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Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials

In low-dose computed tomography (LDCT) screening for lung cancer, all three main conditions for overdiagnosis in cancer screening are present: 1) a reservoir of slowly or nongrowing lung cancer exists; 2) LDCT is a high-resolution imaging technology with the potential to identify this reservoir; and 3) eligible screening participants have a high risk of dying from causes other than lung cancer. The degree of overdiagnosis in cancer screening is most validly estimated in high-quality randomised controlled trials (RCTs), with enough follow-up time after the end of screening to avoid lead-time bias and without contamination of the control group.

Nine RCTs investigating LDCT screening were identified. Two RCTs were excluded because lung cancer incidence after the end of screening was not published. Two other RCTs using active comparators were also excluded. Therefore, five RCTs were included: two trials were at low risk of bias, two of some concern and one at high risk of bias. In a meta-analysis of the two low risk of bias RCTs including 8156 healthy current or former smokers, 49% of the screen-detected cancers were overdiagnosed. There is uncertainty about this substantial degree of overdiagnosis due to unexplained heterogeneity and low precision of the summed estimate across the two trials.

Key points

  • Nine randomised controlled trials (RCTs) on low-dose computed tomography screening were identified; five were included for meta-analysis but only two of those were at low risk of bias.

  • In a meta-analysis of recent low risk of bias RCTs including 8156 healthy current or former smokers from developed countries, we found that 49% of the screen-detected cancers may be overdiagnosed.

  • There is uncertainty about the degree of overdiagnosis in lung cancer screening due to unexplained heterogeneity and low precision of the point estimate.

  • If only high-quality RCTs are included in the meta-analysis, the degree of overdiagnosis is substantial.

  • Educational aims

  • To appreciate that low-dose computed tomography screening for lung cancer meets all three main conditions for overdiagnosis in cancer screening: a reservoir of indolent cancers exists in the population; the screening test is able to "tap" this reservoir by detecting biologically indolent cancers as well as biologically important cancers; and the population being screened is characterised by a relatively high competing risk of death from other causes

  • To learn about biases that might affect the estimates of overdiagnosis in randomised controlled trials in cancer screening




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    Additional safety consideration for azithromycin in the management of SARS-CoV-2 infection [Letters]




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    Canadian Medical Association Journal




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    Proteomic Analysis of CSF from Patients with Leptomeningeal Melanoma Metastases Identifies Signatures Associated with Disease Progression and Therapeutic Resistance

    Purpose:

    The development of leptomeningeal melanoma metastases (LMM) is a rare and devastating complication of the late-stage disease, for which no effective treatments exist. Here, we performed a multi-omics analysis of the cerebrospinal fluid (CSF) from patients with LMM to determine how the leptomeningeal microenvironment shapes the biology and therapeutic responses of melanoma cells.

    Experimental Design:

    A total of 45 serial CSF samples were collected from 16 patients, 8 of these with confirmed LMM. Of those with LMM, 7 had poor survival (<4 months) and one was an extraordinary responder (still alive with survival >35 months). CSF samples were analyzed by mass spectrometry and incubated with melanoma cells that were subjected to RNA sequencing (RNA-seq) analysis. Functional assays were performed to validate the pathways identified.

    Results:

    Mass spectrometry analyses showed the CSF of most patients with LMM to be enriched for pathways involved in innate immunity, protease-mediated damage, and IGF-related signaling. All of these were anticorrelated in the extraordinary responder. RNA-seq analysis showed CSF to induce PI3K/AKT, integrin, B-cell activation, S-phase entry, TNFR2, TGFβ, and oxidative stress responses in the melanoma cells. ELISA assays confirmed that TGFβ expression increased in the CSF of patients progressing with LMM. CSF from poorly responding patients conferred tolerance to BRAF inhibitor therapy in apoptosis assays.

    Conclusions:

    These analyses identified proteomic/transcriptional signatures in the CSF of patients who succumbed to LMM. We further showed that the CSF from patients with LMM has the potential to modulate BRAF inhibitor responses and may contribute to drug resistance.

    See related commentary by Glitza Oliva and Tawbi, p. 2083




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    "Liquid Gold" - The unTAPped Potential of Cerebrospinal Fluid Analysis?

    Obtaining blood and cerebrospinal fluid is generally less invasive than standard tumor biopsy, and are increasingly used to develop surrogate biomarkers. Leptomeningeal disease, a devastating complication of cancer, represents a unique opportunity for using liquid biopsies for diagnosis, treatment, and to elucidate underlying mechanisms of resistance to therapy.

