How To Tow A Vehicle In Emergency

Call a professional towing service if you need to tow your vehicle.
Flatbed equipment
The operator loads your vehicle on the back of a truck.
This is the best way to transport your vehicle.
Wheel lift equipment
The tow truck uses two pivoting arms that go under the front tires and lift them off Ground. The rear tires remain on the ground. This is an acceptable way to tow your vehicle.

Trying to lift or tow your vehicle by the bumpers will cause serious damage. The bumpers are not designed to support the vehicle’s weight. Never tow your vehicle with just a rope or chain. It is very dangerous, since ropes or chains may shift from side to side or break. Improper towing such as towing behind a motorhome or other motor vehicle can damage the Transmission. If your vehicle must be towed with the front wheels on the ground:

1. Check the ground underneath the vehicle around where the transmission housing is For a fluid leak. If you find a leak, call a professional towing service and have your vehicle inspected by a dealer.

2. Put cloth on the edge of the cover. Carefully pry with a small flat-tip screwdriver or a metal fingernail file to remove the cover. The detachable towing hook mounts on The anchor in the front bumper.

3. Take the towing hook and the wheel nut wrench out of the luggage area.

4. Screw the towing hook into the hole, and tighten it with the wheel nut wrench Securely.

5. Hook the towing device to the towing hook.

6. Start the engine.

If it is difficult to turn on the engine, put the ignition switch in ACCESSORY or in ON position

7. Manual Transmission models: Shift to Neutral.

8. Continuously Variable Transmission models: Depress the brake pedal.

9. Shift to Drive mode and hold for five seconds, then to Neutral

10. All models: Release the parking brake.

If your vehicle must be towed with the front wheels on the ground:

Continuously Variable Transmission CVT Models only:

If you cannot shift the transmission or turn on the engine, will damage the transmission. Your vehicle must be transported with the front wheels off the ground.

Models with the keyless access system have an ENGINE START/STOP button instead of an ignition switch.


If you cannot turn on the engine, you may experience the following while your vehicle is being towed.

Braking may become difficult since the brake system’s power assist is disabled. Steering wheel becomes heavy as the power steering system is disabled.

Turning the ignition switch to LOCK (0*1 locks the steering wheel.

With the front wheels on the ground, it is best to tow the vehicle no farther than 80 km, and keep the speed below 55 km/h. Going down a long slope heats up the brakes.

This may prevent the brakes from working properly. If your vehicle needs to be towed on an incline, call a professional towing service.

Make sure to use the properly-designed and attached towing equipment. Manual transmission models Turning the ignition switch to LOCK (0*1 locks the steering wheel.

With the front wheels on the ground, it is best to tow the vehicle no farther than 80 km, and keep the speed below 55 km/h. Going down a long slope heats up the brakes.

This may prevent the brakes from working properly. If your vehicle needs to be towed on an incline, call a professional towing service.

Make sure to use the properly-designed and attached towing equipment.

Why You Should Study International Postgraduate Courses in Nursing

Nurses are a boon to the healthcare sector and the society overall as it is with their relentless efforts that efficient patient care is being possible. Also, considering the financial advantages of being a nurse, it is important to know that nursing as a profession is highly rewarding and respectable if you’re in the right place. With the continuous increase in demand for highly skilled nurses across the globe, a record number of students can get the opportunity to work in the healthcare sector as a nurse and serve the society. So, thinking on these lines, if you are an existing or an aspiring nurse in your country, you might want to enhance your career prospects on an international level by choosing to study postgraduate course in nursing in Canada.

Nursing in Canada has an endlessly wide scope as there is a huge unattended population of old people getting sick with multiple illnesses. It is for these people that nursing services are highly being demanded and in response to this demand, the government of Canada is accepting more than 2, 50,000 applications of healthcare workers who plan to move abroad in search of better employment opportunities. Making a move for higher international education may seem like a tough task initially but looking at the broader aspects of it, you can be assured that it would benefit you personally and professionally in a life-changing way. Needless to say, nursing life in Canada is far more respect worthy and esteemed as compared to that in developing nations.

