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A women buy kamagra canada is seen in Kuala Lumpur with a Malaysia flag as a background.SOPA Images | GettySINGAPORE — Several economists slashed their 2021 growth forecasts for Malaysia after the country announced stricter measures to contain a recent surge in erectile dysfunction treatment cases.The Malaysian government imposed an inter-state travel ban nationwide and a lockdown on six states and territories for two weeks starting Wednesday. The country's king also declared a state of emergency buy kamagra canada that will last until Aug. 1, or earlier if erectile dysfunction treatment cases are effectively lowered.Here are some economists who have cut their forecasts for Malaysia:Capital Economics, a consultancy, said the Southeast Asian buy kamagra canada country will grow 7% this year — down from its previous projection of 10%;Singaporean bank UOB downgraded its forecast from 6% to 5%;Japanese bank Mizuho lowered its projection from 6.7% to 5.9%;Fitch Solutions revised down its forecast from 11.5% to 10%.Malaysia was one of the worst-performing economies in Asia last year. The International Monetary Fund in October buy kamagra canada said the Malaysian economy would shrink 6% in 2020, reversing a growth of 4.3% in the previous year.

Alex Holmes, Asia economist at Capital Economics, said in a Tuesday report that Malaysia's latest lockdown "is likely to hit the economy hard." He pointed out that the six states and territories under lockdown — which include capital city Kuala Lumper and Malaysia's richest state, Selangor — account for 57% of the population and 65% of gross domestic product.The lockdown — locally referred to as a movement control order, or MCO — includes banning all social gatherings and dine-ins, closing schools and allowing only "essential" businesses to open.Most of the rest of the country were placed under less stringent measures, with most businesses allowed to operate but activities that involve large gatherings are banned.Economists from UOB said in a Wednesday report that their growth forecast downgrade assumed buy kamagra canada that the restrictions are extended for another four weeks until end-February. But the overall economic hit from the latest measures is likely "less severe" compared to last year when the whole country was locked down, added the economists.'Blessing in disguise'The state of emergency declared on Tuesday rocked the country's stocks and currency.But the move will remove near-term political uncertainty that the country has struggled with in the past year — and that could be "a blessing in disguise" for the Malaysian ringgit, said Lavanya Venkateswaran, market economist at buy kamagra canada Mizuho.The currency slipped 0.5% against the U.S. Dollar in a knee-jerk reaction to the state of emergency announcement buy kamagra canada on Tuesday, but has since strengthened against the greenback and more than recouped those losses.Malaysia's Prime Minister Muhyiddin Yassin said there won't be a curfew under the state of emergency, and the government and judiciary system will continue to function. But parliament will be suspended and elections cannot be held, he said.Muhyiddin came to buy kamagra canada power in March last year and has been facing increasing calls from within his ruling coalition to step down and make way for a snap election.The emergency declaration "removes unnecessary, and self-inflicted political uncertainty that could compromise the policy response to erectile dysfunction treatment resurgence," said Venkateswaran wrote in a Tuesday report."Instead, a steady policy platform to decisively tackle (the) kamagra with urgency is ultimately a positive for getting the economy back on track," she said..

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Grief does not end with the delivery or memorial service. You can findmore helpful tips at these and other websites:.

There is a famous example of the fear, pain and joy concept told by Howard Schubiner, M.D., a leading pain researcher, of a construction worker who stepped on a nail that went through the sole of buy kamagra canada his boot and came out the top of the boot. Upon seeing the nail emerge through the top of his boot, the man began to scream in pain. He was taken to the emergency room, where he was buy kamagra canada given strong pain medication before they were able to get the boot off his foot. When they got the boot off his foot they discovered that the nail had gone between his toes and left no mark on his foot at all. So why did buy kamagra canada he experience pain?.

Because his brain was expecting it based on what he saw. That is the power of the brain – to create the sensation to protect the body from buy kamagra canada perceived danger. This is anexample of the power of the brain to create pain based on fear and expectation.It neuro-circuits in the brain causing the pain responding to danger signals. Becausethe sensation of pain is one of the brain’s responses to danger signals, anyexperience that increases the potential of danger signals can increase thepossibility of pain signals. Fear is one ofthose things that can increase the danger buy kamagra canada signal.

For example, if a person hashad an injury in their foot that resulted in pain while weight bearing, thenthey may, very understandably, fear bearing weight in the future. That fearwill then turn on the danger signal in the brain and increase the likelihood ofpain being buy kamagra canada experienced. It can become a vicious cycle. This type of painis real pain, because buy kamagra canada all pain is real pain. Anyone who says “it’s all in yourhead” is being insensitive and judgmental.

The truth is, all pain starts in ourhead, as a response to the danger alarm that says something is wrong. Thisdanger alarm might be triggered from a structural injury to the body, or thefear of expecting pain, or the fear of social rejection, or the emotional painof buy kamagra canada a traumatic memory, or anything that the alarm system perceives as adanger. This type of response is an unconscious response in the brain, not a choice that people make. One way to check to see buy kamagra canada if pain is related to the neuro-circuits is to use the imagination. If someone imagines doing the thing that has caused pain in the past and experiences pain or fear while imagining the movement or the situation, it is a good sign that it is learned neuro-circuits in the brain causing the pain.

This is good news because the brain buy kamagra canada can be rewired. Once people know that their brain may be creating the sensation of pain, it can free them to change it. There are anumber of ways a person can rewire the brain. One good buy kamagra canada way is to reduce thefear related to anticipating pain. Self-talk and affirmations can be used toreduce fear.

Once a person knows that all or some of their pain isneuro-circuit pain, and that it is not structural damage, they can say buy kamagra canada tothemselves “I am strong and healthy. There is nothing wrong with this part ofmy body. I am buy kamagra canada okay. I am safe. There is no danger.” This can help turn off thedanger signal.

In comparison, when a person buy kamagra canada says, “There is something wrongwith me. I am damaged,” the alarm system is turned on, which will perpetuatethe pain. It may sound simple,but for many people this is the beginning of changing the brain, rewiringneuro-circuits to stop the fear of pain, stop the tripping of the danger alarm,and break the cycle buy kamagra canada. But just like learning any new skill, which all involvedmaking neuro-circuit connections, it can take time and rehearsal. This rewiring canbecome buy kamagra canada even more powerful when combined with other tools to rewire the brain.Another tool is the use of deep breaths, which lets the danger alarm know thatthings are okay.

Another tool is the use of laughter and humor. Participatingin mindfulness, playfulness and joy can also rewire the brain to turn off thefear signals. Participating in any of these activities, or even imagining thesethings, during the previously feared movement or situation can buy kamagra canada help rewire thebrain. For more information on this, Dr. Schubiner has buy kamagra canada created a series of easy-to-understand animated video beginning with “What is pain.” For those who need more intense treatment for mental health conditions, MidMichigan Health provides an intensive outpatient program called Psychiatric Partial Hospitalization Program at MidMichigan Medical Center – Gratiot.

Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs buy kamagra canada may visit www.midmichigan.org/mentalhealth.Each year, more than a million families in the United States experience a miscarriage, stillbirth or death of an infant. Yet because these events can be emotionally difficult to discuss, there is little public awareness, so families may not always get the support they need. October is Pregnancy and Infant Loss Awareness buy kamagra canada Month, a time to show support for these families, highlight available resources and build understanding of how family, friends and the community can help. If you visit a MidMichiganHealth facility during the month of October, you may notice staff wearing pinkand blue ribbons to show their support.

We will also participate in theInternational Wave of Light, a worldwide remembrance event on October 15, 7 to 8p.m. During this time, candles will be lit buy kamagra canada at the entrances of MidMichigan’sMedical Centers in Alma, Alpena, Midland and West Branch (the sites of our fourMaternity Centers) to honor babies gone too soon and their families. Patients,staff and community members are welcome to attend. Resources for Grieving Parents Your primarycare doctor or OB/Gyn can be a good first contact to help you understand thephysical and emotional impact of a buy kamagra canada loss and to identify other resources. MidMichigan Home Care offers grief support for individuals and families who have lost a loved one, including education, support groups, short-term counseling and referrals to community professionals for longer-term follow-up.

For more buy kamagra canada information, visit www.midmichigan.org/grief or call (800) 862-5002. There are manylocal and national nonprofits that specialize in helping families throughinfant and pregnancy loss. Their services range from resources and materialsthat discuss what families can expect during the grieving process, to in-personand online support groups to financial assistance with funeral and otherexpenses. Some organizations focus buy kamagra canada on certain bereaved family members, such asparents or siblings, or on specific causes of perinatal death. Consider callingUnited Way’s 2-1-1 hotline to identify local agencies in your area that mayprovide targeted grief services.

What to Say When Someone Loses a Child People tend totreat pregnancy or infant loss as a taboo subject, so loved ones are buy kamagra canada oftenuncomfortable or unfamiliar with what to say or do. Some well-meaning peoplemay even say things that are more hurtful than helpful. Experts recommend keepingyour condolences simple, following buy kamagra canada the family’s cues, and asking about theirpreferences if you are unsure. Tips. Acknowledgetheir loss in short, simple phrases, such as, “I’m sorry for your loss.” Or “Iimagine this must be painful for you.” Offer to listen if they want to talk.It’s also okay to simply admit that you don’t know what to say.Askwhether it is okay to talk about the baby and to use the baby’s name.Peopleoften treat miscarriage as “no big deal,” but the value of a life is notproportional to the time spent on earth.

When a family loses a child, they losethe entire future they had dreamed for buy kamagra canada themselves and that child. A lifetime ofmilestones and memories. In some cases, they may not have another opportunityto become parents, which can compound buy kamagra canada their grief. Avoidstatements that downplay their emotions, tell them how to feel, attempt to finda “silver lining” in their grief, or are based on religion, such as:Perhapsit was for the best.Godmust have wanted your special angel to be with him.You’reyoung. You can still have another child.Atleast now you know you can get pregnant.Atleast you buy kamagra canada didn’t really know him/her.Atleast you weren’t that far along.Rememberthe father, siblings and other family members.

The focus tends to be on mothers,but the whole family may need your support. Be aware that men may feel the needto “be strong” which can impede their grieving process.Offerto help with specific tasks. People who are grieving may not be buy kamagra canada able toidentify their needs or ask for help. You can offer to help with caring forother children, preparing meals, doing housework, funeral preparations, notifyingextended family or friends, or creating a special memento or ritual to rememberthe baby. Remember that buy kamagra canada help and support may be especially needed after otherhelpers have moved on.Acknowledgethem as parents.

This isoften overlooked if they don’t have living children, yet they are parents andshould be supported and addressed as parents.Rememberthem in years to come. Call, send a card, or offer to spend time with them onmilestone days. Grief does not end with the delivery or memorial service. You can findmore helpful tips at these and other websites:.

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INTRODUCTIONAs research identifies new ways of caring for patients, services must develop to ensure buy super kamagra online that knowledge image source is applied. It is tempting to argue that this is best achieved if patients are managed by a team that has specialist skills even if its location is remote from the patient’s home. Indeed, the Health Services Journal reports that fundamental changes to London’s Nationa Health Service (NHS) are being considered by NHS England and Improvement buy super kamagra online London in the wake of erectile dysfunction treatment. Centralisation of specialised services is reported to be part of the thinking. Careful consideration of its full effects is lacking in some studies that seek to evaluate centralisation.ASSESSING THE BENEFIT OF CENTRALISATIONIn the 1970s, Indiana University (IU) established a worldwide reputation for developing curative treatment of testicular germ cell tumours.

In 2018, Albany et al of the IU team published a paper arguing outcomes were better when services were buy super kamagra online provided by a centralised multidisciplinary team.1 They used data from their own experience compared with data from the rest of the state of Indiana showing a survival advantage for those treated in the IU facility.This conclusion was not valid. For example, an entry criterion for the IU series was to have received the first cycle of chemotherapy there. The entry criterion for control group was surviving at least 1 day. This amounts to an enormous disparity between the two groups quite sufficient to account for a survival advantage.The IU team also includes a supplementary map to show the wide geographical area within the Eastern USA buy super kamagra online and beyond from which they attract patients. Herein is a further source of bias.

The act of electing to travel to an institution of high repute requires socioeconomic resources and sufficient wellness to make the journey, which implies a significant potential chance of a superior clinical outcome over …CLINICAL DECISION SUPPORT. WHAT WILL HAPPEN IN THE 2020S? buy super kamagra online. Clinical decision support may be defined as ‘a process for enhancing health-related decisions and actions with pertinent, organized, clinical knowledge, and patient information to improve health and healthcare delivery’.1 The aim is to assist when even relatively simple problems (such as the management of chest pain after coronary artery bypass surgery) are in fact enormously complex for most humans to deal with.2 Clinical decision support has changed substantially over the past 20 years and no doubt will continue to change in the 2020s. However, it is unclear to what extent it will change and exactly what new directions this field will take. Some think that there will be buy super kamagra online a dramatic change.

They think that drivers of this transformational change will be data, evidence from both research and databases, algorithms, patient-specific guidance and artificial intelligence that will enable information technologies to learn from outcomes and continually improve.3–5 This may all be correct—but the extent to which it is really new is questionable. Online clinical decision support has been around since the internet has been around. One of the earliest papers that attempted to predict the future of online clinical decision support buy super kamagra online was published in 1998. It is ‘Online practice guidelines. Issues, obstacles, and future prospects’ by Rita Zielstorff.6 And what does this paper predict?.

