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#not usually 8–12.5 hours a week 2-5 days
mwydyn · 2 months
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Every thing I think about as a better job is
Normally full time
You have to think about
Exactly what I don't want! And yet!
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luxurybrownbarbie · 3 years
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I’ve been meaning to ask this, but how did you become a investment banker* and what is your day to day life like? Did it change much because of covid or is it the same?
*I’m asking because all the online “guides” can be quite surface level and never really explain what it’s like to actually become an IBanker. They mention studying finance/Econ and internships, but how does one find those opportunities? I’m interested in this career path but it’s hard to find solid info on it. Sorry, this is such a long ask. Thanks in advance!
Hi there!
I think the online guides are so surface level because it isn’t a career that you need to have anything specific to enter into early on, you know?
I had a bit of a finance background, but my undergrad was more focused on business and languages rather than economics. During my undergrad internship, that wasn’t an issue at all, there were people from all over the map in terms of majors. But I did have extracurriculars which were focused on banking and finance, which might have made a slight difference in my application.
I really sort of randomly went in to banking, I had warred between being a consultant, being a PR manager, or being a news anchor. I applied to a few banks and firms really on a whim, because one of my roommates had scared me and my friends half to death about the job market and how we weren’t expanding ourselves enough and were going to be complete failures basically. (She was super fun to be around.)
I ended up getting interviews from a few of the banks and firms I applied to, and after researching it a bit more, I figured going for them wouldn’t hurt. I really enjoyed the work and the pay; and the hours didn’t bother me, so I found it was a really good fit. I received a full time offer after my undergrad internship, but I declined to go and get a bit more finance knowledge before starting.
The big banks will be scouting at universities, so you’ll always have a chance to meet the recruiters there, and if not, a Google rabbit hole search works just as well. If you keep clicking through, you’ll find more and more companies and opportunities show up.
In terms of my day to day, I usually start at around 7:30/8:00, make myself some breakfast around 9:30/10:00, then get lunch around 1:30/2:00. During that morning time, I’m usually responding to emails, catching up on the news cycle, and in meetings. After lunch I’ll work from 2:45/3:15ish to about 5, go do my workout, quick dinner, and log back on around 6:45/7:15, and will log off fully between 8:30 and 9:00. But right now it’s really malleable, but overall, it’s usually between 9.5-12.5 hours a day, sometimes more if it’s a busy week.
Covid has only made the morning routines less hectic, since technically, I’m always at the office, so the days are a bit more lax, but back when people were in the office, it was crazy.
I hope this helped! 💛
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junker-town · 4 years
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T.J. Watt is showing he’s more than just J.J.’s little brother 
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T.J. Watt has been a star for the Steelers and could vault himself into the Defensive Player of the Year race.
It’s too bad that it might have taken another injury to his brother for T.J. to get noticed. Retired defensive end Stephen White explains why the Steelers’ young pass rusher is the real deal.
Earlier this season while I was working on Nick Bosa’s ”post-draft breakdown,” I noticed that both he and his brother, Joey, had at least three sacks at that point in the season. That got me a little curious, so I decided to check in on the other dynamic duo of edge rushing brothers, J.J. and his “little” brother T.J. Watt, to see what kind of seasons they were having statistically. That’s when I noticed that both of them also had at least three sacks after the fifth week of the season.
I watch all of the games every week, and it was apparent that all four guys were playing well, beyond just their sack totals. I started to muse that there was a good chance all four of them would make Pro Bowl at the end of this year.
If it were to happen and two sets of brothers were named to the Pro Bowl all at practically the same position, that would be unprecedented. Both J.J. and T.J. Watt made it last year, and Joey Bosa was selected in 2017. Back when I was writing Nick’s breakdown, I thought he might end up having a hard time breaking through just because he is a rookie. Since then, however, he has turned it on.
Of that foursome, T.J. Watt is the least heralded
While his big brother was drafted 11th overall, and both Bosas went in the top three, T.J. hung around until the 30th pick. It is worth noting that T.J., who is in his third year in the NFL, has a career high of 13 sacks, which is a half a sack more than Joey’s career high of 12.5.
Sacks are not the only measurement of an edge rusher’s impact. But what I’m saying here is while you may hear a little more about the other guys, T.J. definitely belongs in the conversation with them, too.
Fast forward to this past Sunday and the Bosas certainly did their part to keep pushing closer to a Pro Bowl berth. Nick was absolutely dominant in the 49ers’ rout of the Panthers, with three sacks and an interception, while Joey showed out in the Chargers’ comeback win over the Chicago Bears in which he posted two sacks of his own. Their combined five sacks broke the NFL record for sacks credited to brothers on the same day of the season.
Care to hazard a guess at who previously owned that record?
Yep, that’s right. The Watts had four sacks combined in Week 5 of last season to tie the record with Jimmy and Toby Williams, who also accomplished the feat back in 1985.
Unfortunately, Sunday wouldn’t go nearly as well for the Watt family.
J.J. left the Texans’ game in the middle of the second quarter after suffering an injury. A few hours after the game, he took to social media to announce that the injury would knock him out for the rest of the season. I can’t imagine how disappointing that news must have been for him after he bounced back from multiple injuries in the prime of his career. Selfishly, I was also a little upset because I just love watching the guy play football.
However, injuries are a part of the game, as anyone who has played will tell you, and the show must always go on. While I am sure T.J. was pretty bummed about his brother’s injury as well, he still had a game of his own to play on Monday night.
T.J. Watt biggest play against the Dolphins was a three-step masterpiece
As it turns out, the winless Dolphins still have some fight in them even with such a terrible start to their season. After an interception and a turnover on downs on the Steelers’ first two series, T.J. and his team found themselves down 14-0 right out of the gate on Monday night. The Steelers eventually got the lead in the third quarter, but it was a tight game throughout. Not only could T.J. not afford to be distracted by his brother’s situation, he would need to turn in one of his best performances of the year to help close out the game.
I want to point out probably the most impactful play he made in the second half on Monday night.
By the middle of the fourth quarter, the Steelers had pulled ahead 24-14 and were looking to close the door. The Dolphins had the ball at their own 28-yard line after their defense forced a punt.
The Dolphins came out with their quarterback, Ryan Fitzpatrick, in shotgun with two receivers and a tight end to his right, one wide receiver to his left, and the running back offset to his left beside him.
T.J. Watt was lined up at his usual spot on the left defensive edge in a nine-technique outside of the tight end. On the snap, tight end Mike Gesicki went right into his route straight up the field, leaving Dolphins right tackle Jesse Davis all by his lonesome to block Watt in space.
In about three seconds, here’s everything Watt did to help the Steelers secure the victory.
Step 1: Used a quick move to get by the OL
Watt got off the ball and took five hard steps in a flash to sell a speed rush and get Davis to bail out of his pass set.
On that fifth step, Watt planted his foot in the ground hard while simultaneously clubbing Davis’ inside (left) shoulder with Watt’s inside (right) hand. In one fluid motion, Watt executed what was essentially a jump cut inside of Davis while doing a quick arm-over with his outside (left) arm literally right over Davis’ head.
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Step 2: Got to the quarterback
Watt was so quick with it that Davis couldn’t stop his feet to try to recover and step back. Instead, Davis could only manage to try lunge as Watt slipped by him inside, barely making contact with Watt at all. At the very last minute, Dolphins right guard Chris Reed noticed Watt had beaten Davis inside, but with Watt turning on the jets, Reed just couldn’t get over quick enough to help.
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Step 3: Forced and recovered a fumble
Unsatisfied with just getting a sack, Watt made the most of his opportunity and reached with his inside (right) hand first for Fitzpatrick’s jersey, then for the ball. Watt snatched the football right out of Fitzpatrick’s hands and took him to the ground. Watt ended up flipping over with the ball securely in his hands, and it all happened so quickly that it took a second for it to register with the refs what had just happened.
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In the blink of an eye, Watt had forced a turnover and nipped that Fitzmagic in the bud.
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The Steelers’ offense took over from the Dolphins’ 22-yard line and went on to extend their lead to 17 points by making field goal. That was definitely the kind of play, both in terms of skill needed to make it and impact, that you would expect a Pro Bowl-type player to make.
T.J. Watt could find himself in the Defensive Player of the Year race
Well, my daydream of two sets of brothers making the Pro Bowl may be over after J.J.’s injury, but don’t be surprised if T.J. Watt not only still makes it, but also jumps into the Defensive Player of the Year discussion by the end of the season, too. His two sacks in Week 8 gave him six for the season, which is just off the seven that both of the Bosa brothers have now.
With Ben Roethlisberger out for the year, if the 3-4 Steelers some how manage to claw their way back into the playoff hunt, you can bet that T.J. will have been a big part of that effort. Even if they don’t make the playoffs, there is a very good chance that T.J. will still go on to have the kind of monster year that would make him hard to ignore in any DPOY conversation.
It is a shame that it might have taken another injury to his brother for T.J. to escape from his shadow, considering how well T.J. has played in his own right since being drafted in 2017. But if it is the case that you hadn’t been paying much attention to T.J. until now, this is the perfect time to get familiar because that guy is a friggin’ beast on the field.
Yes, T.J. isn’t quite on J.J.’s level, but he is a damn good player, nonetheless. He’s the real deal, not just a dude riding his big brother’s coattails. Everyone would be wise to recognize that, because it is looking more and more likely that T.J. is going to be kicking ass for a very long time in this league.
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No-tillage and Vegetable Barrier as a Strategy for Pest Management in the Production of Lettuce- Juniper publishers
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The experiments were conducted in randomized blocks, arranged in subdivide parcels scheme, the main factor is the presence and absence of the surrounding sorghum band and in the sub parcels of the soil cover (spontaneous vegetation, millet, goosegrass and sorghum) and the conventional (without cover), with four repetitions. The evaluated variables were biomass production of cover crops, composition rate, weed elimination, pest population variants, natural enemies and lettuce production. The millet showed lower rate of decomposition and longer half-life. The sorghum indicated higher litterfall and greater efficiency in weed elimination during the cycles. The predominant pests in the area were whitefly and thripes, regardless of the management used. The presence of the sorghum-surrounding band provided an increase of the natural enemies, mainly in the lettuce second cycle. As well as the increase of lettuce production when grown with millet and grass goosegras in the first cycle and sorghum in the second cycle. The conservation practices evaluated in this research can be indicated as a phytosanitary management strategy in the lettuce crop.
Keywords: Lactuca sativa L; Sorghum sp; Pennisetum glaucum (L.) R. Brown; Eleusine coracana (L.) Gaertn; Weed Management
    Introduction
Lettuce (Lactuca sativa L.) belongs to the asteraceous family, originating in a temperate climate region, is the most consumed vegetable in Brazil and in the world [1]. To meet the demand, the farmer intensifies the cultivation, which is usually carried out in the conventional production system, based on the use of irrigation, chemical fertilizers, intense soil revolving in the preparation and formation of beds, exposing them to climatic conditions, accelerating the process of water erosion leading to degradation. This cultivation model favors the development of weeds, interferes in crop productivity due to competition for nutrients, light, water, allelochemical release. In addition, weeds can serve as a shelter and food source for insect pests and disease hosts [1-3]. Because it is a short cycle vegetable, several consecutive cycles are performed during the year, which favors the permanence of pests in the cultivation medium. Among these pests stand out the whitefly (Bemisia tabaci) and thrips (Frankliniella schultzei), main responsible for causing direct damage due to sap sucking and toxin injection, affecting its vegetative development and causing indirect damage through transmission of viruses (GUIMARÃES et al., 2013). The control of these pests in conventional vegetable production is done through the application of chemical insecticides, which leads to the death of natural enemies, reduces biological control. Data from ANVISA [4] indicate lettuce as one of the vegetables with the highest rates of contamination with pesticides (45% of the samples), levels above those allowed and/or with active ingredients not recommended for the species.
Therefore, it is necessary to use conservation practices that promote a reduction in the use of pesticides and an increase in vegetable productivity. No-tillage can be highlighted as an alternative due to soil benefits, addition of organic matter, reduction of surface erosion, mitigation of high temperature and the possibility of weed suppression [3]. Another conservationist practice that increases pest control and can reduce the demand for insecticides is the use of the surrounding sorghum band (Sorghum sp.), for being an attractive species to natural enemies [5] (MEDEIROS et al., 2010). Thus, the objective of this work was to evaluate the soil cover and surrounding range as phytosanitary management strategies in two lettuce production cycles.
    Material and Methods
The experiment was carried out in the municipality of Nova Mutum - MT, in the experimental area of the University Campus of Nova Mutum - State University of Mato Grosso (UNEMAT). The municipality is located at south latitude 13o 05’ 04” and west longitude 56o 05’ 16”. The climate of type Aw (Kóppen), tropical, with concentrated rains in summer (October to April). The average annual rainfall is 1900mm and the average temperature is 26 °C [6]. The soil is classified as dystrophic Yellow Red Latosol (EMBRAPA, year). Two consecutive lettuce cycles were conducted, using the cultivar of the crespa type, cv. Crispy SRV 2005. The experimental design was in randomized blocks, in subdivided plots, with four replications. The factor of the main plot was the presence and absence of the surrounding strip with broom sorghum (Sorghum vulgare L. Moench), the plot presented dimension of 12.5 × 24 meters (m). In the subplot, the following soil coverings were implanted: millet (Pennisetum glaucum (L.) R. Brown), forage sorghum (Sorghum bicolor L. Moench), chicken-foot grass (Eleusine coracana L.) Gaertn, spontaneous vegetation and conventional cultivation (with soil revolving and incorporation of weeds, procedure performed in both cycles of lettuce). The subplots consisted of two beds with dimensions of 1.2 × 1.0 m each, allocating 32 lettuce plants.
The soil sample of the experimental area was collected at the depth 0-20 cm and after the analysis presented the following characteristics: sand 82.5%; silt 3.7%; clay 13.8%; pH (CaCl2) = 6.9; H+Al = 1.2 cmolc dm-3; Al = 0.0 cmolc dm-3; Mg = 1.0 cmolc dm- 3; Ca = 3.8 cmolc dm-3; K = 0.04 cmolc dm-3; P = 99.7 mg dm-3; CTC = 6.0 cmolc dm-3; V = 80%; MO = 15.0 g dm-3. Soil preparation was performed with a harrowing and leveling grid, and subsequent lifting of the beds. After this stage, in all subplots, the planting fertilization of the cover species was carried out, 30 kg ha-1 of N (urea - 44% N), 400 kg ha-1 of P2O5 (simple superphosphate - 18% P2O5),150 kg ha-1 of K2O(potassium chloride - 58 % K2O) and 15t ha-1 of chicken manure.
The sowing of the cover species was carried out on the beds, in the spacing between lines of 0.30 m, using 40 kg ha-1 of millet seeds cv. Adr 300; 35 kg ha-1 of sorghum seeds cv AD 200 and 20 kg ha-1 of chicken foot grass seeds cv. ANPG 207. The sowings were carried out on different dates so that the plants were dried and mowed on the same day (January 18, 2016), due to the difference in the cycle, cycles of 74, 60 and 45 days after sowing (DAS) were obtained for crow’s foot grass, sorghum and millet, respectively. The soil cover plants were dried with glyphosate herbicide at 1L ha-1 dosage and then mowed at 0.05m from the soil. The broom sorghum was sown on October 26, 2015 for the formation of the surrounding strip around the plots. This range consisted of three 0.50 m spaced cultivation lines between rows, with a population of 10 plants m-1, distant 2m from the subplots and 5m from the plot with no surrounding broom sorghum band
In the first cycle, lettuce sowing was carried out on January 6, 2016 and, in the second cycle, on February 4, 2016, in trays of 162 black polyethylene cells, filled with commercial substrate (VIVATTO®),kept in a protected environment, covered with agricultural film, with a thickness of 150 micras and black shading screen with 50% in the windows. The transplant of the seedlings was performed at 24 days after sowing, when the seedlings had three or four definitive leaves in both cycles. The spacing used was 0.30 × 0.25m.
Planting fertilization was performed one week before the transplant of lettuce seedlings, using 30 kg ha-1N (urea - 44% N); 400 kg ha-1 of P2O5 (simple superphosphate - 18% P2O5) and102 kg ha-1 of K2O (potassium chloride - 58 % K2O). The cover fertilizers the dosages:15, 15, 30, 30 and 30 kg ha-1 of N, at 5, 10, 15, 20 and 25 days after transplantation (DAT) and potassium applied at doses of 12, 18 and 18 kg ha-1 of K2O, at 10, 15 and 20 DAT. The planting and cover fertilizations for lettuce, in both cycles, were released on the straw, in the treatments under no-tillage. Planting fertilization was incorporated in the treatment with soil revolving (conventional cultivation).
Irrigation was performed using microperforated laser hoses, type Santeno 01. The water management of the crop was performed according to the need of the crop, monitored through vacuometer tensiometers, following the methodology proposed by Marquelli (2008). Due to the high whitefly infestation, weekly sprays of neem leaf extract (Azadirachta indica A. Juss) were performed at a concentration of 1%. These were performed after the replacement of adhesive traps, so as not to interfere with the samples of natural enemies. The biomass (shoot dry) of the cover plants was evaluated at the beginning of flowering. For this, four samples of 0.25 m² per plot were randomly collected. After collection, the material was submitted to drying in a forced circulation oven, at 65 oC, for 72 hours, obtaining constant weight [7].
To evaluate the decomposition rate, 20g Branches of plant material, of each sample, in decomposition bags. These were made with shading mesh (5mm) with a dimension of 0.20 × 0.20 m. Four decomposition bags have been placed on the surface of each subploer the. Two bags were evaluated in the harvest of each lettuce cycle. The determination of decomposition (k) in g-1 plant waste was obtained by Thomas’ methodology and Asakawa [8].
Where:
X: amount of dry matter remaining after a period of time t, in days
Xo: initial amount of dry matter or nutrient
k: biomass decomposition constant
The determination of the half-life time (T1/2) on days of plant residues was obtained by the methodology of Paul and Clark [9].
Weed suppression was evaluated in the two lettuce cycles at 15 and 30 DAT. The identification of weed species was performed with the aid of the “Manual of identification of weeds” [10]. The relative frequency of the predominant weed species in the plots was sized, after the measurement of the fresh and dry mass of the shoot, in an area of one m² per plot, considering the total weeds during the two cycles [11]. After each evaluation in all plots, manual weeding was performed. Between the first and second lettuce cycles, the area with glyphosate herbicide was desiccation at the dosage 1 L ha-1.
To quantify the insects, associated with lettuce crop in areas with and without surrounding range, yellow and blue adhesive traps with dimension of 0.15 × 0.24 m, installed under the canopy of lettuce plants, were used 0.20 m from the soil. The traps were distributed in the plots, four blue and four yellow in the crops with presence and absence of the surrounding broom sorghum range, totaling 16 traps. These were replaced every seven days and the plates, containing insects, were sent to the Laboratory of Entomology - UNEMAT / Campus Tangará da Serra, for screening, quantification. The specimens were identified at the family level, with the aid of a taxonomic key. However, individuals of the orders Hymenoptera and Diptera were stored in 70% alcohol and sent for identification at the National Institute of Amazonian Research. To characterize the population fluctuation of pests in the area, in the evaluated period (7.14, 21, 28 and 35 DAT), the pest populations were obtained and the mean number of individuals/trap present in each color (blue and yellow) was considered in each harvest. To quantify the whitefly during the two cycles, due to the high infestations in the yellow traps, the count was performed by extrapolation in 1 cm² (OLIVEIRA and LABINAS, 2008).
Six central plants were collected to evaluate lettuce production, per subplot, at the harvest point, 35 and 42 DAT, for the first and second cycles, respectively. The number of leaves (total and commercial) and the total and commercial production (g plant-1) were evaluated. For commercial production, only undamaged leaves were considered. Regarding the number of commercial leaves, the number of commercial leaves were considered larger than 5cm [12]. During lettuce cycles, precipitation data were collected with the aid of a rain gauge. Soil temperatures were measured using a digital skewer thermometer (model HM-600), and the average, maximum and minimum air temperature with thermohygrometer (model HM-02), taken daily at 2 p.m. For fresh mass and dry mass of weeds, data transformation (√X+1) was used. The data were submitted to analysis of variance (F test) and the means compared by the Scott-Knott test (p<0.05) in the Assistat program (SILVA and AZEVEDO, 2016).
    Results and Discussion
For biomass and decomposition rate of cover crops there was no significant interaction between the factors presence and absence of surrounding range and soil cover. The highest biomass value was obtained with crow’s foot grass and sorghum. The values obtained in this study of biomass of chickengrass and millet were higher than the work of Boeret al. (2008). Millet was the species that presented the lowest rate of decomposition (k) resulting in a longer half-life time(T1/2) both in the first and second lettuce cultivation cycle (Table 1).
It was observed that the decomposition rate (k) in the first cycle was twice as high as the second lettuce cultivation cycle (Table 1). This fact can be explained by the climatic period of the first cycle in which the accumulated precipitation was 622 mm and in the second cycle 90mm. Torres, Pereira and Fabian [7] found that in the periods of 42 and 98 days, after the management of the roofs, under different climatic conditions, with an average temperature of 22.5 oC, the decomposition rate (k) was also lower than this work, for the millet (0.005 and 0.007 g-1) and sorghum (0.005 and 0.006 days), respectively. Boer et al. [13] evaluating the biomass decomposition of soil cover, 240 days after the management of cover plants, with accumulated precipitation of 9.2mm and average temperature of 22, 8 oC, verified that the decomposition rate was also lower than the results for the millet 0.006 days and for the chicken-foot grass 0.006 days. The lower decomposition rate (k) value observed may be related to the climatic conditions of the evaluation period, the management time of the roofs and the variety used.
During the two lettuce growing cycles, the relative frequency of weeds identified were: 39.66% of Santa-Luzia grass (Chamaesyce hirta L.) 32.21% marmalade grass (Brachiaria plantaginea L. ), 14.06% chicken-foot grass (Eleusine indica L.) and the others represented 13.97% (puts out fire (Alternanthera tenella L. , roundworm Chenopodium ambrosioides L., caruru Amaranthus viridis L. and beldroega Portulaca oleracea L.). For the variables fresh and dry weed mass there was no significant interaction between factors, presence and absence of surrounding broom sorghum range and soil cover (Table 2). In general, it was observed that the soil cover is more efficient than spontaneous vegetation in weed suppression, with sorghum being the species that presented the highest efficiency in suppression. The efficiency of sorghum in weed suppression, this effect may be linked to the substance sorghumone, considered allopathic. In addition to the species presenting great biomass production (10.8 t ha-1) (SANTOS et al., 2012) [3] (Table 1). For the variable, Dry Mass, there was no significant difference between sorghum and crow’s foot grass for weed suppression in the first cycle (15 and 30 DAT) (Table 2), this may have occurred due to the better performance regarding biomass production by these species. In the second cycle, significant differences were observed in weed suppression by soil cover, only at 30 DAT. The reduction of the efficiency of crow’s foot grass in the second lettuce cultivation cycle may be related to the decomposition rate (k), resulting in the decrease of biomass with inhibition of the physical effect of weed suppression. The millet presented the lowest decomposition rate (k), maintaining the suppression effect for the second cycle due to the permanence of the straw on the soil, longer half-life time (T1/2). The low production of fresh and dry weed mass at 15 DAT, in the second cycle, may have occurred by reducing precipitation and effect of glyphosate application, which reduced weed development.
The predominant pests in the area were whitefly and thrips, captured in yellow and blue traps, respectively (Figure 1). In the first lettuce cultivation cycle, it was observed that whitefly adults had a population peak of 53,460 and 49,320 individuals/ trap at 14 DAT in the plot with and without surrounding range, respectively (Figure 1). In the second lettuce cycle, the whitefly population was less than 5,000 individuals/trap (Figure 1). The high population peak of whitefly, in the first lettuce cycle, is probably associated with the migration of this insect from the surrounding soybean areas, since the population was very high. According to Harterreitem-Souza et al. [14] cultivated areas near large (monoculture) soybean and bean crops may favor the dispersal of whitefly populations, infesting the surrounding vegetable cultivation.
