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Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19

Jonathan J.Y. Ong FRCP

Corresponding Author

在英国,从2004年到2014年,非本土出生的人口增长了66%。最近的全民公投中,投票选择“离开”的人大都说移民问题是自己最大的顾虑。

Kesha, 'Rainbow'

Address all correspondence to J.J.Y. Ong, Headache Disorders Service, Division of Neurology, Department of Medicine, University Medicine Cluster, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore 119228, Singapore, email: jonathan_ong@nuhs.edu.sg

华大基因陷“圈地门”:曾携万科涉足苏州健康小镇
Chandra Bharatendu MRCP

It's important to remember that even when the overall number of jobs goes down, some companies are still adding workers -- it's just that others are cutting even more.

不会。事情可能会这样发展:在一次试运营(其间出现多次交易停止)后,比特币期货将慢慢开始吸引机构资金。美国商品期货交易委员会(CFTC)的持仓数据将反映出资金管理公司对该产品存在的长期偏见。随着减仓的巨额成本变得不言自明,多头将越来越大声地抱怨围绕结算时间的例行分歧。就在参议院计划举行听证会调查潜在的市场操纵行为时,比特币期货价格将跌破现货价格,引发抛售。

租赁新政密集下发 房地产市场迎租赁时代
Jonathan Z.Y. Tang MRCEM

默里留了满脸胡子,这样汉农就能修剪成附图中这种浓密的胡子。“比尔以前从没留过这种胡子,”汉农说,“加点新东西,挺可爱的。”

4. HHhH

国土部:因城施策持续加强房地产用地市场管控
Kenneth W.X. Sooi MRCP

The Shanghai Stock Exchange saw 26 IPOs, while its Shenzhen counterpart saw 15 IPOs of small-and-medium-sized enterprises and 20 start-up companies.

二季度武汉155个房地产项目入市
Yi Lin Tan MBBS

The Disaster Artist is part buddy movie, part show-business fable, and part behind-the-scenes DVD featurette.

学生公寓供应匮乏 投资者纷纷寻找机遇
Benjamin Y.Q. Tan MRCP

除了印度,其他金砖国家——巴西,俄罗斯,中国和南非——也削减了对美国政府债券的持有。

一些科学家说,2014年成为创下气温纪录的一年,最值得注意的一点是该年度并没有发生强大的厄尔尼诺现象,一种由于太平洋将巨大的热量输送到大气层所造成的大尺度天气模式。

春装大幕开启 惠州家居建材新品陆续登场
Hock‐Luen Teoh MRCP

相比之下,小型货车销量却开始走下坡路,其成交量仅为7.13万台,同比跌幅31%。

vi. 抱怨,悲叹,控诉

多地租房市场降温 这个城市房租跌得最猛
Shi T. Ong BSc

LBS moves back to the top place, thanks in part to the highest salary, at $167,000, and being second best in value-for-money terms. The school is first for international course experience and second for alumni mobility.

三季度机构“看多”楼市 未来成交量或进一步上升
David M. Allen FAMS

The rest of them, he goes over quickly:

8. Smile every time EXCEPT when my team is losing.

涉房资产频遭减持 个中滋味难评说
Vijay K. Sharma MRCP

1.Shailene Woodley

今年夏季,美国ETF管理的资产规模跨过3万亿美元大关,亚太ETF行业管理的资产仅成功爬上3500亿美元关口。

统计局:下半年基础设施有望企稳
First published: 30 March 2020
Citations: 33
Conflict of Interest: VKS is the current recipient of Senior Clinician Scientist Award from National Medical Research Council, Ministry of Health, Singapore. Other authors have no financial disclosures.
Funding: None

Abstract

Background

全食CEO约翰麦基的《自觉资本主义》(Conscious Capitalism)一书让公司高管们不得不思考这样一个观点,那就是处于最佳运转状态的企业能为所有利益相关方创造价值,而不仅仅是投资者。麦基认为,主要利益相关方包括顾客、员工、供应商、社会以及环境。他以好市多、西南航空(Southwest Airlines ,《财富》500强)和谷歌(Google,《财富》500强)为例,说明思维超越利润能够打造更强大而、更高效的公司。
35岁的阿德里亚娜·利马身着一件凸显身材的白色抹胸式礼服。这位巴西模特选择了简单又时髦的装扮,她把头发扎了起来,戴着一条抢眼的项链,项链上缀满了钻石。
China has overtaken the United States to become Germany's top trading market in 2016 for the first time, according to data collected by the Association of German Chambers of Commerce and Industry (DIHK).
The country's improved performance has notched the 17th place in "innovation quality", an indicator that looks at the caliber of universities, number of scientific publications and international patent filings.

Objectives

按照我们过去三年的观察,感恩节旅游季期间的航班晚点率实际上有所下降——据美国交通运输部的数据显示,去年感恩节航班的晚点率仅为12%,低于2010年的19%。
The banking industry has been experiencing a low profit growth period and will be for a long time, the National Business Daily reported, citing an expert. He said the banks' yearly profits growth reached 35 to 40 per cent in the past dozen years, but now the growth had slowed to less than 1 per cent, with some banks even recording a loss.
祝你在新的一年里身体健康,多福多寿。
这表明,一般而言,大学教育从长期看来收益良多。

Methods

Amid rising pollution and a strengthening yuan, the capital city saw its tourist numbers drop to 4.20 million visits from January to November from 5.01 million visits in 2012, according to China Daily, citing a report from China Tourism Academy and Beijing Commission of Tourism Development. An earlier report based on a survey of domestic travel agents showed that visitors to the capital declined by roughly 50% in the first three-quarters of the year compared with a year earlier.
如果你没听过这句话,你去年绝对没上过中文网。这句简单的话是留在魔兽BBS上的,不知道什么原因——有说法是有网络公司是幕后推手——这句话吸引了710万人点击,在发布后24小时内产生了30万条评论。
3、美酒佳人。 邦德走到哪里喝到哪里,美酒的确能帮他俘获佳人。喜欢喝一杯的人最容易在第一次约会时就抱得美人归。

Results

A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21‐35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre‐existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE‐associated headaches. A pre‐existing primary headache diagnosis (OR = 4.20, 95% CI 1.48‐15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35‐11.31; P = .012) were independently associated with de novo PPE‐associated headaches. Since COVID‐19 outbreak, 42/46 (91.3%) of respondents with pre‐existing headache diagnosis either “agreed” or “strongly agreed” that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance.

Conclusion

For: Well-received by both audiences and critics, it tells a crucial slice of history.
As a measure of that fall, 10 works have sold at auction for more than $100 million since 2004, and all of them were made by modern or contemporary artists in the past 120 years. Older paintings have seen their value, in relative terms, level off or decline. The trend was plain to see in recent weeks, as London’s auction houses tried to find buyers for their latest tranche of old masters. As has been the case in recent years, there were few works by major names.