    See related article by Smalley et al., p. 2163




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    Importation of Extensively Drug-Resistant Salmonella enterica Serovar Typhi Cases in Ontario, Canada [Susceptibility]

    A strain of extensively drug-resistant (XDR) Salmonella enterica serovar Typhi has caused a large ongoing outbreak in Pakistan since 2016. In Ontario, Canada, 10 cases of mainly bloodstream infections (n = 9) were identified in patients who traveled to Pakistan. Whole-genome sequencing showed that Canadian cases were genetically related to the Pakistan outbreak strain. The appearance of XDR typhoid cases in Ontario prompted a provincial wide alert to physicians to recommend treatment with carbapenems or azithromycin in suspected typhoid cases with travel history to Pakistan.




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    An Individual Participant Data Population Pharmacokinetic Meta-analysis of Drug-Drug Interactions between Lumefantrine and Commonly Used Antiretroviral Treatment [Clinical Therapeutics]

    Treating malaria in HIV-coinfected individuals should consider potential drug-drug interactions. Artemether-lumefantrine is the most widely recommended treatment for uncomplicated malaria globally. Lumefantrine is metabolized by CYP3A4, an enzyme that commonly used antiretrovirals often induce or inhibit. A population pharmacokinetic meta-analysis was conducted using individual participant data from 10 studies with 6,100 lumefantrine concentrations from 793 nonpregnant adult participants (41% HIV-malaria-coinfected, 36% malaria-infected, 20% HIV-infected, and 3% healthy volunteers). Lumefantrine exposure increased 3.4-fold with coadministration of lopinavir-ritonavir-based antiretroviral therapy (ART), while it decreased by 47% with efavirenz-based ART and by 59% in the patients with rifampin-based antituberculosis treatment. Nevirapine- or dolutegravir-based ART and malaria or HIV infection were not associated with significant effects. Monte Carlo simulations showed that those on concomitant efavirenz or rifampin have 49% and 80% probability of day 7 concentrations <200 ng/ml, respectively, a threshold associated with an increased risk of treatment failure. The risk of achieving subtherapeutic concentrations increases with larger body weight. An extended 5-day and 6-day artemether-lumefantrine regimen is predicted to overcome these drug-drug interactions with efavirenz and rifampin, respectively.




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    Comparison of Treatment Outcomes between Analysis Populations in the RESTORE-IMI 1 Phase 3 Trial of Imipenem-Cilastatin-Relebactam versus Colistin plus Imipenem-Cilastatin in Patients with Imipenem-Nonsusceptible Bacterial Infections [Clinical Therapeutic

    The RESTORE-IMI 1 phase 3 trial demonstrated the efficacy and safety of imipenem-cilastatin (IMI) combined with relebactam (REL) for treating imipenem-nonsusceptible infections. The objective of this analysis was to compare the outcomes among patients meeting eligibility requirements based on central laboratory susceptibility versus local laboratory susceptibility. Patients with serious infections caused by imipenem-nonsusceptible, colistin-susceptible, and imipenem-REL-susceptible pathogens were randomized 2:1 to IMI-REL plus placebo or colistin plus IMI for 5 to 21 days. The primary endpoint was a favorable overall response. Key endpoints included the clinical response and all-cause mortality. We compared outcomes between the primary microbiological modified intent-to-treat (mMITT) population, where eligibility was based on central laboratory susceptibility testing, and the supplemental mMITT (SmMITT) population, where eligibility was based on local, site-level testing. The SmMITT (n = 41) and MITT (n = 31) populations had similar baseline characteristics, including sex, age, illness severity, and renal function. In both analysis populations, favorable overall response rates in the IMI-REL treatment group were >70%. Favorable clinical response rates at day 28 were 71.4% for IMI-REL and 40.0% for colistin plus IMI in the mMITT population, whereas they were 75.0% for IMI-REL and 53.8% for colistin plus IMI in the SmMITT population. Day 28 all-cause mortality rates were 9.5% for IMI-REL and 30.0% for colistin plus IMI in the mMITT population, whereas they were 10.7% for IMI-REL and 23.1% for colistin plus IMI in the SmMITT population. The outcomes in the SmMITT population were generally consistent with those in the mMITT population, suggesting that outcomes may be applicable to the real-world use of IMI-REL for treating infections caused by imipenem-nonsusceptible Gram-negative pathogens. (This study has been registered at ClinicalTrials.gov under identifier NCT02452047.)




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    Objectively-Measured Light-Intensity Physical Activity and Risk of Cancer Mortality: A Meta-analysis of Prospective Cohort Studies

    Background:

    The impact of light-intensity physical activity (LPA) in preventing cancer mortality has been questioned. To address this concern, the present meta-analysis aimed to quantify the association between objectively-measured LPA and risk of cancer mortality.