During the population peak of whitefly there was direct damage in the leaf blade of lettuce plants, such as chlorosis, mainly close to the central rib, in the leaf stem, due to the continuous suction of nymphs and the reduced growth of plants, drastically affecting production (Figure 2). Guimarães et al., [15] verified similar damage in lettuce production fields with changes in vegetative and reproductive development of the crop. It was verified in the first lettuce cycle that the peak population of thrips was 392 (28 DAT) and 330 (21 DAT) individuals/trap in the plots with presence and absence of surrounding range, respectively (Figure 1). In the second lettuce cycle, there was a population increase of thrips at 28 DAT with 503 and 404 individuals/trap) in the plots with and without the surrounding range, respectively (Figure 1). Despite the increase in the thrips population, in the second cycle, the presence of these insects in the crop was not recorded, probably the collected individuals migrated from host plants, attracted by the blue color of the traps. As observed by Gaertner and Borba [16] in hydroponic lettuce cultivation, the blue color was attractive for adults of thrips.
It is noteworthy that despite the absence of thrips damage in the area, monitoring with traps is important, as several authors report this insect as a key pest in lettuce crop, causing direct damage due to sap suction and indirect damage by transmission of viruses such as the turn vira-cabeça [1,15,16]. The presence of the surrounding range favored the occurrence of natural enemies in the cultivation area in the two cycles evaluated. In the first lettuce cycle, the predators of the family Asilidae (Diptera) and Vespidae (Hymenoptera) predominated in the blue trap. In the second cycle, there was a greater abundance of ants (Formicidae) and predators of the families Dolichopodidae (Diptera) and Carabidae (Coleoptera). In the plot with absence of surrounding range, the natural enemies, with greater abundance, in the blue trap were the predators Formicidae (Hymenoptera), Asilidae (Diptera) and Dolichopodidae (Diptera) in both lettuce cycles. The predator Carabidae (Coleoptera) and the parasitoids of the family Figitidae and Platygastridae showed the highest number in the second lettuce cycle. In the yellow trap the collections were more abundant, in the second lettuce cycle, with predominance of predators of the family Dolichopodidae (Diptera) Formicidae, Vespidae (Hymenoptera) and the parasitoid hymenoptera Figitidae, Platygastridae, Pompilidae, Eulophidae, Diapriididae and Bethylidae, in addition to the parasitoid dipterans of the hybotidae family (Table 3).
The highest number of natural enemies were collected in yellow traps in the second lettuce cycle, probably due to the high whitefly infestation in the first lettuce cycle (Figure 1), preventing the adhesion of other insects to the plate. In addition, the high precipitation (Figure 3) occurred in the period influenced the amount of insects captured, because the strong spatter of raindrops in the soil resulted in the reduction of the adhesive area of the traps, were covered with soil particles, consequently reducing the efficiency of the traps in the capture of insects. The results indicate that regardless of the presence or absence of the surrounding range and lettuce cycle, the yellow trap was efficient in collecting the parasitoids and predators of the hymenoptera and Dolichopodidae diptera families. The blue trap showed specificity in the collection of asylides (Diptera). The efficiency of yellow color in the capture of insects was also observed by Silva et al. [17].
The most abundant family was Dolichopodidae (Diptera), which may be related to the presence of prey in the area (aphid and thrips) [18], since in the second cycle a higher aphid infestation was observed in the surrounding sorghum band. Carvalho, Bueno and Mendes, [19] observed that the increase in predators and parasitoids coincided with the population peaks of aphids in chrysanthemum cultivation. Thus, the higher concentration of phytophagous insects in the crop also favors the increase of their predators in the area. Another important factor is that the lettuce growing area was near the edge of the forest (20m) favoring the Dolichopodidae family in biological control, as verified by BORTOLO et al., (2016). There was a greater abundance of natural enemies in the plot with surrounding sorghum strip, which may be related to the attractiveness of this species as a food source (nectar and pollen) and shelter. According to the record of Pincanço and Paula et al. [5] for hymenoptera predators in tomato cultivation. Regarding the number of total leaves (NFT) and commercial (NFC), in both cultivation cycles, there was no significant interaction for the factors studied, presence and absence of the surrounding strip of sorghum broom and soil cover plants (Table 4). For lettuce cultivation, in the first cycle, the number of commercial leaves (NFC) and totals (NFT) were higher in the cultivation system with the presence of the surrounding broom sorghum range. However, this difference was not observed in the second cycle.
As for soil cover, lettuces grown under no-tillage with millet and chicken-foot grass showed higher number of total and commercial leaves in the first cycle (Table 4). However, in the second cycle the soil cover did not provide significant difference for these variables. The high temperature and precipitation of the experiment period may have affected the development of lettuce reducing the number of commercial and total leaves. The lettuce plant is sensitive to the occurrence of high temperatures. Combined with the occurrence of rains, plants of smaller size and quality are obtained. When lettuce receives temperatures above its ideal range it begins to lose water through the transpiration process, affecting the development of leaves [20]. Seabra et al. [21] reports the main difficulties of lettuce production in the region, and high temperatures and high rainfall are the main problems. In addition, high whitefly infestation and weed competition may have influenced development. The damage caused by the whitefly may compromise the appearance and impair the commercialization of the product [15]. According to Machado et al. [22], lettuce crop is affected, in its initial phase, by weed competition, affecting its leaf area.
For the characteristics of total production and commercial production, there was significant interaction between the factors studied, presence and absence of the surrounding strip of broom sorghum and soil cover for the two lettuce cultivation cycles (Table 5). It was observed higher total and commercial production of lettuce plants when they were cultivated under notillage, with soil cover, associated with the surrounding broom sorghum range. This trend was observed in both cultivation cycles (Table 5). In the first cycle, lettuce grown under no-tillage with soil cover of chicken foot and millet grass, associated with the surrounding broom sorghum range, showed higher total and commercial production. In the second cycle, the best response in terms of lettuce production occurred using sorghum as soil cover. The biomass of cover plants promoted plant suppression and consequently lower weed competition. Some studies conducted with lettuce demonstrate good agronomic performance when grown over no-tillage [17,23].
Millet was the soil cover species used that produced the lowest amount of biomass (6.8 t ha-1). This resulted in less accumulation of straw in the soil, providing better accommodation of the straw, reducing the shading on the plant, since the accumulation of biomass in the soil can cause shading effect that compromises the development of seedlings [23]. Which may explain the higher lettuce production in the first cycle. On the other hand, the biomass of the millet remained longer in the soil due to the lower rate of decomposition in relation to the other studied cover species. This justifies, at the end of the second cycle, the greatest effect of weed suppression and, consequently, higher production, compared to the conventional, in the cultivation with the presence of surrounding ranges. In turn, the chicken foot grass produced twice as much biomass as millet (12.3 t ha-1), the low size of the plants facilitates the accommodation of straw in the soil, so there is no shading effect on lettuce. A factor associated with the reduction of weed infestation justifies the higher production in the first cycle. However, the decomposition rate of crow’s foot grass was higher than millet, reducing the weed suppression effect [22], justifying in the second crop cycle the lowest lettuce yield.
Sorghum also produced a large amount of biomass (10.8 t ha-1) allowing greater accumulation of straw on the soil, which resulted in greater shading in lettuce, affecting development in the first cycle. This may have negatively influenced the initial development of lettuce causing seedling losses [23], and justifies in the first cycle the lower lettuce production obtained in treatments with sorghum as a cover plant. In the second cycle, there was accommodation of straw on the soil, possibly due to partial biomass decomposition in the period, which may justify the higher production of lettuce grown on sorghum. As for the yields obtained, total and commercial, it was found that in the first cycle the production was low, with averages ranging from 15.0 to 55.4g plant -1 and 7.4 to 42.7 g plant-1,respectively. The yields obtained in the second cycle were 10 to 15 times higher than those obtained in the first cycle, this was due to lower rainfall (90 mm) when compared to the first cycle (622 mm) (Figure 3).
The low production obtained in the first cycle can be justified by the higher incidence of weeds at the beginning of the cultivation cycle (Table 2), associated with high whitefly infestation (Figure 1) and high rainfall (Figure 3). Evidencing the difficulty of lettuce cultivation in February, requiring the use of conservation practices and development of technologies that favor the increase in production in this period. The temperatures, in general, presented similar averages in both cycles, with a mean for the first cycle, maximum and minimum of 29.7, 37.2 and 22.1 oC, respectively, and for the second cycle of 29.7, 37.3 and 22, 1 oC, respectively (Figure 3). Santos et al. [24] when evaluating the performance of 13 lettuce cultivars of the crespa type, in the period of high precipitation, in the municipality of Cáceres - MT, obtained lower results than, with the average temperature ranging from 35.3 oC; between 27.2 and 41.2 oC; between 10.7 and 24.4 oC, with total production of 52.5 to 111.5 g plant-1. Silva et al. [24] when studying the effect of different soil cover, under temperature conditions in which the minimum varied from 20.5 to 25 oC and the maximums of 28.6 to 39.2 oC, obtained yield from 204, 78 to 276.67 g lettuce plant-1. de alface.
Thus, soil temperature was lower in beds with implanted soil cover (millet, crow’s foot grass and sorghum), which reduced from 0.8 to 1.1oC, respectively, for the first and second cycle, when compared to treatment without soil cover (Figure 2). Thus, the reduction of soil temperature can contribute to the production of lettuce grown on cover crops in periods of high temperatures. Among the conservation practices evaluated, the surrounding range of broom sorghum can be used in lettuce production areas, contributing to the organization of productive systems, increasing natural biological control, due to its attractiveness of natural enemies, influencing lettuce production in the period of high whitefly infestation.  
No-tillage resulted in reduced soil temperature, weed suppression and consequent increase in lettuce production. In addition, it contributes to reduce the erosion of the beds, preserving their structures, in periods of high precipitation [2]. Therefore, the use of this technique allows a smaller workforce with soil revolving, construction site formation, manual weeding or herbicide use in the area [26].
    Conclusion
Sorghum and chicken grass as cover crops were the species with the highest biomass production and the sorghum the highest weed suppression effect. The surrounding strip of sorghum broom increases pest control, increasing the population of natural enemies in the area. The use of no-tillage associated with the surrounding broom sorghum range provides higher lettuce production.
    Thanks
I thank FAPEMAT (Mato Grosso Research Support Foundation) for funding a scholarship to carry out this work and researchers Karine Schoeninger an
d Alexandre Emanuel Camargo Silveira of the National Institute of Amazonian Research-INPA for identifying insects of the order Hymenoptera and Diptera.
    Acknowledgement
We would like to thank the Coordination for the Improvement of Higher Education Personnel-CAPES (Process 224287/2015), the Mato Grosso State Research Support Foundation - FAPEMAT (Universal Call 005/2015 FAPEMAT) and the State University of Mato Grosso - UNEMAT for their support in the integration for the execution of this work and scientific technical development.
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stuartledrew · 3 years
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Neat Thought...
We're viewing our pasts, from our presents, as we step into our futures.
That is to say:
When I look at you, I'm seeing where you were, not where you are.
The speed of light Doppler effect...The “light barrier”/screen...Am I on yet?
Anyway...
Be nice.
Be happy.
Be you.
How?
We're a light/dark energy/matter, double rainbow...Well, we will be...
Once you find the “you” that you were born to be.
Balance, harmony, diversity, eternity...Life.
Or...
An eternal, double, infinite, single wave length (...-1.0.1...)...Life?...
Take your pick.
Some interesting things start to happen, when you think in terms of the speed of light, being directly connected to, the number of beings on the network. - Truly just beings there are.
The more of us who join, the more harmonic we become.
We begin to think as one mind, not the same thought, just the timing of...We begin to beat...And all time exists at the same time.
Just a thought.
https://stuartledrew.tumblr.com/
Another neat thought:
Given that I'm viewing my past on a slightly convex screen (time plane), with a very concave retina, + rod/cone placement + transmission speeds = 3D = Evolution (Hunting)
Oops...Got a bit lost there myself...
We're the present, a singularity of time.
We're centered.
So...
Simpler biology...Concave, to concave, flipped...
Anyway... Enjoy...
https://www.youtube.com/watch?v=NAEppFUWLfc&list=RDMMNAEppFUWLfc&start_radio=1
“Stone walls do not a prison make,
Nor iron bars a cage.” Richard Lovelace
https://www.youtube.com/watch?v=YkgkThdzX-8&list=RDMMNAEppFUWLfc&index=2
https://www.youtube.com/watch?v=HTTAPCUtbc8&list=RDMMNAEppFUWLfc&index=5
https://www.youtube.com/watch?v=UpoP4YSFKGA&list=RDMMNAEppFUWLfc&index=4
https://www.youtube.com/watch?v=vZA5heWazIQ
https://www.youtube.com/watch?v=QGJuMBdaqIw
https://www.youtube.com/watch?v=xCorJG9mubk
P.s.
This will be my last post, tweet, comment...ANYTHING!!!...On this subject.
In 2008 I got a “tap on the shoulder”. That night I was run through the gamut...I was once Jesus...No, apparently I was Satan...Nope...Wait...I was God...Until I screamed out into the darkness, “NO!!! It just doesn't work!!!”. Then I got to thinking...
I told the doctor (I was “told” to), and ended up being diagnosed as schizophrenic, and being hospitalized. Tip, unless for some reason you wish to be hospitalized, don't tell a doctor that you were once god. Anyway, whilst hospitalized, I briefly lost my temper with my psychiatrist, and got assigned an interview with another psychiatrist, to confirm that I was bipolar too...WHAT?...
Anyway, at that meeting, things got a bit emotional. The psychiatrist's student, started crying and had to leave...And I got a confirmation of bipolar disorder...WHAT?...
I made an RCMP officer cry once too, a male one. He was left to “watch over me” in a room at the hospital, on one of the occasions that I had been told:
“This is a big thing! A REALLY BIG THING!!! You understand that, right? Well the only way they're willing to get you guys together, at the moment, is in a controlled environment. Get yourself checked in to the hospital.”...Phone RCMP...Say “This is Stuart Graham LeDrew I live at...I used to be god, and I fear that I may do harm.”...BINGO!!!...Hospitalized, but no meeting!...No kidding!...Nearly 13 years!...Anyway, back to the RCMP officer I made cry...We talked for a bit and I asked him, “If it isn't, EVERYBODY, what's the bloody point?”, and he began to cry.
Long story short:
Either I'm pure probability, and simply mad.
Or I'm right, and we all win!!! But if so...Where is she? It's the communications era! I'd have been there the next day.  If I hadn't been told, that I have to wait here. Katy has to choose to come to me. I must just be mad! The next day!!! I'd probably have been arrested and detained, but I'd have had to!!!
The way I figure it...
If I'm just mad: I have hyper-inflated lungs, and COVID's on the rise, shouldn't be long now.
If I'm right: Maybe I have to go through all of them, one-by-one, for some reason, and I'm just losing again. C'est la vie.
If I'm, right, right: It has to work, first time. Otherwise,  it's just a trick of sorts, possibly unjust, and personally unacceptable. Something may be back...BUT IT WON'T BE ME!!!
And I'm not “Going long”, that's just the same thing, a trick.
If anyone can hear me...You can't mess it up! Why? Because I'm still here!
HELP!!!
Or not...Your choice...That's the point!
Well, one more.
I WILL FIND A WAY!!!
I'm back, but then again, I did say that I'd find a way.
Perhaps it would illustrate my point, “Stuff like this doesn't 'Just happen'!”, if I give you a few examples.
I was 'told' to go upstairs 'right now!', and watch a video...”Which one? 'You will know.'. I did so. The video was:
https://www.youtube.com/watch?v=xCorJG9mubk
Which is basically a synopsis of this whole thing.
Then, one evening at 10:10 on the 10th, I wondered, “What is 101010 in binary?”. Turns out it's 42. Douglas Adams' “The Meaning of Life, the Universe, and Everything”.
In the video, “This is the part of me”- Katy Perry, at 2:23 Katy is wearing a watch. It's 10:10, and the minute hand is pointing to the 10 on the outside dial. I only just noticed this fact, and I've been watching it for years.
I first encountered Katy with the release of the “I kissed a girl” video. I was walking through the living room, and the video for it came on tv...Our eyes met...I walked away thinking “Oh well, just another talented, pretty girl, they'll “throw away” in a couple of years.”. I mention this because as I said, our eyes met...Then, I walked away at the end of the video. But what happened between those two events...(blackout)? It was odd, but I didn't think much of it at the time (loads going on). Now, did I see Katy, then get my “tap on the shoulder”, or visa versa? I couldn't tell you, it was all too long ago now.
In late 2010 there was a forum called “The Meaning of Life, the Universe, and Everything”, upon which I was posting. It was the usual stuff...Drunks in Florida, “Killing time”, and people only interested in their own theory's. So there really wasn't much point, but one day, a 12.5 year old girl, posted a link to:
https://www.youtube.com/watch?v=QGJuMBdaqIw&list=PLNNEgHxrnU5xrECkqd-mbgyOf6X7_6W9p&index=95&t=0s
And asked, “Is this the sort of thing that you mean?”. I told her that it was basically exactly what I meant, but thought nothing more of it. That's not strictly true. What I meant by it was that I made no connection to Katy or the “I kissed a girl” video. I don't think that I even noticed that they were the same person. If I had, I'd probably have thought something along the lines of, “Oh, still going...Gosh!”. As to the song itself...That has saved me countless hours of thought...We're all on our own “perfect road” leading us all to our own “perfect door”. No need to keep 'checking'/cross referencing etc:. BRILLIANT!!! Anyway...
All of this had fallen into the background, for a couple of weeks or so. It was odd, but nice, a quiet mind. Then on 3/14/2018 Stephen Hawking died. Within 4 hours of his death I had a basic understanding of how all this works. I explained it all on physics forums. My model fixed all of the various problems/oddities in their model, but they would have none of it. Got banned!
Christmas 1987 my mother asked me what I'd like for Christmas. I usually got her to get me a record, but this year the really wasn't one that I had my eye on. So I said “Pop goes the world by Men Without Hats.”, because I thought that the girl in the video was cute. Turned out, I never really listened to it, I didn't really care for it much. But!!! Now, the anomaly in the video that has been bugging me for years becomes clear. What anomaly? What are those floating bubbles with the red bits on them? Do they mean anything? Because, again, the video is pretty damn on-the-nose!
https://www.youtube.com/watch?v=3zUUtf7gOe8
Or the video for “Imagine” - John Lennon, he was a tad over zealous, here and there, but, imagine. Why do they zoom in on the window that has “THIS IS NOT HERE” printed on it? I'm demonstrating that it isn't, so...
And finally, well for now anyway, in 1994 Elastica released “Connection”. Huge amounts of this process have related to music videos. “Connection” was one of those “instant fav's”. The original video is a masterpiece, but could cause epileptic seizures due to the quick cuts.
https://www.youtube.com/watch?v=gY2s4hJ8kuA
“Another heart has made the trade, Forget it, forget it, forget it, I don't understand how a heart is a spade, But somehow the vital connection is made.”
I have to know this! How is a heart a spade? It's ridiculous! It could be anything! Oh well...
Then two days ago, for no reason the thought Juice Newton “Queen of Hearts”, so I played the video. 35 seconds in...
https://www.youtube.com/watch?v=P0DK-0fIKCw
I could go on. My day, everyday, is just a continuous “coincidence” stream. Stuff like this doesn't “Just happen”!!! Well technically it does, but...
I will find a way...I mean, what else ya' gonna do?
Especially after the most powerful moment of this whole thing...
The weekend before my birthday in 2017, Katy had a “Witness Weekend”, four days, on air 24 hours'ish, a day. I'm not entirely sure why I watched, Katy was “relevant” by then, “Firework” had saved me so much time. I watched probably 3-4 hours, or so, each day, but I have a problem with, “I may be wrong...”, so I didn't want to feel like a stalker.
Katy had a psychiatrist come in to the theatre, to have a session with. As the session progressed, Katy started to cry, and Katheryn came out. Our eyes met...And it was literally like a double laser out of her eyes! Then I knew! Her image was burnt into my soul...She must “Meet her Prince Charming!”, it doesn't have to be me, but she has to be happy...I hear tell...
“Friends describe Katy and Orlando, as 'More than in love'.”...
Then there's Daisy Dove...
I think it's wonderful. Orlando's a really nice guy (he played himself on “Extras” with Ricky Gervais), life's complex sometimes, and it's a big house...Anyway, I'm either quite, quite mad...Or right...
And it REALLY SUCKS not knowing for sure, for sure, because I am ya’ know?
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vagabondphotog · 6 years
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My Thoughts On Dry Camping Thus Far
After six days of dry camping (aka boondocking) thus far, here are my thoughts and observations:
1.  This is my first extended dry camping experience.  I started this six day experiment by filling the propane and the fresh water tanks before I arrived, and with both the gray and black tanks completely empty.  My fresh water tank capacity is 80 gallons.  The gray tank capacity is also 80 gallons and the black tank capacity is 40 gallons.  So, from a water standpoint, the limiting factor is my supply of fresh water (since the gray tank can, in theory, hold the entire contents of the fresh water tank after it’s been “used”.
2.  I’m running the refrigerator on propane, and I use propane to make hot water, usually about once a day.  These are the only two appliances using propane.  The hot water tank is insulated, so the water stays at least warm for 24 hours after the propane has been turned off.  I usually turn it on in the late afternoon to heat up water for taking a shower.  After my shower, I leave it on for a bit to heat back up again, then turn it off.  This gives me water that is warm (but not hot) for washing hands and doing dishes all through out the next day.  I could leave the water heater turned on 24/7, but there’s really no reason to “waste” propane keeping the water in the water heater piping hot.  
After doing all of the above for nearly a week, I refilled the propane tank today.  It turns out that I used 2.4 gallons of propane over six days.  The capacity of my onboard propane tank is about 12.5 gallons.  So, 2.4 gallons is about 1/5 of the total capacity of my onboard tank.  Or, to put it in more familiar terms, 2.4 gallons is about 1/2 of a standard BBQ grill tank.  Replenishing the 2.4 gallons of propane cost me $6.97.
3.  I ran the on-board generator every morning, usually for about 45-60 minutes, to top up the house batteries.  While the generator is running, I use the electric coffee maker to make coffee.  As an alternative, I have a tea kettle and a French Press that I could use to make coffee using the propane stove to heat the water, but as of now, I haven’t needed to do that.
4.  For the first six days, I showered every other day, using hot water and taking very short “navy” showers.  This campground has public showers, but they are cold water only.  So, as part of this first trial experiment with dry camping, I opted to have hot showers in the rig, albeit short and every other day.  I also used a pitcher to catch the cold water that comes out of the shower before the hot water gets to the shower head.  I then used this water for doing dishes rather than letting it go straight down the drain to the gray tank.  After a week, it appears that I’ve used about 1/3 of the fresh water from the tank, or about 27 gallons.  This is only a guess by looking at the water level through the side of the tank before I refilled it today.  So, after six days, I’ve got lots of water to spare.  I topped up the tank today and I’ll allow myself to get a “navy” shower every day this week, rather than every other day.  Woo Hoo!
5.  For the most part, I’m cooking outside on the propane grill, using the 1 lb disposable propane bottles.  I went through two of them for the six days I’ve been here.  In my Weber Q-series grill, I have a grill surface on one side, and a griddle surface on the other side.  This makes it convenient for whatever type of food I’m preparing.
6.  It’s November, so the days are getting pretty short.  I changed out most of the lights in the RV to LED lights.  This lets me have lots of light after the sun goes down while putting very little drain on the batteries.
7.  Regarding batteries, I have two LifeLine 225 AmpHour AGM batteries connected in parallel, for a total of 450 AmpHours of capacity.  This effectively gives me 225 AmpHours of usable energy, since the manufacturer recommends discharging the batteries to no more than 50% of capacity without doing long term damage to the batteries.
8.  I also ran the generator for a bit in the evenings, usually 60-90 minutes.  This tops off the batteries for the evening.  During this time, I can watch TV (I get a surprising number of over-the-air digital channels here).  After I shut the generator down, I can continue watching TV using the batteries and the inverter  to create 110 vAC for the TV.  The TV label says that it consumes about 114 watts during operation.  So, to watch TV for 5 hours in the evening on battery only, (if I remember my electrical engineering correctly and assuming an 85% inverter efficiency):
((114 watts * 5 hours)/0.85)/12 volts = 56 amp-hours
This means that I can watch TV for 5 hours in the evening off of the inverter and only use about 25% of my usable capacity out of the batteries.
