text:
Disclosures All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: MR is an employee of Eli Lilly and Company; KSB and BC are employees and shareholders of Eli Lilly and Company; JMK, MRC and AM are employees of Evidera and declare support from Eli Lilly and Company for the submitted work; no other relationships or activities that could appear to have influenced the submitted work.
Original Paper
Rates and risk of hospitalisation among patients with type 2 diabetes: retrospective cohort study using the UK General Practice Research Database linked to English Hospital Episode Statistics
Version of Record online: 23 SEP 2013
DOI: 10.1111/ijcp.12265
© 2013 Eli Lilly and Company. International Journal of Clinical Practice published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
International Journal of Clinical Practice
Volume 68, Issue 1, pages 40–48, January 2014
Additional Information
How to Cite
Khalid, J. M., Raluy-Callado, M., Curtis, B. H., Boye, K. S., Maguire, A. and Reaney, M. (2014), Rates and risk of hospitalisation among patients with type 2 diabetes: retrospective cohort study using the UK General Practice Research Database linked to English Hospital Episode Statistics. International Journal of Clinical Practice, 68: 40–48. doi: 10.1111/ijcp.12265
Publication History
- Issue online: 17 DEC 2013
- Version of Record online: 23 SEP 2013
- Manuscript Accepted: 21 JUL 2013
- Manuscript Revised: 2 JUL 2013
- Manuscript Received: 4 MAR 2013
Funded by
- Eli Lilly and Company
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
To investigate the rates and risk of hospitalisations in patients with type 2 diabetes (T2D) mellitus in England.
This retrospective population-based cohort study used computerised records from the General Practice Research Database linked to Hospital Episode Statistics data in England. Patients with T2D from January 2006 to December 2010 were selected. Primary outcome measures were all-cause, non-diabetes-related, diabetes-related and hypoglycaemia-related hospitalisations. Factors associated with all-cause and diabetes-related hospitalisations were investigated with Cox's proportional hazards models.
Amongst 97,689 patients with T2D, approximately 60% had at least one hospitalisation during the 4-year study period. Rates of hospitalisation were as follows: all-cause, 33.9 per 100 patient-years (pt-yrs); non-diabetes-related, 29.1 per 100 pt-yrs; diabetes-related, 18.8 per 100 pt-yrs and hypoglycaemia, 0.3 per 100 pt-yrs. The risk of all-cause hospitalisation increased with hospitalisation in the previous year, insulin use and the presence of major comorbidities. The risk of a diabetes-related hospitalisation increased with age, female gender, insulin use, chronic renal insufficiency, hypoglycaemia (as diagnosed by a general practitioner) and diabetes-related hospitalisation in the previous year.
Patients with T2D are hospitalised at a considerably high rate for causes directly related with diabetes complications and stay longer in hospital. History of hospitalisation and complications of diabetes were found to be predictive of inpatient hospitalisations suggesting previous hospitalisation episodes could serve as points of intervention. This study highlights important areas for healthcare intervention and provides a reminder for vigilance when risk factors for hospitalisation in patients with T2D are present.
What's known
- The prevalence of diabetes among adults in the United Kingdom is high. Patients with type 2 diabetes (T2D) are at an increased risk of vascular complications, morbidity and mortality and are twice as likely to be admitted to hospital and experience prolonged stays, imposing a significant burden to the healthcare system. Previous studies that attempted to quantify hospitalisation rates amongst patients with T2D in England were limited to small and unrepresentative regional samples.
What's new
- This study is the first to examine a cohort of nationally representative patients with T2D treated in primary care with data linked to hospital admission records in England. Results provide new important insight into the frequency and characteristics of hospitalisations amongst patients with T2D in England to help healthcare professionals improve the management of these patients and their quality of life; thus, contributing to decrease the burden to the National Health Service.
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
Diabetes is a complex group of metabolic disorders associated with impaired insulin secretion and variable degrees of peripheral insulin resistance [1]. A progressive condition, type 2 diabetes (T2D) is characterised by deficient insulin activity arising from decreased insulin secretion secondary to beta cell failure, compromised insulin action in peripheral target tissues, or a combination of these abnormalities. The prevalence of diabetes among adults in the United Kingdom (UK) is estimated to be 6.8% [2], of which 90% are estimated to be patients with T2D. A further million people are estimated to remain undiagnosed [3].
Poor glycaemic control, blood pressure, low-density lipoprotein and cholesterol control [4], as well as high body mass index (BMI) contribute to the high burden of T2D to the healthcare system. Patients with T2D are at an increased risk of vascular complications including cardiovascular (CV) morbidity and mortality [5-8], and are twice as likely to be admitted to hospital and experience prolonged inpatient stays [9-11]. As a consequence of these complications, these patients are more than twice as costly to manage than those without diabetes [12]. The direct cost is estimated to be around 7–12% of total annual National Health Service (NHS) expenditure in England [13, 14]; indirect societal and productivity costs have been estimated to be even higher [14, 15].
Evidence has shown that tight glycaemic control (fasting blood glucose concentration less than 6 mmol/l) has an effect on reducing the risk of microvascular complications [16] and optimal patient management involves a challenging interplay of factors [17]. For example, striving for ideal glycaemic control may result in episodes of hypoglycaemia, which may in turn have negative effects on medication adherence [18], while untreated severe hypoglycaemia can lead to inpatient hospital admissions [19], and in rare cases, brain damage and death.
Current NHS policy targets improving the management of chronic disease patients, including those with T2D, as an important strategy for improving health outcomes and controlling healthcare expenditure [20]. Furthermore, identification of risk factors for hospitalisation of patients with T2D and patient subgroups who may be managed as outpatients is important in reducing healthcare costs. Previous studies have attempted to quantify hospitalisation rates amongst patients with T2D in England; however, conclusions were limited to small and unrepresentative samples in specific regions [21-23].
Accordingly, the aim of this study was to quantify the frequency of hospitalisation amongst patients with T2D in England and describe their characteristics. Specifically, the objectives were to estimate the rate of hospitalisations, report common primary causes and characteristics of hospitalisations, and to identify demographic, clinical and treatment-related factors associated with all-cause and diabetes-related hospitalisations amongst patients with T2D.
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
Data source
This retrospective cohort study utilised the linkage of the General Practice Research Database (GPRD) and the Hospital Episode Statistics (HES) data warehouse in England, being the first known diabetes study of this nature in the UK.
The GPRD1 [24], managed by the MHRA, comprises diagnostic and prescription data of 5.2 million active patients from 640 practices which have passed quality control validation. These practices are considered to be broadly representative of the wider UK population [25].
The HES is a data source containing details of all admissions to NHS hospitals in England [26], including demographic data, dates of hospital admission, diagnoses and surgical procedures. Records are coded using a combination of International Statistical Classification of Disease and Related Health Problems (ICD-10) and Office of Population, Censuses and Surveys Classification of Surgical Operations and Procedure (OPCS4) codes for diagnoses and procedures, respectively.
At the time of the study, 56% of the 640 general practices within the GPRD had individual patient data anonymously linked to HES (KC, Personal Communication, GPRD). Linkages were performed using unique NHS number, date of birth, gender and postcode of residence, and contained information on admissions from 1 April 1997 through to 31 December 2011.
Cohort identification
We identified all active patients registered at GPRD practices, 18 years of age and over, with T2D diagnosed or treated during, or prior to, the study period (January 2006 to December 2010). We defined patients with T2D as either requiring: (i) a diagnosis of T2D or a prescription for an oral antidiabetic or glucagon-like peptide 1 (GLP-1) or (ii) a diagnosis of T2D and insulin using Read codes, a standardised clinical coding system used by general practitioners (GPs) in the UK [27] (Data S1). Patients were excluded if diagnosed with type 1 diabetes (T1D) mellitus, gestational diabetes, polycystic ovary syndrome, were pregnant at the start of or during the study period, did not have at least 1 day of follow-up in their medical record or if the practice where they received care did not meet data quality standards [24]. The date of first diagnosis or prescription of anti-diabetic medication in the study period defined entry to the cohort. If patients were diagnosed or prescribed treatment prior to the study period, they were defined as 'prevalent' and entry to the study (index date) was set to 1 January 2006, the start of the study period. Follow-up was defined as time from study entry to the end of patient follow-up (last data collection date [December 2011], transfer out of the practice, end of HES record or death, whichever came first, allowing for the opportunity of at least 1 year, up to 5 years of follow-up). We restricted our study sample to patients from practices that had consented to linkage with HES records, if available, in accordance with the study objectives. No statistically significant differences in demographic and relevant clinical data were found between linked and non-linked patients (data not shown).
Outcome measures
The primary outcome of this study was hospital admission in the HES records. The primary reason for admission was identified by the responsible healthcare practitioner at the time of hospital admission and used to classify admission by type: (i) diabetes-related (including those related to hypoglycaemia) and (ii) non-diabetes-related. Classification of reason for admission as diabetes-related was based on a previously identified list of ICD-9 and OPCS4 codes as described by Donnan et al. [28], as appropriate, which included neurological, renal, endocrine/metabolic, ophthalmic and CV complications. Non-diabetes-related hospitalisations included all other reasons for hospitalisation not classified as diabetes-related. Hospitalisation admission rates were calculated overall and by age groups in 10-year bands. A sensitivity analysis was conducted amongst those who experienced a hypoglycaemia-related hospitalisation as either the primary, or 'other' cause of hospitalisation. Predictors of all-cause hospitalisations and diabetes-related hospitalisations were also examined.