It suggests that the future will be about ‘data mining’, ‘algorithms and decision tables’, ‘patient-specific decision support’ and patient outcomes buy super kamagra online that ‘can be facilitated by the clinical information system, providing the means to refine the guideline and improve practice still further’. The words and phrases are slightly different from those that we use today, but the ideas are largely the same. The most striking difference from papers of the past few years is the absence of hype.It seems that patient-specific decision support ….

INTRODUCTIONAs research buy kamagra canada identifies visit this website new ways of caring for patients, services must develop to ensure that knowledge is applied. It is tempting to argue that this is best achieved if patients are managed by a team that has specialist skills even if its location is remote from the patient’s home. Indeed, the Health Services Journal reports that buy kamagra canada fundamental changes to London’s Nationa Health Service (NHS) are being considered by NHS England and Improvement London in the wake of erectile dysfunction treatment.

Centralisation of specialised services is reported to be part of the thinking. Careful consideration of its full effects is lacking in some studies that seek to evaluate centralisation.ASSESSING THE BENEFIT OF CENTRALISATIONIn the 1970s, Indiana University (IU) established a worldwide reputation for developing curative treatment of testicular germ cell tumours. In 2018, Albany et al of the IU team published a paper arguing outcomes were better when services were provided by a centralised multidisciplinary team.1 They used data from their own experience compared with data from the rest of the state of Indiana showing a survival advantage for those treated in the IU facility.This conclusion was buy kamagra canada not valid.

For example, an entry criterion for the IU series was to have received the first cycle of chemotherapy there. The entry criterion for control group was surviving at least 1 day. This amounts to an enormous disparity between the two groups quite sufficient to account for a buy kamagra canada survival advantage.The IU team also includes a supplementary map to show the wide geographical area within the Eastern USA and beyond from which they attract patients.

Herein is a further source of bias. The act of electing to travel to an institution of high repute requires socioeconomic resources and sufficient wellness to make the journey, which implies a significant potential chance of a superior clinical outcome over …CLINICAL DECISION SUPPORT. WHAT WILL HAPPEN IN THE buy kamagra canada 2020S?.

Clinical decision support may be defined as ‘a process for enhancing health-related decisions and actions with pertinent, organized, clinical knowledge, and patient information to improve health and healthcare delivery’.1 The aim is to assist when even relatively simple problems (such as the management of chest pain after coronary artery bypass surgery) are in fact enormously complex for most humans to deal with.2 Clinical decision support has changed substantially over the past 20 years and no doubt will continue to change in the 2020s. However, it is unclear to what extent it will change and exactly what new directions this field will take. Some think that there will be a dramatic change buy kamagra canada.

They think that drivers of this transformational change will be data, evidence from both research and databases, algorithms, patient-specific guidance and artificial intelligence that will enable information technologies to learn from outcomes and continually improve.3–5 This may all be correct—but the extent to which it is really new is questionable. Online clinical decision support has been around since the internet has been around. One of the earliest papers that attempted to predict the future of online clinical decision support was buy kamagra canada published in 1998.

It is ‘Online practice guidelines. Issues, obstacles, and future prospects’ by Rita Zielstorff.6 And what does this paper predict?. It suggests that the future will be about ‘data mining’, ‘algorithms and decision buy kamagra canada tables’, ‘patient-specific decision support’ and patient outcomes that ‘can be facilitated by the clinical information system, providing the means to refine the guideline and improve practice still further’.

The words and phrases are slightly different from those that we use today, but the ideas are largely the same. The most striking difference from papers of the past few years is the absence of hype.It seems that patient-specific decision support ….

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Acute coronary kamagra oral jelly suppliers syndrome due to spontaneous coronary artery dissection http://en.cubcadet.eu/amoxil-for-sale-online/ (SCAD) typically is managed conservatively because coronary anatomy returns to normal in most patients at follow-up and because there is a high rate of technical failure and complications with percutaneous coronary intervention (PCI). However, a subgroup of these patients is at risk of extensive myocardial kamagra oral jelly suppliers infarction and might benefit from PCI, despite the risk of complications. In this issue of Heart, Kotecha and colleagues1 report outcomes in 215 SCAD patients (94% women, median age 48 years kamagra oral jelly suppliers with a range of 42–54 years) who underwent PCI for ST-elevation myocardial infarction, cardiac arrest, TIMI grade 0/1 flow or proximal dissection (figure 1). As expected, PCI-related complications were frequent, occurring in 38.6% (83/215), with 13.0% (28/215) of patients suffering a serious complication.

Even so, improved TIMI flow was achieved in 84.3% (118/140) with worsened TIMI flow in only 7% of patients kamagra oral jelly suppliers. At a median follow-up of 900 days, 9.3% suffered recurrent acute myocardial infarction, 4.7% required further revascularisation, 1.5% had a kamagra oral jelly suppliers stroke and 1.4% died. However, there was no difference in outcomes in SCAD-PCI patients compared with a matched cohort of SCAD patients who did not undergo PCI.Details of the PCI procedure in SCAD intervention patients (n=215). (A) interventional strategy, (B) number of stents deployed, (C) stent length compared with lesion length and (D) kamagra oral jelly suppliers coronary heat map of stented AHA coronary segments.

AHA, American Heart kamagra oral jelly suppliers Association. PCI, percutaneous coronary intervention. SCAD, spontaneous coronary artery dissection." data-icon-position data-hide-link-title="0">Figure 1 Details of the PCI procedure in kamagra oral jelly suppliers SCAD intervention patients (n=215). (A) interventional strategy, (B) number of stents deployed, (C) stent length compared kamagra oral jelly suppliers with lesion length and (D) coronary heat map of stented AHA coronary segments.

AHA, American Heart Association. PCI, percutaneous kamagra oral jelly suppliers coronary intervention. SCAD, spontaneous coronary artery dissection.Adamson2 reminds us that SCAD may account for as kamagra oral jelly suppliers many as 2%–3% of acute coronary syndromes and predominantly affects middle-aged women without traditional risk factors for coronary disease. He also points out that in the study by Kotecha and colleagues1 the SCAD patients undergoing PCI, compared with those treated conservatively, more often suffered myocardial infarction or cardiac arrest and more often had left main or proximal left anterior descending coronary artery involvement, reflecting selection of patients in whom the risks of PCI were offset by the severity of the coronary involvement.

He concludes kamagra oral jelly suppliers. €˜Excellent outcomes kamagra oral jelly suppliers for most conservatively managed patients suggest our default should be to ‘do no harm’. But, for an kamagra oral jelly suppliers important minority where intervention is deemed a true necessity—complete vessel occlusion, haemodynamic instability—we ought to take courage that there is scope ‘to do good’.’The effectiveness of angiotensin receptor-neprilysin inhibitor (ARNI) treatment versus renin–angiotensin system (RAS) blockade alone was evaluated by Desai and colleagues3 in a cohort of over 50 000 older (average age 76 years) adults with heart failure due to reduced ejection fraction (HFrEF). Patients treated with an ARNI, compared with RAS blockade alone, had a lower 1-year cumulative incidence of the composite outcome of worsening HF events or all-cause mortality both those in whom ARNI was the initial treatment (‘initiators’, 27.2% vs 26.9%) and among those who switched from RAS blockade to ARNI treatment (‘switchers’, 23.8% vs 29.7%), even after adjustment for numerous pre-exposure characteristics (figure 2).Cumulative incidence of individual endpoints of worsening heart failure and all-cause mortality after propensity score weighting in patients treated with angiotensin receptor-neprilysin inhibitor (ARNI) or renin–angiotensin system blockade alone.