    Methods:

    We conducted a systematic literature search in PubMed and Scopus to January 2020. Prospective cohort studies reporting the association between objectively-measured LPA using activity monitors (e.g., accelerometers) and risk of cancer mortality in the general population were included. The summary hazard ratios (HR) per 30 min/day of LPA and 95% confidence intervals (CI) were obtained using a random-effects model. Dose–response analysis was used to plot their relationship.

    Results:

    Five prospective cohort studies were included, in which the definition of LPA based on accelerometer readings was mainly set within 100 to 2,100 counts/min. The summary HR for cancer mortality per 30 min/day of LPA was 0.86 (95% CI, 0.79–0.95; I2 < 1%), and the association between LPA and risk reduction in cancer mortality was linearly shaped (Pnonlinearity = 0.72). LPA exhibited a comparable magnitude of risk reduction in cancer mortality of moderate-to-vigorous physical activity regardless of equal time-length (0.87 per 30 min/day vs. 0.94 per 30 min/day, Pinteraction = 0.46) or equal amount (0.74 vs. 0.94 per 150 metabolic equivalents-min/day, Pinteraction = 0.11). Furthermore, replacing sedentary time by LPA of 30 min/day decreased the risk of cancer mortality by 9%.

    Conclusions:

    Objectively-measured LPA conferred benefits in decreasing the risk of cancer mortality.

    Impact:

    LPA should be considered in physical activity guidelines to decrease the risk of cancer mortality.




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    Facial Nerve Arterial Arcade Supply in Dural Arteriovenous Fistulas: Anatomy and Treatment Strategies [INTERVENTIONAL]

    BACKGROUND AND PURPOSE:

    Endovascular treatment of petrous dural AVFs may carry a risk of iatrogenic facial nerve palsy if the facial nerve arterial arcade, an anastomotic arterial arch that supplies the geniculate ganglion, is not respected or recognized. Our purpose was to demonstrate that the use of a treatment strategy algorithm incorporating detailed angiographic anatomic assessment allows identification of the facial nerve arterial arcade and therefore safe endovascular treatment.

    MATERIALS AND METHODS:

    This was a retrospective cohort study of consecutive petrous dural AVF cases managed at Toronto Western Hospital between 2006 and 2018. Our standard of care consists of detailed angiographic assessment followed by multidisciplinary discussion on management. Arterial supply, primary and secondary treatments undertaken, angiographic outcomes, and clinical outcomes were assessed by 2 independent fellowship-trained interventional neuroradiologists.

    RESULTS:

    Fifteen patients had 15 fistulas localized over the petrous temporal bone. Fistulas in all 15 patients had direct cortical venous drainage and received at least partial supply from the facial nerve arterial arcade. Following multidisciplinary evaluation, treatment was performed by endovascular embolization in 8 patients (53%) and microsurgical disconnection in 7 patients (47%). All patients had long-term angiographic cure, and none developed iatrogenic facial nerve palsy.

    CONCLUSIONS:

    By means of our treatment strategy based on detailed angiographic assessment and multidisciplinary discussion, approximately half of our patients with petrous AVFs were cured by endovascular treatment, half were cured by an operation, and all had preserved facial nerve function.




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    Treatment Outcomes of Endovascular Embolization Only in Patients with Unruptured Brain Arteriovenous Malformations: A Subgroup Analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) [INTERVENTIONAL]

    BACKGROUND AND PURPOSE:

    Endovascular embolization only has been advocated for treatment of brain arteriovenous malformations in recent trials. Our aim was to evaluate the results of embolization only in a cohort of patients who were enrolled in the A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) study at 39 clinical sites in 9 countries.

    MATERIALS AND METHODS:

    We analyzed the rates and severity of stroke and death in patients who underwent embolization only. Events were identified through in-person neurologic follow-up visits performed at 6-month intervals during the first 2 years and annually, with telephone contact every 6 months thereafter. All event-related data were reviewed by independent adjudicators.

    RESULTS:

    Among 30 patients who had embolization planned, 26 underwent embolization only. A total of 13 stroke events were reported in the follow-up period among 26 subjects (ischemic, hemorrhagic, or both in 4, 7, and 2 subjects, respectively). The adverse event occurred after the first embolization in 11 of 13 patients. One patient had a major motor deficit, and 2 patients developed major visual field deficits. One event was fatal. The modified Rankin Scale score was 0–2 at last follow-up in 11 of the 12 stroke survivors. Estimated stroke-free survival was 46% at 12 months.

    CONCLUSIONS:

    Although the rates of stroke and/or death were high in patients treated with embolization only in ARUBA, the rates of favorable outcomes following stroke were high during follow-up.