Survival analysis was used to calculate unadjusted rates of hospitalisation. All hospitalisation events during follow-up, defined as the period from study entry until end of follow-up or a hospital admission, were used. Patients who experienced more than one hospitalisation re-entered the study after the preceding hospitalisation event. To take account of the probability of repeated hospitalisation for the same patient, hospitalisation events were clustered by patient and hospitalisation type [29]. Rates and 95% confidence intervals (CIs) were reported by age group and hospitalisation type.
Length of stay (LOS) and frequency of admission were calculated using summary statistics (mean, standard deviation [SD], median, interquartile ranges [IQR]) on all hospital events from a subsample of patients with at least 12 months of follow-up, excluding those with a missing discharge date. Same day admissions and discharges were counted as 1 day admissions.
To investigate potential risk factors associated with hospitalisation, a subgroup of prevalent patients was used, as the risk factors (due to disease severity and treatment patterns) for hospitalisation are likely to differ from newly diagnosed patients. Two groups of patients were analysed: (i) all prevalent patients, to investigate factors associated with all-cause hospitalisation and (ii) a subset of prevalent patients who had experienced at least one hospitalisation, to investigate factors associated with a diabetes-related hospitalisation. A set of demographic, clinical and laboratory variables based on previous studies were selected (a priori) as potential risk factors, as defined by clinical Read codes, and investigated for possible confounding effects, as appropriate, at the start of the study period. Percentages of missing data were reported. The first hospitalisation event in the study period was used for the analysis, and the type of event (i.e., diabetes vs. non-diabetes hospitalisation) determined categorisation of hospitalisation. Univariate analyses were conducted using χ2 tests for categorical variables and t-test/Wilcoxon rank sum tests for continuous variables. Multivariable Cox regression models were used to identify factors associated with a hospitalisation, and a backward stepwise selection process was used to identify the included covariates as those statistically significant at 95% level of confidence. Hazard ratios and 95% CIs were reported. The proportional hazard assumption was investigated by testing for a non-zero slope of the scaled Schoenfeld residuals on functions of time.
Analyses were performed using Stata/MP v.11 64bit software package (StataCorp LP, College Station, TX). The study was approved by the Independent Scientific Advisory Committee that provides advice to the MHRA on study design (ISAC protocol 11-072).
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
Population demographics
We identified 97,689 patients with T2D and a HES-linked GPRD record; mean age 64.9 years, 54.4% male, mean BMI 30.8 kg/m2 (SD: 6.3, 20.3% missing). Clinical records from the 12 months prior to the study period indicated that 44.7% of patients had reasonably well-controlled levels of blood sugar (median HbA1c 7.1%; IQR: 6.4–8.1; 26.1% missing). Average total cholesterol was 149.8 mg/dl (SD: 39.9; 42.8% missing). Mean estimated glomerular filtration rate (eGFR) values were 68.3 ml/min (SD: 19.6; 9.9% missing). Overall 28,487 (29.2%) patients were 'incident' cases diagnosed during the study period. Of these patients, 23.6% received diabetes treatment at the time of diagnosis: biguanides (87.8%) or sulphonylureas (11.6%). The remaining 69,202 (70.8%) patients were prevalent (i.e., had been diagnosed prior to the study period). Amongst these patients, 69.0% were receiving drug treatment at the start of the study period: biguanides (69.2%), sulphonylureas (41.5%) and long/intermediate acting insulin (19.8%). Median time since T2D diagnosis for the prevalent patient group was 4.6 (IQR: 1.9–6.2) years at the start of the study period.
Rates of hospitalisation
The median follow-up duration per patient was 4.8 years (IQR: 2.9–4.9), which represented 763,292 patient-years (pt-yrs). During follow-up, 59.4% of patients had at least one hospitalisation (65.0% in the prevalent cohort; 45.8% in the incident cohort) accounting for a total of 258,383 hospitalisation admissions. The rates of hospitalisation were 33.9, 29.1, 18.8 and 0.3 per 100 pt-yrs for all-cause, non-diabetes-related, diabetes-related and hypoglycaemia related hospitalisations, respectively. Patients who were hospitalised due to causes unrelated to diabetes showed a higher rate of hospitalisation in younger age groups. This pattern was not seen in patients who were hospitalised for diabetes-related causes, where rates increased steadily with age (Figure 1).
Reasons and characteristics of hospitalisation
The characteristics of hospitalisation by type of admission are summarised in Table 1. The median LOS was 1 day (IQR: 1–4) as more than half of the hospitalisations (58.6%) were same day admissions and did not require an overnight stay. For episodes that required at least one overnight stay, median LOS was 6 days (IQR: 3–13) for diabetes-related hospitalisations and 5 days (IQR: 3–11) for non-diabetes-related hospitalisations.
|Hospitalisation characteristics
|All hospitalisations
|Diabetes-related hospitalisations
|Non-diabetes-related hospitalisations
|Number of patientsa
|57,993 (100.00%)
|27,441 (47.32%)
|50,387 (86.88%)
|Number of hospitalisation events
|n (%)
|257,826 (100.00%)
|97,759 (37.92%)
|160,067 (62.08%)
|Length of stayb (days) for each event
|Mean (SD)
|5.11 (12.40)
|4.19 (10.71)
|5.67 (13.30)
|Median (min, max)
|1 (1, 673)
|1 (1, 372)
|1 (1, 673)
|IQ range
|Number of hospitalisation events with ≥ 1 overnight
|n (%)
|106,797 (41.42%)
|29,460 (30.14%)
|77,337 (48.32%)
|Length of stay (days) for events requiring ≥ 1 overnight
|Mean (SD)
|10.93 (17.71)
|11.59 (17.39)
|10.67 (17.83)
|Median (min, max)
|6 (2, 673)
|6 (2, 372)
|5 (2, 673)
|IQ range
Amongst hospitalisation events classified as diabetes-related, the most frequently occurring reasons were: renal failure (33.6%), hypertension (12.6%) and cataract (12.0%), which seldom required an overnight stay. For those who did, admissions due to renal failure had a mean LOS longer than the average diabetes-related episodes. Hypoglycaemia-related admissions accounted for 1.2% of diabetes-related admissions, and more than 80% required an overnight stay. For non-diabetes-related hospitalisations, the most frequently occurring reasons were: atherosclerotic heart disease (3.1%), anaemia (1.7%) and 'unspecified' illness (1.4%).
Factors associated with hospitalisation
Among prevalent patients with T2D in the cohort, 40,770 (62.0%) had at least one (all-cause) hospitalisation after the start of the study period and complete information for variables included in the Cox model. Of these, a subset of 20,706 (50.8%) patients had one or more diabetes-related hospitalisation(s) during follow-up. Key demographic features and comorbidities are summarised in Table 2.
|Patients with T2D
|All patients
|No hospitalisation (post-index)
|≥ 1 All-cause hospitalisation (post-index)
|≥ 1 Diabetes-related hospitalisationa (post-index)
|≥ 1 Non-diabetes-related hospitalisationa (post-index)
|Total patients, n (%)
|65,756 (100.0%)
|24,986 (38.0%)
|40,770 (62.0%)
|20,706 (50.8%)
|20,083 (49.2%)
|Male, n (%)
|35,975 (54.7%)
|14,296 (57.2%)
|21,679 (53.2%)
|11,018 (53.2%)
|10,674 (53.2%)
|Age, mean (SD)
|67.1 (12.7)
|64.5 (13.1)
|68.8 (12.2)
|70.8 (11.6)
|66.6 (12.5)
|Years since T2D diagnosis, mean (SD)
|4.7 (3.4)
|4.4 (3.3)
|5.0 (3.6)
|5.4 (3.7)
|4.6 (3.3)
|HbA1c value ≤ 6 months pre-index, mean (SD)
|7.4 (1.4)
|7.3 (1.4)
|7.4 (1.5)
|7.5 (1.5)
|7.3 (1.4)
|BMI value ≤ 12 months pre-index, mean (SD), (kg/m2)
|30.2 (6.1)
|30.2 (6.1)
|30.2 (6.2)
|30.0 (6.0)
|30.5 (6.3)
|eGFR, mean (SD), (ml/min)
|66.6 (19.8)
|69.4 (19.4)
|64.9 (19.8)
|62.0 (20.1)
|67.9 (19.0)
|Hospitalisation in previous year, n (%)
|16,711 (25.4%)
|4208 (16.8%)
|12,503 (30.7%)
|7186 (34.7%)
|5325 (26.5%)
|Insulin treatment, n (%)
|9603 (14.6%)
|2900 (11.6%)
|6703 (16.4%)
|4115 (19.9%)
|2597 (12.9%)
|Sulphonylurea treatment, n (%)
|19,973 (30.4%)
|7143 (28.6%)
|12,830 (31.5%)
|6904 (33.3%)
|5933 (29.5%)
|Peripheral circulatory disorder, n (%)
|5930 (9.0%)
|2115 (8.5%)
|3815 (9.4%)
|2063 (10.0%)
|1753 (8.7%)
|Neurological complications, n (%)
|23,645 (36.0%)
|7340 (29.4%)
|16,305 (40.0%)
|9460 (45.7%)
|6851 (34.1%)
|Cardiovascular complications, n (%)
|5470 (8.3%)
|1500 (6.0%)
|3970 (9.7%)
|2634 (12.7%)
|1343 (6.7%)
|Cancer, n (%)
|6401 (9.7%)
|1782 (7.1%)
|4619 (11.3%)
|2425 (11.7%)
|2196 (10.9%)
|Cerebrovascular complications, n (%)
|1295 (2.0%)
|401 (1.6%)
|894 (2.2%)
|558 (2.7%)
|336 (1.7%)
|Endocrine/metabolic complications, n (%)
|3369 (5.1%)
|987 (4.0%)
|2382 (5.8%)
|1439 (7.0%)
|945 (4.7%)
|Disorders of the liver, n (%)
|380 (0.6%)
|109 (0.4%)
|271 (0.7%)
|145 (0.7%)
|126 (0.6%)
|Diabetes-related hospitalisation in previous year, n (%)
|6087 (9.3%)
|1472 (5.9%)
|4615 (11.3%)
|3128 (15.1%)
|1492 (7.4%)
|Prior amputation, n (%)
|973 (1.5%)
|292 (1.2%)
|681 (1.7%)
|446 (2.2%)
|235 (1.2%)
|Chronic renal insufficiency, n (%)
|1564 (2.4%)
|375 (1.5%)
|1189 (2.9%)
|874 (4.2%)
|316 (1.6%)
|Hypoglycaemia (as reported by GP in previous year), n (%)
|3070 (4.7%)
|898 (3.6%)
|2172 (5.3%)
|1301 (6.3%)
|873 (4.4%)
The results of the Cox regression analyses are presented in Tables 3 and 4. For all-cause hospitalisation, hospitalisation in the previous year was the strongest predictor; these patients were almost twice as likely to experience a subsequent hospitalisation. Other factors associated with all-cause hospitalisation included insulin use, older age, male gender, higher HbA1c values and presence of major comorbidities, especially of the liver and kidney (as represented by the eGFR) (Table 3). Factors associated with an increased risk of a diabetes-related compared with a non-diabetes-related hospitalisation are presented in Table 4. A diabetes-related hospitalisation in previous year was the strongest predictor of subsequent diabetes-related hospitalisation. A diagnosis of chronic renal insufficiency or amputation on or prior to the start of the study and insulin use were also associated with a diabetes-related hospitalisation, as well as higher HbA1c values and previous diagnosis of hypoglycaemia.