Numbers in the table below the kamagra oral jelly suppliers plot represent populations at risk under as-treated follow-up. ARB, angiotensin receptor blocker." data-icon-position data-hide-link-title="0">Figure 2 Cumulative incidence of kamagra oral jelly suppliers individual endpoints of worsening heart failure and all-cause mortality after propensity score weighting in patients treated with angiotensin receptor-neprilysin inhibitor (ARNI) or renin–angiotensin system blockade alone. Numbers in the table below the plot represent populations at risk under as-treated follow-up. ARB, angiotensin receptor blocker.In the accompanying editorial, kamagra oral jelly suppliers Griffin and Cheng4 put this real-world data into the context of previous clinical trials.

For example, mean age kamagra oral jelly suppliers in the current study was older compared with clinical trials (76 vs 64 years), more women (33% vs 21%) and black patients (11% vs 5%) were included, and a sizeable number (12%–14%) had chronic kidney disease. They also point out that the ‘switcher’ group likely represents more chronic HF compared with the ‘initiator’ group, possibly explaining the apparent greater effect in the “switcher group”. However, in the ‘real world’ most patients eligible for an ARNI still do not receive this mediation despite guideline recommendations that ‘ARNI is now indicated in patients with chronic heart failure regardless of ejection fraction’, highlighting the barriers to uptake including lack of physician education, concerns about safety of kamagra oral jelly suppliers switching medications, particularly the effects on blood pressure, and the cost of the drug for patients. Griffin and Cheng conclude ‘As we continue to evaluate efficacy of new indications for ARNI therapy and the focus turns to HF with mid-range and preserved EF, we must continue to improve morbidity and mortality in HFrEF by making it available to those in whom it already has proven benefit.’In another interesting paper in this issue of Heart, Kaiser and colleagues5 looked at the association between serum lipoprotein(a) (Lp(a)) levels and the prevalence and quantity of aortic valve kamagra oral jelly suppliers calcium (AVC), measured by cardiac CT, in 2412 participants in the population-based Rotterdam Study as well as 859 healthy individuals from the Amsterdam University Medical Centers (UMC) outpatient clinics.

In both cohorts, higher Lp(a) levels were associated with higher valve calcium scores although the prevalence of AVC was 33.1% in the Rotterdam Study versus 5.4% in the Amsterdam UMC cohort (figure 3).0. The prevalence of aortic valve calcium for lipoprotein(a) above and below the 80th percentile (47.7 mg/dL), respectively, was 1 of 67 (1.5%) vs 3 of 339 (0.9%) for ages below 45, 6 of 38 (15.8%) vs kamagra oral jelly suppliers 9 of 210 (4.3%) for ages 45–54, 43 of 179 (24.0%) vs 96 of 676 (14.2%) for ages 55–64, 116 of 247 (47.0%) vs 295 of 1005 (29.4%) for ages 65–74 and 78 of 123 (63.4%) vs 197 of 387 (50.9%) for ages 75 and over. Error bars indicate 95% kamagra oral jelly suppliers CIs." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-626079303" data-figure-caption="Prevalence of aortic valve calcium stratified by age and lipoprotein(a). Aortic valve calcium was defined as an aortic valve Agatston score >0.

The prevalence of aortic valve calcium for lipoprotein(a) above and below the 80th percentile (47.7 mg/dL), respectively, was 1 of 67 (1.5%) vs 3 of 339 (0.9%) for ages below 45, 6 of 38 (15.8%) vs 9 of 210 (4.3%) for ages 45–54, 43 of 179 (24.0%) vs 96 of 676 (14.2%) for ages 55–64, 116 of 247 (47.0%) vs kamagra oral jelly suppliers 295 of 1005 (29.4%) for ages 65–74 and 78 of 123 (63.4%) vs 197 of 387 (50.9%) for ages 75 and over. Error bars indicate 95% CIs." kamagra oral jelly suppliers data-icon-position data-hide-link-title="0">Figure 3 Prevalence of aortic valve calcium stratified by age and lipoprotein(a). Aortic valve calcium was defined as an aortic valve Agatston score >0. The prevalence of aortic valve calcium for lipoprotein(a) above and below the 80th percentile (47.7 mg/dL), respectively, was 1 of 67 (1.5%) vs 3 of 339 (0.9%) for ages below 45, 6 of kamagra oral jelly suppliers 38 (15.8%) vs 9 of 210 (4.3%) for ages 45–54, 43 of 179 (24.0%) vs 96 of 676 (14.2%) for ages 55–64, 116 of 247 (47.0%) vs 295 of 1005 (29.4%) for ages 65–74 and 78 of 123 (63.4%) vs 197 of 387 (50.9%) for ages 75 and over.

Error bars indicate 95% CIs.Tzolos and Dweck6 succinctly summarise the key finding of kamagra oral jelly suppliers this study. €˜Once again, Lp(a) appears associated with incident AS and the initiation phase of the kamagra oral jelly suppliers disease. Interestingly, there appears to be a threshold effect underlying this association around the 80th percentile (47.7 mg/dL).’ They emphasise that this data is important because ‘In order to adequately power future randomised controlled trials, we need to target the patients who might benefit most from an intervention. This study suggests that Lp(a) lowering should target patients above the 80th Lp(a) percentile (≥50 mg/dL) independent of their age.’ However, ‘Ultimately, double-blinded randomised controlled trials are required to assess whether Lp(a) lowering in patients with aortic valve calcification can slow disease progression and improve clinical outcomes.’The Education in Heart article in this issue reviews the challenging issue of weight loss through lifestyle changes kamagra oral jelly suppliers for primary prevention of cardiovascular disease.

Yannakoulia and Panagiotakos7 acknowledge the difficulty in helping patients improve dietary kamagra oral jelly suppliers patterns and engage in regular exercise, as well as the high prevalence of weight regaining even when initial weight loss efforts are successful. The Mediterranean diet/lifestyle has the most scientific evidence establishing benefits and as summarised in the article (figure 4).Mediterranean lifestyle, weight and energy balance, in relation to cardiovascular disease risk. MUFA,monounsaturated fatty kamagra oral jelly suppliers acids. PUFA, polyunsaturated fatty acids." data-icon-position data-hide-link-title="0">Figure 4 Mediterranean lifestyle, weight and energy balance, kamagra oral jelly suppliers in relation to cardiovascular disease risk.