When thinking of choosing a suitable province to study in Canada, one can look for postgraduate nursing courses in Ontario as the place itself is a hub of multiple employment opportunities. Ontario offers a friendly territory for all the new immigrants as it has a multi-cultural environment which brightens the scope of finding like-minded people around. However, before choosing to study the postgraduate nursing courses in Canada you must identify the specialty of your interest and then apply with a recognized designated learning institution. To make sure that the entire procedure from putting in an application to finally settling in Canada, it is important for you to choose a trusted education partner and at INSCOL, we make sure to be there from beginning till the end. To know more about exploring global opportunities as a nurse, choose to get in touch with INSCOL from our website and begin your international journey of experiences.

The Importance of Context in Covid-19 Vaccine Safety

Vaccine safety is critical for the successful implementation of any vaccination program, especially during a pandemic. In February 1976, the Centers for Disease Control and Prevention confirmed a cluster of cases of severe influenza-like illness among Army recruits at Fort Dix, New Jersey.1 A swine influenza A strain that resembled the 1918 pandemic influenza strain was identified,2 and a vaccination program was subsequently initiated for the entire U.S. population. After more than 40 million persons were vaccinated, a small excess risk of Guillain–Barré syndrome was noted, with an attributable risk of approximately 1 case per 100,000 doses administered. Given these concerns and because the pandemic did not materialize, the vaccination program was halted in December 1976 so that the issue could be explored further. This experience shed light on the need for real-time vaccine safety surveillance and the importance of context in decision making during a pandemic.

In a study now reported in the Journal by Barda et al., the investigators simultaneously evaluated the risk of adverse events among persons (≥16 years of age) who had received the BNT162b2 vaccine (Pfizer–BioNTech) and the risk of the same events after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.3 The authors used data from the largest integrated payer–provider health care organization in Israel, in conjunction with data on SARS-CoV-2 polymerase-chain-reaction tests and data on coronavirus disease 2019 (Covid-19) vaccine administration from the Israeli Ministry of Health.

This use of multiple data sets highlights the importance of investment in digital capabilities and meaningful integration across systems in order to provide real-time answers to key public health questions. The design of rigorous postauthorization vaccine safety studies during the Covid-19 pandemic has been a challenge because the pandemic itself has caused changes in health care utilization, the rollout of Covid-19 vaccines has occurred in phases because of initial supply limitations, and there have been disparities in access to vaccines. Barda et al. broadly addressed many of these challenges by emulating a trial that matched eligible vaccinees to unvaccinated controls according to sociodemographic characteristics, the number of preexisting chronic health conditions, previous health care utilization, and pregnancy status.

In the vaccination analysis, the study included 42 days of follow-up (i.e., 21 days after the first dose and 21 days after the second dose). This analysis accounted for seasonal and secular trends by matching on the day of vaccination, rather than relying on historical risk estimates that may not have been comparable in the pandemic setting. In the SARS-CoV-2 analysis, a similar approach was used to match persons with a newly diagnosed infection to uninfected persons.

Although the risk estimates in the vaccination and the SARS-CoV-2 analyses were not directly comparable because of differences in the populations (i.e., events were evaluated per 100,000 vaccinated persons and per 100,000 infected persons, respectively), these risks were placed in context. The most salient example is myocarditis, which has received much attention recently given the preponderance of reported cases after vaccination among adolescents and young adults and the incidence of myocarditis observed after SARS-CoV-2 infection.4-6 In the population-based cohort in the study conducted by Barda and colleagues, the risk ratios for myocarditis were 3.24 (95% confidence interval [CI], 1.55 to 12.44) after vaccination and 18.28 (95% CI, 3.95 to 25.12) after SARS-CoV-2 infection, with risk differences of 2.7 events per 100,000 persons (95% CI, 1.0 to 4.6) and 11.0 events per 100,000 persons (95% CI, 5.6 to 15.8), respectively. What is even more compelling about these data is the substantial protective effect of vaccines with respect to adverse events such as acute kidney injury, intracranial hemorrhage, and anemia, probably because infection was prevented. Furthermore, the persons with SARS-CoV-2 infection appeared to be at substantially higher risk for arrhythmia, myocardial infarction, deep-vein thrombosis, pulmonary embolism, pericarditis, intracerebral hemorrhage, and thrombocytopenia than those who received the BNT162b2 vaccine.

