text:
417 Third Avenue Albany, Georgia 31701(229) 312-1000
2000 Palmyra Rd. Albany, Georgia 31701(229) 434-2000
126 Hwy. 280 West Americus, Georgia 31719(229) 924-6011
807 S. Isabella St. Sylvester, Georgia 31791(229) 776-6961
361 Randolph St. Cuthbert, Georgia 39840(229) 732-2181
Many different types of hand conditions require the clinical and surgical expertise of a plastic surgeon. Listed in the directory below are some, for which we have provided a brief overview.
Carpal Tunnel Syndrome
Congenital Hand Deformities
Dupuytren's Contracture
Rheumatoid Arthritis
The third-party content provided in the Health Library of phoebeputney.com is for informational purposes only and is not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. If you or your child has or suspect you may have a health problem, please consult your primary care physician. If you or your child may have a medical emergency, call your doctor or 911 or other emergency health care provider immediately in the United States or the appropriate health agency of your country. For more information regarding site usage, please visit: Privacy Information, Terms of Use or Disclaimer.
© 2014 Phoebe Putney Health System. All rights reserved Privacy Policy
Connect via


text:
Every piece of ongoing research needs to be connected with the work already done, to attain an overall relevance and purpose. The review of literature thus becomes a link between the research proposed and the studies already done. It tells the reader about aspects that have been already established or concluded by other authors, and also gives a chance to the reader to appreciate the evidence that has already been collected by previous research, and thus projects the current research work in the proper perspective.
A large part of review of literature actually needs to be done even before the research project is formalised. This is essential to make sure that you are not repeating the work that someone has already done earlier. Sometimes, if the research proposed by you has already been undertaken earlier, then it provides you an option of modifying your work by adding a new perspective or altering some of the methods of research to obtain a perspective that will be different from earlier works and thus more valuable. Occasionally, your work may be exact repetition of the work done earlier, but with a different set of data or sources of facts, and purpose of the research may just be see if your results are similar to earlier works or otherwise.
A good researcher usually goes through a lot more literature than is actually incorporated in the paper. This is because different literature may have differing relevance for the current project and all of it may not worth reporting in the end, but in the initial phase, when you are looking for all aspects of an issue that could be relevant one would like to extensively explore the literature and see if any relevant findings are already available. Some of the literature reviewed is directly relevant and hence used as a preface to explain the background of work. Then other reports may be relevant from the point of view of the project as they provide some clues to the puzzle by suggesting a hypothesis, which may be the subject matter of your research project.
Lastly, review of literature is also important to highlight difference in opinions, contradictory findings or evidence, and the different explanations given for their conclusions and differences by different authors. In some cases, an analysis of these factors can help one understand may facets of a complex issue and at other times, such analysis can lead to a new possibility that can be researched upon in the current project. Thus review of literature is a very important part of one's research.
To summarise, there is hardly any research project which is totally unrelated with research that has already taken place. Usually every individual research project only adds to the plethora of evidence on a particular issue. Unless the existing work, conclusions and controversies are properly brought about, most research work work would not appear relevant, not will it appear important in the whole framework. Thus, review of literature is a very important aspect of any research both for planning your work as well as to show its relevance and significance.

subset: commoncrawl


text:
Edward Razek, Adriana Lima and Candice Swanepoel announce the exciting news [Getty]
Oh-ma-gawd, news has just arrived that one of our favourite fashion moments of the year is coming to the UK. Take a deep breath… London's is hosting the Victoria's Secret show!
The annual event is usually held in New York, but in 2014, the glitzy shebang will take place at our very own Earls Court. Yes! VS Angels Adriana Lima and Candice Swanepoel announced the news this morning alongside Chief Marketing Officer Edward Razek at a special event held at the brand's New Bond Street store - and naturally, Grazia Daily was there to document the momentous occasion.
'It's so exciting to be here in London, as everybody knows, London is the centre of fashion in the world. And I could not think of a better place than here to hold the fashion show,' Adriana told the excited crowd. In the past we've seen the likes of Taylor Swift and Rihanna performing at the show, so will be a Brit pack this time round? Although the acts haven't been confirmed yet, Adriana is crossing her fingers for Elton John. 'I have a huge crush!' Who knew?! Meanwhile, Candice revealed she'd love to see Prince Harry there. 'He can have a front row seat!' Something tells us he'd be up for that...
[Getty - Adriana Lima]
What's more, Cara Delevingne is set to return to the VS catwalk this year and will be in her element on her home turf. 'I'll let you in on a secret,' said Edward. 'I told Cara a week ago that we were coming to do this and I told her to save the date. She was excited about it.' Us too! In fact, the undies brand has wanted to hold a show here since 1998. So why has taken so long?
'We started opening stores in London, including the one we're all in today,' says the Chief Marketing Officer. 'So there was enough critical mass and we found a good location... it just kind of all came together this year. And candidly when we came to London in 1998, no one knew who we were.'
[The Brit Invasion at the Victoria's Secret Show 2013]
You'll remember Victoria's Secret revealed their love for the UK at their show last year. The event had a whole 'Brit Invasion' section featuring red, white and blue costumes, Taylor Swift performing in a Union Jack dress and Adriana Lima with a cockney makeover. We can expect even more Britishness this time round.
The underwear giant's first fashion show was held in New York in 1995. The event has only been held outside of the US once in 2000 when it was held at Cannes Film Festival to raise money for charity Cinema Against Aids. See the best of last year's show in the gallery below...


text:
The login for HRBlock.com has been found and verified. It was updated Friday, November, 21st 2014 and added to our official website user page account.
The Emerald Card login page is listed online. Please confirm you are using the correct Emerald Card login.
If the entry online is empty, then at the time of adding the login to Emerald Card in our database nothing was found. If there is a entry online then at the time this archive login page for HRBlock.com was created, the login page was:
The HRBlock.com login page meta data has been listed online for your convenience. You can compare this data to the real login page when you arrive in order to verify you are using the correct login for the Emerald Card website.
Emerald Card Prepaid MasterCard
The H&R Block Emerald Prepaid MasterCard — get access to your tax refund wherever MasterCard debit cards are accepted.
We do not archive the keywords for Emerald Card or any other listing in our archives at this time due to the lack of modern websites using them anymore.
HRBlock.com Domain to IP Address:
In order to compare the real login to HRBlock.com to an invalid page or to an updated sign-in for Emerald Card if the website is offline or has been redesigned, we have taken a snapshot of what the Emerald Card login page appeared as at the time of the archive and listed it online:
You can rate the login page for HRBlock.com if you would like.
Please rate only once based on the look, functionality, and style of the Emerald Card sign-in area of the website.
Tech Name: Domain Administrator
Tech Organization: HRB Innovations Inc.
Tech Street: One H&R Block Way
Tech City: Kansas City
Tech State/Province: MO
Tech Postal Code: 64105
Tech Country: US
Tech Phone: +1.8168543000
Tech Phone Ext:
Tech Fax: +1.8168548500
Tech Fax Ext:
Tech Email: email@example.com
Name Server: ns3.hrblock.com
Name Server: auth00.ns.uu.net
Name Server: auth100.ns.uu.net
Name Server: ns4.hrblock.com


text:
St. Lawrence Gap Condo Rental Photos and Description
Spectacular Caribbean Sea views. Rent as a 1-BR or 2-BR 2-BA condo.
This beautiful apartment overlooks the clear blue sparkling Caribbean Sea on the south coast of Barbados in the heart of St Lawrence Gap. In the thick of beautiful beaches and terrific restaurants, #11 'Deja Blue' offers excellent value and everything you'll desire from flat-screen TV to wireless Internet to a view that will knock your socks off.
Whether your idea of an ideal holiday includes quiet relaxation at our pool or on the beach or the fun of exploring the diverse island of Barbados, you will be very happy to have as your home base this gorgeous property with 270-degree view of the Caribbean Sea.
Also, ask about renting this beautiful property as a one-bedroom condo with gorgeous king bed and stupendous Caribbean Sea views.
If the calendar indicates your dates are not available, please write me anyway as I would love to show you other south coast beachfront properties in Barbados.
Scuba, catamaran trips for snorkeling : I can recommend first-class outfits that will take care of all your Scuba and catamaran cruise needs in Barbados. Both are amazing ways to explore our beautiful island.
- Suitability:
- Long-term Renters Welcome
- children welcome
- non smoking only
- pets not allowed
- wheelchair accessible
About Jane Shattuck 246-230-8594
Greetings from beautiful Barbados! I am an American lucky enough to have met and fallen in love with a wonderful man from Barbados. Actually, I fell in love not just with the man but with his beautiful island home.
Jane Shattuck 246-230-8594 purchased this condo in 2008
Why Jane Shattuck 246-230-8594 chose St. Lawrence Gap
Two reasons: 1) Location in the St Lawrence Gap on the south coast, amidst fabulous sugar-white beaches and fantastic restaurants and 2) Caribbean Sea views that are guaranteed to knock your socks off. They still do mine, after years of living here.


text:
You must log in to access this feature. Sign in with Twellow or Facebook to get started.
By signing in to Twellow, you indicate your agreement to our terms of service.
Simply connect with Facebook and kiss those password blues away,
or go here to reset your password.
Riding the social media wave into the commercial and industrial B2B market. Kennesaw State University Alum | B.B.A. Marketing | SNM | SEO | PPC | Consulting


