep white matter through chronic hypoperfusion of the white matter and disruption of the blood brain barrier, leading to chronic leakage of plasma into the white matter.3 6 7 White matter hyperintensities are more common and extensive in patients with cardiovascular risk factors and symptomatic cerebrovascular disease.8 White matter hyperintensities can be measured quantitatively and non invasively on large population samples and have been proposed as an intermediate marker, which could be used for the identification of new risk factors and potentially as a surrogate end point in clinical trials.9Fig 1 matter hyperintensities on magnetic resonance imaging (axial fluid attenuated inversion recovery sequence) in two 80 year old patients: (left) minor white matter hyperintensities; (right) extensive white matter hyperintensities predominating in periventricular region. White matter lesions are considered present if hyperintense on T2 weighted, fluid attenuated inversion recovery, and proton density images, without prominent hypointensity on T1 weighted imagesOpen in new tabSeveral studies have assessed the relation between white matter hyperintensities and risk of stroke, dementia, and death, with partly conflicting results. We systematically reviewed and meta analysed all published longitudinal studies that tested the association of white matter hyperintensities with risk of stroke, dementia, and death, both in the general population and in a hospital based setting.MethodsUsing predefined search terms we identified references through searches of PubMed from 1966 to 23 November 2009 (see web extra methods 1). We also identified papers by reviewing the reference lists of relevant articles.Study selectionStudies were limited to those in adults. We included only prospective studies with longitudinal data on the association of white matter hyperintensities with risk of stroke, dementia, cognitive decline, and death. We excluded studies if they evaluated white matter lesions only by computed tomography (because of the lower sensitivity of this method for measuring white matter lesions compared with magnetic resonance imaging10); carried out magnetic resonance imaging at the end of follow up instead of at baseline; or had a sample size of fewer than 50 patients. For studies with more than one publication describing results among overlapping groups of participants and with the same outcome measure, we included only the dataset replica van cleef and arpels necklace with the longest follow up. If the follow up period was identical we included only the dataset with the largest number of patients (see web extra methods 2).Data extractionFrom the studies we extracted data on number of participants, general population versus high risk participants, mean age, duration of follow up, characteristics of magnetic resonance imaging and definition of white matter hyperintensities, outcome definition (all strokes versus intracerebral haemorrhage or ischaemic stroke; all types of dementia versus Alzheimer's disease, vascular dementia, mixed vascular and Alzheimer's dementia; and neuropsychological measurements used to assess cognitive decline), and number of events that occurred during follow up. For the measure of the association between white matter hyperintensities and the outcome we recorded, when available, hazard ratios, odds ratios, and adjustment variables when applicable.Variable definitionWe defined studies as being in high risk populations if they were carried out in people selected for the presence of prevalent disease such as mild cognitive impairment, stroke, or other vascular events, or for the presence of a high risk factor profile. (See web extra tables 1 5 for the inclusion criteria for each study.) Stroke was defined as an acute onset focal neurological deficit of presumed vascular cause lasting at least 24 hours or interrupted by death within 24 hours. Web extra tables 1 5 show the number of events by stroke type (ischaemic versus haemorrhagic), when available. Unless specified differently (see web extra tables 1 5) we defined dementia according to the criteria van cleef and arpel necklace fake of the Diagnostic and Statistical Manual of Mental Disorders, third or fourth editions11 12; Alzheimer's disease based on the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association for definite, probable, or possible Alzheimer's disease13; and vascular dementia according to the National Institute of Neurological Disorders and Stroke and copy van cleef & arpels necklace the Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria.14 Cognitive decline was defined as worsening performance on repeated neuropsychological tests. In the absence of consensus on which neuropsychological test was the most appropriate, we did not apply restrictions on type of test used. We examined separately tests of global cognitive function and tests assessing performances in specific cognitive domains (see web extra tables 1 5 for types of test used in each study).Web extra table 6 details study quality criteria, including loss to follow up, surveillance carried out for the diagnosis of incident events, description of the definition used for these events, and event subtypes. We also report the availability of effect estimates and whether the analysis took into account time to event. We calculated pooled hazard ratios using the random effects inverse variance method. In a few studies only odds ratios were available despite the longitudinal design,15 16 17 therefore we considered the odds ratios as approximations of hazard ratios.18 Significant heterogeneity was defined by a P value 2 >50%. We carried out meta analysis when at least three studies were available for the same outcome; we included only studies that used a categorical measure of white matter hyperintensities. When more than two categories were present we used the hazard ratio for the highest category compared with the lowest category. Studies for which the association of white matter hyperintensities with the outcome was studied solely in a continuous fashion (per unit increase or standard deviation increase in quantitative volume of white matter hyperintensities or semiquantitative grade for white matter hyperintensities) were not included in the meta analysis. Indeed, white matter hyperintensities were measured on completely different scales in the various cohorts, using either automated quantitative volume measures or different types of visual semiquantitative non linear volume measures. Although a sample size weighted meta analysis could be done, this would not provide a pooled effect estimate. When both adjusted and unadjusted values were available for the hazard ratio, we included the value adjusted for vascular risk factors. For studies that measured deep white matter hyperintensities and periventricular hyperintensities separately and did not provide a global risk estimate for white matter hyperintensities, we meta analysed the results for periventricular hyperintensities (see web extra methods 3). In a secondary analysis we reran the meta analysis replacing the results for periventricular hyperintensities with those for deep white matter hyperintensities. All meta analyses were done separately for population based studies and studies in a high risk population, and overall.ResultsThe initial search identified 958 articles, of which 53 met the inclusion criteria.15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 This included 14 studies for stroke,15 16 19 20 21 22 23 24 25 26 27 28 29 30 20 for dementia,29 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 21 for cognitive decline,17 22 23 29 39 46 48 50 51 52 53 54 55 56 57 58 59 60 61 62 63 and 11 for mortality.15 16 23 25 28 29 64 65 66 67 68 Some studies contained data on more than one outcome. Because of an overlap with another larger study carried out in the same population on the same outcome, seven studies were excluded: two on stroke,27 28 three on dementia,43 44 45 two on cognitive decline,51 59 and one on mortality.28 Hence a total of 46 studies was included in this systematic review15 16 17 19 20 21 22 23 24 25 26 29 30 31 32 33 34 35 36 37 38 39 40 41 42 46 47 48 49 50 52 53 54 55 56 57 58 60 61 62 63 64 65 66 67 68; 12 for stroke,15 16 19 20 21 22 23 24 25 26 29 30 17 for dementia,17 29 31 32 33 34 35 36 37 38 39 40 41 42 47 48 49 19 for cognitive decline,17 22 23 29 39 46 48 50 52 53 54 55 56 57 58 60 61 62 63 and 10 for mortality.15 16 23 25 29 64 65 66 67 68White matter hyperintensities and incident strokeIncident stroke overallSix population based studies15 19 20 21 29 30 and six studies in high risk populations16 22 23 24 25 26 examined the relation between white matter hyperintensities and incident stroke (see web extra table 1). All six population based studies could be included in the meta analysis (fig 2), which showed a significant association of white matter hyperintensities with risk of stroke (hazard ratio 3.1, 95% confidence interval 2.3 to 4.1, P16 24 26 Three studies in high risk populations could not be included in the meta analysis, two because white matter hyperintensities were studied continuously only,23 25 and a third because only intracerebral haemorrhage was studied as an outcome (see web extra table 1).22 All three found a significant association of white matter hyperintensities with incident stroke.The meta analysis combining the data from population based and high risk populations yielded a significant association of white matter hyperintensities with incident stroke (3.5, 2.5 to 4.9, PIncident stroke typesFew data existed on the association of white matter hyperintensities with specific stroke types (intracerebral haemorrhage, ischaemic stroke). One community based study21 found a significant association of white matter hyperintensities with incident ischaemic stroke; another study did not observe any association of white matter hyperintensities with recurrent intracerebral haemorrhage in patients with lobar haemorrhage (see web extra table 1).22Progression of white matter hyperintensities and incident strokeOnly one study assessed the relation between progression of white matter hyperintensities and incident stroke, in 89 patients with a history of lacunar stroke, headache, or dizziness: a significantly increased risk of stroke was observed in patients with progression of white matter hyperintensities after 4.3 years compared with those with no progression.16White matter hyperintensities and incident dementiaIncident dementia overallThree population based studies29 31 32 and 11 studies in high risk populations17 34 35 36 37 38 39 40 41 47 48 examined the relation between white matter hyperintensities and incident dementia overall (see web extra table 2). Meta analysing the three population based studies yielded a significant association of white matter hyperintensities with the occurrence of all types of dementia (2.9, 1.3 to 6.3, P=0.008; fig 3).29 31 32 Six of the 11 studies done in high risk populations could be included in the meta analysis,17 37 39 41 47 48 yielding no significant association of white matter hyperintensities with incident dementia (1.4, 0.9 to 2.3, P=0.14). Four of these six studies included patients with mild cognitive impairment37 39 41 47: meta analysing these separately also did not yield any significant association (1.1, 0.8 to 1.6, P=0.46; see web extra fig 2). Not all quality criteria were satisfied for several of the studies (see web extra table 6).34 37 38 48When combining data from population based studies and high risk populations the risk of dementia associated with white matter hyperintensities was increased overall (1.9, 1.3 to 2.8, P=0.002; fig 3, also see web extra fig 3).Incident subtypes of dementiaThree population based studies31 32 33 and three studies in high risk populations41 42 49 investigated the relation between white matter hyperintensities and incident Alzheimer's disease (see web extra table 2). Only one population based study31 and two studies in high risk populations41 49 fulfilled our predefined criteria for meta analysis. Meta analysis of these yielded a significant association of white matter hyperintensities with the risk of Alzheimer's disease (see web extra fig 4).