MUFA,monounsaturated fatty acids. PUFA, polyunsaturated fatty acids.The Cardiology in Focus article in this issue of Heart provides useful guidance for medical students, residents or cardiology trainees interested in pursing a career in preventative cardiology.8Ethics statementsPatient consent for publicationNot required.Congenital heart diseases (CHD) are kamagra oral jelly suppliers a heterogeneous group of conditions that afflict an increasing number of adults. On some occasions, the singularities of the anatomy and physiology are a kamagra oral jelly suppliers real challenge for the treating cardiologist. Such is the case of patients with congenitally corrected transposition of the great arteries (ccTGA) and those with transposition of the great arteries (TGA) repaired with the atrial switch procedure, in which a morphologically right ventricle (RV) sustains the systemic circulation.

Although there are case reports kamagra oral jelly suppliers of asymptomatic elderly patients being diagnosed with previously undetected ccTGA, these are exceptions. The systemic right ventricle (SRV) usually experiences a progressive decline in kamagra oral jelly suppliers the systolic function ultimately leading to death or heart transplantation in most cases.The Achilles’ heel of the SRV researchAvailable drug strategies for the treatment of the failing left ventricle (LV) in acquired heart disease are commonly used in the SRV dysfunction, but such approach is not based on scientific evidence. Several studies have unsuccessfully tried to prove a net benefit from the use of beta blockers or agents targeting the renin-angiotensin-aldosterone system (RAAS) in patients with biventricular circulation and an SRV. Even a few kamagra oral jelly suppliers randomised controlled trials (RCT), the top method in the hierarchy of scientific evidence, have failed in this purpose.1 There are different reasons that could explain this lack of success, the most important being the small sample size of all the studies.

The largest RCT2 only included 88 patients (44 randomised to valsartan kamagra oral jelly suppliers and 44 to placebo). Considering that the Survival And Ventricular Enlargement ….

Acute coronary read this syndrome due to spontaneous coronary artery dissection (SCAD) typically is managed conservatively buy kamagra canada because coronary anatomy returns to normal in most patients at follow-up and because there is a high rate of technical failure and complications with percutaneous coronary intervention (PCI). However, a subgroup of these patients is at risk of extensive myocardial infarction buy kamagra canada and might benefit from PCI, despite the risk of complications. In this issue of Heart, Kotecha and colleagues1 report outcomes in 215 SCAD patients (94% women, median age 48 years with a range of 42–54 buy kamagra canada years) who underwent PCI for ST-elevation myocardial infarction, cardiac arrest, TIMI grade 0/1 flow or proximal dissection (figure 1). As expected, PCI-related complications were frequent, occurring in 38.6% (83/215), with 13.0% (28/215) of patients suffering a serious complication.

Even so, improved TIMI buy kamagra canada flow was achieved in 84.3% (118/140) with worsened TIMI flow in only 7% of patients. At a median follow-up of 900 days, 9.3% suffered recurrent acute myocardial infarction, 4.7% required further revascularisation, 1.5% had a stroke buy kamagra canada and 1.4% died. However, there was no difference in outcomes in SCAD-PCI patients compared with a matched cohort of SCAD patients who did not undergo PCI.Details of the PCI procedure in SCAD intervention patients (n=215). (A) interventional strategy, (B) number of stents deployed, (C) stent length compared with lesion buy kamagra canada length and (D) coronary heat map of stented AHA coronary segments.

AHA, American Heart buy kamagra canada Association. PCI, percutaneous coronary intervention. SCAD, spontaneous coronary buy kamagra canada artery dissection." data-icon-position data-hide-link-title="0">Figure 1 Details of the PCI procedure in SCAD intervention patients (n=215). (A) interventional strategy, (B) number of stents deployed, (C) stent buy kamagra canada length compared with lesion length and (D) coronary heat map of stented AHA coronary segments.

AHA, American Heart Association. PCI, percutaneous coronary buy kamagra canada intervention. SCAD, spontaneous coronary artery dissection.Adamson2 reminds us that SCAD may account for as many as 2%–3% buy kamagra canada of acute coronary syndromes and predominantly affects middle-aged women without traditional risk factors for coronary disease. He also points out that in the study by Kotecha and colleagues1 the SCAD patients undergoing PCI, compared with those treated conservatively, more often suffered myocardial infarction or cardiac arrest and more often had left main or proximal left anterior descending coronary artery involvement, reflecting selection of patients in whom the risks of PCI were offset by the severity of the coronary involvement.

He concludes buy kamagra canada. €˜Excellent outcomes for most conservatively managed patients suggest our default should be buy kamagra canada to ‘do no harm’. But, for an important minority where intervention is deemed a true necessity—complete vessel occlusion, haemodynamic instability—we ought to take courage that there is scope ‘to do good’.’The effectiveness of buy kamagra canada angiotensin receptor-neprilysin inhibitor (ARNI) treatment versus renin–angiotensin system (RAS) blockade alone was evaluated by Desai and colleagues3 in a cohort of over 50 000 older (average age 76 years) adults with heart failure due to reduced ejection fraction (HFrEF). Patients treated with an ARNI, compared with RAS blockade alone, had a lower 1-year cumulative incidence of the composite outcome of worsening HF events or all-cause mortality both those in whom ARNI was the initial treatment (‘initiators’, 27.2% vs 26.9%) and among those who switched from RAS blockade to ARNI treatment (‘switchers’, 23.8% vs 29.7%), even after adjustment for numerous pre-exposure characteristics (figure 2).Cumulative incidence of individual endpoints of worsening heart failure and all-cause mortality after propensity score weighting in patients treated with angiotensin receptor-neprilysin inhibitor (ARNI) or renin–angiotensin system blockade alone.

Numbers in the table below the plot represent populations buy kamagra canada at risk under as-treated follow-up. ARB, angiotensin receptor blocker." data-icon-position data-hide-link-title="0">Figure 2 Cumulative incidence of individual endpoints of worsening heart failure and all-cause mortality buy kamagra canada after propensity score weighting in patients treated with angiotensin receptor-neprilysin inhibitor (ARNI) or renin–angiotensin system blockade alone. Numbers in the table below the plot represent populations at risk under as-treated follow-up. ARB, angiotensin receptor blocker.In the accompanying editorial, Griffin and buy kamagra canada Cheng4 put this real-world data into the context of previous clinical trials.