Introduction

In late December 2019, reports emerged from the city of Wuhan, in Hubei Province, China, of a cluster of severe acute respiratory illness.1, 2 By January 2020, the condition now known as coronavirus disease 2019 (COVID‐19), attributed to the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), had rapidly spread from Wuhan to other regions.3 As of March 11, 2020, China has reported a total of 80,955 COVID‐19 confirmed cases.4 Outside of China, more than 37,300 cases have been identified across 113 countries or territories.4 The Ministry of Health (MOH), Singapore, shifted its public health response level to enhanced preparedness on January 23, 2020 when it detected the first imported case of COVID‐19.5 It was subsequently followed by new cases among other visitors and returnees as well as community transmission.5, 6 On January 7, 2020, the level of Disease Outbreak Response System Condition (DORSCON), a color‐coded framework that assesses the severity of a pandemic in Singapore, was changed from yellow to orange, with an escalation of measures instituted to contain the disease.4 As of March 11, 2020, Singapore has reported a total of 178 COVID‐19 cases, with 11 cases seen at our institution thus far.4 During the escalation of the COVID‐19 outbreak in Singapore, frontline healthcare workers in all major hospitals were mandated to wear personal protective equipment (PPE), while caring for suspected or confirmed COVID‐19 patients, which involved the donning of close‐fitting N95 face masks, protective eyewear (mainly goggles), gowns, surgical gloves, and the use of powered air‐purifying respirators (PAPR). In real world practice, donning of the PPE is often felt cumbersome and uncomfortable by the frontline healthcare workers,5 especially if a long period of exposure to such equipment is necessary during the outbreaks of emerging infectious diseases.7

Headaches arising from the sustained compression of pericranial soft tissues by donning of objects with tight bands or straps around the head (eg, hat, helmet, googles worn during swimming or diving, or frontal lux devices) have been previously reported in the literature.8-14 Apart from the mechanical effects, adverse effects such as difficulty breathing has also been reported.15 However, the scientific literature related to the PPE‐associated headaches, specifically the combined usage of the N95 face mask and protective eyewear (specifically googles) is scarce. A previous study among healthcare providers wearing the N95 face mask during the 2003 severe acute respiratory distress syndrome (SARS) epidemic in Singapore reported new onset face mask‐associated headaches with a prevalence rate of 37.3%.16 Another study among nurses working in a medical intensive care unit reported headache as one of the main factors accounting for sub‐optimal N95 face mask compliance.17 Previous reports highlighted that pain or discomfort (headache, facial pain, and/or ear lobe discomfort) arising from tight‐fitting face masks as well as elastic head straps resulted in limited tolerability when the N95 face mask was used for a prolonged period.18-20

6、《招魂2:恩菲德的骚灵》
Total Program Cost: $176,600
Two against-the-clock tours of Los Angeles. Two celebrations of the sometimes prickly solidarity among women. Four tremendous performances, from Kitana Kiki Rodriguez, Mya Taylor, Julia Garner and the great Lily Tomlin. “Grandma” is the work of a studio veteran. “Tangerine” was shot on iPhones. Anyone prone to lamenting the death of movies needs to shut up and watch these.
如果反弹幅度小、时间短,那么显然结构性变化已经开始了。我希望,过多投资于大成本项目的公司以及仍然高度依赖于油气收入的国家对此做好了准备。
当小李子上台领取奖杯时,制片人哈维韦恩斯坦兴奋地拍拍他的背,全场观众起立为他喝彩。
"The Chinese government, universities and investors have provided a friendly environment for young startups. However, the failure rate of fresh graduates founding startups is still too high due to the lack of experience, resources and networking," said Wang Yixin, a senior consultant at Zhaopin.
科学家周日表示,2013年,全球温室气体排放量增加了2.3%,达到历史新高。这个最新迹象表明,在控制全球变暖方面,国际社会的努力仍远远不够。
adj. 可用的,可得到的,有用的,有效的
The untitled movie revolves around two intersecting love triangles, obsession and betrayal, set against the music scene. It stars Christian Bale, Cate Blanchett, Michael Fassbender, Ryan Gosling, Rooney Mara and Natalie Portman.
TextPride changed its name to Swyft Media and launched a platform that pushes emojis and stickers from new brands into messaging apps. Brands pay for the privilege, as they would with a regular ad campaign.
Passion, perseverance and a positive attitude tend to set successful entrepreneurs apart. Cultivating these attributes requires an innate skill set and some tips to get started.
人社部下属的社会保障研究所的所长金维刚称,鉴于居民消费价格指数低于预期、工资和GDP涨幅也有所放缓,所以今年上调5.5%这一数字是合理的。
统筹城市地上地下建设,再开工建设城市地下综合管廊2000公里以上,启动消除城区重点易涝区段三年行动,推进海绵城市建设,使城市既有“面子”、更有“里子”。
在6月30日举办的机器人足球世界杯决赛上,荷兰机器人不敌中国“水之队”。比赛刚开始一分钟,中国队便率先破门得分。中场结束前荷兰队扳平比分,但下半场“水之队”再度攻入一球,领先荷兰队一分。
Will the Federal Reserve's path out of bond buying get bumpy?