AbstractObjectives To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death.Study selection Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death.Data extraction Population studied, duration of follow up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome.Data synthesis 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested.Conclusion White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.IntroductionAs magnetic resonance imaging has become widely available and brain magnetic resonance imaging is increasingly being carried out in various clinical settings, clinicians often have to deal with the incidental discovery of white matter lesions, appearing as hyperintensities on T2 weighted images (fig 1). In the general population the prevalence of white matter hyperintensities ranges from 11 21% in adults aged around 64 to 94% at age 82.1 2 Pathological findings in regions of white matter hyperintensity include myelin pallor, tissue rarefaction associated with loss of myelin and axons, and mild gliosis.3 4 These lesions are located in the deep white matter, typically sparing subcortical U fibres, and are often seen together with vessels affected by small vessel disease.5 The affected vessels are presumed to induce the lesions in deep white matter through chronic hypoperfusion of the white matter and disruption of the blood brain barrier, leading to chronic leakage of plasma into the white matter.3 6 7 White matter hyperintensities are more common and extensive in patients with cardiovascular risk factors and symptomatic cerebrovascular disease.8 White matter hyperintensities can be measured quantitatively and non invasively on large population samples and have been proposed as an intermediate marker, which could be used for the identification of new risk factors and potentially as a surrogate end point in clinical trials.9Fig 1 matter hyperintensities on magnetic resonance imaging (axial fluid attenuated inversion recovery sequence) in two 80 year old patients: (left) minor white matter hyperintensities; (right) extensive white matter hyperintensities predominating in periventricular region. White matter lesions are considered present if hyperintense on T2 weighted, fluid attenuated inversion recovery, and proton density images, without prominent hypointensity on T1 weighted imagesOpen in new tabSeveral studies have assessed the relation between white matter hyperintensities and risk of stroke, dementia, and death, with partly conflicting results. We systematically reviewed and meta analysed all published longitudinal studies that tested the association of white matter hyperintensities with risk of stroke, dementia, and death, both in the general population and in a hospital based setting.MethodsUsing predefined search terms we identified references through searches of PubMed from 1966 to 23 November 2009 (see web extra methods 1). We also identified papers by reviewing the reference lists of relevant articles.Study selectionStudies were limited to those in adults. We included only prospective studies with longitudinal data on the association of white matter hyperintensities with risk of stroke, dementia, cognitive decline, and death. We excluded studies if they evaluated white matter lesions only by computed tomography (because of the lower sensitivity of this method for measuring white matter lesions compared with magnetic resonance imaging10); carried out magnetic resonance imaging at the end of follow up instead of at baseline; or had a sample size of fewer than 50 patients. For studies with more than one publication describing results among overlapping groups of participants and with the same outcome measure, we included only the dataset replica van cleef and arpels necklace with the longest follow up. If the follow up period was identical we included only the dataset with the largest number of patients (see web extra methods 2).Data extractionFrom the studies we extracted data on number of participants, general population versus high risk participants, mean age, duration of follow up, characteristics of magnetic resonance imaging and definition of white matter hyperintensities, outcome definition (all strokes versus intracerebral haemorrhage or ischaemic stroke; all types of dementia versus Alzheimer's disease, vascular dementia, mixed vascular and Alzheimer's dementia; and neuropsychological measurements used to assess cognitive decline), and number of events that occurred during follow up. For the measure of the association between white matter hyperintensities and the outcome we recorded, when available, hazard ratios, odds ratios, and adjustment variables when applicable.Variable definitionWe defined studies as being in high risk populations if they were carried out in people selected for the presence of prevalent disease such as mild cognitive impairment, stroke, or other vascular events, or for the presence of a high risk factor profile. (See web extra tables 1 5 for the inclusion criteria for each study.) Stroke was defined as an acute onset focal neurological deficit of presumed vascular cause lasting at least 24 hours or interrupted by death within 24 hours. Web extra tables 1 5 show the number of events by stroke type (ischaemic versus haemorrhagic), when available. Unless specified differently (see web extra tables 1 5) we defined dementia according to the criteria van cleef and arpel necklace fake of the Diagnostic and Statistical Manual of Mental Disorders, third or fourth editions11 12; Alzheimer's disease based on the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association for definite, probable, or possible Alzheimer's disease13; and vascular dementia according to the National Institute of Neurological Disorders and Stroke and copy van cleef & arpels necklace the Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria.14 Cognitive decline was defined as worsening performance on repeated neuropsychological tests. In the absence of consensus on which neuropsychological test was the most appropriate, we did not apply restrictions on type of test used. We examined separately tests of global cognitive function and tests assessing performances in specific cognitive domains (see web extra tables 1 5 for types of test used in each study).Web extra table 6 details study quality criteria, including loss to follow up, surveillance carried out for the diagnosis of incident events, description of the definition used for these events, and event subtypes. We also report the availability of effect estimates and whether the analysis took into account time to event. We calculated pooled hazard ratios using the random effects inverse variance method. In a few studies only odds ratios were available despite the longitudinal design,15 16 17 therefore we considered the odds ratios as approximations of hazard ratios.18 Significant heterogeneity was defined by a P value 2 >50%. We carried out meta analysis when at least three studies were available for the same outcome; we included only studies that used a categorical measure of white matter hyperintensities. When more than two categories were present we used the hazard ratio for the highest category compared with the lowest category. Studies for which the association of white matter hyperintensities with the outcome was studied solely in a continuous fashion (per unit increase or standard deviation increase in quantitative volume of white matter hyperintensities or semiquantitative grade for white matter hyperintensities) were not included in the meta analysis. Indeed, white matter hyperintensities were measured on completely different scales in the various cohorts, using either automated quantitative volume measures or different types of visual semiquantitative non linear volume measures. Although a sample size weighted meta analysis could be done, this would not provide a pooled effect estimate. When both adjusted and unadjusted values were available for the hazard ratio, we included the value adjusted for vascular risk factors. For studies that measured deep white matter hyperintensities and periventricular hyperintensities separately and did not provide a global risk estimate for white matter hyperintensities, we meta analysed the results for periventricular hyperintensities (see web extra methods 3). In a secondary analysis we reran the meta analysis replacing the results for periventricular hyperintensities with those for deep white matter hyperintensities. All meta analyses were done separately for population based studies and studies in a high risk population, and overall.ResultsThe initial search identified 958 articles, of which 53 met the inclusion criteria.15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 This included 14 studies for stroke,15 16 19 20 21 22 23 24 25 26 27 28 29 30 20 for dementia,29 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 21 for cognitive decline,17 22 23 29 39 46 48 50 51 52 53 54 55 56 57 58 59 60 61 62 63 and 11 for mortality.15 16 23 25 28 29 64 65 66 67 68 Some studies contained data on more than one outcome. Because of an overlap with another larger study carried out in the same population on the same outcome, seven studies were excluded: two on stroke,27 28 three on dementia,43 44 45 two on cognitive decline,51 59 and one on mortality.28 Hence a total of 46 studies was included in this systematic review15 16 17 19 20 21 22 23 24 25 26 29 30 31 32 33 34 35 36 37 38 39 40 41 42 46 47 48 49 50 52 53 54 55 56 57 58 60 61 62 63 64 65 66 67 68; 12 for stroke,15 16 19 20 21 22 23 24 25 26 29 30 17 for dementia,17 29 31 32 33 34 35 36 37 38 39 40 41 42 47 48 49 19 for cognitive decline,17 22 23 29 39 46 48 50 52 53 54 55 56 57 58 60 61 62 63 and 10 for mortality.15 16 23 25 29 64 65 66 67 68White matter hyperintensities and incident strokeIncident stroke overallSix population based studies15 19 20 21 29 30 and six studies in high risk populations16 22 23 24 25 26 examined the relation between white matter hyperintensities and incident stroke (see web extra table 1). All six population based studies could be included in the meta analysis (fig 2), which showed a