text:
- freely available
- re-usable
Nutrients 2013, 5(8), 3005-3021; doi:10.3390/nu5083005
Published: 31 July 2013
Abstract: Vitamin D deficiency, as well as cardiovascular diseases (CVD) and related risk factors are highly prevalent worldwide and frequently co-occur. Vitamin D has long been known to be an essential part of bone metabolism, although recent evidence suggests that vitamin D plays a key role in the pathophysiology of other diseases, including CVD, as well. In this review, we aim to summarize the most recent data on the involvement of vitamin D deficiency in the development of major cardiovascular risk factors: hypertension, obesity and dyslipidemia, type 2 diabetes, chronic kidney disease and endothelial dysfunction. In addition, we outline the most recent observational, as well as interventional data on the influence of vitamin D on CVD. Since it is still an unresolved issue whether vitamin D deficiency is causally involved in the pathogenesis of CVD, data from randomized controlled trials (RCTs) designed to assess the impact of vitamin D supplementation on cardiovascular outcomes are awaited with anticipation. At present, we can only conclude that vitamin D deficiency is an independent cardiovascular risk factor, but whether vitamin D supplementation can significantly improve cardiovascular outcomes is still largely unknown.
1. Introduction
Vitamin D is classically known for its role in bone metabolism, being important for the maintenance of calcium homeostasis by ensuring physiologic calcium absorption by the gut [1,2,3]. The discovery that the vitamin D receptor (VDR) is ubiquitously expressed in almost all body cells, such as immune, vascular or myocardial cells, suggests an involvement of vitamin D-mediated effects in several other systems apart from musculoskeletal tissues [2]. This has led to extensive research on vitamin D as a potential influencing factor in the pathogenesis of several chronic non-skeletal diseases, such as infectious or autoimmune diseases, cancer or cardiovascular diseases (CVD) [4,5,6].
Cardiovascular (CV) risk factors, such as arterial hypertension, obesity, dyslipidemia or diabetes mellitus, as well as CVDs, including myocardial infarction, coronary artery disease or stroke, are the most prevalent diseases and account for the major causes of death worldwide, especially in Western countries [7]. This underlines the importance of clarifying the role of vitamin D in the context of CVD.
Already in 1981, Scragg reported on a seasonal variation of CV mortality and suspected a positive, protective effect of UVB-radiation on CV risk [8]. An association of vitamin D and different CV risk factors and diseases has been extensively evaluated during the last few years. Numerous observational studies, prospective meta-analyses, as well as some interventional studies have addressed the possible linkage of vitamin D deficiency and the development of CVD and its risk factors [9,10,11,12].
The scope of this review is to provide a brief overview on basic vitamin D metabolism and vitamin D deficiency. We summarize the most recent studies evaluating the relationship between vitamin D and the presence of cardiovascular risk factors, including hypertension, obesity, type 2 diabetes mellitus, chronic kidney disease, dyslipidemia and endothelial dysfunction. In addition, we give an overview on observational data on the association between vitamin D status and incident CV events. Finally, we discuss randomized controlled trials (RCTs) and meta-analyses on vitamin D treatment and its influence on CVD. Since there has been extensive research, including numerous reviews on this topic within the last few years, we mainly want to concentrate on the latest developments within the years 2012 to 2013. We conclude our work by giving an outlook on expectations concerning the large ongoing interventional trials on vitamin D supplementation and CVD and the future developments in this research field.
1.1. Basic Vitamin D Metabolism
Vitamin D3 is a steroid pro-hormone, which is mainly derived from UVB-induced synthesis of 7-dehydrocholesterole in the skin. This endogenous synthesis is the main source of vitamin D supply to the body and accounts for approximately 80% of the vitamin D supply [1,2,3]. Vitamin D2 or D3 can also be taken up via nutrition in small amounts, as it is also contained in, e.g., eggs, mushrooms and fish. After synthesis in the skin or nutritional uptake, vitamin D is then transported to the liver by a specific vitamin D binding protein (VDBP), where it is hydroxylated to 25-hydroxy-vitamin D (25(OH)D) [1,2,3]. This inactive form is the main metabolite circulating in the blood and is also used for the classification of vitamin D status [1,2,3].
Predominantly in the kidneys, 25(OH)D is further hydroxylated to its most active form, 1,25-dihydroxy-vitamin D (1,25(OH)2D), by the enzyme, 1-α-hydroxylase. Since 1-α-hydroxylase is also found to be active in extra-renal tissues throughout the body [13], this gives rise to the assumption that vitamin D is playing a widespread role for overall health, including, beyond the musculoskeletal system, other tissues, such as the heart and the vessels.
1.2. Classification of Vitamin D Deficiency
Vitamin D status is classified according to 25(OH)D levels in the blood, and its half-life is approximately two to four weeks. There exists no clear consensus on the definition of vitamin D deficiency and vitamin D sufficiency. While the Institute of Medicine (IOM) report classifies vitamin D deficiency according to 25(OH)D levels below 12 ng/mL (multiply by 2.496 to convert ng/mL to nmol/L) and 20 ng/mL as sufficient, the Endocrine Society Guidelines suggest that 25(OH)D levels <20 ng/mL are deficient and levels of 30 ng/mL are sufficient [14,15,16]. These classifications are mainly based on bone related outcomes, since available data are still insufficient to give recommendations related to CVD or other chronic diseases.
1.3. Prevalence of Vitamin D Deficiency
Vitamin D insufficiency and deficiency are highly prevalent; this is very well reflected by the fact that more than half of the population worldwide has levels below 30 ng/mL [16,17]. Different factors, such as increased age, female sex, darker skin pigmentation, reduced sun exposure, as well as seasonal variation and distance from the equator are risk factors for vitamin D deficiency and must be considered. The increasing prevalence of low levels of vitamin D is mainly explainable by changes in lifestyle, reduced sun exposure and, to some extent, by air pollution [18]. It should, however, be acknowledged that previous inter-assay and inter-laboratory comparisons of 25(OH)D levels showed significant variability of the reported values. This, in turn, points to the need for standardization of 25(OH)D measurements and warrants caution when comparing 25(OH)D levels and their cut-offs derived from different studies [19,20,21].
2. Vitamin D and Cardiovascular Risk Factors
2.1. Arterial Hypertension
Vitamin D deficiency has been associated with higher blood pressure levels, which was already shown in most, but not all, prospective studies, as well as meta-analyses of observational studies [9,22,23]. While these observational data support an association between vitamin D status and blood pressure, it must also be acknowledged that residual confounding cannot be excluded. In addition, the reported variations in blood pressure explained by differences in vitamin D status were often relatively small and, thus, of questionable clinical relevance. Possible mechanisms for this association of vitamin D and blood pressure include the inverse association of vitamin D levels with the renin-angiotensin-aldosterone system (RAAS) activity, the effect of improving endothelial function and the prevention of secondary hyperparathyroidism [24,25,26,27]. In this context, it should be noted that high parathyroid hormone (PTH) levels are a hallmark of vitamin D deficiency and are known to be associated with myocardial hypertrophy and higher blood pressure levels [28]. In addition, increasing evidence suggests that the mutual interplay between vitamin D, parathyroid hormone and aldosterone mediates cardiovascular damage independent of the RAAS [29,30].
A large meta-analysis assessing the association of baseline vitamin D status with the risk of hypertension was performed by Kunutsor et al. They included 11 prospective studies published between 2005 and 2012, which comprised a total of 283,537 participants and 55,816 cases of hypertension with a mean follow-up of nine years [31]. The authors reported on a significant inverse association of baseline circulating serum vitamin D levels with the risk of incident hypertension. In detail, the pooled relative risk (RR) was 0.70 (95% confidence intervall (CI) 0.57–0.86) when comparing the highest to the lowest tertile of baseline 25(OH)D levels, with no evidence of heterogeneity among the findings. When evaluating dose-response in five studies that reported RRs for vitamin D exposure, the authors found that the risk for hypertension was lowered by 12% per 10 ng/mL increment of 25(OH)D [31]. Although this was the largest meta-analysis performed giving strong evidence for a relationship of vitamin D and blood pressure (BP), data on causality are still insufficient and warrant further RCTs.
Within the last year, several RCTs were performed to evaluate the effect of vitamin D on blood pressure (BP) levels in various cohorts, showing different results [32,33,34]. Larsen et al. performed an RCT in 130 hypertensive patients who were supplemented with 3000 IU of vitamin D or placebo over 20 weeks during winter in Denmark. They found a non-significant reduction of BP in the results of 24-h ambulatory blood pressure monitoring (ABPM) (−3 mmHg, p = 0.26/−1 mmHg, p = 0.18). Interestingly, when only vitamin D-insufficient patients were analyzed, with 25(OH)D levels below 32 ng/mL, (n = 92), systolic and diastolic BP levels in 24-h ABPM were significantly lowered (−4 mmHg, p = 0.05/−3 mmHg, p = 0.01) in the therapy group compared to placebo [32]. This effect in hypertensive and vitamin D-deficient patients has also been seen in a study by Forman et al., who performed an RCT in black Americans, who are known to be at a very high risk of both vitamin D deficiency and hypertension [33]. They included 283 participants who were allocated to either 1000, 2000 or 4000 IU of vitamin D or placebo over three months. They were able to show that supplementation of vitamin D in an unselected population of blacks lead to a reduction of 0.2 mmHg of systolic BP for each increase of 1 ng/mL of vitamin D over three months (p = 0.02) [33].
These results indicate an effect on BP of vitamin D, particularly in hypertensive, vitamin D-insufficient/deficient patients, rather than in a normotensive population with normal serum vitamin D levels. This should be considered for the design of future RCTs.
2.2. Obesity
Obesity is closely associated with vitamin D deficiency [35]. It had been hypothesized that this may be due to vitamin D deposition in adipose tissue, resulting in lower circulating 25(OH)D levels in the blood [36]. Others hypothesized a causal relationship of vitamin D deficiency leading to obesity [37]. To solve this research question, Vimaleswaran et al. performed a bi-directional Mendelian Randomization study and showed a one-directional causal relationship, indicating that obesity leads to lower vitamin D levels and not the other way around [38]. In that investigation, they included 21 cohorts, comprising a total number of 42,024 patients. They analyzed 12 established single nucleotide polymorphisms (SNPs) related to body mass index (BMI) and four typical vitamin D-related SNPs to perform this bi-directional Mendelian Randomization study. They could show that each unit increase of BMI was associated with a 1.15% decrease of 25(OH)D after adjustments for typical confounders. The authors concluded that obesity can be regarded as a causal risk factor for vitamin D deficiency, accounting for approximately one third of vitamin D deficiency [38]. On the other hand, genetically determined 25(OH)D levels were not significantly related to BMI. These findings suggest that the link between obesity and vitamin D deficiency is only driven by the fact that a higher BMI lowers 25(OH)D levels. By contrast, there seems to be no significant effect of vitamin D status on obesity. While these findings are important for our understanding on the causality regarding the association between vitamin D and obesity, there are several unanswered questions surrounding this topic related, e.g., to the bioavailability of vitamin D stored in adipose tissue.
2.3. Glucose Metabolism and Diabetes Mellitus Type 2
In observational and prospective studies, low vitamin D levels have largely been associated with disturbances in glucose metabolism, as well as higher risk of developing diabetes in the future, although some authors have reported on conflicting results [5,39,40,41,42]. It should also be kept in mind that vitamin D deficiency in diabetic patients may partly be a consequence of reduced physical activity and consecutive obesity, as well as limited sun exposure. Therefore, residual confounding in observational studies due to the close link of obesity with both vitamin D deficiency and glucose intolerance cannot be ruled out with certainty [35,43]. On the other hand, we must also consider that reverse causality may exist, since there are data suggesting that an inflammatory insult might decrease 25(OH)D levels [44].
