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summarizes the echocardiographic characteristics of the study cohort, in aggregate and stratified by UACR quartile. Higher UACR was associated with indicators of LV hypertrophy such as higher LVmass, increased relative wall thickness, and higher LV mass-to-volume ratio. However, UACR was not associated with LV chamber size. Despite the presence of a preserved EF in all study participants, LV systolic function was lower in the subjects withhigher UACR levels: both PRSW (reflective of theability of the LV to increase stroke work with increasing preload, a load-independent marker of contractility), and longitudinal LV systolic function (i.e., tissue Doppler s′ velocity) were inversely correlated with UACR. In multivariable-adjusted analyses, higher UACR remained associated with lower PRSW, even when subjects with macroalbuminuria were excluded ( Superga Womens 2750 Punsnakew Trainers Light UK 6 JuUuY40F
). Higher UACR was associated withreduced tissue Doppler s′ velocity after adjustment for age and sex but not after adjustment for comorbidities.

In a subset of the HFpEF study participants onwhom we performed speckle-tracking analysis (n= 29), log-transformed UACR was significantly correlated with global longitudinal strain ( Figure1 ) (r=−0.48, p= 0.009). The inverse association between UACR and absolute values of global longitudinal strain persisted after adjustment for DM, eGFR, and CAD (p= 0.004). UACR was not associated with global circumferential strain (r= 0.01; p= 0.94) or global radial strain (r=−0.04; p= 0.84).


Scatterplot of UACR vs. Global Longitudinal Strain

Yellow = no albuminuria (UACR <30 mg/g); orange = microalbuminuria (UACR 30 to 300 mg/g); red = macroalbuminuria (UACR >300 mg/g). UACR= urinary albumin-to-creatinine ratio.

In terms of LV diastolic function, higher UACR was associated with worse diastolic dysfunction grade and elevated E/e′ ratio, but these associations were no longer present after adjustment for multiple comparisons ( Salvatore Ferragamo GripTape Leather Sneakers i5LKl0
). UACR was not significantly associated with e′ tissue velocity, a marker of LV diastolic relaxation.

Association of UACR With Right Heart Parameters

UACR was associated with several right heart parameters, including RV wall thickness, RV end-systolic area index, RV basal diameter, and RVFAC ( Table2 ); however, only RV wall thickness and RVFAC were significant after adjustment for multiple comparisons. UACR was significantly elevated in those with RV hypertrophy: median UACR was 41.5 mg/g (interquartile range [IQR]: 12 to 229 mg/g) versus 12 mg/g (IQR: 6 to 46mg/g) for those without RV hypertrophy; p= 0.002. Those with abnormal RV systolic function, defined as RVFAC<35%, had higher median UACR values as well: 67 mg/g (IQR: 16 to 213 mg/g) versus 13mg/g (IQR: 6 to 48 mg/g); p= 0.02. Those with and without abnormal TAPSE did not have significantly different levels of UACR (p= 0.70).

The association between RV size, hypertrophy, and systolic function (RVFAC) persisted after adjustment for multiple possible confounders ( Table3 ). To evaluate the effect of right heart pressures on the association between UACR and these RV parameters, we ran additional models that adjusted for estimated PASP and estimated RAP. Higher UACR was still associated with increased RV wall thickness after adjustment for PASP and RAP (0.12 mm [95% CI: 0.05 to 0.20 mm] increase in RV wall thickness per doubling of UACR, p= 0.002). The association of increased UACR with decreased RVFAC was of borderline statistical significance after multivariable adjustment (−0.78% [95% CI:−1.12% to 0.28%] change in RVFAC per doubling of UACR, p= 0.050). The increase in regression R for each model after theaddition of log UACR is displayed in Online Table1 . As shown in Table3 , the associations between UACR and RV parameters also persisted after the exclusion ofstudy participants with macroalbuminuria (UACR >300 mg/g). Finally, of the 144 patients included inourstudy, 97 (67%) underwent right heart catheterization. In these 97 patients, the mean pulmonary capillary wedge pressure was 23.1 ± 9.6mmHg. Adjustment for LV diastolic pressure (i.e., pulmonary capillary wedge pressure) did not eliminate the association between UACR and RV wall thickness (0.15 mm increase per doubling of UACR; 95% CI: 0.06 to 0.24 mm; p= 0.001).