Overall, the hour meter for the generator says that I’ve put about 16 hours on it in the six days that I’ve been here.  I don’t know exactly how much fuel it consumed, but the manufacturer states that fuel consumption for my generator is about 0.7 gallons per hour under nominal load.  So, that works out to just over 11 gallons of gasoline for the 6 days.  
9.  Temperature control.  The other unknown at this point is temperature control.  The temperature here has been moderate, so I haven’t needed to run the AC or turn on the heat.  Obviously, if I need to run the AC, I will need to run the generator to do that.  As far as heat is concerned, I can run the furnace  on propane (for heat) and the batteries (to circulate air with the fan), but that’s hugely inefficient and burns through propane quickly, from what I understand.  It will be fine for this short stint of boon-docking, but if I want to do more extensive dry camping stays, I will need to invest in a Mr. Buddy propane heater (or equivalent) that produces a lot of warmth while sipping propane.
10.  Internet.  Sigh.  Just as with other services, there’s no WIFI available in this campground, so I have to rely exclusively on cellular connectivity.  I have service on all 4 of the major carriers of one sort or another.  For this location, the service is:
T-mobile - Nada
Sprint - Intermittent 3G.  I remember in the early days of the iPhone when we thought 3G was lightning fast compared to the original AT&T EDGE service.  So, it’s usable, when it connects.
Verizon - Good, consistent LTE service.
AT&T - Good, consistent LTE service.
So, I’ve been spreading my usage across my Verizon and AT&T services.  And I’ve been burning through the data.  
11.  The water pump.  The water pump has been behaving strangely.  I can’t decide if there’s something wrong with it or not (but right now I’m leaning toward yes,).  It works just fine to pressurize the lines and pump water.  It’s a bit noisy, but most RV water pumps are.  But, after running water, it will pressurize, and then shut off (as it’s supposed to).  Then a few minutes later, without any new water demand, it will cycle on again, for just a short period, and then shut off again.  After a few more minutes, it will repeat the cycle on and off.  Typically, this behavior means that there’s a leak in the water system somewhere that is causing water to leak out of the line, requiring the pump to turn on and re-pressurize the line.  I’ve looked everywhere and can find no signs of a leak.  But, the strange thing about this is that after a few of these cycles, the time between cycles gets longer and longer, and the time the pump is on to  re-pressurize gets shorter and shorter.  Eventually, it will stop cycling and then go hours without cycling, which sort of de-bunks the leak theory.  I’ll keep my eye on it, and eventually a leak with show itself or the pump behavior will get worse, signaling a repair or replacement.
Well, that wraps it up for now.  Thanks for reading.
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kissnovel46-blog · 5 years
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Peanut Butter Kitchen Sink Cookies Caramel, Pretzels, M&Ms, and More
Oh yes, these peanut butter kitchen sink cookies (as in, there’s EVERYTHING but the kitchen sink in them) are amazing! Soft, crunchy, caramelly, delicious!
Weeks ago I asked for your help on Instagram (here’s the plea) to name this over-the-top loaded cookie. And wow, did you ever come through! To the tune of 400+ responses! Even more of you chimed in on this Friday Thoughts post with last minute name suggestions. I have loved each and every one of them (I’ll highlight a few of my favorites below) – and laughed out loud at more than one. You guys are funny. 
But in the end, it seemed appropriate to go with the name that sums it all up in one broad, sweeping title (and by far, the most popular name suggested): almighty peanut butter kitchen sink cookies. 
Soft, chewy, crunchy, sweet, salty, caramelly – this cookie has it all. 
When visiting Montana this summer, my sister-in-law, Erin, made these cookies for us two days in a row (because our greedy hands couldn’t get enough), and I knew immediately my blog wouldn’t be the same until I had a recipe like this on my site. Since then, I’ve made these cookies myself four or five times (including making and serving 150 of them at my cousin’s wedding dinner a few weeks ago), and they have skyrocketed to favorite cookie status. I mean, just look at them! The wow factor is huge.
When I was probably about 10 years old, we lived in Houston, Texas, and my mom had a church responsibility to follow up with the young 19-something missionaries serving in our area. One day she went over there to visit with them (and mostly check to see if their often-neglected apartment was getting cleaned), and they proudly told her they had made cookies and sent them to their families!
Because they had a very sparsely furnished kitchen, she was quite surprised. She politely asked them what kind of cookies they had made. Chocolate Chip. Then she kindly and somewhat gently asked what they had used to make them (they literally only had a couple cereal bowls, plates, and a few utensils). Unabashed, they announced that without the use of a large mixing bowl, they had the brilliant idea to use their kitchen sink to mix the dough! (And then borrow baking sheets from a neighbor.) A few more probing questions from my slightly aghast mom revealed that no, no indeed, the rather grimy kitchen sink hadn’t been scrubbed cleaned before the cookie making endeavor. 
I remember my mom coming home and telling us about this kitchen sink cookie experience and with a furrowed brow wondering out loud if she should somehow alert the families that might be on the receiving end of these cookies?? I have no idea if those cookies ever made it to their destination and what the result was, but I’ve always had a bit of a gag reflex thinking of those kitchen sink cookies from the 1980’s
Thankfully these peanut butter kitchen sink cookies I’m sharing with you today are not literal in anyway (no kitchen sinks were used or harmed in the making of these cookies). They are 100% delicious and totally food safe, I promise. 🙂
If you want to see a whole list of name suggestions, here you go. My 12-year old lovingly compiled this list after reading through the hundreds of Instagram responses. So many great cookie name ideas! I just love you guys. 
Here are a few notable/clever favorites: 
–G.O.A.T. (greatest of all time) cookies -Whatcha-Mel-Callsit cookies (hahaha) -What You Find Under the Carseat Cookie (slightly gross but super funny) -Spanx Busters -Pantry Cleanout or Pantry Raid Cookie -Pretzel Monster Cookies -Mary Poppins Cookie (because Mary Poppins is Practically Perfect in Every Way) 🙂
Other than adding in a bazillion extra ingredients, these peanut butter kitchen sink cookies aren’t any more difficult to whip up than your average, every day drop cookie. 
The soft peanut butter cookie dough base is mixed together (in a stand mixer or using an electric hand mixer) with the flour just barely getting incorporated before adding in all those glorious extras.
Why not?? Here’s what’s going on in these cookies so far:
-toasted pecans (I’m normally a don’t-put-nuts-in-my-cookie kind of gal, but they are super tasty in these cookies! Use them!) -peanut butter chips -chocolate chips -caramel balls (I’m talking about the Kraft brand of unwrapped caramel bits similar in size to large chocolate chips; when I’ve been out, I unwrapped soft Kraft or Trader Joe’s caramels and cut them into pieces with my bench knife aff. link…a labor of love that is totally and completely worth it) -M&Ms (I’ve used regular M&Ms, dark chocolate M&Ms, and caramel M&Ms)
I think you could play with the add-ins to your hearts content. What about:
-other chopped up candy bars (the sky is the limit) -pretzels IN the dough vs just pressed on the outside -other types of chopped nuts -coconut
Once the cookie dough is mixed, roll the dough into balls. Because of all the add-ins, the dough balls won’t be perfectly round. That’s ok. All those lumps and bumps just mean extra yumminess. 
Press the top of the cookie dough into the coarsely chopped pretzels and then turn over and lightly press the pretzels into the soft cookie dough so they stick. Again, we aren’t going for perfection here! These cookies have a rustic porcupine-spiked vibe going on, and I love them all the more for it. 
Of course you can eliminate the pretzels from the cookie lineup, but they really do add that salty crunch that is awesome (and they don’t get soft/soggy after baking). 
These cookies will spread just like other drop cookies…but probably not quite as much thanks to all the bulky add-ins. They are meant to be super soft and slightly puffy.
I’ve given some notes in the last step of the recipe directions about how to end up with a flatter cookie if you want (or, conversely, what to do if your cookies are flattening too much). 
Since these cookies have also affectionately been dubbed “clean out the pantry cookies” – I can’t wait to see what other variations you come up with! You clever and adventurous bakers never cease to amaze me. 
Just in case you end up with more cookies than you deem safe for your self-control OR you need to make a bunch in advance, these baked and cooled cookies freeze great (yep, even with the pretzels). I stack the cookies in between sheets of wax paper in a large tupperware and then take them out of the freezer several hours before I want to serve them. Tasty as the day they were made!
After all this talk about PB kitchen sink cookies, looks like I better go grab a couple out of the freezer just to remind myself how delicious they really are. 
One Year Ago: Monterey BBQ Chicken Pasta One Pot Dinner! Two Years Ago: Fresh Zucchini and Tomato Linguine 30-Minute Meal Three Years Ago: Tender Grilled Pork Chops Four Years Ago: Triple Chocolate Zucchini Cookies Five Years Ago: Good Morning Power Muffins Full of Whole Grains and Superfoods! Six Years Ago: Ebelskivers: Puffy Danish Pancakes Seven Years Ago: Cheesy Zucchini Rice Eight Years Ago: Oreo Cheesecake Bites
Yield: 4-5 dozen
Prep Time: 40 minutes
Cook Time: 10 minutes
Total Time: 50 minutes
Ingredients
1 cup (8 ounces, 16 tablespoons) butter, softened (I use salted)
1 cup (9 ounces) creamy peanut butter (I use Skippy or Jiffy)
1 cup (7.5 ounces) granulated sugar
1 cup (7.5 ounces) packed light or dark brown sugar
1 teaspoon baking powder
1 teaspoon baking soda
3/4 teaspoon salt
2 large eggs
2 teaspoons vanilla extract
2 1/2 cups (12.5 ounces) all-purpose flour
1 cup (6 ounces) chocolate chips (I use semisweet)
1 cup (6 ounces) peanut butter chips
1 cup (7 ounces) caramel balls (see note) or chopped soft caramels
1 cup (7 ounces) M&Ms (regular, caramel, etc)
1 cup (4 ounces) chopped, toasted pecans
2 cups coarsely chopped pretzels
Instructions
Preheat the oven to 350 degrees F and line a couple baking sheets with parchment paper.
In the bowl of an electric stand mixer fitted with the paddle attachment or in a large bowl using a handheld electric mixer, mix together the butter, peanut butter, granulated sugar, brown sugar, baking powder, baking soda and salt until well-combined and super creamy, 2-3 minutes, scraping down the sides of the bowl as needed.
Add the eggs and vanilla and mix well, 1-2 minutes.
Add the flour and mix briefly until the flour is partly combined. Add the chocolate chips, peanut butter chips, caramel, M&Ms, and pecans. Stir with a wooden spoon or spatula (or mix very slowly with the electric mixer) until evenly combined.
Scoop out several tablespoons of cookie dough (I use a #40 cookie scoop) and roll into balls. They won't be perfectly round as all those add-ins will create some bumps. Don't stress. Press the top of each cookie ball into the chopped pretzels (and then lightly press the pretzels into the cookie dough to stick) and place the cookie dough balls several inches apart on the prepared baking sheets.
Bake for 9-11 minutes. These cookies stay fairly puffy (thanks to all the add-ins); for slightly flatter cookies, press them lightly into more of a disc-shape before baking or bake at 325 degrees F. If, for some reason, your cookies are flattening too much, try increasing the baking temperature to 375 degrees F.
Notes
The caramel balls I'm talking about in this recipe are the unwrapped soft caramel bits about the size of large chocolate chips sold by Kraft (usually in the baking aisle). When I haven't been able to find those, I unwrap soft caramels (either Kraft or Trader Joe's) and cut into pieces with a bench knife. It's a labor of love, but so worth it for these cookies!
Recommended Products
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Recipe Source: from Mel’s Kitchen Cafe (inspired from a recipe my sister-in-law, Erin, made for us in Montana this summer)
Disclaimer: I am a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for me to earn fees by linking to Amazon.com and affiliated sites.
Posted on July 30, 2019 by Mel
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Source: https://www.melskitchencafe.com/peanut-butter-kitchen-sink-cookies/
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baymaxbarbie · 7 years
Text
<·°·> May 30, 2017
°°°Hours Fasted: 15 hours, broken with iced matcha
°°°Days without binging: 0
<·°·> Intake:
11:15 A.M
°1 water bottle (16.9 oz) of Ceremonial Grade Matcha, chilled, with 1 packet splenda
····Total: 0 cal
12 P.M
°1/2 water bottle (8.4 oz) of water flavored with Mio
····Total: 0 cal
1:30 P.M
°Starbucks Shaken Passion Tango Tea Lemonade, Unsweetened, Venti
····Total: 70 cal
3:25 P.M
°Tuna, Veggie, Egg Bowl:
-1 packet Sundried Tomato Tuna (170 cal)
-1 packet Light Tuna (70 cal)
-1 boiled egg (78 cal)
-1/3 cup frozen spinach (12.5 cal)
-1/3 cup frozen okra (13 cal)
-1/3 cup tomato and basil sauce (26.5)
°1 water bottle (16.9 oz) of water flavored with Mio
····Total: 370 cal
6:30 P.M
°1/2 cup vanilla ice cream
····Total: 130 cal
9:40 P.M (*BINGE*)
°1 bag of frozen peaches (150 cal)
°1/8 of coconut tofu (13 cal)
····Total: 163 cal
<·°·> Total Daily Intake: 733 cal
<°·°> Exercise: 45 minutes on stationary bike, 491 cal
<^> Notes: Bad day bad day bad day!! Many frequent dives into depressive mood, with one slightly high mood followed by an almost immediate crash. A group brought ice cream during presentations in Japanese class today, so of course my fat ass had to have some. Then after a high period, I crashed into a down, and the binge urge was at a 7/5. I almost started crying with how much I wanted to stuff my face. Of course this was when I had to go shopping, because I had no fruit at home to make smoothies with, or any drinks, and would have only be drinking matcha (0 cal), mio water (0 cal), and sparingly cashewmilk (60 cal), and would have been way under cal goal for the rest of the week. Which isn't that bad but still, trying to be a bit healthy with this. So I'm walking past all my binge foods: chips, pretzels, bread, pastries. And I'm miserable. And I know that even when the urge dies down just a bit, I'll go home and smell/see the dinner my aunt cooked and eat it, then probably the junk stash that's in the cabnet. But I managed to avoid it by leaving the kitchen as quick as possible, and grabbing a bag of frozen peaches instead cause I knew logically the sweetness and texture would satisfy the craving. It did, and I managed to avoid a real big deviation (my binges are usually 1000+ cal), while staying comfortably within my cal limit, but I'm still fucking pissed I'm so weak. I woke up to a great loss this morning but something in my brain hates me so much that I wanted to sabotage myself. Well fuck you right back atcha.
Current Thinspo: Jude Karda
5 notes · View notes
greatestlcve · 4 years
Text
Aprovel review Uses, Dosage, Side Effects, Precautions &Warnings
Drug Online
aprovel generic drug of the therapeutic class: Cardiology and angiology
active ingredients: Irbesartan
What is Aprovel 300mg used for and indication?
Aprovel is indicated in adults for the treatment of essential hypertension.
It is also indicated for the treatment of renal impairment in adult hypertensive patients with type 2 diabetes, in the context of management with an antihypertensive drug (see sections Contraindications , Warnings and precautions for use , Interactions with other medicinal products and other forms of interaction andpharmacodynamic properties ).
ِِAprovel 150 mg | 300 mg dosage
Dosage The recommended starting and usual maintenance dose is 150 mg given as a single dose daily during or after meals. Aprovel at a dose of 150 mg once a day usually provides better control of blood pressure over 24 hours than the 75 mg dose. However, initiation of treatment with 75 mg daily may be considered particularly in hemodialysis patients or patients over 75 years of age.
ِِAprovel 150 mg | 300 mg dosage
In patients inadequately controlled at 150 mg once daily, the dosage may be increased to 300 mg or another antihypertensive agent may be added. In particular, the addition of a diuretic such as hydrochlorothiazide has been shown to have an additive effect with Aprovel (see section Interactions with other medicinal products and other forms of interaction ).
In hypertensive patients with type 2 diabetes, treatment should be initiated at a dose of 150 mg irbesartan once daily and increased to 300 mg once daily, a preferable maintenance dose for the treatment of renal impairment. . The demonstration of the renal benefit of Aprovel in hypertensive patients with type 2 diabetes is based on studies in which irbesartan was used, if necessary, in addition to other antihypertensive agents to achieve a blood pressure goal  . Pharmacodynamic properties). Special populations
Renal Insufficiency: No dose adjustment is required in patients with renal impairment. A lower starting dose (75 mg) should be considered in patients undergoing hemodialysis (see section 4.4 Special warnings and precautions for use ).
Hepatic impairment: No dose adjustment is required in patients with mild to moderate hepatic impairment. There is no clinical experience in patients with severe hepatic impairment.
Elderly: Apart from subjects over 75 years of age, in whom treatment may be initiated at a dose of 75 mg / day, no dose adjustment is usually necessary in the elderly.
Pediatric population: The efficacy and safety of Aprovel in children aged 0 to 18 years has not been established. The available data are described in the Adverse Reactions, Pharmacodynamic Properties and Pharmacokinetic Properties sections, but no dosage recommendations can be made.
Administration mode
Oral way.
Contraindications
CONTRA-INDICATED:
Hypersensitivity to one of the components of the product (see composition section).
Second and third trimesters of pregnancy: Aprovel is contraindicated during the second and third trimesters of pregnancy. During the second and third trimesters, substances that act directly on the renin-angiotensin system can lead to fetal or neonatal renal failure, fetal cranial hypoplasia or even fetal death. If pregnancy is diagnosed, irbesartan should be stopped as soon as possible, the skull and renal function should be checked by ultrasound if the treatment has been inadvertently taken for a long time.
Breast-feeding: Aprovel is contraindicated during breast-feeding. It is not known whether irbesartan is excreted in human breast milk. Irbesartan is excreted in the milk of lactating rats.
Due to the presence of lactose , this medication is contraindicated in cases of congenital galactosemia, glucose or galactose malabsorption syndrome or lactase deficiency.
ADVISED AGAINST
 Children: the use of irbesartan in children and adolescents is not recommended due to a lack of efficacy and safety data.
Primary hyperaldosteronism: patients with primary hyperaldosteronism generally do not respond to antihypertensive drugs acting through inhibition of the renin-angiotensin system. Therefore, the use of Aprovel is not recommended.
Hepatic impairment: there is no clinical experience in patients with severe hepatic impairment.
Pregnancy: as a precaution, irbesartan should preferably not be used during the first trimester of pregnancy. A change to an appropriate alternative treatment should be made before considering pregnancy.
Lithium : the combination of lithium and Aprovel is not recommended.
Co- administration of Aprovel with potassium-sparing diuretics, potassium supplementation, potassium-containing diet salts or other drugs which may increase serum potassium levels (eg heparin) is not recommended.
How it works Aprovel
Pharmacotherapeutic group: Antagonists of angiotensin-II receptors, ATC code C09C A04.
Mechanism of action: Irbesartan is a potent selective angiotensin-II receptor antagonist (type AT 1 ), active orally. Irbesartan blocks all the effects of angiotensin-II, involving AT 1 receptors , regardless of the origin or route of synthesis of angiotensin-II. Selective antagonism of angiotensin-II receptors (AT 1) causes elevated renin plasma levels and angiotensin-II levels and a decrease in plasma aldosterone concentration.
 Serum potassium is not significantly affected by irbesartan alone at the recommended doses. Irbesartan does not inhibit ACE (kininase-II), an enzyme that generates angiotensin-II formation and also degrades bradykinin into inactive metabolites. Irbesartan does not require metabolic activation to be active.
Clinical effectiveness:
Hypertension
Irbesartan lowers blood pressure by causing minimal changes in heart rate. The drop in blood pressure is dose-dependent with a tendency to plateau at doses greater than 300 mg once a day. Daily doses of 150 to 300 mg lower the blood pressure values, supine or sitting, by an average of 8-13 / 5-8 mm Hg (PAS / PAD) at the 24th hour after catch (valley). This decrease is greater than that observed with placebo.
The maximum drop in blood pressure is achieved within 3 to 6 hours after administration of the product. The antihypertensive effect is maintained for at least 24 hours. At 24 hours, the drop in blood pressure is still 60 to 70% of the diastolic and systolic peak, at the recommended doses. A dose of 150 mg, taken once a day, produces similar effects on blood pressure 24 hours after dosing (valley) and on 24-hour average blood pressure than the same dose divided into 2 doses per day.
The antihypertensive effect of Aprovel occurs within one to two weeks, with peak effect occurring four to six weeks after the start of treatment. Antihypertensive effects are maintained during long-term treatments. The blood pressure gradually returns to its initial state after stopping treatment. Stopping the treatment does not result in a rebound effect.
The antihypertensive effects of irbesartan and thiazide diuretics are additive. In patients who are not adequately controlled with irbesartan alone, the addition of a low dose of hydrochlorothiazide (12.5 mg) to irbesartan once daily produces a greater decrease in BP. , adjusted to placebo, 24 hours after setting (valley), 7-10 / 3-6 mm Hg (PAS / PAD).
The efficacy of Aprovel is independent of age or sex. As with other drugs that work on the renin-angiotensin system, black hypertensive patients have a significantly lower response to irbesartan alone. When irbesartan is administered in combination with a low dose of hydrochlorothiazide (eg 12.5 mg daily), the antihypertensive response of black patients is similar to that of white patients.
There is no clinically significant effect on serum uricemia or uricuria.
Pediatric population
The reduction in blood pressure obtained after titration with irbesartan target doses of 0.5 mg / kg (low), 1.5 mg / kg (mean) and 4.5 mg / kg (high) was evaluated in 318 hypertensive or at risk children and adolescents (diabetic, family history of hypertension) aged 6 to 16 years over a three-week period.
 At the end of the three weeks, the mean decrease from baseline in the primary efficacy endpoint, systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic , 3 mmHg (medium dose) and 13.2 mmHg (high dose).
 No significant difference was found between these doses. The adjusted mean fall in diastolic blood pressure while sitting in the valley (PAD ass) was: 3.8 mm Hg (low dose), 3, 2 mm Hg (medium dose), 5.6 mm Hg (high dose). Over a further two-week period during which patients were re-randomized to the active drug or placebo, placebo-treated patients experienced an increase in SBP of 2.4 mm Hg and a PAD of 2; 0 mm Hg compared with a change of +0.1 and – 0.3 mm Hg respectively for patients taking irbesartan at all doses (see sectionDosage and method of administration ).
Hypertension and type 2 diabetes with kidney involvement
The Irbesartan Diabetic Nephropathy Trial (IDNT) study shows that irbesartan slows the progression of renal impairment in patients with chronic renal failure and proven proteinuria. IDNT is a double-blind, controlled morbidity-mortality study comparing Aprovel, amlodipine and placebo. 
The long-term (on average 2.6 years) effects of Aprovel on progression of renal impairment and all-cause mortality were studied in 1,715 hypertensive diabetic type 2 patients with proteinuria ≥ 900 mg / day and serum creatinine between 1.0 and 3.0 mg / dl. Patients received progressive doses, depending on the tolerability, of 75 mg up to a maintenance dose of 300 mg irbesartan, 2.5 mg up to a dose of 10 mg amlodipine, or a placebo. In all treatment groups, patients generally received 2 to 4 antihypertensives (eg, diuretics, beta-blockers, alpha-blockers) to achieve a predefined blood pressure goal ≤ 135/85 mm Hg or a reduction of 10 mm Hg.
systolic blood pressure if it was> 160 mm Hg in the basal state. Sixty percent (60%) of patients in the placebo group achieved this blood pressure goal and 76% and 78%, respectively, in the irbesartan and amlodipine groups.Irbesartan significantly reduced the relative risk of the combined primary endpoint:
doubling of serum creatinine, end-stage renal disease (ESRD) or all-cause mortality. Approximately 33% of patients in the irbesartan group achieved this primary combined renal outcome compared to 39% and 41% in the placebo and amlodipine groups [relative risk reduction of 20% versus placebo (p = 0.024) and relative risk reduction of 23%). % relative to amlodipine (p = 0.006)]. In the individual analysis of the components of the primary endpoint, no effect on all-cause mortality was observed, while a positive trend in IRT reduction and a significant reduction in serum creatinine doubling were observed. .