There are, however, several possible mechanisms that could explain the association of vitamin D deficiency with disturbances in glucose homeostasis and diabetes mellitus. VDR, as well as 1-α-hydroxylase are expressed in pancreatic beta cells, indicating a potential role of vitamin D on beta cell function [2,45]. It has also been hypothesized that calcium, which is crucial for insulin synthesis and secretion, could play a role, since it is mainly regulated by vitamin D [46]. Another possible pathway could be vitamin D-induced stimulation of osteocalcin, which may improve insulin sensitivity [47].
Randomized trials, on the other hand, have largely failed to show clear beneficial effects of vitamin D supplementation on improving glycaemia or insulin resistance [48,49]. Addressing this issue, Davidson et al. conducted an RCT in individuals with prediabetes and hypovitaminosis D [50]. Study participants were allocated to high dose vitamin D therapy (mean weekly dose of 88,865 IU) vs. placebo [50]. No difference regarding plasma glucose parameters, insulin secretion and sensitivity or development of diabetes in the therapy group compared to placebo administration was found after one year [50].
Hence, although some preliminary data suggested a relevant effect of vitamin D on glucose homeostasis, the currently available literature on vitamin D does not support the notion that vitamin D supplementation is useful for the prevention and/or treatment of diabetes mellitus. Further RCTs are, however, urgently needed before drawing final conclusions on the relationship between vitamin D and diabetes.
2.4. Lipids
Some observational studies indicate an association of vitamin D deficiency with lower high density lipoprotein (HDL) and higher triglycerides, as well as higher apolipoprotein E levels [51,52]. Towards this, a large prospective evaluation of vitamin D levels and blood lipids showed a significant association of lower vitamin D levels with hypercholesterinemia [53]. However, it should be acknowledged that the results on vitamin D and blood lipids are inconsistent and could be confounded by the above mentioned link of vitamin D and obesity [38].
Recent clinical studies that have evaluated the effect of vitamin D supplementation on blood lipids in some RCTs yielded conflicting evidence. They showed rather inconsistent findings with the majority of the studies reporting on no significant effect on blood lipids when vitamin D supplementation was compared to placebo [33,54,55,56].
These recent results aggravate the decision on a causal relationship of vitamin D deficiency and an unfavorable lipid profile. Nevertheless, no final conclusion can be drawn since large, well-designed RCTs are still missing in this field. In addition, we should also consider that publication bias, i.e., unpublished results showing no effects of vitamin D, might be a problem.
2.5. Chronic Kidney Disease
Vitamin D levels in patients with chronic kidney disease (CKD) are significantly lower compared to the general population. For example, a high prevalence of vitamin D deficiency with values of below 20 ng/mL in more than 70% was seen in dialysis patients [57]. This may be due to the fact that these patients have a reduced sun exposure, due to a higher prevalence of co-morbidities. Moreover, it has also been suggested that CKD patients have an impaired vitamin D synthesis in the skin.
Several epidemiological studies have shown that lower 25(OH)D levels were associated with albuminuria and/or progression of renal failure. Moreover, vitamin D deficiency has been identified as an independent risk factor for higher mortality in patients suffering from CKD, which can mainly be attributed to cardiovascular deaths [58,59,60,61]. Apart from low 25(OH)D, also low 1,25(OH)2D was associated with higher mortality rates in most observational studies among CKD patients [62,63].
Particular attention is paid to vitamin D in the field of nephrology, because the classic and broadly known effect of vitamin D supplementation is the reduction of PTH levels. This is of high clinical relevance, since PTH itself is an independent cardiovascular risk factor [64], and secondary hyperparathyroidism is very common in CKD patients. This therapeutic effect of PTH lowering is achieved with both active (1,25(OH)2D) and natural (25(OH)D) vitamin D supplementation, although stronger when supplementing with 1,25(OH)2D [65].
Addressing the role of active vitamin D treatment in CKD, Duranton et al. conducted a systematic review and meta-analysis of seven prospective and seven retrospective observational trials in CKD patients treated with 1,25(OH)2D or different active vitamin D analogues. The authors found a significant reduction of all-cause mortality (RR 0.73; 95% CI 0.65–0.82) and even 37% reduction of cardiovascular mortality (RR 0.63; 95% CI 0.44–0.92) in patients on active vitamin D treatment [66].
While these data suggest beneficial effects of vitamin D treatment in CKD patients, it must also be pointed out that no major vitamin D RCTs have evaluated hard clinical endpoints in CKD patients yet; though, meta-analyses of randomized trials performed in older study populations, of which a great part showed impaired kidney function, showed a reduction of fractures and all-cause mortality by vitamin D supplementation [67,68].
2.6. Endothelial Dysfunction/Atherosclerosis
Since the VDR is also expressed in the vasculature, it is tempting to hypothesize that vitamin D might also protect against vascular diseases, including atherosclerosis and endothelial dysfunction [27]. According to experimental studies, some putative vasculoprotective actions of vitamin D may be mediated by increasing nitric oxide (NO) production, inhibiting macrophage to foam cell formation or reducing the expression of adhesion molecules in endothelial cells [69,70,71]. This is in line with reports from cross-sectional observational studies, which showed that lower vitamin D levels are associated with endothelial dysfunction, as well as increased arterial stiffness [6,27].
Clinical data from RCTs addressing vitamin D effects on vascular diseases are sparse and revealed inconsistent results. Promising results were, however, published on vitamin D and endothelial function with some, but not all RCTs showing that vitamin D may improve endothelial function [72,73,74].
3. Observational Studies on Vitamin D and Cardiovascular Events
Already in 1981, Scragg found an inverse relationship of cardiovascular mortality and UVB radiation [8]. Since then, several, but not all, observational studies that have been published indicated that low vitamin D levels are associated with higher incidence of cardiovascular events and mortality [10,66,75,76,77]. Even asymptomatic coronary artery disease was associated with lower vitamin D levels in high risk type 2 diabetic patients (adjusted odds ratio (OR) 2.9, 95% CI 1.02–7.66), as observed in a recent observational study [78].
Vitamin D deficiency has been associated with an increased risk of myocardial infarction (MI), and a significant inverse relationship of 25(OH)D levels and matrix-metalloproteinase-9 (MMP-9), a marker for myocardial remodeling after acute MI, has been documented [79,80]. Vitamin D levels also seem to predict the risk of adverse events after acute myocardial events and cardiac surgery, indicating higher risk for patients with lower vitamin D levels, as reported in recent publications [81,82].
Data from prospective observational studies suggest that low vitamin D levels are a risk factor for the occurrence of strokes [83,84,85]. Chowdhury et al. showed in a meta-analysis of seven studies, including 47,809 individuals and 926 cerebrovascular events that, under consideration of established cardiovascular risk factors, the risk for cerebrovascular disease was significantly lower in subjects with high 25(OH)D levels compared to those with insufficient vitamin D status [84]. Another meta-analysis reported on similar results when comparing low versus high vitamin D levels, with an RR for strokes of 1.52 (95% CI 1.20–1.85) in the lowest versus the highest 25(OH)D group [83].
In the currently largest meta-analysis on circulating 25(OH)D levels and risk of CVD, Wang et al. could show an adjusted pooled RR of 1.52 (95% CI 1.30–1.77) for total CVD when comparing the lowest to the highest categories of baseline circulating 25(OH)D concentration [12]. The authors investigated 19 studies, including 65,994 patients and 6123 CVD cases. The increment in CVD risk across decreasing 25(OH)D levels was generally linear over the range of 25(OH)D levels from 20 to 60 nmol/L, with a marginally significant pooled RR of 1.03 per decrement of 25 nmol/L of 25(OH)D [12]. It should, however, be noted that not all single studies reported on a significant association between low 25(OH)D levels and increased risk of CVD [86].
When reviewing these above mentioned meta-analyses, it has to be kept in mind that these observations could also be influenced by confounding factors, such as reduced mobility and physical activity in chronically ill patients, therefore leading to reduced sunlight exposure and lower vitamin D levels. Other confounders, such as increased age or higher rate of obesity, as well as PTH, renin, calcium and phosphorus, cannot be ruled out with certainty, although they are included as possible confounders in most trial analyses [25,87].
4. Vitamin D Supplementation and Cardiovascular Disease
There are only a few RCTs that have evaluated cardiovascular outcomes, and since all large previous RCTs were designed to study vitamin D effects on bone health, most of them were neither primarily designed nor statistically powered to assess vitamin D effects on CVD. Some small RCTs reported on mixed results of vitamin D supplementation on cardiovascular events [33,88], although it bears mentioning that some meta-analyses of these RCTs have found non-significant trends for reduced CV-events in patients receiving vitamin D supplementation compared to placebo [89,90]. Of note, vitamin D supplementation was very often combined with calcium intake, making it hard to interpret the RCT results, especially since calcium intake may be associated with increased cardiovascular risk, as suggested in a previous meta-analysis [91].
Since CVD is globally the leading cause of death, it is of special interest that in a Cochrane review and meta-analysis on randomized controlled trials from 2011, Bjelakovic et al. could show that vitamin D supplementation leads to a moderate, but statistically significant, reduction of total mortality rate (RR 0.94, 95% CI 0.91–0.98) compared to placebo [68]. The authors calculated that 161 individuals have to be treated to prevent one additional death [68]. This result by Bjelakovic et al. was mainly derived from RCTs in older individuals and is in line with several observational studies suggesting that vitamin D deficiency is a risk factor for mortality, particularly in the aging population [92]. The findings by Bjelakovic should, however, be interpreted with caution, since competing risks in elderly people might have an impact on the results. In addition, it must also be underlined that the study by Sanders et al. showed that high-dose vitamin D supplementation caused an increased risk of falls and fractures [93].
5. Discussion and Future Outlook
Based on systematic reviews and meta-analyses of the currently available literature, it can be concluded that vitamin D deficiency is an independent cardiovascular risk factor that is associated with increased risk of cardiovascular events. However, it is largely unclear whether these associations are of causal nature. While it seems plausible that vitamin D deficiency can be considered a surrogate marker for poorer health status, most notably observed in patients with chronic diseases, including cardiovascular risk factors and CVD, it remains to be proven whether vitamin D itself can directly impact on cardiovascular outcomes [94].
Several RCTs in the past failed to prove a causal relationship between vitamin D repletion and reduction of CV risk factors and CVD. This could hypothetically be attributed to small sample sizes or inappropriate study designs, since most trials were initially designed for clinical endpoints other than cardiovascular events [33,88,89,90]. Independent of these conflicting results, it is not entirely clear whether vitamin D supplementation exerts significant beneficial effects on healthy population, in addition to multimorbid patients. Of note, most trials have shown that beneficial effects of vitamin D supplementation are frequently identified in patients with very low 25(OH)D levels, and these patients seem to be at the highest risk for CVD [11,12,31,32,73,95]. On the other hand, it is not entirely clear whether vitamin D supplementation has significant beneficial effects in healthy population, as well, or is only meaningful in vitamin D deficient, chronically ill patients.