|Risk factorsa
|No. of events
|Person-years at risk
|Unadjusted HR (95% CI)
|Adjusted HR (95% CI)b
|Hospitalisation in previous year (yes vs. no)
|2.20 (2.15–2.24)
|1.91 (1.87–1.96)
|Disorders of the liver (yes vs. no)
|1.53 (1.36–1.72)
|1.48 (1.31–1.67)
|eGFR (ml/min)
|≥ 60
|1.41 (1.38–1.44)
|1.07 (1.05–1.10)
|≤ 30
|2.52 (2.39–2.66)
|1.41 (1.33–1.49)
|Cancer (yes vs. no)
|1.61 (1.57–1.66)
|1.26 (1.22–1.30)
|Cardiovascular complications (yes vs. no)
|1.87 (1.81–1.93)
|1.24 (1.19–1.28)
|Insulin treatment (yes vs. no)
|1.37 (1.34–1.41)
|1.23 (1.20–1.27)
|Neurological complications (yes vs. no)
|1.46 (1.43–1.48)
|1.21 (1.19–1.23)
|Cerebrovascular complications (yes vs. no)
|1.42 (1.34–1.52)
|1.12 (1.04–1.19)
|Endocrine/metabolic complications (yes vs. no)
|1.42 (1.37–1.48)
|1.12 (1.07–1.16)
|Peripheral circulatory disorder (yes vs. no)
|1.12 (1.09–1.16)
|1.08 (1.04–1.12)
|Sulphonylurea treatment (yes vs. no)
|1.13 (1.10–1.15)
|1.05 (1.02–1.07)
|Male gender
|1.11 (1.09–1.13)
|1.04 (1.02–1.07)
|HbA1c (%) – 1 unit change
|1.02 (1.01–1.02)
|1.03 (1.02–1.04)
|Age (year) – 1 year change
|1.02 (1.02–1.02)
|1.02 (1.02–1.02)
|Time since diagnosis (years) – 1 year change
|1.04 (1.04–1.04)
|1.01 (1.01–1.01)
|Risk factorsa
|No. of events
|Person-years at risk
|Unadjusted HR (95% CI)
|Adjusted HR (95% CI)b
|Diabetes-related hospitalisation in previous year (yes vs. no)
|2.03 (1.96–2.10)
|1.70 (1.63–1.76)
|eGFR (ml/min)
|≥ 60
|1.47 (1.43–1.52)
|1.17 (1.13–1.20)
|≤ 30
|2.93 (2.75–3.12)
|1.71 (1.59–1.84)
|Prior amputation (yes vs. no)
|1.73 (1.58–1.89)
|1.38 (1.26–1.52)
|Diagnosis of chronic renal insufficiency (yes vs. no)
|2.29 (2.15–2.45)
|1.34 (1.25–1.45)
|Insulin treatment (yes vs. no)
|1.47 (1.42–1.51)
|1.26 (1.22–1.31)
|Diagnosis of hypoglycaemia (yes vs. no)
|1.39 (1.32–1.47)
|1.09 (1.03–1.15)
|HbA1c (%) – 1 unit change
|1.07 (1.06–1.08)
|1.08 (1.07–1.09)
|Age (year) – 1 unit change
|1.03 (1.02–1.03)
|1.02 (1.02–1.02)
|Time since diagnosis (years) – 1 unit change
|1.05 (1.04–1.05)
|1.02 (1.01–1.02)
|Male gender
|0.99 (0.96–1.01)
|0.93 (0.91–0.96)
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
The rates of all-cause, non-diabetes-related and diabetes-related hospitalisations amongst patients with T2D in England represent a significant burden to the NHS [13, 30]. Approximately half the hospitalisation events observed in this study were day admissions. For those requiring at least one overnight stay, LOS was higher for diabetes-related admissions. The most frequent diabetes-related hospitalisations were related to renal failure, hypertension and cataract; whilst for non-diabetes-related hospitalisations atherosclerotic heart disease, anaemia and 'unspecified' illness were most frequently reported. Factors associated with all-cause hospitalisation included hospitalisation in the previous year, low eGFR, insulin use and presence of major comorbidities. Although men were more likely to be hospitalised, women were more likely to be hospitalised for a diabetes-related cause. The risk of a diabetes-related hospitalisation was found to increase with insulin use, age, presence of chronic renal insufficiency, hypoglycaemia (as diagnosed by a GP) and diabetes-related hospitalisation in the previous year.
Comparison with previous literature
In the current study, the observed rate for all-cause hospitalisations amongst patients with T2D (33.8 per 100 pt yrs) was higher than estimated from most previous reports. Rates of 24.2% and 27.1% per year were reported in patients from the Italian region of Turin [31] and from Tayside, Scotland [28] additionally, rates of 31.5% and 50.7% were found in a 4-year follow-up study in England [21] and over 3-year follow-up in Finland [32], respectively. However, these studies included limited populations restricted to a specific geographic location, age group or specific anti-diabetic treatment.
Furthermore, the rate of a diabetes-related hospitalisation in the current study was higher than an Italian study of patients with both T1D and T2D which reported a proportion of 23.9% per year [33]. Direct comparison is difficult, as definitions of hospitalisations due to diabetes-related complications and healthcare settings that may influence inpatient admissions are variable across studies and countries. This study included a broad range of diabetes patients at various stages of disease progression and severity, and included day admissions as collected from hospital records, in contrast with previous reports.
The rate of hospitalisation related to hypoglycaemia reported was lower than found in previous studies [19, 34, 35]. This may be due to our methodology, limiting the cause of admission to the primary diagnosis, or the possibility of misclassification of hypoglycaemia admissions. Service [36] reported that hypoglycaemia has numerous causes including severe systemic illness, advanced malnutrition, various medication use, malignancy and frailty. If recorded in place of hypoglycaemia as the primary cause for hospital admission, such cases would not be included in the estimated rate. Previous studies reporting higher prevalence of hypoglycaemia-related admissions verified the occurrence of hypoglycaemia with additional information from the clinical records [21, 34], while others have used discharge data rather than admission data [37]. To test the sensitivity of our estimate, the rate of hypoglycaemia-related admission was calculated when hypoglycaemia was recorded either as the primary, or 'other' cause of hospitalisation. This doubled the rate from 0.30 to 0.62 per 100 pt-yrs. This remains lower than that seen in other studies focussing on insulin or sulphonylurea use, which are known to be predictors of severe hypoglycaemia [19, 34, 37-39], in patients with T2D. In our study, both incident and prevalent patients were included, and only 14.6% and 30.4% were being treated with insulin and sulphonylureas (with or without insulin), respectively. For treated patients, both insulin treatment and sulphonylurea use were significantly associated with all-cause hospitalisation. Insulin treatment was also significantly associated with diabetes-related hospitalisations.
Median duration of hospitalisation with an overnight stay was found to be 6 days for diabetes, and 5 days for non-diabetes-related admissions in England. These results are within estimates reported from comparable countries ranging from 4.9 to 10.7 days (average of 8 days), and higher than those found for non-diabetic patients [28, 40-42]. However, LOS is likely to be influenced by country-specific healthcare systems and coverage.