For example, mean age in the current study was older compared with clinical trials (76 vs 64 years), more women (33% vs 21%) buy kamagra canada and black patients (11% vs 5%) were included, and a sizeable number (12%–14%) had chronic kidney disease. They also point out that the ‘switcher’ group likely represents more chronic HF compared with the ‘initiator’ group, possibly explaining the apparent greater effect in the “switcher group”. However, in the ‘real world’ most patients eligible for an ARNI still do not receive this mediation despite guideline recommendations that ‘ARNI is now indicated in patients with chronic heart failure regardless of ejection fraction’, highlighting the barriers to uptake including lack of buy kamagra canada physician education, concerns about safety of switching medications, particularly the effects on blood pressure, and the cost of the drug for patients. Griffin and Cheng conclude ‘As we continue to evaluate efficacy of new indications for ARNI therapy and the focus turns to HF with mid-range and preserved EF, we must continue to improve morbidity and mortality in HFrEF by making it available to those in whom it already has proven benefit.’In another interesting paper in this issue of Heart, Kaiser and colleagues5 looked at the association between serum lipoprotein(a) (Lp(a)) levels and the prevalence and quantity of aortic valve calcium (AVC), measured by cardiac CT, in 2412 participants in the population-based Rotterdam Study as well as 859 buy kamagra canada healthy individuals from the Amsterdam University Medical Centers (UMC) outpatient clinics.

In both cohorts, higher Lp(a) levels were associated with higher valve calcium scores although the prevalence of AVC was 33.1% in the Rotterdam Study versus 5.4% in the Amsterdam UMC cohort (figure 3).0. The prevalence of aortic valve calcium for lipoprotein(a) above and below the 80th percentile (47.7 mg/dL), respectively, was 1 buy kamagra canada of 67 (1.5%) vs 3 of 339 (0.9%) for ages below 45, 6 of 38 (15.8%) vs 9 of 210 (4.3%) for ages 45–54, 43 of 179 (24.0%) vs 96 of 676 (14.2%) for ages 55–64, 116 of 247 (47.0%) vs 295 of 1005 (29.4%) for ages 65–74 and 78 of 123 (63.4%) vs 197 of 387 (50.9%) for ages 75 and over. Error bars indicate 95% CIs." class="highwire-fragment fragment-images buy kamagra canada colorbox-load" rel="gallery-fragment-images-626079303" data-figure-caption="Prevalence of aortic valve calcium stratified by age and lipoprotein(a). Aortic valve calcium was defined as an aortic valve Agatston score >0.

The prevalence of aortic valve calcium for lipoprotein(a) buy kamagra canada above and below the 80th percentile (47.7 mg/dL), respectively, was 1 of 67 (1.5%) vs 3 of 339 (0.9%) for ages below 45, 6 of 38 (15.8%) vs 9 of 210 (4.3%) for ages 45–54, 43 of 179 (24.0%) vs 96 of 676 (14.2%) for ages 55–64, 116 of 247 (47.0%) vs 295 of 1005 (29.4%) for ages 65–74 and 78 of 123 (63.4%) vs 197 of 387 (50.9%) for ages 75 and over. Error bars indicate 95% CIs." data-icon-position data-hide-link-title="0">Figure 3 Prevalence of buy kamagra canada aortic valve calcium stratified by age and lipoprotein(a). Aortic valve calcium was defined as an aortic valve Agatston score >0. The prevalence of aortic valve calcium for lipoprotein(a) above and below the 80th percentile (47.7 mg/dL), respectively, was 1 of 67 (1.5%) vs 3 of 339 (0.9%) for ages below 45, 6 of 38 (15.8%) vs 9 of 210 (4.3%) buy kamagra canada for ages 45–54, 43 of 179 (24.0%) vs 96 of 676 (14.2%) for ages 55–64, 116 of 247 (47.0%) vs 295 of 1005 (29.4%) for ages 65–74 and 78 of 123 (63.4%) vs 197 of 387 (50.9%) for ages 75 and over.

Error bars indicate buy kamagra canada 95% CIs.Tzolos and Dweck6 succinctly summarise the key finding of this study. €˜Once again, buy kamagra canada Lp(a) appears associated with incident AS and the initiation phase of the disease. Interestingly, there appears to be a threshold effect underlying this association around the 80th percentile (47.7 mg/dL).’ They emphasise that this data is important because ‘In order to adequately power future randomised controlled trials, we need to target the patients who might benefit most from an intervention. This study suggests buy kamagra canada that Lp(a) lowering should target patients above the 80th Lp(a) percentile (≥50 mg/dL) independent of their age.’ However, ‘Ultimately, double-blinded randomised controlled trials are required to assess whether Lp(a) lowering in patients with aortic valve calcification can slow disease progression and improve clinical outcomes.’The Education in Heart article in this issue reviews the challenging issue of weight loss through lifestyle changes for primary prevention of cardiovascular disease.

Yannakoulia and Panagiotakos7 acknowledge the difficulty in helping patients improve dietary patterns and engage in regular exercise, as well buy kamagra canada as the high prevalence of weight regaining even when initial weight loss efforts are successful. The Mediterranean diet/lifestyle has the most scientific evidence establishing benefits and as summarised in the article (figure 4).Mediterranean lifestyle, weight and energy balance, in relation to cardiovascular disease risk. MUFA,monounsaturated fatty acids buy kamagra canada. PUFA, polyunsaturated fatty acids." data-icon-position buy kamagra canada data-hide-link-title="0">Figure 4 Mediterranean lifestyle, weight and energy balance, in relation to cardiovascular disease risk.

MUFA,monounsaturated fatty acids. PUFA, polyunsaturated fatty acids.The Cardiology in Focus article in this issue of Heart provides useful guidance for medical students, residents or buy kamagra canada cardiology trainees interested in pursing a career in preventative cardiology.8Ethics statementsPatient consent for publicationNot required.Congenital heart diseases (CHD) are a heterogeneous group of conditions that afflict an increasing number of adults. On some occasions, the singularities of the anatomy and physiology are a real challenge for buy kamagra canada the treating cardiologist. Such is the case of patients with congenitally corrected transposition of the great arteries (ccTGA) and those with transposition of the great arteries (TGA) repaired with the atrial switch procedure, in which a morphologically right ventricle (RV) sustains the systemic circulation.

Although there are case reports of asymptomatic elderly patients being diagnosed with previously undetected ccTGA, these are exceptions buy kamagra canada. The systemic right ventricle (SRV) usually experiences a progressive decline in the systolic function ultimately leading to death or heart transplantation in most cases.The Achilles’ heel of the SRV researchAvailable drug strategies for the treatment of the failing left ventricle (LV) in acquired heart disease are commonly used in the SRV dysfunction, but such approach is not buy kamagra canada based on scientific evidence. Several studies have unsuccessfully tried to prove a net benefit from the use of beta blockers or agents targeting the renin-angiotensin-aldosterone system (RAAS) in patients with biventricular circulation and an SRV. Even a few randomised controlled trials (RCT), the top method in the hierarchy of scientific evidence, buy kamagra canada have failed in this purpose.1 There are different reasons that could explain this lack of success, the most important being the small sample size of all the studies.

The largest RCT2 only included 88 patients (44 randomised to valsartan and 44 buy kamagra canada to placebo). Considering that the Survival And Ventricular Enlargement ….