National discussions about benefit–risk balance often focus on the benefits of preventing symptomatic disease, hospitalization, or death due to Covid-19 and the risks of serious adverse events after vaccination.7,8 As specific adverse events such as myocarditis are highlighted, however, the lack of corresponding specificity about benefits can hamper efforts to communicate effectively with patients. Messenger RNA (mRNA) vaccines may be associated with myocarditis, but they can also prevent cases of myocarditis, acute kidney injury, arrhythmia, and thromboembolic disease. The key to comparing these risks depends on the risk of SARS-CoV-2 infection to an individual person, and that risk can vary according to place and over time. Given the current state of the global pandemic, however, the risk of exposure to SARS-CoV-2 appears to be inevitable.

One major limitation of this study is the lack of risk estimates according to age group and sex. For example, thrombosis with thrombocytopenia syndrome occurs predominantly in young adult women who have received adenoviral vector vaccines against SARS-CoV-2, whereas myocarditis predominantly occurs in male teens and young men who have received mRNA vaccines.5,9,10 Age- and sex-stratified comparisons that reflect local epidemiologic factors might support public understanding of different approaches to vaccine use in different countries, such as Israel, the United Kingdom, and the United States. Other limitations of the study include the paucity of data regarding younger teens and children, the conservative assumption that vaccines have no effect on transmission, and the absence of medical record review to validate computable phenotypes (i.e., algorithms used to identify a cohort on the basis of patient records).

As new knowledge of the safety and benefits of vaccines continues to evolve, studies like this one may help to support decision making about the use of Covid-19 vaccines. The benefit–risk balance should be reassessed, refined, and communicated as the disease burden changes, new variants and safety signals emerge, and vaccine effectiveness begins to wane. Context matters, which means that we as a country need to be ready for continual learning and change.

No Correlation between Anti-PF4 and Anti–SARS-CoV-2 Antibodies after ChAdOx1 nCoV-19 Vaccination

Vaccine-induced immune thrombotic thrombocytopenia (VITT), also known as thrombosis with thrombocytopenia syndrome, is a rare but potentially fatal complication of vector-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines.1-3 The clinical picture and the serologic findings in patients with VITT resemble heparin-induced thrombocytopenia.1-3 Several groups have reported the presence of platelet factor 4 (PF4)–reactive antibodies in patients with VITT.1-3 IgG from patients with VITT induces platelet activation and aggregation by cross-linking Fcγ receptor IIA on platelets.1 PF4 is a tetrameric protein that is released from platelet alpha granules on activation. VITT antibodies bind to the heparin-binding site on PF4.4 The link between vaccination and the formation of anti-PF4 antibodies is yet to be determined. A proposed mechanism includes cross-reactivity between anti–SARS-CoV-2 and anti-PF4 antibodies.5 In the current study, we investigated the correlation between anti–PF4–heparin antibodies and anti–SARS-CoV-2 antibodies in vaccinated health care workers (healthy controls) and in vaccinated patients with clinically suspected VITT.

The level of anti–PF4–heparin antibodies was measured with the use of an enzyme-linked immunosorbent assay (ELISA), and the levels of antibodies against various antigenic sites of the SARS-CoV-2 spike protein (spike trimer, receptor-binding domain [RBD], subunit 1 [S1] domain, and subunit 2 [S2] domain) and against nucleocapsid protein were measured with the use of a bead-based assay (Luminex). Antibodies were measured in 101 healthy controls 2 weeks after the first dose of ChAdOx1 nCoV-19 (Oxford–AstraZeneca) had been administered and in 59 patients with clinically suspected VITT between 11 and 22 days after the first dose had been administered. The ability of the sera to activate platelets was tested with the use of a modified heparin-induced platelet aggregation assay. Details of the methods are provided in the Supplementary Appendix, available with the full text of this letter at

Figure 1.