The effect of treatment was assessed in subgroups that included gender, race, age, duration of diabetes, baseline blood pressure, serum creatinine, and baseline. albuminuria. In women and the black patient subgroup, which accounted for 32% and 26% of the total study population respectively, renal benefit was not evident, although confidence intervals did not exclude it. . Similarly for the secondary endpoint of fatal and non-fatal cardiovascular events, there was no difference between the three groups in the total population, whereas an increase in the incidence of nonfatal myocardial infarction was observed in women and that a decrease in the incidence of Nonfatal myocardial infarction was observed in men in the irbesartan group versus placebo treatment. An increase in the incidence of nonfatal myocardial infarction and stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced on the global population. However, no particular explanation for these findings in women has been identified. Stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced in the overall population. However, no particular explanation for these findings in women has been identified.Stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced in the overall population. However, no particular explanation for these findings in women has been identified.
The study “Effects of Irbesartan on Microalbuminuria in Hypertensive Patients with Type 2 Diabetes Mellitus (IRMA 2)” shows that irbesartan 300 mg delays progression to proven proteinuria in patients with microalbuminuria. IRMA 2 is a double-blind, placebo-controlled, morbidity study in 590 patients with type 2 diabetes, microalbuminuria (30-300 mg / day) and normal renal function (serum creatinine ≤ 1.5 mg / day). dl in men and <1.1 mg / dl in women). The study evaluated the long-term (2 years) effects of Aprovel on progression to clinical (proven) proteinuria (urinary albumin excretion rate> 300 mg / day and increased TEUA from minus 30% of the basal value). The predefined voltage target was ≤ 135/85 mm Hg. other antihypertensives (with the exception of ACE inhibitors, angiotensin II receptor antagonists, and dihydropyridine calcium channel blockers) were added as needed to achieve the blood pressure goal. While comparable blood pressure was achieved in all treatment groups, fewer patients achieved the proteinuria criterion in the irbesartan 300 mg group (5.2%) than in the placebo groups (14.9%). or irbesartan 150 mg (9.7%), demonstrating for the highest dose a 70% relative risk reduction versus placebo (p = 0.0004). A concomitant improvement in glomerular filtration rate (GFR) was not observed during the first three months of treatment. The slowdown in progression to clinical proteinuria was evident as early as the third month and continued over a 2-year period. Regression to normal albuminuria (<30 mg / day) was more common in the Aprovel 300 mg (34%) group than in the placebo group (21%).
Double blockade of the renin-angiotensin-aldosterone system (RAAS)
The use of a combination of a converting enzyme inhibitor (ACE) with an angiotensin II receptor antagonist (ARB II) was analyzed in two large randomized controlled trials (ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and VA NEPHRON-D (The Veterans Affairs Nephropathy in Diabetes).
The ONTARGET study was conducted in patients with a history of cardiovascular disease or cerebrovascular disease, or type 2 diabetes with target organ involvement. The VA NEPHRON-D study was conducted in type 2 diabetic patients with diabetic nephropathy.
In comparison with monotherapy, these studies did not show any significant beneficial effect on renal and / or cardiovascular outcomes and mortality, whereas an increased risk of hyperkalemia was observed. , acute renal failure and / or hypotension.
These results are also applicable to other IEC and ARA II, given the similarity of their pharmacodynamic properties.
ACE inhibitors and ARBs should not be used in patients with diabetic nephropathy.
aprovel side effects
In placebo-controlled trials in hypertensive patients, the overall incidence of adverse events was not different between the irbesartan group (56.2%) and the placebo group (56.5%). .
Treatment interruptions due to clinical or laboratory adverse events were less frequent in patients treated with irbesartan (3.3%) than in placebo-treated patients (4.5%).
The incidence of adverse events was independent of dosage (within recommended dose range), sex, age, race or duration of treatment.
In diabetic hypertensive patients with microalbuminuria and normal renal function, orthostatic vertigo and orthostatic hypotension were reported in 0.5% (ie, infrequently) patients, but in excess of placebo.
The following adverse events have been reported in placebo-controlled clinical studies in which 1965 patients received irbesartan. In diabetic hypertensive patients with chronic renal failure and overt proteinuria, the marked adverse effects of (*) were reported in more than 2% of patients and in excess of placebo.
The frequency of adverse reactions listed below is defined according to the following convention: very common (≥ 1/10); frequent (≥ 1/100 to <1/10); uncommon (≥1 / 1,000 to <1/100); rare (≥ 1 / 10,000 to <1 / 1,000); very rare (<1 / 10,000). In each frequency group, adverse effects are presented in order of decreasing severity.
Additional adverse reactions reported after marketing are also listed. These side effects come from spontaneous reports.
Immune system disorders:
Not known: hypersensitivity reactions, such as angioedema, rash, urticaria
Metabolism and nutrition disorders:
Not known: hyperkalemia
Nervous system disorders
Common: dizziness, orthostatic vertigo *
Not known: dizziness, headache
Affections of the ear and labyrinth:
Not known: tinnitus
Heart conditions
Uncommon: tachycardia
Vascular disorders
Common: orthostatic hypotension *
Uncommon: Vasomotor flush
Respiratory, thoracic and mediastinal disorders
Uncommon: cough
Gastrointestinal disorders
Common: nausea / vomiting
Uncommon: diarrhea, dyspepsia / heartburn
Not known: dysgeusia
Hepatobiliary disorders
Uncommon: jaundice
Not known: hepatitis, abnormal liver function
Skin and subcutaneous tissue disorders:
Not known: leukocytoclastic vasculitis
Musculoskeletal and systemic disorders
Frequent: musculoskeletal pain *
Not known: arthralgia, myalgia (associated in some cases with increased creatine kinase levels), muscle cramp
Renal and urinary disorders:
Not known: alteration of renal function, including renal failure in patients at risk (see Warnings and Precautions section )
Disorders of reproductive organs and breast
Uncommon: Sexual dysfunction
General disorders and administration site conditions
Frequency: tiredness
Uncommon: chest pain\
investigations:
Very common: hyperkalemia * occurred more often in diabetic patients treated with irbesartan than in those treated with placebo. In diabetic hypertensive patients with microalbuminuria and normal renal function, hyperkalemia (≥ 5.5 mEq / l) occurred in 29.4% (ie, very frequently) patients in the irbesartan 300 mg group. and in 22% of patients in the placebo group. In diabetic hypertensive patients with chronic renal failure and overt proteinuria, hyperkalemia (≥ 5.5 mEq / l) occurred in 46.3% of patients in the irbesartan group and 26.3% of patients in the placebo group.
Frequent: Significant increases in plasma creatine kinase have been observed frequently (1.7%) in subjects treated with irbesartan. None of these increases were associated with clinically identifiable musculoskeletal events.
In 1.7% of hypertensive patients with advanced diabetic renal disease treated with irbesartan, a non-clinically significant decrease in hemoglobin * was observed.
Pediatric population:
In a randomized study that included 318 hypertensive children and adolescents aged 6 to 16 years, the following adverse events were reported during the 3-week double-blind phase: headache (7.9%), hypotension (2.2%) , vertigo (1.9%), cough (0.9%).
 In the 26-week open-label period of this study, the most frequently observed laboratory abnormalities were increases in creatinine (6.5%) and increased CK values ​​in 2% of children receiving the product.
aprovel drug interactions
Diuretics and other antihypertensives : Other antihypertensive agents may increase the hypotensive effects of irbesartan. However, Aprovel has been safely associated with other antihypertensives such as beta-blockers, long-acting calcium antagonists and thiazide diuretics. Previous treatment with high dose diuretics may cause hypovolemia and a risk of hypotension when treatment with Aprovel is started (see Warnings and Precautions ).
Products containing aliskirenor an IEC: Data from clinical trials have shown that double blockade of the renin-angiotensin-aldosterone system (RAAS) by the concomitant use of angiotensin-converting enzyme inhibitors, antagonists Angiotensin II or aliskiren receptors are associated with a higher incidence of adverse events such as hypotension, hyperkalemia, and impaired renal function (including acute renal failure) compared with the use of a single drug acting on the RAAS (see sections Contraindications , Warnings and Precautions for Use and Pharmacodynamic Properties ).
Potassium-sparing potassium supplementation or diuretics: Based on experience with other substances in the renin-angiotensin system, co-administration of Aprovel with potassium-sparing diuretics, potassium supplementation, A diet containing potassium or other drugs that can increase serum potassium levels (eg heparin) may cause elevated serum potassium, and therefore is not recommended (see Warnings and Precautions section ).
Lithium : reversible increases in serum concentrations and lithium toxicity have been reported with angiotensin converting enzyme inhibitors. To date, similar effects have been reported very rarely with irbesartan. Therefore, this association is not recommended (see section Warnings and precautions for use ).If association is needed, strict monitoring of lithemia is recommended.
Non-steroidal anti-inflammatory drugs : When angiotensin II antagonists are administered concomitantly with nonsteroidal anti-inflammatory drugs (ie, selective cyclooxygenase type 2 (COX-2) inhibitors, acetylsalicylic acid (> 3 g / day) and nonselective nonsteroidal anti-inflammatory drugs, an attenuation of the antihypertensive effect of irbesartan may occur.
As with angiotensin converting enzyme inhibitors, the concomitant use of angiotensin II antagonists and nonselective nonsteroidal anti-inflammatory drugs may increase the risk of deterioration of renal function, with the possibility of acute renal failure, and an increase in serum potassium especially in patients with previously impaired renal function. The combination should be administered with caution, especially in the elderly. Patients should be properly hydrated and monitoring of renal function should be considered after initiation of the combination, then periodically.
Other information on irbesartan interactions: In clinical studies, the pharmacokinetics of irbesartan have not been modified by concomitant administration of hydrochlorothiazide. Irbesartan is mainly metabolized by CYP2C9 and to a lesser extent by glucuronidation. No significant pharmacokinetic and pharmacodynamic interactions were observed when irbesartan was administered concomitantly with warfarin, a drug metabolized by CYP2C9. The effects of CYP2C9 inducers, such as rifampicin, on the pharmacokinetics of irbesartan have not been evaluated. The pharmacokinetics of digoxin were not impaired by simultaneous administration of irbesartan.
Warnings and Precautions
Hypovolemia: Symptomatic hypotension, particularly after the first dose, may occur in patients with sodium depletion and / or hypovolemia secondary to intensive diuretic therapy, low sodium diet, diarrhea or vomiting. These abnormalities should be corrected prior to administration of Aprovel.
Renovascular Hypertension : There is an increased risk of severe hypotension and renal failure when patients with bilateral renal artery stenosis or renal arterial stenosis on a single functional kidney receive drugs that act on the renin-renal system. angiotensin-aldosterone. Although this has not been documented with Aprovel, a similar phenomenon is to be expected with angiotensin-II receptor antagonists.
Renal Impairment and Renal Transplantation : When Aprovel is used in patients with impaired renal function, periodic serum potassium and serum creatinine monitoring is recommended. No experience is available regarding the use of Aprovel in patients with recent kidney transplantation.
Type 2 diabetic hypertensive patients with renal impairment : In an analysis of a study in patients with advanced renal impairment, the effects of irbesartan on both renal and cardiovascular events were not uniform at all. across all subgroups. In particular, they appeared less favorable in women and in non-white patients (see section 5.1 Pharmacodynamic properties ).
Hyperkalemia : As with other drugs acting on the renin-angiotensin-aldosterone system, hyperkalaemia may occur during treatment with Aprovel, particularly in the presence of renal insufficiency, proven proteinuria related to renal impairment due to diabetes, and / or heart failure. Close control of serum potassium in these patients at risk is recommended (see section Interactions with other medicinal products and other forms of interaction ).
Lithium : the combination of lithium and Aprovel is not recommended (see section Interactions with other medicinal products and other forms of interaction ).
Stenosis of the aortic and mitral valve, obstructive hypertrophic cardiomyopathy : as with other vasodilators, particular caution is indicated in patients with aortic or mitral stenosis or obstructive hypertrophic cardiomyopathy.
Primary Hyperaldosteronism : Patients with primary hyperaldosteronism do not generally respond to antihypertensive medications acting through inhibition of the renin-angiotensin system. As a result, the use of Aprovel is not recommended.
General : in patients whose vascular tone and renal function are predominantly dependent on renin-angiotensin-aldosterone system activity (eg patients with severe congestive heart failure or underlying renal disease, including stenosis renal arteries), treatment with ACE inhibitors or angiotensin-II receptor antagonists acting on this system has been associated with acute hypotension, azotemia, oliguria or, rarely, renal failure. acute. As with any antihypertensive agents, a sudden drop in blood pressure in patients with ischemic heart disease or
As observed with angiotensin converting enzyme inhibitors, irbesartan and other angiotensin antagonists appear to be less effective in lowering blood pressure in black subjects compared to non-black subjects, probably because of a greater high prevalence of low renin in the black hypertensive population.
Pregnancy: Angiotensin II Receptor Inhibitors (AIIRAs) should not be started during pregnancy. Unless AIIRA treatment is considered essential, it is recommended that the antihypertensive therapy be modified in patients who are planning pregnancy for a drug with an established safety profile during pregnancy. If pregnancy is diagnosed, treatment with AIIRAs should be stopped immediately and if necessary alternative treatment should be started (see sections Contraindications and Pregnancy and breast-feeding ).
Lactose : Due to the presence of lactose, this drug is contraindicated in case of congenital galactosemia, glucose or galactose malabsorption syndrome or lactase deficiency.
Pediatric population : irbesartan has been studied in pediatric populations of 6 to 16 years of age, but current data are insufficient to support an extension of use in children until additional data are available , Pharmacodynamic properties and Pharmacokinetic properties ).
Drive and use machines
Effects on the ability to drive and use machines have not been studied. Based on its pharmacodynamic properties, it is unlikely that irbesartan will affect this ability.
When driving vehicles or using machines, it should be taken into account that vertigo or fatigue may occur during treatment.
PREGNANCY / BREAST FEEDING / FERTILITY:
aprovel for pregnancy
The use of AIIRAs is not recommended during the 1 st  trimester of pregnancy ( see Warnings and Precautions ). The use of AIIRAs is against-indicated to 2 eand 3 e trimesters of pregnancy ( see Contraindications , Warnings and Precautions ).
Epidemiological evidence regarding the risk of teratogenicity following exposure to ACE inhibitors during the 1 st trimester of pregnancy does not suggest. However, a small increase in the risk of congenital malformation can not be ruled out. There are no epidemiological studies available on the use of AIIRAs at 1 st trimester of pregnancy, however a similar risk to IEC could exist for this class. Unless AIIRA treatment is considered essential, it is recommended that antihypertensive therapy be modified in patients who are planning pregnancy for a drug with an established safety profile during pregnancy. If pregnancy is diagnosed, treatment with AIIRAs should be stopped immediately and, if necessary, alternative treatment should be initiated.
Exposure to AIIRA therapy during the 2 e and 3 e  trimesters is known to induce human fetotoxicity (decreased renal function, oligohydramnios, delayed ossification of the skull) and toxicity in the newborn ( renal insufficiency, hypotension, hyperkalemia): see Preclinical safety .
If exposure to angiotensin II receptor antagonists from 2 th  trimester of pregnancy, it is recommended to do a fetal ultrasound check of renal function and the bones of the skull.
Infants born to mothers treated with AIIRAs should be monitored for blood pressure ( see Contraindications , Warnings and Precautions ).
Breastfeeding
No information is available regarding the use of Aprovel during breastfeeding, so Aprovel is not recommended.
 It is advisable to use alternative treatments with a better established safety profile during breastfeeding, especially for breastfeeding newborns and premature infants.
It is not known whether irbesartan and its metabolites are excreted in milk in women.
Available pharmacodynamic and toxicological data in rats have shown that irbesartan and its metabolites are excreted in milk ( see Preclinical Safety).
Fertility
Irbesartan did not show any effects on the fertility of the treated rats and their progeny up to the doses leading to the first signs of parental toxicity ( see Preclinical safety ).
What happens if I overdose from Aprovel ?
No toxicity has been reported following exposure of adults at doses up to 900 mg / day for 8 weeks. In case of overdose, the most likely clinical signs would be hypotension and tachycardia. Bradycardia may also occur.
 No specific information is available on treatment for overdosage with irbesartan.
The patient should be under close supervision and symptomatic and supportive treatment should be instituted. Measures such as inducing vomiting and / or gastric lavage are suggested.
 Activated charcoal may be useful in the treatment of overdose. Irbesartan is not hemodialysable.
What is  Forms and Composition?
FORMS and PRESENTATIONS
75 mg film-coated tablet (biconvex, oval, with a heart on one side, and number 2871 on the other side, white to cream-white):   Boxes of 30 and 90, in blister packs of 15. Film-coated tablet 150 mg (biconvex, oval, with a heart on one side, and the number 2872 engraved on the other side, white to cream-white):  Boxes of 30 and 90, in blister packs of 15. 300 mg film-coated tablet ( biconvex, oval, with a heart on one side, and the number 2873 engraved on the other side, white to cream-white):   Boxes of 30 and 90, under blister packs of 10. Hospital models (all dosages): Boxes of 56 × 1 tablet under blister packs of 8 for single delivery.
COMPOSITION
 p cpIrbesartan (DCI)75 mgor150mgor300 mg
Excipients (common): lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromellose, silicon dioxide, magnesium stearate. Film coating:
 lactose monohydrate, hypromellose, titanium dioxide (E 171), macrogol 3000, carnauba wax.
Lactose content monohydrate: 25.50 mg / cw at 75 mg, 51 mg / cw at 150 mg, 102 mg / cw at 300 mg.
NOT’s
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Additional information:
General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.
Special warnings:
For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.
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It treats possible side effects and drug interactions that require attention and its effect on continuous use.
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Aprovel review Uses, Dosage, Side Effects, Precautions &Warnings
Drug Online
aprovel generic drug of the therapeutic class: Cardiology and angiology
active ingredients: Irbesartan
What is Aprovel 300mg used for and indication?
Aprovel is indicated in adults for the treatment of essential hypertension.
It is also indicated for the treatment of renal impairment in adult hypertensive patients with type 2 diabetes, in the context of management with an antihypertensive drug (see sections Contraindications , Warnings and precautions for use , Interactions with other medicinal products and other forms of interaction andpharmacodynamic properties ).
ِِAprovel 150 mg | 300 mg dosage
Dosage The recommended starting and usual maintenance dose is 150 mg given as a single dose daily during or after meals. Aprovel at a dose of 150 mg once a day usually provides better control of blood pressure over 24 hours than the 75 mg dose. However, initiation of treatment with 75 mg daily may be considered particularly in hemodialysis patients or patients over 75 years of age.
ِِAprovel 150 mg | 300 mg dosage
In patients inadequately controlled at 150 mg once daily, the dosage may be increased to 300 mg or another antihypertensive agent may be added. In particular, the addition of a diuretic such as hydrochlorothiazide has been shown to have an additive effect with Aprovel (see section Interactions with other medicinal products and other forms of interaction ).
In hypertensive patients with type 2 diabetes, treatment should be initiated at a dose of 150 mg irbesartan once daily and increased to 300 mg once daily, a preferable maintenance dose for the treatment of renal impairment. . The demonstration of the renal benefit of Aprovel in hypertensive patients with type 2 diabetes is based on studies in which irbesartan was used, if necessary, in addition to other antihypertensive agents to achieve a blood pressure goal  . Pharmacodynamic properties). Special populations
Renal Insufficiency: No dose adjustment is required in patients with renal impairment. A lower starting dose (75 mg) should be considered in patients undergoing hemodialysis (see section 4.4 Special warnings and precautions for use ).
Hepatic impairment: No dose adjustment is required in patients with mild to moderate hepatic impairment. There is no clinical experience in patients with severe hepatic impairment.
Elderly: Apart from subjects over 75 years of age, in whom treatment may be initiated at a dose of 75 mg / day, no dose adjustment is usually necessary in the elderly.
Pediatric population: The efficacy and safety of Aprovel in children aged 0 to 18 years has not been established. The available data are described in the Adverse Reactions, Pharmacodynamic Properties and Pharmacokinetic Properties sections, but no dosage recommendations can be made.
Administration mode
Oral way.
How it works Aprovel
Pharmacotherapeutic group: Antagonists of angiotensin-II receptors, ATC code C09C A04.
Mechanism of action: Irbesartan is a potent selective angiotensin-II receptor antagonist (type AT 1 ), active orally. Irbesartan blocks all the effects of angiotensin-II, involving AT 1 receptors , regardless of the origin or route of synthesis of angiotensin-II. Selective antagonism of angiotensin-II receptors (AT 1) causes elevated renin plasma levels and angiotensin-II levels and a decrease in plasma aldosterone concentration.
 Serum potassium is not significantly affected by irbesartan alone at the recommended doses. Irbesartan does not inhibit ACE (kininase-II), an enzyme that generates angiotensin-II formation and also degrades bradykinin into inactive metabolites. Irbesartan does not require metabolic activation to be active.
Clinical effectiveness:
Hypertension
Irbesartan lowers blood pressure by causing minimal changes in heart rate. The drop in blood pressure is dose-dependent with a tendency to plateau at doses greater than 300 mg once a day. Daily doses of 150 to 300 mg lower the blood pressure values, supine or sitting, by an average of 8-13 / 5-8 mm Hg (PAS / PAD) at the 24th hour after catch (valley). This decrease is greater than that observed with placebo.
The maximum drop in blood pressure is achieved within 3 to 6 hours after administration of the product. The antihypertensive effect is maintained for at least 24 hours. At 24 hours, the drop in blood pressure is still 60 to 70% of the diastolic and systolic peak, at the recommended doses. A dose of 150 mg, taken once a day, produces similar effects on blood pressure 24 hours after dosing (valley) and on 24-hour average blood pressure than the same dose divided into 2 doses per day.
The antihypertensive effect of Aprovel occurs within one to two weeks, with peak effect occurring four to six weeks after the start of treatment. Antihypertensive effects are maintained during long-term treatments. The blood pressure gradually returns to its initial state after stopping treatment. Stopping the treatment does not result in a rebound effect.
The antihypertensive effects of irbesartan and thiazide diuretics are additive. In patients who are not adequately controlled with irbesartan alone, the addition of a low dose of hydrochlorothiazide (12.5 mg) to irbesartan once daily produces a greater decrease in BP. , adjusted to placebo, 24 hours after setting (valley), 7-10 / 3-6 mm Hg (PAS / PAD).
The efficacy of Aprovel is independent of age or sex. As with other drugs that work on the renin-angiotensin system, black hypertensive patients have a significantly lower response to irbesartan alone. When irbesartan is administered in combination with a low dose of hydrochlorothiazide (eg 12.5 mg daily), the antihypertensive response of black patients is similar to that of white patients.
There is no clinically significant effect on serum uricemia or uricuria.
Pediatric population
The reduction in blood pressure obtained after titration with irbesartan target doses of 0.5 mg / kg (low), 1.5 mg / kg (mean) and 4.5 mg / kg (high) was evaluated in 318 hypertensive or at risk children and adolescents (diabetic, family history of hypertension) aged 6 to 16 years over a three-week period.
 At the end of the three weeks, the mean decrease from baseline in the primary efficacy endpoint, systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic , 3 mmHg (medium dose) and 13.2 mmHg (high dose).
 No significant difference was found between these doses. The adjusted mean fall in diastolic blood pressure while sitting in the valley (PAD ass) was: 3.8 mm Hg (low dose), 3, 2 mm Hg (medium dose), 5.6 mm Hg (high dose). Over a further two-week period during which patients were re-randomized to the active drug or placebo, placebo-treated patients experienced an increase in SBP of 2.4 mm Hg and a PAD of 2; 0 mm Hg compared with a change of +0.1 and – 0.3 mm Hg respectively for patients taking irbesartan at all doses (see sectionDosage and method of administration ).
Hypertension and type 2 diabetes with kidney involvement
The Irbesartan Diabetic Nephropathy Trial (IDNT) study shows that irbesartan slows the progression of renal impairment in patients with chronic renal failure and proven proteinuria. IDNT is a double-blind, controlled morbidity-mortality study comparing Aprovel, amlodipine and placebo. 