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Autodesk deployed it’s Octo-Copter in Africa for high resolution reality capture.  This was done in support of Louis Leakey in Kenya in search of our ancestral trails


Additonally, they deployed it on their head quarters in San Rafael.

From the Gizmag Website:

The Mikrokopter Octocopter is an 8-rotor flying platform which has a 2 kg (4.4 lbs) capacity to carry cameras. It can be flown using an internal camera to give the operator a copter-based vantage point on video glasses, or can be programmed to follow a GPS-controlled flight path. An Octocopter can fly autonomously at altitudes up to 1000 meters (3280 feet), or can be manually flown as high as 3500 meters (11,480 feet). In the Autodesk tests video was captured using a GOPro Hero 2 camera, and the still pictures from which the 3D model was later built were taken by a remotely triggered Canon SLR camera.

Autodesk 123D is a suite of programs which allow a user to create, manipulate, and construct 3D objects using a 3D printer. Catch is part of the 123D suite, and offers a standalone software package that helps you create 3D models from a series of 2D digital images of an object or a scene. The spatial resolution available using 123D Catch is about 1 part in 600, or 0.167% of the total size of the object pictured, so you would be able to accurately place individual windows on a 3D model of a Boeing 747.

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Get to the Beach and then Treat Yourself

Cranes Beach & Wingaersheek Beech, Head north on 128.  Enjoy the water, and then take the short drive to Essex and go get fried clams and soft serve, call in your fried clam order if you can.  Try Woodman’s, Farnham’s (they got picnic tables over looking the tidal marsh) or try the Village, and Essex Seafood, which has always been a solid go to.

Horseneck Beach, terrific beach going south on 24, Westport, MA almost always less traffic, then go to the Back Eddy for something to cold to drink and a snack.

You’re in and around the city.

Find a Roof Deck and/or Pool, a variety of posts on the subject from Boston.com, but it seems the Colonade for a pool stop is always mentioned. And outside of the city, Indigo in Newton is pretty nice stop.

Walk the Greenway, play in the fountains, get gelatto, try the Gelateria  in the North End.

Have a cold drink in a well air conditioned bar by the Garden, then walk over the river, across the locks into Charlestown and do the same thing there.  Your choice for locations, there are many.  But go ahead and stop at Emack and Bolio’s on the walk back.

Play in the Fountain at the Christian Science Center, walk into the Pru and Copley to soak in the air conditioning, play “how much are these shoes” at Nordstrom.  Have a friend stand back from the shoe tables, have them guess.  Most likely off by a factor of 10, go get a coolata at Dunkin.

If you are feeling particularly flush and it’s after 5, go get a martini at the Oak Room, used to come with side car sitting in ice.  That will frame the rest of your day.  Air Conditioning set on igloo.

Take your dog for a walk at the Middlesex Fells Reservation, or bring him/her to a pond, throw a stick. Jamaica Pond, Spy Pond, Fresh Pond, etc.  You might not get cool, but look at the dog, so happy.  And now I’ve seen Canoe and Kayak Rentals at Spy Pond.

So there’s a start, generally, a cold drink, cone or a slush, water, you get the idea.

 

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With Microsoft’s announcement of Windows 8, and the unveiling of the Surface Tablet, it finally appears there will be a tablet form factor that will run Revit in the field.  According to the press release there will be two versions, one based on the ARM chip and another based on the Intel i5 chip running Windows 8 Pro.  The iPad, as much it is great for so many tasks, simply does not have the horsepower to run Revit in the field, and delivering the type of user experience one would want with heavyweight programs is a real limitation in the ‘cloud.’  I understand Autodesk is now counting solely on Citrix to provide its remote platform but even if you are driving Revit remotely would you want to rely on whatever internet connection you have?  That’s just not a funnel I would want to count on in the field.

At first glance you might say so what, not a big deal.  However, if I can have a device that toggles between my heavyweight AEC programs, and delivers content the way my my iPad does then I might have an iPad to sell you; because frankly I am sick of devices, I live between the Mac and Windows camp, I’m tired of it.  I used to be an Apple fanatic, even being the only kid in business school with a Mac, the disastrous PowerPC model, but what was not to like about Apple.  Now, how did we get to the point where Microsoft is the little guy, relatively speaking.  Now if they could get their content management into a spot that works the way you want.  Imagine the central Revit model up on the sky drive, you check it out in the field, do your work, update it, booyah.

I think single purpose, highly specific apps are great to digest data,  not for the creation of it so I am real interested in the melding of tablet like functionality with horsepower.  I’m rooting for the little guy, I’m rooting for Microsoft.

********************

BTW anyone else bother to notice the blending and vertical integration of software/hardware.  Apple, obviously.  Google buys Motorola. Microsoft with multiple attempts, Zune, XBox, etc.  and now Surface. And more germane to AEC Trimble buys Tekla and SketchUp.  Seems to be the biz strategy du jour, watch for more.

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Tweet about PKNail Pro’s Proven Field to BIM Technology, Get Entered Automatically

PointKnown is giving away a free Apple iPad to one lucky Twitterer…er, tweeter, i.e.  one who uses the service twitter to disseminate clever, witty, informative text burst in 140 characters or less.  PointKnown does not claim to be clever, witty or informative, but will claim producing kick ahh…whup ahh…Excellent productivity software tools for documenting existing buildings.

 

 

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To participate, simply tweet using the hash tags below:

#pknail #revit #bim and mention ‘PKNail Pro’

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PKNail Pro turbo charges Revit and modeling existing buildings #pknail #revit #bim

or “Capture Existing Buildings Directly In Revit with PKNail Pro, 5x-10x faster #pknail #revit #bim

less pertinent but still acceptable “We came, we saw, we conquered with PKNail Pro, #pknail, #bim , #revit

less pertinent verging to the non-sequitur but still acceptable…

beautiful software for happy people PKNail Pro, #pknail, #bim, #revit

or certainly and you are most welcome and encouraged to tweet your own stuff; as we will have a separate drawing of $100 VISA Card for best/most creative tweet as judged by anyone at our next BBQ.

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We are on the road with Microcad and have other excellent resellers including,  Seiler Instrument (ask for Harvey) and CADDFX

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1. This giveaway is offered by PointKnown LLC and is open to anyone with a Twitter account who is at least 16 years of age. Employees of PointKnown, LLC. and/or its affiliated companies and family members of such employees may enter the contest but are not eligible to win.

2. The giveaway will begin at the time of this post and end 62 days after initial post, a winner will be randomly chosen, much like the number 62, and announced via twitter through @pointknown

3. One giveaway will be available: a 16GB Wi-Fi Apple iPad or $499 Apple Store Credit, winner’s choice.

4. You must prove ownership of the winning entry and provide your email address to collect the prize.

5. To enter the giveaway you must send out a tweet from your own Twitter account that includes the #hash tags above in your message.