Previous studies reporting risk factors associated with hospitalisation amongst patients with T2D have reported conflicting results [21, 43-45]. We found insulin treatment to be predictive of both all-cause hospitalisations and diabetes-related hospitalisations, perhaps indicating increased duration and severity of disease; a finding supported by a United States claims database study and an Italian study utilising hospital admission data [19, 31]. Moss et al. found HbA1c level to be the strongest predictive risk factor for hospitalisations; however pre-existing chronic conditions were not evaluated [21]. Similar to results of the current study, previous studies have reported chronic complications and severe comorbidities of T2D to increase risk of hospitalisation [44, 46]. The presence of major comorbidities as risk factors for hospitalisation further highlight the need to implement preventative strategies as recently indicated by NICE public health guidance 38, which encourage providers of public health services to perform risk assessments in higher risk population groups and match interventions to risks identified [47]. Disproportionate use of healthcare resources, often as a consequence of the heavy burden of comorbidities, has been reported in previous studies of patients with diabetes [48, 49]. Therefore, reduction of diabetes-related complications in patients plays an important role in reducing the cost of hospital admissions by shortening and/or decreasing the frequency of hospital stays [50].
Strengths and limitations of results
This is the first study examining a cohort of nationally representative patents with T2D, treated in primary care with data linked to hospital admission records in England. Our study of observational data in general practice allows assessment of risk factors associated with hospitalisation in a UK primary care setting, given management of patients with T2D in the UK differs from management in some other countries [31].
Diagnostic coding for diabetes within GPRD is reliable with a high positive predictive value, likely owing to Quality Outcomes Framework guidelines introduced in 2004, where GPs are incentivised to keep accurate and updated clinical records for patients with specific conditions, including diabetes [30, 51]. Therefore, our data are likely to be more reliable and complete than other studies conducted in primary care before this period.
Hospital admissions were classified as diabetes-related according to a pre-specified list of reasons for hospital admission [28]. It is possible that some of the conditions listed as non-diabetes-related, such as atherosclerotic heart disease, are in fact a complication resulting from diabetes. Similarly, some hospital admission reasons like hypertension, which may be independent of diabetes, were not classified as such in this study. These two factors have opposite effects in the true estimation of the diabetes-related hospitalisation rate. As we were unable to further investigate the timing of the original diagnoses, and information gathered was limited to reason for hospital admission, it was not possible to determine whether hospital admission was due to a condition predating diabetes diagnosis, or that developed as a result of the condition.
We acknowledge that within the GPRD, HES linkage is approximately 50% complete within England and potential differences in linked compared to non-linked populations could limit generalisability of our findings. To this end, we compared non-linked patients with T2D to the linked cohort and no important differences in demographic and clinical characteristics were found, suggesting that no systematic difference in data from the HES-linked and non-linked practices exist within our cohort of patients.
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
Patients with T2D are hospitalised at a considerably high rate for causes directly related to diabetes complications and stay longer in hospital, posing a significant burden to healthcare systems. The most common primary reasons for a diabetes-related admission are associated with renal failure, CV disease and development of cataract. This study investigated risk factors for inpatient admissions amongst patients with T2D, adding important knowledge of risk factors associated with these events in England. Previous hospitalisations and the existence of comorbidities were found to be significant predictors of inpatient hospitalisations.
As hospitalisations are both costly and can have a significant impact on a patient's quality of life, appropriate risk management plans should be developed to prevent or appropriately manage serious complications associated with diabetes. Reduction of these diabetes-related complications would reduce direct health cost by decreasing the frequency of hospital stays. Furthermore, admissions to hospital related to diabetes may be indicative of patients with a higher disease burden and, therefore, should serve as points of intervention.
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
This study was funded by Eli Lilly and Company. The team members reviewed and approved the study design, provided access to data, reviewed all results and manuscript development and participated in the publication decisions.
Authors' contributions
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
JMK, AM, MR and KSB contributed to conception and design of the study and acquisition of data; JMK and MRC contributed to data analysis. All authors contributed to interpretation of data and drafting the article or reviewing and revising it critically for important intellectual content; all authors approved the final version to be published. JMK attests that the authors had access to all the study data, takes responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication.
- 1
Since 1 April 2012, the Clinical Practice Research Datalink (CPRD) combines the resources of the GPRD and the Research Capability Programme piloted over the last 4 years by the National Institute for Health Research (NIHR). CPRD is hosted and managed by the Medicines and Healthcare Products Regulatory Agency (MHRA).
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
- 1Harrison's Principles of Internal Medicine. 16th edn. New York: McGraw-Hill Professional Publishers, 2004., , et al.
- 2Diabetes Research and clinical practice IDF Diabetes Atlas: International Diabetes Federation, Brussels. Australia; Belgium: Baker IDI Heart and Diabetes Institute, 2011., , et al.
- 3Diabetes in the UK (April 2012) – Diabetes UK. http://www.diabetes.org.uk/Professionals/Publications-reports-and-resources/Reports-statistics-and-case-studies/Reports/Diabetes-in-the-UK-2012/ (accessed 29 June 2012).
- 4American Diabetes Association. Standards of medical care in diabetes–2012. Diabetes Care 2012; 35 (Suppl. 1): S11–63.
- 5The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329: 977–86.
- 6
- 7
- 8Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care 2000; 23(Suppl. 2): B21–9., , et al.
- 9Recent advances in the management of type 2 diabetes mellitus: a review. Postgrad Med J 2008; 84: 524–31., , et al.
- 10The economic cost of diabetes in Canada, 1998. Diabetes Care 2002; 25: 1303–7., , et al.
- 11The cost of major comorbidity in people with diabetes mellitus. CMAJ 2003; 168: 1661–7., , et al.
- 12
- 13National Collaborating Centre for Chronic Conditions (UK). Type 2 Diabetes: National Clinical Guideline for Management in Primary and Secondary Care. London: Royal College of Physicians, 2008.
- 14Do people with type 2 diabetes and their carers lose income? (T2ARDIS-4). Health Policy 2003; 64: 291–6., , et al.
- 15Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med 2012; 29: 855–62., , et al.
- 1610-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577–89., , et al.
- 17Insulin therapy and quality of life. A review. Diabetes Metab Res Rev 2009; 25(Suppl. 1): S4–10., .
- 18Medication taking and diabetes: a systematic review of the literature. Diabetes Educ 2007; 33: 1014–29; discussion 30-1., .
- 19Risk factors for hypoglycemia-related hospitalization in patients with type 2 diabetes: a nested case-control study. Clin Ther 2011; 33: 1781–91., , .
- 20Supporting people and integration with long term conditions: an NHS and Social Care Model to support local innovation. Department of Health, http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4122574.pdf (accessed 20 June, 2012).
- 21Risk factors for hospitalization in people with diabetes. Arch Intern Med 1999; 159: 2053–7., , .
- 22Diabetes inpatients: a case of lose, lose, lose. Is it time to use a 'diabetes-attributable hospitalization cost' to assess the impact of diabetes? Diabet Med 2011; 28: 1123–30., .
- 23Interpreting hospital admissions data across the Korner divide: the example of diabetes in the north western region. Diabet Med 1994; 11: 166–9., , et al.Direct Link:
- 24Clinical Practice Research Datalink (CPRD), http://www.cprd.com/intro.asp (accessed 20 June, 2012).
- 25Clinical information for research; the use of general practice databases. J Public Health Med 1999; 21: 299–304., , .
- 26Hospital episode statistics, http://www.hesonline.nhs.uk (accessed 14 May, 2012).
- 27The history of the Read Codes: the inaugural James Read Memorial Lecture 2011. Inform Prim Care 2011; 19: 173–82..
- 28Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: a retrospective cohort study of resource use. Diabetes Care 2000; 23: 1774–9., , et al.
- 29An Introduction to Survival Analysis Using Stata, 3rd edn. College Station, TX: Stata Press, 2010., , et al.
- 30Quality and Outcomes Framework (QOF). Department of Health, http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Primarycare/Primarycarecontracting/QOF/index.htm (accessed 20 June, 2012).
- 31Patients with type 2 diabetes had higher rates of hospitalization than the general population. J Clin Epidemiol 2004; 57: 1196–201., , et al.
- 32Hospital use among diabetic patients and the general population. Diabetes Care 1994; 17: 1320–9., , et al.
- 33The burden of hospitalization related to diabetes mellitus: a population-based study. Nutri Metab Cardiovasc Dis 2012; 22: 605–12., , et al.
- 34Determinants of severe hypoglycemia complicating type 2 diabetes: the Fremantle diabetes study. J Clin Endocrinol Metab 2010; 95: 2240–7., , et al.
- 35Increase in hypoglycemic admissions: California hospital discharge data. Ethn Dis 2007; 17: 536–40., , et al.
- 36Hypoglycemic disorders. N Engl J Med 1995; 332: 1144–52..
- 37Characteristics of patients with sulphonurea-induced hypoglycemia. J Am Med Dir Assoc 2012; 13: 234–8., , .
- 38Type of insulin and age are predictors of hospitalization due to severe hypoglycemia: the EpiHypo Study. Berlin, Germany: European Association for the Study of Diabetes (EASD), 2012., , et al.
- 39Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 1997; 50: 735–41., , .
- 40Hospitalization and expenditures for the treatment of general medical conditions among the U.S. diabetic population in 1991. J Clin Endocrinol Metab 1996; 81: 3671–9., , et al.
- 41
- 42
- 43Hospitalization and mortality of diabetes in older adults. A 3-year prospective study. Diabetes Care 1998; 21: 231–5., , et al.