While existing data are insufficient to draw final conclusions on the effect of vitamin D supplementation on cardiovascular outcomes, several large interventional trials, designed to evaluate the effect of vitamin D supplementation on different CVD as primary endpoints in chronically ill, as well as general populations, have just started. These include a study in 1000 heart failure patients in Germany, the EVITA study by Zittermann et al., the Vitamin D Assessment Study (ViDA) in New Zealand among over 5000 older individuals conducted by Scragg et al. and the VITamin D and OmegA-3 TriaL VITAL trial, evaluating cardiovascular and cancer mortality in over 20,000 older subjects in the USA without cancer or CVD at baseline [96,97,98]. The large sample size of all these studies and a rather long time of intervention seem promising to gain final conclusions, especially regarding vitamin D effects on cardiovascular events and mortality in the general population. Results are expected in the next few years (2017–2020), but it is still open whether the findings of these RCTs will give all the final answers on the question of whether vitamin D is useful for the prevention and treatment of CVD. It has to be kept in mind that patients included in, for example, the VITAL study are not screened for vitamin D deficiency prior to inclusion, and also, an additional amount of up to 800 IU of vitamin D supplementation is also allowed in the placebo group [96]. This could lead to relatively high vitamin D levels in the placebo group, which could mask a possible beneficial effect of supplementation in individuals with very low vitamin D status [77]. Another possible problem with the VITAL study is the vitamin D food fortification in the US. Therefore, we can hope to gain new insights on the association of vitamin D and CVD, but cannot be sure to receive definite answers to be able to recommend vitamin D supplementation as a preventive or therapeutic method in this context.
6. Conclusions
At present, we can conclude that vitamin D deficiency is an independent cardiovascular risk factor, but whether vitamin D supplementation can significantly improve cardiovascular outcomes is still largely unknown.
Katharina Kienreich is supported by funding of the Austrian National Bank (Jubilaeumsfond: project numbers: 13878 and 13905).
Andreas Tomaschitz is partially funded by the EU project "MASCARA" ("Markers for Sub-Clinical Cardiovascular Risk Assessment"; THEME HEALTH.2011.2.4.2-2; Grant agreement No. 278249).
Nicolas Verheyen is supported by funding of the Austrian National Bank (Jubilaeumsfond: project numbers: 14621).
Conflict of Interest
The authors declare no conflict of interest.
- Holick, M.F. Vitamin D deficiency. N. Engl. J. Med. 2007, 357, 266–281, doi:10.1056/NEJMra070553.
- Bouillon, R.; Carmeliet, G.; Verlinden, L.; van Etten, E.; Verstuyf, A.; Luderer, H.F.; Lieben, L.; Mathieu, C.; Demay, M. Vitamin D and human health: Lessons from vitamin D receptor null mice. Endocr. Rev. 2008, 29, 726–776, doi:10.1210/er.2008-0004.
- Wacker, M.; Holick, M.F. Vitamin D—Effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013, 5, 111–148, doi:10.3390/nu5010111.
- Souberbielle, J.-C.; Body, J.-J.; Lappe, J.M.; Plebani, M.; Shoenfeld, Y.; Wang, T.J.; Bischoff-Ferrari, H.A.; Cavalier, E.; Ebeling, P.R.; Fardellone, P.; et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun. Rev. 2010, 9, 709–715, doi:10.1016/j.autrev.2010.06.009.
- Muscogiuri, G.; Sorice, G.P.; Ajjan, R.; Mezza, T.; Pilz, S.; Prioletta, A.; Scragg, R.; Volpe, S.L.; Witham, M.D.; Giaccari, A. Can vitamin D deficiency cause diabetes and cardiovascular diseases? Present evidence and future perspectives. Nutr. Metab. Cardiovasc. Dis. 2012, 22, 81–87, doi:10.1016/j.numecd.2011.11.001.
- Pilz, S.; Tomaschitz, A.; März, W.; Drechsler, C.; Ritz, E.; Zittermann, A.; Cavalier, E.; Pieber, T.R.; Lappe, J.M.; Grant, W.B.; et al. Vitamin D, cardiovascular disease and mortality. Clin. Endocrinol. (Oxf.) 2011, 75, 575–584, doi:10.1111/j.1365-2265.2011.04147.x.
- Organization, W.H. World Health Statistics 2012; World Health Organization: Geneva, Switzerland, 2012.
- Scragg, R. Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation. Int. J. Epidemiol. 1981, 10, 337–341, doi:10.1093/ije/10.4.337.
- Burgaz, A.; Orsini, N.; Larsson, S.C.; Wolk, A. Blood 25-hydroxyvitamin D concentration and hypertension: A meta-analysis. J. Hypertens. 2011, 29, 636–645, doi:10.1097/HJH.0b013e32834320f9.
- Zittermann, A.; Iodice, S.; Pilz, S.; Grant, W.B.; Bagnardi, V.; Gandini, S. Vitamin D deficiency and mortality risk in the general population: A meta-analysis of prospective cohort studies. Am. J. Clin. Nutr. 2012, 95, 91–100, doi:10.3945/ajcn.111.014779.
- Grandi, N.C.; Breitling, L.P.; Brenner, H. Vitamin D and cardiovascular disease: Systematic review and meta-analysis of prospective studies. Prev. Med. 2010, 51, 228–233, doi:10.1016/j.ypmed.2010.06.013.
- Wang, L.; Song, Y.; Manson, J.E.; Pilz, S.; März, W.; Michaëlsson, K.; Lundqvist, A.; Jassal, S.K.; Barrett-Connor, E.; Zhang, C.; et al. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: A meta-analysis of prospective studies. Circ. Cardiovasc. Qual. Outcomes 2012, 5, 819–829, doi:10.1161/CIRCOUTCOMES.112.967604.
- Peterlik, M.; Cross, H.S. Vitamin D and calcium insufficiency-related chronic diseases: Molecular and cellular pathophysiology. Eur. J. Clin. Nutr. 2009, 63, 1377–1386, doi:10.1038/ejcn.2009.105.
- Slomski, A. IOM endorses vitamin D, calcium only for bone health, dispels deficiency claims. JAMA 2011, 305, 453–456, doi:10.1001/jama.2011.50.
- Holick, M.F.; Binkley, N.C.; Bischoff-Ferrari, H.A.; Gordon, C.M.; Hanley, D.A.; Heaney, R.P.; Murad, M.H.; Weaver, C.M. Guidelines for preventing and treating vitamin d deficiency and insufficiency revisited. J. Clin. Endocrinol. Metab. 2012, 97, 1153–1158, doi:10.1210/jc.2011-2601.
- Mithal, A.; Wahl, D.A.; Bonjour, J.-P.; Burckhardt, P.; Dawson-Hughes, B.; Eisman, J.A.; El-Hajj Fuleihan, G.; Josse, R.G.; Lips, P.; Morales-Torres, J. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos. Int. 2009, 20, 1807–1820, doi:10.1007/s00198-009-0954-6.
- Van Schoor, N.M.; Lips, P. Worldwide vitamin D status. Best Pract. Res. Clin. Endocrinol. Metab. 2011, 25, 671–680, doi:10.1016/j.beem.2011.06.007.
- Macdonald, H.M.; Mavroeidi, A.; Fraser, W.D.; Darling, A.L.; Black, A.J.; Aucott, L.; O'Neill, F.; Hart, K.; Berry, J.L.; Lanham-New, S.A.; et al. Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northerly latitudes: A major cause for concern? Osteoporos. Int. 2011, 22, 2461–2472, doi:10.1007/s00198-010-1467-z.
- Couchman, L.; Benton, C.M.; Moniz, C.F. Variability in the analysis of 25-hydroxyvitamin D by liquid chromatography-tandem mass spectrometry: The devil is in the detail. Clin. Chim. Acta 2012, 413, 1239–1243, doi:10.1016/j.cca.2012.04.003.
- Heijboer, A.C.; Blankenstein, M.A.; Kema, I.P.; Buijs, M.M. Accuracy of 6 routine 25-hydroxyvitamin D assays: Influence of vitamin D binding protein concentration. Clin. Chem. 2012, 58, 543–548, doi:10.1373/clinchem.2011.176545.
- Sempos, C.T.; Vesper, H.W.; Phinney, K.W.; Thienpont, L.M.; Coates, P.M.; Vitamin D Standardization Program (VDSP). Vitamin D status as an international issue: National surveys and the problem of standardization. Scand. J. Clin. Lab. Investig. Suppl. 2012, 243, 32–40.
- Witham, M.D.; Nadir, M.A.; Struthers, A.D. Effect of vitamin D on blood pressure: A systematic review and meta-analysis. J. Hypertens. 2009, 27, 1948–1954, doi:10.1097/HJH.0b013e32832f075b.
- Pilz, S.; Tomaschitz, A. Role of vitamin D in arterial hypertension. Expert. Rev. Cardiovasc. Ther. 2010, 8, 1599–1608, doi:10.1586/erc.10.142.
- Forman, J.P.; Williams, J.S.; Fisher, N.D.L. Plasma 25-hydroxyvitamin D and regulation of the renin-angiotensin system in humans. Hypertension 2010, 55, 1283–1288, doi:10.1161/HYPERTENSIONAHA.109.148619.
- Tomaschitz, A.; Pilz, S.; Ritz, E.; Grammer, T.; Drechsler, C.; Boehm, B.O.; März, W. Independent association between 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D and the renin-angiotensin system: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Clin. Chim. Acta 2010, 411, 1354–1360, doi:10.1016/j.cca.2010.05.037.
- Vaidya, A.; Forman, J.P.; Hopkins, P.N.; Seely, E.W.; Williams, J.S. 25-Hydroxyvitamin D is associated with plasma renin activity and the pressor response to dietary sodium intake in Caucasians. J. Renin Angiotensin Aldosterone Syst. 2011, 12, 311–319, doi:10.1177/1470320310391922.
- Brewer, L.C.; Michos, E.D.; Reis, J.P. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr. Drug Targets 2011, 12, 54–60, doi:10.2174/138945011793591617.
- Snijder, M.B.; Lips, P.; Seidell, J.C.; Visser, M.; Deeg, D.J.H.; Dekker, J.M.; van Dam, R.M. Vitamin D status and parathyroid hormone levels in relation to blood pressure: A population-based study in older men and women. J. Intern. Med. 2007, 261, 558–565, doi:10.1111/j.1365-2796.2007.01778.x.
- Tomaschitz, A.; Ritz, E.; Pieske, B.; Fahrleitner-Pammer, A.; Kienreich, K.; Horina, J.H.; Drechsler, C.; März, W.; Ofner, M.; Pieber, T.R.; et al. Aldosterone and parathyroid hormone: A precarious couple for cardiovascular disease. Cardiovasc. Res. 2012, 94, 10–19, doi:10.1093/cvr/cvs092.
- Tomaschitz, A.; Fahrleitner-Pammer, A.; Pieske, B.; Verheyen, N.; Amrein, K.; Ritz, E.; Kienreich, K.; Horina, J.H.; Schmidt, A.; Kraigher-Krainer, E.; et al. Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism: A randomized, double-blind, placebo-controlled trial. BMC Endocr. Disord. 2012, 12, 19, doi:10.1186/1472-6823-12-19.
- Kunutsor, S.K.; Apekey, T.A.; Steur, M. Vitamin D and risk of future hypertension: Meta-analysis of 283,537 participants. Eur. J. Epidemiol. 2013, 28, 205–221, doi:10.1007/s10654-013-9790-2.
- Larsen, T.; Mose, F.H.; Bech, J.N.; Hansen, A.B.; Pedersen, E.B. Effect of cholecalciferol supplementation during winter months in patients with hypertension: A randomized, placebo-controlled trial. Am. J. Hypertens. 2012, 25, 1215–1222, doi:10.1038/ajh.2012.111.
- Forman, J.P.; Scott, J.B.; Ng, K.; Drake, B.F.; Suarez, E.G.; Hayden, D.L.; Bennett, G.G.; Chandler, P.D.; Hollis, B.W.; Emmons, K.M.; et al. Effect of vitamin d supplementation on blood pressure in blacks. Hypertension 2013, 61, 779–785, doi:10.1161/HYPERTENSIONAHA.111.00659.
- Wood, A.D.; Secombes, K.R.; Thies, F.; Aucott, L.; Black, A.J.; Mavroeidi, A.; Simpson, W.G.; Fraser, W.D.; Reid, D.M.; Macdonald, H.M. Vitamin D3 supplementation has no effect on conventional cardiovascular risk factors: A parallel-group, double-blind, placebo-controlled RCT. J. Clin. Endocrinol. Metab. 2012, 97, 3557–3568, doi:10.1210/jc.2012-2126.
- Earthman, C.P.; Beckman, L.M.; Masodkar, K.; Sibley, S.D. The link between obesity and low 25-hydroxyvitamin D concentrations: Considerations and implications. Int. J. Obes. (Lond.) 2012, 36, 387–396, doi:10.1038/ijo.2011.119.
- Wortsman, J.; Matsuoka, L.Y.; Chen, T.C.; Lu, Z.; Holick, M.F. Decreased bioavailability of vitamin D in obesity. Am. J. Clin. Nutr. 2000, 72, 690–693.
- Foss, Y.J. Vitamin D deficiency is the cause of common obesity. Med. Hypotheses 2009, 72, 314–321, doi:10.1016/j.mehy.2008.10.005.
- Vimaleswaran, K.S.; Berry, D.J.; Lu, C.; Tikkanen, E.; Pilz, S.; Hiraki, L.T.; Cooper, J.D.; Dastani, Z.; Li, R.; Houston, D.K.; et al. Causal relationship between obesity and vitamin D status: Bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013, 10, e1001383, doi:10.1371/journal.pmed.1001383.
- Gagnon, C.; Lu, Z.X.; Magliano, D.J.; Dunstan, D.W.; Shaw, J.E.; Zimmet, P.Z.; Sikaris, K.; Ebeling, P.R.; Daly, R.M. Low serum 25-hydroxyvitamin D is associated with increased risk of the development of the metabolic syndrome at five years: Results from a national, population-based prospective study (The Australian Diabetes, Obesity and Lifestyle Study: AusDiab). J. Clin. Endocrinol. Metab. 2012, 97, 1953–1961, doi:10.1210/jc.2011-3187.
- Forouhi, N.G.; Ye, Z.; Rickard, A.P.; Khaw, K.T.; Luben, R.; Langenberg, C.; Wareham, N.J. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes: Results from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort and updated meta-analysis of prospective studies. Diabetologia 2012, 55, 2173–2182, doi:10.1007/s00125-012-2544-y.
- Pilz, S.; van den Hurk, K.; Nijpels, G.; Stehouwer, C.D.A.; Van't Riet, E.; Kienreich, K.; Tomaschitz, A.; Dekker, J.M. Vitamin D status, incident diabetes and prospective changes in glucose metabolism in older subjects: The Hoorn study. Nutr. Metab. Cardiovasc. Dis. 2012, 22, 883–889, doi:10.1016/j.numecd.2012.03.008.
- Schöttker, B.; Herder, C.; Rothenbacher, D.; Perna, L.; Müller, H.; Brenner, H. Serum 25-hydroxyvitamin D levels and incident diabetes mellitus type 2: A competing risk analysis in a large population-based cohort of older adults. Eur. J. Epidemiol. 2013, 28, 267–275, doi:10.1007/s10654-013-9769-z.
- Kabadi, S.M.; Lee, B.K.; Liu, L. Joint effects of obesity and vitamin D insufficiency on insulin resistance and type 2 diabetes: Results from the NHANES 2001–2006. Diabetes Care 2012, 35, 2048–2054, doi:10.2337/dc12-0235.
- Reid, D.; Toole, B.J.; Knox, S.; Talwar, D.; Harten, J.; O'Reilly, D.S.; Blackwell, S.; Kinsella, J.; McMillan, D.C.; Wallace, A.M. The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty. Am. J. Clin. Nutr. 2011, 93, 1006–1011, doi:10.3945/ajcn.110.008490.
- Wolden-Kirk, H.; Overbergh, L.; Christesen, H.T.; Brusgaard, K.; Mathieu, C. Vitamin D and diabetes: Its importance for beta cell and immune function. Mol. Cell. Endocrinol. 2011, 347, 106–120, doi:10.1016/j.mce.2011.08.016.