The median follow-up time was 12.1 months (25th to 75th percentile: 4.1 to 21.6 months), during which time 58(40%) of the study participants experienced the composite outcome of cardiovascular hospitalization (including HF hospitalization) or death. Adverse outcomes were increased in a stepwise fashion with each higher UACR quartile, as shown in Jimmy choo Pumps ELLIS 120 Plateau fabric glitter rosè 8wHhsUOF
. Figure3 shows the Kaplan-Meier curves for the combined endpoint of cardiovascular hospitalization or death, stratified by median UACR, demonstrating that higher UACR levels predicted worse outcomes. SENSO Womens Bailey VII Leather Ankle Boots Ebony/Silver Zip UK 5 FUpFl0
displays Cox proportional hazard ratios per doubling of UACR for the combined outcome of cardiovascular hospitalization or death. Higher UACR was significantly associated with worse outcomes after adjustment for age, sex, African-American race, DM, CKD, CAD, anemia, and several markers of HF severity, including E/e′ ratio, LV mass index, and NYHA functional class. However, adjustment for BNP attenuated the relationship between UACR and outcomes. Gianvito Rossi Velvet Flats JDxE73E
displays the AUC before and after the inclusion of log UACR, IDI, and relative IDI for each outcomes model.

Instagram Stories has Reef CUSHION BOUNCE COURT Tbar sandals rose gold nmCXx
, which is almost double that of Snapchat!

As the Instagram algorithm continues to change and impact users’ engagement, it’s no surprise more and more users are spending time on Instagram Stories, rather than their feeds.

The algorithm takes into account all the interactions you receive on your Instagram Stories as well, such as replies or when your stories are sent to someone.

The more that a user interacts with your Instagram Stories, the more likely your posts will show up in their feed.

A great “hack” to get around the algorithm is to take advantage of Instagram Stories engagement opportunities, including New Balance 824 Trainer Mens Everyday Trainers Shoes MX824LM ANrw1ILKI
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(if you have over 10k followers).

We’ve also been seeing a lot of micro-influencers telling their followers to “DM me for a direct link to this product!” which is a great way to drive people to your inbox, build relationships with your followers, and ultimately increase the chance of your posts showing up on their feed.

It’s now believed that Instagram not only prioritizes posts with high engagement but may also restrict exposure based on your engagement with your followers.

This year it will be more important than ever to stay on top of your incoming comments, especially within the first hour of posting, otherwise your posts visibility may drastically decrease

Treat Instagram comments like a conversation. If you the comment doesn’t require a response, show them some love with a heart!

We know, keeping track of all your Instagram comments is hard. It’s easy to miss comments in the Instagram app, especially if someone is commenting on an older post.

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saves you time and can help you keep track of all your Instagram comments. You can reply from your computer instead of your phone, and even view your conversation history with a user.

To reply to an Instagram comment in Later, just select the comment, post, or Instagram user you’d like to respond to. Then enter your response, click the Reply button, and you’re done!

To get engagement, you have to give it. By replying to your comments, you’re not only not only showing your readers love, but you’re also increasing your chances of increasing your posts visibility.

Not only does the algorithm care about how much engagement your Instagram post gets, it also cares about how quickly you get that engagement.

If your post gets a lot of likes and comments shortly after it’s posted, this signals to the Instagram algorithm that your post is quality content, so the post will get shown to even more of your followers.

Over the past century, scholars have learned a great deal about how core management processes affect a company’s performance. For example, researchers such as Kim Clark, Bob Hayes, and David Garvin documented differences within factories, industries, and companies. But a lack of big data encompassing many firms, industries, and countries inhibited the statistical study of management practices. In the past decade, however, we have developed ways to robustly measure core management practices, and we can now show that their adoption accounts for a large fraction of performance differences across firms and countries.