Methods

With very best wishes for your happiness in the New Year.
“我认为随着社会变得更多元化,未来这个情况会在一定程度上得到改善。不过这需要一定的时间。”
"史上最短的明星婚姻"大盘点
Tencent said in an email it has no current plans to find a profitable model for WeChat. An Internet conglomerate, Tencent is China's largest listed Internet company with a market capitalization of roughly $65 billion and has strong revenue streams from gaming, virtual products and advertising on other platforms.
"Everywhere I go business owners are seeing an increase in demand," said Gus Faucher, senior economist at PNC Financial Services. "Businesses will have to raise wages to attract or maintain workers."
The Journey of Flower
Besides exploring the overall ranking, prospective international students can narrow their search by browsing regional and country rankings. These rankings were determined solely by how schools performed in the overall list.
沃伦·比蒂和费·唐纳薇在宣布奥斯卡最佳影片奖时,因为错拿了评奖结果卡片,误将得奖影片念成了《爱乐之城》,而不是《月光男孩》。事后,负责处理奥斯卡奖项结果的会计公司发了一份公开道歉声明。
英国《泰晤士高等教育》专刊于上周四公布的一项调查显示,中国内地两所高校入选亚洲大学前三名。
但是,斯蒂文森称“这或许反映出美国在保护本国钢铁制造商方面比欧盟更大胆”。
经过救援人员一夜的船体扶正工作,5日7时30分,在长江倾覆的"东方之星"船体已侧翻过来,露出水面的船体写着"东方之星"四个汉字。
1. Bottoms Up Beer System
1. “Timbuktu”(Abderrahmane Sissako)
时间:2009-10-29 编辑:vicki
The judging committee (of one) has spent weeks deciding which members of the Royal family, politicians and celebrities deserve one of these most galling of gongs to mark a grievous breach of protocol or lapse in mannerly judgement over the past year.
protocol
Russian President Vladimir Putin says he wants to develop better ties with the United States no matter who wins next year's U.S. presidential election.
该地区拥有数百英里的海滩和湖岸、美国的最古老丛林以及瀑布景观。最值得一提的是,该地区游客相对较少,环境清幽,价钱也较为合理。
pro在前面+tect盖上+ion→保护
考虑到波士顿咨询集团(Boston Consulting Group)管理合伙人理查德莱塞(Richard Lesser)的第二任期将于10月结束,该公司可能也将引来变化。然而,由于该公司拒绝就其选举流程及领导人最多可以有几个任期置评,莱塞的未来尚不明确。
Even in jobs where you test applicants and those with the top scores are supposed to get the job, I've seen hiring managers fix scores to get the people they like.
此外,维密的许多其他模特也被禁止入境,包括来自俄罗斯的朱莉亚·贝亚科娃、凯特·格里戈瑞瓦和伊丽娜·莱巴里科娃以及乌克兰的达莎·凯尔斯顿。
星巴克的品牌价值增长49%,排名第21位,该公司已从咖啡馆发展到人们可以逗留一整天的地方,它现在供应早餐、午餐和晚餐,一些地方还供应酒水。
但是通常你可以选择匿名求职,Fos说,或者要么就拒绝那个选项坚持在领英上面发布,她补充道这样至少更易被招聘者和经理发现。
(美联社)波多黎各,圣胡安市 - 波多黎各新总督周一宣誓就职,作为美国领土许多人认为要为新的紧缩措施做准备,并为该岛摆脱严重的经济危机重新推动建州或独立。
AIj|MhT7HH]
Besides Edhec and HEC, Essec Business School, ESCP Europe and Skema Business School are in third, fourth and sixth places respectively.
不要在月薪上撒谎。即使你的上任老板没告诉我们(大多数情况都是这样),我们还是会弄清楚的。我还因此开除掉两名员工。
Last year was especially striking because global heat records were broken or tied in every month except January and April, researchers said.
当发生问题时,库克会迅速而无情地采取行动。2012年底,苹果过早推出了有缺陷的苹果地图(Apple Maps)应用之后,库克解雇了乔布斯的亲密盟友、领导开发iOS的斯科特?福斯托(Scott Forstall),以及前Dixons首席执行官、掌管苹果零售部门不到一年的约翰?布劳伊特(John Browett)。此举传递出一条信息:库克不会容忍业绩不佳或内部政治。

All participants completed a self‐administered questionnaire written in English. The questionnaire comprised of 6 main sections which acquired the following information: (1) demographics (gender, age, ethnicity, occupation, and department), (2) past medical history, (3) PPE usage patterns since the start of COVID‐19 in Singapore (N95 face mask and protective eyewear type, primary location where PPE was worn, average number of hours of each equipment used in isolation and together per day and during previous 30 days period, personal views on the change in usage frequency since COVID‐19 outbreak), (4) phenotype and characteristics of any pre‐existing primary headache disorder (changes in headache frequency, attack duration and frequency of acute medication usage), (5) personal views regarding the changes in characteristics of any pre‐existing primary headache disorder since COVID‐19, and (6) the phenotype, characteristics and personal views on de novo PPE‐associated headaches. In addition, we also assessed the perceived impact of PPE‐associated headaches on overall work performance (Supporting Appendix S1).

At our institution, 2 types of National Institute for Occupational Safety and Health (NIOSH) certified 3M® N95 face masks are widely used, with the specification to filter out 95% of particles with a size greater than 0.3 microns. By definition, the donning of full PPE necessitates the use of a pre‐fitted size‐appropriate N95 face mask rather than a surgical mask.7 All healthcare workers at our institution underwent mandatory annual fit tests to select the right size of the N95 face mask. When properly fitted, the N95 face mask forms a tight seal against the wearer's face to provide respiratory protection. Protective goggles that provide splash protection against biological materials are also widely available and are used by the vast majority of healthcare workers instead of face‐shields/visors, while working in high‐risk areas (Fig. 1).

image
Frontal and side profiles of a healthcare working wearing N95 face mask and protective googles in combination (a‐d). Alternatively, a face‐shield or visor may be worn in combination with a N95 face mask (e,f). Posterior profile (g). Note where the edges of the N95 face mask and googles contact the head (including face). The figure also illustrates the positioning of the various elastic straps from the PPE upon the head (including face) and upper cervical region. [Color figure can be viewed at wileyonlinelibrary.com]

Statistical Analyses

Descriptive analyses were used to study baseline characteristics. Variables that were measured on the ordinal scale were compared using a Mann‐Whitney U test and summarized using median (IQR). Interval level data were compared using a t test and described using mean (SD). Chi‐square analyses were used to compare nominal demographic data and PPE usage patterns across 2 groups (respondents with and without de novo PPE‐associated headaches). To maximize sensitivity, variables with a univariable association of P < .2 were included as candidates into a multivariable logistic regression model. Predictor variables that were significant at P < .05 were retained in the multivariable model. Multivariable logistic regression analyses were performed to identify the independent variables associated with the development of de novo PPE‐associated headaches. A 2‐way ANOVA test was conducted to test for differences in the mean hours per day of PPE exposure at various high‐risk areas (isolation/pandemic wards, ED, and MICU) and further post hoc comparisons were performed using the Tukey test to adjust for multiple comparisons. When parametric tests were employed, assumptions of normality were verified using Q‐Q plots and histograms. Statistical significance was set at P < .05. All analyses were 2‐tailed. All statistical analyses were performed using the SPSS statistical package program version 25.0 for Windows (SPSS Inc, 2003, Chicago, IL, USA).

Results

A total of 160 frontline workers were invited to participate in the study, with 158 agreeing, giving an overall response rate of 98.7%. The majority of study respondents were female [111/158 (70.3%)], aged 21‐35 years [126/158 (77.8%)], and of Chinese ethnicity [92/158 (58.2%)]. Nurses contributed most [102/158 (64.6%)] followed by doctors [51/158 (32.3%)] and paramedical personnel [5/158 (3.2%)]. (Table 1). Out of 158 subjects, a pre‐existing primary headache diagnosis was present in 46 respondents (29.1%). Other non‐headache related concomitant co‐morbidities were present in 27 (17.1%) participants (Table 2). There were no missing data.