significant association of white matter hyperintensities with risk of stroke (hazard ratio 3.1, 95% confidence interval 2.3 to 4.1, P16 24 26 Three studies in high risk populations could not be included in the meta analysis, two because white matter hyperintensities were studied continuously only,23 25 and a third because only intracerebral haemorrhage was studied as an outcome (see web extra table 1).22 All three found a significant association of white matter hyperintensities with incident stroke.The meta analysis combining the data from population based and high risk populations yielded a significant association of white matter hyperintensities with incident stroke (3.5, 2.5 to 4.9, PIncident stroke typesFew data existed on the association of white matter hyperintensities with specific stroke types (intracerebral haemorrhage, ischaemic stroke). One community based study21 found a significant association of white matter hyperintensities with incident ischaemic stroke; another study did not observe any association of white matter hyperintensities with recurrent intracerebral haemorrhage in patients with lobar haemorrhage (see web extra table 1).22Progression of white matter hyperintensities and incident strokeOnly one study assessed the relation between progression of white matter hyperintensities and incident stroke, in 89 patients with a history of lacunar stroke, headache, or dizziness: a significantly increased risk of stroke was observed in patients with progression of white matter hyperintensities after 4.3 years compared with those with no progression.16White matter hyperintensities and incident dementiaIncident dementia overallThree population based studies29 31 32 and 11 studies in high risk populations17 34 35 36 37 38 39 40 41 47 48 examined the relation between white matter hyperintensities and incident dementia overall (see web extra table 2). Meta analysing the three population based studies yielded a significant association of white matter hyperintensities with the occurrence of all types of dementia (2.9, 1.3 to 6.3, P=0.008; fig 3).29 31 32 Six of the 11 studies done in high risk populations could be included in the meta analysis,17 37 39 41 47 48 yielding no significant association of white matter hyperintensities with incident dementia (1.4, 0.9 to 2.3, P=0.14). Four of these six studies included patients with mild cognitive impairment37 39 41 47: meta analysing these separately also did not yield any significant association (1.1, 0.8 to 1.6, P=0.46; see web extra fig 2). Not all quality criteria were satisfied for several of the studies (see web extra table 6).34 37 38 48When combining data from population based studies and high risk populations the risk of dementia associated with white matter hyperintensities was increased overall (1.9, 1.3 to 2.8, P=0.002; fig 3, also see web extra fig 3).Incident subtypes of dementiaThree population based studies31 32 33 and three studies in high risk populations41 42 49 investigated the relation between white matter hyperintensities and incident Alzheimer's disease (see web extra table 2). Only one population based study31 and two studies in high risk populations41 49 fulfilled our predefined criteria for meta analysis. Meta analysis of these yielded a significant association of white matter hyperintensities with the risk of Alzheimer's disease (see web extra fig 4).
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The Korean War
At the mid point of a century that had already seen two appallingly destructive and costly global conflicts, a savage war broke out in a remote country at the extremity of the Asian landmass. During the world war of 1939 45, the future of the Japanese empire was decided at Allied summit meetings. In the short term, pending the return of Korean independence, Korea, a Japanese colony since 1910, was to be occupied north of the 38th parallel by Soviet Russia. To the south, a United States military administration under the direction of General Douglas MacArthur would control the area from its headquarters in Tokyo.
In the North, the Soviets backed a Stalinist regime under their client Kim Il sung and created the North Korean Peoples' Army, equipped with Russian tanks and artillery. In the South, the chaotic political situation resulted in an American backed administration under the presidency of Syngman Rhee, whose openly declared aim was the imposition of national unity by force. As a result of this stance, the American trained South Korean army was limited to a lightly armed gendarmerie, lacking tanks, combat aircraft and all but a small amount of field artillery.
After several years of increasingly bloody frontier incidents along the 38th parallel, the Republic of Korea was invaded by the North Korean Peoples' Army on 25 June 1950. Despite earlier indications, the Pentagon was caught off guard. As the North Koreans swept south, overwhelming all opposition, the US called on the Security Council to invoke the United Nations Charter and brand the North Koreans as aggressors. This was done and member states were called on to send in military assistance. The first American troops were then sent in to stiffen resistance against the invader. The British government responded at once and elements of the Far East Fleet were soon in action along the Korean coast, together with ships of Commonwealth navies.
However, the North Koreans still advanced rapidly south, aiming to take the vital port of Pusan. The American troops hurriedly sent from occupation duties in Japan fared badly against superior North Korean troops, but General Walton Walker, commanding the 8th United States Army in Korea (EUSAK), rallied his forces and held the Pusan bridgehead as reinforcements began to arrive. These reinforcements included two British battalions from Hong Kong, the Middlesex and the Argyll and Sutherland Highlanders, and an Australian battalion from Japan. Furthermore, a strong brigade group was mobilised in England and several thousand reservists were recalled to active duty. Their van cleef and arpels necklace clover replica communications cut, and under heavy aerial bombardment, the North Koreans broke and fled back north; MacArthur ordered a hot pursuit which led across the 38th parallel and deep into North Korea. As the victorious UN forces drew near to the Manchurian border, there were ominous signals from Peking that communist China would intervene to defend its territory. In mid October, MacArthur met President Harry Truman on Wake Island in their first encounter to assure him that a massive UN offensive was about to conclude the war victoriously by Christmas. No sooner had this been launched in November than the Chinese unleashed their armies.
The UN forces recoiled in disorder and, by the new year, were defending a line well to the south of Seoul, the capital of South Korea. Morale was low but the new field commander, General Ridgway, revived his heterogeneous command and advanced slowly north in the spring of 1951. By mid April, the allies were back in the area of the 38th parallel when the Chinese launched their spring offensive. The British 29th Brigade narrowly escaped annihilation on the Imjin river as the 27th Commonwealth brigade on the central front beat off savage Chinese attacks. The UN line held, then moved north again. This time, there was no reckless advance into the north. The line stabilised in the general area of the 38th parallel and the remaining two years of fighting consisted of near static operations as both sides fought from heavily fortified positions, using artillery, mines and wire to deny the enemy access to strategically important ground.
Throughout the war, air power was decisive. The North Korean air force was imitation clover necklace van cleef driven from the skies by US Air Force, Navy and Marines, using their superior equipment and training. Heavy bombers razed the cities and industrial plants of North Korea. Continuous attacks on the transport system forced the Chinese to rely on the packhorse for much of their logistical support. A new phase of air war opened when American B 29 bombers and their fighter escorts were challenged by Russian built MiG 15 fighters flown by Chinese airmen. The MiG 15's outflew first generation American jet fighters until the introduction of the swept wing F 86 Sabre tipped the balance. In the world's first supersonic air combats, the Americans prevailed.
In mid 1951, with the land battle in stalemate, both sides agreed to go to the conference table and armistice talks began. They dragged on for two years. The main haggling point was the future of the tens of thousands of communist prisoners held in camps on Koje Island off the coast of South Korea. While the communist negotiators were adamant that all were to be returned to their country of origin, thousands of prisoners were unwilling to be repatriated. There were several great mutinies in the Koje camps before a satisfactory formula enabled those who wished to be repatriated to go home and for asylum to be granted to those who wished otherwise. In July 1953, a great calm descended over the battlefields and in Operation Big Switch, thousands of former prisoners on each side were returned. A Demilitarised Zone or DMZ was established on the border. Both sides withdrew from their fighting positions, and a UN commission was set up to supervise the armistice.
Some 100,000 British servicemen and women served in the Japan Korea theatre during the war. In July 1951, with the arrival of the strong Canadian brigade, the British, Australian, New Zealand and Indian units were formed into the 1st Commonwealth Division, which soon gained an enviable reputation among its allies.
The true casualty figures for the North and South Koreans and Chinese will never be known. It is estimated that some 46,000 South Korean soldiers were killed and over 100,000 wounded. The Chinese are estimated by the Pentagon as having lost over 400,000 killed (including Mao Tse tung's son) and 486,000 wounded, with over 21,000 captured. The North Koreans lost about 215,000 killed, 303,000 wounded and over 101,000 captured or missing.