The long-term (on average 2.6 years) effects of Aprovel on progression of renal impairment and all-cause mortality were studied in 1,715 hypertensive diabetic type 2 patients with proteinuria ≥ 900 mg / day and serum creatinine between 1.0 and 3.0 mg / dl. Patients received progressive doses, depending on the tolerability, of 75 mg up to a maintenance dose of 300 mg irbesartan, 2.5 mg up to a dose of 10 mg amlodipine, or a placebo. In all treatment groups, patients generally received 2 to 4 antihypertensives (eg, diuretics, beta-blockers, alpha-blockers) to achieve a predefined blood pressure goal ≤ 135/85 mm Hg or a reduction of 10 mm Hg.
systolic blood pressure if it was> 160 mm Hg in the basal state. Sixty percent (60%) of patients in the placebo group achieved this blood pressure goal and 76% and 78%, respectively, in the irbesartan and amlodipine groups.Irbesartan significantly reduced the relative risk of the combined primary endpoint:
doubling of serum creatinine, end-stage renal disease (ESRD) or all-cause mortality. Approximately 33% of patients in the irbesartan group achieved this primary combined renal outcome compared to 39% and 41% in the placebo and amlodipine groups [relative risk reduction of 20% versus placebo (p = 0.024) and relative risk reduction of 23%). % relative to amlodipine (p = 0.006)]. In the individual analysis of the components of the primary endpoint, no effect on all-cause mortality was observed, while a positive trend in IRT reduction and a significant reduction in serum creatinine doubling were observed. .
The effect of treatment was assessed in subgroups that included gender, race, age, duration of diabetes, baseline blood pressure, serum creatinine, and baseline. albuminuria. In women and the black patient subgroup, which accounted for 32% and 26% of the total study population respectively, renal benefit was not evident, although confidence intervals did not exclude it. . Similarly for the secondary endpoint of fatal and non-fatal cardiovascular events, there was no difference between the three groups in the total population, whereas an increase in the incidence of nonfatal myocardial infarction was observed in women and that a decrease in the incidence of Nonfatal myocardial infarction was observed in men in the irbesartan group versus placebo treatment. An increase in the incidence of nonfatal myocardial infarction and stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced on the global population. However, no particular explanation for these findings in women has been identified. Stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced in the overall population. However, no particular explanation for these findings in women has been identified.Stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced in the overall population. However, no particular explanation for these findings in women has been identified.
The study “Effects of Irbesartan on Microalbuminuria in Hypertensive Patients with Type 2 Diabetes Mellitus (IRMA 2)” shows that irbesartan 300 mg delays progression to proven proteinuria in patients with microalbuminuria. IRMA 2 is a double-blind, placebo-controlled, morbidity study in 590 patients with type 2 diabetes, microalbuminuria (30-300 mg / day) and normal renal function (serum creatinine ≤ 1.5 mg / day). dl in men and <1.1 mg / dl in women). The study evaluated the long-term (2 years) effects of Aprovel on progression to clinical (proven) proteinuria (urinary albumin excretion rate> 300 mg / day and increased TEUA from minus 30% of the basal value). The predefined voltage target was ≤ 135/85 mm Hg. other antihypertensives (with the exception of ACE inhibitors, angiotensin II receptor antagonists, and dihydropyridine calcium channel blockers) were added as needed to achieve the blood pressure goal. While comparable blood pressure was achieved in all treatment groups, fewer patients achieved the proteinuria criterion in the irbesartan 300 mg group (5.2%) than in the placebo groups (14.9%). or irbesartan 150 mg (9.7%), demonstrating for the highest dose a 70% relative risk reduction versus placebo (p = 0.0004). A concomitant improvement in glomerular filtration rate (GFR) was not observed during the first three months of treatment. The slowdown in progression to clinical proteinuria was evident as early as the third month and continued over a 2-year period. Regression to normal albuminuria (<30 mg / day) was more common in the Aprovel 300 mg (34%) group than in the placebo group (21%).
Double blockade of the renin-angiotensin-aldosterone system (RAAS)
The use of a combination of a converting enzyme inhibitor (ACE) with an angiotensin II receptor antagonist (ARB II) was analyzed in two large randomized controlled trials (ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and VA NEPHRON-D (The Veterans Affairs Nephropathy in Diabetes).
The ONTARGET study was conducted in patients with a history of cardiovascular disease or cerebrovascular disease, or type 2 diabetes with target organ involvement. The VA NEPHRON-D study was conducted in type 2 diabetic patients with diabetic nephropathy.
In comparison with monotherapy, these studies did not show any significant beneficial effect on renal and / or cardiovascular outcomes and mortality, whereas an increased risk of hyperkalemia was observed. , acute renal failure and / or hypotension.
These results are also applicable to other IEC and ARA II, given the similarity of their pharmacodynamic properties.
ACE inhibitors and ARBs should not be used in patients with diabetic nephropathy.
aprovel side effects
In placebo-controlled trials in hypertensive patients, the overall incidence of adverse events was not different between the irbesartan group (56.2%) and the placebo group (56.5%). .
Treatment interruptions due to clinical or laboratory adverse events were less frequent in patients treated with irbesartan (3.3%) than in placebo-treated patients (4.5%).
The incidence of adverse events was independent of dosage (within recommended dose range), sex, age, race or duration of treatment.
In diabetic hypertensive patients with microalbuminuria and normal renal function, orthostatic vertigo and orthostatic hypotension were reported in 0.5% (ie, infrequently) patients, but in excess of placebo.
The following adverse events have been reported in placebo-controlled clinical studies in which 1965 patients received irbesartan. In diabetic hypertensive patients with chronic renal failure and overt proteinuria, the marked adverse effects of (*) were reported in more than 2% of patients and in excess of placebo.
The frequency of adverse reactions listed below is defined according to the following convention: very common (≥ 1/10); frequent (≥ 1/100 to <1/10); uncommon (≥1 / 1,000 to <1/100); rare (≥ 1 / 10,000 to <1 / 1,000); very rare (<1 / 10,000). In each frequency group, adverse effects are presented in order of decreasing severity.
Additional adverse reactions reported after marketing are also listed. These side effects come from spontaneous reports.
Immune system disorders:
Not known: hypersensitivity reactions, such as angioedema, rash, urticaria
Metabolism and nutrition disorders:
Not known: hyperkalemia
Nervous system disorders
Common: dizziness, orthostatic vertigo *
Not known: dizziness, headache
Affections of the ear and labyrinth:
Not known: tinnitus
Heart conditions
Uncommon: tachycardia
Vascular disorders
Common: orthostatic hypotension *
Uncommon: Vasomotor flush
Respiratory, thoracic and mediastinal disorders
Uncommon: cough
Gastrointestinal disorders
Common: nausea / vomiting
Uncommon: diarrhea, dyspepsia / heartburn
Not known: dysgeusia
Hepatobiliary disorders
Uncommon: jaundice
Not known: hepatitis, abnormal liver function
Skin and subcutaneous tissue disorders:
Not known: leukocytoclastic vasculitis
Musculoskeletal and systemic disorders
Frequent: musculoskeletal pain *
Not known: arthralgia, myalgia (associated in some cases with increased creatine kinase levels), muscle cramp
Renal and urinary disorders:
Not known: alteration of renal function, including renal failure in patients at risk (see Warnings and Precautions section )
Disorders of reproductive organs and breast
Uncommon: Sexual dysfunction
General disorders and administration site conditions
Frequency: tiredness
Uncommon: chest pain\
investigations:
Very common: hyperkalemia * occurred more often in diabetic patients treated with irbesartan than in those treated with placebo. In diabetic hypertensive patients with microalbuminuria and normal renal function, hyperkalemia (≥ 5.5 mEq / l) occurred in 29.4% (ie, very frequently) patients in the irbesartan 300 mg group. and in 22% of patients in the placebo group. In diabetic hypertensive patients with chronic renal failure and overt proteinuria, hyperkalemia (≥ 5.5 mEq / l) occurred in 46.3% of patients in the irbesartan group and 26.3% of patients in the placebo group.
Frequent: Significant increases in plasma creatine kinase have been observed frequently (1.7%) in subjects treated with irbesartan. None of these increases were associated with clinically identifiable musculoskeletal events.
In 1.7% of hypertensive patients with advanced diabetic renal disease treated with irbesartan, a non-clinically significant decrease in hemoglobin * was observed.
Pediatric population:
In a randomized study that included 318 hypertensive children and adolescents aged 6 to 16 years, the following adverse events were reported during the 3-week double-blind phase: headache (7.9%), hypotension (2.2%) , vertigo (1.9%), cough (0.9%).
 In the 26-week open-label period of this study, the most frequently observed laboratory abnormalities were increases in creatinine (6.5%) and increased CK values ​​in 2% of children receiving the product.
aprovel drug interactions
Diuretics and other antihypertensives : Other antihypertensive agents may increase the hypotensive effects of irbesartan. However, Aprovel has been safely associated with other antihypertensives such as beta-blockers, long-acting calcium antagonists and thiazide diuretics. Previous treatment with high dose diuretics may cause hypovolemia and a risk of hypotension when treatment with Aprovel is started (see Warnings and Precautions ).
Products containing aliskirenor an IEC: Data from clinical trials have shown that double blockade of the renin-angiotensin-aldosterone system (RAAS) by the concomitant use of angiotensin-converting enzyme inhibitors, antagonists Angiotensin II or aliskiren receptors are associated with a higher incidence of adverse events such as hypotension, hyperkalemia, and impaired renal function (including acute renal failure) compared with the use of a single drug acting on the RAAS (see sections Contraindications , Warnings and Precautions for Use and Pharmacodynamic Properties ).
Potassium-sparing potassium supplementation or diuretics: Based on experience with other substances in the renin-angiotensin system, co-administration of Aprovel with potassium-sparing diuretics, potassium supplementation, A diet containing potassium or other drugs that can increase serum potassium levels (eg heparin) may cause elevated serum potassium, and therefore is not recommended (see Warnings and Precautions section ).
Lithium : reversible increases in serum concentrations and lithium toxicity have been reported with angiotensin converting enzyme inhibitors. To date, similar effects have been reported very rarely with irbesartan. Therefore, this association is not recommended (see section Warnings and precautions for use ).If association is needed, strict monitoring of lithemia is recommended.
Non-steroidal anti-inflammatory drugs : When angiotensin II antagonists are administered concomitantly with nonsteroidal anti-inflammatory drugs (ie, selective cyclooxygenase type 2 (COX-2) inhibitors, acetylsalicylic acid (> 3 g / day) and nonselective nonsteroidal anti-inflammatory drugs, an attenuation of the antihypertensive effect of irbesartan may occur.
As with angiotensin converting enzyme inhibitors, the concomitant use of angiotensin II antagonists and nonselective nonsteroidal anti-inflammatory drugs may increase the risk of deterioration of renal function, with the possibility of acute renal failure, and an increase in serum potassium especially in patients with previously impaired renal function. The combination should be administered with caution, especially in the elderly. Patients should be properly hydrated and monitoring of renal function should be considered after initiation of the combination, then periodically.
Other information on irbesartan interactions: In clinical studies, the pharmacokinetics of irbesartan have not been modified by concomitant administration of hydrochlorothiazide. Irbesartan is mainly metabolized by CYP2C9 and to a lesser extent by glucuronidation. No significant pharmacokinetic and pharmacodynamic interactions were observed when irbesartan was administered concomitantly with warfarin, a drug metabolized by CYP2C9. The effects of CYP2C9 inducers, such as rifampicin, on the pharmacokinetics of irbesartan have not been evaluated. The pharmacokinetics of digoxin were not impaired by simultaneous administration of irbesartan.
Aprovel Warnings and Precautions
Hypovolemia: Symptomatic hypotension, particularly after the first dose, may occur in patients with sodium depletion and / or hypovolemia secondary to intensive diuretic therapy, low sodium diet, diarrhea or vomiting. These abnormalities should be corrected prior to administration of Aprovel.
Renovascular Hypertension : There is an increased risk of severe hypotension and renal failure when patients with bilateral renal artery stenosis or renal arterial stenosis on a single functional kidney receive drugs that act on the renin-renal system. angiotensin-aldosterone. Although this has not been documented with Aprovel, a similar phenomenon is to be expected with angiotensin-II receptor antagonists.
Renal Impairment and Renal Transplantation : When Aprovel is used in patients with impaired renal function, periodic serum potassium and serum creatinine monitoring is recommended. No experience is available regarding the use of Aprovel in patients with recent kidney transplantation.
Type 2 diabetic hypertensive patients with renal impairment : In an analysis of a study in patients with advanced renal impairment, the effects of irbesartan on both renal and cardiovascular events were not uniform at all. across all subgroups. In particular, they appeared less favorable in women and in non-white patients (see section 5.1 Pharmacodynamic properties ).
Hyperkalemia : As with other drugs acting on the renin-angiotensin-aldosterone system, hyperkalaemia may occur during treatment with Aprovel, particularly in the presence of renal insufficiency, proven proteinuria related to renal impairment due to diabetes, and / or heart failure. Close control of serum potassium in these patients at risk is recommended (see section Interactions with other medicinal products and other forms of interaction ).
Lithium : the combination of lithium and Aprovel is not recommended (see section Interactions with other medicinal products and other forms of interaction ).
Stenosis of the aortic and mitral valve, obstructive hypertrophic cardiomyopathy : as with other vasodilators, particular caution is indicated in patients with aortic or mitral stenosis or obstructive hypertrophic cardiomyopathy.
Primary Hyperaldosteronism : Patients with primary hyperaldosteronism do not generally respond to antihypertensive medications acting through inhibition of the renin-angiotensin system. As a result, the use of Aprovel is not recommended.
General : in patients whose vascular tone and renal function are predominantly dependent on renin-angiotensin-aldosterone system activity (eg patients with severe congestive heart failure or underlying renal disease, including stenosis renal arteries), treatment with ACE inhibitors or angiotensin-II receptor antagonists acting on this system has been associated with acute hypotension, azotemia, oliguria or, rarely, renal failure. acute. As with any antihypertensive agents, a sudden drop in blood pressure in patients with ischemic heart disease or
As observed with angiotensin converting enzyme inhibitors, irbesartan and other angiotensin antagonists appear to be less effective in lowering blood pressure in black subjects compared to non-black subjects, probably because of a greater high prevalence of low renin in the black hypertensive population.
Pregnancy: Angiotensin II Receptor Inhibitors (AIIRAs) should not be started during pregnancy. Unless AIIRA treatment is considered essential, it is recommended that the antihypertensive therapy be modified in patients who are planning pregnancy for a drug with an established safety profile during pregnancy. If pregnancy is diagnosed, treatment with AIIRAs should be stopped immediately and if necessary alternative treatment should be started (see sections Contraindications and Pregnancy and breast-feeding ).
Lactose : Due to the presence of lactose, this drug is contraindicated in case of congenital galactosemia, glucose or galactose malabsorption syndrome or lactase deficiency.
Pediatric population : irbesartan has been studied in pediatric populations of 6 to 16 years of age, but current data are insufficient to support an extension of use in children until additional data are available , Pharmacodynamic properties and Pharmacokinetic properties ).
Drive and use machines
Effects on the ability to drive and use machines have not been studied. Based on its pharmacodynamic properties, it is unlikely that irbesartan will affect this ability. When driving vehicles or using machines, it should be taken into account that vertigo or fatigue may occur during treatment.
Aprovel and PREGNANCY / BREAST FEEDING / FERTILITY:
Pregnancy :
The use of AIIRAs is not recommended during the 1 st  trimester of pregnancy ( see Warnings and Precautions ). The use of AIIRAs is against-indicated to 2 eand 3 e trimesters of pregnancy ( see Contraindications , Warnings and Precautions ).
Epidemiological evidence regarding the risk of teratogenicity following exposure to ACE inhibitors during the 1 st trimester of pregnancy does not suggest. However, a small increase in the risk of congenital malformation can not be ruled out. There are no epidemiological studies available on the use of AIIRAs at 1 st trimester of pregnancy, however a similar risk to IEC could exist for this class. Unless AIIRA treatment is considered essential, it is recommended that antihypertensive therapy be modified in patients who are planning pregnancy for a drug with an established safety profile during pregnancy. If pregnancy is diagnosed, treatment with AIIRAs should be stopped immediately and, if necessary, alternative treatment should be initiated.
Exposure to AIIRA therapy during the 2 e and 3 e  trimesters is known to induce human fetotoxicity (decreased renal function, oligohydramnios, delayed ossification of the skull) and toxicity in the newborn ( renal insufficiency, hypotension, hyperkalemia): see Preclinical safety .
If exposure to angiotensin II receptor antagonists from 2 th  trimester of pregnancy, it is recommended to do a fetal ultrasound check of renal function and the bones of the skull.
Infants born to mothers treated with AIIRAs should be monitored for blood pressure ( see Contraindications , Warnings and Precautions ).
Breastfeeding:
No information is available regarding the use of Aprovel during breastfeeding, so Aprovel is not recommended.
 It is advisable to use alternative treatments with a better established safety profile during breastfeeding, especially for breastfeeding newborns and premature infants.
It is not known whether irbesartan and its metabolites are excreted in milk in women.
Available pharmacodynamic and toxicological data in rats have shown that irbesartan and its metabolites are excreted in milk ( see Preclinical Safety).
Fertility:
Irbesartan did not show any effects on the fertility of the treated rats and their progeny up to the doses leading to the first signs of parental toxicity ( see Preclinical safety ).
What happens if I overdose from Aprovel ?
No toxicity has been reported following exposure of adults at doses up to 900 mg / day for 8 weeks. In case of overdose, the most likely clinical signs would be hypotension and tachycardia. Bradycardia may also occur.
 No specific information is available on treatment for overdosage with irbesartan.
The patient should be under close supervision and symptomatic and supportive treatment should be instituted. Measures such as inducing vomiting and / or gastric lavage are suggested.
 Activated charcoal may be useful in the treatment of overdose. Irbesartan is not hemodialysable.
What is  Forms and Composition Aprovel?
FORMS and PRESENTATIONS
75 mg film-coated tablet (biconvex, oval, with a heart on one side, and number 2871 on the other side, white to cream-white):   Boxes of 30 and 90, in blister packs of 15. Film-coated tablet 150 mg (biconvex, oval, with a heart on one side, and the number 2872 engraved on the other side, white to cream-white):  Boxes of 30 and 90, in blister packs of 15. 300 mg film-coated tablet ( biconvex, oval, with a heart on one side, and the number 2873 engraved on the other side, white to cream-white):   Boxes of 30 and 90, under blister packs of 10. Hospital models (all dosages): Boxes of 56 × 1 tablet under blister packs of 8 for single delivery.
COMPOSITION
  p cp Irbesartan (DCI) 75 mg or 150mg or 300 mg
Excipients (common): lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromellose, silicon dioxide, magnesium stearate. Film coating:
 lactose monohydrate, hypromellose, titanium dioxide (E 171), macrogol 3000, carnauba wax.
Lactose content monohydrate: 25.50 mg / cw at 75 mg, 51 mg / cw at 150 mg, 102 mg / cw at 300 mg.
NOT’s
Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:
general information:
Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles
Additional information:
General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.
Special warnings:
For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.
Side effects:
It treats possible side effects and drug interactions that require attention and its effect on continuous use.
The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.
The post Aprovel review Uses, Dosage, Side Effects, Precautions &Warnings appeared first on Drug Online.
from Drug Online https://bit.ly/2CkIW4y via Edrug Online from faculty of medicine https://bit.ly/313A11K via Faculty of Medicine
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colinfitzpatrick · 4 years
Text
Aprovel review Uses, Dosage, Side Effects, Precautions &Warnings
Drug Online
aprovel generic drug of the therapeutic class: Cardiology and angiology
active ingredients: Irbesartan
What is Aprovel 300mg used for and indication?
Aprovel is indicated in adults for the treatment of essential hypertension.
It is also indicated for the treatment of renal impairment in adult hypertensive patients with type 2 diabetes, in the context of management with an antihypertensive drug (see sections Contraindications , Warnings and precautions for use , Interactions with other medicinal products and other forms of interaction andpharmacodynamic properties ).
ِِAprovel 150 mg | 300 mg dosage
Dosage The recommended starting and usual maintenance dose is 150 mg given as a single dose daily during or after meals. Aprovel at a dose of 150 mg once a day usually provides better control of blood pressure over 24 hours than the 75 mg dose. However, initiation of treatment with 75 mg daily may be considered particularly in hemodialysis patients or patients over 75 years of age.
ِِAprovel 150 mg | 300 mg dosage
In patients inadequately controlled at 150 mg once daily, the dosage may be increased to 300 mg or another antihypertensive agent may be added. In particular, the addition of a diuretic such as hydrochlorothiazide has been shown to have an additive effect with Aprovel (see section Interactions with other medicinal products and other forms of interaction ).
In hypertensive patients with type 2 diabetes, treatment should be initiated at a dose of 150 mg irbesartan once daily and increased to 300 mg once daily, a preferable maintenance dose for the treatment of renal impairment. . The demonstration of the renal benefit of Aprovel in hypertensive patients with type 2 diabetes is based on studies in which irbesartan was used, if necessary, in addition to other antihypertensive agents to achieve a blood pressure goal  . Pharmacodynamic properties). Special populations
Renal Insufficiency: No dose adjustment is required in patients with renal impairment. A lower starting dose (75 mg) should be considered in patients undergoing hemodialysis (see section 4.4 Special warnings and precautions for use ).
Hepatic impairment: No dose adjustment is required in patients with mild to moderate hepatic impairment. There is no clinical experience in patients with severe hepatic impairment.
Elderly: Apart from subjects over 75 years of age, in whom treatment may be initiated at a dose of 75 mg / day, no dose adjustment is usually necessary in the elderly.
Pediatric population: The efficacy and safety of Aprovel in children aged 0 to 18 years has not been established. The available data are described in the Adverse Reactions, Pharmacodynamic Properties and Pharmacokinetic Properties sections, but no dosage recommendations can be made.
Administration mode
Oral way.
How it works Aprovel
Pharmacotherapeutic group: Antagonists of angiotensin-II receptors, ATC code C09C A04.
Mechanism of action: Irbesartan is a potent selective angiotensin-II receptor antagonist (type AT 1 ), active orally. Irbesartan blocks all the effects of angiotensin-II, involving AT 1 receptors , regardless of the origin or route of synthesis of angiotensin-II. Selective antagonism of angiotensin-II receptors (AT 1) causes elevated renin plasma levels and angiotensin-II levels and a decrease in plasma aldosterone concentration.
 Serum potassium is not significantly affected by irbesartan alone at the recommended doses. Irbesartan does not inhibit ACE (kininase-II), an enzyme that generates angiotensin-II formation and also degrades bradykinin into inactive metabolites. Irbesartan does not require metabolic activation to be active.
Clinical effectiveness:
Hypertension
Irbesartan lowers blood pressure by causing minimal changes in heart rate. The drop in blood pressure is dose-dependent with a tendency to plateau at doses greater than 300 mg once a day. Daily doses of 150 to 300 mg lower the blood pressure values, supine or sitting, by an average of 8-13 / 5-8 mm Hg (PAS / PAD) at the 24th hour after catch (valley). This decrease is greater than that observed with placebo.
The maximum drop in blood pressure is achieved within 3 to 6 hours after administration of the product. The antihypertensive effect is maintained for at least 24 hours. At 24 hours, the drop in blood pressure is still 60 to 70% of the diastolic and systolic peak, at the recommended doses. A dose of 150 mg, taken once a day, produces similar effects on blood pressure 24 hours after dosing (valley) and on 24-hour average blood pressure than the same dose divided into 2 doses per day.
The antihypertensive effect of Aprovel occurs within one to two weeks, with peak effect occurring four to six weeks after the start of treatment. Antihypertensive effects are maintained during long-term treatments. The blood pressure gradually returns to its initial state after stopping treatment. Stopping the treatment does not result in a rebound effect.
The antihypertensive effects of irbesartan and thiazide diuretics are additive. In patients who are not adequately controlled with irbesartan alone, the addition of a low dose of hydrochlorothiazide (12.5 mg) to irbesartan once daily produces a greater decrease in BP. , adjusted to placebo, 24 hours after setting (valley), 7-10 / 3-6 mm Hg (PAS / PAD).
The efficacy of Aprovel is independent of age or sex. As with other drugs that work on the renin-angiotensin system, black hypertensive patients have a significantly lower response to irbesartan alone. When irbesartan is administered in combination with a low dose of hydrochlorothiazide (eg 12.5 mg daily), the antihypertensive response of black patients is similar to that of white patients.