Table 1. Baseline Characteristics of Healthcare Workers in High‐Risk Areas Who Donned PPE During COVID‐19 (n = 158)
Characteristics Healthcare Workers N (%)
Female Gender 111 (70.3)
Age (years)  
21‐40 138 (87.3)
>40 20 (12.7)
Ethnicity  
Chinese 92 (58.2)
Indian 18 (11.4)
Filipino 23 (14.6)
Malay 15 (9.5)
Others 10 (6.3)
Occupation  
Doctor 51 (32.3)
Nurse 102 (64.6)
Paramedical personnel 5 (3.2)
Department  
Internal medicine 33 (20.9)
Emergency department 56 (35.4)
Nursing 63 (39.9)
Medical intensive care unit 6 (3.8)
Table 2. Pre‐Existing Primary Headache Diagnosis and Other Co‐Morbidities Among Healthcare Workers (n = 158)
Condition Healthcare Workers N (%)
Pre‐existing primary headache diagnosis 46 (29.1)
Migraine 30 (19.0)
Without aura 26 (16.5)
With aura 4 (2.5)
Tension‐type headache 16 (10.1)
Cluster headache 0 (0.0)
Other background medical conditions 27 (17.1)
Asthma 8 (5.1%)
Ankylosis spondylitis 1 (0.6)
Cigarette smoking 2 (1.3)
Depression 1 (0.6)
Anxiety 1 (0.6)
Diabetes mellitus 1 (0.6)
Eczema 2 (1.3)
Fatty liver 1 (0.6)
Hypertension 2 (1.3)
Hypothyroidism 1 (0.6)
Hyperthyroidism 2 (1.3)
Hyperlipidemia 1 (0.6)
Ischemic heart disease 1 (0.6)
Stroke 1 (0.6)
Ventricular septal defect 2 (1.3)

PPE Usage Patterns

All 158 healthcare workers reported that there was an increased frequency of PPE exposure since the COVID‐19 outbreak in Singapore. On average, respondents donned the N95 face mask for 18.3 days over the 30‐day period, with a mean of 5.9 hours per day. Goggles were used as protective eyewear in the majority [153/158 (96.8%)]. Protective eyewear was worn on an average of 18.2 days over the 30‐day period, with a mean of 5.7 hours per day. The combined use of N95 face mask and protective eyewear was worn for an average of 18.0 days over 30 days, with a mean of 5.7 hours per day (Table 3). Two‐way ANOVA test with post hoc Tukey's test revealed that across departments, healthcare workers based at the ED had higher average daily duration of PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001)] or MICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001)] (Fig. 2). However, there was no statistically significant difference when PPE exposure over a 30 days period was compared between high‐risk areas (Fig. 2).

Table 3. PPE Usage Patterns Among Healthcare Workers During COVID‐19 Outbreak (n = 158)
Characteristics Healthcare Workers N (%)
N95 face mask
Type 1 (3M® NIOSH 1860S) 144 (91.1)
Type 2 (3M® NIOSH 1870 + Aura) 14 (8.9)
Number of days worn over last 30 days (days) (mean ± SD) 18.3 ± 5.1
Number of hours worn per day (hours) (mean ± SD) 5.9 ± 2.4
Protective eyewear
Goggles 154 (97.5)
Face shield/visor 4 (2.5)
Number of days worn over last 30 days (days) (mean ± SD) 18.2 ± 5.3
Number of hours worn per day (hours) (mean ± SD) 5.7 ± 2.5
Combination N95 face mask and eyewear usage
Number of days worn in combination over last 30 days (days) (mean ± SD) 18.0 ± 5.2
Number of hours worn in combination per day (hours) (mean ± SD) 5.7 ± 2.5
Primary location where PPE was used by healthcare workers
Isolation wards (designated “pandemic wards”) 96 (60.8)
Emergency department 56 (35.4)
Medical intensive care unit 6 (3.8)
Change in the frequency of PPE usage since the COVID‐19 outbreak
Significant increase in frequency 137 (86.7)
Slight increase in frequency 21 (13.3)
No change in frequency 0 (0.0)
image
Two‐way ANOVA analysis of PPE exposure per day (mean hours per day) across the various high‐risk areas during COVID‐19. ED: emergency department, MICU: medical intensive care unit.

De Novo PPE‐Associated Headaches

Of the 158 respondents, 128 (81.0%) reported de novo PPE‐associated headaches when they wore either the N95 face mask, with or without the protective eyewear. All respondents described the headaches as bilateral in location. Figure 3 illustrates the summated anatomical localization of headaches (marked by the study participants) and the corresponding frequencies of occurrence according to PPE subtype. Interestingly, the location of the discomfort experienced by the participants corresponded to the areas of contact from the face mask or goggles and their corresponding head straps. The majority [112/128 (87.5%)] reported a sensation of pressure or heaviness at the affected sites, with some [15/128 (11.7%)] characterizing it as a throbbing or pulling pain [1/128 (0.8%)].

image
Anatomical localization and frequency distribution among 128 respondents who reported de novo PPE‐related headaches. All respondents (n = 158) completing the questionnaire were asked to shade the areas where pain, pressure or compression from the respective PPE was experienced if this was present. [Color figure can be viewed at wileyonlinelibrary.com]

The time interval between donning of N95 face mask or protective eyewear to the onset of headache was less than 60 minutes for the majority of respondents [104/128 (81.3%)] and [113/128 (88.3%)], respectively). After removal of PPE, the attributed headache resolved spontaneously within 30 minutes in the majority for both N95 face mask [113/128 (88.3%)] and protective eyewear [114/128 (89.1%)] (Table 4).

Table 4. Time Interval Between Wearing or Removal of PPE and the Onset or Resolution of De Novo PPE‐Associated Headaches (n = 128)
Variable Value
Time interval between wearing N95 face mask to onset of headache (minutes), N (%)
≤10 27 (21.1)
11‐20 28 (21.9)
21‐30 19 (14.8)
31‐40 19 (14.8)
41‐50 11 (8.6)
51‐60 0 (0.0)
61‐120 24 (18.8)
Time interval between wearing protective eyewear to onset of headache (minutes), N (%)
≤10 29 (22.7)
11‐20 30 (23.4)
21‐30 24 (18.8)
31‐40 22 (17.2)
41‐50 8 (6.3)
51‐60 0 (0.0)
61‐120 15 (11.7)
Time interval from removal of N95 face mask to resolution of headache (minutes), N (%)
≤10 77 (60.2)
11‐20 22 (17.2)
21‐30 14 (10.9)
31‐40 4 (3.1)
41‐50 5 (3.9)
51‐60 0 (0.0)
61‐120 6 (4.7)
Time interval from removal of protective eyewear to resolution of headache (minutes), N (%)
≤10 81 (63.3)
11‐20 16 (12.5)
21‐30 17 (13.3)
31‐40 5 (3.9)
41‐50 6 (4.7)
51‐60 0 (0.0
61‐120 3 (2.3)

Meanwhile, there are other factors holding back the Asian ETF market that some sceptics fear will hold back development of the retail side.
“让人们感到不幸福的原因有很多——从贫穷,失业,家庭破碎到身体伤害” 报告声称,“但在一些特定的社会中,慢性的精神性疾病却是幸福的‘头号杀手’。如果我们想要一个更加幸福的世界,我们需要花更多努力来关心人们的心理健康。”
Emma Morano’s singular achievement in life may have been perseverance. She lived for 117 years, crediting her longevity to raw eggs and her lack of a husband. She died on April 15.
China has been making progress in terms of prevention and control of AIDS, said Wang Bin, an NHC official in charge of disease prevention, during the press conference.
The End of the Road
“我首要的使命、首要的责任是忠实于这本书的原始感觉,忠实于伊恩·弗莱明:他的作品、他的世界和他的构想。

adj. 忙碌的,使用中的,订婚了的
Quite a few students were disillusioned by UK visa regulations. “A lot of people saw the programme as a gateway to employment in Europe,” says one. “If this was the objective, then a lot of them would have gone away unfulfilled.”
夏普利对这一主题提出了早期的理论,在20世纪50年代和60年代利用博弈论来分析不同的匹配方式。与美国经济学家大卫?盖尔一起,他开发了一个数学公式10个男人和10个女人如何配对才能保证没有人会受益于配对伙伴。虽然这可能有一点影响到结婚和离婚,他们开发的算法已经被用于更好地理解许多不同的市场。
一定要展现自己过人的智慧,努力地表现出心神不定的样子。把那些社交技巧抛到脑后吧!