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    The FRED for Cerebral Aneurysms of the Posterior Circulation: A Subgroup Analysis of the EuFRED Registry [INTERVENTIONAL]

    BACKGROUND AND PURPOSE:

    Flow diversion for the posterior circulation remains a promising treatment option for selected posterior circulation aneurysms. The Flow-Redirection Intraluminal Device (FRED) system has not been previously assessed in a large cohort of patients with posterior circulation aneurysms. The purpose of the present study was to assess safety and efficacy of FRED in this location.

    MATERIALS AND METHODS:

    Consecutive patients with posterior circulation aneurysms treated at 8 centers participating in the European FRED study (EuFRED) between April 2012 and January 2019 were retrospectively reviewed. Complication and radiographic and functional outcomes were evaluated.

    RESULTS:

    Eighty-four patients (median age, 54 years) with 84 posterior circulation aneurysms were treated with the FRED. A total of 25 aneurysms (29.8%) had previously ruptured, even though most aneurysms were diagnosed incidentally (45.2%). The intradural vertebral artery was the most common location (50%), and saccular, the most common morphology (40.5%). The median size was 7 mm. There were 8 (9.5%) symptomatic thromboembolic and no hemorrhagic complications. Thromboembolic complications occurred mostly (90.9%) in nonsaccular aneurysms. On last follow-up at a median of 24 months, 78.2% of aneurysms were completely occluded. Functional outcome at a median of 27 months was favorable in 94% of patients. All mortalities occurred in patients with acute subarachnoid hemorrhage and its sequelae.

    CONCLUSIONS:

    The largest cohort of posterior circulation aneurysms treated with the FRED to date demonstrated favorable safety and efficacy profiles of the device for this indication. Treatment in the setting of acute subarachnoid hemorrhage was strongly related to mortality, regardless of whether procedural complications occurred.




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    Contrast-Induced Acute Kidney Injury in Radiologic Management of Acute Ischemic Stroke in the Emergency Setting [INTERVENTIONAL]

    BACKGROUND AND PURPOSE:

    The use of invasive cerebral angiography with CTA for active treatment of patients with suspected ischemic strokes has been increasing recently. This study aimed to identify the incidence of postcontrast acute kidney injury using baseline renal function when CTA and cerebral angiography were performed sequentially.

    MATERIALS AND METHODS:

    This retrospective observational study evaluated adults (18 years of age or older) with ischemic stroke who underwent CTA and cerebral angiography sequentially between 2010 and 2018. The incidence of postcontrast acute kidney injury was determined using the baseline estimated glomerular filtration rate. The value of the baseline estimated glomerular filtration rate at which the occurrence of postcontrast acute kidney injury increased was also determined.

    RESULTS:

    Postcontrast acute kidney injury occurred in 57/601 (9.5%) patients. Those with a baseline estimated glomerular filtration rate of <30 mL/min/1.73 m2 showed a higher incidence of acute kidney injury. Age, chronic kidney disease, medication (nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β blockers, statins, and insulin) use following contrast media exposure, and serum albumin affected the incidence of postcontrast acute kidney injury. The incidence of postcontrast acute kidney injury increased when the baseline estimated glomerular filtration rate was <43 mL/min/1.73 m2.

    CONCLUSIONS:

    Patients with low baseline renal function had the highest incidence of postcontrast acute kidney injury after CTA and cerebral angiography, but no fatal adverse effects were documented. Thus, patients suspected of having a stroke should be actively managed with respect to neurovascular function.




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    The Lateral Ventricles: A Detailed Review of Anatomy, Development, and Anatomic Variations [review-article]

    SUMMARY:

    The cerebral ventricles have been studied since the fourth century BC and were originally thought to harbor the soul and higher executive functions. During the infancy of neuroradiology, alterations to the ventricular shape and position on pneumoencephalography and ventriculography were signs of mass effect or volume loss. However, in the current era of high-resolution cross-sectional imaging, variation in ventricular anatomy is more easily detectable and its clinical significance is still being investigated. Interpreting radiologists must be aware of anatomic variations of the ventricular system to prevent mistaking normal variants for pathology. We will review of the anatomy and development of the lateral ventricles and discuss several ventricular variations.




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    Wyndham Soleil - One-bedroom condo for sale in Danang

    Wyndham Soleil Danang is a four-tower complex consisting of one hotel and three condotel buildings meeting five-star standards in the 50-57 storeys range. When completed, Wyndham Soleil Danang will be an iconic Landmark in Danang City. Soliel invites investors to experience luxur...




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    One-bedroom condotel for sale in Wyndham Soleil Project - Danang City - Call 0935 38 48 27

    One-bedroom condotel for sale in Danang City Location: diamond location - four facades - in front of the beach: - North: in Morrison Street - West: in Ho Nghinh Street - South: in Pham Van Dong Street - East: in Vo Nguyen Giap StreetHotline: 0935 38 48 27Wyndham Soleil Danang is ...