- Pilz, S.; Kienreich, K.; Rutters, F.; de Jongh, R.; van Ballegooijen, A.J.; Grübler, M.; Tomaschitz, A.; Dekker, J.M. Role of vitamin D in the development of insulin resistance and type 2 diabetes. Curr. Diabetes Rep. 2013, 13, 261–270, doi:10.1007/s11892-012-0358-4.
- Wu, Y.-Y.; Yu, T.; Zhang, X.-H.; Liu, Y.-S.; Li, F.; Wang, Y.-Y.; Wang, Y.-Y.; Gong, P. 1,25(OH)2D3 inhibits the deleterious effects induced by high glucose on osteoblasts through undercarboxylated osteocalcin and insulin signaling. J. Steroid Biochem. Mol. Biol. 2012, 132, 112–119, doi:10.1016/j.jsbmb.2012.05.002.
- Mitri, J.; Muraru, M.D.; Pittas, A.G. Vitamin D and type 2 diabetes: A systematic review. Eur. J. Clin. Nutr. 2011, 65, 1005–1015, doi:10.1038/ejcn.2011.118.
- George, P.S.; Pearson, E.R.; Witham, M.D. Effect of vitamin D supplementation on glycaemic control and insulin resistance: A systematic review and meta-analysis. Diabetes Med. 2012, 29, e142–e150, doi:10.1111/j.1464-5491.2012.03672.x.
- Davidson, M.B.; Duran, P.; Lee, M.L.; Friedman, T.C. High-dose vitamin D supplementation in people with prediabetes and hypovitaminosis D. Diabetes Care 2013, 36, 260–266, doi:10.2337/dc12-1204.
- Jorde, R.; Grimnes, G. Vitamin D and metabolic health with special reference to the effect of vitamin D on serum lipids. Prog. Lipid Res. 2011, 50, 303–312, doi:10.1016/j.plipres.2011.05.001.
- Jaimungal, S.; Wehmeier, K.; Mooradian, A.D.; Haas, M.J. The emerging evidence for vitamin D-mediated regulation of apolipoprotein AI synthesis. Nutr. Res. 2011, 31, 805–812, doi:10.1016/j.nutres.2011.09.005.
- Skaaby, T.; Husemoen, L.L.N.; Pisinger, C.; Jørgensen, T.; Thuesen, B.H.; Fenger, M.; Linneberg, A. Vitamin D status and changes in cardiovascular risk factors: A prospective study of a general population. Cardiology 2012, 123, 62–70, doi:10.1159/000341277.
- Ponda, M.P.; Dowd, K.; Finkielstein, D.; Holt, P.R.; Breslow, J.L. The short-term effects of vitamin D repletion on cholesterol: A randomized, placebo-controlled trial. Arterioscler. Thromb. Vasc. Biol. 2012, 32, 2510–2515, doi:10.1161/ATVBAHA.112.254110.
- Ponda, M.P.; Huang, X.; Odeh, M.A.; Breslow, J.L.; Kaufman, H.W. Vitamin D may not improve lipid levels: A serial clinical laboratory data study. Circulation 2012, 126, 270–277, doi:10.1161/CIRCULATIONAHA.111.077875.
- Salehpour, A.; Shidfar, F.; Hosseinpanah, F.; Vafa, M.; Razaghi, M.; Hoshiarrad, A.; Gohari, M. Vitamin D3 and the risk of CVD in overweight and obese women: A randomised controlled trial. Br. J. Nutr. 2012, 108, 1866–1873, doi:10.1017/S0007114512000098.
- Drechsler, C.; Pilz, S.; Obermayer-Pietsch, B.; Verduijn, M.; Tomaschitz, A.; Krane, V.; Espe, K.; Dekker, F.; Brandenburg, V.; März, W.; et al. Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients. Eur. Heart J. 2010, 31, 2253–2261, doi:10.1093/eurheartj/ehq246.
- Drechsler, C.; Verduijn, M.; Pilz, S.; Dekker, F.W.; Krediet, R.T.; Ritz, E.; Wanner, C.; Boeschoten, E.W.; Brandenburg, V. Vitamin D status and clinical outcomes in incident dialysis patients: Results from the NECOSAD study. Nephrol. Dial. Transplant. 2011, 26, 1024–1032, doi:10.1093/ndt/gfq606.
- De Boer, I.H.; Katz, R.; Chonchol, M.; Ix, J.H.; Sarnak, M.J.; Shlipak, M.G.; Siscovick, D.S.; Kestenbaum, B. Serum 25-hydroxyvitamin D and change in estimated glomerular filtration rate. Clin. J. Am. Soc. Nephrol. 2011, 6, 2141–2149, doi:10.2215/CJN.02640311.
- De Boer, I.H.; Sachs, M.C.; Cleary, P.A.; Hoofnagle, A.N.; Lachin, J.M.; Molitch, M.E.; Steffes, M.W.; Sun, W.; Zinman, B.; Brunzell, J.D. Circulating vitamin D metabolites and kidney disease in type 1 diabetes. J. Clin. Endocrinol. Metab. 2012, 97, 4780–4788, doi:10.1210/jc.2012-2852.
- Pilz, S.; Iodice, S.; Zittermann, A.; Grant, W.B.; Gandini, S. Vitamin D status and mortality risk in CKD: A meta-analysis of prospective studies. Am. J. Kidney Dis. 2011, 58, 374–382.
- Pilz, S.; Tomaschitz, A.; Friedl, C.; Amrein, K.; Drechsler, C.; Ritz, E.; Boehm, B.O.; Grammer, T.B.; März, W. Vitamin D status and mortality in chronic kidney disease. Nephrol. Dial. Transplant. 2011, 26, 3603–3609, doi:10.1093/ndt/gfr076.
- Kendrick, J.; Cheung, A.K.; Kaufman, J.S.; Greene, T.; Roberts, W.L.; Smits, G.; Chonchol, M. Associations of plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations with death and progression to maintenance dialysis in patients with advanced kidney disease. Am. J. Kidney Dis. 2012, 60, 567–575, doi:10.1053/j.ajkd.2012.04.014.
- Hagström, E.; Hellman, P.; Larsson, T.E.; Ingelsson, E.; Berglund, L.; Sundström, J.; Melhus, H.; Held, C.; Lind, L.; Michaëlsson, K.; et al. Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation 2009, 119, 2765–2771, doi:10.1161/CIRCULATIONAHA.108.808733.
- Kovesdy, C.P.; Lu, J.L.; Malakauskas, S.M.; Andress, D.L.; Kalantar-Zadeh, K.; Ahmadzadeh, S. Paricalcitol versus ergocalciferol for secondary hyperparathyroidism in CKD stages 3 and 4: A randomized controlled trial. Am. J. Kidney Dis. 2012, 59, 58–66, doi:10.1053/j.ajkd.2011.06.027.
- Duranton, F.; Rodriguez-Ortiz, M.E.; Duny, Y.; Rodriguez, M.; Daurès, J.-P.; Argilés, A. Vitamin D treatment and mortality in chronic kidney disease: A systematic review and meta-analysis. Am. J. Nephrol. 2013, 37, 239–248, doi:10.1159/000346846.
- Bischoff-Ferrari, H.A.; Willett, W.C.; Orav, E.J.; Oray, E.J.; Lips, P.; Meunier, P.J.; Lyons, R.A.; Flicker, L.; Wark, J.; Jackson, R.D.; et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N. Engl. J. Med. 2012, 367, 40–49, doi:10.1056/NEJMoa1109617.
- Bjelakovic, G.; Gluud, L.L.; Nikolova, D.; Whitfield, K.; Wetterslev, J.; Simonetti, R.G.; Bjelakovic, M.; Gluud, C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst. Rev. 2011, doi:10.1002/14651858.CD007470.pub2.
- Molinari, C.; Uberti, F.; Grossini, E.; Vacca, G.; Carda, S.; Invernizzi, M.; Cisari, C. 1α,25-Dihydroxycholecalciferol induces nitric oxide production in cultured endothelial cells. Cell. Physiol. Biochem. 2011, 27, 661–668, doi:10.1159/000330075.
- Oh, J.; Weng, S.; Felton, S.K.; Bhandare, S.; Riek, A.; Butler, B.; Proctor, B.M.; Petty, M.; Chen, Z.; Schechtman, K.B.; et al. 1,25(OH)2 vitamin D inhibits foam cell formation and suppresses macrophage cholesterol uptake in patients with type 2 diabetes mellitus. Circulation 2009, 120, 687–698, doi:10.1161/CIRCULATIONAHA.109.856070.
- Tare, M.; Emmett, S.J.; Coleman, H.A.; Skordilis, C.; Eyles, D.W.; Morley, R.; Parkington, H.C. Vitamin D insufficiency is associated with impaired vascular endothelial and smooth muscle function and hypertension in young rats. J. Physiol. (Lond.) 2011, 589, 4777–4786, doi:10.1113/jphysiol.2011.214726.
- Harris, R.A.; Pedersen-White, J.; Guo, D.-H.; Stallmann-Jorgensen, I.S.; Keeton, D.; Huang, Y.; Shah, Y.; Zhu, H.; Dong, Y. Vitamin D3 supplementation for 16 weeks improves flow-mediated dilation in overweight African-American adults. Am. J. Hypertens. 2011, 24, 557–562, doi:10.1038/ajh.2011.12.
- Witham, M.D.; Dove, F.J.; Sugden, J.A.; Doney, A.S.; Struthers, A.D. The effect of vitamin D replacement on markers of vascular health in stroke patients—A randomised controlled trial. Nutr. Metab. Cardiovasc. Dis. 2012, 22, 864–870, doi:10.1016/j.numecd.2010.11.001.
- Gepner, A.D.; Ramamurthy, R.; Krueger, D.C.; Korcarz, C.E.; Binkley, N.; Stein, J.H. A prospective randomized controlled trial of the effects of vitamin D supplementation on cardiovascular disease risk. PLoS One 2012, 7, e36617.
- Bittner, V.; Wenger, N.K.; Waters, D.D.; DeMicco, D.A.; Messig, M.; LaRosa, J.C. Vitamin D levels do not predict cardiovascular events in statin-treated patients with stable coronary disease. Am. Heart J. 2012, 164, 387–393, doi:10.1016/j.ahj.2012.06.016.
- Schöttker, B.; Ball, D.; Gellert, C.; Brenner, H. Serum 25-hydroxyvitamin D levels and overall mortality. A systematic review and meta-analysis of prospective cohort studies. Ageing Res. Rev. 2012, 12, 708–718.
- Pilz, S.; Kienreich, K.; Tomaschitz, A.; Lerchbaum, E.; Meinitzer, A.; März, W.; Zittermann, A.; Dekker, J.M. Vitamin D and cardiovascular disease: Update and outlook. Scand. J. Clin. Lab. Investig. Suppl. 2012, 243, 83–91.
- Joergensen, C.; Reinhard, H.; Schmedes, A.; Hansen, P.R.; Wiinberg, N.; Petersen, C.L.; Winther, K.; Parving, H.-H.; Jacobsen, P.K.; Rossing, P. Vitamin D levels and asymptomatic coronary artery disease in type 2 diabetic patients with elevated urinary albumin excretion rate. Diabetes Care 2012, 35, 168–172, doi:10.2337/dc11-1372.
- Karakas, M.; Thorand, B.; Zierer, A.; Huth, C.; Meisinger, C.; Roden, M.; Rottbauer, W.; Peters, A.; Koenig, W.; Herder, C. Low levels of serum 25-hydroxyvitamin D are associated with increased risk of myocardial infarction, especially in women: Results from the MONICA/KORA Augsburg case-cohort study. J. Clin. Endocrinol. Metab. 2013, 98, 272–280, doi:10.1210/jc.2012-2368.
- Khalili, H.; Talasaz, A.H.; Salarifar, M. Serum vitamin D concentration status and its correlation with early biomarkers of remodeling following acute myocardial infarction. Clin. Res. Cardiol. 2012, 101, 321–327, doi:10.1007/s00392-011-0394-0.
- Ng, L.L.; Sandhu, J.K.; Squire, I.B.; Davies, J.E.; Jones, D.J.L. Vitamin D and prognosis in acute myocardial infarction. Int. J. Cardiol. 2013, doi:10.1016/j.ijcard.2013.01.030.
- Zittermann, A.; Kuhn, J.; Dreier, J.; Knabbe, C.; Gummert, J.F.; Börgermann, J. Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery. Eur. Heart J. 2013, 34, 1358–1364, doi:10.1093/eurheartj/ehs468.
- Sun, Q.; Pan, A.; Hu, F.B.; Manson, J.E.; Rexrode, K.M. 25-Hydroxyvitamin D levels and the risk of stroke: A prospective study and meta-analysis. Stroke 2012, 43, 1470–1477, doi:10.1161/STROKEAHA.111.636910.
- Chowdhury, R.; Stevens, S.; Ward, H.; Chowdhury, S.; Sajjad, A.; Franco, O.H. Circulating vitamin D, calcium and risk of cerebrovascular disease: A systematic review and meta-analysis. Eur. J. Epidemiol. 2012, 27, 581–591, doi:10.1007/s10654-012-9729-z.
- Pilz, S.; Tomaschitz, A.; Drechsler, C.; Zittermann, A.; Dekker, J.M.; März, W. Vitamin D supplementation: A promising approach for the prevention and treatment of strokes. Curr. Drug Targets 2011, 12, 88–96, doi:10.2174/138945011793591563.
- Welsh, P.; Doolin, O.; McConnachie, A.; Boulton, E.; McNeil, G.; Macdonald, H.; Hardcastle, A.; Hart, C.; Upton, M.; Watt, G.; et al. Circulating 25OHD, dietary vitamin D, PTH, and calcium associations with incident cardiovascular disease and mortality: The MIDSPAN Family Study. J. Clin. Endocrinol. Metab. 2012, 97, 4578–4587, doi:10.1210/jc.2012-2272.
- Palmer, S.C.; Hayen, A.; Macaskill, P.; Pellegrini, F.; Craig, J.C.; Elder, G.J.; Strippoli, G.F.M. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: A systematic review and meta-analysis. JAMA 2011, 305, 1119–1127, doi:10.1001/jama.2011.308.
- Sokol, S.I.; Srinivas, V.; Crandall, J.P.; Kim, M.; Tellides, G.; Lebastchi, A.; Yu, Y.; Gupta, A.K.; Alderman, M.H. The effects of vitamin D repletion on endothelial function and inflammation in patients with coronary artery disease. Vasc. Med. 2012, 17, 394–404, doi:10.1177/1358863X12466709.
- Wang, L.; Manson, J.E.; Song, Y.; Sesso, H.D. Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann. Intern. Med. 2010, 152, 315–323, doi:10.7326/0003-4819-152-5-201003020-00010.
- Avenell, A.; MacLennan, G.S.; Jenkinson, D.J.; McPherson, G.C.; McDonald, A.M.; Pant, P.R.; Grant, A.M.; Campbell, M.K.; Anderson, F.H.; Cooper, C.; et al. Long-term follow-up for mortality and cancer in a randomized placebo-controlled trial of vitamin D(3) and/or calcium (RECORD trial). J. Clin. Endocrinol. Metab. 2012, 97, 614–622, doi:10.1210/jc.2011-1309.
- Bolland, M.J.; Grey, A.; Avenell, A.; Gamble, G.D.; Reid, I.R. Calcium supplements with or without vitamin D and risk of cardiovascular events: Reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ 2011, 342, d2040.
- Pilz, S.; Dobnig, H.; Tomaschitz, A.; Kienreich, K.; Meinitzer, A.; Friedl, C.; Wagner, D.; Piswanger-Sölkner, C.; März, W.; Fahrleitner-Pammer, A. Low 25-hydroxyvitamin D is associated with increased mortality in female nursing home residents. J. Clin. Endocrinol. Metab. 2012, 97, E653–E657, doi:10.1210/jc.2011-3043.
- Sanders, K.M.; Stuart, A.L.; Williamson, E.J.; Simpson, J.A.; Kotowicz, M.A.; Young, D.; Nicholson, G.C. Annual high-dose oral vitamin D and falls and fractures in older women: A randomized controlled trial. JAMA 2010, 303, 1815–1822, doi:10.1001/jama.2010.594.
- McGreevy, C.; Williams, D. New insights about vitamin D and cardiovascular disease: A narrative review. Ann. Intern. Med. 2011, 155, 820–826, doi:10.7326/0003-4819-155-12-201112200-00004.
- Vacek, J.L.; Vanga, S.R.; Good, M.; Lai, S.M.; Lakkireddy, D.; Howard, P.A. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am. J. Cardiol. 2012, 109, 359–363, doi:10.1016/j.amjcard.2011.09.020.
- ClinicialTrials.gov Website. Available online: http://clinicaltrials.gov/show/NCT01326650 (accessed on 26 July 2013).
- The Vitamin D Assessment (ViDA) Study. Available online: http://www.fmhs.auckland.ac.nz/soph/depts/epi/vida/research.aspx (accessed on 26 July 2013).
- Manson, J.E.; Bassuk, S.S.; Lee, I.-M.; Cook, N.R.; Albert, M.A.; Gordon, D.; Zaharris, E.; Macfadyen, J.G.; Danielson, E.; Lin, J.; et al. The VITamin D and OmegA-3 TriaL (VITAL): Rationale and design of a large randomized controlled trial of vitamin D and marine omega-3 fatty acid supplements for the primary prevention of cancer and cardiovascular disease. Contemp. Clin. Trials 2012, 33, 159–171, doi:10.1016/j.cct.2011.09.009.
© 2013 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).