Antibody Levels and Correlation Analysis.
VITT was confirmed in 20 of 59 patients (34%) on the basis of a positive PF4 ELISA and a positive modified heparin-induced platelet aggregation assay (Table S1 in the Supplementary Appendix). The level of anti–PF4–heparin antibodies was higher among the patients with confirmed VITT than among the healthy controls and the patients who did not have VITT (Figure 1A and Table S1). The 95% confidence intervals for the differences between the groups are presented in Table S2; these confidence intervals were not adjusted for multiplicity and therefore cannot be used to infer effects. The levels of antibodies against spike trimer, RBD, S1 domain, and nucleocapsid protein were similar in the three groups. The levels of antibodies against S2 domain were lower among the patients who did not have VITT than among the persons in the other two groups. We did not find any correlation between the level of anti–PF4–heparin antibodies and the level of anti–SARS-CoV-2 IgG antibodies in any of the three groups (Figure 1B and Table S3).

Moreover, the levels of anti–SARS-CoV-2 antibodies did not differ substantially between vaccinated persons without complications (i.e., the healthy controls) and patients with VITT. Similarly, Scully et al.2 reported that the levels of antibodies to spike protein and RBD in patients with VITT were in the same range as those of the recipients of one dose of ChAdOx1 nCoV-19. Furthermore, our study did not show a correlation between anti–PF4–heparin antibodies and anti–SARS-CoV-2 antibodies in patients with VITT. Although a preprint publication suggested that spike protein shares an immunogenic epitope with PF4, purified anti-PF4 and anti–PF4–heparin antibodies from patients with VITT did not show cross-reactivity to recombinant SARS-CoV-2 spike protein.5

Our results do not support the hypothesis that the immune response against SARS-CoV-2 proteins leads to the formation of anti-PF4 antibodies in patients with VITT. However, we cannot exclude the possibility of cross-reactivity between a subgroup of anti–SARS-CoV-2 antibodies and a subgroup of anti-PF4 antibodies. A better understanding of the link between vaccination and VITT is necessary for the development of more targeted therapies.

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation

Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear.

In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days.

A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P=0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups.

Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension

The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear.

In this multicenter, randomized, controlled trial, we assigned Chinese patients 60 to 80 years of age with hypertension to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment). The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.

Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group. At 1 year of follow-up, the mean systolic blood pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg in the standard-treatment group. During a median follow-up period of 3.34 years, primary-outcome events occurred in 147 patients (3.5%) in the intensive-treatment group, as compared with 196 patients (4.6%) in the standard-treatment group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.92; P=0.007). The results for most of the individual components of the primary outcome also favored intensive treatment: the hazard ratio for stroke was 0.67 (95% CI, 0.47 to 0.97), acute coronary syndrome 0.67 (95% CI, 0.47 to 0.94), acute decompensated heart failure 0.27 (95% CI, 0.08 to 0.98), coronary revascularization 0.69 (95% CI, 0.40 to 1.18), atrial fibrillation 0.96 (95% CI, 0.55 to 1.68), and death from cardiovascular causes 0.72 (95% CI, 0.39 to 1.32). The results for safety and renal outcomes did not differ significantly between the two groups, except for the incidence of hypotension, which was higher in the intensive-treatment group.

Moving the Goalposts for Blood Pressure — Time to Act

We often lament the lack of confirmatory studies that can either reassure us all that the previous evidence for a trialed intervention is robust or indicate that the evidence is questionable. Zhang and colleagues have conducted such a study — the STEP trial1 — which in essence investigates the veracity of the findings of the previous trial SPRINT,2 but in an older cohort and in China, a country with a considerable burden of high blood pressure and stroke. The investigators have demonstrated impressive organizational skills in completing recruitment for such a large multicenter trial within a calendar year. As in . . .

Effect of Salt Substitution on Cardiovascular Events and Death

Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain.