There is no clinically significant effect on serum uricemia or uricuria.
Pediatric population
The reduction in blood pressure obtained after titration with irbesartan target doses of 0.5 mg / kg (low), 1.5 mg / kg (mean) and 4.5 mg / kg (high) was evaluated in 318 hypertensive or at risk children and adolescents (diabetic, family history of hypertension) aged 6 to 16 years over a three-week period.
 At the end of the three weeks, the mean decrease from baseline in the primary efficacy endpoint, systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic , 3 mmHg (medium dose) and 13.2 mmHg (high dose).
 No significant difference was found between these doses. The adjusted mean fall in diastolic blood pressure while sitting in the valley (PAD ass) was: 3.8 mm Hg (low dose), 3, 2 mm Hg (medium dose), 5.6 mm Hg (high dose). Over a further two-week period during which patients were re-randomized to the active drug or placebo, placebo-treated patients experienced an increase in SBP of 2.4 mm Hg and a PAD of 2; 0 mm Hg compared with a change of +0.1 and – 0.3 mm Hg respectively for patients taking irbesartan at all doses (see sectionDosage and method of administration ).
Hypertension and type 2 diabetes with kidney involvement
The Irbesartan Diabetic Nephropathy Trial (IDNT) study shows that irbesartan slows the progression of renal impairment in patients with chronic renal failure and proven proteinuria. IDNT is a double-blind, controlled morbidity-mortality study comparing Aprovel, amlodipine and placebo. 
The long-term (on average 2.6 years) effects of Aprovel on progression of renal impairment and all-cause mortality were studied in 1,715 hypertensive diabetic type 2 patients with proteinuria ≥ 900 mg / day and serum creatinine between 1.0 and 3.0 mg / dl. Patients received progressive doses, depending on the tolerability, of 75 mg up to a maintenance dose of 300 mg irbesartan, 2.5 mg up to a dose of 10 mg amlodipine, or a placebo. In all treatment groups, patients generally received 2 to 4 antihypertensives (eg, diuretics, beta-blockers, alpha-blockers) to achieve a predefined blood pressure goal ≤ 135/85 mm Hg or a reduction of 10 mm Hg.
systolic blood pressure if it was> 160 mm Hg in the basal state. Sixty percent (60%) of patients in the placebo group achieved this blood pressure goal and 76% and 78%, respectively, in the irbesartan and amlodipine groups.Irbesartan significantly reduced the relative risk of the combined primary endpoint:
doubling of serum creatinine, end-stage renal disease (ESRD) or all-cause mortality. Approximately 33% of patients in the irbesartan group achieved this primary combined renal outcome compared to 39% and 41% in the placebo and amlodipine groups [relative risk reduction of 20% versus placebo (p = 0.024) and relative risk reduction of 23%). % relative to amlodipine (p = 0.006)]. In the individual analysis of the components of the primary endpoint, no effect on all-cause mortality was observed, while a positive trend in IRT reduction and a significant reduction in serum creatinine doubling were observed. .
The effect of treatment was assessed in subgroups that included gender, race, age, duration of diabetes, baseline blood pressure, serum creatinine, and baseline. albuminuria. In women and the black patient subgroup, which accounted for 32% and 26% of the total study population respectively, renal benefit was not evident, although confidence intervals did not exclude it. . Similarly for the secondary endpoint of fatal and non-fatal cardiovascular events, there was no difference between the three groups in the total population, whereas an increase in the incidence of nonfatal myocardial infarction was observed in women and that a decrease in the incidence of Nonfatal myocardial infarction was observed in men in the irbesartan group versus placebo treatment. An increase in the incidence of nonfatal myocardial infarction and stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced on the global population. However, no particular explanation for these findings in women has been identified. Stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced in the overall population. However, no particular explanation for these findings in women has been identified.Stroke was observed in women in the irbesartan treatment group versus the amlodipine treatment group, while hospitalizations for heart failure were reduced in the overall population. However, no particular explanation for these findings in women has been identified.
The study “Effects of Irbesartan on Microalbuminuria in Hypertensive Patients with Type 2 Diabetes Mellitus (IRMA 2)” shows that irbesartan 300 mg delays progression to proven proteinuria in patients with microalbuminuria. IRMA 2 is a double-blind, placebo-controlled, morbidity study in 590 patients with type 2 diabetes, microalbuminuria (30-300 mg / day) and normal renal function (serum creatinine ≤ 1.5 mg / day). dl in men and <1.1 mg / dl in women). The study evaluated the long-term (2 years) effects of Aprovel on progression to clinical (proven) proteinuria (urinary albumin excretion rate> 300 mg / day and increased TEUA from minus 30% of the basal value). The predefined voltage target was ≤ 135/85 mm Hg. other antihypertensives (with the exception of ACE inhibitors, angiotensin II receptor antagonists, and dihydropyridine calcium channel blockers) were added as needed to achieve the blood pressure goal. While comparable blood pressure was achieved in all treatment groups, fewer patients achieved the proteinuria criterion in the irbesartan 300 mg group (5.2%) than in the placebo groups (14.9%). or irbesartan 150 mg (9.7%), demonstrating for the highest dose a 70% relative risk reduction versus placebo (p = 0.0004). A concomitant improvement in glomerular filtration rate (GFR) was not observed during the first three months of treatment. The slowdown in progression to clinical proteinuria was evident as early as the third month and continued over a 2-year period. Regression to normal albuminuria (<30 mg / day) was more common in the Aprovel 300 mg (34%) group than in the placebo group (21%).
Double blockade of the renin-angiotensin-aldosterone system (RAAS)
The use of a combination of a converting enzyme inhibitor (ACE) with an angiotensin II receptor antagonist (ARB II) was analyzed in two large randomized controlled trials (ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and VA NEPHRON-D (The Veterans Affairs Nephropathy in Diabetes).
The ONTARGET study was conducted in patients with a history of cardiovascular disease or cerebrovascular disease, or type 2 diabetes with target organ involvement. The VA NEPHRON-D study was conducted in type 2 diabetic patients with diabetic nephropathy.
In comparison with monotherapy, these studies did not show any significant beneficial effect on renal and / or cardiovascular outcomes and mortality, whereas an increased risk of hyperkalemia was observed. , acute renal failure and / or hypotension.
These results are also applicable to other IEC and ARA II, given the similarity of their pharmacodynamic properties.
ACE inhibitors and ARBs should not be used in patients with diabetic nephropathy.
aprovel side effects
In placebo-controlled trials in hypertensive patients, the overall incidence of adverse events was not different between the irbesartan group (56.2%) and the placebo group (56.5%). .
Treatment interruptions due to clinical or laboratory adverse events were less frequent in patients treated with irbesartan (3.3%) than in placebo-treated patients (4.5%).
The incidence of adverse events was independent of dosage (within recommended dose range), sex, age, race or duration of treatment.
In diabetic hypertensive patients with microalbuminuria and normal renal function, orthostatic vertigo and orthostatic hypotension were reported in 0.5% (ie, infrequently) patients, but in excess of placebo.
The following adverse events have been reported in placebo-controlled clinical studies in which 1965 patients received irbesartan. In diabetic hypertensive patients with chronic renal failure and overt proteinuria, the marked adverse effects of (*) were reported in more than 2% of patients and in excess of placebo.
The frequency of adverse reactions listed below is defined according to the following convention: very common (≥ 1/10); frequent (≥ 1/100 to <1/10); uncommon (≥1 / 1,000 to <1/100); rare (≥ 1 / 10,000 to <1 / 1,000); very rare (<1 / 10,000). In each frequency group, adverse effects are presented in order of decreasing severity.
Additional adverse reactions reported after marketing are also listed. These side effects come from spontaneous reports.
Immune system disorders:
Not known: hypersensitivity reactions, such as angioedema, rash, urticaria
Metabolism and nutrition disorders:
Not known: hyperkalemia
Nervous system disorders
Common: dizziness, orthostatic vertigo *
Not known: dizziness, headache
Affections of the ear and labyrinth:
Not known: tinnitus
Heart conditions
Uncommon: tachycardia
Vascular disorders
Common: orthostatic hypotension *
Uncommon: Vasomotor flush
Respiratory, thoracic and mediastinal disorders
Uncommon: cough
Gastrointestinal disorders
Common: nausea / vomiting
Uncommon: diarrhea, dyspepsia / heartburn
Not known: dysgeusia
Hepatobiliary disorders
Uncommon: jaundice
Not known: hepatitis, abnormal liver function
Skin and subcutaneous tissue disorders:
Not known: leukocytoclastic vasculitis
Musculoskeletal and systemic disorders
Frequent: musculoskeletal pain *
Not known: arthralgia, myalgia (associated in some cases with increased creatine kinase levels), muscle cramp
Renal and urinary disorders:
Not known: alteration of renal function, including renal failure in patients at risk (see Warnings and Precautions section )
Disorders of reproductive organs and breast
Uncommon: Sexual dysfunction
General disorders and administration site conditions
Frequency: tiredness
Uncommon: chest pain\
investigations:
Very common: hyperkalemia * occurred more often in diabetic patients treated with irbesartan than in those treated with placebo. In diabetic hypertensive patients with microalbuminuria and normal renal function, hyperkalemia (≥ 5.5 mEq / l) occurred in 29.4% (ie, very frequently) patients in the irbesartan 300 mg group. and in 22% of patients in the placebo group. In diabetic hypertensive patients with chronic renal failure and overt proteinuria, hyperkalemia (≥ 5.5 mEq / l) occurred in 46.3% of patients in the irbesartan group and 26.3% of patients in the placebo group.
Frequent: Significant increases in plasma creatine kinase have been observed frequently (1.7%) in subjects treated with irbesartan. None of these increases were associated with clinically identifiable musculoskeletal events.
In 1.7% of hypertensive patients with advanced diabetic renal disease treated with irbesartan, a non-clinically significant decrease in hemoglobin * was observed.
Pediatric population:
In a randomized study that included 318 hypertensive children and adolescents aged 6 to 16 years, the following adverse events were reported during the 3-week double-blind phase: headache (7.9%), hypotension (2.2%) , vertigo (1.9%), cough (0.9%).
 In the 26-week open-label period of this study, the most frequently observed laboratory abnormalities were increases in creatinine (6.5%) and increased CK values ​​in 2% of children receiving the product.
aprovel drug interactions
Diuretics and other antihypertensives : Other antihypertensive agents may increase the hypotensive effects of irbesartan. However, Aprovel has been safely associated with other antihypertensives such as beta-blockers, long-acting calcium antagonists and thiazide diuretics. Previous treatment with high dose diuretics may cause hypovolemia and a risk of hypotension when treatment with Aprovel is started (see Warnings and Precautions ).
Products containing aliskirenor an IEC: Data from clinical trials have shown that double blockade of the renin-angiotensin-aldosterone system (RAAS) by the concomitant use of angiotensin-converting enzyme inhibitors, antagonists Angiotensin II or aliskiren receptors are associated with a higher incidence of adverse events such as hypotension, hyperkalemia, and impaired renal function (including acute renal failure) compared with the use of a single drug acting on the RAAS (see sections Contraindications , Warnings and Precautions for Use and Pharmacodynamic Properties ).
Potassium-sparing potassium supplementation or diuretics: Based on experience with other substances in the renin-angiotensin system, co-administration of Aprovel with potassium-sparing diuretics, potassium supplementation, A diet containing potassium or other drugs that can increase serum potassium levels (eg heparin) may cause elevated serum potassium, and therefore is not recommended (see Warnings and Precautions section ).
Lithium : reversible increases in serum concentrations and lithium toxicity have been reported with angiotensin converting enzyme inhibitors. To date, similar effects have been reported very rarely with irbesartan. Therefore, this association is not recommended (see section Warnings and precautions for use ).If association is needed, strict monitoring of lithemia is recommended.
Non-steroidal anti-inflammatory drugs : When angiotensin II antagonists are administered concomitantly with nonsteroidal anti-inflammatory drugs (ie, selective cyclooxygenase type 2 (COX-2) inhibitors, acetylsalicylic acid (> 3 g / day) and nonselective nonsteroidal anti-inflammatory drugs, an attenuation of the antihypertensive effect of irbesartan may occur.
As with angiotensin converting enzyme inhibitors, the concomitant use of angiotensin II antagonists and nonselective nonsteroidal anti-inflammatory drugs may increase the risk of deterioration of renal function, with the possibility of acute renal failure, and an increase in serum potassium especially in patients with previously impaired renal function. The combination should be administered with caution, especially in the elderly. Patients should be properly hydrated and monitoring of renal function should be considered after initiation of the combination, then periodically.
Other information on irbesartan interactions: In clinical studies, the pharmacokinetics of irbesartan have not been modified by concomitant administration of hydrochlorothiazide. Irbesartan is mainly metabolized by CYP2C9 and to a lesser extent by glucuronidation. No significant pharmacokinetic and pharmacodynamic interactions were observed when irbesartan was administered concomitantly with warfarin, a drug metabolized by CYP2C9. The effects of CYP2C9 inducers, such as rifampicin, on the pharmacokinetics of irbesartan have not been evaluated. The pharmacokinetics of digoxin were not impaired by simultaneous administration of irbesartan.
Aprovel Warnings and Precautions
Hypovolemia: Symptomatic hypotension, particularly after the first dose, may occur in patients with sodium depletion and / or hypovolemia secondary to intensive diuretic therapy, low sodium diet, diarrhea or vomiting. These abnormalities should be corrected prior to administration of Aprovel.
Renovascular Hypertension : There is an increased risk of severe hypotension and renal failure when patients with bilateral renal artery stenosis or renal arterial stenosis on a single functional kidney receive drugs that act on the renin-renal system. angiotensin-aldosterone. Although this has not been documented with Aprovel, a similar phenomenon is to be expected with angiotensin-II receptor antagonists.
Renal Impairment and Renal Transplantation : When Aprovel is used in patients with impaired renal function, periodic serum potassium and serum creatinine monitoring is recommended. No experience is available regarding the use of Aprovel in patients with recent kidney transplantation.
Type 2 diabetic hypertensive patients with renal impairment : In an analysis of a study in patients with advanced renal impairment, the effects of irbesartan on both renal and cardiovascular events were not uniform at all. across all subgroups. In particular, they appeared less favorable in women and in non-white patients (see section 5.1 Pharmacodynamic properties ).
Hyperkalemia : As with other drugs acting on the renin-angiotensin-aldosterone system, hyperkalaemia may occur during treatment with Aprovel, particularly in the presence of renal insufficiency, proven proteinuria related to renal impairment due to diabetes, and / or heart failure. Close control of serum potassium in these patients at risk is recommended (see section Interactions with other medicinal products and other forms of interaction ).
Lithium : the combination of lithium and Aprovel is not recommended (see section Interactions with other medicinal products and other forms of interaction ).
Stenosis of the aortic and mitral valve, obstructive hypertrophic cardiomyopathy : as with other vasodilators, particular caution is indicated in patients with aortic or mitral stenosis or obstructive hypertrophic cardiomyopathy.
Primary Hyperaldosteronism : Patients with primary hyperaldosteronism do not generally respond to antihypertensive medications acting through inhibition of the renin-angiotensin system. As a result, the use of Aprovel is not recommended.
General : in patients whose vascular tone and renal function are predominantly dependent on renin-angiotensin-aldosterone system activity (eg patients with severe congestive heart failure or underlying renal disease, including stenosis renal arteries), treatment with ACE inhibitors or angiotensin-II receptor antagonists acting on this system has been associated with acute hypotension, azotemia, oliguria or, rarely, renal failure. acute. As with any antihypertensive agents, a sudden drop in blood pressure in patients with ischemic heart disease or
As observed with angiotensin converting enzyme inhibitors, irbesartan and other angiotensin antagonists appear to be less effective in lowering blood pressure in black subjects compared to non-black subjects, probably because of a greater high prevalence of low renin in the black hypertensive population.
Pregnancy: Angiotensin II Receptor Inhibitors (AIIRAs) should not be started during pregnancy. Unless AIIRA treatment is considered essential, it is recommended that the antihypertensive therapy be modified in patients who are planning pregnancy for a drug with an established safety profile during pregnancy. If pregnancy is diagnosed, treatment with AIIRAs should be stopped immediately and if necessary alternative treatment should be started (see sections Contraindications and Pregnancy and breast-feeding ).
Lactose : Due to the presence of lactose, this drug is contraindicated in case of congenital galactosemia, glucose or galactose malabsorption syndrome or lactase deficiency.
Pediatric population : irbesartan has been studied in pediatric populations of 6 to 16 years of age, but current data are insufficient to support an extension of use in children until additional data are available , Pharmacodynamic properties and Pharmacokinetic properties ).
Drive and use machines
Effects on the ability to drive and use machines have not been studied. Based on its pharmacodynamic properties, it is unlikely that irbesartan will affect this ability. When driving vehicles or using machines, it should be taken into account that vertigo or fatigue may occur during treatment.
Aprovel and PREGNANCY / BREAST FEEDING / FERTILITY:
Pregnancy :
The use of AIIRAs is not recommended during the 1 st  trimester of pregnancy ( see Warnings and Precautions ). The use of AIIRAs is against-indicated to 2 eand 3 e trimesters of pregnancy ( see Contraindications , Warnings and Precautions ).
Epidemiological evidence regarding the risk of teratogenicity following exposure to ACE inhibitors during the 1 st trimester of pregnancy does not suggest. However, a small increase in the risk of congenital malformation can not be ruled out. There are no epidemiological studies available on the use of AIIRAs at 1 st trimester of pregnancy, however a similar risk to IEC could exist for this class. Unless AIIRA treatment is considered essential, it is recommended that antihypertensive therapy be modified in patients who are planning pregnancy for a drug with an established safety profile during pregnancy. If pregnancy is diagnosed, treatment with AIIRAs should be stopped immediately and, if necessary, alternative treatment should be initiated.
Exposure to AIIRA therapy during the 2 e and 3 e  trimesters is known to induce human fetotoxicity (decreased renal function, oligohydramnios, delayed ossification of the skull) and toxicity in the newborn ( renal insufficiency, hypotension, hyperkalemia): see Preclinical safety .
If exposure to angiotensin II receptor antagonists from 2 th  trimester of pregnancy, it is recommended to do a fetal ultrasound check of renal function and the bones of the skull.
Infants born to mothers treated with AIIRAs should be monitored for blood pressure ( see Contraindications , Warnings and Precautions ).
Breastfeeding:
No information is available regarding the use of Aprovel during breastfeeding, so Aprovel is not recommended.
 It is advisable to use alternative treatments with a better established safety profile during breastfeeding, especially for breastfeeding newborns and premature infants.
It is not known whether irbesartan and its metabolites are excreted in milk in women.
Available pharmacodynamic and toxicological data in rats have shown that irbesartan and its metabolites are excreted in milk ( see Preclinical Safety).
Fertility:
Irbesartan did not show any effects on the fertility of the treated rats and their progeny up to the doses leading to the first signs of parental toxicity ( see Preclinical safety ).
What happens if I overdose from Aprovel ?
No toxicity has been reported following exposure of adults at doses up to 900 mg / day for 8 weeks. In case of overdose, the most likely clinical signs would be hypotension and tachycardia. Bradycardia may also occur.
 No specific information is available on treatment for overdosage with irbesartan.
The patient should be under close supervision and symptomatic and supportive treatment should be instituted. Measures such as inducing vomiting and / or gastric lavage are suggested.
 Activated charcoal may be useful in the treatment of overdose. Irbesartan is not hemodialysable.
What is  Forms and Composition Aprovel?
FORMS and PRESENTATIONS
75 mg film-coated tablet (biconvex, oval, with a heart on one side, and number 2871 on the other side, white to cream-white):   Boxes of 30 and 90, in blister packs of 15. Film-coated tablet 150 mg (biconvex, oval, with a heart on one side, and the number 2872 engraved on the other side, white to cream-white):  Boxes of 30 and 90, in blister packs of 15. 300 mg film-coated tablet ( biconvex, oval, with a heart on one side, and the number 2873 engraved on the other side, white to cream-white):   Boxes of 30 and 90, under blister packs of 10. Hospital models (all dosages): Boxes of 56 × 1 tablet under blister packs of 8 for single delivery.
COMPOSITION
  p cp Irbesartan (DCI) 75 mg or 150mg or 300 mg
Excipients (common): lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromellose, silicon dioxide, magnesium stearate. Film coating:
 lactose monohydrate, hypromellose, titanium dioxide (E 171), macrogol 3000, carnauba wax.
Lactose content monohydrate: 25.50 mg / cw at 75 mg, 51 mg / cw at 150 mg, 102 mg / cw at 300 mg.
NOT’s
Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:
general information:
Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles
Additional information:
General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.
Special warnings:
For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.
Side effects:
It treats possible side effects and drug interactions that require attention and its effect on continuous use.
The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.
The post Aprovel review Uses, Dosage, Side Effects, Precautions &Warnings appeared first on Drug Online.
from Drug Online https://bit.ly/2CkIW4y via Edrug Online
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instantdeerlover · 4 years
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The London Alcohol Delivery Guide (1) added to Google Docs
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There’s only one place you can drink right now: Your home. But if you’re anything like us, the only drinks you have indoors include a six-pack of Fosters someone brought to your housewarming party last January, and a bottle of WKD whose origin story is unknown.
So here are places that can stock your bar via delivery. Even though you can’t go drink at these restaurants and bars, you can still support them (and drink something great) by ordering from them. We’ll keep updating this guide with more information - so stay tuned, and stay well.
Got a winery, bar, brewery, or store offering collection or delivery? Email us at [email protected].
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DELIVERY ACROSS LONDON Passionevino £ £ £ £ Shoreditch ££££ 85 Leonard Street
This little Italian wine bar and shop on Leonard Street in Shoreditch have launched a new #wineonwheels service. In true Italian fashion they’re delivering across London on their trusty Vespa, with countless independent bottles to choose from. You can also get involved in their £25 aperitivo pack with artisanal cheese and ham.
Hacha £ £ £ £ Bar Food ,  Mexican  in  Dalston ££££ 378 Kingsland Road
Hacha is home to our favourite margarita in London. We once referred to it as ‘an astonishing delicious feat of alcohol alchemy’ and now you can get their crystal clear mirror margarita delivered to your front door. Each 500ml bottle is priced at £35 but you’ll need to get two bottles to qualify for delivery.
P. Franco £ £ £ £ Wine Bar ,  Experimental  in  Hackney ££££ 107 Clapton Road 9.0 /10
Fun fact: P. Franco is one of our highest rated restaurants in London. Here’s another: they’re now delivering their wines across London from their online shop. Look out for their mixed 6 wine selection for £77.
Bright £ £ £ £ Modern European  in  Hackney ££££ 1 Westgate Street 9.0 /10
Part of the P. Franco family, Bright are not only delivering their menu of excellent wines across London, they’re also available for collection if you’re a London Fields local. Hit up their website to see the full wine list and place an order.
Quality Wines £ £ £ £ British  in  Clerkenwell ,  Farringdon ££££ 88 - 94 Farringdon Road 8.0 /10
Quality Wines has a special place in our heart. We regularly hit up this excellent wine shop and grocery for our lunch, a bottle of something nice for the weekend, or several slices of ginger loaf. Now, you can get curated cases of wine delivered every Friday. Plus, they’re holding regular virtual wine tastings.
St. John Bar And Restaurant £ £ £ £ British  in  Clerkenwell ,  Farringdon ££££ 26 St John St 9.3 /10
St. John, a restaurant that we’d usually visit for any and every occasion, has got any and every one of your home wine needs covered with delivery throughout the UK. Their mixed cases range from the rosé-focused pink set to the classic St John 12 bottle collection for £215, and you can also order their surprisingly affordable boxed wines that start at £38 for three litres.
The Sun Tavern ££££ 66 Long Acre
The Sun Tavern is part of the same family of drinking dens as our East End favourite Discount Suit Company and you can now hit up their online shop for everything from big bottled cocktails to a ‘lucky dip’ box of beers. Their Quarantini Kit for £30 comes with 4 large cocktail serves of either negroni, boulevardier, or old fashioned. The best part is they’re doing free same day delivery too.