- 44
- 45Do diabetes clinic attendees stay out of hospital? A matched case-control study. Diabet Med 1999; 16: 687–91., , et al.
- 46Economic cost of diabetes mellitus – Minnesota, 1988. MMWR Morb Mortal Wkly Rep 1991; 40: 229–31., , .
- 47NICE. Preventing type 2 diabetes: risk identification and interventions for individuals at high risk. Issued: July 2012, NICE public health guidance 38.
- 48Empiric investigation on direct costs-of-illness and healthcare utilization of Medicaid patients with diabetes mellitus. Am J Manag Care 1998; 4: 1433–46., , et al.
- 49Healthcare use by veterans treated for diabetes mellitus in the Veterans Affairs medical care system. Am J Manag Care 2003; 9: 145–50., , et al.
- 50Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41). United Kingdom Prospective Diabetes Study Group. BMJ 2000; 320: 1373–8., , et al.
- 51Validity of diagnostic coding within the General Practice Research Database: a systematic review. Br J Gen Pract 2010; 60: e128–36., , .
Supporting Information
- Top of page
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- Acknowledgements
- Authors' contributions
- References
- Supporting Information
|Data S1. Read code list.
Please note: Wiley Blackwell is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.


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who said hunters are squishy?
who said hunters are squishy?
Wtb moar huntanks
Patriot can you post your equip? the only way i could hunttank meg is if i had revealing mark cast on him (he just deals too much damage on me) (1.5-2k per hit) for heals to keep me alive..
I think the key here (if not beeing at 20khp, capped resist, 50% critical defence, etc...) is the LM's debuffs
Anacamptis - Lv100 Minstrel, Fluva - Lv100 Warden, Vanva - Lv100 Guardian, Snufo - Lv100 Burglar
You want the setup I used to duo that water t2c? cuz its way different from the setup I use when I have actual healers and a full fellowship.
For the duo I used a mixture of greater erebor huntsman and crafted wildermore vit gear that boosted crit def,inc heal and mits. I think I had about 40% crit def and inc. heals. Mits were around that range also but I had tome of def. Full tank gear gives about 53% crit def and around 16k mits. Was safer to use since dps wasn't really an issue but I found it to be boring cuz you took almost no damage where a single wl kept you up.
farm runs I just use
sunbrand agil vit neck(replaces wildermore agil neck)
eagle egg(replaces hunter token)
sarchol(Replaces Hunter cloak)
ring of precision(replaces Former resident)
moors offhand(replaces sambrog club)
and sometimes Shadowstalkers
and a semi tanking FA spear.
Everything else is pretty much straight up max pm/crit gear and rarely do I need to
p.s. LT t2c is like, really easy to dps tank. Still looking to get that stifled ring +150 agil +75 vit +384 pm from challenge
- farm runs i usually just use this
- For the duo run
i didnt have more of the agil vit food :P
Last edited by Patriotp3a; Aug 29 2013 at 07:02 AM.
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subset: commoncrawl


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Bakery Story Answers for iPhone - iPadHome / iPhone - iPad /
Game Questions & Answers (Q&A) service lets you ask questions about video games for game consoles or PC games. So ask your Bakery Story question for iPhone - iPad and get answers from real gamers or answer questions and share your insights and experience with the rest of the gaming community.
- Developer: Teamlava
- Publisher: Teamlava
- Genre: Adventure
- Release: Nov 12, 2010
- ESRB: Not Set
Question & Answers
Help me with bakery story!
If you download the games that they tell you to in bakery story, can you download it, get the gems, delete the game that you downloaded and still keep the gems???
Answer from: Bakery Luva
Yes you can!!! i have done this multiple times and it always work!!!
my suggestion: go in the app for a moment, then go back to bakery story and see if you have any new gems. if not, go back to the other app for a longer amount of time. wait until after you know you have the gems before deleting the app because you will never have the same offer again!!!
Answer from: sweet
No you can't. i tried this at least six times, and it never worked.
Answer from: krissyistormy
It worked for me each and everytime and in more than one app! i used this for city,bakery,restaurant and zoo story.
its simple when the news pops up and asks you to download a new app click the link and it will take you to the app store. close the page without downloading and do this same thing in every other "tap" app you have. when you get to the last app asking you to download then download it, open it up put in your storm8 id play the first level and then delete if you want to.
by the time you re open your other tap apps the extra cash and gems should be there
Bakery Story - Review Trailer
- Aug 22, 2014, Views: 241
Bakery Story - GamePlay Trailer
- Aug 22, 2014, Views: 165
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Goldman Sachs sees 14 million iPhones sold by end of 2008
Goldman Sachs said it believes Apple will sell more than 14 million iPhones through 2008 based on results from a recent buying intention survey. The investment firm forecasts sales of 4 million iPhones in 2007 and 10.5 million in 2008. The consumer survey—conducted in the U.S., U.K., China, and India prior to the iPhone's official unveiling—found that the number of potential iPhone buyers is equivalent to 75% of the installed base of current iPod owners. In the U.S., where Apple ranked as the No. 4 most desired handset brand, 71% of respondents indicated interest in a potential Apple phone. The survey also found that a number of consumers are willing to switch carriers to get the iPhone, with 30% of U.K. respondents and 15% in the U.S. suggesting that they would switch.
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this may be true, but i doubt the statistics, seeing as the poll was taken before any price tag was released.
Posted by thewho61 on February 26, 2007 at 4:46 PM (CST)
Let's not forget all those $900 Motorolas, and they didn't have iTunes, or email or anything- it's all about cachet, not dollars!
Posted by Cyrus on February 26, 2007 at 5:20 PM (CST)
Nope. No way anything could get me to go to Cingular.
Posted by m.s. on February 26, 2007 at 7:18 PM (CST)
I'm looking foward to getting one iPhone. These phones look pretty smart, yet complex and simple at the same time, I'm sure you will meet your goal. Don't forget how sucsessful your iPod was.
Posted by Kevin on February 26, 2007 at 7:25 PM (CST)
I doubt the statistics too. First of all, I really doubt all iPod owners have cingular as their cellphone service or would ever switch their carrier to cingular.
Posted by doompod on February 26, 2007 at 9:37 PM (CST)
Yes, I doubt the statistics too. It's quite difficult for iPod to get more consumers with this scheme.
Posted by Atniga Tayadih on February 27, 2007 at 9:21 AM (CST)
I wonder what sort of carrier they will use. I would assume that the phones would be compatible with any carrier. Sort of like how the Razr is available from pretty much any carrier.
The thing about the price tag is that people who like iPods easily drop $250-$300 when buying a new one. Most of those people also carry cell phones which also usually range from $150+ If you add the two products together and work under the assumption that the new iPhone will replace BOTH items the pricing isn't really that astronomical. Personally I won't buy one unless I can get a discount through my carrier.
Posted by pyralis on February 27, 2007 at 3:55 PM (CST)
Goldman Sachs just loves their own propaganda. They love to manipulate the public all the way to the bank. What's no longer in your wallet—will be in theirs.
Posted by FahrenheiPod 451 on February 27, 2007 at 11:41 PM (CST)
does anyone else thing that the next ipod is going to look a lot like the iphone?
Posted by jp on March 1, 2007 at 1:13 AM (CST)
This is bad for Goldman Sachs… Wrong Prediction, totaly wrong by underestimating the iPhone fever now going on in China… That figure is chicken feed when China lays there hand on official iPhone release considering how many the are buying and unlocking iPhone now, not enough iPhone to satisfy Chinese demand today.
Posted by miliky on December 13, 2007 at 5:43 AM (CST)
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3 weeks ago the car started shaking. and in the last week the check engine light came on and the car will no longer move into gears. Does this mean the transmission is completely shot? Also the back seat behind the passenger side gets completely soaked. Do you know what this comes from????
How much does a transmission cost to repair for this car?? on 1999 Volkswagen Passat
0 answers
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Fire injures 14 at Formosa Plastics plant in Texas
AKRON, OHIO — A fire that injured 14 at a Formosa Plastics Corp. USA plant in Texas is featured in this week's Material Insights video. Also this week we report a big drop in North American PP prices, as well as news that compounding leader A. Schulman Inc. has opened its first plant in India.
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text: Heh. I remember how I was told that we revolve around the sun "because it's large" so I immediately put the planets in order of size and tried to make them revolve around each other simultaneously. I think eventually I had us doing a weird figure-of-eight around Jupiter and the sun, lol.


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The best so far.,
Verified Purchase(What is this?)
This review is from: Indian Hill 4: From The Ashes (Kindle Edition)
I will confess I wasn't sure about this series at first, but as it's progressed I've found myself enjoying each book more & more & this one is no exception. In fact I think it's the best to date, with the story progressing, & new/familiar characters being introduced. The banter & one liners between Mike & Dee is brilliant, & you can picture the battle scenes due to the excellent writing style of Mark Tufo. I don't know how many books Mark has planned for this series, but for now Mike has some serious unfinished business with not only the aliens, but people he once regarded as his closest friends. Roll on book 5 I say.
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James McVey
this wiki
|James McVey
|Background Information
|Birth Name
|James Daniel McVey
|April 30, 1994 (21)
|Pop,Pop Rock
|Years Active
|Mercury, Virgin EMI
James Daniel McVey is a member of The Vamps along with Bradley Simpson, Connor Ball and Tristan Evans. He is the vocalist and guitarist in the band.
McVey met band member Bradley Simpson via YouTube in 2011 and they have been working on their debut album since. Together they formed a group and are formed the band The Vamps with Tristan Evans and Connor Ball.