However, before starting their EMBAs, there is already a wide gap in salaries, with women earning on average 15 per cent less than men, at $111,000 and $128,000 respectively.
受此影响,对设备等关键领域的商业投资一直处在美国复苏历史中的低点。若就业市场缓慢改善,且家庭财富增长,则可能引发消费支出增加的良性循环,增强商业信心并增加投资。但若情况并非如此,那么今年将再度令人失望。
谷歌研究员发现,用安全性问题作为恢复账号登录的唯一方式,并不是那么有效。
主机运营商HostGator.com公司的布兰迪o班奈特认为,在一家可靠的网站上坚持写博客,或者做一名志愿者,贡献出你的时间和技能。不要去告诉别人你是谁,而应该通过实际行动去展示你自己,这样做可以积累专业知识以及个人信誉。

当啤酒杯抬高,从啤酒机挪开,杯底磁铁会封住杯底,您就可以取走啤酒享用了。
When it’s time to buy a new car, you have 36 brands to choose from. Each automotive brand has something to offer, but not every brand is right for every buyer. Some brands excel at making performance cars, others focus on making family-friendly crossovers or specialize in luxury cars.
But John Davies, head of institutional investment in the Hong Kong team at CBRE, the property services business, says that lower prices should make the market more reliable. “The market is showing characteristics of a mature market, which institutional investors understand better,” he says.
Congress will authorize billions more in stimulus that won't be called 'stimulus' and won't actually create jobs. And Congress will convene a bi-partisan deficit cutting commission that won't do much either. Until investors stop buying US Treasurys, why should Congress change its ways?
Soyabeans which are trading above $10 a bushel are expected to remain strong, while dairy prices are also expected to rise during 2017 as demand steadily increases, said the bank.
谷歌发布了今年用户搜索最多的热门榜单。
Canadians: I'm afraid that while you are here you will be repeatedly mistaken for Americans and blamed for all sorts of stuff you had nothing to do with. Unless you can think of a quick and simple way to distinguish yourselves at a glance – flower in lapel? Saddle shoes? Maple leaf eyepatch? – then you are just going to have to suck it up.

Study participants with a pre‐existing primary headache diagnosis (OR = 3.44, 95%; CI 1.14‐10.32; P = .013) and those working in the emergency department (OR = 2.39, 95% CI 1.05‐5.47; P = .019) were more likely to develop de novo PPE‐associated headaches. None of the pre‐existing headache subtype was found to predispose to de novo PPE‐associated headaches. When PPE usage patterns were evaluated, N95 face mask (OR = 1.59, 95% CI 1.15‐2.18; P < .001), protective eyewear (OR 1.60, CI 1.13‐2.25; P < .001) or using them together (OR = 1.50, 95% CI 1.09‐2.07; P = .002) for >4 hours per day had a higher chance of developing such headaches. Similar patterns were observed with the headache frequency of >15 days per month with the use of N95 face mask (OR = 1.34, 95% CI 0.96‐1.86; P = .043), protective eyewear (OR = 1.50, 95% CI 1.03‐2.18; P = .013), or both together (OR = 1.47, 95% CI 1.01‐2.13; P = .016) (Table 5).

Table 5. Univariate Logistic Regression Analysis of Factors (Demographic Variables, Primary Location of PPE Usage, Pre‐Existing Primary Headache Diagnosis, and PPE Usage) in Respondents With and Without De Novo PPE‐Associated Headaches (n = 158)
Demographic Variables With De Novo PPE‐Related Headaches N = 128 (%) Without De Novo PPE‐Related Headaches N = 30 (%) OR (95% CI) P‐Value Chi‐square analyses (statistically significant if P < .05).
Gender, female 92 (71.9) 19 (63.3) 1.14 (0.85‐1.52) .380
Age (years)        
21‐40 111 (86.7) 27 (90.0) 0.96 (0.84‐1.11) .770
>40 17 (13.3) 3 (10.0)    
Ethnicity        
Chinese 72 (56.3) 20 (66.7) 0.84 (0.63‐1.13) .410
Non‐Chinese 56 (43.8) 10 (33.3)    
Occupation        
Doctors and nurses 125 (97.7) 28 (93.3) 1.05 (0.95‐1.16) .241
Paramedical staff 3 (2.3) 2 (6.7)    
Underlying co‐morbidities 23 (18.0) 3 (10.0) 1.80 (0.57‐5.60) .414
Originating department of healthcare workers        
Emergency department 51 (39.8) 5 (16.7) 2.39 (1.05‐5.47) .019** Statistically significant results.
Others: medicine, nursing, ICU 77 (60.2) 25 (83.3)    
Pre‐existing primary headache diagnosis 43 (33.6) 3 (10.0) 3.44 (1.14‐10.32) .013** Statistically significant results.
Duration of N95 face mask wear per day        
>4 hours 115 (89.8) 17 (56.7) 1.59 (1.15‐2.18) <.001** Statistically significant results.
1‐4 hours 13 (10.2) 13 (43.3)    
Frequency of N95 face mask wear per month        
>15 days 97 (75.8) 17 (56.7) 1.34 (0.96‐1.86) .043** Statistically significant results.
3‐15 days 31 (24.2) 13 (43.3)    
Duration of protective eyewear use per day        
>4 hours 109 (85.2) 16 (53.3) 1.60 (1.13‐2.25) <.001** Statistically significant results.
1‐4 hours 19 (14.8) 14 (46.7)    
Frequency of protective eyewear use per month        
>15 days 96 (75.0) 15 (50.0) 1.50 (1.03‐2.18) .013** Statistically significant results.
3‐15 days 32 (25.0) 15 (50.0)    
Duration of combined N95 face mask and eyewear use per day        
>4 hours 109 (85.2) 17 (56.7) 1.50 (1.09‐2.07) .002** Statistically significant results.
1‐4 hours 19 (14.8) 13 (43.3)    
Frequency of combined N95 face mask and eyewear use per month        
>15 days 94 (73.4) 15 (50.0) 1.47 (1.01‐2.13) .016** Statistically significant results.
3‐15 days 34 (26.6) 15 (50.0)    
  • * Statistically significant results.
  • Chi‐square analyses (statistically significant if P < .05).