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    Hot! Wyndham Soleil Danang apartment for sale, frontage on Pham Van Dong street

    Da Nang Soleil Project Project 1- Located on YELLOW land of Danang city2- Convergence of delicate and modern essence of the world.The project of Condotel Anh Duong Soleil Da Nang was determined to become a new symbol of Danang city by the investor, An Thinh, along with the famous...




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    Wyndham Soleil Danang - one-bedroom condo for sale at only 989k USD

    WYNDHAM SOLEIL DA NANGStudio APARTMENT Construction area: 30.72m2 - 41.78m2 Clearance area: 26.87m2 - 37.14m2 1 Bedroom Apartment Construction area: 60.64m2 - 86.31m2 Carpet area: 54.98m2 - 79.17m2 2 Bedrooms Apartment Construction area: 111.4m2 - 125.7m2 Carpet area: 102.46m2 - ...




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    Officially open for sale - Soleil Anh Duong Danang - Hotline: 0935 38 48 27

    One-Bedroom Condotel for sale in Danang Location: diamond location - four facades - in front of the beach: - North: in Morrison Street - West: in Ho Nghinh Street - South: in Pham Van Dong Street - East: in Vo Nguyen Giap StreetHotline: (+84) O935 38 48 27Wyndham Soleil Danang i...




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    Long Điền Oriana

    Khu dân cư Long Điền Oriana là dự án đất nền do Công ty Cổ Phần YESHOUSE làm chủ đầu tư, triển khai trên khu đất quy hoạch rộng 10.000m2 tại Long Điền, Bà Rịa Vũng Tàu.




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    Căn hộ Centana Thủ Thiêm 88.8m2, 3PN, An Phú Quận 2

    Cần cho thuê căn hộ quận 2, 3PN, 2WC, DT 88.8m2, full nội thất, giá thuê 15tr/tháng (đã bao gồm phí quản lý).Địa chỉ: CH Centana Thủ Thiêm - 36 Mai Chí Thọ, Phường An Phú, Quận 2 (ngay góc Mai Chí Thọ và Cao tốc Long Thành - Dầu Giây).Tiện ích: Full gồm hồ bơi, phòng tập gym miễn...




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    Công ty CP Danatol




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    Vedana Resort Ninh Bình

    Vedana Resort là dự án do Công ty cổ phần Dịch vụ du lịch Cúc Phương làm chủ đầu tư và Công ty Cổ Phần P&A Holding chịu trách nhiệm phát triển.




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    Sakana Resort Hòa Bình

    Khu du lịch nghỉ dưỡng Hồ Dụ - Sakana Resort Hòa Bình là dự án nghỉ dưỡng tiêu chuẩn 5 sao tọa lạc tại Kỳ Sơn, Hòa Bình - cách cao tốc Hòa Lạc - Hòa Bình chỉ 3km.




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    L'Alyana Senses World

    L’Alyana Senses World Phú Quốc là quần thể nghỉ dưỡng do chủ đầu tư Sài Gòn Sovico Phú Quốc triển khai với quy mô 219ha trải dài 1,5km bờ biển phía Tây đảo Phú Quốc.




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    Chuyên gia dự báo thị trường nhà đất Canada sẽ phục hồi trong 2 năm tới

    Các chuyên gia bất động sản tin rằng thị trường nhà ở Canada sẽ phục hồi trở lại trong vòng 2 năm tới, sau một thời gian dài liên tục chứng kiến sự sụt giảm cả về hoạt động xây dựng, doanh số và giá bán nhà.




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    CENTANA CÓ SỔ HỒNG GIÁ TỐT NHẤT OT 1PN 1,75 TỶ, DUY NHẤT 2PN 2.75 TỶ, 88M2 3.2 TỶ, 97M2 3.6 TỶ

    Cam kết giá tốt nhất thị trường có lợi cho KH mua ở, làm việc trực tiếp chủ nhà. Hãy liên hệ chúng tôi để chọn căn hợp với nhu cầu của quý khách. Cập nhật căn giá tốt tháng 2/2020: + Officetel 1PN: 1,75 tỷ (có thương lượng). Căn hộ đã có sổ hồng, công chứng sang tên. +...




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    Haryana: जानें अब किस जोन में मिलेगी कितनी छूट, ऑरेंज और ग्रीन जोन में क्या-क्या खुलेगा

    लॉकडाउन के तीसरे चरण में हरियाणा सरकार रेड ऑरेंज और ग्रीन जोन के लिहाज से विभिन्न बंदिशों में कुछ हद तक ढील देगी।




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    Jason Kenney is Canada's least popular premier -- some caveats may apply

    David J. Climenhaga

    Jason Kenney is Canada's least popular premier.