Personal LifeEdit
James was dating a model called Kirstie Brittain, but eventually broke up when she was caught in an instagram photo with another man.
James later started dating Game of Thrones actress Sophie Turner. However the two split up due to unknown reasons after a small Twitter fight.
James is now rumored to have rekindled his relationship with Kirstie Brittain, but nothing has been confirmed yet.
After his coming out on twitter in 2013, he is dating his band mate Tristan Evans.


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Look, It's Kate Middleton Pregnant!
Okay, so we're officially contributing to what's lamely being coined the "Royal Bump Watch." Guilty as charged — but, honestly, we always love peeping Duchess Kate's outfits, and maternity wear is no exception. Middleton's been MIA of late, what with her morning sickness and all, so we were excited to see a healthy-looking princess-to-be out and about shopping in London. We love her tartan cape-jacket from Zara, but there's no denying that she's sporting the first signs of a growing belly under there (and looking gorgeous, might we add).
Apparently, a feeling-better Kate is a shopaholic Kate — she's been spied all over London browsing up a storm, buying workout clothes at Selfridges, perusing sweaters at Reiss, and checking out some yoga gear at Sweaty Betty. Here's to wishing all the new duds translate to more DoC (Duchess of Cambridge —it's happening, okay?) snaps — we haven't been this excited about maternity fashion since the other Royal Bump Watch. (We're talking about Posh Spice, obviously.) (Us Weekly)
Photo: Via Us Weekly
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In case the cave you've been living in doesn't have wifi, there's a certain model popping up constantly on Instagram, in the pages of tabloids, on the runways, and, oh, everywhere on the internet. We're talking about Kendall Jenner, the tallest of her famous blended family. She's currently making the most of the Big Apple's...
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Neoseeker : LSmaniac : Collections : Monster Hunter Freedom Unite
LSmaniacTrying to unlock the G rank black Fatalis, am stuck of the G rank Terra S. crab training MonsterHunterFreedomUniteForiOS
Jun 29, 11 10:41pm
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Times Now is India's most watched English news channel. Follow us for breaking news & updates.
RT @iatoday: Reactions in India? @Madrassan @Rsundaram05 @TimesNow @NewsNationTV @aajtak @narlak @narendramodi @BJP4India https://t.co/ngjPbl1EXm
@TimesNow Wen EXPERT ppl do a crime leads r hard 2 find...dats wot PM said..n dats y d congi is smarting arnd. But d thieves'd b caught!!!!
RT @PMOIndia: Our Jawans have the full freedom, they have been answering and will continue to answer in an appropriate language: PM to @TimesNow
RT @TimesNow: #PMSpeaksToArnab interview sets global benchmark, creates a new record. A @TimesNow Digital media report https://t.co/w8n7o2CCke
RT @AdityaRajKaul: We had first and exclusive @OfficeOfRG interview in 2014. Only highlights why @TimesNow is most trusted in #India. https://t.co/TFh5xNVudf
@abpmajhatv hahaha so idiotic debate @ibnlokmattv @zee24taasnews @TimesNow @ndtv @abpnewstv @sachin_rt @PMOIndia @SrBachchan @Dev_Fadnavis
RT @gracemadhu: Congratulations Arnab @TimesNow @thenewshour Always doing IMPACTFUL Journalism for a Better India! #PMSpeaksToArnab @twitter @rsjaitly
RT @AdityaRajKaul: We had first and exclusive @OfficeOfRG interview in 2014. Only highlights why @TimesNow is most trusted in #India. https://t.co/TFh5xNVudf
RT @dharmirdave: @TimesNow @twitter @rsjaitly great interview. Never saw such a great interview by any PM or president of any country
RT @TimesNow: VIDEO #PMSpeaksToArnab Historic interview of PM @narendramodi with Arnab Goswami creates social media records https://t.co/lDKca6wB2E
RT @s_2748: @M_Lekhi @narendramodi @TimesNow क्यों १विश्वविख्यात संत को ३वर्षों से अन्याय सहना पड़ रहा है? #अति_हो_गयी_जुल्म_की https://t.co/2SShnOVIR7
After watching @TimesNow Arnab speaking to PMNM many news channels in Coma Editors Nt sleeping whole night Peopl convinced By honest efforts
RT @TimesNow: Argentine football legend Diego Maradona urges Lionel Messi not to follow through on his vow to quit https://t.co/Dg1QAyISl5
RT @trehan_barkha: @PMOIndia @narendramodi @TimesNow Sir help MEN in distress who r d actual tax payers. Scrap biased laws #LiberateMen https://t.co/gFh9QscCvz
RT @PMOIndia: The youth of this nation believes in development and it is development that can solve people's problems: PM @narendramodi to @TimesNow
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Microsoft Azure (formerly Windows Azure) Jobs in Yorkshire
Jobs 1 to 15 of 23
Lead Cloud Developer, 50K, Leeds
Fancy yourself as a coding genius who can lead a team of junior to mid developers for a Born in the Cloud Microsoft Partner?... Having just secured a 10 million project, the Lead Developer will be responsible for taking technical ownership of projects working alongside a Platform Architect on the...
Leeds, West Yorkshire -
Nigel Frank International Ltd
Salary: £50000 - £55000 per annum + Bonus, PensonPosted: 4 days ago
Contract .NET Developer
Harvey Nash have partnered a fast-growing company to source and secure a .NET developer to work on their next generation of services... The successful candidate will have significant commercial experience in the .NET ecosystem and familiar with Azure. You will also have comprehensive skills in the following: * Excellent C# *...
Leeds, West Yorkshire -
Harvey Nash plc
Posted: 5 days ago
Software Developer
Job title: Web Developer (ASP.NET, MVC, JavaScript) Location: Leeds... The successful Web Developer (ASP.NET, MVC, JavaScript) should have full development life cycle experience in building web application. The technologies used will include: ASP.NET MVC, C# (latest versions a bonus) JavaScript frameworks. Web Services. SQL Server, Microsoft Azure,...
Leeds -
Computer Futures
Rate: competitivePosted: 6 days ago
.Net Developer 100% remote work
ASP.NET MVC Developer 6 month's contract, 100% remote work... This is a remote position, but you will need to be in contact with the client daily via Skype and meet occasionally, so ideally someone who can get to the clients site... -Experience with C# -Strong in ASP.Net/...
North Yorkshire -
Computer Futures
Rate: £180 - £200 per dayPosted: 26 days ago
C#, ASP.NET developer - Doncaster
Senior C#, ASP.Net Developer is sought by an award winning Software company based in Doncaster. The successful developer needs to have at least 5 years proven commercial experience working with ASP.NET and be proficient in both SQL Server development alongside C# coding, and have an interest in web...
Doncaster, South Yorkshire -
Applause IT Innovation
Salary: £30000 - £45000 per annumPosted: 4 days ago
C# .NET Developer
We are seeking an innovative and passionate C# .NET Developer to join an ambitious organisation based in Teesside... Working within the Development team, you will produce scalable software applications and deliver across the full Software Development Lifecycle... You will enjoy working in a fast paced agile development environment and seeing...
Middlesbrough, Cleveland -
Harvey Nash plc
Rate: £300 - £375 per dayPosted: 3 days ago
DevOps Engineer - Yorkshire - Cloud - £450 - 6 months
A leading cloud based solutions company is actively recruiting for an experienced devops engineer to come on board during the creation of a new agile robust environment. Key skills and experience required: Proven experience in a senior DevOps role. Good experience working with Microsoft Azure & System Center... Solid background in...
Huddersfield, West Yorkshire -
Maclean Moore Consulting
Rate: Up to £450 per dayPosted: 6 hours ago
SQL DBA, Database Administrator - SQL Server DBA
We are looking for an experienced SQL DBA to join the IT team at a well established household name, and perform a mixture of BAU DBA tasks as well as regular project work. As well as all of the SQL Server DBA responsibilities you'd expect, you will have the...
Bradford, West Yorkshire -
Fruition IT Resources Limited
Posted: 3 days ago
Cloud Engineer
Application deployment in Cloud technologies (Amazon AWS or Azure) *Automated application deployment in Puppet. *VMWare. *Linux. *DevOps Tools... Essentially, you will need to come from a broad technical background and bring with you experience deploying applications in Cloud technologies as well as automated application deployment using the latest DevOps tools...
Yorkshire and the Humber -
Amoria Bond
Rate: £0.00 per annumPosted: 27 days ago
Solutions Architect (.Net) - Microsoft Gold Partner
Previous experience as a C# .Net developer (particularly API). *Strong knowledge of Microsoft Azure and developing for the cloud... *Agile, Scrum, Test Driven Development (TDD) or Kanban experience. *Excellent scoping and time management... *Decent understanding of identity management, with exposure to Active Directory, ADFS, FIM/MIM. *Decent understanding of full...
Leeds, West Yorkshire -
Redrock Consulting Ltd
Salary: £55000 - £75000 per annum + Excellent benefits / enthronementPosted: 5 days ago
SQL Database Developer - SQL Server / SSAS / Agile
SQL Database Developer required. The successful SQL Database Developer will possess excellent experience of MS SQL Server and will be working in a large, enterprise environment... The Senior SQL Database Developer will be responsible for working on some exciting new data loading projects... SQL Server. SSAS... ETL. Datawarehousing. Agile/DevOps.....