Post hoc multivariable logistic regression analysis revealed that a pre‐existing primary headache diagnosis (OR = 4.20, 95% CI 1.48‐15.40; P = .030), as well as the combined use of N95 face mask and eyewear for >4 hours per day (OR 3.91, 95% CI 1.35‐11.31; P = .012) was independently associated with developing de novo PPE‐associated headaches. Due to multi‐collinearity, the effect of only N95 face mask use and its use in combination with protective eyewear was analyzed in2 separate models for evaluating their role in the development of de novo PPE‐related headaches (Table 6 and Supporting Appendix S2).

Table 6. Multivariable Logistic Regression Analysis of Independent Factors and PPE Usage Patterns Associated With the Development of De Novo PPE‐Associated Headaches (N = 158) Due to multi‐collinearity of variables (“duration of combined N95 face‐mask & eyewear use per day” and “duration of N95 face‐mask use per day), they were analyzed in 2 separate models, including only one of these variables in each model.
Demographic Variables Odds Ratio (95% Confidence Interval) P‐Value
Female gender 0.88 (0.33‐2.34) .790
Age (years)    
21‐40 0.49 (0.11‐2.12) .337
>41    
Ethnicity    
Chinese 0.69 (0.27‐1.79) .454
Others: Indian, Malay, Filipino, Caucasian, etc    
Originating department of healthcare workers    
Emergency department 2.60 (0.84‐8.03) .087
Others: medicine, nursing, ICU    
Pre‐existing primary headache diagnosis 4.20 (1.48‐15.40) .030** Statistically significant results.
Duration of combined N95 face mask and eyewear use per day    
>4 hours 3.91 (1.35‐11.31) .012** Statistically significant results.
1‐4 hours    
  • * Statistically significant results.
  • Due to multi‐collinearity of variables (“duration of combined N95 face‐mask & eyewear use per day” and “duration of N95 face‐mask use per day), they were analyzed in 2 separate models, including only one of these variables in each model.

PPE‐Associated Headaches Fulfilling ICHD‐3 (2018) Diagnosis of 4.6.1 External Compression Headache

n. 马厩,
The ability of customers to air their dirty laundry to the world via Twitter and Facebook has already changed the customer service game. A 2012 Nielsen survey shows more than half of all customers now turn to social media for redress; meanwhile, some 81% of Twitter users expect a same-day response to questions and complaints. But this fall, things got even more interesting: On Sept. 2, British Airways passenger Hasan Syed spent an estimated $1,000 to purchase several promoted Tweets blasting the company for losing luggage. With paid social media now in customers' arsenal, 2014 may mark the beginning of the end of abysmal customer service at major airlines, credit card companies, banks, and other repeat offenders, characterized by endless phone wait times and those automated "phone trees" (i.e., "Press 1 for English, 2 for Spanish, 3 to waste your entire afternoon on hold ...").
adj. 有毒的
农村贫困人口减少1240万;
有一颗大小与地球相近的行星围绕着距离太阳最近的恒星——半人马座比邻星运转。这颗行星的“一年”仅有11天。但因为比邻星是一颗红矮星,它比太阳暗100倍左右,因此行星位于宜居区。另一则热门消息称,40光年外的一颗相似恒星的宜居区可能存在三颗行星。
re再次+form形状→再形成→改革,改造
1. "Game of Thrones" (5.9 million)
谷歌发布了今年用户搜索最多的热门榜单。

The ICHD‐3 criteria for ECH were satisfied in majority of respondents who developed de novo PPE‐associated headaches attributed to the N95 face mask [96/128 (75.0%)] and to protective eyewear usage [106/128 (82.8%)] (Table 7).

Table 7. International Classification of Headache Disorders, 3rd Edition (ICHD‐3) (2018) Criteria for External Compression Headache
  1. 明年深圳102个新建住宅入市 总量破千万平方米
  2. 不过,漫长的收缩期也符合正在放缓的中国经济的总体趋势。
  3. 楼市调控走向精准化 限购政策从一刀切变差别化
  4. The THE Asia University Rankings for 2017 rated Peking University and Tsinghua University, both in the Chinese capital of Beijing, as the second and third best universities in the continent. National University of Singapore is ranked the best.
  5. 住建部:前8月全国棚户区改造开工超过465万套

Pre‐Existing Headache Diagnosis and Concomitant De Novo PPE‐Related Headaches

intel在…中间+lig选择,收集+ence→从中选出好的→智力;聪明
The .40-calibre Smith & Wesson that killed her, a semi-automatic handgun, was seized by police to undergo ballistics testing to determine if it had been used in other crimes.
● “特朗普为想要离开美国的公民提供非洲或墨西哥单程机票”
1.手指存储器
许多成功的创业者都是在中年之后才开始创业。《哈利波特》的作者JoKo罗琳、大厨茱莉亚o查尔德和沃尔玛超市创始人山姆o沃尔顿,都是在经过多年的舒适生活之后,才创建了自己的品牌,并大获成功。随着年龄增长,经验更加丰富,你会对自己的事业产生一种独特的看法。生活经验所带来的睿智,是大多数受过教育的年轻人难以预见的。
这是自去年9月以来进口最大单月跌幅,也意味着中国进口已在过去15个月里连续同比收缩。
为了解决上述问题,报告建议应尽快制定电子商务法。同时,该报告还呼吁应建立一个在线信用体系,以此加强对电子商务行业的纪律监督。
Additional reporting from Stefan Wagstyl in Berlin

Course of Pre‐Existing Headaches During COVID‐19

Majority of respondents [42/46 (91.3%)] with an underlying pre‐existing headache diagnosis either “agreed” or “strongly agreed” that the increased PPE usage aggravated their background headaches in terms of frequency and attack duration (Figs. 4 and 5). Other important factors that could have potentially worsened their pre‐existing headaches included sleep deprivation [28/46 (60.9%)], physical stress [13/46 (29.3%)], emotional stress [6/46 (13.0%)], irregular meal times [7/46 (15.2%)] and inadequate hydration [18/46 (39.1%)]. Nearly half of the respondents indicated that there was a “slight” or “significant increase” [25/46 (53.4%)] in acute medication usage and majority of them [41/46 (90.7%)] opined that their work performance was adversely affected “slightly” or “significantly.”

image
Extent of change in the average number of headache days per month in those with a pre‐existing headache diagnosis (a), and the perceived relationship of this change attributable to PPE use (b).
image
Extent of change in average attack duration in those with a pre‐existing headache disorder (a), and the perceived relationship of this change attributable to PPE use (b).