    When you add in Prime Minister Justin Trudeau, he's also Canada’s least popular first minister.

    I'm not going to belabour this point, but Jason Kenney is Canada's least popular premier.

    Actually, I am going to belabour the point. I'm just not going to provide a lot of smarty pants analysis. That's because while we can speculate, it's too soon to say why Jason Kenney is Canada's least popular premier, or what that might mean.

    Unfortunately, there are caveats. Far too many.

    As far as we can tell, Jason Kenney is Canada's least popular premier. Maybe there's a less popular premier in Atlantic Canada, because the Campaign Research Inc. poll that indicates how unpopular Kenney is doesn't include the Maritimes or Newfoundland.

    But who can imagine any Atlantic premier being less popular than Kenney? So I'm just going to keep on saying Kenney is Canada's least popular premier until somebody proves otherwise.

    How unpopular is Kenney? Well, Kenney has both the lowest approval rating of any first minister about which the Toronto-based pollster asked questions in its monthly omnibus poll and the highest disapproval rating of any premier on the list.

    Mind you, another caveat, the Alberta sample appears to be pretty small, tiny even, a mere 181 souls out of the 2,007 who responded to the firm's online panel on May 1 and 2. And, in this province, who knows why people might disapprove of the guy?

    Still, even with all those qualifiers, it's nice to be able to say that Jason Kenney is Canada's least popular premier, and considerably less popular than Prime Minister Justin Trudeau to boot!

    The poll was published yesterday under the heading COVID-19/Coronavirus Study, so you might have missed it. The bit about Jason Kenney being Canada's most unpopular premier is buried rather deep, starting down on page 36 of the explanatory slide show. It's one of those online panel thingies, so all of the usual negative caveats about that apply too.

    Just the same, according to Campaign Research, Canada's three most popular premiers are Quebec's Francois Legault with an 83-per-cent approval rating and 13 per cent disapproving, Saskatchewan's Scott Moe (80 per cent/16 per cent), and British Columbia's John Horgan (73 per cent/13 per cent). Ontario's Doug Ford was fourth (76 per cent/17 per cent).

    I suppose because they're a Toronto pollster, Campaign research threw in Toronto Mayor John Tory (75 per cent/17 per cent). In fairness, though, Toronto's population is more than twice those of Saskatchewan and Manitoba, and a bit larger than both combined, so fair's fair.

    Plus Campaign Research added the prime minister (65 per cent/29 per cent).

    Canada's second-least popular premier, according to this, was Manitoba's Brian Pallister (51 per cent/37 per cent).

    And then came Kenney, in a distant last place with an approval rating of 44 per cent, and a disapproval rating of 48 per cent, the only leader on the list with a higher disapproval rating than approval rating.

    Have I read too much into this? Almost certainly.

    But who cares? It's just nice to be able to say … Jason Kenney is Canada's least popular premier.

    David Climenhaga, author of the Alberta Diary blog, is a journalist, author, journalism teacher, poet and trade union communicator who has worked in senior writing and editing positions at The Globe and Mail and the Calgary Herald. This post also appears on his blog, AlbertaPolitics.ca.

    Image: Chris Schwarz/Government of Alberta/Flickr




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    Justin Trudeau should lift Canada's economic sanctions now

    Ken Stone

    On March 23, UN Secretary-General António Guterres appealed to G20 leaders: "I am encouraging the waiving of (economic) sanctions imposed on countries to ensure access to food, essential health supplies, and COVID-19 medical support. This is the time for solidarity not exclusion ... Let us remember that we are only as strong as the weakest health system in our interconnected world." At the same time, AP News reported, ambassadors of eight countries currently affected by economic sanctions -- namely, Cuba, Iran, Venezuela, Syria, Nicaragua, China, Russia and North Korea -- petitioned the secretary-general for "the immediate and complete lifting of those measures to enable nations to respond to the coronavirus pandemic." 

    Regrettably, so far the wealthy and powerful countries of the world haven't heeded the secretary-general's call to loosen the screws on the weaker and poorer ones. They also ignored a similar appeal by Pope Francis in his Easter address. On the contrary, President Trump actually weaponized the pandemic by instituting further sanctions on both Iran and Venezuela, countries already targeted for regime change. 

    In Canada, however, two peace groups, the Hamilton Coalition to Stop the War and le Mouvement Québécois pour la paix, sent an open letter signed by 100 prominent Canadians to Trudeau asking him to lift all of Canada's economic sanctions now. 

    Unknown to most Canadians, Trudeau's government maintains economic sanctions regimes against 20 countries of the world, including nine African countries. In fact, under the Harper government in Ottawa in June 2013, Canada co-ordinated economic sanctions for the U.S.-led coalition of countries participating in the regime change operation against Syria. Similarly, under the Trudeau government, Canada helped lead the Lima Group in organizing multilateral sanctions against Venezuela. 