British veterans of the campaign were left with abiding memories of a South Korea which had been deprived of its dignity, fought over and ruined, its demoralised population brought to beggary and its infrastructure destroyed. Since 1953, the Republic of Korea has transformed into a modern state. In the North, however, the Stalinist regime created by Kim Il sung is only now beginning to move out of its hermit state. The economy is in ruins and famine stalks the land. It is too early to say if copy van cleef arpels alhambra necklace the tentative moves towards reconciliation will result in attainment of the unity so deeply desired by many Koreans.
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At the mid point of a century that had already seen two appallingly destructive and costly global conflicts, a savage war broke out in a remote country at the extremity of the Asian landmass. During the world war of 1939 45, the future of the Japanese empire was decided at Allied summit meetings. In the short term, pending the return of Korean independence, Korea, a Japanese colony since 1910, was to be occupied north of the 38th parallel by Soviet Russia. To the south, a United States military administration under the direction of General Douglas MacArthur would control the area from its headquarters in Tokyo.
In the North, the Soviets backed a Stalinist regime under their client Kim Il sung and created the North Korean Peoples' Army, equipped with Russian tanks and artillery. In the South, the chaotic political situation resulted in an American backed administration under the presidency of Syngman Rhee, whose openly declared aim was the imposition of national unity by force. As a result of this stance, the American trained South Korean army was limited to a lightly armed gendarmerie, lacking tanks, combat aircraft and all but a small amount of field artillery.
After several years of increasingly bloody frontier incidents along the 38th parallel, the Republic of Korea was invaded by the North Korean Peoples' Army on 25 June 1950. Despite earlier indications, the Pentagon was caught off guard. As the North Koreans swept south, overwhelming all opposition, the US called on the Security Council to invoke the United Nations Charter and brand the North Koreans as aggressors. This was done and member states were called on to send in military assistance. The first American troops were then sent in to stiffen resistance against the invader. The British government responded at once and elements of the Far East Fleet were soon in action along the Korean coast, together with ships of Commonwealth navies.
However, the North Koreans still advanced rapidly south, aiming to take the vital port of Pusan. The American troops hurriedly sent from occupation duties in Japan fared badly against superior North Korean troops, but General Walton Walker, commanding the 8th United States Army in Korea (EUSAK), rallied his forces and held the Pusan bridgehead as reinforcements began to arrive. These reinforcements included two British battalions from Hong Kong, the Middlesex and the Argyll and Sutherland Highlanders, and an Australian battalion from Japan. Furthermore, a strong brigade group was mobilised in England and several thousand reservists were recalled to active duty. Their van cleef and arpels necklace clover replica communications cut, and under heavy aerial bombardment, the North Koreans broke and fled back north; MacArthur ordered a hot pursuit which led across the 38th parallel and deep into North Korea. As the victorious UN forces drew near to the Manchurian border, there were ominous signals from Peking that communist China would intervene to defend its territory. In mid October, MacArthur met President Harry Truman on Wake Island in their first encounter to assure him that a massive UN offensive was about to conclude the war victoriously by Christmas. No sooner had this been launched in November than the Chinese unleashed their armies.
The UN forces recoiled in disorder and, by the new year, were defending a line well to the south of Seoul, the capital of South Korea. Morale was low but the new field commander, General Ridgway, revived his heterogeneous command and advanced slowly north in the spring of 1951. By mid April, the allies were back in the area of the 38th parallel when the Chinese launched their spring offensive. The British 29th Brigade narrowly escaped annihilation on the Imjin river as the 27th Commonwealth brigade on the central front beat off savage Chinese attacks. The UN line held, then moved north again. This time, there was no reckless advance into the north. The line stabilised in the general area of the 38th parallel and the remaining two years of fighting consisted of near static operations as both sides fought from heavily fortified positions, using artillery, mines and wire to deny the enemy access to strategically important ground.
Throughout the war, air power was decisive. The North Korean air force was imitation clover necklace van cleef driven from the skies by US Air Force, Navy and Marines, using their superior equipment and training. Heavy bombers razed the cities and industrial plants of North Korea. Continuous attacks on the transport system forced the Chinese to rely on the packhorse for much of their logistical support. A new phase of air war opened when American B 29 bombers and their fighter escorts were challenged by Russian built MiG 15 fighters flown by Chinese airmen. The MiG 15's outflew first generation American jet fighters until the introduction of the swept wing F 86 Sabre tipped the balance. In the world's first supersonic air combats, the Americans prevailed.
In mid 1951, with the land battle in stalemate, both sides agreed to go to the conference table and armistice talks began. They dragged on for two years. The main haggling point was the future of the tens of thousands of communist prisoners held in camps on Koje Island off the coast of South Korea. While the communist negotiators were adamant that all were to be returned to their country of origin, thousands of prisoners were unwilling to be repatriated. There were several great mutinies in the Koje camps before a satisfactory formula enabled those who wished to be repatriated to go home and for asylum to be granted to those who wished otherwise. In July 1953, a great calm descended over the battlefields and in Operation Big Switch, thousands of former prisoners on each side were returned. A Demilitarised Zone or DMZ was established on the border. Both sides withdrew from their fighting positions, and a UN commission was set up to supervise the armistice.
Some 100,000 British servicemen and women served in the Japan Korea theatre during the war. In July 1951, with the arrival of the strong Canadian brigade, the British, Australian, New Zealand and Indian units were formed into the 1st Commonwealth Division, which soon gained an enviable reputation among its allies.
The true casualty figures for the North and South Koreans and Chinese will never be known. It is estimated that some 46,000 South Korean soldiers were killed and over 100,000 wounded. The Chinese are estimated by the Pentagon as having lost over 400,000 killed (including Mao Tse tung's son) and 486,000 wounded, with over 21,000 captured. The North Koreans lost about 215,000 killed, 303,000 wounded and over 101,000 captured or missing.
British veterans of the campaign were left with abiding memories of a South Korea which had been deprived of its dignity, fought over and ruined, its demoralised population brought to beggary and its infrastructure destroyed. Since 1953, the Republic of Korea has transformed into a modern state. In the North, however, the Stalinist regime created by Kim Il sung is only now beginning to move out of its hermit state. The economy is in ruins and famine stalks the land. It is too early to say if copy van cleef arpels alhambra necklace the tentative moves towards reconciliation will result in attainment of the unity so deeply desired by many Koreans.
Search term:
BBC navigation News Sport Weather iPlayer TV Radio More
CBBC CBeebies Comedy Food History Learning Music Science Nature Local Northern Ireland Scotland Wales Full A Z of BBC sites
BBC links Mobile site Terms of Use About the BBC Privacy Accessibility Help Cookies Contact the BBC Parental Guidance
BBC 2014 The BBC is not responsible for the content of external sites. Read more.
This page is best viewed in an up to date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.
Robert Munce jailed after killing woman while using 2 mobile phones while driving
He said: 'The vehicle left Hull shortly before 9am, bound for Peterborough and, during the course of the journey, he was sending messages or texts, one or the other, and using them to gain internet access.'When arrested, Munce admitted he had used his phone, but tried to shorten the amount of usage.Mrs Nile's son Steven, who wept as he read his victim impact statement, said: 'The events which occurred will live with me for the rest of my life.The Nile family car, which was on its way to a funeral, was immediately destroyed after Munce's van veered into it'Our vehicle was hit from behind, as we were slowing to exit from the highway.'He added that he did not have a chance to say goodbye to the mother he described as 'wonderful, kind, loving and caring'.Richard Clewes, defending, said his client lost his job almost immediately and his health had suffered considerably since the accident.Mr Clewes added: 'He is deeply and genuinely remorseful.'Judge Michael Stokes QC, sentencing, said: 'It is quite clear, from what I have read and have heard from her son that, like any mother and wife, her death is devastating to her family.'She is irreplaceable. The impact on her family will never cease. It is a fact of life that we must all die eventually. But when death comes sudden and in these circumstances, the impact is always much worse.'Detective constable Paul Jaycock, the officer leading the replica van cleef diamond bracelet investigation, said the case demonstrates the 'devastating consequences' of using mobile phones by driving.He added: 'Margaret Nile died because Robert Munce was needlessly distracted by his mobile phone when he should have been concentrating on driving.'Sadly he cannot turn back the clock and has been imprisoned for his actions.'Margaret's family now have to try and rebuild their shattered lives. Their lives and arguably Munce's life too, have changed forever.'I would urge any driver that looks at their mobile phone when they should be fully focussed on the road ahead, to heed the lesson that Munce has been learning since November 11, 2014.'Most watched News videos EXCLUSIVE: Ariana Grande plane arrives back in the US Homeless man describes how he helped after Manchester attack Moment bomb fake van cleef bangle explodes at Ariana Grande concert Eye witness describes spotting the Manchester attacker Armed police prepare to raid of Manchester suicide bomber Blood seen dripping from victim leg after Manchester Forensic officers raid of Manchester suicide bomber Moment armed police storm of Manchester suicide bomber Threat level now CRITICAL: PM raises terror level Mum of Manchester attack victim Georgina Callander releases balloons Man is arrested by police outside Buckingham Palace Sickening video warns of more attacks after ManchesterEXCLUSIVE: First photos of Ariana Grande since Manchester. Help for the homeless heroes: Millionaire West Ham owner. The schoolgirls massacred by ISIS coward: Five teenagers. Revealed: Manchester bomber returned to Britain from. Theresa May copy van cleef bracelets warns a fresh terror attack is feared to be. 'Our little princess has been so lucky': Father's joy as. Britain on lockdown: Army deploys 1,000 heavily armed. Horror on the M6: Lorry driver is arrested after four. Tourists watch in horror as armed police arrest man. Mother of child actress pictured hugging a female police. Aaron Hernandez's hell behind bars: NFL star killed. More than 24 hours on, desperate families still search. BREAKING NEWS: My son is innocent, insists father of. 'I won't forget what you said!' Trump tells Pope after. Comedian Jason Manford deletes Twitter after being. Terrorist's brother arrested: Dramatic moment armed. Grisly photos of scorched remnants of suicide bomber's. Bomber from a red brick semi who 'knew an ISIS. MOST READ NEWS Previous.