Albertine £ £ £ £ Wine Bar  in  Shepherds Bush ££££ 1 Wood Ln Not
Rated
Yet
There are several advantages to ordering your wine from Albertine. First up, you get to support one of the nicest wine bars in west London. Next, you get a great choice of wines, ranging in price from a single bottle for £15 through to a crate of the ‘fine and rare’ stuff for £200. Finally, you can add a wide range of choice products to your order, from fresh baguettes through to pots of terrine, and entire ready meals.
Milroy's ££££ 3 Greek St
Whisky, whisky, and more whisky. If you like the sound of that then place an order with old school whisky shop Milroys. This Soho spot is not only delivering across London, but also across the UK so it’s worth keeping in mind whether you’re after a highland malt for your Friday night in or something special from the ’90s to send as a gift.
Berkmann Wine Cellars ££££ 10-12 Brewery Road
Some people (us) feel a little (very) guilty for buying a third consecutive bottle of red in a week. Lockdown, right? But now, thanks to Berkmann Wine Cellars you can feel good about ordering any amount of wine, because for every order you make, 12.5% of your spend will be donated to the hospitality industry. They’ve already raised over £40,000 and as they usually supply London’s top restaurants there are plenty of excellent bottles to choose from.
Hedonism Wines ££££ 3-7 Davies St
The very fancy wine folk behind Hide’s enormous and seriously impressive wine list are doing delivery. For orders of six bottles or more said delivery is also free. There are around 6,000 wines to choose from, a fully stocked spirits boutique, and even the odd bottle for around the £20 mark.
Mountgrove Bothy £ £ £ £ Highbury ££££ 90 Mountgrove Road 7.6 /10
BOTHYBEATS might sound like the Tik Tok dance you spent hours attempting to master last night but it’s actually the code that will get you 15% off at Mountgrove Bothy’s online wine shop. This neighbourhood wine bar in Highbury is currently expanding their delivery selection but for now you can find a great mixed three-pack of wine for £40, as well as a 24-pack of craft beer for £50.
Lady Of The Grapes £ £ £ £ French  in  Covent Garden ££££ 16 Maiden Lane
Lady of the Grapes is one of our favourite West End wine bars, and we could honestly order any one of their five curated wine boxes right now. If we had to choose one it would be their new survival mixed box at £100 containing a half-dozen bottle from across Spain, Portugal, and France made exclusively by female winemakers or couples. We’d also order their Survival Artisan Cheese Box, because cheese. Order here.
Crate Brewery £ £ £ £ Pizza  in  Hackney ££££ Unit 7, White Building
We’re already missing Crate Brewery’s sourdough pizzas but thanks to their website there’s no need to miss their craft beers. Everything from their core lagers to limited edition flavoured beers are available online, with their 20-bottle case options falling around the £40 mark.
London Shell Co £ £ £ £ Seafood ££££ The Prince Regent Not
Rated
Yet
For the first time ever, you can now buy London Shell Co’s own-brand sparkling white wine to enjoy at home. A full case is available for £117 on this website, using the password Duch3ss-sTar - very cryptic, we know. Put on that old fancy dress hat you pretend you don’t own, cook a nice piece of fish, get your flatmate to make questionable river noises, and your Wednesday night at sea is sorted.
Top Cuvée £ £ £ £ Modern European ,  Wine Bar  in  Highbury ££££ 177B Blackstock Rd 7.5 /10
On Top Cuvée’s website you can now order everything from a wine ‘survival pack’ that’s £60 for six bottles, to their very boozy Spread The Joy pack that you can send to your mates. There’s also a Tayer x Top Cuvée gimlet collaboration for £12.
Bar Douro £ £ £ £ Portuguese  in  City ££££ Finsbury Avenue Square Not
Rated
Yet
Bar Douro is a little Portuguese restaurant in the City that we’d usually recommend for a laidback, romantic date. Now, we’re recommending them for Portuguese wines delivered straight to your front door. You can pick anything from their curated wine list to collect, or go for a six-bottle case with free delivery. Plus, for every bottle purchased they’re donating £1 to Hospitality Action.
Rock Leopard Brewing ££££ 81 Bellegrove Road
Rock Leopard very well might sound like our dads’ inevitable Def Leppard cover band, but it’s actually a craft beer company based in South East London. If you happen to live in Bexley, Greenwich, or Dartford you can get quick, local delivery. But don’t worry, they’re also delivering across London and the rest of the UK from their online shop.
Heads & Tails ££££ 175 west end lane, london nw6
Pina Colada Swizzle is not only our new rap name, it’s also one of the many cocktails you can order from this West Hampstead bar. If you live within three miles you can get same day delivery on everything from a classic Cosmopolitan to their gin and apricot Archangel mix. Live further afield? Don’t worry, they’re shipping nationwide too.
Small Beer Brew ££££ 70-72
Sadly, Small Beer isn’t producing teeny tiny beers for rodents - although honestly we’d love to see Remy the rat on the lash - they actually produce low-alcohol brews. You can order everything from a refreshing lager to a tropical-finish pale ale, or even a selection gift pack. Plus, not only are they delivering nationwide, their beers are vegan-friendly too.
Highbury Library ££££ Highbury Library
If you’ve decided that your quarantine project is going to be getting into natural wines then we salute you. And we also recommend you check out Highbury Library’s online shop. They specialise in small scale producers and their natural wines have handy ratings so you can start with a more conventional 1 and work your way up to a ‘funky’ 5. Plus, you can drop them a question about any of their wines before you buy.
The 10 Cases £ £ £ £ Wine Bar  in  Covent Garden ££££ 16 Endell Street
This Covent Garden wine bar and restaurant have released their own wine-delivery app called Drop Wines. The slogan is ‘want the power to summon wine to wherever you are?’. Our answer is a resounding, 'yes'. Chosen by experts, they’ll deliver their wines to your home, picnic, or mate’s garden. Download the app here.
Bottle Apostle ££££ 49 Park Road
Aptly named Bottle Apostle have shops in Victoria Park Village, Crouch End, Clapham, and Primrose Hill. If you happen to live in any of the above then you can swing by to pick them up between 11 and 6pm, or simply order in from delivery apps.
Kicking Horse Craft Beer ££££
The spot provides craft beer for some of our favourite London restaurants, including St John, Blacklock, Hoppers, and Brigadiers. Now, at their online store you’ll find big, mixed cases full of beers from independent breweries, and even the odd bottled cocktail. London delivery is also free.
Vins £ £ £ £ Modern European  in  Highbury ,  Islington ££££ 93 Grosvenor Avenue Not
Rated
Yet
Vins is a little neighbourhood wine bar that, thanks to their low-intervention wines and comfortable feel, we have a proper soft spot for. You can order everything from a fruity pinot noir to a chenin blanc that’s perfect for sipping over a slice of cheese. And yes, you can also get their 18-month comte delivered.
Provisions £ £ £ £ Wine Bar  in  Highbury ,  Islington ££££ 167 Holloway Road Not
Rated
Yet
Holloway Road’s #1 wine and cheese hangout is delivering all over London. Email [email protected]⁠ or hit this link to get wine, cheese, charcuterie - the lot - straight to your door.
Low Intervention Wines ££££
Now, you probably weren’t expecting this, but Low Intervention wines deliver… Low Intervention Wines. There are countless bottles to choose from, whether you want to invest in some future classics for your cellar (cupboard) or a selection of rare rosés to sip on whilst you sit in the garden. Order before 1.30pm for next-day delivery.
The Proofing Room ££££ 76 Commercial Street
The Proofing Room is a speakeasy-style basement bar from the people behind one of our favourite drinking spots, The Vault. You can now get a bunch of their cocktails delivered in batch, including a coconut butter old fashioned, their big highball, and a tequila and habanero fizz. Princes start at a tenner and if you happen to live within a three-mile radius of Commercial Street, same-day delivery is free.
The Vintner ££££ 25 Heathman's Road
The Vintner are an independent wine merchant that are not only delivering everything from chenin blancs to riojas across London, they’re also delivering nationwide - and the best part is that there are plenty of options around the £10 mark. Heads up, they’re also donating 100% of their profits to Hospitality Action if you order between now and Easter Day.
Modal Wines ££££
If you’re after natural wines that are not only delivered across London but across the UK - yes, you do still have to send your aunt a birthday present - then Modal Wines is your friend. They specialise in independent winemakers and their online shop is split into useful sections like ‘Rustic Italian Reds’, ‘Intro The Wild’, ‘Playing It Safe’, and our personal favourite, ‘Keeping It Cool’.
Tillingham Wines ££££
To be honest, when it comes to Tillingham Wines we’re not sure whether to drink their bottles of wine, or frame them. We have a feeling we’ll end up going for the former, but this English wine company make some seriously good looking natural wines. You can order from their online shop, which includes helpful tasting notes like ‘sexy oak’ and ‘chablis from another mother’.
40 Maltby St ££££ 40 Maltby St
40 Maltby Street is a cute wine bar near London Bridge serving low-intervention wines from select makers around Europe, and you can get those wines delivered to your door from Gergovie Wines. For £9 (for up to 12 bottles), they’re aiming for overnight delivery to most addresses in the UK. Just make sure you get an order to them before dispatch days (Tuesday and Thursday). N.b. if you order 36 bottles or more - and we don’t think you should rule that out - delivery is free, so get ordering.
Salon Wine Store ££££ 20 Market Row
As the wine brains behind Brixton’s Salon and Peckham’s Levan, Salon Wine Store know their wines. That’s why it’s totally okay by us that they’re shipping mixed cases all over south London, elsewhere in London for a small delivery surcharge, and further afield for a larger delivery surcharge. There are four options, from Fun (at £70 for six bottles) all the way up to Off The Charts (£210) which they promise contains a curated selection of six iconic, elegant, and classy wines. Order here.
north The Rose & Crown £ £ £ £ Pub  in  Kentish Town ££££ 71-73 Torriano Ave Not
Rated
Yet
Neighbourhood boozer, Rose and Crown, are delivering pints of craft beer to Kentish Town locals. Check their Instagram for updates and call 020 7267 4305 to place your order. Looking for a bottle of wine or champagne? They’ve got that too.
Authentique ££££ 114a - 116 Fortess Road
Cow. Goat. Soft. Ewe. No, we haven’t finally succumbed to our daily quarantine breakdown, we’re listing the types of cheese you can order along with Authentique’s excellent selection of wines. You can expect everything from natural reds to surprisingly affordable sparkling wines, and although they’re open from 10am to 8pm for collection, they’re also delivering locally around Tufnell Park.
La Fromagerie £ £ £ £ French  in  Highbury ££££ 30 Highbury Park Not
Rated
Yet
La Fromagerie have been selling wine and cheese for over 25 years but their delivery service is brand new. Hit them up for their in-house wines, crackers, and a selection of seriously tasty cheese.
The Camden Grocer ££££
Scientists say that if you drink two bottles of wine on a Friday night but also order organic date and walnut spread, then you’re still a functioning grown-up. And when we say scientists, we mean us. This Camden spot specialises in artisanal food but they’ve also got wine, spirits, and beer available for next-day delivery. Heads up, they’re covering the following postcodes: NW1, N1, NW3, NW5, NW8, WC1.
Bodega Rita’s £ £ £ £ American ,  Deli  in  Kings Cross ££££ Coal Drops Yard Not
Rated
Yet
Our inner student shed a tear when we first saw Bodega Rita’s new bagged negroni mix. Their £20 batched cocktails are available for delivery around King’s Cross from their new drop-off situation, Rita’s 4 U on the Slerp app. They also have plenty of natural wines and are launching ready-to-drink margaritas too.
69 Colebrooke Row £ £ £ £ Islington ££££ 69 Colebrooke Row
69 Colebrooke Row - otherwise known as The Bar With No Name - serve some of the very best cocktails in London and now you can drink them from your sofa whilst avoiding their usual 90-minute booking slots. There are a handful of pre-mixed cocktails available for delivery - including their famous negroni, which is now available in a 700ml bottle for around £35 - along with a few nibbles so you can recreate the feeling of being there.
Ladies and Gentlemen ££££ 2 Highgate Rd
The people behind this Kentish Town dive bar have hustled up a whole range of creative quarantini batched-cocktails, as well as classics like negronis, margaritas, and old fashioneds. For £32.50, you get five servings. Plus, they’ve also got a bunch of pressed juices, all of which you can order here.
Oak N4 ££££ 5 - 7 Wells Terrace
Finsbury Park’s Oak N4 is usually a buzzing neighbourhood bar with lots of wine and lots of feel-good atmosphere. If you live within the three-mile radius, you can get three bottles delivered for £50 and take part in their virtual wine tasting on Saturday night.
Yield N16 £ £ £ £ Highbury ,  Stoke Newington ££££ 44-45 Newington Green Not
Rated
Yet
Yield are delivering their solid range of natural wines and craft beers to addresses within a one mile radius of Newington Green. You can also throw in some essentials from the pantry, sunblushed tomatoes, cheese, and charcuterie. Order direct before 2pm for same day delivery, or order here up till 8pm if you live up to three miles away
SOUTH Peckham Cellars ££££ 125 Queens Road
If you live in or around Peckham and like Negronis, we have good news. This neighbourhood spot is not only delivering wine, survival packs, and beer, they’re also delivering three-serve negroni bottles for £12. Check to see if they’re delivering to your postcode on their website.
The Winemakers Club Deptford ££££ 211 Deptford High Street
See above, but you know, replace Farringdon with Deptford. Order before 5pm for same-day delivery.
Diogenes The Dog £ £ £ £ Wine Bar  in  Elephant and Castle ££££ 96 Rodney Road Not
Rated
Yet
Calling all wine drinkers that live within a one-mile radius of Elephant And Castle - Diogenes The Dog’s excellent collection of wines are now available to be delivered. You can also get their charcuterie to your door if you’re looking to make a night of it.
Goldfinch ££££
Goldfinch is a small Tooting bar serving big-deal cocktails. We’re fans of their white negroni and Clover Club classic, and all of their daily, creative specials we’ve tried have been top-notch. You can buy their entire menu bottled to takeaway and as an added bonus they’re offering 25% off standard prices. Email [email protected] to have it delivered to your door.
Lechevalier ££££
Lechevalier is a wine bar in Southwark that’s offering free delivery within a one or two mile radius on all of the best things: wine, cheese, charcuterie, and bread. If you’re not sure what you want, DM them. They seem very nice.
Hop Burns And Black ££££ 38 East Dulwich Road
Hop Burns And Black not only sounds like the jazz trio we all need right now, it’s also a mini chain of south London craft beer stores. They have two shops, one in Peckham and another in Deptford - both of which are currently closed but you can get same-day delivery on all of their beers if you live south of the river.
EAST Weino Bib ££££
Weino Bib, coincidentally, is now what we call our pyjama top, but it’s also the name of this little Dalston wine bar. If you live within two miles of Balls Pond Road, you can hit up their online shop to order everything from bagged and boxed wines to bottles of natural red, as well as groceries and IPAs.
The Laughing Heart £ £ £ £ Modern European ,  Wine Bar  in  Hackney ££££ 277 Hackney Road Not
Rated
Yet
The Laughing Heart arguably sounds like the self-help book we all need right now, but it’s actually a cool, neighbourhood spot in Hackney that is super popular with locals thanks its eclectic menu and, importantly, its great selection of wines. Click here to see their reds, whites, fizz, rosé, spirits, and skin contact options that start from £19. They’re delivering in and around Hackney.
Forest Road Brewing Co ££££ 8 Netil Lane
Forest Road brewed their first 60 litre batch of beer in a garden back in 2015. That might sound like the beginning of the next Hangover film, but it’s actually the beginning of you sipping on their craft beers from the comfort of your sofa. They’re doing next-day delivery - or same-day if you’re lucky - around Hackney, including their aptly named Posh Lager and a new Stay Home brew that will donate £1 to the NHS for every one sold.
Furanxo ££££ 85 Dalston Lane
If you spend £120 online at Furanxo’s website you get 10% off. Honestly, to us that sounds less like a deal and more like a challenge we’re very willing to participate in. This little Dalston wine bar and shop are delivering across Hackney, Highbury, and Islington. Plus, they have a very handy ‘under £20’ section.
Newcomer Wines £ £ £ £ Wine Bar  in  Dalston ££££ 5 Dalston Lane Not
Rated
Yet
200 wines will likely become the name of our memoir but for now, it’s also how many different bottles you can get delivered from Newcomer Wines. This little Dalston-based wine bar is delivering within a 3-mile radius through the Slerp app, but if you’re not in a rush or fall outside the catchment area you can still get their wines delivered in 2-3 days by placing an order on their website.
Nobody Asked Me ££££ 88 Chatsworth Road
Nobody Asked Me is not only a statement relating to our lack of virtual party invites, it’s also a neighbourhood cocktail bar in Lower Clapton. They’re now delivering everything from lagers, to gin martinis, to wine, to big-deal spirits and mixers.
Bistrotheque £ £ £ £ French  in  Bethnal Green ££££ 23-27 Wadeson St 7.8 /10
Sure, you can pre-order a weekend lunch or dinner from Bistrotheque, along with your choice of beer, cider, or wine, but you can also put in an order for 500ml bottles of pre-mixed cocktails. The negroni, the cosmo, the margarita, and the martini all come in at £30, while a half-litre of blood mary is just £15. Order here.
Bar Tincture ££££ 202 Brick Lane
When all of this is over, you should know that Bar Tincture on Brick Lane makes a mean Sazerac. What you should know right now is that they’re delivering a limited number of their more creative zero-waste cocktails, including a rhubarb, kombucha, and tequila number.
Yardarm ££££ 238 Francis Road
This little bottle shop and deli on Francis Road is Leyton is offering collection or local delivery on their whole range. They’re only open till 5pm, but they are open seven days a week. Give them a call on 020 8556 2444 to see what they can hook you up with.
west Lea And Sandeman Wines ££££ 167 Chiswick High Road
This Chiswick spot has been selling wines since the year Die Hard was released. Which means they’ve been picking great wines directly from vineyards since we’ve been quoting Bruce Willis, which is basically forever. Hit them up here to order everything from champagne to a classic Rioja.
Last Drop Wines ££££ 492 King's Road
Last Drop Wines have been at 492 King’s Road for over a decade. So about as long as this lockdown has been going on, right? They’re offering delivery and collection of their independent wines and have a super helpful ‘£15 to £24.99’ section on their website. Call them on 020 7351 2973 to place an order.
Real Ale ££££ 4 Formosa St
Real Ale is a craft beer specialist with shops in Maida Vale, Twickenham, and Notting Hill that are delivering across west London. Their online shop is not only selling IPAs, no-alcohol beer, and natural wines, they’re also doing big, mixed gift packs that are perfect for someone special. And when we say someone special, we mean you.
CENTRAL The Winemakers Club £ £ £ £ Wine Bar  in  City ,  Farringdon ££££ 41a Farringdon St
Do you live within a two-mile radius of Farringdon? Well, congratulations, because you can now get a selection of the Winemaker’s Club’s wines delivered. You can order directly from their website and there are mixed case discounts with 5% off six bottles and 10% off 12 bottles.
Hakkasan ££££ 17 Bruton St
Whether you’re after a big bottle of Johnnie Walker Black Label or a proper bottle of champagne, you can get it delivered from upmarket Cantonese restaurant, Hakkasan. Their new Wine By Hakkasan alcohol delivery situation is available through the Supper app and you can expect quick delivery.
Moto ££££ 7 Maiden Lane
Sake, shochu, craft beer, and cocktails. That’s what Covent Garden’s Moto is all about. This little artisan beverage spot is delivering plenty of sakes and Japanese craft beers that you won’t be able to find anywhere else in London.
The Cocktail Trading Co. ££££ 68 Bethnal Green Rd
Bethnal Green’s The Cocktail Trading Co. have bottled up a bunch of their boozy creations which ship daily between 6 and 7pm, and on demand from 4pm till 11pm on Fridays and Saturdays. You can order single servings of drinks like the Buchu Highball and the Hench 75 for just £7, double servings for £12.50, or whopping big 500ml bottles (that’s six servings) for £30. They’re also offering a full set which includes all seven single servings for just £42.
via The Infatuation Feed https://www.theinfatuation.com/london/guides/the-alcohol-pick-up-and-delivery-guide Nhà hàng Hương Sen chuyên buffet hải sản cao cấp✅ Tổ chức tiệc cưới✅ Hội nghị, hội thảo✅ Tiệc lưu động✅ Sự kiện mang tầm cỡ quốc gia 52 Phố Miếu Đầm, Mễ Trì, Nam Từ Liêm, Hà Nội http://huongsen.vn/ 0904988999 http://huongsen.vn/to-chuc-tiec-hoi-nghi/ https://trello.com/userhuongsen
Created June 19, 2020 at 04:42PM /huong sen View Google Doc Nhà hàng Hương Sen chuyên buffet hải sản cao cấp✅ Tổ chức tiệc cưới✅ Hội nghị, hội thảo✅ Tiệc lưu động✅ Sự kiện mang tầm cỡ quốc gia 52 Phố Miếu Đầm, Mễ Trì, Nam Từ Liêm, Hà Nội http://huongsen.vn/ 0904988999 http://huongsen.vn/to-chuc-tiec-hoi-nghi/ https://drive.google.com/drive/folders/1xa6sRugRZk4MDSyctcqusGYBv1lXYkrF
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Home to the world-renowned Mayo Clinic, Rochester is Minnesota's third largest city behind Saint Paul and Minneapolis.
Offering many of the same urban amenities as the Twin Cities, Rochester also provides a small town feel in the form of city-wide celebrations and a welcoming community. Mixing natural spaces with a bustling downtown district, the city has a rich history that can still be seen today. Popular things to do here include touring the historic Mayowood Mansion, admiring multicultural art at the Rochester Art Center, and exploring the environment at the Quarry Hill Nature Center. Whether you are looking for a Minnesota city experience or a respite in nature not far from the urban landscape, Rochester has a wide range of attractions worth visiting and a sprawling network of bike trails that leads you right to them.
1. Rochester Art Center
Situated along the banks of the Zumbro River, the Rochester Art Center contains a vast collection of multicultural, multimedia artworks that connects visitors to the world around them. Operating since 1946, the Rochester Art Center has occupied its eye-catching riverside location since 2004, and while it is impressive enough to view from the outside, the true cultural insights are found within.
Featuring an ever-rotating display of various media and artworks from emerging and nationally recognized artists, the center makes it easy to engage with something new on each visit. It also offers many community programs, such as kid's dance parties, adult Creative Development Series, and summer youth camps, giving everyone in Rochester a chance to discover themselves through art.
2. Editor's ChoiceSoldiers Field Veterans Memorial
Constructed to honor all southeast Minnesotans who gave their life in battle, the Soldiers Field Veterans Memorial also stands as a tribute to all citizens who have stepped up to support their country. The memorial features visual illustrations of every military combat from the Revolutionary to the Gulf War. Its centerpiece is the Wall of Remembrance, a large granite monolith inscribed with the names of more than 3,000 patriots who lost their life in battle. You can visit the memorial any time, including at night, when the names and figures depicted glow under the lights.
3. Downtown Peace Plaza
If you are looking for a shopping and dining experience in Rochester, the Peace Plaza is a great place to start. Neighboring the Mayo Clinic, the Peace Plaza is a pedestrian friendly public space that lends quick access to everything the downtown area has to offer. With fashionable boutiques, first-class restaurants, and a great civic assembly space, the plaza emanates the welcoming atmosphere found throughout Rochester.
A sprawling network of skywalks and underground walkways stems from the Peace Plaza and spreads throughout the downtown area, providing a climate-controlled way to travel as you peruse the various shops and restaurants.
4. Plummer House
Originally home to Dr. Stanley Plummer and his wife Daisy, the Plummer House is another cultural attraction of Rochester that can be directly tied to the nearby Mayo Clinic. Serving as a founder and innovator for the Mayo Clinic, Dr. Plummer worked closely with the architects who began construction of his home in 1917. A full century later, this historic home and estate has been meticulously preserved and is open for the public to get a glimpse of the past. Visitors to the Plummer House are free to explore the manicured grounds and gardens during sunlight hours, and guided tours of the Tudor mansion take place on Wednesdays throughout June, July, and August.