    Canada typically applies five types of sanctions: arms embargoes, asset freezes, import-export restrictions, financial prohibitions and technical assistance prohibitions. Not all sanctioned countries feel the full weight of all five. However, some countries do: Iran, Syria, North Korea and Libya. 

    The effect on the targeted country is crippling. The first result is usually a drastic decline in its currency's value, which translates into ordinary people being unable to put food on the table for their children. Then follow other crises for working people: unemployment due to closing markets for the country's exports and the inability to get spare parts; inability to receive payments from relatives abroad because the international banking system excludes the targeted country; the closing down of whole industries, such as tourism, because access to credit cards or even air access to national airports, as in the case of Syria, is turned off by the sanctioners.

    Supporters will point out that sanction regimes generally exclude food and medical supplies. However, international trade requires financing through banks which are subject to penalties in the U.S., for example for trading with Iran, even though the participating bank may be domiciled in a country that has lifted its sanctions on Iran. This practice by the U.S. is called extraterritoriality.

    Some have likened economic sanctions to acts of war and compared them to sieges of medieval towns in which the besiegers hope to make life so difficult for the besieged that they rise up against their feudal lords and open the gates. The comparison isn't far off since the brunt of sanctions aren't felt so much by the targeted countries' ruling elites but rather their civilian populations. A monstrous example was the decade of UN sanctions against Iraq between the First and Second Gulf Wars. Between 1992 and 2000, 500,000 Iraqi children perished from lack of food and medicines. But Madeleine Albright, former U.S. secretary of state in the Clinton administration, famously quipped that it was "worth it."  It was worth it to Albright because sanctions were part of U.S. foreign policy to soften up Iraq in preparation for the Anglo-American invasion and occupation of 2003 which continues today.

    Notably, coercive economic measures are not levelled against U.S. client states, no matter the enormity of their crimes. Israel, which turned Gaza into the world’s largest open air prison and is annexing the West Bank, and Saudi Arabia, which wages a bloody war on Yemen and murdered journalist Jamal Khashoggi, don't worry about sanctions.

    Under international law, economic sanctions are acts of war. That's why the UN charter restricts the power to level sanctions exclusively to the UN Security Council. That also explains why Canada's unilateral sanctions against 19 countries are illegal. Only in the case of North Korea are Canada's regime of a full spectrum of coercive measures explicable under international law.

    While Trudeau tries to play the competent caring leader in his daily COVID-19 press conferences, he cannot ignore the damage he is doing to the efforts to fight the novel coronavirus in 20 of the world's poorest countries, and indeed to the global effort.

    Ken Stone is a longtime peace, social justice, labour, anti-racist and environmental activist-resident in Hamilton, Ontario. He is treasurer of the Hamilton Coalition To Stop The War and executive member of the Syria Solidarity Movement.

    Image: CanadianPM/Video Screenshot/Twitter




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    Jason Kenney calls Elizabeth May, Yves-François Blanchet 'un-Canadian,' accuses them of 'blaming the victim'

    David J. Climenhaga

    Now that Premier Jason Kenney has declared it "un-Canadian" to say oil is dead, I wonder if it's OK to admit Alberta's fossil fuel industry is on the ropes?

    Probably. Kenney said as much himself in a remarkable rant yesterday directed at the parliamentary leader of the Bloc Québécois and the former leader of the Green Party of Canada.

    But if you don't want to be accused of un-Canadian activities, you'd better make it clear none of these troubles are the fault of anything that's ever been done by any Alberta government, except perhaps the NDP's, and especially not by the United Conservative Party Kenney leads.

    There is acceptable speech in Alberta, you see, and it doesn't include saying that oil is done like dinner, which is probably not true just yet, but is nevertheless a position that can be argued in respectable company almost anywhere else in the world, including a number of countries known for producing what Kenney rather sophomorically calls "dictator oil."

    As has become his practice lately, Kenney took over Chief Medical Officer of Health Deena Hinshaw's daily COVID-19 briefing in Edmonton yesterday afternoon for the sustained blast of gaslighting he directed at Yves-François Blanchet and Elizabeth May.

    Blanchet had dared to suggest at a news conference Wednesday that oil "is never coming back" (uttered en francais, bien sûr) and that Ottawa's bailout package should really be directed at "something which is more green." May, for her part, opined at the same event that "oil is dead."

    Specifically, the MP for Saanich-Gulf Islands told the media: "My heart bleeds for people who believe the sector is going to come back. It's not. Oil is dead and for people in the sector, it's very important there be just transition funds." This may be wrong, but outside Alberta I doubt it sounds like a stab in the back or a curb-stomping.