He said: 'The vehicle left Hull shortly before 9am, bound for Peterborough and, during the course of the journey, he was sending messages or texts, one or the other, and using them to gain internet access.'When arrested, Munce admitted he had used his phone, but tried to shorten the amount of usage.Mrs Nile's son Steven, who wept as he read his victim impact statement, said: 'The events which occurred will live with me for the rest of my life.The Nile family car, which was on its way to a funeral, was immediately destroyed after Munce's van veered into it'Our vehicle was hit from behind, as we were slowing to exit from the highway.'He added that he did not have a chance to say goodbye to the mother he described as 'wonderful, kind, loving and caring'.Richard Clewes, defending, said his client lost his job almost immediately and his health had suffered considerably since the accident.Mr Clewes added: 'He is deeply and genuinely remorseful.'Judge Michael Stokes QC, sentencing, said: 'It is quite clear, from what I have read and have heard from her son that, like any mother and wife, her death is devastating to her family.'She is irreplaceable. The impact on her family will never cease. It is a fact of life that we must all die eventually. But when death comes sudden and in these circumstances, the impact is always much worse.'Detective constable Paul Jaycock, the officer leading the replica van cleef diamond bracelet investigation, said the case demonstrates the 'devastating consequences' of using mobile phones by driving.He added: 'Margaret Nile died because Robert Munce was needlessly distracted by his mobile phone when he should have been concentrating on driving.'Sadly he cannot turn back the clock and has been imprisoned for his actions.'Margaret's family now have to try and rebuild their shattered lives. Their lives and arguably Munce's life too, have changed forever.'I would urge any driver that looks at their mobile phone when they should be fully focussed on the road ahead, to heed the lesson that Munce has been learning since November 11, 2014.'Most watched News videos EXCLUSIVE: Ariana Grande plane arrives back in the US Homeless man describes how he helped after Manchester attack Moment bomb fake van cleef bangle explodes at Ariana Grande concert Eye witness describes spotting the Manchester attacker Armed police prepare to raid of Manchester suicide bomber Blood seen dripping from victim leg after Manchester Forensic officers raid of Manchester suicide bomber Moment armed police storm of Manchester suicide bomber Threat level now CRITICAL: PM raises terror level Mum of Manchester attack victim Georgina Callander releases balloons Man is arrested by police outside Buckingham Palace Sickening video warns of more attacks after ManchesterEXCLUSIVE: First photos of Ariana Grande since Manchester. Help for the homeless heroes: Millionaire West Ham owner. The schoolgirls massacred by ISIS coward: Five teenagers. Revealed: Manchester bomber returned to Britain from. Theresa May copy van cleef bracelets warns a fresh terror attack is feared to be. 'Our little princess has been so lucky': Father's joy as. Britain on lockdown: Army deploys 1,000 heavily armed. Horror on the M6: Lorry driver is arrested after four. Tourists watch in horror as armed police arrest man. Mother of child actress pictured hugging a female police. Aaron Hernandez's hell behind bars: NFL star killed. More than 24 hours on, desperate families still search. BREAKING NEWS: My son is innocent, insists father of. 'I won't forget what you said!' Trump tells Pope after. Comedian Jason Manford deletes Twitter after being. Terrorist's brother arrested: Dramatic moment armed. Grisly photos of scorched remnants of suicide bomber's. Bomber from a red brick semi who 'knew an ISIS. MOST READ NEWS Previous.
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seeking behaviour in rural Ethiopia
5School of Foreign Service, Georgetown University, Doha, QatarCorrespondence toResults We find almost universal preference for modern care. Foregone care ranges from 0.6% for diarrhoea to 2.5% for tetanus. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult related conditions with households in higher consumption quintiles more likely to seek care in health centres, private/Non Government Organization (NGO) clinics as opposed to health posts. Delays in care seeking behaviour are apparent mainly for adult related conditions and among poorer households.
Health EconomicsPrimary CareStrengths and limitations of this study
This paper identifies factors that drive healthcare seeking behaviour in rural Ethiopia using context specific clinical vignettes which avoid reporting bias in a self perceived need.
It examines healthcare seeking behaviour for child related and adult related conditions separately and investigates differences in the level and timing of care sought.
While the use of clinical vignettes allows us to establish patterns of healthcare seeking behaviour across population groups that are not driven by differences in health status, there is the risk that the reported hypothetical healthcare seeking behaviour does not match the actual healthcare seeking behaviour.
Because the symptoms described in the vignettes are quite specific and severe, they might not pick up foregone care in relation to diseases that are more difficult to recognise or more chronic in nature. These changes have been accompanied by a rapid expansion of healthcare infrastructure at all levels.1 3 There has been an 18 fold increase in the number of health posts in 2011 and a 7 fold increase in replica van cleef bangle the number of health centres over the same period.4 6 Consequently, it is estimated that primary healthcare coverage, defined as a village level access to a health post, has increased from 51% in 2000 to 92% in 2011.1 ,3
Despite these increases in the supply of healthcare and increases in the utilisation of some specific services, overall outpatient healthcare utilisation rates remain low and have increased only marginally from 0.27 visits in 2000 to 0.3 visits in 2011.1 ,3 ,7 Institutional deliveries have gone up from 5% to 11% in the same period, but remain extremely low compared with other sub Saharan African countries (eg, 28.3% in Eritrea, 43% in Kenya, 73% in Senegal and 75% in Malawi).8 Therefore, the main aim of this paper is to examine the extent of foregone care and to gain an understanding of the factors that are responsible for driving a wedge between availability and utilisation.
Available attempts at measuring foregone care for developed countries typically rely on explicitly asking survey respondents whether they did not use care when needed.9 ,10 For low income and middle income countries the evidence is mainly limited to the use and inequity in use of maternity and child (preventive) care.11 Self reported information on foregone care is likely to be biased, in particular in low income settings where knowledge about medical conditions and the need for care may be limited.12 This is illustrated by comparing data from the Ethiopian World Health Survey, which reveals that only 13% of respondents in the poorest quintile reported an unmet need for medical care,13 to data from the 2011 Ethiopian Demographic Health Survey in which 74.4% of women in the poorest quintile reported not having received any antenatal care during their last pregnancy.14 The current study therefore uses a series of context specific child related and adult related clinical vignettes to explore the healthcare seeking behaviour of rural Ethiopian households. Survey respondents are presented with well defined medical cases and asked about treatment needed. By fixing the medical condition, variation in responses to the vignettes may be attributed only to individual differences in perceptions of the care needed and not due to varying severity in the ill health condition.15 19 Studies that have used clinical vignettes in high income countries reveal that in these countries lower socioeconomic (ethnic or education level) groups are more likely to consult a doctor for a given set of symptoms. Therefore, they conclude that inequalities in actual healthcare utilisation may be attributed to barriers in healthcare provision and differences in case management due to ethnic origins and not due to difficulties in understanding the symptoms of the disease or due to a lower perception of the need for care.15 18 Despite the potential advantages of using healthcare vignettes as an alternative technique to analyse van cleef jewelry replica healthcare seeking behaviour, this approach has not been widely used in the context of low income and middle income countries where presumably variations in the perceived need for healthcare are much greater than in high income countries.11 A recent exception is a study in Peru. Based on a vignette designed to capture acute coronary syndrome (ACS), this study reports that women are less likely to recognise symptoms of ACS and also less likely to seek healthcare for chest pain as compared with men.19
The analysis deals with three issues. First, do households seek modern care? Second, conditional on seeking modern care, where do they seek care? And finally, what is the timing of their care seeking behaviour?This study is a part of a larger project which aims to evaluate a pilot community based health insurance scheme (CBHI) which was rolled out in four main regions (Tigray, Amhara, Oromiya and Southern Nations, Nationalities and People's Region (SNNPR)) of the country in June 2011 (see figure 1). In each of the pilot regions, which together account for about 86% of the country's population,20 the government chose three rural districts as CBHI pilot districts. Districts were selected if they had undertaken healthcare financing reforms designed to increase cost recovery and retention of locally raised revenues and if they had geographically accessible (located close to a main road) health centres. Our household survey covered all 12 CBHI pilot districts and four control districts (1 from each region) which were selected on the same basis as the pilot CBHI districts. It is important to point out that districts were not selected on the basis of healthcare seeking behaviour or awareness of health issues. From each of the sampled districts, six villages (kebeles) were randomly selected, and from each village 17 households were randomly chosen (based on household lists obtained from the village administrative office), yielding a total of 1632 households comprising 9455 individuals. Respondents were typically the head of the household (87%) or the spouse of the household head (13%). The survey was canvassed between March and April 2011 and contains extensive information on a variety of individual and household socioeconomic attributes including information on health status, healthcare utilisation and healthcare seeking behaviour.