5. Bike Trails
A fuel-efficient and friendly way to see the city, the many different bike trails found throughout Rochester provide endless avenues of enjoyment. Connecting users to natural spaces like Silver Lake and the Soldiers Field Veterans Memorial, and including a scenic downtown waterfront route that puts pedestrians in proximity to the Rochester Art Center and various shopping outlets, the bike trails in Rochester allow a choose-your-own-adventure kind of day. While most of the trails are separate from the roadways, a few use bike lanes and sidewalks to arrive at different destinations. Along the way, you can expect to pass by commuters heading to work, wildlife that shares the urban landscape, and many other members of the community who enjoy the pace of muscle-powered transportation.
6. Thursdays on First & 3rd
While any day of the week is a good time to check out Rochester's thriving shopping and dining scene, Thursdays during the summer are even more lively than usual. That's because throughout the months of June, July, and August, the city of Rochester hosts the Thursdays on First & 3rd Summer Market and Music Festival. Featuring more than 100 craft and food vendors plus a soundtrack of live music, Thursdays on First & 3rd can accurately be described as a weekly celebration of fine weather and a welcoming community. Every week is different thanks to the ever-changing lineup of live performances and special events.
7. Quarry Hill Nature Center
Within the 329 acres of the Quarry Hill Nature Center, you can expect to find eight miles of hiking trails, a children's pond, a limestone fossil quarry, and historic sandstone caves to explore. The Quarry Hill Nature Center doesn't just provide a backdrop to connect with these natural features, it also provides education about the environment. Within the actual brick and mortar nature center itself are informational exhibits and live animals, and the center also offers naturalist programs. It is open throughout the year, and during the winter months, the hiking trails easily convert to snowshoe and cross-country ski routes, making year-round exploration fun and easy.
8. Mayo Civic Center
Offering more than 200,000 square feet of space to enjoy, the Mayo Civic Center is one of the largest event centers in southern Minnesota. Hosting local and international musical acts, semi-pro and exhibition sporting events, as well as numerous conferences, business meetings, and conventions, the Mayo Civic Center has established itself as a vital part of the Rochester community. A 2017 expansion added a second-floor grand ballroom and an architecturally pleasing facade on Civic Street. While there is a long list of shows and performances to choose from, a simple way to enjoy this venue is just sitting on the riverfront terrace that overlooks the scenic Zumbro River.
9. Douglas State Trail
Operated by the Minnesota DNR, the Douglas State Trail is a 12.5-mile pathway that connects Rochester with the northern city of Pine Island and takes users through the small town of Douglas, for which the trail is named. It features both a paved trail and adjacent natural surface trail. With the exception of snowmobiles in winter, the Douglas State Trail prohibits motorized vehicles, allowing plenty of room for hikers, bikers, inline skaters, and horseback riders to explore the scenic environment. Serving once as the passageway for the Chicago Great Western Railway, the Douglas State Trail not only provides an accessible, even grade that everyone can explore, but it is a great example of how Rail to Trail conversions greatly benefit the community.
10. History Center of Olmsted County, Mayowood Mansion
Serving as a non-profit organization dedicated to preserving the people, places, and stories that have made Olmsted County what it is today, the History Center of Olmsted County provides opportunities for locals and tourists to learn about the community's progress over the years. Featuring rotating exhibits and a handful of preserved historic buildings, the center also hosts youth camps, lecture series, and family-friendly movies under the stars throughout the summer. No history lesson on Rochester and the surrounding Olmsted County would be complete, however, without mentioning the Mayo Clinic, which was founded in Rochester and has developed a reputation.
In conjunction with the Mayo Clinic, the History Center of Olmsted County helps provide access to the historic Mayowood Mansion, the former residence of the Mayo Clinic co-founder, Charles H. Mayo. During the holiday season, special Christmas Tours are available and generally sell out quickly. Whenever you choose to reserve your guided tour of this historic estate, be prepared to take a step back into history as you explore the home of a man whose influence still shapes Olmsted County today.
Here are a few more ideas for what to do in the area: Top 10 things to do in Jacksonville NC
From : https://wikitopx.com/travel/top-10-things-to-do-in-rochester-mn-702230.html
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gymnasticcrazy-blog · 5 years
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42/M/5'10"/160 lb: new to lifting at 40+, my 1 year transformation http://bit.ly/2SrnEpl
Pics
Let's start with the good stuff:
before/after pics
  Left: Age 29, roughly 175 pounds. Also before I discovered manscaping. :) I had to go back pretty far to find a shirtless pic of me, but rest assured that this is roughly what I've looked like for the past couple decades.
  Right: A couple weeks ago, days after I turned 42. I'm about 160 pounds and 12 weeks into my current bulk. The image is kind of a double cheat, since the photo is post-workout and with flattering light, but it's the first time I've ever seen myself in a photo and been really happy with the way I looked, so I'm using it! :)
  Here is a "fairer" image (eg: no post-workout pump & not posed) of my semi-current physique, taken 3 months ago, near the bottom of my most recent cut.
Background
I'm a 5'10", 160 lb guy that just turned 42 a couple weeks ago. I rarely see progress posts from older people, so hopefully some of you 40+ folks will see this and post your own stories; I'd love to see them.
  During my 20s and 30s, I mostly sat in front of a computer for 8+ hours a day, rarely exercised, and never really paid any attention to my diet. As a result, my weight slowly ballooned from about 155 in my early 20s, to ~190 at my peak in my early 30s. At 190 lbs, a helpful friend pointed out that I was fat (it happened slowly and I honestly couldn't see it), and I was able to bring my weight back down to a more reasonable 175 relatively quickly through cardio and programs like P90X. I never attempted to adjust my diet because I believed that exercise was the key to weight loss.
  Throughout my 30s and early 40s, I hovered around 175 lbs, where I basically looked "fine" - at least with a shirt on, anyway. I knew I was out of shape, but I had neither the motivation nor knowledge to make changes to my physique.
  I started taking my health more seriously when I hit 40, and I took up running. I've always been a terrible runner, and had awful shin splints when first starting out. It took me several weeks to get to the point where I could run a single mile at a ridiculous 12-13 minute pace, but I was ecstatic at the time. I stuck with it, and over the next year I worked my way up to ~30 miles per week. My 5K mile pace was down to about 7:20 and I felt really good about myself. I felt fit for the first time since my teenage years!
  Even then, my physique hadn't changed much. I'd dropped a few pounds, but I still had a decent belly and no muscle to speak of - I was pretty much the definition of skinny fat.
  Everything changed just over a year ago, in October 2017. I was visiting a friend that happened to be into bodybuilding, and I agreed to join him for a workout. Until that day, I had never touched a barbell in my life. The most I'd ever done with weights was some curls with light dumbbells in my living room while watching TV.
  That day was a serious wake-up call. I had always assumed that I was about average as far as strength went, but on that day I discovered that I was weak AF! My friend took me through the big 4 lifts, and the only one that I didn't feel completely embarrassed by was squats, where I able to successfully complete 4x12 reps with the empty bar, although I seriously struggled. I could only overhead press the empty bar for 3-4 reps, and had to drop down to something like 12.5 pound dumbbells to get a full 12. Similarly, I could only bench the empty bar for maybe 5-6 reps. It was a real shitshow!
  That's the day that I decided I needed some muscles. So I jumped into weightlifting.
  TL;DR version: Was skinny-fat for all of my adult life, realized I was also weak af recently, decided to change!
Training
As an absolute beginner, I stumbled onto this subreddit and found the recommended workout routines. I thought I'd give the dumbbell stopgap routine a try for 2-3 months, because I already had a set of adjustable dumbbells, and I wasn't yet sure if I wanted to join a gym, or just install equipment in my basement. So that's what I did, and if nothing else it got me used to scheduling workout time into my day.
  In late January 2018, I bought a power rack, olympic bar & plates, and bench and set them up in my basement (pic of my setup if anyone is interested). I decided on Phrak's full-body 3-day LP program, as it was geared toward beginners.
  I stuck with Phrak's for about 3 months and saw some pretty good beginner gains. I went from struggling with the empty bar on all movements to 5x70 OHP, 5x110 BP, 5x150 SQ, 5x155 DL (no idea on 1RMs). Still weak, but improving!
  Around May of this year, I switched over to a 5-day nSuns 5/3/1 program. The volume increase compared to Phrak's was a bit shocking, but I stuck with it. I decided to do nSuns on a cut, which in hindsight may have been a mistake, but I still managed to make some pretty good gains. By November my 1RM looked like: OHP 110 lbs, BP 160 lbs, SQ 245 lbs (no idea on deadlift; I'm scared to go too heavy). Compared to some of the numbers I see you guys and girls throwing around, I'm still weak - but I feel a whole lot better about myself!
  I recently started a bulk and switched to a PPL split to mix things up a bit, but I'll probably return to nSuns at some point to try it while bulking.
  On weekends, I run (both Saturday and Sunday). Usually not more than 10 miles per week.
  TL;DR version: Started my weightlifting journey with a dumbbell-only program for a couple months, graduated to a full-body 3-day barbell program for 3 months, been doing a 5-day barbell split program since. Went from struggling with the empty bar to (barely!) benching my weight, and squatting ~1.5x my weight in roughly a year.
Diet
Probably the most important adjustment I made was to start using MyFitnessPal around the time I started lifting. Going from guessing about my daily caloric/protein intake to having detailed information has made a tremendous difference.
  Other than logging everything with MFP in order to hit my calorie goals (~1600 while cutting / ~2200 while bulking), I shoot for at least 150g of daily protein.
  I meal prep once per week, and thus tend to eat mostly the same things on weekdays. A typical day might look like:
  Breakfast:
shake (1/2 frozen banana, 8 oz almond milk, 1 serving greek yogurt, spinach, 1 tbsp flax seeds, whey protein)
2 eggs
toast or light english muffin
  Snack 1:
cereal (something low sugar like Cheerios) with almond milk & blueberries
  Lunch:
5 oz chicken breast or thigh
100g brown rice OR 6 oz sweet potato
green vegetable (broccoli, brussell sprouts, etc)
  Snack 2:
peanut butter sandwich (1.5 tblsp peanut butter on light bread)
  Dinner:
typically same as lunch
  Snack 3:
shake (almond milk, casein protein - maybe peanuts and/or oats if I'm bulking)
  On weekends I typically eat what I want, though I always try to hit 150g+ protein. I still track my calories but I don't beat myself up too much if I'm out with friends and go over by a bunch. I'm a social drinker and probably average 3-4 drinks per week (usually weekends).
Supplements
Whey protein wherever I need it to hit my protein goal, although usually I find that I can get there with mostly real food.
One scoop of casein protein before bed on lifting days.
5g creatine daily - just started this a few weeks ago and haven't really noticed any difference.
Goals/Questions
My main goal is to put on some more muscle mass while staying relatively lean. From my reading, it seems like most of you recommend alternating cut/bulk cycles to accomplish this. My last cut put me at just over 150 lbs, and my plan is to bulk up to 175 lbs or so and then cut again - with the understanding that the "ideal me" (more muscle, less fat) probably weighs around 160-165 lbs. Does that make sense?
I do want to also improve my running, which has taken a backseat to weightlifting this past year. I know the two goals (lifting / running) aren't that compatible, so if anyone has any advice/tips I'd love to hear it!
I'd like to improve my numbers a bit more, maybe eventually hit 1.5x bodyweight bench and 2x bw squat. I'm assuming that just continuing to put in the work will allow me to eventually hit those numbers, although my progress is definitely slower than many of you (I'm 42, so that's not unexpected either). Any suggestions?
Thanks for reading - this sub has been a tremendous source of motivation and knowledge for me over this past year!
submitted by /u/rbbrdckybk [link] [comments] December 29, 2018 at 11:56AM
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jakehglover · 5 years
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Anthocyanin: This Purple Pigment Fights Disease
Authors of a literature review involving data collected from more than 602,000 individuals across Australia, Europe and the U.S. assert anthocyanins, a flavonoid pigment found in a variety of fruits and vegetables, may lower your risk of cardiovascular disease, as well as help in the treatment of certain types of cancer and diabetes.
Researchers suggest about 400 individual anthocyanins have been identified, most of which are concentrated in the skins of fruits, particularly berries such as blueberries, raspberries and strawberries. Let's take a closer look at this important class of health-boosting flavonoids.
High Intake of Anthocyanins May Lower Your Risk of Cardiovascular Disease
A literature review and meta-analysis published in the journal Critical Reviews in Food Science and Nutrition1 suggests anthocyanins, the water-soluble pigments known to give certain fruits and vegetables their distinctive blue, purple and red hues, may also help reduce your risk of cardiovascular disease and aid in the treatment of other illnesses.
According to Johns Hopkins Medicine, an estimated 84 million Americans suffer from some type of cardiovascular disease, which is attributed to one out of every three deaths in the U.S.2 The study authors analyzed data collected from 19 prospective cohort studies, with a focus on evaluating the effect of anthocyanins on circulatory and heart health.
The research involved more than 602,000 individuals from across Australia, Europe and the U.S., who were monitored for periods ranging from four to 41 years.3 Compared to those with the lowest intake, the researchers noted participants with the highest anthocyanin intake were:4
9 percent less likely to suffer from coronary heart disease
8 percent less likely to die from causes associated with heart disease
That said, the study authors noted the absence of any relationship between the intake of anthocyanins and a reduced risk of heart attack or stroke.5 About the research, professor Glyn Howatson, Ph.D, director of research and innovation for the department of sport, exercise and rehabilitation at the U.K.'s Northumbria University, said:6
"Our analysis is the largest, most comprehensive evaluation of the association between dietary anthocyanin intake and the risk of cardiovascular disease. Evidence has been growing in recent years to suggest these natural plant compounds might be especially valuable for promoting cardiovascular health."
What Are Anthocyanins and Where Are They Found?
Anthocyanins are a class of flavonoids — natural antioxidants known to protect your body from cellular degeneration.
Authors of a 2010 study commented, "Approximately 400 individual anthocyanins have been determined. They are generally more concentrated in the skins of fruits, especially berry fruits. However, red berry fruits, such as strawberries and cherries, also have anthocyanins in their flesh."7 Fruits noted for their high anthocyanin content include:8
Acai berries
Blueberries
Raspberries
Black currants
Cherries
Red or purple grapes
Blackberries
Cranberries
Strawberries
Vegetables containing anthocyanins include:9
Eggplant
Red cabbage
Red onion
Certain types of potatoes
A body of 2010 research published in the journal Nutrition Reviews suggests anthocyanin content is usually proportional to the color intensity of the fruit or vegetable in which it is found, ranging from 2 to 4 grams (g)/kilogram per item and increasing as the produce ripens.10
The study authors note the levels of polyphenols, including anthocyanins, found in berries (and therefore the potential impact of berry consumption on your heart health) are affected by post-harvest processing methods such as drying, pasteurization and pressing.11
As you may expect, the highest levels of anthocyanins will be found in the whole fruit. The researchers further claim Americans consume an average of 12.5 to 215 milligrams of anthocyanins per day, while asserting, "Berry anthocyanins are poorly bioavailable, are extensively conjugated in the intestines and liver and are excreted in urine within two to eight hours post consumption."12
Given the poor bioavailability, it does not make sense to overconsume berries or any other potential food source of anthocyanins. Due to the ongoing nature of research on anthocyanins and other flavonoids, it seems best to wait until more definitive conclusions are drawn about the many benefits associated with them.
Other Studies Demonstrate the Value of Anthocyanins for Heart Health
The author of an earlier study on anthocyanins suggested they are prized for their many biological functions, including their well-known anticarcinogenic, anti-inflammatory, antimicrobial and antioxidant activities.13 He asserted they "display a variety of effects on blood vessels, platelets and lipoproteins," as well, making them useful to reduce your risk of coronary heart disease.14
The authors of the 2010 research mentioned above claim studies using blueberries, cranberries and strawberries have demonstrated "significant improvements in [low-density lipoprotein (LDL)] oxidation, lipid peroxidation, total plasma antioxidant capacity, dyslipidemia and glucose metabolism" in both healthy subjects and participants dealing with metabolic risk factors.15 
As to the manner in which berries, as a source of anthocyanins, influence your health, the study authors said, "Underlying mechanisms for these beneficial effects are believed to include upregulation of endothelial nitric oxide synthase, decreased activities of carbohydrate digestive enzymes, decreased oxidative stress and inhibition of inflammatory gene expression and foam cell formation."16 Based on the evidence, they concluded berries are an essential addition to a heart-healthy diet.
Anthocyanins in Blueberries and Strawberries Is Shown to Lower Your Blood Pressure
Blueberries and strawberries, both of which are rich in anthocyanins, have been highlighted for their role in helping protect your heart and lower your blood pressure. Past research revealed women ages 25 to 42 who ate more than three servings per week of blueberries and strawberries had a 32 percent lower risk of having a heart attack.17
That is likely so because anthocyanins are known to benefit the endothelial lining of your circulatory system, possibly preventing plaque buildup in your arteries, as well as promoting healthy blood pressure.
Other research has shown these antioxidants protect against heart disease by reducing oxidative stress and inflammation, while enhancing capillary strength and inhibiting platelet formation.18 Eating blueberries has also been shown to lower your blood pressure.
A study published in the Journal of the Academy of Nutrition and Dietetics19 involving postmenopausal women suggests blueberry consumption positively affects blood pressure. The women, who had either prehypertension or hypertension, received a placebo powder or freeze-dried blueberry powder (an amount equivalent to about 1 cup of fresh blueberries) daily for eight weeks.
While the placebo group saw no significant changes, the women supplementing with blueberries realized a 5 to 6 percent drop in both their systolic (top number) and diastolic (bottom number) blood pressure readings. Measurements of nitric oxide were also significantly increased in the blueberry group.
Nitric oxide helps your blood vessels maintain their elasticity and also dilates your blood vessels, thereby reducing your blood pressure. The study authors stated: "Daily blueberry consumption may reduce blood pressure and arterial stiffness, which may be due, in part, to increased nitric oxide production."20
Anthocyanins May Aid in Treatment of Colon Cancer
In a study published in Scientific Reports, 21 researchers from the University of Eastern Finland, working in conjunction with the U.S. National Institute on Aging, noted the promising role anthocyanins may play in cancer treatment.
The study focused on the effect of berry pigment on sirtuins — a type of protein involved in regulating your body's cellular processes with respect to DNA repair, inflammation response reduction, longevity and metabolism.
Specifically, the study highlighted the effects of anthocyanins on a lesser-known sirtuin referred to as SIRT6, which has been linked to glucose metabolism.22 Given the study outcomes, it's possible the regulation of this enzyme could open up new avenues for cancer treatment.
"The most interesting results of our study relate to cyanidin, which is an anthocyanin found abundantly in wild bilberry, blackcurrant and lingonberry," said lead study author Minna Rahnasto-Rilla, who holds a doctorate in pharmacy at the University of Eastern Finland.23 Specifically, the researchers noted cyanidin:24
Increased SIRT6 levels in human colorectal cancer cells
Decreased the expression of the twist-related protein (Twist1) and glucose transporters (GLUT1) cancer genes
Increased the expression of the tumor-suppressor forkhead box O3 (FoXO3) gene in cells
These findings show anthocyanins like cyanidin can increase the activation of SIRT6, and thereby reduce the expression of cancer genes and cancer cell growth.
Prostate Cancer Also Impacted Positively by Anthocyanins
Researchers have long thought differences in diet — particularly the consumption of wine, which contains anthocyanins and other beneficial polyphenols — may explain the high rates of prostate cancer in the U.S. as compared to other regions.
Given the fact about 164,000 new cases of the disease were expected to be diagnosed in 2018 and more than 29,000 American men die of prostate cancer annually, this disease is a real concern. 25   
The Mediterranean diet, on the other hand, which is rich in fish and olive oil, as well as healthy amounts of fruits, nuts and vegetables, is thought to act as a natural cancer inhibitor. About the impact of flavonoids like cyanidin and kaempferol, authors of a study published in the Journal of Nutritional Biochemistry said: 26
"Epidemiological evidence indicates that polyphenolic compounds in diets are protective against cancer, and cyanidin and kaempferol are abundant in wine and plants.
Therefore, the objective of the investigation was to determine the effects of cyanidin and kaempferol on prostaglandin E2 (PGE2) and cyclooxygenase-2 (COX-2) protein levels, and if peroxisome proliferator-activated receptor gamma (PPARgamma) and nuclear factor kappaB (NFkappaB) are involved in the expression of COX-2 in prostate cancer cells."
What they found was that the anthocyanin cyanidin lessens PGE2 production and COX-2 expression in human prostate cancer cells.
The study authors stated, "Cyanidin and kaempferol … reduced the level of PGE2 in … cell cultures and also attenuated the effect of arachidonic acid on increasing the amount of PGE2. Cyanidin reduced the levels of COX-2 protein in a dose- and time-dependent fashion." 27
Beyond that, a 2015 study published in the International Journal of Oncology 28 found cyanidin induced cell death and differentiation in prostate cancer cells. About the results, the researchers said: 29
"[C]ompounds like polyphenols, capable of inducing differentiation may represent potential chemotherapeutic agents.
We show for the first time that C3G, the most abundant anthocyanin in the human diet, inhibits cell growth and cell viability, resulting in the reversion of both androgen-sensitive (LnCap) and of the androgen-independent (DU145) [prostate cancer] cells from a proliferating to a differentiated state."
Can Anthocyanins Help Prevent and Control Diabetes?
The significance of anthocyanins in the prevention and treatment of Type 2 diabetes was highlighted in a 2018 literature review conducted at the Wroclaw Medical University in Poland.30
The study authors reviewed previous research related to the importance of anthocyanins in regulating carbohydrate metabolism and reducing insulin resistance as major factors in lowering the risk of Type 2 diabetes. According to the team, to date, a number of studies involving humans and animals have demonstrated anthocyanins:31
Enhance the secretion of adiponectin and leptin
Fuel the activation of adenosine monophosphate (AMP)-activated protein kinase
Increase the activation of PPARγ in adipose tissue and skeletal muscles
Inhibit intestinal alpha-glucosidase and pancreatic alpha-amylase
Reduce retinol binding protein 4 (RBP4) expression
Regulate glucose transporter type 4 (GLUT4) gene expression and translocation
Additionally, anthocyanins were found to improve insulin secretion by rodent pancreatic beta cells. Because individual anthocyanins and their glycosides have different activity, the researchers recommended eating a variety of plant products as part of your daily diet to ensure you are getting a wide range of anthocyanins.
Get the Benefits of Anthocyanins but Watch Your Daily Fructose Intake
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While berries and other colorful fruits are both tasty and nutrient-rich, I continue to recommend you eat them in moderation. Even though whole fruit contains natural sugars, for optimal health, you must limit your fructose consumption. As such, I advise you keep your total fructose intake below 25 g daily, including fructose from whole fruit.
If you have diabetes, heart disease, high blood pressure or insulin resistance, you'd be wise to limit your daily intake of fructose to 15 g until your condition improves. As noted in the Environmental Working Group (EWG) video above, because most berries and thin-skinned fruits (and vegetables) are sprayed with pesticides, it's always best to buy organic or grow your own.
For more information on the importance of buying organic, check out the EWG's Dirty Dozen list. Below is a table showing the amount of fructose present in some anthocyanin-rich fruits:32
Fruit Serving Size Vitamin E (mg)
Apple
1 medium
9.5
Blackberries
1 cup
3.5
Blueberries
1 cup
7.4
Boysenberries
1 cup
4.6
Cherries, sour
1 cup
4.0
Cherries, sweet
10
3.8
Cranberries
1 cup
0.7
Pears (red)
1 medium
11.8
Raspberries
1 cup
3.0
Strawberries
1 cup
3.8
As mentioned earlier, it would be unwise to overindulge in berries and other food sources of anthocyanins until more conclusive studies are completed.
As one researcher stated, "[U]ntil the absorption and metabolic fate of anthocyanins in vivo is unraveled, it would be unwise to conclude a high consumption of them will reduce the risk of chronic diseases. Long-term intervention trials must be properly designed and carried out to provide definite proof."33
For now, to achieve optimal health, it's best to eat a balanced diet from whole food sources. Be sure to include a variety of anthocyanin-rich foods in moderation. Because diet is just one factor known to contribute to your well-being, I also advise you to lower your stress level and get plenty of exercise and sleep, too.
from HealthyLife via Jake Glover on Inoreader http://articles.mercola.com/sites/articles/archive/2018/11/19/anthocyanin-health-benefits.aspx
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