Leeds, West Yorkshire -
4it Recruitment Ltd
Salary: £Excellent salary + bonus + benefits!Posted: 3 days ago
Ruby Automation Specialist
Strong commercial experience in Chef or Puppet... Continuous Integration (e.g. Jenkins, Travis) ?Worked in TDD/ BDD/ Agile teams... Desirable: ?Windows PowerShell. PowerShell DSC. Linux scripting. AWS/ Azure experience. API familiarity with any of: ?VMware virtualisation. EMC Storage. NetApp storage. Cisco networking. F5 networking... Angular/ React) or on the server (...
Leeds, West Yorkshire -
CPS Group UK
Salary: £45000 - £60000 per annum + Excellent Benefits & 10% bonusPosted: 6 days ago
Full Stack Javascript Developer
The approach is agile, pragmatic and open... ●Commercial JavaScript experience. ○At least one of Angular/ React/ Polymer/ Blaze. ○Node.js experience (or other server-side JavaScript) ●Thorough understanding of. ○JavaScript standards and versions. ○Modern CSS toolchain (e.g. SASS/ LESS) ○HTML5. ○Continuous Integration (e.g. Jenkins, Travis) ○Git... ●Worked in...
Leeds -
CPS Group Limited
Salary: £40000 - £50000 per annum + Excellent Benefits & 10% bonusPosted: 17 days ago
Systems Engineer Red Hat, Cloud, Puppet, PowerShell
Chef / Puppet / Salt / CFengine. VMware. Understanding of Windows Server... Advantageous: Knowledge of Amazon AWS, Google Cloud, or Azure. F5, Stingray / Steel. PowerShell... Cloud Engineer, Amazon, AWS, Azure, Linux Engineer, Unix, Redhat, Red Hat, DevOps Engineer, Development operations, TechOps, Agile, Jenkins, Chef, Git, Rundeck, Automate, automation, deployment, cloud, develop, test, splunk,...
Leeds, West Yorkshire -
4it Recruitment Ltd
Salary: £Excellent salary + bonus + benefits!Posted: 7 hours ago
DevOps & Automation Specialist - Microsoft Gold Partner
My client is looking for a DevOps & Automation Specialist to help build innovative automated DevOps processes around releases and testing. If you're a talented DevOps specialist with strong skills in automation, experience with Microsoft Azure, and have a passion and ambition for solving big challenges and experimenting with the...
Leeds, West Yorkshire -
Redrock Consulting Ltd
Salary: £45000 - £55000 per annum + Benefits + Career DevelopmentPosted: 5 days ago
Microsoft Azure Jobs in Yorkshire


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Mazen Istanbouli knows his way around many of Chicago's top cultural spots but is planning to visit a club he's never been to before. No big deal for most people, except the political science teacher is legally blind -- so navigating an unknown venue is more daunting for him.
When he goes to a new place, "I question if anyone around will help me in the lobby, show me to my seat, show me around," he says. "It makes me reluctant."
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The More Details Part:
I would bring a day pack along with your backpack. All the normal pack gear as some of our hikes will be after we have set up camp for the day and you may want to bring snacks, towel, camera, your water bottle & filter, map, bug spray etc.
Weather: The weather can be anywhere from 80 degrees during the day to 40 degrees at night. Pack accordingly.
WATER: There is NO fresh water source once we are in the back country of Picture Rock. You MUST have a water filter with you or have permission to borrow someone's, no exceptions! All the campgrounds with car camping will have water.
COMPASS & MAPS: Maps are located below, make sure to print and have your own copy along with a compass. http://www.nps.gov/piro/planyourvisit/upload/BackcountryMap.pdf
GROUP: We are hiking as a group. Please do not leave the group without letting everyone know where you are going. There are lots of cliffs, this is bear country and it's for your own safety. None of the planned hikes are that long but they will be strenuous in places.
FOOD: The only planned meal is Wednesday (lunch in Munising) on our way to the Porcupine Mountains campground. Outside of that bring what you would like to eat. Coolers can stay in the cars on Saturday & Sunday evening. Wednesday we can refill them if needed when we drive through Munising for Wednesday, Thurs. & Friday. If you have a stove and fuel go ahead and bring it along. If you would like to share some ones please bring your own fuel.
This area of the UP offers moderate to more difficult hiking on well marked trails. Camping & backpacking skills required with the ability to hike up to 7 miles in 5 hours on moderate terrain with a pack. If you have never backpacked or hiked this amount before this is NOT the trip to learn on.
Pictured Rocks:
Sat. July 19 - Bay Furnace campground. Set up camp site 33 - car camping (2 nights). Water and toilets. http://www.recreation.gov/camping/bay-furnace-campground/r/campgroundDetails.do?contractCode=NRSO&parkId=72065
Follow link for location info. (this link should show up with a close up of Bay Furnace Bay. The campground is the 2 loops on he left at the top. There is no physical address for Bay Furnace campground. https://firstname.lastname@example.com,-86.705534,16z
Sun. July 20 - Kayaking for all levels - $129 for 6.5 hours or day hiking. Group discount available. http://www.paddlingmichigan.com/wp-content/uploads/2013/12/Pictured-Rocks-Tour-Brochure10.pdf (if weather is bad this will change to hiking in Picture Rock and maybe moved).
Mon. July 21 –
• Leave campground, head to Munising visitor center & get permits.
• Drive to Little Beaver Lake trailhead, gather backpacking gear.
• Hike to Trappers Lake (4 miles/2-3 hours), set up camp, hike trails around camp site.
Tue. July 22 –
• Break camp by 8:30am, Hike to Coves (5 miles/3 hours), set up camp.
• Afternoon/Evening hike to Chapel Beach (4.3 miles/6 hours RT)
Wed. July 23 –
• Break camp by 9am, Hike to Little Beaver Lake trailhead (car) 2 miles.
• Stop at Miners falls, Lunch in Munising then head to Porkies (4 hours)
Porcupine Mountains:
• Check in at Porcupine Mt. Campground- Union Bay site 59, car camping with restrooms & hot showers (Site already reserved).
Thur. July 24 –
• Drive to Lost Lake trailhead hike to Government Peak trail(4 miles/2 hours),
• Hike Government Peak trail (2 miles/1 hours)
• Return on same route (6 miles/3 hours)
• Possibly hike Union Spring (4 miles)
Fri. July 25
• Drive to Little Carp River rd. Overlook falls
• Hike Little Carp trail to River trail to Mirror Lake (11 miles/6 hours RT)
• Friday night at Presque Rustic Campground site 25 (Site already reserved)
Sat. July 26 – Drive home
The $25 will cover:
1) Backcountry reservations for Pic Rocks
2) Group Campground for 7/19 & 7/20
You will also need to pay:
1) $5/day for individual backcountry reservation (at Munising Visitor Center)
2) Union Bay & Presque Campground - $15 per person to Robyn (total)
3) Kayaking - $129 per person (6.5 hours) if you would like to kayak.
If anyone has questions you can email me at [masked]
CARPOOLING: Those attending can set up carpooling via this page, I leave from the Ann Arbor area and travel up US-23 to I-75.
I have to do a deposit for the Kayaking and since I haven't heard otherwise I am guessing all 6 of us are a go for that on Sunday. It is $129 and they supply everything but the guy I talked to said its been a bit cooler on the water so you may want to bring a sweatshirt. If it ends up raining/storming we will have to find another way to occupy ourselves on Saturday :)
0 · July 15, 2014
I happened to see this event this week and thought I should mention I was up there over fourth of July week for backpacking around the Coves/Chapel area and the mosquitoes and black flies were pretty extreme. Make sure you pack bug management with sprays and at minimum head nets. Pants and loose long sleeve shirts would help too.
0 · July 15, 2014
We need to be at the campground on Saturday 7/19 by 2pm at the latest for check in. I believe the drive is 5 to 6 hours. I will be leaving the area (Brighton) around 7am. In order to figure out car pools we need to figure out where everyone is coming from. I can fit 2 more people in my car who can meet me either near Whitmore Lake/Brighton area or somewhere along US 23 or I-75.
0 · July 3, 2014
Hi Robyn, 4 of us from the Louisville Hiking Meetup are coming up with our kayaks to paddle the lakeshore. We might have some down time and would like to get some hiking in as well. Maybe we could link up with you all for some of the time?
0 · June 5, 2014
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text:
Luxury Chinese Boat Launches, Sinks Immediately
- Printer-friendly version
- Oct 12, 2011 5:15 PM
- 465
See. They need a floating currency!
Dim sunk
I'm trying so hard not to laugh at my desk right now.
coming soon to a walmart near you!
Currently available at a Wallmart near you.
Will the yellow smiley face on the price sign have slanted eyes?
(OK, stupid question --- if they don't all by now, ...)
(At least we know why they are yellow.)
So when's the maiden voyage for that refurbished navy carrier they're working on again??
So the best way to sink a Chinese boat is.....
Put it in water?
The naming of the traditional Chinese boat as a "junk" might have been a clue.
Curious how they managed to foresee their main 21st century export hundreds of years before the fact.
Actually the characters "??" means Wine Steel. But to ordinary Chinese they sound like Wine Jar.
China, known for poisoning pets and children, now known for making shitty boats as well.
"In China, you float boat. It not float you."
Lead-based bottom-paint?
Ummm, hey Ren?
Stimpy, you idiot!!
Perfect metaphor for the Chinese economy perhaps?
Metaphor for the long-term survival of the giant Three Gorges Dam, as well?