Location of the survey regions.
Open in new tabFigure1 Location of the survey regions.
The household survey instrument contains five short clinical vignettes which were developed with input from researchers at Addis Ababa University's School of Public Health. The vignettes are based on illnesses that are widely prevalent in the study region and may be related to acute respiratory infection/pneumonia among babies, diarrhoea affecting female infants, an adult male replica Van Cleef & Arpels yellow gold bracelet experiencing malaria, an adult male experiencing tetanus and an adult female affected by tuberculosis. According to information from the WHO's Global Health Observatory, in terms of burden of disease (BOD), diarrhoea, respiratory infections, malaria and unintentional injuries are the four most prominent contributors to the country's BOD.21 The vignettes were primarily designed to enable an exploration of heterogeneity in healthcare seeking behaviour for conditions affecting children and adults. For each case, respondents were asked what they would do, that is, whether and where they would seek care and when they would seek care in case they or someone in their household were to experience the symptoms described in the vignettes. Respondents were offered a set of 11 choices for a healthcare provider including an option for foregone care (do nothing). Based on the government's service guidelines, diagnosis and treatment for diarrhoea and malaria are expected to be available at health posts. Health centres and hospitals are expected to be able to cater to all the illnesses described in the vignettes. The vignettes were designed with the view that medically the immediate care seeking option may be considered the appropriate course of action (for details, see appendix 1).
In addition to the vignettes, information on a range of other variables was collected in order to enable an exploration of the associations between healthcare seeking behaviour and other attributes of interest. These include information on household demographic composition, education of the household head, household health status, economic status as captured by per capita household consumption, attitudes towards modern healthcare and a range of variables to control for access to public (health) infrastructure and finally a set of indicators to control for regional differences. Descriptive statistics for the sample as a whole as well as region specific descriptive statistics are provided in appendix 2.
5School of Foreign Service, Georgetown University, Doha, QatarCorrespondence toResults We find almost universal preference for modern care. Foregone care ranges from 0.6% for diarrhoea to 2.5% for tetanus. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult related conditions with households in higher consumption quintiles more likely to seek care in health centres, private/Non Government Organization (NGO) clinics as opposed to health posts. Delays in care seeking behaviour are apparent mainly for adult related conditions and among poorer households.
Health EconomicsPrimary CareStrengths and limitations of this study
This paper identifies factors that drive healthcare seeking behaviour in rural Ethiopia using context specific clinical vignettes which avoid reporting bias in a self perceived need.
It examines healthcare seeking behaviour for child related and adult related conditions separately and investigates differences in the level and timing of care sought.
While the use of clinical vignettes allows us to establish patterns of healthcare seeking behaviour across population groups that are not driven by differences in health status, there is the risk that the reported hypothetical healthcare seeking behaviour does not match the actual healthcare seeking behaviour.
Because the symptoms described in the vignettes are quite specific and severe, they might not pick up foregone care in relation to diseases that are more difficult to recognise or more chronic in nature. These changes have been accompanied by a rapid expansion of healthcare infrastructure at all levels.1 3 There has been an 18 fold increase in the number of health posts in 2011 and a 7 fold increase in replica van cleef bangle the number of health centres over the same period.4 6 Consequently, it is estimated that primary healthcare coverage, defined as a village level access to a health post, has increased from 51% in 2000 to 92% in 2011.1 ,3
Despite these increases in the supply of healthcare and increases in the utilisation of some specific services, overall outpatient healthcare utilisation rates remain low and have increased only marginally from 0.27 visits in 2000 to 0.3 visits in 2011.1 ,3 ,7 Institutional deliveries have gone up from 5% to 11% in the same period, but remain extremely low compared with other sub Saharan African countries (eg, 28.3% in Eritrea, 43% in Kenya, 73% in Senegal and 75% in Malawi).8 Therefore, the main aim of this paper is to examine the extent of foregone care and to gain an understanding of the factors that are responsible for driving a wedge between availability and utilisation.
Available attempts at measuring foregone care for developed countries typically rely on explicitly asking survey respondents whether they did not use care when needed.9 ,10 For low income and middle income countries the evidence is mainly limited to the use and inequity in use of maternity and child (preventive) care.11 Self reported information on foregone care is likely to be biased, in particular in low income settings where knowledge about medical conditions and the need for care may be limited.12 This is illustrated by comparing data from the Ethiopian World Health Survey, which reveals that only 13% of respondents in the poorest quintile reported an unmet need for medical care,13 to data from the 2011 Ethiopian Demographic Health Survey in which 74.4% of women in the poorest quintile reported not having received any antenatal care during their last pregnancy.14 The current study therefore uses a series of context specific child related and adult related clinical vignettes to explore the healthcare seeking behaviour of rural Ethiopian households. Survey respondents are presented with well defined medical cases and asked about treatment needed. By fixing the medical condition, variation in responses to the vignettes may be attributed only to individual differences in perceptions of the care needed and not due to varying severity in the ill health condition.15 19 Studies that have used clinical vignettes in high income countries reveal that in these countries lower socioeconomic (ethnic or education level) groups are more likely to consult a doctor for a given set of symptoms. Therefore, they conclude that inequalities in actual healthcare utilisation may be attributed to barriers in healthcare provision and differences in case management due to ethnic origins and not due to difficulties in understanding the symptoms of the disease or due to a lower perception of the need for care.15 18 Despite the potential advantages of using healthcare vignettes as an alternative technique to analyse van cleef jewelry replica healthcare seeking behaviour, this approach has not been widely used in the context of low income and middle income countries where presumably variations in the perceived need for healthcare are much greater than in high income countries.11 A recent exception is a study in Peru. Based on a vignette designed to capture acute coronary syndrome (ACS), this study reports that women are less likely to recognise symptoms of ACS and also less likely to seek healthcare for chest pain as compared with men.19
The analysis deals with three issues. First, do households seek modern care? Second, conditional on seeking modern care, where do they seek care? And finally, what is the timing of their care seeking behaviour?This study is a part of a larger project which aims to evaluate a pilot community based health insurance scheme (CBHI) which was rolled out in four main regions (Tigray, Amhara, Oromiya and Southern Nations, Nationalities and People's Region (SNNPR)) of the country in June 2011 (see figure 1). In each of the pilot regions, which together account for about 86% of the country's population,20 the government chose three rural districts as CBHI pilot districts. Districts were selected if they had undertaken healthcare financing reforms designed to increase cost recovery and retention of locally raised revenues and if they had geographically accessible (located close to a main road) health centres. Our household survey covered all 12 CBHI pilot districts and four control districts (1 from each region) which were selected on the same basis as the pilot CBHI districts. It is important to point out that districts were not selected on the basis of healthcare seeking behaviour or awareness of health issues. From each of the sampled districts, six villages (kebeles) were randomly selected, and from each village 17 households were randomly chosen (based on household lists obtained from the village administrative office), yielding a total of 1632 households comprising 9455 individuals. Respondents were typically the head of the household (87%) or the spouse of the household head (13%). The survey was canvassed between March and April 2011 and contains extensive information on a variety of individual and household socioeconomic attributes including information on health status, healthcare utilisation and healthcare seeking behaviour.