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in earlier articles in HBR, in 2002 we began an in-depth study of how organizations in 34 countries use (or don’t use) core management practices. Building on a survey instrument that was initially developed by John Dowdy and Stephen Dorgan at McKinsey, we set out to rate companies on their use of 18 practices in four areas: operations management, performance monitoring, target setting, and talent management. (See the sidebar “Core Managerial Practices” for a detailed list. Though these don’t represent the full set of important managerial practices, we have found that they’re good proxies for general operational excellence.) The ratings ranged from poor to nonexistent at the low end (say, for performance monitoring using metrics that did not indicate directly whether overall business objectives were being met) to very sophisticated at the high end (for performance monitoring that continuously tracked and communicated metrics, both formally and informally, to all staff with an array of visual tools).

In our research, we assess the sophistication with which organizations manage the four broad dimensions—and the 18 specific aspects—of management shown below. The list varies slightly depending on sector (this one is for manufacturers). It’s not exhaustive, but companies that manage these fundamentals well tend to have high levels of overall operational excellence.

Operations Management

Use of lean techniques Reasons for adopting lean processes

Performance Monitoring

Process documentation Use of key performance indicators KPI reviews Discussion of results Consequences for missing targets

Target Setting

Choice of targets

Connection to strategy, extent to which targets cascade down to individual workers

Time horizon Level of challenge Clarity of goals and measurement

Talent Management

Talent mindset at the highest levels Stretch goals Management of low performance Talent development Employee value proposition Talent retention

Read more

Our aim was to gather reliable data that was fully comparable across firms and covered a large, representative sample of enterprises around the world. We realized that to do that, we needed to manage the data collection ourselves, which we did with the help of a large team of people from the Centre for Economic Performance at the London School of Economics. To date the team has interviewed managers from more than 12,000 companies about their practices. On the basis of the information gathered, we rate every organization on each management practice, using a 1 to 5 scale in which higher scores indicate greater adoption. Those ratings are then averaged to produce an overall management score for each company.

His comparison between different types of data encryption is also useful to explain the difference between the widely used encryption in transit and the more secure end-to-end encryption process:

encryption in transit end-to-end encryption

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Since 2016, WhatsApp has enabled and implemented end-to-end encryption , so users can enjoy a more secure communication. With more than 1.5 billion users, the platform has been acquired by Facebook and offers a free app to small-to-medium sized and enterprise businesses alike.

Security-wise, encryption enhances communication privacy and protects users’ messages from impostors or malicious actors. While Golden GooseFrancy Rose Edition sneakers vlGUbQGM
may appear, if cyber criminals were to breach WhatsApp today, they couldn’t decrypt your conversations. That’s due to the encryption and to the fact that WhatsApp doesn’t store your messages on its servers.

App cost : FREE

App cost

Since 2017 its corporate name has been Rakuten Viber and is currently based in Luxembourg.

This private chat app has plenty of useful features in order to offer users high-quality calling experience and all of them are secured, so the information shared is protected along the way with the end-to-end encryption system.

As long as you make sure to use the sharing method pointed out by Viber, your data will remain encrypted from your end all the way up the recipient.

Users : More than 900 million registered users

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to its platform. This featured is called “Letter Sealing” and it’s available to all its users. They just have to turn it on to benefit from it.

LINE added end-to-end encryption

Users : over 700 million

Similar to other messaging apps, Telegram offers end-to-end encryption as well, being considered one of the most secure messaging platforms. For users who want more privacy, they can turn on “Secret Chats” from the app’s advanced settings. Read more details about FitFlop LULU TOETHONG SHIMMER Tbar sandals silver shimmer BHrcUS7q

“And when you delete messages on your side of the conversation, the app on the other side of the secret chat will be ordered to delete them as well.

You can order your messages, photos, videos and files to self-destruct in a set amount of time after they have been read or opened by the recipient. The message will then disappear from both your and your friend’s devices.”


All secret chats in Telegram are device-specific and are not part of the Telegram cloud, meaning that you can only access messages in a secret chat from their device of origin. If your device is safe, your secret chats are safe as well.

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