Discussion

新兴市场GDP增速会超过5%吗?
200911/88511.shtml
However, others argued that doctors' hands may be forced by an unfair system. "As a patient, I'm more concerned about whether they can cure my illness rather than how many papers they've published," another netizen said.
失宠行业
2.管理自己,对他人负责
麦肯锡将于3月宣布当选者,预计此人将对麦肯锡的发展方向产生重大影响。一些内部人士倾向于那些在快速增长领域(比如数据分析)具备专长的候选人,而其他人想要一位可以维护公司品牌的传统主义者。

Our findings are in agreement with the report by Lim et al, albeit for N95 face mask exposure only.16 Not surprisingly, doctors and nurses working in high‐risk hospital areas, especially at the emergency department, had a greater risk for the development of such headaches. Nearly 70% of our cohort did not require any acute analgesic treatment for their de novo PPE‐associated headaches, which is contrary to the previously reported use of up to 60%.16 This could have occurred due to the infrequent episodic headaches in our cohort, which were mild in intensity. However, a large proportion of our participants experienced at least a “slight” decreased work performance, underscoring the potential impact on occupational health and productivity. We hypothesize that the headache frequency, severity, use of analgesics, and work performance may worsen if the current COVID‐19 outbreak is sustained for a longer time. Perhaps, shorter duty shifts and the resultant shorter duration of PPE use might be a better strategy to avoid the adverse impacts of PPE usage.

The pathogenesis of de novo PPE‐associated headaches could possibly have several etiological considerations, which include mechanical factors, hypoxemia, hypercarbia, or the associated stress.17-21 The phenotypic findings from our study suggest an anatomic basis for the headache or facial pain from PPE usage (Figs. 1 and 3). Pressure or tractional forces from the mask and/or goggles together with the accompanying straps may lead to local tissue damage and exert an irritative effect on the underlying superficial sensory nerves (in particular trigeminal or occipital nerve branches) innervating the face, head, and cervical region (Fig. 6).9 The cervical neck strain from donning the equipment could have led to the development of cervicogenic headache or tension‐type headache (TTH)22-24 The peripheral sensitisation may activate the trigeminocervical complex through nociceptive information transmitted via different branches of the trigeminal nerve through the trigeminal ganglia and brainstem to the higher cortical areas thereby triggering the headache attacks coronavirus disease 201925, 26 Alternatively, a neuralgia with transient effects on the underlying superficial sensory nerves could have occurred, although other reasons were more likely as most respondents did not report characteristics suggestive of a neuropathic process.27 These etiological reasons could perhaps explain why a large proportion of those with pre‐existing primary headache disorders and concomitant de novo PPE‐associated headaches reported an increase in the average number of headache days over a 30 day period, with the perception that this change was probably attributable to the PPE.

image
Sensory innervation of the head. Auriculotemporal nerve (AT); deep branch of the supraorbital nerve (SON‐D); greater occipital nerve (GON); infratrochlear nerve (ITN); lesser occipital nerve (LON); mandibular branch of the trigeminal nerve (V3); maxillary branch of the trigeminal nerve (V2); nasal nerve (NN); ophthalmic branch of the trigeminal nerve (V1); superficial branch of the supraorbital nerve (SON‐S); supratrochlear nerve (STN); third occipital nerve (TON); zygomaticotemporal nerve (ZTN). [Color figure can be viewed at wileyonlinelibrary.com]

Depending on the subtype of PPE exposure, the majority of respondents with de novo PPE‐associated headaches fulfilled the ICHD‐3 criteria for external compression headache (ECH) (Table 7) coronavirus disease 2019 8 A lower proportion of participants in our study had a pre‐existing primary headache disorder, and thus the fulfillment of the ICHD‐3 criteria for ECH was predictable in those who developed de novo PPE‐associated headaches. We observed that in some participants the “on‐gear‐to‐start‐of‐headache” and “off‐gear‐to‐end‐of‐headache” intervals exceeded the 60‐minutes limit as stipulated in the criteria. Our study found that responders with a combined exposure to N95 face mask and protective eyewear use for >4 hours per day were predisposed to the development of such de novo headaches. The increased duration of PPE exposure among frontline healthcare workers during COVID‐19 is brought about by necessity as mandated by infectious diseases protocols, which is a clear departure from prior usage patterns before the start of the pandemic. Despite any discomfort, our subjects may have had to endure varying degrees of pain during their working hours, without the option of frequent adjustments or removal. In contrast, prior reports of ECH attributed to exposure to swimming googles or head gear were often short‐lived, limited to approximately an hour, with the duration perhaps dictated by when the gear was removed due to any discomfort experienced by the wearer.9, 11, 13 Additionally, up to a quarter of subjects had associated migrainous symptomatology such as nausea/vomiting, photophobia, phonophobia and movement sensitivity. We propose that in predisposed patients, if the stimulus is prolonged, external compression may lead to a more severe migraine headache or even a full‐blown migraine attack.28 From a purely anatomic standpoint, the report locations where pain is experienced may be consistent with migraine or TTH (Figure 3). Perhaps, larger field studies are necessary to clarify the phenotypic variance of ECH.

Since the start of COVID‐19 in Singapore, most respondents with a pre‐existing primary headache disorder experienced an increase in headache frequency, mostly attributed to PPE exposure. Other factors such as sleep deprivation, physical and emotional stress, irregular meal times and inadequate hydration contributed to this phenomenon. Our findings are in keeping with multiple studies demonstrating that the triggers in migraine or TTH were often related to a change in internal and external homeostasis, underscoring the importance of addressing these factors in optimizing headache control.26, 29-31

We recognize that conventional N95 face mask and protective eyewear fit tests consider only the overall fit factor and do not take into account the level of comfort or tolerability especially when used for prolonged periods of time.32, 33 Pain or discomfort is often experienced from tight‐fitting PPE, especially after prolonged use. The current mask and protective eyewear designs rely on elastic head straps to ensure a tight‐fit, often causing headache, facial pain, and/or ear lobe discomfort due to tractional and tensional forces to the head. In addition, the PPE leads to thermal discomfort, causing a build‐up of moist warm air inside the mask and googles.34 These factors may cause de novo PPE‐associated headache as well as affect compliance, with important ramifications for occupation health, workplace safety and productivity, and ultimately job satisfaction among healthcare workers. Through novel engineering solutions, we envisage that the next generation protective face mask and eyewear will have an improved design with an emphasis on tolerability, and consequently less propensity for headaches.35