We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia.

A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P=0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P=0.76).

Social Media Marketing And SEO

The digital world is an increasingly crowded but mandatory field that businesses owners must play in. As a Tampa business in today’s world it is now not enough to just have a website and Tampa social media marketing strategy, you also must employ a comprehensive search engine optimization plan. For this reason, the smart option is to work with a company, like Webhead Interactive that does both.

Webhead social media strategies are designed in a way to complement their SEO work. This way each end of the marketing spectrum maximizes the work of the other. The result? More traffic to your site and more customers to your business. Tampa social media is a very crowded field. Most businesses are active on one or more of the popular social media platforms, such as Facebook, Twitter, YouTube, even Pinterest and Instagram. For this reason it is important that your business not just be active in your Tampa social media marketing, but also be found through comprehensive SEO efforts.

Webhead Interactive, known as not only a top rated Tampa SEO company, but also the premier Tampa social media marketing agency, has the experience and expertise necessary to help businesses reach their market audience through a fully integrated and optimized social media management strategy. They work on multiple levels to be able to not only help your customers find you, but also interact with you through your social media channels. Since Webhead social media doesn’t just focus on one aspect of your digital marketing, but instead takes a 360 approach, they far surpass the impact of other social media companies in Tampa. Quicker, more powerful results and a proven track record of success.

As the leading full-service Tampa social media agency, Webhead Interactive will help you identify how your business and brand can benefit from an optimized social media presence. An example of some of the services they offer and might recommend include; custom Twitter, Google+ and YouTube backgrounds to help you promote your brand, Facebook timeline design and implementation to increase visitor click-through rates, Pinterest set-up and board strategy, content distribution and sharing strategy to maximize exposure and much more. They will also help you with your digital and social media promotional advertising strategy to further encourage engagement and fan development.

In order to make sure your Tampa business is found by the customers that are looking for you the best strategy is to maximize your online exposure by using both social media marketing and SEO as part of your communications strategy. By choosing a company like Webhead Interactive and Webhead social media, you know you are working with a team that understand and excels at both. The author has an immense knowledge on Tampa social media marketing. Know more about Webhead social media, Tampa social media marketing related info in his website.

Paton Marketing: Quality Solutions for Effective Internet Marketing

Paton Marketing is an Internet Marketing Company Miami that has helped many clients generate great revenues through various online marketing techniques and procedures. Paton Marketing offers services like Search Engine Optimization, Website Development, Pay per Click Management, Reputation Management, and Social Media Marketing. We provide all the services you need at affordable rates.

Our online marketing strategy constantly thrives to get desired results for the clients. Our SEO campaigns cover all critical and diverse factors ranging from on-page, back link, content to website design. All SEO aspects are covered with the simplified three phase approach of Plan, Optimize and Track to strategize, execute and report SEO campaigns.

Miami Marketing Agency uses expert knowledge in a range of marketing services to help bring our clients’ websites to unprecedented levels of success. Through effective online marketing strategies and our expert SEO services, we can help turn your website in to your business’ most powerful lead generator. Google, like many other search engine ranks pages based on certain criteria. To start with, the quality of your site matters a lot.

We also specialize in Web Development and Web Design. Paton Marketing provides our clients with a strategically-developed premium custom website. A great website will go a long way in getting your business noticed online. It also delivers a high-quality user experience. We keep your website up to date regularly.

Internet marketing is much more than site creation. It requires precise marketing techniques and tools across the board. Without our professional assistance, your website will simply fail to generate essential web traffic. Web marketing also entails weekly progress reports. This includes web traffic, along with the number of hits your site secures on a weekly basis.

Miami Marketing Agency also specializes in Reputation Management. Reputation Management is one of most important factor in web marketing. Negative content can terribly affect your business. Paton Marketing Reputation Management strategies can protect your online reputation by suppressing negative content on the search results. We create positive and multiple micro-sites ensuring that the negative links are pushed further out of search results.

If you are struggling with web traffic issues, our dedicated marketing team can help you within time and budget. Simply contact us today.