text:
Happy Birthday, StyleSheet! Let's Party!
It feels like only yesterday we were celebrating the launch of our street style fashion blog, StyleSheet. But it's hasn't. It's been a whole year. And you know what that means? You got it. PAR-TY. So let's do this. Scratch out tomorrow night's plans and pencil in StyleSheet's one-year anniversary fête in Neiman Marcus NorthPark's […]Full Story


text:
Photos and Description of this 5 bedroom holiday villa in Lorgues - Maison de Thym
5 en suite bedrooms, quiet rural location, 5 minutes from town
Masion de Thym is a charming stone house, built in 2006, to a high standard and incorporating traditional local provencal features. This is a luxurious 5 bedroom family house with a large 12 x 6 metre pool and large paved areas with plenty of sun loungers.There is a covered and uncovered terrace on one side of the house and a summer house with its own chimney and terrace on the other side providing shaded areas at different times of the day.
Looking south are panoramic views of the Maures mountains and to the south west is woodland and a boules court. Inside there is a fully equipped kitchen, large sitting room and dining area on the main floor, upstairs is the master bedroom with its own balcony and downstairs there are 4 further bedrooms. The house is in a quiet rural setting and yet only 5 minutes drive from Lorgues a small town with local restaurants, shops and weekly market.
- Suitability:
- children welcome
- non smoking only