6. Entries using automated tweets will be disqualified, however there is no limit on the number of tweets you may enter.

7. PointKnown LLC will choose a winner randomly from all the entries within the specified period. The winner will be announced from our twitter account (@pointknown) once the contest ends.

8. Entrants agree to allow @pointknown to use their twitter handles and entry tweets for marketing purposes.

9. Neither PointKnown LLC. nor its affiliated companies shall have any liability for (i) any technical failures of any kind, including but not limited to malfunctions, interruptions or disconnections in phone lines or network hardware or software; (ii) technical or human error which may occur in the administration of the giveaway; (iii) any malfunction of or damage to the prize; (iv) any corruption, typos or hacking of prize winners email accounts; or (v) any restrictions or delays imposed by any customs authorities or any import or other taxes of any kind imposed by any taxation authority in respect of the prizes.

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Announced today, Autodesk Acquires Vela Systems.  If you are developing products within the Building Life Cycle somewhere between and including design to demolition, you are in play.  Trimble has been going on an acquisition rampage with its acquisition of Tekla and Sketch Up and Autodesk never one to be a wallflower has just acquired Vela.  This is almost 2 years to the date that Vela was unveiled publicly.  No idea of their market size but their own press releases state that they are more than ‘twice as big’ as any competitive Field BIM Systems.  Regardless, market penetration means little at this point now that the Autodesk marketing/sales system is behind it.  How big was Revit in 2006 when they were purchased.  A primer of Vela’s Key Features below.  Congrats Vela folks, job well done.

Vela Field Management Suite Key Features
The Vela Field Management Suite of Web, Mobile and Reports enables everyone throughout the enterprise to access documents, field activities and reports in the office and in the field. Since its release a year ago, and to further broaden the usability throughout the enterprise, Vela Systems has expanded upon the following features:

  • Field BIM® for commissioning and handover that ties BIM to the field for data and document exchange
  • Company-level checklist and issue template capabilities to implement and enforce quality and safety programs
  • Increased accessibility via the Internet on multiple devices like iPads and Smart Phones
  • Better web-based reporting that turns field data into powerful information for managing quality, safety and risk at the project and company level
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As reported by Industry Week, ‘The world’s most sophisticated malware had a ‘high interest in AutoCAD drawings,’ Kaspersky Lab said.  The Flame Virus, which mainly affected computers in the Middle East used a loophole in Microsoft software tricking computers into thinking they are downloading a legitimate Windows update.  This fact, being reported by Reuters, The Times, CNET, and others. CNN reported that Flame can turn on your microphone, webcam, log e-mails, etc.  I have not read if it can do anything malicious itself as the Stuxnet Virus did to Iran Uranium enrichment facilities by having centrifuges essentially tear themselves apart.  However, going after CAD, essentially engineering and building documents can let whoever is collecting this information know what you are designing and building, and possibly have the blueprints of the building you are designing and building in.  And you thought google knowing that you smoke cigars and eat ice cream on your back porch at 5:23 PM was intrusive.

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File under cool.   The City of New York has unveiled an initiative for the electronic submission of BIM safety plans; you can learn more here; and a  Turner Press Release yesterday stated they used both 2D and 3D BIM submissions to get approval for their construction project at the Energy Building at NYU Langone Medical Center.

“The digital submission of 3D, BIM-based site safety plans reduced the approval times from weeks to days,” said Di Fillipo, Turner Senior Vice President.

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The more demos I go on, the more I get asked about our field kit, so I wanted to post what’s in my bag and what we use on a day to day basis when surveying/modeling in the field with PKNail Pro.  Those of you not interested in the day-in day-out particulars of surveying buildings may want to hit your back button now… Anyway an individual equally equipped will be ready for knocking out BIM Building Surveys, and this kit, all in, costs a fraction of most other technology solutions, plus the added benefit of surveying/modeling directly in the platform you or your clients are most likely working in.  However, always choose the tool/service that fits your needs.  In fact, we’ll be posting shortly where we combined workflows of PKNail Pro and pointclouds.  But here you go, what’s in my bag or my complete kit.

So it might seem like a lot but all fits in the bag except for the tripods.  The laptop tripod is excellent when mobility/portability with your gear is at a premium but I will use a laptop cart with wheels if the space allows;  it is easier with wheels and has more surface area to put stuff.

The real minimum you need to have with you is a laptop/tablet PC running the appropriate software, a Disto D8 or 330i, a measuring tape, and something to use for a target when needed, like an outside corner.  Stickynotes (larger size) are excellent for shorter distances, a reflective Leica Target attached with Painter’s Tape is better for longer ones.  Rechargeable batteries for both the laptop and Disto.  I prefer an external battery pack for the laptop as it can be used on any laptop and it is self contained unlike an extra battery for a specific laptop.

I  like Eneloop rechargeables for devices, my preference, they come preloaded with a charge, and seem to carry it longer when not being used.  You need a measuring tape on occasion for distances to short or sometimes nice to hook something with a tape when finding a distance manually.  I like thick banded measuring tapes because they will extend longer without ‘breaking’ but find they are just as prone to wear down as any other so sometimes not worth the expense.  LED flashlight because they are bright and do not use as much juice as others, and are always nice to have.  I also have an LED light that you can wear on your head, which is my preferred.  Diameter tape is a luxury but one side is graduated the other will measure the diameter of any round column which is helpful.

The tripod attachment from Leica allows it to pivot properly on the its axis so the measurements stay as accurate as possible.  This is great to have for exterior work  when you might not have access to the interior of the building.  Building chalk or a marking crayon can be helpful but usually would want to mark with painters tape or sticky pad because they are easily removed, however, the former comes in handy sometimes, especially in basements.

And bring food and drink, nothing clouds your mind like being hungry, so eat.

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Interioreview, utilized PKNail Pro, an add in to Revit, combined with Leica Disto D8 laser range finders as the main surveying tool and software for capturing and modeling the 28 Story DuBois Library at UMass Amherst.  The structure designed by Durell Stone in 1966 is tallest library in the United States.  While intially considering combining LIDAR and creating a pointcloud for the exterior and utilizing PKNail Pro for the interior it turned out the exterior was the easiest part of the job and it was interior that was the most difficult.  Every 3rd floor contained  90+ rooms  with study carrels combined with classrooms where very few technologies would work well.  Nico Martinez, a Project Manager with Interioreview, commented,”Without PKNail the survey work could have taken  5 times, 10 times what it was.”

The project was completed to support the design and retrofitting a fire protection system.

Interioreview, an architecural surveying firm founded in 2003 specialzies in documenting the built environment in both 2D CAD and 3D Revit formats.

PointKnown, a software firm, founded in 2008 develops productivity tools for the built environment / AEC (Architectural, Engineering, and Construction) Industry

PKNail Pro, allows a user to measure and model objects in real time directly in Revit.

Autodesk® Revit® software is specifically built for Building Information Modeling (BIM), helping building professionals design, build, and maintain higher-quality, more energy-efficient buildings.

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