Programming these same signals into artificial human limbs would give amputees replacement hands unlike anything we've developed before.
怎样拥有平坦小腹
创业会对创业者的个人生活造成严重影响。虽然上面的建议对创业成功至关重要,但从精神和身体上照顾好自己同样是必要的。锻炼、睡眠和饮食是确保你成功执行这些策略的关键要素。这些要素能够帮助你调整心态,获得动力,拓展人际关系。
Christine "Lady Bird" MacPherson is a high school senior from the "wrong side of the tracks." She longs for adventure, sophistication, and opportunity, but finds none of that in her Sacramento Catholic high school. Lady Bird follows the title character's senior year in high school, including her first romance, her participation in the school play, and most importantly, her applying for college.
figure
The quality of its students makes LBS particularly valued. “Studying among so many talented people has instilled in me the belief that I can actually achieve something on my own,” comments one MBA graduate from the class of 2011.
Sweden’s foreign minister, Margot Wallstrom, a proponent of a “feminist foreign policy,” opened up to Ellen Barry about her abuse at the hands of an old boyfriend when she was a young woman, something she had never said publicly before.
宾夕法尼亚州立大学的气候科学家迈克尔·E·曼恩(Michael E. Mann)在电子邮件中说,“如果不是由于燃烧化石燃料所产生的、导致地球变暖的气体排放越来越多的原因,在上千年史无前例的几十年较暖期间、创纪录地变暖的十年中,看到变暖的又一个记录年度,是非常不可能的。”
Tom Hanks has got a slightly more level head around his. He apparently keeps his best actor awards, one each for Philadelphia and Forrest Gump, on the family trophy shelf alongside football (the English kind) trophies and a World’s Greatest Mom trophy left from a mother’s day past.
['tmpj?n]
The result has been increased ratings this regular season. Everything has been flipped. The offseason is thrilling, "stay on your phone every second checking what's happening" drama. The regular season is fascinating and competitive, with superstar matchups and explosive performances every night. The playoffs? Ho-hum, the Warriors win again. What's interesting is that this might be an actually better growth strategy for the league. A dynamite dynasty to attract the casual viewers who only want to see greatness, a super-compelling offseason and intriguing regular season to keep the die-hards engaged. It flips the standard models on their heads, but it also makes the best use of the NBA's ever-expanding digital presence.
麻省理工学院斯隆管理学院(MIT Sloan School of Management)教授迈克尔?库苏马诺(Michael Cusumano)表示:“我曾经认为乔布斯是不可取代的,而且这在一定程度上是个事实。但乔布斯的精神依然留存在苹果内部,而且公司正围绕着一种不那么对抗性的文化组织在一起。我们应为此给予蒂姆赞扬。”
有些人仍坚持一种可称为“资源稀缺”的理论。该理论的核心是,资源开发遵循线性模式,低成本的资源最先被开发,也就是说,未来大部分乃至全部开发活动的成本一定会更高。遗憾的是,行业发展历史并不支持这一观点。过去几十年的经验表明,情况正相反。
怎样拥有平坦小腹
穆迪分析(Moody's Analytics)在报告发布之前表示:“由于大宗商品价格不断下跌,生产者价格仍将处于下行趋势。”
历史会这样回首2012年:这一年,中国“第五代”领导层亮相,同时中国经济转向较低速增长的轨道。这种转变发生的背景,将是一系列令人畏惧的国内挑战——不断增加的社会不安定,不断扩大的收入差距,以及生态和人为的灾难——加上不断升级的外部紧张,这源于美国重新转向亚洲,同时亚太邻国对中国的经济崛起越来越感到忧虑。
伯利兹城最富盛名的旅游胜地莫过于巨大的水下天坑--蓝色巨洞以及玛雅遗址。
"My hair has turned white, half because of housing prices and half because of you reporters." JIANG WEIXIN, member of the CPPCC National Committee and minister of housing and urban-rural development, responding to media questions about government measures to curb housing prices
Wishing you a sparkling New Year and bright happy New Year! May the season bring much pleasure to you.
[in'tennli]
Actively expanding China's opening up to the world
['k?:p?rit]
“…brought his dog.”
The more powerful the passions and the more uncontained the ambitions, the more likely the democratic system will collapse into despotism.
John Hummel, chief investment officer for AIS Group, a fund manager with $400 million under management, said all the new sources of global oil are expensive to extract, and he sees U.S. shale output falling by 2015.
In 2016, 1,576 foreigners became permanent Chinese residents, an increase of 163% on the previous year, according the Ministry of Public Security.
2. Livers grow by almost half during waking hours. New research suggests that livers have the capacity to grow by almost 50 percent during the day, before shrinking back to their original size at night. They are the only organ we know of that oscillate this way.
You are so engaged in thinking of him that you don't notice that there is no No.12.
The number of people living in poverty in rural areas was reduced by 12.4 million.

Conclusions

Despots use the former as an excuse for repression and the latter to demand absolute obedience.
vt. 抵押
此外,菲亚特一款引擎不仅首次进入《沃兹汽车》十大引擎榜单,而且还是一款电动发动机,这就是起亚500E所使用的83千瓦发动机。遗憾的是,该车只在加利福尼亚州发售,但是如果汽油价格上涨至每加仑4.00美元大关或以上,市场力量可能说服这家汽车生产商进行更大范围的分销。
Falke’s fall from grace is sad, but nothing compared with eBay. The company I thought I would love forever for supplying my entire wardrobe and the contents of my house told the New York Times: “We are passionate about harnessing our platform to empower millions of people by levelling the playing field for them.”
Turkey dance “Fire” (Fire of Anatolia)
“BlackBerry has not engaged in discussions with Samsung with respect to any possible offer to purchase BlackBerry,” the company said in a statement issued Wednesday afternoon. “BlackBerry’s policy is not to comment on rumors or speculation, and accordingly it does not intend to comment further.”
昔日影坛风光无限米高梅公司重组计划已获得批准,电影公司将由望远镜娱乐公司( Spyglass Entertainment )掌舵再次出发。而MGM也将不会在作为电影电影发行公司,而仅仅是一个制作公司。这使得第二十三部《007詹姆斯-邦德》电影问世日期更加具体化。
In terms of salary three years after graduation, Germany leads the way for masters in management programmes, with three schools in the top four. Graduates of WHU Beisheim have the distinction of earning the highest salary, at $98,123 on average.
According to the list, ge (哥, older brother, big brother) is without doubt the hottest net word of the year. Both of the top two cited lines use the word. In Chinese, ge here is used more like the first person pronoun (like the English, “Can a brother get a break?”)

Statement of Authorship

Category 1

(a) Conception and Design

清华博士:如没家庭支持 我可能一辈子买不起房

(b) Acquisition of Data

In an effort to protect China's role in the global economy as a manufacturing hub, the central bank devalued the currency in August, in the biggest drop in decades. Later in the year, after the International Monetary Fund added the renminbi to its group of global reserve currencies, the value of the currency fell further, possibly reflecting capital outflows.
王斌表示,去年母婴传播率也达到了历史最低点,从2012年的7.1%下降到2017年的4.9%。

(c) Analysis and Interpretation of Data

In the first 10 months of the year, Chinese exports to the US were up 5.2 per cent from the same period in 2014, while exports to countries in Asean were up 3.7 per cent, according to Chinese customs figures.

Category 2

(a) Drafting the Manuscript

10. Computer systems analyst

(b) Revising It for Intellectual Content

由于州政府和市政府试图打击不法的旅馆经营者,明年可能会出台一项规定。而与此同时,房产租赁网站Airbnb将游说政府改变法规。“你会看到,规范这一市场的要求会变得更加迫切。”代表租户的律师塞缪尔·J·希莫尔斯泰因(Samuel J. Himmelstein)说。
['steitm?nt]

Category 3

(a) Final Approval of the Completed Manuscript

如果你有什么问题,就到我的办公室里来讨论,别把我堵在厕所里。
12. Zoho CRM

    Number of times cited according to CrossRef: 33

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