text:
You must log in to access this feature. Sign in with Twellow or Facebook to get started.
By signing in to Twellow, you indicate your agreement to our terms of service.
Simply connect with Facebook and kiss those password blues away,
or go here to reset your password.
I want to learn and love as much about this abundant life as I can


text:
7 Things Houstonians Don't Care About
By Chris Lane
The Weirdest Texas School Mascots
By Jeff Balke
By Aaron Reiss
By Angelica Leicht
Behind the Doors of the Spy Store
By Dianna Wray
The Best Things in Houston Pawn Shops
By Aaron Reiss
Ten Underrated Things About Houston
By Camilo Smith
Pet Products for the Rich and Insane
By Craig Malisow
Trellis is the newest, fanciest day spa in Houston. From the interior float pool to the Mediterranean-style balcony, this 17,000-square-foot spa wraps up luxury and serenity into one nice package. Visitors can relax with a Vichy rainfall shower or a tension relief cocoon body wrap. Those self-conscious about baring their aging bodies before the ultrafit Houstonian crowd can opt for a cellulite or stretch mark treatment. And for couples who can't bear to be separated even for a facial, the Trellis offers treatment rooms and hot tubs for use a deux.


text:
Christmas celebrations are not complete without the friends and family that are the backbone of our spirit and strength. Here at Best Holiday Cards, we
cherish the opportunity to be part of this season's thoughtful gesture of sharing sentiments to your loved ones. Our Friends and Family Christmas Cards
bring out the best Yuletide intentions and sentiments in solemn tone through a wide variety of themes.
You can send your friends and family Christmas cards that convey prayers, poems and Biblical verses solely intended for their happiness and joy, or generic
cards that are not overtly religious but still convey the season's celebration. We can match any Christmas belief and celebration with our wide collection
of cards in commanding designs, shapes and sizes.
Christmas Cards Created to Deliver the True Season's Greetings
We at Best Holiday Cards create Christmas cards on a variety of themes so you can properly send your season's sentiments to your friends and family.
Those who celebrate Christmas will be overjoyed to receive our nativity scenes, Christmas trees, or favorite tinsel designs that remind them of the
colorful season of gift giving and joyfulness. If you are unsure of a friend's sentiments, you can send a greeting card in a non-denominational theme from
our winter and Season's Greetings collection.
Fashioned digital Christmas cards may be a trend nowadays, but there is something in a physical Christmas card that makes a greeting more personalized and
heartfelt. Words are meaningful and printed designs come alive and set a more festive mood when they come from paper. If you feel guilt tugging on you for
using paper, we are pleased to offer cards that are completely made from recycled paper. Our Friends and Family Christmas cards are clearly created to
bring you the best greetings you can ever send.


text:
Much talk about JPII "gambling with our children" etc.
… by leaving in place bishops like Law or Mahony. I think the whole "endangering kids" thing is not going to be much of an issue in future. I think it far more likely the bishops will put in some sort of draconian overkill policy that will cut priests adrift on the slightest provocation ("they're private contractors, not my problem"), than that anything like the previous regime of reshuffle, abuse, coverup and payoff will ever obtain again. Those days are gone forever. I would not be surprised by (and would favor) a one strike yer out policy. So I sincerely do not believe that JPII is "gambling with our children" or anything like that. I do think he is gambling that the American Church (that'd be you and me, not just the bishops) will learn to bear the cross. I do not think he is motivated by a fascination with perks and power. Nor with some bizarre notion that the bishops must continue in their offices merely for the sake of continuance. His entire life tells against this. He may be given to over-optimism (but then when you've seen the Iron Curtain fall without a shot you might have a rather more sanguine view of the power of God than comfortable Americans who prefer to "fix" problems rather than approach them supernaturally), but he is not given to cynical politics.
Really, folks. We have to catch our breath here and stop hyperventilating. A few months ago, everybody was dead certain JPII was going to cart Law off to Rome in the dead of night because they just knew it was a good old boys network etc. Didn't happen. Now, in the twinkling of an eye, JPII goes from being one of the champions of the human person to a heartless lab technician gambling with our children in a grand ecclesial experiment that thinks only of the comfort of ecclesiats and cares nothing for the screams of abused kids who are–somehow–endangered. When such voices whisper in our ears it's always a good idea to splash cold water on our faces and ask if this is really terribly likely given what we know of him.
The danger to our kids is past, by and large. Yes, there are still a bunch of skeletons to be uncovered (perhaps literally, judging from the headlines today). And they will be. Bad priests and bad bishops will be and are being thoroughly outed. The old regime of shuffling, cover up, etc is gone for good. Now we have the problem of what to do with the bad bishops who did this stuff. We do not have the problem, I think, of any future risk that the will ever be dumb or wicked enough to do it again. Pavlov is in the driver's seat on that score and they have learned–really learned–that lesson.
Now they must learn to take responsibility for what they've done and they must learn their office. It may well be that some are taken out or resign. Then again, maybe not. But I don't believe, whether they go or stay, that another child will be endangered again. They will far more likely be draconian toward their priests than toward the victims. That's a step up, though it's still not putting the spotlight on the main authors of this crisis: themselves. To do that requires grace and that, I think, is what the Holy Father is hoping will be given them as they bear the cross.


text:
21st Century Living
Who is the Author of Spamlet? (And Other Thought Experiments)
Dr. Frankenstein creates a creature called Spakesheare that immediately writes a play,Spamlet. Who is the play's author?
We live in a time of information abundance, which far too many of us see as information overload. With the sum total of human knowledge, past and present, at our fingertips, we're faced with a crisis of attention: which ideas should we engage with, and why? Big Think is an evolving roadmap to the best thinking on the planet — the ideas that can help you think flexibly and act decisively in a multivariate world.
A word about Big Ideas and Themes — The architecture of Big Think
Big ideas are lenses for envisioning the future. Every article and video on bigthink.com and on our learning platforms is based on an emerging "big idea" that is significant, widely relevant, and actionable. We're sifting the noise for the questions and insights that have the power to change all of our lives, for decades to come. For example, reverse-engineering is a big idea in that the concept is increasingly useful across multiple disciplines, from education to nanotechnology.
Themes are the seven broad umbrellas under which we organize the hundreds of big ideas that populate Big Think. They include New World Order, Earth and Beyond, 21st Century Living, Going Mental, Extreme Biology, Power and Influence, and Inventing the Future.
Browse videos featuring experts across a wide range of disciplines, from personal health to business leadership to neuroscience.
Big Think's contributors offer expert analysis of the big ideas behind the news.
Big Think's Edge learning platform for career mentorship and professional development provides engaging and actionable courses delivered by the people who are shaping our future.
Life and relationships in the internet age
Dr. Frankenstein creates a creature called Spakesheare that immediately writes a play,Spamlet. Who is the play's author?
Try a few new things and yeah, sometimes it will be embarrassing. But maybe that is not such a bad thing. Maybe it's worth it.
To transform mind, body and spirit requires cultivating self-love.
If, as a new study claims, they can be clustered along specific routes and set for certain times of the day, home deliveries are much more environmentally friendly than individual trips to the store.
Today's Medicaid could affect a small number of poor people within two years. Truly finding out how Medicaid might change their lives would take much longer. Moreover, Medicaid would change with time, too – and almost certainly for the better.
Who will last longer -- Twitter or The New York Times?
As Neil deGrasse Tyson said, we spend the first year of a child's life teaching him or her to walk and talk, "and the rest of their lives telling them to shut up and sit down."
Robel Phillipos is a friend of suspected bomber Dzhokhar Tsarnaev. Here is the complaint against him.
May 1, or May Day, or the Feast of St Joseph the Worker, the patron saint of workers, is a day that workers were traditionally given off following the planting of the fields that later became a bank holiday and is today an annual occasion for displays of social unrest throughout much of Europe.
After enduring years of misery, Jason Collins is now the first openly gay athlete in a major American professional sport. And yet, Collins is not technically the first.
Artists have to try to connect. They have to try to be very clear in what it is that they're purpose is and what it is they're conveying because otherwise, it's just more stuff.
When you click on an article you are voting. You're telling an editor to produce more content like that at the expense of the stuff that you didn't click on.
Creating clarity with a large, diverse team is one of the huge challenges that any leader is faced with.
For those women who are still interested in the conventional monogamous heterosexual family, the sexual revolution has placed these women in an asymmetrical relationship to men.
There's a lot of pressure these days to be on, and there are some real, legitimate external factors for people, whether it's the client might call or the customer might need something or you're a manager and you manage across time zones. Those are legitimate reasons why you might be on and ...


text:
- lightweight so it's easy for sheet changes Review by Julie
This is the best crib mattress in the world. Its so comfortable for my baby and the best part....its so light!!!! I can easily lift it up and change the sheets with no struggles
(Posted on 8/25/14)
- Worth the money Review by Glen
Worth every penny. Easy to clean too whenever she has an accident....my baby sleeps so well on it. Love the dual side.
(Posted on 8/14/14)


text:
Two men fish in the calm waters beneath a train bridge near the Chickamauga Dam lock.
Photo by Doug Strickland .
published Sunday, March 31st, 2013
Stories this photo appears in:
Hunting and fishing have a long history in the Chattanooga area, attracting many local residents and visitors to the numerous lakes, streams and wilderness areas throughout the region.


text:
Find records of Fred Hinkle
Find birth, death, marriage, military, and other records of Fred E Hinkle at Ancestry.com.Search for records
Biography & Family History Add details
Fred E Hinkle (1909 - 1997) was born on June 16, 1909. He was born into the Hinkle family.
Fred had no marriages. Fred died on May 30, 1997 at 87 years of age.
Fred E Hinkle's last known residence is at Lewisburg, Greenbrier County, West Virginia.
The data on this page comes from the official record for Fred E Hinkle in the SSDI (United States Social Security Master Death Index). According to information provided to the SSDI, this death record has been verified by a family member of the deceased. This data can be considered very accurate. What is the SSDI?
This look at Fred E Hinkle's history is maintained by the AncientFaces community Share what you know to connect to the people who knew him. Some common things we would like to know about Fred's genealogy:
- Where was Fred born?
- Where did Fred die?
- Who was Freds family?
- What did Fred look like? Add some photos of their life.
Family Tree & Genealogy Add / Edit People
You can add or remove people from this genealogy by clicking here.
History of Fred E Hinkle Add details
- Given name
- Fred
- Surnames
- Hinkle family history
- Last Known Residence
- Lewisburg, Greenbrier County, West Virginia
- Born
- Death
- Gender
- Male
Do you know more about Fred E Hinkle?
You can add details to this page and share Fred's story.
Obituary Add details
There isn't any info about the obituary records of Fred. You can add obituary information about Fred E Hinkle by clicking "Add Details".
Discuss Fred
Share your memories below with the rest of Fred's family. We'll notify anyone else who is searching for Fred of your message.
Find records of Fred Hinkle
Find birth, death, marriage, military, and other records of Fred E Hinkle at Ancestry.com.Search for records
Possible Relatives
- Daniel Hinkle
- ·
- Roy B Hinkle
- ·
- Elbia E Hinkle
- ·
- O P Hinkle
- ·
- Otha M Hinkle
- ·
- Ernest Hinkle
- ·
- Brent Hinkle
- ·
- Leonard Hinkle
- ·
- Teddie Hinkle
- ·
- Billie R Hinkle
- ·
- Reba Hinkle
- ·
- Conrad Hinkle
- ·
- Albert Hinkle
- ·
- Samuel Hinkle
- ·
- Mary E Hinkle
- ·
- Richard D Hinkle
- ·
- Major Hinkle
- ·
- Ocie Hinkle
- ·
- Bessie L Hinkle
- ·
- Shelton Hinkle
- ·


text:
The American family has become less stable because of two forces that are battering its once-stable foundations. That doesn't mean either factor is bad, but the combination can seriously shake things up.
There are so many ways to enjoy movies theses days — including picking up a Blu-ray, streaming from a wide variety of services or going the old-school route and heading to the theater.
President Obama Monday said he intends to nominate Rabbi David Saperstein, a veteran religious liberty advocate, as the first non-Christian to serve as U.S. Ambassador-at-Large for International Religious Freedom, a post vacant for nine months.
Think love is dead and Tinder is the killer? Here are six stories that will make you think differently.
House Republicans unveiled a slimmed-down bill Tuesday to address the immigration crisis on the U.S.-Mexico border by sending in National Guard troops and speeding migrant youths back home. The election-year measure would allow Republicans to say...
Siskiyou County is looking to build a new jail with state funds, and this year's Grand Jury has weighed in on the importance of completing the project.
ETNA – After nearly 38 years, Kidder Creek Camp in Scott Valley, an outdoor spiritual recreation camp, is looking to expand.Since it's inception in 1976, the camp has been providing exciting outdoor adventures to kids...
Etna rolled out the red carpet Monday for Bicycle Rides Northwest, with two days of activities for the bikers participating in the Klamath Knot California Bicycle Ride.
- Events Calendar


text: Mountain Top Experience View full-size image < previous next > Is this photo a winner? "This past June, 2010, our youth group took a trip to TN to help the needs of a family living in the mountains. We truly had a "Mountain Top" experience working together and helping meet the needs of this special family in TN. Our CustomInk t-shirts will always help us remember the AMAZING trip that we took as a group! All of the students and leaders loved wearing their shirts and the youth director loved the ease and expertise of CustomInk. The whole design and ordering process was quick and easy! Thanks CustomInk!" - http://www.jamestownrc.org - youth_director (Jul 06, 2010) Share this photo on: Twitter Facebook Pinterest Similar Photos: mountain | religious | youth group | tennessee | trip | mission trip | jamestown reformed church Feeling inspired? Visit the CustomInk Design Lab to start your own group order. Design Your Own