You think that is bad you should try their baby formula.
melamine milk for all........hoooooray
"SUPPLIES!" ->uhf
CHINESY vs. AMERICANA:
I'm going to go out on a limb and say that the person who gave a -1 to everyone above is of Chinese origin.
Me no rikey!
Nah, but maybe they lined the hull with all that overpriced tungsten Robert Ruben sold to them.
Shut your uselessly flapping jabber lips long enough to read this article, then send it to something like 3-7 friends. Then you can resume chattering like parakeets.
That goes for all of you, in case any one of you gets personally butthurt.
> " Is there a Congressman around who will vote to allow the Fed to pay banks 25 times the current market rate?"
The Congress IS THE FED'S FETUS IN FETU.
There are TWO United States:
"when the trials come Bernanke will be up there, with the other lawbreakers, having to explain why he ignored the law and paid the banksters interest 25 times greater than what is allowed by law."
Like he has had to explain all his other illegal actions? Gimme a break.
If Bernanke and all the other banksters are actually punished for breaking the law, well, I'll eat my iPad! It just is not going to happen.
There has been no respect for the law by the Fed up until now, why would they suddenly be held accountable? The law will be changed to accomodate a "flexibility" regarding rates, or whatever they have to do to get their way.
The risk is very small, but ... leave out the battery: The lithium will make funny pyrotechnic colours with your stomach acid, the surgeon stitching up that mess will retire in luxury - eventually.
The name translated to "Liquor Steel"...why/what? Your guess is as good as mine?
As to how they managed to foresee...hundreds of years before the fact? Guess they would have to hyper-jump back to their future, to their re-drawing board.
Wait, weren't there significant influence in the early part of last century from Europe to have the communist party established in China?
You sure that isn't a homonym?
Maybe "Lick Her Still"? (sophmoric, yeah, I know, but it's been a long assed day)
In fact, Chinese 'junks' were far superior vessels to European ships for nearly 800 years. They had sealed, isolated compartments in the hull, so that a leak in one part of the hull would not sink the ship (unlike the Titanic, whose hull segments were not sealed, and you know the rest).
The Chinese 'junk' was the first vessel to have a foresail, so they could tack against the wind hundreds of years before European vessels, which relied on the trade winds.
As the for ship in the video, it looks like European design. Maybe if they had modernised the design of the 'junk' for the 21st century with new materials, it would float.
But dont let the FACTS get in the way of your frothing-at-the-mouth China bashing. Carry on ...
The boat seemed to have a shallow hull. The angle of launch was steep. The boat appeared to angle in off center. Probably not the boat. Primitive launching method. "Junk Launch".
I agree, the frenzy of China bashing here although some are extremely witty is frightening and this from the supposedly ZH intelligent elite.I shiver to imagine what Joe Sixpack and his ilk are thinking if the sinking of some small boat in China draws such a rabid response and outpourings of shadenfreude. In any case it seems that Amerikan politicians have already sniffed blood and are busy getting ready to implement Smoot-Hawley No.2.How American centric their world is. Please don't forget that made in Japan, Taiwan and Korea labels were originally indications of poor quality.The Chinese cock may yet have the last crow !
excellent points all and, as you note, the sinophobia will turbocharge the decline as it spills out into international financial relations.
Yes, yes, it was the launch angle, but you take the thing in its totality, so F 'em, and have some SchadenF*ckyoutoo. A rocket launched incautiously deserves the same respect as a boat launched improperly--none. If your point is that the boat would have been fine with somebody else launching it, well, that hardly sticks up for your red commie pals.
Not so good at finding things with them though. Like North America.
This happened to the Swedish Navy as well back in the day.
If the mandarins had not have stopped Zheng Ho the New World would have been Chinese.
That's a "luxury" boat?
Well duh!
Did you see any shackles anywhere on it at all? I hear that it actually has some seats on it, as well --- although that is just a rumor. And what hygenic facilities it has! Did you know that there are actually restrooms on it? Yep, no more hanging one's ass over the gunwales! (Of course, the toilets still empty directly into the river --- but now one can pollute in luxurious privacy.)
Why, I bet they only allow 200 people on the roof of it while in transit, too!
It actually sunk because of the toilets (aka, giant holes) in the floor. Someone thought that would be a luxurious feature.
A Chinese beday!!!
"luxury" as in "unleaded" paint from china.
whatever floats your boat
And who doubts their Ghost Cities are falling apart as we speak?
Good thing ghosts aren't picky about little things like moldy drywall and crumbling substandard concrete. I hear that ghost dogs are just wild about the flavor of melamine, too.
It gets worse. The chinese also "thin out" rebar. Anything to lower the cost. They also run steel mills a bit cooler to save money which mean inpurities in the steel melt remain. Bad drywal, bad concrete and bad rebar.
Best way to sink the United States in debt - buy Made in China products
I cant believe I am saying this but there is something so remarkably sad about this that I actually feel sorry for the Chinese. I am no naval engineer but look at that POS.
Forgive me ZH I know not what I say


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It all started September 11 - not 2001 - but 1922The Truth will set you Free
Jul. 23, 2006
Pope Says Church Should Apologize to Gays for Orlando Shooting
SHOCKER: Police Say Leftists Started Violence at Rally in Sacramento
Walls For Me But Not For Thee: Zuckerberg Builds Giant Wall Around Hawaii Property
Bill O'Reilly on Brexit Motive: "In Parts of London, You're Not Really in England, You're in Pakistan"
Putin on Brexit: "Some Don't Want to Dissolve National Borders"
A chilling documentary of Israeli occupation of Palestine that begins with Balfour's infamous declaration and culminates in a brutal escalation that threatens to plunge the world into darkness.
This ten minute preview reveals the gruesome and deadly hand of racism in Israel, in all its brutal glory. Watch the full movie at WE.


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Three Dog Night
8pm Thu, Nov 21, 2013
Venue: The Colonial Theatre
111 South Street, Pittsfield, MA 01201Contact:
Berkshire Theatre Group Info
0 people saved this
In the early '70s, Three Dog Night had more top 10 hits and sold more records than any other group. Today, their music is wound through the fabric of pop culture, whether on the radio, in television commercials or on the big screen. Songs like "Mama Told Me (Not To Come)," "Joy to the World," "Black and White," "Shambala," and "One (Is The Loneliest Number)" serve to heighten our emotions and solidifies the band's continuing popularity.
An Unforgettable Summer in Massachusetts
Because we all know the two most beautiful words in the English language are summer...
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Aerosphere Aviation Services, Inc.
10 - 19
1 - 2.5 Million
SIC Code:
5088 - Transportation Equipment and Supplies
Full company description is available with the free trial.
Additional Info:
This member of the Automotive/transportation industry is located in Greensboro, NC and you can find important contact information regarding significant company contacts on their Lead411 profile like linkedin, phone numbers, facebook and cfo details. The profile also contains Aerosphere Aviation Services, Inc. email addresses which have a domain of @aerosphereav.com format. If you sign up for our free trial you will see our email@example.com addresses.
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Old Dominion Freight Line, Inc
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text:
Edgar Lopez Survives Tough Test, Beats Orlando Vazquez
By Jake Donovan
Edgar Lopez overcame a stiff challenge from Orlando Vazquez to obtain a close but clear unanimous decision win Saturday evening at Coliseo Cosme Beitia Salamo in Catano, Puerto Rico.
Scores were 79-73, 78-74 and 77-75 in their WAPA-America televised main event.
Both fighters enjoyed their share of success, but it was Lopez who was able to land the more telling blows throughout the evening. The night was not without its obstacles; Lopez (6-0-1, 3KO) was forced to contend with swelling around his right eye and was also warned for a vicious low blow in round seven.
Vazquez (5-2-1, 1KO) attempted a late rally, but fell just short in the end as Lopez did enough to remain unbeaten.
It's not often that a scheduled four-round preliminary bout is remembered by year-end awards season, but Angel Acosta gave plenty of reason for future consideration with a savage 2nd round knockout of debuting Cristian Lopez.
Acosta was in control throughout the first round, but it was his rally early in round two that was worthy of highlight reel attention. A combination had Lopez in trouble and covering up, before getting nailed with a left hook to put him down and out 0:35 into round two.
Acosta moves to 2-0 (2KO). Lopez (0-1, 0KO) was still on the canvas when the fight was waved off, receiving immediate medical attention before eventually making it out of the ring on his own.
Alberto Machado (2-0, 2KO) was impressive in his disposing of debuting Efrain Salgado (0-1, 0KO). Machado stunned Salgado early and unloaded before cornering him and sending him to the canvas. Referee Geno Rodriguez immediately intervened, waving off the bout without a count at 1:19 at round one.
Carlos 'El Chicano' Cotto - yet another member of the royal Cotto family - needed just 27 seconds to dispatch Jesus Gonzalez. The former pro wrestling standout went uppercut crazy before a right hand put Gonzalez (0-2, 0KO) on queer street. Cotto (2-0, 2KO) has now fought a total of 64 seconds of ring time in his two pro bouts to date.
Joel Collazo won a four-round decision over Luis Hernandez (0-1, 0KO) in a matchup for debuting flyweights. Scores were 39-37 across the board for Collazo (1-0, 0KO).
Jake Donovan is the Managing Editor of Boxingscene.com, as well as a member of Transnational Boxing Ratings Board, Yahoo Boxing Ratings Panel and the Boxing Writers Association of America. Twitter: @JakeNDaBox
Tags: Carlos Chicano Cotto
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