    Nevertheless, that is what sent Kenney over the edge, in a calculated sort of way, responding to a set-up question provided by Calgary Sun political columnist Rick Bell, who can be counted on to get the first question at one of Hinshaw's frequently hijacked news conferences.

    "I just think it's deeply regrettable that we would see national political leaders piling on Albertans and energy workers at a time of great trial for us," Kenney said piously, opening what appeared to be a carefully rehearsed answer. "This is the opposite of leadership. Leaders should be seeking to bring us together, not to divide us."

    This is a bit of an irony, of course, coming from a premier who has been ginning up an Alberta separatist threat for months while denying the oil industry had anywhere to go but up, but let's just take it as a lesson in gaslighting 101.

    In his remarks, Kenney trotted out benefits he said have been conferred on Quebec by Alberta's oil industry, noted the province's equalization complaints, blamed "predatory actions" by OPEC countries that "want to dominate the world with dictator oil," reminded Quebeckers they like to drive cars and go on airplane trips, and totted up the medical equipment recently sent by Alberta to other provinces.

    Having said it in English, he said it over again in French.

    Tsk-tsking and shaking his head, Kenney declared, "I would say to Mr. Blanchet and Madam May: Please stop kickin' us while we're down!"

    "These attacks on our natural resource industries are unwarranted, they are divisive, they're, I believe, in a way, un-Canadian at a time like this. It's like blaming the victim!" (Italics added for emphasis. And, yes, Kenney really said that.)

    Premier Kenney also took particular umbrage at Blanchet's remark that Quebec receives a string of insults from Alberta -- although anyone who has paid attention to political discourse in this province for the last half century would have trouble refuting the claim.

    After the news conference, backup was provided in columns filed by Bell and his Postmedia colleague Don Braid.

    Bell pronounced Blanchet and May to be "the Bobbsey Twins of B.S." and the "deluded duo," and accused them of choosing "to kick Alberta when we're down" and indulging "in a little curb-stomping."

    Braid, the Dinger's bookend of acceptable oilpatch opinion, charged them with "the foulest kind of cheap shot," to wit, saying "Alberta's oil and gas industry should be left prostrate in the dust with no help from the federal government."

    Well, there you have it: the debased state of political discourse in Alberta in the plague year 2020. It's not reassuring.

    David Climenhaga, author of the Alberta Diary blog, is a journalist, author, journalism teacher, poet and trade union communicator who has worked in senior writing and editing positions at The Globe and Mail and the Calgary Herald. This post also appears on his blog, AlbertaPolitics.ca.

    Image: Screenshot of Government of Alberta video/YouTube




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    Mervyn King's brutal analysis of banking sector exposed in blow to coronavirus recovery



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    Chelsea news LIVE: Chilwell makes transfer decision, Onana warning, target learns English



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    RPGCast – Episode 245: “Mass Effect Football Manager 2013”

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    RPG Cast – Episode 528: “I Demand An Explanation”

    Whether it be about spanking sounds or male pasties, RPGamer has a long history of being an authoritative source of information. That said, we're still trying to figure out what version of EarthBound Kelley is playing.



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    ‘Of course I smoked marijuana!’ Elliott Gould on stardom, Streisand and Elvis Presley

    The star of M*A*S*H, The Long Goodbye – and more recently, Friends – talks about drugs, his fiery marriage to Barbra Streisand and getting his best reviews from Groucho Marx and Muhammad Ali

    The best review ever received by Elliott Gould – renowned actor and star of M*A*S*H and The Long Goodbye; not to mention, Ross and Monica’s dad on Friends – was from Groucho Marx. The two of them had become close in the comedian’s latter years – so close, Gould says, “he used to let me shave him”. One day Marx asked Gould to change a lightbulb in his bedroom. Gould took off his shoes, stood on the bed and replaced the broken bulb. Marx told him: “That was the best acting I’ve ever seen you do.”

    Gould, now 81, has been telling the story for decades – but it is clear even in our pixelated video call that it still delights him. “Isn’t that great?” he says, his distinctive nasal, New York baritone now deepened with age. As we speak he is sitting at a computer at a friend’s house in Los Angeles, relaxed in a blue hoodie, with a seemingly bottomless mug of coffee before him. In isolation on either side of the Atlantic, neither of us has anywhere to be. And after more than half a century in Hollywood, in which he went from leading man to exile and, eventually, fixture – Gould could fill days, not just hours, with his stories. Even without his eight-year marriage to Barbra Streisand.

    Continue reading...




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    Tijuana coronavirus death rate soars after hospital outbreaks

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    Harry Kane: England World Cup hero favourite to win Golden Boot after Panama hat-trick

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    Ariana Grande granted a restraining order against fan who was found trespassing at her home

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