text:
Government and society's increasing reliance on the Internet, and the commensurate cybersecurity dangers it poses, are forcing the U.S. to reevaluate priorities and get creative in meeting today's threats. But there's still a capability gap, and one member of Congress is targeting the development of a cyber workforce as one solution.
"The reliance is driving a short-term race to fully staff new missions and a long-term requirement to establish a strong pipeline for cyber talent," said Rep. Jim Langevin (D-R.I.), speaking at the University of Rhode Island on May 2.
Langevin plans to push through legislation in Congress and launch efforts in his home state to address both near-term and future deficiencies and catalyze better cyber training and expertise. His goals stem from a cyber workforce workshop he commissioned last year with the Defense Department at National Defense University. The workshop focused on four key areas: the size and growth of the cyber workforce; state and local cyber workforce issues; K-12, college and science, technology, engineering and math education; and credentialing for the cyber workforce.
This workshop stressed not only that the cybersecurity workforce must be significantly expanded, but that it has to grow in both quantity and quality," Langevin said. "We must define cyber careers that will build a framework for both government and industry positions."
But he conceded that funding hurdles will only increase, limiting policy options for both state and federal governments.
"The workshop therefore spent significant time exploring how to build partnerships in order to better leverage our resources and find new and unique ways to fill the gaps in the workforce that exist today," he said. "This initiative is designed to determine what role the local and federal government can play in protecting state, local, or even private assets."
Langevin noted that his goals for federal cybersecurity progress are bolstered by the recently passed Cyber Intelligence Sharing and Protection Act and the Federal Information Security Act, at least to some degree, and are a good start. He expressed disappointment in some aspects of the bills, and also stressed that the Obama administration should be provided with a more central coordinating role in cyber policy and authority.
"Five years ago, I and many of you in this room seemed out in the wilderness as we tried to raise awareness about an issue that most had never thought about," he said. "Now cybersecurity and the cyber debate are part of our daily policy conversations, and it's universally identified by the country's top security officials as one of the biggest threats to our national security. We have made progress in protecting the nation in cyberspace, but we must continue to build on this success."
That ongoing progress includes sustainable job growth in the cyber industry as well as continued efforts to reach students and foster interest in the cyber arena – including a program Langevin announced that targets computer security skills at the high school level. The program is being done in conjunction with the SANS Institute, he said.
"We want to show the next generation that an interest in computers is not just a hobby – it can become a career," Langevin said.
About the Author
Amber Corrin is a former staff writer for FCW and Defense Systems.
E-Mail this page
Printable Format
Advanced Search
Nominations are now open for the 2015 Federal 100 awards. Get the details and submit your picks!
Make a nomination today
Steve Kelman considers the costs of corruption in Mexico, China, and most developing countries -- and argues that Americans should keep their own government troubles in perspective.
Agency leaders must proactively invest time, energy and resources to shape the future rather than reactively wait for change to happen.
Meet 24 men and women who are driving key changes in federal IT -- and shaping up as the community's likely leaders of tomorrow.
GSA's administrator talks with FCW about short-term hiring, long-term planning and Robert Frost.
Without a future vision and an appetite for risk, reforms lead down a rabbit hole. There is a better way.
VA's top tech official says he is balancing risks while trying to keep the department's online services open for business.
After five years on the job, the founding director of the Office of Government Information Services believes that a deeper understanding and acceptance of FOIA is seeping into the federal government.
The September attack, made public Nov. 10, potentially puts customer and employee personal information at risk, including addresses, Social Security numbers and emails.
The General Services Administration's Matthew Goodrich predicts more agency-driven authorizations and previews a new two-year road map.
8609 Westwood Center Drive, Suite 500Vienna, VA 22182-2215 703-876-5100
© 1996-2013 1105 Media, Inc. All Rights Reserved. This copy is for your personal, non-commercial use only.To order presentation-ready copies for distribution to colleagues, clients or customers, visit: www.1105Reprints.com


text:
This time of year, conversations at Chow Bella meetings tend to turn to who's eaten what -- where. With the summer travel season in full swing, we bring you Food Tours, our writers' suggestions of what to eat and drink out of town. We will freely admit that we get so weak-kneed at the sight of the ... More >>
If you've pulled out of your lingering calorie coma and haven't been trampled by eager, deal-hungry shoppers, here are your best bets for riding out the rest of Turkey Day weekend. David Spade @ Stand Up LiveWe read somewhere that laughter burns calories. Get a humor workout when David Spade, the ... More >>
It's kinda tough to be a stand-up comic from Arizona. No matter how successful and funny you might be, you'll always have to measure up the king of locally grown comedians, David Spade. Pablo Francisco, however, has done his best at giving the former Saturday Night Live performer a run for h ... More >>
Anderson's Fifth Estate is back. Longstanding Valley club Anderson's Fifth Estate is set to return, says club owner Tom Anderson.The club was known as Anderson's from 1982 to 2007, when it became Club Forbidden, then switched names to Vagabond Ballroom in November, 2010."We were trying to get ro ... More >>
When the Arizona Republic posted a story on April 1 about CityScape's adding a giant comedy club, I sorta figured it was an April Fools Day prank. Nope.Stand Up Live, a 17,000-square-foot space with 600 seats, will be located next to Lucky Strike Bowling on the second level of the project's weste ... More >>
Funnyman Rob Schneider hits Tempe
I don't think Carson Daly or Jay Leno'll be breaking a sweat over this one any time soon, but I just got a little promo e-mail in my in-box announcing the launch of ex-Arizona Attorney General Grant Woods' "new interactive website and online talk show" grantwoods.com. What's next, Terry Goddard pimp ... More >>
As our blogger Yvonne Zusel noted a couple days ago, there's plenty of things to see and do in the Valley this weekend that have absolutely nothing to do with the hoopla surrounding the 2009 NBA All-Star Game. And here's the proof to back up said statement: our regular weekly round-up of all the no ... More >>
David Spade doesn't forget his roots. The former Valley resident cut a $100,000 check today to fund the purchase of new rifles for the Phoenix Police Department. In a news release, (reprinted below), police say Spade "had been made aware" of a program -- covered in a previous Valley ... More >>
We understand that in the 24-hour news cycle it can be difficult to keep up. Worry not! We have the solution. Check back on Valley Fever every evening for highlights from each of New Times' blogs. Today's entries: Valley Fever: DMX Extradited to Arizona; Rap Star Fugitive Cooling Off in Maricopa Co ... More >>
Welcome to the Cult of Katie Rose. Hope your liver can handle it
A zero on the board
Making it big in the valley's comedy scene is no laughing matter
Diesel fumes can't start this vehicle
Racing Stripes is strictly for kids. Actually, it's not for them, either
Tempe Little Theatre wakes George Washington
Ideas that were forgotten but not gone in 2003
Just how does David Spade keep getting work?
DEJ Productions tries to give 'direct-to-video' a good name
Trying to remember the best in a forgettable year of film
Trying to pass off gross-out gags as fantasy, Saving Silverman is a stink bomb
The Emperor's New Groove is a new groove for Disney, too
Only the devil could have possessed Adam Sandler to make such a bad movie, dragging half of Hollywood with him
Coyote Ugly's tavern toughies fail bar exam
Downtown Phoenix dining hasn't gotten much respect, historically
Valley-based infomercial czar Don Lapre has made millions selling his Money Making Secrets to late-night-TV viewers. So what's the secret behind his bankruptcy?
Indie Jerome's a jolting joy ride off the beaten path
February 11 - 17, 1999
April 16 - 22, 1998
8 Heads in a Duffel Bag, and all of them drearily mindless


text:
Local Weather Cameras
Clarkton, NC 28433
Live weather camera images from:
Bladen Lakes Primary School, Elizabethtown, NC 28337
Camera Animation
Next Featured Camera
Weather News
Other Top Weather Headlines
Snow Likely To Affect East Coast Wednesday
Mother Nature is preparing to throw a major wrench into pre-Thanksgiving plans this week, in the form of a major winter…More >
Thanksgiving Travel: Weather Hiccups In East, Northern Tier
The biggest weather challenges for holiday travelers early this week will be the East Coast and Northern…More >
Snow Drenched Buffalo Prepares For Flooding
People in storm-socked areas around Buffalo began returning to work on Monday as fast-melting mounds of snow fed into creeks…More >
WeatherBug Featured Content
Green Living
You too can help save our planet and put money back in your wallet. Learn how you can take the first steps to reduce your environmental impact, including driving green, easy ways you can conserve water, and energy saving tips. To learn more and discover the benefits of going green, visit WeatherBug's green living section. More >
Sponsored Content
Be Prepared, Know Before
Get faster alerts and better forecasts from the exclusive neighborhood-level WeatherBug network.Learn More


text:
About Us
Staffing Solutions
IT Solutions
IT Consulting
Photo Gallery
Contact Us
Requirement Detail
Job Title
Smartgrid Deployment Field Technician Assistant
Job Code
Contact Phone #
954-985-6650 - Ext 203
Date Posted
Number Of Positions Available
Cincinnati, OH USA
Pay Rate
Job Description
• Assist Field technicians with trouble shooting Radio Frequency capture of Electric and Gas meters being installed in the Grid Modernization AMI Deployment projects.
• Capture and record data utilizing radio frequency spectrum analyzers.
• Learn and practice Radio Frequency engineering principles for Investigation of Wi-Fi mesh anomalies.
• Learn and practice Radio Frequency engineering principles for investigation of Bluetooth anomalies.
• Will be primarily working in the field under various weather conditions.
• Position will be based in Cincinnati, OH or in the Greater Cincinnati/N. KY and Indiana area.
• The Associates will be required to travel frequently to customer sites within their service territory, usually within a 50 miles radius.
• The Associates will team with a Field Technician and will be required to drive company vehicle.
• They may be required to use personal vehicle to travel to work sites.
• Enter and maintain/edit data within the assigned data systems as needed using the normal system interface software.
• Insure integrity of data contained within the assigned data systems by understanding and adhering to the rules and standard practices for data entry, and by identifying and helping to correct data inaccuracies or inconsistencies.
• Strive to continually improve job-related, technical and professional knowledge, skills and performance.
• Analyze, resolve, and document problems associated with the field data contained in the applicable databases and field tools
Basic Qualification:-
• Associates degree or higher in one of the following: Electrical Engineering, Mechanical Engineering, or Civil Engineering, or 2 years of demonstrated experience in an engineering occupation.
Terms of Use
Privacy Statement
Copyright 2007 by GDKN Corporation


text:
From victory thrills to sad spills, see the most intriguing moments to come out of Turin. By Serena Kappes
Credit: (CW L-R) JOHN G. MABANGLO/EPA/Landov; AP
Updated: Friday Feb 24, 2006 | 05:15 PM EST
More from PEOPLE
See More News
8 of 12
"I made a mistake. It happens," U.S. snowboardcrosser Lindsey Jacobellis, 20, said, shrugging off a mountainload of criticism after losing a sureshot at the gold. Her slip-up? Adding a just-for-show trick – which caused her to crash. But Jacobellis, who came in second to Switzerland's Tanja Friedan and still has endorsement deals, says it's all good. "I had a blast."
Copyright © 2014 Time Inc. All rights reserved. Reproduction in whole or in part without permission is prohibited.