Location of the survey regions.
Open in new tabFigure1 Location of the survey regions.
The household survey instrument contains five short clinical vignettes which were developed with input from researchers at Addis Ababa University's School of Public Health. The vignettes are based on illnesses that are widely prevalent in the study region and may be related to acute respiratory infection/pneumonia among babies, diarrhoea affecting female infants, an adult male replica Van Cleef & Arpels yellow gold bracelet experiencing malaria, an adult male experiencing tetanus and an adult female affected by tuberculosis. According to information from the WHO's Global Health Observatory, in terms of burden of disease (BOD), diarrhoea, respiratory infections, malaria and unintentional injuries are the four most prominent contributors to the country's BOD.21 The vignettes were primarily designed to enable an exploration of heterogeneity in healthcare seeking behaviour for conditions affecting children and adults. For each case, respondents were asked what they would do, that is, whether and where they would seek care and when they would seek care in case they or someone in their household were to experience the symptoms described in the vignettes. Respondents were offered a set of 11 choices for a healthcare provider including an option for foregone care (do nothing). Based on the government's service guidelines, diagnosis and treatment for diarrhoea and malaria are expected to be available at health posts. Health centres and hospitals are expected to be able to cater to all the illnesses described in the vignettes. The vignettes were designed with the view that medically the immediate care seeking option may be considered the appropriate course of action (for details, see appendix 1).
In addition to the vignettes, information on a range of other variables was collected in order to enable an exploration of the associations between healthcare seeking behaviour and other attributes of interest. These include information on household demographic composition, education of the household head, household health status, economic status as captured by per capita household consumption, attitudes towards modern healthcare and a range of variables to control for access to public (health) infrastructure and finally a set of indicators to control for regional differences. Descriptive statistics for the sample as a whole as well as region specific descriptive statistics are provided in appendix 2.
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Report finds no evidence to support earlier belief that Toto's Jeff Porcaro died of an allergic reaction to a pesticide
Jeff Porcaro, drummer for the rock band Toto, died of hardening of the arteries caused by cocaine use not from an allergic reaction to a pesticide as originally reported, the Los Angeles County coroner's office said Thursday,
The alhambra necklace imitation 38 year old rock star fell ill after spraying insecticide in the yard of his Hidden Hills home Aug. 5, and died that evening at Humana Hospital West Hills.
The band's co manager, Larry Fitzgerald, said at the time that doctors told him the cause of death may have been a reaction to inhaling the insecticide.
However, an autopsy released van cleef & arpels necklace knock off Thursday determined that Porcaro died of occlusive coronary artery disease caused by hardening of the arteries because of cocaine use, coroner's spokesman Bob Dambacher said. A toxicology report discovered cocaine and a byproduct of the drug in Porcaro's blood, he said.
Tests performed to detect the presence of the insecticide came up negative, but there was .21 micrograms per milliliter of cocaine in the musician's blood, Dambacher said.
Porcaro helped found Toto, a group that sold millions of records during the 1970s and '80s. van cleef vintage alhambra necklace imitation He was also a highly respected session drummer who played for musicians such as Bruce Springsteen, Elton John and Paul McCartney.
Porcaro began his 20 year music career as a student at Grant High School in Van Nuys, playing in bands with friends who later earned reputations as top sessions players and later formed the basis for Toto.
Jeff Porcaro, drummer for the rock band Toto, died of hardening of the arteries caused by cocaine use not from an allergic reaction to a pesticide as originally reported, the Los Angeles County coroner's office said Thursday,
The alhambra necklace imitation 38 year old rock star fell ill after spraying insecticide in the yard of his Hidden Hills home Aug. 5, and died that evening at Humana Hospital West Hills.
The band's co manager, Larry Fitzgerald, said at the time that doctors told him the cause of death may have been a reaction to inhaling the insecticide.
However, an autopsy released van cleef & arpels necklace knock off Thursday determined that Porcaro died of occlusive coronary artery disease caused by hardening of the arteries because of cocaine use, coroner's spokesman Bob Dambacher said. A toxicology report discovered cocaine and a byproduct of the drug in Porcaro's blood, he said.
Tests performed to detect the presence of the insecticide came up negative, but there was .21 micrograms per milliliter of cocaine in the musician's blood, Dambacher said.
Porcaro helped found Toto, a group that sold millions of records during the 1970s and '80s. van cleef vintage alhambra necklace imitation He was also a highly respected session drummer who played for musicians such as Bruce Springsteen, Elton John and Paul McCartney.
Porcaro began his 20 year music career as a student at Grant High School in Van Nuys, playing in bands with friends who later earned reputations as top sessions players and later formed the basis for Toto.
Sudden infant death syndrome cases need review
SubscriptionsGo to the Subscriptions Centre to manage your:My ProfileA former Nunavut regional director of health is urging the territorial government to conduct an independent review of all cases of sudden infant death syndrome handled by its current chief coroner.Elise Van Schaik's call comes after a damming report released Monday on the circumstances surrounding the death of three month old Makibi Timilak in 2012.Makibi Timilak death: Former Nunavut nurse calls on coroner to resignCBC INVESTIGATION: Death and denial in Cape DorsetThe report is calling for a formal inquest into the death and Timilak's father is calling on the territory to van cleef and arpels jewellery replica fire Suramala.Over the following months and years after his death, Nunavut's chief coroner Padma Suramala's opinion of the cause changed from sudden infant death syndrome to a lung infection, then back to SIDS."There is definitely reason to doubt and further investigate," said Van Schaik, who worked as the director of health services from 2013 to 2014 in the south van cleef necklaces knock off Baffin region."I think it would warrant that previous cases that were controversial regarding any SIDS determination need to be investigated as well. I think that would be very prudent."This is the second former Nunavut health employee to criticize Padma Suramala's handling of Timilak's death.Okalik has said he will leave it up to the family to decide if they want to pursue an formal inquest. Van Schaik says he shouldn't wait."I think the minister of health, the minister of justice, he really has a mandate to ensure that this inquest goes through. To van cleef & arpels necklace knock off leave it to the parents, is not a very appropriate or responsible mandate to give to the parents," she said."They lost their first son and they are relying on their government to do what is right for them and for Okalik to bring it back to the parents to make that decision, I don't find that that is right. It also doesn't give accountability to the government of Nunavut."CBC contacted Okalik's office to request an interview and was told the minister will not be commenting out of respect for the family. Okalik did say earlier this week that the government is ready to approve the recommendations from the report.
SubscriptionsGo to the Subscriptions Centre to manage your:My ProfileA former Nunavut regional director of health is urging the territorial government to conduct an independent review of all cases of sudden infant death syndrome handled by its current chief coroner.Elise Van Schaik's call comes after a damming report released Monday on the circumstances surrounding the death of three month old Makibi Timilak in 2012.Makibi Timilak death: Former Nunavut nurse calls on coroner to resignCBC INVESTIGATION: Death and denial in Cape DorsetThe report is calling for a formal inquest into the death and Timilak's father is calling on the territory to van cleef and arpels jewellery replica fire Suramala.Over the following months and years after his death, Nunavut's chief coroner Padma Suramala's opinion of the cause changed from sudden infant death syndrome to a lung infection, then back to SIDS."There is definitely reason to doubt and further investigate," said Van Schaik, who worked as the director of health services from 2013 to 2014 in the south van cleef necklaces knock off Baffin region."I think it would warrant that previous cases that were controversial regarding any SIDS determination need to be investigated as well. I think that would be very prudent."This is the second former Nunavut health employee to criticize Padma Suramala's handling of Timilak's death.Okalik has said he will leave it up to the family to decide if they want to pursue an formal inquest. Van Schaik says he shouldn't wait."I think the minister of health, the minister of justice, he really has a mandate to ensure that this inquest goes through. To van cleef & arpels necklace knock off leave it to the parents, is not a very appropriate or responsible mandate to give to the parents," she said."They lost their first son and they are relying on their government to do what is right for them and for Okalik to bring it back to the parents to make that decision, I don't find that that is right. It also doesn't give accountability to the government of Nunavut."CBC contacted Okalik's office to request an interview and was told the minister will not be commenting out of respect for the family. Okalik did say earlier this week that the government is ready to approve the recommendations from the report.
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Rediff On The NeT Special
gaurav in my opinion the government should try to pressurize the taliban governmrnt in afghanistan over allowing an indian commando team to burst into the aircraft . if the government gives in to imitation necklace van cleef arpels thier demands then. we should be prepared for more ic 814's.
The government completely failed to take any action when the plane was actually in the Indian territory Amritsar. It is very very sad. Karuna
Nagesh Charka Govt. should make all efforts to stop plane for any further take offs, negotiate with hijackers and bring all the passengers in a special plane from current place at the earliest. Do not let the Saran and his team continue to command the flight. They should get a BIG break in life, hats off replica van cleef necklace to Saran and his team for their patience and will. Nagesh
It is time Indian forces are put on high alert along the western front. A general mobilization of forces is in order. Let us open up a front from Kashmir to Karachi. The consequences for this action by Musharaf AKA the dummy AKA the stupid CE needs to be serious and final. This is Kargil under a different cover. We must not enter the New Year and a new century under fear. Let us see the Pakistanis are willing to pay the price for nurturing these bastards. Indians keep on weeping about a seat on Security Council, this is the time to prove that they have the balls to deserve it. No body wants wimps on the Security Council. When the Paki's will know that the consequences for their actions will be higher then the action it self.
nishrin Indian government should fulfill their demand save innocent peoples life.
Abhi Sashittal First of all we should not give in to their demands. Secondly we should take all the terrorists whose release is being negotiated, to a open piece of land and should be assasinated. all relatives and friends of any suspected hijaker must be imprisoned without food or water till these guys give up, after they do these relatives and friends should be shot in both legs!
Abhijit Mitra The govt should tell the world they are prepared to return the militants; get them into a van and then fake an accident in which they all die. Once the militants die in an accident, the GOI may be able to get the hijackers to present more reasonable demands.
sky The Indian Govt shud talk to the hijackers in their own language. if they kill one person on board, one of their brethren in indian jails gets killed! thats the way this situation shud be dealt.
Krishna
India missed the one chance it had to defuse the hostage situation on its soil when the plane landed for nearly an hour in Amritsar for refueling. As voiced by Maj. General Afsir Karim and KPS Gill, it is hard to understand why the government copy van cleef and arpels diamond necklace could not have acted swiftly to delay the takeoff from Amritsar and try to overpower the militants using NSG commandos, who are specifically trained to do such operations. This would have definitely resolved the hostage issue favorably, since we now know that the hijackers were mostly brandishing knives and "1940 vintage" pistols. What a shame to Indian crisis management and security officials!
However, after all being said and done we must now focus on how best to resolve the hostage crisis keeping in mind the safety of the passengers who have been through nearly 36 hours of horror, suffering, frustration, and anguish and continue to do so as we speak. The first priority for the Indian government is to get the plane out of Afghanistan before a meaningful dialogue with the hijackers and a suitable course of action can be planned out.
The decision taken by New Delhi to involve UN in the mediation efforts is a step in the right direction more so because the hostages are in a country with which Indian government has no diplomatic relations. The best course of action would be to have the hijackers take off the plane from Afghanistan and land preferably on Indian soil or in a neutral country as precondition to starting a dialogue. It should be borne in mind that no matter how ruthless and well planned the hijackers might reportedly be, their threats to crash the plane are just that. Threats! After having the plane landed at a strategically advantageous location for us, while continuing the dialogue with the hijackers a well orchestrated operation should be launched to overpower the hijackers and put an end to the hostage situation. While there is no denying that this approach is wrought with a certain amount of risk, this happens to be the only way to respond to this dastardly act of terrorism.
gaurav in my opinion the government should try to pressurize the taliban governmrnt in afghanistan over allowing an indian commando team to burst into the aircraft . if the government gives in to imitation necklace van cleef arpels thier demands then. we should be prepared for more ic 814's.
The government completely failed to take any action when the plane was actually in the Indian territory Amritsar. It is very very sad. Karuna
Nagesh Charka Govt. should make all efforts to stop plane for any further take offs, negotiate with hijackers and bring all the passengers in a special plane from current place at the earliest. Do not let the Saran and his team continue to command the flight. They should get a BIG break in life, hats off replica van cleef necklace to Saran and his team for their patience and will. Nagesh
It is time Indian forces are put on high alert along the western front. A general mobilization of forces is in order. Let us open up a front from Kashmir to Karachi. The consequences for this action by Musharaf AKA the dummy AKA the stupid CE needs to be serious and final. This is Kargil under a different cover. We must not enter the New Year and a new century under fear. Let us see the Pakistanis are willing to pay the price for nurturing these bastards. Indians keep on weeping about a seat on Security Council, this is the time to prove that they have the balls to deserve it. No body wants wimps on the Security Council. When the Paki's will know that the consequences for their actions will be higher then the action it self.
nishrin Indian government should fulfill their demand save innocent peoples life.
Abhi Sashittal First of all we should not give in to their demands. Secondly we should take all the terrorists whose release is being negotiated, to a open piece of land and should be assasinated. all relatives and friends of any suspected hijaker must be imprisoned without food or water till these guys give up, after they do these relatives and friends should be shot in both legs!
Abhijit Mitra The govt should tell the world they are prepared to return the militants; get them into a van and then fake an accident in which they all die. Once the militants die in an accident, the GOI may be able to get the hijackers to present more reasonable demands.
sky The Indian Govt shud talk to the hijackers in their own language. if they kill one person on board, one of their brethren in indian jails gets killed! thats the way this situation shud be dealt.
Krishna
India missed the one chance it had to defuse the hostage situation on its soil when the plane landed for nearly an hour in Amritsar for refueling. As voiced by Maj. General Afsir Karim and KPS Gill, it is hard to understand why the government copy van cleef and arpels diamond necklace could not have acted swiftly to delay the takeoff from Amritsar and try to overpower the militants using NSG commandos, who are specifically trained to do such operations. This would have definitely resolved the hostage issue favorably, since we now know that the hijackers were mostly brandishing knives and "1940 vintage" pistols. What a shame to Indian crisis management and security officials!
However, after all being said and done we must now focus on how best to resolve the hostage crisis keeping in mind the safety of the passengers who have been through nearly 36 hours of horror, suffering, frustration, and anguish and continue to do so as we speak. The first priority for the Indian government is to get the plane out of Afghanistan before a meaningful dialogue with the hijackers and a suitable course of action can be planned out.
The decision taken by New Delhi to involve UN in the mediation efforts is a step in the right direction more so because the hostages are in a country with which Indian government has no diplomatic relations. The best course of action would be to have the hijackers take off the plane from Afghanistan and land preferably on Indian soil or in a neutral country as precondition to starting a dialogue. It should be borne in mind that no matter how ruthless and well planned the hijackers might reportedly be, their threats to crash the plane are just that. Threats! After having the plane landed at a strategically advantageous location for us, while continuing the dialogue with the hijackers a well orchestrated operation should be launched to overpower the hijackers and put an end to the hostage situation. While there is no denying that this approach is wrought with a certain amount of risk, this happens to be the only way to respond to this dastardly act of terrorism.
Sauber to defend van der Garde
Sauber said in a statement on Friday that a Swiss arbitration tribunal had ordered the team "to refrain from taking action" to deprive Van der Garde from taking part in the 2015 season as one of the team's two nominated race drivers.
The 29 year old driver has brought an replica van cleef necklace application to a Victoria court to enforce the tribunal's decision, which would be heard fake van cleef and arpels jewellery on Monday and "defended by Sauber", the team said.
"As this matter is currently before the courts it would be inappropriate for me to comment on specific details," Team Principal Monisha Kaltenborn said.
"However, we will take all necessary steps to protect our company, this van cleef and arpels diamond necklace fake team and its interests.
"Last year was a challenging time for us but going into the 2015 season we have been focused on putting steps in place to ensure that we are delivering the best outcomes for F1's fans."
Sauber, who failed to score a point last season, have signed Sweden's Marcus Ericsson and Brazilian Felipe Nasr as their race drivers, with Italian Raffaele Marciello as reserve for 2015.
Sauber said in a statement on Friday that a Swiss arbitration tribunal had ordered the team "to refrain from taking action" to deprive Van der Garde from taking part in the 2015 season as one of the team's two nominated race drivers.
The 29 year old driver has brought an replica van cleef necklace application to a Victoria court to enforce the tribunal's decision, which would be heard fake van cleef and arpels jewellery on Monday and "defended by Sauber", the team said.
"As this matter is currently before the courts it would be inappropriate for me to comment on specific details," Team Principal Monisha Kaltenborn said.
"However, we will take all necessary steps to protect our company, this van cleef and arpels diamond necklace fake team and its interests.
"Last year was a challenging time for us but going into the 2015 season we have been focused on putting steps in place to ensure that we are delivering the best outcomes for F1's fans."
Sauber, who failed to score a point last season, have signed Sweden's Marcus Ericsson and Brazilian Felipe Nasr as their race drivers, with Italian Raffaele Marciello as reserve for 2015.
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